To summarize the effectiveness of the improv ed surgical techniques in fasciocutaneous flaps of the limbs. MethodsFrom February 1999 to December 2005, 58 patients (39 males, 19 females, aged 1068 years) underwent repairs of the skin defects with improved fasciaocu taneous flaps of the limbs. Twentyone patients had the skin defects in front of the tibial bone in the middle and lower parts, 12 patients had the skin defect s in the heels, 16 patients had the skin defects in the ankles, 3 patients had t he skin defects around the knees, 1 patient had a wide sacrococcygeal bedsore, and 5 patients had the skin defects in the wrists and hands. The wounds ranged in size from 5 cm×3 cm to 18 cm× 12 cm. According to the wound lo cations, the following flaps were selected: 4 cutaneous antebrachii medialis nerve and basilic vein fasciocutaneous flaps, 1 cutaneous antebrachii lateralis nerve and cephalic vein fasciocutaneous flap, 3 saphenous nerve and great saphenousvein fasciocutaneous flaps, 1 cutaneous nerve of thigh posterior fasciocutaneous flap, 32 reverse sural nerve and saphenous vein fasciocutaneous flaps, and 17 reverse saphenous nerve and great saphenous vein fasciocutaneous flaps. The dissected flaps ranged in size from 6 cm× 4 cm to 18 cm× 13 cm. The donor wounds underwent straight sutures in 39 patients, and the skin grafting (6 cm×3 cm to 13 cm× 6 cm) was performed on 19 patients after the donor wounds were closed. Results The wounds healed by first intention, and the flaps survived completely in 54 patients. The flaps developed partial necrosis in 4 patients. The followup for 120 months (average, 8 months) revealed that the flaps had a satisfactory appearance with a soft texture and the function was also satisfactory. Conclusion A fasciocutaneous flap of the limbs is an ideal flap for repairing defects in the skins and soft tissues of the limbs. The survival rate of the flap can be further improved by an improvement of the surgical techniques.
The ideological and political education in standardized residency training plays an important role in cultivating medical talents with noble medical ethics and exquisite medical skills. Teaching evaluation is an important method to promote teaching improvement and optimization. However, there are still some problems and challenges in the evaluation of ideological and political education for standardized residency training. This article proposes the ideological and political education of standardized residency training can be comprehensively evaluated by the context-input-process-product evaluation model from four aspects: background, input, process, and result evaluation. The aim is to provide solid support and guidance for the ideological and political education route in standardized residency training.
Objective To compare the therapeutic effects between endoscopic thyroidectomy by anterior chest approach and modified Miccoli thyroidectomy. Methods Sixty patients with thyroid goiter were performed endoscopic thyroidectomy by anterior chest approach (endoscopic thyroidectomy by anterior chest approach group, n=30) and modified Miccoli thyroidectomy (modified Miccoli group, n=30) respectively. The operative time, the drainage volume, cosmetic benefit, the postoperative hospitalization time, the expenses of hospitalization and postoperative complications of two groups were compared. Results The operative time and the drainage volume after operation of endoscopic thyoidectomy by anterior chest approach group were significantly more than modified Miccoli group 〔(99.9±23.4) min vs. (74.0±29.6) min; (68.6±8.7) ml vs. (40.9±6.1) ml, respectively〕, Plt;0.05. The cosmetic benefit score of endoscopic thyoidectomy by anterior chest approach group was higher than that of modified Miccoli group 〔(4.7±0.2) points vs. (3.7±0.1) points〕, Plt;0.05. The postoperative hospitalization time and expenses of hospitalization were no significant differences between the two groups 〔(6.5±1.7) d vs. (5.5±0.9) d; (9 328.3±1 107.1) yuan vs. (8 568.2±1 032.3) yuan, respectively〕, Pgt;0.05. One case had transient hoarseness in 2 groups respectively, no other complications happened. Conclusions Modified Miccoli operation is both minimally invasive and cosmetic, but endoscopic thyroidectomy by anterior chest approach has better cosmetic benefit, which can release patients’ psychological trauma. The patients with specific cosmetic demand may choose endoscopic thyroidectomy by anterior chest approach.
Objective To investigate the effectiveness of modified percutaneous suture in repairing acute closed Achilles tendon rupture by comparing with conventional open suture. Methods Between January 2006 and October 2009, 50 patients with acute closed Achilles tendon rupture were treated with modified percutaneous suture by making 5 small incisions at both sides of Achilles tendon and zigzag suture (improved group, n=22) and with Kessler suture (conventional group, n=28), respectively. No significant difference was found in gender, age, time from injury to operation between 2 groups (P gt; 0.05). Results In improved group, the patients achieved healing of incisions by first intention after operation and nocomplication occurred; however, incision infection occurred in 1 case, Achilles tendon re-rupture in 1 case, and incision scar contracture in 2 cases in conventional group. The operation time of improved group [(38.7 ± 6.6) minutes] was significantly shorter (t= —12.29, P=0.00) than that of conventional group [(52.3 ± 6.9) minutes]; the blood loss of improved group [(4.9 ± 2.0) mL] was significantly less (t= —25.20, P=0.00) than that of conventional group [(40.7 ± 7.1) mL]. The patients were followed up 2-3 years (mean, 29.9 months). The American Orthopaedic Foot and Ankle Society (AOFAS) score was 99.6 ± 1.0 in improved group and was 98.4 ± 3.0 in conventional group, showing no significant difference between 2 groups (t=1.66, P=0.10). Conclusion Comparison with conventional open suture, modified percutaneous suture has some advantages, such as easy operation, less complications, rapid recovery of limb function, and so on. Modified percutaneous suture is one of the best choices for the treatment of acute closed Achilles tendon rupture.
ObjectiveTo analyze why sleeve gastrectomy (SG) with jejunojejunal bypass (SG-JJB), despite being the second most common bariatric procedure in China, has not been recommended in national and international guidelines nor endorsed by expert consensus; to investigate the primary obstacles to its standardization and widespread adoption; and to propose strategies leveraging China’s extensive clinical experience to refine the technique, establish standardized protocols, and address existing challenges, thereby defining its future role in metabolic surgery. MethodsBy systematically reviewing the evolution, current evidence profile, and distinctive features of SG-JJB compared to other SG-Plus procedures, this study aimed to identify constraints hindering its adoption. Concurrently, considering the characteristics of domestic healthcare resources, we explored the feasibility of procedural refinements, key steps for standardization, and solutions to potential challenges, thereby facilitating the optimization and standardization of SG-JJB. ResultsThe three key constraints hindering SG-JJB development were: risks of blind loop syndrome, uncertainty regarding optimal bypass limb length, and limited evidence on long-term efficacy. To address these issues, this study proposed leveraging China’s clinical and multi-center collaboration strengths to: conduct high-quality studies defining the impact of bypass length on outcomes, establish unified diagnostic and monitoring protocols for blind loop syndrome, and systematically collect longitudinal data to evaluate long-term efficacy, thereby informing evidence-based surgical standardization. ConclusionsSG-JJB holds significant potential in Chinese bariatric-metabolic practice, yet its standardization faces persistent challenges. Addressing concerns about blind loop syndrome, defining optimal bypass limb length, and accumulating robust long-term efficacy data are pivotal for advancing SG-JJB standardization and adoption. Leveraging domestic clinical resources through multi-center collaborations, high-quality research, and evidence-based protocol development is the essential pathway to overcoming these barriers, achieving standardized implementation, and securing recognition in authoritative guidelines.
Objective To evaluate the effect of the modified extended iliofemoral approach on treatingcomplex acetabular fractures. Methods Thirty-six cases of complex acetabular fractures were treated by the open reposition and internal fixation by a modified extended iliofemoral approach. Results Thirty-sixcases were followed up for 7-46 months, with an average of 23.8 months. According to the Matta standard, anatomical reposition was performed in 24 cases, perfect reposition in 8 cases, and unsatisfactory reposition in 4 cases. By the modified d’Aubignepostel score, among the 36 cases, 22 had an excellent result, 9 had a good result, and 5 had a poor result. Conclusion Themodified extended iliofemoral approach facilitates the operative exposure of the anterior and posterior walls and both columns of the acetabulum in the surgically-treated acetabular fractures by the open reposition and internal fixation.Because of the reconstruction, the functions of the abductor muscle mass managed by the lagscrew-fixed osteotomies of the iliac crest, and greater trochanter, the patients can achieve a rapid rehabilitation of the joint.
目的 探讨乳腺癌改良根治术后影响局部复发与远处转移的相关因素。方法 对陕西省汉中市铁路中心医院略阳医院2000年3月至2007年3月期间行乳腺癌改良根治术且资料完整的637例原发性乳腺癌患者的临床资料进行回顾性分析。结果 66例（10.36%）患者术后发生局部复发和远处转移，其中局部复发50例（7.85%），远处转移16例（2.51%）；术后3～4年内发生复发与远处转移者47例（71.21%）。术后复发和远处转移与患者年龄、肿瘤大小、腋窝淋巴结转移情况、TNM分期、激素受体（ER/PR）表达情况及术后是否接受正规的辅助治疗有关，与患者有无家族史无关。结论 肿瘤大小、腋窝淋巴结转移情况、TNM分期、ER/PR表达情况及术后是否接受正规的辅助治疗是影响乳腺癌改良根治术后复发与远处转移的危险因素，重视乳腺癌术后随访，规范乳腺癌的手术方式，强化乳腺癌的综合治疗是降低乳腺癌改良根治术后复发与远处转移率的主要措施。
Objective To compare the clinical effect between high flow rate modified ultrafiltration （HMUF） and conventional modified ultrafiltration（CMUF）, and the effect on hemodynamic data and inflammatory mediators. Methods Forty children were divided into two groups with random number table, HMUF group and CMUF group, 20 cases each group. Hematocrit （HCT） and hemodynamic changes were recorded and the concentration of tumor necrosis factor （TNF） and interleukin 6 （IL-6） were measured. Results The operations were done uneventfully with moderate hypothermia cardiopulmonary bypass in 40 patients. Duration of ultrafiltration of HMUF group （7.83±0. 75 min） was less than that of CMUF group （13.86±1.95 min, P〈0.01）. The volumes ultrafiltrated of HMUF group （440.00±91.86ml） was more than that of CMUF group （372.22±56.52ml, P〈0.01）. There are no significant differences about the hemodynamic data, HCT, TNF and IL-6 between two groups. Conclusion The HMUF is safe and efficient,when it was used after pediatric cardiopulmonary bypass, the duration of ultrafiltration can be shortened significantly.