Microsurgical thinned anterolateral thigh perforator flap to repair soft tissue defects of foot and ankle / 中国骨伤

OBJECTIVE@#To explore method and clinical effect of microsurgical thinned anterolateral thigh perforator flap to repair soft tissue defects of foot and ankle.@*METHODS@#From March 2017 to January 2022, totally 20 patients with soft tissue defects of ankle joint were treated with micro-thinning anterolateral perforator flap for free transplantation, included 13 males and 7 females, aged from 22 to 58 years old with an average of (36.45±12.36) years old. The size of flap ranged from 8.0 cm×5.0 cm to 20.0 cm×12.0 cm. Before operation, perforating vessels on the anterolateral thigh region were detected and marked with a portable Doppler detector. For the defect width less than 8 cm, 11 patients were repaired with a single flap. For the defect width more than 8 cm, the wound could not be sutured directly, and the lobulated flap technique was used in 9 patients, the width was converted to length, and the donor site was closed directly. Under the microscope, all flaps were thinened in a stepwise manner from the center of the pedicle to the periphery. After operation, survival of the flap, the shape, texture, sensory function recovery were observes, and recovery of foot function was evaluated by Maryland foot function evaluation standard.@*RESULTS@#All 20 patients with microsurgical thinned anterolateral thigh perforator flaps were survived. Venous crisis occurred in 1 patient due to subcutaneous hematoma, after removal of the hematoma, the crisis was relieved and the flap survived successfully. The wounds in the donor and recipient sites healed well, and only linear scars left in the donor sites. Twenty patients were followed up for 3 to 26 months after operation, good shape of flaps without bloated, and good texture. The two-point discrimination of free flaps ranged from 9.0 to 16.0 mm, and the protective sensation was restored. The ankle flexion and extension function recovered well and patients could walk normally. According to Maryland foot function evaluation standard, 8 patients got excellent result, 10 patients good and 2 middle.@*CONCLUSION@#Microsurgical thinned anterolateral thigh perforator flap is an ideal method to repair soft tissue defects in functional area of foot and ankle, with good appearance and texture of the flap, no need for re-plastic surgery, reduced hospitalization costs, and less donor site damage.

Effect of High-Concentration Uric Acid on Nitric Oxide / 中国医学科学院学报

Uric acid (UA) is the final product of purine metabolism in human body,and its metabolic disorder will induce hyperuricemia (HUA).The occurrence and development of HUA are associated with a variety of pathological mechanisms such as oxidative stress injury,activation of inflammatory cytokines,and activation of renin-angiotensin-aldosterone system.These mechanisms directly or indirectly affect the bioavailability of endogenous nitric oxide (NO).The decrease in NO bioavailability is common in the diseases with high concentration of UA as an independent risk factor.In this review,we summarize the mechanisms by which high concentrations of UA affect the endogenous NO bioavailability,with a focus on the mechanisms of high-concentration UA in decreasing the synthesis and/or increasing the consumption of NO.This review aims to provide references for alleviating the multisystem symptoms and improving the prognosis of HUA,and lay a theoretical foundation for in-depth study of the correlations between HUA and other metabolic diseases.

[Influence of inhaled anesthesia on bispectral index of elderly patients with cognitive decline].

OBJECTIVE: To investigate the influence of inhaled anesthesia on bispectral index (BIS) of elderly patients with cognitive decline at loss of consciousness and regain of consciousness, and on deepening of sedation. METHODS: The patients aged more than 65 years undergoing elective operations from January 2012 to September 2012 were recruited, then 60 cognitive intact patients and 60 cognitive decline patients were screened by mini-mental state examinations. Inhaled anesthesia was administered using sevoflurane. BIS's of the two groups at loss of consciousness and regain of consciousness, and during end-tidal concentration of sevoflurane (CETSev) changing from 0.7% to 2.8% were recorded. The data were compared with independent-samples t test and repeated-measures general linear model of ANOVA. RESULTS: In the study, 117 patients finshed the investigation, The BIS's of the cognitive decline group at loss of consciousness were significantly higher than those of the cognitive intact group (P<0.01). There were no significant differences at regain of consciousness between the two groups (P>0.05). The BIS's of the cognitive decline group during CETSev changing from 0.7% to 2.8% were significantly lower than those of the cognitive intact group (P<0.05). The BIS's of the cognitive decline group at CETSev 0.7%, 1.05%, 1.4% and 1.75% were significantly lower than those of the cognitive intact group (P<0.05), but there were no significant differences at CETSev 2.1%, 2.45% and 2.8% between the two groups (P>0.05). CONCLUSION: During inhaled anesthesia, the BIS of the elderly patients with cognitive decline at loss of consciousness is higher than that of the patients with cognitive intact, The BIS of elderly patients with cognitive decline on deepening of anesthesia is lower than that of the patients with cognitive intact, especially during light anesthesia, and its mechanisms may attribute to cognitive decline related neurodegeneration and neurotransmitter system dysfunction.

[Effects of continuous interscalene brachial plexus block plus general anesthesia versus general anesthesia alone on perioperative management of arthroscopic rotator cuff repair surgery].

OBJECTIVE: To compare continuous interscalene brachial plexus block (CISB) in the patients undergoing rotator cuff repair surgery. METHODS: A total of 60 patients undergoing rotator cuff repair surgery were randomly assigned to either ISB plus GA group (ISB + GA group) or GA group. Preoperatively, an interscalene catheter was placed in the ISB + GA group patients. Both groups received general anesthesia. The intraoperative mean arterial pressure (MAP) at the level of external acoustic meatus was maintained at a target of 60 - 65 mm Hg with a continuous infusion of remifentanil. Postoperatively, the patients in the ISB + GA and GA groups received CISB and patient controlled intravenous analgesia (PCIA) respectively for 48 h. RESULTS: Surgical field conditions were similar in two groups (P = 1.000). Compared to the GA group, the consumption of remifentanil [(0.04 ± 0.03) vs (0.14 ± 0.03) µg×kg(-1)×min(-1), P < 0.01] and the inhalational concentration of sevoflurane(1.80% ± 0.5% vs 2.1% ± 0.5%, P < 0.05)were lower in the ISB + GA group. Compared to the GA group, the values of MAP and heart rate (HR) were lower at all postoperative time-points in the ISB + GA group(P < 0.05). The postoperative measurements of numerical rating pain score (NRPS) were lower (P < 0.01) and the level of patient satisfaction was greater in the ISB + GA group [8(6 - 10) vs 7 (5 - 10), P < 0.01]. CONCLUSION: In comparisons with GA alone for rotator cuff repair surgery, the combined uses of ISB and GA may achieve a better perioperative control of hemodynamic responses, a markedly reduced consumption of general anesthetics, a rapid recovery of consciousness from anesthesia, superior analgesia with fewer side effects and greater patient satisfaction.

[Effect of enhanced ultrasound guiding on brachial plexus block].

OBJECTIVE: To assess whether the enhanced imaging technology can improve the needle visibility during ultrasound-guided auxillary brachial plexus block. METHODS: After obtaining informed consent, 60 ASA (American Society of Anesthesiologists) I-II patients undergoing forearm or hand surgery were enrolled in this prospective, randomized, double-blind study. The patients were randomly assigned to two groups, the common image group (n=30) and enhanced image group (n=30). Ultrasound was used in guiding the block of the four branches of brachial plexus, i.e. the median, radial, ulnar and musculocutaneous nerves. In the enhanced image group a special function key "Multi-beam enhance" (MBe) was turned on during the needle insertion. After the nerve stimulator identification of the median, radial, ulnar and musculocutaneous nerves, 10 mL of 0.5% ropivacaine was injected near each nerve. The operating time, the visibility of the needle, the depth of each nerve, the onset time of the block, and the complications related to the block were assessed and recorded. RESULTS: The operating time was significantly shorter in the enhanced image group compared with the common image group [(2.63±0.81) min vs. (5.07±1.89) min, P=0.01]. The visibility of the needle was better in enhanced image group when the radial and musculocutaneous nerve blocks were performed (P<0.05). CONCLUSION: The enhanced image technology can reduce the operating time and improve the visibility of the needle during the peripheral nerve block for the nerve which is relatively deep.