OBJECTIVETo analyze the related factors of the infection after operation of open tibiofibula fractures.

METHODSThe clinical data of 141 patients with open tibiofibula fractures underwent surgical treatment from June 2009 to December 2012 were retrospectively analyzed. All the patients were male and aged from 18 to 61 years old with an average of 39.2 years; all the fractures were unilateral. According to Gustilo typing of fracure, 5 cases were type I, 44 cases were type II, 27 cases were type III a, 56 cases were type III b and 9 cases were type III c. These clinical data included patients' age, gender, body mass index (BMI), underlying diseases, time of operation, fracture site, fracture type, fixation method, postoperative drainage, debridement condition and so on. The postoperative infection conditions were recorded, and the correlation between above factors and infections were analyzed. Finally, the significant related variables were introduced into a Logistic regression model to evaluated their risk.

RESULTSAmong the 141 patients, 22 cases developed with infection (15.6%). The significant relative factors with infection contained fixation method, debridement condition, underlying diseases and postoperative drainage (P < 0.05). The correlativities were stepped up in order, their odds ratios value was 2.451, 3.164, 3.414, 5.117, respectively.

CONCLUSIONActive treatment for underlying diseases before operation, thorough debridement for open wound, suitable fixation method for fracture and thorough draining are effective measures in preventing postoperative infection.

Adolescent ; Adult ; Debridement ; Fibula ; injuries ; Fractures, Open ; surgery ; Humans ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; etiology ; Tibial Fractures ; surgery

BACKGROUND:Large volume of bone can be harvested by the reamer-irrigation-aspirator (RIA), which can be used for autologous bone graft, because there are many stromal stem cells and a variety of osteogenesis factors in the harvested bone. OBJECTIVE:To introduce the application progress of the RIA. METHODS:PubMed database was retrieved by the first author for RIA-related articles published from January 2000 to May 2017 using the keyword of "reamer-irrigator-aspirator". A total of 87 articles were searched initially and finally 38 articles met the inclusion criteria. RESULTS AND CONCLUSION:Compared with harvesting bone tissues from the iliac bone, the RIA can harvest more autologous bone tissues with more bone marrow stromal stem cells. Moreover, the osteogenic effect of the harvested autologous bone is better and there are fewer complications. Therefore, the RIA has been widely used as a method of harvesting non-structural autologous bone tissues. Removal of intramedullary lesions by the RIA is used in the treatment of long bone infection, osteomyelitis and bone tumors, as well as in the removal of intramedullary cement. RIA was originally used as a special reaming during intramedullary nailing for femoral shaft fractures, which could reduce high pressure and high temperature so as to decrease the risks of fat embolism and osteonecrosis. To conclude, the RIA can achieve satisfactory outcomes and result in few complications, but the clinical use is still limited by high cost, frequent fluoroscopy, bleeding and limited indications, as well as risks for iatrogenic fractures and perforation.

Objective To report the surgical method and treatment outecome of transfer of free upper limb lateral bone-skin flap for repair of bone defects and nonunion in hand and forearm.Methods 17 cases of hand composite trauma,5 cases of forearm composite trauma and 2 cases of nonunion in forearm were treated with free bone-skin flaps in distal humerus,whose pedicle was the posterior branch of radical collateral artery. Area of the flap was 2cm?3cm to 8cm?10cm,length of exseeted bone was 3～6 cm.Results All the bone-skin flaps completely survived,the donor area all achieved primary healing,On postoperative 1～4 years follow-up,the texture of the flap was excellent,and bone union was obtained in all transplants,the donor area of distal lateral humerus became thicker and thicker with new cortical bones formed.According to the upper arm function assessment criterion issued by hand surgery association of Chinese medical association.The hand function had excellent results in 17 cases and good results in 2 cases.Conclusion The bone-skin flap has following advantages:easy dissection,reliable blood supply,and no major vessel needed to be sacrificed,so it is an effective method for repair of skin and soft tissue with bone defects in hand and forearm,It.also can be used to repair refractory nonunion in ulna and radius.

OBJECTIVETo study clinical outcomes of serial tightening of reserved suture threads in delayed incision closure.

METHODSFrom January 2005 to June 2013, 67 patients with delayed incision closure were treated with serial tightening of reserved suture threads. There were 37 males and 30 females, with an average age of 40 years old (ranged from 12 to 75 years old). Among them, 36 patients suffering from leg or forearm double fractures had the incision difficult to those primarily due to high tension or mergency; 13 patients had open wound which lasted for more than routine time for debridement and closure; 9 patients had wound infection; 9 patients had decompression incisions owing to compartment syndrome. The No. 4 suture thread was used to sew up the incision, and the 4 to 6 cm long thread was reserved at two ends of each thread. The reserved thread was tightened gradually from 2 to 4 days after operation according to conditions of swelling relieving. Finally, the reserved thread was not tied until the incision was completely closed.

RESULTSAfter operation, the reserved threads were tightened and tied for 1 time in 6 patients, 2 times in 23 patients, 3 times in 27 patients, 4 times in 11 patients. Postoperative closure time ranged from 3 to 9 days, with an average of 6.2 days. All the incisions got delayed primary healing.

CONCLUSIONThe method of serial tightening of reserved suture threads to close delayed incision closure avoids a second operation, which is simple and obtains a fine result.

Adolescent ; Adult ; Aged ; Child ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Suture Techniques ; Time Factors

PURPOSE: Radical prostatectomy is the gold standard treatment for clinically localized prostate cancer, a disease whose incidence is increasing. Erectile dysfunction(ED) after radical prostatectomy influences a patient's quality of life significantly. So we evaluated the correlation of preoperative and postoperative factors with postoperative ED and its treatment. MATERIALS AND METHODS: Hospital records of 27 patients who underwent radical prostatectomy by one surgeon at our department were retrospectively reviewed. We performed univariate analyses to correlate preoperative prognostic factors with intaoperative factors and postoperative variables. RESULTS: Excluding 10 patients who had preoperative ED, erectile dysfunction developed in 10 of 17 patients, and the rate was higher in the older age group(p=0.02). Patients underwent non-nerve sparing radical prostatectomy maintained their potency in 0.0% (0/1) comparative with 44.4% (4/9) in unilateral nerve sparing and 42.9% (3/7) in bilateral nerve sparing surgery. Patients with preexisting comorbidity, such as cardiovascular disease(OR=2.38) and margin positivity(OR=4.67) had greater risk of postoperative ED. In 8 erectile dysfunction patients, 3 sildenafil-treated and 2 alprostadil-treated patients showed improvement one year after the operation. CONCLUSIONS: Older patients have greater risk of postoperative ED, and they have more preexisting risk factors including hypertension, cardiovascular disease, diabetes mellitus, and margin positivity.
Cardiovascular Diseases ; Comorbidity ; Diabetes Mellitus ; Erectile Dysfunction* ; Hospital Records ; Humans ; Hypertension ; Incidence ; Male ; Prostatectomy* ; Prostatic Neoplasms ; Quality of Life ; Retrospective Studies ; Risk Factors ; Urinary Incontinence

PURPOSE: Radical prostatectomy is the gold standard treatment for clinically localized prostate cancer, a disease whose incidence is increasing. Erectile dysfunction(ED) after radical prostatectomy influences a patient's quality of life significantly. So we evaluated the correlation of preoperative and postoperative factors with postoperative ED and its treatment. MATERIALS AND METHODS: Hospital records of 27 patients who underwent radical prostatectomy by one surgeon at our department were retrospectively reviewed. We performed univariate analyses to correlate preoperative prognostic factors with intaoperative factors and postoperative variables. RESULTS: Excluding 10 patients who had preoperative ED, erectile dysfunction developed in 10 of 17 patients, and the rate was higher in the older age group(p=0.02). Patients underwent non-nerve sparing radical prostatectomy maintained their potency in 0.0% (0/1) comparative with 44.4% (4/9) in unilateral nerve sparing and 42.9% (3/7) in bilateral nerve sparing surgery. Patients with preexisting comorbidity, such as cardiovascular disease(OR=2.38) and margin positivity(OR=4.67) had greater risk of postoperative ED. In 8 erectile dysfunction patients, 3 sildenafil-treated and 2 alprostadil-treated patients showed improvement one year after the operation. CONCLUSIONS: Older patients have greater risk of postoperative ED, and they have more preexisting risk factors including hypertension, cardiovascular disease, diabetes mellitus, and margin positivity.
Cardiovascular Diseases ; Comorbidity ; Diabetes Mellitus ; Erectile Dysfunction* ; Hospital Records ; Humans ; Hypertension ; Incidence ; Male ; Prostatectomy* ; Prostatic Neoplasms ; Quality of Life ; Retrospective Studies ; Risk Factors ; Urinary Incontinence

OBJECTIVETo evaluate the clinical effectiveness of three localization methods, including methylene blue, metal clips and intraoperative colonoscopy in laparoscopic colorectal surgery.

METHODSA retrospective analysis was performed to review the clinical data of 64 patients who underwent the laparoscopic colorectal operations in Cancer Hospital of Fudan University from December 2009 to June 2012. Three methods of tumor localization were used perioperatively, including 23 cases of methylene blue, 20 of metal clips and 21 of colonoscopy.

RESULTSOperations were successfully performed in this cohort and there were no deaths or complications. In methylene blue group, intraoperative colonoscopy was performed in two cases because of the inability to visualize blue dye on the serosal surface of the intestinal wall, another 2 cases were converted to open operation because of methylene blue diffusion and inability to identify resection margin. Intraoperative colonoscopic localization was required for 3 cases of sigmoid colon or upper rectal tumor because of inaccurate tumor localization by metal clips. Poor operative exposure due to obvious bowel distension prompted the conversion to open surgery in 2 cases of colonoscopy localization group, and the accurate position of the lesion was not found in another 2 cases due to long pedunculated adenoma.

CONCLUSIONSColorectal tumor can be localized effectively by endoscopic methylene blue tattooing at a maximum of 2 tumors before operation and the method of 4-point positioning can significantly improve the accuracy of colorectal tumor localization. Tumor localization preoperatively on the day of surgery by metal clip is accurate for the right or left colon cancer. Intraoperative colonoscopy can localize tumor accurately and rapidly for rectosigmoid or descending tumor, and the incidence of bowel distension can be significantly reduced. Localization method should be considered according to the tumor location and surgical procedure.

Adult ; Aged ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Disability questionnaires are used for clinical assessment, outcome measurement, and research methodology. Any disability measurement must be adapted culturally for comparability of data, when the patients, who are measured, use different languages. This study aimed to conduct cross-cultural adaptation in translating the original (English) version of the Oswestry Disability Index (ODI) into Korean, and then to assess the reliability of the Korean versions of the Oswestry Disability Index (KODI). We used methodology to obtain semantic, idiomatic, experimental, and conceptual equivalences for the process of cross-cultural adaptation. The KODI were tested in 116 patients with chronic low back pain. The internal consistency and reliability for the KODI reached 0.9168 (Cronbach's alpha). The test-retest reliability was assessed with 32 patients (who were not included in the assessment of Cronbach's alpha) over a time interval of 4 days. Test-retest correlation reliability was 0.9332. The entire process and the results of this study were reported to the developer (Dr. Fairbank JC), who appraised the KODI. There is little evidence of differential item functioning in KODI. The results suggest that the KODI is internally consistent and reliable. Therefore, the KODI can be recommended as a low back pain assessment tool in Korea.
Sensitivity and Specificity ; Risk Factors ; Risk Assessment/methods ; Reproducibility of Results ; *Questionnaires ; Pain Measurement/*methods ; Middle Aged ; Male ; Low Back Pain/classification/*diagnosis/*epidemiology/psychology ; Korea/epidemiology ; Humans ; Female ; *Disability Evaluation ; *Cross-Cultural Comparison ; Aged ; Adult ; *Activities of Daily Living

OBJECTIVETo prospectively evaluate the safety and efficacy of nickel- titanium temperature-dependent memory-shape device(CAR27) for colorectal anastomosis.

METHODSSixty colorectal cancer patients were randomly divided into two groups and received colorectal anastomosis with CAR27 or traditional stapling device. Complications, bowel function return, and the extrusion of anastomosis ring were prospectively monitored.

RESULTSBoth CAR27 and stapler group had one case of anastomotic leakage. Other complications such as stricture or obstruction were not found. Time for anastomosis of the two groups were (10.1±1.2) minutes and (11.2±2.1) minutes respectively. Time to first flatus was(3.2±1.2) days and (3.5±1.4) days respectively. Time to food intake resumption was (4.0±1.4) days and (4.3±1.3) days respectively. The differences above between the two groups were not statistically significant(P>0.05). The ring was expelled with stool within 7-16 days. The two groups were similar in operative time and the return of bowel function.

CONCLUSIONCAR27 is safe and simple for colorectal anastomosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; instrumentation ; Colorectal Neoplasms ; surgery ; Colorectal Surgery ; instrumentation ; Female ; Humans ; Male ; Middle Aged ; Nickel ; Prospective Studies ; Titanium ; Young Adult

Adult ; Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Mouth Mucosa ; transplantation ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Treatment Outcome ; Urethral Stricture ; surgery ; Young Adult