Purpose: To explore anatomic abnormalities causing congenital ulnar-angled thumb at the distal phalanx, so as to identify the differential diagnosis and guide for surgical treatment. Methods: Reviewing the clinical manifestations, x-ray films, and operative findings of 43 children with congenital ulnar-angled thumbs in the distal phalanges without radially inserting terminal tendons at the base of distal phalanx, and analyzing their anatomic abnormality as well as differential diagnosis. Results: There were 57 ulnar-angled thumbs in this study. Abnormal hypertrophic epiphyses were found in 35 thumbs. In x-ray, distal phalanx was in good apposition with its epiphysis and they got pretty close to the average of less than 1 mm. In operation, we measured the length of the radial side of the hypertrophic epiphyseal averaged 3.2 mm. Extra bones were found to exist between the proximal phalanges and distal phalanges in the remaining 22 triphalangeal thumbs. The preoperative radiography showed a larger distance between the distal phalanx and the extra bone, which averaged to more than 2 mm. The length of the radial side of the hypertrophic epiphyseal measured in operation averaged 3.7 mm. Conclusions: Abnormal hypertrophic epiphysis and triphalangeal thumb are two different causes for congenital ulnar-angled thumb at the distal phalanx. The distance between the hypertrophic epiphysis and the distal phalanx is much smaller in x-ray so we can distinguish it from a triphalangeal thumb before surgery.
Multimedia is a widely-used teaching means in contemporary medical education.Establishing and improving the multimedia teaching material library is a strong guarantee for the smooth implementation of multimedia.The causes,significance and methods for establishment of pediatric surgery teaching multimedia material library according to the characteristics of pediatric surgery teaching are described in this article,with a view to provide a reference to other relevant professional institutions.
Key words:
Multimedia; Pediatric surgery medicine; Clinical teaching
Polyotia is a very rare auricular malformation, and only few cases have been reported to date. Polyotia has been ambiguously defined, and due to the instability of its shape and condition, no uniform surgical technique has been established up to now. Thus, it is necessary to standardize the diagnosis and treatment of polyotia. The aim of the present study was to present a new set of objective diagnostic criteria for discussion, and introduce our surgical design for polyotia.A retrospective analysis was performed on 34 cases of polyotia, which were diagnosed and treated in our Plastic Surgery Department during a 3-year period from January 2016 to March 2019. The preoperative photographs, manifestations and operation records of these 34 cases were reviewed.On the basis of the new set of objective diagnostic criteria, only 12 of 34 cases were diagnosed as polyotia, while the remaining 22 cases were diagnosed as accessory tragus. Polyotia was redefined as the presence of a broad-based accessory auricle in the tragus area along with accessory cavitas conchae similar to cavitas conchae. The new surgical design emphasized the use of cartilage and skin to fill up the concavity and reconstruct the tragus.The diagnosis of polyotia was presented on the basis of a new set of objective criteria, which include an accessory auricle and accessory cavitas conchae. The use of cartilage and skin to fill up the concavity and reconstruct the tragus were the emphases.
Many pediatric surgeons have little training in laparoscopic application.The major problem in clinical practice of laparoscopic technician is without regularly training,unsuitable indication,and ignoring peroperation management.so that there are much more serious complications.For these reasons,it is a prerequisite that surgon and anesthetist must be trained before clinical practice,and the qualification of admission should be strictly controlled.
Key words:
Pediatrics; Laparoscopy training; Clinical practice; Problem's and strategy
Clinical practice is an important period to train student's skills in pediatric surgical learning,but it is confronted with difficult condition under the new doctor-patient relationship.How to resolve these difficulties is the key to carry on teaching successfully.Aaccording to the students' interests and the knowledge structure characteristics,teachers should cultivate their professionalism,train their communication skills,extend their thinking ability with appropriate use of teaching aid to increase the teaching interests and develop self-learning ability.
Key words:
Clinical practice course; Pediatrics teaching
To investigate the method for simultaneous correction of nasal deformity and unilateral cleft lip so as to decrease the secondary operation for the deformity.The Millard procedure (or Millard plus triangle flap insertion) was used to repair the unilateral cleft lip. Through the incisions, the greater alar and nasalis were repositioned to the normal anatomical positions. The deviated septum and columella were corrected by cutting the abnormal attachment of the orbicular muscle of mouth to the anterior nasal spine. The mattress sutures through the tip of the columella and ala nasi helped to recover the shape of the nostril.108 patients were treated with this method. They aged from one month to 19 years, included 30 with second degree cleft lip and 78 with third degree cleft lip. The follow-up for as long as 3 years showed satisfactory results.This technique can eliminate the severe cleft nasal deformity and elevate the displaced alar cartilage at the time of lip repair without interference with nasal growth. It is recommended for the treatment of unilateral cleft lip with severe nasal deformity.
To explore the clinical effect of using dorsal two wing-shaped flap to reconstruct finger web for treatment of congenital syndactyly.This technique has been used in 19 children with congenital syndactyly. At the dorsum, a flap with V-shaped tip and two wing-shaped pedicle were designed and was just sewed up with an anchor-shaped incision at the palm. The web was primarily reconstructed without skin graft at base of fingers. Distal end of fingers were separated by using serrated flap and were closed after removal of fatty tissue. At some cases with tight skin connection. The defect area at lateral and distal end of fingers was closed by small pieces of skin graft.All the webs were reconstructed primarily without skin graft at the base of fingers. 7 cases with tight skin connection had small pieces of skin graft at lateral and distal end of fingers. Primary healing was achieved in all cases. After 1 to 6 months of follow-up, both the appearance and function were satisfactory without conspicuous scar. The reconstructed finger webs were in normal depth and width.Primary web space can be achieved by dorsal two wing-shaped flap without skin graft at base of fingers. It is one of the best choices for treatment of congenital syndactyly.
Objective To assess the diagnosis and treatment of staphylococcal scalded skin syndrome (SSSS)in children.Methods A total of 177 children whh SSSS were eligible for this study.Clinical data were retrospectively reviewed to assess the patients' age and geographical areas,predisposing factors,prodrome,clinical features,results of laboratory examination (including bacterial isolation and drug susceptibility test),treatment and prognosis.Results The median age at onset was 23 days past 15 months.Infants aged 1 to 3 years were the most commonly affected population.The male to female ratio was 8:9.SSSS occurred in summer or autumn in 71.2％ of the patients.Most patients came from countryside.Of these patients,148 (83.6％) had no definite inducement,13 (7.3％) had fever or cold history before the occurrence of SSSS.Skin lesions often began in the face (71.6％).Almost all cases presented with erythema and blisters.Abnormal myocardial enzymes were observed in 104 (80.6％) of 129 patients,and Staphylococcus aureus was isolated from 38.7％ of 142 patients.Susceptibility testing of 21 Staphylococcus aureus isolates from patients in the past 3 years showed that 95.2％ and 95.0％ were sensitive to cephalosporins and amoxicillin/clavulanic acid respectively.Double-antibiotic therapy was effective in 72.9％ of the patients.Intravenous gamma globulin was given to 36.2％ of the patients in the early stage.Myocardial-protecting drugs were also administrated early in patients with abnormal myocardial enzymes.All the patients healed without scarring.Conclusions For infants with acute facial erythema and exfoliative skin lesions,SSSS should be suspected and timely antibiotic treatment should be given.Cephalosporins and semi-synthetic penicillins are effective and the first choice for the treatment of SSSS.Meanwhile,early addition of gamma globulin and myocardial-protecting drugs may be beneficial to disease recovery.
To investigate the effectiveness of autologous nano-fat mixed granule fat transplantation in the treatment of facial soft tissue dysplasia in children with mild hemifacial microsomia (HFM).A total of 24 children with Pruzansky-Kaban type Ⅰ HFM were admitted between July 2016 and December 2020. Among them, 12 children were treated with autologous nano-fat mixed granule fat (1∶1) transplantation as study group and 12 with autologous granule fat transplantation as control group. There was no significant difference in gender, age, and affected side between groups ( P>0.05). The child's face was divided into region Ⅰ(mental point-mandibular angle-oral angle), region Ⅱ (mandibular angle-earlobe-lateral border of the nasal alar-oral angle), region Ⅲ (earlobe-lateral border of the nasal alar-inner canthus-foot of ear wheel). Based on the preoperative maxillofacial CT scan+three-dimensional reconstruction data, the differences of soft tissue volume between the healthy and affected sides in the 3 regions were calculated by Mimics software to determine the amount of autologous fat extraction or grafting. The distances between mandibular angle and oral angle (mandibular angle-oral angle), between mandibular angle and outer canthus (mandibular angle-outer canthus), and between earlobe and lateral border of the nasal alar (earlobe-lateral border of the nasal alar), and the soft tissue volumes in regions Ⅰ, Ⅱ, and Ⅲ of healthy and affected sides were measured at 1 day before operation and 1 year after operation. The differences between healthy and affected sides of the above indicators were calculated as the evaluation indexes for statistical analysis. At 1 year after operation, the parents, the surgeons, and the nurses in the operation group made a self-assessment of satisfaction according to the frontal photos of the children before and after operation.The study group and the control group were injected with (28.61±8.59) and (29.33±8.08) mL of fat respectively, with no significant difference ( t=0.204, P=0.840). After injection, 1 child in the control group had a little subcutaneous induration, and no related complications occurred in the others. All children in both groups were followed up 1 year to 1 year and 6 months, with an average of 1 year and 4 months in the study group and 1 year and 3 months in the control group. At 1 year after operation, the asymmetry of the healthy and affected sides improved in both groups; the satisfactions of parents, surgeons, and nurses in the study group were all 100% (12/12), while those of the control group were 100% (12/12), 83% (10/12), and 92% (11/12), respectively. The differences between healthy and affected sides in mandibular angle-oral angle, mandibular angle-outer canthus, earlobe-lateral border of the nasal alar, and the soft tissue volume in 3 regions of the two groups after operation were significantly smaller than those before operation ( P<0.05). There was no significant difference in the above indexes between the two groups before operation ( P>0.05). After operation, all indexes were significantly lower in study group than in control group ( P<0.05).Autologous nano-fat mixed granule fat transplantation and autologous granule fat transplantation can both improve the facial soft tissue dysplasia in children with mild HFM, and the former is better than the latter.探讨自体纳米脂肪混合颗粒脂肪移植治疗儿童轻度半侧颜面短小畸形（hemifacial microsomia，HFM）面部软组织发育不良的疗效。.2016年7月—2020年12月，收治Pruzansky-Kaban Ⅰ型HFM患儿24例。其中采用自体纳米脂肪混合颗粒脂肪（1∶1）移植12例（研究组），自体颗粒脂肪移植12例（对照组）。两组患儿性别、年龄以及患侧侧别比较，差异均无统计学意义（ P>0.05）。将患儿面部分为Ⅰ区（颏点-下颌角-口角）、Ⅱ区（下颌角-耳垂-鼻翼外侧脚基点-口角）、Ⅲ区（耳垂-鼻翼外侧脚基点-内眦-耳轮脚），术前基于颌面部CT扫描+三维重建数据采用Mimics软件计算3区健、患侧软组织容积差，以此确定自体脂肪抽取量及注射量。术前1 d及术后1年测量健、患侧下颌角至口角距离（下颌角-口角）、下颌角至外眦距离（下颌角-外眦）、耳垂至鼻翼外侧缘距离（耳垂-鼻翼外侧缘）以及Ⅰ、Ⅱ、Ⅲ区软组织容积，计算上述指标健、患侧差值，作为评价指标进行统计分析。术后1年患儿家长、手术医师及手术组护士三方，根据患儿手术前后正位照片评价手术满意度。.研究组、对照组分别注射脂肪（28.61±8.59）、（29.33±8.08）mL，差异无统计学意义（ t=0.204， P=0.840）。注射后仅对照组1例皮下有少许脂肪钙化硬结。两组患儿均获随访，随访时间均为1年～1年6个月，研究组平均1年4个月，对照组平均1年3个月。术后1年，两组患儿健、患侧不对称均改善，研究组患儿家长、手术医师及手术组护士三方满意度均为100%（12/12），对照组满意度分别为100%（12/12）、83%（10/12）、92%（11/12）。术后两组下颌角-口角、下颌角-外眦、耳垂-鼻翼外侧缘以及Ⅰ、Ⅱ、Ⅲ区软组织容积的健、患侧差值均小于术前（ P<0.05）。两组间术前上述指标差异均无统计学意义（ P>0.05）；术后研究组各指标均小于对照组，差异有统计学意义（ P<0.05）。.自体纳米脂肪混合颗粒脂肪移植及自体颗粒脂肪移植均能改善儿童轻度HFM面部软组织发育不良，但前者疗效优于后者。.
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