ObjectiveTo investigate pathogenesis, diagnosis, and treatment of crush syndrome of chest and arm.MethodsBetween January 2010 and January 2015, 5 cases of crush syndrome of chest and arm caused by pressing oneself in a coma after CO poisoning or alcoholic intoxication were treated. There were 4 males and 1 female with an average age of 36.7 years (range, 28-46 years). Two patients involved left upper limb and chest, while the other three patients involved right upper limb and chest. The crushed time ranged from 4 to 12 hours (mean, 7 hours). All 5 cases received emergency decompression and vacuum sealing drainage (VSD). After surgery, the patients were transferred to Intensive Care Unit to receive continuous renal replacement therapy (CRRT). The wounds were repaired with skin grafts after the patients’ condition were stable.ResultsThe hospitalization time was 26-48 days (mean, 33 days). Necrosis of the skin graft occurred in 1 case, which cured after debridement and skin graft again. The skin graft survived in the other cases and the wounds healed by first intension. Five patients were followed up 12-18 months (mean, 15 months). At last follow-up, the results were excellent in all 5 cases according to the assessment criteria proposed by GU Yudong. The patients got full recovery of their upper limb activities and sensation. All the patients returned to the normal life and work.ConclusionCO poisoning, drunkenness, and pressing oneself together will lead the crush syndrome to severe and rapid progress. The key of the treatment is a comprehensive therapy including a thorough and rapid tension reduction to save the limb function, CRRT, and correction of anemia and electrolyte imbalance.
Objective To investigate the effectiveness of cross finger flap pedicled with the dorsal branch of proper digital artery in repairing degloving injury of the fingertip. Methods Between January 2010 and June 2012, 13 cases of degloving injury of single fingertip were treated, including 9 males and 4 females with an average age of 33.6 years (range, 17-46 years). The defect locations were index finger in 5 cases, middle finger in 3 cases, ring finger in 3 cases, and little finger in 2 cases, including 4 cases of mechanical injury, 6 cases of twist injury, and 3 cases of crushing injury. The extent of skin avulsion was beyond the distal interphalangeal joint. The length of the avulsion was 1.0-2.1 cm (mean, 1.8 cm). Complicated injuries included phalangeal fracture in 2 cases. The time from injury to operation was 90-330 minutes (mean, 150 minutes). The wound was repaired with the cross finger flap pedicled with the dorsal branch of proper digital artery. The size of flaps ranged from 3.2 cm × 2.3 cm to 4.2 cm × 3.1 cm. After 3-4 weeks, the pedicle was cut. The donors were closed by skin graft. Results Tension blisters of the flap and partial necrosis of skin graft occurred in 3 cases and in 1 case respectively, which were cured after symptomatic treatment; the flap and skin graft survived, and primary healing was obtained in the other cases. Thirteen patients were followed up 6-10 months (mean, 7 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 7 to 10 mm (mean, 8.1 mm). The total active movement of the fingers were excellent in 10 cases and good in 3 cases, and the excellent and good rate was 100%. Conclusion The treatment of degloving injury of fingertip with the cross finger flap pedicled with the dorsal branch of proper digital artery is recommendable for the advantages of reliable blood supply, simple operation, high survival rate of the flap, good function recovery of the finger, and satisfactory appearance.
Objective To study the therapeutic effect of combining vacuum seal ing drainage (VSD) with gluteus maximus myocutaneous flap on the repair of soft tissue defect caused by the resection of sacral tumors. Methods From June2007 to June 2008, 6 patients with skin and soft tissue necrosis in the sacrococcygeal region, deep infection, and formation of cavity at 3-6 weeks after sacral tumors resection were treated. There were 4 males and 2 females aged 17-51 years old. The size of skin and soft tissue defects ranged from 15 cm × 11 cm × 6 cm to 20 cm × 18 cm × 7 cm. Every patient underwent VSD treatment for 7-10 days, and the recombinant bovine bFGF was injected into the wound intermittently for 7-14 days (250-300 U/ cm2 once, twice daily). The wound was repaired by either the gluteus maximus myocutaneous flap (5 cases) or the lumbar-gluteus flap (1 case), and those flaps were 9 cm × 9 cm-20 cm × 18 cm in size. The donor site were sutured or repaired with spl itthickness skin graft. Results All the flaps survived uneventfully. The wound healed by first intention in 5 cases, but 1 case suffered from fat l iquefaction 2 weeks after operation and healed after drainage and dressing change. All the donor sites healed by first intention, and all the skin grafts survived uneventfully. All the patients were followed up for 6-10 months, there was no relapse of sacral tumor, and the flaps showed no obvious swell ing with good color and elasticity. Conclusion With fewer compl ications, the combination of VSD and gluteus maximus myocutaneous flap is a safe and rel iable operative method for repairing the skin and soft tissue defects caused by the resection of sacral tumors.