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Objective To explore the clinical efficacy of anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair or first web reconstruction.Methods A total of 13 cases were underwent anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair from June,2008 to January,2016.There were 9 males and 4 females.The average age was 25 years old,ranging from 18 to 52.There were 3 cases of Ⅲ-degree thumb defect with soft tissue defect of hand,6 cases of Ⅳ-degree thumb defect with soft tissue defect of hand,3 cases of single Ⅴ-degree thumb defect and 1 Ⅴ-degree thumb defect with soft tissue defect.There were 5 patients accompanied with injury of other fingers of the affected hand.And the thenar muscles were also damaged to a varied degree.There were 10 patients with soft tissue defect before surgery,with the wound surface ranging from 3 cm × 5 cm-6 cm × 13 cm.And the wound of other 3 cases was closed.After the surgery,follow-up visit was conducted on the appearance,sensation,function,daily life and working condition of reconstructed thumb,the appearance and function condition of donor site.Results The reconstructed thumbs and anterior superior malleolus flaps in 13 cases survived and healed primarily.The average post-operative followed-up time was 5.5 years,ranging from 2.5 to 10.0 years.The appearance of reconstructed thumb was satisfactory,and the temperature sensation,pain sensation and touch sensation were recovered.The two-points discrimination was 8-18 mm.Moreover,the flexion and extension function,opposing function and finger-to-thumb function was recovered,which could meet the demand of daily life and work.The appearance of donor site was satisfactory,without claudication,pain or dysfunction.The survival of transplanted skin area in the calf was good,with no ulcer noticed.According to the Trial Standard for Thumb and Finger Reconstitution Functional Assessment of Hand Surgery Society of Chinese Medical Association,there were 10 cases excellent results,2 good and 1 fair.Conclusion Application of anterior superior malleolus flap and second toe transplantation for first-stage thumb reconstruction and soft tissue defect repair or thenar muscles and first web reconstruction is an effective therapeutic approach.
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OBJECTIVE: To investigate the effects of neurorrhaphy, nerve grafting and nerve implantation in phrenic nerve transfer for treatment of brachial plexus root avulsion. METHODS: One hundred and eighty Sprague-Dawley rats were divided into three groups: the neurorrhaphy group, the nerve grafting group and the nerve implantation group. Evaluations such as motor nerve latency, amplitude of compound actional potentials, muscle weight, cross sectional areas of muscle fibers and myelinated axons, and muscle function were performed at 1, 2, 3, 4, 5 and 6 months postoperatively. All data were analyzed by the Student-Newman Keuls test in SAS software. RESULTS: Variable recovery in each group was found at different postoperative intervals. At six months after operation, the following results were observed in descending superiority: neurorrhaphy > nerve grafting > nerve implantation. Nerve implantation demonstrated the function recovery was 75.76%. CONCLUSIONS: This study demonstrates that neurorrhaphy is statistically superior to nerve grafting and nerve grafting superior to nerve implantation, and also confirms the validity of phrenic nerve implantation. But when no reparable distal nerve stump is available, nerve implantation is an effective method in phrenic nerve transfer for brachial plexus root avulsion to some extent.
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Objective To observe the results of restoration of shoulder abduction by spinal accessory nerve transfer which was sectioned infraclavicularly to repair the suprascapular nerve in avulsed brachial plexus injury. Methods The donor nerve of accessory nerve was sectioned at the level of medial and lateral muscular branch entering the trapezius; the proximal segment was used for the transfer to repair the suprascapular nerve. The function of shoulder abduction was followed-up for 2-4 years in 49 patients with avulsed brachial plexus injury, the function of the trapezius after operation was also measured by physical check up and electrophysiological detection in 20 patients. Results The average range of the shoulder abduction was 61? , the muscle strength of the trapezius was unaffected on the upper and middle parts except the lower parts after the operation. Conclusion The shoulder function of the patients with brachial plexus injury recovered satisfactorily after transfer of the accessory nerve sectioned infraclavicularly to repair the suprascapular nerve; the muscle strength of the trapezius was unaffected on its upper and middle portion.
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Objective\ To introduce the clinical application of the osteocutaneous flap pedicled with the lateral superior genicular artery or the lateral most superior genicular artery in reconstruction of defect of the soft tissue, bone or compound tissue defect on the hand or distal of the forearm.Methods\ The origin course distribution and an astomosis of the lateral superior genicular artery and the lateral most superior genicular artery were observed on the lower limbs of 30 adult cadavers perfused with pink plastics. The osteocutaneous flap based on the lateral superior genicular artery or the lateral most superior genicular artery were designed according to anatomic study. Results\ One cutaneneous flap, 1 osteo flap and 3 osteocutaneous flaps pedicled with lateral superior genicular artery were used; the area of the cutaneous or osteo flap were 7.5 cm?5.0 cm-14.5 cm?6.5 cm and 5.0 cm?1.5 cm?1.2 cm-6.5 cm?2.0 cm?1.6 cm respectively; all the flap and osteocutaneous flap survived. Bone union occurred 3-5 months after the operation. Conclusion\ The lateral supragenual osteocutaneous flap can be used to reconstruct the defect of soft tissue, bone or compound tissue defect on the hand and distal of the forearm.