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1.
Article in Chinese | WPRIM | ID: wpr-879420

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis.@*METHODS@#From June 2013 to August 2016, the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed, including 55 males and 28 females, aged from 27 to 72 (49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods, 35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation, regular quadruple antituberculosis drugs were continued for 18 months. The operation time, intraoperative blood loss, hospital stay, bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain, Oswestry Disability Index (ODI), sagittal Cobb angle, erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed.@*RESULTS@#The operation was successfully completed in both groups, and the operation mode was not changed during operation. The operation time, intraoperative blood loss and hospital stay were (149.4±13.3) min, (354.3±69.0) ml, (9.4±1.6) d in group A and(116.8±10.0) min, (721.9±172.3) ml, (11.8±1.7) d in group B, respectively, with significant difference between the two groups (@*CONCLUSION@#The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay, which is conducive to early rehabilitation of patients.


Subject(s)
Aged , Bone Transplantation , Debridement , Female , Humans , Lumbar Vertebrae/surgery , Male , Pedicle Screws , Retrospective Studies , Spinal Fusion , Thoracic Vertebrae , Treatment Outcome , Tuberculosis, Spinal/surgery
2.
Article in Chinese | WPRIM | ID: wpr-885947

ABSTRACT

Objective:To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods:From December 2016 to February 2019, 16 female breast cancer patients, aged 27-59 years, with an average of 40.3 years, were treated in the Department of Oncoplastic Surgery, Hunan Cancer Hospital. The tumors were unilateral in 9 cases on the left side and 7 cases on the right side, with a diameter of 1.5-4.5 (2.9±0.3) cm, and all of them were stage I. Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma. After the modified radical mastectomy, the medial thigh perforator flap was used to reconstruct the breast. Patients were randomly divided into group A and group B. In group A, the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated. In group B, the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested. After all the flaps were harvested with only one major adductor perforator as vascular pedicle, ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results:Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted, The length, width and thickness of the flaps were (27.5±0.4) cm, (7.1±0.5) cm and (3.8±0.4) cm, (7.4±0.3) cm and (10.8±0.5) cm respectively. The average weight of the flap was 255 g (195 g-315 g). The mean ischemia time was 75 min (55-90 min). In 16 cases, the proximal and distal ends of internal mammary vessels were used as the recipient vessels. Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap. All flaps survived successfully in one stage. The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation. 16 cases were followed up for an average of 12.5 months, and the patients' self perception and appearance were satisfactory. Only hidden linear scar was left on the donor site of the medial thigh flap, and the function of hip joint and leg was not affected.Conclusions:Large size of medial thigh perforator flap pedicled with the perforator of adductor magnus can be safely and reliably cut with no needing additional harvest of gracilis muscle vascular pedicle.

3.
Article in Chinese | WPRIM | ID: wpr-882016

ABSTRACT

Objective To understand the prevalence of obesity among primary and middle school students in Taizhou, and provide scientific evidence for prevention and control. Methods A primary school, a middle school and a high school were randomly selected from each of 9 counties(cities or districts)in Taizhou using stratified sampling. We collected data on height, weight and age to calculate body mass index(BMI)and evaluated it according to the Appendix A of Technical Specification for Student Health Examination(GB/T 26343-2010)"Screening Standards for Overweight and Obesity in Children and Adolescents". Descriptive statistics of obesity was conducted. Results The prevalence of obesity among primary, middle, and high school students in Taizhou was 8.08%. It was higher among boys(10.80%)than girls(5.08%)(P < 0.05). The trend of obesity significantly decreased among students in different schools was as follows:primary school > middle school > high schoolt(χboy2 = 259.309, P < 0.001; χgirl2 = 244.679, P < 0.001), regardless of sex. Conclusion Obesity among primary, middle, and high school students in Taizhou remains high, with an increasing trend in recent years. The targeted population for prevention and control is 7-12-year-old primary school students, especially boys.

4.
Article in English | WPRIM | ID: wpr-880661

ABSTRACT

The preliminary screening of oral cancer mostly depends on the experience of clinicians, The surgical margin of tumor is mostly based on physical examination and preoperative imaging examination. It lacks real-time and objective intraoperative evaluation methods. Indocyanine green (ICG), as a safe and pollution-free organic fluorescent pigments, combined with near-infrared fluorescence imaging can be applied in the screening of early oral cancer, the determination of tumor resection margins, sentinel lymph node biopsy, cervical lymph node dissection, targeted chemotherapy, and other aspects. Near-infrared fluorescence imaging may become a key link in the early diagnosis and accurate treatment for oral cancer in the future.


Subject(s)
Humans , Indocyanine Green , Lymph Nodes , Mouth Neoplasms/therapy , Optical Imaging , Sentinel Lymph Node Biopsy
5.
Article in Chinese | WPRIM | ID: wpr-846142

ABSTRACT

Objective: Using LC-MS to explore the pharmacokinetic process in rats of Shenling Baizhu Pulvis (SBP), which was modified by particle design technology. Methods: Particle design powder of SBP was prepared by particle design technology. A scientific and feasible LC-MS analysis method was established to determine the blood concentration of index compounds such as ginsenoside Re (GI-Re), ginsenoside Rb1 (GI-Rb1), ginsenoside Rg1 (GI-Rg1), atractylenolide I (AT-I), atractylenolide II (AT-II) and pachymic acid (PA) in rats at different time points after administration. DAS 3.2.8 pharmacokinetic software was adopted to analyze the data, which related to blood concentration of index compounds, and the pharmacokinetics parameters were calculated by the non-compartmental model. Results: LC-MS analysis method was established, which has a good linear relationship and specificity for the index compounds in rats, and the RSD of precision, accuracy, extraction recovery and stability were all less than 5% or 10%. Compared with ordinary powder, the particle design powder displayed increased Cmax and AUC0-∞ after administration, and the AUC0-∞ of GI-Re, GI-Rb1, GI-Rg1, AT-I, AT-II and PA were increased to 1.52, 2.02, 1.22, 1.41, 1.13 and 1.43 times, respectively. Conclusion: The LC-MS analysis method meet the requirements of biological sample analysis in Pharmacopoeia of the People's Republic of China. After particle design and modification, the absorption speed of SBP in vivo become faster and the bioavailability is improved significantly.

6.
Article in English | WPRIM | ID: wpr-776601

ABSTRACT

OBJECTIVE@#To investigate the effects of Ganoderma lucidum polysaccharides (GL-PS) on human fibroblasts and skin wound healing in Kunming male mice and to explore the putative molecular mechanism.@*METHODS@#Primary human skin fibroblasts were cultured. The viability of fibroblasts treated with 0, 10, 20, 40, 80, and 160 μg/mL of GL-PS, respectively were detected by 3-4,5-dimethyl-2-thiazolyl-2,5-diphenyl-2-Htetrazolium bromide (MTT). The migration ability of fibroblasts treated with 0, 10, 20, and 40 μg/mL of GL-PS were measured by transwell assay. The secretion of the C-terminal peptide of procollagen type I (CICP) and transforming growth factor-β1 (TGF-β1) in the cell supernatant was tested by enzyme-linked immunosorbent assay. The expression of β-catenin was detected by Western blot. Furthermore, the Kunming mouse model with full-layer skin resection trauma was established, and was treated with 10, 20, and 40 mg/mL of GL-PS, respectively as external use. The size of the wound was measured daily, complete healing time in each group was recorded and the percentage of wound contraction was calculated.@*RESULTS@#Compared with the control group, 10, 20, and 40 μg/mL of GL-PS significantly increased the viability of fibroblasts, promoted the migration ability of fibroblasts, and up-regulated the expressions of CICP and TGF-β1 in fibroblasts (Plt;0.05 or Plt;0.01). The expression of β-catenin in fibroblasts treated with 20 and 40 μg/mL of GL-PS was significantly higher than that of the control group (Plt;0.01). Furthermore, after external use of 10, 20, and 40 mg/mL of GL-PS, the rates of wound healing in mice were significantly higher and the wound healing time was significantly less than the control group (Plt;0.05 or Plt;0.01).@*CONCLUSION@#A certain concentration of GL-PS may promote wound healing via activation of the Wnt/β-catenin signaling pathway and up-regulation of TGF-β1, which might serve as a promising source of skin wound healing.


Subject(s)
Animals , Cell Movement , Cell Survival , Cells, Cultured , Collagen Type I , Fibroblasts , Humans , Male , Mice , Polysaccharides , Pharmacology , Reishi , Chemistry , Skin , Wounds and Injuries , Transforming Growth Factor beta1 , Physiology , Wound Healing , beta Catenin , Physiology
7.
Article in Chinese | WPRIM | ID: wpr-776099

ABSTRACT

OBJECTIVE@#To assess the clinical results of one stage temporary atlantoaxial segmental fixation and reduction for Grauer type IIB dens fractures in teenagers.@*METHODS@#From February 2009 to April 2015, 19 teenagers with Grauer type IIB dens fractures not amenable to anteiror screw fixation were enrolled and treated using one stage temporary atlantoaxial segmental fixation and reduction without fusion. There were 14 males and 5 females, aged from 14 to 32 years with an average of (24.6±5.0 ) years. The internal fixation was removed after bone healing confirmed by CT scan. At the last follow-up (at least 1 year after internal fixation removal), dynamic CT was used to assess the atlantoaxial rotation activity. Visual analogue scale (VAS) was recorded before the first operation, before the second operation (removal of internal fixation) and at the last follow-up. Neck Disability Index(NDI) was used to evaluate the efficacy before the second operation (removal of internal fixation) and the last follow-up.@*RESULTS@#After operation, 2 patients developed the symptoms of occipital nerve stimulation such as numbness and pain in the occipitocervical region, and were treated with drugs such as dehydration and neurotrophic drugs, and the symptoms were relieved after 1 to 2 months. All the internal fixations were removed and all the patients were followed up more than 1 year, with time ranging from 18 to 25 months and an average of (21.47±2.41) months. The time of bone fusion after operation was 6 to 10 months with the mean of(8.21±1.27) months. Secondary surgical removal of internal fixation were performed immediately after fracture healing without internal fixation failure. The symptoms of neck pain improved significantly after operation, VAS score decreased from 6.74±0.65 before operation to 0.42±0.51 at the last follow-up after the second operation (removal of internal fixation), with statistically significant differences(<0.01). The NDI value decreased from (10.58±2.04)% before the second operation (removal of internal fixation) to (3.79±2.23)% at the last follow-up after the second operation (removal of internal fixation), with statistically significant difference(<0.01). At the last follow-up after the second operation (removal of internal fixation), dynamic CT showed that the unilateral rotation of the atlantoaxial spine reached (15.73±5.57)° to the left, (15.55±5.78)° to the right, and the overall rotation of the atlantoaxial spine was (31.28±10.71)°.@*CONCLUSIONS@#One stage temporary atlantoaxial segmental fixation and reduction for the treatment of Grauer type IIB dens fractures not amenable to anteiror screw fixation in teenagers can avoid the loss of atlantoaxial rotation function caused by atlantoaxial fusion, and to some extent retain the rotation activity of atlanto-axial joint.


Subject(s)
Adolescent , Adult , Atlanto-Axial Joint , Bone Screws , Female , Fracture Fixation, Internal , Fractures, Bone , Humans , Male , Odontoid Process , Treatment Outcome , Young Adult
8.
Article in Chinese | WPRIM | ID: wpr-805608

ABSTRACT

Objective@#To review the clinical data of patients who underwent maxillary and mandibular reconstruction with vascularized fibula osteomycutaneous flap, using virtual surgery planning.@*Methods@#From January 2012 to December 2016, 23 patients with mandibular defect and 2 patients with maxillary defect were treated in our department. In virtual surgery planning, the optimal osteotomy line and angle were designed. Segmental maxillectomy and mandibulectomy, as well as mandibular reconstruction were performed using guided templates to practice the virtual planning.Actual reconstruction results were compared with those of virtual surgery.@*Results@#Among the 25 patients, 2 patients were repaired with the ipsilateral fibula myocutaneous flap, 22 patients were lateral fibula myocutaneous flap. One case of maxillary type Ⅱd defect was repaired with left fibular muscle flap. All patients were followed up for 12 to 48 months. Satisfied bony unions and occlusion were observed in 25 patients.All patients reported excellent or good facial appearance. One of them received dental implants at 1 year postoperatively.@*Conclusions@#An ideal contour of maxilla and mandible can be obtained using vascularized fibula osteomycutaneous flap in virtual surgery.

9.
Chinese Journal of Burns ; (6): 277-283, 2019.
Article in Chinese | WPRIM | ID: wpr-805023

ABSTRACT

Objective@#To explore the clinical effects of free deep inferior epigastric perforator flap carrying lymphatic groin flap for treatment of upper limb lymphedema after radical mastectomy and breast reconstruction.@*Methods@#From October 2014 to December 2016, 10 female patients, aged 37-60 (48±8) years, who had lymphedema in the upper limb after radical mastectomy, were admitted to Department of Oncology Plastic Surgery of Hunan Cancer Hospital. Three patients suffered recurrent erysipelas infections, and 4 patients suffered consistent neuropathic pain in the upper limb. Free deep inferior epigastric perforator flap carrying lymphatic groin flap was used for breast reconstruction and lymphedema treatment. Operation was performed by 2 surgeon groups including recipient site prepare group and flap harvest group. In the 10 patients, the length of the flaps was (26.2±0.3) cm, the width of the flaps was (13.4±0.4) cm, and the thickness of the flaps was (3.4±0.3) cm. All the donor sites in the abdomen were closed directly. The choices of vascular pedicles and vessels in the recipient sites, operation time, complications, operation effects, and follow-up were recorded.@*Results@#(1) Bilateral vascular pedicle was adopted in flaps of 5 patients. Unilateral vascular pedicle was adopted in flaps of 5 patients. The recipient vessels were proximal and distal ends of internal thoracic vessels in 4 cases, the proximal end of thoracodorsal vessels in 3 cases, the proximal end of internal thoracic vessels in 2 cases, and the proximal end of internal thoracic vessels and thoracodorsal vessels in 1 case. (2) The operation time of the patients was 330-480 (406±55) min. (3) Subcutaneous edema was observed in flaps of 2 patients and donor site of 1 patient, which were all healed by dressing change therapy. The other flaps survived successfully. The reconstructed breasts were in good shape and elasticity. Nine patients had different degrees of relief in lymphedema in the upper limb. All 10 patients were followed up for 6 to 28 months, no one had recurrent erysipelas infections, and neuropathic pain in the upper limb was relieved in 2 patients. Only linear scar was left in the donor sites of 10 patients, and the function of abdomen was not affected without related complications.@*Conclusions@#Free deep inferior epigastric perforator flap carrying lymphatic groin flap can simultaneously accomplish breast reconstruction and upper limb lymphedema treatment, which is worthwhile to be popularized in clinic.

10.
Article in Chinese | WPRIM | ID: wpr-804844

ABSTRACT

Objective@#To explore the clinical application of the transverse upper gracilis flap (TUG) in breast reconstruction for breast cancer patients.@*Methods@#From March 2010 to September 2016, 15 breast cancer patients received radical or modified radical mastectomy in Hunan Cancer Hospital, 8 cases of breast cancer were in stage Ⅰ and 7 cases was in stage Ⅱ. The age of patients ranged from 37 to 62 years old, (39.5±4.7) years. The TUG flap was used to reconstruct breast at the same time.The donor leg is placed in frog-leg position. Free TUG flap was harvested with gracilis muscular branch of profunda artery as pedicle. To keep tight connection between skin paddle and gracilis muscle, the perforators are not visualized. The flap was transferred to reconstruct breast, and the donor site was directly closed.@*Results@#Mean operative time of unilateral reconstruction was 5 hours and (35± 44) minutes (with the range from 4 hours and 17 minutes to 6 hours and 5 minutes). Mean ischemia time was (52± 9 )minutes (with the range from 40 minutes to 1 hour and 16 minutes). The length of flap was (27.1±0.1) cm. The width of flap was (7.8±0.5) cm. The thickness of flap was (3.4±0.2) cm. The length of pedicle was( 6.8±0.5) cm.The average weight of flap was 350 g (ranged from 285 g to 525 g). All TUG flaps were survived. The shape, texture and elasticity of all reconstructed breasts were satisfactory, and there is no flap contracture deformation happened. Only linear scar left in the donor sites, without sacrifice of the function of thighs. All 15 patients were followed for 9-36 months (16.5 months on average). No local recurrence happened.@*Conclusion@#TUG flap can be safely harvested. It is reliable, with good texture. It is an alternative method for breast reconstruction after radical or modified radical mastectomy.

11.
Article in Chinese | WPRIM | ID: wpr-804843

ABSTRACT

Objective@#To explore the clinical application of the transverse upper gracilis flap (TUG) in breast reconstruction for breast cancer patients.@*Methods@#From March 2010 to September 2016, 15 breast cancer patients received radical or modified radical mastectomy in Hunan Cancer Hospital, 8 cases of breast cancer were in stage Ⅰ and 7 cases was in stage Ⅱ. The age of patients ranged from 37 to 62 years old, (39.5±4.7) years. The TUG flap was used to reconstruct breast at the same time.The donor leg is placed in frog-leg position. Free TUG flap was harvested with gracilis muscular branch of profunda artery as pedicle. To keep tight connection between skin paddle and gracilis muscle, the perforators are not visualized. The flap was transferred to reconstruct breast, and the donor site was directly closed.@*Results@#Mean operative time of unilateral reconstruction was 5 hours and (35± 44) minutes (with the range from 4 hours and 17 minutes to 6 hours and 5 minutes). Mean ischemia time was (52± 9 )minutes (with the range from 40 minutes to 1 hour and 16 minutes). The length of flap was (27.1±0.1) cm. The width of flap was (7.8±0.5) cm. The thickness of flap was (3.4±0.2) cm. The length of pedicle was( 6.8±0.5) cm.The average weight of flap was 350 g (ranged from 285 g to 525 g). All TUG flaps were survived. The shape, texture and elasticity of all reconstructed breasts were satisfactory, and there is no flap contracture deformation happened. Only linear scar left in the donor sites, without sacrifice of the function of thighs. All 15 patients were followed for 9-36 months (16.5 months on average). No local recurrence happened.@*Conclusion@#TUG flap can be safely harvested. It is reliable, with good texture. It is an alternative method for breast reconstruction after radical or modified radical mastectomy.

12.
Chinese Journal of Geriatrics ; (12): 1028-1032, 2019.
Article in Chinese | WPRIM | ID: wpr-797885

ABSTRACT

Objective@#To observe the feasibility and clinical curative effect of anatomical reduction and fixation of lesser trochanter through posterior-lateral approach for the treatment of comminuted femoral intertrochanteric fractures in elderly patients.@*Methods@#A total of 19 cases with comminuted femoral intertrochanteric fracture, aged 60 to 84 years were enrolled in this study.According to Evans-Jensen classification, 13 cases had type Ⅱ B and 6 cases had type Ⅲ femoral fracture.Through the posterior-lateral approach, the lesser trochanter was fully exposed, reduced and fixed by screw.The proximal and distal femur were well fixed with dynamic hip screw(DHS)or proximal femoral locking plate(PFLP). The lesser trochanter reduction was observed by intraoperative vision and postoperative X-ray.The function evaluation after hip surgery was performed by using Sanders hip function score.@*Results@#All 19 patients obtained the anatomic reattachment in the lesser trochanter.All patients were followed up for an average of 18 months.After treatment, the Sanders hip function score were excellent in 7 patients(36.8%), fine in 12 cases(63.2%). And curative efficacy was good in all cases(100%). There was no significant difference in the curative effect between patients with different classification and gender.@*Conclusions@#Through the posterior-lateral approach, the surrounding structures of the lesser trochanter can be fully exposed, and the lesser trochanter can be anatomically repositioned.The posterior-lateral approach to anatomical reduction and fixation of lesser trochanter is an effective and feasible method for the treatment of comminuted intertrochanteric fracture in the elderly.

13.
Article in Chinese | WPRIM | ID: wpr-797701

ABSTRACT

Objective@#To explore the clinical application of the deep inferior epigastric artery perforator flap in bilateral breast reconstruction of patients with breast cancer.@*Methods@#Deep inferior epigastric artery perforator flap was applied for breast reconstruction in four cases of breast cancer patients received radical or modified radical surgery in Hunan Provincial Cancer Hospital. All patients are female, age ranged from 31 to 53 years old (36.2±5.9).@*Results@#The length of flap was (15.1±0.4) cm, the width of flap was (12.6±0.3) cm, the thickness of flap was (4.3±0.5) cm. The length of pedicle was (12.6±0.3) cm, the outer diameter of artery was (1.8±0.2) mm, the outer diameter of vein was (2.1±0.4) mm.The average weight of flaps was 235 g(ranged from 195 g to 335 g). In one case flap fat necrosis occurred and in other one donor site fat necrosis was noted. The two flaps both healed with dressing treatment and no other complications were found. The reconstructed breasts′shape, texture and elasticity were good and no flap contracture deformation happened. Only linear scar left in the donor sites, the function of abdomen did not affected. All 4 patients were followed up for 14 to 33 months (21.7 months on average) with satisfied result. No local recurrence happened.@*Conclusions@#Free deep inferior epigastric artery perforator flap is suitable to reconstruct bilateral breast for breast cancer patients.

14.
Chinese Journal of Surgery ; (12): 686-690, 2019.
Article in Chinese | WPRIM | ID: wpr-797585

ABSTRACT

Objective@#To investigate the safety and feasibility of the modified transoral endoscopic thyroidectomy vestibular approach (TOETVA) by dissection of mental nerve in clinical practice.@*Methods@#Totally 140 patients underwent the modified TOETVA from the Department of Head and Neck Surgery, Hunan Cancer Hospital from July 2016 to June 2018 were analyzed retrospectively. There were 130 females and 10 males, aging (35.4±9.8) years (range: 11 to 56 years). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative suction drainage, postoperative pain score, postoperative cosmetic satisfaction and postoperative complications (recurrent laryngeal nerve palsy, hypoparathyroidism, infection, pneumoderm, seroma and mental nerve injury) were summarized.@*Results@#Of the 140 patients, 1 patient was transferred to open surgery. Fifty-nine patients underwent thyroidectomy with an operation time of (100.8±18.9) minutes. Sixty-three patients underwent thyroidectomy and central lymphadenectomy with an operation time of (112.1±16.6) minutes. Eighteen cases underwent total thyroidectomy and central lymphadenectomy with an operation time of (185.3±25.9) minutes. The postoperative hospital stay was (3.76±0.98) days. The postoperative drainage was (96.8±36.2) ml. The 24-hour postoperative pain score was 2.66±1.23, the postoperative cosmetic satisfaction was 9.65±0.24. Among the postoperative complications, there were 3 cases of temporary recurrent laryngeal nerve palsy, 2 cases of permanent recurrent laryngeal nerve palsy, 4 cases of temporary hypoparathyroidism but no permanent hypoparathyroidism, 2 cases of infection, 1 case of seroma, 3 cases of pneumoderm, and no cases of mental nerve injury.@*Conclusion@#The modified TOETVA by dissection of mental nerve is safe and feasible.

15.
Article in Chinese | WPRIM | ID: wpr-796693

ABSTRACT

Objective@#To explore the clinical outcomes of multiple-paddled anterolateral thigh flap in composite cheek through-and-through defect reconstruction.@*Methods@#From September, 2014 to Feburuary, 2016, 20 patients were performed complicated through-and-through defect reconstruction following oral cancer removal with free multiple-paddled anterolateral thigh flap including 12 cases of buccal mucosa carcinoma, 5 cases of basal cell carcinoma of buccal skin and 3 cases of gingiva carcinoma.The intraoral defects ranged from 6.0 cm×4.0 cm to 8.0 cm×5.0 cm. The cheek skin defects ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm and the flaps ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm in size.Multiple-paddled anterolateral thigh flap was divided into 3 types based on the anatomical variation, including: (1) lateral descending branch type; (2) descending branch + oblique branch type; (3) lateral and medial descending branch type; different methods were applied according to the different types.@*Results@#All the 20 flaps survived totally, including 13 cases of type 1, 5 cases of type 2, and 2 cases of type 3. In all of the 20 cases, the flaps survived well and the donor sites were closed directly.All wounds healed primarily. The follow-up period was 9 to 28 months (13.6 months on average). All patients were satisfied with their facial appearance. Mouth opening ranged from 3 to 5 cm. All patients had normal deglutition and normal oral competence and intelligible speech, although linear scar was left in the donor site. 6 patients received post-operative radiotherapy. 2 patients died of recurrence and all other patients were alive without disease.@*Conclusions@#The multiple-paddled anterolateral thigh flap is suitable for the through-and-through cheek defect reconstruction following oral cancer removal. Satisfying outcome can be achieved. This method is worthy of being popularized. Since the anatomical variation forms exist, flexible strategies for flap harvest and reconstruction are needed.

16.
Chinese Journal of Geriatrics ; (12): 1028-1032, 2019.
Article in Chinese | WPRIM | ID: wpr-791621

ABSTRACT

Objective To observe the feasibility and clinical curative effect of anatomical reduction and fixation of lesser trochanter through posterior-lateral approach for the treatment of comminuted femoral intertrochanteric fractures in elderly patients.Methods A total of 19 cases with comminuted femoral intertrochanteric fracture,aged 60 to 84 years were enrolled in this study.According to Evans-Jensen classification,13 cases had type Ⅱ B and 6 cases had type Ⅲ femoral fracture.Through the posterior-lateral approach,the lesser trochanter was fully exposed,reduced and fixed by screw.The proximal and distal femur were well fixed with dynamic hip screw(DHS)or proximal femoral locking plate(PFLP).The lesser trochanter reduction was observed by intraoperative vision and postoperative X-ray.The function evaluation after hip surgery was performed by using Sanders hip function score.Results All 19 patients obtained the anatomic reattachment in the lesser trochanter.All patients were followed up for an average of 18 months.After treatment,the Sanders hip function score were excellent in 7 patients (36.8 %),fine in 12 cases (63.2 %).And curative efficacy was good in all cases(100%).There was no significant difference in the curative effect between patients with different classification and gender.Conclusions Through the posterior-lateral approach,the surrounding structures of the lesser trochanter can be fully exposed,and the lesser trochanter can be anatomically repositioned.The posterior-lateral approach to anatomical reduction and fixation of lesser trochanter is an effective and feasible method for the treatment of comminuted intertrochanteric fracture in the elderly.

17.
Article in Chinese | WPRIM | ID: wpr-746135

ABSTRACT

Objective To provide anatomical basis for the design of the V-Y advancement flap and investigate the morphological characters of the dorsal carpal perforators.Methods From August,2017 to October,2018,30 sides aduh specimens of hand were perfused with red latex.The following contents were observed under surgical magnifier:①The origin,courses,branches,and distribution of the dorsal carpal perforators.②The characters of dorsal carpal perforators in agreement with the antebrachial and dorsal metacarpal vascular net.Results The dorsal carpal vascular network was composed of deep vascular network (bone and joint network) and superficial vascular network (fasciocutaneous network).The deep vascular network was located at the deep aspect of the extensor tendons and was commonly formed by dorsal carpal branch of radial artery,dorsal carpal branch of anterior interosseous artery,ascending branch of the dorsal carpal perforator from the deep palmar arch,and dorsal carpal branch of ulnar artery.The superficial vascular network was located on the surface of the extensor tendons and was mainly formed by dorsal carpal branch of radial artery,dorsal carpal branch of ulnar artery,dorsal carpal branch of anterior interosseous artery,radial and ulnar myocutaneous branches of posterior interosseous artery,and the perforators from the deep vascular network.The 3rd and 4th perforators puncturing out from the ulnar and radial margins of the extensor tendon had a constant occurrence rate (100%) with an outer diameter of (0.7±0.3) mm and (0.6±0.2) mm,respectively,and a length of (1.1±0.4) cm and (0.9±0.4) cm,respectively.They were divided into the ascending branch,descending branch,and collateral branch.And finally anastomosis with antebrachial and dorsal metacarpal perforators.Conclusion The V-Y advancement flap based on the dorsal carpal perforators can be a good choice for restoring the dorsal metacarpal defects.

18.
Chinese Journal of Oncology ; (12): 496-500, 2019.
Article in Chinese | WPRIM | ID: wpr-810769

ABSTRACT

Objective@#To evaluate the effect of vascular localization using computerized tomography angiography (CTA) combined with refined three dimensional (3D) printing in guiding the resection and reconstruction of complex oral cancer.@*Methods@#From December 2013 to July 2017, the clinical data of 30 patients with complex oral cancer enrolled in the Hunan Cancer Hospital were retrospectively analyzed. 15 patients received CTA+ 3D assisted surgery, while the other 15 patients underwent traditional surgery. In CTA+ 3D assisted surgery group, CT and Magnetic Resonance Imaging (MRI) data were combined with CTA to print refined solid 3D model and surgical guide plate. The preoperative and intraoperative virtual surgical system and the operative experience were combined for preoperative evaluation and surgery. In traditional surgery group, preoperative evaluation and surgery were performed according to imaging data and surgeons′ clinical experience. Operative time, intraoperative blood loss, hospital stay and local recurrence rate were compared between the two groups.@*Results@#In CTA+ 3D assisted surgery group, one patient gave up surgical treatment after intuitively watching the lesion through the 3D model, and the remaining 14 patients underwent surgery as planned. All the 15 patients in traditional surgery group received surgery. But the preoperative plans of three patients were temporarily and passively modified due to insufficient preoperative evaluation. The average intraoperative blood loss was(320.1±27.2)ml in CTA+ 3D assisted surgery group and(430.2±30.3)ml in traditional surgery group. Mean operation time was(440.3±19.2)min and(552.2±23.3)min, respectively. Mean hospitalization time was (20.4±3.2)d and (25.1±3.7)d, respectively. The differences were all statistically significant (all P<0.05). 1 year and 3 years local recurrence rates were 9.1% and 28.6% in CTA+ 3D assisted surgery group, as well as 14.3% and 50.4% in traditional surgery group with statistical significance (P<0.05).@*Conclusion@#For complex oral cancer patients with difficulty in opening the mouth or postoperative recurrence, CTA vascular localization combined with fine 3D printing technology has significant advantages in the surgical process, surgical effect and postoperative evaluation index compared with traditional method using imaging data and clinical experience.

19.
Article in Chinese | WPRIM | ID: wpr-813097

ABSTRACT

To investigate the effect of adipose-derived stem cells (ADSCs) on radiation-induced skin injury in SD rats.
 Methods: Radioactive particles 192Ir were used to irradiate the left medial thigh skin of SD rats, and the irradiation dose was at 90 Gy. Then, the rats were randomly allocated into a control group and a treatment group (each n=9). After the irradiation, the control group was injected with 60 μL PBS and the treatment group was injected with 60 μL ADSCs in irradiated skin. The progress of skin damage and healing was observed and photographed every day. Twenty-eighth days after the irradiation, the irradiated skin tissue was taken from the left thigh, and then fixed with formaldehyde fixative solution. At the same time, the skin tissue of the corresponding part of the normal group (n=9) that was not irradiated was also taken. After sampling, embedding and slicing, immunohistochemical staining was used to compare the levels of α-smooth muscle actin (α-SMA), and HE staining was used to compare pathological features of the skin.
 Results: Radioactive particle 192Ir caused the development of III or IV radioactive skin damage. The score of the treatment group was significantly lower than that of the control group. The wounds of the treatment group were basically healed at 28 days, while the ulcer of the control group was unhealed. So, the healing time was shorter in the treatment group. The expression of α-SMA in the skin of the two groups was increased after the radiotherapy. By analyzing the pathological microstructure image, we found that the thickness of epidermis in the control group was greater than that in the treatment group, while the vascular density in the treatment group was greater than that in the control group (all P<0.05).
 Conclusion: Radioactive particles 192Ir can cause skin damage, while the adipose-derived stem cells might alleviate radiation-induced skin injury and promote ulcer healing by promoting angiogenesis.


Subject(s)
Adipocytes , Animals , Iridium Radioisotopes , Rats , Rats, Sprague-Dawley , Skin , Stem Cells
20.
Chinese Journal of Lung Cancer ; (12): 147-159, 2018.
Article in Chinese | WPRIM | ID: wpr-776334

ABSTRACT

Background and objective As computed tomography (CT) screening for lung cancer becomes more common in China, so too does detection of pulmonary ground-glass nodules (GGNs). Although anumber of national or international guidelines about pulmonary GGNs have been published,most of these guidelines are produced by respiratory, oncology or radiology physicians, who might not fully understand the progress of modern minimal invasive thoracic surgery, and these current guidelines may overlook or underestimate the value of thoracic surgery in the management of pulmonary GGNs. In addition, the management for pre-invasive adenocarcinoma is still controversial. Based onthe available literature and experience from Shanghai Pulmonary Hospital, we composed this consensus about diagnosis and treatment of pulmonary GGNs. For lesions which are considered as adenocarcinoma in situ, chest thin layer CT scan follow-up is recommended and resection can only be adopt in some specific cases and excision should not exceed single segment resection. For lesions which are considered as minimal invasive adenocarcinoma, limited pulmonary resection or lobectomy is recommended. For lesions which are considered as early stage invasive adenocarcinoma, pulmonary resection is recommend and optimal surgical methods depend on whether ground glass component exist, location, volume and number of the lesions and physical status of patients. Principle of management of multiple pulmonary nodules is that primary lesions should be handled with priority, with secondary lesions taking into account.
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Subject(s)
Adenocarcinoma , Diagnosis , Diagnostic Imaging , General Surgery , Adenocarcinoma of Lung , China , Consensus , Hospitals , Humans , Lung Neoplasms , Diagnosis , Diagnostic Imaging , General Surgery , Physicians , Psychology , Positron Emission Tomography Computed Tomography , Practice Guidelines as Topic , Retrospective Studies , Solitary Pulmonary Nodule , Diagnosis , Diagnostic Imaging , General Surgery , Tomography, X-Ray Computed
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