BACKGROUND Injuries to multiple fingertips pose a significant treatment dilemma.Numerous reconstructive options exist,all with the ultimate goal of restoring function and sensibility to the injured fingertips.CASE SUM...BACKGROUND Injuries to multiple fingertips pose a significant treatment dilemma.Numerous reconstructive options exist,all with the ultimate goal of restoring function and sensibility to the injured fingertips.CASE SUMMARY A 24-year-old male suffered injury to multiple fingertips of the right hand,resulting in exposed distal phalanges of the middle,ring,and small fingers.The amputated distal stumps were not possible for replantation.Free flap coverage was selected in order to achieve better functional outcome.The fingertip defects were covered by performing a right second toe split tibial flap using local anesthesia at the harvest site and brachial plexus nerve block for the right upper extremity.At 6-month follow-up,all three of the reconstructed fingertips had some preserved nail growth,Semmes-Weinstein Monofilaments testing was equal to the contralateral side and the Static Two-Point Discrimination were comparable to the contralateral side.CONCLUSION This report provides a novel reconstructive option for the management of multiple fingertip injuries and demonstrates the utility of supermicrosurgery in management of these injuries.展开更多
BACKGROUND Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons ...BACKGROUND Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons.CASE SUMMARY A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function.CONCLUSION Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuumassisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.展开更多
BACKGROUND Cleft foot is a very rare congenital anomaly,which is characterized by central rays deficiency of the foot.It is also known as split foot or ectrodactyly of the foot,and it is very often combined with split...BACKGROUND Cleft foot is a very rare congenital anomaly,which is characterized by central rays deficiency of the foot.It is also known as split foot or ectrodactyly of the foot,and it is very often combined with splitting of the hands.The defect develops due to insufficient activity of the median apical ectodermal ridge,which leads to an increase in cell death or a decrease in cell proliferation.Due to the rarity of the pathology,there are few papers on the surgical treatment of this congenital foot disease,and publications to date concern the treatment of children.CASE SUMMARY We present a clinical case of congenital splitting of the feet and hands in a 31-year-old woman and a long-term result of foot treatment using the minimal arrangement of the Ilizarov apparatus.The patient had paternal inheritance of the trait.After the surgical treatment,cosmetic view and functional condition of the foot were improved and persisted two years after intervention.There were no complications in the treatment process.CONCLUSION The possibility of dosed control and stable fixation of the foot rays made it possible to create favorable conditions for the healing of the central wound and the closure of the segment splitting without complications.The long-term outcome of the treatment of foot congenital splitting using the proposed Ilizarov apparatus arrangement has shown its effectiveness.Our approach should be considered as an option of treatment in similar cases.展开更多
In this paper,the forecasting equations of a 2nd-order space-time differential remainder are deduced from the Navier-Stokes primitive equations and Eulerian operator by Taylor-series expansion.Here we introduce a cubi...In this paper,the forecasting equations of a 2nd-order space-time differential remainder are deduced from the Navier-Stokes primitive equations and Eulerian operator by Taylor-series expansion.Here we introduce a cubic spline numerical model(Spline Model for short),which is with a quasi-Lagrangian time-split integration scheme of fitting cubic spline/bicubic surface to all physical variable fields in the atmospheric equations on spherical discrete latitude-longitude mesh.A new algorithm of"fitting cubic spline—time step integration—fitting cubic spline—……"is developed to determine their first-and2nd-order derivatives and their upstream points for time discrete integral to the governing equations in Spline Model.And the cubic spline function and its mathematical polarities are also discussed to understand the Spline Model’s mathematical foundation of numerical analysis.It is pointed out that the Spline Model has mathematical laws of"convergence"of the cubic spline functions contracting to the original functions as well as its 1st-order and 2nd-order derivatives.The"optimality"of the 2nd-order derivative of the cubic spline functions is optimal approximation to that of the original functions.In addition,a Hermite bicubic patch is equivalent to operate on a grid for a 2nd-order derivative variable field.Besides,the slopes and curvatures of a central difference are identified respectively,with a smoothing coefficient of 1/3,three-point smoothing of that of a cubic spline.Then the slopes and curvatures of a central difference are calculated from the smoothing coefficient 1/3 and three-point smoothing of that of a cubic spline,respectively.Furthermore,a global simulation case of adiabatic,non-frictional and"incompressible"model atmosphere is shown with the quasi-Lagrangian time integration by using a global Spline Model,whose initial condition comes from the NCEP reanalysis data,along with quasi-uniform latitude-longitude grids and the so-called"shallow atmosphere"Navier-Stokes primitive equations in the spherical coordinates.The Spline Model,which adopted the Navier-Stokes primitive equations and quasi-Lagrangian time-split integration scheme,provides an initial ideal case of global atmospheric circulation.In addition,considering the essentially non-linear atmospheric motions,the Spline Model could judge reasonably well simple points of any smoothed variable field according to its fitting spline curvatures that must conform to its physical interpretation.展开更多
文摘BACKGROUND Injuries to multiple fingertips pose a significant treatment dilemma.Numerous reconstructive options exist,all with the ultimate goal of restoring function and sensibility to the injured fingertips.CASE SUMMARY A 24-year-old male suffered injury to multiple fingertips of the right hand,resulting in exposed distal phalanges of the middle,ring,and small fingers.The amputated distal stumps were not possible for replantation.Free flap coverage was selected in order to achieve better functional outcome.The fingertip defects were covered by performing a right second toe split tibial flap using local anesthesia at the harvest site and brachial plexus nerve block for the right upper extremity.At 6-month follow-up,all three of the reconstructed fingertips had some preserved nail growth,Semmes-Weinstein Monofilaments testing was equal to the contralateral side and the Static Two-Point Discrimination were comparable to the contralateral side.CONCLUSION This report provides a novel reconstructive option for the management of multiple fingertip injuries and demonstrates the utility of supermicrosurgery in management of these injuries.
基金Supported by National Natural Science Foundation of China,No.81702135Zhejiang Traditional Chinese Medicine Research Program,No.2016ZA124 and No.2017ZB057+1 种基金Zhejiang Medicine and Hygiene Research Program,No.2016KYB101 and No.2015KYA100Zhejiang Medical Association Clinical Scientific Research Program,No.2013ZYC-A19 and No.2015ZYC-A12
文摘BACKGROUND Although skin avulsions to male external genitalia are rare, they can be both physically and psychologically traumatic. Thus, the necessity for judicious management poses significant challenges to surgeons in order to avoid potential permanent disabilities. We report a case of massive penoscrotal skin avulsion and a composite graft was creatively applied to cover the defect which achieved good results. We believe that this case is of great reference value for fellow surgeons.CASE SUMMARY A 52-year-old male presented with massive traumatic avulsion of the penile and scrotal skin following mishandling of an electric drill. The avulsed skin was missing. The patient was diagnosed with massive skin avulsion of external genitalia. Following initial complete debridement of devitalized or infected tissues, Pelnac dermal substitute was secured to the defect with the assistance of negative-pressure wound closure. In the final step, the silicone layer of Pelnac was removed and a split-thickness skin graft was applied. The defect had healed at the two-month follow-up. The patient now has normal erections and satisfactory sexual function.CONCLUSION Our experience with this wound repair demonstrated that the combination of a dermal regeneration template and a split-thickness skin graft with vacuumassisted closure is a safe, well-tolerated and efficient solution for the reconstruction of massive penoscrotal skin defects.
文摘BACKGROUND Cleft foot is a very rare congenital anomaly,which is characterized by central rays deficiency of the foot.It is also known as split foot or ectrodactyly of the foot,and it is very often combined with splitting of the hands.The defect develops due to insufficient activity of the median apical ectodermal ridge,which leads to an increase in cell death or a decrease in cell proliferation.Due to the rarity of the pathology,there are few papers on the surgical treatment of this congenital foot disease,and publications to date concern the treatment of children.CASE SUMMARY We present a clinical case of congenital splitting of the feet and hands in a 31-year-old woman and a long-term result of foot treatment using the minimal arrangement of the Ilizarov apparatus.The patient had paternal inheritance of the trait.After the surgical treatment,cosmetic view and functional condition of the foot were improved and persisted two years after intervention.There were no complications in the treatment process.CONCLUSION The possibility of dosed control and stable fixation of the foot rays made it possible to create favorable conditions for the healing of the central wound and the closure of the segment splitting without complications.The long-term outcome of the treatment of foot congenital splitting using the proposed Ilizarov apparatus arrangement has shown its effectiveness.Our approach should be considered as an option of treatment in similar cases.
文摘In this paper,the forecasting equations of a 2nd-order space-time differential remainder are deduced from the Navier-Stokes primitive equations and Eulerian operator by Taylor-series expansion.Here we introduce a cubic spline numerical model(Spline Model for short),which is with a quasi-Lagrangian time-split integration scheme of fitting cubic spline/bicubic surface to all physical variable fields in the atmospheric equations on spherical discrete latitude-longitude mesh.A new algorithm of"fitting cubic spline—time step integration—fitting cubic spline—……"is developed to determine their first-and2nd-order derivatives and their upstream points for time discrete integral to the governing equations in Spline Model.And the cubic spline function and its mathematical polarities are also discussed to understand the Spline Model’s mathematical foundation of numerical analysis.It is pointed out that the Spline Model has mathematical laws of"convergence"of the cubic spline functions contracting to the original functions as well as its 1st-order and 2nd-order derivatives.The"optimality"of the 2nd-order derivative of the cubic spline functions is optimal approximation to that of the original functions.In addition,a Hermite bicubic patch is equivalent to operate on a grid for a 2nd-order derivative variable field.Besides,the slopes and curvatures of a central difference are identified respectively,with a smoothing coefficient of 1/3,three-point smoothing of that of a cubic spline.Then the slopes and curvatures of a central difference are calculated from the smoothing coefficient 1/3 and three-point smoothing of that of a cubic spline,respectively.Furthermore,a global simulation case of adiabatic,non-frictional and"incompressible"model atmosphere is shown with the quasi-Lagrangian time integration by using a global Spline Model,whose initial condition comes from the NCEP reanalysis data,along with quasi-uniform latitude-longitude grids and the so-called"shallow atmosphere"Navier-Stokes primitive equations in the spherical coordinates.The Spline Model,which adopted the Navier-Stokes primitive equations and quasi-Lagrangian time-split integration scheme,provides an initial ideal case of global atmospheric circulation.In addition,considering the essentially non-linear atmospheric motions,the Spline Model could judge reasonably well simple points of any smoothed variable field according to its fitting spline curvatures that must conform to its physical interpretation.
