Functional muscular transfer of lateral femoral muscle superficial region in emergency reconstruction of traumatic defects of dynamical muscle: A report of preliminary clinical study / 中华显微外科杂志

Objective:To explore the feasibility and clinical effect of emergency lateral thigh muscle transfer in functional reconstruction of major traumatic muscle defects.Methods:Emergency surgeries for 8 patients(7 males and 1 female) with muscle defects were carried out subject to emergently reconstruct the power of lateral femoral muscle superficial region, between March 2020 and December 2021, in the Department of Hand and Foot Microsurgery Hospital, Xi'an Fengcheng Hospital. The 8 patients were 23 to 52 years old with an average of 37.6 years old. Five patients injured by machine crush, 2 by heavy object crush and 1 by traffic accident. Five patients were in Gustilo III B injury in forearm, including 2 with flexor muscle group defects, 2 with extensor muscle group defects and 1 with defect of dorsal metacarpal flexor muscle and extensor muscle. Among the 5 patients, 2 patients had the defects in left forearm and 3 in right forearm. One patient had defect of right 1st metacarpal bone and skin and thenar muscle. One patient suffered a complete right upper arm detachment with musculocutaneous nerve being drawn out from the bicipital muscle. One patient had Gustilo III C injury in the right calf with defects of extensor hallucis longus and extensor digitorum. The areas of soft tissue defect were 10.0 cm×8.0 cm-36.0 cm×11.0 cm and the size of flaps was 12.0 cm×6.0 cm-38.0 cm×12.0 cm with the volumes of excised muscle at 18.0 cm×9.0 cm×1.5 cm-10.0 cm×2.0 cm×1.0 cm. The anatomical cross-section and length of the corresponding muscle on the healthy side were measured by musculoskeletal ultrasound. The chimeric tissue flap was designed on the anterolateral side of the thigh. The flap was designed according to the size of the wound and the corresponding flap. Then 1 or 2 muscle tissue blocks were designed and cut from the superficial region of the lateral femoral muscle according to the condition of the muscle defect, to cover the wound and reconstruct the muscle power. Postoperative follow-ups were conducted by scheduled hospital visit. The contents of follow-up included dynamic observation, evaluation and record through musculoskeletal ultrasound, electromyography and strength of muscle.Results:For the 8 patients who were subject to a muscle reconstruction, the transferred muscles and flaps survived in stage-one without vascular event. Postoperative follow-ups lasted for 10 to 32 months with an average of 19.6 months. The strength of muscle was evaluated according to the M 4 strength of muscle. Strength of muscle restored to M 4 or above in 7 patients who could lift, hook or push a heavy object in 5-30 kg of weight, with free joint movement. One patient restored the strength of muscle to M 3+. Muscle contraction was detected 2-4 months after surgery by musculoskeletal B ultrasound. The average ratio of contraction to resting cross sectional area in 5 cases was 1.45±0.42. The shape of limb was bilaterally symmetrical. There was no discomfort in the donor site and knee joint. The flaps were soft and glossy, with protective sensation restored. Conclusion:Muscle transfer from the lateral femoral muscle superficial region in emergency surgery for functional reconstruction of traumatic muscle defects is feasible and effective with a good clinical effect.

Clinical analysis of 8 cases of neonatal intestinal muscle defect with perforation / 中华实用儿科临床杂志

Objective To study the clinical characteristics,treatment and prognosis of neonatal intestinal muscle defect with perforation.Methods The clinical data of 8 cases of newborns who had intestinal muscle defect with perforation in Department of Surgical Intensive Care Unit,Nanjing Children's Hospital Affiliated to Nanjing Medical University,were analyzed retrospectively.Results These 8 cases included 1 premature infant,1 term low birth weight infant,6 cases of term infants with normal birth weight,and all had no history of perinatal asphyxia.The ages of onset of all cases were ＜ 7 d.Clinical manifestations were crying and sudden onset of obvious abdominal distention.Bile or fecal vomiting occurred in 5 cases.These patients included 5 cases with congenital anorectal malformations,of which 3 cases had low deformity,1 case with middle deformity and 1 case with high deformity,with no other complications of gastrointestinal malformation.Surgical treatment was used in 8 cases,in which 7 cases of rectal perforation and 1 case of ileal perforation were confirmed.All cases were isolated perforation with a diameter of about 0.8-2.0 cm.The perforated periphery of the intestine was membranous.Intestinal repair was performed after total removal of the diseased tissue,and the patients with rectal perforation were performed at the same time for the proximal colostomy.The histopathologic examinations showed that the periphery of perforation had intact mucosa,muscularis propria was absent,myenteric plexus was absent in the region of muscle loss.Two cases were discharged within 1 d after colostomy.Except for 1 case with high anorectal malformation in the control of poor defecation functions,there were no other postoperative gastrointestinal complications in these 6 cases.Conclusions Rectal perforation is the most common in neonatal intestinal muscle defects,and it is an isolated and large diameter perforation.Most cases are term infants with normal birth weight.These patients are often associated with congenital anorectal malformations.High,middle and low deformity can be accompanied by intestinal muscle defect.Surgical excision of diseased tissue should be complete,in principle,and intestinal stoma should be performed proximal to the perforation.In case of congenital anorectal malformations complicated with gastrointestinal perforation,the rectum should be explored as an important region.Neonatal intestinal muscle defect maybe a primary lesion according to clinical characteristics of early sudden onset after birth and pathological examinations.Except for complications caused by associated malformations,the prognosis is satisfactory.

A live birth after spontaneous complete chorioamniotic membrane separation associated with uterine scar

Spontaneous complete chorioamniotic membrane separation (CMS) without invasive fetal procedure is extremely rare and associated with adverse perinatal outcomes. A woman with complete CMS which was detected at the 21 weeks' gestation. She did not take any fetal invasive procedures before the diagnosis. At 27 weeks' gestation, an emergency Caesarean section was performed because of fetal distress. The defect of the uterine muscle was detected on the fundus. The baby has grown well without any morbidity. This is the first reported case of complete CMS relative to uterine scar. And we suggest that the pregnancy can be maintained successfully if there is no fetal abnormality when complete CMS is detected on ultrasound.

Oribicularis Oris Muscle Defects in Philtral Deformities in the Repaired Cleft Lip

PURPOSE: The purpose of this study is to estimate muscle defect by ultrasonography in the patients with secondary deformities of the lip. We investigated the association between the muscle defect in the repaired cleft lip and the philtral appearance not only at resting state but also maximal puckering. METHODS: From December 2006 to November 2007, 52 children were evaluated after primary or secondary cheiloplasty. Digital photographs were taken both from the front and both three quarter views in repose and at maximal pucker. Video clips were also taken in repose and at maximal pucker. A panel of four, scored the philtral ridge and dimple seen on these photographs and videos by using two visual analog scales. Eminence of the philtral ridge was scored by a 5 point grading scale, from "conspicuous groove" to "normal philtral ridge" and the philtral dimple was scored by 3 point grading scale, from "no dimple" to "prominent dimple". Ultrasound images of the upper lip were made using a linear array transducer at the resting position of the lip and evaluated by a single radiologist. RESULTS: The philtral ridge eminence scored 2.79+/-0.54 and 1.40+/-0.53 at resting and maximal pucker, correlating with "flat" and "conspicous groove". The philtral dimpling scored 1.44+/-0.53 and 2.27+/-0.66 at resting and maximal pucker, correlating with "no dimple" and "slight dimple". Ultrasound imaging showed the average muscle dehiscence to be 3.78+/-2.14mm at resting position. Correlation between the muscle defect in ultrasound imaging and philtral ridge eminence at rest was statistically significant (p<0.050), but was not significant(p=0.756) at maximal pucker using Spearman's rank correlation. Correlation between the muscle defect in ultrasound imaging and philtral dimpling was not statistically significant both at rest (p=0.920) and at maximal pucker(p=0.815) using Spearman's rank correlation. CONCLUSION: Quantitative assessment of the muscle defect using ultrasonography correlates with the static philtral appearance, but does not correlate with the dynamic appearance. Also, the size of the muscle defect does not show any correlation with the philtral dimpling. Our findings reveal that ultrasound imaging partially reflect static appearance of philtrum but cannot reflect dynamic appearance and suggest the need for further research to evaluate dynamic appearance.