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1.
Rev. bras. cir. plást ; 37(1): 60-65, jan.mar.2022. ilus
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1368215

ABSTRACT

Introdução: A microcirurgia reparadora é ramo hoje indissociável e imprescindível na cirurgia plástica. O treinamento é longo, custo financeiro relativamente alto e exige muito dos proponentes. Para melhorar essa equação a favor da formação de novos microcirurgiões no Brasil, é fundamental facilitar o acesso ao treinamento experimental, utilizando materiais simples. Huaraca descreveu uma técnica utilizando um simples fio mononylon 5-0 para substituir o clamp vascular, que é instrumento indispensável da anastomose microcirúrgica e geralmente de alto custo. O objetivo é comparar a técnica de Huaraca com fio de mononylon e o clamp metálico tradicional durante anastomose microcirúrgica vascular. Métodos: Seis ratos da raça Wistar cujas duas artérias femorais foram aleatoriamente selecionadas para sutura término-terminal após secção completa, sendo um dos lados realizado com clamp vascular habitual e o contralateral com técnica de Huaraca, no mesmo tempo cirúrgico e pelo mesmo cirurgião. Resultados: Em ambas as situações, a taxa de patência foi de 67% após 72 horas, sendo que o tempo médio foi de 26 minutos com a técnica de Huaraca e de 18 minutos com o clamp tradicional (p=0,001). Conclusão: Apesar do tempo de execução mais longo, a técnica de Huaraca é medida simples e de baixo custo que pode substituir o clamp vascular tradicional.


Introduction: Reconstructive microsurgery is now an inseparable and essential branch of plastic surgery. The training is long, has a relatively high financial cost and requires a lot of the proponents. To improve this equation in favor of the formation of new microsurgeons in Brazil, it is essential to facilitate access to experimental training, using simple materials. Huaraca described a technique using a simple 5-0 mononylon thread to replace the vascular clamp, which is an indispensable instrument for microsurgical anastomosis and is generally expensive. The objective is to compare the Huaraca technique with mononylon thread and the traditional metal clamp during vascular microsurgical anastomosis. Methods: Six Wistar rats whose both femoral arteries were randomly selected for end-to-end suture after complete section, with one side performed with usual vascular clamp and the contralateral with Huaraca technique, at the same surgical time and by the same surgeon. Results: In both situations, the patency rate was 67% after 72 hours, with an average time of 26 minutes with the Huaraca technique and 18 minutes with the traditional clamp (p=0.001). Conclusion: Despite the longer execution time, the Huaraca technique is a simple and low-cost measure that can replace the traditional vascular clamp.

2.
Rev. bras. ortop ; 57(1): 69-74, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365758

ABSTRACT

Abstract Objective To evaluate the use of external fixators in the delta-type kickstand configuration as an adjuvant method in the postoperative period of patients submitted to free flaps in the lower limbs. Methods A total of 17 external delta fixators were used in patients submitted to free flaps in the lower limbs. The surgical technique was performed in a standardized manner, with the distal pin located 6 cm proximally to the anastomosis, and the proximal pin, 6 cm distally to the anterior tuberosity of the tibia. Results The mean age of the sample was of 34.76 years (range: 15 to 66 years). In total, 11 men and 6 women were selected. The posterior tibial artery was used in 14 cases, and the anterior tibial artery, in 3 cases. The mean time of use of the external fixators was of 3.88 weeks. The rate of reoperation was of 17.64%; that of retail loss was of 11.76%; that of success rate was of 88.23%; and the rate of infection was of 5.9%. Conclusion The use of delta-type fixators as an adjunct method in the postoperative period is reliable; however, more studies are needed to evaluate its true role in the postoperative period.


Resumo Objetivo Avaliar o uso de fixadores externos, na configuração kickstand do tipo delta, como método adjuvante no período pós-operatório de pacientes submetidos a retalhos livres nos membros inferiores. Métodos Ao todo, 17 fixadores externos do tipo delta foram utilizados em pacientes submetidos a retalhos livres nos membros inferiores. A técnica cirúrgica foi realizada de forma padronizada, com o pino distal localizado 6 cm proximal à anastomose, e o pino proximal, 6cm distal à tuberosidade anterior da tíbia. Resultados A idade média da amostra foi de 34,76 anos (variação: 15 a 66 anos). Foram selecionados 11 homens e 6 mulheres. Utilizou-se a artéria tibial posterior em 14 casos, e a tibial anterior, em 3 casos. O tempo médio de uso dos fixadores externos foi de 3,88 semanas. A taxa de reoperação foi de 17,64%; a de perda do retalho foi de 11,76%; a de sucesso foi de 88,23%; e a taxa de infecção foi de 5,9%. Conclusão O uso de fixadores do tipo delta como método adjuvante no pós-operatório é confiável; porém, mais estudos são necessários para avaliar seu verdadeiro papel no pós-operatório.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Fractures, Bone , Perforator Flap , Myocutaneous Flap , Microsurgery
3.
Article in Chinese | WPRIM | ID: wpr-904816

ABSTRACT

@#Endodontic microsurgery is one effective method for preserving teeth affected by periapical disease, and is also an essential technique for treating difficult cases. However, due to the restricted operating space at the posterior site and the proximity of the root apex to the maxillary sinus, endodontic surgery in the posterior maxillary area represents great challenges. This article summarizes the anatomical relationship between the maxillary sinus and the maxillary posterior teeth, the influence on endodontic microsurgery, and the application of assistive techniques on maxillary posterior teeth, such as 3D-printed surgical guides and ultrasonic osteotomes. Literature review results show that the spatial relationship between the apex of maxillary posterior teeth and the maxillary sinus is usually divided into three categories: the apex enters the maxillary sinus; the apex contacts the bottom of the maxillary sinus; and there is a distance between the apex and the bottom of the maxillary sinus. CBCT should be performed before the operation, and the periapical state of the tooth and the maxillary sinus and the distance between the lesions and the sinus floor should be considered to evaluate the difficulty of the operation. Meanwhile, during surgery, equipment such as surgical guides, endoscopes and ultrasonic osteotomes should be used to ensure that the operation is safer, reliable, precise and less invasive, but the clinical popularity of ultrasonic osteotomes still needs further promotion. Moreover, high-quality clinical studies on the long-term effects of micro-apical surgery in the posterior maxillary area are still lacking.

4.
Rev. colomb. cir ; 37(2): 251-258, 20220316. tab
Article in Spanish | LILACS | ID: biblio-1362961

ABSTRACT

Introducción. La simulación como estrategia de aprendizaje activo se ha constituido en una herramienta centrada en el estudiante, para la construcción de aprendizajes en entornos seguros y el perfeccionamiento de sus habilidades técnicas. La evaluación objetiva estructurada de habilidades técnicas (OSATS, por sus siglas en inglés) es una herramienta evaluativa en el área quirúrgica, que puede ser implementada en los programas en microcirugía. Métodos. Estudio descriptivo, de corte transversal y doble ciego, donde se incluyeron 34 estudiantes de especialidades quirúrgicas, quienes fueron evaluados mediante los OSATS para los módulos finales: módulo 1: disección vascular; módulo 2: ejecución de sutura de puntos independientes; y módulo 3: ejercicios de revascularización. Al finalizar la materia, los estudiantes evaluaron la implementación de esta metodología por medio de una encuesta de satisfacción. Resultados. La evaluación del diseño de la guía práctica tipo OSATS por los estudiantes fue satisfactoria (88,2 %). Al evaluar la actividad de disección y sutura en microcirugía la consideraron de gran utilidad (88,2 %), para los ejercicios de anastomosis y revascularización (aprobación del 79,5 %). La aplicabilidad práctica y la calidad de los ejercicios mediante guías de evaluación OSATS tuvieron 94,2 % de aceptación. Conclusión. Las escalas OSATS son un instrumento útil, valido y objetivo para el modelo de evaluación por competencias en habilidades técnicas, que puede ser implementado en los modelos de enseñanza en simulación, contando con confiabilidad, validez de contenido y de constructo. Es aplicable en los programas de microcirugía, con una percepción positiva por parte de los estudiantes.


Introduction. Simulation as an active learning strategy has become a student-centered tool for the construction of learning in safe environments and the improvement of their technical skills. The Objective Structured Assessment of Technical Skills (OSATS) is an evaluation tool in the surgical area, which can be implemented in microsurgery programs. Methods. Descriptive, cross-sectional and double-blind study, which included 34 students from surgical specialties, who were evaluated through the OSATS for the final modules: module 1: vascular dissection; module 2: execution of independent sutures; module 3: revascularization exercises. At the end of the course, the students evaluated the implementation of this methodology under evaluation by means of a satisfaction survey. Results. The evaluation of the design of the practical guide OSATS-type by the students was satisfactory (88.2%). When evaluating the dissection and suturing activity in microsurgery, they consider it very useful (88.2%), for anastomosis exercises and revascularization exercise (79.5% approval). The practical applicability and quality of the exercises using OSATS evaluation guides had 94.2% acceptance.Conclusion. The OSATS scales are a useful, valid and objective instrument for the evaluation model for technical skills, which can be implemented in simulation teaching models, with reliability, content and construct validity. It is applicable in microsurgery programs, with a positive perception by students.


Subject(s)
Humans , Competency-Based Education , Education, Medical , Microsurgery , Simulation Technique , Health Postgraduate Programs , Learning Health System
5.
Coluna/Columna ; 21(1): e246193, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1364778

ABSTRACT

ABSTRACT Objectives: To compare microdiscectomy (MD) and endoscopic interlaminar discectomy (EID) as methods for the surgical treatment of lumbar disc herniation, describing their efficiency in reducing hospitalization time, pain, and neurological deficit, and comparing the findings and the quality of studies that used the microscopic and endoscopic techniques. Methods: A systematic literature review that used the PRISMA protocol as a methodology. The search was conducted in the PUBMED/MEDLINE and The Cochrane Library databases, using publications from the last 5 years in Portuguese and English. After applying the inclusion and exclusion criteria and validating the qualified studies via STROBE and CONSORT, there were a total of 16 studies for data compilation. Results: A sample of 1004 patients who underwent lumbar discectomy was obtained, 62% of whom were male, and 493 of whom underwent EID (49%) and 511 MD (51%). The mean patient age was 38.7 years and the predominant vertebral level operated was L5-S1 (64.8%). The EID had shorter surgical time (66.38 min) and hospitalization time (3.3 days), in addition to greater variation in the VAS LLLL score (5.38), while the MD presented greater variation in the VAS LUMBAR score (3.14). Conclusion: EID demonstrated efficacy like that of MD, given the similarity in the results obtained, in addition to non-inferiority in the reduction of pain and neurological deficit, and superiority in surgical and hospitalization times. Level of Evidence I; Systematic review .


RESUMO Objetivos: Comparar a microdiscectomia (MD) e a discectomia endoscópica interlaminar (DEI) como métodos de tratamento cirúrgico da hérnia de disco lombar, descrevendo a sua eficiência quanto à redução do tempo de hospitalização, da dor e do déficit neurológico e comparando os achados e a qualidade de estudos que utilizaram as técnicas microscópica e endoscópica. Métodos: Revisão sistemática da literatura que utilizou o protocolo PRISMA como metodologia. A busca foi realizada nas bases de dados: PUBMED/MEDLINE e The Cochrane Library, utilizando publicações dos últimos 5 anos, em português e inglês. Aplicados os critérios de inclusão e exclusão, bem como a validade dos estudos qualificados via STROBE e CONSORT, totalizaram 16 estudos para compilação de dados. Resultados: Foram obtidas amostras de 1.004 pacientes submetidos à discectomia lombar, sendo 493 com DEI (49%) e 511 com MD (51%), do sexo masculino (62%), média de idade de 38,7 anos e o nível vertebral L5-S1 (64,8%) como mais prevalente. A DEI mostrou menor tempo cirúrgico (66,38 min.) e de hospitalização (3,3 dias), além de maior variação no escore EVA MMII (5,38), enquanto a MD apresentou maior variação na EVA Lombar (3,14). Conclusões: A DEI demonstrou eficácia similar à MD diante dos resultados obtidos, além da não inferioridade na redução da dor e do déficit neurológico e da superioridade no tempo de cirurgia e de hospitalização. Nível de Evidência I; Revisão sistemática .


RESUMEN Objetivos: Comparar la microdiscectomía (MD) y la discectomía endoscópica interlaminar (DEI) como métodos de tratamiento quirúrgico de la hernia de disco lumbar, describiendo su eficiencia para reducir el tiempo de hospitalización, el dolor y el déficit neurológico y comparando los hallazgos y la calidad de los estudios que utilizaron la técnicas microscópicas y endoscópicas. Métodos: Revisión sistemática de la literatura que utilizó el protocolo PRISMA como metodología. La búsqueda se realizó en las bases de datos: PUBMED / MEDLINE y The Cochrane Library, utilizando publicaciones de los últimos 5 años, en portugués e inglés. Tras aplicar los criterios de inclusión y exclusión, así como la validez de estudios calificados a través de STROBE y CONSORT, se recopilaron un total de 16 estudios para la compilación de datos. Resultados: Se obtuvieron muestras de 1004 pacientes sometidos a discectomía lumbar, 493 con DEI (49%) y 511 con MD (51%), hombres (62%), edad promedio de 38,7 años y el nivel vertebral L5-S1 (64,8%) como más prevalente. La DEI mostró un menor tiempo quirúrgico (66,38 min) y de hospitalización (3,3 días), además de una mayor variación en el puntaje EVA MMII (5,38), mientras que el MD presentó una mayor variación en el EVA Lumbar (3,14). Conclusión: DEI demostró una eficacia similar a la MD mediante los resultados obtenidos, además de la no inferioridad en la reducción del dolor y del déficit neurológico, y de la superioridad en el tiempo de cirugía y hospitalización. Nivel de Evidencia I; Revisión Sistemática .

6.
Einstein (Säo Paulo) ; 20: eAO6318, 2022. graf
Article in English | LILACS | ID: biblio-1360397

ABSTRACT

ABSTRACT Objective To describe the technical specificities and feasibility of simulation of minimally invasive spine surgery in live pigs, as well as similarities and differences in comparison to surgery in humans. Methods A total of 22 Large White class swine models, weighing between 60 and 80kg, were submitted to surgical simulations, performed during theoretical-practical courses for training surgical techniques (microsurgical and endoscopic lumbar decompression; percutaneous pedicular instrumentation; lateral access to the thoracic spine, and anterior and retroperitoneal to the lumbar spine, and management of complications) by 86 spine surgeons. For each surgical technique, porcine anatomy (similarities and differences in relation to human anatomy), access route, and dimensions of the instruments and implants used were evaluated. Thus, the authors describe the feasibility of each operative simulation, as well as suggestions to optimize training. Study results are descriptive, with figures and drawings. Results Neural decompression surgeries (microsurgeries and endoscopic) and pedicular instrumentation presented higher similarities to surgery on humans. On the other hand, intradiscal procedures had limitations due to the narrow disc space in swines. We were able to simulate situations of surgical trauma in surgical complication scenarios, such as cerebrospinal fluid fistulas and excessive bleeding, with comparable realism to surgery on humans. Conclusion A porcine model for simulation of minimally invasive spinal surgical techniques had similarities with surgery on humans, and is therefore feasible for surgeon training.


Subject(s)
Animals , Spinal Fusion/methods , Intervertebral Disc Degeneration , Swine , Treatment Outcome , Minimally Invasive Surgical Procedures/methods , Lumbar Vertebrae , Lumbosacral Region
7.
Arq. bras. neurocir ; 40(3): 288-293, 15/09/2021.
Article in English | LILACS-Express | LILACS | ID: biblio-1362169

ABSTRACT

Virtual reality (VR) has increasingly been implemented in neurosurgical practice. A patient with an unruptured anterior communicating artery (AcoA) aneurysm was referred to our institution. Imaging data from computed tomography angiography (CTA) was used to create a patient specific 3D model of vascular and skull base anatomy, and then processed to a VR compatible environment. Minimally invasive approaches (mini-pterional, supraorbital and mini-orbitozygomatic) were simulated and assessed for adequate vascular exposure in VR. Using an eyebrow approach, aminiorbitozygomatic approach was performed, with clip exclusion of the aneurysm from the circulation. The step-by-step process of VR planning is outlined, and the advantages and disadvantages for the neurosurgeon of this technology are reviewed.

8.
Rev. bras. cir. plást ; 36(3): 353-357, jul.-set. 2021. graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1365558

ABSTRACT

RESUMO Introdução: O escalpelamento é caracterizado pelo trauma em região do couro cabeludo, que pode ser classificado como parcial ou total. O trauma por escalpelamento é extremamente mutilante e estigmatizante, principalmente quando expõe o osso sem periósteo, que pode levar a quadro de osteomielite crônica e erosão de tábua externa. Quando há lesões extensas de couro cabeludo acima de 200cm² e com lesão de periósteo é necessária grande quantidade de tecido com retalho microcirúrgico, que não está disponível em todos os centros. O objetivo deste trabalho é relatar caso de paciente de 69 anos, feminina, que sofreu trauma por avulsão total de couro cabeludo de grande extensão de 550cm² com exposição de calota craniana sem periósteo e inviabilização total do escalpe após mordida de cachorro. Devido à inviabilização total do escalpe avulsionado, optou-se pelo transplante de retalho livre de músculo grande dorsal com anastomose microvascular do pedículo toracodorsal com os vasos temporais superficiais. O retalho evoluiu com boa perfusão e na área cruenta foi realizado enxertia parcial. Métodos: Análise retrospectiva de prontuário da paciente em questão. O presente trabalho segue os padrões de declaração de Helsinque e aprovação do comitê de ética e pesquisa. Conclusão: O retalho livre de músculo grande dorsal mostrou-se eficaz neste caso de reconstrução de lesão extensa do couro cabeludo (550cm²) com lesão parcial de periósteo devido ao escalpelamento. O retalho recuperou a forma do crânio e a função de proteção da calota craniana.


ABSTRACT Introduction: Scalping is characterized by trauma in the scalp region, which can be classified as partial or total. Scalping trauma is extremely mutilating and stigmatizing, especially when exposing the bone without periosteum, leading to chronic osteomyelitis and external table erosion. When there are extensive scalp lesions above 200cm², and with periosteum, the lesion is required a large amount of tissue with microsurgical flap, which is not available in all centers. This work aims to report a case of a 69-year-old female patient who suffered trauma due to total avulsion of a big scalp of 550cm² with exposure of a skull cap without periosteum and total unviability of the scalp after a dog bite. Due to the total unviability of the avulsed scalp, we opted to transplant a large dorsal muscle free flap with microvascular anastomosis of the thoracodorsal pedicle with the superficial temporal vessels. The flap evolved with good perfusion, and partial grafting was performed in the bloody area. Methods: Retrospective analysis of the medical records of the patient in question. This paper follows the Declaration of Helsinki's standards and the approval of the Ethics and Research Committee. Conclusion: The free flap of the large dorsal muscle proved effective in this case of reconstruction of the scalp's extensive lesion (550cm²) with partial periosteum lesion due to scalping. The flap recovered the shape of the skull and the protective function of the skull cap.

9.
Rev. bras. cir. plást ; 36(1): 76-80, jan.-mar. 2021. ilus
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1151657

ABSTRACT

Trata-se de um relato de caso de reconstrução microcirúrgica de mandíbula com retalho osteocutâneo de fíbula em um paciente de 16 anos, vítima de agressão com projétil de arma de fogo e trauma contuso em face, acarretando em fratura cominutiva de mandíbula, com perda de elementos dentários e lesões extensas de partes moles. Após tratamento da fase aguda, optou-se pela reconstrução microcirúrgica com retalho livre de fíbula, devido à extensão do defeito mandibular e possibilidade de reabilitação dentária. O uso de modelos tridimensionais da mandíbula e fíbula foram excepcionalmente úteis para tornar possível o melhor planejamento cirúrgico das áreas de osteotomia, com diminuição do tempo de isquemia do retalho da cirurgia.


This is a case report of the mandible microsurgical reconstruction with osteocutaneous fibular flap in a 16-year-old patient. A victim of an assault with a firearm projectile and blunt trauma to the face, resulting in a comminuted mandible fracture, loss of dental elements, and extensive soft tissue injuries. After treatment of the acute phase, we chose microsurgical reconstruction with a free fibula flap due to the mandibular defect's extension and the possibility of dental rehabilitation. The use of three-dimensional models of the mandible and fibula was exceptionally helpful in making the best surgical planning of the osteotomy areas, decreasing the surgery flap's ischemia time.

10.
Article in Chinese | WPRIM | ID: wpr-910009

ABSTRACT

Objective:To explore the clinical efficacy of microsurgery combined with Ilizarov technique in the treatment of Gustilo ⅢC open tibiofibular fractures.Methods:From January 2014 to December 2016, 20 patients with Gustilo ⅢC open tibiofibular fracture were treated at Department of Hand Surgery 2, Repair and Reconstruction, Wuhan NO. 4 Hospital, Wuhan Puai Hospital. They were 13 men and 7 women, aged from 36 to 56 years (average, 42.6 years). The time from injury to operation ranged from 2 to 6 hours (average, 4.3 hours). The defects were at the proximal bone in 6 cases, at the middle bone in 9 cases and at the distal bone in 5 cases. The area of soft tissue defect ranged from 10 cm×6 cm to 12 cm×9 cm, and the lengths of bone defects averaged 10.3 cm. Microsurgery was conducted at the first stage to repair blood vessels and nerves and to reconstruct blood circulation, and an Ilizarov circular external fixator was installed at the second stage to repair bone and soft tissue defects by two-way bone transport. Bone transport time, wound healing time, bone transport distance, external fixation time, external fixation index, solidification time for the extended area and complications were recorded after operation. The curative efficacy was evaluated by Palay evaluation.Results:All patients were followed up for 12 to 30 months (average, 24 months). After the bone and soft tissue defects were well repaired, all the patients returned to daily life. The time from bone transport to apposition of fracture ends ranged from 50 to 160 days, averaging 75.8 days; the wound healing time ranged from 60 to 150 days, averaging 100.6 days; the bone transport distance ranged from 8 to 13 cm, averaging 10.3 cm; the external fixation time ranged from 12 to 20 months, averaging 14.0 months; the external fixation index was 1.6 months/cm; the solidification time for the extended area ranged from 5 to 16 months, averaging 10.9 months. No infection, malunion or re-fracture was observed; postoperative axis deviation was observed in 2 cases and ankle stiffness in 3 cases. According to the Palay evaluation, 5 cases were excellent, 12 cases good, and 3 cases fair.Conclusion:As microsurgery combined with Ilizarov technique can treat Gustilo ⅢC open tibiofibular fractures effectively by reconstructing limb blood circulation, it is worthy of clinical promotion.

11.
Chinese Journal of Trauma ; (12): 799-804, 2021.
Article in Chinese | WPRIM | ID: wpr-909941

ABSTRACT

Objective:To investigate the clinical outcomes of anterolateral thigh flap combined with great saphenous vein transplantations for the treatment of extensive elbow soft tissue defects accompanied by brachial artery embolism.Methods:A retrospective case series study was carried out to investigate the clinical data of 19 patients with extensive elbow soft tissue defects accompanied by brachial artery embolism admitted to Fuyang People's Hospital of Anhui Medical University from March 2017 to March 2020. There were 15 males and 4 females,aged 14-59 years[(37.6±14.1)years]. The areas of elbow soft tissue defects ranged from 7 cm×3 cm to 12 cm×5 cm. Before operation,angiography test was performed to confirm brachial artery embolism of the affected upper limb. The length of embolization ranged from 5 to 12 cm[(7.3±1.6)cm]. All patients were treated using the anterolateral thigh flap combined with great saphenous vein transplantation. The operation time and intraoperative blood loss were recorded. Angiography test was re-examined one week after operation. The degree of flap swelling,elbow Broberg-Morrey functional score and scar contracture were evaluated at postoperative 3,6,and 12 months. Healing of donor site and postoperative complications were observed.Results:All patients were followed up for 12-24 months[(18.1±3.0)months]. The operation duration was 3.5-6.4 hours[(4.9±0.8)hours],with intraoperative blood loss of 200-600 ml[(338.7±101.6)ml]. The blood flow of repaired brachial artery was unobstructed in all patients one week after operation,with all flaps survived. The degree of flap swelling was(0.9±0.3)cm at postoperative 12 months,significantly reduced from that at postoperative 3 and 6 months[(1.2±0.3)cm,(1.1±0.3)cm]( P<0.05). The elbow Broberg-Morrey functional score was(87.8±4.8)points,significantly higher than those at postoperative 3 and 6 months[(71.4±7.0)points,(80.2±4.8)points]( P<0.05). The rating of elbow function score was excellent in 9 patients,good in 8 and fair in 2 at postoperative 12 months,with the excellent and good rate of 90%. The rate of scar contracture was 63%(12/19)at postoperative 12 months,significantly higher than that at postoperative 3[11%(2/19)]( P<0.05),while not different from that at postoperative 6 months[42%(8/19)]( P>0.05). The donor site was healed in all patients,without complications related to blood vessels or flaps. Conclusions:For extensive elbow soft tissue defect accompanied by brachial artery embolism,the anterolateral thigh flap combined with great saphenous vein transplantations can successfully restore the blood supply of the distal site of the affected limb with a high survival rate of the flap and well recovered limb function,and hence is a feasible method for severe elbow trauma. However,due to various factors such as elbow joint immobilization during perioperative period,scar contracture is prone to occur in the area of the flap.

12.
Chinese Journal of Trauma ; (12): 769-772, 2021.
Article in Chinese | WPRIM | ID: wpr-909936

ABSTRACT

The wound may usually lead to exposure of deep tissue and result in persistent infection and dysfunction. The perforator flap is one of the most important methods for wound repair due to the minimum morbidity of donor site and good aesthetic contour,with extensive clinical application. However,there are still some controversies regarding the clinical application of the perforator flap,such as whether the perforator flap should be pedicled transplantation or free transplantation for repairing wounds on the back of the foot,how to harvest a larger perforator flap for pedicled transplantation,how to choose perforator vessels for pedicled transplantation,and how to reconstruct the sensory function of the skin flap. In this study,the authors summarize the above problems and propose application suggestions.

13.
Chinese Journal of Trauma ; (12): 514-518, 2021.
Article in Chinese | WPRIM | ID: wpr-909899

ABSTRACT

Objective:To investigate the efficacy of induced membrane technique combined with anterolateral thigh flap transfer in treating composite foot defect.Methods:A retrospective case series study was performed for 7 patients with composite foot defect treated at 920th Hospital of Joint Logistic Support Force of PLA from February 2014 to December 2018. There were 5 males and 2 females, with the age of 20-73 years [(38.9±16.3)years]. The composite defect located at the forefoot in 5 patients, midfoot in 1, and hindfoot in 1. There were 9 metatarsal bone defects, 1 medial cuneiform bone defect, and 1 calcaneus bone defect. The size of soft tissue defect varied from 6 cm×5 cm to 70 cm×35 cm. At stage I, the anterolateral thigh flap transfer and vancomycin loaded cement implantation were performed. The flap survival and complications were recorded. At stage II, the cement was removed and autogenous bone was grafted into the induced membrane. The duration of two-stage operation, bone union time, and complications were recorded. The postoperative function was assessed using Maryland foot score system before operation and at the last follow-up and postoperative compications were documented.Results:All patients were followed up for 22-54 months [(33.8±9.7)months]. At stage I, flaps survived in all patients, and bulking of the flap was seen in 3 patients. One patient with calcaneus bone defect had repeated infection after operation, and received debridement. At stage II, 6 patients received bone grafting surgery. The duration of two-stage operation was 2-4 months [(2.8±0.9)months]. The bone union time was 3 and 7 months [(4.7±1.2)months]. At the last follow-up, the Maryland foot function score was 63-92 points [(82.1±8.7)points], significantly different from 0 point before operation ( P<0.01). The results were excellent in 1 patient, good in 5, and fair in 1. Except for one nonunion of metatarsal bone, all the other 8 sites were with bone union uneventfully. Conclusion:The induced membrane technique combined with anterolateral thigh flap transfer is an effective protocol for composite foot defect, which can well repair soft tissue and bone defect, and restore walking.

14.
Clinical Medicine of China ; (12): 420-425, 2021.
Article in Chinese | WPRIM | ID: wpr-909770

ABSTRACT

Objective:To evaluate the effect of microsurgery for parafalcine meningioma through contralateral longitudinal fissure approach assisted by 3DSlicer software.Methods:From January 2020 to January 2021, 18 patients with parafalcine meningioma in The second hospital of Hebei Medical University were randomly selected as the observation group.The contralateral longitudinal fissure was treated by microsurgery assisted by 3DSlicer software.Before operation, improve the imaging examinations such as brain CT plain and enhancement, magnetic resonance angiography and magnetic resonance venography, establish the models of tumor, superior sagittal sinus and superior cerebral artery by using 3DSlicer software, analyze the positional relationship between tumor and superior sagittal sinus and superior cerebral vein, and remove the tumor by contralateral longitudinal fissure approach.Nineteen patients with parafalx meningioma treated by traditional ipsilateral longitudinal fissure approach from January to December 2019 were selected as the control group.The differences in operation time, intraoperative bleeding, limb muscle strength recovery rate, headache and dizziness relief rate were compared between the two groups.Results:In the observation group, the positional relationship between the reconstructed tumor and the superior cerebral vein above its base was completely consistent with the actual situation during the operation.All patients underwent Simpson grade I resection, and there was no injury to the superior cerebral vein and venous sinus during the operation.The recovery rate of limb muscle strength in the observation group (75%(9/12)) was higher than that in the control group (23%(3/13))( P=0.009). There was no significant difference in the operation time, intraoperative bleeding and the remission rate of headache and dizziness one week after operation in the observation group ( P>0.05). Conclusion:3DSlicer software was helpful for preoperative evaluation of the positional relationship between parafalcine meningioma and the anatomic structures such as superior cerebral vein and superior sagittal sinus.Under the guiding of 3DSlicer software, surgeon removed the tumor totally through the contralateral longitudinal fissure approach, which effectively reduced the operative side injury of the important structures such as superior cerebral vein and functional cerebral cortex, and contributed highly to the recovery of limb muscle strength of patients.

15.
Article in Chinese | WPRIM | ID: wpr-908985

ABSTRACT

In view of the problems and shortcomings of the domestic ophthalmic microsurgery training system, drawing lessons from the training programs of famous ophthalmic centers abroad, our hospital has explored a set of hierarchical comprehensive training system for ophthalmic microsurgery. Through the four levels-eight scales microsurgery training, the hierarchical comprehensive training system organically integrates the multimedia theoretical teaching, the microscopic practice of Wet-Lab laboratory, microscopic training of surgical simulator and the clinical practice to achieve a better teaching effect in clinical practice, being widely praised by teachers and students.

16.
Article in Chinese | WPRIM | ID: wpr-908167

ABSTRACT

Objective:To explore the clinical effect and nursing experience of papaverine intramuscular injection after finger replantation with self-designed hip intramuscular injection positioning device.Methods:Totally 216 cases of patients treated with palavering for anti-vasospasm after of severed fingers from January 2018 to December 2019 were randomly divided into control group (108 cases) and observation group (108 cases) by random number table method. The control group received intramuscular injection of buttock muscle according to the conventional method, and the observation group used the auxiliary intramuscular injection with self-designed glutei muscle positioning device. The incidence of postoperative hip indurations and ecchymosed, survival rate of and buttock were analyzed Pain scores were compared.Results:Totally 76 cases (70.37%) and 62 cases (48.15%) in the control group, 12 cases (11.11%) and 6 cases (5.56%) in the observation group. The difference between the two groups was statistically significant ( χ2 values were 78.545, 67.307, P<0.01). 78 cases (72.22%) survived in the control group and 96 cases (88.89%) survived in the observation group ( χ2 value was 11.416, P<0.01). After papaverine intramuscular injection, there was no significant difference in hip pain score between the two groups on the first and second day ( P>0.05), but there was significant difference between the two groups on the third to seventh day ( t values were 17.17 to 45.97, P<0.05). Conclusion:Palavering intramuscular injection can reduce the incidence of hip indurations and ecchymosed, relieve buttock pain and improve the survival rate of amputated finger, which is worthy of clinical application.

17.
Journal of Rural Medicine ; : 184-190, 2021.
Article in English | WPRIM | ID: wpr-906925

ABSTRACT

Objective: Schwannomas are the most common type of neoplasm of the peripheral nerves. Enucleation is a standard surgical procedure; however, it occasionally results in iatrogenic nerve injury, even with atraumatic procedures. Herein, we present the clinical characteristics of schwannoma arising in the extremities and discuss the clinical outcomes of extra- and intra-capsular enucleation.Patients and Methods: We reviewed 122 schwannomas treated at our institute. Schwannomas arising from the minor nerve (n=30) or intramuscularly (n=15) were operated using the extra-capsular technique. Of the 77 major nerve schwannomas, 62 schwannomas were treated using the intra-capsular technique and 15 schwannomas using the extra-capsular technique.Results: Neurological deficits following enucleation were significantly lower using the intra-capsular technique than with the extra-capsular technique. The patient age, duration of symptoms, maximum tumor diameter, and site of occurrence were not associated with subsequent neurological deficits. With both techniques, no tumor recurrence was observed at the final follow-up.Conclusion: These results support the use of intra-capsular micro-enucleation as a safe and reliable treatment for every type of schwannoma. To minimize the risk of nerve injury, en bloc resection should not be used because the main purpose of schwannoma surgery is the relief of symptoms, not tumor resection.

18.
Chinese Journal of Microsurgery ; (6): 584-590, 2021.
Article in Chinese | WPRIM | ID: wpr-912276

ABSTRACT

Objective:To sort out the history of microsurgery in China from 1960 to 1973 based on the literatures in chronological order.Methods:Chinese and English scientific journals and academic monographs published in public and in house were searched, and the words "microsurgery" and "microsurgery related" literatures in both Chinese and English were carefully read and analysed. The dates of operation, communication and report were recorded and confirmed.Results:Microsurgery in China started in early 1963, thanks to the report of the world's first successful severed limb replantation in Shanghai Sixth Hospital. In the following 3 years, many teams carried out experimental researches on microvascular technology and explored the replantation of severed fingers. In 1964, the world's first severed leg replantation. In 1966, the world's first toe transfer was operated to reconstruct the thumb, and the world's first batch of completely severed fingers were successfully replanted by microvascular suture. In 1972, it was reported, at the Guangzhou Conference on Replantation of Severed Limbs, that a 44.9% of survival rate had been achieved over 260 cases and the term "microsurgery" was used for the first time in the conference. In March, 1973, the second free inguinal flap transfer in the world was completed. In May, 1973, an American Replantation Mission visited China. It opened a precedent for academic exchange in microsurgery between China and foreign countries. With 10 years of clinical practices, the original and advanced Chinese limb (finger) replantation technology and principle had been recognised by the international peers.Conclusion:The research on the history of Chinese microsurgery has confirmed that the development of Chinese microsurgery was basically synchronised with the world, but with a difficult start in 1960-1973.

19.
Chinese Journal of Microsurgery ; (6): 359-360, 2021.
Article in Chinese | WPRIM | ID: wpr-912251

ABSTRACT

The career development of young doctors is related to the future of medicine as a whole. Medicine is a subject that needs to be researched. Diagnosis and treatment work. The importance of scientific research for the development of medicine is self-evident. In addition to clinical work, young doctors need to take scientific research into account. We will provide the key elements in a road map of a successful scientific research for young doctors.

20.
Chinese Journal of Microsurgery ; (6): 245-254, 2021.
Article in Chinese | WPRIM | ID: wpr-912239

ABSTRACT

The special form of perforator flap, initially derived from traditional perforator flap, have enhanced the connotation of perforator flap and extended its indications to more sophisticated applications. The special-form perforator flaps could be classified into 5 basic types and 18 derivatives. The 5 basic types consist of a Flow through perforator flap, a micro-dissected thin perforator flap, a polyfoliate perforator flap, a chimeric perforator flap and a conjoined perforator flap. The 18 derivatives are based on the combination of either 2, 3 or 4 types of the flaps from the 5 basic types named above, such as the Flow through-polyfoliate perforator flap, the Flow through-microdissected-polyfoliate perforator flap, and the Flow through-microdissected-chimeric-polyfoliate perforator flap etc.. In order to popularise the special forms of perforator flap, it is necessary to standardise the nomenclature and classification of the flaps. The present article provides a principle for nomenclature of the special-form perforator flaps and their derivatives, hence to facilitate the peer communications and clinical promotions.

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