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Objective@#To explore the effect of reconstructing the finger extension function by using partial flexor digitorum profundus tendon transposition.@*Methods@#Twelve patients were treated by using the partial proximal end of the tendon core of flexor digitorum profundus tendon regionⅠand part of region Ⅱ to cut off to the base of the distal digital phalanx, and puncturing at the end of the phalanx with a 2.0 drill. The tendon strips were pierced to the back overlap sutured to the proximal end of the avulsion of the extensor tendon .@*Results@#In 3-18 month follow-up, the average follow-up duration was 10.6 months. According to Dargan function evaluation method, 12 cases were excellent and one case was poor.@*Conclusions@#The method of reconstructing the extensor tendon by partial flexor deep tendon is a reliable method for the treatment of Mallet finger.
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Objective@#To observe and study clinical efficacy of restruction of finger pulp using tibial flap.@*Methods@#From January 2009 to October 2013, we reconstructed the 20 finger pulps with free tibial flap of the second toe.@*Results@#20 flaps survived completely and were followed up for 6 months to 2 years, with an average of 1 year. There were no obvious scars in the reconstructive finger pulps. And the reconstructed finger pulps all had good appearance, texture, a fingerprint point discrimination at 6-8 mm, and finger function recovered well.@*Conclusions@#The shape of finger pulp after reconstuction with the free tibial flap of the second toe has the similar appearance to the normal finger pulp and a good sensory function, which is one of the best ways to reconstruct the finger pulp defects.
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Objective@#To investigate the feasibility and indication of free grafting of split big toe nail bed for defects of fingernail bed.@*Methods@#From September 2008 to September 2011, 13 cases (4 females and 9 males) with fingernail bed defects(aged 17-38, average, 32) were treated with split big toe nail bed. The split big toe nail was harvested according to the defects size without bone exposure at donor site.@*Results@#Three grafted nail beds were necrotic completely and reconstructed with flaps. The 2 grafted nail bed was partial loss and healed after dressing. All the other grafted nail bed survived completely with primarily healing both in donor sites and recipient sites. The patients were followed up for 6-30 months(average, 14 months). The therapeutic effect was graded as excellent in 8 cases, good in 2 cases and poor in 14 cases(good rate, 76.9%). The nail matrix was excellent in 8 cases, good in 1 case and poor in 1 case(good rate, 90%). The toe nails in donor sites grew well.@*Conclusions@#The single fingernail defect with intact nail matrix can be reconstructed by split toe nail bed graft with good cosmetic and functional effect. There is no malfunction at donor site. The indication should be selected.
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Objective To explore the treatment method with combined dorsal flap based on the second toe and tibial flap for repairing the finger distal degloving injury.Methods From March 2008 to September 2011,our department chose treatment with combined use of free dorsal flap based on the second toe and contralateral second toe tibial flap for repairing finger distal degloving injury.The 11 fingers in 11 cases were treated and followed up after surgery.Results The flaps in 11 cases all survived; The donor site with skin grafting successfully healed; The follow-up was 4-15 months,averaged of 6 months.There was not obvious atrophy for the toe dorsal flaps in the finger back side and toe tibial flaps in the palm side.The finger pulp was full,the nails grew well and the appearance of the fingers was good.There was satisfactory sensory function restoration for finger pulp,two cases for S4,five cases for S3,three cases for S2 and 1 case for S1.The protective sensation was restored in the finger back for all the cases; the finger function was restored to normal; the foot donor site was healing well without scarring.Walking was completely normal.Conclusion It is an ideal treatment with combined use of free dorsal flap based on the second toe and contralateral second toe tibial flap for repairing finger distal.
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Objective To investigate MR findings and dynamic changes of the brain after gas explosion,and to evaluate the relationship between MR findings and post-traumatic stress disorder (PTSD).Methods Forty-nine survivors of a gas explosion (group A) were examined with brain MRI within 1 to 3 days,and serial MR follow-up examinations were also performed.Forty miners not under the ground that day were assigned as group B,and 40 staff working on the ground as group C.The signal intensity values of hippocampus and globus pallidus on T2WI were measured in the three groups and F test was performed by using SPSS 13.0.The relationship between signal intensity values of hippocampus/globns pallidus and PTSD was explored,and the relationship between ADC values of hippocampus and PTSD was also investigated.Results In group A,slight low signal on T1WI and high signal on T2WI were detected on initial MRI in hippocampus (33 cases),globus pallidus (12 cases),cortex (10 cases),and midbrain (2 cases),respectively.On follow-up MRI at 2 months,lesions in hippocampus disappeared (25 cases) or remained slight high signal on T2WI (8 cases),lesions in globus pallidus disappeared (3 cases,5 sides) or showed shrinkage and encephalomalacia (9 cases),cortical lesions resulted in encephalomalacia in 2 cases and returned normal in the others,and lesions in the midbrain showed encephalomatacia.For comparison of T2 signal intensity values in hippocampus and globus pallidus,there was significant difference between group A and group B(P <0.01),and also between group A and group C(P <0.01),but no difference was detected between group B and group C (P>0.05).In group A,the T2 signal intensities of PTSD and non-PTSD were 455±37 and 462±53 in the left hippocarnpus,and 458±36 and 460±43 in the right hippoeampus on 1 to 3 days,and the T2 signal intensities of PTSD and non-PTSD were 438±29 and 424±37 in the left hippocampns,and 442±31 and 430±32 in the right hippocampus at 2 months.The T2 signal intensities of PTSD and non-PTSD were 361 ±35 and 366±63 in the left globus pallidus,and 363 ±41 and 375±62 in the right globus pallidus on 1 to 3 days,and the T2 signal intensities of PTSD and non-PTSD were 341±24 and 337±39 in the left globns pallidus,340±26 and 332±35 in the tight glohus pallidns at 2 months.There was no difference of T2 signal intensity values in hippocampus and globus pallidus between PTSD and non-PTSD( t=0.350,0.826,0.503,0.907,P>0.05).In group A,ADC values of PTSD and nun-PTSD were (8.1±1.1)×10-4 and(8.1 ±0.9)×10-4mm2/s in the left hippocampus,and (8.2±1.0)×10-4 and(8.2±0.8)×10-4mm2/s in the tight hippocampus on 1 to 3 days,ADC values were (8.8±0.7)×10-4 and (9.0±1.0)×10-4mm2/s in the left hippocampus,and (8.5±0.9)×10-4 and (9.3±1.1)×10-4mm2/s in the tight hippocampus at 2 months.ADC values in hippocampns showed no difference between PTSD and non-PTSD(t=0.016,0.081,P>0.05)on initial MRI,but showed significant difference between PTSD and non-PTSD in tight hippocampus (t=7.407,P < 0.05) on follow-up MRI at 2 months,while no difference in left hippocampus (t =0.333,P>0.05) was observed at 2 months.Conclusion Hippocampns and globus pallidus are the most vulnerable structures in gas explosion.The occurrence of PTSD may be related to the injury of fight hippocampus,but not related to the injury of globns pallidus.