To find new technique for repair of peripheral nerve defect, the nerve elongation repair technique was adopted. Two cases with nerve defect were treated by this method. One was a 12 year old male, the defect length of right radial nerve was 7.2 cm at the elbow. The other one was a 28 year old male, the defect length of left ulnar nerve the was 5 cm at elbow. In this method, the nerve was elongated by slow stretch from distal and proximal end of the ruptured nerve. After a few days, the nerve was repaired by direct suture. After operation, the function of nerves were recovered in 119 days and 114 days respectively. Follow-up for 5 years, the function of the effected limbs were recovered to the normal side. It was concluded that: (1) the peripheral never can be elongated by slow stretch; (2) to stretch the nerve end in a rubber tube can prevent adhesion and connective tissue blocking; (3) strength and supporting point of stretching should be designed carefully.
Ten, fifteen and twenty millimeter nerve defects were produced on both trunks of sciatic nerve in 18 rabbits. The stumps of the nerve were enclosed by a silicon tube in the right hind limb (slilcon group) and the left limbs were free (free group). The proximal and distal nerve stumps in both groups were elongated by using a selfdesigned nerve stretching device, and the nerve were gradually stretched by 1mm, 2mm and 3mm per day respectively. when the expected lengths were achieved, the defects of the nerve were managed by endtoend coaptation. The samples were analysed by electrophysiological examination, and light and electron microscopes. Results were as follows: (1) The nerve defect could be repaired by gradual elongation in rabbits; (2) The results of silicon group were superior to the free group; (3) The structure and microcirculation of the nerve would be damaged if the stretching speed exceeded the limit of 2mm per day. But the eventual results following repair by elongation could not reached the normal level.
Objective To analyze the risk factors associated with prolonged length of hospital stay (PLOS) after lobectomy for lung cancer patients. Methods The clinical records of 771 lung cancer patients undergoing lobectomy between May 2012 and June 2016 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. According to different length of hospital stay (LOS), 771 patients were divided into two groups, a normal LOS group and a PLOS group. In the normal LOS group, there were 551 patients including 234 females and 317 males with a median age of 59 years, whose LOS was shorter than 8.0 days. In the PLOS group, there were 220 patients including 72 females and 148 males with a median age of 60 years, whose LOS was no less than 8.0 days. Then, we analyzed the independent risk factors of PLOS by multivariate logistic regression analysis. Results Univariate analysis showed that risk factors for PLOS included male, arrhythmias and atrioventricular block, smaller FVC%, unilateral pneumonectomy, operation and anesthesia duration, intraoperative blood loss and number of lymph node dissection in the operation (P<0.05). Multivariate logistic regression analysis showed that the age ≥75 years (OR=4.100, 95%CI 1.677 to 10.026), unilateral pneumonectomy (OR=2.563, 95%CI 1.473 to 4.460), FVC% < 89.05% (OR=1.500, 95%CI 1.020 to 2.206), numbers of lymph node dissection≥ 13.5 (OR=1.826, 95%CI 1.262 to 2.642), operation duration≥126.5 min (OR=1.858, 95%CI 1.200 to 2.876) and arrhythmia (OR=2.944, 95%CI 1.380 to 6.284) were independent risk factors of PLOS (all P<0.05). Conclusion LOS is influenced by age, surgical type, FVC%, numbers of lymph node dissection, arrhythmia and operation duration. Careful assessment and appropriate management of risk factors are helpful to improve postoperative recovery after lobectomy for lung cancer patients.
The changes of nerve function were observed from the study of electrophysiology and histomorphology in 15 rabbits undergoing gradual lengthening of the legs from different rates and magnitudes. The results showed that if the leg was increased at a rate of 1 mm per day would not result in any changes of nerve morphology or functional damage. The conduction rate of the motor nerve and the potential of the muscular action were all normal; if at a rate of 2mm per day, the leg length was increased within 40％, it was still quite safe. It was believed that the peripheral nerve markedly tolerable to gradual lengthening from traction.
ObjectiveTo summarize the research and clinical application progress of foot lengthening surgery. Methods Relevant research literature on foot lengthening surgery in recent years at home and abroad was reviewed, and a summary was made from aspects such as the types of lengthening surgery, the types of foot diseases treated by clinical application, effectiveness, and complications. ResultsBone defects and shortening deformities of the foot are relatively common clinically. As an innovative treatment method, foot lengthening surgery has gradually attracted attention, mainly including the Ilizarov technique and one-stage bone grafting lengthening surgery. The former promotes bone regeneration based on the tension-stress principle and is widely used in the treatment of calcaneal defects and congenital metatarsal brachymetatarsia, achieving good curative effects. However, there are also complications such as pin-tract infection, joint stiffness and contracture, non-union and delayed union of bone, re-fracture, and alignment deviation. The latter has a short treatment cycle, but the lengthening length is limited. Bone graft resorption and soft tissue complications are its main complications. ConclusionFoot lengthening surgery will develop towards the direction of personalization, intelligence, and precision. With the help of multi-center research, biological materials, and intelligent technologies, the effectiveness and safety will be further improved to better restore the function and appearance of the foot.
Objective To introduce a modified penile elongation method and observe its postoperative compl ications. Methods From January 1993 to December 2007, 130 patients with congenital short and small penis were divided into 2 groups: the routine group and the modified group, with 65 patients in each group. In the routine group, the patients were 18-55 years old (39.6 on average), and the penile length during erection was (4.9 ± 1.4) cm. In the modified group, the patients were 20-56 years old (35.4 on average), and the penile length during erection was (5.0 ± 1.5) cm. There was no significant difference between the two groups (P gt; 0.05). On the basis of scrotal flap which was transferred to cover the prolonged cavernous body of penis, the “+” shaped incision at the root of the penis was made in the routine group, and theincision was shifted upward by 1.5 cm in the modified group. And V-Y incision was made for the penises with more than 4 cm prolonged length. In order to compare the conditions in the two groups, no physical therapy was appl ied in 30 days after the operation. Results All the 130 patients’ incisions obtainedt heal ing by the firs intention, and all flaps survived successfully. Postoperative hydrophallus appeared differently between both groups. In the routine group, obvious hydrophallus appeared on the 3rd day after the operation and lasted for (15.11 ± 2.71) days, with 3 cases (4.62%) suffering from refractory hydrophallus. In the modified group, hydrophallus appeared on the 3rd day after the operation and lasted for (6.65 ± 0.29) days without any refractory hydrophallus. There was significant difference between the two groups in the duration of hydrophallus (P lt; 0.05). All patients were followed up for 6-8 months. After the operation, the shape and function of the penis were found good. The prolonged length was (4.9 ± 1.4) cm in the routine group and (5.0 ± 1.5) cm in the modified group. There was no significant difference between the two groups (P gt; 0.05). The satisfaction rate (according to the patients’ self-rating) was 95% and 98% in the routine group and the modified group, respectively. Conclusion The method using the scrotal flap transferred to cover the prolonged cavernous body of the penis is safe and of low compl ication rate. The modified method is more effective to abate postoperative hydrophallus.