A safer technique of internal jugular venipuncture: Experience with 320 cases

Placement of central venous catheters for monitoring or long-term access has become an indispensable surgical procedure. Various routes to establish central venous access have previously been described. The internal jugular vein can be cannulated percutaneously from several access points, using the clavicle and the sternocleidomastoid muscle as reference landmarks. An alternate method of internal jugular venipuncture using a previously undescribed point of entry is described. Experience with this modified technique in 320 cases where it was used for various purposes is reviewed. The incidence of complication was less than 1% and the improved safety of the procedure is attributed to the vertical direct method of venipuncture through the new access point.     

Smart flap of sternocleidomastoid muscle in anterior cervical spine surgery: Surgical anatomical dissection technique

The use of sternocleidomastoid muscle flap has firstly been described in 1909. In spine surgery, it is usually reserved in the cases of revision after anterior cervical spine procedures. The aim of this article is to introduce its usage as prophylactic measure in cases at high risk of iatrogenic fistula formation. The procedure consists of three main steps: sternocleidomastoid isolation, flap design and harvesting, and flap fixation. The use of a surgical anchor allows a better adherence to the plate preventing hematoma formation. The use of SCM smart flap in primary anterior cervical spine surgery as a prophylactic method could be considered a safe and feasible procedure in patients with a high risk of iatrogenic fistulas.     

86例腮腺混合瘤手术后Frey(L)综合征的临床分析

本文对86例腮腺混合瘤术后发生Frey(L)综合征的52例患者进行了分析。表明Frey(L)综合征发生与手术方式有关,保留面神经的肿瘤及部分腮腺切除术与肿瘤及全腮腺切除术二者之间有显著性差别,后者明显高于前者(P<0.01)。本文认为采用部分胸锁乳突肌肌瓣插入腮腺缺损部位的方法可预防或减少Frey(L)综合征的发生。     

Sonographic appearance of pyomyositis of the sternocleidomastoid muscle: A case report

Pyomyositis in the neck has rarely been described. We present the sonographic findings in a case of pyomyositis of the sternocleidomastoid muscle. A 62‐year‐old man with poorly controlled diabetes presented with an induration of the neck and fever. On gray‐scale sonography, a part of the sternocleidomastoid muscle appeared swollen and contained irregularly shaped hypoechoic areas. Power Doppler imaging showed increased vascularity in the muscle. Sonographic‐guided aspiration confirmed abscesses in the sternocleidomastoid muscle. Surgical drainage was successfully performed along with antibiotic treatment. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45 :520–523, 2017     

电击伤所致喉瘘的修复

目的：探讨电击伤所致喉瘘的修复方法。方法：应用胸锁乳突肌皮瓣带蒂移植的方法修复喉瘘,放置喉模防止喉狭窄,恢复喉功能。结果：患者颈部皮损及喉功能恢复良好。结论：利用近处组织瓣修复电击伤,有利于创伤组织的恢复。     

Pseudotumor of Infancy and Congenital Muscular Torticollis: 170 Cases

Objectives To review pseudotumor of infancy (POI) and congenital muscular torticollis (CMT) and to suggest an algorithm for treatment. Study Design Retrospective review of cases from 1962 to 1998 at a tertiary care center. Methods Patients included in this study were 81 boys and 89 girls who had a diagnosis of POI (n = 38) or CMT (n = 132) before 24 months of age. Results For all patients, the mean age at diagnosis was 4 months; 54.1% had the left side of the neck affected, over 90% had a head tilt, and 2.4% had feeding difficulty as a result of the disorder. Plagiocephaly was present in 39.5% of patients with POI and 63.6% of patients with CMT; a neck mass, in 63.2% and 18.2%, respectively; and facial asymmetry, in 7.9% and 15.9%, respectively. All patients had a complete physical examination; 54.1% had plain cervical radiography, 4.1%, computed tomography, and 2.9%, ultrasonography. Passive range of motion was the initial treatment recommended for 65.3% of patients. Conservative treatment failed for 16 patients; subsequently, they had surgical treatment. Follow‐up data were available for 159 patients; 85.5% experienced total resolution and 14.5% experienced subtotal resolution or long‐term abnormality. Conclusions Children diagnosed with POI or CMT should be treated and observed for at least 12 months or until symptoms resolve. If symptoms persist 1 year after diagnosis despite conservative therapy, surgical treatment should be considered. The majority of children with POI or CMT experience total resolution of symptoms.     

胸锁乳突肌瓣在腮腺良性肿瘤切除术中的应用

目的：探讨胸锁乳突肌瓣在腮腺良性肿瘤切除术中的应用效果。方法：196例腮腺良性肿瘤患者随机分为对照组和实验组。对照组75例,采用常规手术方法切除腺体和肿瘤后,遗留凹陷处不做任何处理。实验组121例,应用胸锁乳突肌瓣修复腺体和肿瘤切除后遗留的凹陷缺损。病例随访6～48个月。结果：实验组患者术后面部凹陷畸形、Frey综合征及涎瘘的发生率均显著低于对照组患者（P〈0.01）。结论：胸锁乳突肌瓣能够显著改善腮腺良性肿瘤切除术后面部凹陷畸形,明显降低Frey综合征及涎瘘的发生率,值得在临床上推广应用。     

胸大肌皮瓣修复口腔颌面部缺损临床效果观察

目的:探讨胸大肌皮瓣修复口腔颌面部缺损的临床疗效。方法:选择我院2010年3月～2012年3月期间收治的53例口腔颌面部缺损患者,分为观察组(n=31)和对照组(n=22),观察组采用胸大肌皮瓣修复,对照组采用胸锁乳突肌瓣修复,比较两组患者的临床疗效。结果:观察组患者皮瓣修复成活率为96.8%,高于对照组的86.4%,组间差异有统计学意义(P<0.05)。观察组术后并发症发生率为9.7%,对照组并发症发生率为13.6%,组间差异无统计学意义(P>0.05)。结论:胸大肌皮瓣修复口腔颌面部缺损是一种安全有效的治疗方法,具有较高的临床应用价值,值得临床进一步推广使用。     

胸锁乳突肌瓣转位术后面瘫畸形的二期修整

目的探讨面瘫胸锁乳突肌瓣转位术后二期修整的手术指征和方法。方法21例经胸锁乳突肌瓣转位修复术后的晚期面瘫患者，术后随访3～25月。根据随访结果和患者的自身要求，对其中11例面部皮肤中度松弛、口角轻度下垂、颈部疤痕明显的患者，进行肌瓣悬吊提紧、面部松弛皮肤提紧和面颈部疤痕“z”改形等二期修整。结果患者术后面部的对称性及面颈部疤痕等情况均有明显改善。结论晚期面瘫患者经一期手术修复后遗留的面部不对称和面颈部疤痕等情况，可通过二期修整得到改善。