2022年 · 第60卷第05期

For complex wounds with large skin and soft tissue defects, the risk of limb salvage is significantly increased^{［1, 2］}。 Patients often have injuries to the main artery of the limb, or in order to ensure sufficient blood supply to the distal limb, the main artery is not allowed to be the main blood supply artery of the flap^［3］。 Therefore, the repair room of free flaps is very limited^［4］Some patients were amputated due to lack of suitable skin flaps to cover the wound^［5］。 With the deepening of research on perforator flap and the rapid development of microsurgical technique, the clinical requirements for limb-saving treatment of severely traumatized limbs are higher^［2］。 Since January 2019, we have used different combination protocols of anterolateral femoral perforator flaps to perform limb salvage treatment for patients on the verge of amputation after severe trauma, and achieved satisfactory clinical results, which are reported below.

percutaneous transluminal angioplasty (PTA) is currently the main method to treat vascular stenosis or occlusive lesions caused by atherosclerosis or other causes. Although PTA has good immediate efficacy in the treatment of femoropopliteal artery disease, the incidence of restenosis is as high as 60% at one year after surgery^{［1, 2］}。 Although the clinical application of drug-coated balloon (DCB) and drug-eluting stents (DES) has significantly improved the patency rate of endovascular therapy of lower extremities, vascular elastic retraction, dissection, severe calcification and long-segment lesions are still the main reasons for endovascular therapy failure, so adequate vascular preparation becomes an important part of endovascular therapy. The Nitinol Constraint Balloon Catheter creates an "occipital" and "decompression groove" in the balloon through a unique constraint structure, which releases pressure through the decompression groove while increasing the balloon contact area, providing controlled, uniform and non-invasive expansion to minimize vascular trauma. The clinical results and experience of endovascular treatment of lower extremity atherosclerosis obliterans with nickel-titanium alloy restraint balloon in our center are reported below.

A 49-year-old male was admitted to the hospital on August 31, 2020 due to "wasting and fatigue for more than 2 months". The patient developed fatigue 2 months ago, gradually lost about 10 kg of weight, and had no abdominal distension, abdominal pain, nausea and vomiting, and no discomfort such as fever and chills. One week ago, I was examined in the local hospital. The ultrasound results of liver, gallbladder and pancreas showed that the liver occupied space. I went to our hospital for further treatment. The patient's past history and family history were not special. Physical examination: The patient was clear and energetic, no obvious yellowing staining of the skin and sclera was found, and the superficial lymph nodes of the whole body were not palpable and swollen. The abdomen is soft, and a huge mass can be palpable under the right costal margin, about 10 cm ×8 cm in size, with tenderness, no obvious tenderness or rebound pain in other parts of the abdomen, no obvious swelling is palpable in the spleen, and mobile voicing is negative. Laboratory test: white blood cell count 6.6×10⁹/L, hemoglobin 116 g/L, platelet count 360×10⁹/L; Liver function: total bilirubin 13.6 μ mol/L, ALT 35 U/L, AST 64 U/L; Hepatitis B surface antigen (+), HBV DNA copy number is lower than the detected value; Coagulation function: prothrombin time 12.3 s, international normalized ratio 1.09; Tumor markers: alpha-fetoprotein 6.8 μ g/L, abnormal prothrombin (protein induced by vitamin K absence or antagonist-II, PIVKA-II)>75 000 AU/L. Imaging: The results of abdominal enhanced CT and enhanced MRI showed that the right hemihepatic massive hepatocarcinoma with hemorrhagic cystic degeneration, peripheral sub-foci, and the tumor squeezed and occluded the right branch of the portal vein and the right hepatic vein (Figure 1A1D). CT findings of the lung showed multiple small nodules in both lungs, and some metastases were suspected (Figures 1E, 1H). Diagnosis: Giant liver cancer with suspicious lung metastasis, staged as stage III of Chinese liver cancer (stage IIIB is highly likely), 2020 Chinese Society of Clinical Oncology stage III (stage IIIB is highly likely); Clinical liver cancer stage C in Barcelona.

The patient, a 48-year-old male, was admitted to the hospital on May 1, 2020 due to "physical examination found that the liver occupied space for more than 2 weeks". During routine physical examination 2 weeks before admission, the patient underwent chest CT examination to find liver space-occupying lesions. Further liver MRI examination showed that the caudate lobe and left lobe of the liver occupied multiple space, the larger one was about 4.0 cm ×3.5 cm. Liver cancer with multiple intrahepatic metastases (≥4 lesions) was considered (Figure 1), and was admitted to our department for further treatment. The patient had a history of chronic hepatitis B for more than 20 years and was not treated. Physical examination: The abdomen was flat and soft, no intestinal shape and peristaltic waves, no mass, no subcostal reach of liver and spleen, no percussion pain in the liver area, negative mobile voicing, and normal intestinal sounds. Laboratory tests: carcinoembryonic antigen 3.56 μ g/L, CA19-9 10.73 U/mL, abnormal prothrombin 69 AU/L, alpha-fetoprotein 6 585 μ g/L; normal liver function; hepatitis B surface antigen (+), hepatitis B surface antibody<2.000 IU/L, hepatitis B E antigen (-), hepatitis B E antibody (+), hepatitis B core antibody (+).