An algorithmic approach for the management of hand deformities in dystrophic epidermolysis bullosa

Treatment of hand deformities in epidermolysis bullosa patients represents a challenging field in hand surgery practice, thus a systematic approach by a team is mandatory for a successful result. A simple and practical algorithm for the surgical treatment of hand deformities in EB was employed by the authors where the deformities of each digit in EB patients was categorized according to pseudosyndactyly and interphalangeal joint contracture severity for guidance during the surgical treatment. The current study retrospectively reviewed the medical records and photographic data of 13 EB patients followed in our department, for whom a systematic approach to the management and treatment was used. Mild cases were treated by surgical release and secondary healing with non-adhesive dressing while moderate cases were treated with autologous dermal grafts harvested with a special technique that were fixed on denuded areas on the proximal interphalageal joints after release. The remaining areas were treated similarly to the mild group. Additional K-wires were applied for two weeks in severe cases. A total of 21 procedures were performed on 13 EB patients with hand deformities according to the proposed treatment strategy. Functional recovery was satisfactory for each patient and the outcomes were dependent upon the severity of deformity. A multidisciplinary and conscious approach followed by an algorithmic surgical treatment protocol described in the study has been beneficial in providing consistent and successful long-term results for these patients.     

中国乳腺癌术后假体乳房重建补片材料应用现状

假体为基础的乳房重建（IBBR）可以减少或避免自体组织乳房重建手术供区的损伤和瘢痕,近十年来逐渐成为了乳腺癌术后主要的乳房重建方式,同时随着材料学的进步和乳腺外科的发展,补片材料辅助技术已经广泛应用于IBBR手术。特别是对于需要植入较大假体的病例,借助人工材料联合胸肌,起到“延伸”肌肉组织、无张力覆盖假体的作用,使重建乳房下皱襞更为饱满、自然,进一步降低手术创伤的同时也增加了重建乳房的美学效果。近期在国内进行的补片材料应用情况调查显示：我国区域经济发达状况和患者的经济条件是选择乳房重建和人工补片应用的主要因素。此外,由于中国女性乳房的形态特点不同于欧美女性,对于乳房体积较小的假体乳房重建,较少应用人工补片,因此,国内重建补片材料的应用更具个体化和区域性。     

Anatomical study of Lapidus arthrodesis using two different plantar plate systems

BackgroundFirst tarsometatarsal arthrodesis (modified Lapidus procedure) constitutes a sufficient treatment for moderate to severe hallux valgus deformity and first ray instability. The plantar plate arthrodesis was shown to provide superior mechanical stability and less postoperative complications than screw fixation or dorsal plating. Nevertheless, the in-brought hardware may cause irritation of the tibialis anterior or peroneus longus tendon requiring explantation of the material in some cases.The purpose of this study was to investigate the potential of tendon irritation after plantar first tarsometatarsal joint arthrodesis in a cadaver study.MethodsPlantar plate arthrodesis was performed as in real surgery on twelve pairs of fresh frozen cadaveric feet. Two different plate systems were randomly allocated to each pair of feet. After plate fixation careful dissection of the feet followed to analyze potential tendon irritation and to determine a “safe zone” for plantar plate placement.ResultsA “safe zone” between the insertion sties of tibialis anterior and peroneus longus tendon was found and proven to be sufficiently exposed using a standard medio-plantar approach. Both plates were fixed in this zone without compromising central tendon parts. Peripheral tendon parts were irritated in 42% using Darco Plantar Lapidus Plating System® (Wright Medical, Memphis, TN) and in 8% using the Plantar Lapidus Plate® (Arthrex, Naples, FL). Bending of the anatomically preshaped plates is often necessary to ensure optimal fit on the bone surface.ConclusionsModified Lapidus procedure with plantar plating of the first tarsometatarsal joint can be performed safely without compromising central tendon parts via standard medio-plantar approach.Level of clinical evidence5, Cadaver Study.     

Malignant Skin Cancer Excision in Combined Therapy with Electro-Chemotherapy and Dermal Substitute

Squamous cell carcinoma (SCC) is the second most common malignancy skin cancer. It is characterized by abnormal, accelerated growth of squamous cells (SCs). SCC occurs when DNA damage from exposure to ultraviolet radiation or other damaging agents trigger abnormal changes in the SCs, presenting as painless lesions on areas of high sun exposure, such as the dorsum of the hand and upper extremity. For most skin SCC, the surgical excision alone is standard practice. However, recent efforts in new treatment strategies have involved around adjuvant or concomitant electrochemotherapy (ECT). ECT is a non-thermal tumor ablation modality, safe and effective on any type of solid tumor. An 87-year-old patient affected by hand SCC with invasion of deep structures including tendons was treated with neoadjuvant intra-tumoral ECT sessions followed by a selective surgical removal and reconstruction of the substance loss with collagen dermal template (CDT). Two neoadjuvant intra-tumoral ECT procedures, at distance of 3 months, with the aim to reduce the tumor size before a selective surgery, were performed. This study shows that combined surgical selective excision with ECT and CDT is a valid technique for the extended-deep dorsal hand tumor lesions reconstruction.     

New advances in the pathophysiologic and radiologic basis of the exstrophy spectrum

The exstrophy–epispadias complex is a rare spectrum of anomalies affecting the genitourinary system, anterior abdominal wall, and pelvis. Recent advances in the repair of classic bladder exstrophy (CBE) and cloacal exstrophy (CE) have resulted in significant changes in outcomes of surgical management (including higher continence rate, fewer surgical complications, and better cosmesis) and health-related quality of life in these patients. These noteworthy changes resulted from advances in the pathophysiological and genetic backgrounds of this disease and better radiologic assessment of the three-dimensional anatomy of the bony pelvis and its musculature. A PubMed search was performed with the keyword exstrophy. The resulting literature pertaining to genetics, stem cells, imaging, tissue engineering, epidemiology, and endocrinology was reviewed. The following represents an overview of the advances in basic science understanding and imaging of the exstrophy–epispadias spectrum and discusses their possible and future effects on the management of CBE and CE.     

经筋排刺法结合皮肤针对脑卒中后上肢偏瘫患者痉挛状态的影响:多中心随机对照研究

ObjectiveTo explore the effect of meridian sinew row needling combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis.MethodsFour hundred and eighty-eight cases of post-stroke patients with upper limb spasticity were randomly divided into two groups at the ratio of 1: 1, the group of meridian sinew row needling combined with dermal needling (group A, 244 cases) and western medication group (group B, 244 cases). Coupled with rehabilitation, the patients in the group A were given meridian sinew row needling combined with dermal needling where five shu points were specifically selected, and three yang meridians of the hand were treated with acupuncture with muscle region, and three yin meridians of the hand were treated with dermal needles; the patients in the group B was treated with conventional western medication with piracetam injection and cerebroprotein hydrolysate included. Clinical efficacy was evaluated among patients in the two groups after three weeks of continuous treatment, and upper limb spasticity and motor functions were observed through modified Asworth Scale and Fugl-Meyer Assessment Scale (FMA) before and after treatment.ResultsFor Asworth Scale, group A was significantly superior to group B (3.04 ± 1.29 vs 3.88 ± 1.54, P<0.05); for FMA scale, group A was also significantly superior to group B (48.67 ± 15.64 vs 42.96 ± 14.72, P<0.05); mitigations of motor status of upper limb joints in group A, such as remission of shoulder adduction (90.5%), pronation of forearm (70.7%), elbow joint flexion (73.1%), wrist joint flexion (80.9%) and finger flexion (88.1%), were superior to those of group B (70.0%, 60.0%, 61.9%, 57.4%, 63.2%, all P<0.05).ConclusionsGood clinical efficacy of the treatment with combined with dermal needling on spasticity of post-stroke patients with upper limb hemiparalysis is achieved.     

头孢菌素类药物临床皮肤过敏试验种类的现状调查

目的规范头孢菌素类药物皮肤过敏试验(以下简称皮试)医嘱及方法,保障医疗和护理安全。方法查阅218份使用头孢菌素类药物病历,了解皮试医嘱及护士执行情况;调查55名护士对头孢菌素类药物皮试液的了解情况。结果218名病人共做各类皮试222次,其中青霉素皮试112例,占50.5%;头孢菌素皮试87次,占39.2%;6例无皮试医嘱,占2.7%。55名护士对头孢菌素皮试液配制正确率为14.5%,对皮试浓度知晓率为3.6%。结论头孢菌素类药物皮试医嘱及皮试方法亟待国家有关部门进行规范。     

一种卷烟用抗菌接装纸抑菌效果及毒性试验观察

为了解卷烟用抗菌接装纸抗菌效果及卫生质量,进行了细菌污染检测和抑菌试验及皮肤刺激性试验。结果,此种卷烟用抗菌接装纸细菌污染检测全部合格,抑菌试验作用2 m in,对大肠杆菌、金黄色葡萄球菌抑菌率达到93%以上。该接装纸对家兔皮肤无刺激性,亦无皮肤变态反应。结论,新型卷烟用抗菌接装纸抑菌效果好,对皮肤无刺激,无致变态反应作用。     

重组人干扰素β-1a注射液制剂安全性研究

目的 检测重组人干扰素β-1a注射液的制剂安全性并探讨可能的影响因素。方法 分别以重组人干扰素β-1a注射液进行家兔肌肉和皮下刺激性试验、豚鼠主动全身过敏性试验、大鼠被动皮肤过敏性试验和体外溶血性试验,检测药物的局部刺激性、Ⅰ型过敏反应性和溶血作用。结果 pH 3.6的11、22 μg/kg重组人干扰素及其空白溶媒对家兔肌肉和皮肤黏膜具有轻度刺激作用,相应剂量下pH为4.3的重组干扰素及其空白溶媒对家兔组织无明显刺激作用;pH 3.5的5.5、22 μg/kg剂量下重组人干扰素及其空白溶媒对大鼠无被动致敏作用,对豚鼠主动致敏作用呈强阳性,辅料中不含人血清白蛋白的样品则对豚鼠无致敏作用;pH 3.5的重组人干扰素对家兔红细胞具有极轻度体外溶血作用,pH 4.5样品则无体外溶血和致红细胞凝聚作用。结论 pH值对重组人干扰素β-1a注射液刺激性和体外溶血性具有一定影响,应注意对其pH值的控制;干扰素对豚鼠致敏作用为辅料中人血清白蛋白所致,临床使用中对人产生致敏的可能性很小。重组人干扰素β-1a注射液制剂安全性较好。