Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

Objective:To preliminarily evaluate the outcome of fat grafting breast augmentation using filtration-adsorption technique.Methods:Patients undergoing autologous fat grafting (AFG) breast augmentation between July of 2020 and March of 2021 were retrospectively reviewed at Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College. Patients with complete data who followed up for at least 3 months were included. The lipoaspirates were processed with filtration-adsorption technique and AFG breast augmentation were performed (filtration-adsorption group), and then sedimentation method which was commonly used clinically was set as the control group (sedimentation group). During the follow-up, breast palpation and ultrasound inspection were performed, and the breast volumetric change between preoperative and postoperative was quantitatively compared by three-dimensional scanning technique. Demographic and surgical details were statistically analyzed. Postoperative breast volume retention rates and complication rates were calculated and compared. Normally distributed continuous variables were described in the form Mean±SD, and t-test was used for analysis. Non-normal distributed continuous variables were described in the form of M ( Q1, Q3) and analyzed by Mann-Whitney U test. The classified data were analyzed by Fisher exact probability test. Results:A total of 20 female patients (40 breasts) were included, including 10 patients (20 breasts) aged (31.4±2.5) years in sedimentation group and 10 patients (20 breasts) aged (28.5±4.4) years in the filtration-adsorption group. The fat injection volume in the filtration-adsorption group was 151.1 (125.0, 175.0) ml, and 165.0 (151.3, 196.3) ml in sedimentation group, respectively, with no statistical significance ( P>0.05). The breast volume retention rate in filtration-adsorption group was (62.93±14.06)%, which was significantly higher than that in sedimentation group (24.97±11.02)% ( P<0.01). During postoperative breast ultrasound examination, 2 breasts in sedimentation group had palpable nodules (< 6 mm), 1 breast had ultrasonically detectable but clinically inaccessible nodules (< 4 mm), while only 1 breast in the filtration-adsorption group had an oil cyst (4 mm×2 mm). The complication rate in the filtration-adsorption group was lower than that in sedimentation group[5.0%(1/20) vs. 15.0%(3/20), P>0.05]. Conclusion:The filtration-adsorption technique is an ideal method for fat grafting, which would multiply the volume retention rate in large-volume AFG breast augmentation and reduce the rate of complications.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

Objective:To preliminarily evaluate the outcome of fat grafting breast augmentation using filtration-adsorption technique.Methods:Patients undergoing autologous fat grafting (AFG) breast augmentation between July of 2020 and March of 2021 were retrospectively reviewed at Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College. Patients with complete data who followed up for at least 3 months were included. The lipoaspirates were processed with filtration-adsorption technique and AFG breast augmentation were performed (filtration-adsorption group), and then sedimentation method which was commonly used clinically was set as the control group (sedimentation group). During the follow-up, breast palpation and ultrasound inspection were performed, and the breast volumetric change between preoperative and postoperative was quantitatively compared by three-dimensional scanning technique. Demographic and surgical details were statistically analyzed. Postoperative breast volume retention rates and complication rates were calculated and compared. Normally distributed continuous variables were described in the form Mean±SD, and t-test was used for analysis. Non-normal distributed continuous variables were described in the form of M ( Q1, Q3) and analyzed by Mann-Whitney U test. The classified data were analyzed by Fisher exact probability test. Results:A total of 20 female patients (40 breasts) were included, including 10 patients (20 breasts) aged (31.4±2.5) years in sedimentation group and 10 patients (20 breasts) aged (28.5±4.4) years in the filtration-adsorption group. The fat injection volume in the filtration-adsorption group was 151.1 (125.0, 175.0) ml, and 165.0 (151.3, 196.3) ml in sedimentation group, respectively, with no statistical significance ( P>0.05). The breast volume retention rate in filtration-adsorption group was (62.93±14.06)%, which was significantly higher than that in sedimentation group (24.97±11.02)% ( P<0.01). During postoperative breast ultrasound examination, 2 breasts in sedimentation group had palpable nodules (< 6 mm), 1 breast had ultrasonically detectable but clinically inaccessible nodules (< 4 mm), while only 1 breast in the filtration-adsorption group had an oil cyst (4 mm×2 mm). The complication rate in the filtration-adsorption group was lower than that in sedimentation group[5.0%(1/20) vs. 15.0%(3/20), P>0.05]. Conclusion:The filtration-adsorption technique is an ideal method for fat grafting, which would multiply the volume retention rate in large-volume AFG breast augmentation and reduce the rate of complications.

Cannula ; Catheters ; Drainage ; Duodenal Diseases ; Humans ; Intestinal Fistula/surgery*

OBJECTIVES: To study the effect of glucose metabolism disorders on the short-term prognosis in neonates with asphyxia. METHODS: A retrospective analysis was performed on the medical data of the neonates with asphyxia who were admitted to 52 hospitals in Hubei Province of China from January to December, 2018 and had blood glucose data within 12 hours after birth. Their blood glucose data at 1, 2, 6, and 12 hours after birth (with an allowable time error of 0.5 hour) were recorded. According to the presence or absence of brain injury and/or death during hospitalization, the neonates were divided into a poor prognosis group with 693 neonates and a good prognosis group with 779 neonates. The two groups were compared in the incidence of glucose metabolism disorders within 12 hours after birth and short-term prognosis. RESULTS: Compared with the good prognosis group, the poor prognosis group had a significantly higher proportion of neonates from secondary hospitals (48.5% vs 42.6%, CONCLUSIONS Recurrent hyperglycemia in neonates with asphyxia may suggest poor short-term prognosis, and it is necessary to strengthen the early monitoring and management of the nervous system in such neonates.
Asphyxia ; Asphyxia Neonatorum/epidemiology* ; Humans ; Hyperglycemia ; Infant, Newborn ; Prognosis ; Retrospective Studies

Objective:Introducing clinical application, planning strategy, and surgical tips of bipedicled deep inferior epigastric perforator (DIEP) flaps in delayed breast reconstruction.Methods:A retrospective study of patients who underwent delayed breast reconstruction using bipedicled DIEP flaps from April 2015 to April 2019 at the facility of the authors was carried out. Preoperative CT angiograph was performed for evaluation of deep inferior epigastric perforators. Intraoperative indocyanine green angiography was performed for real-time flap perfusion assessment. Baseline data, information of mastectomy and adjuvant therapy, surgical details, and follow-up records were reviewed and collected for statistical analysis.Results:A total of 31 patients were enrolled, with years of 43.0 on average (range, 30 to 55). Among them 16 patients received radiotherapy (51.6%), 9 patients had lower abdominal scars due to previous surgery (29.0%), 2 patients had body mass index (BMI) lower than 20 kg/m 2(6.5%). Measurements of flaps ranged from 20 cm×8 cm to 20 cm×38 cm. The operative time was 593±94 minutes. Of the 31 flaps enrolled, 24 were DIEP/DIEP flaps, 6 were DIEP/SIEA flaps, one was SIEA/SIEA flap. Intraflap anastomoses were performed in 6 flaps. The other 25 flaps were anastomosed to separate recipients. There was no flap loss encountered. Marginal necrosis of the flap happened in one patient, fat liquefaction of the donor site occurred in four patients, which was treated with conservative debridement. Patients were followed up for 13 months on average (range, 10 to 60 months). No long-term complication was observed during the follow-up. All patients reported satisfying aesthetic outcomes. Conclusions:Bipedicled DIEP flaps provide sufficient tissue quantity and reliable blood supply. Patients with severe breast deficiency, lacking lower abdominal fat, or having abdominal midline scars were appropriate to perform this type of flaps for delayed breast reconstruction.

Objective:Introducing clinical application, planning strategy, and surgical tips of bipedicled deep inferior epigastric perforator (DIEP) flaps in delayed breast reconstruction.Methods:A retrospective study of patients who underwent delayed breast reconstruction using bipedicled DIEP flaps from April 2015 to April 2019 at the facility of the authors was carried out. Preoperative CT angiograph was performed for evaluation of deep inferior epigastric perforators. Intraoperative indocyanine green angiography was performed for real-time flap perfusion assessment. Baseline data, information of mastectomy and adjuvant therapy, surgical details, and follow-up records were reviewed and collected for statistical analysis.Results:A total of 31 patients were enrolled, with years of 43.0 on average (range, 30 to 55). Among them 16 patients received radiotherapy (51.6%), 9 patients had lower abdominal scars due to previous surgery (29.0%), 2 patients had body mass index (BMI) lower than 20 kg/m 2(6.5%). Measurements of flaps ranged from 20 cm×8 cm to 20 cm×38 cm. The operative time was 593±94 minutes. Of the 31 flaps enrolled, 24 were DIEP/DIEP flaps, 6 were DIEP/SIEA flaps, one was SIEA/SIEA flap. Intraflap anastomoses were performed in 6 flaps. The other 25 flaps were anastomosed to separate recipients. There was no flap loss encountered. Marginal necrosis of the flap happened in one patient, fat liquefaction of the donor site occurred in four patients, which was treated with conservative debridement. Patients were followed up for 13 months on average (range, 10 to 60 months). No long-term complication was observed during the follow-up. All patients reported satisfying aesthetic outcomes. Conclusions:Bipedicled DIEP flaps provide sufficient tissue quantity and reliable blood supply. Patients with severe breast deficiency, lacking lower abdominal fat, or having abdominal midline scars were appropriate to perform this type of flaps for delayed breast reconstruction.

Objective:The purpose of this study was to introduce an endoscopic approach to harvest latissimus dorsi muscle(LDM)flap using a single transverse axillary incision and evaluate its safety and efficacy to repair the chest deformities of Poland syndrome.Methods:Poland syndrome patients were recruited prospectively to repair the thoracic wall deformity plus breast reconstruction(combined with breast implant insertion) using the endoscopic approach to transfer LDM flap with single transverse axillary incision in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from October 2015 to January 2018. Information including patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time(endoscopic time for LDM flap harvesting, endoscopic anterior subcutaneous pocket creating time and total time), the survival of LDM flap, deformity of thoracic wall and back and post-operative complications were collected. The pain visual analog scale was used to assess the severity of postoperative pain. The Breast-Q reconstruction module was used to evaluate patients’ psychosocial well-being and satisfaction with the outcome. The disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities. A paired t-test was utilized to analyze the difference between the preoperative and postoperative score of the Breast-Q and DASH questionnaire. Results:Twenty-eight patients were recruited in this study, including 11 males and 17 females aged (22.5±3.9) years old with a body mass index of (20.5±6.1) kg/m 2. Two patients received contralateral implant augmentation and two received fat grafting for breast symmetry. The postoperative follow-up time was (50.4±23.1) months. All the reconstructed breasts or thoracic walls was in a good shape. All the LDM flap survived with good blood supply. The postoperative pain was mild, and there was no obvious abnormality of the thoracic wall and back. The area of harvested LDM flap was (437.2±110.0) cm 2. The size of the implant used for breast reconstruction was (240.4±46.0) ml. Total operation time was (169.4±16.1) minutes for patients without contralateral symmetrical surgery. The endoscopic time for LDM flap harvesting was (69.0±13.9) minutes. The endoscopic anterior subcutaneous pocket creating time was (32.8±6.0) minutes. The postoperative drain time was (7.6±1.4) days. The postoperative complications included one case of early seroma, one case of wound dehiscence, one case of flap malposition. The pain visual score of the patient was 2.7±0.5 on the first day after the operation and decreased to 0.8±0.4 after 1 week. The score of satisfaction with breast before surgery was 27.8±20.8, psychosocial well-being score was 49.6±17.0. The postoperative score of satisfaction with breast was 63.1±11.6, and psychosocial well-being score was 68.1±16.7. The postoperative score of satisfaction with breast ( t=-9.000, P=0.008) and psychosocial well-being ( t=-6.543, P<0.001) were significantly higher than those before surgery. The score of DASH was 3.7±3.3 before surgery and 4.0±3.7 after surgery respectively, with no statistically significant differences ( t=-1.160, P=0.276). All patients were highly satisfied with the result of the surgery. Conclusions:The endoscopic approach to transfer latissimus dorsi muscle flap using a single transverse axillary incision provides a safe and efficient way to repair thoracic wall deformities in Poland syndrome patients with a high satisfaction rate, a better aesthetic outcome, and a minimal complications rate.