Objective To explore the clinical application effects of artificial dermis in the repair of traumatic finger skin defects with bone exposure.Methods From January 2022 to January 2024,10 patients with fingertip skin defects and bone exposure,totaling 10 fingers,were treated.The defect areas ranged from 0.5 cm × 1.0 cm to 1.0 cm × 1.5 cm.After debridement,the wounds were covered with artificial dermis,and regular dressing changes were performed postoperatively.The artificial dermis was removed 3-4 weeks post-surgery.The wound healing,skin appearance,and sensory recovery of the fingertip were evaluated.Results All 10 fingertip wounds healed successfully,with a healing time of 3 to 4 weeks.Patients were followed up for more than 3 months,and the wound healing was satisfactory.The finger pads appeared full,the skin was smooth and flat with no obvious scarring,and the texture was soft.Skin sensory ability recovered well,with no pain or hypersensitivity,and the two-point discrimination ability reached 3 to 8 mum.According to the upper limb function evaluation standards set by the Hand Surgery Society of the Chinese Medical Association,the sensory recovery of all 10 fingertips achieved an S3+level,with a good to excellent rate of 100％.Conclusion The primary repair of fingertip skin defects with bone exposure using artificial dermis resulted in no donor site damage.The surgical procedure is safe and simple,and the appearance and sensory function of the fingers have recovered well,demonstrating reliable efficacy.

Objective To explore the clinical application effects of artificial dermis in the repair of traumatic finger skin defects with bone exposure.Methods From January 2022 to January 2024,10 patients with fingertip skin defects and bone exposure,totaling 10 fingers,were treated.The defect areas ranged from 0.5 cm × 1.0 cm to 1.0 cm × 1.5 cm.After debridement,the wounds were covered with artificial dermis,and regular dressing changes were performed postoperatively.The artificial dermis was removed 3-4 weeks post-surgery.The wound healing,skin appearance,and sensory recovery of the fingertip were evaluated.Results All 10 fingertip wounds healed successfully,with a healing time of 3 to 4 weeks.Patients were followed up for more than 3 months,and the wound healing was satisfactory.The finger pads appeared full,the skin was smooth and flat with no obvious scarring,and the texture was soft.Skin sensory ability recovered well,with no pain or hypersensitivity,and the two-point discrimination ability reached 3 to 8 mum.According to the upper limb function evaluation standards set by the Hand Surgery Society of the Chinese Medical Association,the sensory recovery of all 10 fingertips achieved an S3+level,with a good to excellent rate of 100％.Conclusion The primary repair of fingertip skin defects with bone exposure using artificial dermis resulted in no donor site damage.The surgical procedure is safe and simple,and the appearance and sensory function of the fingers have recovered well,demonstrating reliable efficacy.

Background:With the development of medical technology,cholangioscopy has been increasingly utilized in the diagnostic and therapeutic process of endoscopic retrograde cholangiopancreatography(ERCP).They play a significant role in the visual diagnosis and biopsy of tumors,providing more accurate and detailed information for clinicians.Aims:To evaluate the safety and effectiveness of peroral cholangioscopy combined with ERCP in biliary diseases.Methods:A total of 90 cases underwent peroral cholangioscopy and ERCP from October 2022 to October 2023 at Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine were recruited retrospectively,and the clinical data were collected.The success rate,postoperative complications,and other relevant indicators were evaluated.Results:A total of 90 patients were enrolled,the preoperative diagnosis including common bile duct stones(43 cases),biliary obstruction by tumor invasion(21 cases),benign biliary stenosis(15 cases),benign ampullary tumors(6 cases),postoperative biliary stricture after liver transplantation(3 cases),primary sclerosing cholangitis(1 case),and biliary varices(1 case).The technical success rate of peroral cholangioscopy with ERCP was 100%,and the stone removal rate was 95.3%(41/43),the average operation time was(81±37)min,and the ERCP re-intervention rate within six months was 17.8%.Postoperative complications included fever(7.8%),abdominal pain(3.3%),bleeding/anemia(2.2%),and postoperative pancreatitis(2.2%).Conclusions:The combination of peroral cholangioscopy with ERCP is safe and effective for the biliary diseases with no increase in procedure-related adverse events and risks.

Background:With the development of medical technology,cholangioscopy has been increasingly utilized in the diagnostic and therapeutic process of endoscopic retrograde cholangiopancreatography(ERCP).They play a significant role in the visual diagnosis and biopsy of tumors,providing more accurate and detailed information for clinicians.Aims:To evaluate the safety and effectiveness of peroral cholangioscopy combined with ERCP in biliary diseases.Methods:A total of 90 cases underwent peroral cholangioscopy and ERCP from October 2022 to October 2023 at Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine were recruited retrospectively,and the clinical data were collected.The success rate,postoperative complications,and other relevant indicators were evaluated.Results:A total of 90 patients were enrolled,the preoperative diagnosis including common bile duct stones(43 cases),biliary obstruction by tumor invasion(21 cases),benign biliary stenosis(15 cases),benign ampullary tumors(6 cases),postoperative biliary stricture after liver transplantation(3 cases),primary sclerosing cholangitis(1 case),and biliary varices(1 case).The technical success rate of peroral cholangioscopy with ERCP was 100%,and the stone removal rate was 95.3%(41/43),the average operation time was(81±37)min,and the ERCP re-intervention rate within six months was 17.8%.Postoperative complications included fever(7.8%),abdominal pain(3.3%),bleeding/anemia(2.2%),and postoperative pancreatitis(2.2%).Conclusions:The combination of peroral cholangioscopy with ERCP is safe and effective for the biliary diseases with no increase in procedure-related adverse events and risks.

Objective:To evaluate the safety and feasibility of laparoscopic radical anterograde modular pancreatosplenectomy (Lap-RAMPS).Methods:From Jan 2014 to Dec 2020, the clinical data of 83 patients who underwent laparoscopic radical resection for pancreatic tail cancer in LiHuili Hospital of Ningbo Medical Center were retrospectively analyzed.Results:Eighty-three cases were divided into Lap-RAMPS group (44 cases) and laparoscopic conventional distal pancreatectomy and splenectomy(Lap-CDP) group (39 cases). There were no significant differences in the duration of surgery [(245.34±70.30) min vs. (239.87±68.10) min], intraoperative blood lose [(159.32±115.60) ml vs. (208.97±161.70) ml] and intraoperative transfusions (2 cases vs. 3 cases) between the two groups ( P>0.05). There were no statistical significance in both groups in postoperative pancreatic fistula, postoperative bleeding grade, postoperative gastric emptying delay, Clavien-Dindo complication and postoperative hospital stay ( P>0.05). There were statistically significant differences in the negative margin rate (93.2% vs. 76.9%),lymph node harvest(12.91±8.24 vs. 8.49±6.85) and median survival time (25.0 months vs. 15.0 months) between the two groups ( P<0.05). Conclusion:Lap-RAMPS for pancreatic tail cancer is safe and feasible, increasing the negative rate of pancreatic margins, improving the lymph node harvest, and prolonging patients' survival time.

Objective:To evaluate the therapeutic effect of exposed bone cement in treatment of infectious bone and soft tissue defect by comparison with routine bone cement therapy.Methods:A retrospective analysis was carried out in 27 patients who had been treated from January 2016 to January 2020. Of the 27 patients, 12 were treated by exposed bone cement filling for bone defect at the first stage, followed by flap and bone grafting at the second stage. Other 15 patients were treated by routine bone cement filling and flap repair at the first stage, followed by bone grafting at the second stage. Regular dressing change was carried out after surgery. All patients entered follow-up by out-patient review for wound condition and X-ray. Infection rate of bone and soft tissue, time of bone union, flap survive rate and complication were compared between the 2 groups.Results:The follow-up lased for 9-24(16.5±3.9 ) months. The bone defects were all healed. The treatment time of bone defects in the group of exposed bone cement was 25-34(28.5±2.8) weeks. The treatment time of bone defect in the routine cement group was 25-36(29.6±3.4 )weeks. There was no statistical difference between the 2 groups( P<0.05). Two cases in each group had failed in infection control after bone cement implantation. With further debridement, cleaning and other treatment, the infection was under control. All flaps in the 2 groups survived. In the group of exposed bone cement, there were 3 flaps splitting, 2 hemorrhage(effusion) and 1 partial flap necrosis, In the routine bone cement group, there were 4 wound dehiscence, 8 hemorrhage(effusion) and 3 partial flaps necrosis. There was no significant difference in flap complications between the 2 groups( P>0.05). The healing of bone defect was evaluated by Samantha X-ray score, the scores of the 2 groups were 5.41±0.67 and 5.40±0.63, respectively, with no statistical significance. The Paley's approach was used to grade the bone healing and the function of adjacent joints. Paley bone defect healing evaluation results weve all excellent. Joint function assessment were as follow: in the group of exposed bone cement, 6 cases were excellent and 3 were good; in routine bone cement group: 6 cases were in excellent and 5 in good. There was no significant statistical difference. Conclusion:Compared with a routine bone cement treatment, the exposed bone cement in the treatment of infectious bone defects saw a fewer flap splitting and fewer hemorrhage/effusion, without an increase in bone and soft tissue infection. This procedure could be considered for further trials in the treatment of a composite defects of infected bone and soft tissue.

Objective To investigate the independent risk factors for acute severe cholangitis and related protective factors, and to construct a risk prediction scoring model for acute severe cholangitis. Methods A retrospective analysis was performed for the clinical data of 381 patients with acute cholangitis who were admitted to Department of Hepatobiliary Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, from January 2016 to July 2021, among whom there were 273 patients with non-severe cholangitis and 108 patients with severe cholangitis. Univariate and multivariate logistic regression analyses were used to screen out the independent risk factors for acute severe cholangitis and related protective factors, and then a logistic regression model was established. The receiver operating characteristic (ROC) curve was used to evaluate the discriminatory ability of the model, the calibration curve was used to evaluate the prediction accuracy of the model, and decision curve analysis (DCA) was used to evaluate the clinical value of the model. Moreover, the enhanced Bootstrap method was used to perform internal validation of the model and evaluate the performance of the model in internal validation. The model was visualized by the construction of Web calculator, nomogram, and scoring system. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. Results The univariate and multivariate logistic regression analyses showed that total bilirubin (TBil) (odds ratio [ OR ]=1.014, 95% confidence interval [ CI ]: 1.009-1.020, P < 0.001), percentage of neutrophils ( OR =1.128, 95% CI : 1.088-1.175, P < 0.001), and age ( OR =1.053, 95% CI : 1.027-1.082, P < 0.001) were independent risk factors, and albumin (Alb) ( OR =0.871, 95% CI : 0.817-0.924, P < 0.001) was a protective factor. The above independent risk factors and protective factor were included in the logistic regression analysis for model fitting, and the predictive model obtained had an area under the ROC curve (AUC) of 0.925 (95% CI : 0.897-0.952), with a specificity of 0.817 and a sensitivity of 0.935 at the optimal cut-off value of 0.245. The calibration curve showed that the predicted probability of the model was approximately equal to the actual probability, with a Brier value of 0.098, and the decision curve analysis showed that the model had a higher net income within the threshold probability interval of 0.1-0.9. Internal validation showed an AUC internal validation of 0.915 and a Brier value internal verification of 0.106. Conclusion TBil, percentage of neutrophils, and age are independent risk factors for acute severe cholangitis, while Alb is a protective factor. The established risk prediction scoring model has good discriminatory ability, calibration, and clinical value and can identify patients with acute severe cholangitis at an early stage, which provides a reference for subsequent diagnosis and treatment.

Background: Unintended intraoperative hypothermia is a common complication of general anesthesia surgery, which can cause pain, coagulation dysfunction, wound infection, delayed recovery, and other adverse consequences. There are few studies related to intraoperative hypothermia during endoscopic retrograde cholangiopancreatography (ERCP). Aims: To analyze the risk factors of intraoperative hypothermia during ERCP under general anesthesia and establish a predictive model. Methods: A total of 121 patients underwent ERCP under general anesthesia from September 2021 to November 2021 at Shanghai General Hospital were recruited, and relevant clinical data were collected. Logistic regression analysis was used to screen risk factors, and a predictive model was constructed. The model was externally validated by independent datasets with ROC curve and Hosmer⁃Lemeshow goodness of fit test. Results: A total of 114 patients were enrolled in modeling group. The incidence of intraoperative hypothermia was 11.40% (13/114). There were more women in the hypothermia group (P<0.05). The temperature of entering the operating room and operating room temperature were relatively lower in the hypothermia group (P<0.05). Gender was an independent risk factor for intraoperative hypothermia in ERCP under general anesthesia (P<0.05). The predictive model constructed by using gender and temperature of entering the operating room screened by Logistic regression analysis had a good discrimination and calibration, area under the ROC curve by external validation was 0.78. Conclusions: Gender and temperature of entering the operating room can effectively predict the occurrence of intraoperative hypothermia and assist perioperative monitoring and management.

Objective:To access the efficacy of external fixation combined with Prontosan management for open fractures complicated with multidrug-resistant bacterial infection.Methods:A retrospective analysis was conducted of the data of 22 patients with open fracture complicated by multidrug-resistant bacterial infection who had been admitted to Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University from January 2015 to January 2020. According to whether the Prontosan management was used or not, the patients were divided into 2 groups.The Protosan group [9 males and 3 females with an age of (44.6±13.1) years] were subjected to external fixation, vacuum sealing drainage(VSD) or conventional dressing changes, and at the same time Protosan management to flush the wound or Prontosan gel to change dressings.The control group[6 males and 4 females with an age of (45.1±11.7) years] were subjected to external fixation plus VSD or conventional dressing changes. Skin flaps or skin grafts were used to repair the wound immediately after the wound infection was controlled in both groups. The time for negative culture of the bacteria on the wound surface, number of debridement, survival of the skinflaps or grafts, and fracture union were recorded and compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups which were comparable( P>0.05).All patients were followed up for 10 to 24 months (mean, 14.5 months).In the Prontosan group, the number of debridement was 2.0 (2.0, 3.0) times, significantly fewer than that in the control group [4.0 (3.0, 4.0) times]; the time for negative bacterial culture (8.3±2.2) d, significantly shorter than that in the control group [(14.2±3.1) d]; the fracture union time (5.5±1.1) months, significantly shorter than that in the control group [(6.5 ±1.1) months]; the Samantha X-ray score at 6 months after operation 6.0 (5.0,6.0) points, significantly higher than that in the control group [5.2(4.5,5.5) points] (all P<0.05). Skin flaps or grafts survived in all the patients without any nonunion or chronic osteomyelitis. Conclusion:In the external fixation of open fractures complicated with multidrug-resistant bacterial infection, combination with Prontosan management can effectively control infection and promote granulation, early wound healing and fracture union.

Objective:To summarize the preliminary experience in ward management, medical protection, standardised diagnosis and treatment procedures in trauma microsurgery during the outbreak of COVID-19.Methods:Taking an example from the Department of Trauma and Microsurgery at Zhongnan Hospital of Wuhan University, the orthopedic patients and medical staff with COVID-19 admitted from Decemberm 31, 2019 to March 1, 2020, in-cluding clinical diagnosis and confirmed cases, were analyzed retrospectively. General information, including age, gen- der, basic diseases, contact history, symptoms, lung CT and prognosis, were collected and analysed preliminarily. On January 20, 2020, the COVID-19 outbreak was confirmed as "human to human transmission". COVID-19 infection of patients and medical staff in the wards were analysed, through the update of protection awareness and control measures. Department management, medical protection and standardized control procedures of trauma microsurgery were explored.Results:Five cases with clinical diagnosis or confirmed COVID-19 were included. One was inpatient and the rest 4 were medical staff, aged 25-81 years, 3 with confirmed and 2 with clinical diagnosis of COVID-19. After the treatment by specialists from Department of Infectious Disease and Department of Respiratory Disease, 4 of infected persons were cured and 1 died. Since January 20, 2020, when it was clear that the virus transmitted to people, there was no new case of infection among the medical staff and inpatients after the multidisciplinary collaboration in the ward prevention and control procedures were standardized and took in action.Conclusion:The spread of the COVID-19 can be effectively controlled by standardised diagnosis and treatment procedurs in the word of trauma microsurgery.