Objective,To report the occurrence,management and outcome of late-onset traumatic dehiscence and dislocation of laser assisted in situ keratomileusis(LASIK)flaps.Treatment and Results:One patient occurred late-onset L...Objective,To report the occurrence,management and outcome of late-onset traumatic dehiscence and dislocation of laser assisted in situ keratomileusis(LASIK)flaps.Treatment and Results:One patient occurred late-onset LASIK corneal flap dislocation after ocular trauma 7days after surgery.The flap was lifted,stretched,and repositioned after irrigation and scraping of the stromal bed and the underside of the flap.A bandage contact lens was placed,and topical antibiotic and corticosteroids were given postoperatively.The dislocated corneal flap was successfully repositioned in the case.The dislocated flap was repositioned 7 days after the trauma,and the patient recovered his uncorrected visual acuity(UCVA)of 10/20,20/20 day 1 and day 20 after the procedure,of 20/20 20 days later and had a well-positioned flap with a clear interface.Diffuse lamellar keratitis developed in the patients that resolved with the use of topical corticosteroids.Conclusion:Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation,which should be pay more attention to it for us.展开更多
Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and Februa...Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a “two team” approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.展开更多
We described a 27-year-old case of avulsion and traumatic degloving of penile with extensive penis skin necrosis. Under general anesthesia, donor skin was partially resected from lower limbs according to defect area o...We described a 27-year-old case of avulsion and traumatic degloving of penile with extensive penis skin necrosis. Under general anesthesia, donor skin was partially resected from lower limbs according to defect area of penile skin. Then shear the shape of graft was sheared, sutured to hostage skin defect and enswathed with tension. The postoperative appearance and function of the penis were satisfactory. It is suggest the homologous free skin flap from lower limbs is suitable for penile skin repair and beneficial to patient resulting in satisfactory erection and shape.展开更多
This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. ...This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors’ work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.展开更多
目的比较控制性阶梯式减压术与快速标准大骨瓣减压术治疗重度颅脑损伤的疗效。方法计算机检索PubMed、Embase、The Cochrane Library、Web of Science、万方医学网、CNKI、CBM和VIP数据库,查找自建库至2022年11月能查到的有关控制性阶...目的比较控制性阶梯式减压术与快速标准大骨瓣减压术治疗重度颅脑损伤的疗效。方法计算机检索PubMed、Embase、The Cochrane Library、Web of Science、万方医学网、CNKI、CBM和VIP数据库,查找自建库至2022年11月能查到的有关控制性阶梯式减压术和快速标准大骨瓣减压术治疗重度颅脑损伤疗效对比的相关文献,采用RevMan 5.4软件对符合条件的文献进行meta分析。结果共纳入23篇文献,其中17篇是回顾性临床对照研究,6篇是随机对照试验,共计2141例患者,其中控制性阶梯式减压术患者1080例,快速标准大骨瓣减压术患者1061例。Meta分析结果显示,与快速标准大骨瓣减压术相比,控制性阶梯式减压术开始减压时间更早[MD=-25.39,95%CI(-30.96,-19.81),P<0.01]、手术时间[MD=-21.49,95%CI(-34.22,-8.76),P<0.01]、住院时间[MD=-3.02,95%CI(-3.70,-2.34),P<0.01]更短、术中出血量[MD=-23.82,95%CI(-32.42,-15.22),P<0.01]更少、减压术后第1天颅内压(ICP)[MD=-4.58,95%CI(-6.03,-3.13),P<0.01]更低,术中术后总并发症发生率[OR=0.18,95%CI(0.15,0.23),P<0.01]更低、术后2周GCS评分[MD=1.94,95%CI(1.31,2.56),P<0.01]及预后恢复良好率(GOS≥4)[OR=3.08,95%CI(2.15,4.43),P<0.01]优于快速标准大骨瓣减压。结论相比于快速标准大骨瓣减压术,控制性阶梯式减压术在开始减压时间、手术时间、术中出血量、术后住院时间、术中术后总并发症发生率以及后期恢复方面有着一定的优势,表明控制性阶梯式减压术可以在大多数情况下作为降低ICP的首选手术方式,可以在临床上进行推广及应用。展开更多
文摘Objective,To report the occurrence,management and outcome of late-onset traumatic dehiscence and dislocation of laser assisted in situ keratomileusis(LASIK)flaps.Treatment and Results:One patient occurred late-onset LASIK corneal flap dislocation after ocular trauma 7days after surgery.The flap was lifted,stretched,and repositioned after irrigation and scraping of the stromal bed and the underside of the flap.A bandage contact lens was placed,and topical antibiotic and corticosteroids were given postoperatively.The dislocated corneal flap was successfully repositioned in the case.The dislocated flap was repositioned 7 days after the trauma,and the patient recovered his uncorrected visual acuity(UCVA)of 10/20,20/20 day 1 and day 20 after the procedure,of 20/20 20 days later and had a well-positioned flap with a clear interface.Diffuse lamellar keratitis developed in the patients that resolved with the use of topical corticosteroids.Conclusion:Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation,which should be pay more attention to it for us.
文摘Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a “two team” approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.
文摘We described a 27-year-old case of avulsion and traumatic degloving of penile with extensive penis skin necrosis. Under general anesthesia, donor skin was partially resected from lower limbs according to defect area of penile skin. Then shear the shape of graft was sheared, sutured to hostage skin defect and enswathed with tension. The postoperative appearance and function of the penis were satisfactory. It is suggest the homologous free skin flap from lower limbs is suitable for penile skin repair and beneficial to patient resulting in satisfactory erection and shape.
文摘This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors’ work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.
