The "bayonet" deformity from poliomyelitis is a peculiar type of deformity of knee. From January 1986 through December 1994, 23 cases of this type of knee deformity were corrected by surgery. The operative procedures performed were suprachondylar osteotomy of femur or subplateau osteotomy of tibia. The patients were followed up from 1 to 5 years, with an average of 3 years. The result rated excellent to good was 95.6%. The features of this disorder and the main points in the surgical procedure were discussed.
ObjectiveTo summarize the characteristics of bicuspid aortic valve (BAV) aortopathy and analyze the association between aortopathy and BAV phenotype and patterns of valvular dysfunction.MethodsClinical data of 191 patients who underwent the first aortic valve replacement in Fuwai Hospital from June 2017 to March 2018 were retrospectively analyzed, including 143 males and 48 females with an average age of 53.91±12.52 years. All patients underwent multidetector computed tomography (MDCT) and echocardiography before the operation, excluding patients with aortic coarctation. The BAV aortopathy phenotype was classified during operation. The characteristics of BAV aortopathy were analyzed by cluster and artificial analysis. BAV anatomic phenotype was divided into two types according to the direction of valve opening: BAV-AP and BAV-LR.ResultsFour distinct BAV aortopathy phenotypes were identified: a common type (n=70, 36.6%), with no dilation or mild dilation of aorta; a root type (n=24, 12.6%), with predominant dilatation of aortic sinus; an ascending aorta type (n=72, 37.7%), with predominant dilatation of ascending aorta; an arch type (n=25, 13.1%), with predominant dilatation of aortic arch dilatation. The root type was mainly in young patients, while the arch type was mainly in elderly patients (P<0.05). BAV-AP and aortic insufficiency were most prevalent in root type, while BAV-LR and aortic stenosis were most prevalent in arch type (P<0.05). There were 111 (58.1%) patients undergoing aortic surgery, and the coincidence rate of BAV aortopathy phenotype and aortic surgery was 80.6%.ConclusionAccording to the location of aortic dilation, BAV aortopathy can be divided into four types. There is an association between BAV aortopathy and valvular phenotype and dysfunction.
Various tissue flaps were used in the repair of 255 cases of the wounds from severe deep burns and cicatricial deformities. The types of flaps used included: 6 kinds of myocutaneous flaps in 54 cases, 10 kinds of axial cutaneous flaps in 50cases, 7 kinds of fasciocutaneous flaps in 44 cases, pedicled subcutaneous tissues flaps in 12 cases, pedicled thin skin flaps in 54 cases, subdermal vascular networks cutaneous flaps in 38 cases, and free skin flaps with arter ialization of vein flap, retrograd island cutaneous flap with great or small saphaneous vein, in each. The survival rate from the transplantation was 99.2 per cent, and the rate of primary healing was 94.5 per cent. According to the time interval between the injury and operation and the conditions of the wounds, the patients were divided into acute, infected and selective cases, and the rate of primary healing was 93.0 per cent, 91.6 per cent and 97.9 per cent, respectively. The selection of the types of flap to be used and the attentions to be taken dueing operation were discussed.
ObjectiveTo investigate the effectiveness of the mortise-tenon orbicularis oris muscle flap for philtrum column deformity secondary to the unilateral cleft lip repair. MethodsBetween January 2009 and August 2011, 43 patients with philtrum column deformity secondary to unilateral cleft lip repair were treated. There were 23 males and 20 females with an average age of 23.6 years (range, 18-31 years). The left philtrum column was involved in 26 cases, and the right side in 17 cases. Cleft lip was repaired with Millard I in 15 cases and with Millard II in 28 cases. The time between cleft lip repair and philtrum column deformity correction was 15-30 years (mean, 21.7 years). The bilateral double orbicularis oris muscle flap was obtained, and then was divided horizontally into two layers. The overlapping suture of the bilateral lower muscle flap was perfomed, and the upper layer muscle was designed into the mortise-tenon orbicularis oris muscle flap and was sutured with contralateral skin. ResultsAll incisions healed by first intention. Forty cases were followed up 13.4 months on average (range, 6-34 months). The patients achieved satisfactory effects in bilateral symmetry philtrum column and normal concave shape. At 6 months after operation, significant improvement was observed in 38 cases and no obvious improvement in 2 cases. ConclusionThe mortise-tenon orbicularis oris muscle flap is a simple operation and can obtain good results in the appearance and function of the upper lip in the correction of philtrum column deformities secondary to the unilateral cleft lip repair.
OBJECTIVE To sum up the experience of diagnosis and treatment of intrinsic upper gastro-intestinal membrane, 13 cases in children were studied retrospectively. METHODS There were 10 boys and 3 girls, the major symptoms were vomiting and epigastric distension. Eleven cases were treated by membranectomy with intestinal plasty, and 2 cases were treated by retrocolic side to end duodenojejunostomy. RESULTS All cases had good results without severe complications. CONCLUSION The children who have typical symptom of upper digestive tract should be considered duodental and upper jejunal membrane, and should be proved by contrast radiology. The membranectomy with intestinal plasty is the better operative method.
ObjectiveTo evaluate the effectiveness of autologous costal cartilage-based open rhinoplasty in the correction of secondary unilateral cleft lip nasal deformity.MethodsBetween January 2013 and June 2020, 30 patients with secondary unilateral cleft lip nasal deformity were treated, including 13 males and 17 females; aged 14-41 years, with an average of 21.7 years. Among them, 18 cases were cleft lip, 9 cases were cleft lip and palate, and 3 cases were cleft lip and palate with cleft alveolar. The autologous costal cartilage-based open rhinoplasty was used for the treatment, and the alar annular graft was used to correct the collapsed alar of the affected side. Before operation and at 6-12 months after operation, photos were taken in the anteroposterior position, nasal base position, oblique position, and left and right lateral positions, and the following indicators were measured: rhinofacial angle, nasolabial angle, deviation angle of central axis of columella, nostril height to width ratio, and bilateral nasal symmetry index (including nostril height, nostril width, and nostril height to width ratio).ResultsThe incisions healed by first intention after operation, and no complications such as acute infection occurred. All 30 patients were followed up 6 months to 2 years, with an average of 15.2 months. During the follow-up, the patients’ nasal shape remained good, the tip of the nose and columella were basically centered, the back of the nose was raised, the collapse of the affected side of nasal alar and the movement of the feet outside the nasal alar were all lessened than preoperatively. The basement was elevated compared to the front, and no cartilage was exposed or infection occurred. None of the patients had obvious cartilage absorption and recurrence of drooping nose. Except for the bilateral nostril width symmetry index before and after operation, there was no significant difference (t=1.950, P=0.061), the other indexes were significantly improved after operation when compared with preoperatively (P<0.05). Eleven patients (36.7%) requested revision operation, and the results were satisfactory after revision. The rest of the patients’ nasal deformities were greatly improved at one time, and they were satisfied with the effectiveness.ConclusionAutologous costal cartilage-based open rhinoplasty with the alar annular graft is a safe and effective treatment for secondary unilateral cleft lip nasal deformity.
The simple ablation of the duplicated thumb might have some residual deformities after operation that often leads to functional disorders of the hand. Since 1988, the postoperative disorders in 9 patients were treated. The plastic surgery was performed for the adduction of the thumb, lateral deviation and insufficient after plastic repair of the hand. The configuration and the function of the thumb were satisfactory.