Objective To evaluate the influence of lumbar disc herniation type on the curative effect of percutaneous lumbar discectomy (PLD). Methods 158 patients were classified into two groups including contained and discontained herniation according to clinical symptoms and diagnostic images. They were treated by meanes of the same technique in nonvascular intervention. Their curative effects were compared with each other in this study. Results The curative and total effective rates were 81.1% and 98.5% respectively in contained group, 7.7% and 38.5% in discontained group without serious complications. The duration of follow up ranged from 3 months to 73 months. Conclusions PLD is a effective procedure for lumbar disc herniation, which is relatively simple and safe with rapid recovery and without serious complications. It should be confirmed in simple contained herniation only.

Objective To explore the surgical technique and clinical effect of combined great toe wraparound flap and second toe tissue flap transfer for subemergency reconstruction of grade Ⅲ and Ⅳ thumb defect.Methods From July,2011 to March,2014,12 patients of grade Ⅲ and Ⅳ thumb defect were treated by transfering combined great toe wrap-around flap and second toe tissue flap transfer.The second toe tissue flap was carried out to cover donor site defect of the big toe.Results All the 12 transplants survied and were followed up for 6 to 24 months.The reconstructed thumbs had near nomal appearace and good fuction,2-point discrimination ranged from 0.6 cm to 0.8 cm.According to the trial standard of upper limb part of functional assessment of the Hand Surgery Branch of Chinese Medical Association,among the 12 eases,there were excellent in 9,good in 3.Impact on the donor foot was minor with limited complications.The patients were able to weight-bearing walking after one months of operation.For long-term follow-up,no case had successive ulces,obvious pain and claudication.Conclusion The reconstructed thumbs by great toe wrap-around flap combined with the tissue flap of second toe had near nomal appearace and good fuction.

Objective To assess the efficacy of laryngeal mask airway Proseal (LMA Proseal) and Supreme (LMA Supreme) used in patients undergoing laparoscopic surgery when the cuff-pressure was 35 cm H2O.Methods Sixty ASA Ⅰ or Ⅱ patients, aged 20-70 yr, weighing 50-80 kg, undergoing elective laparoscopic surgery, were randomized into2 groups (n = 30 each): LMA ProSeal group (group P) and LMA Supreme group (group S). After the LMA Proseal and LMA Supreme were inserted in group P and S respectively, the cuff pressure was monitored and maintained at 35 cm H2O by manipulate manometer. The airway sealing pressure, peak and mean airway pressure before and after pneumoperitoneum during mechanical ventilation and the complications were also recorded. Results The peak airway pressure was significantly higher after pneumoperitoneum than before pneumoperitoneum during mechanical ventilation (P ＜ 0.05), but there was no significant difference in the peak airway pressure before and after pneumoperitoneum between the two groups ( P ＞ 0.05). The air leakage had never happened before or after pneumoperitoneum during mechanical ventilation. There was no significant difference in the airway sealing pressure between the two groups ( P ＞ 0.05). There was no significant difference in the incidence of throat pain between the two groups(P＞0.05).Conclusion When the cuff pressure is 35 cm H2O, the LMA ProSeal and Supreme can provide adequate ventilation during operation with fewer complications and can be used safely for laparoscopic surgery.

Objective:To explore the clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers.Methods:This study was a retrospective observational study. From March 2021 to March 2022, 15 patients with stage Ⅳ ischial tuberosity pressure ulcers who met the inclusion criteria were admitted to Dezhou Dongcheng Hospital, including 11 males and 4 females, aged 31 to 72 years. The pressure ulcer wound size ranged from 6.0 cm×4.5 cm to 10.0 cm×6.0 cm, with cavity diameters of 10-14 cm. Five cases were complicated with ischial tuberosity bone infection. After clearing the lesion, the biceps femoris long head muscle flap with an area of 10.0 cm×4.0 cm-18.0 cm×5.0 cm and the semitendinosus muscle flap with an area of 8.0 cm×4.0 cm-15.0 cm×5.0 cm combined with the posterior femoral cutaneous nerve nutrient vessel flap with an area of 6.5 cm×5.5 cm-10.5 cm×6.5 cm was transplanted to repair the pressure ulcer wound. The flap donor area was directly sutured, and the closed lavage with tubes inserted into the wound cavity was performed for 2-3 weeks. The postoperative survival of the muscle flaps and skin flaps, the wound healing of the donor and recipient areas were observed. The recurrence of pressure ulcers, the appearance and texture of flaps, and scar conditions of the donor and recipient areas were followed up.Results:All the muscle flaps and skin flaps in the 15 patients successfully survived after surgery. Two patients experienced incisional dehiscence at one week after surgery due to improper turning over, during which the incision in the recipient area was pressed on, and the wounds healed after dressing changes of 3 to 4 weeks; the wounds in the donor and recipient areas healed well in the other patients. All patients received follow-up after surgery. During the follow-up period of 6 to 12 months, none of the patients experienced pressure ulcer recurrence, and the texture, color, and thickness of the skin flaps closely resembled those of the surrounding skin at the recipient site, with only linear scar left in the donor and recipient areas.Conclusions:When using the posterior femoral muscle flaps combined with the posterior femoral cutaneous nerve nutrient vessel flap and closed lavage to treat stage Ⅳ ischial tuberosity pressure ulcers, the tissue flap can be used to fully fill in the dead space of the pressure ulcers. After treatment, the wound heals well, the appearance of the donor and recipient areas is better, and the pressure ulcers are less prone to reoccur.

Objective:To scientifically measure and morphologically evaluate the anatomical shape of the skin in the first web space based on cadavers, and to guide the design of flap in this area.Methods:Sixteen human cadavers fixed with 10% formaldehyde without injury or deformity on the hand were selected in the Department of Hand Surgery, the Third Hospital of Suqian. According to the characteristics of the first web area, marker points were selected for measurement and morphological observation. Morphological characteristics of the first web with thumb radial abduction(r) or palmar abduction(p) were measured and compared. The t-test was used for statistical analysis. P<0.05 was considered statistically significant. According to the results of measurement, standardised shapes and parameters of the skin were obtained for flap repair of defect of the first web. Results:When the thumb was in palmar abduction, the maximum distance [a(p)] of the first web of female(F) and male(M) was 5.78/8.42 cm(F/M), and the skin [S(p)] was 17.09/23.63 cm 2(F/M), both were significantly greater than the distance [a(r)] at 4.86/6.28 cm and the area of skin area [S(r)] at 14.39/20.15 cm 2 when thumb was in the radial abduction position( P<0.05). There was no significant difference in the length of [b(r)] and [b(p)] alone the long axis of flap between palmar and radial abductions(7.54/9.38 cm and 7.34/9.74 cm, respectively) of the thumb( P>0.05). It was found that the area of first web was not shaped as a symmetrical spindle, but an irregular quadrilateral inclined to the index finger. Conclusion:Design and measurement of a flap for the first web space should take the maximum palmar abduction of a thumb as a reference. The asymmetric quadrilateral flap design is more in line with the anatomical and characteristics in the region.

Objective:To investigate the therapeutic effect of modified sural neuro-fasciocutaneous perforator flap in reconstruction of foot and ankle soft tissue defects.Methods:Sixteen patients undergoing the modified flap for foot and ankle reconstruction were included in this study between June, 2016 and June, 2018. The 16 patients were 11 males and 5 females with an average age of 32.5 (range 21 to 51) years. Ten defects were in heel and 6 in ankle and dorsal side of foot. A "Z" -shape skin incision was performed to explore the perforator vessels. A peroneal-based perforator, a superficial vein, and the vascular axis of the sural nerve were included in the pedicle. A relaying island perforator flap was used to close the donor site without skin graft. Follow-up was carried out through outpatient service, telephone follow-up and Wechat photo transmission.Results:The patients were followed-up for 12 to 18 months. All flaps survived completely without complications. The colour, texture and apperance of the flaps were good. The area of the flaps ranged from 12 cm×5 cm to 30 cm×15 cm. The diameter of the pedicle ranged from 1 to 2 cm. No complication occurred in the donor sites. A relaying perforator island flaps were used in 10 cases for donor site closure and without a skin graft. All cases were satisfied with appearance and function at the final followed-up.Conclusion:It is possible to use the modified sural neuro-fasciocutaneous perforator flap to repair foot and ankle soft tissue defects. A relaying island perforator flap can be used as a relaying flap to cover the donor site without skin graft.

Objective:To evaluate the clinical effect of the modified transfer of the proximal interphalangeal joint (PIPJ) from the second toe in the treatment of a finger PIPJ defect.Methods:A total of 13 patients with finger PIPJ defects caused by traumatic injury were enrolled from May, 2017 to March, 2020. All the PIPJ defects had primary traumatic repairs. The causes of injury: 5 patients were caused by strangulation, 4 by chainsaw, 2 by strangulation and 2 by crushing. Of which, 7 patients had index finger injury, 3 middle fingers and 3 ring fingers. The operations were carried out 3-7 months after the first stage of treatment. The grafting of the PIPJ of the second toe with modified vascular anastomosis were performed. The ipsilateral second toe was taken in 10 patients, and the contralateral second toe in 3 patients. The grafted joints all carried observation skin islands, with an area of 1.0 cm×1.5 cm-1.0 cm×2.0 cm. All the secondary bone defects in the donor site of the toe were reconstructed with iliac bone grafts, and the length of the iliac bone strips was 4.0-6.0 cm. At the same time, the island flap on the fibular side of the great toe was removed and repaired at the donor site, with an area of 1.1 cm×1.6 cm - 1.1 cm×2.1 cm. Early postoperative rehabilitation was performed. The patients were followed-up through outpatient visits, telephone and WeChat interviews.Results:All the 13 finger PIPJ and donor site island flaps survived. Bone healing were observed in all patients with the healing time in 8-12(average 10) weeks. Three patients with severe adhesion of joint and tendon were treated with secondary release. All the patients were followed-up for 10 - 18 months without degeneration of PIPJ. Active range of motion of PIPJ ranged: 45°-90° in flexion and 0°-10° in extension, the average motion activity was 66.3°. Seven patients were in excellent, 4 in good and 2 in fair, according to the function assessment proposed by the Society of Hand Surgery of Chinese Medical Association. The appearance on donor site was good and the walking was normal in the longterm follow-up. Only one linear scar was left in the ilioinguinal donor site without obvious discomfort.Conclusion:It was possible to use the modified transfer of the PIPJ from the second toe in the treatment of a finger PIPJ defect. An iliac bone graft and an island flap of the first toe transfer can preserve the appearance and function of the toes.

Developing and implementing biosafety standards for pathogenic microbiology laboratories is essential to achieving scientific, efficient, and standardized management and operation. This article analyzes the current standardization construction in biosafety in pathogenic microbiology laboratories domestically and internationally. It proposes a framework for the biosafety standard system of pathogenic microbiology laboratories, which mainly includes four parts: basic standards, management standards, technical standards, and industry applications. It provides a reference for the standardization work of pathogenic microbiology laboratories and helps to standardize the biosafety industry in China.

Objective:To investigate the clinical effect of the relaying perforator flap for repairing the donor site of the anterolateral thigh flap.Methods:From March 2019 to June 2020, 28 consecutive patients who underwent anterolateral thigh free flap reconstruction for limb soft tissue defects were retrospectively reviewed. A relaying perforator flap was selected from one of the four areas adjacent to the donor site of the anterolateral thigh flap for covering the donor site of the anterolateral thigh flap. The secondary donor site was closed directly. The followed-up contents included the appearance and texture of the flaps. The postoperative followed-up was performed through outpatient visits, telephone, and WeChat interviews.Results:A total of 28 patients were included, with an average age of 37.3 (ranging from 15 to 65). The relaying perforator flap was selected from the anteromedial thigh region ( n=13), the proximal anterolateral thigh region( n=6), the distal anterolateral thigh region ( n=5), and the ilioinguinal region ( n=4). The size of the anterolateral thigh flap ranged from 12.0 cm×10.0 cm to 20.0 cm×13.0 cm, and the size of the relaying perforator flap ranged from 6.0 cm×5.0 cm to 11.0 cm×7.5 cm. The followed-up time ranged from 1 to 6 months (mean 4.8 months). The color, texture, and contour of the flaps were good. Only one linear scar is left in the donor site. Two cases with small necrosis (1.0 cm×2.0 cm and 1.5 cm×1.5 cm, respectively) were found in the distal edge of relaying perforator flaps. Conclusions:The relaying perforator flap is considered as an optimized and reliable method for repairing the donor site of an anterolateral thigh flap and should be recommended.

Objective:To investigate the clinical effect of the relaying perforator flap for repairing the donor site of the anterolateral thigh flap.Methods:From March 2019 to June 2020, 28 consecutive patients who underwent anterolateral thigh free flap reconstruction for limb soft tissue defects were retrospectively reviewed. A relaying perforator flap was selected from one of the four areas adjacent to the donor site of the anterolateral thigh flap for covering the donor site of the anterolateral thigh flap. The secondary donor site was closed directly. The followed-up contents included the appearance and texture of the flaps. The postoperative followed-up was performed through outpatient visits, telephone, and WeChat interviews.Results:A total of 28 patients were included, with an average age of 37.3 (ranging from 15 to 65). The relaying perforator flap was selected from the anteromedial thigh region ( n=13), the proximal anterolateral thigh region( n=6), the distal anterolateral thigh region ( n=5), and the ilioinguinal region ( n=4). The size of the anterolateral thigh flap ranged from 12.0 cm×10.0 cm to 20.0 cm×13.0 cm, and the size of the relaying perforator flap ranged from 6.0 cm×5.0 cm to 11.0 cm×7.5 cm. The followed-up time ranged from 1 to 6 months (mean 4.8 months). The color, texture, and contour of the flaps were good. Only one linear scar is left in the donor site. Two cases with small necrosis (1.0 cm×2.0 cm and 1.5 cm×1.5 cm, respectively) were found in the distal edge of relaying perforator flaps. Conclusions:The relaying perforator flap is considered as an optimized and reliable method for repairing the donor site of an anterolateral thigh flap and should be recommended.