Mammaplasty: A New Approach

In this paper, the authors demonstrate a single stitch that brings together and encircles the mammary base at the aponeurosis of the musculus pectoralis major, closing the mammary base while elevating the mammary cone and achieving better projection of the superior poles.     

双环型缝合法矫正乳头内陷

乳头内陷手术方法较多，多数人术后有不同程度瘢痕遗留，患者感觉不甚满意。为矫治乳头内陷提供一种新的手术方法。我科从１９９２ 年以来采用双环型缝合法矫治乳头内陷３０ 例，全部获得满意的效果。随访３ ～２４ 个月矫治的乳头形态自然，无遗留瘢痕，无不良反应，无需拆线。本法是矫治乳头内陷的一种简单、安全、有效的方法。     

Reduction Mammaplasty and the Use of Dextran Against Thromboembolism

A retrospective study was conducted on 98 consecutive patients who had reduction mammaplasty done by different techniques during 1995, to find out the effect of dextran 70 on operative blood loss and postoperative complications. The most common procedure was reduction with a laterally based flap ( n = 67) followed by a Lejour vertical mammaplasty ( n = 15) and a medially based flap ( n = 12). Four had other operations. Dextran 70 was given peroperatively to 64 patients and their median (range) blood loss was 350 (30-1000) ml and drainage volume 80 (10-465) ml. In 33 patients not treated with dextran 70 the median (range) blood loss was 200 (25- 650) ml and the drainage volume 40 (0-115) ml. Ten patients developed major complications and 16 minor complications and there was no difference in the complication rate between those given dextran 70 (18/64, 28%) and those who were not (8/33, 24%), p = 0.8. Complications were no more common in smokers, overweight patients or those whose breasts were reduced by more than 1500 g, but there was a tendency to find more complications after the Lejour vertical mammaplasty. In conclusion, the study shows that patients undergoing mammaplasty and given Dextran 70 have an acceptable blood loss and drainage. In patients with a high risk of developing thromboembolism there is a need for a prophylactic agent and this study shows that dextran 70 may safely be used during reduction mammaplasty.     

Mammaplasty: Shape,volume, and scar size

Recently many mammaplasty techniques have been presented with special attention paid to the resulting scar's size and its position. The surgeon should try to hid the scar, and if the inverted T incision is used, its horizontal branch should be as short as possible and kept in the breast area. Neverthelss, excessive concern about the final scar size should not interfere with the final results of the mammaplasty as far as shape, volume and lasting results are concerned. The author presents his experience in mammaplasty with respect to the volume, the shape, and the scar size interrelationships.     

全系膜切除术和双吻合技术在低位直肠癌保肛术中的应用

目的探讨全直肠系膜切除（TME）联合双吻合器（DST）在低位直肠癌手术中的应用效果。方法回顾性分析2007年至2008年133例直肠癌应用全直肠系膜切除联合双吻合器行低位直肠前切除的临床资料。结果本组术后出现吻合口漏8例（6%）,吻合口狭窄4例（3%）,直肠阴道瘘2例（1.5%）,吻合口出血3例（2.3%）,经对症治疗后治愈,死亡3例（2.3%）。结论全直肠系膜切除联合双吻合器的应用可有效保留肛门功能,是治疗低位直肠癌的有效方法。     

经骨缝合与缝合锚钉技术在内侧髌股韧带双束重建术中应用的比较研究北大核心CSCD

目的探讨经骨缝合术在内侧髌股韧带(medial patellofemoral ligament,MPFL)双束重建术中应用的效果。方法回顾分析2014年1月—2017年12月收治且符合选择标准的75例复发性髌骨脱位患者临床资料,均采用MPFL双束重建术治疗,根据术中固定技术分为研究组(39例,新型经骨缝合术)和对照组(36例,传统缝合锚钉固定)。两组患者性别、年龄、身体质量指数、患膝侧别以及术前胫骨结节-滑车沟距离、Insall-Salvati比值、膝关节活动度、Kujala评分、国际膝关节文献委员会(IKDC)评分、适合角、倾斜角等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、住院时间、术后并发症等情况。手术前后采用Kujala评分、IKDC评分及膝关节活动度评价患者功能改善情况;于X线片上测量适合角、倾斜角。结果两组患者手术时间、术中出血量、住院时间比较差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间24~36个月,平均29.4个月。随访期间均未出现切口感染、脂肪液化,髌骨再脱位及髌前疼痛等并发症。末次随访时,两组患者Kujala评分、IKDC评分、膝关节活动度、适合角和倾斜角均较术前显著改善,差异有统计学意义(P<0.05);两组间比较差异均无统计学意义(P>0.05)。结论应用缝合锚钉固定或经骨缝合术完成MPFL双束重建均可恢复髌骨稳定性,二者术后近期疗效无明显差异。     

低位直肠前切除术应用双重器械吻合的经验

目的：探讨应用双重器械吻合在保留肛门手术中的应用。方法：回顾性分析我们1994年6月至2002年1月期间对114例低位直肠癌病人应用双重器械吻合,行低位直肠前切除术的临床资料及经验。结果：本组114例无手术死亡,4例（3．5％）术后出现吻合口漏,5例（4．4％）发生吻合口狭窄,经冲洗引流及扩肛2个月后皆治愈。结论：对于低位直肠癌的保肛手术,应用双重器械吻合可使手术简便、可靠、安全、省时。     

全直肠系膜切除联合双吻合器在低位直肠癌手术中的应用

目的 探讨全直肠系膜切除(TME)联合双吻合器(DST)在低位直肠癌手术中的应用效果.方法 回顾性分析2004年至2006年15例直肠癌应用全直肠系膜切除联合双吻合器行低位直肠前切除的临床资料及经验.结果 本组无死亡病例.无排尿及性功能障碍.吻合口狭窄2例,经扩肛后治愈.结论 全直肠系膜切除联合双吻合器的应用可保持盆腔脏器功能,是治疗低位直肠癌的有效方法.     

弧形切割吻合器在低位直肠癌双吻合器技术中的应用

目的 评价弧形切割吻合器在双吻合器技术中的作用.方法 309例低位直肠癌患者分别采用弧形切割吻合器(弧形切割吻合器组,90例)及直线型闭合器(直线型闭合器组,219例)进行双吻合器吻合,对两组患者的术后保肛率及并发症进行比较.结果 弧形切割吻合器组保肛率(57.8%)高于直线型闭合器组(44.7%),两组比较,P＜0.05,差异有统计学意义.两组吻合口瘘、吻合口狭窄和吻合口出血发生率比较,P＞0.05,差异无统计学意义.结论 应用弧形切割吻合器可以提高低位直肠癌患者的保肛率.     

腘绳肌腱结合双固定技术重建前交叉韧带

目的探讨采用腘绳肌腱股骨端胫骨端双固定技术重建前交叉韧带(ACL)的可行性及近期疗效。方法对25例ACL损伤行关节镜下ACL重建术,采用笔者自行设计双监视法解剖等长重建技术建立股骨胫骨隧道。移植物股骨端用Endobutton钢板和Rigidfix固定,胫骨端用Bio-Intrafix和Stample门形加压钉固定。结果本组获随访12～18(13.76±1.61)个月,未发现滑膜炎、韧带断裂、活动度明显障碍等并发症。根据Lysholm膝关节功能评分,术前评分:20～48(31.32±8.71)分;术后1年评分:90～98(94.96±2.56)分(t=37.69,P<0.01)。结论在腘绳肌腱重建ACL中应用股骨端胫骨端双固定技术具有手术操作简便,固定牢固,效果可靠的优点,值得推广。     

经腹经裂孔纵隔内食管-胃和食管-空肠双吻合新技术的应用

目的探讨经腹经裂孔行扩大近端胃或全胃切除术后,在纵隔内完成食管-胃或食管-空肠吻合的方法。方法2010年5月至2012年1月,对15例食管胃交界部腺癌患者在施行开放经腹膈肌裂孔扩大胃切除术或全胃切除术后,采用腹段食管逆向置入抵钉座、弧形吻合器切断食管、利用缝线牵出抵钉座的方法予以双吻合技术完成食管-胃或食管-空肠吻合,其中9例为近端胃大部切除行食管-管状胃端端吻合,6例为全胃切除术行食管-空肠吻合。结果全部病例吻合过程顺利,手术时间（185．5±13．1）min,吻合耗时（42．0±8．6）min,术中出血量（106．7±34．9）ml,食管切缘距肿瘤近端（4．4±1．2）cm．残端均无癌残留。无手术死亡及吻合口瘘发生,术后随访发现1例吻合口狭窄．经扩张后缓解。结论抵钉座逆向置人食管联合弧形切割闭合器双吻合技术能简单而安全地在下后纵隔完成食管-胃或食管-空肠吻合．可能成为食管胃交界处癌行扩大胃切除术后的一种较理想的吻合方式。     

一种新的重睑成形术──“切埋法”重睑成形术

本文报道一种重睑成形术的新方法“切埋法”重睑成形术１４８例，该手术优点是术后切口瘢痕小，成形自然，恢复期短，重睑保持时间长，集中了埋线法与切开法重睑成形术的优点，改进了二者之缺点。本术缺点是要求术者有一定的经验，若切口切开后临时改变设计弧线，则重睑线高低可调节的范围不大。     

A double running suture technique for keratoplasty: earlier visual rehabilitation.

The technique of using two continuous sutures of different caliber and relative tightness, running in the same direction, is described for penetrating keratoplasties. The primary purpose of the technique is to allow visual correction earlier in the postoperative period. In addition, graft slippage with override and posterior wound gape, both occurring at suture removal with resultant functional loss, have been eliminated.     

Endoscopic stenting of colovaginal fistula: the transanal and transvaginal "kissing" wire technique.

Interventional endoscopy is a rapidly evolving field allowing surgeons and endoscopists to approach surgical conditions nonoperatively. Stenting of benign colorectal disease has been limited due to technical issues and lack of long-term data. Colovaginal fistula can be a challenging condition to treat. In this report, we describe the technical aspect and results of endoscopic stenting of benign colovaginal fistula in 2 patients, using the combined transanal and transvaginal approach.     

微小切口双重荷包缝合法矫正重度乳头内陷

目的 介绍一种疗效确切,创伤小,矫正重度乳头内陷的新术式.方法 设计切口位于乳晕第四象限,方向斜向外下方,呈放射状切口,长约1.5 cm,松解乳头基底部,切断牵拉的纤维条索,上提乳头,在距乳头0.8cm和1.5cm处,双重荷包缝合固定.结果 12例乳头内陷患者术后随访1个月至4年,均获得满意疗效.乳头横径、纵径、高度及外观明显改善.结论 该术式矫正乳头内陷具有切口小、创伤轻微、操作简单易行、效果确切、不易复发和并发症少等优点.     

改良型双反牵引技术治疗胫骨平台骨折的疗效分析北大核心CSCD

Objective To study the clinical efficacy of our modified double reverse traction technique in the treatment of tibial plateau fractures. Methods A retrospective study was conducted of the 66 patients with tibial plateau fracture who had been treated by our modified double reverse traction technique at Articular Department, Zhongshan Hospital of Traditional Chinese Medicine from March 2019 to December 2021. There were 37 males and 29 females, with an age of (44±14) years. The double reverse traction technique was used in all patients for reduction of the tibial plateau fracture, and their collapsed articular surfaces were restored by our self-designed universal high affinity prying technique, or by fibular graft support, or by the hooping technique to restore the transverse diameter of the tibial plateau which had been widened. The outcomes of fracture reduction at 2 days postoperation were recorded and evaluated by Rasmussen imaging assessment. Complications were also recorded. The visual analog scale (VAS) pain scores and Hospital for Special Surgery (HSS) scores were compared between preoperation, 3 and 6 months postoperation and the rates of fracture healing between 3 and 6 months postoperation. Results This group of 66 patients was followed up for 12.0(8.0, 16.5) months. The Rasmussen imaging assessment at 2 days postoperation: 60 excellent, 4 good, and 2 fair cases, yielding an excellent to good rate of 97.0% (64/66). At 3 and 6 months postoperation, the VAS scores [1 (0, 1) and 0 (0, 1)] and HSS scores [84 (78, 88) and 91 (85, 95)] were significantly improved compared with those before operation [4 (3, 5) and 36 (29, 39)], and the values at 6 months postoperation were significantly improved compared with those at 3 months postoperation (P<0.05). The rate of clinical fracture healing at 6 months postoperation (100%, 66/66) was significantly higher than that at 3 months postoperation (77.3%, 51/66) (P<0.05). Perioperatively, no adverse events were observed like incision infection, deep vein thrombosis of lower limbs, or failure or exposure of internal fixation, except for delayed incision healing in only one patient. Conclusion In the minimally invasive surgery for tibial plateau fractures, our modified double reverse traction technique can result in excellent fracture reduction by imaging assessment, fine functional recovery of the knee joint and relief of pain. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

Mammaplasty: a technique of comprehensive correction of the ptotic breast

Ptosis of the breast and the optimum position of the nipple in the non-ptotic breast have been defined. A descent of the infra-mammary fold in ptosis is demonstrated: the concept of the nipple infra-mammary distance is introduced and the optimum values are defined. The principle of relocating the infra-mammary fold in any form of mammaplasty where the nipple is elevated is introduced together with a precise method for defining the new level of the infra-mammary fold in relation to the proposed size of the reconstructed breast. Emphasis is placed on the aesthetic significance of avoiding inter- and extra-mammary scarring.     

The McCannel suture: a bimanual technique.

The bimanual technique utilizing the iris manipulator and a full air bubble allows excellent control of anterior chamber depth and IOL position. It also minimizes the risk of trauma to the underlying lens, posterior capsule or vitreous during placement of iris sutures; and its use may prevent the tragedy of severe endothelial damage during insertion of the McCannel suture.     

Partial primary closure in sacrococcygeal pilonidal sinus: Modified with suture technique

Aim and backgroundThe primary purpose of pilonidal sinus treatment is to minimize complications, accelerate wound healing, and minimize recurrence. However, invasive and minimally invasive methods are being developed to reduce these problems. Early and late postoperative complications remain significant problems in pilonidal surgery. This study aimed to contribute to this issue in surgery by comparing the results of the Karydakis flap (KF) technique and those of the partial primary closure (PPC) technique, to which we applied suture modification.MethodsA total of 96 patients diagnosed with pilonidal sinus disease (PSD) were randomly assigned to two groups. Apply the partial primary closure in 46 patients and the Karydakis technique in 50.ResultsIn comparison to the Karydakis technique, the partial primary closure (PPC) group's hospitalization stay was shorter, although the difference was not significant. Healing time was also longer in uncomplicated cases (p = 0.200 and 0.064, respectively). Abscesses and hematomas were not observed with partial primary closure, but the total complication rate was similar to that of the Karydakis technique. Surgical site infections were often seen in the PPC group (21.7% vs. 10%). In contrast, healing time for complicated cases was found to be significantly shorter in the PPC technique (p < 0.05).ConclusionPostoperative abscess, hematoma, and seroma are the most common causes of total wound dehiscence, and delay in wound healing in off-midline techniques. We recommend the PPC technique with suture modification as an alternative to off-midline techniques in clean and chronically infected cases, other than cellulitis, abscess, and purulent discharge cases. However, we primarily recommend off-midline techniques in clean or asymptomatic cases.     

Combination of the vertical and periareolar mammaplasty

Vertical mammaplasty has been perfected and popularized by Madeline Lejour; this technique is one of the most versatile methods of manunaplasty today. The vertical scar from the nipple areola to the submammary line is often much longer and distorted than the conventional mammaplastys. The length of the vertical scar can be reduced by 2–3 cm by combining the skin pattern of the periareolar and vertical mammaplasty. The aesthetic result can be improved by shortening the vertical scar.