Objective: To investigate the clinical outcome of distraction osteogenesis in the treatment of pediatric maxillofacial fractures. Methods: From November 2017 to November 2018, 6 cases of maxillofacial fractures were treated, including 3 cases of maxillary fracture and 3 cases of mandibular fracture. All of them were associated with facial asymmetry of different severity, disordered occlusion and displacement of fracture segments. The distraction osteogenesis device was used to fix the fracture during the operation. The distraction was initiated after 1 day latency period, and proceeded at approximately 0.5 mm each time, twice a day, until the normal occlusal relationship was achieved. Distractor was maintained for 1 month after distraction, and then removed. The degree of fracture healing, the mouth opening and the occlusal status at the fracture site were evaluated during follow-up, and the corresponding curative effect was observed and evaluated. Results: All fractures were healed well, without infection, dislocation, or pseudo-joint formation after 1 month. The distraction duration is 15-20 days and the distraction distance is 15-20 mm. At the end, the occlusal relationship was normal, and the mouth opening was not limited. The follow-up period was from 1 month to 1 year. The maxillofacial appearance of the children was normal, and the maxillofacial development was not significantly affected. Conclusions Distraction osteogenesis is an effective and controllable method for child maxillofacial fracture. It can be used as a supplement to the conventional treatment of maxillary and mandibular fracture in children.

Objective: To discuss the application of plane-shaped flaps for reconstruction of the web space in polysyndactyly of the fifth toe fused with the fourth toe. Methods: A total of 62 cases (81 feet) with polysyndactyly of the fifth toe fused with the fourth toe were involved in the study, 53 of which were incomplete and 9 were complete fusion of the fourth and fifth toe. The fifth toe showed various degrees of fibular clinodactyly and minor deformities. Excision of polydactyly and then using arthroplasty or osteotomy correction deviation was for fibular clinodactyly. All plane-shaped flaps were used for reconstruction of the web space deeply, and the lateral sides of toes were closed with flaps and the distal soft tissues of polydactyly were used lengthening the reconstructed fifth toe. Brachydactylias were improved, and nail folds were reconstructed. Thus, the appearances reached the normal level. Results: All the webs were reconstructed primarily without skingraft. After 12 months of follow-up, these reconstructed web space were satisfied with good appearances of width, depth and gradient. The fibular clinodactyly was completely corrected, and brachydactylias were corrected in various degrees. Nail folds reached the normal ones. Conclusions Plane-shaped flap in polysyndactyly of the fifth toe fused with the fourth toe for reconstruction of the web space is satisfactory. The reconstructed webs not only achieves good appearance, but also avoids skin grafts. It is one of the best choices of the polysyndactyly treatment.

Objective:To evaluate the effect of general anesthesia under the guidance of bispectral index (BIS) on postoperative fatigue syndrome (POFS) in elderly patients undergoing laparoscopic resection of gastrointestinal tumor.Methods:A total of 90 patients of both sexes, aged 65-80 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiology physical status Ⅰ-Ⅲ, undergoing elective laparoscopic resection of gastrointestinal tumor, were divided into 3 groups ( n=30 each) using a random number table method: control group (C group), BIS value 40-49 group (B1 group), and BIS value 50-60 group (B2 group). Combined intravenous-inhalational anesthesia was used.The intraoperative BIS value was maintained at 40-49 in group B1, the intraoperative BIS value was maintained at 50-60 in group B2, and the fluctuation range of heart rate and mean arterial pressure was maintained within 20% of the baseline value during operation, and vasoactive drugs were given when necessary in group C. Patient-controlled intravenous analgesia was performed with sufentanil plus dezocine plus palonosetron after surgery, when the VAS score > 3 points, oxycodone/acetaminophen tablets 5 mg were administered orally or flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.The Christensen′s Fatigue Scale (CFS) scores were recorded at 1 day before operation and 1, 3, 7 and 30 days after operation, and the development of POFS (CFS score ≥ 6) was recorded.The intraoperative consumption of propofol, remifentanil and sufentanil was recorded.The serum C-reactive protein concentration was determined by immunoturbidimetry at 1 day before operation and 1 day after operation.The requirement for rescue analgesia within 48 h after operation was recorded.The time to the first flatus, the first ambulation time, length of hospital stay, and occurrence of fever, vomiting and delirium within 3 days after operation were recorded.The Quality of Recovery-15 (QoR-15) scores were measured at 1, 3 and 7 days after operation. Results:Compared with group C, CFS scores were significantly decreased at 1, 3 and 7 days after surgery, the incidence of POFS was decreased at 7 days after surgery, QoR-15 scores were increased at each time point after operation, the length of hospital stay was shortened, and the intraoperative consumption of propofol was reduced in B1 and B2 groups ( P<0.05). Compared with group B1, the intraoperative consumption of propofol was significantly reduced, QoR-15 scores were increased at each time point after operation ( P<0.05), and no significant change was found in CFS scores, incidence of POFS at each time point after operation, or length of hospital stay in group B2 ( P>0.05). There were no significant differences in serum C-reactive protein concentration, postoperative requirement for rescue analgesia, time to first flatus, first ambulation time, and incidence of fever, vomiting and delirium at each time point among the three groups ( P>0.05). Conclusions:General anesthesia under BIS guidance can reduce POFS and promote early postoperative recovery in elderly patients undergoing laparoscopic resection of gastrointestinal tumor.