RESUMO
Objective:To investigate the clinical value of thromboelastogram in early diagnosis of deep vein thrombosis (DVT) in patients undergoing free flap surgery of lower extremity.Methods:A retrospective study was conducted to analyze the 192 patients undergoing surgical repair of soft tissue defects at lower extremity with free anterolateral femoral flap at Department of Orthopaedics, Tongji Hospital from January 2018 to June 2022. There were 117 males and 75 females, with an age of (45.6±12.7) years and an area of skin defects ranging from 5 cm × 3 cm to 18 cm × 9 cm. The patients were divided into 2 groups according to whether DVT occurred on the first day after surgery. In the DVT group of 22 patients, there were 14 males and 8 females, with an age of (47.7±14.3) years; in the DVT-free group of 170 patients, there were 103 males and 67 females, with an age of (45.3±12.5) years. The 2 groups were compared in terms of reaction time, coagulation time, maximum amplitude and coagulation angle in the thromboelastogram. Diagram of receiver operating characteristic (ROC) curves was used to evaluate the predictive value of thromboelastography in assessing the risk of DVT after surgery.Results:The 2 groups were comparable because there was no significant difference in the baseline information or operation time between them ( P>0.05). The reaction time [(5.21±0.85) min] and coagulation time [(1.12±0.30) min] in the DVT group were significantly shorter than those in the DVT-free group [(6.48±0.06) min and (1.60±0.03) min], and the maximum amplitude [(71.45±1.17) mm] and coagulation angle [69.54° (64.59°, 76.64°) ] in the DVT group were significantly larger than those in the DVT-free group [(66.63±0.40) mm and 64.92°(54.11°, 74.21°)] (all P<0.05). The optimal cut-off points in the ROC diagram were 5.46 min at reaction time, 1.52 min at coagulation time, 72.31 mm at maximum amplitude and 59.89° at coagulation angle. The sensitivity and specificity of detecting DVT on the first day after surgery were 80.7% and 71.6%, respectively, according to the combination of the best cut-off points in the ROC diagram and all the indexes in the thromboelastogram. Conclusion:Thromboelastogram is of a great value for the diagnosis of lower extremity DVT, and of a positive significance for the prevention of serious complications after surgery in patients undergoing free flap surgery of lower extremity.
RESUMO
ObjectiveTo evaluate the influence of different surgical technique on the pup and adult rats after the rupture of upper trunk and middle trunk so as to find the best way of surgical therapy.MethodsFrom January 2010 to June of 2010, forty-eight Sprague-Dawley male rats were divided into two groups of 24 each, i.e., pup groups at the age of 7 days postnatal (P7)and one adult (3 months old)group.After C5-7 injured,each group was subdivided into three equally:group A (repair C5-7),B(repair C5,6),and C (no reinnervation performed).In the 3rd month postoperatively,the following tests were performed to estimate the recovery of each group:(1)Compared the rate of carpoptosis of each group.(2)Compared the regenerated nerve traversing rate of the radial nerve in each group.(3)HE stain to compared the cross-sectional area recovery rate.(4)The MyoD1 and Myogenin of the affected extensor of forearm were measured by Western blot.Results(1) The ethology test:there were no carpoptosis in group of adult A and pup A; the carpoptosis rate of pup B and pup C were higher than that of adult A(P ＜ 0.05) ;the carpoptosis rate of pup A was lower than that of B and C(P ＜ 0.05); there was no difference between carpoptosis rate of adult A and B,but they were both lower than C(P ＜ 0.05).(2) Histological test of radial nerves:The percentage of myelinated both higher than C (P ＜ 0.05).(3) Western blot:The protein level of MyoD1 and Myogenin in radial nerve fiber in experimental side of pup A,B and C descended progressively (P ＜ 0.05).There was no difference between adult A and B,but they were both higher than C (P ＜ 0.05).(4) Histological test of the extensor digitorium:There was no difference between cross-sectional area recovery rate of adult A and B,but they were pup A,B and C increased progressively (P ＜ 0.05).There was no difference between protein level of MyoD1 and Myogenin in adult A and B,but they were both lower than C (P ＜ 0.05),ConclusionIn adult rats, there is no difference between the recovery of wrist extensor of the two surgical procedure after the C5-7 injured. The restoration of C5-7 but not C5,6 can do more good to the recovery of wrist extensor in pup rats.It's important to repaire the C7 by nerve graft after injury of C5-7 in newborn.