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Objective:To explore the effects of lateral finger flap and micro free venous flap on the replantation repair of skin defect type severed fingers and their impact on finger function recovery.Methods:A retrospective selection was conducted on the clinical data of 94 patients (94 fingers) with skin defect type finger amputation admitted to Affiliated Hospital of Jiangnan University from January 2020 to September 2022. According to the different design methods of the skin flap, there were 48 cases in the observation group (micro free venous flap) and 46 cases in the control group (finger side flap). We compared the repair effects, blood circulation, finger function recovery, and complications between two groups.Results:Two months after surgery, there was no statistically significant difference ( P>0.05) in the total effective rate of repair between the observation group [79.17%(38/48)] and the control group [76.09%(35/46)]. The blood flow velocity, skin temperature, and skin redness ratio of the observation group were higher than those of the control group, and the capillary filling time was shorter than that of the control group, with statistical significance (all P<0.05). There was no statistically significant difference (all P>0.05) in the scores of joint autonomy, daily living activities, and recovery between the two groups. The subjective sensation and appearance scores of the observation group were lower than those of the control group, and the differences were statistically significant (all P<0.05). The incidence of complications in the observation group was 10.42%(5/48), and there was no statistically significant difference ( P>0.05) compared to the incidence of complications in the control group [13.04%(6/46)]. Conclusions:For patients with severed fingers with skin defects, the lateral finger flap and mini free vein flap are effective methods for replantation. In clinical practice, reasonable skin flap repair methods can be flexibly selected based on the patient′s actual situation.
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Abstract: INTRODUCTION: Due to the wide use of tigecycline in the treatment of severe infections caused by multidrug-resistant (MDR) bacteria, clinical resistance to tigecycline has increased in recent years. Here, we investigated the relationship between tigecycline resistance and the expression of efflux pumps. METHODS: Clinical isolates of Acinetobacter baumannii and Klebsiella pneumoniae were consecutively collected from hospitalized patients in three hospitals. The minimum inhibitory concentration (MIC) of tigecycline was determined using the broth microdilution method. Expression levels of efflux pump genes and regulators were examined by quantitative real-time reverse transcription polymerase chain reaction. The correlations between tigecycline MICs and gene expression levels were analyzed. RESULTS: Overall, 1,026 A. baumannii and 725 K. pneumoniae strains were collected. Most strains were isolated from sputum. The tigecycline resistance rate was 13.4% in A. baumannii isolates and 6.5% in K. pneumoniae isolates. Overexpression of AdeABC and AcrAB-TolC efflux systems was observed found in clinical tigecycline-resistant isolates. The tigecycline MIC had a linear relationship with the adeB expression level in A. baumannii isolates, but not with the acrB expression level in K. pneumoniae isolates. There were significant linear trends in the overexpression of ramA as the tigecycline MIC increased in K. pneumoniae isolates. CONCLUSIONS: Tigecycline resistance in A. baumannii and K. pneumoniae was strongly associated with the overexpression of efflux systems. More studies are needed to elucidate whether there are other regulators that affect the expression of adeB in A. baumannii and how ramA affects the expression of acrB in K. pneumoniae.