Three-dimensional mesh for ventral hernias: a new technique for an old problem

The morbidity/mortality associated with ventral hernias continues to be a serious medical problem due to high rates of recurrence. Meshes offer a simple and effective solution and, bearing this in mind, we describe a new protocol developed in our department, which consists of dissecting the hernia to free the peritoneal space, in which the three-dimensional mesh (PHS) is lodged. From July 1999–November 2002, this technique was used in 32 adult and elderly patients: four eventrations caused by trocars, seven eventrations from laparotomy, 14 umbilical hernias, five epigastric hernias, and two spigelian hernias. The size of the hernial ring was 10 cm or less in all cases. All patients underwent surgery under spinal anaesthesia and with antibiotic prophylaxis. No patient required readmission, experienced infection of the mesh or recurrence, or required more oral analgesia than prescribed on discharge. The mean hospital stay was 30±15 h, and only five of 32 patients required more than 1 day of stay. No deaths occurred. Therefore, we think that the use of the PHS mesh in ventral hernia is a safe, effective, and simple technique.     

Perforator flaps—how many perforators are necessary to keep a flap alive?

Perforator flaps are becoming increasingly important in reconstructive microsurgery because of their reduced donor-site morbidity. However, one drawback is partial necrosis caused by vasospasm or inconsistency of delicate perforator vessels. In this study we have evaluated the number and capacity of perforator vessels with respect to the size of a flap, and the influence of vascular endothelial growth factor (VEGF) on the capacity of perforators in a standard animal model. We realised an epigastric perforator flap 4 cm × 7 cm in 36 rats. In 3 control groups (n = 6 in each), flaps were raised based on 4, 2, or 1 perforator vessel(s), while all other perforators as well as the epigastric vessels were ligated. In three study groups (n = 6 in each), set up in the same way as the control groups, we also injected a single dose of VEGF into the wound area. After one week, all areas of necrosis were assessed planimetrically. We also evaluated the wounds by laser Doppler flowmetry preoperatively and after one week, and by histological and immunohistochemical examination. An increased number of perforators, together with VEGF, was associated with a significant reduction in the areas of necrosis. This observation was particularly true in flaps based on only one perforator. The inclusion of additional perforators has a more important role in the success of a flap than theoretical models suggest. Proangiogenetic factors may improve the viability of perforator flaps.     

腹壁下动脉穿支皮瓣游离移植修复四肢创面(附9例报告)

目的:总结应用腹壁下动脉穿支皮瓣游离移植修复四肢创面的手术方法与疗效.方法:对9例四肢皮肤缺损骨外露患者根据伤情切取腹壁下动脉穿支皮瓣游离移植修复创面.结果:8例皮瓣完全成活,1例坏死,成活皮瓣外观较好,不显臃肿,皮瓣供区组织损伤较轻.结论:腹壁下动脉穿支皮瓣游离移植修复四肢创面符合组织移植“受区修复重建好,供区破坏损失小“的原则,疗效满意.     

黄穗平教授治疗胃脘痛经验

从由虚实两端,把握病机;虽痛在胃脘,多与他脏关联;辨病结合辨证,掌握辨证要领;审证求因,灵活施治(探病之源,治病求本;疏调气机,开郁散滞;寒热错杂,辛开苦降;虚实夹杂,通补结合);药疗调养并重,防止病情变化等论述黄穗平教授治疗胃脘痛经验。     

反流性食管炎病因病机研究简况

反流性食管炎病因病机为饮食失节、情志不遂、禀赋不足、外邪侵袭等,与肝脾胃肺关系密切,临床重视对肝郁、肝火的辨治,以和胃降逆为治疗大法,重视调节肺气,恢复其肃降之性。     

胃脘下俞穴埋线对糖尿病家兔血糖影响的实验观察

目的观察中医穴位埋线方法对糖尿病家兔血糖影响。方法通过对四氧嘧啶（Alloxan）致糖尿病家兔血糖（BG）的检测和胃脘下俞穴埋线对其影响的动态观察。结果胃脘下俞埋线具有降低Alloxan糖尿病家兔BG浓度的作用。结论胃脘下俞穴埋线方法可用于糖尿病的治疗。