OBJECTIVETo explore the application of the horn shaped fasciocutaneous flap for the middle or small defect of low leg.

METHODSBetween April 2008 and November 2010,12 cases were covered the defects with horn flap in the leg, in which 4 cases were male, and 8 cases were female, such as squamous cell carcinoma, basal cell carcinoma, angioneoplasm, trauma and so on. Surgical repair of tissue defect size of about 3 cm x 3 cm-5 cm x 5 cm.

RESULTSTwelve cases were treated. Vascular deficiency happened at the distal end of one flap. All the other 11 flaps survived. The appearance and functional results were satisfactory with following up for 6 to 24 months.

CONCLUSIONSThe horn shaped fasciocutaneous flap is simple, reliable, easy to perform, has a low complication rate, is cosmetically acceptable

Adult ; Fascia ; transplantation ; Female ; Humans ; Leg ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Young Adult

OBJECTIVETo evaluate whether lipid-lowering therapy with Xuezhikang can reduce the risk of cardiac events and total mortality in coronary heart disease (CHD) patients with or without hypertension.

METHODSIn this random, double-blinded, placebo controlled clinical trial, 2704 patients with hypertension and 2166 patients without hypertension were enrolled and capsule Xuezhikang 0.6 g Bid or placebo on the top of conventional therapy without other lipid-lowering drugs. The mean follow-up period was four years. The primary end-points were nonfatal myocardial infarction and total mortality.

RESULTSCompared to placebo group, the incidence of cardiac events was reduced by 44.0% (P<0.0001) and 47.4% (P<0.0001) respectively in CHD patients with or without hypertension, and the total mortality was lowered by 35.8% (P=0.0012) and 28.6% (P=0.0737) respectively in CHD patients with or without hypertension. There was no significant difference in side effects between study groups.

CONCLUSIONXuezhikang can reduce the cardiac events and mortality in CHD patients with or without hypertension.

Adolescent ; Adult ; Aged ; Coronary Disease ; drug therapy ; mortality ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Hypertension ; complications ; drug therapy ; mortality ; Hypolipidemic Agents ; therapeutic use ; Lipids ; blood ; Middle Aged ; Phytotherapy ; Survival Rate

OBJECTIVETo investigate the feasibility of using modified peroneal tendofascial compound flap with partial tendon of peroneal long muscle in lower leg refractory defect with Achilles tendon rupture.

METHODSBased on the application experience of peroneal tendofascial compound flap for lower leg refractory defects, partial tendon of peroneal long muscle was included in the flap to repair the Achilles tendon rupture.

RESULTS6 cases were treated. The maximum size of modified compound flap reached 5 cm x 5 cm. The maximal included tendon in the flap was 5 cm in length. All the flaps survived completely. Partial epidermis necrosis happened in one case between the skin graft at the donor site and the edge of the flap pedicle. The patients were followed up for 5 months to 2 years with satisfactory cosmetic and functional results.

CONCLUSIONSThe modified compound flap has reliable blood supply and can be easily transposed, leaving less morbidity at the donor site. It is very suitable for lower leg refractory defect with the Achilles tendon rupture.

Achilles Tendon ; injuries ; Adult ; Aged ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged ; Surgical Flaps ; Tendon Injuries ; surgery ; Treatment Outcome

OBJECTIVETo investigate the application and therapeutic effect of modified neurovascular flaps nourished by sural nerve and small saphenous venous, or saphenous nerve and great saphenous venous.

METHODSAccording to the anatomy and recipient area, we made some modifications for the two neurovascular flaps. 1) The small and great saphenous venous were ligated or anastomosed with the venous in recipient area; 2) The flap was delayed for 8 - 14 days if the donor area was above the middle and upper one third of leg; 3) The sural nerve and its branch were anastomosed to the nerve in recipient site to restore the sense of flap; 4) the lower turning point could be designed just 3 cm above the point of internal and external malleolus; 5) Partial gastrocnemius or soleus muscle could be included in the flap if needed; 6) Reversed cross leg flap was considered if the adjacent flap in the affected side could not be used. Sometimes, we adopted more than one modification in one patients.

RESULTSFrom Sep, 1994 to Apr, 2007, 63 cases were treated, including 51 cases of sural and 12 cases of saphenous neurovascular flaps. Partial necrosis (about 1 - 2 cm width) happened in the distal end of flaps in 2 cases which healed after dress changing. The patients were followed up for 3 months to 2 years with satisfied functional and cosmetic results.

CONCLUSIONSThese two modified flaps have reliable blood supply and survival rate. The operation is easily performed and very practical. The flaps, or combined with other methods can repair about 70% of the refractory defects in legs.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Lower Extremity ; innervation ; Male ; Middle Aged ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Veins ; surgery ; Young Adult

OBJECTIVETo elucidate whether lipid-lowering therapy with Xuezhikang can induce a decrease of cardiac events and an attenuation of total mortality in coronary heart disease (CHD) patients with diabetes.

METHODSWe designed a random, double-blinded, placebo controlled clinical trial in selected 591 patients. All patients were administrated with capsule Xuezhikang (0.6 g, Bid) or placebo in addition to conventional therapy. The mean follow-up period was four years. The primary end-points were nonfatal myocardial infarction and death from CHD.

RESULTS(1) The incidence of CHD events and that of death from CHD were reduced by 50.8% (P = 0.0008) and by 44.1% (P = 0.0246) in treatment group, respectively; Also, the incidence of nonfatal myocardial infarction was reduced by 63.8% (P = 0.0151). (2) The incidence of stroke, tumor, and PCI/CABG were decreased by 20.2%. (3) The total mortality were lowered by 44.1% in treatment group (P = 0.0097).

CONCLUSIONXuezhikang can effectively reduce the incidence of cardiac events and total mortality in CHD patients with diabetes.

Aged ; China ; Coronary Disease ; complications ; drug therapy ; prevention & control ; Diabetes Mellitus ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Hypolipidemic Agents ; therapeutic use ; Male ; Middle Aged ; Secondary Prevention

OBJECTIVETo study the anatomy of peroneal tendofascial flap combined with adipofascial flap for the repair of heel tissue defects.

METHODSThe lower extremities of five cadavers (10 sides) were perfused with red latex, the blood supply of peroneal tendofascial flap and vicinity adipofascial flap were observed. The diameter, course, branches and location of the blood vessels were measured. Eight fresh cadavers (16 sides) were perfused with lead oxide-gelatine mixture. The covering fascia tissues of the lower extremities was obtained and photographed by X-ray. The vascular anastomosis and association of nutrient vessel of peroneal tendofascial flap and vicinity adipofascial flap were observed. Two adult lower extremities specimens (4 sides) were used to construct vessel diagrams for observation of the course, distribution and anastomosis of the vessels. Eight cases were treated successfully with theses flaps.

RESULTSThe blood supply of the combined fascial flap is multi-originated. For the area within 4 cm below and above the lateral malleolus cusp, the blood supply includes 2-5 branches from heel lateral artery with an average diameter of (0.5 +/- 0.2) mm, 1-2 branches from posterior lateral malleolus artery with an average diameter of (0.6 +/- 0.2) mm and 2-3 branches from the descending part of perforating branches of peroneal artery with an average diameter of (0.5 +/- 0.2) mm. The blood supply of area 4 cm above lateral malleolus cusp is 1-3 branches from intermuscular septum perforating branches of peroneal artery with an average diameter of (1.0 +/- 0.2) mm. These above branches are anastomosed each other and also send off many smaller branches to form vascular net around tendon. The fascial flaps and free skin grafts in eight patients were completely survived. All patients were followed up for 3-24 months, the donor and recipient sites were healed very well. The functional and cosmetic results were satisfactory.

CONCLUSIONSPeroneal tendofascial flap combined with adipofascial flap, with proximal pedicle or reverse distal pedicle, can be used to repair the defect at the lower leg and refractory small- and medium-sized defects at the heel.

Adipose Tissue ; anatomy & histology ; transplantation ; Adult ; Aged ; Fascia ; anatomy & histology ; transplantation ; Female ; Fibula ; Heel ; injuries ; surgery ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; anatomy & histology ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps

OBJECTIVETo investigate the application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar.

METHODSThe proximal end of the plantar fasciocutaneous perforator flaps were at the edge of defects. The deep fascia was cut off at the both sides of flaps. The plantar fascia should be included into the flaps. Then the flaps were rotated to cover the defects, containing two or three perforators. If necessary, the original supplying vessels could be cut off to facilitate the advancement of flaps.

RESULTSFrom Jan. 2010 to Oct. 2012, 7 cases with plantar defects were treated with the horn shaped perforator flaps. The defects size ranged from 1.5 cm x 2.0 cm to 4.0 cm x5. 0 cm with the size of the flaps ranging from 7 cm x 3 cm to 13 cm x 7 cm. All the flaps survived completely with primary healing both on donor and recipient sites. The flap color, texture, function and appearance were satisfactory during the follow-up period of 3-24 months.

CONCLUSIONSThe plantar horn shaped perforator flap can reconstruct the defects at plantar weight-bearing area with the similar thick skin tissue, which facilitates the functional reconstruction. No skin graft is necessary for the defect at donor site.

Adult ; Female ; Foot Diseases ; surgery ; Humans ; Male ; Middle Aged ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Soft Tissue Injuries ; surgery

OBJECTIVETo summarize the reasons for bile duct injury (BDI) after laparoscopic cholecystectomy (LC), and to determine the effect of multiple treatment after BDI.

METHODSA retrospective cohort study was performed. The medical records of 110 patients diagnosed with BDI after LC from October 1993 to November 2007, in ten large hospitals in Guangdong of China, were reviewed.

RESULTSAmong 110 patients with BDI, 58 cases (52.7%) were local patients, whereas 52 cases (47.3%) were transferred from outside hospitals. Reasons for BDI following LC were: (1) Lack of experience of the LC operator (48.2%); (2) LC performed during acute cholecystitis (20.0%); (3) The structure of Calot triangle was unclear (15.5%); (4) Variable anatomical position (11.8%); (5) Intra-operation bleeding (4.5%). The commonest sites of injury were the choledochus and common hepatic duct (76.4%). Following BDI, endoscopic stenting or operative repair was performed in 106 patients. The overall success rate was 95.3% (101/106), with a mortality rate was 0.9% (1/106). Cholangitis occurred in 3.8% (4/106) cases. Choledocho-enterostomy operation was performed in almost 60.0% (63/106) cases, and the success rate was 93.7% (59/63). Endoscopic stenting or operative repair was performed immediately following BDI in 23.6% (25/106) patients, the success rate was 100%; and within 30 days in 63.2% (67/106) patients. Eighty-eight out of 106 patients who underwent repair were successful following the first operative procedure.

CONCLUSIONSFactors such as an un-experienced operator and unclear anatomical position were causes of BDI following LC. Early operative repair should be regarded as the treatment of choice, in patients diagnosed with BDI. Early refer to an experienced hepatobiliary operator ensures a high success rate.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bile Ducts ; injuries ; surgery ; Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Humans ; Iatrogenic Disease ; Intraoperative Complications ; diagnosis ; etiology ; surgery ; Male ; Middle Aged ; Retrospective Studies