Objective To compare the effect of anesthesia management between enhanced recovery after surgery (ERAS) protocol and traditional protocol on stress level of thyroid surgery.Methods Sixty-two patients receiving thyroid surgery from May 2016 to August 2016, 13 males and 49 females, aged 18-65 years, of ASA physical status Ⅰ or Ⅱ, were randomly divided into group ERAS (n=29) and traditional group (group C, n=33).Each group had its own anesthesia management protocol.Operation method, operation duration, the level of pain during emergence and on the first postoperative day, the occurrence rate of complications and the satisfaction evaluation of pain and nausea and vomiting after the operation day were recorded.C-reactive protein (CRP), serum cortisol, interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor (TNF-α) before and after the operation day were evaluated.Results The visual analogue scale (VAS) pain score in group ERAS was lower than that in group C during emergence [(0.42±0.83) points vs (0.95±1.16) points]and on the first postoperative day [(1.90±1.21) points vs (2.73±1.40) points] (P<0.05).Group ERAS was more satisfied with pain relief at first day after the surgery than that of group C (P<0.05).The level of CRP in group ERAS was lower than that in group C on the operative day and the first postoperative day (P<0.05).In group C, the level of CRP on the operative day and the first postoperative day were much higher than those before the surgery (P<0.05).The occurrence rate of complications between the two groups had no statistical difference.Conclusion The perioperative ERAS anesthesia management of thyroid surgery is safe and effective in pain management, patient satisfaction and accelerated recovery.

Objective:To investigate the application effect of venous superdrainage in repairing skin defects of wrist and hand with the flap based on ascending branch of the supracarpal cutaneous branch of ulnar artery.Methods:From July 2014 to March 2021, the clinical data of patients with hand and wrist skin defects repaired with the flap based on ascending branch of the supracarpal cutaneous branch of ulnar artery in the Emergency Department of Tangshan Second Hospital were retrospectively analyzed. According to the intraoperative venous anastomosis or not the patients were divided into venous superdrainage group(from July 2017 to March 2021) and traditional group(from July 2014 to June 2017). On the basis of the traditional method, the subcutaneous vein carried by the flap and the subcutaneous vein around the wound were anastomosed end to end in the venous superdrainage group. The donor sites in both groups were directly sutured or repaired with free partial or full thickness skin grafts. The survival of flaps in the two groups was observed after operation. Fisher’s exact test was used to compare the incidence of tension blister and pigmentation between the two groups. P<0.05 was considered statistically significant. Results:A total of 51 patients were enrolled. There were 27 patients in the venous superdrainage group, which including 18 males and 9 females, aged 18 to 57 years. The wound area after debridement ranged from 6 cm × 2 cm to 13 cm × 4 cm. There were 24 patients in traditional group, which including 15 males and 9 females, aged 20 to 61 years. The wound size after debridement ranged from 7 cm × 2 cm to 14 cm × 3 cm. In the venous superdrainage group, the flap size ranged from 7 cm × 3 cm to 15 cm × 6 cm. All the flaps survived without infection and tension blisters. During the follow-up period of 8 to 22 months, one flap showed pigmentation. In the traditional group, the area of flaps ranged from 8 cm × 3 cm to 16 cm × 4 cm. Tension blisters occurred in 5 cases of flaps due to venous reflux disorder, and the flaps survived without infection after removing some sutures at the pedicle and dressing change. During the follow-up period of 8 to 23 months, seven flaps showed pigmentation. The incidences of tension blisters and pigmentation in the venous superdrainage group were 0 (0/27) and 3.7% (1/27), respectively, which were significantly lower than those in the traditional group [20.8% (5/24) and 29.2% (7/24)] (both P<0.05). Conclusions:The use of venous superdrainage in the repair of hand and wrist skin defects with the ascending branch of the supracarpal cutaneous branch of ulnar artery flap can reduce the risk of venous reflux disorders, decrease the incidences of tension blisters and pigmentation of the flap significantly.

Objective:To investigate the application effect of venous superdrainage in repairing skin defects of wrist and hand with the flap based on ascending branch of the supracarpal cutaneous branch of ulnar artery.Methods:From July 2014 to March 2021, the clinical data of patients with hand and wrist skin defects repaired with the flap based on ascending branch of the supracarpal cutaneous branch of ulnar artery in the Emergency Department of Tangshan Second Hospital were retrospectively analyzed. According to the intraoperative venous anastomosis or not the patients were divided into venous superdrainage group(from July 2017 to March 2021) and traditional group(from July 2014 to June 2017). On the basis of the traditional method, the subcutaneous vein carried by the flap and the subcutaneous vein around the wound were anastomosed end to end in the venous superdrainage group. The donor sites in both groups were directly sutured or repaired with free partial or full thickness skin grafts. The survival of flaps in the two groups was observed after operation. Fisher’s exact test was used to compare the incidence of tension blister and pigmentation between the two groups. P<0.05 was considered statistically significant. Results:A total of 51 patients were enrolled. There were 27 patients in the venous superdrainage group, which including 18 males and 9 females, aged 18 to 57 years. The wound area after debridement ranged from 6 cm × 2 cm to 13 cm × 4 cm. There were 24 patients in traditional group, which including 15 males and 9 females, aged 20 to 61 years. The wound size after debridement ranged from 7 cm × 2 cm to 14 cm × 3 cm. In the venous superdrainage group, the flap size ranged from 7 cm × 3 cm to 15 cm × 6 cm. All the flaps survived without infection and tension blisters. During the follow-up period of 8 to 22 months, one flap showed pigmentation. In the traditional group, the area of flaps ranged from 8 cm × 3 cm to 16 cm × 4 cm. Tension blisters occurred in 5 cases of flaps due to venous reflux disorder, and the flaps survived without infection after removing some sutures at the pedicle and dressing change. During the follow-up period of 8 to 23 months, seven flaps showed pigmentation. The incidences of tension blisters and pigmentation in the venous superdrainage group were 0 (0/27) and 3.7% (1/27), respectively, which were significantly lower than those in the traditional group [20.8% (5/24) and 29.2% (7/24)] (both P<0.05). Conclusions:The use of venous superdrainage in the repair of hand and wrist skin defects with the ascending branch of the supracarpal cutaneous branch of ulnar artery flap can reduce the risk of venous reflux disorders, decrease the incidences of tension blisters and pigmentation of the flap significantly.

Objective:To explore the effects of 3 osteotomy methods on the bone healing in Ilizarov tibial bone transport.Methods:The data of 93 patients were retrospectively reviewed who had been treated by Ilizarov single-segment tibial bone transport at Department of Hand Surgery, The Second Hospital of Tangshan from December 2003 to April 2019. Minimally invasive osteotomy was performed in 16 patients [group A: 16 males with an age of (37.1±8.3) years; 5 cases of type Ⅱ and 11 ones of type Ⅲ by Gustilo classification], subperiosteal saw osteotomy in 57 patients [group B: 47 males and 10 females with an age of (39.1±11.8) years; 17 cases of type Ⅱ and 40 ones of type Ⅲ by Gustilo classification] and extraperiosteal wire saw osteotomy in 20 patients [group C: 19 males and one female with an age of (37.7±11.2) years; 18 cases of type Ⅱ and 2 cases of type Ⅲ by Gustilo classification]. The 3 groups were compared in terms of the bone healing index and the Association for the Study and Application of the Method of Ilizarov (ASAMI) functional scores.Results:The 3 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). All the patients were followed up for 19 to 50 months (average, 27.4 months). All patients achieved bony healing, and their associated complications were cured after corresponding treatments. There were no significant differences in the bone healing index between the 3 groups [(53.09±21.88) d/cm for group A, (59.97±33.29) d/cm for group B and (46.20±14.11) d/cm for group C] ( P>0.05). There were no significant differences either in the good to excellent rate by the ASAMI functional scores between the 3 groups (87.5% for group A, 89.5% for group B and 90.0% for group C) ( P> 0.05). Conclusion:All the 3 osteotomy methods may achieve good bony union, leading to similar bone healing indexes and postoperative functional scores.

Objective:To establish a rat model of transverse tibial bone transfer on the diabetic foot.Methods:A diabetic model was created by intraperitoneal injection of streptozotocin into 40 SD rats after 5 weeks of high-fat feeding, taking random blood glucose ≥16.7 mmol/L as the criterion for successful modeling. Changes in body weight, food intake, water intake, faecal output and blood glucose were monitored every week after the acclimatization period until random blood glucose ≥16.7 mmol/L was observed for 3 running weeks. After the blood glucose was stabilized, 34 surviving diabetic rats were divided into 2 groups using a random number table. In the experimental group, a transverse transfer outer frame was installed and transverse tibial bone transfer performed after removal of the skin over the dorsal foot; in the control group, a transverse transfer outer frame was installed and the skin over the dorsal foot removed but no transverse tibial bone transfer performed. The wound changes were recorded on the 1, 5, 10, 15 and 20 days after installation of the transverse transfer outer frame. After completion of transverse tibial bone transfer (24 days after modeling of transverse tibial bone transfer), one rat was randomly chosen from each of the 2 groups for angiography while the rest rats were sacrificed for observation of the skin changes on the lower limbs. The densitometric values of CD31 immunohistochemical staining were compared between the 2 groups.Results:The random blood glucose increased from (6.89±1.03) mmol/L before modeling to (25.91±6.42) mmol/L at the last test, keeping at ≥16.7 mmol/L for 3 running weeks. The percentages of ulcer healing of the foot dorsal wound in the experimental group on days 5, 10, and 20 were significantly higher than those in the control group ( P<0.05). Gross observation and angiography found more abundant vessels in the lower extremity on the side of transverse transfer in the experimental group. The immunohistochemical staining of the lower limb skin tissue for CD31 found an AOD value of 0.60±0.23 in the experimental group, significantly higher than that in the control group (0.37±0.13) ( t=3.722, P=0.001). Conclusion:A rat model of transverse tibial bone transfer has been successfully established through installation of a self-designed transverse transfer outer frame on the basis of a successful rat model of diabetic foot, characterized by improved microcirculation in the lower limbs.

BACKGROUND:Peripheral nerves play an important role in bone metabolism.In clinical practice,the specific impact of nerve injury on bone transport technology needs further study. OBJECTIVE:To investigate the effect of tibial nerve injury on the treatment of tibial slip by single-plane osteotomy. METHODS:Thirty-two patients with tibial bone defects admitted to Tangshan Second Hospital from May 2011 to June 2022 were selected.According to the presence or absence of tibial nerve injury,patients were divided into the tibial nerve injury group(n=16)and the non-tibial nerve injury group(n=16).Both groups were treated with single-plane osteotomy and bone slip.After treatment,the patients were followed up to collect the mineralization zone healing index,external fixation index,docking point healing and needle infection.After the removal of external fixation,the bone healing and functional evaluation were evaluated by a classification of the Association for the Study and Application of the Method of Ilizarov(ASAMI). RESULTS AND CONCLUSION:(1)All 32 patients were followed up for(25.28±4.79)months.There were no significant differences in bone healing time,external fixation time,healing index and external fixation index between the two groups(P＞0.05).Needle infection occurred in two cases of the tibial nerve injury group and one case of the non-tibial nerve injury group,all of which were PALEY I,and there was no significant difference between the two groups(P＞0.05).The non-union rate of the occlusal end of the tibial nerve injury group was 31%,and that of the non-tibial nerve injury group was 13%;there was no statistical difference between the two groups(P＞0.05).The excellent and good rate of ASAMI bone healing score in the two groups was 100%;the excellent and good rate of limb score was 81%in the tibial nerve injury group and 94%in the non-tibial nerve injury group;there was no statistical difference between the two groups(P＞0.05).(2)Our research shows that tibial nerve injury has no significant effect on the mineralization speed,external fixation time,union of the occlusal end,infection of the needle tract,and the quality of bone formation in the mineralized area of the single-plane osteotomy.