Objective:To explore the effect of intraoperative local application of thrombin on postoperative blood loss in internal fixation of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA).Methods:A retrospective study was conducted to analyze the 50 patients with intertrochanteric femur fracture who had been treated at Department of Orthopaedics, The First Ningbo Hospital & Longshan Hospital Medical Health Group between January 2021 and December 2023. The patients were divided into 2 groups according to whether local thrombin was applied intraoperatively or not. In the treatment group of 25 cases [9 males and 16 females aged (76.5±10.1) years], after PFNA implantation, 6 pieces of thrombin freeze-dried powder were dissolved in 60 mL of sterile physiological saline, 30 mL of which was sprayed inside the main nail incision, 20 mL of which inside the spiral blade incision, and 10 mL of which inside the distal locking nail incision. In the control group of 25 cases [11 males and 14 females aged (71.1±10.1) years], after PFNA implantation, the incisions were rinsed only with the same doses of physiological saline. The hemoglobin (Hb) and hematocrit (Hct) on the 1st, 3rd, and 7th days after surgery, total blood loss, occult blood loss, transfusion rate, and deep vein thrombosis (DVT) were compared between the 2 groups.Results:There were no significant differences in the preoperative general data or operation time between the 2 groups, indicating comparability ( P>0.05). On the 1st, 3rd, and 7th days after surgery, respectively, the Hb was (101.48±12.15) g/L, (102.96±12.76) g/L, and (107.24±13.47) g/L, and the Hct 0.31±0.03, 0.32±0.03, and 0.33±0.04 in the treatment group, significantly higher than those in the control group [(92.72±10.95) g/L, (86.52±7.43) g/L, and (91.56±10.24) g/L; 0.28±0.03, 0.26±0.03, and 0.27±0.03] ( P<0.05). In the treatment group, the total postoperative blood loss was (364.60±134.27) mL, and the occult blood loss was (258.04±112.59) mL, both significantly lower than those in the control group [(481.72±218.69) mL and (355.84±176.97) mL] ( P<0.05). In the treatment group and the control group, respectively, 2 patients and 1 patient developed DVT after surgery, showing no statistically significant difference in the incidence ( P>0.05). Conclusion:Intraoperative local application of thrombin can significantly reduce postoperative blood loss but may not increase postoperative thrombosis or other complications in PFNA internal fixation of femoral intertrochanteric fracture.

Objective:To explore the surgical procedure and clinical efficacy of free chimeric tendon mini-flap pedicled with superficial palmar branch with flexor carpi radialis of radial artery in reconstruction of the dorsal finger composite tissue defects.Methods:From January 2020 to December 2022, 6 fingers (6 patients) with combined dorsal soft tissue and extensor tendon defects were treated in the Department of Plastic and Reconstructive Surgery, the First Affiliated Hospital of Ningbo University. The ipsilateral free chimeric flexor carpi radialis tendon mini-flap pedicled with superficial palmar branch of radial artery was used to reconstruct the soft tissue defects that sized 1.5 cm×1.8 cm - 2.5 cm×3.0 cm and the extensor tendon defects ranged 1.5 - 2.5 cm in length. The flap donor sites were directly sutured. Blood supply and survival of the flaps were observed after surgery. Postoperative follow-ups were scheduled at the 1, 3, 6, 12, 18 and 24 months after surgery and mainly conducted at the outpatient clinic and by home visits. Patients who were inconvenient to visit the hospital were reviewed through WeChat or telephone interviews. The follow-up included the colour, texture, appearance, sensation of the flap and functional status of the affected fingers.Results:After surgery, all 6 flaps survived without any incidence. All flap donor sites achieved stage I healing. The postoperative follow-up lasted 6-22 (mean 11.3) months. The colour and texture of the flaps were similar to those of the skin of dorsal finger, without bulky appearance. For the 3 flaps that had nerve anastomoses, the sensation recovery of the flap achieved to S 3+, with TPD at 7.6 mm, 7.9 mm and 8.3 mm, respectively, and 7.93 mm in average. For the 3 flaps without nerve anastomosis, the sensation recovery of the flap achieved S 3. No complication occurred at the donor sites. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 4 patients were in excellent and 2 in good. Conclusion:Transfer of free chimeric flexor carpi radialis tendon mini-flap pedicled with superficial palmar branch of radial artery in reconstruction of the soft tissue defect in dorsal finger offers the advantages of reliable blood supply, sufficient blood reflux, bridging blood vessels, nerves and tendons, a minimal damage to the donor site and satisfactory postoperative outcome. It is an ideal surgical procedure for reconstruction of the composite tissue defects in dorsal finger.