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Clinical application of little finger ulnar palmar artery perforator flaps

Jian LIN ; Heping ZHENG ; Hua LU ; Tianhao ZHANG ; Zhijiang WANG ; Haojie ZHANG

Chinese Journal of Trauma.2014;30(11):1089-1092. doi:10.3760/cma.j.issn.1001-8050.2014.11.007

Objective To investigate the feasibility of repairing soft-tissue defects of the fifth phalange and the back of hand with ulnar palmar artery perforator flaps from the little finger.Methods Based on anatomic dissection,the fifth phalange ulnar palmar artery perforator flaps were created and transferred to repair soft-tissue defects at the little finger and the back of hand in 15 cases.Types of injury were stamping injury in 5 cases,planer injury in 4 cases,mechanical crash injury in 3 cases,blast injury in 2 cases,and cicatrical contracture following electric burn in 1 case.Injury involved in the palmar aspect near the middle segment of fifth phalange in 4 cases,dorsal aspect near the middle segment of fifth phalange in 6 cases,ulnar mesiodistal of the back of hand in 3 cases,and distal ulnar palmar aspect of hands in 2 cases.There were 6 patients wounded in left hands and 9 patients wounded in right hands.Results All flaps survived and all wounds healed by first intention.At the follow-up of 2-18 months,the flaps resurfaced the soft-tissue defects with good color and texture match and the maintenance of contour and function of donor and recipient sites were satisfactory.Conclusion The fifth phalange ulnar palmar artery perforator flap,as it has advantages of constant perforator vessels,rich blood supply and good texture and can be operated safely and easily,is considered an ideal treatment choice in repairing softtissue defects of the fifth phalange and the back of hand.

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Comparative analysis between susceptibility-weighted imaging and conventional T2*-weighted spoiled phase gradient-echo imaging in detecting intracranial bleeds in patients with mild traumatic brain injury

Rui LUO ; Jun CHEN ; Hui CHEN

Chinese Journal of Trauma.2014;30(11):1107-1111. doi:10.3760/cma.j.issn.1001-8050.2014.11.013

Objective To investigate the advantages of susceptibility-weighted imaging (SWI) over conventional T2*-weighted spoiled phase gradient-echo imaging (T2* WI) in detecting brain hemorrhage in patients with mild traumatic brain injury (MTBI) and its relationship to outcome after MTBI.Methods Clinical information,T2* WI and SWI of 57 patients with MTBI were collected.Bleeding cases and number of cerebral micro-cerebral bleeds (MCBs) detected using T2* WI and SWI were compared statistically.Correlation analysis between SWI and clinical outcome was performed.Results Hemorrhage in 43 patients (75％) with MCBs amounting to 237 was detected using SWI,while hemorrhage in 32 patients (56％) with MCBs amounting to 123 was found using T2* WI (P＜0.01).Thirty-five patients experienced short-term unconsciousness,including 22 being detected with post cerebral traumatic syndrome (PCTS) at follow-up.Twenty-two patients experienced no coma,among which 10 developed PCTS at follow-up.Based on the SWI,patients who experienced coma showed higher incidence of hemorrhage compared with patients who did not (86％ vs 59％,P＜0.05),and patients with hemorrhagic focus was associated with higher probability of PCTS compared with patients without (65％ vs 29％,P＜0.05).Conclusions SWI is more sensitive than conventional T2* WI in detecting cerebral MCBs.MCBs are related to the late prognosis of MTBI patients,but SWI can supply certain valuable and objective information.

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Effect of early normobaric hyperoxia on cerebral oxygenation in patients with extremely severe craniocerebral injury

Xuri SUN ; Yuqi LIU ; Guoliang TAN ; Sibai HONG ; Tinglong HUANG

Chinese Journal of Trauma.2014;30(12):1172-1175. doi:10.3760/cma.j.issn.1001-8050.2014.12.003

Objective To observe the changes of brain oxygenation in patients with extremely severe craniocerebral injury and the therapeutic effect of early normobaric hyperoxia.Methods Sixtyeight patients with extremely severe craniocerebral injury treated from January 2011 to January 2013 were assigned to two groups according to the random number table:50％ oxygen breathing for one week in control group (34 cases) and 80％ oxygen breathing for one week in treatment group (34 cases).Blood samples from jugular vein and radial artery were collected at 1,3,5,and 7 days to measure indices of blood gas analysis,i.e.,PaO2,PjvO2,CaO2,CjvO2,Da-jvO2,CERO2 and Djv-a Lac.GCS and content of neuron-specific enolase (NSE) were recorded as well.Results Values of PaO2 at each time point and GCS at 5 and 7 days were significantly higher in treatment group than in control group (P ＜0.05).Djv-a Lac at 3,5 and 7 days and NSE at 7 days revealed significantly higher levels in treatment group than in control group(P ＜ 0.05).Whereas at each time point,there were no significant differences between the two groups in aspects of PjvO2,CaO2,CjvO2,Da-jvO2 and CERO2 (P ＞ 0.05).Conclusion Early use of 100％ oxygen in patients with extremely severe craniocerebral injury may be beneficial to the prognosis.

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Traumatic brain injury in Ya'an earthquake: a report of 69 cases

Chaohua YANG ; Qiang LI ; Maojun CHEN ; Li LI ; Siqing HUANG ; Chao YOU

Chinese Journal of Trauma.2014;30(12):1176-1179. doi:10.3760/cma.j.issn.1001-8050.2014.12.004

Objective To analyze the clinical features of patients with traumatic brain injury in the Ya' an earthquake and discuss the treatment experiences.Methods Medical records of 69 patients admitted from April 2013 to May 2013 because of traumatic brain injury in the Ya' an earthquake were collected.Retrospective review was performed for age,gender,causes of injury,time from injury to hospitalization,types of injury,associated injury,treatment methods and outcomes.Results There were 47 males and 22 females.Forty-two patients (61％) were injured from falling objects.Fifty-eight patients (84％) were sent to the West China Hospital within 72 hours postinjury.Twenty-two cases (32％) sustained associated injuries.Twenty-nine patients (42％) were critically injured.Twenty-four patients underwent operation at the local hospital and twelve patients had operation at our hospital.Outcome measure using GOS one month after treatment showed 55 favorable recovery,5 moderate disability,4 severe disability,and 5 coma.Conclusions Main cause of injury is hit by falling objects during the Ya' an earthquake.Majority of the patients obtained effective treatment in the time window.GCS in combination with patients' general condition used in casualty triage and critical patients charged by neurosurgeons and treated with the cooperation of multiple disciplinary teams are helpful to successful treatment.

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Effect and economic analysis of operative treatment of severe rib fracture

Zhe HE ; Guibin QIAO ; Enwu XU

Chinese Journal of Trauma.2014;30(12):1201-1204. doi:10.3760/cma.j.issn.1001-8050.2014.12.009

Objective To evaluate economic benefits and clinical effects of internal fixation treatment of severe rib fracture so as to provide objective basis for improving medical treatment for rib fracture.Methods A retrospective review was made on clinical data of 50 patients with severe rib fracture hospitalized from January 2009 to April 2014.With varied treatment modalities,the patients were assigned to operative group (n =13) and non-operative group (n =37).Variables were recorded including length of stay,total hospital charges,length of ventilatory support,off-bed time,duration of antibiotic use and incidence of complications and used to perform cost-efficiency analysis.Results Between operative and non-operative groups,length of hospital stay was (25.9 ± 8.2) days vs (35.4 ± 7.0) days,total hospital charges were (121 676.2 ± 10 991.1) yuan vs (148 724.5 ± 21 254.3) yuan,length of ventilatory support was (7.9 ± 2.8) days vs (14.1 ± 3.3) days,off-bed time was (14.3 ± 4.9) days vs (26.1 ± 6.5) days,duration of antibiotic use was (12.4 ± 3.3) days vs (21.2 ± 6.2) days and complications occurred in 2 cases vs 13 cases respectively.The findings were length of ventilatory support,off-bed time and duration of antibiotic use differed significantly between the two groups (P ＜ 0.05).Cost-effectiveness ratios based on subjective and objective measures were superior in operative group (1 962.52 and 3 925.03) over those in non-operative group (1 931.48 and 3 718.10),suggesting operative treatment could yield higher economic returns.Conclusion Internal fixation can accelerate bone healing in patients with severer rib fracture and cut down medical expense,which should be promoted in medical treatment.

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Epidemiological study of traffic accidents-related traumatic brain injury in 159,242 cases

Yihua ZHANG ; Jun QIU ; Jihong ZHOU ; Lunshan XU ; Minhui XU

Chinese Journal of Trauma.2014;30(12):1215-1218. doi:10.3760/cma.j.issn.1001-8050.2014.12.015

Objective To retrospectively review the epidemiological data from 159,242 patients hospitalized after traumatic brain injury in traffic accidents and provide epidemiological evidences for the prevention and treatmentmeasures.Methods Patient data were collected using the Chinese Trauma Database for the years 2001-2007.Epidemiological features of age,gender,time distribution,length of hospital stay,state of injury,and treatment outcome were recorded.Results Age of the patients was (33.01 ± 15.20) years and ratio of male to female patients was 2.39∶ 1.The majority were aged 21-50 years with the 31-40 age group were more vulnerable.Annual average growth of age was 3.92％.Within a year,number of the patients accounted for 54.10％ from July to December with it reached the peak in October.Mean length of stay was 20.20 days with the longest stay in the ≥90 age group and shortest stay in the ≤10 age group.Mean hospital charges was 13 689.8 yuan with the ≤10 age group occupying the least and 51-60 age group occupying the most.Overall cure rate was 66.92％ and mortality was 4.22％.Proportion of severe traumatic brain injury in traffic accidents increased and related cure rate decreased with increased age.Male patients showed higher death rate and lower cure rate compared with female patients.Conclusions Incidence of traffic accidents-related traumatic brain injury is the most in the young and middle-aged population and is prevalent in the second half year.There should be emphasis on the aged or male patients.Measures to prevent and treat the injury may produce better results when defined based upon these epidemiologic features.

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Impact of mild hypothermia on changes of somatosensory evoked potential and synaptophysin mRNA level following traumatic brain injury

Qiaoli WU ; Ying CAI ; Weijia FAN ; Ke PU ; Huiling HUANG

Chinese Journal of Trauma.2014;30(12):1236-1239. doi:10.3760/cma.j.issn.1001-8050.2014.12.019

Objective To investigate effect of mild hypothermia on changes of somatosensory evoked potential (SEP) and synaptophysin mRNA level after traumatic brain injury (TBI) and determine hypothermia-induced neuroprotection.Methods Forty-five SD rats were allocated into mild hypothermia group,TBI group and sham operation group with 15 rats per group according to the random number table.Left-side fluid percussion impact was performed to induce models of TBI.Rats were exposed to hypothermia environment (32-35℃) for 6 hours in mild hypothermia group after TBI.Rats in sham operation group were treated by only drilling on left side of the head,rather than hitting.To evaluate function outcome,modified neurological severity score (mNSS),SEP and synaptophysin mRNA level were measured at 6 hours,24 hours and 7 days postinjury.Results The mNSS in mild hypothermia group lowered compared with TBI group,especially at 24 hours and 7 days (P ＜ 0.05).SEP in mild hypothermia group was significantly shortened at 6 and 24 hours compared with TBI group (P ＜ 0.05),but SEP revealed no significant difference among the 3 groups at 7 days (P ＞ 0.05).Level of synaptophysin mRNA in mild hypothermia group increased at 6 hours postinjury compared with TBI group [(0.08 ± 0.02) vs (0.12 ±0.04)],with further increase at 7 days postinjury[(0.06 ± 0.01) vs (0.33 ± 0.10)] (P ＜0.05).Conclusion The shortage of nerve conduction time of the injured side and promotion of nerve regeneration suggest the neuroprotective role of mild hypothermia following TBI.

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Correlation between expression of resistin in adipose tissues and glycometabolism in rats with traumatic brain injury

Laifang SUN ; Zhiyi WANG ; Lielie ZHU ; Rong ZHANG ; Fan WU ; Daqing CHEN ; Zhongqiu LU

Chinese Journal of Trauma.2014;30(12):1240-1244. doi:10.3760/cma.j.issn.1001-8050.2014.12.020

Objective To investigate the expression pattern of resistin in subcutaneous adipose tissue and its effect on glycometabolism in rats with traumatic brain injury (TBI).Methods Fifty-six SD rats were randomly divided into TBI group (n =48) and control group (n =8) according to the random number table.mRNA and protein expressions of resistin in subcutaneous adipose tissue were detected with real-time PCR and Western-blot.Concentrations of serum insulin and serum fasting blood glucose were evaluated using the ELISA method and quantitative estimation of insulin sensitivity was performed.Indices measured and their correlations were statistically analyzed.Results Levels of the resistin,serum insulin and FBG were significantly higher in TBI group than in control group (P ＜ 0.05).Quantitative estimation of insulin sensitivity lowered in TBI group compared to control group (P ＜ 0.05).Single factor linear correlation analysis showed negative correlation between resistin expression and quantitative insulin sensitivity check index in TBI group (P ＜ 0.05).Conclusions Resistin is shown to have significant expression in subcutaneous adipose tissue and involve in glycometabolism.Obviously,resistin may play a significant role in insulin resistance after TBI in rats.

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Hyperbaric oxygen against stress ulcer in blast-related traumatic brain injury

Wei LIU ; Jun TANG ; Bin ZHU ; Yongming ZHANG ; Jiachuan LIU

Chinese Journal of Trauma.2014;30(12):1245-1248. doi:10.3760/cma.j.issn.1001-8050.2014.12.021

Objective To investigate the effect of hyperbaric oxygen to reduce stress-induced gastric mucosal injury in rabbits with blast-related brain injury.Methods Posttraumatic stress ulcer in a rabbit model of blast-related brain injury was created using paper detonators.Ninety New Zealand white rabbits were randomly divided into normal control group (n =10),blast-related injury group (n =40) and hyperbaric oxygen treatment group (hyperbaric oxygen group,n =40) according to the random number table.Rabbits in blast-related injury group and hyperbaric oxygen group were subgrouped at 6 hours,24 hours,72 hours and 7 days postinjury,with 10 rabbits at each time point.Gastric mucosal injury was detected in aspects of ulcer index,TUNEL method for apoptotic index,and alcian blue-periodic acid-schiff (AB/PAS) staining and semi-quantitative analysis of pathological histology using.Results Neither stress ulcer nor apoptosis occurred in normal control group.At 6 hours,24 hours,72 hours and 7 days postinjury,index of gastric ulcer in blast-related injury group was 12.08 ± 1.02,25.56 ± 0.88,20.36 ±0.96 and 17.56 ± 1.12 respectively,far higher than 8.02 ±0.58,15.22 ± 1.05,12.39 ±0.65 and 9.22 ± 0.79 in hyperbaric oxygen group (P ＜ 0.05) ; apoptotic index in blast-related injury group was 20.22 ± 1.56,27.56 ± 0.96,24.36 ± 1.23 and 16.38 ± 1.24,far higher than 10.78 ± 0.93,13.89 ±0.84,10.55 ± 1.58 and 8.56 ± 1.47 in hyperbaric oxygen group (P ＜ 0.05).Thickness of AB/PAS-positive mucin layers showed marked attenuation even loss in blast-related injury group,but the loss was minor in hyperbaric oxygen group (P ＜ 0.05).Conclusion Hyperbaric oxygen is effective to decrease the stress ulcer index and apoptosis index of gastric mucosa,increase the thickness of AB/PAS positive layer and lighten the gastric mucosal injury of rabbits with blast-related brain injury.

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Sequential damage of posterior ligamentous complex and its clinical significance in patients with thoracolumbar fracture

Jianhao YU ; Jianqiao XU ; Weifeng ZHOU ; Keqi ZHAO ; Songlin TONG ; Weishan CHEN

Chinese Journal of Trauma.2015;31(1):20-25. doi:10.3760/cma.j.issn.1001-8050.2015.01.006

Objective To investigate the damage sequence of posterior ligamentous complex (PLC) and its clinical significance in thoracolumbar fracture.Methods Data of 132 patients with spinal fracture evaluated with X-rays,CT and short-tau inversion-recovery (STIR) sequences in MRI were collected prospectively.Fracture morphology was classified using the AO classification.PLC components including interspinous ligament (ISL),supraspinous ligament (SSL),ligamentum flavum (LF) and facet capsules (FC) were assessed and classified as intact,edema,or tear.ISL edema was further subdivided depending on the extension (＞ 50％ or ≤50％).Correlation between MRI signal and AO progressive scale of morphological damage was analyzed.Results AO type A1/A2 fracture associated with only FC distraction.AO type A3 fracture showed additional ISL tear,usually less than 50％,with neither LF nor SSL tear.AO type B1 fracture showed FC distraction,ISL edema or disruption,and low rate of SSL/LF tear,but B2 fracture increased the rate of SSL/LF tear.AO type C fracture showed facet fracture or dislocation and ISL,SSL as well as LF tear.High correlation was found between AO progressive scale and MRI signal (P ＜ 0.01).Conclusions MRI study can well display the PLC damage and damage sequence.MRI correlates with AO progressive scale of morphological damage,which shows a progressive orderly rupture sequence among different PLC components as traumatic forces increase.

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