Defects of sixteen peripheral nerve were re-paired by skeletal muscle bridging from December1986 though December 1989. Satisfactory resultswere achieved after follow-up for 8-31 months.The key point of this operation were proper explo-ration and exposure of the nerve stumps ,thoroughresection of the cicatricial tissues from the stumpsproper chois of muscular fascicle for bridging, pro-viding a good blood supply to the muscle strip, andcorrect suture of the nerve under microscope. Irri-gation of the operativ field with hydrocortisone could play some roles of decreasing the postoperative local inflammation,edema,adhesion, and scar formation.
Objective To summarize the general situation of perioperative venous thromboembolism (VTE) and summarize the perioperative antithrombotic strategies. Methods Domestic and international literatures and guidelines on antithrombotic therapy were collect and reviewed. Results VTE was common during the perioperative period. Reasonable assessment of each patient’s condition during the perioperative period, as well as reasonable use of anticoagulant, antiplatelet drugs, and hemostatic agents could reduce the incidence of VTE events during the perioperative period. Conclusions Clinicians need to properly assess the timing of the usage and discontinuation of antithrombotic drugs, weigh the risk of thrombosis and bleeding, develop a rational and scientific antithrombotic strategy based on the specific circumstances of each patient. Simultaneously, hemostatic agents need to be prescribed perioperatively to reduce the incidence of thromboembolic complications.
Objective To evaluate the effectiveness of percutanous fixation with helical bridge combined fixation system (BCFS) for treatment of long split fractures involving the middle and upper humerus. Methods Between February 2018 and February 2020, 15 patients of long split fractures involving the middle and upper humerus were treated. There were 6 males and 9 females, with an average age of 62 years (range, 37-82 years). The fractures were caused by slipping in 7 cases, falling from height in 3 cases, and traffic accident in 5 cases. According to AO classification, the shaft fractures were rated as type A in 4 cases, type B in 9 cases, and type C in 2 cases. And all fractures extended to proximal humerus; and the proximal fractures were rated as one-part fracture in 11 cases and two-part fracture in 4 cases according to Neer classification. The interval between injury and operation was 1-7 days (mean, 3.2 days). Nine patients underwent closed reduction and 6 patients underwent open reduction after lengthening the incisions. All fractures were percutaneously internal fixated with helical BCFS after reduction. The operation time, intraoperative blood loss, incision healing, and fracture healing were recorded. Constant-Murley score was used to evaluate shoulder joint function, and Mayo score was used to evaluate elbow joint function. ResultsThe operation time ranged from 55 to 175 minutes, with an average of 76.5 minutes; the intraoperative blood loss ranged from 80 to 300 mL, with an average of 185.5 mL. All incisions healed by first intention, without infection or radial nerve injury. All patients were followed up 12-23 months, with an average of 16 months. The fractures all reached clinical healing, and the healing time was 12-20 weeks, with an average of 14.5 weeks. At 1 year after operation, the Constant-Murley score of the affected side was 88.7±7.6, and there was no significant difference when compared with that of the healthy side (90.8±8.3) (t=1.421, P=0.052). According to the elbow Mayo score, the score of the affected side was 97.6±6.5, and there was no significant difference when compared with the healthy side (97.7±7.3) (t=0.433, P=0.913). ConclusionThe helical BCFS can avoid the dissection of deltoid insertion and prevent the iatrogenic radial nerve injury. With satisfied effectiveness, it is suggested for minimally invasive surgical treatment of long split fractures involving the middle and upper humerus.
Objective To evaluate the clinical effect of sural nerve bridging transplantation for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy. Methods Between May 2014 and May 2016, 23 patients underwent sural nerve bridging transplantation for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy. The age ranged from 19 to 38 years (mean, 27 years). The course of disease was 1-28 months (mean, 14 months). The defect length was 1.0-1.5 cm. Preoperative main neurological sign was sensory disturbance. The chief complaint of 21 patients was a erectile dysfunction; all had normal hormone levels, and there was no other organic diseases or surgical contraindication. According to the self-assessment lists of symptom-SCL90 evaluation, 19 cases had depression, 16 cases had anxiety, and 15 cases had both anxiety and depression; 3 cases had psychological abnormalities (social barriers, etc.). According to the functional neurological evaluation standard of British Medical Research Institute, the static two-point discrimination and sensation recovery standard rating were evaluated before and after operation; sexual pleasure obstacle sensitivity, temperature sense, and other subjective improvement were recorded. The International Index of Erectile Function 5 (IIEF-5) was used to evaluate questionnaire of the patient with erectile dysfunction before and after operation. The psychological state was accessed with the self-assessment lists of symptom-SCL90 evaluation after operation. Results All incisions healed by first intention. The mean follow-up time was 8 months (range, 6-12 months). Sexual pleasure obstacle was obviously improved in 11 cases, partially improved in 5 cases; the improvements in temperature and tactile sensitivity were achieved in 21 cases; no obvious improvement was observed in 1 case. The sensation recovery standard rating, static two-point discrimination and grade of IIEF-5 were significantly improved at 3 and 6 months after operation when compared with preoperative ones (P<0.05). At 6 months after operation, symptom was improved in 14 of 19 patients with depression (73.68%), in 12 of 16 patients with anxiety (75.00%), and in 12 of 15 patients with anxiety and depression(80.00%). Conclusion Sural nerve bridging transplantation is an effective method for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy.
The complication rate and mortality rate of traditional emergency surgery for acute obstructive colorectal cancer are very high. Self-expanding metal stent (SEMS) as a bridge to surgery can rapidly decompress the intestinal tract and radical surgery can be performed after the patients’ general condition improve. This technology has been widely developed, but its safety is still controversial, mainly related to the risk of SEMS implantation and its impact on the long-term survival of patients. This article will introduce the rationale, pathophysiology, short-term safety and long-term oncology safety of SEMS implantation, in order to provide basis for clinicians to choose treatment methods.
Objective To investigate the clinical efficacy and safety of intravenous thrombolysis bridging endovascular thrombectomy (EVT) in patients with acute cardioembolic stroke. Methods We retrospectively included patients with cardioembolic stroke who were admitted within 24 h after onset of stroke symptoms and had received EVT in the Department of Neurology, West China Hospital of Sichuan University between January 2017 and December 2021. Based on whether they had received intravenous thrombolysis, the patients were divided into bridging therapy group and direct EVT group. The primary outcome was unfavorable outcome by 3 months, defined as a modified Rankin Scale (mRS) score of 3 to 6. The secondary outcomes included intracranial hemorrhage during hospitalization and 3-month death. Multivariable logistic regression was performed to assess the treatment effect on the primary outcome after adjusting for confounding factors. Results A total of 285 patients were enrolled. Among them, 174 (61.1%) were female, the median age was 74 years (interquartile range 64-80 years), and the median time from stroke onset to admission was 4.0 h (interquartile range 3.0-5.0 h). Compared to patients in the direct EVT group (n=202), patients in the bridging therapy group (n=83) had a lower rate of unfavorable functional outcome (55.4% vs 68.3%, P=0.039) by 3 months, while the incidences of intracranial hemorrhage (47.0% vs. 39.6%, P=0.251) and 3-month death (20.5% vs. 30.7%, P=0.080) were comparable between the two groups. After adjusting for confounding factors, the bridging therapy improved 3-month functional outcomes over direct EVT [odds ratio=0.482, 95% confidence interval (0.249, 0.934), P=0.031]. Conclusion In patients with acute cardioembolic stroke, intravenous thrombolysis bridging endovascular treatment can significantly improve 3-month functional outcomes without increasing the risk of intracranial hemorrhage.
Objective To evaluate the effectiveness of bridging fixation with long locking plate for displaced midshaft clavicular fractures. Methods Between October 2010 and December 2011, 18 patients with displaced midshaft clavicular fracture were treated with reduction and bridging fixation with 9 or 10 holes locking plate. There were 17 males and 1 female with an average age of 47 years (range, 23-82 years). Fracture was caused by traffic accident in 6 cases, by falling in 10 cases, by crushing in 1 case, and by crashing object in 1 case. All fractures were closed and displaced or shortened (range, 2.1-3.4 cm; mean, 2.62 cm) with angulation deformity. According to Robinson classification criteria, 5 cases were rated as type 2B1 and 13 as type 2B2. The duration from injury to surgery was 5 hours to 19 days (mean, 5 days). The fracture healing time and complication were recorded; the effectiveness evaluation was performed with Constant-Murley score and satisfaction to appearance. Results No neurologic or vascular complication occurred with primary healing of incision. All patients were followed up 12-22 months (mean, 14.7 months). The fracture healing time was 9-14 weeks (mean, 11.4 weeks). During follow-up, no loosening or breakage of internal fixator was observed. The Constant-Murley score was 82-98 (mean, 92.4) at last follow-up; the satisfaction rate of appearance was 88.9% (16/18). Conclusion Bridging fixation with long locking plate is an effective method for treatment of displaced midshaft clavicular fractures. Preserved blood supply and stable angle are important to fracture healing.
Objective To investigate the effectiveness of facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury resulting from closed temporal bone fractures. Methods Between January 2017 and December 2019, 9 patients with facial nerve injury resulting from closed temporal bone fracture caused by head and face trauma were treated. Among them, 5 patients were treated with facial nerve-sublingual nerve parallel bridge anastomosis (operation group), and 4 patients were treated with neurotrophic drugs combined with rehabilitation exercise (conservative group). There was no significant difference in gender, age, side, cause of injury, duration of facial nerve injury before surgery, House-brackmann grading (hereinafter referred to as HB grading) of facial nerve injury, and other general information between 2 groups (P>0.05). HB grading was used to evaluate the improvement of facial nerve function before and after treatment. At the same time, facial nerve neuroelectrophysiological test was performed to evaluate the electrical activity of facial muscles before and after treatment. Tongue function, atrophy, and tongue deviation were evaluated after nerve anastomosis according to the tongue function scale proposed by Martins et al. Results Patients in both groups were followed up 12-30 months, with an average of 25 months. None of the 5 patients in the operation group showed symptoms such as tongue muscle atrophy, tongue extension deviation, hypoglossal nerve dysfunction (mainly including slurred speech, choking with water), postoperative infection, bleeding, lower limb muscle atrophy or lower limb motor dysfunction after sural nerve injury. Postoperative skin sensory disturbance in lateral malleolus area was found, but gradually recovered to normal. During the follow-up, facial nerve and sublingual motor neurons were innervated to paralyzed facial muscle in the operation group. At last follow-up, the HB grading of 5 patients in the operation group improved from preoperative grade Ⅴ in 2 cases, grade Ⅵ in 3 cases to grade Ⅱ in 3 cases, grade Ⅲ in 1 case, and grade Ⅳ in 1 case. And in the conservative group, there were 1 patient with grade Ⅴ and 3 patients with grade Ⅵ before operation, facial asymmetry continued during follow-up, and only 2 patients improved from grade Ⅵ to grade Ⅴ at last follow-up. There was significant difference in prognosis HB grading between the two groups (t=5.693, P=0.001). In the operation group, the amplitude and frequency of F wave were gradually improved, and obvious action potential could be collected when the facial muscle was vigorously contracted. On the contrary, there was no significant difference in neuroelectrophysiological results before and after treatment in the conservative group. ConclusionFacial nerve-sublingual nerve parallel bridge anastomosis can effectively retain the integrity of the facial nerve, while introducing the double innervation of the sublingual nerve opposite nerve, which is suitable for the treatment of severe incomplete facial nerve injury caused by closed fracture.
Objective To review the clinical applications of functional perforator flaps in restoring human body functions. Methods An extensive literature review was conducted on both domestic and international publications to summarize the clinical use of functional perforator flaps for functional restoration. Results Perforator flaps are among the most commonly used flaps in reconstructive surgery. Beyond providing soft tissue repair, they are increasingly employed to reconstruct diverse bodily functions, leading us to propose the concept of the “functional perforator flap”. Although various forms of functional perforator flaps are currently utilized, reports are predominantly scattered case studies, lacking systematic organization. Commonly used functional perforator flaps can be categorized into five types: chimeric perforator flaps, perforator flaps for nerve function restoration, perforator flaps for lymphatic drainage enhancement, flow-through perforator flaps, and perforator flaps for restoring bone and joint motion. These flaps significantly broaden the application scope of perforator flaps, elevating the goal of reconstruction from mere wound repair to achieving repair concurrent with functional reconstruction. ConclusionThe application of various functional perforator flap designs significantly improves wound reconstruction outcomes and represents an effective approach for managing complex defects. Future developments will undoubtedly see more forms of functional perforator flaps reported to meet increasingly sophisticated reconstructive demands.