Objective:To evaluate the clinical outcome of the reconstruction of finger-pulp defects, using modified dorsal digital fasciocutaneous flap.Methods:Between June 2018 and March 2019, 14 patients with finger-pulp defects were admitted to the Department of Hand and Foot Surgery. There were 14 males and 2 females, aged from 27 to 63 years, with the mean age of 49 years. The defect areas of finger pulp were 1.6 cm × 1.4 cm-2.5 cm × 1.6 cm. All of the finger-pulp defects were treated by the modified dorsal digital fasciocutaneous flap and the inverted L-shaped incision was made at the distal part of the pedicle. The defects at donor sites were reconstructed with full-thickness skin grafts harvested from the forearm. Viability of the flap was recorded postoperatively. At the last follow-up, aesthetics, sensibility of the flap and hand performance were assessed.Results:All of the 14 flaps survived successfully, the areas were 1.8 cm×1.6 cm-2.7 cm×1.8 cm. Partial distal blister occurred on the flap in only one case, which was solved by aspiration without surgical intervention. All cases acquired follow-up visits for 5 to 12 months with a mean time of 8.9 months. The texture of flaps was similar to surrounding skin and the shape of reconstructed finger pulp was satisfactory. According to the assessment of total active movement, the results were excellent in 9 fingers, good in 5 fingers. The 2-point discrimination of flap was 8 to 11 mm (mean, 9.9 mm).Conclusions:It is an effective and simple method for the reconstruction of finger-pulp defects using modified dorsal digital fasciocutaneous flap. The clinical effectiveness is definite.

Objective:To evaluate the clinical outcome of the reconstruction of finger-pulp defects, using modified dorsal digital fasciocutaneous flap.Methods:Between June 2018 and March 2019, 14 patients with finger-pulp defects were admitted to the Department of Hand and Foot Surgery. There were 14 males and 2 females, aged from 27 to 63 years, with the mean age of 49 years. The defect areas of finger pulp were 1.6 cm × 1.4 cm-2.5 cm × 1.6 cm. All of the finger-pulp defects were treated by the modified dorsal digital fasciocutaneous flap and the inverted L-shaped incision was made at the distal part of the pedicle. The defects at donor sites were reconstructed with full-thickness skin grafts harvested from the forearm. Viability of the flap was recorded postoperatively. At the last follow-up, aesthetics, sensibility of the flap and hand performance were assessed.Results:All of the 14 flaps survived successfully, the areas were 1.8 cm×1.6 cm-2.7 cm×1.8 cm. Partial distal blister occurred on the flap in only one case, which was solved by aspiration without surgical intervention. All cases acquired follow-up visits for 5 to 12 months with a mean time of 8.9 months. The texture of flaps was similar to surrounding skin and the shape of reconstructed finger pulp was satisfactory. According to the assessment of total active movement, the results were excellent in 9 fingers, good in 5 fingers. The 2-point discrimination of flap was 8 to 11 mm (mean, 9.9 mm).Conclusions:It is an effective and simple method for the reconstruction of finger-pulp defects using modified dorsal digital fasciocutaneous flap. The clinical effectiveness is definite.

OBJECTIVE: To investigate the clinical effect of Shenfu injection combined with glucocorticoid in the treatment of acute left heart failure complicated with bronchospasm. METHODS: A prospective study was conducted.Ninety patients with acute left heart failure complicated with bronchospasm admitted to Huai'an Second People's Hospital from January 2021 to July 2022 were selected and divided into conventional treatment group, hormone therapy group and combined treatment group according to random number table method, with 30 cases in each group. All patients in the 3 groups received basic Western medicine treatment. On this basis, the conventional treatment group was given 0.25-0.50 g aminophylline injection plus 5% glucose injection or 0.9% sodium chloride injection (diabetes patients) 100 mL slow intravenous infusion, 1-2 times a day. In the hormone treatment group, 1 mg of budesonide suspension for inhalation was diluted to 2 mL by 0.9% sodium chloride injection, twice a day, and applied until 48 hours after the pulmonary wheezing disappeared. The combined treatment group was given glucocorticoid combined with Shenfu injection 80 mL plus 5% glucose injection or 0.9% sodium chloride injection (diabetes patients) 250 mL intravenously, once a day. All treated for 1 week. The general data, traditional Chinese medicine (TCM) syndrome score, TCM syndrone efficacy index, acute left heart failure efficacy, bronchospasm efficacy, systolic blood pressure (SBP), mean arterial pressure (MAP), serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level and safety of the 3 groups were compared. The patients were followed up for 6 months, and the mortality and re-hospitalization rate of the 3 groups were recorded. RESULTS: Among the 90 patients, a total of 83 patients completed the study, excluding the cases dropped due to death and other reasons. There were 29 cases in the combined treatment group, 25 cases in the hormone therapy group and 29 cases in the conventional treatment group. There were no significant differences in age, gender, course of disease, and previous history (history of diabetes, history of hypertension, history of hyperlipidemia) among the 3 groups. Therefore, they were comparable. The difference of TCM syndrome score before and after treatment, TCM syndrome efficacy index of combined treatment group and hormone therapy group were higher than those of conventional treatment group [difference of TCM syndrome score: 15.14±5.74, 13.24±5.75 vs. 10.62±5.87, TCM syndrome efficacy index: (67.84±14.31)%, (59.94±14.26)% vs. (48.92±16.74)%, all P < 0.05], and the difference of TCM syndrome score and TCM syndrome efficacy index of combined treatment group were higher than those of hormone treatment group (both P < 0.05). The total effective rate of acute left heart failure and bronchospasm in the combined treatment group was significantly higher than that in the conventional treatment group (total effective rate of acute left heart failure: 96.55% vs. 75.86%, total effective rate of bronchospasm: 93.10% vs. 65.52%, both P < 0.05). The difference of serum NT-proBNP before and after treatment in combination therapy group and hormone therapy group was significantly higher than that in conventional treatment group (ng/L: 7 922.86±5 220.31, 7 314.92±4 450.28 vs. 4 644.79±3 388.23, all P < 0.05), and the difference of serum NT-proBNP before and after treatment in the combined treatment group was significantly higher than that in the hormone treatment group (P < 0.05). There were no significant differences in SBP difference, MAP difference, mortality and re-hospitalization rate among the 3 groups. No adverse reactions occurred in the 3 groups during treatment. CONCLUSIONS Shenfu injection combined with glucocorticoid is effective in the treatment of patients with acute left heart failure complicated with bronchospasm. It is superior to glucocorticoid and aminophylline in relieving bronchospasm, reducing NT-proBNP level and improving total effective rate, and has good prognosis and safety.
Humans ; Glucocorticoids/therapeutic use* ; Bronchial Spasm ; Prospective Studies ; Aminophylline/therapeutic use* ; Sodium Chloride/therapeutic use* ; Natriuretic Peptide, Brain ; Peptide Fragments ; Heart Failure/drug therapy* ; Diabetes Mellitus ; Glucose

OBJECTIVE: To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures. METHODS: A clinical data of 37 patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed. Among them, 17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling (group A), and 20 cases were treated with the traditional Kirschner wire tension band technique (group B). There was no significant difference in terms of gender, age, body mass index, fracture side, combined medical disease, and preoperative hemoglobin between the two groups ( P>0.05). Operation time, intraoperative blood loss, postoperative complications, fracture healing time, knee range of motion, and knee function Bostman score (range of motion, pain, daily work, muscle atrophy, walking aids, knee effusion, soft leg, and stair climbing) and grading were recorded in both groups at last follow-up. RESULTS: There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All incisions healed by first intention. All patients were followed up 1-2 years, with an average of 1.7 years. X-ray films reexamination showed that all fractures in group A healed, while 2 cases in group B did not heal. There was no significant difference in bone healing time between the two groups ( P>0.05). At last follow-up, the knee range of motion, the range of motion score of Bostman score, total score and effectiveness grading in group A were significantly better than those in group B ( P<0.05). There was no significant difference in the other items of Bostman scores between the two groups ( P>0.05). During follow-up, 2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B, and no complication related to internal fixation occurred in group A. The occurrence of complications was significantly lower in group A than in group B ( P<0.05). CONCLUSION Compared with the traditional Kirschner wire tension band technique, the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation, reliable fixation, early flexion and extension activity, and better functional recovery of knee joint.
Humans ; Blood Loss, Surgical ; Bone Wires ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; Knee Injuries ; Patella/surgery* ; Retrospective Studies ; Suture Anchors ; Treatment Outcome ; Male ; Female