Objective:To compare the efficacy and safety between microvascular anastomostive device (MAD) and hand-sewn (HS) in free flap reconstruction.Methods:Databases in Pubmed, Embase, CNKI, Wanfang, CBM and Weipu etc. The comparative study of MAD device and manual suture in free flap repair of soft tissue defects published in domestic and foreign official journals from January, 1950 to October, 2019 was collected. The quality of the included studies was strictly evaluated and relevant data were extracted. Revman 5.3 software was used to analyze all relevant data.Results:Fifteen trials with 5 539 patients were included. There was significant difference between MAD and HS in time of venous anastomoses ( SMD=-5.46, 95% CI: -7.50, -3.41, P<0.001), time of artery anastomoses ( SMD=-5.16, 95% CI: -9.61, -0.71, P=0.02), vascular crisis ( RR=0.49, 95% CI: 0.34, 0.70, P<0.001) and flap necrosis ( RR=0.52, 95% CI: 0.32, 0.86, P=0.01), the difference between the 2 groups was statistically significant ( P< 0.05). Conclusion:According to the analyses of the pooled results of MAD group and HS group, the data tend to suggest that MAD is superior to HS in the reconstruction with free flap.

Objective To discuss the efficiency of fibrin glue amikacin complex in controlling infection by observing the changes of leukocyte and neutrophilic granulocyte classifying counts after fibrin glue amikacin complex treated deep wound. Methods Clinical case-control study was used in the study. All patients were divided randomly into test group (100 patients) and control group (100 pa-tients), matched by wound location, wound size, time from injury to operation, combined injury and gen-eral antibiotics use to compare leukocyte and neutrophilic granulocyte classifying counts between both groups and observe possible toxic and side-effect in test group. Results Firstly, the test group and control group had the comparability in aspects of gender distribution, average age and injury mechanism (P >0.05). Secondly, there was statistical difference in classifying counts of leukocyte and neutrophilic granulocyte in the test group at different time points (P <0.05). The classifying counts of leukocyte and neutrophilic granalocyte peaked at 24 hours after operation, then decreased with treatment time and reached the lowest at 24 days after surgery or at day 1 before discharge. Thirdly, there existed statistical significance upon leukocyte counts in the test group and control group except for at day 1 after operation (P > 0.05), with lower counts in test group than control group. In aspect of neutrophil classifying counts, there was statistical significance (P < 0.05) at other time points in beth groups except for time points at days 1,2 and 12 (P >0.05). The test group had lower neutrophil classifying counts compared with con-trol group at different time points. Conclusion The fibrin glue amikacin complex has good clinical effort and high security, with no toxic or side effort in treatment of deep wound infection, and is worth clinical applicaiton.

Objective To compare the clinical effects of combined anterolateral and posterolateral approach,lateral incision via double intermuscular spatia approach,and posterolateral transfibular approach in the treatment of fractures of anterolateral and posterolateral columns of tibial plateau.Methods A retrospective analysis was done of the 18 patients with fracture of anterolateral and posterolateral columns of tibial plateau who had been treated at our hospital from January 2012 to January 2015.They were 10 men and 8 women,aged from 28 to 58 years (mean,35.5 years).They were divided into 3 equal groups.Group A was treated with combined anterolateral and posterolateral approach,group B with lateral incision via double intermuscular spatia approach and group C with posterolateral transfibular approach.Operation time,surgical blood loss and complications were recorded.At the final follow-ups,Rasmussen score was used to evaluate the fracture reduction and Hospital for Special Surgery (HSS) knee score to assess functions of the involved knees.Results The 18 patients were followed up for 10 to 18 months (average,13.3 months).No such early complications as incision infection or deep vein thrombosis occurred.The operation time (89.5 min and 79.3 min,respectively) and surgical blood loss (151.7 mL and 207.8 mL,respectively) for groups A and B were obviously less than those for group C (102.5 min;260.2 mL);the incision length for group A (10.5 cm) was shorter than that for group B (17.4 cm) and for group C (16.3 cm);group C had more cases of excellent reduction (6) than groups A and B (4 for both).There were no obvious differenc es between groups A,B and C in the Rasmussen score (16.8,17.0 and 16.3) or HSS score (86.3,86.0 and 85.7).One case of delayed incision healing due to partial necrosis occurred in group B.At the final follow-ups in group C,the varus stress test showed 2 cases of laxation of degree Ⅱ and 2 cases of laxation of degree Ⅰ.Conclusions In the treatment of fractures of anterolateral and posterolateral columns of tibial plateau,all the 3 approaches can lead to good exposure,fine reduction,rigid fixation and satisfactory outcomes.Although the combined anterolateral and posterolateral approach and lateral incision via double intermuscular spatia approach can lead to similar exposure ranges and fixation effects,the latter is easier in operation while the former exposes the anterior and posterior spatia more fully,allowing the anterior and posterior plates to be better positioned.The posterolateral transfibular approach can lead to the largest exposure range and more precise reduction,but it has risks of damage to the lateral ligamentous structure,greater invasion,postoperative lateral instability and injury to the common peroneal nerve.