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Reconstructive surgery for phantom and residual limb pain in post-conflict settings

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Chinese Journal of Plastic and Reconstructive surgery 2024年第1期6卷 54-55页

作者： Damián Palafox Plastic and Reconstructive surgery department, Hospital Angeles Puebla Hospital Angeles Puebla Plastic and Reconstructive surgery department

Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict. In this scenario,most amputees develop residual and phantom limb pain, impacting their quality of life. There are several elective surgical procedures available for both conditions, such as neuroma excision followed by nerve reconstruction,nerve relocation, e.g., surgically implanting a transected nerve into a muscle, nerve transfers in cases of associated paralysis, and most recently, regenerative peripheral nerve interface surgery. Whenever possible in the postconflict phase, a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees. While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article, we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide: the high-quality care and treatment of refugees and those whose lives have been impacted by conflict, disaster, or displacement.

关键词： Residual limb pain Phantom limb pain Refugees Reconstructive surgery Microsurgery Amputees

Classification and a decade-long follow-up of rat bite injuries in the nasal region

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Chinese Journal of Plastic and Reconstructive surgery 2024年第1期6卷 28-33页

作者： Chu-Hsin Chen Yahong Chen Peng Xu Kai Liu 1.department of Plastic and Reconstructive surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine 2.department of Plastic surgery, Shanghai Industrial Investment (Holding) Company Limited Medical Cosmetology department of Plastic and Reconstructive surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine department of Plastic surgery Shanghai Industrial Investment (Holding) Company Limited Medical Cosmetology

Background: Nasal defects due to rat bites are frequently encountered in rural regions of China. In addition to serving as disease vectors, rats can also inflict bite injuries. In this study, we delineated the characteristics of rat bite injuries in the nasal region and discussed the clinical features observed during a 10-year follow-up period.Methods: We retrospectively reviewed hospital records for patients admitted due to rat bites. This study outlines the demographics, clinical features, and follow-up outcomes supported by comprehensive photo documentation of the patients' progress.Results: Twenty-five patients, with a mean age of 29 years, were admitted due to rat bites. Treatment was provided for three distinct types of injuries: nasal tip defect(type Ⅰ), nasal defect(type Ⅱ), and full-thickness nasal defect with loss of surrounding tissues(type Ⅲ). All patients recovered fully.Conclusions: The treatment for rat bites should be based on the wound type. The long-term follow-up outcomes are more favorable when fewer subunits of the nose affected. We recommend early surgical intervention, along with psychological therapy, to prevent interference with growth and development.

关键词： Rat bite Wound classification Nasal reconstruction

Ultrasound-assisted isolation: A new method to isolate stromal vascular fraction

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Chinese Journal of Plastic and Reconstructive surgery 2024年第1期6卷 8-15页

作者： Yiming Gao Xiaojie Zhang Poh-Ching Tan Yun Xie Peiqi Zhang Tianyu Zhang Qingfeng Li Shuangbai Zhou 1.department of Plastic and Reconstructive surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine 2.department of Burns and Plastic surgery, Shanghai Changzheng Hospital 3.College of Life Sciences, Shanghai Normal University department of Plastic and Reconstructive surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine department of Burns and Plastic surgery Shanghai Changzheng Hospital College of Life Sciences Shanghai Normal University

Background: The stromal vascular fraction(SVF), a cluster of stem and progenitor cells isolated from adipose tissue, holds significant promise for application in regenerative medicine. However, the existing methods for SVF isolation are time-consuming and expensive. Thus, in this study, we explored a new method of SVF extraction—ultrasound-assisted SVF isolation(USASI)—and compared the viability and characteristics of SVF isolated using different methods.Methods: SVF extraction methods using different combinations of ultrasound power, ultrasound time, collagenase dosage, and collagenase digestion time were compared with those of the control group(collagenase digestion method). The cell yield and vitality of the SVF were evaluated via cell counting and trypan blue staining. The cell components and immunophenotypes of freshly isolated SVF were analyzed using flow cytometry. The proliferative capacity and differentiation potential of the SVF were also identified.Results: Ultrasonication at 95 W-20 k Hz for 30 s followed by digestion with 0.15% collagenase for 30 min was identified as the most suitable parameter for the USASI method in isolating SVF, as recommended based on the evaluation of various tested conditions. The USASI method significantly reduced the collagenase dosage and shortened the digestion time. Compared to the collagenase digestion method, the USASI method had a higher cell yield and cell viability, with no adverse effects on cell components, proliferative capacity, or multipotential differentiation capacity.Conclusion: With reduced processing time, lower collagenase dosage, and increased cell yield without impairing the viability and characteristics of SVF, USASI holds the potential to emerge as a time-saving and cost-effective method for future clinical applications.

关键词： Stromal vascular fractions SVF isolation Mechanical force Ultrasound

Current practice in autologous rib and costal-cartilage harvest for rhinoplasty: A systematic review

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Chinese Journal of Plastic and Reconstructive surgery 2024年第1期6卷 41-48页

作者： Mengyuan Jiang Haizhong Huo Lu Zhang 1.department of Plastic and Reconstructive surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine 2.department of General surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine department of Plastic and Reconstructive surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine department of General surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine

Background: Autologous costal grafts are used universally in clinical practice for rhinoplasty and reconstruction.However, surgeons worldwide have not agreed on the details of graft harvesting, including rib selection, side preference, operation mode, cutting methods, and handling of the periosteum and perichondrium. This study aimed to provide an overview of the novel techniques used for auto-rib harvesting in rhinoplasty within the past 5years and identify potential avenues for future research.Methods: We searched for related articles in Pub Med, Embase, and Web of Science from 2019 to 2023, summarized crucial but controversial steps in recent practice, and analyzed their theoretical basis and clinical feasibility.Results: Auto-rib and cartilage open harvest is still mainstream in rhinoplasty and reconstruction, with the 5th to8th ribs and cartilage being the most used. The laparoscopic harvest is gaining attention, being second only to the open harvest, with the 9th/10th ribs and cartilages being particularly convenient. The clinical applications of fullcut and split-cut methods differ in their advantages. Except for some special reasons, almost all studies tended to preserve the periosteum and perichondrium in situ, and few surgeons chose to harvest the grafts on the left side.Conclusion: Multiple techniques have emerged, requiring surgeons to balance the benefits and risks of various strategies at each step. New theories and techniques should be fully tested promptly and in clinical practice before wide application. Overall, a professional consensus is needed for better directivity, precision, and stability in clinical practice.

关键词： Rhinoplasty Autologous graft Cartilage Rib Periosteum Perichondrium

Clinical and Therapeutic Aspects of Inguinal Hernia in Children in the General surgery department of Reference Health Center in Commune I of Bamako Mali

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Surgical Science 2024年第2期15卷 54-63页

作者： Tounkara Cheickna Samake Hamidou Simpara Mama Diarra Issaka Sanogo Modibo Sidibe Souleymane Togola Modibo Dembele Bakary Tientigui Coulibaly Yacaria Togo Pierre Adégné Kante Lassana department of General surgery the Reference Health Center of Commune I Bamako Mali Directorate of Social Health Service the Armed Forces of Mali Bamako Mali department of Pediatric surgery Mali Hospital Bamako Mali department of General surgery the Gabriel TOURE University Hospital Bamako Mali department of Pediatric surgery Gabriel TOURE University Hospital Bamako Mali

Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of cases and hematoma: 1.7%). The immediate consequen

关键词： Inguinal Hernia Child surgery Cs Ref C I Bamako Mali

Study of Hemorrhoid Disease in the department of General surgery of the Cs Ref of the Commune I Bamako

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Surgical Science 2024年第2期15卷 36-47页

作者： Tounkara Cheickna Diarra Issaka Sanogo Modibo Togola Modibo Camara Ladji Soma Dembele Bakary Tientigui Traore Alhassane Togo Adégné Pierre Kante Lassana Ouattara Zanafon Diallo Gangaly department of General surgery The Reference Health Center in Commune I Bamako Mali department of General surgery The Gabriel Toure University Hospital Bamako Mali department of Urology The Gabriel Toure University Hospital Bamako Mali

This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemorrhoidal disease, to identify the contributing factors, describe the clinical and therapeutic aspects and analyze the surgical consequences. We collected 73 patients with an average age of 37.8 years (range: 19 years and 77 years) with a sex ratio of 2.5 in favor of men. We operated on 49 patients or 67.1% of cases. 71.2% of our patients were married and lived in Bamako. Schoolchildren and middle managers made up 39.8% of cases. 82.2% of patients were seen in ordinary consultation and 69.9% complained of progressive anal pain in 66.7% of cases. This pain was triggered by defecation in 88.2% of our patients. The contributing factors were dominated by constipation (53.4%), working in a seated position (41.1%) and a sedentary lifestyle (16.4%) of cases. Stage IV external hemorrhoids and hemorrhoidal thrombosis represented 53.8% of surgical indications. The most used surgical technique was that of Milligan-Morgan, i.e. 51.9% of cases and 45.2% of patients treated medically received a combination of transit regulator, venotonics and analgesics. The surgical aftermath was marked by hemorrhage (3 cases), delayed healing (5 cases), urinary retention (1 case) and scarring anal stenosis (1 case). The morbidity rate was 5.48% of cases and a zero mortality rate. The average length of hospitalization was 2 days with extremes of 1 and 5 days.

关键词： Hemorrhoid surgery Cs Ref C I Bamako Mali

Postoperative Complications in the General surgery department of the Cs Ref of Commune I of the District of Bamako Mali

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Surgical Science 2024年第6期15卷 409-419页

作者： Tounkara Cheickna Samake Hamidou Dembele Lamine Diarra Issaka Togola Modibo Sanogo Modibo Dembele Bakary Tientigui Traore Alhassane Togo Adégné Pierre Kante Lassana department of General surgery Reference Health Center of Commune I of Bamako Bamako Mali Directorate of Social and Health Services of the Armies Bamako Mali department of General surgery CHU Gabriel Tour Bamako Mali

Postoperative complications represent important indicators for the quality of surgical care. The objectives of this work were to study post-operative complications in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of post-operative complications, to identify the factors of occurrence, to describe the clinical aspects, diagnostic and therapeutic in order to assess the additional cost linked to post-operative complications. This study was prospective, carried out in the general surgery department on 300 cases of surgical interventions. It covered all patients aged at least 15 years, operated on and hospitalized or not, and who presented complications during the 30 days postoperatively. Patients under the age of 15 were not included (our general surgery department is not a pediatric surgery department). We collected 300 patients among whom 199 (66.33%) were men and 101 (33.66%) women, i.e. a sex ratio = 1.9. The average age was 38 years with extremes of 15 and 87 years. The main initial diagnoses were: acute appendicitis, peritonitis, occlusions, wall hernias, hemorrhoids, uterine prolapse, uterine myomas, ovarian cysts and acute cholecystitis. Emergencies represented 43% (N = 129) of interventions with 6.98% post-operative complications (POC). Postoperative complications were dominated by surgical site infections, 75% of cases (N = 20), wall hemorrhage 5% (N = 1), testicular necrosis 5% (N = 1) and testicular calcification 5% (N = 1), wire rejection 5% (N = 1) and death 5% (N = 1). The management of postoperative complications was surgical in 95% and medical in 100%. Their occurrence extended the hospital stay by 3.65 days and increased the average cost of care by 60541.85 CFA francs. The mortality index lowered by efficient management of complications (IMAGE) calculated in relation to deaths was 95% of cases. Anemia, ASA score ≥ III, Alteimeir II and IV classes, duration of surgery and post-operative hospitalization were factors contributing to post-operative complica

关键词： Complications Post Opératoires Chirurgie Cs Ref CI Bamako Mali

Review of Two Years of Surgical Activities of the General surgery department of the Reference Health Center of Commune I of Bamako Mali

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Surgical Science 2024年第4期15卷 195-206页

作者： Tounkara Cheickna Cisse Amadou Beydi Samake Hamidou Diarra Issaka Sanogo Modibo Diarra Bogoba Doumbia Seydou Yena Sadio department of General surgery of the Reference Health Center of Commune I Bamako Mali Directorate of Social and Health Services of the Armed Forces of Mali department of Public Health of the Faculty of Medicine and Odontology-Stomatology Bamako Mali department of surgery Mali Hospital Bamako Mali

The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.

关键词： Assessment Surgical Activities 2 Years Reference Health Center of Commune I Bamako

Ruptured Ectopic Pregnancy: Epidemiology and Management in the General surgery department of the Ignace Deen National Hospital, Conakry University Hospital

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Open Journal of Obstetrics and Gynecology 2024年第4期14卷 503-508页

作者： Barry Mamadou Sakoba Barry Boubacar Guirassy Mariam Touré Aboubacar Diallo Aissatou Taran department of General surgery Ignace Deen National Hospital/Conakry University Hospital Conakry Guinea Faculty of Health Sciences and Technology Gamal Abdel Nasser University of Conakry Conakry Guinea

Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.

关键词： Ruptured Ectopic Pregnancy Epidemiology and Management