Clinical Application of a Modified Local Transposition Flap Surgery in Repairing Fingertip Defects

Abstract Background: A modified local transposition flap surgery was performed for fingertip injuries, which allows a more significant transfer distance with good outcomes.Methods: The study collected patients who underwent parallelogram transposition flaps and V-Y flaps to repair fingertip defects from 2017 to 2020. 122 cases (122 fingers) were included in our study, The interval between the injury and operation was 5.78 h (the mean value was 4.7-8.4 h). All operations were performed by one surgical team, and the average operation time was 31.2 min.Record the operation time，two-point discrimination（2PD），Total Active Movement (TAM)and the MHQ (Michigan Hand Questionnaire) of the injured fingers to evaluate the therapeutic effect.Results: All parallelogram （Group A）and V-Y flaps （Group B）had survived postoperatively. There was no difference with operative duration and follow-up time in two groups. At last follow-up, there was no difference with the 2PD of the palmar part of the flaps and the TAM of injured figures in Group A and Group B . The MHQ summary scores in Group A were much higher than in Group B . Evaluation of the MHQ subscale performance showed that the overall hand function, activities of daily living, work performance and pain score had no differences, but aesthetics and satisfaction score was higher in Group A .Conclusions: The reconstruction using parallelogram flaps is a easier and more versatile treatment with better functions, less morbidity and better aesthetics. This method is a better choice for reconstruction of fingertip injury.

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Clinical Application of a Modified Local Transposition Flap Surgery in Repairing Fingertip Defects

10.21203/rs.3.rs-729156/v1 ◽

2021 ◽

Author(s):

YingKai Zhang ◽

Yao Wang ◽

Rongbo Wu ◽

Jiaqi Zhou ◽

Mingdong Zhao

Keyword(s):

Work Performance ◽

Hand Function ◽

Operation Time ◽

Mean Value ◽

Active Movement ◽

Flap Surgery ◽

Transposition Flap ◽

Transfer Distance ◽

Healthy Side ◽

Qualification Rate

Abstract Purpose: A modified local transposition flap surgery was performed for fingertip injuries. Given the shape of the flap turnover resembling a parallelogram, we called it a parallelogram flap. This transposition flap surgery allows a more significant transfer distance with good outcomes.Method: The study collected patients who underwent parallelogram transposition flaps to repair fingertip defects from 2017 to 2020. 32 cases (32 fingers) were included in our study, including 20 males and 12 females, aged 17 to 60 years, with an average age of 36 years. The causes of injury were crush injury in 13 cases, punch injury in 11 cases and sharp cutting injury in 8 cases. There were 6 cases in thumbs, 6 cases in index fingers, 14 cases in middle fingers, 4 cases in ring fingers and 2 cases in little fingers. The area of fingertip defects was 1.2 cm × 2~3 cm × 4 cm, with bone exposure. The interval between the injury and operation was 5.78 h (the mean value was 4.7-8.4 h). All operations were performed by one surgical team, and the average operation time was 31.2 min.Record The length and width of the finger，two-point discrimination（2PD），Total Active Movement (TAM)and the MHQ (Michigan Hand Questionnaire) of the injured fingers to evaluate the therapeutic effect.Results: all our parallelogram flaps had survived postoperatively.，At last follow-up,There was no difference between the length and width of the reconstructed finger and that of the healthy side（P>0.05）. The qualification rate of the static 2PD of the flaps were 84.37% .The qualification rate of the TAM of injured figures were 100% . Evaluation of the MHQ subscale performance showed that the score of the overall hand function is 93.71, activities of daily living is 95.22, work performance is 94.23,pain score is 4.34 , aesthetics is 92.15 and satisfaction score is 92.45.All of these were perform well.Conclusion: This transposition flap surgery allows a more significant transfer distance with good outcomes.

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Clinical Effect of Suture Anchor and Double-Pulley Technique in the Treatment of Inferior Patellar Fracture

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/4964195 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Hang Yu ◽

Hui Dong ◽

Binjia Ruan ◽

Xiaohang Xu ◽

Yongxiang Wang ◽

...

Keyword(s):

Fracture Healing ◽

Suture Anchor ◽

Alternative Therapy ◽

Operation Time ◽

Healing Time ◽

Significant Difference ◽

Group A ◽

Group B ◽

Clinical Healing

Objective. To evaluate the efficacy of suture anchor combined with double-pulley technique for subpatellar comminuted fractures compared with wire vertical suture and Krachow in the treatment of subpatellar fractures. Methods. Retrospectively selected 48 patients with subpatellar pole comminuted fracture admitted in our hospital from February 2013 to July 2019, 25 patients with double-pulley technique (group A), and 23 patients with vertical wire suture with Krachow suture. Patient age, gender, AT/OTA typing, injury mechanism, follow-up time, surgical time, bleeding volume, mean fracture healing time, and postoperative complications were recorded. The Insall-Salvati index immediately and 6 weeks after surgery. Bostman scores and knee activity were recorded at each follow-up, and month 12 was taken as the final result. Results. Time of surgery in group A (46.52 min) was significantly shorter than in group B (76.30 min). Intraoperative bleeding in group 15.1 ml, B, group 15.9 ml. Both incisions healed in stage I, averaging clinical healing of patella fracture within 10 weeks. There was no significant difference in mean Bostman score and knee activity at month 12 (group A: 28.4, 124.8°; group B: 28.1, 125.7°). There was no significant statistical difference in the Insall-Salvati index immediately or 6 weeks between the two groups. Group B patients had two wire fractures, fracture healing and the wire removed one year after surgery, and the remaining patients had no complications such as internal fixation loosening, fracture, delayed healing, or nonhealing of fracture. Conclusion. Compared with the treatment of subpatellar fracture with wire vertical suture and Krachow method, suture anchor with double-pulley technique has short operation time, reliable fixation, and less complications. Patients can have early functional exercise and good knee function recovery without secondary surgery. It can be considered as an alternative therapy for this fracture and deserves clinical adoption and promotion.

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A Modified Method to Treat Severe Asymptomatic Pre-existing Degeneration of Adjacent Segment: A Retrospective Case-Control Study

10.21203/rs.3.rs-70798/v1 ◽

2020 ◽

Author(s):

Xinliang Zhang ◽

Jinwen Zhu ◽

Yibing Li ◽

Dingjun Hao ◽

Wenjie Gao

Keyword(s):

Interbody Fusion ◽

Operation Time ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Retrospective Case ◽

Modified Method ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background: Pre-existing degeneration of adjacent segment is an important risk factor for adjacent segment degeneration (ASD), but limited and controversial studies have addressed its management.Methods: Patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment were retrospectively analyzed. Among them, those who underwent interbody fusion in the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion in the adjacent L4/5 segment were included as Group A (n=103). Patients who underwent interbody fusion in both L5/S1 and L4/5 segments were included as Group B (n=81). Clinical and radiographic outcomes were evaluated.Results: Mean follow-up was 58.5 months (range, 48-75 m). No significant difference in clinical outcomes or the incidence of adjacent segment degeneration in L3/4 segment was found between Groups A and B. Compared with Group B, less bleeding (315±84 vs. 532±105 ml), shorter operation time (107±34 vs. 158±55 min) and lower costs (13,830±2640 vs. 16,020±3380 US$) were found in Group A (P<0.05). In Group A, disc height ratio (DHR) of L4/5 segment was significantly increased from preoperative value of 0.40±0.13 to last follow-up value of 0.53±0.18 (P<0.05), while the degree of canal stenosis (DCS) was decreased from preoperative value of 34.3±11.2% to last follow-up value of 15.9±9.3% (P<0.05). Conclusions: This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in lumbar spine.

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A Comparison of the Bridge-type ROI-C Interbody Fusion Cage System and Titanium Mesh Graft With Titanium Plate Fixation in 2-level Anterior Cervical Discectomy and Fusion With Plating and Cage System: A Retrospective Study

10.21203/rs.3.rs-48049/v1 ◽

2020 ◽

Author(s):

Shuangjun He ◽

Zhangzhe Zhou ◽

Xiaofeng Shao ◽

Changhao Zhang ◽

Xinfeng Zhou ◽

...

Keyword(s):

Interbody Fusion ◽

Operation Time ◽

Fusion Rate ◽

Cage System ◽

Significant Difference ◽

Group A ◽

Bridge Type ◽

Group B ◽

Fusion Cage

Abstract Objective To explore the clinical efficacy and radioactive results of the bridge-type ROI-C interbody fusion cage (ROI-C) and anterior cervical discectomy and fusion with plating and cage system (ACDF) for cervical spondylopathy. Methods From January 2014 to January 2018, 45 patients undergoing ACDF were retrospectively analyzed, including 24 cases of ROI-C (group A) and 21 cases of ACDF (group B). The operation time, blood loss, Neck Disability Index (NDI), Japanese Orthopaedic Association score (JOA), postoperative complications, imaging results including cervical Cobb angle and fusion were compared between groups. Results All patients were successfully treated with surgery, and no cerebrospinal fluid leakage, esophageal fistula, or hoarseness occurred after surgery. The operation time and blood loss in group A were lower than those in group B (P < 0.05). During the follow-up period, JOA score increased and NDI score decreased after operation (P < 0.05), but there was no significant difference between the groups (P > 0.05). The incidence of dysphagia in group A was lower than that in group B at 1 month and 3 months after operation (P < 0.05), but the final follow-up results showed that there was no significant difference in the incidence of dysphagia between the two groups (P > 0.05). In group A, the fusion rate was 83.3% 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 12.5%. In group B, the fusion rate was 85.7% 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 23.8%. Conclusion Both ROI-C and ACDF can achieve satisfactory results, but ROI-C has shorter operation time, less bleeding and lower incidence of dysphagia in the short term.

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A modified method to treat severe asymptomatic pre‐existing degeneration of adjacent segment: a retrospective case‐control study

BMC Surgery ◽

10.1186/s12893-021-01163-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xinliang Zhang ◽

Jinwen Zhu ◽

Yibing Li ◽

Dingjun Hao ◽

Wenjie Gao

Keyword(s):

Interbody Fusion ◽

Operation Time ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Retrospective Case ◽

Modified Method ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background Pre-existing degeneration of adjacent segment is an important risk factor for adjacent-segment degeneration (ASD), but only limited and controversial studies have addressed its management. Methods We retrospectively analyzed patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment. Of these patients, those who underwent interbody fusion of the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion of the adjacent L4/5 segment were included in Group A (n = 103), while those who underwent interbody fusion of both the L5/S1 and L4/5 segments were included in Group B (n = 81). Clinical and radiographic outcomes were evaluated. Results Mean follow-up time was 58.5 months (range, 48–75 months). We found no significant difference in clinical outcomes or incidence of ASD in the L3/4 segment between Groups A and B. Compared with Group B, Group A experienced less bleeding (315 ± 84 ml vs. 532 ± 105 ml), shorter operation time (107 ± 34 min vs. 158 ± 55 min) and lower costs (US $13,830 ± $2640 vs. US $16,020 ± $3380; P < 0.05). In Group A, the disc height ratio (DHR) of the L4/5 segment was significantly increased from a preoperative value of 0.40 ± 0.13 to a last–follow-up value of 0.53 ± 0.18 (P < 0.05), while the degree of canal stenosis (DCS) was decreased from a preoperative value of 34.3 ± 11.2% to a last–follow-up value of 15.9 ± 9.3 % (P < 0.05). Conclusions This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in the lumbar spine.

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Comparison of single posterior debridement, bone grafting, and instrumentation with single anterior debridement, bone grafting, and instrumentation in treatment of thoracic spinal tuberculosis

10.21203/rs.2.15859/v1 ◽

2019 ◽

Author(s):

Yongchun Zhou ◽

Weiwei Li ◽

Liqun Gong ◽

Jiao Zhou ◽

Jing Luo

Keyword(s):

Bone Grafting ◽

Spinal Tuberculosis ◽

Operation Time ◽

Anterior Debridement ◽

Thoracic Spinal ◽

Group A ◽

Group B ◽

Posterior Debridement ◽

Thoracic Spinal Tuberculosis

Abstract Objective To explore the clinical effect of single posterior debridement, bone grafting, and instrumentation and single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis of adult patients. Methods: A retrospective analysis was made by involving 38 adult patients with thoracic spinal tuberculosis from between June 2013 and December 2015. Of the 38 patients, 21 patients were categorized in single anterior approach group and underwent single posterior debridement, bone grafting, and instrumentation (Group A). The remaining 17 patients were classified in single posterior approaches group (Group B), which received single posterior debridement, bone grafting and instrumentation. Clinical manifestations, laboratory and imaging results of the two groups were analyzed subsequently. Results: All patients were followed up for 23.9 ± 3.8 m (range, 19–36 m). Bony fusion was achieved in all bone grafts. The operation time and intraoperative blood loss in group B were significantly less than those in group A (P<0.05). The VAS scores, ESR, and CRP levels 6 weeks after operation and at the final follow-up were significantly lower than the preoperative levels (P<0.05). At the last follow-up, ASIA improvement no significant difference between groups (P>0.05). Furthermore, the postoperative and final-follow-up kyphosis angles in group B were both significantly smaller than those in group A (P<0.05). Group A had a postoperative angle correction rate smaller than group B, and its postoperative angle loss was greater than group B’s (P<0.05). Conclusion: Single posterior debridement, bone grafting, and instrumentation can achieve similar curative effect as single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis, but also accompanied by additional advantages of shorter operation time and less bleeding .

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A comparison of the bridge-type ROI-C interbody fusion cage system and ACDF with plating and cage system in 2-level anterior cervical discectomy and fusion: A retrospective study

10.21203/rs.3.rs-48049/v2 ◽

2021 ◽

Author(s):

Shuangjun He ◽

Zhangzhe Zhou ◽

Xiaofeng Shao ◽

Changhao Zhang ◽

Xinfeng Zhou ◽

...

Keyword(s):

Interbody Fusion ◽

Operation Time ◽

Fusion Rate ◽

Postoperative Dysphagia ◽

Cage System ◽

Group A ◽

Bridge Type ◽

Group B ◽

Fusion Cage

Abstract Objective: A study was conducted to explore the clinical efficacy and radioactive results of the bridge-type ROI-C interbody fusion cage (ROI-C) and anterior cervical discectomy and fusion with plating and cage system (ACDF) for cervical spondylopathy.Methods: From January 2014 to January 2018, 45 patients who underwent operations were retrospectively analyzed, including 24 cases of ROI-C (group A) and 21 cases of ACDF (group B). The operation time, blood loss, Neck Disability Index (NDI), Japanese Orthopaedic Association score (JOA), postoperative complications, imaging results including cervical Cobb angle, and fusion were compared between groups.Results: All patients were successfully treated with surgery. No cerebrospinal fluid leakage, esophageal fistula, or hoarseness occurred after the surgery. The operation time and blood loss in group A were lower than those in group B (P<0.05). During the follow-up period, JOA score increased and NDI score decreased after the operation (P<0.05), but no significant difference was found between the groups (P>0.05). In group A, the incidence of postoperative dysphagia was 12.5%, which returned to normal after 1 month. In group B, the incidence of postoperative dysphagia was 38.1%, which was 19% after 1 month and 4.8% at the final follow-up. In group A, the fusion rate was 83.3% at 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 12.5%. In group B, the fusion rate was 85.7% at 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 23.8%.Conclusion: Both ROI-C and ACDF achieved satisfactory results, but ROI-C had a shorter operation time, less bleeding, and lower incidence of dysphagia in the short term.

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Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach.

10.21203/rs.3.rs-30950/v1 ◽

2020 ◽

Author(s):

Chen Zhao ◽

Lei Luo ◽

Liehua Liu ◽

Pei Li ◽

Lichuan Liang ◽

...

Keyword(s):

Loss Rate ◽

Deformity Correction ◽

Operation Time ◽

Clinical Results ◽

Surgery Group ◽

Significant Difference ◽

Functional Scores ◽

Group A ◽

Group B

Abstract Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis.Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores and complications were compared between the two groups.Results: There was no significant difference in the operation time or blood loss between groups A and B (P>0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2±15.2° and 27.9±7.7°, respectively, which significantly decreased to 4.9±11.8° and 10.4±5.6° after the operation, respectively (P<0.05). At the final follow-up, the angles were 7.1±10.5° and 14.6±8.0°, respectively. The correction angle and correction rate in group A (31.3±16.6°, 88.6±43.6%) were greater than those in group B (17.5±4.4°, 64.9±14.0%) (P<0.05). There was no significant difference in the loss angle between groups A and B (P>0.05), but the loss rate in group B (24.0±27.8%) was higher than that in group A (9.6±10.2%) (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

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Comparison between single anterior and single posterior approaches of debridement interbody fusion and fixation for the treatment of mono-segment lumbar spine tuberculosis

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03955-4 ◽

2021 ◽

Author(s):

Hangli Wu ◽

Yaqing Cui ◽

Liqun Gong ◽

Jun Liu ◽

Yayi Fan ◽

...

Keyword(s):

Lumbar Spine ◽

Blood Loss ◽

Posterior Approach ◽

Interbody Fusion ◽

Operation Time ◽

Group A ◽

Spine Tuberculosis ◽

Group B ◽

Single Posterior Approach

Abstract Purpose To compare the efficacy of single anterior and single posterior approach of debridement, interbody fusion, and fixation for the treatment of mono-segment lumbar spine tuberculosis (TB) patients. Methods Eighty-seven patients with mono-segment lumbar TB who underwent debridement, interbody fusion, and fixation through either single anterior (Group A) or single posterior approach (Group B) from January 2007 to January 2017 were enrolled in this study. The duration of the operation, blood loss, complication rate, visual analog scale (VAS), Oswestry disability index (ODI), Frankel scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphosis angle, correction rate, correction loss, and time taken for bone graft fusion were compared between the groups. Results The average period of follow-up was 34.3 ± 9.5 months (24–56 months). No significant differences were observed between patients in Group A and patients in Group B in terms of gender, age, body mass index (BMI), duration of illness and preoperative evaluative indices (P > 0.05). The mean operation time and blood loss was significantly higher in Group A (P = 0.000), along with a slightly higher rate of complications compared with Group B (P = 0.848). The VAS, ODI and Frankel scale scores showed significant improvement in both groups (P = 0.000), along with the ESR, CRP and kyphosis indices (P = 0.000), which were similar in both groups at the final follow-up. Conclusion Both single anterior and single posterior approaches of debridement, interbody fusion and fixation are effective for mono-segment lumbar TB patients, although the single posterior approach is of a shorter duration and results in less blood loss.

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Role of Zinc in Patients Presenting with Recurrent Hepatic Encephalopathy in Medical Unit of Tertiarycare Hospital Lahore

Esculapio ◽

10.51273/esc20.251631 ◽

2020 ◽

Vol 16 (03, july 2020-Septmber 2020) ◽

Author(s):

Asma Kamal ◽

Asifa Kamal ◽

Naeem Afzal ◽

Shazia Siddique ◽

Khadija Tahir

Keyword(s):

Hepatic Encephalopathy ◽

Zinc Supplementation ◽

Mean Value ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Improved Outcome

Abstract Objective: To observe the effects of zinc replacement on hepatic encephaopahty. To reducce hospital admission and heath burden by reducing episodes of recurrent hepatic encephalopathy. Methods: This study was carried out on 160 patients presenting with hepatic encephalopathy in medical ward of services hospital Lahore. The aim of the study was to assess the role of zinc in the improvement of encephalopathy. Results: The mean age of patients in group A was 55.78 and that in group B was 56.88years.There was significant difference in mean value of hepatic encephalopathy grade in both groups A and B after 3 months of follow up (p.value 0.027) indicating zinc is beneficial in treatment of hepatic encephalopathy. Conclusion: Our study showed that zinc replacement improved outcome in patients with Hepatic encephalopathy. Key words: Hepatic encephalopathy, zinc supplementation, chronic liver disease.

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