Objective:To study the feasibility of design and harvest of free medial sural artery perforator flap with the "two-point and two-line method".Methods:From September 2022 to June 2023, Suzhou Ruihua Orthopaedic Hospital implemented the "two-point and two-line method" to guide preoperative perforator positioning and flap design. Thirty medial sural artery perforator flaps were successfully harvested with the method, and 21 wounds of hand and 9 of foot and ankle were reconstructed with the flaps. The size of soft tissue defects were 2.5 cm×2.5 cm-7.0 cm×14.5 cm, and the flaps size were 3.0 cm×3.0 cm-7.5 cm×15.0 cm. All donor sites were directly closed or by skin grafting. All patients were entered in 6-15 months of postoperative outpatient follow-up, and the recovery of donor and recipient sites was assessed by the comprehensive evaluation scales. The sensory function of the flaps was evaluated using the sensory function evaluation standard of British Medical Research Council (BMRC).Results:All perforators were successfully located with 47 perforators in total, and all of them were musculocutaneous perforator. It was found that there was 1 perforator in 14 flaps, 2 perforators in 15 flaps and 3 perforators in 1 flap. All 30 flaps survived after surgery, beside 2 flaps that had arterial insufficiency but survived successfully after surgical exploration. All donor sites healed in one stage. Comprehensive evaluation scale of flap was employed to evaluate the flaps and the scores were 84 points to 96 points with an average score of 92.5 points. The excellent and good grades were achieved in 27 flaps and 3 flaps, respectively, with a combined excellent and good rate at 100%. Sensation of the flaps was evaluated by BMRC with 1 flap of S 1, 17 of S 2 and 12 of S 3. Conclusion:The "two-point and two-line method" has been used in design of the perforator flap of medial sural artery. This method is simple and accurate, and is feasible and ideal in design of flaps before surgery.

Objective To explore the application effect of arthroscopic knotless suture bridge technique in the treatment of patients with large rotator cuff tear.Methods Retrospective analysis of clinical data from 213 patients with large rotator cuff tear in first department of orthopedics of Qinhuangdao Military Hospital from January 2022 to October 2023.According to different treatment methods,they were divided into conventional knot group(n=77)and knotless group(n=136).The conventional knot group was treated with arthroscopic knot suture bridge technique,while the knotless group was given arthroscopic knotless suture bridge technique.The treatment effects were compared.Postoperative complications were recorded and the occurrence of rotator cuff re-tear was followed up.Results At 6 months after treatment,the SF-MPQ pain scores in conventional knot group and knotless group significantly reduced(P＜0.05),and the Constant score,UCLASS score and ASES shoulder joint score and the angles of shoulder anteflexion,abduction,internal rotation and external rotation in both groups were significantly improved at 6 months after treatment(P＜0.05).However,there was no significant difference in SF-MPO scores,Constant,UCLASS and ASES scores between the two groups compared with those before surgery(P＞0.05).The incidence of complications and retear were 4.41％and 1.47％in the no-nodule group,and 11.69％and 6.49％in the conventional nodule group,respectively,and there was statistical significance between the two groups(P＜0.05).Conclusion Arthroscopic knot and knotless suture bridge techniques can promote joint function recovery of large rotator cuff tear,and both have high minimally invasive value.However,knotless suture bridge technique has greater advantages in reducing complications and re-tear rate.

Objective To explore the application effect of arthroscopic knotless suture bridge technique in the treatment of patients with large rotator cuff tear.Methods Retrospective analysis of clinical data from 213 patients with large rotator cuff tear in first department of orthopedics of Qinhuangdao Military Hospital from January 2022 to October 2023.According to different treatment methods,they were divided into conventional knot group(n=77)and knotless group(n=136).The conventional knot group was treated with arthroscopic knot suture bridge technique,while the knotless group was given arthroscopic knotless suture bridge technique.The treatment effects were compared.Postoperative complications were recorded and the occurrence of rotator cuff re-tear was followed up.Results At 6 months after treatment,the SF-MPQ pain scores in conventional knot group and knotless group significantly reduced(P＜0.05),and the Constant score,UCLASS score and ASES shoulder joint score and the angles of shoulder anteflexion,abduction,internal rotation and external rotation in both groups were significantly improved at 6 months after treatment(P＜0.05).However,there was no significant difference in SF-MPO scores,Constant,UCLASS and ASES scores between the two groups compared with those before surgery(P＞0.05).The incidence of complications and retear were 4.41％and 1.47％in the no-nodule group,and 11.69％and 6.49％in the conventional nodule group,respectively,and there was statistical significance between the two groups(P＜0.05).Conclusion Arthroscopic knot and knotless suture bridge techniques can promote joint function recovery of large rotator cuff tear,and both have high minimally invasive value.However,knotless suture bridge technique has greater advantages in reducing complications and re-tear rate.

Objective:To study the feasibility of design and harvest of free medial sural artery perforator flap with the "two-point and two-line method".Methods:From September 2022 to June 2023, Suzhou Ruihua Orthopaedic Hospital implemented the "two-point and two-line method" to guide preoperative perforator positioning and flap design. Thirty medial sural artery perforator flaps were successfully harvested with the method, and 21 wounds of hand and 9 of foot and ankle were reconstructed with the flaps. The size of soft tissue defects were 2.5 cm×2.5 cm-7.0 cm×14.5 cm, and the flaps size were 3.0 cm×3.0 cm-7.5 cm×15.0 cm. All donor sites were directly closed or by skin grafting. All patients were entered in 6-15 months of postoperative outpatient follow-up, and the recovery of donor and recipient sites was assessed by the comprehensive evaluation scales. The sensory function of the flaps was evaluated using the sensory function evaluation standard of British Medical Research Council (BMRC).Results:All perforators were successfully located with 47 perforators in total, and all of them were musculocutaneous perforator. It was found that there was 1 perforator in 14 flaps, 2 perforators in 15 flaps and 3 perforators in 1 flap. All 30 flaps survived after surgery, beside 2 flaps that had arterial insufficiency but survived successfully after surgical exploration. All donor sites healed in one stage. Comprehensive evaluation scale of flap was employed to evaluate the flaps and the scores were 84 points to 96 points with an average score of 92.5 points. The excellent and good grades were achieved in 27 flaps and 3 flaps, respectively, with a combined excellent and good rate at 100%. Sensation of the flaps was evaluated by BMRC with 1 flap of S 1, 17 of S 2 and 12 of S 3. Conclusion:The "two-point and two-line method" has been used in design of the perforator flap of medial sural artery. This method is simple and accurate, and is feasible and ideal in design of flaps before surgery.

OBJECTIVE To predict the core ingredients, targets and signaling pathways of Sanhuang ointment in the treatment of haemorrhoids based on network pharmacology, and preliminarily discuss the mechanism of action preliminarily by means of molecular docking and experimental verification. METHODS Active ingredients, targets and haemorrhoid related targets of Sanhuang ointment were obtained through literature research and database screening. Association networks were constructed and core targets were screened by Cytoscape, and gene function analysis and pathway enrichment analysis were conducted. Autodock Vina was used for molecular docking verification, and the regulatory effects of Sanhuang ointment on core targets were verified by ELISA and immunohistochemistry. RESULTS The 77 active ingredients and 61 potential targets of Sanhuang ointment for treating haemorrhoids were collected. KEGG showed that Sanhuang ointment could regulate calcium signaling pathways, neuroactive ligand receptor interactions, cGMP-PKG pathway, etc. Affect 6 core targets of CGRP, NK-1R, TRPV1, VEGF, IL-6 and TNF-α. Molecular docking showed that Sanhuang ointment had a good affinity with target protein, and animal experiments verified that Sanhuang ointment could inhibit the expression of IL-6, CGRP, substance P, and promote the expression of VEGF. CONCLUSION Sanhuang ointment may act on CGRP, NK-1R and other targets, regulate Calcium signaling pathway and PI3K-Akt pathways, and exert analgesic and anti-inflammatory effects, promoting blood circulation and removing blood stasis to treat haemorrhoids.

Objective:To explore the effects of the first dorsal metatarsal artery terminal branch flaps in repairing skin and soft tissue defects of fingers.Methods:The study was a retrospective observational study. From October 2021 to December 2022, 44 patients with skin and soft tissue defects in 55 fingers who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital. There were 39 males (48 fingers) and 5 females (7 fingers), aged 18 to 54 years. The single wound area after debridement ranged from 1.5 cm×1.0 cm to 3.0 cm×2.0 cm. The color Doppler ultrasonography was performed before operation to locate the first dorsal metatarsal artery and its terminal branches, and a first dorsal metatarsal artery terminal branch flap was designed according to the wound condition, with the area of harvested single flap ranged from 1.7 cm×1.2 cm to 3.2 cm×2.2 cm. The wounds in the flap donor areas were transplanted with full-thickness skin grafts from ipsilateral inner calf. The type of flap was recorded, and the diameter of the terminal branch of the first dorsal metatarsal artery was measured during operation. The survival of the flap was observed one week after operation. The wound healing in the flap donor and recipient areas was observed two weeks after operation. At the last follow-up, the functional recovery of the affected fingers was evaluated by the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, the sensory function of the flap was evaluated using the sensory function evaluation standard of British Medical Research Council, the scar in the donor and recipient areas of the flap was evaluated using the Vancouver scar scale (VSS), and the Allen test was conducted in the toe of flap donor area to evaluate the blood flow.Results:The monoblock type flaps in 31 patients and flow-through type flaps in 2 patients were used to repair wounds in single finger, 2 monoblock type flaps in 8 patients were used to repair wounds in 2 fingers at the same time, and the single-pedicle and two-flap type flaps in 3 patients were used to repair wounds in 2 fingers at the same time. The diameter of the fibular terminal branch of the first dorsal metatarsal artery ranged from 0.40 to 1.10 mm, and the diameter of the tibial terminal branch of the first dorsal metatarsal artery ranged from 0.70 to 0.75 mm. All the flaps survived at one week after operation, and all the wounds demonstrated optimal healing in the flap donor and recipient areas at two weeks after operation. All patients were followed up for 6 to 18 months. At the last follow-up, the functional recovery of 48 fingers was evaluated as excellent, and the functional recovery of 7 fingers was evaluated as good; the sensory function of 8 flaps was rated as S2, and the sensory function of 47 flaps was rated as S3, and the two-point discrimination distance of the flaps was 8-14 mm; the VSS scores in the flap recipient areas ranged from 3 to 6, and the VSS scores in the flap donor areas ranged from 4 to 7; the Allen test result of the toes in the donor areas were all negative with normal blood flow.Conclusions:The first dorsal metatarsal artery terminal branch flaps have several advantages, including relatively hidden donor area, shallow anatomical level, simple intraoperative operation, and flexible flap design. The flap is incised without damaging the main artery of the toe, which can repair skin and soft tissue defects of the fingers and ensure the utmost protection of the toes in donor areas. The fingers exhibit improved appearance, texture, sensation, and function after operation.

Objective To explore the surgical technique and clinical effects of free anterolateral thigh flaps with fascia lata for repair of dorsal tendon and soft tissue defect of ophisthenar.Methods From February,2014 to July,2016,dorsal tendon and soft tissue defect of ophisthenar in 13 cases was repaired by free anterolateral thigh flaps with fascia lata.The area of soft tissue defect was 5.0 cm×6.0 cm-9.0 cm×12.0 cm.Extensor tendon defect and bone exposure occurred in all cases.The area of flap was 6.0 cm×7.0 cm-10.0 cm×13.0 cm,while the area of anterolateral thigh flap was 3.0 cm×4.0 cm-6.0 cm×8.0 cm.The regular post-operatively followed-up was performed.Results All flaps survived.The donor sites healed well without skin graft.The followed-up time was 6-36 months with the average of 13 months.The appearance of the flap was good.The color and texture of flaps was similar to the dorsal skin of ophisthenar.Three female patients who were not satisfied with the flap appearance received the revision and the results were satisfactory.The activity of finger flexion and extension was satisfactory.All patients walked well without difficulty.According to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association,the function recovery result was excellent in 8 cases,good in 4 cases,and poor in 1 case.Conclusion It is a good method to use the free anterolateral thigh flaps with fascia lata to repair of dorsal tendon and soft tissue defect of ophisthenar.

Objective: To explore the effects of multiple free homologous superficial peroneal artery perforator flaps of crus for repair of multiple hand wounds. Methods: From November 2017 to December 2018, eight cases with eighteen hand wounds were hospitalized in our unit. Among them, wounds were distributed in the forefinger and middle finger in four cases, wounds were distributed in the middle finger and ring finger in two cases, wounds were distributed in the forefinger, middle finger, and ring finger in one case, and wounds were distributed in the middle finger, ring finger, and little finger in one case. The area of skin defect ranged from 1.5 cm×0.8 cm to 4.0 cm×3.0 cm. There were 4 males and 4 females, aged 34-62 years. Wounds of six cases were repaired by two free superficial peroneal artery perforator flaps from homolateral crus, and those of two cases were repaired by three free superficial peroneal artery perforator flaps from homolateral crus. Superficial peroneal artery and its accompanying vein of flap were anastomosed by end to end with digital artery and palmar or dorsal subcutaneous vein of recipient site during the operation. The area of flap ranged from 2.5 cm×1.2 cm to 5.0 cm×4.0 cm. No nerve was harvested during the operation, and donor site was sutured directly. The survival of the flaps and the healing of donor sites were recorded. During follow-up, the recovery of donor and recipient sites was observed. Results: All flaps survived well, donor site healed well. No vascular crisis occurred. Follow-up for 4 to 12 months showed that the appearance of flap was satisfactory with good color, texture, elasticity, and function. Protective sensation of recipient site was recovered. Five months after operation, flap of finger pulp in one case was swollen slightly with two-points discrimination of 10 mm, which received the thinning surgery. Obvious scar formation was not observed in donor site of crus. The appearance of the donor site was good without functional damage. Conclusions The application of multiple free homologous superficial peroneal artery perforator flaps of crus to repair the multiple hand wounds has advantages of easy acquisition, easy operation, little effect on donor sites, and satisfactory clinical effects.

Objective To observe the clinical efficacy of procedure for prolapse and hemorrhoids ( PPH) for treatment of rectal mucosa prolapse.Methods The 100 patients who suffered from rectal mucosa prolapse and were planning to take surgical treatment for the first time in our hospital from June 2013 to June 2015 were randomly divided into the treatment group and the control group .Patients in the treatment group(n=50) underwent PPH while patients in the control group (n=50) underwent traditional simplified mucosal plication technique .To observe the therapeutic effect of the two groups ,the average operation time ,average length of stay in hospital ,postoperative pain within 72 hours,postoperative anal function and postoperative complications of the two groups .Results There was no significant difference in the over-all treatment effect between the two groups(P>0.05).The average operation time, average length of stay in hospital,postoperative pain with-in 72 hours and postoperative anal function of the treatment group were lower than those of the control group ,and the differences were significant (P<0.05).Bleeding and anal bearing-down occurred much less in the treatment group compared with the control group ,and the differences were statistically significant(P<0.05).But there was no significant difference in postoperative complications such as recurrence ,rectal steno-sis and anal incontinence (P>0.05).Conclusion Compare to the traditional simplified mucosal plication technique ,PPH technique has more advantages such as shorter operation time ,less anguish of patients,less complication,shorter hospitalization time,and higher security, which indicates PPH could become the preferred method for treatment of rectal mucosa prolapse .

Objective:To investigate the influence of chronic kidney disease(CKD),including slight renal damages,on prognosis of coronary artery disease(CAD).Methods: A retrospective study was performed in 732 patients who visited our Cardiology Department and Cardiothoracic Surgery Department in 2000-2004.All patients suspected of CAD underwent a selective coronary angiography.Five hundred and seventy-nine patients with established diagnosis of CAD were followed up and their cardiovascular events(angina pectoris,myocardial infarction,recurrent myocardial infarction,heart failure,stroke,death,etc.) were recorded.Patients with CAD were divided into normal,slight,moderate,and severe groups according to the degree of renal function damages.The influences of different degrees of renal damages on the prognosis of CAD were compared.Results: There were obvious differences in the morbidities of angina pectoris,myocardial infarction,recurrent myocardial infarction,heart failure,stroke,etc.in CAD patients with different degrees of renal function damages.The worse the renal function,the higher the incidences of angina pectoris,myocardial infarction,recurrent myocardial infarction,heart failure and stroke,etc((P