Objective To observe the effectiveness of skin graft combined with thorax wire fastening for repairing postoperative coloboma after resection of chest back giant nevus. Methods Between June 2007 and October 2010, 17 cases of chest back giant nevus were treated. There were 7 males and 10 females, aged from 3 years and 6 months to 15 years(mean, 8 years). The size of giant nevus was 20 cm × 12 cm to 60 cm × 50 cm. Two cases of them were ever treated by laser, while the others were never treated. The check before operation showed ulcer of the skin and effusion in 2 cases, hard skin in 3 cases, hair growth in 7 cases, and normal in 5 cases. Five cases had serious itch. After giant nevus was cut off, thorax wire was fastened to reduce the wound area, and then the intermediate spl it thickness skin graft of thigh was used to repair the wound. Comprehensive anti-scar treatment was given postoperatively. Results The wound size was (2 110.74 ± 725.69) cm2 after resection of giant nevus, and was (1 624.94 ± 560.57) cm2 after thorax wire fastening, showing significant difference (t=9.006, P=0.001). All the grafting skin survived; the incision and wound at donor site healed by first intention. The patients were followed up 6 months to 2 years (mean, 13 months). No scar prol iferation or contracture occurred. The skin color and elasticity were similar to the normal skin; the nipple, navel, and other local apparatus were not shifted after operation. Conclusion It can reduce donor site of skin and postoperative scar, and achieve satisfactory appearance to cover the wound by skin graft combined with thorax wire fastening after chest back giant nevus was cut off .
ObjectiveTo investigate the application effect of wire reduction technique guided by minimally invasive wire introducer in the treatment of difficult-reducing intertrochanteric fractures.MethodsBetween April 2016 and April 2018, 30 patients with intertrochanteric fractures who had difficulty in closed reduction under the traction bed were treated. There were 17 males and 13 females, aged from 60 to 93 years (mean, 72 years). The causes of injury included falls in 22 cases and traffic accidents in 8 cases. The fractures were classified according to AO/Orthopaedic Trauma Association (AO/OTA) classification: 12 cases of type A1, 12 cases of type A2, and 6 cases of type A3. Intramedullary nail incision and self-made minimally invasive wire introducer were used to assist reduction of intertrochanteric fracture, and then intramedullary nail internal fixation was performed.ResultsThe operation time was 30-70 minutes, with an average of 45 minutes. The intraoperative blood loss was 100-210 mL, with an average of 160 mL. One case died of cerebrovascular accident at 3 months after operation; the remaining 29 cases were followed up 6-18 months, with an average of 8.3 months. Postoperative DR reexamination showed that all patients had a good reduction in the fracture end, no retraction, fracture displacement, hip valgus deformity, and other serious complications occurred. The fracture was completely healed and the healing time was 3-8 months, with an average of 6 months. At 3 months after operation, the visual analogue scale (VAS) score was 1-3, with an averge of 1.7. According to Harris functional score of hip joint, 26 cases were excellent and 3 cases were good.ConclusionFor the difficult-reducing intertrochanteric fractures, minimally invasive wire introducer is used to insert steel wire into the incision of head and neck nail for assisted reduction, which can achieve satisfactory reduction results and improve the effectiveness of intertrochanteric fracture.
ObjectiveTo explore the method and effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures.MethodsBetweern January 2015 and January 2019, 22 patients with inferior patellar pole avulsion fractures were admitted and treated. There were 12 males and 10 females. The age ranged from 20 to 69 years, with an average age of 39.4 years. The causes of injury included 9 cases of traffic accident and 13 cases of falling. All of them were unilateral closed injury of knee joint, including 7 cases of skin contusion around patella. Preoperative range of motion of the affected knee was (20.82±7.16)° (range, 10°-35°). The time from injury to operation ranged from 3 to 12 days, with an average of 5.9 days. During the operation, the inferior patellar avulsion fracture was reduced with forceps; the patella was circumferentially ligated through the distal bone surface of the fracture with 0.8 mm diameter steel wire; then 3 longitudinal bone tunnels were made in the upper patella, respectively. The 0.8 mm diameter steel wire passed through the bone tunnel, and the longitudinal ring was attached to the ring to fix the upper and inferior patellar fracture. Tighten the transverse and longitudinal rings with No.2 tendon suture line, then longitudinally ringed and sutured to strengthen the patella. The knee range of motion, fracture healing time, and complications were recorded. The functional recovery of the knee joint was evaluated by Böstman score.ResultsAll incisions healed by first intention, and no incision related complications occurred. All the 22 patients were followed up 13 months to 5 years with an average of 26.7 months. The fracture healing time was 9-12 weeks (mean, 10.9 weeks). At last follow-up, the knee range of motion was (129.77±2.35)° (range, 126°-135°), showing significant difference when compared with preoperative one (t=−67.022, P=0.000). The Böstman score ranged from 31 to 36, with an average of 34.3. No reduction loss, fracture of steel wire, failure of internal fixation, and other complications occurred during follow-up.ConclusionMultidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures has the advantages of reliable fixation, early functional recovery, and fewer complications, so the effectiveness is satisfactory.