Pulsatile Perfusion Reduces the Incidence of Delayed Graft Function in Expanded Criteria Donor Kidney Transplantation

The use of expanded criteria donors (ECD) has been proposed to help combat the discrepancy between organ availability and need. ECD kidneys are associated with delayed graft function (DGF) and worse long-term survival. The aim of this study is to evaluate the impact of pulsatile perfusion (PP) on DGF and graft survival in transplanted ECD kidneys. From January 2000 to December 2003, 4618 ECD kidney-alone transplants were reported to the United Network for Organ Sharing. PP was performed on 912 renal allografts. The prognostic factors of DGF were analyzed using multivariate logistic regression analysis. Risk factors for reduced allograft viability were greater in donors and recipients of PP kidneys. Three-year graft survival of ECD kidneys preserved with PP was similar to cold storage (CS) kidneys. The incidence of DGF in PP kidneys was significantly lower than CS kidneys (26% vs. 36%, p < 0.001). Despite having a greater number of risk factors for reduced graft viability, the ECD-PP kidneys had similar graft survival compared to ECD-CS kidneys. The use of PP, by decreasing the incidence of DGF, may possibly lead to lower overall costs and increased utilization of donor kidneys.     

Pedicled deltoid hatchet flap for treatment of pressure sore at the shoulder

Whereas decubitus ulcer in the back or hip region is a common entity in plegic or elderly patients, the occurrence in the lateral shoulder region is seldom seen. However, resulting from continuous lateral decubitus positioning or limited compliance by the patient, pressure sores may occur in almost any region of the body, but predominately, they arise in acral zones with underlying bone prominences. The deltoid area is such an anatomically critical region, especially if the underlying deltoid muscle is paralyzed. The transposition of a pedicled deltoid flap, slightly modified as a hatchet flap, is described for cover of a decubitus ulcer in the deltoid region in a paraplegic male. Although utilization of the deltoid flap as a free flap is an established procedure for selected indications [Russell et al. (1985) Extremity reconstruction using the free deltoid flap. Plast Reconstr Surg 76:586–595, Serafin D (1996) The deltoid flap. In: Serafin D (ed) Atlas of microsurgical composite tissue transplantation, chapter 19. Saunders, Philadelphia, PA, pp 153–159, Wang et al. (2003) The free deltoid flap: microscopic anatomy studies and clinical application to oral cavity reconstruction. Plast Reconstr Surg 112:404–411], transposition as a pedicled flap, to the best of our knowledge, has not been previously described in the available literature.     

A new pedicled seromuscular flap technique for high-risk intestinal anastomoses

A new method for protecting intestinal anastomoses in patients at high risk of anastomotic dehiscence or fistula formation is described herein. This method involves raising a seromuscular flap on a pedicle from the stump of the intestine to be anastomosed. The anastomosis is performed, then covered with the seromuscular flap.     

胸大肌肌皮瓣在口腔颌面部缺损修复中的应用

报道２１９例口腔颌面部肿瘤，其中良性肿瘤１８例，恶性肿瘤２０１例，在肿瘤切除后，均采用胸大肌肌皮瓣修复缺损。采用单皮岛肌皮瓣２０１例，双皮岛肌皮瓣１６例，肌皮骨瓣２例。成功２０１例，失败１８例。讨论了胸大肌皮瓣的优点及适用范围。介绍了手术设计、操作方法。分析了成功与失败的影响因素，认为正确，精细的手术技巧是成功的关键因素。     

便携式多普勒血管探测仪在皮瓣移植中的应用

目的 :研究皮瓣移植前简单、可靠的血管探测的方法。方法 :在皮瓣移植前 ,以 HADECO ES-1 0 0 0 SPM多普勒血管探测仪对皮瓣血管蒂及皮动脉进行探测 ,与术中皮动脉探查结果进行比较 ,考察术前血管探测的准确性和意义。结果 :皮瓣血管蒂及皮动脉术前探测与术中探查结果完全一致。结论 :便携式血管多普勒仪是皮瓣移植前 ,简单、可靠的血管探测的仪器 ,根据探测结果进行皮瓣设计 ,有效地降低了手术失败的风险     

Anatomic bases of tongue flaps

Summary The morphological structure of the lingual a. was studied in 50 dissected and 14 vascular cast specimens. The course of this artery is divided into 4 segments: the original segment, the segment within hyoglossus, the ascending and the horizontal segments of the deep lingual a. The root of the tongue is supplied by 2 to 3 root branches of the lingual a., the ascending palatine a. and the tonsillar a. The body of the tongue is nourished on average by 25 arterial branches from the deep lingual a. The ventral surface of the tongue, as well as the sublingual gland and the floor of the mouth, is supplied by the sublingual a. The termination of the lingual a. anastomoses with the submental branch of the facial a. to form the lingual frenal a. Except for a submucous arterial network on the dorsum of the tongue, all blood vessels are separated completely by the lingual septum, through which arterial anastomoses (2.0 mm in diameter) can be found occasionally.This work was supported by the National Natural Science Fund     

Fricke supraorbital flap for reconstruction of total lower eyelid defects

Summary Split or full thickness eyelid defects resulting from tumor destruction or surgical excision present a dilemma for plastic and reconstructive surgeons. Full thickness eyelid replacement requires composite grafting of the skin, together with tarsal support of its substitute and mucosa. The flap described by Fricke in 1829 was used for reconstruction of anterior lamella in six lower eyelid defects. In three of our cases chondromucosal grafts taken from nasal septum were utilized for posterior lamella repair. The results have been satisfactory from a functional and cosmetic standpoint.     

The surgical management of resistant club foot by rotation skin flap and extensive soft tissue release

Summary Resistant club foot remains an unsolved problem because of the complex aetiological and pathological factors, and is still seen quite frequently, especially in developing countries. The posteromedial skin contracture is a potent deforming force which is responsible for many failures or relapses. I report the results of an operation in which a rotation skin flap was combined with an extensive soft-tissue release. The age of the children was from 9 months to 10 years. The follow-up period was from one to 9 years with an average of 43 months, and in 50 cases for more than 5 years. I consider that the outcome has been excellent or good in 94 out of 100 feet.

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Résumé Le pied bot invétéré demeure un problème mal résolu en raison de la complexité des facteurs étiologiques et anatomiques et il est encore bien souvent rencontré, notamment dans les pays en voie de développement. La rétraction cutanée postéro-interne représente un puissant élément de la déformation, qui est responsable de bon nombre d'échecs ou de récidives. Nous rapportons les résultats d'une opération qui associe un lambeau cutané de rotation à la libération des parties molles. L'âge des enfants était compris entre neuf mois et dix ans. Le recul est de un à neuf ans, avec une moyenne de 43 mois. Cinquante enfants ont été suivis plus de cinq ans. Les résultats sont excellents ou bons dans 94% des cas.

     

The Broad Spectrum of Quality in Deceased Donor Kidneys

The quality of the deceased donor organ clearly is one of the most crucial factors in determining graft survival and function in recipients of a kidney transplant. There has been considerable effort made towards evaluating these organs culminating in an amendment to allocation policy with the introduction of the expanded criteria donor (ECD) policy.
Our study, from first solitary adult deceased donor transplant recipients from 1996 to 2002 in the National Scientific Transplant Registry database, presents a donor kidney risk grade based on significant donor characteristics, donor–recipient matches and cold ischemia time, generated directly from their risk for graft loss. We investigated the impact of our donor risk grade in a naïve cohort on short- and long-term graft survival, as well as in subgroups of the population.
The projected half-lives for overall graft survival in recipients by donor risk grade were I (10.7 years), II (10.0 years), III (7.9 years), IV (5.7 years) and V (4.5 years). This study indicates that there is great variability in the quality of deceased donor kidneys and that the assessment of risk might be enhanced by this scoring system as compared to the simple two-tiered system of the current ECD classification.     

168例食管烧伤后瘢痕狭窄的预防和治疗

目的 总结食管烧伤后瘢痕狭窄预防和治疗的经马命。方法 168例中158例进行了172次外科治疗，11例进行了2次以上手术。早期人院Ⅱ度期以上34例采用改良食管腔内置管预防食管烧伤后瘢痕，末切除瘢痕狭窄结肠重建77例，切除狭窄食管胃重建27例，颈阔肌皮瓣修复颈部食管狭窄22例，其他类型手术12例。结果 29例拔出支撑管后治愈（85％）；5例再狭窄，其中1例扩张治愈。77例结肠重建术后5例死亡，颈部吻合口瘘14例，吻合口狭窄4例，腹部切口裂开2例。27例胃重建中，吻合口狭窄2例。脓胸1。颈阔肌皮瓣修复颈段狭窄22例中，3例发生颈部瘘。其他手术12例中，1例术后死于肠梗阻。所有生存出院患者均能进普食。 结论 管腔内置管能有效预防食管烧伤后瘢痕形成，根据瘢痕狭窄部位确定食管重建时是否切除狭窄食管。颈阔肌皮瓣是修复颈段食管狭窄或吻合口狭窄的优良方法。