Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.
ObjectiveTo investigate the anatomy and function of pectoralis fascia in breast cancer operation, and the choice of resection and preservation of pectoralis fascia in different operation methods.MethodWe searched the articles related to pectoralis fascia and breast cancer through PubMed, Web of Science, EBSCO, WanFang Medical Network, SinoMed, and other databases, and then selected the Chinese and foreign articles that met the objective of this paper, and made an review after reading the articles.ResultsIn the immediate breast reconstruction of breast prosthesis after breast cancer operation, the preservation of pectoralis fascia was beneficial to the complete coverage of breast prosthesis and improved the cosmetic effect after operation. The purpose of preserving pectoralis fascia adipose tissue in breast-conserving surgery was to reduce the loss of breast volume and to pursue the cosmetic effect after operation. At present, there had been reports on the safety of pectoralis fascia oncology, but there was no final conclusion on the safe distance between tumor and pectoralis fascia, and the current research could not provide sufficient evidence for the preservation of pectoralis fascia.ConclusionsThe question of whether the pectoralis fascia needs to be removed in breast cancer surgery is still controversial. The preservation of pectoralis fascia is more for better immediate breast reconstruction after operation. However, the current evidence of evidence-based medicine is not sufficient. Clinicians need to conduct multicenter, randomized controlled clinical trials to improve the evidence.
Objective To explore the feasibility and effectiveness of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet. Methods Between July 2017 and January 2023, 35 cases of hand and foot defects were repaired with plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue (13 pedicled flaps and 22 free flaps). There were 18 males and 17 females, with an average age of 38.8 years (range, 8-56 years). Thirty cases of defects were caused by trauma, and the interval between injury and admission ranged from 2 to 6 hours (mean, 3.3 hours). Three cases were ulcer wounds with a course of 3.0, 3.8, and 7.0 months, respectively. Two cases were malignant melanoma. Eight cases of wounds located in the fingers, 13 cases in the palm, 12 cases in the heel, and 2 cases in the distal foot. The size of skin defects ranged from 4.0 cm×3.5 cm to 12.0 cm×10.0 cm, and the size of flap ranged from 5.0 cm×4.5 cm to 13.0 cm×11.0 cm. The donor sites were repaired with skin grafts. Results All flaps were survived and the wounds healed by first intention after operation. The partial necrosis at the edge of the skin graft occurred in 1 case, which healed after dressing change; the other skin grafts survived successfully. All patients were followed up 6-24 months (mean, 18 months). The flaps exhibited similar color and thickness to the surrounding hand and foot skin. Two-point discrimination ranged from 7 to 10 mm in the flaps with an average of 8 mm. The donor sites had no painful scars or sensory abnormalities. Foot and ankle functions were good and gaits were normal. ConclusionApplication of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet had good flap shape, high survival rate of skin graft at the donor site, and no obvious complications.
Objective To study the vascular applied anatomy，the anatomic features of fascial，and interfascial space around the pancreas and duodenum，observe marker and safe surgical plane of pancreaticoduodenal region，and provide clinical anatomy basis for surgery of duodenum， pancreatic head，and distal common bile duct．Methods Anatomical observations were performed in 7 formalin fixed cadavers on duodenum，distal common bile duct，and pancreatic peripheral blood supply．Transverse mesocolon，pancreatic capsule and potential interfascial space，surgical plane and anatomic marker for reorganization around pancreas were observed．Results Gastropancreatic fold and hepatopancreatic fold formed by pancreatic capsule were good markers to locate the root of left gastric artery and common hepatic artery．A vessel-free plane between the behind pancreas and the anterior lamella of Gerota fascia could be used to make lymphadenectomy and pancreatic dissection behind pancreas and duodenum．Gerota fascia should be regarded as a safe posterior border to avoid injuring vessels and adrenal gland by mistake．The descending part and horizontal part of duodenum were mainly supplied by the anterior and posterior pancreaticoduodenal arterial arcade．The anterior and posterior pancreaticoduodenal arterial arcade should be protected in duodenum-preserving resection of pancreatic head．Conclusions Full understanding of pancreatic fascial and interfascial space formed in embryonic development is very important．Operation along the interfascial spaces is safe without bleeding and organ injury，which is essential in oncosurgery．
The noses of eight patients being dead for 2hours were dissected to investigate the layers andstructure of the nose, and the stability of theimplanted silicone noae prosthesis was tested.According to the structure and microstructure ofthe nose studied by us, we suggested a newconcept of nasal muscle and dorsal deepfasciacomplex. We confirmed the prcathesis should beimplanted in the space between the nasal boneand the complex. The reason for complicationhappened in this approach was that...
Objective To evaluate the reliability and effectiveness of a deep circumflex iliac artery based iliac-internal oblique musculofascial chimeric flap (DCIA-IIOF) in reconstruction of complex oromandibular defect. Methods Between January 2010 and December 2015, DCIA-IIOFs were used to repair complex oromandibular defects in 11 patients. There were 8 males and 3 females, with an age of 27-75 years (median, 56 years). Original disease was lower gingival squamous cell carcinoma in 7 cases (T3N1M0 in 2 cases, T3N2M0 in 1 case, T4N0M0 in 2 cases, and T4N2M0 in 2 cases), osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma in 2 cases, central mandibular squamous cell carcinoma in 1 case (T4N0M0), and mandibular malignant fibrous histiocytoma in 1 case. The length of mandibular bone defects ranged from 7 to 10 cm (mean, 8 cm), and the area of the mucosal defects ranged from 5 cm×3 cm to 7 cm×4 cm. Preoperative ultrasonic identification of the DCIA and its ascending branch was routinely performed. The DCIA-IIOF was harvested by using an anterograde dissection technique, of which the iliac island was used for segmental mandibular defect repair and the musculofascial island for soft tissue and mucosal defect repair. Results All 11 cases were followed up 15-75 months (median, 37 months). All flaps survived after operation, without necrosis of both iliac island and oblique internal musculofascial island. One patient had a mild submandibular infection which healed after wound drainage and intravenous antibiotics. At 1 month after operation, the color and texture of the musculofascial island were similar to oral mucosa without contracture, and the occluding relation was good for all patients. At 6 months after operation, the mouth opening hardly improved in 2 patients who had osteoradionecrosis; 1 patient who underwent postoperative radiotherapy had restriction of mouth opening; the remaining 8 patients had normal month opening and normal diet. Three patients died of cancer recurrence, 2 patients died of other diseases (encephalorrhagia in 1 case and myocardial infarction in 1 case), and the others survived without recurrence during follow-up. No patient developed abdominal hernia during follow-up. Conclusion DCIA-IIOF is a reliable flap in reconstruction of complex oromandibular defects. The occluding relation after operation is good and the mucosal lining is soft. This technique provides an effective option for moderate complex oromandibular defects repair.
Since the concept of total mesorectal excision (TME) was proposed and carried out in 1982, the postoperative local recurrence rate of rectal cancer has decreased significantly and the long-term survival rate has increased, thus TME has become the gold standard for middle and low rectal cancer surgery. However, the incidence of postoperative urination and sexual dysfunctions caused by pelvic autonomic nerve injury during TME operation remains high, which needs to be investigated and solved. Over the years, through systematic studies of anatomy, histology and physiology, we have confirmed that dissection anterior to Denonvilliers’ fascia for the anterior wall of rectum, and thus partial resection of Denonvilliers’ fascia, were the leading cause of nerve injury during TME operation. On the contrary, dissection posterior to Denonvilliers’ fascia and entire preservation of Denonvilliers’ fascia are feasible and necessary. Moreover, through anatomical study, Wei’s Line, the surgical marker line of Denonvilliers’ fascia is discovered for the first time, and thus innovative TME (iTME) navigated with Wei’s Line is proposed. The multi-center clinical study has confirmed that compared with traditional TME surgery, the incidences of postoperative urination and sexual dysfunctions in iTME group decrease significantly, with comparable oncologic outcomes, suggesting that iTME surgery could be a better choice for male patients with middle and low rectal cancer at specific stages. This study systematically reviews the research process and operation standard of iTME, and summarizes the application status and future prospects of iTME.
Since October 1984, we have designed a method of conversed transplant of radial styloid bone flap with fascial pedicle in the treatment of 22 patients with non-united waist fractures of carpal scaphoid. The results from follow-up of 2-7 years were satisfactory.This article introduced the design of the bone flap, the operative procedure and the advantages of the bone flap.
ObjectiveTo evaluate the clinical experiences and treatment effectiveness of chronic venous insufficiency with venous ulcer in lower limb. MethodsSeventy-eight patients (88 limbs) suffering lower limb chronic venous insufficiency with venous ulcer from May 2004 to April 2011 in this hospital were analyzed retrospectively. All the patients had undergone high ligation for great saphenous vein plus endovenous laser treatment plus subfascial endoscopic perforator vein surgery (SEPS). ResultsPostoperative complications included 3 cases of subfascial haematoma; 2 cases of pneumohypoderma; 3 cases of numbness in anterior tibial and ankle areas. All the ulcers healed between 4 to 6 weeks. Follow up period was between 6 months to 5 years. There was only one recurrence due to residual varicose from ankle area. The mean operation time was 20 min (15－30 min) in SEPS, the average blood loss was 2 ml (1－5 ml), and the mean duration of postoperative hospitalization was 5 d (2－8 d). ConclusionsSEPS is a first treatment choice for CVI with venous ulcer. It has less invasiveness, lower chances for bleeding, shorter operation time, quicker recovery, and fewer complications.
Objective To investigate the method and the curative effect of postauricular muscular fasciae-periosteal flap and modified unwrinkle incision in parotidectomy. Methods From January 2006 to August 2008, 28 patients with benign lesions of parotid gland were treated. There were 17 males and 11 females aged 19 to 79 years old (average 50 years old),including 20 cases of mixed tumor, 5 cases of adenolymphoma, 1 case of branchial cleft cyst, 1 case of eosinophil ic hyperplastic lymphogranuloma, and 1 case of myoepithel ioma. Tumor masses were all prominent, with the diameter of 2.4-3.8 cm and partial-tough texture. The course of disease was 3-18 months (average 9.5 months). Parotid gland and tumor mass were resected with postauricular incision hidden within the hairl ine, introcession defect (3.0 cm × 2.0 cm × 1.0 cm-3.5 cm × 2.5 cm × 1.5 cm) were repaired with simultaneouly adopting postauricular muscular fasciae-periosteal flap (4.0 cm × 3.0 cm × 1.0 cm-5.0 cm × 4.0 cm × 1.5 cm) by turning the pedicle flap 180°. Results All incision healed by first intention and no necrosis of postauricular muscular fasciae-periosteal flap occurred. All patients were followed up for 6-24 months (average 12 months). The incision was hidden within postauricular hairl ine and shape of parotid realm was good. No sal ivary fistula, facial paralysis, and earlobe numbness occurred. No Frey syndrome were found by local iodine-starch tests. Conclusion Because of hidden incision, good repair effect of region introcession deformity, and fewer postoperative compl ications, the modified parotidectomy with postauricular muscular fasciae-periosteal flap and modified unwrinkle incision is a better method in parotidectomy.