Objective To explore the efficacy of transplantation of a U-shaped ilioinguinal flap in the re pair of skin and soft tissue defects of the extremity.An axial flap based on the superficial iliac circumflex artery and trimmed to a subdermal vascular network flap was used for the procedures.Methods Seven patients with skin and soft tissue defects treated between June,2009 and May,2014 were studied.The patients were 22-45 years of age (mean,32 years),and included 5 males and 2 females.Four patients had punch-press injuries,1 patient had a hot-crush injury,and the remaining 2 patients were injured in the accidents.The wound sizes were 14.0 cm × 10.0 cm to 6.0 cm × 5.0 cm,with a varying extent of exposed tendons and bones.Repairs were performed using free ilioinguinal flaps,which were 15.0 cm × 11.0 cm to 7.0 cm × 5.0 cm in size.The axial flap was trimmed to a U-shaped subdermal vascular network flap and transplanted to the recipient site with anastomosis of blood vessels.Results All transplanted flaps survived.Four patients were followed for 1-6 months,with a mean duration of follow-up of 4 months.The trimmed flaps showed gradual reddening immediately after surgery,and the capillaries were recovered with a flat surface.Re-examination 3 months after surgery showed that the flaps were thin and flexible and met the aesthetic demand.No obvious pigmentation occurred,and the donor site was sutured directly,leaving only linear scars.Conclusion Repair of skin and soft tissue defects of the extremity using a U-shaped trimmed ilioinguinal flap has the advantages of a hidden donor site,small scar,and conformity to aesthetic requirements.The trimmed flaps are preferred over untrimmed flaps in terms of color and texture.The former flap is thinner,meets the aesthetic demand,and achieves a better efficacy.

ObjectiveTo observe the effects of different suture techniques on complications after choledochojejunostomy. MethodsA retrospective analysis was performed on the clinical data of 162 patients who underwent choledochojejunostomy from January 2005 to December 2014 in our hospital. The patients were divided into group A undergoing simple interrupted suture (n=68), group B undergoing simple continuous suture (n=45), and group C undergoing parachute type continuous suture (n=49). The intraoperative conditions and postoperative complications were compared between the three groups. Comparison of continuous data between the three groups was made by ANOVA and pairwise comparison between any two groups was made by LSD t-tests; comparison of categorical data between the groups was made by chi-square test. ResultsThe anastomosis time and the rate of T-tube insertion showed significant differences between the three groups (P＜0.05). Groups B and C had significantly shorter anastomosis time than group A(P＜0.001), but there was no significant difference in the anastomosis time between groups B and C (P＞0.05). Among the three groups, group A had the highest rate of T-tube insertion; group B had the second highest rate; group C had the lowest rate. Significant differences were found between any two groups in the rate of T-tube insertion by pairwise comparison (P＜0.05). However, there were no significant differences between the three groups in the incidence rates of postoperative bile leakage and choleperitonitis (P＞0.05). There was significant difference in biliary stricture between the three groups in the follow-up examination 6 months after surgery (P＜0.001) and the differences analyzed by pairwise comparison were also significant (P＜0.05). Among the three groups, the degree of biliary stricture in the group A was the highest and that in the group C was the lowest. ConclusionParachute-type continuous suture is a fine suture technique for choledochojejunostomy, which can reduce the anastomosis time, the rate of T-tube insertion, and the degree of biliary stricture.

ObjectiveTo investigate the incidence rate and risk factors for the complications after laparoscopic splenectomy in patients with portal hypertension. MethodsThe clinical data of 83 patients with portal hypertension, who were admitted to our hospital and underwent laparoscopic splenectomy from June 2009 to December 2014, were analyzed retrospectively. The incidence rate of the complications was analyzed using the Clavien-Dindo classification system and the risk factors for the complications were analyzed using chi-square test and logistic regression method. ResultsThe incidence rate of postoperative complications was 24.10% (20/83). According to the Clavien-Dindo classification system, the numbers of patients with grade Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴ complications were 5, 3, 10, 2, and 0, respectively. The patients undergoing total laparoscopic splenectomy had a significantly higher incidence rate of postoperative complications than those undergoing hand-assisted laparoscopic splenectomy (32.59% vs 15.00%, χ2=3.966, P=0.046). According to the univariate analysis, the Child-Pugh class, application of the hand-assisted device, gastroesophageal vein ligation, and American Society of Anesthesiologists (ASA) grade were all risks factors for the postoperative complications (all P＜0.05). Further analysis using multiple logistic regression illustrated that Child-Pugh class B and ASA grade Ⅲ were independent risk factors for the postoperative complications (OR=0.328, 95%CI: 0.129~0.834, P＜0.05; OR=0.294, 95%CI: 0.150~0.573, P＜0.05). ConclusionPatients with portal hypertension undergoing laparoscopic splenectomy have a high incidence of postoperative complications and the occurrence of the complications is closely associated with the Child-Pugh class and the ASA grade.

Objective To explore the effects of crisis-based interventions on breast cancer patients who received peripherally inserted central catheters (PICC). Methods A total of 104 breast cancer patients who were admitted in He'nan Cancer Hospital between May 2016 and May 2017 were selected by purposive sampling and divided into the control group (n=52) and the observation group (n=52) according to the random number table. Patients in the control group received routine nursing care for PICC, while patients in the observation group received crisis-based interventions. The Triages Assessment Form (TAF) and Hamilton Depression Scale (HAMD) were used to compare the effects of interventions. Results Patients in the observation group scored (4.11±1.65), (5.14±0.31) and (5.32±0.54) in the dimensions of emotion, cognition and behavior in TAF, lower than those of the control group (t=3.229, 8.933, 5.290; P＜ 0.01). Patients in the observation group scored (1.47±0.46), (1.02±0.89) and (1.13±0.21) in the dimensions of depression, somatic anxiety and mental anxiety, lower than those of the control group (t=4.890, 3.039, 11.264; P＜ 0.01). Conclusions Crisis-based interventions can improve the negative emotions of breast cancer patients receiving PICC, which is worth promoting in clinical practice.