To summarize the effectiveness of the improv ed surgical techniques in fasciocutaneous flaps of the limbs. MethodsFrom February 1999 to December 2005, 58 patients (39 males, 19 females, aged 1068 years) underwent repairs of the skin defects with improved fasciaocu taneous flaps of the limbs. Twentyone patients had the skin defects in front of the tibial bone in the middle and lower parts, 12 patients had the skin defect s in the heels, 16 patients had the skin defects in the ankles, 3 patients had t he skin defects around the knees, 1 patient had a wide sacrococcygeal bedsore, and 5 patients had the skin defects in the wrists and hands. The wounds ranged in size from 5 cm×3 cm to 18 cm× 12 cm. According to the wound lo cations, the following flaps were selected: 4 cutaneous antebrachii medialis nerve and basilic vein fasciocutaneous flaps, 1 cutaneous antebrachii lateralis nerve and cephalic vein fasciocutaneous flap, 3 saphenous nerve and great saphenousvein fasciocutaneous flaps, 1 cutaneous nerve of thigh posterior fasciocutaneous flap, 32 reverse sural nerve and saphenous vein fasciocutaneous flaps, and 17 reverse saphenous nerve and great saphenous vein fasciocutaneous flaps. The dissected flaps ranged in size from 6 cm× 4 cm to 18 cm× 13 cm. The donor wounds underwent straight sutures in 39 patients, and the skin grafting (6 cm×3 cm to 13 cm× 6 cm) was performed on 19 patients after the donor wounds were closed. Results The wounds healed by first intention, and the flaps survived completely in 54 patients. The flaps developed partial necrosis in 4 patients. The followup for 120 months (average, 8 months) revealed that the flaps had a satisfactory appearance with a soft texture and the function was also satisfactory. Conclusion A fasciocutaneous flap of the limbs is an ideal flap for repairing defects in the skins and soft tissues of the limbs. The survival rate of the flap can be further improved by an improvement of the surgical techniques.
Objective To introduce a kind of improved operative method for correction of severe inverted nipples. Methods Sixteen patients (aged 2838 years) with 31 inborn inverted nipples were operated with theimproved method from January 2002 to March 2005. The nipple was incised horizontally through the middle, the fibrotic band was released, and the tissue below the nipple was contracted. Then the defective space with mammary glandflap. Finally,a Zshaped suture was employed at each base of nipple. Results The shapes of these nipples were satisfactory. No infection and necrosis of the nipples occurred. The follow-up showed that the results were perfect in thesensory and ejective functions of nipples. All the corrected nipples did not have recurrence except one nipple. The scars in the local site were limited andunconspicuous. Conclusion Severe inverted nipples can be corrected effectively by the combined improved incisions and Z-shaped sutures. This method is suitable for the female patients with no requirment for feeding.
Objective To improve the Heron’s technique for heterotopic cardiac transplantation in rats by cuff vessel anastomosis in some aspectsand successfully establish the simplified model of cervical cardiac xenotransplantation from guinea pigs donor to SD rats recipients. Methods The donors were 64 male guinea pigs, whose weight ranged from 250 to 350 g； the recipients were 64 male SD rats, whose weight ranged from 300 to 350 g.The guinea pigs donor’s ascending aorta and pulmonary artery were anastomosed to SD rats recipient’s right common carotid artery and external jugular vein respectively with a self-made “sleeve” anastomosis. The modified cuff technique of heterotopic grafting is described in detail. Results 64 consecutive successful transplantations have been performed by single surgeon were done with negligible operative risk. No anastomosis leakage nor vessel obstruction. The total time of surgical procedure were 45 to 60 minutes. The new technique allowed vascular anastomoses to be completed in 2 to 5 minutes. The total cold ischemia time for donor heart was 14 minutes in average. Conclusion This modified Heron’s technique was a simple, economical, practicable,reliable and high reproducible model can be operated by surgeons with minimal training in microvascular surgery, and be applied to various transplantation immunological studies.
Objective To find a more perfect method of treating developmental dislocation of the hip(DDH). Methods From March 1994 toDecember 2002, on the basis of the ordinary operative method, Pemberton method was improved for 48 cases of DDH 49 articulatio coxae which had superficial and small acetabula but bigheads of femur. Osteotomy points were moved higher to enlarge area of bone flapturned over. A piece of full thickness ilium including periosteum was removed as a free bony graft. Capsula articularis growing thicker was made into 2 layers, of which the inner layer was used to tighten articularis and the outer layerwas used to stabilize bone flap. Results All patients were followed up for 18 months to 5 years, the function of articulatio coxae and degree of bony union, inclusion area to head of femur and ischemic necrosis of femoral head were observed through X-ray. According to Zhou Yongde’s criteria for the curative effect of congenital dislocation of the hip, there were 18 cases of 26-30 scores(3 hips), 27 cases of 21-25 scores, 2 cases of 1620 scores(3 hips), and 1 case under 15 scores, and the total superior ratewas 93.8%. Conclusion Improved Pemberton method can enlarge inclusion area tohead of femur, avoid decreasing acetabular volume, and stabilize articulatio well, which made operative indication bigger than original Pemberton method.
This paper introduces the concept, characteristics, similar concepts, system of knowledge, theoretic model and typical example of improvement science in health care sector, and analyzes a project of quality improvement in order to demonstrate the practical implication. It attempts to provide evidence and reference for future relative studies.
Guideline implementation with decision support checklist (GUIDES) aims to assist the self-reflection of evidence-based clinical decision support system (CDSS) related professionals to enhance the process monitor and continuous improvement of evidence-based CDSS. This paper interpreted the development process, target user, and assessment method of GUIDES, analyzed the practical value of GUIDES through a typical example, and then reflected on the GUIDES and current studies on evidence-based CDSS in China. It is expected to provide references for future studies.
Remarkable results have been realized by the U-Net network in the task of medical image segmentation. In recent years, many scholars have been researching the network and expanding its structure, such as improvement of encoder and decoder and improvement of skip connection. Based on the optimization of U-Net structure and its medical image segmentation techniques, this paper elucidates in the following: First, the paper elaborates on the application of U-Net in the field of medical image segmentation; Then, the paper summarizes the seven improvement mechanism of U-Net: dense connection mechanism, residual connection mechanism, multi-scale mechanism, ensemble mechanism, dilated mechanism, attention mechanism, and transformer mechanism; Finally, the paper states the ideas and methods on the U-Net structure improvement in a bid to provide a reference for later researches, which plays a significant part in advancing U-Net.