Objective To evaluate the correlation between left ventricular function and arterial stiffness of left femoral artery in patients with lower extremity atherosclerotic disease (LEAD).Methods Thirty-three patients with LEAD and 37 healthy subjects (control group) were enrolled in this study.The intima-media thickness (IMT),diameter and parameters of arterial stiffness [dispensability coefficient (DC),compliance coefficient (CC),stiffness α,stiffness β,pulse wave velocity (PWVβ) ]were measured by ultrasonography with the technology of QIMT and QAS.The thickness of the interventricular septum (IVSd),end-diastolic left ventricular diameter (LVDd) and left ventricular mass (LVM),and parameters of the left ventriculsr function (EF,E/A,E'/A',E/E' and Tei index) were measured by echocardiography.These parameters were compared between two groups.Correlations between the parameters of the arterial stiffness and those of the cardiac function were evaluated by Pearson correlative analysis.Results ①The IVSd,LVM and E/E' ratio were significantly higher in LEAD group than those in control group ( P ＜0.05).There were no significant differences in EF,E/A,E'/A',and Tei index between two groups ( P ＞0.05).②The IMT,α,β,PWVβ of left femoral artery were significantly higher in LEAD group than those in control group,while DC and CC were significantly lower in LEAD group than those in control group ( P ＜0.05).③The E/E' ratio,one of the parameters representing the left ventricular diastolic function,was correlated negatively with CC and positively with α,β,and PWVβ ( P ＜0.05 or P ＜0.01 ).The E'/A' ratio was correlated positively with DC and CC,and negatively with α,β,and PWVβ ( P ＜0.05 or P ＜0.01 ).Both EF and Tei index were not significantly correlated with the above parameters of arterial stiffness ( P ＞0.05).Conclusions Patients with LEAD have thickened femoral IMT,higher arterial stiffness of left femoral artery,as well as impaired left ventricular function.There is a close correlation between the atherosclerosis of the femoral artery and the early left vcntricular dysfunction.

Objective To evaluate the association between the left carotid arterial stiffness and left ventricular diastolic function in patients with lower extremity atherosclerosis (AS).Methods ①A total of 32 patients with AS and 34 control objects were enrolled.The carotid arterial stiffness parameters:compliance coefficient (CC),distensibility coefficient (DC),stiffness parameter (α,β),pulse wave velocity β (PWVβ) were measured by using quality arterial stiffness(QAS) technology.And the values were compared between the two groups.②The parameters of left ventricular (LV) structure and function:LV end-diastolic interventricular septal thickness (IVSd),LV end-diastolic diameter (LVDd),LV end-diastolic wall thickness (PWd),LV ejection fraction (EF),systolic velocity (s'),early-diastolic velocity (e'),Tei index and E/e' ratio were measured by using two-dimensional echocardiography and tissue Doppler.These parameters were compared between the two groups.The association between the carotid arterial stiffness parameters and LV function parameters were analyzed by correlative analysis.Results ①Compared with the control group,the DC and CC were lower,and α,β,PWVβ,IMT were higer than the control group,with statistically significant differences(P ＜0.05).②The IVSd,Tei index and E/e'was significantly higher in the AS group than those in the control group.And the PWd,s',e' were lower than those in the control group (P ＜ 0.05).There was no significant difference in EF between the two groups (P ＞0.05).③The e' was correlated positively with DC and CC (r =0.39,0.36,P ＜0.01),and negatively with α,β,and PWVβ (r =-0.42,-0.42,-0.49,P ＜0.01).Tei index was correlated negatively with DC and CC (r =-0.50,-0.52,P ＜0.01),and positively with α,β,and PWVβ (r =0.58,0.58,0.62,P ＜0.01).The E/e' was correlated regatively with CC (r =-0.27,P ＜0.05),and positively with PWVβ (r =0.28,P ＜0.05).There were no significant correlation between s',EF and the stiffness parameters of carotid artery (P＞0.05).Conclusions In patients with AS,the left carotid artery stiffness increases and left ventricular systolic and diastolic function are impaired.The carotid artery stiffness and left ventricular diastolic function is correlated.Changes in carotid artery stiffness reflect the change in left ventricular diastolic function.

OBJECTIVETo evaluate preoperative application of recombinant human erythropoietin (rHuEPO) in reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanteric fractures.

METHODSFrom January 2011 to December 2013,442 cases of elderly patients with femoral intertrochanteric fracture were retrospectively reviewed. According to inclusion and exclusion criteria, 119 cases were eventually included and divided into the treatment group and the control group. There were 12 males and 40 females, with a mean age (71.4 ± 12.8) years old, and the patients received preoperative administration of rHuEPO 10,000 U qod combined with iron dextran 200 mg (3 times each day). While 16 males and 51 females in control group, with a mean age (70.9 ± 16.2) years old, and the patients only received preoperative administration of iron dextran 200 mg (3 times each day). All the patients received closed reduction and PFNA-II or Internal fixation surgeries. The perioperative blood transfusion rate, average amount of blood transfusion, postoperative complications, the length of hospital stay and mortality within 30 days were compared between the two groups.

RESULTSThere were no statistical differences between two groups in the baseline indexes (P > 0.05). Overall,71 of 119 patients (59.7%) received at least one unit allogeneic blood transfusion (ABT). However,there were significant differences in perioperative ABT rates (48.1% vs 68.7%, χ2 = 4.77, P < 0.05) and the average amount of blood transfusion between treatment group and control group, which were (1.8 ± 0.4) U/pte vs (3.6 ± 1.1) U/pte (t = 2.244, P < 0.05). Postoperative hemoglobin (Hb) on postoperative days 7 and 30 was higher in treatment group than that in control group. In addition, in treatment group, Hb levels were higher on postoperative day 30 than those on admission, which were (128.2 ± 20.6) g/L vs (118.2 ± 18.9) g/L (t = 2.133, P < 0.05). There were no statistical differences in postoperative complications, the length of hospital stay and mortality within 30 days.

CONCLUSIONFor elderly patients with femoral intertrochanteric fractures undergoing elective surgery, preoperative application of rHuEPO can significantly reduce perioperative transfusion requirements, and is likely to reduce ABT-related infection, but its long-term safety remains to be evaluated.

Aged ; Aged, 80 and over ; Blood Transfusion ; Case-Control Studies ; Erythropoietin ; administration & dosage ; Female ; Femoral Fractures ; blood ; surgery ; therapy ; Fracture Fixation, Internal ; Hemoglobins ; analysis ; Hip Fractures ; blood ; surgery ; therapy ; Humans ; Male ; Preoperative Care ; Retrospective Studies

OBJECTIVETo investigate the early clinical efficacy of induced membrane technique for reconstruction of large bone defects after debridement in adults with chronic osteomyelitis of limbs.

METHODSFrom March 2010 to March 2012,a total of 23 adult patients with chronic osteomyelitis of limbs were treated in our department. There were 15 males and 8 females, with a mean age 35.2 years old (ranged from 26 to 49 years old). Sixteen patients had open fracture history. According to the lesion site, there were 12 cases of tibia, 7 cases of femur, 3 cases of humerus, and 1 case of both radius and ulna. Among them, 19 patients had diseases in diaphysis and 4 patients in the metaphysis. The mean interval from infection to operation was 6.9 months (ranged from 4 to 13 months). All the patients were treated by using induced membrane technique. The follow-up evaluation included clinical complications, time of bone healing and limbs function. The Chinese version of SF-36 scores was used in the assessment of quality of life pre- and post-operation.

RESULTSThe average duration of follow-up was (27.6 ± 5.3) months (ranged from 18 to 43 months). Two patients had postoperative flap edge necrosis, 1 patient had superficial iliac incision infection, no obvious complications were recorded. Twenty patients obtained radiological union at a mean time of 4.6 months (ranged from 3 to 7 months). Among them, 16 patients treated with lower limbs surgery achieved full weight-bearing at about 5.2 months (ranged from 4 to 8 months) postoperatively. Four patients suffered from reinfection during follow-up, but 3 of them achieved complete bone healing after the second surgeries with induced membrane technique. At the final follow-up, there was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery.

CONCLUSIONWhen treating with adult chronic osteomyelitis of limbs, the induced membrane technique can effectively reconstruct large bone defects after debridement, significantly shorten treatment cycle, provide satisfactory results with minimal complications, promote good recovery of limbs function and require relatively simple operation technique.

Adult ; Chronic Disease ; Extremities ; surgery ; Female ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery ; Reconstructive Surgical Procedures ; methods

OBJECTIVETo evaluate the clinical outcome of accessory navicular fusion for treatment of the painful accessory navicular bone of type II in adults.

METHODSFrom June 2006 to June 2012, a total of 38 feet (in 35 adult patients) with painful accessory navicular with type I underwent an fusion operation of the primary and accessory navicular bones,including 26 males and 9 females with a mean age of (32.4±7.3) years old ranging from 18 to 44 years old. The course of disease ranged from 3 to 10 months. The perioperative complications and radiological outcomes were observed and recorded. The foot function before and after operation were assessed by the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, and the easement of the pain was evaluated by visual analog score (VAS).

RESULTSTwo patients had transient superficial inflammation of the incision, no obvious perioperative complications occurred. All patients were follow-up for (53.5±14.7) months (12 to 84 months). Bone union was confirmed on plain radiography in 32 cases (35 feet). The mean time from the operation to union was (13.7±2.3) weeks (9 to 18 weeks). Postoperative pain VAS score was improved obviosly than preoperative (V=12.14,P< 0.01). The talar-to-first metatarsal angle [(9.4±3.5)° vs (8.3±2.7)°, t=0.736, P>0.05)], calcaneal tilt angle [(17.7±2.2)° vs (18.9±3.4)°, t=0.794, P>0.05],talonavicular uncoverage angle [(14.3±3.4)° vs(12.5?4.6)°,t=0.947, P>0.05) ],and height of the first tarsometatarsal joint [(14.8±3.1) mm vs (15.9±2.8) mm,t=0.814,P>0.05)] before and after operations had no statistic difference. The AOFAS midfoot score was improced from preoperative 45.6±5.3 to postoperative 82.5±7.4 (t=3.214,P< 0.01).

CONCLUSIONFor the painful accessory navicular bone of type II in adults, if the patient has a large navicular bone and not complicated with rigid flatfoot, once the conservative treatment fails, fusion of the primary and accessory naviculars may be a successful intervention. Overall, the procedure provides reliable pain relief, definite foot function improvement, and good patient satisfaction.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Foot Diseases ; physiopathology ; surgery ; Humans ; Male ; Tarsal Bones ; abnormalities ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

Objective To explore the operative method and skill for female frontotemporal hairline reconstruction.Methods From October 2010 to October 2016,120 female patients were performed with the hairline reconstruction.The follicular units were arranged irregularly,40-55 FUs/ cm2,with 30°-45° angle from the forehead skin and 15°-20° angle from the temporal skin.The finest hairs were selected and arranged in hairline margin.Results All the patients were followed up for 10-24 months.95 patients were very satisfied,25 patients were satisfied,and no patients were unsatisfied.9 patients complained low density in the middle of the hairline and they had another surgery to improve the density.3 patients's hairline was regular,and another graft was done to correct the unnatural appearance.6 patients's hairs of the hairline margin were thick,hut no further treatment was done.1 patient underwent hair transplantation again,because of the still high hairline.6 patients's transplanted hairs appeared curly,and the curly degree was decreased after 1-2 years.The density of the transplanted hair was (44.7±8.1) FU/cm2.The density of 9 cases who complained low density in the middle of the hairline,was (36.9 ± 3.1) FU/cm2.The hair diameter of the hairline edge was (57.5±13.5) μm.The hair diameter of 6 cases who felt the hair thick was (70.2±5.1) μm.The angle of hair and the frontal skin was (40.2±8.5)°,The angle of hair and the temporal skin was (18.2± 4.7)°.Conclusions In female frontotemporal hairline reconstruction,nature hairline is created by irregular arrangement of hairs,proper density and angle and exact arrangement of different diameter hairs.

OBJECTIVETo evaluate the early clinical and radiographic outcome of scaphoid non-unions treated with Acutrak headless compression screw.

METHODSFrom January 2008 to July 2011,21 patients with scaphoid non-union were treated in our department. There were 18 males and 3 females with a mean age of (23.6 +/- 4.6) years; 12 cases were on right hand and 9 were on left. According to Herbert-Fisher classification, there were 10 cases with type D1, 7 cases with type D2, 3 cases with type D3, and 1 case with type D4. The mean time from injury to operation was (12.4 +/- 2.7) months. All patients were treated with Acutrak headless compression screw fixation (6 cases received 2 screws fixation, 15 cases received 1 screw fixation, and Matti-Russe bone grafting was applied in 7 cases). The carpal height, the scaphoid index and changes of the scapholunate angle were assessed before and after the operation. Range of motion and grip strength were recorded and the wrist function was assessed according to the Patient-Rated Wrist Evaluation (PRWE).

RESULTSAverage duration of follow-up was (21.3 +/- 3.6) months. All the patients attained radiological union in a mean time of (13.3 +/- 2.4) weeks following the operation. No obvious complications were recorded. The surgical treatment allowed the preoperative mean scaphoid index of 0.61 +/- 0.13 and the preoperative mean scapholunate angle of (59.4 +/- 6.8) degree to be improved to 0.69 +/- 0.10 and (44.3 +/- 8.2)degree postoperatively, respectively. There was a substantial improvement in grip strength and pain amelioration after surgery. The preoperative mean PRWE score of 45.2 +/- 4.7 was improved to 76.1 +/- 5.2 postoperatively. All patients returned back to the original work,the average time from surgery to work was (6.0 +/- 1.1) months.

CONCLUSIONFor scaphoid non-unions, Acutrak headless compression screw fixation can provide anatomical reduction, provide satisfactory results with a high union rate, well return of function and minimal complications in the early stage.

Adolescent ; Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Ununited ; surgery ; Humans ; Male ; Range of Motion, Articular ; Scaphoid Bone ; injuries ; physiopathology ; surgery ; Treatment Outcome ; Wrist Injuries ; physiopathology ; surgery ; Wrist Joint ; physiopathology ; surgery ; Young Adult

Objective:Dorsocervical fat pad is common in middle-aged women. Current treatments include surgical excision and liposuction. We evaluated the therapeutic effect of tumescent liposuction on dorsocervical fat pad. Anatomical study was also carried out to explore the anatomical structure and significance of dorsocervical fat pad.Methods:From Jan. 2009 to Dec. 2018, twenty-seven patients with dorsocervical fat pad were treated with tumescent liposuction in Peking University Third Hospital. Small incisions were made in bilateral scapular region and 4 mm suction cannula was applied. A female cadaver fixed with formaldehyde was dissected to investigate the structure of posterior cervical and dorsal region. The specimens were stained with HE and Masson staining.Results:14 patients were followed up for no less than 6 months, with an average follow-up time of 27 months. Patients＇ dorsocervical area were flat and smooth after the surgery. Patient satisfaction rate was 100% and no severe complication was reported except bruise and pain. The symptoms of dorsocervical pain in two patients were significantly improved after operation. Anatomical study showed that the dorsocervical fat pad was composed of superficial and deep layer of adipose tissue, with clear boundary between the two layers and no obvious capsule. The collagen fibers in deep layer were more and denser than those in superficial layer.Conclusions:Tumescent liposuction can effectively treat dorsocervical fat pad. The surgery outcome is ideal with little complication.Through the study of the anatomical structure of the dorsocervical fat pad, the operation method and principle of liposuction can be improved and the operation efficiency can be enhanced.

Objective:To investigate the clinical effect of autologous fat transplantation combined with hair transplantation in the treatment of hard and/or thin scalp flat scar after burn.Methods:The clinical data of patients with hard and thin scalp scar after burn admitted to the Department of Plastic Surgery of Peking University Third Hospital from January 2017 to December 2022 were retrospectively analyzed. Fat was extracted from the lower abdomen or outer thigh during the operation, and then injected into the scalp scar after standing for 15 minutes, about 0.8 ml/cm 2 under the hard and/or thin scar area, and 0.2-0.4 ml/cm 2 under the thick and soft scar area. Three months after fat transplantation, hair transplantation was performed in the scar bald area, and the transplant density was 25-35 follicular units (FUs)/cm 2 in the hard and thin scar area, and 30-40 FUs /cm 2 in the thick and soft scar area. The Vancouver scar scale (VSS) was used by two third party plastic surgeons to score the hard and/or thin scar areas of the scalp before and 3 months after scalp fat transplantation. The VSS score was expressed as M ( Q1, Q3), and the preoperative and postoperative data were compared by paired sample Wilcoxon signed rank test. During hair transplantation, the density of implanted hair in the hard and/or thin scar area were recorded. The density of living hair at these sites was measured at the last follow-up, and then the survival rate of hair (living hair density/implant hair density ×100%) was calculated. A third party plastic surgeon evaluated the extent to which scalp scars in the hair transplant area were covered, including completely covered, basically covered, partially covered. Patients’ evaluation with the surgical result was divided into very satisfied, satisfied and dissatisfied. Results:A total of 57 patients with scalp scar after burn were included in this group, including 31 males and 26 females, aged 13-47 years old. The time from scalp scarring to treatment was 8-41 years. The area of scalp scar was 17-120 cm 2, with an average of 63.3 cm 2. The fat injection volume of 57 patients was 13-75 ml. The hair transplantation was performed 3-8 months after a single fat filling procedure. The total amount of hair transplantation was 510-3 120 FUs. The total score of postoperative scar VSS was 4(3, 4), significantly lower than the preoperative score of 7(6, 7) ( W=6.70, P < 0.001). The color, thickness, blood vessel distribution and softness were significantly reduced compared with those before surgery ( P< 0.01). All patients were followed up for 12-18 months (mean, 14 months) after hair transplantation. The survival rate of hair in hard and thin scar area was 68.2% (22.7 FUs/cm 2/33.3 FUs/cm 2) to 89.7% (26.1 FUs/cm 2/29.1 FUs/cm 2), with an average of 81.3%. In 32 patients, scalp scars were completely covered. The scalp scar of 25 patients was basically covered. Twenty-nine patients were very satisfied with the result of the operation, and 28 patients were satisfied. Conclusion:The high survival rate of hair transplantation can be obtained by injecting fat under the hard and/or thin scalp scars before hair transplantation, which is an effective method to repair scalp scars.

Objective:To investigate the technical route and clinical application effects of correcting abnormal hairline position after rhytidectomy with hair transplantation.Methods:A total of 61 patients in this group were female. The age distribution was 28 to 65 years. Among them, 45 cases underwent forehead (with endoscopy) and mid-face rhytidectomy, 11 cases underwent forehead rhytidectomy (with endoscopy). 5 cases underwent mid-face rhytidectomy. The interval between rhytidectomy and hair transplantation ranged 6 to 79 months, with an average of 18.4 months. The hairline position and morphology of the frontal, temporal and sideburns were redesigned according to aesthetic theory. Hair transplantation was performed to correct the abnormal hairline. When the patients were followed up, the hair survival rate was calculated.The patient’s hairline satisfaction and the degree of concealment of the infratemporal hairline scar were evaluated by patient and a third party attending plastic surgeon, respectively.Results:25 cases underwent hair transplantation of frontotemporal hairline and infratemporal hairline, 23 cases underwent hair transplantation of frontotemporal hairline and 13 cases underwent hair transplantation of infratemporal hairline. All patients were followed up for 12 to 24 months. The hair survival rate of frontotemporal hairline was 94.3%[90.8%(51.1/56.3) to 98.9%(52.5/53.1)]on average.The hair survival rate of the infratemporal hairline, whose incision was inside the temporal, was 93.2%[89.1%(31.1/34.9) to 98.6%(34.4/34.9)]on average. The hair survival rate of the infratemporal hairline, whose incision was on the edge of the temporal hairline, was 81.2%[60.4%(17.2/28.5) to 87.6%(26.8/30.6)]on average. The average satisfaction score of the frontal-temporal hairline for the patients and doctors was 4.5 points and 4.7 points, respectively. The evaluation of the satisfaction of the infratemporal hairline was divided into two parts. The average satisfaction score of the patients with incisions in the hairline was 4.4 points from patients and 4.7 points from doctors. The average satisfaction score of the patients with hairline incisions was 4.0 points for patientsand 4.2 points for doctors. The scar concealment degree of infratemporal hairline scar was 3.7 points for patients and 3.9 points for doctors in average.Conclusions:Correcting abnormal hairline position after rhytidectomy with hair transplantation can achieve satisfactory result. Since the position of the infratemporal hairline and the low hair survival rate on the scar, the effect of scar concealing is average. Replanting hair grafts and improving the design of the rhytidectomy incision are the method to solve this issue.