From 1984 to 1994, 236 different types of traumatic defects of foot were repaired by microsurgical tissue grafting. They included simple cutaneous flap in 187 and composite flap in 49. Among the 236 different tissue flaps, vascularized flap was used in 97 and pedicled flap in 139. The 4 fore-foot and 6 heel defects were repaired by composite skeleted cutaneous grafts with scapula and vascularized febula respectively. After the follow-up from 1 to 10 years, all the grafted tissues were survived and healed well. The functions were satisfactory, and 186 patients had resumed their original works. The key to good function following repair was to maintaion the integrity of foot structures and the sensation of the sole and heel.
Objective To investigate the benefits of using a stapler tractor in the treatment of segmental bronchus during lung segmentectomy through detailed video replay analysis of surgical procedures. Methods We collected data from patients who underwent segmentectomy performed by the same surgical team in the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, from November 2020 to August 2023. After excluding data that lacked analysis parameters, the remaining patients were divided into four groups based on the methods used for dissociating segmental bronchus: a stapler tractor group (group A), a stapler with bronchial stretching group (group B), a stapler only group (group C), and a silk ligature group (group D). Then, we compared baseline data and videotaped surgical details across all groups. Surgical details included the success rate of one-time segmental bronchus dissociation and severance, the time taken for successful one-time dissociation and severance of the segmental bronchus, the incidence of bleeding during bronchus dissociation, the conversion rate to thoracotomy during surgery, and surgical outcomes such as total operative time, postoperative hospitalization days, postoperative thoracic drainage volume, and pulmonary air leakage rate. Results The study included 325 patients (203 in the group A, 62 in the group B, 29 in the group C, and 31 in the group D). There was no statistically significant difference in baseline data among the four groups. However, significant differences were found in terms of total operation time, postoperative hospitalization days, intraoperative blood loss, segmental bronchial stump length, postoperative air leakage rate, hemorrhage rate during segmental bronchial dissociation, and conversion to thoracotomy rate among the four groups (P<0.05). ConclusionUsing a stapler tractor for dissociating segmental bronchus in lung segmentectomy results in shorter operative time, less risk of intraoperative bleeding, and less surgical complications. This study provides valuable evaluation methodologies through the analysis of video replay surgical details, contributing to the improvement of lung segmentectomy quality.
Seventeen cases involving 18 fingers of acute rupture of flexor tendon within the Zone Ⅱ were repaired by microsurgical technique for reconstructing the digital sheath with biological membrane since 1989. The excellent/good rate based on Eaton grading was 89%. The main procedure of the operation. the early postoperative rehabilitation and active excercises were described.
ObjectiveTo explore the technique of hepatic artery reconstruction in complicated hilar cholangiocarcinoma surgery. MethodThe clinicopathologic data of 3 patients with complicated hilar cholangiocarcinoma with arterial invasion underwent hepatic artery reconstruction in the Department of Hepatopancreatobiliary Center of Beijing Tsinghua Changgung Hospital from March to July 2022 were retrospectively analyzed. ResultsAll 3 patients (case 1–3) were the males, aged 53, 68, and 56 years, respectively, and with hypertension or diabetes; the longitudinal diameters of the tumor were 3.5 cm, 3.0 cm, and 3.2 cm, respectively. All patients had the right hepatic artery invasion. Case 2 and 3 had the arterial stratification. The arterial defects after radical resection were 4.5 cm, 3 cm, and 3 cm, respectively. The right or right posterior hepatic artery was reconstructed by the autotransplantation of right gastroomental artery, the left hepatic artery, and the anterior superior pancreaticoduodenal artery, respectively. After operation, the reconstructed hepatic arteries were unobstructed and free of stenosis, and there were no complications such as bleeding, infection, and thrombosis by Doppler ultrasound and CT angiography. The results of postoperative pathological diagnosis were the hilar cholangiocarcinoma with arterial invasion, and all the incisal edges were negative. ConclusionFrom the preliminary results of 3 cases, it is safe, feasible, and effective to select proper autologous artery (matched in length and caliber) for reconstruction the defective invaded hepatic artery which resected together with hilar cholangiocarcinoma, but the technical difficulty is still relatively high.
Objective To summarize the current management of anterior cruciate ligament (ACL) injury in children and adolescents, in order to provide reference for the management of ACL injury in children and adolescents. MethodsThe relevant literature at home and abroad in recent years was extensively accessed to summarize the management status of ACL injury in children and adolescent. Results The number of ACL injury in children and adolescents is increasing every year. The diagnosis of ACL mainly depends on symptoms and signs. Rehabilitation, physeal-sparing techniques, partial transphyseal techniques, all-epiphyseal techniques, and transphyseal techniques are used to treat ACL injury in children and adolescents. Conclusion Dynamic monitoring of knee joint in children and adolescents should be strengthened. The best treatment for ACL injury in children and adolescents is selected according to the patients’ actual age, bone age, Tanner stage, and physiological conditions such as menstruation, body growth speed, and other characteristics.
Objective To evaluate the surgical method and the results of endoscopic decompression and anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome. Methods Between May 2008 and August 2009, 13 cases of cubital tunnel syndrome were treated with endoscopic decompression and anterior transposition of the ulnar nerve. There were 4 males and 9 females with an average age of 47.5 years (range, 32-60 years). The injury was caused by fractures of the humeral medial condyle in 1 case, by long working in elbow flexion position with no obvious injury in 10 cases, and subluxafion of ulnar nerve in 2 cases. The locations were the left side in 6 cases and the right side in 7 cases. The disease duration was 4-30 months. The time from onset to operation was 3-20 months (mean, 8.5 months). Ten patients compl icated by intrinsic muscle atrophy. Results The operation was successfully performed in 13 cases, and the operation time was 45-60 minutes. All the wounds gained primary heal ing. All patients were followed up 12-18 months (mean, 14 months). The numbness of ring finger, l ittle finger, and the ulnar side of hand were decreased obviously on the first day after operation. The examination of electromyogram showed that the ulnar nerve conduction increased at 2 weeks, the ampl itude was improved, and recruitment of the intrinsic muscles of hand enhanced. In 10 cases compl icated by intrinsic muscle atrophy, myodynamia was recovered to the normal in 7 cases and was mostly recovered in 3 cases at 3 months after operation. The symptom of cubital tunnel syndrome disappeared and gained a normal function at 12 months after operation. According to the assessment of Chinese Medical Association and Lascar et al. grading criteria, the cl inical results were excellent in 10 cases and good in 3; the excellent and good rate was 100%. Patients recovered to work 12-16 days (mean, 14 days) after operation. No recurrence occurred during followup. Conclusion The surgical method of endoscope and microscope assisted three small incisions for treatment cubital tunnel syndrome has less invasion with small incision and complete decompression. Patients can recover to work early. It is a convenient and efficient procedure for treating cubital tunnel syndrome.
ObjectiveTo study the effectiveness of Keystone flap in the repair of soft tissue defect of lower extremity.MethodsThe clinical data of 27 cases with soft tissue defects of lower extremity treated by Keystone flap between January 2018 and June 2020 were retrospectively analyzed. There were 18 males and 9 females, with an average age of 43.9 years (range, 8-63 years). The cause of soft tissue defects included skin tumor in 3 cases, ulcer in 2 cases, soft-tissue infection in 8 cases, trauma in 7 cases, and donor site defect after free or pedicled flap transplantation in 7 cases. Defect size ranged from 2.0 cm×1.5 cm to 15.0 cm×9.5 cm. The types of Keystone flaps included type Ⅰ in 2 cases, type Ⅱa in 16 cases, type Ⅱb in 1 case, type Ⅲ in 6 cases, and Moncrieff modified type in 2 cases. The area of flap ranged from 3.0 cm×1.5 cm to 20.0 cm×10.0 cm. The donor site was directly sutured (26 cases) or repaired with skin grafting (1 case).ResultsThe operation time was 45-100 minutes, with an average of 67.5 minutes; the hospitalization stay was 3-12 days, with an average of 8.5 days. Postoperative incision dehiscence occurred in 1 case, and flap marginal necrosis occurred in 2 cases, all of which were completely healed after dressing change; 1 case of incision was swollen and congested with tension blisters, which resolved spontaneously at 7 days after operation. The other flaps and the skin grafting survived and healed successfully, the wounds of recipient and donor sites healed by first intention. The healing time was 2-3 weeks (mean, 2.2 weeks). No pain occurred in all patients. All 27 cases were followed up 3-26 months (mean, 11.5 months). No obvious scar contracture and bloated skin flap were found. The texture and color of the skin in the recipient area were similar to those of the surrounding tissues and feel existed.ConclusionThe Keystone flap is a feasible and efficient way to repair soft tissue defect of lower extremity. Furthermore, the skin color and texture is similar to the surrounding tissue after healing.
Severe hallux valgus, a triplanar foot deformity significantly impairing patients’ quality of life, has witnessed progressive advancements in surgical management. This article systematically reviews the therapeutic progress through literature analysis, encompassing modifications of conventional surgical procedures and applications of novel techniques and innovative biomaterials. A critical analysis and discussion of these technological advancements and future developmental directions are presented to provide valuable insights and references for clinical management of severe hallux valgus.
Objective To investigate the management strategies of external fixation combined with microsurgical techniques for repairing complex foot and ankle wounds in children. MethodsThe clinical data of 9 children with complex foot and ankle wounds who met the selection criteria between June 2017 and December 2021 was retrospectively analyzed. There were 6 boys and 3 girls, aged 3-13 years, with an average of 7.4 years. The causes of injury included crush injury in 5 cases and traffic accident injury in 4 cases. The wound size ranged from 6 cm×5 cm to 25 cm×18 cm. The time from injury to surgery ranged from 3 to 8 hours, with an average of 5 hours. All cases underwent staged surgical treatment. Among the 3 cases requiring deformity correction, 2 cases initially underwent free anterolateral thigh flap transplantation for wound coverage and limb salvage, followed by circular external fixation combined with osteotomy to address postoperative limb deformity, while 1 case received osteotomy for tibial fracture realignment prior to local pedicled flap reconstruction. All the 6 cases with non-deformity correction underwent initial external fixation followed by secondary flap reconstruction for wound management. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the foot and ankle function of children. Results All children successfully achieved limb salvage postoperatively. Among the 6 non-deformity correction cases, all flaps survived with satisfactory wound healing and no infection was observed; fractures healed within 2.5-4.5 months, after which external fixators were removed for functional rehabilitation with favorable recovery. One case treated with circular external fixation combined with osteotomy achieved bone union at 4 months postoperatively, followed by fixator removal. One case undergoing osteotomy for tibial fracture realignment showed bone healing at 2.5 months post-correction, with subsequent fixator removal. One patient receiving bone lengthening developed infection at 1 week postoperatively, which was managed with multiple debridements, ultimately achieving bone union at 16 months postoperatively and followed by fixator removal. At last follow-up, all patients demonstrated satisfactory ankle-hindfoot functional recovery, with AOFAS ankle-hindfoot scores ranging from 80 to 90 (mean, 84.2). Conclusion The combination of external fixation and microsurgical techniques demonstrates significant advantages in reconstructing complex foot and ankle wounds in children. The synergistic interaction provides both mechanical stability and biological repair, enabling early functional rehabilitation while reducing infection risks.
Lung transplantation has developed in China for nearly half a century. The Wuxi lung transplant team completed our first lung transplantation on September 28, 2002. By the year of 2021, the total number of lung transplantation in China has been increased to 775, while 49 medical centers have been qualified to perform lung transplantation. During the past two decades, we vigorously promoted lung transplantation technique, cooperated and communicated with colleagues in relevant specialties. Thus, more and more patients with end-stage lung diseases could be evaluated and transplanted to save their lives, with the support of medical insurance and funds. The full-process monitoring and staged objective management, have been well established regarding to donor evaluation standards and acquisition procedures, the green channel for organ transportation, postoperative intensive care unit management, prevention of rejection and infection, as well as long-term follow-up of recipients. Based on the classical lung transplantation surgical techniques, technical breakthroughs have been made while the public’s acknowledgement of lung transplantation has been also enhanced. In the future, lung transplantation techniques will be increasingly challenged by new technologies and ethics, bringing diversified opportunities and challenges to the lung transplantation team collaboration.
