A V-Y shaped flap with digital artery nerve at metacarpophalangeal joint was used to repair the defect of middle and distal phalanx / 中国骨伤

OBJECTIVE@#To explore a surgical method for the reconstruction of volar soft tissue defect and sensory and vascular repair in middle and far phalangeal digits.@*METHODS@#From January 2016 to January 2020, a total of 14 patients , 9 males and 5 females, ages ranging from 22 to 69 years old, and with volar soft tissue defects in the middle and distal digits 2 to 4, underwent surgical reconstruction using the V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint. The defect area was (2.0~2.5) cm×(1.5 ~2.0) cm. The procedure involved the harvest of a V-Y shaped flap with the digital artery and nerve from the metacarpophalangeal joint. Flap design, dissection of blood vessels and nerves, and anastomosis with the digital artery and nerve were performed according to a standardized protocol., Functional exercise of affected finger was initiated 3 weeks postoperatively. Subsequent assessments were conducted to evaluate finger pulp sensation, shape and other relevant parameters. According to the upper extremity functional evaluation standard set up by Hand Surgery Branch of Chinese Medical Association, the surgical outcomes were evaluated.@*RESULTS@#All 14 cases demonstrated successful tissue transplantation, , with immediate recovery of sensation observed in 10 cases with distal finger pulp defects. Four patients with middle phalangeal defects experienced gradual sensory recovery within 2 to 3 months postoperatively. Thirteen patients were followed up for a mean duration of (8.8 ± 4.49) months, during which satisfactory outcomes were observed. The average two-point resolution of the finger pulp was 4-6mm, and sensory function evaluation yielded a score of S3 or above. Patients exhibited realistic finger shape, normal skin color and temperature, good wear resistance, and cold resistance. Furthermore, finger joint function was essentially normal.@*CONCLUSION@#The V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint offers a suitable solution for repairing the defect of the middle or distal phalangeal finger. This technique is characterized by its simplicity, low risk, and favorable outcomes, including restored finger shape, blood supply and sensation. Moreover, high patient satisfaction was achieved.

Clinical analysis of repairing the defect of hand with reverse island skin flap of upper carpal cutaneous branches of ulnar artery / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effect of repairing soft tissue defect after hand wound using reverse island skin flap of upper carpal cutaneous branches of ulnar artery.</p><p><b>METHODS</b>From June 2010 to November 2016, 12 patients with hand soft tissue defects were repaired by reverse island skin flap of upper carpal cutaneous branches of ulnar artery, including 9 males and 3 females with an average age of (35.2±9.4) years old ranging from 22 to 58 years. The defect area varied from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm. Time interval from injury to operation ranged from 3 to 15 days with an average of (8.4±2.6) days. The flap was designed beforehand according to the size of the defect, sharply dissected the aponeurotic fascia from the proximal to the distal, abscised the communicating branch between the flap and the ulnar artery at the wrist epithelial branch, repairing the defect of flap with method of metastasis retrograde. The sensation, shape of the flap and hand function were observed, and the upper extremity function was evaluated according to the standard of hand surgery branch from Chinese Medical Association to assessment of functional recovery.</p><p><b>RESULTS</b>The flaps in 10 patients obtained primary healing, the healed time was 14 to 18 days with an average of(15.0±1.5) days. Two patients occurred distal flap necrosis, and wound surface healed after change dressing and skingrafting cover. All patients were followed up from 3 to 15 months with an average of(7.0±3.8) months. According to the upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, 2 cases got excellent results, 7 good, 2 fair and 1 poor.</p><p><b>CONCLUSIONS</b>Reverse island skin flap of upper carpal cutaneous branches of ulnar artery for the treatment of soft tissue defect caused by hand wound has advantages of concealed donor area, no need sacrifice the main blood vessel, flap thin and no need repair it for thick and thin.</p>

Internal fixation with one-hole microplate for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical effects of one-hole microplate internal fixation for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture.</p><p><b>METHODS</b>Twenty-two patients (16 males, 6 females) with collateral ligament injuries of the metacarpophalangeal joint of the thumb combined fracture were treated with one-hole microplate internal fixation. The age of the patients ranged from 18 to 53 years old with a mean age of 28.5 years old. The duration from injury to surgery ranged from 2 hours to 2 months, and the mean time was 6 days. All the patients had collateral ligament injuries combined with fracture of the metacarpophalangeal joint of the thumb. Thirteen patients had injuries in the right hand and 9 patients had injuries in the left hand. There were 18 cases of closed wound and 4 cases of open wound. Eighteen patients had fresh injuries (< 2 weeks) and 4 had old injuries (> 2 weeks). Sixteen patients had injuries in the ulnar collateral ligament of the thumb combined with fracture, 6 patients had radial collateral ligament injuries of the thumb combined with fracture, 4 cases of which were complicated with injuries of abductor pollicis brevis and the end of the flexor pollicis brevis tender. The size of the avulsed fragment was about 3.0 mm x 4.0 mm to 6.0 mm x 7.0 mm.</p><p><b>RESULTS</b>The incisions of 22 patients healed by first intention. The follow-up periods ranged from 6 months to 5 years old,with an average of 2.5 years old. The thumb function was evaluated by Saetta and other evaluation criteria, and 20 patients got an excellent result and 2 good.</p><p><b>CONCLUSION</b>The application of one-hole microplate internal fixation in treating collateral ligament injuries with fracture of the metacarpophalangeal joint of the thumb is an effective method.</p>

Application of vacuum sealing drainage and cryopreservation technology in hand and foot skin replantation / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the clinical effect of avulsed skin replantation of hand and foot via vacuum sealing drainage (VSD) combing low temperature technique.</p><p><b>METHODS</b>From March 2012 to October 2013,13 cases with avulsed skin replantation of hand foot using combined technique included 8 males and 5 females with an average age of 32 years old ranging from 18 to 62 years. The time from injury to hospital was 1 to 4 hours (2.4 hour in average). The reasons of injury included machine injury in 7 cases and rolling over by cars in 6 cases. The parts of injuried involved finger in 2 cases,back of the hand in 5 cases and dorsum of foot in 6 cases. The area of avulsed skin was 5 cm x 6 cm to 12 cm x 16 cm,tendon and bone exposure was found in 4 cases. VSD was operated in all patients and the avulsed skin was refrigerated in the temperature of -4 °C or -80 °C. After 4 days, the skin stored in the -4 °C was replanted to the wounded place in 5 cases and in 3 cases the skin was planted to the donor site of flap. The skin stored in the -80 °C was replanted in 4 cases after 7 or 8 days, 1 case after 45 days.</p><p><b>RESULTS</b>Of the 13 cases, 1 case of degloved injury from lower leg to dorsal foot,the replanted skin was necrosis completely; 1 case of degloving injury with fourth finger,the skin which replanted after 45 days survived approximately 30%,cured after skin-graft many times. In the other cases, the survival area of replanted skin was more than 85%, all cured after dressing. According to the standard of skin survival area evaluation by Jia et al, 11 cases showed excellent, 1 showed medium and 1 showed inferior. There were no complication about grafted skin rupture after the skin survived in 11 patients,after 4 to 22 months follow-up, the resiliency of grafted skin showed good. Sensation recovery was measured by BMRC standard: 3 cases of S3, 5 cases of S3, 3 cases of S2.</p><p><b>CONCLUSION</b>VSD combining lower temperature technique in skin replantation provides time and space for wound preparation and treatment plan for the patients who need second surgery, especially for the large area skin degloving,this method could utilize the degloved skin efficiently, decrease the donor site area, alleviate the pain and financial burden,reduce the scar formation of donor site and impediment.</p>

Containing negative pressure drainage technology combined dermatoplasty of full thick skin graft to repair surgical donor site of hallux toe / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effectiveness of vacuum sealing drainage (VSD) combined with skin grafting to repair donor site for wrap around flap of hallux toe.</p><p><b>METHODS</b>From Jan. 2009 to Apr. 2010,20 patients with injury of hallux toe were repaired by wrap around flap of hallux. There were 16 males and 4 females,with ranging in age from 18 to 45 years (averaged 36 years). The causes of injury: mechanical injury in 18 cases, road accident in 1 and postoperative hemangioma of hallux in 1. The degree of hallux defect as follow: grade I 10 cases, grade II 6 cases, grade III 4 cases. All patients' feet underwent 64-row CT angiography pre-operation, there were exposed bone and tendon tissue, the area of hallux ranged from 5 cm x 3 cm to 7 cm x 5 cm, all cases underwent vacuum sealing drainage combined with dermatoplasty of full thick skin graft for repair of donor site for wrap around flap of hallux toe.</p><p><b>RESULTS</b>The raw surface of donor site in all patients survived without complications such as skin ulceration and exudation. After follow-up for 3 to 12 months, the skin appearance of raw surface was excellent with well function.</p><p><b>CONCLUSION</b>VSD associated with dermatoplasty of full thick skin graft to repair donor site for wrap around flap of hallux toe can obtain satisfactory effect in treating injury of hallux toe, which can reduce difficulty of wound healing, improve skin appearance of donor site and relieve pain of patients.</p>

Diagnosis and treatment of the metacarpophalangeal joint locking caused by sesamoid turned-over dislocation of the thumb / 中国骨伤

<p><b>OBJECTIVE</b>To introduce diagnosis and treatment of the metacarpophalangeal joint (MPJ) locking caused by sesamoid turned-over dislocation of the thumb.</p><p><b>METHODS</b>Five cases with metacarpophalangeal joint locking were involved in the study, male 4 and female 1. The average age was 35 years old(ranging from 18 to 47 years). All the patients received manual reduction under local anaesthesia. But only three were successful, others patients were reduced by operation. Metacarpophalangeal joint locking caused by sesamoid turned-over dislocation with the volar plate and the short flexor muscle of the thumb tendon were reveded. The metacarpophalangeal joint locking was released after reduction of sesamoid turned-over dislocation of the thumb.</p><p><b>RESULTS</b>The mean follow-up time was 15 months (3-34 months). The mean range of MPJ flexion was 45 degrees (35 degrees - 60 degrees). The signs for pain and swelling were released. Satisfactory thumb opposition can be seen.</p><p><b>CONCLUSION</b>It was one of the important reasons of the metacarpophalangeal joint locking caused by sesamoid turned-over dislocation of the thumb.</p>