ObjectiveTo evaluate the feasibil ity and effectiveness of suture ligation combined with super-wet tumescent technique to replace embolization before surgical resection of peri pheral arteriovenous malformations (AVMs) of the head and neck. MethodsBetween July 2007 and November 2010, 9 patients with peri pheral AVMs of the head and neck were treated, including 4 males and 5 females with a median age of 21 years (range, 8 months to 55 years). The causes were congenital malformation in 6 cases, trauma in 2 cases, and unknown origin in 1 case. The lesions were located at the frontotemporal region in 2 patients, cheek in 2 patients, occi pitocervical region in 2 patients, temporoparietal region in 1 patient, upper lip in 1 patient, and lower lip in 1 patient. The size of the AVMs lesions ranged from 2.2 cm×1.2 cm to 13.0 cm×10.0 cm. Of 9 cases, 8 were classified as Schobinger gradeⅡand 1 as gradeⅢ. The AVMs involved 2 to 7 main nutrient arteries, with a diameter range of 1.7-3.1 mm. At one-stage operation, AVMs was removed and direct suture, skin graft or flaps were used for repair in 6 cases; the skin was expanded at one-stage operation, and then AVMs removal and repair were performed at twostage operation in 3 cases. Before resection of AVMs, No.7 silk suture was used to l igate the main nutrient vessels, and then annular interrupted suture of soft tissue was performed with the silk sutures around the lesions, at least two rings. Tumescent anesthetic solution was injected into lesions, and super wet end-point achieved. ResultsPartial incision dehiscence occurred in 1 patient; the flaps and grafting skin survived, and primary healing of incision was obtained in the other patients. The mean operation time was 136 minutes (range, 42-367 minutes). The mean intraoperative blood loss was 268 mL (range, 15-1 000 mL). Only 1 patient received 3 units of blood transfusion. All patients were followed up for 4.2 years on average (range, 2 years to 6 years and 6 months); there was no recurrence case. The self-assessment cosmetic results were excellent or good in 5 cases and fair in 4 cases. ConclusionIntensive suture ligation followed by super-wet tumescent techniques might partially substitute preoperative embolization to facil itate surgical resection of peri pheral AVMs of the head and neck, due to simple operation and less bleeding.
ObjectiveTo analyze the clinical effect of vacuum-assisted closure in treating venous ulcer. MethodsThirty seven patients including 21 males and 16 females with lower extremity venous ulcer treated in our hospital from January 2013 to January 2014 were included in our study. Based on random number table, the patients were divided into treatment group [n=19, (66.47±6.22) years old] and control group [n=18, (66.39±5.37) years old]. The treatment group received vacuum-assisted closure, while the control group underwent routine moist therapy. Wound healing and visual analogue pain scores were observed. Chi-square test and t-test were used for statistical analysis. ResultsWound healing rate was 84.2% in the treatment group and 55.6% in the control group, and the difference between the two groups was statistically significant (χ2=26.66, P<0.05). Wound healing time was (13.84±3.13) days in the treatment group and (27.35±1.73) days in the control group, and the difference was statistically significant (t=-7.498, P<0.01). Visual analogue pain scores in the treatment group was 3.53±0.51, and in the control group, it was 4.41±0.51, and the difference was statistically significant (t=-5.197, P<0.01). ConclusionVacuum-assisted closure can significantly improve wound healing and alleviate sufferings in the treatment of venous ulcer.