Objective To investigate the effectiveness of using lateral homodigital flaps pedicled with cutaneous branches of digital artery for repairing nail bed defects. Methods Between December 2008 and July 2010, 5 patients with nail bed defects were repaired with lateral homodigital flaps pedicled with cutaneous branches of digital artery. Nail bed defects were caused by crush injury of machine. There were 3 males and 2 females, aged from 22 to 35 years (mean, 28 years). Injured fingers included 3 thumbs, 1 index finger, and 1 middle finger. The size of the defects ranged from 1.1 cm × 1.0 cm to 1.8 cm × 1.2 cm and the size of the flaps ranged from 2.7 cm × 1.3 cm to 3.1 cm × 1.7 cm. The donor sites were covered by skin graft. The time between injury and admission ranged from 1 hour and 12 minutes to 3 hours and 24 minutes (mean, 2.1 hours). Results All flaps and skin grafts survived, and the incision healed by first intention. The follow-up time ranged from 6 to 9 months (mean, 7.5 months). The fingers had good appearance. Four cases gained full postoperative sensory recovery and the two-point discrimination was 4-5 mm at 3 months after operation, but it did not recover in 1 case at last follow-up. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medicine Association, the results were excellent in 4 cases and good in 1 case. Conclusion The lateral homodigital flaps pedicled with cutaneous branches of digital artery can repair nail bed defects without sacrifice of digital artery, and can gain a full sensory recovery. It is a feasible solution for treatment of nail bed defects especially for those unwilling to cause any damage to their toes.
Objective To study the therapeutic effect of combining vacuum seal ing drainage (VSD) with gluteus maximus myocutaneous flap on the repair of soft tissue defect caused by the resection of sacral tumors. Methods From June2007 to June 2008, 6 patients with skin and soft tissue necrosis in the sacrococcygeal region, deep infection, and formation of cavity at 3-6 weeks after sacral tumors resection were treated. There were 4 males and 2 females aged 17-51 years old. The size of skin and soft tissue defects ranged from 15 cm × 11 cm × 6 cm to 20 cm × 18 cm × 7 cm. Every patient underwent VSD treatment for 7-10 days, and the recombinant bovine bFGF was injected into the wound intermittently for 7-14 days (250-300 U/ cm2 once, twice daily). The wound was repaired by either the gluteus maximus myocutaneous flap (5 cases) or the lumbar-gluteus flap (1 case), and those flaps were 9 cm × 9 cm-20 cm × 18 cm in size. The donor site were sutured or repaired with spl itthickness skin graft. Results All the flaps survived uneventfully. The wound healed by first intention in 5 cases, but 1 case suffered from fat l iquefaction 2 weeks after operation and healed after drainage and dressing change. All the donor sites healed by first intention, and all the skin grafts survived uneventfully. All the patients were followed up for 6-10 months, there was no relapse of sacral tumor, and the flaps showed no obvious swell ing with good color and elasticity. Conclusion With fewer compl ications, the combination of VSD and gluteus maximus myocutaneous flap is a safe and rel iable operative method for repairing the skin and soft tissue defects caused by the resection of sacral tumors.
ObjectiveTo compare the complications and clinical scores of posterior lumbar intervertebral fusion (PLIF) in middle-aged and older patients of different ages, and to assess the risk of complications of PLIF in different ages, providing a reference for clinical treatment.MethodsThe clinical data of 1 136 patients, who were more than 55 years old and underwent PLIF between June 2013 and June 2016, were retrospectively analyzed. According to the age of patients undergoing surgery, they were divided into 3 groups as 55-64 years old, 65-74 years old, and ≥75 years old. The general characteristics, comorbidities, and surgical data of the three groups were compared, with comparison the morbidity of complications. According to the minimal clinical important difference (MCID), the improvement of patient’s pain visual analogue scale (VAS) score and the Oswestry disability index (ODI) score were compared. Univariate logistic regression analysis was used to analyze the difference of complications and the improvement of VAS and ODI scores. Multivariate logistic regression analysis was performed for the risk factors of complications.ResultsThere were significant differences in the number of surgical fusion segments and osteoporosis between groups (P<0.05); there was no significant difference in gender, body mass index, operation time, preoperative American Society of Anesthesiologists (ASA) classification, and comorbidities between groups (P>0.05). All patients were followed up 6-62 months with an average of 27.4 months. Among the results of postoperative complications, there were significant differences in the total incidence of intraoperative complications, systemic complications, minor complications, and the percentage of improvement of ODI score to MCID between groups (P<0.05); but there was no significant difference in the total incidence of complications at the end of long-term follow-up and the percentage of improvement of VAS score to MCID between groups (P>0.05). Univariate logistic regression analysis showed that after adjusting the confounding factors, there were significant differences in intraoperative complications and the percentage of improvement of ODI score to MCID between 55-64 and 65-74 years old groups (P<0.05); systemic complications, minor complications, complications at the end of long-term follow-up, and the percentage of improvement of ODI score to MCID in ≥75 years old group were significantly different from those in the other two groups (P<0.05). Multivariate logistic regression analysis showed that age was a risk factor for systemic complications, minor complications, and complications at the end of long-term follow-up. Except for age, long operation time was a risk factor for intraoperative complications, increased number of fusion segments was a risk factor for systemic complications, the number of comorbidities was a risk factor for minor complications, and osteoporosis was a risk factor for complications at the end of long-term follow-up.ConclusionThe risk of surgical complications is higher in the elderly patients (≥75 years) with lumbar degenerative diseases than in the middle-aged and older patients (<75 years), while the improvements of postoperative VAS and ODI scores were similar. Under the premise of fully assessing surgical indications, PLIF has a positive effect on improving the elderly patients’ quality of life.
Objective To analyze the prospective effect of pre-existing spinal stenosis of adjacent segment on the short-term effectiveness after lumbar fusion surgery. Methods A prospective comparative study was conducted to divide 183 patients with L4-S1 lumbar spinal stenosis who met the selection criteria between July 2015 and December 2017 into two groups according to the status of adjacent segment degeneration (ASD) judged by preoperative disc degeneration and spinal stenosis. There were 98 patients in group A (no degeneration of adjacent segments before operation) and 85 patients in group B (adjacent segments degenerated before operation). There was no significant difference in gender, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), combined spondylolisthesis, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) score between the two groups (P>0.05); the age of group A was significantly younger than that of group B (t=−3.560, P=0.000). The operation time, intraoperative blood loss, hospitalization stay, and perioperative complications were recorded and compared. The VAS score of low back pain and leg pain, JOA score, and ODI score at last follow-up were used to evaluate the effectiveness. The incidence of ASD after operation was compared between the two groups, and logistic regression was used to analyze the independent risk factors affecting the occurrence of ASD after operation. Results There was no significant difference in operation time, intraoperative blood loss, and hospitalization stay between the two groups (P>0.05). The incidence of perioperative complications in groups A and B was 13.3% and 20.0%, respectively, with no significant difference (χ2=1.506, P=0.220). Two groups of patients were followed up, the follow-up time of groups A and B was (24.9±8.8) months and (24.8±7.8) months, respectively, there was no significant difference (t=0.050, P=0.960). At last follow-up, no adjacent segment disease was found in either group. There was no significant difference in Pfirrmann grade between the two groups at last follow-up (P>0.05), and there was significant difference in Pfirrmann grade between the two groups before operation and at last follow-up (P<0.001). At last follow-up, 21 cases (21.4%) in group A and 53 cases (62.4%) in group B had ASD, with significant difference (χ2=31.652, P=0.000). The main cause of ASD was the severity of adjacent spinal canal stenosis. The clinical scores of the two groups at last follow-up were significantly improved when compared with those before operation (P<0.05). The JOA score of group A was significantly higher than that of group B at last follow-up (P<0.05). In group B, the VAS score of low back pain and ODI score in patients with ASD after operation at last follow-up were significantly higher than those in patients without ASD (P<0.05). logistic regression analysis showed that preoperative pre-existing degeneration and BMI were independent risk factors for ASD after operation (P<0.05). Conclusion Pre-existing mild spinal stenosis in adjacent segment can significantly affect the effectiveness, and can significantly increase the risk of ASD early after operation. The main pathological type of ASD was the severity of adjacent segment spinal stenosis. For preoperative assessment of pre-existing degeneration, we should evaluate the overall degeneration of the adjacent segment of the spinal canal, rather than simply evaluating the degeneration of the adjacent disc and facet joints.