Objective To evaluate the effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus with absorbable screws or metal screws fixation by clinical and radiological data. Methods Between March 2014 and May 2016, the Scarf osteotomy combined with Akin osteotomy was used to treat 62 patients (83 feet) with moderate to severe hallux valgus. Twenty-five patients (35 feet) were fixed by absorbable screws (group A) and 37 patients (48 feet) were fixed by metal screws (group B). The difference in gender, age, affected side, etiology, severity, disease duration, preoperative hallux valgus angle (HVA) and first-second intermetatarsal angle (1-2IMA) measured in weight-bearing anteroposterior X-ray film, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS) scores between 2 groups (P>0.05). The complications and healing time of 2 groups were recorded and compared. At last follow-up, the AOFAS and VAS scores, and HVA, 1-2IMA measured by weight-bearing anteroposterior X-ray film were used to evaluate the effectiveness. Results All incisions healed by first intention and no incision-related complication occurred in the two groups after operation. Both groups were followed up, the follow-up time in group A was 12-36 months (mean, 24.4 months) and in group B was 14-38 months (mean, 25.7 months). In group A, 1 foot was complicated with hallux varus, 2 feet had mild stiffness, 1 foot appeared metastatic metatarsal pain, and in group B was 2, 3, 2 feet, respectively. There was no recurrence of hallux valgus in both groups. The difference in the incidence of complications between the two groups after the first operation was not significant (χ2=0.275, P=0.843). The removal rate of internal fixator in group B was 89.2% (33 cases) during the second operation, among which 3 cases had screw slip and 1 case had screw fracture. And 10.8% (4 cases) refused the second removal operation due to their age. Postoperative X-ray films showed that both groups had good healing at the osteotomy site, and there was no significant difference in healing time between the two groups (t=1.633, P=0.285). At last follow-up, the AOFAS score, VAS score, HVA, and 1-2IMA were significantly improved in the two groups when compared with preoperative ones (P<0.05); but no significant difference was found between the two groups (P>0.05). Conclusion The effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus is significant, with few complications. Compared with being fixed by metal screws, being fixed by absorbable screws has the same effectiveness, but can avoid the risk of second operation to remove the internal fixator.
Objective To evaluate the short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus. Methods The clinical data of 30 patients (48 feet) who were diagnosised hallux valgus associated with mild to moderate metatarsus adductus and treated by Scarf osteotomy and Akin osteotomy combined with soft tissue procedures between February 2013 and May 2015 were analyzed retrospectively. There were 2 males (2 feet) and 28 females (46 feet) with an average age of 29.4 years (range, 18-50 years). The disease duration was 3-12 years (mean, 6.1 years). The degree of metatarsal adductus was assessed by Sgarlato’s measurement and Yu et al classification criteria, and the degree of metatarsal adductus was mild in 20 feet and moderate in 28 feet. Preoperative X-ray examination showed that the hallux valgus angle (HVA) was (39.4±5.6)°, the first-second intermetatarsal angle (1-2IMA) was (15.2±3.5)°, the metatarsus adductus angle (MAA) was (21.2±3.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 51.7±10.0, and visual analogue scale (VAS) score was 4.9±2.7 before operation. Postoperative complications and the union time of osteotomies were recorded. At last follow-up, the HVA, 1-2IMA, and MAA were measured on X-ray films, and the AOFAS scores and VAS scores were recorded, then compared them with preoperative ones. Roles - Maudsley score was used to investigate patients’ satisfaction. Results All the incisions healed by first intention. Thirty patients were followed up 24-27 months (mean, 26.4 months). Three patients (4 feet) occured metatarsalgia, and the pain relieved after treated by Custom-Made Orthotics. All the osteotomies were unoin, the healing time was 2-4 months (mean, 2.7 months). At last follow-up, the HVA and the 1-2IMA were (13.2±3.1)° and (5.1±2.3)°, respectively, showing significant differences when compared with preoperative ones (t=14.606, P=0.000; t=22.356, P=0.000); the MAA was (21.0±3.4)° and there was no significant difference when compared with preoperative one (t=0.789, P=0.434). The AOFAS and VAS scores were 91.8±7.5 and 1.1±1.0, respectively, showing signifiant differences when compared with preoperative ones (t=13.787, P=0.000; t=14.781, P=0.000). Satisfaction survey showed that 28 patients were very satisfied and satisfied (93.3%), and 2 cases were not satisfied (6.7%). Conclusion The short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus is satisfactory, and no correction is required for metatarsal adductus.
Objectives To analyze the risk factors of uterine rupture in pregnancy in Chengdu Women’s and Children’s Central Hospital in recent years. Methods The clinical data of pregnant uterine rupture patients who were hospitalized in Chengdu Women’s and Children’s Central Hospital from January 2011 to December 2017 were collected. The risk factors of uterine rupture in pregnancy were analyzed compared with the maternal delivery during the same period. The SPSS 23.0 software was used for statistical analysis. Results A total of 69 patients with uterine rupture were included, involving 14 cases of complete uterine rupture and 55 cases of incomplete uterine rupture. Compared with the pregnant females who were hospitalized during the same period, the incidence of uterine rupture in patients with scar uterus after cesarean section, history of laparoscopic hysterosalping surgery, placental implantation, twins and uterine malformation was higher, and the difference was statistically significant (P<0.05). Among them, the risk of uterine rupture was greater in the interpregnancy interval (IPI)>24 months after cesarean section in patients with scar uterus. There was no significant difference in the incidence of uterine rupture between the elderly and the multiple pregnant females and the maternal delivery during the same period (P>0.05). Conclusions Scar uterus (postoperative cesarean section), history of laparoscopic hysterosalping surgery, placental implantation, twins, and uterine malformation are possible risk factors for uterine rupture in pregnancy. Among them, patients with scar uterus have a greater risk of uterine rupture with IPI>24 months.
Since 1987, One hundred and fifty-four patients suffered from alopecia, neck and facial scar, and nasal defect had been treated with skin soft tissue expansion. The incidence of complication was decreased markedly, compared to previons report which was 11.7%. Two cases of this group were given up this procedure. The lessous learned from these case were as following. Strictly evaluated the case according to the indication, examined the expander carefully, improved the techniques to inbed the expander and infilled the sailine, those of which could obtain satisfactory result.
Objective To investigate the therapeutic effect of the chitosan/polyethylene glycols-succinate/ mitomycin C (CH/PEG-SA/MMC) film on epidural scarring tissues. Methods According to a specific proportion of respective materials, the film of CH/PEG-SA/MMC was developed under some condition. Thirty SD rats were selected and randomized into 6 groups with 5 rats in each group. A rat model of lumbar laminectomy was used. The amount of 20 mg of the CH film was implanted into the animals in group I, 20 mg of CH/PEG film in group II, 20 mg of CH/PEGSA film in group III, 0.05 mg/mL of the MMC soaking for 5 minutes in group IV, 20 mg of CH/PEG-SA/MMC film in group V, and nothing was done in group VI. Specimens were harvested 4 weeks after the above procedures and were then subjected to immunohistochemical and histological examinations to compare their therapeutic effects on epidural cicatricial tissues. Results All rats were in good conditions after operation, without gait abnormal ity, restlessness, infection and death. There was no significant difference among the 6 groups in the postoperative Rydell score (P lt; 0.05). The content of hydroxyprol ine in groups I, II, III, IV, V and VI was (0.570 8 ± 0.345 0), (0.728 6 ± 0.150 6), (0.553 4 ± 0.122 3), (0.313 3 ± 0.106 4), (0.261 9 ± 0.102 1)and (1.020 1 ± 0.120 6) μg/ mg, respectively. There was a significant difference between groups IV, V and groups I, II, III (P lt; 0.05), and there was significant difference between group VI and the rest 5 groups (P lt; 0.05). According to the histological observation, group V had less collagenous fiber parallel ing the dura mater, with few inflammatory cells infiltration, with few capillary vessels and no reaction of macrophages. Conclusion CH/PEG-SA/MMC films can effectively reduce the amount of Hyp in epidural scarring tissues after lumbar laminectomy and therefore is a good treating method in preventing scarring tissue adhesion.
A combined rotational flap was used to repair large scar on the face. The flap was removed from the lateral part of the neck, face and postaural region, between the zygmatic arch and clavicle. The dissection was carried out on the superfic ial of SMAS and platysmus M. Twentysix (12 males and 14 females) were reported. The age ranged from 5 to 28 years. The flap was survived completely in 19 cases. Small area at the margin of the flap was necrotic, which was reducing appeared in the postaural cular region in 6 cases. By reducing the size of the postaural cual component of the flap, necrosis never occured. Among these cases, 11 were followed up for 6 to 14 months. The results were satisfactory. The combined flap was classified as randomized flap because it had no axial and it could be used to cover a large area of skin defect. The color, thickness and quality of the flaps were all close to the normal facial skin. It was considered especially suitable for repair the large wound on the medial twothirds of the cheek.
Objective To investigate the feasibility of laparoscopic cholecystectomy through the transumbilical approach. MethodsThe clinical data of 18 patients underwent endoscopic cholecystectomy through only one transumbilical incision at West China Hospital were retrospectively analyzed. Results All of the operations were successfully completed without conversion to routine laparoscopic surgery or open surgery. The operation time was 40-130 （58±10） min. There was no intraoperative complication. The patients did well postoperatively and were discharged 1 day after operation. There was no postoperative complications and without visible abdominal scar on 1 month follow-up. Conclusions Laparoscopic cholecystectomy through the transumbilical approach is technically feasible and safe. But this technique is difficult, the patients should be selected carefully.
ObjectiveTo investigate the feasibil ity and effectiveness of using scar spl it thickness skin grafts combined with acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar. MethodsBetween January 2013 and December 2013, 20 cases of large deep Ⅱ degree burn scar undergoing plastic operation were enrolled. There were 14 males and 6 females, aged 4 to 60 years (mean, 40 years). Burn reasons included hydrothermal burns in 10 cases, flame burns in 9 cases, and lime burns in 1 case. The burn area accounted for 70% to 96% total body surface area (TBSA) with an average of 79% TBSA. The time from wound healing to scar repair was 3 months to 2 years (mean, 7 months). Based on self-control, 0.7 mm scar spl it thickness skin graft was used to repair the wound at the right side of joints after scar resection (control group, n=35), 0.5 mm scar spl it thickness skin graft combined with acellular allogeneic dermis at the left side of joints (trial group, n=30). Difference was not statistically significant in the scar sites between 2 groups (Z=-1.152, P=0.249). After grafting, negative pressure drainage was given for 10 days; plaster was used for immobilization till wound heal ing; and all patients underwent regular rehabil itation exercises. ResultsNo significant difference was found in wound heal ing, infection, and healing time between 2 groups (P>0.05). All patients were followed up for 6 months. According to the Vancouver Scar Scale (VSS), the score was 5.23±1.41 in trial group and was 10.17±2.26 in control group, showing significant difference (t=8.925, P=0.000). Referring to Activities of Daily Living (ADL) grading standards to assess joint function, the results were excellent in 8 cases, good in 20 cases, fair in 1 case, and poor in 1 case in trial group; the results were excellent in 3 cases, good in 5 cases, fair in 22 cases, and poor in 5 cases in control group; and difference was statistically significant (Z=-4.894, P=0.000). ConclusionA combination of scar spl it thickness skin graft and acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar is feasible and can become one of solution to the problem of skin source tension.
【Abstract】 Objective To investigate the method and effectiveness of expanded delto-pectoral and abdominalperforator flaps in repairing large defects of the face and upper limb after scar excision. Methods Between August 2000 and February 2011, 25 patients with large scars on face and upper l imb were treated. There were 14 males and 11 females with an average ageof 27 years (range, 7-36 years). Scars causes were burn and scald in 25 cases with a disease duration of 6 months to 7 years (mean, 4.5 years). The hypertrophic scars located at face in 15 cases, and at upper limb and hand in 10 cases. The soft tissue expanders (300-500 mL in volume) were implanted in the delto-pectoral zone and abdominal region in one-stage operation. In two-stage operation, after scars were resected, defects (9 cm × 7 cm to 17 cm × 8 cm) were repaired with the delto-pectoralperforator flaps (17 cm × 7 cm to 20 cm × 8 cm) in 15 facial scar cases and with the deep inferior epigastric artery perforator flaps (10 cm × 9 cm to 25 cm × 14 cm) in 10 upper limb and hand scar cases. The donor sites were sutured directly. Results Partial necrosis of the flaps occurred in 2 cases after operation, then the flap survived after expectant treatment. The other flaps and skin grafts survived successfully, and the incisions healed by first intention. Ten patients were followed up 6 months to 4 years. Theappearance, texture, and color of the flaps were similar to those at the donor site. Conclusion It is an effective method to use the delto-pectoral perforator flap and the deep inferior epigastric artery perforator flap for repairing soft tissue defects of the face and upper limb after scar excision.
OBJECTIVE In order to reduce the complication of the transposition of superficial cervical artery skin flap for the repair of neck defect, the method of pre-expanded skin flap was designed, and its clinical result was observed. METHODS From March 1995 to October 1997, 12 cases with cicatricial contracture of the neck were treated by the following methods, preexpanded superficial cervical artery skin flap, and then transposed it for the reconstruction the cervical scar after burns. There were 8 males and 4 females and the age ranged from 6 to 32 years. A maximal size of flap was 35 cm x 14 cm and a minimal size was 16 cm x 7 cm. RESULTS All the flaps were survived except one, which partial necrosis occurred in the tip. Postoperative follow-up for 6 months to 3 years showed that the physiological angle of cervico-mandibular angle was recovered and the appearance of flap was satisfactory without swelling and contracture. CONCLUSION The preexpanded superficial cervical artery skin flap has many advantages, and it is particularly suitable for reconstruction of severe cervical contracture after extensive burns.