Pectoralis major muscle flaps for closure of sternal defects

Summary A reliable and simple technique involving the use of pectoralis major muscle flaps is described for the closure of sternal and costal cartilage defects caused by debridement for chronic osteomyelitis following median sternotomy. No bone grafts, omentum flaps or skin grafts have been needed in more than 20 patients.     

经角膜缘结膜切口小梁切除术

小梁切除术降眼压机理主要是外引流,故泸枕形成的好坏是手术成败的重要标志。结膜瓣的制备直接影响泸枕的形成。本文总结29例41眼经角膜缘切口小梁切除术,与对照组比较,具有损伤轻、愈合快、泸枕形成好、手术野清晰、简便、省时、效果可靠等优点。     

喉及下咽部少见恶性肿瘤6例

目的：增加对喉及下咽部少见肿瘤的认识，为临床积累资料。方法：回顾分析喉及下咽部少见恶性肿瘤6例的临床资料。结果：6例中4例表面黏膜光滑，术前活检困难；1例仅有咽部异物感，曾误诊为慢性咽炎；经治疗，随访2－3年无复发4例，0．5－1．5年复发2例。结论：术前活检宜在直接喉镜下深取或术中作快速冰冻检验；如患者仅有咽部异物感，应常规检查下咽部；治疗以手术为主，切除范围应足够大，有的患者术后需加以放疗。     

The dorso-nasal artery-island flap

Skin defects on the nasal dorsum remain a challenge for the plastic surgeon. Because the skin of the glabella and nasion is rather loose, it can be advanced or rotated into the defect at the dorsum of the nose in a one-stage repair. This article reports on an arterialized fronto-nasal island flap of the upper nose, based on only one dorsal nasal artery. Received: 22 July 1997 / Accepted: 6 February 1999     

AO external fixator for definitive treatment of an open distal tibia fracture during the COVID-19 pandemic

BackgroundThe accepted gold standard for primary treatment of long bone open fractures consists of aggressive debridement, irrigation and temporary external fixation. Removal of the external fixator followed by definite internal fixation is recommended within the first two weeks after the injury to obtain a more stable fixation, alleviate rehabilitation and to avoid pin infection.Materials & MethodsHere, we report a case of a Gustilo IIIB open tibia fracture with extended soft tissue degloving of the distal tibia. Following removal of the AO external fixator, plate fixation and soft tissue coverage with a free flap, implant loosening occurred warranting a return to external fixation. The patient did not return for follow-up due to a prolonged COVID-19-quarantine and no further treatment was installed.Results & ConclusionsThe patient returned after 6 months with the fractures and soft tissues fully healed. In specific situations, the external fixator may be used as a definitive form of treatment.     

PAIN-FREE INTRALESIONAL INJECTION OF TRIAMCINOLONE FOR THE TREATMENT OF KELOID

Intralesional injection of triamcinolone acetonide (TA) for the treatment of keloid is painful, and lidocaine-mixed preparations are much the same. I have injected TA (10 mg/ml) at the speed of 3-6 ml/hour using an electric syringe pump 40 times for the treatment of 10 keloids, 18 times without lidocaine and 22 times with lidocaine. The 95% confidence intervals (CI) of the 100 mm visual analogue pain scale of the TA alone group and the lidocaine-mixed group were 2.0 to 9.5 mm and 1.0 to 6.7 mm respectively, suggesting that both are practically pain-free. The speed of injection is an important determinant of pain in intralesional chemotherapy. The injection should be extremely slow, and lidocaine should be added for sensitive patients.     

前臂外侧皮神经营养血管远端蒂皮瓣的临床应用

目的报道前臂外侧皮神经营养血管远端蒂皮瓣的临床应用疗效。方法根据前臂外侧皮神经营养血管皮瓣血供来源及其与前臂筋膜皮肤血供的相互关系，在前臂外侧设计皮神经营养血管远端蒂皮瓣，转位修复手部、腕部及前臂远端软组织缺损19例。结果术后皮瓣完全成活，创面一期愈合，经3～30个月随访，皮瓣外形与手部功能恢复满意。结论前臂外侧皮神经营养血管远端蒂皮瓣解剖位置恒定，血液供应良好，手术方法简单，适用于修复手部、前臂软组织的缺损。     

Hemicorporectomy: back to front

Hemicorporectomy involves amputation of the pelvis and lower extremities by disarticulation through the lumbar spine with concomitant transection of the aorta, inferior vena cava, and spinal cord, as well as creation of conduits for diversion of the urinary and fecal streams. A review of the literature reveals that the surgical technique has been relatively unchanged since 1960. The standard anterior to posterior approach is associated with significant blood loss and morbidity, likely contributing to lengthy hospital stay. Herein, we describe our back-to-front approach to hemicorporectomy, involving early division of the vertebral structures and spinal cord, pre-empting engorgement of Batson's plexus, thus minimizing blood loss. In addition, this approach greatly improves exposure of the pelvic vessels, allowing for a technically less challenging and safer procedure.