[Clinical effects of free superficial circumflex iliac artery superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities]

Objective: To investigate the clinical effects of free superficial circumflex iliac artery (SCIA) superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities. Methods: The study was a retrospective observational study. From January 2020 to June 2022, 19 patients with large wounds in extremities who met the inclusion criteria were admitted to the First Affiliated Hospital of Bengbu Medical College, including 15 males and 4 females, aged 28-75 years. The debridement, fracture reduction and fixation, tendon, vessel, and nerve repair, and vacuum sealing drainage were performed in the first stage surgery. After debridement in the second stage surgery, the total wound area was 13.0 cm×8.0 cm-34.0 cm×15.0 cm. The tendon and bone exposed wound with area of 9.0 cm×6.0 cm-14.0 cm×7.0 cm was repaired with free SCIA superficial branch perforator flap with area of 10.0 cm×6.5 cm-15.0 cm×8.0 cm. The remaining granulation tissue wound with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm was repaired with full-thickness skin graft far from the flap donor site with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm. All the wounds in donor site were sutured. The operation time and amount of bleeding of patients during the surgery were recorded, the survival of flap and skin graft were observed after surgery. During follow-up, the flap and skin graft, scar in the donor site and its effect on donor site function were observed. At the last follow-up, the satisfaction of patients with the efficacy was evaluated by the efficacy satisfaction rating score. Results: The operation time of patients was 2.0-3.5 h. The amount of bleeding of patients during the surgery was 100-320 mL. One patient had ecchymosis and venous crisis in the edge of flap on the second day after surgery, and the flap survived after exploration. The flaps of the other patients survived smoothly. The skin grafts of patients all survived smoothly. Two patients had bloated flaps due to obesity in the later stage, and the expected results were achieved after flap thinning surgery 6 months after operation. During the follow-up of 6 to 24 months, the flaps had good elasticity and soft texture, and the skin grafts had no wear or ulceration; linear scars were left in all the donor sites but their functions were not affected. The patients were all satisfied with the efficacy. Conclusions: Free SCIA superficial perforator flap combined with full-thickness skin graft far from the donor site was used to repair the large wounds in extremities, which was safe, reliable, and less traumatic and short in operation time, and resulted in good postoperative appearance and function in the donor sites and recipient sites.

[The influence on the peeling off time of the tunica albuginea after 4-8℃ cool water was applied to children's low temperature plasma-assisted tonsillectomy]

Objective:The aim of this study is to discuss the influence on the peeling off time of the tunica albuginea after 4-8℃ cool water was applied to children 's low temperature plasmaassisted tonsillectomy.Method:One hundred and seventeen benign hypertrophy of tonsil patients were recruited,the 56 cases of them were served as experimental group,who were treated with plasma tonsillectomy using 4-8℃ normal saline as medium,while the 61 cases were served as control group,who were treated with plasma tonsillectomy using 22-25℃ normal saline as medium.Then,we analyzed the peeling off time of the tunica albuginea between experimental and control group.Result:The difference of formation time between experimental group and control group was not statistically significant(P >0.05).The average peeling off time of the tunica albuginea was (11.32±2.51) days in experimental group,while time was(15.03±4.12) days in control group.There was a statistical difference between them.Conclusion:The use of 4-8℃ cold water in children's low temperature plasma-assisted tonsillectomy can reduce the peeling off time of the tunica albuginea,and it indicate that the ice water medium can reduce the heat injury caused by the plasma operation.

[Clinical significance of plasma alpha-granule membrane protein-140 in blood stasis of primary glomerular disease]

Plasma alpha-granule membrane protein 140(GMP-140) was determined in 53 patients of primary glomerular disease (PGD) with or without blood stasis. At the same time, the relationships between plasma GMP-140 and hyperlipoidemia and hypertension were investigated. Results showed that plasma GMP-140 in PGD patients was higher than that of normal control subjects, P < 0.01, platelet of patients was in a high activated status. The elevation was more significant in patient with blood stasis than in those without blood stasis, P < 0.01. Among the patients with blood stasis, plasma GMP-140 level in those with Qi-Deficiency was higher than that without Qi-Deficiency (P < 0.05). The above-mentioned results suggested that GMP-140 was an objective indicator for blood stasis of PGD patients. Deficiency of Qi could enhance platelet activation so as to aggravate the tendency of blood stasis. It was in accordance with the traditional Chinese medicine theory of "Qi-Deficiency induces blood stasis". Hyperlipoidemia and hypertension showed close relationship with abnormal increase of GMP-140, suggesting they play important roles in induction of hypercoagulability and blood stasis in PGD patients.