Objective To introduce a modified method to correct type I and type II cup ear and to evaluate the effectiveness. Methods Between May 2006 and November 2011, 23 patients with type I or type II cup ear (27 ears, type I in 6 ears and type II in 21 ears according to Tanzer’s criteria) were treated. There were 14 males and 9 females with an average age of 10 years (range, 7-16 years). The unilateral ear was involved in 19 cases and bilateral ears in 4 cases. The main clinical manifestations included the flat helix and scapha and ptosis of upper 1/3 auricle. The arc incision was adopted in the auriculocephalic angle, elevation of the dis-clothing-like flap in the front and rear of the auricular cartilage, relocation of the craniofacial initiation site of the scapha and the cavity of auricular concha, correction of deformational auricular cartilage and reconstruction of smooth helix, antihelix, superior and inferior antihelix crus. Results All the incisions healed by first intention without any hematoma, postoperative infection, or flap necrosis. All patients were followed up 9 months-6 years (median, 36 months). No auricle ptosis, deformity contour, or atrophy was observed. The structure of the helix, scapha, and antihelix were clear, natural, and excellent. The scars at the local site were limited and unconspicuous. Conclusion Modified method can almost correct all the anatomic defects of cup ear. It is an ideal method to treat type I and type II cup ear.
Objective To investigate the surgical procedures and outcomes of curing the mild and medium vaginal relaxation by double suturing vaginal muscularis. Methods From May 2005 to November 2008, 8 patients (aged 30-45 years old) with mild and medium vaginal relaxation were treated. All the patients were married and had reproductive history of naturalchildbirth. The double semiring suture was performed in the region 4 cm and 0.5 cm away from the vaginal orifice, respectively, forming the first and the second semicycle to make vagina outside 1/3 segments and vagina muscles tighten. Results The time of operation was 20-30 minutes (average 25 minutes). There was no obvious bleeding and injury of the rectum and urethra during operation. All the incisions healed by first intention. The vagina accommodated 2 fingers without scar on its mucosa 1-2 months after operation. Eight patients were followed up for 6-24 months and the patients resumed their sexual l ife 4-8 weeks after operation with satisfied improvement. Conclusion The technique of double suturing vaginal muscularis is easy and simple to perform with mild injury, fast postoperative recovery, and less postoperative compl ications. It is one of the effective methods to treat mild and medium vaginal relaxation.
To introduce a way to correct mildly and moderately inverted ni pple. Methods From May 2004 to January 2007, 16 patients (aged 18-38 years) with original bilateral inverted nipple were corrected with the double stitching of U-shape. Sixteen cases included 11 mildly inverted nipples and 5 moderately inverted nipples. Six of them received massage and vacuum aspiration, and the results were not satisfactory. After the pull ing out inverted ni pples, four microincisions about 0.1 cm on the border of areola and the basilar part of nipple were designed in each horizontal and perpendicular directions, then double stitching was performed to increase the supporting and sustaining tissue under the nipple and close the way nipple invert. Results Most cases exhibited excellent aesthetic projection and incision healed by first intention. Followup examinations were performed at 6 months to 2 years and revealed no evidence of recurring inversion, ni pple tilting or lactation disturbance. No surgical compl ications such as infection, nipple and areola of breast necrosis, permanent numbness. The scars in the local site were l imited and not conspicuous. Conclusion Double stitching of U-shape is easy and simple with few compl ications. It is an ideal method to correct mild and moderate inverted nipple.
【摘要】 目的 应用彩色多普勒血流成像技术（CDFI）对下肢皮瓣移植术前供区血管进行检测，掌握血管的来源走行、分布规律、体表的定位及血流动力学特点，为皮瓣设计提供依据。 方法 2005年1月-2009年7月，采用CDFI技术对38例下肢皮瓣内深部动脉干及其肌皮穿支动脉血管的数目、内径、走行方向及分布范围等形态学表现进行检测和血流动力学定量分析。 结果 检出供区皮瓣内深部动脉干38条，肌皮穿支动脉72条。手术所见与此一致。38例皮瓣全部成活。 结论 CDFI显像客观，简便易行，判断血管走行及功能可靠，能够准确测定下肢血管穿出部位和血管内径，对临床皮瓣设计，具有重要参考价值。【Abstract】 Objective The color Doppler ultrasound was used to assess the design of lower limbs flaps and to understand the vessel distribution of the skin flaps, so as to provide basis for design of skin flap. Methods Between January 2005 and July 2009, 38 patients were enrolled in this study and the blood supply of their lower limbs prepared to design skin flap was analyzed by color Doppler flow imaging(CDFI), and the vascular diameter and blood stream distribution were observed respectively. The quality of the blood vessel and its flowing dynamics were measured. Results Before operation, the blood vessel in donor areas had been completely found(100%), and then the artery was verified by operation.For the skin flap in the donor areas, 38 branches of arteries were deep, 72 branches were shallow.The quality of the blood vessels by the color Doppler flow imaging was consistent with the results of operation. Conclusion The color Doppler flow imaging could show the quality of the blood vessels inside the donor area accurately.It is a premier choice for lower limb vascular examination for the design of skin flap.
Objective To evaluate the results of rotational acetabular osteotomy (RAO) combined with debridement under arthroscope in the treatment of adult developmental dysplasia of the hip (DDH). Methods Between April 2002 and August 2007, 24 cases (29 hips) of DDH were treated with RAO combined with debridement under arthroscope. There were 2 males (2 hips) and 22 females (27 hips) with an average age of 37.7 years (range, 21-50 years). The locations were the left hip in 7 cases, the right hip in 12 cases, and both hips in 5 cases. The course of hip pain was 8-216 months (median, 30.5 months). According to Crowe DDH classification, there were 24 hips of type I and 5 hips of type II. According to Touml;nnis hip osteoarthritis classification, there were 20 hips of stage I and 9 hips of stage II. Results The mean operation time was 150 minutes (range, 120-180 minutes); the mean intraoperative blood loss was 600 mL (range, 500-700 mL); and the mean postoperative drainage volume was 200 mL(range, 50-400 mL). All incisions healed by first intention. Twenty-four cases were followed up 4.5 years on average (range, 3-8 years). At last follow-up, claudication disappeared in 16 hips and was improved in 8 hips. The Harris hip score was improved from 79.4 ± 9.8 preoperatively to 95.1 ± 8.6 postoperatively, showing significant difference (t=2.467, P=0.010). The visual analogue scale (VAS) score was improved from 5.1 ± 0.8 preoperatively to 1.1 ± 0.6 postoperatively, showing significant difference (t=2.118, P=0.011). The X-rayfilms showed union was achieved at 12-16 weeks (mean, 13.5 weeks). There were significant differences in the centre edge angle, Sharp angle, acetabular coverage rate, and acetabulum-head index between preoperation and postoperation (P lt; 0.05). Twenty hips at Touml;nnis stage I maintained after operation, among 9 hips at Touml;nnis stage II, 5 hips was improved to stage I and 4 hips maintained. Conclusion It has a satisfactory result to treat adult DDH by RAO combined with debridement under arthroscope, which may increase the congruency of hip joint, delay or prevent the progression of hip osteoarthritis.
To observe the histology change of the insertion using different diamertrical bone tunnel in anterior cruciate l igament (ACL) reconstruction. Methods Ninety Japanese rabbits were selected, wihout female and male l imit, weighing 2.5-3.0 kg, and were randomly divided into 3 groups, 30 in each group. The ratio of transplantation l igament diameter and bone tunnel diameter was 1/1 (group A), the ratio was 1/1.5 (group B), and the ratio was 1/2 (group C). Bone tunnel observation and histology observation were carried out in the 4th, 8th and 16th weeks postoperat ively. Results Wound healed well in 3 groups. The mean time of walking functional recovery was 1.5, 2.0 and 3.5 days in groups A, B and C respectively. After 4 weeks of operation, more soft tissues at tunnel entry were observed in group A and group B than in group C; after 8 weeks of operation, there was no crevice at bone-tunnel entry of the groups A and B, there was no improvement in group C; after 16 weeks of operation, groups A and B showed the normal insertion, group C had no normal insertion. Histology observation: in groups A, B and C, bone-tunnel was filled with loose connective tissue after 4 weeks of operation; group A and group B emerged the discontinuation ACL insertion tidal l ine after 8 weeks of operation, group C had no insertion; groups A and B emerged the similarity normal ACL insertion tidal l ine structure after 16 weeks of operation, but group C had no this structure. The results of ultimate tensile strength in groups A, B and C were (75.44 ± 7.06), (91.37 ± 6.14) and (126.91 ± 4.61) N respectively at 4 weeks; the results were (74.31 ± 4.81), (88.30 ± 7.46) and (124.34±8.44) N respectively at 8 weeks; and the results were (62.20 ± 5.32), (71.53 ± 5.99) and (83.62 ± 5.69) N respectively at 16 weeks. There was no significant difference between group A and group B (P gt; 0.05), and there were significant differences between groups A, B and group C (P lt; 0.05). Conclusion In the ACL reconstruction, the ratioof transplantation l igament diameter and bone tunnel diameter being 1/1.5 will not affect the insertion outcome, but if theratio less than the l imit it will affect the insertion outcome.
ObjectiveTo investigate the effect of vascularized peroneus longus tendon graft reconstruction on anterior cruciate ligament (ACL) insertion in rabbits.MethodsEighty healthy New Zealand white rabbits were harvested to prepare ACL injury models and randomly divided into two groups (n=40). The ACL was reconstructed with vascularized peroneus longus tendon graft in group A and peroneus longus tendon graft without blood supply in group B. The survival of animals and the healing of incision were observed after operation; the grafts were taken for gross and histological observations at 4, 8, and 16 weeks; the biomechanical test of the grafts was carried out to record the maximum tensile strength and incidence of ACL insertion rupture at 8 and 16 weeks.ResultsAll animals survived until the experiment completed. General observation showed that the tunnel was combined with grafts, the vascular infiltration was abundant, and no obvious boundary between the tunnel and grafts existed at 16 weeks in group A; there was still an obvious boundary between the tunnel and graft in group B. Histological observation showed that the collagen fibers between tendon and bone in group A increased gradually, the dense fiber connection was formed, and the “tidal-line” like structure similar to the normal ACL insertion was formed at 16 weeks; but the“tidal-line” like structure was not obvious in group B. Biomechanical test showed that there was no significant difference in the incidence of ACL insertion rupture at 8 and 16 weeks between group A and group B (P=0.680; P=0.590), but the maximum tensile strength at 8 and 16 weeks were higher in group A than in group B (t=18.503, P=0.001; t=25.391, P=0.001).ConclusionThe vascularized peroneus longus tendon graft for ACL reconstruction can obviously promote the outcome of the ACL insertion.
Objective To explore the impact of gender difference in 90-day outcomes after mechanical thrombectomy for acute cerebral infarction. Methods A prospective registration, observational, and retrospective analysis study was carried out. Patients with acute cerebral infarction who were admitted to the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College and the Department of Neurology of Nanjing First Hospital between June 2015 and June 2019 were collected. Patients were divided into two groups based on gender. The detailed demographic, laboratory examination, imaging examination and clinical data were collected. Then, the data were analyzed using univariate and multivariate logistic regression analyses. Results A total of 298 patients were included. Among them, there were 185 males and 113 females. The differences in age, smoking, atrial fibrillation, using antiplatelet drugs before stroke, TOAST classification, and involved cerebrovascular sites between the two groups were statistically significant (P<0.05), and there was no statistically significant difference in other baseline data between the two groups (P>0.05). The results of univariate logistic regression analysis showed that the rate of 90-day favourable outcome of female patients was lower than that of male patients [odds ratio (OR)=0.462, 95% confidence interval (CI) (0.275, 0.775), P=0.030]. The results of multivariate logistic regression analysis showed that, after adjusting for confounding factors, there was no independent correlation between gender and the 90-day favourable outcome of patients with acute cerebral infarction who underwent mechanical thrombectomy [OR=1.511, 95% CI (0.745, 3.066), P=0.253]. Conclusion The gender has no significant effect on the 90-day favourable outcome of acute cerebral infarction patients treated with mechanical thrombectomy.
Objective To investigate the effectiveness of local skin flaps such as V-Y advancement flap (V-Y plasty) and transposition flap (Z plasty) in the adjustment of reconstructed nasal alars at second stage. Methods Between June 2012 and January 2017, 14 cases of reconstructed nasal alars by nasolabial flap or expanded forehead flap were recruited. There were 9 males and 5 females with an average age of 34.8 years (range, 18-52 years). The interval time between one- and two-stage operations was 1-12 months (mean, 3 months). The type of local skin flap was decided according to the flaws of reconstructed nasal alars. V-Y plasty was used in 5 cases, Z plasty in 2 cases, and V-Y plasty combined with Z plasty in 7 cases. Results All operations were successfully completed. The flaps in 3 cases suffered from epidermal necrosis at the far end and healed by dressing change. The other wounds healed by first intention. All 14 cases were followed up 6-40 months (mean, 12 months). The nasal alars had verisimilar shape and symmetrical appearance. The color and texture of reconstructed nasal alar were closed to peripheral tissues. Conclusion Applying local skin flaps such as V-Y plasty and Z plasty can acquire a better shape in the adjustment of reconstructed nasal alars.
Objective To investigate the technical points and effectiveness of autogenous costal cartilage transplantation in repair of Binder’s syndrome. Methods Between June 2012 and June 2017, 8 cases of Binder’s syndrome were admitted. There were 3 males and 5 females, aged 16-31 years (mean, 22 years). All patients were conformed to the typical manifestations of Binder’s syndrome. The autogenous costal cartilage was harvested and carved into the nasal dorsum graft, nasal column graft, and nasal basement graft. Before and after operation, standard pictures of the anterior view, lateral view, and base view were taken to measure facial related parameters of nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection. Then the effectiveness of this surgical procedure for Binder’s syndrome was evaluated. Results All incisions healed by first intention without acute infections. All patients were followed up 6-36 months, with an average of 18 months. The foreign body sensation in upper lip and scar hyperplasia in thoracic incision occurred in 1 case, respectively. The nasal morphology improved significantly and the coordinated relationships of the nose with the upper lip and face were restored postoperatively. Postoperative parameter measurements were taken in 6 cases. The nasal dorsum length, nasal columella-lobule ratio, nasofrontal angle, nasal columella-upper lip angle, nasal tip projection rate, and nasion projection at preoperation were significantly improved when compared with the values at 6 months after operation (P<0.05). The difference in nasal dorsum length, nasal tip projection rate, and nasion projection between actual values at 6 months after operation and normal values was no significant (P<0.05). There was significant difference in nasal columella-lobule ratio between actual value at 6 months after operation and normal value (P>0.05). Conclusion Autogenous costal cartilage transplantation in repair of Binder’s syndrome can obviously improve patients’ appearance of the external nose and middle face, and obtain the persistent effectiveness.