Objective To assess the efficacy of the extra long scapular-lateral thoracic-il ioinguinal siamese flap to repair the contracture deformity of perineal scar caused by burn and to discuss its characteristics. Methods From January2008 to August 2009, 9 patients with contracture deformity of perineal scar after deep II degree to III degree burn were treated. There were 7 males and 2 females aged from 22 to 54 years (35.4 years on average). The course of disease ranged from 8 months to 5 years. All cases had central type of perineal scar. Among the cases, 3 cases were compl icated by abdominal scar, 4 cases by legs scar, and 2 cases by abdominal and legs scar. Scar ulcer was observed in 2 cases. The opening-closing angle of bilateral lower extremities was (29.4 ± 8.8)°. And anus could not expose entirely so that squatting and rel ieving the bowels were difficult in 6 cases. Defect areas after scar resection ranged from 20 cm × 6 cm to 28 cm × 8 cm. The size of extra long scapular-lateral thoracic-il ioinguinal siamese flap ranged from 35 cm × 12 cm to 58 cm × 15 cm. The donor sites were sutured directly. Results Bl ister and necrosis occurred in 1 case and was cured after dressing changed, and others flaps survived with wounds primary heal ing. Incision at donor site healed by first intention. All cases were followed up 6-12 months. The perineal function improved and the partial deformities were corrected. The opening-closing angle of bilateral lower extremities increased to (75.6 ± 11.3)°, showing significant difference between pre- and post-operation (P lt; 0.05). The functions of squatting and rel ieving the bowels recovered well. The perineal scar adhesion recurred in 2 cases after 6 months of operation and were cured after scar resectionand expanding flaps transposition. Conclusion In view of large donating region, great facil ity for transposition, stableand sufficient blood supply, reutil ization as expanded flap, it was an effective treatment and a beneficial trial by applying the transposition of the extra long scapular-lateral thoracic-il ioinguinal siamese flap for contracture deformity of perineal scar caused by burn.
As an important component of the healthcare system reform, the regional rehabilitation medical alliance aims to integrate medical resources within the region, promote standardization, specialization, and accessibility of rehabilitation medical services, and achieve efficient collaboration and resource sharing among medical institutions at all levels. This article comprehensively and systematically reviews and analyzes the current situation of the construction of regional rehabilitation medical alliance in China. At the same time, combined with the construction practice of West China Airport Hospital of Sichuan University, it summarizes experience and puts forward suggestions, providing a reference for the development of regional rehabilitation medical alliance.
ObjectiveTo summarize the diagnosis and treatment of thoracoomphalopagus conjoined twins according to successful separation of two cases of conjoined twins. MethodsA retrospectives study was performed on two pairs of thoracoomphalopagus twins. One case was omphalopagus with complex congenital heart disease (transposition of the great arteries and single cardiac ventricle), and the other was sternoxiphopagus with single pericardium and complex congenital heart disease (single cardiac ventricle and cardiac atrium). All the two cases of conjoined twins shared the common livers. The separation surgery was performed at one month after birth. Results All the two cases of conjoined twins were successfully separated. These conjoined twins were connected by a liver bridge, and shared a pericardium or had a contact pericardium, respectively. The coloboma of peritoneum, diaphragm， and mediastinum were repaired by Gore-Tex patch. Each patient, to varying degrees, had a wound infection after surgery, and healed by taking out the Gore-Tex, debridement or drainage. The first two infants were discharged on 37 d after operation, but one died of pneumonia after 6 months. The two other infants were discharged on 40 d and 93 d after operation, respectively. ConclusionsDetailed information about the twins’ general and conjoined condition, especially on cardiovascular system and the joined liver, shall be understood by the imagination examinations before the operation. Adequate preoperative preparation, elaborate liver separation and rational reconstruction for thoracic and abdominal wall are the key to successful operation.
At present, the rapid integration and development of internet technology and medical services have made internet diagnosis and treatment an important part of medical services, and it is also an inevitable development trend of future diagnosis and treatment services. In order to meet the needs of patients for more timely, accurate and convenient medical treatment, West China Hospital of Sichuan University has innovated the internet diagnosis and treatment mode, adopted the innovative mode of diversified online services, pre-treatment mode, expert team mode, specialized medical consortium platform and whole process management, optimized medical resources and structure, promoted regional medical association linkage, and improved patients’ medical experience. The West China Internet Hospital of Sichuan University takes the whole process ecological closed-loop of “medical+health” as the goal, has greatly improved the efficiency and quality of diagnosis and treatment, which is of great significance for the positioning and development of internet hospital. This article will share the construction experience of West China Internet Hospital of Sichuan University.
Objective To investigate the effectiveness of the lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries (SIEA) for repairing the large soft tissue defects on the foot and ankle. Methods The clinical data of 18 patients with large soft tissue defects on foot and ankle treated between October 2017 and January 2020 were retrospectively analyzed, including 12 males and 6 females; the age ranged from 25 to 62 years, with a median age of 35 years. The causes of injury included machine injury in 9 cases, traffic accident injury in 5 cases, cutting injury in 2 cases, and electric injury in 2 cases. All wounds were accompanied by exposure of blood vessels, tendons, bones, and joints. Wound located at ankle in 8 cases, dorsum of foot in 6 cases, and sole in 4 cases. In the emergency department, complete debridement (the defect area after debridement was 15 cm×10 cm to 25 cm×16 cm) and vacuum sealing drainage on the wound was performed. The time from debridement to flap repair was 3-10 days, with an average of 5 days. According to the defect location and scope, the lower abdominal conjoined flap with bilateral SIEA was prepared. The size of the flap ranged from 15 cm×10 cm to 25 cm×16 cm. The length of vascular pedicle was 4.5-7.5 cm, with an average of 6.0 cm; the thickness of the flap was 0.5-1.2 cm, with an average of 0.8 cm. The abdominal donor site was closed in one-stage. Results One flap was altered as the conjoined flap with the bilateral superficial circumflex iliac artery because of the absence of the SIEA in one side. Except for 1 case of skin flap with distal necrosis, the flap healed after two-stage skin grafting repair; the rest skin flaps survived, and the wounds of the donor and recipient sites all healed by first intention. All patients were followed up 12-28 months, with an average of 16 months. The skin flap had a satisfactory appearance and soft texture, without abnormal hair growth or obvious pigmentation. Only linear scars were left at the donor site, and no complication such as abdominal hernia occurred. The foot and ankle function was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) scores were rated as excellent in 16 cases and good in 2 cases. Conclusion The lower abdominal conjoined flap with bilateral SIEA is an ideal flap for repairing large defects of foot and ankle with less morbidity scarcely, which ascribed to its ease of dissection, adjustable thinness, and concealed donor site, as well as the flexible perforator match.
The implementation of the medical alliance has promoted the effective integration of medical resources in China. However, with the increase in the demand for rehabilitation medical care, the construction of rehabilitation medical alliance will provide a new strategy for the development of rehabilitation medicine. The rehabilitation medical alliance will promote the subsidence of high-quality rehabilitation resources, enhance the service capacity of grass-roots rehabilitation, and achieve the hierarchical rehabilitation diagnosis and treatment. The rehabilitation medical alliance combines four alliance models to construct a three-tier system, forming a three-level alliance of administration and classification. Regarding rehabilitation clinical pathway, rehabilitation evaluation system, rehabilitation treatment system and the homogenization guarantee of rehabilitation nursing as its main content, intelligent rehabilitation medicine alliance could be established by means of technical means such as artificial intelligence and big data cloud platform.
【摘要】 目的 探讨B型超声检查对联体双胎的诊断价值。 方法 回顾性分析2008年—2010年产前诊断为联体双胎的8例孕妇B型超声声像图资料，总结其声像表现。 结果 对称性联体双胎8例， 其中胸腹部联体6例， 头部联体2例。 结论 产前B型超声检查能为联体双胎的诊断提供重要临床信息，并可做出不同类型的诊断。【Abstract】 Objective To evaluate the value of B-scan ultrasound in diagnosing conjoined twins. Methods Prenatal ultrasound diagnosis of eight cases of conjoined twins from 2008 to 2010 in West China Second University Hospital was retrospectively analyzed, and their ultrasonograhical performances were summarized. Results Eight cases of conjoined twins with symmetry were diagnosed by B-scan ultrasound, including six with thoraco-omphalodidymus, and two with cephalodymus. Conclusion Prenatal ultrasound can provide important information for diagnosis of conjoined twins, and perform differential diagnosis for different types.