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Objective:To evaluate the clinical effect of soft tissue defects around knee joints repaired with thigh distal perforator propeller flap.Methods:Clinical data of 72 patients with defects around knee joints from January, 2009 to October, 2019 were analyzed retrospectively, including 43 males and 29 females, aged from 17 to 83 years. The sizes of soft tissue defects ranged from 4.0 cm×3.0 cm to 22.0 cm×13.0 cm. Perforator propeller flaps were designed and harvested to repair the defects according to anatomical features of the origin, course, branches, distribution and anastomosis of vascular network of the perforator vessels and location as well as the size and shape of defects. Nine patients repaired with the lateral distal perforator propeller flaps (LDF), 53 with descending genicular artery perforator propeller flaps (DGF) and 10 with direct popliteal artery perforator propeller flaps (DPF). The size of flap was 4.5 cm×3.5 cm to 24.0 cm×14.0 cm. The donor sites were sutured directly or covered with free full-thickness skin. To evaluate the effect, the skin swelling rating in early and later stage were taken. Three to 72 months of followed-up was conducted through outpatient clinic (78%), telephone (15%) and WeChat (7%).Results:The flaps totally survived in 65 patients and 7 patients underwent partial necrosis at the distal end of the flaps ( 2 cases of LDF, 4 cases of DGF, 1 case of DPF) who were treated with dressing, and the donor sites were completely healed. The appearance and shape of the repaired knee joints was good, and the color and elasticity was close to surrounding normal skin, TPD of the flaps were 7-10 mm, and the scar was small after 3 to 72 months' follow-up. The efficacy was satisfactory in 48 cases ( 4 cases of LDF, 39 cases of DGF, 5 cases of DPF), general in 24 cases ( 5 cases of LDF, 14 cases of DGF, 5 cases of DPF). Degree of flap swelling: in early stage, I° in 40 cases ( 4 cases of LDF, 31 cases of DGF, 5 cases of DPF), II° in 20 cases ( 3 cases of LDF, 14 cases of DGF, 3 cases of DPF), III° in 10 cases ( 2 cases of LDF, 7 cases of DGF, 1 case of DPF), IV° in 2 cases(1 case of DGF, 1 case of DPF); in later stage: I° in 55 cases ( 6 cases of LDF, 41 cases of DGF, 8 cases of DPF), II° in 15 cases ( 2 cases of LDF, 12 cases of DGF, 1 case of DPF), III° in 2 cases ( 1 case of LDF, 1 case of DPF). The evaluation of knee joint function: excellent in 17 cases ( 2 cases of LDF, 12 cases of DGF, 3 cases of DPF), good in 35 cases( 4 cases of LDF, 27 cases of DGF, 4 cases of DPF), general in 20 cases( 3 cases of LDF, 14 cases of DGF, 3 cases of DPF). The good rate was about 73%. The range of motion and stability of the knee joint were basically normal and there was no pain found to affect study and life. All the patients were satisfied with the effect.Conclusion:Repairing soft tissue defect around knee joint with thigh distal perforator propeller flap is reliable and clinical applicable.
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Objective@#To evaluate the design and clinical application of forearm proximal radial inferior cubital artery perforator flap.@*Methods@#The clinical data of 11 patients with defects of anterior elbow from June 2013 to June 2018 were analyzed retrospectively, in which including 8 male and 3 female, mean age is 51.5 years old, ranged from 48 to 76 years old. The sizes of soft tissue defects ranged from 7.5 cm×4.5 cm to 14 cm×7 cm. Forearm proximal inferior cubital artery perforator flaps were used to repair the defects according to flap their location, size and shape, in which the largest is 15 cm×10 cm and the smallest is 7 cm×5 cm. To evaluate the effect according to flap survival, infection control, elasticity and color, appearance, the scar of the donor site, cutaneous sense, and satisfaction of patients. The elbow efficacy and function were evaluated according to Mayo criteria and the swelling degree of flap was also evaluated.@*Results@#All the flaps survived in 11 cases, the incisions in donor and recipient site were primary healing. The survival of flaps is good and the appearance, color and elasticity are close to normal, on the other hand, the scar at the donor site is small after 6 to 36 months follow-up. The efficacy is satisfied in 8 cases, general in 3 cases and no dissatisfactory. The function of elbow is excellent in 4 cases, good in 6 cases and general in 1 case. Skin swelling rating in early stage is 1st degree in 6 cases, 2nd degree in 3 cases, 3rd degree in 2 cases; in later stage is 1st degree in 8 cases, 2nd degree in 2 cases, 3rd degree in 1 case.@*Conclusions@#The anatomic position of forearm proximal radial inferior cubital artery perforator flap is constant, the blood supply is good, and the operation method is simple and safe which could be a new supplementary method and be available for clinical selection to repair the soft tissue defects of elbow.
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Objective@#To explore the clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area.@*Methods@#Eleven patients (7 males and 4 females, aged from 18 to 73 years) with soft tissue defects of finger web area in distal dorsal side were admitted to Xinhua Hospital (Chongming) of Shanghai Jiao Tong University School of Medicine from October 2010 to September 2018. The sizes of skin and soft tissue defects ranged from 2.5 cm×1.5 cm to 6.0 cm×2.5 cm. According to the origin, course, branches, and distribution of the dorsal perforator of deep palmar arch, and the anatomical characteristics with vascular network of dorsal carpal and dorsal metacarpal, dorsal perforator fascia pedicle flaps of the deep palmar arch from the back of the injured hands were designed and transferred to repair the wounds of finger web area in distal dorsal side. The sizes of the flaps of patients ranged from 3.5 cm×2.0 cm to 6.5 cm×3.0 cm. The donor sites were sutured directly or covered with free forearm full-thickness skin graft. The clinical effects and swelling degree of flaps in early and late stages were evaluated during the follow-up of 3 to 36 months post surgery.@*Results@#All the flaps survived in 11 patients, the incisions in donor and recipient sites were healed. During the follow-up of 3 to 36 months post surgery, the survival of flaps was good, and the appearance, color, and elasticity were close to normal skin, with two-point discrimination distance of 7 to 10 mm and sensory function recovery of grade S3. The wounds in donor site had small scar without infection. The efficacy was evaluated as satisfactory in 8 patients, general in 3 patients, and dissatisfactory in no patient. Flap swelling rating in early stage was 1st degree in 7 patients, 2nd degree in 2 patients, and 3rd degree in 2 patients. Flap swelling rating in late stage was 1st degree in 8 patients, 2nd degree in 2 patients, and 3rd degree in 1 patient. The extension and flexion of the metacarpal and interphalangeal joints were basically normal and the patients were satisfied with the outcomes.@*Conclusions@#Based on the dorsal perforator of deep palmar arch, dorsal perforator fascia pedicle flap of the deep palmar arch is reliable to transfer to repair skin and soft tissue defects of finger web area in distal dorsal side, which is worthy of promotion in clinic.
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Objective@#To report the method and effect of in situ suturing technique for severe amputation of facial composite tissues.@*Methods@#We in situ sutured severely amputated composite tissues of facial region in 14 cases in emergency by vessels and nerves anastomosis from May 2004 to December 2017.@*Results@#All replanted composite tissues survived in 13 cases. Edge necrosis of auricle occurred in 1 case because of serious contusion and it was cured after dressing changed. The color and appearance of the replanted composite tissues were close to normal after 3 to 48 months′ follow-up.@*Conclusions@#In situ suturing technique in emergency is the ideal treatment for severe amputation of composite tissues of facial region.
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Objective To evaluate the clinical effect of the perforator fascial flap of the lower leg for the repair of large skin and soft tissue defects around the ankle in the elderly.Methods A retrospective case series study was conducted on the clinical data of 23 elderly patients with skin and soft tissue defect around the ankle joint admitted to Xinhua Hospital (Chongming) Affiliated to Medical College of Shanghai Jiaotong University,from November 2013 to December 2017.There were 13 males and 10 females,aged 65-78 years (mean,71 years).The wound areas around the ankle joint ranged from 13.5 cm × 5.5 cm to 16.0 cm × 8.5 cm.According to the position,size,and shape of the wound area around the ankle joint of the lower leg,the perforator fascia flap was designed and transferred for repairing.The maximum flap area was 17.0 cm × 9.5 cm while the minimum area was 14.0 cm ×6.5 cm.According to the conditions of survivals of the skin flap,elasticity,color,appearance,infection control,donor site scar,skin sensation,joint activity,patient satisfaction,etc.,the ankle and foot function was evaluated by referring to Tornetta and other standards.Besides,the swelling degree of the flap was graded.Results A total of 21 flaps survived and the wound at both donor site and recipient site obtained stage Ⅰ union.Two cases of skin edge necrosis occurred at the distal end of the flap,and the wounds at the donor and recipient sites were completely healed after dressing change.The patients were followed up for 6-48 months,with an average of 15 months.The flaps had good survival,satisfactory shape,and small scar at donor site,with similar elasticity and color with the surrounding normal skin.Twenty patients were satisfied with the efficacy and three were fine with the outcome.In terms of functional evaluation of the ankle and foot,the results were excellent in eight patients,good in 12,and fair in three.Flap swelling grading was as follows:degree Ⅰ in 16 patients,degree Ⅱ in 5,and degree Ⅲ in 2 at the early stage;degree Ⅰ in 20 patients,degree Ⅱ in 2,and degree Ⅲ in 1 at the later stage.Conclusion In repairing large skin and soft tissue defects around the ankle in the elderly,the perforator fascia flap of the lower leg transferring is a convenient,safe,and reliable method with less damage,which can promote the wound healing and functional recovery of ankle and foot.
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Objective To explore the anti-inflammation, pain-relieving and bleeding-stopping effects of Veronicastrum sibiricum and its potential to be a medicinal resource of Radix clematidis.Methods Total of 120 mice were randomly divided into 6 groups, including the Veronicastrum sibiricum water extract (1.5, 1.0, 0.5 g·mL-1) groups, Radix clematidis water extract (1.0 g·mL-1) group, the 0.9% sodium chloride solution group and 2% aspirin solution group.The mouse hot-plate test and writhing test were carried out to evaluate the analgesic effect.The anti-inflammation effect was observed by the xylene-attracted swelling of the mouse's ears.The bleeding time of the breaking mouse's tails was used for studying hemostatic effect.Results The Veronicastrum sibiricum could significantly increase the pain threshold of mice in hot plate.At the same dosage, the Veronicastrum sibiricum reducing the writhing times of mice was similar to Radix clematidis.Auricle swelling inhibition rate was 5.72% higher than Radix clematidis (P<0.05);The mouse tail bleeding time was 7.6% shorter than Radix clematidis (P<0.05).Conclusion The Veronicastrum sibiricum shows similar analgesic effect to Radix clematidis,and more strong hemostatic and anti-inflammation effects than Radix clematidis.
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Objective To explore the clinical effects of ankle anterior perforating flaps in reconstruction of the soft tissue defects on dorsum of foot.Methods A retrospective cases series study was done to analyze 11 patients with dorsal skin soft tissue defects:eight males and three females,with age ranging from 18-76 years (mean,43.5 years),treated from January 2009 to March 2017.The sizes of the soft tissues defects varied from 4.0 cm × 3.5 cm to 15.0 cm × 6.0 cm.According to the anatomical basis of ankle anterior perforating flaps,the sizes and shapes of the skin defects of the dorsal ankle,the flaps were designed and harvested in the anterior part of the lower leg to repair the dorsal skin soft tissue defects.The sizes of flaps ranged from 15.0 cm × 6.0 cm to 4.0 cm × 3.2 cm.The clinical effect was evaluated based on the flap survival,infection control,elasticity,color,appearance,scars of the donor sites,skin sensitivity and patient satisfaction.The extent of the flap swellings was also evaluated.Results All ten flaps survived after the surgery.Both the donor and recipient sites healed very well at Ⅰ stage.One case had flap distal phalanx necrosis.After changing the ointments on time,both the donor and recipient sites survived completely.Duration of follow-up was 3-24 months (mean,12 months).The flaps survived very well with good shape,and the color and elasticity were very close to the normal skin nearby.The scars of the donor sites were small and the functions of ankle and foot were satisfactory.Satisfaction extents of treatment efficacy were good in nine patients and general in two,with no unsatisfaction.Flap swelling classification were nine cases of degree Ⅱ and two cases of degree Ⅲ in early stage while 11 cases of degree Ⅰ in later stage.Conclusions The ankle anterior perforating flap has constant perforating blood vessels,reliable blood supply,high survival rate of flaps and hence is one of the simple,safe and optimal ways to repair the dorsal skin soft tissue defects.
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Objective To evaluate the emergency repair method and its effect for treatment of extensive avulsion injury of the lower extremity in the elderly patients.Methods From May 2008 to February 2015,11 patients aged over 60 years sustaining large avulsion injury (across the knee or ankle joint) of the lower limb in traffic crushes were treated by emergency debridement and one-stage repair with the procedures of autologous skin replantation,arteriovenous anastomosis and vacuum sealing drainage (VSD).Two patients sustained injury to both lower limbs,and nine patients sustained a unilateral injury.Effect of wound repair was evaluated with skin flap survival area.Active and passive motility of the knee and ankle were recorded at postoperative 24 h.Results One patient with multiple fracture and extensive muscular inactivity due to severe crush injury to the lower limbs had poor blood supply after the replantation and was amputated at postoperative 24 h.The remaining ten patients with large skin avulsion showed 90％ of the avulsed skin survived after operation.At the follow-up of 3-24 months,the ten patients showed no obvious pigmentation or scar tissue,were satisfied with the function recovery in knee (106°-110° in flexion and 0°-5°in extension) and ankle joint (15°-20°in dorsiflexion and 30°-35° in plantar flexion),and could walk freely,including excellence outcomes in 3 patients and good outcomes in 6 patients.Conclusion The emergency repair methods including autologous skin replantation,arteriovenous anastomosis and VSD combined with one-stage in situ repair can attain satisfactory clinical effect.
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Objective To investigate the feasibility of repairing soft-tissue defects of the fifth phalange and the back of hand with ulnar palmar artery perforator flaps from the little finger.Methods Based on anatomic dissection,the fifth phalange ulnar palmar artery perforator flaps were created and transferred to repair soft-tissue defects at the little finger and the back of hand in 15 cases.Types of injury were stamping injury in 5 cases,planer injury in 4 cases,mechanical crash injury in 3 cases,blast injury in 2 cases,and cicatrical contracture following electric burn in 1 case.Injury involved in the palmar aspect near the middle segment of fifth phalange in 4 cases,dorsal aspect near the middle segment of fifth phalange in 6 cases,ulnar mesiodistal of the back of hand in 3 cases,and distal ulnar palmar aspect of hands in 2 cases.There were 6 patients wounded in left hands and 9 patients wounded in right hands.Results All flaps survived and all wounds healed by first intention.At the follow-up of 2-18 months,the flaps resurfaced the soft-tissue defects with good color and texture match and the maintenance of contour and function of donor and recipient sites were satisfactory.Conclusion The fifth phalange ulnar palmar artery perforator flap,as it has advantages of constant perforator vessels,rich blood supply and good texture and can be operated safely and easily,is considered an ideal treatment choice in repairing softtissue defects of the fifth phalange and the back of hand.
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Objective To evaluate the performance of clinical medicine and joint research projects,funded by Capital Medical Research Fund.Method Data of clinical medicine and joint research projects were obtained from the project of Data analysis and evaluation of Capital Medical Development Scientific Research Fund.Out puts include published papers,undergraduate textbooks,prize,patents,students' trainingsnew techniques and follow-up projects; Each project is considered as an evaluation unit,the grant amount as input indicator.Then Data Envelopment Analysis (DEA),software MaxDEA 5.2 were used to calculate the relative performance of these projects.Result The rate of recovery of questionnaire was 77.70％.Among 115projects,the average score of new technology,prize obtained and patent are less than other output indexes.15 projects have no output,7 projects reached the effectiveness of DEA.11 projects obtained the pure technology efficiency,20 projects obtained scale efficiency.Conclusion The funding for projects in 2005 and 2007 are within the appropriate amount,while funding for some projects are excessive; certain projects have less outputs in personnel trainings,publications,the follow-up projects,published papers and achievements.In order to improve project performance,the quantity of published papers and personnel trainings has to be increased.
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This article applied stochastic frontier analysis to estimate the efficiency of the 2007 Beijing Medicine Development Foundation,and analyzed the dominant influencing factors of the performance.The following results were found out..(1) The performance of 2007 Beijing Medicine Development Foundation was good in general,however there was a 23％ gap between the actual output and the frontier output.As time passes by,the expected performance will get better.(2) There are large differences existed between various categories of projects and the different levels of institutions and project leaders.The relatively high profile projects,which means large input and more complexity,requires higher level of facility and environmental support,project manager's degree,professional title,while technical efficiency is not obvious for small scale independent innovation projects.
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@#The pain is an emerging subject and need developing. The design of the research is the most important. This article emphatically introduced about the issues on quality monitoring and the logical administrative levels during practice.
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@#ObjectiveTo explore the physical growth and development conditions of the disabled children (except physical disability) aged 7～18 in Guangzhou and Dongying.MethodsA census was carried out among disabled children aged 7～18 in Guangzhou and Dongying. The physical growth and development condition was analyzed through height and weight of the disabled children.ResultsHeight and weight of the disabled children were both lower, compared with physically healthy children. The rate of thinness was 12.61% among the boys and 12.54% among the girls of the disabled children, the rate of growth retardation was 31.41% among the boys and 34.94% among the girls of the disabled children.ConclusionDisabled children aged 7～18 are in bad condition of physical growth and development. The rates of thinness and growth retardation are high among boys and girls with disability.
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@#Objective To investigate the effect of self-efficacy theory in rehabilitation on stroke patients with hemiplegia complicated psychological disorder. Methods 26 cases were divided into the combined therapy group (13 cases, accepted physical therapy with self-efficacy) and the routine physical therapy group (13 cases). They were assessed with General self-efficacy scale (GSES), Fugl-Meyer Assessment before and 1, 3 months after treatment, as well as symptom checklist (SCL-90) before and 1 month after treatment. Results The scores of GSES raise 63% in the combined therapy group 1 month after treatment, obviously different from that of routine physical therapy (P<0.01).The score of Fugl-Meyer Assessment of the combined therapy group were increased from (53.08±13.04) to (90.07±6.54 ) and from (56.46±12.95) to (81.77±8.51)in the routine physical therapy group (F= 85.53,P<0.05). All the scores of depression, anxiety, compulsion, hostility in SCL-90 were markedly lower in the combined therapy group than in the routine physical therapy group(P<0.01). Conclusion Utilization of self-efficacy theory in rehabilitation can improve the emotion and effect of rehabilitation.
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Objective To study the pathologic changes of the gallbladder in rabbits with calculous cholecystitis and the causes of gallstone recurrence after choleystolithotomy. Methods Twenty- four rabbits were randomly divided into four groups:(1) normal control group (n=5);(2) operative control group(n=5);(3) stone-implanted(S-I) group (n=6),and (4)stone- removed(S-R) group(n=8).The human cholesterol gallstones were implanted into the rabbit gallbladder in stone-implanted and stone- removed rabbits,The pathologic change of the gallbladder was observed by light microscopy 3 months before and after cholecystolithotomy. Results (1)The wet weight of gallbladder in the S-R group [ (1.1?0.06)g] was significant higher than that in S-I group [(0.515?0.1)g] (P0.05);(3)Sever chronic cholecystitis was 33.3% in S-I group 87.5% and in S-R group(P