Clinical application of neurovascular staghorn flap for repairing of defects in fingertips / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the effectiveness of neurovascular staghorn flap for repairing defects in fingertips.@*METHODS@#Between August 2019 and October 2021, a total of 15 fingertips defects were repaired with neurovascular staghorn flap. There were 8 males and 7 females with an average age of 44 years (range, 28-65 years). The causes of injury included 8 cases of machine crush injury, 4 cases of heavy object crush injury, and 3 cases of cutting injury. There were 1 case of thumb, 5 cases of index finger, 6 cases of middle finger, 2 cases of ring finger, and 1 case of little finger. There were 12 cases in emergency, and 3 cases with finger tip necrosis after trauma suture. Bone and tendon exposed in all cases. The range of fingertip defect was 1.2 cm×0.8 cm to 1.8 cm×1.5 cm, and the range of skin flap was 2.0 cm×1.5 cm to 2.5 cm×2.0 cm. The donor site was sutured directly.@*RESULTS@#All flaps survived without infection or necrosis, and the incisions healed by first intention. All patients were followed up 6-12 months, with an average of 10 months. At last follow-up, the appearance of the flap was satisfactory, the wear resistance was good, the color was similar to the skin of the finger pulp, and there was no swelling; the two-point discrimination of the flap was 3-5 mm. One patient had linear scar contracture on the palmar side with slight limitation of flexion and extension, which had little effect on the function; the other patients had no obvious scar contracture, good flexion and extension of the fingers, and no dysfunction. The finger function was evaluated according to the total range of motion (TAM) system of the Hand Surgery Society of Chinese Medical Association, and excellent results were obtained in 13 cases and good results in 2 cases.@*CONCLUSION@#The neurovascular staghorn flap is a simple and reliable method to repair fingertip defect. The flap has a good fit with the wound without wasting skin. The appearance and function of the finger are satisfactory after operation.

Lesiones de punta de dedo: experiencia en el manejo en los últimos 5 años en un centro pediátrico / Fingertip injuries: experience in handling the last 5 years in a pediatric center

Las lesiones de punta de dedo son comunes en pacientes pediátricos que acuden a salas de Emergencia; son causadas por accidentes en el hogar y con aplastamiento en puerta como principal mecanismo de trauma. El tratamiento se realiza individualizado por cirujanos plásticos y cirujanos pediátricos en dependencia de la herida y el compromiso tisular. El propósito de este estudio es describir el manejo de pacientes con lesiones de punta de dedo en un centro pediátrico. Se realizó un análisis de historias clínicas en el período entre enero 2015 y diciembre 2020, se evaluaron 228 pacientes atendidos en el Hospital de Niños Dr. Roberto Gilbert Elizalde, en Guayaquil, Ecuador. Los resultados incluyen un predominio de pacientes en edad preescolar (67%), masculinos (56%) y de mano derecha (53%). Los dedos más afectados fueron el medio y anular. Los procedimientos fueron realizados por cirujanos plásticos (55%) y la técnica electiva fue bajo anestesia general. La extensión del daño involucró tejidos blandos (92%), avulsión de uña (29%) y fracturas asociadas (15%). El 3% de los pacientes presentó complicaciones que requirieron seguimiento. El tipo de reparo se seleccionó en dependencia de la extensión de la herida, se realizaron suturas simples (37%) y suturas complejas con reparo de la uña (27%). Nuestros datos son similares a los descritos en la literatura internacional, con buenos resultados a largo plazo, menor tasa de complicaciones y respuestas similares en los reparos realizados por cirujanos plásticos y cirujanos pediatras.

Fingertip injuries are common in pediatric patients who present to the emergency room. They are usually caused by accidents at home, being door-crush the main mechanism. Treatment is performed on an individual basis, by a Plastic or General Pediatric Surgeon, according to the wound findings and tissue involvement. The purpose of this study is to describe the management on a pediatric center in patients with a fingertip wound. A descriptive and retrospective analysis of medical records was carried out from January 2015 until December 2020. In this period 228 patients were seen in the Dr. Roberto Gilbert Elizalde Children´s Hospital in Guayaquil, Ecuador. A high incidence was found in the preschool age with 67% of cases. The injuries were more common in males (56 %) and more predominant on the right hand (53%). The most affected fingers were the middle and annular. Procedures were mostly performed by Pediatric Surgeons (55%) and the elective technique was under general anesthesia. Damage extension of the fingertip included soft tissues in 92% of patients, nail avulsion in 29% and associated fractures in 15%. Only 3% of patients developed complications that required follow up. The type of repair was selected according to the extension of the injury. Mostly simple sutures (37%) and complex sutures with nail repair (27%)were used.Our data is similar to the one found in international literature, with good long-term outcomes, minor complications and similar results when the repair was performed by a Plastic or Pediatric surgeon

High energy photobiomodulation therapy in the early days of injury improves sciatic nerve regeneration in mice / Aplicação de alta energia da terapia de fotobiomodulação nos primeiros dias de lesão otimiza a regeneração de nervo ciático em camundongos

INTRODUCTION: Different studies have evaluated the effects of electrophysical agents on regeneration after peripheral nerve injury. Among them, the most used in clinical and experimental research is photobiomodulation therapy (PBMT). OBJECTIVE: To analyze the effect of standard energy (16.8 J) of PBMT on peripheral nerve regeneration, applied at different periods after sciatic nerve injury in mice. METHODS: Thirty male Swiss mice were divided into six groups: naive; sham; control; LLLT-01 (660 nm, 16.8 J of total energy emitted in 1 day); LLLT-04 (660 nm, 4.2 J per day, 16.8 J of total energy emitted in 4 days); LLLT-28, (660 nm, 0.6 J per day, 16.8 J of total energy emitted over 28 days). The animals were evaluated using thermal hyperalgesia, Sciatic Functional Index (SFI), and Static Sciatic Index (SSI). Data were obtained at baseline and after 7, 14, 21, and 28 days after surgery. RESULTS: For the SFI and SSI, all groups showed significant differences compared to the control group, and the LLLT-04 group presented the best results among those receiving PBMT. In the assessment of thermal hyperalgesia, there was a significant difference in the 14th day of evaluation in the LLLT-04 group. CONCLUSION: The application of 16.8 J was useful in sciatic nerve regeneration with an improvement of hyperalgesia, with higher efficacy when applied in four days (4.2 J/day).

INTRODUÇÃO: Estudos avaliaram os efeitos de diferentes terapias aplicadas após lesão nervosa periférica, com o intuito de promover a regeneração local. Dentre elas, a mais utilizada em pesquisa clínica e experimental é a terapia de fotobiomodulação (TFBM). OBJETIVO: Analisar o efeito da fotobiomodulação (16,8 J) na regeneração nervosa periférica, aplicada em diferentes regimes após a lesão do nervo ciático em camundongos. MÉTODOS: Foram utilizados trinta camundongos machos (Swiss) divididos em: naive; sham; controle; LBI-01 (660 nm, 16,8 J de energia total emitida em 1 dia); LBI-04 (660 nm, 4,2 J por dia, 16,8 J de energia total emitida em 4 dias); LBI-28, (660 nm, 0,6 J por dia, 16,8 J de energia total emitida durante 28 dias). Os animais foram avaliados utilizando a hiperalgesia térmica, Índice Funcional do Ciático (IFC) e Índice estático do ciático (IEC). Os dados foram obtidos na linha de base e após 7, 14, 21, e 28 dias após a cirurgia. RESULTADOS: Para o IFC e IEC, todos os grupos mostraram um aumento no valor e diferenças significativas em relação ao grupo de controle, e o grupo LBI-04 apresentou os melhores resultados, alcançando valor basal no 21° dia dentre os que foram submetidos a TFBM. Na avaliação da hiperalgesia térmica, houve aumento do tempo de resposta com diferença significativa no 14° dia de avaliação no grupo LBI-04. CONCLUSÃO: A aplicação de 16,8 J foi eficaz na regeneração do nervo ciático quando distribuída ao longo dos 4 primeiros dias pós-lesão, com dose diária de 4,2 J/ponto.

Review of current concept in the management of pressure ulcers

Pressure ulcers are quite distressing, and they cut across all age groups. Aside from increasingmortality, it results in protracted hospital stay and an upsurge in the consumption of healthcare resourcesPressure ulcers are considered to be essentially preventable, but in order to prevent them it is important to identify the people most at risk and deliver timely preventative care. In case of severe acute respiratory distress syndrome (ARDS), as in coronavirus dis­ease 2019 (COVID-19) affected patients, prone position and invasive ventilation improve the clinical status of this group of patients. This form of therapy is associated with an increased risk of facial pressure ulcers. When pressure ulcer occurs, appropriate documentation of each ulcer and staging of the ulcer are essential for good wound assessment.Treatment involves, assessing the nutritional needs of the patient, management of infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery

Quantitative Evaluation of Sciatic Nerve Crush Injury with Conventional Ultrasound Combined with Shear-wave Elastography in Rabbit Models / 中国医学科学院学报

To explore the value of conventional ultrasound combined with shear-wave elastography in the quantitative evaluation of sciatic nerve crush injury in rabbit models. Forty healthy male New Zealand white rabbits were randomly divided into four groups (=10 in each group):three crush injury (CI) groups (2,4,and 8 weeks after crush) and control group (without injury). The thickness and stiffness of the crushed sciatic nerves and denervated triceps surae muscles were measured at different time points and compared with histopathologic parameters. Inter-reader variability was assessed with intraclass correlation coefficients. Compared with the control group,the inner diameters of the sciatic nerves significantly increased in the 2-week CI group [(1.65±0.34) mm (0.97±0.15) mm,=0.00] but recovered to the nearly normal level in the 8-week CI group [(1.12±0.18) mm (0.97±0.15) mm,=0.06];however,compared with control group [(8.75±1.02)kPa],the elastic modulus of the nerves increased significantly in all the CI groups [2-week:(14.77±2.53) kPa;4-week:(19.12±3.46) kPa;and 8-week:(28.39±5.26) kPa;all =0.00];pathologically,massive hyperplasia of collagen fibers were found in the nerve tissues. The thickness of denervated triceps surae muscle decreased gradually,and the elastic modulus decreased 2 weeks after injury but increased gradually in the following 6 weeks;pathologically,massive hyperplasia of collagen fibers and adipocytes infiltration were visible,along with decreased muscle wet-weight ratio and muscle fiber cross-sectional area. The inter-reader agreements were good. Conventional ultrasound combined with shear-wave elastography is feasible for the quantitative evaluation of the morphological and mechanical properties of crushed nerves and denervated muscles.

A possible role of endoneurial fibroblast-like cells in the resolution of endoneurial oedema following nerve crush injury / El posible rol de los fibroblastos endoneurales en la resolución del edema endoneural después de una lesión por aplastamiento nervioso

SUMMARY: Endoneurial oedema is a salient feature of all types of neuropathy. Its elimination is crucial during the complications of nerve recovery. The objective was to study a possible role of the endoneurial fibroblasts in the resolution of nerve edema. Forty-two albino male rats aged between 30 and 40 days (weight 200 g to 250 g) were used in this study. The left sural nerves of 36 rats were subjected to crush injury at one to three-week intervals with six animals per interval. The right and left sural nerves of the remaining six rats were used as controls. At the end of the second week after crush injury, the endoneurium showed channel-like spaces that were lined by fibroblast-like cells and collagen bundles that contained degenerated myelin, and were connected to the subperineurial spaces. Flattened fibroblast-like cells were arranged in several layers in the subperineurial, forming barrier-like cellular sheets localizing to the endoneurial oedema in the space. Fibroblast-like cells also wrapped around the regenerating nerve fibres with their branching cytoplasmic processes. During the third week, the flattened fibroblast-like cells formed nearly continuous cellular sheets in the subperineurial spaces. Macrophages were frequently observed between these cellular barrier-like sheets and in the subperineurial. The endoneurial fibroblast-like cells form barrier-like cellular sheets that probably localise the endoneurial oedema in the subperineurial space. It also appear to create endoneurial channel-like spaces containing degenerated myelin and endoneurial oedema, which may be helpful in localizing and resolving such oedema.

RESUMEN: El edema endoneural es una característica destacada de todos los tipos de neuropatía. Su eliminación es importante durante las complicaciones de la recuperación nerviosa. El objetivo fue estudiar un posible papel de los fibroblastos endoneurales en la resolución del edema nervioso. En este estudio se utilizaron 42 ratas macho albinas con edades entre los 30 y 40 días (peso 200 a 250 g). Los nervios surales izquierdos de 36 ratas se sometieron a lesiones por aplastamiento en intervalos de una a tres semanas con seis animales por intervalo. Se usaron los nervios surales derecho e izquierdo de las seis ratas restantes como controles. Al final de la segunda semana después de la lesión por aplastamiento, el endoneuro mostró espacios en forma de canal que estaban revestidos por células similares a fibroblastos y haces de colágeno que contenían mielina degenerada y se conectaron a los espacios subperineurales. Las células aplanadas de fibroblastos se dispusieron en varias capas en el subperineuro, formando láminas celulares de tipo barrera que se localizaban en el espacio del edema endoneural. Las células similares a fibroblastos también envolvían las fibras nerviosas regeneradoras con sus procesos citoplásmicos ramificados. Durante la tercera semana, las células aplanadas de fibroblastos formaron láminas celulares casi continuas en los espacios subperineurales. Los macrófagos se observaron con frecuencia entre estas láminas similares a barreras celulares y en el subperineuro. Las células de tipo fibroblasto endoneural formaban láminas celulares de tipo barrera que probablemente localizan el edema endoneural en el espacio subperineural. También parece que crea espacios en forma de canal endoneural que contienen mielina degenerada y edema endoneural, que pueden ser útiles para localizar y resolver este edema.

Persistent Bordetella petrii Infection Related to Bone Fractures

No abstract available.

Epidemics, diseases, and health emergencies in the aftermath of natural disasters in the Philippines

OBJECTIVES: The study aimed to present the data on the frequency and severity of natural disasters in the Philippines, the common diseases in affected communities after a natural disaster, the immediate health effects after a natural disaster and the preceding environmental risk factors, as well as evaluation scheme for pre- and post- disaster management in the Philippines. METHODS: Data were gathered from local and international agencies dealing with epidemics diseases and health emergencies related to natural disasters. Critical analysis was done in order to come up with an evaluation scheme on both ex ante risk reduction, and ex post disaster response. RESULTS: The study showed that there are immediate adverse health effects of natural disasters. Drought brings about protein malnutrition; earthquakes can cause crush injuries; and fires can cause poor air quality. The study showed that the most common communicable diseases arisng from disasters and emergencies include diarrhea, acute respiratory infection, measles, and malaria. In the international scene, cholera, diarrhea, hepatitis A and E, measles, meningitis, tetanus, diarrhea, leptospirosis, acute respiratory syndrome, coccidiomycosis, and malaria were reported to be the major epidemics after certain types of natural disaster. CONCLUSION AND RECOMMENDATIONS: There are several recommendations proposed in this study for disaster management such as integration of permanent LGU disaster risk management, better coordination among agencies involved in disaster management, strengthened vertical and horizontal integration of disaster risk reduction plans, creation of an overall framework that integrates environmental issues with disaster management strategies, documentation, evaluation and replication of successful local disaster prevention and management strategies, and coordination with health units, and economic development units. The Philippines is challenged to come up with and implement a comprehensive disaster preparedness and mitigation measures for disasters and epidemics.