Intervention for arch obstruction after the Norwood procedure: Prevalence,associated factors,and practice variability

Objective

Arch obstruction after the Norwood procedure is common and contributes to mortality. We determined the prevalence, associated factors, and practice variability of arch reintervention and assessed whether arch reintervention is associated with mortality.

颈肩背轴型反流皮瓣修复儿童颏颈瘢痕挛缩

目的探讨修复儿童颏颈瘢痕挛缩一种实用而较理想的方法.方法以颈横动脉浅支为蒂,利用其与旋肩胛动脉皮支的丰富吻合,反流形成超长的轴型皮瓣,向前旋转修复瘢痕松解后的颈前创面.结果采用本皮瓣修复30例儿童颏颈瘢痕挛缩,其中18例随访2年,颈部活动自如,颌骨发育无明显异常,皮瓣色泽良好,效果令人满意.结论本皮瓣轴型血管恒定,反流灌注动脉压高有保证,供瓣面积充足,供区多可直接拉拢缝合,是修复儿童颏颈瘢痕挛缩的较理想方法.     

带浅静脉干逆行皮瓣早期微血管构筑变化的体视学研究

目的 探讨带浅静脉干的逆行皮瓣早期微血管构筑变化的特点以供临床实践参考。方法 应用生物体视学技术测量带浅静脉干皮瓣微血管体积密度，结合组织学观察，与不带静脉干皮瓣作对照比较。结果 带浅静脉干皮瓣组微血管密度整体水平高于不带静脉干皮瓣组（P〈0．05）。结论 浅静脉干的存在有利于皮瓣的血管化进程，保留浅静脉干对皮瓣成活有利。     

Revisit on congenital bronchopulmonary vascular malformations: a haphazard branching theory of malinosculations and its clinical classification and implication.

We propose a haphazard branching theory to support the concept of bronchopulmonary malinosculations, and we apply this theory to classify congenital bronchopulmonary vascular malformation (BPVM) based on the anatomical results we have found. Between January 1990 and December 1997, a total of 22 pediatric patients (10 male and 12 female), aged 2 days to 14 years (median, 19.6 months), with congenital BPVM were enrolled in this retrospective study. Study modalities include the clinical features and plain chest films (n = 22) plus at least two of the following: echocardiography (n = 13), barium esophagraphy (n = 2), bronchoscopy (n = 4), contrast bronchography (n = 8), high-resolution direct coronal CT (n = 1) and electron beam or ultrafast CT (n = 1) of the chest, MRI (n = 10), MRA (n = 1), contrast cineangiocardiography (n = 9), surgery (n = 11), or autopsy (n = 2). The salient clinical features were recurrent lung infections in 14 patients, acute respiratory distress in 13, associated cardiovascular malformations in 8, dextroversion in 7, congestive heart failure in 7, dextrocardia in 4, and complex congenital heart diseases in 4. There were abnormal openings (malinosculations) of the pulmonary airway in 20 patients: to an artery in 12, to a vein in 8, and to the lung parenchyma in 9. These 22 patients with congenital BPVM can be classified into bronchial malinosculation (10 cases), arterial malinosculation (2 cases), and bronchoarterial malinosculation (10 cases). Congenital BPVM can be classified in terms of bronchopulmonary malinosculation based upon a haphazard branching theory, in which abnormal communications between two independent systems (primitive foregut system and aortic-pulmonary arch system) occurred coincidentally rather than causally.     

Anatomical Course of the Superficial Branch of the Radial Nerve and Clinical Significance for Surgical Approaches in the Distal Forearm

Abstract 10 embalmed cadaver forearms and wrists were dissected to determine the anatomical course of the superficial branch of the radial nerve in the distal forearm. The superficial radial nerve bifurcated in two branches at a mean of 54,7 mm proximal to the radial styloid. From the styloid process of the radius, the mean distance to the closest dorsal branch of the superficial radial nerve was 3,5 mm and the mean distance to the closest volar branch was 9,8 mm. The mean distance between the closest branch of the superficial radial nerve and Lister?s tubercle was 16,4 mm. The crossing point between the nerve and the cephalic vein was located at a mean of 54,3 mm proximal to the styloid process. At the level of styloid process the mean distance between the closest dorsal branch of the superficial radial nerve and the first dorsal compartment was 15,2 mm and between the closest volar branch and the first dorsal compartment 4,4 mm. Detailed knowledge of anatomic characteristics of the superficial branch of the radial nerve may help prevent injury during operations and treat traumatic lesions of the nerve. Because of great variations in the course of the superficial radial nerve we could not define an absolute safe zone for surgical procedures on the distal forearm. Iatrogenic lesions of the superficial radial nerve are described complications of percutaneous procedures. Therefore open surgical approaches are recommended. Daniela Klitscher and Lars Peter Müller contributed equally to this work.     

肿胀局麻技术的临床应用

目的探讨肿胀技术在体表外科手术中的应用价值。方法随机选择体表肿物与先天性畸形、体表瘢痕、乳房整形、脂肪抽吸、腹壁整形、除皱、隆胸、褥疮、面瘫及颅骨电烧伤等２３０例体表外科手术应用肿胀技术，成人１６４例，完全采用肿胀法局麻技术，儿童６６例，在全麻下应用肿胀技术。并与相应手术非肿胀法下施行进行了比较。结果脂肪抽吸术中利多卡因用量可达３０～６０ｍｇ／ｋｇ体重。肿胀技术具有易于进行解剖间隙的分离、减少术中失血、增强麻醉效果、增加手术安全性和术后恢复快等优点。结论肿胀技术可推广到体表外科手术中广泛应用，对儿童更为适宜，对减少输血造成的疾病具有重要意义。     

带血管蒂舟骨瓣移位术的应用解剖

目的:为治疗距骨骨折提供新术式的解剖学基础.方法:在30侧灌注红色乳胶的成人下肢标本上,对舟骨背侧面形态、血供来源进行观测.结果:舟骨背侧面动脉主要来自内踝前动脉、跗内侧动脉以及足底内侧动脉浅支,分别发3～5支、1～3支和1～2支外径在0.2～1.0mm之间的骨膜支,形成骨膜动脉网.结论:以内踝前血管为蒂,可切取舟骨背侧2.0cm×1.0cm×0.5cm大小的骨瓣,用于距骨颈骨折修复.术式经临床应用证实,手术简便,效果可靠.     

上颌扩弓治疗纠正早期功能性下颌偏斜

目的:通过头颅定位后前位片(P-A)测量,探讨上颌扩弓纠正单侧后牙反牙合,改善早期功能性下颌偏斜. 方法:混合牙列或早期恒牙列,单侧后牙反牙合伴有或不伴有前牙反牙合, 下颌功能性偏斜患者16名,采用上颌Quad-Helix扩弓的方法,矫治前后头颅定位后前位片P-A测量分析,用统计软件处理数据. 结果:单侧后牙反牙合矫正后,下颌骨两侧结构不对称性有明显改善. 下颌骨两侧综合长度差亦减小(P<0.01),两侧下颌体长度差明显减小(P<0.01). 结论:混合牙列或早期恒牙列,由于单侧后牙反牙合导致的功能性下颌偏斜,采用扩大上颌牙弓,可以使下颌骨的不对称得到一定的改善,是早期纠正下颌功能性偏斜的有效手段.