Development and usability of a Mobile Interactive Application (VCPW) for Vascular Crisis Prewarning after Skin Flap Transplantation.

Background: In microsurgical tissue transfer, skin flap transplantation is frequently used to heal the surface of a wound. Effective microcirculation surveillance of the skin flap is crucial. However, with traditional monitoring methods-that is, clinical observation-vascular crisis can still occur, thereby impairing postoperative recovery. A smartphone application is required to assist health care professionals in the standardized collection of flap perfusion parameters for flap management. Methods: The Vascular Crisis Prewarning Application was created using a design science research methodology that prioritizes users and problems. The system usability scale was used to assess the application's usability among medical practitioners. The application was used at the clinic from December 2020 to September 2022. The unplanned return to the operating room, time to diagnose vascular crisis, and flap survival rate were compared with and without the application. Results: The application consisted of 5 modules: patient addition and basic information entry, flap labeling, flap observation, crisis warning, and case archiving. The average rating for the application's usability among medical practitioners was 97.95 score (SD 2.36). With the application, the time to detect vascular crisis reduced from 26.71 to 16.26 h (P < 0.001), the unplanned return to the operation room increased from 8.18% to 10.24% (P = 0.587), and the flap survival rate went from 94.55% to 99.21% (P = 0.083). Conclusions: An easy-to-use flap perfusion monitoring and prewarning application for medical practitioners was produced using a user-centered development method. The application provided a more standardized and accurate platform for data collection in flap management and reduced the time to detect vascular crisis. Larger cohort studies are required in the future to better assess the full potential of the application.

Effect of PI3K/AKT/mTOR signaling pathway-based clustered nursing care combined with papaverine injection on vascular inflammation and vascular crisis after replantation of severed fingers.

This research aimed to investigate the effect of PI3K (phosphatidylinositol 3-kinase)/AKT (protein kinase B)/mTOR (mammalian target protein of rapamycin) signaling pathway-based clustering care combined with papaverine injection on vascular inflammation and vascular crisis after finger amputation and replantation. 100 patients admitted in General Hospital of Ningxia Medical University from April 2022 to December 2022 for replantation of severed fingers were selected and divided into a control group (n = 50) and an observation group (n = 50) using the randomized grouping principle. The control group received a papaverine injection and general nursing care, the observation group received a papaverine injection and clustered care. The pain score; constipation incidence; replantation finger survival rate; physician, nurse, and patient satisfaction; serum inflammatory factors; vascular crisis parameters; and occurrence of adverse reactions were compared between the two patient groups. Enzyme-linked immunosorbent assay was performed to detect PI3K, AKT, and mTOR protein concentrations in the venous blood of the two groups, and statistical analysis of the data was performed. On postoperative day 7, the pain score and incidence of constipation in the observation group were lower than those in the control group (P < 0.05); the survival rate of reimplanted fingers in the observation group was 88.00%, which was higher than that in the control group 80.00% (P < 0.05); the satisfaction of doctors, nurses, and patients in the observation group was higher than that in the control group; the concentrations of interleukin-1 (IL-1), tumor necrosis factor (TNF-α), blood flow resistance index (RI), and arterial pulsatility index (PI) in the observation group were lower than those in the control group, while the concentration of interleukin-10 (IL-10), vascular diameter, and Vm (mean blood flow velocity) were higher in the observation group than those in the control group; the differences were statistically significant (P < 0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant (P > 0.05). The concentrations of PI3K, AKT, and mTOR proteins in the observation group were higher than those in the control group (P < 0.05). The concentrations of PI3K, AKT, and mTOR proteins in the observation group were higher than those in the control group (P < 0.05). Overall, these findings suggest that clustered care combined with papaverine injection reduces vascular inflammatory symptoms and vascular crisis in the treatment of severed finger replantation through the PI3K/AKT/mTOR signaling pathway.

Comparison of application of three dimensional microscope and optical microscope in oral and maxillofacial vascular anastomosis / 口腔疾病防治

Objective@#To investigate the application value of 3D microscope in vascular anastomosis in oral and maxillofacial surgery, to provide a reference for clinicians. @*Methods @#Eighty-seven cases of free flap reconstruction in oral and maxillofacial surgery were retrospectively included, including 30 cases in the 3D microscope group and 57 cases in the optical microscope group. The differences in intraoperative vascular anastomosis time, postoperative flap survival rate and doctor evaluation scores between the 3D microscope group and the optical microscope group were compared and statistically analyzed, and the feasibility of using three-dimensional microscope in surgery was evaluated. @*Results @#The arterial anastomosis time was (26.53±3.83) min/root in the 3D microscope group and (24.88 ± 2.97) min/root in the optical microscope group, and the difference was statistically significant (P<0.05). The venous anastomosis time was (30.68 ± 3.51) min/root in the three-dimensional microscope group and (28.70 ± 2.91) min/root in the optical microscope group, and the difference was statistically significant (P<0.05). There was no significant difference in the survival rate of flaps between the 3D microscope group (n = 28, 93.33%) and the optical microscope group (n = 53, 92.98%) (P>0.05). The doctor's evaluation scores of visual fatigue, training and learning, operative difficulty index, image sharing in the three-dimensional microscope group were higher than those in the optical microscope group, and the differences were statistically significant (P<0.05). @* Conclusion @# 3D microscope has good reliability and safety in surgery, a strong sense of three-dimensionality, and the convenience of teaching and training. It can be well applied to vascular anastomosis in oral and maxillofacial surgery.

Application of color Doppler ultrasound in nursing observation of flap vascular circulation after free flap transplantation / 中国实用护理杂志

Objective:To summarize the clinical application value of color Doppler ultrasound (CDU) in the nursing observation of flap vascular circulation after free flap transplantation.Methods:From September 2018 to November 2020, 18 patients with skin defect of limbs treated by free flap transplantation in the Second Affiliated Hospital of Wenzhou Medical University were monitored by skin color, skin temperature, skin tension, capillary reaction time and CDU. When the vascular circulation disorder was found, the patients should be treated with volume expansion, rehydration, local massage of the flap, anticoagulation and microcirculation improvement. Positive drainage under the flap to prevent infection, combined with hyperbaric oxygen treatment, accurate and timely exploration of vascular crisis to avoid flap necrosis.Results:Postoperatively, CDU monitoring found that 2 cases had regional vascular circulation disorder, 1 case had complete embolization of the main vessels and perforators in the flap, the flap was thinned and changed to full thickness skin grafting, the deep tissue exposed area was healed by dressing change, and 1 case had incomplete embolization of the flap′s reflowing vein. After operation, the venous crisis was relieved and the flap survived completely.Conclusions:Comprehensive observation is needed after free flap transplantation. Combined with four routine vascular circulation indexes, CDU monitoring of flap blood flow can provide more objective, accurate and detailed basis for vascular circulation status, and can accurately find the vascular circulation disorder after free flap transplantation in early stage, and understand the vascular flow status of the flap, so as to effectively avoid the continuous progress of vascular crisis, to avoid flap necrosis and improve the survival rate of flap.

Paired logistic regression analysis of influencing factors for vascular crisis after repair of oral and maxillofacial tumors with free tissue flaps / 口腔疾病防治

Objective @#To investigate the influencing factors of vascular crisis after oral and maxillofacial tumor free tissue flap transplantation. @*Methods @# A retrospective analysis was performed on all patients who underwent free tissue flap transplantation and developed vascular crisis in the surgical ward of head and neck cancer in a grade A specialized hospital. Forty-six possible influencing factors were collected using 1:1 matching according to surgeons, operation time, sex and age of patients from patients without vascular crisis from 2015-2020 in this ward during the same period. SPSS 26.0 statistical software was used for univariate and multivariate logistic regression analyses of the data.@*Results @#A total of 158 patients were enrolled, including 79 in the crisis group and 79 in the pairing group. Univariate analysis was performed for each variable. Paired logistic regression analysis showed that only postoperative blood potassium (P = 0.048, OR = 3.118, 95% CI: 1.008-9.641) and preoperative and postoperative red blood cell count differences (P = 0.004, OR = 4.53, 95% CI: 1.609-12.750) were statistically significant.@*Conclusion @#High blood potassium levels and red blood cell count differences before and after surgery were risk factors for vascular crisis.

Methylenetetrahydrofolate reductase polymorphisms as genetic markers to predict homocysteinemia and clinical severity in sickle cell disease.

Aim: The present study observed the relationship between the methylenetetrahydrofolate reductase genotypes and clinical outcome in children with sickle cell disorder. Methodology: A total of 249 children were recruited for the study and evaluated clinically for calculating severity score, homocysteine levels and C677T and A1298C genotyping. Results: The frequencies of variant genotypes were 28.1% CT/TT677 and 69.1% AC/CC1298. Plasma homocysteine was significantly elevated in variant groups (p < 0.001). Both the genotypes accorded significant association with homocysteinemia (p < 0.001). Vascular crisis (p = 0.04), frequency of hospitalization (p < 0.001) and severity score (p = 0.02) revealed association with C677T and not with A1298C. The CT/TT677 genotypes showed 3.39-times (p = 0.032) increase in a higher score for severity. Conclusion: C677T depicted significant association with clinical severity in study population.

Jaw reconstruction with vascularized fibular flap: The 11-year experience among 104 patients.

BACKGROUND: A vascularized fibular osteomyocutaneous flap with severe vascular crisis often results in serious consequences. This study aims to examine the clinical effect of non-vascularized fibular graft on patients with severe vascular crisis after reconstruction of the defect jaw with vascularized fibular osteomyocutaneous flap. MATERIALS AND METHODS: From December 2007 to December 2018, a total of 104 patients with jaw neoplasms that underwent reconstruction with free vascularized fibular flap were retrospectively analyzed; seven of these cases had postoperative vascular crisis during mandibular reconstruction. RESULTS: Of the seven cases with postoperative vascular crisis, the vascularized fibular flaps in three patients survived completely, thanks to early detection; two cases were completely necrotic and removed in the end, and the remaining two cases had severe vascular crisis after the removal of the soft tissue attached to the fibular flap. The non-vascular fibular grafts were retained regardless of the severe absorption after follow-ups for 25 and 69 months, respectively. CONCLUSIONS: If vascular crisis occurs following jaw reconstruction with a vascularized fibular osteomyocutaneous flap, early re-surgical exploration effectively improves the salvage rate. In addition, when a severe vascular crisis occurs, the vascularized fibular flap can be changed to a non-vascular fibular graft to reconstruct the mandibular defect, thus avoiding the serious consequences resulting from the complete failure of fibular graft.

Application of venous super drainage technique in free flaps transfer / 中华显微外科杂志

To investigate the effect of venous super drainage applying in free flaps. Methods From June, 2017 to December, 2018, 7 cases who had severe soft tissue injuries were treated with free flap. Cause of injury: 1 electric injuries, 2 tumor-related wounds, 1 deep burns, 2 mechanical trauma, and 1 necrotizing fasciitis. All patients were underwent free flap transplantation. There were 5 cases of anterolateral thigh artery perforator flap, 1 case of superficial circumflex iliac artery perforator flap, and 1 case of first dorsal metatarsal artery perforator flap.The application of venous super-drainage technology was carried out according to needs and specific conditions. Two sets of venous passages were prepared in both recipient and donor site to form a double set of venous reflux super-drainage mode. Blood supply, swelling, exudation, secondary exploration and survival rate of the flap were observed after operation, and regularly followed-up. Results All 7 flaps survived. Venous super drainage technique was ap-plied in 7 cases. No arteriovenous crisis occurred after the operation. The flaps had good blood circulation, slight swelling, less exudation, rapid edema regression and no secondary surgical exploration. Followed-up for 2-18 (average 10.5) months, there was no infection recurred. Flaps survived well, and the donor sites healed well without sensory loss.The flexion and extension function of joint was normal. Conclusion The technique of venous super-drainage prepares 2 sets of venous systems for the free flap in the treatment of vascular pedicle in the free flap repair operation, which is conducive to reducing the venous crisis after flap surgery, reducing flap edema, reducing exudation, reducing secondary surgical exploration and improving the survival rate of the flap.

Non-vascularised fibular bone graft after vascular crisis: compensation for the failure of vascularised fibular free flaps.

After reconstruction of a segmental mandibular defect with a fibular free flap, a vascular crisis can be detected clinically and a "no-flow" phenomenon found during re-exploration. Traditional methods used to solve this include removal of the failed flap and delayed mandibular reconstruction, or restoration of the defect with a functional reconstruction plate or contralateral fibular free flap. Our aim therefore was to investigate under what circumstances it is feasible to use a non-vascularised fibular bone graft (NVFB) as a free bone graft after the failure of a vascularised fibular free flap. From 1 January 2010-31 December 2014, 10 patients who had NVFB after failure of a fibular free flap were included in the study. All patients were treated at the Peking University School and Hospital of Stomatology. NVFB were preserved successfully without infection in all 10 cases, and follow-up imaging showed that it had incorporated well with the residual mandible, the basic function and facial aesthetics of which were maintained. In conclusion we have identified that by precise selection of patients, detailed preoperative planning, and meticulous postoperative care, NVFB can be used as a "rescue" technique after failure of a fibular free flap, and can successfully restore the segmental mandibular defect and facial contour.

Design and clinical application of postoperative marker system of perforator flap / 中华显微外科杂志

Objective To investigate the design of the postoperatively marker system based on the perforator flap and its clinical application.Methods According to the basic anatomy and blood supply characteristics of perforator flap,the observation points were marked on the flap surface and recipient area postoperatively,and judge flap blood flow changes with hand-held Doppler(HHD) and clock-face measurement based on perforators.From November,2015 to November,2017,prospectively conducted a control study evaluating the incidence of vascular crisis,accuracy rate,reoperation rate and survival rate of flaps between simple traditional flap monitoring group (n=100) and traditional flap monitoring combine with postoperatively marker system monitoring group (n=100).Results Vascular crisis was mostly concentrated with in 48 h postoperative in traditional flap monitoring group and combined group.There was no significant difference in the incidence,positive rate and negative rate of vascular crisis in the two groups (P＞0.05).The reoperation rate in the traditional flap monitoring group (87.5％) was higher than the combined group (27.8％)(P＜0.01).The survival rate of flap of combined group (99％) was higher than the traditional falp monitoring group (90％) (P＜0.05).Conclusion The postoperatively marker system of perforator flap can effectively guide the medical staff to observe the blood supply of the flap,detect and judge the vascular crisis in time,and It is simple and easy to do without increasing the patient's trauma and medical expenses as well as no additional equipments.

[Vascular crisis after multiple tissue transplantation for thumb and other finger reconstruction by toe-to-hand transfer].

Objective: To explore the causes of vascular crisis after thumb and other finger reconstruction by toe-to-hand transfer and effective treatment methods so as to improve the survival rate of transplanted tissues. Methods: Between February 2012 and October 2015, 59 cases of thumb and other finger defects were repaired with different hallux nail flaps with the same vascular pedicle flap to reconstruct thumb and other fingers and repair skin defect. The donor site was repaired by a perforator flap. A total of 197 free tissues were involved. There were 46 males and 13 females with the average age of 30.6 years (range, 18-42 years). Vascular crisis occurred in 21 free tissues (10.7%) of 17 patients, including 9 arterial crisis (4.6%) of 8 cases, and 12 venous crisis (6.1%) of 10 cases. Conservative treatment was performed first; in 8 free tissues of 7 cases after failure of conservative treatment, anastomotic thrombosis was found in 5 free tissues of 4 cases, twisted vascular pedicle in 1 free tissue of 1 case, surrounding hematoma in 1 free tissue of 1 case, and anastomotic thrombosis associated with hematoma in 1 free tissue of 1 case, which underwent clearing hematoma, resecting embolization, regulating vascular tension, re-anastomosis or vascular transplantation. Results: In 8 cases of arterial crisis, 5 free tissues of 5 cases survived after conservative treatment; partial necrosis occurred in 1 free tissue (1 case) of 4 free tissues (3 cases) undergoing surgical exploration. In 10 cases of venous crisis, 1 free tissue necrosis and 1 free tissue partial necrosis occurred in 8 free tissues (6 cases) undergoing conservative treatment; partial necrosis occurred in 1 free tissue of 4 free tissues (4 cases) undergoing surgical exploration. Free flap and skin graft were performed on 2 free tissues of 4 cases having flap necrosis respectively. Conclusion: Vascular crisis is complex and harmful to survival of transplanted tissue in reconstruction of the thumb and other fingers. Immediate intervention is helpful to obtain a higher survival rate.

The application of strengthened night nursing to the prevent of vascular crisis in patients after finger replantation / 中国实用护理杂志

Objective To investigate application effect of strengthened night nursing to the prevent of vascular crisis in patients after finger replantation. Methods A total of 155 patients with finger replantation in Hand surgery from February 2014 to February 2016 were selected as research object, 90 cases from March 2015 to February 2016 with strengthened night nursing were as the observation group,65 cases from February 2014 to February 2015 with routine nursing were as the control group. The two groups were compared of limb replantation success rate, vascular crisis rate and nursing satisfaction. Results The replantation success rate in the observation group was 90.00%(81/90)higher than 76.92%(50/65)in the control group,the occurrence of vascular crisis rate was 11.11%(10/90)lower than 27.69%(18/65)in the control group,the success rate was 7/10 higher than 10/18 in the control group, and the difference was statistically significant (χ2=4.932, 7.013, 4.216, all P<0.05). The nursing satisfaction in the observation group was (94.32 ± 3.57) points, 93.33%(84/90) higher than (91.22 ± 4.48) points, 83.08%(54/65) in the control group, and the difference was statistically significant (t=4.789, χ2=4.071, P<0.05). Conclusions Strengthened night nursing can effectively prevent vascular crisis in patients after finger replantation,improve nursing satisfaction of patients.

Risk factors of free flap necrosis: Multivariate Logistic regression analysis / 中华显微外科杂志

Objective To explore the related factors with skin flap necrosis,we concluded the cases of patients with skin defects after free flap plantation.Methods From 2001 to 2016,188 cases about 20 influencing factors were analyzed (The characteristics of patients:age,sex,smoke,diabetes,high blood pressure;Preoperative factors:injured sections,injured causes,preoperative wound infection,preoperative wound osteomyelitis,the time from injury to operation;Intraoperative factors:operator,operation time,anesthesia time,intraoperative rehydration fluids,the way of vascular anastomosis,the number of venous anastomosis,the area of flap;Postoperative factors:flap hematoma,flap infection,vascular crisis) and multivariate logistic regression analysis was used to analyze the relationship between these risk factors and flap necrosis.Results All 188 cases were treated with free anterolateral thigh flap to repair soft tissue defect and it was revealed that the 174 cases were successful (92.55％) and 23 cases were occured vascular crisis (12.23％),8 cases were arterial crisis,11 cases were vein crisis,4 cases were ateriovenous crisis.After the treatment,the rescue was successful in 5 cases (38.46％).After the analysis we made the conclusion that the number of venous anastomoses,flap hematoma and vascular crisis were related with the skin flap necrosis.Conclusion The number of venous anastomose (≥2) will increase blood return to make the flap easier to survive.Intraoperative stanching and drainage tube placement work will reduce the skin flap hematoma as a result of reducing the skin flap necrosis.Artery and venous crisis handled in time,can enhance the survival rate of flap.

Clinical observation of Shangke Huangshui Gauze on preventing vascular crisis after digital replantation / 中成药

AIM To investigate the preventive effects of Shangke Huangshui Gauze (Scutellariae Radix,Coptidis Rhizoma,Phellodendri chinensis Cortex,etc.) on vascular crisis after digital replantation.METHODS Sixty-eight cases of patients with amputated digits meeting the inclusion criteria were randomly divided into observation group (36 cases with 57 fingers) and control group (32 cases with 54 fingers),the former was wet-dressed with Shangke Huangshui Gauze,the latter was bandaged with sterile dry gauze.The observation and comparison were made between the two groups on four coagulation indexes,visual analog scores (VAS),improvement of swelling degrees,the occurrence rates and survival rates of vascular crisis after operation,together with the evaluation of efficacy and adverse reaction.RESULTS In the observation group,the 7th day after operation,the prothrombin time,activated partial thromboplastin time,international normalized ratio,thrombin time and swelling improvement rate were higher than those in the control group;but the fibrinogen and postoperative 4 days' VAS pain score were lower than those in the control group.The incidence rates of vascular crisis and adverse reaction in the observation group were lower than those in the control group,and the survival rate of replanted fingers was higher than that in the control group.CONCLUSION Shangke Huangshui Gauze can prevent the occurrence of vascular crisis after digital replantation to a certain extent without obvious adverse reaction.

Effect of dexmedetomidine combined with sufentanil on postoperative analgesia and the vascular crisis in patients undergoing free flap transplantation / 中国医师进修杂志

Objective To investigate the effect of dexmedetomidine combined with sufentanil on postoperative analgesia and the vascular crisis in patients undergoing free flap transplantation. Methods Forty patients with ASA physical statusⅠ-Ⅱhaving underwent free flap transplantation were divided into groupⅠand groupⅡaccording to the random digits table method with 20 cases each. The drugs of patient controlled intravenous analgesia (PCIA) in groupⅠwere sufentanil 1.0μg/(kg·d)+tropisetron 5 mg/100 ml, and the drugs of PCIA in group Ⅱ were sufentanil 1.0 μg/(kg · d) +dexmedetomidine 1.0 μg/(kg · d) + tropisetron 5 mg/100 ml. The PCIA pump was set in 2 groups as follows: continuous perfusion rate 2 ml/h, single bolus 2 ml, lockout time 15 min. The visual analogue score (VAS), Ramsay sedation score, press number of PCIA pump within 48 h after operation, satisfaction score after operation, untoward reaction and vascular crisis were recorded. Results The VAS at 6, 12, 24 and 48 h after operation in group Ⅱ were significantly lower than those in group Ⅰ: (2.18 ± 0.41) scores vs. (3.00 ± 0.63) scores, (2.64 ± 0.51) scores vs. (3.82 ± 0.60) scores, (2.55 ± 0.52) scores vs. (3.36 ± 0.51) scores and (2.27 ± 0.47) scores vs. (3.09 ± 0.70) scores, the Ramsay sedation scores were significantly higher than those in group Ⅰ: (2.42 ± 0.51) scores vs. (2.00 ± 0.58) scores, (2.74 ± 0.45) scores vs. (2.11 ± 0.57) scores, (2.58 ± 0.51) scores vs. (2.05 ± 0.52) scores and (2.53 ± 0.51) scores vs. (2.00 ± 0.47) scores, and there were statistical differences (P0.05). Conclusions Dexmedetomidine can relieve anxiety and nervousness, reduce postoperative consumption of sufentanil, and decrease the incidence of nausea and vomiting. In addition, dexmedetomidine does not affect the incidence of vascular crisis.

The reason of skin flap necrosis caused by vascular crisis of reverse island flap of forearm posterior interosseous artery / 中华显微外科杂志

Objective To discuss the reason of skin flap necrosis caused by vascular crisis of reverse island flap of forearm posterior interosseous artery.Methods Eight-six patients who were underwent reverse island flap of forearm interosseous posterior artery for deep tissues and skin defect on the back of hand between March,2002 and April,2014 were analyzed in this study.Eleven patients had occurred skin flap necrosis,include 5 cases had completely flap necrosis caused by circulation crisis,and 6 cases had partial necrosis at the distal of the flap.Among the necrosis cases,5 cases were injured by the machine injury,4 cases by the heavy crush and 2 cases by the traffic accident.The cause of circulation crisis was analyzed.Results In the series,75 skin flaps survived completely and 11 cases had occurred necrosis,included completely necrosis with 5 cases.The reasons of flap crisis were as follows:for the completely necrosis,2 cases with variation of perforating branch of posterior interosseous artery,1 case with absence of posterior interosseous artery,1 case with vessel pedicel entrapment in subcutaneous tunnel,and 1 case with misconduct venous congestion caused by the reverse perfusion of superficial vein.The reason of circulation crisis of completely necrosis were as follows:2 cases with artery crisis and 3 of them with distortion of entrapment at pedicel and vein crisis.One case was cured through debridement,change of medical prescription and skin grafting;and 4 cases were cured with other flap repair technique.For the partial necrosis,2 cases with variation of perforating branch of posterior interosseous artery,1 case with excessively narrow entrapment at pedicel in subcutaneous tunnel,1 case with folding vessel pedicel entrapment of skin at the back of wrist,1 case with misconduct of superficial vein trunk and 1 case with intraoperative side-injury.The symptoms of circulation crisis of completely necrosis were as follows:2 cases with artery crisis and 4 of them with distortion of entrapment at pedicel and vein crisis.Four cases were cured through debridement and skin grafting,1 case was cured by the vacuum-sealing drainage (VSD) and 1 case with skin flap repair at pedicle of abdomen.Conclusion The anatomic variation of perforator vessel of reverse island flap of forearm posterior interosseous artery;narrow entrapment at pedicel in subcutaneous tunnel and distortion of entrapment at pedicel;venous congestion caused by the reverse perfusion of superficial vein;intraoperative side-injury of the pedicel of the flap;excessively folding vessel pedicel entrapment of skin at the back of wrist after surgery will cause the circulation crisis of reverse island flap of forearm posterior interosseous artery and induce the necrosis of the skin flap.

Effect of auricular seeds pressing on postoperative vascular crisis for patients undergoing replantation of severed fingers / 中国实用护理杂志

Objective To find ways to reduce vascular crisis of the patients undergoing replantation of severed fingers by pain, adverse analgesics and sleep quality with auricular seeds pressing. Methods 310 digital replantation patients were divided into 2 groups according to admission time. There were 155 cases in the traditional group treated with routine postoperative care ,while 155 cases in the controlled group treated with routine postoperative care plus auricular seeds pressing. Results The scores of pain, adverse analgesics and sleep quality in two groups were statistically significant ( P<0.05). The rate of vascular crisis of the traditional group [18.06%(28/155)] was much more higher than the controlled group [5.16%(8/155)], the difference was significant, χ2=12.571, P < 0.01. Conclusion In digital replantation, auricular seeds pressing was effective to pain relieving, constipation and reduce adverse reactions, and could significantly improve sleeping time and survival rate of the severed fingers.

The pedicle modification of grafting in free flap which use medial-lower-leg-flap with a healthy limb cross-leg bridging thoracic umbilical flap / 中华显微外科杂志

Objective To investigate the methods and effects of the pedicle modification in free flap which use medial-lower-leg-flap with a healthy limb cross-leg bridging thoracic umbilical flap.Methods From June 2006 to June 2010,twenty-eight cases with a large area of soft tissue defects caused by severe trauma were included in this study.We used The flap was used to repair the wound,the pedicle of the flap was improved which was designed by medial lower leg flap with a healthy limb cross-leg bridging thoracic umbilical flap:thoracic umbilical flap carrying the cross midline side flap.Medial lower leg flap in tongue cutting out and carrying on the medial malleolus perforator.In the processing of bridge-pedicled,we rolled the proximal porting of cross-leg flap,used medial malleolus perforator flap as a posterior wall and used thoracic umbilical flap carrying the cross midline lateral flap as anterior wall.Two portions formed a combined percutaneous tube.The two tile formmed a combined percutaneous tube.Fixing method for operation adopted external fixator which two legs were paralleling.Observation of postoperative flap survival situation,shape,color,elastic,scar contracture,and dysfunction.Results Twenty-eight cases of postoperative all flaps survived.Vascular crisis was appeared in 2 cases after 8 hours.Upon examination that was low blood pressure,low hematocrit.In treatment of transfusion and infusion,crisis mitigated.In 1 case after 12 hours with pain occurred arterial crisis,which was reliefed with analgesia.There were no vascular crisis in other 26 cases.Followed up for 2-20 months,flap had good blood supply,color and good elasticity.The appearance was not bloated and sensory recoverred partly.There was no apparent stiffness in double knee,ankle joint.Conclusion Medial lower leg flap with a healthy limb cross-leg bridging thoracic free flap transplantation for repairing serious soft tissue defects of the leg is clinically proven good means.Based on the improvement of pedicle,it can reduce the risk and complications.At the same time,it can improve the postoperative nursing care effects.It is worthy of popularization and application.

A correlative study of ultrashortwave therapy affecting survival of rat tail replantation / 中华显微外科杂志

Objective To research the effect mechanism of ultrashortwave in the correlation of ultrashortwave and the tail replantation, provide the experiment basis of clinical practice of prevention and cure for the vascular crisis after micromodule anastomosis. Methods Eighty Sprague-Dawley(SD) rats of clean grade were 3-month-old,female,and were divided into four groups:control group (group 0),model group (group 1 ),contrast group (group 2),ultrashortwave (USW) group (group 3).The preparation of tail replantation model was cut off soft tissue except for caudal veins on both sides of the tail. The coccyx was not broken away from tail.At last,the audal artery under abdominal main centre ditch was anastomosed.In experiment process, the USW group was divided into high dosage group (group 3A) and low dosage group (group 3B). The caudal arterys were ligated and not anastomosed in the group 0. Caudal arterys in other groups were anastomosed.Rats in the group 0 and group 1 received no treatment,normal management after the operation. Rats in the group 2 were given abdominal cavity injection of papaverin liquid immediately,then once a day to 5 days after the tail replantation.Rats in the group 3 were immediately given USW therapy of twenty minutes on the anastomosis section,and then once a day for 5 days after the tail replantation.The USW dosage of group 3A was 3th grade and 50mA. The USW dosage of group 3B was 2th grade and 28mA.The survival rate of the rat tails was observed after the tail replantation for 10 day.Before being grouped,it was measured that the tail skin temperature diference between near and far side of anastomosis section.After the tail relpantation, the temperature diference was inspected daily for 10 postoperative days hence. Before rats were grouped and the eighth hour after the tail replantation, rats were collected blood plasma specimens and measured contents of nitric oxide with destination colorimetric mathods of nitric oxide.Results Carrying out comparison of survival rate of every group,the output weve:between tail cutting off group (group 0,0) and tail replantation group (group 1,2,3,43.94％) to compare P ＞ 0.05; between each group of the tail replantation groups (1,2,3A,3B group) to compare P＞ 0.05,group 3B ＜ 2 ＜ 1 ＜ 3A; between group 3B and group 1 to compare P ＞ 0.05; between group 2 and group 1 to compare P ＞ 0.05. Each group were compared with the change daily between postoperative and preceding operative the skin temperature diference,single-factor analysis of variance (One-Way ANOVA) analysis:Postoperative 1 day,group 3A ＜ 1,P ＜ 0.05.Postoperative 6 day:3A ＜ 3B ＜ 1 ＜ 2,P ＞ 0.05.Postoperative 7 day:group 3B ＜ 1 ＜ 3A ＜ 2,P ＜ 0.05.Each group were compared with the change of the content of nitric oxide between postoperative 8 hour and preceding operative,with rank-sum test:group 3B ＞ 3A ＞ 2 ＞ 1 ＞ 0,H =33.760,P ＜ 0.05,shows statistically significant.Conclusions USW therapy,especially USW low-dose therapy,can reduce vascular crisis and improve the survival rate of replanted rat tails,after the postoperative 1,6,7 days,reduce skin temperature,improve blood supply,improve nitric oxide at postoperative eighth hour,prevent vascular crisis.Rat tail replantation model in this experiment is feasible.

Negative Emotion and Psychological Intervention after Digit Replantation / 中国康复理论与实践

@#Patients replanted severed finger generally have negative emotion after operation. Negative mood could induce vascular crisis and reduce survival of replanting finger. This paper reviewed the studies on negative emotion and psychological intervention in patients after digit replantation in various stages post-operation, and prospected the future.