Anatomical reconstruction of donor site after large iliac crest graft harvest with equivalent iliac crest allograft. A prospective controlled study.

BACKGROUND: Iliac bone graft harvesting is a common procedure in spinal surgery and trauma center for spinal fusion and nonunion of the extremities. AIM, PATIENTS AND METHODS: To compare the pain and cosmetic outcomes of patients undergoing iliac crest anatomical reconstruction using equivalent iliac crest allograft (R group) with those of patients without reconstruction of the iliac crest defect (NR group), a prospective nonrandomized controlled study was conducted. RESULTS: In R group, the intensity and prevalence of pain were significantly lower than those in NR group. Cosmetic outcome and satisfaction score were also significantly improved in R group. One patient of R group suffered from lipolysis and superficial infection which healed by regular dressing change for two weeks. There were no cases of allograft displacement, implant loosening, internal fixation breakage or immunological rejection. Seven patients in NR group had significant pain related to the tenting of skin over the defect. Radiologic incorporation of pelvis was documented in all patients except four having partial re-sorption of the allograft. Early fibrous healing and the late creeping substitution were noted in all patients of R group. CONCLUSIONS: Equivalent iliac crest allograft provides an effective alternative for iliac crest anatomical reconstruction, leading to reduced donor site pain and better cosmesis.

The study on bactericidal effect and ultrastructural alterations of chlorocresol nanoemulsion disinfectant against Staphylococcus aureus.

Chlorocresol nanoemulsion disinfectant (CND) is an environmental disinfectant prepared with nanoemulsion as its drug carrier. This study aimed to investigate the bactericidal effect of CND on Staphylococcus aureus ( S. aureus) and its effect on bacterial ultrastructure. The neutralizing effect of CND against S. aureus was first screened by suspension quantitative evaluation experiment procedure of neutralizer. Disinfection performance was evaluated by the determination of Minimal Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC), quantitative bactericidal experiment, and comparative experiment of disinfection performance between 0.1% CND and 0.1% chlorocresol aqueous solution. Meanwhile, the effect of CND on the ultrastructure of S. aureus was investigated with scanning electron microscope (SEM) and transmission electron microscope (TEM) to preliminarily explore the bactericidal mechanism. The results showed that 3% Tween-80 in PBS could be screened as the neutralizer of CND against S. aureus. MIC and MBC were 100 µg/mL and 200 µg/mL, respectively. The bactericidal rates were all 100% when 0.06% and 0.08% disinfectant acted for 15 and 5 min, respectively. Furthermore, compared with 0.1% chlorocresol aqueous solution, the bactericidal effect of 0.1% CND was significantly enhanced (p⟨0.01). After treatment with CND for 10 min, SEM observation showed that the morphology of S. aureus cells were changed and the integrity destroyed. TEM observation showed that the cell shape changed, and the structures of the cell wall, cell membrane and cytoplasm were damaged in varying degrees. CND showed the strong bactericidal effect on S. aureus and could cause ultrastructure alterations of S. aureus.

[Effects of three kinds of proximal pedicled flaps of hand for relaying repair of degloving injuries of fingertips and the soft tissue defects in the donor sites].

Objective: To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum. Methods: A total of 21 patients with degloving injuries of fingertips at the 2nd to 5th fingers were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females aged 24-60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the three flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured finger joints was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results: All the flaps survived after operation. Tension blisters appeared on the surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, the three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and with only linear scars in donor sites of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied with the appearance of hand, and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured finger joints was evaluated as excellent in 17 cases, good in 4 cases. Conclusions: The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal injury.

[Expression of regulation protein of glial fibrillary acidic protein gene in hippocampus of epileptic rats induced by kainic acid].

AIM AND METHODS: The DNA binding protein from hippocampus of epileptic rats was investigated by southwestern blot, which regulated the expression of glial fibrillary acidic protein (GFAP) gene. Its expression pattern was also studied. RESULTS: Southwestern blot showed that there were two specific DNA binding proteins that regulated the expression of GFAP gene, and their molecular weight were 39 kDa and 35.5 kDa, respectively. The expression of the DNA binding proteins was markedly increased in hippocampus of kainic acid (KA) + NS group at 5 d, reached the peak at 3 w, lasted for 3 m observed. CONCLUSION: The results above suggest that KA may increase the expression of GFAP in hippocampus by upregulating the transcription factor that regulated the expression of GFAP gene, which may participate in the formation of epileptic seizures.