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Objective:To evaluate the clinical outcome of transplantation of metatarsophalangeal and proximal interphalangeal joint of the second toe with toe preservation for repair of traumatic digital arthritis.Methods:From February, 2016 to June, 2018, nine cases with traumatic digital arthritis were treated, including 7 males and 2 females aged from 19 to 46 (average 26.7) years. Three cases had index finger and 6 middle fingers injuried. Four cases had arthritis in metacarpophalangeal joint (MP) and 5 in proximal interphalangeal joint (PIP). All cases with digital arthritis were secondary to trauma. The involved digital joints were reconstructed by transplanting the MP or PIP of the second toes. At the same time, the affected joints (7 cases) or autologous iliac bone grafts (2 cases) were used to repair the bone defects to retain the length of toes. The donor site were closed directly. The appearance and healing of fractures of the fingers and toes, range of motion (ROM) of the transplanted digital joint, healing of the donor site, foot function and complications were observed.Results:All 9 grafted joints survived. In 1 case, the bone defect in the donor site was fixed with iliac bone graft and mini-plate. The wound did not heal at 1 week after operation, which was considered as a rejection of internal fixator. The wound healed smoothly after having the plate removed and replaced it with a cross-fixation by Kirschner pins. Duration of postoperative followed-up was 6-30 (mean 16.3) months. Primary postoperative healing was achieved in all cases. The bone healing time in the hand was 7 to 10 (mean 8.3) weeks. The appearance and function was satisfactory. The postoperative range of motion (ROM) in the transferred MP was 50°-75°(mean 65.3°), and ROM of PIP was 10°-80°(mean 61.5°). According to the evaluation standard of upper limb function set up by the Society of Hand Surgery of Chinese Medical Association, excellent in 5 cases, good in 3 cases and fair in 1 case, with an overall satisfaction of 88.9%. The bone healing time in the foot was 9 to 12 (mean 10.2) weeks. All cases presented with good appearance of the toe without obvious affect to walking and running. For the ilium, there was only an inconspicuous linear scar without any discomfort in the donor iliac area of 2 cases.Conclusion:Transfering of MP and PIP of the second toe with toe preservation can restore the anatomy structure and function of the digital joint. Meantime, the use of autogenous iliac bone graft to replace the donor site defect may retain the length of the toe and minimizes the injury to the donor site.
ABSTRACT
Objective@#Based on the principle of evidence-based nursing, we searched, studied and summarized a nursing pathway for patients who after transverse tibial bone transportation, and explored its effect.@*Methods@#With A set of targeted nursing intervention program, 17 patients with type 2 diabetic foot patients after transverse tibial bone transportation were nursed. After 2 months, the percentage of ulcer decreased, the visual analogue scale and the temperature of foot dorsum were used to evaluate the nursing effect.@*Results@#The average temperature of foot dorsum was (28.49±1.12) ℃, the average visual analogue scale was (4.06±1.40) . And after 2 months, the average temperature of foot dorsum was (29.97± 1.26)℃, the average visual analogue scale was (1.94±1.92), and the area of ulcer in 15 cases (2 cases could not be counted due to toe amputations in treatment) decreased by 25%~100%, with an average of 59%, compared with that before intervention.@*Conclusions@#The implementation of evidence-based nursing can provide effective nursing intervention, relieve the pain of patients, and promote the rehabilitation of diabetic foot ulcers after transverse tibial bone transportation.
ABSTRACT
Objective Based on the principle of evidence-based nursing, we searched, studied and summarized a nursing pathway for patients who after transverse tibial bone transportation, and explored its effect. Methods With A set of targeted nursing intervention program, 17 patients with type 2 diabetic foot patients after transverse tibial bone transportation were nursed. After 2 months, the percentage of ulcer decreased, the visual analogue scale and the temperature of foot dorsum were used to evaluate the nursing effect. Results The average temperature of foot dorsum was (28.49±1.12)℃, the average visual analogue scale was (4.06 ± 1.40). And after 2 months, the average temperature of foot dorsum was (29.97± 1.26)℃, the average visual analogue scale was (1.94±1.92), and the area of ulcer in 15 cases (2 cases could not be counted due to toe amputations in treatment) decreased by 25%~100% , with an average of 59% , compared with that before intervention. Conclusions The implementation of evidence-based nursing can provide effective nursing intervention, relieve the pain of patients, and promote the rehabilitation of diabetic foot ulcers after transverse tibial bone transportation.
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Objective To observe the treatment outcome of using reversed island flap based on cutaneous branch of dorsal metacarpal artery for middle-and-distal finger soft tissue defect.Methods From May,2015 to March,2017,21 cases of middle-and-distal finger soft tissue defect were treated with reversed island flaps based on cutaneous branch of dorsal metacarpal artery which were designed on the dorsal hand pedicled by dorsal metacarpal artery.The flap was then elevated and rotated at the point where digital common artery was anastomosed with the terminal branch of the dorsal metacarpal artery.The cutaneous nerve included in the flap was anastomosed with the terminal branch of digital nerve to restore sensation and the donor site was covered directly.Regular followed-up was performed after operation.Results Except 1 case was suffered with distal 1/3 skin flap necrosis,flaps were well developed.Postoperative follow-up period was 3 to 12 months.All these flaps recovered with satisfying appearance and quality,excellent sensation with grade S3 to S4 and 5 to 8 mm of two-point discrimination.Range of motion(ROM)of the metacarpalphangeal and interphalangeal joint of the injured fingers was good.The excellent and good rate was 95.2％.Conclusion Reversed island flap based on dorsal cutaneous branch of dorsal metacarpal artery transfer is an ideal method for repairing middle-and-distal finger soft tissue defect.The surgery is simple.Reliable blood supply and sensation can be achieved without sacrificing the primary artery and nerve.There is minor donor site damage and very few complications.
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Objective@#To investigate the effect of O-Z flap for the reconstruction of round-or elliptical-shaped defects following the scalp tumor removal.@*Methods@#The resection of the scalp tumor resulted in a round or elliptical-shaped defect. Intraoperative frozen section identified pathological diagnosis, while also ensured margin being tumor-free. Based on the size and location of the defect, the mobility of the surrounding scalp and hair distribution, two local flaps were designed in opposite directions on each side of the defect. The two flaps were rotated to close the defect in an O-Z fashion.@*Results@#From April 2016 to November 2017, 6 patients underwent defect reconstruction using the scalp O-Z flap. The etiologies included basal cell carcinoma (n=2), squamous cell carcinoma (n=2), and trichilemoma and epidermoid cyst (n=2). The defect size ranged from 3.0cm×3.5cm to 5.0cm×6.0cm. Necrosis on the distal of the flap had occurred in 1 patient. It was taken approximately 6% of the flap size, and healed after conservative management. Other flaps survived without any complications. After 3 to 12 months follow-up, the appearance of the sclap was satisfactory and tumor recurrence was not noticed.@*Conclusions@#The O-Z flap technique can be considered as an alternative for the medium-sized defect reconstruction of the scalp. The postoperative outcome of scalp was satisfactory, without disrupted hair orientation.