Repair of multiple hand defects with superficial circumflex iliac artery perforator flap.

BACKGROUND: Reconstruction and repair of multiple defects in the hand is a combination of function, sensation and aesthetics. The reconstruction using the superficial circumflex iliac artery perforator flap has become popular, which overcomes the inherent shortcomings of traditional inguinal flaps by preserving the deep fascia. In this report, we present our experience in the design and clinical application of the superficial circumflex iliac artery perforator flap, which we used to repair multiple defects in the hand. METHODS: From January 2015 to December 2020, 41 patients received free superficial circumflex iliac artery perforator flap to repair multiple hand defects. All flaps were carefully designed according to the hand defect including 21 single and 20 bilobed flaps. The area of ​​the donor area is 2.5 cm × 3.0cm∼8.0 cm × 6.5 cm. We followed up all patients regularly and completed standardized assessments of outcomes based on post-reconstruction hand function and esthetic scores. RESULTS: 41 cases of flaps survived completely.3 cases of vascular crisis was relieved after surgical exploration, 1 case of mild distal necrosis was healed after dressing change, 1 case of pigmentation happened. There were 41 patients, 27 males and 14 females, with an average age of 40.5 years (4 to 59 years old). The defects included 20 cases opisthenars and 21 cases palms. The wounds were irregular, with exposed or damaged tendons, nerves or bones. All flaps were followed for a mean of 10.5 months (3 to 15 months). The functional and esthetic outcomes were satisfactory for all flaps without complications such as hand spasms, adhesions and scar contractures CONCLUSION: The superficial circumflex iliac artery perforator flap's donor site was concealed, relatively stable perforators, easy dissection. Recipient site condition was good and acceptable for the patients. It is a significant choice for multiple hand defects.

One-stage coverage of multi-digital pulp defects with sensate flaps from the foot.

BACKGROUND: The reconstruction of the digital pulp defects was a mix of the sensation, function, and aesthetics. As the conventional flaps became out of date, the sensate flaps were increasingly utilized in covering such defects. In this report, we present our experience with some novel flaps design, located on the foot. METHOD: From April 2015 to September 2018, nine patients received the free sensate flaps to resurface soft tissue defects in the multi-digital pulps. And all flaps were harvested from each aspect of the foot, which dimensions were tailored to the defects. The cutaneous nerve was preserved within the flap. Standardized assessment of outcome in terms of sensory, functional, and esthetic scores of the reconstructed pulps was completed. RESULTS: Nineteen flaps survived completely without significant complications, and mild venous congestion was observed in one flap. The free sensate flaps were performed for digital pulp reconstruction in 9 patients: 6 male and 3 female patients with a mean age of 49 years (ranged, 16 to 72 years). The defects involved 3 thumbs, 6 index fingers, 5 long fingers, 3 ring fingers, and 2 little fingers. All flaps were available for a mean follow-up of 30 months (ranged, 24 to 36 months). The functional and esthetic outcomes were satisfied for all flaps, as well as the sensory restoration. CONCLUSION: The sensate flap from the foot is a remarkable alternative for digital pulp reconstruction with less morbidity and better outcomes. Furthermore, the foot region presents a sensitive, glabrous skin with the proper bulkiness and allows for easy dissection.

[Vacuum sealing drainage with anterolateral thigh perforator flap for repair foot soft tissue defect].

OBJECTIVE: To investigate clinical effect of vacuum sealing drainage(VSD) with anterolateral thigh perforator flap for repair foot soft tissue defect. METHODS: From September 2014 to September 2016, 45 patients with foot soft tissue defect repaired by VSD with anterolateral thigh perforator flap, including 31 males and 14 females aged from 17 to 55 years with an average of 36 years old. Thirty patients were dorsal soft tissue defects, and 15 patients were plantar soft tissue defects. Sizes of soft tissue defect ranged from 7 cm×10 cm to 11 cm×18 cm, the wound was contaminated seriously and assisted with deep soft tissue exposure. Emergency surgical wound debridement with VSD treatment were performed, and wound surface was cleaned after 5 to 7 days, free anterolateral thigh flap were repaired. Sizes of flap ranged from 9 cm×12 cm to 13 cm×21 cm. Appropriate method was used to repair flap donor area. RESULTS: All 45 free propeller flap were survived without skin edge necrosis, ulcerative infection. Forty patients were followed up from 3 to 24 months with an average of 13 months. Flap showed good color, beautiful appearance, good elasticity, soft texture, but without obvious bloated, the wood of leg healed well. CONCLUSIONS: VSD with anterolateral thigh perforator flap for repair foot soft tissue defect could effective control wound soft tissue infection, receive reliable flap blood supply and skin flap could repaired at stage I. It is an effective method for repairing foot soft tissue defects.

[Survey on status of staff for Plasmodium microscopy examinations in Changzhou City].

OBJECTIVE: To understand the current state of staff for Plasmodium microscopy examinations in Changzhou City in the early stage of eliminating malaria action, so as to provide the evidence for achieving the target of malaria elimination. METHODS: The staff for Plasmodium microscopy examinations from medical institutions and centers for disease control and prevention at different levels were investigated by questionnaires and tests of the malaria related theory and microscopic operation. RESULTS: Totally 95 people were investigated, and among them, 40.0% had college degree and 45.3% were university educated. There were 18.9% of them working on Plasmodium microscopy examinations for less than 1 year, 40.0% for 2-5 years, 18.9% for 6-10 years and 22.1% for more than 10 years. The numbers of person-time of provincial and municipal level training, district-level training, and unit-level training in the last year were 0.57, 0.59, and 0.14, respectively. Totally 18.9% of them had the experience of finding Plasmodium at work, and 97.9% of them considered it was necessary or very necessary to do Plasmodium microscopy examinations. However, 57.9% and 8.4% of them considered Plasmodium microscopy examinations increased their work load and work difficulty, respectively. The average correct rates of knowledge tests on malaria before and after training were 72.5% and 91.6% respectively (P < 0.05). The average mark of Plasmodium microscopic tests was 25.3 points (full mark being 50 points), and the passing rate (> or = 30 points) was 58.9%. CONCLUSION: The working experience of staff for Plasmodium microscopy examinations in Changzhou City is relatively poor, and the related training should be enhanced.

[Factors related to anterior knee pain after total knee arthroplasty].

OBJECTIVE: To investigate the incidence rate of anterior knee pain after total knee arthroplasty (TKA) and identify the related factors. METHODS: This prospective, double-blind clinical trial involved a total of 128 patients scheduled for primary ipsilateral cemented three-component TKA for osteoarthrosis. The patients were randomized into two groups to receive operations for TKA with patellar resurfacing (experimental group) or not (control). The incidence of anterior knee pain was observed in these patients and the factor affecting the occurrence of anterior knee pain and knee was analyzed. RESULTS: The patients were followed up for a mean of 16.5 months (range 6~24 months). The incidence rate of anterior knee pain was 10.9% (7/64) in the experimental group, showing no significant difference from the rate of 14.1% (9/64) in the control group. But the 52 patients with varus or valgus knee showed a significantly higher incidence rate of anterior knee pain (21.2%, 11/52). CONCLUSION: TKA with patellar resurfacing can not decrease the incidence of anterior knee pain, and varus or valgus before the operation is associated with a higher risk of anterior knee pain.

[Two-stage revision for treatment of periprosthetic infection following hip arthroplasty].

OBJECTIVE: To evaluate the efficacy and optimal re-implantation time of two-stage revision for management of periprosthetic infection following hip arthroplasty. METHODS: We retrospectively analyzed the clinical data of 15 patients (15 hip joints) undergoing two-stage ipsilateral total hip arthroplasty (THA) revision from January, 2006 to January, 2010. In the first stage, after surgical debridement and thorough removal of all the implants, a self-made Vancomycin-loaded cement spacer was implanted. The second stage operation was performed 3-6 months later for debridement and removal of the antibiotic-loaded spacer, followed by re-implantation of Vancomycin-loaded bone cement prosthesis in 9 cases and cementless prosthesis in 6 cases. The patients were followed up for 9-46 months (mean 25 months) after the operation. RESULTS: No reinfection or prosthesis loosening/displacement was found in these cases after the operation. The Harris score increased from 40.3 before the operation to 54.0 after the first-stage operation, and to 88.2 at the last follow-up. CONCLUSION: Two-stage revision is effective for treatment of periprosthetic infection following hip arthroplasty, and 3-6 months can be the optimal interval between the two the first-stage and second-stage operation for re-implantation.

[Impact evaluation of universal salt iodization on spectrum of thyroid diseases in Changzhou area, Jiangsu, China].

OBJECTIVE: To evaluate the impact of universal salt iodization using monitoring data on correctional status of iodine deficiency and hospitalized thyroid diseases. METHODS: Retrospective survey was conducted to collect medical records of hospitalized thyroid disease cases. Routine monitoring data on population iodine nutrition status and goiter prevalence were analyzed. RESULTS: The coverage of adequately iodized salt was consistently above 95%. Hospitalization rate of thyroid diseases rose steadily, and peaked at 54.5 per 100,000. The proportion of hospitalized thyroid disease among hospitalized diseases also rose with female and those aged above 40 years old mostly affected. The proportion of hospitalized hyperthyroidism among total hospitalized thyroid disease rose from 13.6% to 34.7%. CONCLUSIONS: Universal salt iodization might eliminate iodine deficiency while other impact still exists. However, the benefits of universal salt iodization should be far overweight the adverse effects.