ABSTRACT
Objective To explore the efficacy of simultaneous reconstruction of composite tissue defects in two adjacent metacarpophalangeal joints of hand by split the 2nd toes.Methods From December 2006 to December 2011,the second toe composite flap pedicled with the dorsalis pedis artery-first,second metatarsal dorsal artery-dorsal artery were designed,and split it into the second metatarsophalangeal joint composite flap pedicled with the dorsalis pedis artery-first dorsal metatarsal artery-tibial artery and the proximal interphalangeal joint composite flap pedicled with dorsalis pedis artery-second dorsal metatarsal arteryfibular dorsal artery.Then they were used to repair composite tissue defects in two adjacent metacarpophalangeal joints of hand at the same time after reconstruction.Results This group includes 14 metacarpophalangeal joints of 7 cases,twelve joints was successful,two joints of 1 case to give up because the first dorsal metatarsal artery variation.At 6-24 months follow-up study in 12 out of 14 cases showed that there was no joint degeneration in X-ray manifestation and the recovering of joint function was satisfying.According to the function evaluation standard of reconstraction of thrumb and finger issued by Hand Surgery Society Chinese Medical Association,the excellent and good rate was 83.3％.Conclusion It is feasible to reconstruct of composite tissue defects in two adjacent metacarpophalangeal joints of hand at the same time by split the 2nd toes,and can effectively improve the functions of injury metacarpophalangeal joint.
ABSTRACT
Objective To observe the cardiac function in acute brain injury patients(ABI)and the relationship between ABI and plasma neuropeptideY(NPY),and to inspect the mechanism and find the evidences for preventing cardiac impairment caused by ABI. Methods 89 patients with acute brain injury within 24 hours after the injury were divided into severe group(n =47)and mild group(n = 42)according to Glasgow Coma Scale(GCS),and 35 normal healthy adults were selected as control group.In 24 hours and 72 hours after the brain injury,all patients were examined with echocardiography to observe cardiac structure,Doppler blood flow velocity and cardiac function,and in the same time the plasma NPY were determined by radioimmunoassay.Then the results were compared with controls. Results The parameters of cardiac function such as EF、 SV.AV、CO、CI had statistical change in 24 hours and 72hours after the brain injury between severe ABI group and mild ABI group,and it also had statistical change between severe ABI group and control group(all P <0.05),but no statistical change between mild ABI group and control group(all P ＜0.05).The level of plasma NPY in ABI patients was significantly higher than that before injury,there was statistically different change between severe ABI group and mild ABI group,and it also had statistical change between severe ABI group and control group(all P＜0.05).The parameters of cardiac function was negatively correlated with the rise of plasma NPY by pearson correlation analysis(EF:r =- 0.79,P <0.01; SV:r =- 0.71,P <0.01;AV:r=-0.67,P ＜0.01 ;E/A:r =-0.63,all P ＜0.01)and(CO:r =- 0.32,P ＜0.05;CI:r =-0.35,all P ＜0.05). Conclusion The parameters of cardiac function were significantly decreased in the patients with acute brain injury,and it was closely related with the level of plasma NPY.