Objective To introduce a new design of the scapular flap.Methods The lateral descending cutaneous branch of the circumflex scapular artery was investigated in 10 cadavers with radiography. Based on the results, we usedthe scapular flap(from 8 cm×25 cm to 11 cm×35 cm) pedical on the lateral descending cutaneous branch of the circumflex scapular artery to reconstruct defects offaciocervical region after burning in 7 patients, with direct suture the donatearea,or skin grafting.Results Sever flaps survived completely, satisfactoryresults were obtained except 2 patients’ flap to need to be thinned during the following up.Conclusion This flap can be designed to extend to the inframamary fold, the donor-site scar of the flap is well hidden. The design of the flap broadens the application of the scapular flap.
OBJECTIVE To investigate a new operative method for repairing nonunion and defect of tibia. METHODS First, observe the relation between the joint branches of descending genicular artery and the saphenous branch of descending genicular artery in 10 cadevers. Then the medial femoral condylar bone flap pedicled with the saphenous vessels was prepared in 4 cadavers for simulated purpose. Clinically, two patients with tibial nonunion were treated by transplantation of this pedicled bone flap. RESULTS: In the 4 simulated operations, the ink which was injected into the femoral artery could be released from the joint branches. And in the clinical operation, the area of the pedicled bone flaps were 5.0 cm x 2.0 cm x 1.5 cm and 4.5 cm x 1.5 cm x 1.5 cm respectively. Followed up for 8 to 12 weeks, the fracture unioned well. CONCLUSION: This operation is simple and reliable, it is characterised by 1. unnecessary to anastomosis the vessels 2. reliable blood supply 3. high quality of bone flap 4. either bone flap or bone-skin flap can be chosen 5. long vessel pedicle.
Objective To observe the clinical effect of intravenous thrombolytic therapy for central retinal artery occlusion (CRAO) with poor effect after the treatment of arterial thrombolytic therapy. Methods Twenty-four CRAO patients (24 eyes) with poor effect after the treatment of arterial thrombolytic therapy were enrolled in this study. There were 11 males and 13 females. The age was ranged from 35 to 80 years, with the mean age of (56.7±15.6) years. There were 11 right eyes and 13 left eyes. The visual acuity was tested by standard visual acuity chart. The arm-retinal circulation time (A-Rct) and the filling time of retinal artery and its branches (FT) were detected by fluorescein fundus angiography (FFA). The visual acuity was ranged from light sensation to 0.5, with the average of 0.04±0.012. The A-Rct was ranged from 18.0 s to 35.0 s, with the mean of (29.7±5.8) s. The FT was ranged from 4.0 s to 16.0 s, with the mean of (12.9±2.3) s. All patients were treated with urokinase intravenous thrombolytic therapy. The dosage of urokinase was 3000 U/kg, 2 times/d, adding 250 ml of 0.9% sodium chloride intravenous drip, 2 times between 8 - 10 h, and continuous treatment of FFA after 5 days. Comparative analysis was performed on the visual acuity of the patients before and after treatment, and the changes of A-Rct and FT. Results After intravenous thrombolytic therapy, the A-Rct was ranged from 16.0 s to 34.0 s, with the mean of (22.4±5.5) s. Among 24 eyes, the A-Rct was 27.0 - 34.0 s in 4 eyes (16.67%), 18.0 - 26.0 s in 11 eyes (45.83%); 16.0 - 17.0 s in 9 eyes (37.50%). The FT was ranged from 2.4 s to 16.0 s, with the mean of (7.4±2.6) s. Compared with before intravenous thrombolytic therapy, the A-Rct was shortened by 7.3 s and the FT was shortened by 5.5 s with the significant differences (χ2=24.6, 24.9; P＜0.01). After intravenous thrombolytic therapy, the visual acuity was ranged from light sensation to 0.6, with the average of 0.08±0.011. There were 1 eye with vision of light perception (4.17%), 8 eyes with hand movement/20 cm (33.33%), 11 eyes with 0.02 - 0.05 (45.83%), 2 eyes with 0.1 - 0.2 (8.33%), 1 eye with 0.5 (4.17%) and 1 eye with 0.6 (4.17%). The visual acuity was improved in 19 eyes (79.17%). The difference of visual acuity before and after intravenous thrombolytic therapy was significant (χ2=7.99, P＜0.05). There was no local and systemic adverse effects during and after treatment. Conclusion Intravenous thrombolytic therapy for CRAO with poor effect after the treatment of arterial thrombolytic therapy can further improve the circulation of retinal artery and visual acuity.
In order to preserve more normal tissue in situ in case of severe traumatic rupture of spleen, simultaneous ligation of splenic artery and vein was performed successfully on animals and then was applied for clinic use. The preserved splenic tissue all survivied and functioned well. Patients with severe traumatic rupture of spleen grade Ⅳ-Ⅴ were all cured by ligation of both the splenic artery and vein at the same time.
In order to study the clinical efficacy of facial artery musculocutaneous flap on repairing the defect of the floor of mouth, 21 patients had received this type of treatment from 1991 to 1997. The size of the flaps ranged from 8.0 x 3.4 cm to 12.1 x 5.4 cm and the average age of these patients was 59.5 years old. The donor site was closed directly. Nineteen flaps survived completely, while necrosis occurred at the apex of the other 2 flaps, which healed by ordinary management. The applied anatomy of the flap and the design and the main points of the operation were reported in details. The advantage of the flap and the prevention of facial malformation following operation were discussed. The conclusion was that this type of flap was ideal for reconstruction of the defects of floor of the mouth.
ObjectiveTo summarize the use of harmonic scalpel to harvest bilateral internal mammary artery in coronary artery bypass grafting (CABG). MethodsThe clinical data of 54 patients of bilateral skeletonized internal mammary artery harvesting for CABG in our hospital from January 2016 to May 2020 were analyzed retrospectively. There were 51 males and 3 females with a mean age of 62.37±9.56 years. ResultsAll patients went through the procedure unevently and discharged from hospital. The number of grafts was 4.07±0.85 per patient, the operation time was 267.21±47.00 min, mechanical ventilation time was 342.43±132.17 min and hospital stay was 12.21±4.43 d. ConclusionIt is safe and effective to use harmonic scalpel to harvest skeletonized bilateral internal mammary artery in CABG.
Objective To explore ability of deformation ,small deformation, orientation and in vivo half-life of erythrocytes following intraoperative autotransfusion by ZITI-3000 cell saving system (Jingjing medical facility corporation, Beijing). Methods Twenty consecutive patients undergoing scheduled off-pump coronary artery bypass grafting (CABG) were divided into two groups according to intraoperative autotransfusion, experimental group(n=10): intraoperative autotransfusion was performed; control group (n=10): intraoperative autotransfusion wasn’t used. Laser diffractometer was used to measure deformation index(DI), small deformation index[(DI)d.max], and orientation index [(DI)or.max],and chromium51 istope labeling technique was used to measure half-life of erythrocytes (51C1/2) of processed and unprocessed in vivo. Results There were no significant difference in DI, (DI)d.max, (DI)or.max and 51C1/2 in vivo between experimental group and control group. Conclusion Intraoperative autotransfusion has no significant effect on erythrocytes’s ability of DI, (DI)d.max, (DI)or.max and 51C1/2 in vivo in off-pump CABG.
ObjectiveTo investigate the therapeutic method and effect of thrombolysis via superselective ophthalmic artery catheterization treating central retinal artery occlusion (CRAO).Methods9 patients with CRAO were treated by urokinase infusion via superselective ophthalmic artery catheterization with Seldinger technique.ResultsIn the 9 patients, the visual acuity was improved to different extent in 8, and remained unchanged in 1. No complications was found during the treatment in any patients.ConclusionsThrombolysis via super-selective ophthalmic artery catheterization for CRAO can improve the visual acuity of most of the patients in different degrees. No positive relation exists in clinical therapeutic effect, time of onset, quantity of urokinase and the visual acuity before the treatment. The method of thrombolysis via super-selective ophthalmic artery catheterization for CRVO is safe and reliable.(Chin J Ocul Fundus Dis, 2005,21:22-24)
Abstract:Objective To investigate the pattern and affecting factors of hematopoietic stem cell mobilization after off-pump coronary artery bypass grafting（OPCAB）. Methods Fifty-five patients of coronary artery disease without acute myocardial infarction （AMI） who underwent selective OPCAB were chosen for this study. Four ml blood sample was taken at 30 min before operation, and 6, 12, 24, 48, 72 and 120 h after operation. The hematopoietic stem cell count was made by flow cytometer with CD34 and CD45 double antibody. The serum myoeardium enzyme and troponin T （cTnT） were measured at the same time. Results The hematopoietic stem cell count was 0. 13%±0. 12% of all nucleated cells in the peripheral blood circulation before operation. It increased significantly witha peak value at 24 halter OPCAB（0.34%±0.20%）. It turned back to pre-operativelevelat 120h after operation. Smoking, hyperlipemia and diabetes mellitus had no effect on hematopoietic stem cell mobilization. But hypertension could reduce its mobilization significantly. The hematopoietic stem cell count was positively correlated with creatine kinase （CK）, creatine kinase-MB isoenzyme （CK-MB）, lactate de hydrogenase （LDH） and cTnT （r=0. 692,P=0. 000; r=0. 558, P=0. 000; r=0. 447, P=0. 000 and r=0. 401, P=0. 004, respectively） 24h after OPCAB. Conclusion Hematopoietic stem cells mobilize rapidly and temporarily after OPCAB. Myocardial injury and CABG risk factors take part in hematopoietic stem cell mobilization.
In order to explore a new method to treat the ischemic necrosis of the head of 2nd metatarsal bone in adult, transposition of reversed vascularized metatarsal bone graft was adopted in the treatment of 4 cases, 2 of which were followed up for one and a half years. The postoperative X-ray showed the round head of the 2nd metatarsal bone became round and even density. The clinical observation showed that there was excellent function of metatarsophalangeal joint. It was concluded that the reversed vascularized metatarsal bone graft could provide a reliable blood supply and various osteogenic factors to the avascularized head of the metatarsal bone, and the operation could also debride the joint cavity and carry out decompression.