Operation robot has 3D vision and 7 activity degrees of freedom,also has vibration elimination system and operation scale system.These can ensure its operative precise in limited space.Meanwhile the console meets vito dynamics can relieve fatigue of doctors.Operation robot has great effect in many subjects.But it still needs to be improved because it lacks of feedback system,mechanical failure and software failure.Furthermore,its price demands to decrease.The newest progress was reviewed for better use of operation robot.

Objective To investigate the damage control surgery(DCS)in the treatment of severe abdominal trauma and the clinical value of learning from experience.Method Forty-severl cases of severe abdominal trauma patients treated with DCS were analyzed retrospectively.Results Forty-one cases (87.23%)were cured,liver abscess after re-operation was 3 cases(6.38%),intestinal fistula,biliary fistula,pancreatic fistula was 1 case(each 2.13%),they were cured by conservative treatment,6 cases(12.77%)were died,the causes of death were nothing to do with the surgery.Conclusion For patients with severe abdominal trauma actively adopt DCS,is safe and effective,with clinical value.

Objective Radiofrequency ablation (RFA) and endoscopic breast conserving surgery (EBCS) has been developed as a potential means for treating breast tumors with minimal disruption to adjacent soft tissues.The purpose of this study was to evaluate the cosmetic outcomes of RFA assisted by EBCS on patients with early breast carcinoma (T1 -2 N0-1 M0).Methods Twenty-three patients with biopsy proven invasive breast carcinoma ( ≤3 cm in diameter),were treated with ultrasound (US)guided percutaneous-RFA for the local tumors followed by sentinel lymph node biopsy and endoscopic auxiliary node dissection and lumpectomy.The reactions to breast cosmetics were observed and compared to the conventional approaches using the breast asymmetry score for EBCS and a self -assessment questionnaire targeting objective and subjective data about treatment related breast change.Results Twenty-three patients were successfully treated with RFA.Complete coagulation necrosis of the tumor was visualized at US and mammography in 22 of 23 patients (95.6 ％).22 patients being per formed RFA and EBCS presented little scars and the breasts preserved more cosmetically acceptable than the reported results of traditional protocols.Self-assessment acceptable rate was 100 ％,aesthetic outcome as good or excellent rated in 95.5 ％(21/22).Within the follow-up of above 36 months,there were no local recurrence,metastasis,wound infection or necrosis,nerve damage,haematoma,as well as upper limb swelling or lymphoedema,no reduced upper limb mobility and tumor seeding.Conclusions RFA with endoscopic breast conservation therapy for the treatment of early breast carcinoma is more effective and cosmetically acceptable than the traditional approaches.

Objective To explore the clinical effects of sequential flap of thigh perforator for closure of the anterolateral thigh free flap donor site.Methods From March,2014 to May,2015,8 consecutive patients underwent elective anterolateral thigh free flap reconstruction for limb soft tissue defect.To design a sequential flap of thigh perforator to achieve primary closure of the anterolateral thigh free flap donor site.The area of anterolateral thigh free flap ranged from 9.0 cm×6.0 cm to 20.0 cm×1 1.0 cm,respectively.The area of thigh perforator flap ranged from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm.Results All flaps healed uneventfully.Distal skin flap necrosis appeared in 1 flap which was healed after local transposition flap.All the patients were followed up for 1 to 6 months,with mean time of 4 months.The color,texture and appearance of flaps were satisfactory.Conclusion Sequential flap of thigh perforator,with reliable blood supply and constant position,represents an ideal model to close the anterolateral thigh free flap donor site of small defect.

Objective:To explore the effect of laryngeal massage combined with feeding training on swallowing function and quality of life in patients with poststroke swallowing disorders.Methods:From November 2021 to October 2022, convenience sampling was used to select 148 patients with poststroke swallowing disorders in the Department of Neurosurgery and Rehabilitation at the North China University of Science and Technology Affiliated Hospital. The patients were divided into a control group, a laryngeal massage group, a feeding training group, and a combination group using the random number table method, with 37 cases in each group. The control group was given routine nursing, while the laryngeal massage group and feeding training group respectively received laryngeal massage and feeding training on the basis of routine nursing. The combination group underwent laryngeal massage combined with feeding training on the basis of routine nursing. Before and after 2, 4, and 8 weeks of intervention, the Water Swallowing Test, Standardized Swallowing Assessment (SSA), and Chinese version Swallowing Quality of Life Questionnaire (SWAL-QOL) were used to compare the swallowing function and quality of life of four groups of patients with poststroke swallowing disorders.Results:After 2, 4, and 8 weeks of intervention, the Water Swallowing Test rating and efficacy evaluation of the 4 groups of patients with poststroke swallowing disorders were better than those before intervention ( P<0.05). Moreover, the SSA scores decreased compared to before intervention ( P<0.05), and the SWAL-QOL scores increased compared to before intervention ( P<0.05). The Water Swallowing Test efficacy evaluation and SWAL-QOL scores in the combined group were higher than those of the other groups ( P<0.05), while the SSA scores were lower than those of the other groups ( P<0.05) . Conclusions:Laryngeal massage and feeding training can improve the swallowing function and quality of life of patients with poststroke swallowing disorders, and the combination of the 2 interventions has a significant effect.

Objective:To explore the influence of symptom group of stroke patients with exercise disorder on acute stress disorder.Methods:Patients with stroke and motor impairment hospitalized in the Department of Neurology and surgery of North China University of technology from October 2018 to August 2019 were selected as the research objects.The general information of patients, brain injury subscale (BIS) and Stanford acute stress reaction questionnaire (SARSQ) were investigated by questionnaire.Results:A total of 324 patients with stroke and motor disorders were investigated.The demographic characteristics of education, age, degree of motor function, number of combined dysfunction and Activity Of Daily Living Scale(ADL) grade had effects on acute stress disorder, and the differences were statistically significant( P<0.05). The score of acute stress disorder in stroke patients with motor disorders was (99.60±13.69 ) points.From the highest to the lowest symptom group, the scores were obsessive symptom (11.35±2.71), depression (7.44±1.86), hostility (7.23±2.26), somatization (3.69±1.42) and psychosis (2.81±1.09). The results of correlation analysis showed that somatization, depression, obsessiveness, hostility and psychosis were positively correlated with the total score of acute stress disorder and the scores of each dimension ( r=0.164, 0.355, 0.329, 0.298, 0.279, all P<0.05), the symptoms were also positively correlated with all the dimensions of acute stress disorder(all P<0.05). Multiple linear regression analysis showed that age(Regression coefficient=7.682, 95% CI: 4.930-10.435, P<0.001), the number of combined dysfunction(Regression coefficient=3.937, 95% CI: 0.268-7.605, P=0.036), depression(Regression coefficient=1.662, 95% CI: 0.727-2.597, P=0.001) had influence on ASD of stroke patients. Conclusion:The level of acute stress disorder in stroke patients with motor impairment is on the high side, and the characteristics of symptom group are obvious, which has a positive correlation with acute stress disorder.Medical staff should pay attention to the characteristics of symptom group and acute stress reaction level of stroke patients with motor impairment, so as to provide targeted intervention strategies to avoid disease recurrence and improve the quality of life.

This is a report of a complex defects in the right upper extremity treated in the Department of Hand and Microsurgery, 521 Hospital of Norinco Group, in October 2016. The patient received multi-transfers of flaps for one-stage reconstruction, including a double-paddled ALTPF and a compound flap of the great toe and the second toe. Vascular compromises occurred in flaps on the 2nd day after surgery. All the flaps were rescued and survived completely after surgical exploration. Followed-up at 3 year after surgery showed that the appearance and function of the affected limb recovered well. The flexion and extension of elbow and wrist were normal. The pinch function of the reconstructed thumb and index finger recovered well.

Objective:To explore the clinical application and effect of repairing the donor site of ipsilateral fibular hallux flap with the transverse V-Y advancement flap of the great toe.Methods:Form January 2017 to January 2020, the donor sites of the ipsilateral fibular hallux flap were repaired by the transverse V-Y advancement flap of the great toe in the Department of Hand Surgery, 521 Hospital of Weapon Industry on 20 patients, including 16 males and 4 females with an average age of 33 (18-52) years old. First, the donor site of the fibular hallux flap was sutured to reduce the size of wound. The width of the remaining wound was 0.4 to 1.6 cm, and the area of the remaining wound was 0.5 cm×0.8 cm-1.6 cm×1.8 cm. Then the remaining wound was repaired with the transverse V-Y advancement flap of the ipsilateral great toe. The distance for transfer of transverse advancement V-Y flap was 0.2-0.8 cm, and the area of the transverse V-Y advancement flap was 1.0 cm×1.4 cm-1.8 cm×2.4 cm. The end of postoperative follow-up was scheduled in July 2021. The follow-up items included: survival of the transverse V-Y advancement flap, wound infection, appearance, shape, texture and sensation of the V-Y advancement flap, pain on the V-Y advancement flap and the great toe, cold tolerance and the scar condition at the donor site of the ipsilateral fibular hallux flap and the V-Y advancement flap, the appearance, sensation and flexion and extension of the great toe at the donor site, other discomforts in the donor site of great toe, walking and other functions affected by the discomforts.Results:The postoperative follow-up lasted from 12 to 18(average of 14) months. All the V-Y advancement flaps survived without infection at the donor sites of the great toe, and donor sites healed primarily. The appearance, shape and texture of the advancement V-Y flap were close to the skin of the same area of the contralateral great toe. The TPD of the V-Y advancement flap and the ipsilateral great toe ranged from 4 to 7 mm. The average score of the Visual analog scale(VAS) was 0.3 and 0.6 respectively in the evaluation of cold tolerance of the advancement V-Y flap and the ipsilateral great toe. The average score of the Vancouver scar scale(VSS) was 0.2 and 1.2 respectively in the scar evaluation of the V-Y advancement flap and the ipsilateral great toe. There was no visual difference between the appearance of the great toe at the donor site and the contralateral toe. There was no pain and other discomfort on the V-Y advancement flap and the ipsilateral great toe. The functions of the donor foot were not affected in walking, running, jumping and tiptoeing in all cases.Conclusion:It is a simple, safe and effective method to repair the donor site of the small-area ipsilateral fibular hallux flap by the transverse V-Y advancement flap of the great toe. It only causes a small wound but the appearance and function of the ipsilateral great toe can be repaired with a transverse V-Y advancement flap of the great toe.

Objective:To explore the clinical effect of cosmetic reconstruction for partial defect of distal segment of digits.Methods:Form January 2018 to January 2021, the Department of Hand Surgery of Institute for Hygiene of Ordnance Industry(The 521 Hospital of Weapon Industry) admitted 129 patients with partial defect of distal segment of thumb or fingers with phalange or tendon exposure. The patients were 111 males and 18 females with an average age of 34(17-59) years old. The sizes of nailbed defect were 0.4 cm×1.1 cm-1.8 cm×2.0 cm, the length of phalange defect was 0.4-1.8 cm, and the sizes of the soft tissue defect were 1.6 cm×1.8 cm-3.2 cm×4.8 cm. Great toe tissue flaps were used to reconstruct the partial defect of distal segment of thumb or fingers after debridement. Wounds of fibular flap of great toe in 77 cases were directly sutured in 17 patients. The donor sites in rest 60 great toes were narrowed first and then repaired with skin grafts in 10 cases, with artificial dermis in 28 cases and with transverse V-Y advancement flaps of ipsilateral great toes for 22 cases. Forty-nine of 52 donor site wounds for hallux toenail flap were repaired with artificial dermis and 3 with free peroneal artery perforator flaps. The method was outpatient follow-up. Postoperative follow-up lasted until July 2022. The check-items for follow-up included: occurrence of necrosis, appearance, shape and texture of the flap, appearance of the reconstructed nails, TPD of the reconstructed digit pulps, tolerance to cold on the scars of flaps, flexion and extension of the reconstructed digits. The healing time of phalanges of the reconstructed digits was evaluated by X-rays. The appearance, sensation, the tolerance to cold of great toe and the movement of donor foot were also assessed.Results:Postoperative follow-up lasted for 18 to 24 months, with an average of 21 months. A total of 128 flaps survived. Necrosis occurred in 1 fibular hallux flap, the necrosis was cured with a reverse digital proper artery island flap. Thereafter, all flaps healed well. The appearance, shape, texture and nails of reconstructed digits were close to the contralateral digits. The reconstructed thumb and finger were evaluated according to Zook, 127 cases were excellent and 2 cases were good.TPD of the pulps of the reconstructed digits was 4-10 mm. The mean score of the Vancouver scar scale(VSS) was 0.6 for scars of the reconstructed digits. The mean score of the Visual analog scale(VAS) was 0.3 for the tolerance to cold. Flexion and extension function recovered well in all the reconstructed digits. According to the Evaluation Criteria of Upper limb Function Hand Surgery Society of Chinese Medical Association, the function of hand was excellent in 127 cases and 1 in each of good and fair. X-rays of all digits showed the phalange healing of the reconstructed digits, with an average healing time of 2 months after surgery, without phalange resorption, infection, nonunion nor stress fracture. There was no difference between the length of the donor great toe and the contralateral toe, except the donor site of the great toe nail root. There was no significant visual difference between the appearance of the donor great toe and the contralateral toe. TPD of the pulps of donor great toe was 4-8 mm. The mean score of the VSS was 1.4 for scars in the donor great toe. The mean score of the VAS was 0.7 for the tolerance to cold of the donor great toe. There was no stress fracture at donor site, and the functions of donor foot were not affected when walking, running, jumping and tiptoeing in all patients.Conclusion:It is an ideal method for reconstructing a partial defect of distal segment of digit by great toe flap. It can not only reconstruct the partial defect of distal segment of the digit, but also results in a good appearance and satisfactory functions of the reconstructed digit. Damage to the donor site is minimum. The length of the donor great toe is unchanged, and it has little impact on sensation and appearance of the donor great toe. Meanwhile, there is no adverse effect on walking, running and jumping with the donor foot.