ABSTRACT
Objective:To discuss outcomes of emergency repairing for Gustilo III B and III C fractures of forearm with complicated tissue defects and the related influence factors.Methods:From January 2014 to Feburary 2022, data of 98 cases of Gustilo III B and III C fractures with large compound defects of soft tissue, blood vessel, bone, tendon or muscle from elbow to wrist were collected. Primary debridement, bone fixation, wound coverage by free flap, bone transfer(or bone cement filling) or dynamic reconstruction of muscle were completed with emergency surgery in Department of Hand and Foot Microsurgery, Xi'an Fengcheng Hospital. Postoperative follow-ups were conducted through outpatient clinic visits, telephone and WeChat reviews. Video clips, questionnaires and the latest information of patients were also analysed. Rank sum test and Chi-square test were used to examine the relationship between independent variables such as general condition, disease condition and surgical procedures of chimeric tissue transfer group and simple flap transfer group, together with dependent variables such as limb salvage, number of surgery, wound healing, function scores, and complications. P<0.05 were further included in the regression equation to discover the relationship between multiple independent variables and dependent variables. Results:Follow-up lasted for 6-96 months, with an average of 71.1 months. In the chimeric group, the limb salvage rate was at 95.1%, with an infection rate of 8.50% and an average number of surgery was 2.13±0.89. In the simple flap transfer group, the limb salvage rate was at 87.5%, with an infection rate of 15.38% and an average number of surgery was 2.62±0.64. The good rate of Anderson score was 65.3% and the average score of Disability of the Arm, Shoulder and Hand(DASH) was 32.9(0-60) points for all the patients. There were significant differences in dependent variables of limb salvage and infection rate between the 2 groups ( P<0.05). Ischemia time and method of bone fixation led to significant differences in number of surgery ( P<0.05). Methods of bone fixation and the types of flap made significant differences in wound healing ( P<0.05). Underlying disease, bonedefect, Gustilo classification and method of bone fixation all contributed to the significant differences in function score ( P<0.05 or P<0.01) . Conclusion:Emergency surgery for repair of serious injury of forearm has a relatively high limb salvage rate and good functional effects. The limb salvage rate is not correlated with independent variables such as severity of injury, Mangledextremity Severity Score (MESS) and ischemia time, while transfer of a simple flap or a chimeric flap is significantly correlated with the limb salvage rate, infection and wound healing. The severity of injury, ischemia time and bone defect are correlated with functional assessment, number of surgery and bone healing.
ABSTRACT
In November 2011, a 7-year-old child with shoulder avulsion was treated in the Department of Hand and Foot Microsurgery, Xi’an Fengcheng Hospital with debridement, transfer of free anterolateral thigh flap(ALTF) and decompression with forearm incision. After operation the limb survived. Six months after surgery, the function of right shoulder abduction was reconstructed by transposition of trapezius muscle. At the 11 years after surgery, the length of the limb on the affected side was slightly shorter than that of the healthy side. The circumference of forearm was slightly less than that of the healthy side. The pain, touch and temperature sensations were recovered. The TPD was 15-20 mm, and the skin temperature on both sides of the limb was normal. The shoulder abduction reached 30°. The muscle strength of elbow and wrist flexions reached grade Ⅴ with the recovered wrist pronation and all digit flexions. The affected limb can cooperate with the healthy limb to complete all daily duties.
ABSTRACT
BACKGROUND:Scholars have carried out a lot of research on the main cariogenic microorganisms, but there is stil no comprehensive and systematic evaluation. OBJECTIVE:To perform an evidence-based medicine analysis on the six main cariogenic microorganisms. METHODS:Literature about microbial factors and age factors of caries disease etiology were retrieved, which were published from 2011 to 2014 in the Cochrane Library, EMBASE, PubMed, Wanfang, China Biology Medicine disc (CBMdisc), Chinese Journal Ful-text Database (CJFD) and VIP. Eligible studies were divided into two groups according to absorbance values: observation group (higher absorbance value) and control group (lower absorbance value). The probability of dental caries under the impact ofStreptococcus mutans, Lactobacilus microbe,Prevotela,Selenomonas,Capnocytophaga,Veilonelawere statisticaly analyzed using Meta-analysis. RESULTS AND CONCLUSION:Eight articles were included in result analysis. Odds ratio (OR) values refer to the statistical difference in the probability of dental caries under same pathogenic factors between two groups:OR > 1 indicates the incidence of dental caries is higher in the observation group than the control group, andOR < 1 suggests the incidence of dental caries is lower in the observation group than the control group. Meta-analysis results showStreptococcus mutans (OR=2.41),Lactobacilus microbe (OR=1.68),Prevotela (OR=2.75),Capnocytophaga (OR=1.98),Selenomonas(OR=2.38), indicating that the probability of dental caries is higher in the observation group than the control group, and these microorganisms are greatly correlated with the occurrence and development of dental caries;Veilonela (OR=0.45), indicating the probability of dental caries is lower in the observation group than the control group, andVeilonela has smal correlation with dental caries and only plays an important role in a certain development stage of dental caries.