Upper limb compartment syndrome after an adder bite:a case report

Compartment syndrome after an adder bite is extremely rare, whose effects are only secondary to the cytotoxic and hemorrhagic effects of venom. Here we reported a case of compartment syndrome in the upper limb following an adder bite in the thenar eminence. Elevated compartment pressure was documented and immediate surgical fasciotomy was practiced. The patient achieved complete recovery with a good functional result. We discussed the controversies on fasciotomy and non-invasive measures in such a situation, and recommended intracompartmental pressure monitoring during the management of compartment syndrome following adder bites.     

寰枢椎椎弓根螺钉治疗Ⅲ型齿状突骨折的临床应用

<正>随着交通和高层建筑事业的发展,枢椎齿状突Ⅲ型骨折损伤更多见,这是一种严重的上颈椎损伤。由于齿状突在解剖形态及结构上的特殊性,损伤后不仅可导致寰枢椎不稳的严重损伤,也可能导致急性或迟发性颈脊髓损伤压迫并危及生     

胸腰椎爆裂性骨折前路术中硬膜损伤及脑脊液漏的处理

[目的]探讨胸腰椎爆裂性骨折前路手术中硬脊膜损伤及脑脊液漏的处理及其疗效。[方法]1999~2009年532例胸腰椎爆裂性骨折前路减压手术中出现硬膜损伤及脑脊液漏23例,为术中减压损伤硬膜、骨折块刺破硬膜或骨折移位致硬膜严重撕裂伤所致。硬膜缺损面积(0.6~3.0)cm×(0.8~2.5)cm。采用皮下筋膜和明胶海绵或阔筋膜和医用耳脑胶封堵填塞法处理。术后取低枕平卧位,常规应用甲强龙、甘露醇及抗生素4~6 d。术后24~48 h拔除引流管。[结果]经术中采用皮下筋膜和明胶海绵或阔筋膜和耳脑胶封堵填塞法和术后辅助处理后,21例治愈,切口Ⅰ期愈合;另2例术后存在脑脊液漏者,分别在术后8、15 d治愈。术后随访3~52个月(平均23个月)。全部病例无切口感染及脑脊液囊肿形成,效果良好。[结论]对胸腰椎爆裂性骨折前路减压术中发生CSFL者采用皮下筋膜和明胶海绵或阔筋膜和医用耳脑胶封堵填塞法处理是行之有效的措施,疗效满意。     

带阔筋膜的股前外侧皮瓣移植在手背复合组织缺损中的应用

目的总结带阔筋膜的股前外侧皮瓣一期修复手背皮肤、肌腱缺损的临床应用。方法回顾2003年5月～2010年1月临床应用带阔筋膜的股前外侧皮瓣修复手背复合组织缺损13例,观察其成活率、外形和术后功能,运用临床评价标准进行评价,并结合相关文献,分析应用该复合组织瓣修复手背皮肤、肌腱缺损的临床价值。结果13例皮瓣全部成活,按中华医学会手外科学会上肢功能评定标准,优2例,良5例,可5例,差1例。结论采用带阔筋膜的股前外侧皮瓣移植是一种修复手背皮肤、肌腱同时缺损的可靠手术方法。     

筋膜减张法在妇科腹腔镜手术第一穿刺中的应用

目的为避免妇科腹腔镜手术第一穿刺可能出现的严重并发症腹膜后血管损伤,找到最安全、省力的穿刺方法。方法观察纽252例,以筋膜减张法进行的闭合性穿刺,对照组130例按常规闭合性穿刺。筋膜减张法穿刺是在常规闭合性穿刺气腹针形成人工气腹后,用尖刀切开部分筋膜,再穿入穿刺套管。通过分析两组病例穿刺的安全性和易操作性,探索筋膜减张法穿刺的实用价值。结果临床观察组比对照组穿刺更省力,一次成功率高,穿刺深度可控性强。结论在妇科腹腔镜手术中第一穿刺采用筋膜减张法进行闭合性穿刺省力、省时．一次穿刺成功率高．安全可控制性强。更加适用妇科女医生的操作．有推广价值。     

Traumatic lumbar hernia

BACKGROUND:

Trauma has various presentations ranging from common injuries that are easily managed to uncommon presentations such as traumatic hernia that may be missed.

METHODS:

Despite being operated for fracture of the femur after a road traffic accident, a 50-year-old female patient remained undiagnosed with a right sided traumatic lumbar hernia for nearly six months after the accident. In this period, the patient underwent incision and drainage thrice for swelling in the right flank which was diagnosed as an infected hematoma by a doctor.

RESULTS:

The patient underwent surgery for repair of traumatic lumbar hernia by combined fascia lata graft and mesh hernioplasty. She remains well on follow-up.

CONCLUSION:

This case underscores the need for awareness of this entity for correct diagnosis and appropriate management that are the key to avoiding complications.KEY WORDS: Trauma, Femur, Hematoma, Hernioplasty, Fascia lata     

Diced cartilage for dorsal augmentation in rhinoplasty: effect on nasal projection and frontal nasal width

This research study was designed to evaluate the aesthetic consequences of different dorsal augmentation techniques using diced cartilage on dorsal width and projection in rhinoplasty. Patients were assigned to three groups based on the dorsal augmentation technique used: diced cartilage wrapped in fascia (DCIF), free diced cartilage under fascia (DCUF), and free diced cartilage without fascia (FDC). Dorsal projection and dorsal aesthetic width were measured at two levels using pre- and postoperative photographs. A total of 98 patients were included in the study. DCIF was used in 51 patients, FDC in 27 patients, and DCUF in 20 patients. There was no significant difference in nasion projection, rhinion projection, or width of the dorsal aesthetic lines at the intercanthal and keystone levels among these groups. Significantly greater nasion and rhinion projection was observed with DCIF in thin-skinned patients followed-up for 6–12 months (nasion, P = 0.028; rhinion P = 0.039) but not at>12 months. Two patients with a graft infection and one with graft malposition were encountered in the DCIF group. Experience from this study suggests that the application of FDC prevents such complications without sacrificing the dorsal augmentation and that DCIF is a better choice for more severe deformities.     

Chimeric ALT Plus TFL Perforator Flap for Breast Reconstruction Post Radical Mastectomy with Large Skin Defect

A 17-year-old girl with large malignant phyllodes tumor of left breast underwent a radical mastectomy with large skin excision resulting in defect of 20 cm × 18 cm. Postoperative radiation therapy necessitated robust cover with flap. The challenge was compounded by her body habitus. Both abdomen and back were deficient as donor sites and a single-island anterolateral thigh (ALT) flap would need skin grafts, volume deficit withstanding. We harvested chimeric ALT plus tensor fascia lata (TFL) perforator free flap sparing all muscles and nerves. Microvascular anastomoses were done to the second internal mammary artery (IMA) perforator artery and vein. The donor site was closed primarily. The TFL flap territory recruited almost three times the volume of ALT territory and allowed us to create a matching breast mound in addition to covering the defect. She tolerated 40 Gy radiation well and doesn’t desire further augmentation. Consistency of ALT and TFL perforators makes this a replicable procedure.     

应用皮肤牵张带延期闭合骨筋膜室减张切口

目的观察应用皮肤牵张带延期直接缝合骨筋膜室减张切口的效果。方法因骨筋膜室综合征而行切开减压术导致皮肤缺损患者 21例,年龄 7～ 36岁,小腿皮肤缺损 17例、前臂皮肤缺损 3例、足部皮肤缺损 1例。缺损区最小 5 cm× 15 cm,最大 11 cm× 28 cm,合并骨外露和肌腱外露者各 1例。于骨筋膜室切开减压后第 4～ 7 d放置皮肤牵张带,此后 3～ 7 d天待牵拉至两侧皮缘靠近时延期缝合伤口, 2周后拆线。结果 21例患者, 20例伤口一期愈合,形成线状瘢痕; 1例在放置皮肤牵张带之前伤口红肿,有较多分泌物,置皮肤牵张带 2 d后分泌物仍较多,故拆除 3根硅胶带,伤口引流,遗留 2 cm× 5 cm创面,经换药、小块游离皮片植皮后伤口愈合。 2例合并骨外露和肌腱外露者伤口愈合良好。随访 3～ 15个月,患肢远端关节活动自如,无肌肉挛缩现象。结论急性骨筋膜室综合征切开减压后,使用皮肤牵张带延期缝合伤口,安全、有效。其优点 :(1)操作方法简便、快速,病程短,费用相对较低; (2)无需游离皮片植皮,愈合后形成线状瘢痕,局部皮肤质量较好,对美观影响小; (3)同样适用于伴骨外露和肌腱外露者,可避免施行皮瓣转移覆盖手术。     

大鼠阔筋膜襻神经的免疫组织化学研究

目的 :证明Wistar鼠模型人工阔筋膜襻有神经分布。方法 :采用SP免疫组织化学染色方法 ,标记人工阔筋膜襻的S 1 0 0蛋白受体。结果 :术后一个月时 ,大鼠的阔筋膜襻有S 1 0 0蛋白表达 ,表明该人工阔筋膜襻有神经支配。结论 :人工阔筋膜襻是有神经支配的人工装置。