Objective To explore the security of propofol used in internal carotid artery anesthesia by observing the effect of internal carotid artery infusion of propofol on neurovascular tissue of cerebral infusion areas in rats.Methods A total of 40 SD rats were randomly divided into a V group and an A group (n=20); rats in the V group were given treatment of right femoral vein infusion of 30 mg/ (kg· h) propofol,and those in the A group were given treatment of right internal carotid artery infusion of 30 mg/(kg· h) propofol for 3 h.Rats were sacrificed 4 h after propofol withdrawal.HE staining and transmission electron microscopy were employed to detect the morphological and ultrastructural changes in the right cerebral cortex tissues; and semi-quantitative real time PCR was used to observe the mRNA expressions of bcl-2 and Bax.Results No obvious acute injury was noted in both groups,and the morphology of cortical neurons,neuralgia cells and vascular structures was normal in both groups.And the neuronal nuclei,organelles and capillary endomembrane of both groups were normal,without obvious changes.No significant difference in mRNA expressions ofbcl-2 and Bax was noted between the two groups (P＞0.05).Conclusion It is insignificant in the effects of internal carotid artery infusion of propofol on neurovascular tissues of cerebral infusion areas in rats.

Objective To utilize the magnetic resonance neurography (MRN) as a feasible tool for measuring the anatomical parameters of lumbar spinal nerves, and further to evaluate the neuro-safety of interlaminar percutaneous endoscopic lumbar discectomy.Methods Thirty healthy adult volunteers without significant history of low back pain or lumbar deformity were selected in our hospital from September 2016 to December 2016. All subjects accepted MRN. The nerve roots of L2-S1 were measured at the starting point of dural sac, and the angles between nerve roots and dural sac were measured. The distances between L2-L5 nerve roots and the edge of ipsilateral dural sac were measured and analyzed statistically.Results All MRN showed a gradual increase in the origin of the nerve roots from L2 to S1. The origin of the root was found to be below the corresponding disc for the L2 to L4 roots. There were 70％ of the L5 roots originated below the L4/5 disc, 26.7％ at the L4/5 disc, and 3.3％ above the L4/5 disc; about 70％ of the S1 roots originated above the L5/S1 disc. There were no statistically significant differences in the angles between dural sac and both left and right nerve roots (P>0.05). The angels between the nerve root and the dural sac from L5 and S1 was smaller than those from L2, L3, and L4 (P<0.05); that from S1 was significantly smaller than that from L5 (P<0.05). The distance of the nerve root and the ipsilateral dural sac was significantly increased in each side from L2 to L5 (P<0.05). There was no statistically significant difference in the distances between the left and right nerve roots and the edge of the ipsilateral dural sac in the same segment (P>0.05).Conclusion MRN is a feasible tool to measure the anatomical parameters of the lumbar spinal nerve, and there is a safe neurological area of the percutaneous endoscopic lumbar discectomy through the interlaminar approach.

Objective:To investigate the clinical effect of repairing soft-tissue defect of foot weight-bearing area with the help of CT angiography (CTA) using medial plantar artery perforator (MPAP) flap.Methods:This was a retrospective study spanning over a period, from May 2011 to October 2019, conducted at the Yidu Central Hospital of Weifang. The data was focused on the cases of soft tissue defect in plantar bearing area repaired by fascial island skin flap containing a perforating branch of the medial plantar artery perforator. CTA of the foot was performed before procedure. The 3D digital model was reconstructed by computer software to explore the number, diameter, course, and distribution of perforating vessels in the donor site, and a personalized repair scheme was designed to match the shape and size of recipient site. The outcome of the flap repair, foot function, and sensory function were followed up. Pared-sample t-test was used to compare the difference of perforator vessel diameter and the distance from heel margin to perforator branch between preoperative and intraoperative actual measurement by CTA. Results:A total of 9 patients were enrolled, including 5 males and 4 females. The mode for age group were 41 (range, 16-65 years). The area of the wound defect was 2.0 cm×2.0 cm-4.0 cm×5.0 cm, and the size of perforator fascial skin flap was 6.0 cm × 4.0 cm -12.0 cm × 8.0 cm. All the 9 flaps were survived and followed up for half a year to 5 years. All the patients were satisfied with the outcomes, the satisfaction score of flap efficacy was 8.7±3.1. Outcomes were evaluated according to the foot function scoring criteria: 3 cases were excellent, 5 cases were good, and 1 case was medium. Sensory recovery reached S4 in 3 cases, S3 in 5 cases, and S2 in 1 case. There were 4 cases in R4, 4 cases in R3, and 1 case in R2. There was no significant difference between the preoperative measurement of perforator diameter and the distance between the heel edge and perforator ( P>0.05). Conclusions:The MPAP flap is simple, safe and easy to operate. It is one of the ideal methods to repair the soft tissue defects in small and medium-sized areas of the foot weight-bearing area.

Objective:To investigate the clinical effect of repairing soft-tissue defect of foot weight-bearing area with the help of CT angiography (CTA) using medial plantar artery perforator (MPAP) flap.Methods:This was a retrospective study spanning over a period, from May 2011 to October 2019, conducted at the Yidu Central Hospital of Weifang. The data was focused on the cases of soft tissue defect in plantar bearing area repaired by fascial island skin flap containing a perforating branch of the medial plantar artery perforator. CTA of the foot was performed before procedure. The 3D digital model was reconstructed by computer software to explore the number, diameter, course, and distribution of perforating vessels in the donor site, and a personalized repair scheme was designed to match the shape and size of recipient site. The outcome of the flap repair, foot function, and sensory function were followed up. Pared-sample t-test was used to compare the difference of perforator vessel diameter and the distance from heel margin to perforator branch between preoperative and intraoperative actual measurement by CTA. Results:A total of 9 patients were enrolled, including 5 males and 4 females. The mode for age group were 41 (range, 16-65 years). The area of the wound defect was 2.0 cm×2.0 cm-4.0 cm×5.0 cm, and the size of perforator fascial skin flap was 6.0 cm × 4.0 cm -12.0 cm × 8.0 cm. All the 9 flaps were survived and followed up for half a year to 5 years. All the patients were satisfied with the outcomes, the satisfaction score of flap efficacy was 8.7±3.1. Outcomes were evaluated according to the foot function scoring criteria: 3 cases were excellent, 5 cases were good, and 1 case was medium. Sensory recovery reached S4 in 3 cases, S3 in 5 cases, and S2 in 1 case. There were 4 cases in R4, 4 cases in R3, and 1 case in R2. There was no significant difference between the preoperative measurement of perforator diameter and the distance between the heel edge and perforator ( P>0.05). Conclusions:The MPAP flap is simple, safe and easy to operate. It is one of the ideal methods to repair the soft tissue defects in small and medium-sized areas of the foot weight-bearing area.

Objective:To explore the methods and effects of high-frequency color Doppler ultrasound assisted reverse island flap of dorsal digital artery of ulnar thumb for repairing skin and soft tissue defects in the distal end of the same finger.Methods:The retrospective cohort study method was applied. From March 2014 to January 2020, 43 patients with skin and soft tissue defects in the distal end of thumb were hospitalized in the Department of Hand and Foot Surgery of Yidu Central Hospital of Weifang, including 28 males and 15 females, aged 19-58 years. The time from injury to operation was 4 to 10 hours, and the area of wound defect was 1.5 cm×1.0 cm-5.0 cm×3.0 cm. The type and course of dorsal digital artery of ulnar thumb were detected by high-frequency color Doppler ultrasound before operation, based on which the reverse transfer of the island flap of dorsal digital artery of ulnar thumb was designed to repair the skin and soft tissue defects in the distal end of the same finger. The patients with absence of the dorsal digital artery of ulnar thumb were repaired by the greater fish reverse island flap pedicled with the radial palmar artery. The area of the flap was 2.0 cm×1.5 cm-5.5 cm×3.5 cm. The donor site wound was directly closed by suturing or covered with split-thickness skin graft from the inner side of the upper arm in the same arm. The status of dorsal digital artery of ulnar thumb detected by high frequency color Doppler ultrasound before operation was recorded. The type, course, and distribution of the dorsal digital artery of ulnar thumb detected before operation were compared with those observed during the operation. The survival of the flap was observed after operation. During the last follow-up, the appearance of the donor and recipient area of flaps was observed, the thumb function was evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association, and the sensory function of the area transplanted with flap was evaluated with the sensory function evaluation standard.Results:The results of high-frequency color Doppler ultrasound showed that the dorsal digital artery of ulnar thumb was absent in 2 patients, while 41 patients had the dorsal digital artery of ulnar thumb, among which 20 cases were type 1 that started from the first dorsal metacarpal artery and ran on the surface of the first interosseous dorsal muscle; 16 cases were type 2 that started from the deep branch of the radial artery or the main artery of thumb and ran in the deep surface of the first interosseous dorsal muscle, including 10 cases of type 2a with the starting point in the basal region of the first metacarpal bone and 6 cases of type 2b with the starting point in the first metacarpal bone region; 5 cases were type 3 that started from the confluence of the first dorsal metacarpal artery and the main thumb artery in the region of the first metacarpophalangeal joint. The outer diameter of the vessel at the beginning of the dorsal digital artery of ulnar thumb was (1.12±0.31) mm, and the outer diameter of the vessel at the beginning of the accompany vein was (0.63±0.21) mm. The dorsal digital artery of ulnar thumb was concentrated in the ulnar side of the first metacarpophalangeal joint and snuff box region. The type, course, and distribution range of the dorsal digital artery of ulnar thumb observed during the operation were consistent with the results detected by high-frequency color Doppler ultrasound before operation. After the operation, the flaps survived in 43 patients. The patients were followed up for 6 months to 1 year. During the last follow-up, only linear scars were left in the donor area; there were no obvious pigmentation in the area transplanted with reverse island flap of dorsal digital artery of ulnar thumb, with good texture and elasticity, and beautiful appearance; the thumb function was evaluated as excellent in 23 cases, good in 17 cases, and fair in 3 cases; the sensory function of the area transplanted with flap was evaluated as S 4 level in 16 cases, S 3 level in 22 cases, and S 2 level in 5 cases. Conclusions:The reverse island flap of dorsal digital artery of ulnar thumb is one of the ideal methods to repair the skin and soft tissue defect in the distal end of the same finger, especially that beyond the distal interphalangeal joint. Preoperative detection with high-frequency color Doppler ultrasound can identify the type and distribution of dorsal digital artery of ulnar thumb, so as to design a personalized operation plan, resulting in good appearance of the donor and recipient area and thumb function after operation.