Fat Liquefaction Research Articles

Clinical Efficacy of Autogenous Vertebrae-Filled PEEK Cage in Anterior Cervical Discectomy and Fusion with Instrumentation

This study aimed to investigate the clinical efficacy of the autologous vertebral-filled polyetheretherketone (PEEK) cage in anterior cervical discectomy and fusion with instrumentation (ACDFI). The clinical data of 368 patients who received ACDFI from September 2012 to September 2017 were retrospectively analyzed. Based on the material that filled PEEK cage during the surgery, the patients were divided into two groups, the autologous vertebrate group (n equal to 185) and the autologous iliac group (n equal to 183). The operative time, operative blood loss, postoperative complications in the two groups were recorded and analyzed. The bone graft fusion and postoperative functional outcomes, including scores of modified Japanese Orthopedic Association score (mJOA), Neck Disability Index (NDI), and Visual Analog Scale (VAS) were compared. Patients were followed-up for 14.04 ± 0.98 months. At 6-months follow-up, the rate of spinal fusion was 96.29% (178/185) in the vertebral group and 95.94% (176/183) in the iliac group, with no significant difference between the two groups (p > 0.05). The postoperative VAS, mJOA, and NDI scores were also not significantly different between two groups during the follow-up (p > 0.05). The operative time and blood loss in the vertebral group were significantly less than that of the iliac group (p < 0.01). All patients in the iliac group suffered pain at the iliac donor site, 65 patients suffered numbness, 12 patients had fat liquefaction at donor incision. Meanwhile, all the patients in the vertebral group had no postoperative complications. This study concluded that the autologous vertebrae-filled PEEK cage could achieve the same clinical outcome as the autologous iliac, but have the advantages of shorter operative time, less intraoperative blood loss, and postoperative complications.

Application of percutaneous screwdriver rod-assisted closed reduction in treatment of valgus-impacted femoral neck fractures

To evaluate the feasibility and effectiveness of percutaneous screwdriver rod-assisted closed reduction in the treatment of valgus-impacted femoral neck fractures. Between January 2021 and May 2022, 12 patients with the valgus-impacted femoral neck fractures were treated with percutaneous screwdriver rod-assisted closed reduction and femoral neck system (FNS) internal fixation. There were 6 males and 6 females with a median age of 52.5 years (range, 21-63 years). The fractures were caused by traffic accident in 2 cases, falling in 9 cases, and falling from height place in 1 case. All were unilateral closed femoral neck fractures, including 7 on the left side and 5 on the right side. The time from injury to operation was 1-11 days, with an average of 5.5 days. The fracture healing time and postoperative complications were recorded. The quality of fracture reduction was evaluated by Garden index. At last follow-up, Harris score was used to evaluate the hip joint function, also the shortening of femoral neck was measured. All the operations were successfully completed. After operation, the incision fat liquefaction occurred in 1 case, which healed after enhanced dressing change, and the other patients' incisions healed by first intention. All patients were followed up 6-18 months, with an average of 11.7 months. The X-ray film reexamination showed that the quality of fracture reduction was grade Ⅰ in 10 cases and grade Ⅱ in 2 cases according to the Garden index. All fractures reached bony union, and the healing time was 3-6 months, with an average of 4.8 months. At last follow-up, the femoral neck was shortened by 1-4 mm, with an average of 2.1 mm. No internal fixation failure or osteonecrosis of the femoral head occurred during follow-up. At last follow-up, the hip Harris score was 85-96, with an average of 92.4; 10 cases were rated as excellent and 2 were good. The percutaneous screwdriver rod-assisted closed reduction can effectively reduce the valgus-impacted femoral neck fracture. It has the advantages of simple operation, effective, and less impact on blood supply.

The short-term outcomes of non-contact low frequency ultrasonic debridement in treating periprosthetic joint infections:a prospective single-arm clinical study

Objective: To evaluate the short-term outcomes of non-contact low-frequency ultrasonic debridement in treating periprosthetic joint infections(PJI). Methods: The clinical data of patients with PJI who met the eligibility criteria and were treated with non-contact low-frequency ultrasonic debridement from August 2021 to January 2022 at the Department of Orthopaedics,the First Affiliated Hospital of Xinjiang Medical University were prospectively analyzed. PJI was defined according to the modified Musculoskeletal Infection Society criteria in 2016. After mechanical debridement,an 8-mm handheld non-contact low-frequency ultrasound probe was used for ultrasonic debridement in the whole surgical area at a frequency of (25±5)kHz and power of 90% for 5 minutes. Each ultrasound lasted 10 seconds with 3-second intervals. The probe was repeatedly sonicated among all soft tissue,bone interface and metal prosthesis surface(patients underwent debridement,antibiotics and implant retention (DAIR)) in the surgical area. The femoral canal of the hip joint,the distal femoral canal and the posterior capsule of the knee were fully sonicated with a special right-angle probe. Before and after ultrasonic debridement,20 ml of liquid was extracted from each operation area and injected into aerobic and anaerobic culture bottles,respectively,for pathogen culture. Harris hip score and Hospital for Special Surgery (HSS) score were used to evaluate clinical function. Treatment failure was defined as the recurrence of infection in the same joint. The patients were routinely followed up in the outpatient clinic at 1,3,and 6 months postoperatively and then annually with a deadline of August 2022. The paired t-test,rank sum,Mann-Whitney U or χ2 test was used to compare the observed data,and rates among multiple groups were compared using the Bonferroni approach. Results: A total of 45 patients were included in the study,including 21 men and 24 women with age of (65.8±15.2)years(range: 20 to 80 years) and body mass index of (29.3±4.2)kg/m2(range: 20.2 to 38.5 kg/m2). Twenty-eight patients (18 hips and 10 knees) underwent one-stage revision,and 17 cases (5 hips and 12 knees) underwent DAIR. Three of the patients (6.7%) had recurrent infections during follow-up. There were no intraoperative complications related to ultrasonic debridement (neurovascular and muscle injury,poor wound healing and fat liquefaction). Seventeen patients who received DAIR were followed for a median(M(IQR)) of 9(3) months,and two relapsed 3 weeks and 3 months post-operation,respectively. In addition,28 patients who underwent one-stage revision were followed for a median of 9(2) months,and one of the patients (3.6%,1/28) had a recurrence 6 months post-operation. The culture-positive rate of preoperative aspiration was 47.6% (20/42). The data of intraoperative soft tissue culture was 86.7% (39/45). The culture-positive rate of wound liquid before ultrasonic debridement was 46.7% (21/45). And the culture-positive rate after ultrasonic debridement was (75.6% (34/45)). After sonication,the culture-positive rate of explanted prostheses was 88.9% (40/45). There was a significant difference in culture-positive rates among all five cultures (χ2=35.483,P<0.01). Further pairwise comparison showed that the culture-positive rate of wound liquid after ultrasonic debridement was higher than that before ultrasonic debridement (χ2=7.901,P=0.005) but was not significantly different from the positive rates of other cultures (all P>0.05). The median number of colonies 24 hours after ultrasonic debridement(2 240 (1 310) CFU/ml,range: 310 to 3 140 CFU/ml) was significantly higher than that before debridement(450 (550) CFU/ml,range: 10 to 910 CFU/ml) (U=43, P=0.017). The post-operative Harris ((78.6±4.2)points,range:70.5 to 85.3 points) and HSS scores((76.4±4.8)points,range: 68.5 to 84.3 points) were significantly higher than the preoperative scores((46.0±9.8)points,range: 27.5 to 64.3 points;and (45.5±10.3)points,range: 27.6 to 63.1 points) (t=-14.6,t=-12.7;both P<0.01). Conclusions: Non-contact low-frequency ultrasonic debridement can increase the culture-positive rate and lead to a favorable short-term outcome. In addition,no complications are associated with using this new technique to treat PJI.

Application of volume replacement techniques in breast conserving surgery for breast cancer treatment

Objective: To examine the application of volume replacement techniques in breast conserving surgery for breast cancer. Methods: The clinic data of 76 breast cancer patients underwent a breast conserving surgery with volume replacement techniques at the Breast Center, Beijing Tongren Hospital, from June 2019 to June 2021 were analyzed retrospectively. All patients were female, aged (42.6±6.4) years (range: 32 to 56 years). Tumor staging inlcuded stage ⅡA in 36 cases, stage ⅡB in 24 cases, stage ⅢA in 12 cases, stage ⅢB in 4 cases. Three types of techniques included the lateral thoracic adipofascial flaps in 47 cases, the upper abdominal wall adipofascial flaps in 22 cases and the latissimus dorsi myocutaneous flap in 7 cases. The specimen volume of tumor expansion resection in breast conserving surgery was measured, while the operative time used for volume replacement techniques, postoperative drainage retention time, postoperative complications and patients' satisfaction with the breast shape were recorded. Results: The specimen volume of tumor was (100.9±24.2) ml (range: 55 to 157 ml) in lateral thoracic adipofascial flap group, (88.4±14.5) ml (67 to 118 ml) in upper abdominal wall adipofascial flap group, (179.7±22.9) ml (range: 155 to 220 ml) in latissimus dorsi myocutaneous flap group. The operative time used to restore the breast shape of the three groups were (52.9±9.0) minutes (range: 45 to 70 minutes), (63.2±8.8) minutes (range: 50 to 70 minutes) and (99.3±3.4) minutes (range: 95 to 105 minutes), respectively. The postoperative drainage retention times of the three groups were (8.6±1.2) days (range: 7 to 10 days), (9.4±0.9) days (range: 8 to 10 days) and (11.4±1.3) days (range: 10 to 13 days), respectively. All the 76 patients were evaluated for their satisfaction with the cosmetic outcomes, 64 patients (84.2%) were strongly satisfied and 12 patients (15.8%) were generally satisfied. The postoperative complications included fat liquefaction in 6 cases (2 cases in the lateral thoracic adipofascial flap group and 4 cases in the upper abdominal adipofascial flap group) and seroma in 4 cases (each 2 cases in the lateral thoracic adipofascial flap group and the latissimus dorsi myocutaneous flap group). Conclusions: For patients with large tissue loss during breast conserving surgery, the corresponding volume replacement techniques, including lateral thoracic adipofascial flaps, upper abdominal wall adpofascial flaps and latissimus dorsi myocutaneous flaps, should be reasonably selected for repair according to the tumor site and the size of the intraoperative breast loss, which can ensure the original volume and shape of the breast, with controllable postoperative complications.

Nursing of a patient with fat liquefaction of incisions after peritoneal dialysis catheter placement

Nursing of a patient with fat liquefaction of incisions after peritoneal dialysis catheter placement

Analgesic effect of a new "cocktail" of local infiltration analgesia after total hip arthroplasty-A prospective randomized controlled study

To study the analgesic effect of a new "cocktail" of local infiltration analgesia (LIA) with Deprosone after total hip arthroplasty (THA). In a prospective randomized controlled study, 100 patients with hip joint disease requiring unilateral primary THA in West China Hospital of Sichuan University between January 2018 and December 2018 were enrolled and randomly divided into observation group and control group, with 50 cases in each group. There was no significant difference in age, gender, operative side, disease type, body mass index, American Society of Anesthesiologists (ASA) classification, preoperative rest and activity visual analogue scale (VAS) score, hip Harris score (HHS), quality of life scale (SF-12) score, and other general data between the two groups ( P>0.05). The patients in the observation group were treated with a new "cocktail" LIA around the hip joint before suturing the incision, and the drug formula was ropivacaine 200 mg, Diprospan 1 mL, morphine 10 mg, and added normal saline to 80 mL; the patients in the control group were not treated with LIA. The operation time, postoperative hospital stay, the amount of morphine used during hospitalization, and the range of motion of hip joint at discharge were recorded, and the complications were counted. The VAS score at rest and activity, HHS score, and SF-12 score [physiological score (PCS) and psychological score (MCS)] of the hip joint were recorded before and after operation, and the postoperative analgesic effect and the recovery of hip joint function were evaluated. There was no significant difference in the operation time between the two groups ( P>0.05), and the postoperative hospital stay in the observation group was significantly shorter than that in the control group ( P<0.05). The postoperative morphine consumption in the observation group was significantly less than that in the control group ( P<0.05), and the total morphine consumption in the observation group was less than that in the control group during hospitalization, but the difference was not significant ( P>0.05). Patients in both groups were followed up to 6 months after operation. The resting VAS scores of the observation group were significantly lower than those of the control group at 2, 6, 12 hours after operation and in the morning and afternoon of the first day after operation, and the active VAS scores of the observation group were significantly lower than those of the control group at 6, 12 hours after operation and in the morning of the first day after operation, and the differences were significant ( P<0.05). There was no significant difference in the resting and active VAS scores between the two groups on the day of discharge and at 3 and 6 months after operation ( P>0.05). At discharge, the flexion range of motion of hip joint in the observation group was significantly greater than that in the control group ( P<0.05), but there was no significant difference in the abduction range of motion of hip joint between the two groups ( P>0.05). There was no significant difference in HHS score and SF-12 score between the two groups at 3 and 6 months after operation ( P>0.05). There was no significant difference in analgesic satisfaction and functional satisfaction between the two groups at last follow-up ( P>0.05). There was no complication such as skin pruritus, superficial and deep infection of incision, skin necrosis, deep venous thrombosis of lower extremity, and pulmonary embolism in both groups. There was no significant difference in the incidence of complications such as nausea and vomiting, urine retention, fat liquefaction of incision, local hematoma, and large fluctuation of blood sugar between the two groups ( P>0.05). The new "cocktail" LIA with Diprospan can effectively reduce the early postoperative pain of THA, reduce the dosage of opioids, shorten the length of hospital stay, and is conducive to the early functional rehabilitation of patients.

Low molecular weight heparin combined with aspirin to prevent perioperative venous thromboembolism in patients with splenic rupture and lower extremity fracture

To investigate the effectiveness and safety of low molecular weight heparin combined with aspirin for perioperative prophylactic anticoagulation in patients with lower extremity fracture after splenectomy. The clinical data of 50 patients with splenic rupture combined with lower extremity fracture between January 2009 and June 2022 were retrospectively analyzed. All patients were given enoxaparin sodium at 48 hours after splenectomy, and stopped at 24 hours before fracture surgery. After fracture surgery, the patients were divided into aspirin group (group A, 15 cases), low molecular weight heparin group (group B, 16 cases), and low molecular weight heparin combined with aspirin group (group C, 19 cases) according to different anticoagulation regimens. The treatment course was 28 days. There was no significant difference in gender, age, body mass index, cause of injury, fracture site, time from injury to operation, complications, and other general data between groups ( P>0.05). The occurrence of venous thromboembolism (VTE) was observed; hemoglobin (Hb), platelet (PLT), D-D dimer, and fibrinogen degradation product (FDP) were recorded before operation and at 1, 3, and 7 days after operation, and the effect of anticoagulation regimen on coagulation function was observed. The incidences of wound complications and bleeding related complications were recorded, and the total perioperative blood loss, hidden blood loss, and overt blood loss were calculated. The incidences of VTE in groups A, B, and C were 13.33% (2/15), 12.50% (2/16), and 5.26% (1/19), respectively, and there was no significant difference between groups ( χ 2=0.770, P=0.680). There was no portal vein thrombosis and no VTE-related death in the 3 groups. There was no significant difference in the levels of Hb, PLT, D-D dimer, and FDP between groups before and after operation ( P>0.05); and there was no significant difference in total perioperative blood loss, hidden blood loss, and overt blood loss between groups ( P>0.05). No local skin necrosis was found in all patients. In group A, 1 case occurred redness and swelling of incision; in group B, 1 case had incision discharge, redness, and swelling, and 1 case had fat liquefaction; in group C, 1 case had repeated incision exudation accompanied by local tissue redness and swelling, and 1 case had local hematoma. The incidences of adverse incision in groups A, B, and C were 6.66% (1/15), 12.50% (2/16), and 11.76% (2/19), respectively, with no significant difference ( χ 2=0.302, P=0.860). There were 4 cases of bleeding related complications, including 1 case of incision ecchymosis in groups A and B respectively, with the incidence of 6.66% and 6.25%, respectively; there was 1 case of incision hematoma and 1 case of bleeding in group C, with the incidence of 11.76%; showing no significant difference in the incidence of bleeding related complications between groups ( χ 2=0.268, P=0.875). Perioperative combined use of low molecular weight heparin and aspirin for prevention of anticoagulation in patients with splenic rupture and lower extremity fracture can effectively prevent the occurrence of VTE without increasing the incidence of complications, which is an effective and safe treatment method. However, whether the incidence of VTE can be reduced needs to be further studied by expanding the sample size.

Application of three-dimensional printed customized prosthesis with preserved epiphysis and articular surface in the reconstruction of large bone defects in treatment of adolescent femoral malignant tumors

To investigate the clinical application and effectiveness of three-dimensional (3D) printed customized prosthesis with preserved epiphysis and articular surface in the reconstruction of large bone defects in treatment of adolescent femoral malignant tumors. The clinical data of 10 adolescent patients with femoral primary malignant tumor who met the selection criteria and underwent limb salvage surgery with 3D printed customized prosthesis with preserved epiphysis and articular surface between January 2020 and October 2021 were retrospectively analyzed. There were 6 males and 4 females with an average age of 12.5 years ranging from 7 to 18 years. There were 8 cases of osteosarcoma and 2 cases of Ewing's sarcoma. Enneking stage was Ⅱb. The length of the lesions ranged from 76 to 240 mm, with an average of 138.0 mm. The length of osteotomy (i. e. length of customized prosthesis) ranged from 130 to 275 mm, with an average of 198.5 mm; the distance between distal osteotomy end and epiphyseal line ranged from 0 to 15 mm, with an average of 8.8 mm; the bone defect after osteotomy accounted for 37.36% to 79.02% of the total length of the lesion bone, with a mean of 49.43%. The operation time, intraoperative blood loss, complications, tumor outcome (refered to RESIST1.1 solid tumor efficacy evaluation criteria), and limb length discrepancy were recorded. The Musculoskeletal Cancer Society (MSTS) 93 score was used to evaluate the function at 6 months after operation, and visual analogue scale (VAS) score was used to evaluate the pain before and after operation. The operation was successfully performed in all the 10 patients, and the postoperative pathological results were consistent with the preoperative pathological results. The operation time was 165-440 minutes, with an average of 263 minutes; and the intraoperative blood loss was 100-800 mL, with an average of 350 mL. All patients were followed up 7-26 months, with an average of 11.8 months. No tumor was found on the osteotomy surface; the customized prosthesis were firmly installed and closely matched with the retained articular surface. The tumor outcome of neoadjuvant chemotherapy was stable in 4 cases and partial remission in 6 cases. No local recurrence or distant metastasis was found in 9 cases after postoperative adjuvant chemotherapy; pulmonary metastasis was found in 1 case at 12 months after operation. Two patients had local incision fat liquefaction, superficial infection, and delayed healing at 14 days after operation; 1 patient had local bone absorption at the contact surface of the prosthesis, and the screw and prosthesis did not loosen at 7 months after operation; the other patients had good incision healing, with no infection, prosthesis loosening, fracture, or other complications. At 6 months after operation, the MSTS93 score was 19-28, with an average of 24.1; 8 cases were excellent and 2 cases were good. The VAS score was 0.9±1.0, which significantly improved when compared with before operation (5.9±1.0) ( t=23.717, P<0.001). The height of the patients increased by 1-12 cm, with an average of 4.6 cm. At last follow-up, 4 patients had limb length discrepancy, with a length difference of 1 cm in 2 cases and 2 cm in 2 cases. The application of 3D printed customized prosthesis in the resection and reconstruction of adolescents femoral primary malignant tumors can achieve the purpose of preserving epiphysis and articular surface, and obtain good effectiveness.

Identification and Validation of a Novel Model: Predicting Short-Term Complications After Local Flap Surgery for Skin Tumor Removal.

BACKGROUND The aim was to analyze the risk factors for the occurrence of complications after local flap transfer and to construct a simple prediction model to help surgeons in the perioperative screening of high-risk patients. MATERIAL AND METHODS Short-term complications were defined as any postoperative infection, dehiscence, bleeding, subcutaneous effusion, fat liquefaction, arteriovenous crisis, and tissue necrosis that required medical consultation or intervention. To explore 16 factors influencing short-term complications after local flap transfer, least absolute shrinkage and selection operator (LASSO) logistic regression was used to reduce the dimensionality of the data and to screen for predictors. Independent risk factors affecting the development of complications after local flap transfer were analyzed using logistic multiple regression models. The consistency (C-)index, receiver operating characteristic (ROC) curves, and calibration curves were used to check the model's discrimination and calibration. Decision curve analysis (DCA) curves were used to evaluate the clinical applicability of this model, and internal validation was assessed using bootstrap validation. RESULTS The C-index of the nomogram model to predict short-term complications after local flap transfer was 0.763 (95% CI: 0.702-0.824), the area under the ROC curve was 0.763, and the internal validation C-index was 0.747. The calibration curve showed good agreement between observed and predicted values, and the DCA showed the model can benefit patients. CONCLUSIONS The model identified the relevant factors influencing short-term complications after local flap transfer, facilitating the identification and targeted intervention of patients at high risk of flap complications after surgery.

Histopathological evaluation of the R134a multipulsed spray cooling assisted 1210 nm laser lipolysis by the murine model in vivo.

Owing to the greater absorption affinity for lipo-rich tissue than water, the 1210 nm laser is a promising candidate for transcutaneous lipolysis in the near-infrared band. However, fat reduction is limited because laser therapy may yield thermal injury of normal tissue. A new protocol to incorporate multipulsed cryogen spray cooling is beneficial to improve the lipolysis effect, and the parameters of laser and cooling can be optimized via skin histopathological analysis. A murine in vivo model of inguinal tissue of SD rats was established to test the effectivity of transcutaneous lipolysis protocol by R134a multipulsed spray cooling assisted 1210 nm laser irradiation. Tissue response of lipolysis with/without cooling 10 days post the treatment was evaluated by histopathological analysis of skin samples stained with hematoxylin-eosin (HE), through which safe and effective parameters for lipolysis were determined. From histopathological analysis of the inguinal tissue of SD rats irradiated by the 1210 nm laser alone, the optimal durations are respectively 7 and 3 s (seconds) for low-dosage (6 W) and high-dosage (9 W) therapy, with pronounced lipolysis effect and minimum injury of skin tissue. The multipulsed spray cooling by R134a with a pulse duration of 10ms (milliseconds), a pulse delay of 2000ms, and a pulse number of 5 can be introduced to assist the 1210 nm laser therapy with a power of 9 W and a duration of 7 s to achieve desirable fat liquefaction while keeping the complete structure of skin tissueas well as esthetic-related beneficial effects of hair removal and skin rejuvenation. Excellent lipolysis effect can be achieved via R134a multipulsed spray cooling assisted high-dosage 1210 nm laser irradiation with reasonably matched laser and cooling parameters. The protocol is as follows: Start MP-CSC for one cycle, and then fire the laser with specific power and duration, while keeping MP-CSC accordingly. This new protocol may promote the safe and effective clinical implement of transcutaneous laser lipolysis in body contouring.

Treatment of acetabular fracture involving anterior and posterior columns using a single pararectus approach: surgical experience and preliminary results.

This study aims to evaluate the efficacy of single pararectus approach in patients confirmed with acetabular fracture involving anterior and posterior columns. A total of 58 patients confirmed with acetabular fracture involving anterior and posterior columns and treated at our hospital between January 2015 and January 2020 were retrospectively analyzed. A single pararectus approach was applied for all patients. Routine X-rays were performed at follow-up of one, three, six, 12, and 18months, and three-dimensional CT scans were added at six and 18months. Fracture reduction quality was assessed using the Matta score system, and functional assessment used the Modified Merle D'Aubigné and Postel score system. Post-operative complications, including fat liquefaction and deep vein thrombosis, were recorded and analyzed. The median operation time was 186min while the intra-operative blood loss was 421mL. The rate of good-to-excellent reduction was 94.8%, and the rate of good-to-excellent hip function score reached 93.1%. Seven patients presented with post-operative complications, including three intra-operative small vascular injuries, two peritoneal small perforations, one fat liquefaction, and one deep vein thrombosis. Using a single pararectus approach is convenient and effective for treating acetabular fracture involving anterior and posterior columns, especially those involving the quadrilateral area. ChiCTR, ChiCTR2100054604. Registered 21 December 2022. Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=144783 .

Microwave in situ inactivation in the treatment of bone giant cell tumor: a mid-term descriptive study.

To evaluate the mid-term clinical efficacy of microwave in situ inactivation combined with bone grafting or polymethyl methacrylate (PMMA) filling in the treatment of giant cell tumor of bone (GCTB). This is a retrospective, descriptive, and analytical study. A total of 30 GCTB patients received microwave in situ inactivation from January 2012 to January 2020, whose clinical recurrence rate was evaluated at the last follow-up after microwave in situ inactivation surgery. The Musculoskeletal Tumor Society (MSTS) function score was used to evaluate the postoperative clinical panoramic results. All patients were followed up for 21 to 110months, with an average of 63.79months. Distal femur (40%) and proximal tibia (28%) had a higher rate of GCTB incidence. Seventeen percent of tumor patients suffered from associated pathologic fracture. The rate of Campanacci classification stage III was 60%. The average MSTS score was evaluated as 27.53 points overall at the last follow-up. In terms of complications, three, two, two and one cases developed fat liquefaction, controllable tissue rejection reaction, incision infection and degenerative changes around lesion joint, respectively, without in situ recurrences and reoperation as well as distant lung metastasis. The method of microwave in situ inactivation combined with bone grafting or PMMA filling is prudently recommended as one of the options for the limb salvage treatment of giant cell tumor of long and periarticular bone. IV: case series.

Clinical evaluation of corrective effect of infraorbital depression by fat granule auto-transplantation via oral mucosa incision

Moderate facial depression is an important manifestation of aging, and traditional fat grafting is filled through the skin approach, and there may be damage to the terminal branch of the surface artery, thereby increasing the risk of fat embolism, so there is a safety implication. Therefore, a safe and effective filling pathway is a key point in the study of facial fat grafting in the suborbital area. Based on the results of anatomical research, this study looks for the filling level of non-well-known blood vessels, improves the path and surgical method of suborbital fat grafting in the suborbital region, and discusses the treatment of intraoral fat grafting through oral incision in the suborbital region Efficacy and safety. In this study, 107 patients who visited our hospital from January 2017 to January 2022 all had local depressions in the suborbital area and facial asymmetry, requiring fat grafting to improve. The age range of patients is 28-50 years, with an average age of 38 years. The effectiveness of the operation is assessed based on the patient's self-evaluation and a comparison of preoperative and postoperative photographs. A grading scale is used in the first half of the postoperative period for patient satisfaction assessment. A total of 107 patients were followed for 6 to 24 months, with an average follow-up time of 12 months, 67.3% of patients said "very satisfied", 29.0% of patients said "satisfied", 3.7% of patients said "average", and no patients rated the results as "not satisfied". No complications such as skin ulcers, infections, local indurations, and fat liquefaction occurred after surgery. Fat grafting through oral incision is a safe and effective way to improve fat depression in the suborbital area, in addition, it is necessary to pay attention to preoperative and postoperative oral disinfection and care during this operation to prevent the occurrence of complications such as fat infection.

Ultrasound-guided microwave ablation for symptomatic abdominal wall endometriosis and treatment response evaluation with contrast-enhanced imaging: The first experience.

Abdominal wall endometriosis (AWE) is a relatively uncommon condition associated with diagnostic and therapeutic difficulties among all the extra pelvic endometriosis. The main therapies include surgery and oral contraceptive administration. Percutaneous cryoablation and high intensity focused ultrasound (HIFU) are also proven to be valid alternatives. Microwave ablation (MWA) as one of the thermal ablation methods has not been applied in the treatment of AWE yet. Herein the feasibility of ultrasound (US) -guided MWA for AWE was explored and treatment response evaluation was carried out using contrast-enhanced imaging. Three consecutive patients who underwent US-guided MWA for AWE with typical symptoms were included in this retrospective study. US, magnetic resonance imaging (MRI), laboratory tests, and US-guided core-needle biopsy were conducted for pre-treatment assessment and ruling out malignancy. The interventional procedure was carried out under local anesthesia with MWA and the output power was 60w. Post-treatment contrast-enhanced ultrasound (CEUS) was performed to evaluate the instant treatment response. The follow-up intervals were 1 month, 6 months, and 12 months after treatment. The clinical symptoms and condition of AWE lesions were recorded in each follow-up. The MWA procedure was completed in all the patients with no blood perfusion inside each lesion by instant CEUS after treatment. The mean ablation time was 687 seconds (s) for a single patient (ranged from 660s to 742s). Clinical symptoms were relieved evidently at the end of the follow-up. The pain according to the visual analogue scale (VAS) decreased from 4-6 before treatment to 0-2 after treatment. Mild to moderate complications included slightly abdominal pain and fat liquefaction occurred. In terms of technical outcomes, the volume of all six lesions reduced in different degrees at the end of follow-up (ranged: 16.6% to 100%). US-guided MWA may be a feasible and promising approach for symptomatic AWE.

Treatment of posterolateral tibial plateau fractures with a novel lateral tibial plateau annular plate via fibular neck osteotomy approach

To investigate the effectiveness of a novel lateral tibial plateau annular plate (hereinafter referred to as the novel plate) fixation via fibular neck osteotomy approach for posterolateral tibial plateau fractures. Between January 2015 and December 2018, 22 patients with posterolateral tibial plateau fractures were treated. There were 10 males and 12 females with an average age of 39.0 years (range, 25-56 years). Seven fractures were caused by falls, 10 by traffic accidents, and 5 by falling from height. The time from injury to hospitalization ranged from 3 to 12 days, with an average of 7.0 days. All patients were closed fractures. According to Schatzker classification, the fractures were classified as type Ⅱ in 8 cases, type Ⅲ in 9 cases, type Ⅴ in 1 case, and type Ⅵ in 4 cases. The fractures were fixed with the novel plates after reduction via fibular neck osteotomy approach. The fracture reduction and healing were observed by X-ray film after operation. The range of motion of the knee joint was recorded and the function was evaluated by modified American Hospital for Special Surgery (HSS) score. All operations were completed successfully. The operation time was 60-95 minutes (mean, 77.6 minutes). The intraoperative blood loss was 100-520 mL (mean, 214.5 mL). There was 1 case of common peroneal nerve injury during operation and 2 cases of fat liquefaction of incision after operation. All patients were followed up 13-32 months (mean, 19.4 months). Postoperative X-ray films showed that the fracture reduction was good in 17 cases and moderate in 5 cases, and all fractures healed with a healing time of 10-18 weeks (mean, 13.0 weeks). At last follow-up, the range of motion of the knee joint ranged from 100° to 145° in flexion (mean, 125.5°) and from 0° to 4° in extension (mean, 1.2°). The modified HSS score was 82-95 (mean, 86.3). There was no complications such as plate deformation, screw fracture, fracture reduction loss, skin necrosis, and so on. For posterolateral tibial plateau fractures, the novel plate fixation via fibular neck osteotomy approach has the advantages of clear intraoperative field, firm fracture fixation, and less postoperative complications, which is beneficial to the recovery of knee joint function.

Improvement of Nasal Dorsal Onlay Graft Appearance after Augmentation Rhinoplasty with Costal Cartilage for Thin-Skinned Patients.

The camouflage of the nasal dorsum is very important for thin-skinned patients. In this study, the authors presented an improved method for these patients and evaluated the safety and efficacy of this method in augmentation rhinoplasty. Fifty-two thin-skinned nose Chinese patients, ranging in age from 18 to 42 years, who underwent open augmentation rhinoplasty with modified perichondrium on dorsal onlay graft were included in the study. Among these patients, 24 of them were primary cases, and the other cases were secondary. The Rhinoplasty Outcomes Evaluation (ROE) scale and Visual aid scoring (VAS) questionnaire were used to evaluate aesthetic outcomes. During the long-term follow-up (ranging from 6 to 20 months), the ROE scores of each item before and after surgery were statistically significant in our study. The total scores of the preoperative and postoperative ROE scale of the study were 9.77 ± 3.18 and 20.65 ± 1.88, respectively, which indicated reasonably high satisfaction. According to the VAS questionnaire, patients' own evaluations of the nasal dorsal improvement rendered a high satisfaction rate. One case of fat liquefaction at the donor site and two cases of warping occurred and no other major complications were encountered. Covering the two edges of the graft with perichondrium on the onlay dorsal graft seems a convenient and effective method for thin-skinned augmentation rhinoplasty, which was the best choice for camouflage of the nasal dorsum in our department. IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

Risk Factors for Postoperative Complications Following Aesthetic Breast Surgery: A Retrospective Cohort Study of 4973 Patients in China.

The popularity of aesthetic breast surgery in China results in greater demand for assessing risk factors for complications and mortality. To determine the incidence and independent risk factors for postoperative complications following aesthetic breast surgery in China. A retrospective cohort study on 4973 patients who had aesthetic breast surgery between 2012 and 2021 was performed. Postoperative complications include minor complications (incision healing impaired, hematoma, or fat liquefaction) and surgical site infection (SSI), which were recorded within 30 days after surgery. The follow-up time was expanded to 1year only after prosthesis implantation procedures. Potential risk factors including age, weight, length of hospital stay, operation time, volume resection, incision location, and other clinical profile information were evaluated. Among 4973 patients who underwent aesthetic breast surgery, the minor complication rate was 0.54%, and SSI was 0.68%. Augmentation with prosthesis implantation had the highest SSI rate (4.23%), which was significantly associated with increasing age (relative risk [RR] 1.12; P < 0.01) and periareolar incision (RR 5.87, P < 0.01). After augmentation with autologous fat transplantation, postoperative antibiotic use (RR 6.65, P < 0.01) was an independent risk factor for SSI. After adjusting for weight, volume resection over 1500 g (RR 14.7, P < 0.01) was an independent risk factor for SSI of reduction-mastopexy surgery. The complication rate of reduction mammaplasty (1.01%) and gynecomastia correction was lower (0.75%), and there was no record of complication in mastopexy procedures (n = 161). The incidence of postoperative complications following aesthetic breast surgery is low. Risk factors for complications mainly include increasing age, perioperative antibiotic use, periareolar incision, and extensive volume resection. Much more attention should be focused on those high-risk patients in clinical practice to decrease breast infection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Subcutaneous Nodules in a 28-week-old Girl.

Subcutaneous Nodules in a 28-week-old Girl.

Treatment of Posterior Malleolar Fractures in Elderly Individuals with Kirschner Wire Tension Band Fixation.

Generally, posterior malleolar fragments are fixed either with percutaneous anteroposterior screws or through a posterolateral approach using screws and/or a buttress plate. Both surgical methods have some shortcomings, and the use of anteroposterior screws to fix osteoporotic posterior malleolar fractures carries a risk of failure. Nine elderly patients (average age, 67 years) with posterior malleolar fractures were treated with transfibular Kirschner wire tension band fixation. According to the Lauge-Hansen classification, all fractures were of the supination-external rotation type. The operative duration, intraoperative blood loss, and wound healing outcome were recorded. During the follow-up period, clinical outcomes were measured using the American Orthopaedic Foot and Ankle Society ankle-hindfoot score, and the occurrence of complications was observed. The patients were followed up for 12 to 18 months (mean, 15 months). The operative duration ranged from approximately 30 to 95 minutes, with an average of 70 minutes. Anatomical reduction was achieved in nine cases, and there were no complications, such as skin necrosis, wound infection, or skin sensory disturbance. There was one case of delayed wound healing caused by fat liquefaction, which was cured by a dressing change. The functional scores were excellent in four cases, good in four cases, fair in one case, and poor in zero cases. The rate of excellent and good results was 88.89% (eight of nine), with an average of 78.78 points. Kirschner wire tension band fixation through a transfibular approach for the treatment of posterior malleolar fractures does not require a change in patient posture. It facilitates the reduction and internal fixation of the posterior malleolar fragment; furthermore, it is easier to remove internal fixation after fracture healing, which provides a new surgical method for elderly patients with posterior malleolus fracture. Thus, this has potential as a new surgical method for elderly patients with posterior malleolar fractures.