Objective:To explore the effect of core muscle strength training intervention on postoperative rehabilitation of patients after total knee arthroplasty, and to provide reference for the rehabilitation of patients after total knee arthroplasty.Methods:A total of 109 patients with total knee arthroplasty who were admitted to Medical Health Group of First People′s Hospital of Xiangshan County from May 2020 to July 2021 were selected as the research objects, and were divided into an intervention group of 54 cases and a control group of 55 cases according to the random number table method. The control group received conventional rehabilitation methods after surgery, and the intervention group received core muscle strength training on the basis of conventional rehabilitation. The intervention time was 6 weeks. The knee joint function, balance function and activities of daily living were evaluated by Hospital for Special Surgery Knee Score, Berg Balance Scale, modified Barthel Index before and after intervention and the results were compared between the two groups.Results:In the end, there were 50 cases in the intervention group and 52 cases in the control group. There was no significant difference in the score of the knee joint function, balance function and activities of daily living before intervention between the two groups( P>0.05). The scores of the knee joint function, balance function and activities of daily living were (74.78 ± 3.12), (46.50 ± 3.82), (92.80 ± 5.17) points in the intervention group, and (72.15 ± 3.31),(44.44 ±3.66),(89.42 ± 4.50) points in the control group, the differences were statistically significant ( t=4.12, 2.78, 3.52, all P<0.01). The knee joint function recovery grade in the intervention group was higher than that in the control group, and the difference was statistically significant ( Z=3.43, P<0.01); the degree of dependence on self-care ability in daily life in the intervention group was lower than that in the control group, and the difference was statistically significant ( Z=3.98, P<0.01). Conclusions:Core muscle strength training can effectively improve postoperative knee function, balance function and activities of daily living in patients with total knee arthroplasty. This program is practical in clinical work and has clinical application value.

Objective: This article provides an overview of our experience using indocyanine green angiography (ICGA) in breast reconstruction with abdominal flap to ascertain the application value of ICGA and its usage in decreasing postoperative complications. Methods: A total of 21 breast reconstructions with intraoperative ICGA were analyzed retrospectively, including 7 bilateral deep inferior epigastric perforator (DIEP) flaps, 5 pedicled transverse rectus abdominis myocutaneous (TRAM) flaps with contralateral free TRAM flaps, 4 pedicled TRAM flaps with contralateral DIEP flaps, 3 unilateral DIEP flaps and 2 unilateral pedicled TRAM flaps. According to different breast reconstruction methods, ICGA were applied respectively after flap harvesting and vessel anastomosis, in order to evaluate the blood supply of flaps and vessel perfusion. Results: A total of 52 ICGA were performed and recorded intraoperatively without any indocyanine green-associated complications. The operation methods were modified according to ICGA findings in 6 of 21 cases. The distal part of flaps were discarded due to poor perfusion in 2 cases (1 DIEP flap and 1 TRAM flap), additional free vessel anastomosis were needed in 2 cases to ensure sufficient blood supply, 2 vascular complication including 1 vascular occlusion and 1 vascular thrombosis were found and managed in time. During the follow-up (range from 3 to 30 months, median of 16 months), no vascular crisis was reported. All flaps survived satisfactorily without partial or whole flap necrosis or wound infection. Conclusions Intraoperative ICGA can provide real-time information of flap′s blood supply and vessel perfusion to evaluate the conditions of flaps and vascular anastomosis, which can help surgeons take actions accordingly to increase the successful rate of breast reconstruction.

Objective:To investigate the effect and necessity of aesthetic suture techniques training in improving the suture quality of non-plastic surgeons.Methods:The well-planned aesthetic suture techniques training programs were run in non-plastic surgery senior residents and attending surgeons at Peking University People＇s Hospital from January 2017 to January 2019. There were 120 senior residents and attending surgeons included (aged from 25-32 years, average 28.9 years, with 66 males and 54 females). Mixed teaching methods were used such as video shows, lectures, surgery live show and scenario simulation. Baseline tests were taken before the training. Suture quality tests were taken when the trainings came to the end. Self-assessments were carried out both before and after the trainings.Results:Eight rounds of aesthetic suture techniques training were accomplished and 120 trainees were included in all. One hundred and two trainees passed the test while eight failed, while 10 trainees were absent in some courses or the final test. The passing rate was 85.0%. The scales of suture tools and material selection, incision design, subcutaneous tissue suture quality, tension relaxation, aesthetic suture appearance, and flexibility of different suture techniques were sharply improved after the training in both subjective and objective assessments.Conclusions:The aesthetic suture techniques training is effective in improving the suture quality of non-plastic surgeons, which is worthy to generalize in resident training.

To investigate the possibility of microsurgical anastomosis of artery, vein and lymphat-ic vessel under 3-dimension screen without eyepiece. Methods During March, 2019, 2 cases (48 and 62 years old) were operated for breast reconstruction, chest wall deformity modified, and axillary scar contracture release, under 3-dimension screen without eyepiece.Deep epigastric artery perforators (artery and vein) dissections were carried on, and microsurgical anastomosis of artery, vein and lymphatic vessel were finished. Coupler was used to do the end-to-end anastomosis of veins (2.5 mm), interrupted suture end-to-end anastomosis with 9-0 nylon for artery (2.0 mm). Reverse arm lymphatic dynamic fluorescence methylene blue tracer under Near Infrared Imaging was used to test the func-tion of lymphatic system. The ends of 2 dominant drainage lymphatic vessels was found in the released axillary area (0.2 mm and 0.3 mm, respectively), and were anastomosis to the vein (0.5 mm) of lateral chest lymphatic tissue.Im-mediate methylene blue tracer under near infrared imaging was used to confirm the patency of lymphatic vessels-veins anastomosis and follow-up post operation. Flap were monitored use HHD. Results Two patients recovered well, and the flaps survived completely with appreciated appearances. The lymphedema of the arms were getting better, the peripheral diameter was reduced by about 2.0 cm compared with that before operation. Conclusion The technique of microsurgical anastomosis of artery, vein and lymphatic vessel without eyepiece under 3-dimension screen is possi-ble and safe.

Objective: To figure out the clinical application value of indocyanine green (ICG) lymphangiography in supermicrosurgical lymphaticovenular anastomosis. Methods: A total of 6 supermicrosurgical lymphaticovenular anastomosis with intraoperative ICG lymphangiography were performed during April 2015 to May 2017 and were analyzed retrospectively. All the cases are female (range from 30 to 54 years old, median of 46.5 years old), including 3 cases for prevention and 3 cases for treatment of lymphedema. Results: A total 6 supermicrosurgical lymphaticovenular anastomosis were performed with intraoperative ICG lymphangiography to make sure the influx of lymph fluid to the vein. During the median of 23 months follow-up (range from 7 to 32 months), the 3 preventive cases did not show upper limb lymphedema and the 3 theraputic cases were relieved at different levels. Conclusions Intraoperative ICG lymphangiography can provide real-time information to locate suitable lymph vessels and ascertain the anastomotic patency in supermicrosurgical lymphaticovenular anastomosis, thus improve the operation effectiveness.

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Objective To study the value of cooperative training for general hospital and community hospital based on network in improving the cancer pain management ability of community health care workers. Methods From January 2015 to May 2016, 60 community health workers were recruited as research subjects and randomly divided into experimental group and control group. The experimental group received the general hospital-community hospital cooperative network training, the control group accepted the traditional training methods. After the training, 180 cancer patients who were in the charge of the relevant community from June 2015 to December 2016 were selected as the study subjects. Patients in the control group and experimental group were randomly assigned to cancer pain management for 6 months. After 6 months, the pain management knowledge of two group nursing staff was compared. The NRSscores of two groups of patients, the satisfaction of medical staff and the quality of life of the patients were compared. Results In the aspect of cancer pain knowledge, the score of experimental group was significantly higher than that of control group (P＜0. 05). In both groups, NRSscore of experimental group was significantly lower than that of control group (P＜0. 05). The Chinese version of QLT-C30 V3. 0 in both groups showed that the experimental group was better than the control group(P＜0. 05) except for three aspects: shortness of breath, diarrhea and economic difficulty (P＞0. 05). Conclusion Cooperative training based on Internet can better improve cancer care management in community health care.