Reattachment Research Articles

Suprachoroidal injection of sodium hyaluronate in the treatment of 12 patients with rhegmatogenous retinal detachment

Objective To observe the retinal reattachment of suprachoroidal injection with sodium hyaluronate in the treatment of rhegmatogenous retinal detachment (RRD). Methods Twelve eyes of 12 patients with RRD diagnosed by the examinations of B-mode ultrasound, binocular indirect ophthalmoscope, OCT and scanning laser ophthalmoscope in West China Hospital of Sichuan University from October 2018 to February 2019 were included in this study. There were 7 males and 5 females, aged from 15 to 66 years, with the mean age of 32.40±14.81 years. There were 4 eyes with BCVA 0.4. The extent of retinal detachment involves 1 to 4 quadrants. All eyes were injected with sodium hyaluronate via suprachoroidal space under non-contact wide-angle system. Surgery was performed by the same ophthalmologist with extensive surgical experience. During the operation, the retinal hole was handled with scleral freezing and laser photocoagulation. The follow-up was 2 months. The retinal reattachment was observed. Results Of the 12 eyes, 6 eyes (50.00%) were anatomically reattached, 4 eyes (33.33%) ere partly anatomically reattached with subretinal fluid, 2 eyes (16.67%) were not reattached. The holes in 4 eyes of partly anatomically reattached with subretinal fluid were located on the choroidal pad and the holes were closed, in addition, the subretinal fluid gradually absorbed over time. Two eyes failed in retinal reattachment received vitrectomy with silicone oil tamponade or sclera buckling surgery. No severe complications such as endophthalmitis and choroidal hemorrhage were found at follow-up visits. Conclusion Suprachoroidal injection of sodium hyaluronate is an effective and safe treatment for RRD, which can promote retinal reattachment. Key words: Retinal detachment; Sodium hyaluronate; Suprachoroidal injection

Vitrectomy combined with air tamponade for the treatment of rhegmatogenous retinal detachment

Objective To evaluate the efficacy of vitrectomy combined with air tamponade for the treatment of rhegmatogenous retinal detachment (RRD). Methods The clinical data of 31 eyes of 31 patients with RRD treated with 23G vitrectomy (PPV) combined with air tamponade from Dec. 2017 to Aug. 2018 were retrospectively analyzed. Results Recurrent detachment of retina occurred in 2 cases at 2 weeks after surgery. And the retinal reattached after silicone oil tamponade. The retinal of 29 eyes (93.55%) were reattached after one surgery. BCVA at 3 months after surgery improved in 25 eyes (80.65%) and unchanged in 6 eyes (19.35%). The preoperative mean intraocular pressure was (12.01±2.45) mmHg (1 mmHg=0.133 kPa) and (14.11±2.14) mmHg at 3 months after operation, which was significantly higher than that before operation (t=-4.090, P=0.000). Conclusion 23G PPV combined with air tamponade for the treatment of RRD is effective, with high success rate of retinal reattachment, fewer complications and easy to accept and tolerate. Key words: Detachment, retinal, rhegmatogenous; Vitrectomy, 23G; Tamponade, air

Photoperiod sensitivity of Canadian flax cultivars and 5-azacytidine treated early flowering derivative lines

BackgroundEarly flowering and maturing flax (Linum usitatissimum L.) cultivars are better adapted than lines with a longer reproductive phase for the short growing season of the northern Canadian Prairies. We examined the role of long days (LD) and short days (SD) on the time taken to flower in five established flax cultivars and three mutant-derived F10 lines. The photoperiod sensitivity of these eight different genotypes was determined using a reciprocal transfer experiment involving weekly transfers between LD and SD environments.ResultsThe genotypes tested had varying degrees of photoperiod sensitivity and demonstrated reduced time to flowering if exposed to LD environments prior to a critical time point. The duration of each of the three phases of vegetative growth differed among the genotypes studied. Transfers from SD to LD shortened the vegetative stage, reduced time to flowering, and extended the reproductive phase in the genotypes studied. Mutant-derived lines RE1/2/3 flowered significantly earlier compared to CDC Sorrel, CDC Bethune, Flanders, Prairie Thunder, and Royal. Modelling of the flowering times indicated that transferring the cultivars from SD to LD increased the photoperiod sensitive time; however, different reproductive phases for mutant lines were not defined as parsimonious models were not identified. Expression of the putative flax homologs for CONSTANS (CO), FLOWERING LOCUS T (FT), and GIGANTEA (GI) was examined in the leaves of Royal and RE1/2/3 plants at 10, 15, 19 and 29 days after planting. Expression of putative FT homologs was detected in all three early-flowering lines but expression was negligible, or not detected, in Royal.ConclusionsModels defining the three phases of reproductive development were established for the five cultivars studied; however, it was not possible to identify these phases for the three early flowering and photoperiod insensitive epimutant-derived lines. A putative flax homolog of FT, a key regulator of flowering time, is more highly expressed in RE plants, which may condition the day-length insensitivity in the early flowering ‘epimutant’ lines.

Clinical effect analysis of palmar venous anastomosis in fingertip replantation

Objective To investigate the feasibility and clinical effect of palmar venous anastomosis in fingertip replantation. Methods From October, 2008 to May, 2017, the clinical data of 15 patients with 24 finger replantation were retrospectively analyzed by outpatient, telephone and WeChat followed-up. One artery was anastomosed for revascularization with or without nerve repair, and 1 palmar venous anastomosis was performed to reestablish the outflow system. The finger nerve was sutured randomly according to the injury. Results The patients were followed-up for 18-65 (mean, 39.9) months. Except for 1 replantation finger with rotation avulsed injury failed, the remaining 14 cases with 23 fingers survived completely. Excellent restoration of finger motion was observed during the follow-up. The mean regained static 2-point discrimination sensation was 3.6 (2.8-4.0) mm. All patients were satisfied with the treatment effect. Conclusion Successful palmar venous anastomosis can improve the survival rate of replanted fingertips, simplify postoperative care, reduce postoperative complications, and improve the treatment effect. Key words: Fingertip; Replantation; Palmar vein of finger; Follow-up

Causes and the efficacy of treatment of retinal detachment in silicone oil-filled eyes

Objective To analyze the causes and the efficacy of retinal detachment in silicone oil-filled eyes. Methods The clinical data of 70 silicone oil-filled eyes of 70 cases of retinal detachment from Jan. 2017 to Jun. 2018 were collected and analyzed retrospectively. The causes of retinal detachment in silicone oil-filled eyes were observed. Results There were 3 kinds of causes of retinal detachment in silicone oil-filled eyes: subretinal effusion with retinal detachment in 10 eyes (14.29%); poor closure of primary tear or formation of new tear in 13 eyes (18.57%); the progress of proliferative vitreoretinopathy (PVR) in 47 eyes (67.14%). The retinas of all cases were reattached after retinal reconstructive surgery. Visual acuity after second surgery improved in 60 eyes (85.71%), unchanged in 9 eyes (12.86%), decreased in 1 eye (1.43%). The average visual acuity after second surgery were better than that before surgery (t=8.316, P=0.000). Conclusion The retinal detachment in silicone oil-filled eyes is mainly caused by progress of PVR, followed by the poor closure of primary tear, the formation of new tear and the formation of subretinal effusion. Retinal reattachment surgery for the treatment of retinal detachment in silicone oil-filled eyes is effective. Key words: Detachment, retinal; Causes; Efficacy, treatment

Replanting the complex amputated thumb with the pedicled flap from the rasceta area

Objective To explore the operative method and effect of replantation of complex severed thumb with the pedicled flap from the rasceta area. Methods From March, 2015 to March, 2017, 12 cases of complicated thumb injury were treated by retrograde transfer flap pedicled with the superficial palmar branch of the radial artery. All digital arteries defective with soft tissue defect, the area was 1.5 cm×3.0 cm to 5.5 cm ×7.0 cm. The wound of the wrist donor site was sutured directly. Postoperative followed-up was performed to review if the flap survival. Results There was 1 case of venous reflux disorder. After removal of some sutures, the symptoms were relieved. All other fingers survived successfully, and the flap survived completely. The donor site incision healed at I stage. The followed-up period was 12-18 (average, 13.5) months. The appearance of the thumb and flap was satisfactory, and the scar in the donor site was not obvious. The thumb function was evaluated according to the evaluation standard of thumb and finger reconstruction function of the Chinese society of medical surgery. Eight cases were excellent, 3 cases were good, and 1 case was medium. Conclusion The pedicled flap from the rasceta area has the advantages of simple operation and reliable blood supply. It can reconstruct the defect vessels and repair the wound at the same time. It is a new method for replantation of complicated severed thumb. Key words: Wrist transverse flap; Severed finger; Replantation; Microsurgical technique

Efficacy of minimally invasive vitrectomy for the treatment of retinal detachment with choroidal detachment

Objective To evaluate the efficacy of 25 G minimally invasive vitrectomy for the treatment of retinal detachment with choroidal detachment. Methods The data of 32 patients of retinal detachment with choroidal detachment were retrospectively analysed and all patients underwent minimally invasive vitrectomy combined with silicone oil tamponade. Results The average best corrected visual acuity (LogMAR ) was 2.21±0.37 before surgery, and increased to 1.32±0.63 after surgery, and the difference was statistically significant (t=10.930, P=0.001). The intraocular pressure was (7.38±2.03)mmHg before surgery, and (14.59±3.41)mmHg after surgery (1 mmHg=0.133 kPa). The difference was statistically significant (t=-11.550, P=0.001). The rate of retinal reattachment at discharge was 100%(32/32), and 87.5% (28/32) at 3 months after silicone oil removal. Conclusion 25 G minimally invasive vitrectomy is an effective method for the treatment of retinal detachment associated with choroidal detachment. Key words: Vitrectomy, minimally invasive; Detachment, retinal, detachment, choroidal

Advance of massive tear of the rotator cuff treated with a deltoid flap

Massive rotator cuff tears often destroy equilibrium of couples of the shoulder joints, whichlead toshoulder pain and functional incapacitation. At present, there is a great controversy about the best treatment strategy for the massive rotator cuff tear, nevertheless surgery has been proved to have more satisfactory results than non-operative treatment. It has been confirmed by numerous studies that cuff repair could prevent loss of shoulder strength and glenohumeral osteoarthritis. However, it is impossible to suture tendon to bone directly due to retraction of tendon stump, fat infiltration of rotator cuff and prominent tear size in massive rotator cuff tear. Muscular flap transfer procedures have played important roles in the treatment of massive rotator cuff tears. Compared with other tendon transposition procedures, such as latissimus dorsi transfer, the deltoid muscular flap may be an optimal method as it works synergistically with the infraspinatus and supraspinatus muscle, and presses down the humeral head potentially. Cuff repair in open operation with tendon stump re-attachment to the deltoid muscle flap, aims to reconstruct the cuff continuity and cover the humeral head toform a new cuff. The deltoid muscle flap, also acting as a muscle cushion, is expected to reduce impingement between the humeral head and the acromion and get better results of pain relief and improvement of shoulder function. However, it is still controversial about the efficacy of deltoid muscle flap transfer in reconstructing a new balance of couple with better shoulder strength, alleviating glenohumeral arthritis and preventing tendon retears. This article reviews the advances in the treatment of chronic massive rotator cuff tears with deltoid flap transfer.

Intentional replantation of endodontically treated second premolar with chronic apical abscess

A case of 51-year-old female reported with pain of failed root canal treatment of the mandibular right second premolar. Periapical lesion, mobility, and deep periodontal pocket were detected during examination. Intentional replantation was discussed with the patient. The tooth was atraumatically extracted followed by root end resection and retrograde cavity preparation and filling with MTA. Curettage in conjunction with irrigation of the alveolus was considered to eliminate the inflammatory tissue. The tooth was replanted back into its socket and splinted to the adjacent tooth. The total extraoral treatment time was ≤15 min. One- and three-month follow-up revealed no clinical symptoms and progressive periapical healing. After 2 years and 7 months, complete periapical healing was evident. The success rate of intentional replantation is very promising when the procedural techniques are applied properly.

Parents' awareness and attitude toward urgent management of avulsed permanent tooth in AL-Baha city

Objective: This study was conducted to evaluate the parents' awareness and attitude toward emergency management of avulsed tooth in AL-Baha city. Materials and Methods: Eleven-item questionnaire form was designed and sent randomly to parents with different demographic characteristics in Al-Baha city. A total of 263 questionnaires were collected. Data were statistically analyzed using SPSS program. Results: The majority of the respondents (n = 227; 86.3%) were females. The result revealed insufficient awareness among parents regarding the emergency management of tooth avulsion. One hundred fifty-two (58%) of the respondents think that replantation of an avulsed tooth is impossible where 76% (n = 202) of the parents were not aware of the transportation medium for the avulsed tooth. The demographic characteristics showed a nonsignificant impact on the awareness and attitude toward emergency management of the avulsed tooth in this study (P Conclusion: This study showed an insufficient awareness regarding tooth avulsion among Saudi subpopulation.

Microsurgical repair of ring avulsion injuries

Objective To investigate the clinical effect of microsurgical repair after ring avulsion injuries. Methods From March, 2009 to December, 2014, 6 cases (6 fingers) of ring avulsion injury were repaired. There were 4 males and 2 females with an age range of 18-30(mean, 22) years, which were 4 cases of ring finger and 2 cases of middle finger. The plane of injury was metacarpophalangeal band. Fracture and dislocation was reduced and fixed if damage fingers following with fracture and dislocation of interphalangeae. The damage ligament and volar plate and extensor tendon was repaired. The digital arteries and veins were repaired, and the digital nerves were sutured. System rehabilitation exercise carried out postoperatively. Results All fingers survived, and were followed-up for 8 to 30 months. The appearance of the fingers was excellent. The avarege range of motion of the proximal interphalangeal was 80°(ranged from 70° to 100°). The distal interphalangeal was 50° (ranged from 40° to 60°). The sensory recovery of finger pulp ranged from S3 to S3+. The two-point discrimination was 5 mm to 12 mm. According to the Evaluation Criteria for Finger Replantation and Reconstruction Issued by Chinese Hand Surgery of Chinese Mdical Association, 4 fingers had excellent while 2 had fairly good function. Conclusion Microsurgical repair of ring avulsion injury can achieve satisfactory clinical results by rehabilitation exercises postoperatively. Key words: Fingers; Ring avulsion injury; Repair; Microsurgical technique

Application of blocking one side of the finger artery in replantation of distal severed finger

Objective To explore the application and clinical efficacy of blocking one side of the proximal middle segment digital artery combined with wet dressing of heparin sodium cotton on the nail bed in replantation of distal severed finger, at the nail root of which venous drainage cannot be established. Methods From December 2014 to November 2017, 10 patients with distal finger complete dissection at the plane of nail root were treated by blocking one side of the proximal middle segment digital artery combined with wet dressing of heparin sodium cotton on the nail bed, which established the venous drainage and promoted the survival of the replanted finger. After anastomosing the bilateral digital artery, non-dominant side of the proximal middle segment digital artery was ligated. According to the principle of vascular pressure difference, a part of the dominant side of the finger arterial blood provided nutrition for replanted finger through the arterial arch. Another part flowed to the non-dominant side and enters the venous system through the capillaries in the middle segment. The normal venous system was formed later. Results All the 10 replanted fingers survived. The follow-up period ranged from 3 to 15 months with an average of 10 months. The nail of replanted fingers grew well without deformity. Slightly atrophy of finger body occurred. The sensation recovered to S2to S3+. According to the criteria of functional evaluation of finger replantation issued by the Hand Surgery Society of the Chinese Medical Association, the results were graded as excellent in 8 cases, good in 1 case and fair in 1 case. All the patients were satisfied with the appearance and function of the replanted fingers. Conclusion It is a simple and effective method for improving the survival rate of the replanted finger by blocking one side of the proximal middle segment digital artery combined with wet dressing of heparin sodium cotton on the nail bed, especially for the patients with severe contusion of injured fingers. Key words: Finger injuries; Replantation; Distal fingers; Venous drainage

Clinical application of replantation of Yamano I zone fingertip with anastomosis of central artery

Objective To investigate the clinical efficacy and the application experience of replantation of Yamano I zone fingertip with anastomosis of one artery. Methods From January 2012 to February 2017, 21 cases of Yamano I zone fingertip amputation without available vein for anastomosis were treated by replantation with only one central artery anastomosis. The nails were removed and blood-letting therapy was not used postoperatively. The survival rate, pulp fullness, finger appearance, sensory recovery and complications were observed. Results All the cases survived uneventfully. The follow-up period ranged from 10 to 36 months with an average of 15. 9 months. The patients were satisfied with the appearance of fingers, full pulp and no hyperalgesia. The two-pointuneventfullydiscrimination was 3 to 6 mm, averaging 4 mm. The wounds and fractures achieved primary healing. The appearance of nail was good. The mild finger atrophy occurred in 3 cases. The movements of the injured finger joints recovered well. Conclusion The replantation of Yamano I zone fingertip with only anastomosis of central artery can achieve satisfactory survival rate, full pulp and good recovery of sensation after the operation. The operation time is short. It is worthy of clinical promotion. Key words: Replantation; Microsurgery; Fingertip amputation; Vascular anastomosis

Laparoscopic ureteroureterostomy for the treatment of complete duplicated systems with hydronephrosis and ureteral dilation in children

Objective To discuss the efficacy of laparoscopic ureteroureterostomy for upper pole hydronephrosis and ureteral dilatation in children with complete duplex kidney. Methods The clinical data of 14 patients (15 units in total) who underwent laparoscopic ureteroureterostomy from April 2016 to October 2017 were retrospectively analyzed.Nine out of 14 cases had repeated urinary tract infections(UTI) and other symptoms[6 cases in group A: patients without vesicoureteral reflux(VUR) but presenting urinary tract infection (UTI) symptoms, 3 cases in group C: patients diagnosed with VUR]; 5 cases of asymptomatic patients were selected as group B. All the 14 cases had upper pole hydronephrosis and ureteral dilatation.Preoperative examinations included ultrosonograpy, urinary magnetic resonance urography(MRU), intravenous pyelography (IVP), voiding cystourethrogram(VCUG), and nuclear renal scanning.It was found that 4 cases had ureterocele; 3 cases had recurrent cystoureteral reflux (group C) before operation, and 1 case had cystoureteral refluxed after replantation. Results Laparoscopic surgery was successful in all of 14 children.None of them were shifted to open surgery because of abdominal viscera injury bleeding.The operation duration was 85-140 min.The average posto-perative hospital stay was 5.58 days.There was neither urinary anastomotic leakage nor UTI.Fourteen cases were followed up and the postoperative follow-up period was 7-23 months.No cases developed urinary tract infection except 2 cases with vescioureteral reflux.Ultrasound examination showed that the upper renal parenchyma of 5 children was thicker, ultrasonography showed that upper pole hydronephrosis was better and ureteroceles were smaller.There was no complication such as lower pole hydronephrosis.The symptoms of urinary tract infection disappeared after operation. Conclusions Laparoscopic ureteroureterostomy can treat renal duplication with less trauma, and it is safe and effective.It can be one of therapeutic regimen to treat low-functional upper pole hydronephrosis and ureteral dilatation in renal duplication.Howe-ver, this procedure cannot be used for vescoureteral reflux cases because of high rate of stump infection. Key words: Child; Complete duplex kidney; Laparoscope; Ureteroureterostomy

Observation on the efficacy of vitrectomy for dialysis patients with end stage renal disease

Objective To observe the clinical efficacy of minimally invasive vitrectomy for dialysis patients with end stage renal disease(ESRD). Methods The clinical data of 21 eyes of 18 dialysis patients with ESRD, who underwent minimally invasive vitrectomy due to proliferative diabetic retinopathy or vitreous hemorrhage were retrospectively reviewed. Six eyes of 5 cases were treated with peritoneal dialysis and 15 eyes of 13 cases were received heparin-free hemodialysis. The visual acuity, intraocular pressure and complications intraoperative and postoperative were observed in two groups. Results The postoperative visual acuity improved in two groups(t=2.589, P=0.018). The difference of intraocular pressure was not statistically significant between before and after surgery (t=-0.476, P=0.639). The difference of visual acuity, intraocular pressure and the rate of intraoperative and postoperative complications were not statistically significant between two groups (P>0.05). Preoperative intravitreal ranibizumab injection had no influence on complications, surgery time and final visual acuity. Conclusion Minimally invasive vitrectomy can improve the final visual acuity and achieve retinal reattachment for dialysis patients with ESRD, who suffering from vitreous hemorrhage or proliferative diabetic retinopathy. Compared with peritoneal dialysis, heparin-free hemodilysis is unlikely to increase the risk of intra and postoperative complications. Key words: Renal disease, end stage, dialysis; Vitrectomy

A heterotopic digital replantation in an 18-month-old child

In multiple digital amputations, it is not always possible to replant the same amputated part. In these cases, heterotopic digital replantation is a suitable option in terms of cosmetic and functional outcomes. In our report, we described a heterotopic digital replantation in an 18-month-old male child who had multiple digital amputation as a result of placing his hand in the ventilator. Heterotopic replantation is an important method that should be kept in mind in multiple finger amputations which can enable a good cosmetic and functional result, especially in cases where the stump of the amputated finger is not suitable/veya convenient.

Observation on the efficacy of scleral buckling and laser photocoagulation around the tear for retinal detachment

Objective To observe the efficacy of scleral buckling and laser photocoagulation around the tear for the treatment of rhegmatogeous retinal detachment. Methods The clinical data of 41 eyes of 41 cases of rhegmatogenous retinal detachment were analyzed retrospectively. The retinal tear were located under the indirect ophthalmoscope. A silicone sponge cylinder was radiatively sutured to compress the tear according to the size and shape of the hole. The radial silicone sponge pad was only limited in the retinal tear without scleral buckling. All cases received laser photocoagulation around the tear after operation. The follow-up time was 3 - 18 months after operation. Results The retina reattached in 37 eyes(90.24%) after primary operation. The retina failed to be attached in 4 eyes after primary operation. Four cases underwent re-scleral buckling or vitreous surgery 3 days postoperatively, and retinal reattachment was achieved permanently in 3 eyes. The finally success rate of retinal reattachment was 97.57%. Conclusion Most case of rhegmatogenous retinal detachment could be successfully treated with scleral buckling and laser photocoagulation around the tear. Key words: Retinal detachment, rhegmatogenous; Buckling, scleral; Photocoagulation, around the tear

Replantation of the interphalangeal joint with reserving joint in children

Objective To discuss the treatment method and clinical efficacy of replantation of the interphalangeal joint with non-section osteotomy and reserving joint in children. Methods From January 2008 to January 2016, 19 children with completely severed interphalangeal joint were treated with distal middle 1/3 plane osteotomy shortening 0.3 to 0.5 cm, and the injured interphalangeal joints were reserved and replanted. Results All the replanted fingers survived uneventfully. The follow-up time ranged from 6 to 36 months with an average of 17 months. According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association, the results were graded as excellent in 14 cases, good in 4 cases and poor in 1 case. The replanted fingers were well developed with good interphalangeal joint motion. X-ray showed that the articular surface was intact without obvious degeneration. Conclusion For the children with completely severed interphalangeal joint, the replantation of interphalangeal joint with osteotomy and shortening of the proximal phalanx can reserve joint and epiphysis. The joint flexibility is restored and the normal development of the injured finger is observed. Key words: Replantation; Child; Osteotomy; Reserve joint

Replantation: Is the Glory Well Deserved?

Replantation: Is the Glory Well Deserved?

Minimally invasive scleral buckling surgery under operating microscope for the treatment of rhegmatogenous retinal detachment

Objective To evaluate the efficacy of minimally invasive scleral buckling surgery under operating microscope for the treatment of rhegmatogenous retinal detachment (RRD). Methods The data of 74 eyes of 72 patients with RRD from Dec. 2015 to Jun. 2017 were analyzed retrospectively. All cases were treated with minimally invasive scleral buckling under operating microscope. The operation time, postoperative reattachment, ocular surface recovery and complications were observed. Results The average duration of surgery was (26.7±20.2) min. One week after surgery, 68 eyes gained retinal reattachment; subretinal fluid was not absorbed at 3 days after surgery in 3 eyes and they received air tamponade. The retina was successfully reattached in 2 eyes and 1 eye received air tamponade again. One eye with large retinal tear gained retinal reattachment after vitrectomy. During the follow-up period, there were 2 eyes with new retinal redetachment. All retina were reattached after second surgery. The BCVA (LogMAR) was mean 1.32±0.37 before surgery, and BCVA at the last follow-up was 0.12±0.16. The difference was significant between after and before operation (t=16.52, P<0.001). Conclusion Minimally invasive scleral buckling surgery under operating microscope is a safe and efficient surgical method. Key words: Minimal invasive; Scleral buckling; Surgical microscope; Retinal detachment, rehgmatogenous