Transfer of anteriolateral thigh flap with partial iliotibial tract in reconstruction of composite tissue defect in dorsal wrist and hand / 中华显微外科杂志

Objective:To investigate the curative effect of transfer of free anteriolateral thigh flap (ALTF) with partial iliotibial tract on reconstruction of composite tissue defects in dorsal wrist/hand.Methods:Ten patients who were admitted in the Department of Hand Surgery of Yongkang Orthopaedic Hospital from March 2018 to August 2022 were entered in the study due to extensive composite tissue defects in dorsal wrists and hands. The patients were 24-48 (37 in average) years old. All patients had tendon defects in 3 or more digits with 35 digits in total. The length of the tendon defects were 5.0-11.0 cm in various digits. The soft tissue defects ranged from 6.0 cm×8.0 cm to 11.0 cm×21.0 cm in size. Six patients had defects accompanied with metacarpal and phalangeal bone fracture and joint capsule. In emergency surgery, all patients received thorough debridement and VSD coverage after internal fixation for combined fractures. At 3-5 days after the primary surgery, free ALTF transfer with partial iliotibial tract was employed to reconstruct the defects on dorsal wrists and hands and the digit extension function. The size of flap was 6.0 cm×9.0 cm-9.0 cm×17.0 cm, and the rest of defect wound was covered by skin graft. All the donor sites were sutured directly, except 1 that received abdominal skin graft. Patients had the follow-ups in outpatient clinics, or via telephone or Wechat, to observe the sensation and appearance of the flap, and the healing of the donor site. The recovery of the extension function of the hand was evaluated according to the totle active motion (TAM) system.Results:All flaps survived except one that had vascular compromise after the surgery and it survived after two explorations and a vascular transfer. Postoperative follow-ups lasted for 6 to 24 months, with 13 months in average. At the last follow-up, a all the flaps were found soft in texture and slightly swollen in appearance. There was no obvious pigmentation or rupture of skin and extensor tendon. Sensory recovery achieved to S 2 in 7 patients and S 3 in 3 patients. The hand function was evaluated according to TAM system and rated as excellent for 3 digits, good for 18 digits, fair for 9 digits and poor for 5 digits. There were linear scars in the donor sites. Conclusion:Free ALTF transfer with partial iliotibial tract in the reconstruction of composite tissue defect of dorsal wrists and hands can not only reconstruct the wound surface, but also the extension of digits, which cuts short the course of treatment.

Observation of the curative effect of two kinds of mini perforator free flap for digital injuries reconstruction / 中华显微外科杂志

Objective Discuss the clinical efficacy by using two kinds of mini perforator free flap for digital injuries reconstruction. Methods From August, 2014 to February, 2017, 45 patients were managed randomly with either radial artery superficial palmar branch(RASPB)perforator free flap or digital artery(DA)perforator free flap for digital skin defects reconstruction, and they were therefore divided into two groups according to the flap type. There were 24 patients in RASPB group, with an average wound dimensions ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm, and an average harvested flap size ranged from 2.0 cm×1.7 cm to 4.2 cm×2.6 cm. Another 21 patients were in DA group, with an average wound dimensions ranged from 2.0 cm×1.5 cm to 3.8 cm×3.0 cm, and an average harvested flap size ranged from 2.2 cm×1.6 cm to 3.9 cm×3.2 cm. The survival rate, sensory function, donor site complications, hand function recovery and aesthetic outcomes of two groups were compared by the SPSS22.0 statistical software after surgery. Results The mean follow up period was 15 months. All flaps were primary survived without vascular crisis. The flaps were soft in texture,trimness in appearance and none of them overtop the normal skin for more than 0.5 cm. Both groups had a favorable sensory recovery.All cases recovery to S3+or better.In Group RASPB,the mean two point discrimination(2 PD)was 7.85±1.15 mm(ranged from 7.0 mm to 9.0 mm). And it was 6.02±0.94 mm(ranged from 6.0 mm to 8.0 mm)in DA group. The difference between two groups was statistically significant(P <0.05). Then we synthetically analyzed flap texture and sensory function,and calculated the qualified ratio of each group.There was no significant difference between two groups(P > 0.05). The degree of scar contracture demonstrated donor site compli cations in RASPB group was lesser than that in DA group(P<0.05).The range of motion of interphalangeal joint was used to reflect the hand function. And we calculated the ratio of repaired and contralateral sites. The difference of the mean ratio between two groups was not statistically significant(P>0.05). Conclusion On account of the characteristics of invariant anatomy position, sufficient blood supply, favorable aesthetic outcome and minimal donor site mobility, both RASPB perforator flap and DA perforator flap were optimal for digital skin defects reconstruction.Besides,incorporated with nerve and tendon,the RASPB perforator flap can also be used for complex tissue transplantation,and the surgery field was only on the arm.While the DA perforator free flap had an advantage of better sensory recovery and appearance.

Repairing atrial septal defects with bilateral lung transplantation in treatment of ASD with Eisenmenger's syndrome / 中华器官移植杂志

Objective To investigate the feasibility and the perioperative treatments of repairing atrial septal defects and bilateral lung transplantation in treatment of ASD with Eisenmenger's syndrome.Methods On May 24th,2016,one case of atrial septal defect with Eisenmenger's syndrome underwent repair for the atrial septal defect with bilateral sequential lung transplantation aided by extracorporeal circulation ECMO in Zhongshan People's Hospital.In strict accordance to the procedure,the lung was collected and preserved with the HTK solution.The operation went smoothly,the cold ischemic time for the right lung was 120 min and that for the left lung was 260 min.Postoperatively,Tacrolimus (FK506) + Mycophenolate Mofetil (MMF) + adrenal cortical hormone Sanlian immunosuppression was used.Results At 60th h post-operation the patient was hemodynamically stable,with good oxygenation after removal of the ECMO.At 7th day post-operation the patient was extubated.At 12th-20th day post-operation bacterial culture of the sputum was found to be positive and the patient was treated with the corresponding sensitive antibiotics and recovered.Cardiac ultrasound before discharge showed that there was no residual shunt.One month after discharge the cardiopulmonary function of the patient was quite good,chest X-ray showed that the bilateral transplanted lungs were clear and the patient's quality of life was much better.Conclusion Cardiac malformation repairs with bilateral lung transplantation is a feasible treatment for patients with end-stage Eisenmenger's syndrome with bi-directional shunts.The key to success is sufficient preoperative preparation,and a smooth operation with the timely and effective treatment of postoperative complications.

Progress and ideas of irritable bowel syndrome animal model construction based on combination of disease and syndrome / 中国药理学通报

Establishment of combination of disease and syndrome animal model is an ideal technology platform in TCM research. Currently, many scholars have prepared matching IBS animal models combined typical animal models with etiology, which em-bodies the advantages of syndrome differentiation and promotes the development of combination disease and syndrome animal model. Even though, there still exists some problems about sub-jective evaluation on syndromes, paying more attention on dis-ease and less on syndromes. Therefore, we should deepen the pathogenesis of diseases and TCM syndromes research on animal model replication and improve the method of construction of combination of disease and syndrome animal model through the biological research of combination of disease and syndrome sys-tem. By this way, the idea of preparation animal models will be more mature and the scientific connotation of TCM will be pres-ented more exactly.

Perioperative lung protection of ambroxol in general thoracic surgery in the elderly / 中华老年医学杂志

Objective To study the lung protection of ambroxol in general thoracic surgery perioperation for the elderly.Methods Totally 130 hospitalized patients aged (65.1±4.3) years in our hospital during general thoracic surgery were randomly divided into two groups:ambroxol intervention(2 mg/kg,intravenous drip,once/d) and control groups (n=65 for each).The incidenceof pulmonary complications,changes of blood gas analysis before and after surgery and time of hospitalization were compared between the groups.Results The incidence of pulmonary complications was significantly lower in ambroxol intervention group than in control group (9.23％ vs.24.62％,P＜0.05).Blood gas analysis results before and after surgery were improved in ambroxol intervention group[PaO2:(61.32±8.65) mm Hg,(95.07±13.62)mm Hg; PaCO2:(44.15±5.52)mm Hg,(37.28±4.06)mm Hg] as compared with control group[PaO2:(62.11 ± 8.83) mm Hg,(80.37±10.46)mm Hg; PaCO2:(44.39±5.17) mm Hg,(40.73±4.51)mm Hg] (t=3.61,3.75,both P＜0.05).The time of hospitalization was shorter in ambroxol intervention group than in control group [(12.14±0.29) d vs.(15.85±0.62)d,t=3.41,P=0.036].Conclusions Perioperative use of ambroxol in general thoracic surgery in the elderly is worthy of clinical application because of reduction of pulmonary complications and shortness of hospital stay.