Objective To evaluate the short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus. Methods The clinical data of 30 patients (48 feet) who were diagnosised hallux valgus associated with mild to moderate metatarsus adductus and treated by Scarf osteotomy and Akin osteotomy combined with soft tissue procedures between February 2013 and May 2015 were analyzed retrospectively. There were 2 males (2 feet) and 28 females (46 feet) with an average age of 29.4 years (range, 18-50 years). The disease duration was 3-12 years (mean, 6.1 years). The degree of metatarsal adductus was assessed by Sgarlato’s measurement and Yu et al classification criteria, and the degree of metatarsal adductus was mild in 20 feet and moderate in 28 feet. Preoperative X-ray examination showed that the hallux valgus angle (HVA) was (39.4±5.6)°, the first-second intermetatarsal angle (1-2IMA) was (15.2±3.5)°, the metatarsus adductus angle (MAA) was (21.2±3.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 51.7±10.0, and visual analogue scale (VAS) score was 4.9±2.7 before operation. Postoperative complications and the union time of osteotomies were recorded. At last follow-up, the HVA, 1-2IMA, and MAA were measured on X-ray films, and the AOFAS scores and VAS scores were recorded, then compared them with preoperative ones. Roles - Maudsley score was used to investigate patients’ satisfaction. Results All the incisions healed by first intention. Thirty patients were followed up 24-27 months (mean, 26.4 months). Three patients (4 feet) occured metatarsalgia, and the pain relieved after treated by Custom-Made Orthotics. All the osteotomies were unoin, the healing time was 2-4 months (mean, 2.7 months). At last follow-up, the HVA and the 1-2IMA were (13.2±3.1)° and (5.1±2.3)°, respectively, showing significant differences when compared with preoperative ones (t=14.606, P=0.000; t=22.356, P=0.000); the MAA was (21.0±3.4)° and there was no significant difference when compared with preoperative one (t=0.789, P=0.434). The AOFAS and VAS scores were 91.8±7.5 and 1.1±1.0, respectively, showing signifiant differences when compared with preoperative ones (t=13.787, P=0.000; t=14.781, P=0.000). Satisfaction survey showed that 28 patients were very satisfied and satisfied (93.3%), and 2 cases were not satisfied (6.7%). Conclusion The short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus is satisfactory, and no correction is required for metatarsal adductus.
Objective To evaluate the effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus with absorbable screws or metal screws fixation by clinical and radiological data. Methods Between March 2014 and May 2016, the Scarf osteotomy combined with Akin osteotomy was used to treat 62 patients (83 feet) with moderate to severe hallux valgus. Twenty-five patients (35 feet) were fixed by absorbable screws (group A) and 37 patients (48 feet) were fixed by metal screws (group B). The difference in gender, age, affected side, etiology, severity, disease duration, preoperative hallux valgus angle (HVA) and first-second intermetatarsal angle (1-2IMA) measured in weight-bearing anteroposterior X-ray film, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS) scores between 2 groups (P>0.05). The complications and healing time of 2 groups were recorded and compared. At last follow-up, the AOFAS and VAS scores, and HVA, 1-2IMA measured by weight-bearing anteroposterior X-ray film were used to evaluate the effectiveness. Results All incisions healed by first intention and no incision-related complication occurred in the two groups after operation. Both groups were followed up, the follow-up time in group A was 12-36 months (mean, 24.4 months) and in group B was 14-38 months (mean, 25.7 months). In group A, 1 foot was complicated with hallux varus, 2 feet had mild stiffness, 1 foot appeared metastatic metatarsal pain, and in group B was 2, 3, 2 feet, respectively. There was no recurrence of hallux valgus in both groups. The difference in the incidence of complications between the two groups after the first operation was not significant (χ2=0.275, P=0.843). The removal rate of internal fixator in group B was 89.2% (33 cases) during the second operation, among which 3 cases had screw slip and 1 case had screw fracture. And 10.8% (4 cases) refused the second removal operation due to their age. Postoperative X-ray films showed that both groups had good healing at the osteotomy site, and there was no significant difference in healing time between the two groups (t=1.633, P=0.285). At last follow-up, the AOFAS score, VAS score, HVA, and 1-2IMA were significantly improved in the two groups when compared with preoperative ones (P<0.05); but no significant difference was found between the two groups (P>0.05). Conclusion The effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus is significant, with few complications. Compared with being fixed by metal screws, being fixed by absorbable screws has the same effectiveness, but can avoid the risk of second operation to remove the internal fixator.
A combined rotational flap was used to repair large scar on the face. The flap was removed from the lateral part of the neck, face and postaural region, between the zygmatic arch and clavicle. The dissection was carried out on the superfic ial of SMAS and platysmus M. Twentysix (12 males and 14 females) were reported. The age ranged from 5 to 28 years. The flap was survived completely in 19 cases. Small area at the margin of the flap was necrotic, which was reducing appeared in the postaural cular region in 6 cases. By reducing the size of the postaural cual component of the flap, necrosis never occured. Among these cases, 11 were followed up for 6 to 14 months. The results were satisfactory. The combined flap was classified as randomized flap because it had no axial and it could be used to cover a large area of skin defect. The color, thickness and quality of the flaps were all close to the normal facial skin. It was considered especially suitable for repair the large wound on the medial twothirds of the cheek.
Since 1987, One hundred and fifty-four patients suffered from alopecia, neck and facial scar, and nasal defect had been treated with skin soft tissue expansion. The incidence of complication was decreased markedly, compared to previons report which was 11.7%. Two cases of this group were given up this procedure. The lessous learned from these case were as following. Strictly evaluated the case according to the indication, examined the expander carefully, improved the techniques to inbed the expander and infilled the sailine, those of which could obtain satisfactory result.
OBJECTIVE: To study the relationship between intracellular actin and scar contracture. METHODS: Fibroblasts from 10 cases of hypertrophic scar and 5 cases of keloid were cultured in vitro. Total actin, filamentous actin(F actin), globular actin (G actin) and the ratio of F to G actin(F/G) were measured by densitometry after differential extraction and separation by polyacrylamide gel electrophoresis in the presence of sodium sulfate. RESULTS: Total actin, F actin, G actin and F/G in hypertrophic scar fibroblasts were 2.38 ng/10(4) cells, 0.98 ng/10(4) cells, 1.42 ng/10(4) cells and 0.68 respectively, while in keloid fibroblasts were 1.68 ng/10(4) cells. 0.46 ng/10(4) cells, 1.26 ng/10(4) cells, and 0.36 respectively. There was significant differences between two tissues fibroblasts in the items of total actin, F actin, G actin, and F/G (P lt; 0.01), while no significant difference in G actin (P gt; 0.05). CONCLUSION: Total intracellular actin, F actin, and F/G may play an important role in the scar contracture. The hypertrophic scar and keloid can be distinguished by the contents of total intracellular actin, F actin and F/G.
Objective To summarize the therapeutic effectinevess of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist. Methods Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, l imitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm × 4.5 cm to 11.3 cm × 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm × 5.0 cm to 12.5 cm × 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft. Results Bl ister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P lt; 0.05). Conclusion Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.
Objectives To analyze the risk factors of uterine rupture in pregnancy in Chengdu Women’s and Children’s Central Hospital in recent years. Methods The clinical data of pregnant uterine rupture patients who were hospitalized in Chengdu Women’s and Children’s Central Hospital from January 2011 to December 2017 were collected. The risk factors of uterine rupture in pregnancy were analyzed compared with the maternal delivery during the same period. The SPSS 23.0 software was used for statistical analysis. Results A total of 69 patients with uterine rupture were included, involving 14 cases of complete uterine rupture and 55 cases of incomplete uterine rupture. Compared with the pregnant females who were hospitalized during the same period, the incidence of uterine rupture in patients with scar uterus after cesarean section, history of laparoscopic hysterosalping surgery, placental implantation, twins and uterine malformation was higher, and the difference was statistically significant (P<0.05). Among them, the risk of uterine rupture was greater in the interpregnancy interval (IPI)>24 months after cesarean section in patients with scar uterus. There was no significant difference in the incidence of uterine rupture between the elderly and the multiple pregnant females and the maternal delivery during the same period (P>0.05). Conclusions Scar uterus (postoperative cesarean section), history of laparoscopic hysterosalping surgery, placental implantation, twins, and uterine malformation are possible risk factors for uterine rupture in pregnancy. Among them, patients with scar uterus have a greater risk of uterine rupture with IPI>24 months.
OBJECTIVE To investigate the different expression of actin, myosin II in hypertrophic scars, keloids and normal skins, and to understand the relationship of actin, myosin II and the scar contracture. METHODS Fifteen cases with hypertrophic scars, 10 cases with keloids and 15 cases with normal skins were chosen randomly. The expression of actin and myosin II were detected by immunohistochemical method in the hypertrophic scars, keloids and normal skins. The fibroblasts isolated from three types of tissue were cultured in vitro, then actin and myosin II in three different fibroblasts were measured using flow cytometry. RESULTS The immunohistochemical staining of myosin II in hypertrophic scars was positive, while the staining in keloids and normal skins were negative. The positive rate of myosin II expression in hypertrophic scars, keloids and normal skins were (95.11 +/- 2.78)%, (16.86 +/- 7.11)%, and (5.31 +/- 1.79)% respectively. There were significant difference between keloids and the two others(P lt; 0.01). The actin expression in three difference tissues were positive, there were no significant difference in hypertrophic scars, keloids and normal skins(P gt; 0.05). The positive rate of actin expression in hypertrophic scars, keoids and normal skins were(77.77 +/- 15.43)%, (88.89 +/- 10.29)%, and (82.92 +/- 13.48)% respectively, and there were no significant difference(P gt; 0.05). CONCLUSION Myosin II may play an important role in the scar contracture. Actin is the contractile protein of cell, it plays
Objective To review the application and research progress of transcutaneous oxygen pressure (TcPO2) in scar assessment. Methods The original articles about scar and TcPO2 were reviewed and analyzed. Results Hypoxia environment plays an important role in the progression of scar tissue. TcPO2 can accurately reflect the oxygen tension of scar tissue, which is of great significance in the assessment of scar maturity, the guidance of scar treatment, and the study of correlations between hypoxia and the progression of scar. Conclusion TcPO2 measurement is important in the study of scar evaluation, treatment, and correlation between hypoxia and scar formation.
Objective To investigate the operative method and efficacy of subcutaneous pedicle scar-band rotation flap in the treatment of cervical postburn scar contracture. Methods Between August 2008 and May 2010, 15 patients with cervical postburn scar contracture were treated with subcutaneous pedicle scar-band rotation flaps, including 9 males and 6 females with an average age of 17.3 years (range, 7-35 years). The disease duration was 1-8 years (mean, 3 years). The locations were the left cervical region in 6 cases, the right cervical region in 8 cases, and mental cervical angle region in 1 case. According to LI Ao’s classification standard for cicartrical contracture, there were 12 cases of grade I and 3 cases of grade II. The area of scar ranged from 8 cm × 5 cm to 25 cm × 12 cm. After scar relaxation, wounds were repaired with the subcutaneous pedicle scar-band rotation flaps of 7 cm × 5 cm to 15 cm × 10 cm at size. In 3 cases of grade II, free split thickness skin grafts (7 cm × 4 cm to 12 cm × 7 cm at size) were used simultaneously. Results After 2 weeks of operation, 2 scar-band flaps had distal partial necrosis and healing was achieved after dressing change with formation of hypertrophic scar; the others survived with healing of incisions by first intention. After 6-12 months of follow-up, all patients possessed good cervical contours, sufficient release of scar contractures, and normal cervico-mandicular or mental cervical angles. The skin’s color and texture were satisfactory. There was no recurrence of cervical scar contracture and other complications. All patients acquired normal cervical movement at last follow-up. Conclusion Subcutaneous pedicle scar-band rotation flap is a simple, efficient, and versatile technique in release of cervical postburn scar contracture. It is an effective method to make use of the lateral excess scar flap to resurface defects caused by scar release.