Objective:To explore the curative effects of medial plantar free flap in reconstructing electric burn wound and scar contracture in the palm.Methods:A retrospective observational study was conducted. From January 2020 to January 2023, 6 patients with electric burn wounds or scar contracture in the palm who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 5 males and 1 female, aged 35 to 55 years. The wound area was 5.0 cm×3.0 cm-8.0 cm×7.0 cm after the debridement of electric burn wounds or resection of scar in the palm. The medial plantar free flap anastomosed with cutaneous nerve was used for wound reconstruction, with flap area of 5.5 cm×3.5 cm-8.5 cm×7.5 cm. The wound in the donor site was repaired with transplantation of abdominal full-thickness skin graft. After surgery, the survival of flaps and skin grafts were observed, the shape and texture of flap and the recovery of donor site of flap were observed, and the holding function of the affected hand was assessed. At the last follow-up, the two-point discrimination distance of flap was measured, the sensory recovery of flap was evaluated with the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association, and the function recovery of flap was evaluated by post-surgery flap function evaluation scale.Results:After surgery, 5 flaps survived well, while the distal part of 1 flap was partially necrotic, which was repaired by medium-thickness skin graft from lateral thigh after debridement. All the skin grafts at the donor sites survived well. During follow-up of 3 to 24 months, the flap was not bloated, the texture and color were good, the match with the surrounding tissue was high, with no obvious scar contracture occurred at the donor site. The affected hand had good holding function. At the last follow-up, the two-point discrimination distance of flap was 6-8 mm, the flap sensation recovery was as follows: 5 flaps recovered to grade S3 +, 1 flap recovered to grade S3, and the functional evaluation of flaps was excellent in 5 cases and good in 1 case. The patients basically returned to normal life and work. Conclusions:The medial plantar free flap with cutaneous nerve anastomosis has many advantages, such as high matching degree of appearance, good sensory recovery, and holding function of the affected hand. It is an ideal choice for the reconstruction of the electric burn wound and scar contracture in the palm.

Objective To analyze the changes in morphology of intervertebral foramina in patients with cervical spondylotic radiculopathy (CSR) treated with fixedpoint lateral flexion and rotation manipulation based on three-dimensional (3D) reconstruction technology, so as to provide references for the effectiveness of manipulation treatment. MethodsForty patients with CSR were treated with fixed point lateral flexion and rotation manipulation once every other day for a total of 7 times and 2 weeks as a course of treatment. CT data of the patients before and after treatment were analyzed by using multifunctional CT, Mimics 21.0, Geomagic and SolidWorks 2017. The area of the intervertebral foramen, anterior and posterior diameter of the intervertebral foramen, upper and lower diameter of the intervertebral foramen were measured before and after treatment, as well as the infrared thermal imaging temperature differences of the bilateral neck and shoulder, front and back of the upper limb, and the VAS scores of the patients were observed before treatment, 7 d after treatment, 14 d after treatment and 1 month follow-up. Results Foraminal area, anterior and posterior diameters, upper and lower diameters of 40 patients were improved after treatment, and the temperature differences of infrared thermal imaging of patients before and after treatment were statistically significant. The VAS score of the patients decreased progressively. Conclusions Fixed point lateral flexion manipulation can significantly improve the shape of the intervertebral foramen in patients with CSR, so as to achieve the treatment purpose of relieving nerve compression.

Objective:To investigate the thyroid volume of adults in Lanzhou City, and analyze its influencing factors.Methods:In June 2016, according to the principle of multi-stage stratified cluster sampling, Han residents aged 18 and above in Chengguan, Xigu and Qilihe districts of Lanzhou City who had lived there for more than 5 years were selected as research subjects, and a portable B-ultrasound machine was used for thyroid examination. Morning urine samples of the subjects were collected to test urinary iodine; fasting venous blood samples of the subjects were collected to test serum thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), anti-thyroglobulin antibody (TgAb), blood lipids [triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL)] and blood uric acid (Ua) levels. At the same time, body indexes systolic blood pressure (SP), diastolic blood pressure (DP), waist circumference, height and weight were measured, and the body mass index (BMI) was calculated. Multiple linear regression was used to analyze the influencing factors of thyroid volume.Results:A total of 1 009 subjects were included, aged (43.50 ± 15.16) years, and the thyroid volume was (8.74 ± 3.39) ml. Among them, 534 males had a thyroid volume of (9.46 ± 3.43) ml; 475 females had a thyroid volume of (7.93 ± 3.15) ml, the thyroid volume of males was larger than that of females ( t = 7.36, P < 0.01). Thyroid volume was positively correlated with age, height, weight, BMI, SP, waist circumference, LDL, Ua and TgAb ( r = 0.07, 0.23, 0.33, 0.27, 0.10, 0.27, 0.10, 0.08, 0.07, P < 0.05), and it was negatively correlated with thyroid nodules, TPOAb, TSH and urinary iodine ( r = - 0.16, - 0.07, - 0.10, - 0.08, P < 0.05). After multiple linear regression analysis, TSH, TPOAb, TgAb and thyroid nodules were included in the regression equation, and the standardized B values were - 0.135, - 0.065, 0.123 and - 0.197, respectively. Conclusions:The thyroid volume of males is larger than that of females in Lanzhou City. TSH, TPOAb, TgAb and thyroid nodules are influencing factors of thyroid volume.

Objective:The surgical method and clinical efficacy was studied on the anterior lateral malleolar venous network grafting in repair of the defects of superficial palmar arch.Methods:From February 2015 to July 2021, 8 cases (6 males and 2 females; aged 32-44 years old, mean age at 39 years old) were treated in the Department of Hand Surgery of Yantaishan Hospital. Anterior lateral malleolar venous network was grafted to repair the defects of superficial palmar arch of the patients. The patients had different degrees of tendon damage, and injuries of nerve, deep palmar arch, common palmar digital artery or proper palmar digital artery. The length of the vessel defect was 6.0-10.0 cm. Blood supply insufficiency occurred in 1st-5th digits in 1 case, 2nd-4th fingers in 5 cases, and 2nd-5th fingers in 2 cases. The anterior lateral malleolar venous network was transferred to repair 3 broken ends of vessels in 5 cases, 4 broken ends in 1 case and 5 broken ends in 2 cases. The wound of hand was sutured directly in 2 cases. The emergency surgical repair of the wound of hand by transfer of ALTPF was performed in 2 patients, and elective ALTPF transfer in 3 cases. Forearm dorsi-ulnar flap transfer was performed in 1 case. The follow-up reviews were carried out via the outpatient clinic visit, telephone, WeChat interviews or home visits. The blood supply of the distal digit, skin sensation, TPD, the range of motion of the phalangeal joints were observed.Results:The results showed that all the digits and the grafted flaps survived. The follow-up was carried out for 10-53 months, with an average of 17.9 months. The functions of digit extension and flexion, finger opposition and thumb opposition were restored in 5 cases, and the patients returned back to former jobs. The finger flexion and thumb opposition were limited in 3 cases, and these cases participated in light physical work. The proprioception of the digits were recovered, and the TPD was 5-7 mm. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association and rated as excellent in 5 cases and good in 3 cases. The donor sites of the foot showed a linear scar. There was no effect on the function and the shape of the donor site.Conclusion:The anterior lateral malleolar venous network grafting is an ideal method in repair of the defects of superficial palmar arch.

Objective:To explore the clinical application of the posterior tibial artery perforator flap with the great saphenous vein (GSV) in the treatment of severe degloving injury of the forearm.Methods:From June 2015 to October 2020, 5 patinets (4 males and 1 female, aged 20-46 years old, mean age 37 years old) were treated in the Department of Hand Surgery of Yantaishan Hospital in Yantai. Aposterior tibial artery perforator flap with GSV was used to repair the partial wound of the injured forearm, together with the establishment of venous circulation of dorsal hand for all 5 patients. All the patients suffered from severe forearm degloving injury. Of which, 3 accompanied with ulna radius fracture, 2 with ulnar and radial artery injury and 2 with blood supply insufficiency in the injured fingers. The sizes of soft-tissue defect were 26 cm×18 cm-32 cm×25 cm. The sizes of the posterior tibial artery perforator flap with GSV ranged from 12 cm×5 cm to 33 cm×6 cm. The anastomoses were performed on the perforating artery and the radial artery. The GSV was anastomosed with cephalic vein with bridging anastomosis to re-establish the venous circulation of dorsal hand. Combined anterolateral thigh flaps (ALTF) were used to repair the rest wound of injured limbs in 4 patients, and the combined pedicled abdominal flap was used in 1 patient. The donor site of calf flap was sutured directly, and the skin of upper limb was thinned into medium thick to cover the thigh flap donor site, which was packed with pressure dressing. Regular follow-up reviews were carried out by outpatient clinic, telephone, WeChat APP or home-visit after the operation to observe the survival of flaps, the swelling of the distal end of injured limb, functional recovery and healing at the donor site. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the grafted flaps in 5 patients survived. Necrosis at epidermal edge occurred in 1 calf flap, and achieved secondary healing after dress changing for 4 weeks. There was neither arterial nor venous crisis in all flaps. The oedema of the hand disappeared within 4-8 weeks, with clear dermatoglyph. There was no obvious enlarged circumference of thumb and fingers. The follow-up was carried out for 8-20 months, with 11 months in average. The flaps were elastic in good colour, and full texture without pigmentation. The donor site of the calf flap showed a linear scar. No swollen was seen in the hands of the injured forearm and the feet of donor lower legs. The range of motion of phalangeal joints was good. Recovery of finger sensation achieved at S 4. The recovery of the sensation of posterior tibial artery perforator flap reached S 3 in 2 patients and S 2 in 3 patients. Assessment of the Upper Limb Function using the Standard Issued by the Hand Surgery Society of Chinese Medical Association rated excellent in 3 patients and good in 2 patients. Conclusion:The posterior tibial artery perforator flap with GSV has a reliable blood supply with a small damage to the donor site. This flap is ideal for repair of severe degloving injury of forearm and meanwhile to achieve the re-establishment of venous circulation in dorsal hand.

Objective:To explore the clinical effects of expanded flap made by skin and soft tissue expander (hereinafter referred to as expander) in repairing the wounds with exposed titanium mesh after cranioplasty with titanium mesh.Methods:A retrospective observational study was conducted. From April 2015 to October 2019, 13 patients with wounds with exposed titanium mesh after cranioplasty with titanium mesh were admitted to the First Affiliated Hospital of Air Force Medical University, including 10 males and 3 females, aged 18 to 70 years. Exposure of titanium mesh occurred 3 months to 4 years after cranioplasty with titanium mesh. The wound area of exposed titanium mesh ranged from 1.5 cm×0.6 cm to 6.3 cm×6.0 cm. In the first stage, one or two square expanders with rated capacity of 50-200 mL were placed under the normal scalp 1 cm away from the edge of the wound surface of exposed titanium mesh. The water injection time was 2 to 3 months with the total water injection volume being 1.6 to 2.0 times of the rated capacity of expander. In the second stage, the expander was removed and the expanded flap (size ranging from 4.1 cm×1.8 cm to 9.1 cm×7.9 cm) was transferred to repair the wound of exposed titanium mesh. The placement site of the expander, the transfer form of the expanded flap, the postoperative wound healing of the titanium mesh exposed site, and the survival of expanded flap were recorded. The scar of the head incision and the appearance of head were followed up.Results:Among the patients in this group, the expanders of 7 were placed in the temporal region, while the other 6 were placed at the top. The 11 patients were treated with advanced expanded flap, while the other 2 patients were treated with pedicled expanded flap. The head wounds of patients in this group successfully healed with retaining of the titanium mesh. The wound was healed after dressing change in 1 patient with necrosis at the tip of the expanded flap. The expanded flaps of 12 patients survived after transfer. Patients in this group were followed up for 12 months after surgery, the exposed titanium meshes were retained, the incisions healed well with the scars concealed, the hair on the scalp grew well, and the appearance of head was comparatively good.Conclusions:Using expanded flap in the repair of the wounds with exposed titanium mesh after cranioplasty with titanium mesh can effectively cover the wound and retain the titanium mesh, achieving good function and appearance.

In the recent years, the damage of the spleen has been increased due to trauma or neoplastic diseases. Traditional view holds the point that the damaged spleen should be completely removed, but with the development of spleen surgery, the important physiological function of the spleen has been widely recognized, and partial splenectomy has been well recognized by the surgeons. This paper summarized the clinical experience in partial splenectomy and raised some technical points.

Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.

Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.

Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.