Objective To investigate the outcome of repairing hand composite defects using pedicle osteocutaneous groin flap. Methods From February 1998 to May 2004, 33 cases of hand composite defects were repaired with pedicle osteocutaneous groin flap. There were 22 males and 11 females. The age was 19 to 54 years with an average of 243 years. The defect was caused by palmar penetrating injury in 17 cases, by dorsal hand crushing injury in 9 cases and by other injury in 7 cases. Twentythree cases complicated by metacarpal defect, 10 by phalanx defect. Thesize of skin defect was 3.5 cm×2.0 cm to 15.0 cm×10.0 cm, the size of bonedefect was 1.5 to 3.5 cm. After 3 to 7 days of primary debridement, defect was repaired by the pedicle osteocutaneous groin flap based on the superficial circumflex iliac vessels. The flap size was 4.0 cm×2.5 cm to 17.0 cm×11.0 cm. Results All the osteocutaneous flaps survived. During the 4 to 22 months follow-up postoperatively, thetexture, appearance and function of the flap were excellent and bone union was obtained in all cases after 7 to 9 weeks of operation.Conclusion The pedicle osteocutaneous groin flap is an ideal flap to repair the composite defect of the hand, with the benefit of simple procedure and reliable blood supply.
Objective To summarize the operation opportunity and recovery effect of pedicle skin flap of subdermal vascular plexus on repairing theraw surface of hand injury. Methods From January 1999 to June 2004, the thoracic or abdominal pedicle skin flap of subdermal vascular plexus was used to repair the raw surface of hand with defect of skin and soft tissue in 22 patients with hand injury. 17 cases were males, 5 cases were females, the ages ranged from 9 to 42. Thecauses of hand injuryincluding avulsed wound in 12 cases, mangled injury in 2 cases, hot crush injury in 5 cases, electric burn in 3 cases; 13 cases needed emergency operation, 9 cases needed operation in 3 to 7 days. The thoracic or lower abdominal flap was selected depending on the raw surface of hand injury. Subcutaneous fat was trimmed and retained the thickness of 2 to 4 mm. The skin flap was designed into 2 to 3 leaves to form several pedicle skin flap of subdermal vascular plexus, which were used to repair defect of skin and soft tissue of several fingers. The defect site of skin and soft tissue of hand were put into flap.Results A little of skin flap in distal end became necrosis in 1 case after operation, but recovered fully after changing dressing to the raw surface. The rest of the flaps all survived. Followup was conducted 3 months to 2 years.The pedicle skin flap was living,the skin of the recipient site was smooth and integrated, color and luster was satisfactory and texture was soft.The disrupted pedicle skin flap needed no trimming. The hand function was significantly recovered. Conclusion To repair the defect of skin andsoft tissue in the hand injury by using thoracic or lower abdominal pedicle skin flap of subdermal vascular plexus has the forte of shorter course of treatment and better functional recovery and good outlook. It is one of the ideals for repairing the hand injury with defect of skin and soft tissue.
From jan.1984 through dec.1991,65 cases of hand skin defects were primarily repaired by podicled groin flap. Four of the 65 cases had skin defects on both sides of the palms and dorsal aspot of the hands which were treated by the Y-shaped hypogastric groin flap .Five easec had thumb loss in which the lxdicled groin tubed flap was used to reconstruct the thumb.The time of division of the pedicles ranged from 14 to 28 days(averaged 16 days).All flape survived after division of the podicl...
Objective To summarize the clinical experiences of various types of the second dorsal metacarpal artery (SDMA) flap for hand reconstruction. Methods From 1988 to 2003, 139 SDMA flaps were transferred for hand injuries. The flaps were used in 5 types according to vascularization and technique in transplantation:orthograde pedicled island SDMA flaps in 37 cases (cutaneous in 24and teno-cutaneous in 13), retrograde pedicled island SDMA flaps in 25 cases(cutaneous in 19 and teno-cutaneous in 6),double pivot SDMA flaps in 36 cases(cutaneous in 28 and teno-cutaneous in 8), distal perforator branch pedicledflaps in 19cases (cutaneous in 16 and composite in 3), free SDMA flaps in 22 cases (cutaneous in 15 and composite in 7). The skin islands were 3.0 cm×1.5 cm to 6.3 cm×5.0 cm in size. Results Of the 139 flaps, 135 flaps survived completely, 3 survived partially, and1 failed in the operation because of intractable vascular spasm. Follow-up wasdone in 116 cases for 12 to 57 months. The flap had good texture and color match. The twopoint discrimination was 5 to 9 mm in 78 sensate flaps, while it was 10 to 15 mm in 38 nonsensate flaps. In 21 tenocutaneous flaps, the TAM score of range of motion was 60% to 70% of the healthy side. Conclusion The SDMA flap has a constant and reliable vessel and a thin, pliable, and good-quality skin. It is versatile in creatingcomposite flaps. It is a good flap resource for hand and finger reconstruction.
Objective To share the experience of the diagnosis and treatment of children with hand-foot-mouth disease. Methods We retrospectively analyzed 31 children with hand-foot-mouth disease in our hospital from April 2007 to June 2007 in terms of epidemiology, clinical features, treatment and prognosis. Results The average age of the children was 2.8 years, and 20 out of the 31 cases were from nurseries and kindergartens. Eighteen had clear contact history. Typical signs and symptoms, including oral ulcerative herpes and blister-like rash in extremities, were found in all cases. All the children were cured after timely diagnosis and early treatment with ribavirin, without any severe complications. Conclusion Timely treatment based on early diagnosis and considerate care are important for children with hand-foot-mouth disease. Nurseries, kindergartens and primary schools should attach great importance to relevant prophylaxis and isolation. These are essential for reducing the occurrence and prevalence of this disease.
ObjectiveTo explore feasibility and advantages of hand-assisted laparoscopic radical resection for remnant gastric cancer.
MethodsThe clinical data of 26 patients with remnant gastric cancer who underwent hand-assisted laparoscopic (hand-assisted group, n=13) or open (open group, n=13) radical resection from December 2007 to May 2016 in this hospital were retrospectively analyzed. The perioperative outcomes were compared between these two groups.
ResultsThere was no conversion to open surgery in the hand-assisted group. Compared with the open group, the incision length was significantly reduced (P=0.000), the intraoperative blood loss was significantly decreased (P=0.038), postoperative the first anal exhaust time was significantly shortened (P=0.025) in the hand-assisted group. The operation time, the number of lymph nodes dissection, and the incidence of postoperative complications had no statistically significant differences between these two groups (P>0.05).
ConclusionThe preliminary results of limited cases in this study show that hand-assisted laparoscopic radical resection for remnant gastric cancer is safe and feasible, it has several advantages including small incisions, mild intraoperative hemorrhage, rapid postoperative recovery, better recent clinical therapeutic outcome and so on as compared with open surgery.
Objective To evaluate the clinical application of hand assisted laparoscopic radical surgery for gastric cancer. Methods From June 2010 to September 2011，a series of 51 patients were undertook hand assisted laparoscopic D2 gastrectomy （hand assisted group），49 patients were undertook laparoscopic assisted D2 gastrectomy （laparoscopic group），the secure indexes of surgery effect in perioperative period were compared betwee two groups. Results The incision length was （6.82±0.33） cm and （5.74±1.11） cm （t=6.57，P=0.00），numbers of harvested lymph nodes were 16.10±5.11 and 14.16±3.60 （t=2.18，P=0.03），intraoperative bleeding was （249.40±123.40） ml and （251.00±90.40） ml （t=-0.74，P=0.94），operation time was （177.7±23.8） min and （188.1±16.9） min （t=-2.53，P=0.01），postoperative hospital stay was （11.12±5.02） d and （10.88±3.13） d （t=0.29，P=0.78） in the hand assisted group and in the laparoscopic group，respectively. One case of gastric atony happened in the hand assisted group，one case of gastric atony and incision infection happened in the laparoscopic group. No mortality case was found in two groups. Conclusions Hand assisted laparoscopic D2 gastrectomy is less difficult，and shorter operation time，and considerable treatment effection as compared with laparoscopic operation.
ObjectiveTo study the effectiveness of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle in the treatment of severe cubital tunnel syndrome.
MethodsBetween March 2006 and May 2015, 22 cases (23 hands) of severe cubital tunnel syndrome were treated by use of anterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle. There were 15 males and 7 females, aged 45-60 years (mean, 55 years). The causes were valgus deformity of elbow joint in 12 cases, ulnar nerve subluxation in 4 cases, and osteoarthritis in 6 cases. The disease duration was 10 months to 3 years (mean, 17 months). According to Akahori classification, 14 cases were rated as type 4 and 9 cases as type 5. The ring/little finger's numbness, hand intrinsic muscle atrophy, recovery of thumb adduction function, and improvement of claw hand deformity were observed after operation. Thumb and index finger's pinch strength was measured by use of pinch device; postoperative hand function was evaluated by the standards of Chinese Medical Society of Hand Surgery of upper limb assessment protocol.
ResultsAll incisions healed well and all cases were successfully followed up 8 to 24 months (mean, 14 months). Numbness of ring/little finger was significantly reduced at 1 day after operation in 10 hands; numbness disappeared completely at 1 month after operation in 12 hands; mild numbness remained at 14 months after operation in 11 hands. At last follow-up, hand intrinsic muscle atrophy partially improved (+++) in 1 hand, no improvement in 22 hands; improvement of claw hand deformity was achieved in 17 hands, no improvement in 6 hands; pinch strength of thumb and index finger was significantly improved to (5.07±1.11) kg from preoperative (2.91±0.63) kg (t=-12.340, P=0.032). At last follow-up, the results were excellent in 11 hands, good in 8 hands, fair in 3 hands, and poor in 1 hand, and the excellent and good rate was 82.6%.
ConclusionAnterior subcutaneous transposition of ulnar nerve with reconstruction of hand intrinsic muscle is a simple, effective, and reliable surgical treatment for severe cubital tunnel syndrome.
A series of 28 cases of fractures of the small tubular bones of the hand, including Bennetts fracture, were treated with the minor unilateral multifunctional external fixator. After manipulation, a hole was drilled on the proximal and distal parts of the fractured bone. Hand in functional position, the external fixator was set in place. Functional exercises were begun after the fixation. The patients were follwed up for two to six months. The average healing time was thirtyfive days. The average healing time for Bennett’s fractures was twentyeight days, and for the fractures of metacarpal bone was forty-two days. There were no deformity and complication of infection following external fixation.The functional recovery of the hands was satisfactory. The fixator had the following advantages: It was simple and had tight fixation; fractures with infection, was still indicated and could be adjusted according to the clinical purpose.
Objective To survey the knowledge of hand hygiene among nurses and to identify factors influencing the performance of hand hygiene.Methods A questionnaire of hand hygiene developed according to the Guideline for Hand Hygiene in Health Care Settings was used to investigate nurses’ knowledge about hand hygiene.Results The average score for nurses’ knowledge about hand hygiene was 18.59±2.19 out of a possible maximum score of 21. Knowledge about hand hygiene among nurses varied significantly in different departments (P=0.004). The main self-reported factors influencing the performance of hand hygiene were irritation and dryness caused by hand-washing agents (73.44%) and busy workload (65.53%).Conclusions Nurses generally have good knowledge about hand hygiene but are less aware of some hand hygiene indications. Effective measures are needed to improve compliance with hand hygiene among nurses.
