Improve reconstructed metacarpophalangeal joint function with second toe transplantation after curved osteotomy under the metatarsal head cartilage / 中华显微外科杂志

ObjectiveTo investigate the technique and clinical results of curved osteotomy under the metatarsal head's cartilage for improving reconstructed metacarpophalangeal joint function of fingers with second toe transplantation. MethodsThere were total 21 cases with 21 digits. During second toe transplantation with the metatarsophalangeal joint, the bottom of the second metatarsal head was incised. Then a curved osteotomy were carried out on about 5.0 mm under the metatarsal head's cartilage until the passive range of motion could be 90°.Longitudinal or cross-Kirschner wires were used to fix the joint.Finally,the conventional methods were used to reconstruct the blood supply, movement and nerves. ResultsAll 21 digits of the 21 cases survived uneventfully.The follow-up time was ranged from 6 to 24 months.Their average passive range of motion of the reconstructed metacarpophalangeal joint was 75°,ranging from 65° to 85°.The average active range of motion was 65°, ranging from 45° to 80°. Postoperative X-ray revealed fracture healed well without joint degeneration. ConclusionCurved osteotomy under the metatarsal head's cartilage is an effective way to improve active and passive activities function of the reconstructed metacarpophalangeal joint with second toe transplantation.

Application of nail skin flap of big toe connected with tibial flap of second toe in reconstruction of thumb and first web / 中华显微外科杂志

Objective To introduce 13 clinical cases of reconstructing traumatic defect on skin of thumb and first web using nail skin flap of big toe connectedwith tibial flap of second toe.Methods From May 2003 to April 2007,a series of 13 case8 of traumatic thumb and first web defect were treated by transplantation of nail skin flap of big toe connecting with tibial skin flap of second toe.Among which two total hand degloving injury cages were included too.Two kind of way according the Gilbert type of the Ist metatarsus dorsal artery were used.Results All the cases were successful and healed by first intention.The contour of reconstructed thumbs showed to be normal or approximately normal.Follow-up examination were obtained in nine cases for 3-17 postoperative months(average 7 months).Sensations of pain,touch and temperature recovered.The two-point-discrimination sensation were found to be 7-17 mm respectively.Opposition measured were 60°-85°(average 75°).All the patients can be back to work and restored activities of daily living.Conclusion In treating soft tissue defect of thumb and first web,transplantation of the nail skin flap of big toe connecting with tibial lateral skin flap Can yield ideal skin covering and exceHent motor function.

Long- term results of vascularized fibular graft / 中华骨科杂志

Objective To analyze the long- term results of vascularized fibular graft to repair defects of long bone. Methods Nineteen patients undergone vascularized fibular graft were followed- up for 5－ 20 years(mean 10.79 years). Limb function was graded with Enneking s system, and presented as percentage of normal limb function. The changes of the vascularized fibular graft were evaluated radiographically according to the International Symposium on Limb Salvage. Results The long term results of the vascularized fibular graft varied in different types of bone defects. Nine patients with congenital pseudoarthrosis of tibia had the limb function restored in 65％ and one had nonunion of fibular graft, 3 fractures(7 times), and 5 angular deformities. Three patients with congenital radial deficiency had 62％ restoration of the limb function. All of them showed early closure of epiphyses of the grafted fibulae. Five cases with osteomyelitis and bone defects combined soft tissue deficiency had 94％ restoration of the limb function, and only one occurred fracture of fibular graft. One case with soft tissue defect and concomitant ulnar defect, ulnar nerve and median nerve injury, 67％ function of limb was recovered, and union of fibula graft was good. 100％ function of limb was recovered in 1 case with cavernoma of radius and without occurring valgus deformity of donor site. Conclusion The vascularized fibular graft is a good method for repairing long segmental defects of bone. Combined with other tissue flap, the operation can reconstruct bone defect and fulfil the cover of soft tissue. For congenital tibia pseudoarthrosis and radial deficiency, the long- term results are not so satisfactory.

ESOPHAGEAL RECONSTRUCTION BY VASCULARIZED FREE OR PEDICLED JEJU- NAL GRAFT: A REPORT OF 29 CASES / 解放军医学杂志

A series of 29 cases of esophageal stenosis or obstruction caused by chemical burn or malignancy in the cervical or upper thoracic segment were treated by resection, and its continuity was re-established by a vascularized free or pedicled jejunal graft. It was successful in 28 cases, with only one failure. The age of these cases ranged from 4 to 65 years old. Among them, 4 children were between 4 and 6. Sixteen cases of pedicled jejunal grafts had their vessels anastomosed to cervical vessels at the upper end. The lengths of the grafts varied from 40 to 60 cm. In the 13 free jejunal grafts, jejunal blood vessels were anastomosed to the right gastroepiploic vessels and cervical vessels at the lower and upper ends, respectively, to re-establish circulation for long jejunal segments, while for the short jejunal grafts anastomosis was made to the cervical vessels only. The vascularized jejunal patch graft is an effective measure for repairing anastomotic fistula or localized wall defect. A regime of monitoring blood circulation of the jejunal transplant is described.

EMERGENCY RECONSTRUCTION OF THUMB OR FINGER / 解放军医学杂志

Since 1970, 13 cases of reconstruction thumb and finger utilizing the second toe were performed. 13 out of 14 reconstructed digits survied with no complication. All wounds healed by primary intention. Emergency reconstruction has the following merits: it is completed in one stage, hence less suffering and economic loss to the patients;it promises early rehabilitation, early return to work and better functional results, as compared with delayed operation. Traumatic amputation of the thumb at or near the metacarpo-phalangeal joint with the transected part so badly injured that replantation is no longer fet-sible, and severe crushing injury of the thumb or all fingers are indicated for emergency reconstruction. Patient's age, occupation, desire for operation and general health should be considered individually before operation. The method of dissecting the second toe with the preservation of vasculization pattern of dorsalis pedis artery-first plantar metatarsal artery should be adopted in case the anatomic pattern of dorsal metatarsal artery belongs to Gilbert type Ⅲ.