Objective To investigate the clinical efficacy of free wrist crease radial artery perforator flap for repair of finger skin defects. Methods From July 2015 to May 2018, 42 patients with finger skin defects were treated. All the wounds were combined with bone and tendon exposure and repaired with free wrist crease radial artery perforator flap. The area of skin defects ranged from 1.5 cm×1.2 cm to 3.9 cm×2.0 cm. The patients were followed up regularly after operation. The survival of the flaps and the functional recovery of the repair site were observed, and the clinical efficacy was evaluated. Results All the flaps survived without vascular crisis. The follow-up period was 5 to 28 months, with an average of 13.5 months. The flaps had good blood supply, soft texture and good elasticity. Among them, 2 flaps were slightly bulky and the appearance was improved after secondary plasty. The movement and sensory function of the affected fingers recovered well. Conclusion The application of free wrist crease radial artery perforator flap for repair of finger skin defects can achieve good clinical efficacy postoperatively. Key words: Finger injuries; Surgical flap; Radial artery; Microsurgery
{"title":"Application of free wrist crease radial artery perforator flap for repair of finger skin defects","authors":"Chunsheng Wang, Yiming Zhong, Huanwei Sun, Hongquan Zhang","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.008","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of free wrist crease radial artery perforator flap for repair of finger skin defects. \u0000 \u0000 \u0000Methods \u0000From July 2015 to May 2018, 42 patients with finger skin defects were treated. All the wounds were combined with bone and tendon exposure and repaired with free wrist crease radial artery perforator flap. The area of skin defects ranged from 1.5 cm×1.2 cm to 3.9 cm×2.0 cm. The patients were followed up regularly after operation. The survival of the flaps and the functional recovery of the repair site were observed, and the clinical efficacy was evaluated. \u0000 \u0000 \u0000Results \u0000All the flaps survived without vascular crisis. The follow-up period was 5 to 28 months, with an average of 13.5 months. The flaps had good blood supply, soft texture and good elasticity. Among them, 2 flaps were slightly bulky and the appearance was improved after secondary plasty. The movement and sensory function of the affected fingers recovered well. \u0000 \u0000 \u0000Conclusion \u0000The application of free wrist crease radial artery perforator flap for repair of finger skin defects can achieve good clinical efficacy postoperatively. \u0000 \u0000 \u0000Key words: \u0000Finger injuries; Surgical flap; Radial artery; Microsurgery","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"419-421"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42045972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.018
Linfeng Tang, J. Ju, G. Jin, Guangliang Zhang, Yu-xiang Hu, R. Hou
Objective To explore the repair method and clinical efficacy of finger web defect of hand. Methods From January 2014 to December 2017, 7 cases with finger web defects were repaired by the first toe web flaps. Full-thickness abdominal skin grafts were used in all donor sites. Results All the 7 flaps survived and the donor site healed well. The follow-up period ranged from 6 to 12 months with an average of 8 months. The appearance and sensation of the free first toe web flaps recovered well after the operation. There was no obvious contracture in the reconstructed finger webs. The abduction angle was close to the normal finger web. There was no obvious scar hyperplasia in the donor site, and the walking function of the foot was good. Conclusion It is a better method to repair finger web defect with the first toe web skin flap, which can achieve satisfactory appearance and function of the hand. Key words: Surgical flaps; Transplantation; Finger webs; Microsurgery
{"title":"Application of free modified first toe web skin flap for repair of finger web defect","authors":"Linfeng Tang, J. Ju, G. Jin, Guangliang Zhang, Yu-xiang Hu, R. Hou","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.018","url":null,"abstract":"Objective \u0000To explore the repair method and clinical efficacy of finger web defect of hand. \u0000 \u0000 \u0000Methods \u0000From January 2014 to December 2017, 7 cases with finger web defects were repaired by the first toe web flaps. Full-thickness abdominal skin grafts were used in all donor sites. \u0000 \u0000 \u0000Results \u0000All the 7 flaps survived and the donor site healed well. The follow-up period ranged from 6 to 12 months with an average of 8 months. The appearance and sensation of the free first toe web flaps recovered well after the operation. There was no obvious contracture in the reconstructed finger webs. The abduction angle was close to the normal finger web. There was no obvious scar hyperplasia in the donor site, and the walking function of the foot was good. \u0000 \u0000 \u0000Conclusion \u0000It is a better method to repair finger web defect with the first toe web skin flap, which can achieve satisfactory appearance and function of the hand. \u0000 \u0000 \u0000Key words: \u0000Surgical flaps; Transplantation; Finger webs; Microsurgery","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"445-447"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45211560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.020
Ling Li, Li Xueyuan, Chen Huajun, Wu Tianquan
Objective To explore the clinical efficacy of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger. Methods From January 2017 to January 2018, 14 patients with soft tissue defect of finger were treated. The super-thin venous flaps were harvested from the dorsal foot according to the area of finger defects. The wound was repaired by arterialization of veins. The dorsal cutaneous nerve of foot was incised in 4 cases. The donor site was sutured directly. The functional exercises were started after 2 weeks of immobilization. Results All the patients were follow-up for 6 to 12 months, 11 cases survived uneventfully, 2 cases had partial necrosis of skin flaps, and 1 case lost follow-up after 3 months. The partial necrosis of skin flaps healed after dressing change. 10 cases had two-point discrimination of 11 to 13 mm, and 4 cases with nerve in flaps had two-point discrimination of 7 to 9 mm. Conclusion It is simple and satisfactory to repair finger tissue defects with super-thin venous skin flap of dorsal foot. The donor site can be sutured directly and the sensory function can be reconstructed simultaneously with dorsal foot nerve excision. Key words: Finger injuries; Surgical flaps; Arterialized venous; Super-thin skin flap
目的探讨足背游离超薄静脉皮瓣修复手指软组织缺损的临床疗效。方法2017年1月~ 2018年1月对14例手指软组织缺损患者进行治疗。根据手指缺损面积从足背取超薄静脉皮瓣。伤口通过静脉动脉化修复。切除足背皮神经4例。直接缝合供体部位。固定2周后开始功能锻炼。结果所有患者随访6 ~ 12个月，11例顺利存活，2例皮瓣部分坏死，1例3个月后失访。换药后皮瓣部分坏死愈合。2点辨别11 ~ 13 mm 10例，2点辨别7 ~ 9 mm 4例。结论足背超薄静脉皮瓣修复手指组织缺损方法简单，效果满意。在切除足背神经的同时，可直接缝合供区，重建感觉功能。关键词:手指损伤;外科皮瓣;静脉动脉化皮瓣;超薄皮瓣
{"title":"Application of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger","authors":"Ling Li, Li Xueyuan, Chen Huajun, Wu Tianquan","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.020","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.020","url":null,"abstract":"Objective \u0000To explore the clinical efficacy of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger. \u0000 \u0000 \u0000Methods \u0000From January 2017 to January 2018, 14 patients with soft tissue defect of finger were treated. The super-thin venous flaps were harvested from the dorsal foot according to the area of finger defects. The wound was repaired by arterialization of veins. The dorsal cutaneous nerve of foot was incised in 4 cases. The donor site was sutured directly. The functional exercises were started after 2 weeks of immobilization. \u0000 \u0000 \u0000Results \u0000All the patients were follow-up for 6 to 12 months, 11 cases survived uneventfully, 2 cases had partial necrosis of skin flaps, and 1 case lost follow-up after 3 months. The partial necrosis of skin flaps healed after dressing change. 10 cases had two-point discrimination of 11 to 13 mm, and 4 cases with nerve in flaps had two-point discrimination of 7 to 9 mm. \u0000 \u0000 \u0000Conclusion \u0000It is simple and satisfactory to repair finger tissue defects with super-thin venous skin flap of dorsal foot. The donor site can be sutured directly and the sensory function can be reconstructed simultaneously with dorsal foot nerve excision. \u0000 \u0000 \u0000Key words: \u0000Finger injuries; Surgical flaps; Arterialized venous; Super-thin skin flap","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"452-455"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46825980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.016
Xiaozhi Liu, Kunxiu Song, Bing-jun Ma, D. Zhao, Xiuguo Li, Yulei Qu, Yongtao Liu
Objective To investigate the causes of instability of distal radioulnar joint caused by displacement in distal radius fracture, and to analyze the importance of radial displacement in distal radius fracture to wrist stability. Methods There were 60 patients with distal radius fracture, 22 males and 38 females, aged from 26 to 67 years, with an average age of 41 years. There were 29 cases with ulnar styloid process fracture and 31 cases without ulnar styloid process fracture. According to the degree of displacement, they were divided into three groups: 13 cases with displacement less than 2 mm, 20 cases with displacement more than 2 mm and less than 4 mm, and 27 cases with displacement more than 4 mm. All the patients were treated with open reduction and plate internal fixation of distal radius fracture. The stability of distal radioulnar joint was examined after plate fixation. Fifteen patients with unstable distal radioulnar joint examined by intraoperative physical examination (associated with ulnar styloid process fracture) were divided into two groups. In one group, the styloid process of ulna was fixed with steel wire, while in the other group the styloid process of ulna was not fixed. The effect of radial displacement on ulnar styloid process after distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were analyzed. The degree of radial displacement of distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were evaluated according to the postoperative follow-up of palmar inclination angle, ulnar deviation angle and wrist function score. Results The injury of TFCC when radial displacement of distal radius fracture was greater than 4 mm was the main cause of instability of distal radioulnar joint and affecting wrist function. There was statistically significant difference in the incidence of distal radioulnar joint instability whether distal radial fractures accompanied by ulnar styloid process fractures or not. There was significant difference between radial displacement greater than 4 mm and ulnar styloid process fracture. Conclusion The radial displacement of distal radius fracture has great influence on the stability of distal radioulnar joint. There are more patients with ulnar styloid process fracture in the instability of distal radioulnar joint. The ulnar styloid process fracture suggests a higher risk of TFCC injury. The good reduction of ulnar styloid process plays an important role in the stability of distal radioulnar joint. Key words: Radius; Fractures,bone; Distal radioulnar joint; Triangular fibrocartilage complex; Ulnar styloid process
{"title":"The influence of radial displacement in distal radius fracture on the stability of distal radioulnar joint","authors":"Xiaozhi Liu, Kunxiu Song, Bing-jun Ma, D. Zhao, Xiuguo Li, Yulei Qu, Yongtao Liu","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.016","url":null,"abstract":"Objective \u0000To investigate the causes of instability of distal radioulnar joint caused by displacement in distal radius fracture, and to analyze the importance of radial displacement in distal radius fracture to wrist stability. \u0000 \u0000 \u0000Methods \u0000There were 60 patients with distal radius fracture, 22 males and 38 females, aged from 26 to 67 years, with an average age of 41 years. There were 29 cases with ulnar styloid process fracture and 31 cases without ulnar styloid process fracture. According to the degree of displacement, they were divided into three groups: 13 cases with displacement less than 2 mm, 20 cases with displacement more than 2 mm and less than 4 mm, and 27 cases with displacement more than 4 mm. All the patients were treated with open reduction and plate internal fixation of distal radius fracture. The stability of distal radioulnar joint was examined after plate fixation. Fifteen patients with unstable distal radioulnar joint examined by intraoperative physical examination (associated with ulnar styloid process fracture) were divided into two groups. In one group, the styloid process of ulna was fixed with steel wire, while in the other group the styloid process of ulna was not fixed. The effect of radial displacement on ulnar styloid process after distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were analyzed. The degree of radial displacement of distal radius fracture and the effect of ulnar styloid process fracture on the stability of distal radioulnar joint were evaluated according to the postoperative follow-up of palmar inclination angle, ulnar deviation angle and wrist function score. \u0000 \u0000 \u0000Results \u0000The injury of TFCC when radial displacement of distal radius fracture was greater than 4 mm was the main cause of instability of distal radioulnar joint and affecting wrist function. There was statistically significant difference in the incidence of distal radioulnar joint instability whether distal radial fractures accompanied by ulnar styloid process fractures or not. There was significant difference between radial displacement greater than 4 mm and ulnar styloid process fracture. \u0000 \u0000 \u0000Conclusion \u0000The radial displacement of distal radius fracture has great influence on the stability of distal radioulnar joint. There are more patients with ulnar styloid process fracture in the instability of distal radioulnar joint. The ulnar styloid process fracture suggests a higher risk of TFCC injury. The good reduction of ulnar styloid process plays an important role in the stability of distal radioulnar joint. \u0000 \u0000 \u0000Key words: \u0000Radius; Fractures,bone; Distal radioulnar joint; Triangular fibrocartilage complex; Ulnar styloid process","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"437-440"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45945625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.006
Kai Wang, J. Ju, G. Jin, Liping Guo, Quanwei Guo
Objective To report the clinical application and efficacy of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers in children. Methods From May 2012 to July 2018, 16 children with 17 fingers of degloving amputated injuries were replanted. According to Hou Ruixing's classification method of finger degloving injury type Ⅲ, the cases were classified intoⅠ degree of 6 fingers,Ⅱ degree of 11 fingers base on different skin avulsion planes. Three kinds of anastomosis methods of digital artery were in situ anastomosis of bilateral digital artery in 7 cases 8 fingers, cross anastomosis of a digital artery in 7 cases 7 fingers and transposition anastomosis of adjacent digital artery in 2 cases 2 fingers. Results The replantation of 17 fingers in 16 cases was successfully completed. The postoperative blood circulation was good. Among them, 7 cases 8 fingers with bilateral digital artery anastomosis survived, 3 cases 3 fingers with cross anastomosis of a digital artery occurred necrosis, and 2 cases 2 fingers with transposition anastomosis of digital artery survived. Thirteen patients with 14 fingers survived were follow-up for 3 to 36 months, with an average of 18 months. The growth of nails was found in all the fingers anastomosed with bilateral phalangeal arteries, including 2 cases of nail growth deformity, 1 case of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, while the function of pinching and the skin color and temperature were normal. The growth of nails was found in 4 surviving affected fingers with cross anastomosis of a digital artery, including 2 cases of nail growth deformity, 2 cases of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, which did not affect the holding function with slightly poor skin color, low temperature and finger body atrophy. The growth of nails was found in all the fingers with transposition anastomosis of digital artery, including 1 case of nail growth deformity. The finger was shorter and thicker than the healthy side. The flexion and extension of the finger were good. The skin color was normal and the skin temperature was slightly lower. According to the functional evaluation criteria of replantation of severed fingers issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 7 cases, good in 4 cases and poor in 2 cases. Conclusion For Urbaniak Ⅲ type amputated finger, replantation should be performed as long as the finger body is relatively intact, and the blood supply should be reconstructed by in situ anastomosis of bilateral digital arteries as far as possible. This method has high survival rate and good recovery of finger shape and function after replantation. Key words: Replantation; Treatment outcome; Child; Degloving injury
{"title":"Clinical application of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers of Urbaniak III type in children","authors":"Kai Wang, J. Ju, G. Jin, Liping Guo, Quanwei Guo","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.006","url":null,"abstract":"Objective \u0000To report the clinical application and efficacy of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers in children. \u0000 \u0000 \u0000Methods \u0000From May 2012 to July 2018, 16 children with 17 fingers of degloving amputated injuries were replanted. According to Hou Ruixing's classification method of finger degloving injury type Ⅲ, the cases were classified intoⅠ degree of 6 fingers,Ⅱ degree of 11 fingers base on different skin avulsion planes. Three kinds of anastomosis methods of digital artery were in situ anastomosis of bilateral digital artery in 7 cases 8 fingers, cross anastomosis of a digital artery in 7 cases 7 fingers and transposition anastomosis of adjacent digital artery in 2 cases 2 fingers. \u0000 \u0000 \u0000Results \u0000The replantation of 17 fingers in 16 cases was successfully completed. The postoperative blood circulation was good. Among them, 7 cases 8 fingers with bilateral digital artery anastomosis survived, 3 cases 3 fingers with cross anastomosis of a digital artery occurred necrosis, and 2 cases 2 fingers with transposition anastomosis of digital artery survived. Thirteen patients with 14 fingers survived were follow-up for 3 to 36 months, with an average of 18 months. The growth of nails was found in all the fingers anastomosed with bilateral phalangeal arteries, including 2 cases of nail growth deformity, 1 case of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, while the function of pinching and the skin color and temperature were normal. The growth of nails was found in 4 surviving affected fingers with cross anastomosis of a digital artery, including 2 cases of nail growth deformity, 2 cases of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, which did not affect the holding function with slightly poor skin color, low temperature and finger body atrophy. The growth of nails was found in all the fingers with transposition anastomosis of digital artery, including 1 case of nail growth deformity. The finger was shorter and thicker than the healthy side. The flexion and extension of the finger were good. The skin color was normal and the skin temperature was slightly lower. According to the functional evaluation criteria of replantation of severed fingers issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 7 cases, good in 4 cases and poor in 2 cases. \u0000 \u0000 \u0000Conclusion \u0000For Urbaniak Ⅲ type amputated finger, replantation should be performed as long as the finger body is relatively intact, and the blood supply should be reconstructed by in situ anastomosis of bilateral digital arteries as far as possible. This method has high survival rate and good recovery of finger shape and function after replantation. \u0000 \u0000 \u0000Key words: \u0000Replantation; Treatment outcome; Child; Degloving injury","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"415-418"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46441731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.013
Tan Qi, Liu Guangjun, Zhang Yongqiang, W. Qian, Y. Lei, Li Zhen, Li Xiangxia
Objective To introduce a modified method of thumb reconstruction by combined transplantation of free big toe nail bone flap and second toe tibial flap. Methods According to the condition of thumb defect, free big toe nail bone flap and second toe tibial flap with the common vascular pedicle were cut from the first and second toes of the ipsilateral foot. The second toe tibial flaps were transversely transferred to the tibial side of the toe nail bone flap to reconstruct the toe nail flap belly and nail folds, improve the shape of the reconstructed thumb and reduce the damage of the donor site. Results All the 7 cases survived and the donor and recipient wounds achieved primary healing. The postoperative follow-up period ranged from 3 to 15 months. The reconstructed thumb had good appearance and normal function. According to the functional evaluation criteria of the upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 5 cases and good in 2 cases. All the patients could manage their activities of daily living independently. The donor site had little injury, good shape and function. Conclusion The method of reconstructing thumb defect with free big toe nail bone flap combined with second toe tibial flap can effectively improve the appearance of reconstructed thumb, make the reconstructed thumb symmetrical, beautiful and functional, and reduce the damage of donor toes. Key words: Thumb; Surgical flaps; Second toe; Reconstruction
{"title":"Application of free big toe nail bone flap combined with second toe tibial flap for reconstruction of thumb defect","authors":"Tan Qi, Liu Guangjun, Zhang Yongqiang, W. Qian, Y. Lei, Li Zhen, Li Xiangxia","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.013","url":null,"abstract":"Objective \u0000To introduce a modified method of thumb reconstruction by combined transplantation of free big toe nail bone flap and second toe tibial flap. \u0000 \u0000 \u0000Methods \u0000According to the condition of thumb defect, free big toe nail bone flap and second toe tibial flap with the common vascular pedicle were cut from the first and second toes of the ipsilateral foot. The second toe tibial flaps were transversely transferred to the tibial side of the toe nail bone flap to reconstruct the toe nail flap belly and nail folds, improve the shape of the reconstructed thumb and reduce the damage of the donor site. \u0000 \u0000 \u0000Results \u0000All the 7 cases survived and the donor and recipient wounds achieved primary healing. The postoperative follow-up period ranged from 3 to 15 months. The reconstructed thumb had good appearance and normal function. According to the functional evaluation criteria of the upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 5 cases and good in 2 cases. All the patients could manage their activities of daily living independently. The donor site had little injury, good shape and function. \u0000 \u0000 \u0000Conclusion \u0000The method of reconstructing thumb defect with free big toe nail bone flap combined with second toe tibial flap can effectively improve the appearance of reconstructed thumb, make the reconstructed thumb symmetrical, beautiful and functional, and reduce the damage of donor toes. \u0000 \u0000 \u0000Key words: \u0000Thumb; Surgical flaps; Second toe; Reconstruction","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"429-431"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42854689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To explore the clinical treatment effect of radial artery perforator flap for repairing hand skin defects. Method: From May 2014 to December 2018, we used radial artery perforator flaps to repair 13 patients with hand skin defects. Among them, 3 cases were treated with radial artery perforator vascular pedicle flaps that preserved the superficial branch of the radial nerve, 5 cases were treated with free radial artery snuff pit terminal perforator flaps, and 5 cases were treated with free radial artery forearm mid distal perforator flaps. The results showed that all 13 flaps survived after surgery, including 1 case with distal venous reflux obstruction of the radial artery perforator vascular pedicle flap that retained the superficial branch of the radial nerve. The flap survived after epidermal detachment; One case of distal partial necrosis of the radial artery free flap was considered due to wound infection, and the flap survived after dressing change. Among them, 12 flaps were followed up for a period of 3-12 months, with an average of 8 months. The appearance of the flaps was not bulky, and the texture was flat and soft. According to the trial criteria for evaluating upper limb function of the Chinese Medical Association's Hand Surgery Society, 12 cases were excellent, and 1 case was good. Conclusion: The radial artery perforator vascular pedicle skin flap preserving the superficial branch of the radial nerve has rich blood supply, simple operation, flexible rotation points, and a non bulky appearance; The free radial artery snuff pit terminal perforator flap and the free radial artery forearm middle and distal perforator flap are easy to cut, do not sacrifice the main blood vessels, have minimal damage to the donor area, have a constant anatomy, and have a good recovery of the appearance, sensation, and motor function of the hands and fingers after surgery. Direct suture of the donor area is one of the feasible methods for repairing skin and soft tissue defects in the hands.
{"title":"Clinical application of radial artery perforator flap for repair of hand skin defects","authors":"S. Zhong, Pei Li, Li Ling, Qinghong Wang, Chun-bin Yu, Deqing Zeng","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.009","url":null,"abstract":"目的 \u0000探讨桡动脉穿支皮瓣修复手部皮肤缺损的临床治疗效果。 \u0000 \u0000 \u0000方法 \u0000自2014年5月至2018年12月，我们对13例手部皮肤缺损患者采用桡动脉穿支皮瓣修复，其中应用保留桡神经浅支的桡动脉穿支血管蒂皮瓣3例，游离桡动脉鼻烟窝终末穿支皮瓣5例，游离桡动脉前臂中远端穿支皮瓣5例。 \u0000 \u0000 \u0000结果 \u0000术后13例皮瓣全部存活，其中1例保留桡神经浅支的桡动脉穿支血管蒂皮瓣远端静脉回流障碍，表皮脱落后存活；1例桡动脉中远端游离皮瓣出现远端部分坏死，考虑伤口感染引起，经换药后皮瓣存活。其中12例皮瓣获得随访，时间为3~12个月，平均8个月，皮瓣外形不臃肿，质地平软，按中华医学会手外科学会上肢部分功能评定试用标准评定：优12例，良1例。 \u0000 \u0000 \u0000结论 \u0000保留桡神经浅支的桡动脉穿支血管蒂皮瓣血运丰富，操作简单，旋转点灵活，外形不臃肿；游离桡动脉鼻烟窝终末穿支皮瓣、游离桡动脉前臂中远端穿支皮瓣切取方便，不牺牲主要血管，供区损伤小，解剖恒定，术后手及手指的外形、感觉、运动功能恢复良好，供区直接缝合，是修复手部皮肤软组织缺损的可行方法之一。","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"422-424"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45178986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.014
Xingguo Xu, Qingzhong Chen, Huimin Fu, S. Xing, Bei Meng, Jianping Yang
Objective To observe the nerve block effect and intraoperative bleeding of different local anesthetics used in patients with carpal tunnel syndrome (CTS). Methods Sixty patients with CTS were randomly divided into 4 groups with 15 patients in each, namely lidocaine+adrenaline group (group A), lidocaine+dexmedetomidine group (group B), ropivacaine+adrenaline group (group C), ropivacaine+dexmedetomidine group (group D). The onset time, maintenance time, analgesic and sedative effects, night sleep, adverse reactions and intraoperative bleeding were observed. Results The duration of block in group B and D was significantly longer than that in group A and C (P 0.05). The night sleep of group C was acceptable. The VAS score and Ramsay score of group D had no significant change within 48 hours after operation (P>0.05) and the night sleep was good. Conclusion Low dose dexmedetomidine-assisted nerve block can prolong the action time of local anesthetics and provide a good night sleep, but it has no obvious hemostatic efficacy. The combination of ropivacaine and epinephrine can achieve blockade duration, sigificantly decrease the intraoperative blood loss, which will improve patients' comfort and satisfaction. Key words: Carpal tunnel syndrome; Anesthetics; Nerve block effect
{"title":"Clinical study on the effect of different local anesthetics on nerve block in patients with carpal tunnel syndrome","authors":"Xingguo Xu, Qingzhong Chen, Huimin Fu, S. Xing, Bei Meng, Jianping Yang","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.014","url":null,"abstract":"Objective To observe the nerve block effect and intraoperative bleeding of different local anesthetics used in patients with carpal tunnel syndrome (CTS). Methods Sixty patients with CTS were randomly divided into 4 groups with 15 patients in each, namely lidocaine+adrenaline group (group A), lidocaine+dexmedetomidine group (group B), ropivacaine+adrenaline group (group C), ropivacaine+dexmedetomidine group (group D). The onset time, maintenance time, analgesic and sedative effects, night sleep, adverse reactions and intraoperative bleeding were observed. Results The duration of block in group B and D was significantly longer than that in group A and C (P 0.05). The night sleep of group C was acceptable. The VAS score and Ramsay score of group D had no significant change within 48 hours after operation (P>0.05) and the night sleep was good. Conclusion Low dose dexmedetomidine-assisted nerve block can prolong the action time of local anesthetics and provide a good night sleep, but it has no obvious hemostatic efficacy. The combination of ropivacaine and epinephrine can achieve blockade duration, sigificantly decrease the intraoperative blood loss, which will improve patients' comfort and satisfaction. Key words: Carpal tunnel syndrome; Anesthetics; Nerve block effect","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"432-435"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45185582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.017
Jian-feng Li, G. Tian, Da-cun Li
Objective To compare the effect of arthrodesis and arthroplasty in patients with thumb carpometacarpal osteoarthritis, and to compare the advantages and disadvantages of the two methods. Methods From February 2012 to September 2017, 39 patients with phases Ⅱ and Ⅲ thumb carpometacarpal osteoarthritis underwent surgical treatment. 22 cases were performed with trapeziometacarpal arthrodesis and 17 cases were performed with trapezial excision arthroplasty with ligament reconstruction and tendon interposition (LRTI). Postoperatively, objective and subjective evaluation were performed on the two groups, respectively. The objective evaluation included grip strength, pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score. The subjective evaluation included visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score. The data of the two methods were compared and their differences were observed. Results In the comparison between arthrodesis and arthroplasty group, the differences of pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score were obvious, but there was no significant difference in grip strength, VAS and DASH score. Conclusion For patients with progressive thumb carpometacarpal osteoarthritis, carpometacarpal arthroplasty or arthroplasty can significantly relieve joint pain and improve grip strength. Arthrodesis can improve thumb pinch strength better, while arthroplasty can improve thumb mobility better. The patients are consciously satisfied with the effects of the two surgical methods. Key words: Thumb; Carpometacarpal joints; Arthrodesis; Arthroplasty
{"title":"Comparison of arthrodesis and arthroplasty in patients with thumb carpometacarpal osteoarthritis","authors":"Jian-feng Li, G. Tian, Da-cun Li","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.017","url":null,"abstract":"Objective \u0000To compare the effect of arthrodesis and arthroplasty in patients with thumb carpometacarpal osteoarthritis, and to compare the advantages and disadvantages of the two methods. \u0000 \u0000 \u0000Methods \u0000From February 2012 to September 2017, 39 patients with phases Ⅱ and Ⅲ thumb carpometacarpal osteoarthritis underwent surgical treatment. 22 cases were performed with trapeziometacarpal arthrodesis and 17 cases were performed with trapezial excision arthroplasty with ligament reconstruction and tendon interposition (LRTI). Postoperatively, objective and subjective evaluation were performed on the two groups, respectively. The objective evaluation included grip strength, pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score. The subjective evaluation included visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score. The data of the two methods were compared and their differences were observed. \u0000 \u0000 \u0000Results \u0000In the comparison between arthrodesis and arthroplasty group, the differences of pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score were obvious, but there was no significant difference in grip strength, VAS and DASH score. \u0000 \u0000 \u0000Conclusion \u0000For patients with progressive thumb carpometacarpal osteoarthritis, carpometacarpal arthroplasty or arthroplasty can significantly relieve joint pain and improve grip strength. Arthrodesis can improve thumb pinch strength better, while arthroplasty can improve thumb mobility better. The patients are consciously satisfied with the effects of the two surgical methods. \u0000 \u0000 \u0000Key words: \u0000Thumb; Carpometacarpal joints; Arthrodesis; Arthroplasty","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"441-444"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46133627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1005-054X.2019.06.004
Fenghuo Zhang, Wen-ya Zhang, Yuxiang Hu, Xuan Jiang, Hanle Zhao, Xiaomin Hu
Objective To explore the surgical method and clinical efficacy of emergency finger reconstruction with forearm replantation using abandoned fingers. Methods From February 2003 to February 2019, 15 patients with only 2 or 3 finger intact were treated by forearm replantation using abandoned fingers for finger reconstruction. Among them, 3 fingers were reconstructed in 2 cases and 2 fingers were reconstructed in 13 cases. Results All reconstructed fingers survived and the wounds achieved primary healing. The follow-up time was 3 to 12 months with an average of 6 months. The reconstructed finger was similar to the original finger in shape, with good function, grasping and other basic functions. The pulp sensation recovered well. The two-point discrimination was 5 to 10 mm. The patients were satisfied. According to the evaluation criteria of thumb and finger reconstruction function issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 3 cases, good in 9 cases and fair in 3 cases. Conclusion Emergency replantation of forearm with abandoned fingers to reconstruct finger is an ideal method for emergency treatment of wrist injury, reconstruction and recovery of some hand functions. Key words: Finger injuries; Replantation; Microsurgery; Hand reconstruction
{"title":"Replantation of forearm with abandoned fingers for emergency finger reconstruction","authors":"Fenghuo Zhang, Wen-ya Zhang, Yuxiang Hu, Xuan Jiang, Hanle Zhao, Xiaomin Hu","doi":"10.3760/CMA.J.ISSN.1005-054X.2019.06.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1005-054X.2019.06.004","url":null,"abstract":"Objective \u0000To explore the surgical method and clinical efficacy of emergency finger reconstruction with forearm replantation using abandoned fingers. \u0000 \u0000 \u0000Methods \u0000From February 2003 to February 2019, 15 patients with only 2 or 3 finger intact were treated by forearm replantation using abandoned fingers for finger reconstruction. Among them, 3 fingers were reconstructed in 2 cases and 2 fingers were reconstructed in 13 cases. \u0000 \u0000 \u0000Results \u0000All reconstructed fingers survived and the wounds achieved primary healing. The follow-up time was 3 to 12 months with an average of 6 months. The reconstructed finger was similar to the original finger in shape, with good function, grasping and other basic functions. The pulp sensation recovered well. The two-point discrimination was 5 to 10 mm. The patients were satisfied. According to the evaluation criteria of thumb and finger reconstruction function issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 3 cases, good in 9 cases and fair in 3 cases. \u0000 \u0000 \u0000Conclusion \u0000Emergency replantation of forearm with abandoned fingers to reconstruct finger is an ideal method for emergency treatment of wrist injury, reconstruction and recovery of some hand functions. \u0000 \u0000 \u0000Key words: \u0000Finger injuries; Replantation; Microsurgery; Hand reconstruction","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"35 1","pages":"409-411"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42308763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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