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OB JECTIVE To conduct overview of the systematic revi ew（SR）/meta-analysis for the effectiveness and safety of pharmacological interventions for hospitalized neconatal pain ， and to provide evidence-based reference for neonatal pain management. METHODS CNKI，CBM，Wanfang，VIP，PubMed，Embase，the Cochrane Library ，Web of Science ，CINAHL and Google Scholar were searched for SR/meta-analysis of pharmacological interventions for hospitalized neonatal pain. The search period was from Nov. 1st，2016-Nov. 1st，2021. After literature screening and data extraction ，AMSTAR 2 scale was used to evaluate the methodological quality of the included literature ，and GRADE method was used to assess the evidence quality of the outcome of the include d literature . A su mmary analysis was then conducted. RESULTS Totally 36 outcome indexes of 7 SR/ meta-analysis were included. Five studies were of moderate quality，and two were very poor according to AMSTAR 2 scale. GRADE results showed that among 36 outcome indexes，there were 7 moderate-quality indexes （19.44％），low-quality indexes （61.11％），and 7 critically-low-quality indexes （19.44％）. The main reason for downgrading the quality of evidence was impr ecision of results （71.74％）. CONCLUSIONS Opioids c an significantly reduce t he pain score of mechanically ventilated neonates but may increase hypotension. Acetaminophen can significantly reduce pain scores during eye examinations and postoperative morphine consumption with no adverse reaction report. However ，its analgesic effect on procedural pain is less than glucose and sucrose. Lidocaine and prilocaine and tetracaine may relieve venipuncture and lumbar puncture pain but lidocaine and prilocaine may increase the risk of adverse reaction. Clonidine can reduce neonatal mechanical ventilation pain with no adverse reaction report. It is suggested that neonatal pediatricians should use analgesic drugs selectively based on clinical judgment and pain assessment results.
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Objective:To evaluate the surgical technique and clinical effect of free KISS anterolateral thigh flap in repairing soft tissue defect of dorsal side of fingers.Methods:From January, 2014 to June, 2019, 7 patients with soft tissue defects in dorsal side of multiple fingers were treated. Step one, a KISS anterolateral thigh flap was used and a temporary syndactyly between adjacent affected fingers was created by suture of the digital palmar skin. The donor sites were sutured directly. Step two, a procedure of partial de-bulking and division of syndactyly was followed-up 1-3 months later. All cases were followed-up in observations of appearance, texture, functions and donor site of flaps.Results:All flaps survived, and all went through disorders of no blood circulation. The followed-up time were 3 to 24 (average 12.5) months. The flaps had fine appearance, texture and colour. The dorsal aspects of reconstructed fingers demonstrated an aesthetically pleasing effect after the flap de-bulking and division of syndactyly. The donor site only left a linear scar, and the thigh had no functional deficit.Conclusion:Free KISS anterolateral thigh flap in repairing defects of dorsal skin in multiple fingers could simplify the operation, shorten operative time and reduce surgical trauma.
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Objective@#To evaluate the surgical technique and the clinical effect of the reconstruction of forearm and hand defects, using double foliated anterolateral thigh flap with a single perforator.@*Methods@#From January 2013 to September 2017, 9 cases (forearm, n=3; hand, n=6) of the skin and soft tissue defects were reconstructed with double foliated anterolateral thigh flaps. The patients include 7 males and 2 females, with the mean age of 35.2 years(18-65 years). Blood supply of the double foliated flap was derived from the first musculocutaneous branches of the lateral femoral circumflex artery. The length and width of flaps were adjusted, to close the donor site directly. The descending branch of the lateral circumflex femoral artery was connected to the recipient vessels with end-to-end anastomosis. All cases were followed for the evaluation of appearance, texture, function and donor site condition.@*Results@#All flaps survived, and all cases were followed for 3 to 24 months (average 10.5 months). All flaps showed no blood circulation disorder. Except for 4 cases had slightly bloated flap, the other flaps had fine appearance and texture. The donor site left only a linear scar, and the donor thigh had no functional deficiency.@*Conclusions@#Double foliated anterolateral thigh flap for repairing the large area of the skin and soft tissue defect in hand and forearm could simplify the operation, shorten operation time and reduce operation trauma. It is an ideal method to repair the skin and soft tissue defect of forearm and hand.
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Objective To discuss clinical application of descending genicular artery perforator flap.Methods According to the anatomic features of direction,branches and anastomosis of the descending genicular artery,the descending genicular genicular artery perforator flap at medial superior aspect of knee joint was designed to reconstruct the soft tissue defects at the anterior medial 1/3 of the calf and the anterior medial part and popliteal fossa of the knee,with the axis based on the anterior border of the Sartorius and with the pivot point on the site where the cutaneous branches from the superior medial genicular artery pierced out within the triangle concave surface bounded by the vastus medialis,the tendon of adductor magnus and the condylus medialis.Results All flaps survived well in five patients,with primary healing.After a follow-up of 1-12 months,all flaps turned out to be with good texture,near-normal color and good appearance.Conclusion With a constant anatomic location,excellent blood supply and easy surgical procedure,the descending genicular artery perforator flap is one of feasible ways for repair of soft tissue defects around the knee.