Objective To overview the effect of bacterial biofilms (BBF) on the formation of chronic osteomyel itis and the treatment measure. Methods The original articles in recent years about the relationship between BBF and chronic osteomyel itis were reviewed. Results The diagnosis and treatment of chronic osteomyel itis was very difficult, besides hyperplasia oflocal scar, poor blood supply, drug-resistant, forming of BBF also was an important reason. BBF formed on the surface of necrosis soft tissue and dead bone. Due to the protection of BBF, the bacterium were far more resistant to antimicrobial agents, which caused the recurrence of chronic osteomyel itis. The forming of BBF included three processes which were adhesion, development and maturity. As the major pathogens of chronic osteomyel itis, staphylococcus had its own characteristic. Designing therapeutic programmes according to these characteristics had become the trend of anti-infection treatment of BBF. Conclusion Although there are lots of studies on anti-biofilm due to the key factors during the forming of BBF, the most effective way of anti-biofilm is still debridement.
In recent years, flap surgery has been well-developed, and many theories and techniques of flap surgery have been updating. The purpose of manuscript which is based on the flap-related literature is to summarize recent developments of basic and clinic researches, indicate the future of the flap surgery, and show the consensus and guidelines of flap surgery made by Chinese experts.
ObjectiveTo explore the effectiveness and safety of a new temporary intravascular shunt (TIVS) device for limb injury in dogs.MethodsEighteen adult beagle dogs, male or female, weighing (20±2) kg, were taken for experiment. A semi-amputated limb model was made by circular amputating the knee joint of one hindlimb, which retained only skin, femoral artery, femoral vein, femoral nerve, and femur. Then the femoral artery was clamped for 2 hours in all animals, resulting in the ischemic environment of the distal limbs. The animals were randomly divided into 3 groups (n=6). In group A, the bypass was started by using a new TIVS device and replenishing saline through the infusion port; In group B, after intravenous injection of heparin sodium solution, the bypass was started by using a new TIVS device and replenishing 3% heparin sodium solution through the infusion port; In group C, the bypass was started by using the self-made bypass tube. The bypass was end after 12 hours. The general vital signs (body temperature, heart rate, blood pressure) before and after bypass were measured, and the time required for the insertion of the bypass tube, the patency during the bypass, shedding, and thrombosis were recorded. Routine blood test and blood coagulation indicators [white blood cell (WBC), red blood cell (RBC), platelet (PLT), hemoglobin (HGB), activated partial thromboplastin time (APTT), fibrinogen (Fib)] and biochemical indicators [lactic dehydrogenase (LDH) and creatine kinase (CK)] were recorded before bypass and after 3, 6, 9, and 12 hours of bypass, respectively. The gastrocnemius muscles on the surgical side before and after bypass were harvested and the muscle necrosis, the wet-to-dry weight ratio, and the content of malondialdehyde (MDA) and myeloperoxidase (MPO) were measured. In addition, the gastrocnemius muscle and femoral artery were observed after bypass by HE staining.ResultsThere was no significant difference in body temperature, heart rate, and blood pressure between groups before and after bypass (P>0.05). Compared with groups A and B, the time required for the insertion of the bypass tube in group C was significantly longer (P<0.05), and the number of thrombus in the bypass tube, the blockage time significantly increased (P<0.05). Shedding and sliding of bypass tube occurred in 3 cases of group C, but no shedding or sliding of bypass tube occurred in groups A and B; there was no significant difference in the incidence of shedding between groups (P=1.000). There was no significant difference (P>0.05) in routine blood test, blood coagulation indicators, LDH, CK, MPO, MDA, and wet-to-dry weight ratio between groups before bypass. After bypass, the routine blood test and blood coagulation indicators of the 3 groups did not change significantly, and the differences between groups was not significant (P>0.05); LDH and CK gradually increased (P<0.05), and group C significantly higher than groups A and B at 12 hours (P<0.05). After bypass, thrombosis was seen in the bypass tube, the distal gastrocnemius muscle necrosis occurred in group C, and the femoral artery injury was slightly heavier than that in groups A and B.ConclusionThe new TIVS device is safe and effective and has the advantages of convenient implantation, lower thrombosis rate, and less limb ischemia-reperfusion injury.
Objective To reviewe the research progress of liposomes as antibiotic carriers. Methods Domestic and abroad literature concerning liposomes as antibiotic carriers was reviewed and analyzed thoroughly. Results Liposomes as antibiotic carriers can significantly improve drug distribution, enhance antibacterial activity, and reduce the side effects of antibiotics during treatment. But it also has some problems, such as poor physical and chemical stabilities and low encapsulation efficiency. Conclusion Liposomes as antibiotic carriers can reduce the drug toxicity, improve drug biodistribution, and pharmacokinetics, and bring the dawn to completely curing infections disease.
Objective To investigate the surgical methods and cl inical results of reconstructing soft tissue defects in distal dorsal is pedis with distally based medial dorsal neurocutaneous flap on foot. Methods From January 2004 to July 2007, 11 cases of soft tissue defects in distal dorsal is pedis were treated with the distally based medial dorsal neurocutaneousflap on foot, including 8 males and 3 females aged 18-55 years. Nine cases were caused by crash and 2 cases were caused by traffic accident. There were 4 cases of tendon exposure and skin defects in the distal dorsal is pedis, 6 cases of bone exposure and skin defects in and adjacent to the first metatarsal head and 1 case of bone exposure and skin defects in the distal dorsal is pedis due to the third and fourth toe damage. The area of defects ranged from 3 cm × 3 cm to 7 cm × 5 cm. Distally based medial dorsal neurocutaneous flaps on foot were incised to repair the soft tissue defects and the size of the flaps ranged from 4 cm × 4 cm to 8 cm × 6 cm. Thickness skin graft was appl ied to repair donor site. Results All the flaps survived and all wounds healed by first intention. Skin graft in donor site survived completely in 10 cases and survived partly in 1 cases (heal ing was achieved after the flap above lateral malleolus was used to repair). All cases were followed up for 6 months-1 year. The color, texture and thickness of the flaps were similar to those of recipient site. All patients returned to their normal weight-bearing walking. No skin ulceration in flaps and donor site was observed. Conclusion The operative technique of the distally based medial dorsal neurocutaneous flap on foot is simple, convenient and safe. The distally based flap is effective in repairing soft tissue defects of middle and small sized skin and soft tissue defects in distal dorsal is pedis.
Objective To investigate the surgical methods and cl inical results of reconstructing soft tissue defects in dorsum of forefoot with distally based saphenous neurocutaneous flap of lower rotating point. Methods From January 2005 to August 2007, 6 cases of soft tissue defects in dorsum of forefoot, including 4 males and 2 females aged 28-53 years, were treated with the distally based saphenous neurocutaneous flaps of lower rotating point. The soft tissue defect was in left foot in 2 cases and in right foot in 4 cases. Five cases of soft tissue defects were caused by crush, and 1 case was caused by traffic accident. Tendons and bones were exposed in all cases. The defects after debridement were 7.0 cm × 5.0 cm to 9.0 cm × 5.5 cm in size. Emergency operation was performed in 2 cases and selective operation in 4 cases. Rotating point of the flaps was from 1 to 3 cm above medial malleolus. The size of the flaps ranged from 8.0 cm × 6.0 cm to 13.0 cm × 6.5 cm. Neuroanastomosis was performed in 2 cases of the flaps. Skin defects in donor site were repaired with thickness skin graft. Results Four cases of the transferred flaps survived completely and the other 2 cases began to swell and emerge water bl ister from the distant end of the flap after operation, which resulted in distal superficial necrosis of flaps, heal ing was achieved after change dressings and skin grafted. Skin graft in donor site survived completely in all cases. All cases were followed up from 6 to 18 months. The color and texture and thickness of theflaps were similar to reci pient site. Pain sensation and warmth sensation of the 2 flaps whose cutaneous nerve were anastomosed recovered completely, two point discrimination were 8 mm and 9 mm respectively. Sensation and warmth sensation of the 4 flaps whose cutaneous nerve were not anastomosed recovered partly. All patients returned to their normal walking and running activities and no ulceration occurred. No donor site morbidity was encountered. Conclusion Blood supply of the distally based saphenous neurocutaneous flap of lower rotating point is sufficient, the flap is especially useful for repair of soft tissue defects in dorsum of forefoot.
Objective To investigate the basic mechanism of venous flow in reverseflow island flap. Methods Recent relevant literature on the mechanism of venous reverse flow in reverseflow island flap wereextensively reviewed. Results The mechanism of venous reverse flow was a multifactorial phenomenon. “Communicating and collateral by pass route” and “incompetent valve route” were two theories. Conclusion The two routes of venous reverse flow in reverse-flow island flap coexistand complement each other.
OBJECTIVE: To review the recent progress in the treatment of wrist disorder by limited intercarpal arthrodesis and the related experimental study. METHODS: Recent original articles related to limited intercarpal arthrodesis, including clinical practice and experimental study, were extensively retrieved and carefully analyzed. RESULTS: Limited intercarpal arthrodesis could relieve pain and stabilize the wrist joint with partial motion. CONCLUSION: With suitable indication and well selected operation approach, the limited intercarpal arthrodesis should be the optimal surgical intervention than total carpal athrodesis in the treatment of wrist disorder.
ObjectiveTo study the surgical treatment method and effectiveness of Rüedi-Allgöwer Ⅲ type Pilon fractures. MethodsBetween May 2011 and April 2013,25 cases of Rüedi-Allgöwer Ⅲ type Pilon fracture (5 cases of open fractures and 20 cases of closed fractures) were treated.Of 25 cases,16 were male,and 9 were female,aged 24-45 years (mean,31 years).The left side was involved in 8 cases,and the right side in 17 cases.The disease causes were falling from height in 11 cases,traffic accident injury in 9 cases,and crash injury in 5 cases.The interval of injury and admission was 10-36 hours (mean,23.5 hours).The open reduction and internal fixation by posterolateral fibular incision and exposure of distal tibia and tibiotalar articular surface by anterior ankle incision were performed;the tibiotalar articular surface was reset and the tibia fracture end was fixed. ResultsHealing of incision by first intention was obtained in 15 cases,and healing by second intention in 6 cases undergoing skin grafting.Tension blister occurred in 4 patients,who achieved healing by second intention after treatment.All 25 patients were followed up 6-12 months (mean,8 months).During follow-up,no complication of ankle joint instability,traumatic arthritis,or loosening and breakage of internal fixation occurred.The X-ray films showed stable ankle joint,anatomic or near anatomic reduction of the tibiotalar articular surface,normal alignment of distal tibia,and good bony healing.At 6 to 12 months after operation,the flexion and extension of the ankle were normal,without pain of the ankle joint after removal of internal fixation.According to Mazur et al.rating system for ankle symptoms and function,the results were excellent in 5 cases,good in 12 cases,fair in 5 cases,and poor in 3 cases;the excellent and good rate was 68%. ConclusionThe procedure by anterior ankle lateral approach and posterolateral fibular approach can completely expose the tibiotalar articular surface,which is advantageous to displaced fracture reduction and fixation,and can achieve good effectiveness in treating Rüedi-Allgöwer Ⅲ type Pilon fractures.