ABSTRACT
Objective To introduce the technique and treatment outcome of the fingertip soft tissue defect with improved transverse palmar island flap.Methods From January 2011 to February 2013,15 cases(17 fingers) fingertip defect were repaired by improved transverse palmar island flap,the vascular pedicled of flap was a side of the neurovascular bundle,the flap revolved 90° to coversoft tissue defect.Defect area:1.2 cm × 0.8 cm to 1.7 cm × 1.6 cm.The time between the injury and admission was 40 minutes to 27 hours.Five cases were repaired defection with flap immediately,10 cases were repaired defection in stage Ⅱ.Results The wounds of injury in 15 cases get primary healing,and all the flaps were successfully survived.The 13 cases were followed up for 6 months to 14 months.The blood circulation of flap was fine,and the fingertip shape as well.The two point discrimination of the skin pulp was 6 mm to 11 mm.Conclusion The improved transverse palmar island flap for repairing transverse finger pulp defect and a small area of skin defect in patients.The procedure has a simple surgery,donor area don't skin graft,postoperative appearance and hand finger satisfactory functional recovery,etc.
ABSTRACT
Objective To introduce the therapeutic measure of preventing the first web contracture after hand crush injury in early stage. Methods Three types were divided according to the traumatic condition in 57 cases: closed injury, open injury and with blood vessel of thumb or fingers injury, and used different method such as closing injury postpone, opening the first web by kischner wire or mini-external fixation splint and covered by local or island flap to cure each type in primary and early stage, after 6 months, measured the width and angle of the first web. Results Forty-one cases were followed-up after 3 months - 2 years,abduction and opposition of the thumbs were fine, the average of width and angle of the first web were (5.89 ± 0.58)cm and (87.85 ± 6.03)°. Conclusion The key points of preventing the first web contracture after crush injury are opening the first web that being covered by local flap and to use splint in primary stage.
ABSTRACT
@#Objective To evaluate the treatment effect of hand reconstruction with bilateral multiple toe transplantation. Methods There are four schedules as follow applied in 102 cases: (1) bilateral second toes to thumb and index finger transplantation in 86 cases; (2) wrap-around flap to thumb and second toe on opposite side to index or middle finger transplantation in 11 cases; (3) wrap-around flap to thumb and bilateral second toes to index and middle fingers transplantation in 8 cases; (4) bilateral wrap-around flap to bilateral thumb and second toe to index finger transplantation in 1 case. Results All reconstructed finger survived in 102 cases except for partial wrap-around flap necrosis in one case and second toe in two cases. Sixty-two patients got more than one-year following up. Two points discrimination in reconstructed finger was between 8 to 14 mm in all cases. The reconstructed finger grew synchronously with toe among children. Thumb opposition function recovered in all cases except for one case. Donor site: no limp or hallux eversion observed in all cases. Conclusion There is less damage on foot and most hand function recovery using bilateral multiple toe transplantation to repair hand or multiple fingers defect.
ABSTRACT
[Objective]To inrestigate the clinical outcomes of using bilateral tibial flap of the second toe nail flap combined with the fibulal flap of the big toe to repair the multi-finger degloving injury.[Method]A variety of different methods were used to repair the multi-finger degloving injury,six fingers in 3 cases were repaired by partial bilateral wrap-around flaps combined with the tibial flap of the second toe.Sixteen fingers in 8 cases were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe.Six fingers in 2 cases were repaired by bilateral second toenail flap,the fibulal flap of the big toe and the digital arterial island flap.Three fingers in l case were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe and the the lateral flap of dorsum of foot.Six fingers in 3 cases were repaired by bilateral second toe nail flap and the fibulal flap of the big toe and bilateral dorsum flap of foot.Four fingers in 1 case were repaired by partial bilateral wrap-around flaps and the tibial flap of the second toe and the anterolateral thigh flap.Six fingers in 3 cases were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe,and bilateral dorsum flap of foot and bilateral anterolateral thigh flap.[Result]Ninety-seven flaps of 98 flaps of 47 fingers in 21 cases were suvived well,with 1 flap developed necrosis.The follow-up duration ranged from 6 months to 9 years in 17 cases (37 fingers).In addition to the activities of DIP limited,the other interphalangeal joint activities were nearly normal.All of the fingernail grew well.Two point discrimination of the fingers was between 5mm and 11 mm.The donor site was hardly affected.[Conclusion]It is a better method using the big toe flap combined with the second toe flap to repair the the multi-finger degloving injury at one stage.
ABSTRACT
Objective To report microsurgical treatment of severed palm caused by crush injury. Methods From 1998 to 2002, 14 patients with severed palm and destructive crush injury were treated in our hospital. According to the specific severity and level of different injuries, replantation of severed palm with vessel transfer, replantation of fingers to the distal forearm with resection of wrist and palm, replantation of severed palm combined the thumb reconstruction were applied to reserve a maximal part of hand or fingers. Results Of the 14 cases of replantation, 3 experienced death of middle or index finger and the others all survived. The follow up of 11 cases lasted more than 6 months. After functional exercises, 10 cases recovered the function of pinch, and 1 case nearly regained normal functions. All of them regained sensation and the two point discrimination was 8 to 10 mm. Conclusion Reasonable replantation for severed palm with crush injury is still a method to regain part of hand functions.
ABSTRACT
Objective To summerize clinical application of the trifoliated flap from the dorsal foot. Methods The flaps,which were made of the first dorsal metatarsal flap, medial foot flap and lateral foot flap,were designed on the basis of the anatomy of flap whose common pedicle was anterior tibial artery or dorsal foot artery and whose other branches was medial tarsal artery or medial anterior, melleolar artery and lateral tarsal artery respectively,the single flaps were harvested to repair multi-finger skin defect.The flaps from both feet were repaired digit degloving injuries. Results Thirty-one patients were treated by trifoliated flap from the dorsal foot.29 of 31 flaps survived completely.Two flaps in patient necrosised.One flap in two patients necrosised. Conclusion The trifoliated flap from the dorsal foot is a good procedure for coverage problems in multiple-finger avulsion and digit degloving in juries.
ABSTRACT
Object To investigate the therapeutic effects and mechanism of traditional Chinese compound decoction of Radix Curcumae (RC), Rhizoma Sparganii (RS), and Rhizoma Zedoariae (RZ) (DRRR) on liver fibrosis in rats induced by carbon tetrachloride (CCl 4). Methods Fifty Wistar rats were randomly divided into four groups: group A was healthy control (n=8), group B was model rats of liver fibrosis induced by CCl 4 (n=14), group C and D were treated with DRRR after the liver fibrosis in rats induced by CCl 4 four weeks later (n=14). B, C, and D groups were injected subcutaneously with CCl 4; C and D groups were administrated with DRRR 0.6 and 1.2 g/100 g, once per day. After administration of DRRR four weeks all rats were sacrificed, their blood and liver were harvested for further examination. The effect of DRRR was explored by the expressions and sites of transforming growth factor-beta 1 (TGF-? 1), Smad3 and Smad7 in liver tissues by immunohistochemical staining. The liver function, serum hyaluronic acid (HA), and liver histopathology were also examined by biochemsitry, RIA, HE, and Van Gieson stainings respectively. Results To compare with model group, in rats that received DRRR, the expressions of TGF-? 1 and Smad3 were significantly decreased, while the expression of Smad7 was obviously increased in the livers (P
ABSTRACT
Objective To investigate the effect and its mechanism of “JinSanE” on liver fibrosis induced by carbon tetrachloride (CCl4) in rats. Methods Thirty-six Wistar rats were divided into three groups: healthy controls, CCl4 induced cirrhotic rats, and CCl4 induced cirrhotic rats treated with “JinSanE”, which was begun at the fourth week after exposure to CCl4. “JinSanE” was given once a day. Rats were killed after the administration of “JinSanE” for 4 weeks. The anti-fibrosis effect was determined by the expressions of connective tissue growth factor (CTGF) and transforming growth factor-? 1 (TGF-? 1) in liver tissue. The CTGF and TGF-? 1 mRNA expressions were detected by RT-PCR, CTGF and TGF-? 1 were assessed after immunohistochemistry staining. The serum level of hyaluronic acid (HA) was determined by RIA, and the liver histopathology was observed with light and electronic microscopy. Results Compared with the CCl4 induced cirrhotic rats, the expressions of TGF-? 1 and CTGF were decreased in the liver of the rats which were given “JinSanE” (P