The ultra length and width random calf fasciocutaneous flaps whose blood supply came from the calf fasciocutaneous vascular network were transposed in 9 cases for the treatment of severe trauma of leg. All of the flaps survived except one having necrosis of the distal fourth. The length and width of the flap to the width of the pedicle were 6.1∶1 and 2.7∶1 respectively. Properly extended the area and decreased of blood perfusion of the flan would reduce the burden of the venous backflow to the flap relatively. The abundant vascular networks of the calf fasciocutaneous flap was a very important factor that this type of flap would possibly survive.
Objective To study the method and effect of free rectusabdominis muscle flaps with intermediate split thickness skin graft in repairing defects on legs and ankles.Methods From May 1998 to December 2002, 11 cases of defects on legs(2 cases) and on ankles( 9 cases) were repaired by use of unilateral free rectus abdominis flap with skin graft. The soft tissue defects were accompanied by osteomyelitis or the exposure of bone or tendon.The disease course was 1 month to 10 years. The defect size ranged 3 cm×4 cm to 8 cm×14 cm. The area ofrectus abdominis muscle flaps was 4 cm×6 cm to 8 cm×15 cm. Results All patients were followed up 6 months to 4 years after operation. All rectusabdominis flaps survived with good appearances and functions.The primary healing was achieved in 8 cases, intermediate split thickness skin graft necrosed in 3 cases and the wound healed after skin re-graft.Conclusion Free rectus abdominis flap is a proper option for repair of the soft tissue defects or irregular woundson legs and ankles. It has the advantages of abundant blood supply, b anti-infection ability, good compliance and satisfied appearance.
ObjectiveTo analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.MethodsThe data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.ResultsA 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.ConclusionsLegionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.
OBJECTIVE In order to increase the survival area of pedicled fasciocutaneous flap, a multiple pedicled blocking randomized fasciocutaneous flap was designed. METHODS From January 1991 to September 1998, this technique was used to repair 33 cases, including 27 males and 6 females and the ages ranged from 6 to 58 years. All of the patients were suffered from traffic accidents. In these cases, 22 cases had skin defects of legs and feet with bone, nerve and tendon exposed, 5 cases had osteomyelitis as well as internal fixaters exposed and the other 6 had deformity from scar. The size of the flap was 25.0 cm x 13.0 cm x 2.4 cm at its maximum and 6.0 cm x 3.5 cm x 1.5 cm at its minimum. Based on the traditional blocking flap, according to the severity of the wound and conditions of the neighboring tissues, a flap having 2 to 4 orthogonal pedicles with a width of 1.5 to 3.0 cm was designed. The medical-graded stainless steel sheet was implanted below the deep fascia, and after blocking for 3 to 6 days, the side pedicles were divided. 6 to 14 days later, one of the two remaining pedicles was divided and was transferred to repair the defect. RESULTS 31 cases were followed up for 6 months to 5 years without any trouble of the joints. The flap had a good external appearance and was high pressure-resistant. CONCLUSION The multiple pedicled blocking randomized fasciocutaneous flap increased the size of the flap and the length to width ratio. It had the following advantages: manage at will, high resistance to infection and a large survival area of flap.
【Abstract】 Objective To explore the prevention and treatment of leg length discrepancy after total hip arthroplasty(THA). Methods There were 87 patients who were treated by THA from January 2004 to December 2006, including 36males and 51 females, with the average age of 60.2 years (ranging from 35 years to 78 years). Among these cases, there were 35 of avascular necrosis of the femoral head, 38 of subcapital femoral neck fracture, 4 of femoral neck tumor, 6 of rheumatoid arthritis and 4 of acetabular dysplasia. In 70 cases, the patients had leg length discrepancy, and the legs shortened from 1 cm to 6 cm. Based on the cl inical measurement and radiographic examination, the surgical protocols were designed, the type of the hip prosthesis was chosen, and the neck length of the femoral prosthesis and the position of osteotomy were estimated. By the proper wearing of the acetabula, the best rotation point was found out. The cut plane of the femoral neck was adjusted according to the results of the radiographic and other examinations. The neck length was readjusted after the insertion of the prosthesis so as to achieve intended leg-length equal ization. The discrepancy of the leg length was measured and evaluated after operation. Results Superficial infestation happened in 2 cases 5 days after the operation and was cured by mero-drainage. Luxation happened in 4 cases 4 weeks after the operation, in which 2 cases were cured by operation while the other 2 were cured by manual reduction. All the patients were followed up for 6 months to 36 months, with the average time of 18.3 months. The Harris scores were 34.81 ± 1.36 preoperatively and 91.50 ± 1.87 postoperatively (P lt; 0.05). In the 17 patients with equal legs before the operation, 1 was lengthened 1.5 cm in the leg, while in the 70 patients with shortened legs before the operation, 66 returned to the same length in their legs, and 4 were lengthened or shortened from 1.6 cm to 2.1 cm. The total rate of equal leg length was 94.25%. Conclusion The preoperative measurement, radiographic templating and intraoperative correction, together with postoperative orthopraxy, are effective in prevention and treatment of leg length discrepancy after THA.
This paper introduces the current situation of patient safety movement in 20 years from its origin, and expounds the strategies of patient safety from six view points of medical reform, medical insurance, system, culture, education and training, and patient participation in patient safety, so as to promote the healthy development of patient safety work in China.
ObjectiveTo investigate the application value of acetabular centralization technology for correction of leg-length inequality in total hip arthroplasty (THA). MethodsBetween June 2001 and January 2012, 147 cases of abnormal acetabular center were treated. Of them, 68 cases underwent routine THA (control group), and 79 cases underwent acetabular reconstruction by fossae ovalis oriented centralized technology in THA (test group). There was no significant difference in gender, age, side, pathogeny, acetabular rotation center indexs, difference of relative and absolute leg-length, and Harris score between 2 groups before operation (P>0.05). The hip joint function was evaluated by Harris score; the difference of relative leg-length was measured by tape; the difference of absolute leg-length and the horizontal and vertical distances of actual and true rotation center were also measured on the X-ray films by software. ResultsThe patients were followed up 8-26 months (mean, 8.3 months) in the test group, and 6-33 months (mean, 9.7 months) in the control group. Sciatic nerve injury occurred in 2 cases (1 in each group, respectively), lower extremity deep venous thrombosis in 7 cases (3 in test group and 4 in control group), and hip joint dislocation in 2 cases (control group); the other patients had no related complications. The difference of relative leg-length and Harris score in test group were significantly better than in control group (P<0.05), and significant difference was also found when compared with preoperative one in 2 groups (P<0.05). The horizontal and vertical distances of actual and the true rotation center in test group was significantly better than those in control group at immediate after operation on the X-ray films (P<0.05); and significant differences were also found when compared with preoperative ones in 2 groups (P<0.05). At 6 months after operation, the absolute leg-length difference in test group was significantly better than that in control group (P<0.05); and significant difference was also found when compared with preoperative one in 2 groups (P<0.05). ConclusionThe fossae ovalis oriented acetabular centralized technology in THA can significantly correct abnormal hip center of rotation, thus reduce the relative and absolute leg-length inequality and improve the life quality of the patients.
Medical behaviors involve multi level and multi subject legal relations. In the process of medical and nursing care, there are two categories of legal relations concerning medical behaviors. They are external and internal legal relations. External legal relations involve legal relations between hospitals, between physicians and patients and between major medical accidents and penalties; internal legal relations involve physicians, nurses and hospital authorities.
Tissues defect of the sole of the foot requires a high quality of repair, because the sole bears the body weight most. Once there is loss of soft tissues and skin from the sole, the os calsis and the plantar fascia will be exposed. The use of vascularized tissue flaps to cover the beare area of the sole has been generally recognized. From May, 1985 through May, 1994, 26 cases of extensive tissue defects of the soles were treated. During the primary debridement, the wounds were repaired primarily by using retrograde island skin flap from the medial side of the leg with the posterior tibial artery. From the follwup, the results weresatisfactory. The advantages were: the skin flap had rich blood supply, large skin flap was avallable, the thickness of the flap was appropriate, and the elasticity or the weight bearing was good. Besides, the location of the artery was constant, and the operative technique was easy to handle and could be done in onestage with high survival rate of the skin flap.
Objectives To investigate the clinical therapeutic effect of tibial boneskin flaps in the repair of infective boneskin defects of the leg. Methods Between February 2000 and March 2005, 68 cases of leg infective wounds with tibial bone and skin defects were treated: 4 cases using free grafting, 64 cases using crossleg or ipsilateral transposition grafting of tibial boneskin flaps so that the tibial support continuity of the affected leg could be reconstructed and the wound could be covered at one stage. The skin flap area ranged from 9 cm×4 cm to 25 cm×12 cm and the bone flap length ranged from 6 cm to 21 cm. Results The flaps were completely survived in 67 of the 68 cases except 1 case which was repaired by fibular boneskin flaps because of the failed blood-vessel anastomosis; the bone flaps were healed in 66 cases,except 1 case which had delayed union of the proximal end through 6month follow-up because tibial bone flap was lengthened, leading to long soft tissue stripping of the proximal end. All the 68 patients were followed up 6 months to 5 years. The leg function and contour weresatisfactory 2 years after operation. Those patients followed up more than 2 years showed normal weight loading walking without obviously abnormal gait, and can engaged in original work. Conclusion On the basis of sufficient antiinfection, the onestage reconstruction of tibial support continuity and the covering of wound by the three methods are suitable for many types of leg bone and skin defects, have a great application value and high successful rate and can retain the affected limb and create the conditions for the functional recovery.