OBJECTIVE: To investigate the effectiveness of tibial transverse transport (TTT) combined with modified neurolysis in treatment of diabetic foot ulcer (DFU) through a prospective randomized controlled study. METHODS: The patients with DFU and diabetic peripheral neuropathy, who were admitted between February 2020 and February 2022, were selected as the research objects, of which 31 cases met the selection criteria and were included in the study. The patients were divided into two groups by random number table method. The 15 patients in the trial group were treated with TTT combined with modified neurolysis, and the 16 patients in the control group received treatment with TTT alone. There was no significant difference in gender, age, duration of DFU, ulcer area, Wagner classification, as well as preoperative foot skin temperature, visual analogue scale (VAS) score, ankle-brachial index (ABI), motor nerve conduction velocity (MNCV) of the common peroneal nerve, MNCV of the tibial nerve, MNCV of the deep peroneal nerve, two-point discrimination (2-PD) of heel, and cross-sectional area (CSA) of the common peroneal nerve between the two groups ( P>0.05). The time for ulcer healing, foot skin temperature, VAS scores, ABI, 2-PD of heel, and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups. The differences in MNCV of the common peroneal nerve, MNCV of the tibial nerve, and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated. RESULTS: All patients in both groups were followed up 12-24 months (mean, 13.9 months). The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase. Ulcer wounds in both groups healed successfully, and there was no significant difference in the healing time ( P>0.05). During the follow-up, there was no ulcer recurrences. At 12 months after operation, the MNCV of the common peroneal nerve, the MNCV of the tibial nerve, and the MNCV of the deep peroneal nerve in both groups accelerated when compared to preoperative values ( P<0.05). Furthermore, the trial group exhibited a greater acceleration in MNCV compared to the control group, and the difference was significant ( P<0.05). The foot skin temperature, VAS score, ABI, 2-PD of heel, and CSA of the common peroneal nerve at 6 and 12 months after operation significantly improved when compared with those before operation in both groups ( P<0.05). The 2-PD gradually improved over time, showing significant difference ( P<0.05). The 2-PD of heel and VAS score of the trial group were superior to the control group, and the differences were significant ( P<0.05). There was no significant difference in ABI, foot skin temperature, and CSA of the common peroneal nerve between groups after operation ( P>0.05). CONCLUSION Compared with TTT alone, the TTT combined with modified neurolysis for DFU can simultaneously solve both microcirculatory disorders and nerve compression, improve the quality of nerve function recovery, and enhance the patient's quality of life.
Humans ; Diabetic Foot/surgery* ; Microcirculation ; Prospective Studies ; Quality of Life ; Treatment Outcome ; Diabetes Mellitus

OBJECTIVETo compare the efficacy and micromanipulation techniques of microvascular decompression with whole-range encirclement method and the conventional method in 65 cases of hemifacial spasm.

METHODSThe data of 65 surgically managed cases of hemifacial spasm were retrospectively analyzed for intraoperative findings, surgical techniques, and the patients' outcomes. Microvascular decompression with the conventional approach was performed in 30 patients (group A), and whole-range encircling method was used in the other 35 patients (group B). The patients were also divided into group C (below 40 years, n=27) and group D (above 40 years, n=38) according to the onset age of the symptom.

RESULTSIn these patients, 4 patterns of facial nerve compression were identified: simple contact, contact and indentation, adhesion and encasement, and unidentified offending vessels. The offending vessels included the arteries, veins, and vascular loops. In most patients in group C, the arachnoid membrane around the facial nerve thickened and encircled the offending ve;ssel; in group D, the characteristic changes of the vasculature occurred in the offending artery, resulting in its displacement. In groups A and B, the overall efficacy rate was 80% and 97.1%, with recurrence rates of 13.3% and 2.9%, respectively. The major permanent complications in group A included hearing impairment (10.0%) and ataxia (6.7%), whose incidences in group B were 2.9% and 2.9%, respectively.

CONCLUSIONMicrovascular decompression with whole-range encircling method is a safe approach associated with high cure rate, in which careful avoidance of injuries to the cranial nerves and the penetrating vessels from the root entry/exit zone and the pons ensure good outcome and minimize the likeliness of recurrence and complications.

Adult ; Aged ; Decompression, Surgical ; methods ; Facial Nerve ; surgery ; Female ; Hemifacial Spasm ; surgery ; Humans ; Male ; Microcirculation ; Middle Aged ; Retrospective Studies

BACKGROUNDHyperbaric oxygen preconditioning (HBO) is a new method of ischemia preconditioning. In this study, we examined its effects on skin flap survival and the mechanisms involved.

METHODSThirty-six rats were divided into three groups: HBO preconditioning, control, and sham groups. An extended epigastric adipocutaneous flap based on the right superficial epigastric artery and vein was raised. A 3-hour period of flap ischemia was induced by clamping the pedicle vessels with a microvascular clamp. At the end of ischemia induction, the clamp was removed and the flap was resutured. Rats in the HBO preconditioning group were treated with HBO four times before surgery. Microcirculation in the skin flap was measured on postoperative days 1, 3 and 5. The size of the flap was measured on postoperative day 5, before the animals were sacrificed. Samples of the skin flap were prepared and stained with hematoxylin and eosin. The levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 in the flap samples were measured.

RESULTSSurviving flap size was significantly higher in the HBO preconditioning group compared with controls, with a reduced inflammatory response and increased perfusion. IL-1, TNF-α, and IL-6 levels in the HBO preconditioning group were lower than in controls.

CONCLUSIONSHBO preconditioning improved flap survival in this ischemia-reperfusion rat model. The mechanisms responsible for this effect may relate to attenuation of the inflammatory response and increased flap perfusion following HBO preconditioning.

Animals ; Graft Survival ; Hyperbaric Oxygenation ; methods ; Ischemia ; surgery ; Male ; Microcirculation ; physiology ; Rats ; Rats, Sprague-Dawley ; Skin ; Surgical Flaps

PURPOSE: We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We enrolled 113 patients with STEMI (age, 56+/-11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [<18 U (12.9+/-2.6 U), n=38], Mid IMR [18-31 U (23.9+/-4.0 U), n=38], and High IMR [>31 U (48.1+/-17.1 U), n=37]. RESULTS: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively). CONCLUSION: Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunction in STEMI patients with a door-to-balloon time of <90 minutes.
Aged ; Angiography/*methods ; Female ; Humans ; Male ; Microcirculation ; Middle Aged ; Myocardial Infarction/physiopathology/*surgery ; Operative Time ; *Percutaneous Coronary Intervention ; Regression Analysis

OBJECTIVETo monitor the microcirculation of lateral groin skin flaps.

METHODSThe microcirculation in 12 lateral groin skin flaps was monitored continuously by laser doppler flowmetry (LDF).

RESULTSThe microcirculatory changes in lateral groin skin flaps were divided into two phases: rapid rising (2-6 days after operation) and plateau (6-11 days after operation). PU values were 2.83 +/- 0.46, 3.21 +/- 0.41, 3.66 +/- 0.43, 4.77 +/- 0.71, 7.08 +/- 0.37; 7.53 +/- 0.41, 7.57 +/- 0.62, 7.70 +/- 0.44, 7.60 +/- 0.26, 7.58 +/- 0.17.

CONCLUSIONIn clinical application, division of the lateral groin skin flaps within the plateau, and the values (PU) returned to or exceeded 50% of that values (PU) determined before application of the tourniquet, causes flaps survival (100%). The time of division was decreased to 8-11 postoperative days in our clinical application.

Adolescent ; Adult ; Groin ; surgery ; Humans ; Laser-Doppler Flowmetry ; Microcirculation ; Middle Aged ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; Time Factors

OBJECTIVETo evaluate the short-term and long-term curative effect of microvascular decompression sensory root of trigeminal nerve combing (MVD + SRTNC) by post-sigmoid approach as well as the complications in these operations.

METHODSThe data from 138 idiopathic trigeminal neuralgia (TN) patients treated with MVD + STRNC that followed up 33 months to 58 months was analyzed.

RESULTSImmediate relief from pain occurred in 136 patients (98.6%). On Kaplan-Meier analysis, cumulative proportion effectiveness at the end of 25 months decreased to 91.4%, and 85.8% from 49 months to 58 months. There were cases of 63.83% and 19.15% with slight and midrange hypoesthesia after surgery but majority recovered at the end of 3-58 months (P < 0.01). No serious hypoesthesia occurred. The complications including leakage of cerebrospinal fluid, herpes and headache caused by high intracranial pressure, were observed in 4 cases (2.90%), 36 cases (26.09%) and 3 cases (2.17%), respectively. Two cases (1.43%) died of cerebral hemorrhage.

CONCLUSIONSThe proposed surgical strategy of standard MVD plus sensory root of trigeminal nerve combing was a good strategy option for TN, but It was important for surgeons to think highly of the risks of the surgery.

Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical ; Female ; Humans ; Male ; Microcirculation ; Middle Aged ; Treatment Outcome ; Trigeminal Nerve ; blood supply ; surgery ; Trigeminal Neuralgia ; surgery ; Young Adult

Expanded polytetrafluoroethylene(ePTFE) grafts 4mm long and 1mm in diameter were implanted into the iliac artery of 100-150g male rats using standard microvascular technique. Prior to clamp removal, the cremaster muscle was isolated as an island flap based on the iliac artery and observed using intravital fluorescence microscopy. Fields which contained a bifurcation of a first order arteriole(80-100 microns diameter) into second order arteriole(50-80 microns) were chosen for observation. Platelets were labeled in vivo with acridine red to visualize and quantify the aggregates. Images of microemboli were counted manually and the area was measured by computerized planimetry. Six control grafts were implanted with no further processing, six were irrigated with heparin, and six were coated with tridodecylmethylammonium chloride(TDMAC) and heparin. Most thrombi appeared within the first five minutes after implantation in all groups. The total number of emboli observed in the control group was 91 pr animal, in the heparin irrigation group it was 84, and in the TDMAC-heparin group it was 22. The total thrombus area observed per animal was 137,660 +/- 29,467 microns 2 in the control group, 79,040 +/- 10,893 microns 2 in the heparin irrigation group, and 17,498 +/- 6,059 microns 2 in the TDMAC-heparin group (p<.01 vs control or heparin irrigation group). With this results we could find that heparin irrigation and TDMAC-heparin coating appear to reduce the number, size, and total amount of microemboli generated by ePTFE graft implantation and apparent thromboresistant property of TDMAC-heparin coating may have widespread application in many clinical and research areas and this experimental model can be used for evaluation of other graft matrials.
Ammonium Compounds/pharmacology ; Animal ; Blood Vessel Prosthesis/*adverse effects ; Heparin/pharmacology ; Male ; Microcirculation/surgery ; Polytetrafluoroethylene/adverse effects ; Rats ; Thrombosis/*etiology/prevention & control

OBJECTIVETo analyze several methods of wound repair for deep partial thickness burn wounds retrospectively, so as to evaluate the significance of improvement of wound microcirculation on wound healing.

METHODS(1) 2,976 burn patients admitted to our department were enrolled in the study, among them 614 undertook tangential excision, 32, eschar abrasion, 86 allo-skin coverage after debridement, 1836 tropical application of silver sulfadiazine and 408 with traditional Chinese medicine (Jing Wan Hong ointment) with gauze bandage. The results of the management with different methods were compared. (2) Rat model with deep partial thickness burn was reproduced and topical application of silver sulfadiazine was given. The rats were randomly divided into control (n = 10, with normal saline injected via caudal vein within 5 minutes postburn), and treatment (n = 10, with batroxobin injected via caudal vein within 5 minutes postburn) groups. The blood flow perfusion unit in the wound skin was measured before burn and at 0.5 to 72 postburn hours by Laser Doppler. The wound healing rate, contraction rate and wound healing time in each group were calculated on 14 and 18 postburn days (PBDs). The number of hair follicles after wound healing was observed by histological method.

RESULTS(1) The burn wound treated by tangential excision healed within 2 to 3 post operation weeks (POWs), with the healing rate of 94.8% in patients with burn covering 50% - 70% TBSA and 93.4% in those with burn of 80% approximately 98% TBSA. The healing time of patients with allo-grafts coverage after eschar abrasion was 13.8 +/- 2.1 days without scar formation. The wound healing time was 18.0 +/- 2.3 day in 82 patients with allo-graft coverage after debridement, and it was 26.0 +/- 3.2 days with subeschar healing in 1658 patients with topical application of silver sulfadiazine. Infection in burn wound was encountered in most patients undergoing traditional Chinese medicine bandage treatment with wound healing time of 26.0 +/- 2.8 days in the lower extremities. (2) The blood flow perfusion unit of the rats in the treatment group was significantly higher than that in the control group (P < 0.01). The wound healing rate in treatment group on 14 and 18 PBD was obviously higher than that in the control group (P < 0.01). But the wound contraction rate in the two groups was similar (P > 0.05). The wound healing time in treatment group was much shorter than that in control group (P < 0.01). A few hair follicles remained in the dermis of the rats in the control group on 30 PBD, and the number was evidently smaller than that in the treatment group (P < 0.01).

CONCLUSIONEarly tangential excision and eschar abrasion remained better methods in the management of deep partial thickness burn wounds, as they could ameliorate burn wound infection, shorten treatment period, raise wound healing rate and quality. Application of batroxobin could accelerate wound healing rate by improving wound microcirculation in deep partial thickness burn wound.

Adult ; Animals ; Batroxobin ; therapeutic use ; Burns ; pathology ; surgery ; therapy ; Female ; Humans ; Male ; Microcirculation ; Rats ; Rats, Wistar ; Retrospective Studies ; Skin ; blood supply ; Skin Transplantation ; methods ; Wound Healing

OBJECTIVE: To explore clinical effect of modified transverse tibial bone transfer microcirculation reconstruction in treating end-stage diabetic foot. METHODS: From August 2016 to June 2018, 87 patients with diabetic foot treated with modified tibial transverse bone removal and microcirculation reconstruction, inclduing 54 males and 33 females;aged from 39 to 95 years old with an average of (68.9±11.3) years old;2 patients were grade 2, 37 patients were grade 3 and 50 patients were grade 4 according to Wagner's classification;the courses of diabetic were for 10 to 16 years with an average of (13.0±2.2) years;the courses of diabetic feet were for 21 to 48 days with an avergae of (34.2±8.6) days. Postoperative comlications were observed. Skin temperature, visual analogue scale(VAS) and ankle brachial index(ABI) and wound healing were recorded before and 3 months after operation. RESULTS: All patients were followed up for 4 to 19 months with an average of (12.6±2.8) months. Two patients occurred subcutaneous tissue liquefaction and seepage under needle passage during bone transfer, and scabed without special treatment. One patient was performed amputation above 5 cm of ankle joint because of severe infection, and 1 patient occurred re-ulceration at 1 year after wound healing, bone transfer was performed again at the same site, and was completely healed at 8 weeks after operation. The healing time of wound ranged from 3 to 24 weeks with an average of (11.9± 3.8) weeks. Foot skin temperature before operation was (28.9±0.91) ℃, and increased to (31.70±0.32)℃ at 3 months after operation( CONCLUSION Modified lateral tibial bone transfer could effectively reconstruct microvascular network under lower leg, promote recovery of peripheral blood vessels, and promote wound healing of foot, reduce or avoid amputation. At the same time, the improved osteotomy is one of the effective methods for the treatment of diabetic foot which has advantags of less trauma, simple opertaion.
Adult ; Aged ; Aged, 80 and over ; Bone Transplantation ; Diabetes Mellitus ; Diabetic Foot/surgery* ; Female ; Humans ; Male ; Microcirculation ; Middle Aged ; Tibia ; Treatment Outcome