Objective To explore the clinical value of human acellular dermal matrix (HADM) in giant complex abdominal wall reconstruction (GCAWR) after open abdomen.Methods The retrospective crosssectional study was conducted.The clinical data of 6 patients with severe trauma who were admitted to the Nanjing General Hospital of Nanjing Military Command of Nanjing University School of Medicine between January 2013 and January 2014 were collected.After open abdomen,fascia of the abdominal wall was fully freed using the component separation,and abdominal wall defects were reconstructed using HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture.Observation indicators:(1) intra-and post-operative situations:operation time,volume of intraoperative blood loss,removal time of postoperative drainage-tube,postoperative complications,duration of hospital stay and hospital expenses;(2) follow-up situations:recurrence of abdominal wall hernia at postoperative year 2.Follow-up using outpatient examination and telephone interview was performed to detect the recurrence of abdominal wall hernia up to April 2016.Measurement data with normal distribution were represented as ~±s.Results (1) Intra-and post-operative situations:6 patients underwent successful surgery.Operation time,volume of intraoperative blood loss and removal time of postoperative drainage-tube were respectively (77±9)minutes,(225±57)mL and (8±3)days.Two patients with postoperative seroma were cured by conservative treatment.One patient with postoperative anastomotic leakage received continuously irrigation and drainage,and leakage was stopped using the biomedical fibrin glue.There was no abdominal bulge of the 6 patients in hospital.Duration of hospital stay and hospital expenses were respectively (10±3) days and (12±7) × 104 yuan.(2) Follow-up situations:6 patients were followed up for 14-28 months,with a median time of 23 months.Two patients had relaxation and bulge of HADM in peritoneal layer at postoperative 2 years,without bulge of HADM in the rectus abdominis anterior sheath layer.There were no occurrence of abdominal wall hernia,chronic pain,paraesthesia,swelling in the local area and other adverse reaction.Conclusion Using of HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture is safe and feasible for GCAWR,with good short-term outcomes.

Objective To evaluate the postoperative complications of esophageal anastomosis for esophageal atresia (EA) in children.Methods From January 2012 to August 2016,a total of 76 EA cases undergoing esophageal end-to-end anastomosis were recruited.There were 36 type Ⅲ-a and 40 type Ⅲ-b according to the Gross' classification scheme.There were 49 boys (64.47％) and 27 girls (35.53％) with a mean birth weight range of (2 730 ± 580) (1 380-4 300) grams and a mean age (3.79± 3.81) (0.4-22) days.They were divided into two subgroups based upon complications,length of blind esophageal end and birth weight.Results All patients underwent operative esophageal correction and survived.The follow-up period was from 1 month to 4 years.Two cases were reoperated for anastomotic leakage.Among 19 cases of anastomotic stricture,16 cases underwent endoscopic balloon dilatation at 1 month while another 3 cases with severe postoperative stenosis had excision and anastomosis of esophageal stricture at 3,5 and 8 months.Significant differences existed between non-complicated and complicated groups in length of blind esophageal end,birth weight and cardiovascular malformation.However,no significant difference existed in operative age (3.12 ± 2.24 vs 1.86 ± 1.46 days) or average operative duration (135.3 ± 27.2 vs 136.8 ± 34.3 min).Conclusions Birth weight and length of blind esophageal end are more likely to be risk factors for complicated patients.However,complication is no significant correlation with operative duration.

Since its introduction as an alternative treatment technique, radiotherapy has been increasingly used as the medical treatment of choice for patients with malignant tumors. However, radiotherapy is associated with a number of common, well-described side effects, which may compromise the quality of life of the patients. Scrotal edema is an infrequent complication in patients who undergo pelvic irradiation, which is suspected to be due to lymphatic obstruction. An extensive literature search found no previous case report describing this complication in patients receiving pelvic radiotherapy. Herein, we present a case of recurrent scrotal edema in a 59-year-old man with prostate cancer and radiation enteritis. Conservative therapy was applied and was successful in relieving the symptoms. To the best of our knowledge, this is the first case report of scrotal edema in a patient with radiation enteritis.

Chronic radiation enteritis (CRE) is defined as loss of absorptive capacity after irradiation due to chronic inflammation and damage of intestinal mucosa, which may lead to varying degrees of malnutrition. The aim of this study was to evaluate the potential correlation between the nutritional status and systemic inflammation in patients with CRE.