ABSTRACT
Objective:To explore rational surgical treatment for childhood nail matrix nevi.Methods:A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi, who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019. Different surgical approaches were adopted according to the site and width of lesions. For lesions with a width of ≤ 3 mm, the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases. For lesions with a width of > 3 mm, one of the following 3 surgical procedures was selected by the children′s parents: (1) shaving of nail bed and nail matrix lesions under a microscope at ×8 magnification (8 cases) ; (2) excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx (8 cases) ; (3) excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting (5 cases) , or excision of lesions of the thumb followed by abdominal-wall flap transfer (3 cases) . The patients were followed up for 12 months, and clinical efficacy was evaluated.Results:During the follow-up, no recurrence occurred in the 11 cases receiving direct excision and suture, with good appearances and longitudinal linear scars on the nail. Among the 8 cases receiving shaving therapy under a microscope, 4 experienced relapse during the follow-up of 6 - 12 months, and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence. No recurrence was observed in the 8 cases receiving excision of the lesions and full-thickness skin grafting, of whom 1 experienced skin graft necrosis, and skin grafts survived with obvious pigmentation in the other 7 cases. Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer, no recurrence was observed, and all transferred flaps survived; good appearances, nearly normal color and gloss of nails were obtained in the cases after transfer of skin flaps from the thenar muscle area, while the color and gloss of postoperative nails were markedly different from those of normal nails in the cases receiving abdominal-wall flap transfer.Conclusion:For nail matrix nevi with a width of ≤ 3 mm, direct excision and suture with 1-to-2-mm margins are recommended; for those with a width of > 3 mm, excision of lesions combined with full-thickness skin grafting, transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer is recommended; the shaving procedure under a microscope should be used with caution.
ABSTRACT
Objective@#To preliminarily investigate the influence of recombinant human growth hormone (rhGH) on the immune function of younger children with severe burn injuries.@*Methods@#A total of 30 younger children with severe burn injuries, conforming to the study criteria, were admitted to our hospital from July 2016 to July 2018. They were enrolled in the prospective, randomized, double-blinded, controlled trial and divided into group rhGH [n=15, 10 boys and 5 girls, aged (22±10) months] and control group [n=15, 8 boys and 7 girls, aged (21±7) months] according to the random number table. The patients in control group received anti-shock, anti-infection, and wound caring therapies, etc. On the basis of above-mentioned treatment, the patients in group rhGH were subcutaneously injected with rhGH once every night before bedding, with a dosage of 0.2 IU·kg-1·d-1, from the 3rd day post injury for 7 consecutive days. Before and on the 3rd and 7th day of rhGH treatments, the fasting peripheral venous blood was collected from patients in both groups. Blood glucose level was detected by glucometer. Percentages of CD4+ T lymphocytes, CD8+ T lymphocytes, CD3+ T lymphocytes, CD19+ B lymphocytes, and ratio of CD4+ T lymphocytes to CD8+ T lymphocytes were determined by flow cytometer. Mass concentration of serum immune globulin (Ig) A, IgG, and complement C3 were detected by enzyme-linked immunosorbent assay. Data were processed with Fisher′s exact probability test, independent sample t test, analysis of variance for repeated measurement and Bonferroni correction, and Mann-Whitney U test.@*Results@#(1) The blood glucose levels of children in the two groups were similar before and on the 3rd and 7th day of rhGH treatment (t=0.474, 1.652, 1.997, P>0.05). The glucose levels of children in group rhGH on the 3rd and 7th day of rhGH treatment [(6.9±1.0) and (7.7±1.1) mmol/L] were significantly higher than (5.9±0.9) mmol/L before rhGH treatment (P<0.05). The glucose level of children in control group on the 7th day of rhGH treatment was significantly higher than that before rhGH treatment (P<0.05). (2) The percentages of CD4+ T lymphocytes of children in group rhGH before rhGH treatment and on the 7th day of rhGH treatment were (35.1±2.0)% and (38.5±2.2)%, which were close to (36.2±2.0)% and (33.6±2.2)% in control group, respectively (t=0.371, 1.553, P>0.05). The percentages of CD4+ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment[(44.7±2.2)%] was significantly higher than (36.5±2.2)% in control group (t=2.624, P<0.05). The percentage of CD4+ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment was significantly higher than that before rhGH treatment (P<0.05). The percentages of CD4+ T lymphocytes of children in control group on the 3rd and 7th day of rhGH treatment were both close to the percentage before rhGH treatment (P>0.05). (3) The percentage of CD8+ T lymphocytes of children in group rhGH on the 3rd day of rhGH treatment was significantly lower than that in control group (t=2.107, P<0.05). (4) The ratio of CD4+ T lymphocytes to CD8+ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment (2.36±0.20) was significantly higher than 1.72±0.20 in control group (t=2.285, P<0.05). The ratio of CD4+ T lymphocytes to CD8+ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment was significantly higher than 2.04±0.19 before rhGH treatment (P<0.05). (5) The percentages of CD3+ T lymphocytes and CD19+ B lymphocytes of children in the two groups were similar before and on the 3rd and 7th day of rhGH treatment (t=1.913, 0.552, 1.327, 1.465, 1.587, 0.407, P>0.05). The percentages of CD3+ T lymphocytes of children in group rhGH on the 3rd and 7th day of rhGH treatment were significantly higher than the percentage before rhGH treatment (P<0.05). (6) The mass concentration of serum IgA, complement C3, and IgG of children in the two groups was similar before and on the 3rd and 7th day of rhGH treatment (t=-1.596, -0.100, 1.263, -0.220, 1.378, 1.631, Z=0.228, 0.519, 1.182, P>0.05). The mass concentration of serum IgA and complement C3 of children in group rhGH on the 3rd and 7th day of rhGH treatment was significantly higher than that before rhGH treatment(P<0.05).@*Conclusions@#rhGH has little effect on humoral immunity of younger children with severe burn injuries with limited influence on CD19+ B lymphocyte, mass concentration of serum IgA, IgG, and complement C3. It may improve the cellular immunity function mainly through promoting the release of CD4+ T lymphocyte, reducing the release of CD8+ T lymphocyte. It can be used in clinical treatment of younger children with severe burn injuries.
ABSTRACT
Objective@#To report the clinical outcome for Wassel Type I and Ⅱ thumb duplication with connected nail by excising the extra digit and reconstructing of nail ridge with the flap from the ablated digit.@*Methods@#63 polydactyly of the thumbs in 61 patients with connected nail were treated the procedure by excising of the inferior phalangeal bones and nails and straightening the IP joint by orthroplasty or wedge osteotomy and reconstructing the nail ridge with the flap from the extra digit. The patients were followed up postoperatively for the assessment of thumb′s appearance and function by using the modified TADA scoring.@*Results@#All cases acquired primary wound healing and 55 of 63 cases were followed up for 6 months to 4 years. The nails were flat and the width were more than 80% of the contralateral side. Symmetric nail lunula was found in 46 thumbs (80.7%) as well as symmetric nail ridge in 40 thumbs (70.1%), but 50 thumb′s nail grooves were not obvious (87.7%). All incisions were made at the lateral of thumbs and no scars were found in the finger pulps. Except mild IP joint deviation was found in 6 thumbs, the others were roughly normal. The range of motion of the IP joint was more than 45° in all cases. Modified TADA scoring result: 52 fingers were excellent and 5 were good.@*Conclusions@#Satisfactory surgical outcome and better parental acceptance can be obtained after the procedures of excising the extra digit and forming of nail ridge, including aesthetics appearance, unaffected sense of touch with finger pulp intact and good mobility of the joint.
ABSTRACT
Objective@#To explore the application of dorsal double-wing flap for reconstruction of the web space in the fifth and fourth toe polysyndactyly.@*Methods@#99 patients (112 feet) with polysyndactyly of the fifth toe fused with the fourth toe were treated, 75 of which were incomplete and 37 were complete fusion of the fourth and fifth toes. The fifth toes showed various degrees of fibular deviation and minor deformities. Excision of polydactyly and then with the use of wedge osteotomy correction deviation. Using 77 traditional and 35 modified dorsal double-wing flap for reconstruction of the web space, and close the lateral sides of toes with flaps from polydactyly. The distal soft tissue of polydactylies were used lengthening the reconstructed fifth toes.@*Results@#Polydactyly excision and syndactyly releasing in same procedure and lateral sides of the toes were all closed with flaps without skin grafts. Patients were followed up average 27 months after operation, the constructed web space showed good appearance, with slightly deeper or normal location. The fibular deviation were complete correction, and minor deformities were improved.@*Conclusions@#The dorsal double-wing flap is used for reconstruction of the web space in the fifth and fourth toes polysyndactyly without skin grafts. Reconstruction of the web depth, combined with lengthen distal end of the fifth could improve the toe appearance. Compared with traditional dorsal double-wing flap reconstruction of the web space, the modified flaps have better appearance in palmar of foot.
ABSTRACT
Objective To investigate the application of modified negative pressure closure drainage in early stage of snakebite .Methods 60 patients with early bite ulcer were selected as study objects ,and they were randomly divided into two groups according to the digital table .30 patients in the observation group received vacuum sealing drainage(VSD) combined with chymotrypsin continuous rinsing treatment .30 patients in the control group were given conventional dressing bandaging treatment .The two stage skin grafting time,wound healing time,complications,disa-bility rate,hospitalization time and C reactive protein ( CRP) levels of the two groups were observed .And the treatment effect was analyzed .Results The incidence rates of complications and disability in the observation group were 0.00％and 3.33％,respectively,which were significantly lower than 16.67％and 26.67％in the control group ,and the differences between the two groups were statistically significant (χ2 =4.356,6.405,all P<0.05).The CRP levels of 3 d and 7 d in the observation group were (15.8 ±1.7)mg/L,(6.9 ±1.6)mg/L,respectively,which in the control group were (18.6 ±2.3) mg/L,(13.8 ±1.9) mg/L,respectively,there were statistically significant differences between two groups(t=5.362,15.214,all P<0.01).The two stage skin grafting,wound healing,hospital stay of the observation group were (9.5 ±1.8) d,(24 ±1.8) d,(25.3 ±1.9) d,respectively,which were significantly shorter than those of the control group [(16.2 ±2.6)d,(32.0 ±3.2)d,(33.2 ±3.7)d],the differences were statistically significant(t=11.604,11.93410.403,all P<0.01).Conclusion For patients with injury of cobra bite to early ulcer,using VSD technology combined with chymotrypsin continuous irrigation ,can significantly reduce the level of CRP and the occurrence of complications and disability rate ,shorten the time of two stage skin grafting ,wound healing time,hospitalization time,reduce the pain of patients,it is the best treatment to accelerate recovery .
ABSTRACT
<p><b>OBJECTIVE</b>To investigate difference between the appearance and the bony structure in the polysyndactyly of the fifth toe fused with the fourth toe.</p><p><b>METHODS</b>From Jan. 2009 to Jan. 2014, 54 patients (65 feet) with polysyndactyly of the fifth toe fused with the fourth toe were treated. The appearance, X-ray and intraoperative finding were recorded and compared to classify the deformity. Then the extra toe was excised and syndactyly was separated. The malalignment and brachydactyly of the sixth toes were corrected simultaneously.</p><p><b>RESULTS</b>According to the bone and joint type, the fifth toes were neoplastic toes without joints in 17 feet, or had poor bony and joint alignment with the sixth toes in 48 feet. So the fifth toes were excised in all the cases. The patients were followed up for 1 month to 4 years. The oblique deformity of sixth toes were corrected completely with improved length.</p><p><b>CONCLUSIONS</b>The polysyndactyly of the fifth toe fused with the fourth toe should be classified to design the excised toe (usually fifth toe) and correction procedure. The appearance and bony joint recovery are both important.</p>
Subject(s)
Humans , Polydactyly , Pathology , General Surgery , Syndactyly , Pathology , General Surgery , Toe Phalanges , Congenital Abnormalities , General Surgery , Toes , Congenital Abnormalities , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the clinical effect of using dorsal two wing-shaped flap to reconstruct finger web for treatment of congenital syndactyly.</p><p><b>METHODS</b>This technique has been used in 19 children with congenital syndactyly. At the dorsum, a flap with V-shaped tip and two wing-shaped pedicle were designed and was just sewed up with an anchor-shaped incision at the palm. The web was primarily reconstructed without skin graft at base of fingers. Distal end of fingers were separated by using serrated flap and were closed after removal of fatty tissue. At some cases with tight skin connection. The defect area at lateral and distal end of fingers was closed by small pieces of skin graft.</p><p><b>RESULTS</b>All the webs were reconstructed primarily without skin graft at the base of fingers. 7 cases with tight skin connection had small pieces of skin graft at lateral and distal end of fingers. Primary healing was achieved in all cases. After 1 to 6 months of follow-up, both the appearance and function were satisfactory without conspicuous scar. The reconstructed finger webs were in normal depth and width.</p><p><b>CONCLUSIONS</b>Primary web space can be achieved by dorsal two wing-shaped flap without skin graft at base of fingers. It is one of the best choices for treatment of congenital syndactyly.</p>