Fiftyone thumbs with complete or partial loss of the distal segment in 50 patients has been reconstructed with transplantation of great or second toe by microsurgical technique from 1985 to 1993. All cases were survived and regained favourable functions. Ninteen cases had been followup after operation, with an average of 51 months. In the group Ⅱ° of thumb loss, the overall functional impairment inproved from 11% to 1.7%, and in the remaining cases, from 5% to 0%. Sensation examination found S+3 in 42%, S4 in 37% and the two point discrimination between 4mm to 10mm. The merits of reconstruction of the distal thumb segment was stated and emphasized. The choice of operative procedures, the advantagesof emergency reconstruction, the selection emphasized of anastomosis site of blood vessels and the complications and sequelae of the donor foot were discussed in detaill.
Objective To explore the clinical effect of different types of free tissue transplantation on repairing tissue defects and reconstructing functions. Methods From November 2001 to September 2004, 14 types of freetissue transplantation and 78 free tissue flaps were applied to repairing tissue defects and reconstructing functions in extremities and maxillofacial region in 69 cases. Of the 69 cases, there were 53 males and 16 females (their ages ranged from 18 to 56, 31 on average). Five cases were repaired because of skin defects in foot, 22 cases were repaired because of skin defects in leg, 36 cases were repaired as the result of skin defects in hand or forearm and finger reconstruction, 3 cases were restored by virtue of ulna or radius defects, and 3 cases were repaired in maxillofacial region. There were 55 cases of open wound, in which 16 cases were infectious wound, 6 cases were osteomyelitis or pyogenic arthritis. There were 14 cases of noninfectious wound. The area of these tissue flaps ranged from 2.0 cm×1.5 cm to 43.0 cm×12.0 cm. The length of bone transplantation ranged from 10 cm to 15 cm. Results Arterial crisis occurred in 2 cases, venous crisis occurred in 2 cases.Seventysix flaps survived completely and 2 flaps survived partially which werelater healed. Fiftytwo cases were healed at stageⅠ, 13 cases were healed at stageⅡ(healing time ranged from 20 to 30 days), purulent infection occurred to 4cases(healing time ranged from 3 to 11 months). Bone healing time ranged from 6 to 8 weeks in finger reconstruction. Bone healing time ranged from 4 to 6 months in fibula transplantation. The function reconstruction and appearance were satisfying. The functions of all regions, where free tissues were supplied, were not disturbed. Conclusion Tissue transplantation and composite tissue transplantation are effective in repairing tissue defects and reconstructing functions.
Objective To observe the clinical efficacy of external-route microsurgery for retinal detachment (RD). Methods In 36 patients (36 eyes) with single rhegmatogenous RD, the silica gel piece and/or buckling bands were preplaced, and drainage of subretinal fluid, retinal cryotherapy, e xamination of locating the holes, and intraocular injection of gas were performe d under surgical microscope. The surgical effects were compared with those of ot her simultaneous 37 patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmscope. Results The simultaneous intraoperative observation of the fundus details and the sclera through the microscope was excellent in all cases. Under the surgical microscope, the reaction of r etinal cryotherapy was clearly visible without any serious surgical sequela. The observation of reaction of retinal cryotherapy and the orientation of the holes were not affected by mild opacity of the refractive media. Retinal reattachment was achieved in 31 eyes after the primary surgery and in 3 eyes after the secon dary surgery, with the final rate of rettachment of 94%. The best-corrected vi sual acuity was ＜0.1 in 6 eyes (16.7%), 0.1-0.4 in 15 eyes (41.7%), and ≥ 0.5 in 15 eyes(41.7%). The results were similar to those of the patients underwent surgery under indirect ophthalmoscope.Conclusion The external route microsurgery is simple, convenient, reliable, and effective. (Chin J Ocul Fundus Dis，2004，20：369-373)
To report the diagnosis methods and cl inical treatment effects of blood vessel trunk damage in l imbs. Methods From January 2001 to June 2006, 72 patients with vascular injury in l imbs were treated. There were 50 males and 22 females, aged from 5-60 years (median 39 years) and including 44 cases of open injury and 28 cases of closed injury.The locations were subclavian artery in 1, femoral artery in 23, popl iteal artery in 20, radia artery and ulna artery in 12, brachial artery in 11, axilary artery in 3 and anterior and posterior tibia artery in 2. The disease course was 30 minutes to 27 days. Injured arteries were repaired by suturing directly in 3 cases, by end-end anastomosis in 39 cases and by saphenous transplantation in 30 cases. The length of transplant veins was 3 cm to 8 cm. Results In 72 cases, 67 survived and 5 were given amputation. Fortyeight cases were followed up 6 months to 5 years. The blood flow rate and the diameter of blood vessel on the affected l imbs were not different from that of normal l imbs by colorful Doppler blood flow monitor. Forty cases recovered satisfactory l imb function. Eight cases had different degrees of dysfunction, of them, four cases received functional reconstructive operation, and the function and appearance were improved. Conclusion To investigate the mechanism and situation of injury, to examine patients carefully and analyze comprehensively are the key points of making earl ier diagnosis for branch blood vessel damage; microsurgical repair of the injured blood vessel is the assurance of the blood flow rate. For the blood vessel above elbow and knee injured and lacked blood supply more than 4 hours and fascia syndrome, earl ier opening the fascia cavity is the effective methods to recover the function of the l imbs and to avoid disabil ity.
OBJECTIVE To explore the pathogenic mechanism of intrinsic muscle contracture after replantation of severed palm or wrist, and put forward the prevention and treatment methods. METHODS From 1985 to 1997, 48 cases were received replantation of severed palm or wrist, among them, 9 cases with thumb adductor contracture and 6 cases with intrinsic muscle contracture were occurred in different degree. Two cases with mild thumb adductor contracture were received conservative treatment, and 7 cases with moderate thumb adductor contracture and 6 cases with intrinsic muscle contracture were received operative treatment. The pathogenic mechanism, clinical results, and prevention methods were studied in those 15 cases. RESULTS The postoperative function recovery was better in 4 cases, moderate in 5 cases with thumb adductor contracture, and better in 3 cases, moderate in 1 case with intrinsic muscle contracture, and moderate in 1 case, poor in 1 case with intrinsic muscle contracture of cord-like induration. Followed up 1 to 10 years, no recurrence was observed in all of 15 cases. The incidence and degree of thumb adductor contracture and intrinsic muscle contracture were closely related to the ischemia time of replanting graft. CONCLUSION Prevention of thumb adductor contracture and intrinsic muscle contracture is most important in severed palm or wrist replantation. When the ischemia time of replanting graft is longer than 12 hours, the effective decompression in myofascial compartment is performed in time to reach satisfactory result.
A total of 15 amputated adult upper limbs were used for this experiment by arterial infusion of Chengdu ink in 10% formalin, followed by dissection of the specimens, and then undergoing the process of making the specimens transparent. The speciments were immersed in winter-green oil, and the vascular architecture at the different levels of the flexor tendon of fingers were observed under surgical microscope. It was noted that the vascular supply of the flexor tendons of the fingers had a regular pattern: a richer blood vessels inside te tendon sheath were distributed eccentrically over the tendon; the blood vessels in the interior of the tendon located in the connecive tessues in between the tendon fascicules; the longitudinal blood vessels in the interior of the tendon did not run through the entire length of the tendon, but rather segmentally.
In order to find out the causes, diagnosis, and the prevention and treatment of vascular crisis following anastomosis of small vessels, 314 cases vascular crisis from 1985 to 1997, were analyzed, in which 152 cases, suffered from tissue necrosis either total or partial, making up 48.4%. One hundred and forty-four cases underwent conservative treatment occupying 45.8% and 104 cases had tissue necrosis, occupying 68.4%. Operative exploration was done on 170 cases, occupying 54.1% and 48 cases of them suffered from necrosis, which made up 31.6% of all necrotic cases. Eighty-six cases were followed up by regular visits, ranging from 40 days to 7 years, with the finding that those who had regained normal circulation after vascular crisis recovered as well as those without crisis, and among those who did not regain normal circulation but survived with the help of collateral circulation after vascular crisis, they were usually cases of bad union, healing of wound, persistent swelling, different degree of tissue atrophy, poor recovery of sensation. It was concluded that proper use of vascular anastomosis technique and prophylactic measures preventing postoperative vascular spasm were extremely important, in the prevention of development of vascular crisis following anastomosis of small vessels. If vascular crisis did not respond well to conservative treatment, prompt surgical exploration should be undertaken.
A study was carried out to observe the application of microsurgical technique in the repair defects of soft tissue and infected wounds of extremities. Eighty-three patients with soft tissue defects and infected wounds of extremities were treated by either transferring of vascularized cutaneous flap or transplantation of myocutaneous flap with vascular anastomosis. The result showed that eighty-three patients had gained success after a follow-up of 6 months to 4 years. It was concluded that soft tissue defects and infected wounds of extremities should be repaired as early as possible. Selecting the donor flap near the recipient site was of first choice. The method used for repair should be simple and easily applicable rather these very complicated one. The success depended on the correct treatment of local conditions, resonable design of donor flap and close monitoring after operation.
ObjectiveTo study the anatomicopathological relation between facial nerve (FN) and acoustic neuronoma (AN) and summarize the techniques of how to protect facial nerves in microsurgery. MethodsA retrospective analysis of 585 patients with acoustic neuronmas treated by microsurgery for the first time between January 2007 and March 2012 was carried out. Anatomicopathological relation between FN and AN and protection of the facial nerve were described. ResultsThe tumors were totally removed microsurgically in 552 patients, and the total removal rate was 94.4%. Subtotal removal was performed in 33 patients. Facial nerve was anatomically preserved in 558 cases, and the rate of facial nerve preservation was 95.4%. After one-year follow-up, 549 patients had House-Brackmann Ⅰ-Ⅳ function. The location and shape of the FN along the tumor was identified as the follows: FN displaced along the ventral and superior surface of the tumor in 279 patients (47.7%), the ventral and central in 243 (41.5%), the ventral and inferior in 33 (5.6%), the dorsal in 10, the superior pole in 6, the inferior pole in 3, and FN surrounded in 11. ConclusionGood understanding of the meaning of anatomicopathological relation between FN and AN, intraoperative monitoring and perfect microneurosurgical skills are important in achieving the goal of total resection of acoustic neuromas and anatomic reservation of the facial nerve.
ObjectiveTo analyse the microsurgical treatment and facial nerve preservation of giant acoustic neuromas. MethodsUnder the conditions of facial nerve monitoring, 400 patients with giant acoustic neuromas underwent microsurgical removal via suboccipital retrosigmoid approach between January 2005 and January 2013. There were 186 males and 214 females, with the age ranged from 15 to 74 years (mean, 41.6 years). The disease duration was 2-13 years (mean, 2.4 years). The lesions were located at the left cerebellopontine angle region (CPA) in 191 cases, right CPA in 200 cases, bilateral CPA in 9 cases. The clinical manifestations included unilateral hearing loss and tinnitus as first symptoms in 389 cases, facial numbness in 373 cases, unilateral facial paralysis in 370 cases, headache in 269 cases, lower cranial nerve symptoms with drinking cough and dysphagia in 317 cases, and unstable gait in 342 cases. Preoperative skull base thin layer CT showed varying degrees of horn-like expansion in ipsilateral internal auditory canal opening. MRI showed cysts in 78 cases and solid masses in 322 cases; with hydrocephalus in 269 cases. Postoperative cranial MRI or CT was taken to observe the extent of tumor resection. The preservation of facial nerves in anatomy was assessed by intraoperative microscope video and electrophysiological monitoring; the facial nerves function was assessed according to House-Brackmann (HB) classification on the first day after operation; and the rehabilitation of facial nerve function was also assessed at discharge and at 1 year postoperatively by using HB grade. ResultsTotal tumor removal was achieved in 372 cases (93.00%), and subtotal removal in 28 cases (7.00%). One case died of delayed brainstem ischemia at 14 days after operation, and 1 case died of lung infection at 20 days after operation; 398 cases were followed up 6 months to 8 years (mean, 3.5 years). Recurrence occurred in 1 case because of neurofibromatosis at 5 years after operation. The rate of anatomical preservation of the facial nerve during operation was 91.75% (367/400), and the functional preservation rate at the first day after operation was 62.75% (251/400). The HB grade of facial nerve function showed significant difference aomng 3 time points (at the first day, at discharge and at 1 year after operation) (χ2=23.432, P=0.000). Complications included postoperative intracranial infection in 11 cases (2.75%), cerebrospinal fluid leakage in 29 cases (7.25%), aggravated lower cranial nerve symptoms in 18 cases (4.50%), subcutaneous effusion in 13 cases (3.25%), second operation to remove hematoma in 9 cases (2.25%), postoperative circumoral herpes simplex virus infection in 25 cases (6.25%), and all complications were cured after symptomatic treatment. Postoperative hydrocephalus disappeared in 261 cases. ConclusionSurgical operation is the first choice in the treatment of giant acoustic neuromas. Under the auxiliary of neural electrophysiological monitoring, the microsurgery operation via suboccipital retrosigmoid approach for giant acoustic neuromas has extremely low mortality and high preservation rate of facial nerve function.