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Objective To investigate the clinical curative effect of the surgical method of transferring the radialis proper digital nerve of damaged index finger and its dorsal branch to repair the thumb nerve evulsion.Methods 13 patients with thumb nerve evulsion were treated.There were 8 males and 5 females with an average age of 28 years (ranged 18-52 years old).The injuries were caused by machine twist (8 cases),gear(4 cases),electric saw (1 case).And thumb rotational avulsion amputation (10 cases),thumb incompleteness amputation(3 cases).The time from injury to admission was 1-3.5 h (mean 2.2 h).The average time from injury to admission was (1.1 ± 1.5) h.The amputate level of skin was at the juxtra-articular of metacarpophalangeal joint.The amputate level of bone was at the base of proximal phalanx (6 patients) and metacarpophalangeal joint (4 patients),interphalangeal joint(3 patients).Using transferring the radialis proper digital nerve of index finger without reimplantation and its dorsal branch to.repair the both side injuries of thumb nerve evulsion.According to routine method to repair digital bone,veins,arteries and tendons.Results All 13 chases were followed up for 6 months to 2 years and 7 months postoperatively,with an average of 22 months.The wounds and incisions at donor sites were healed by first intention.All 13 cases of thumb reimplantation were successful.Two-point discrimination of ulnaris finger pulp was 2 to 6mm,average 4.2mm,and the radialis was 5 to 9mm,average 7.8mm.Sensory function was rated as S4(the ulnaris in 12 cases and the radialis in 2 cases) and S3 + (the radialis in 11 cases and the ulnaris in 1 cases).Conclusion Transferring the radialis proper digital nerve of damaged index finger and its dorsal branch to the digital nerve on the neighboring thumb is a simple and effective method to restore sensory function of the pulp.
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Objective To explore the clinical value of applying digital technology to make the course of toe vein clear before toe free flap transplantation for thumb reconstruction.Methods Before operation,scan the donor and recipient site by CT,and apply digital three-dimensional CT angiography reconstruction technology to got threedimensional images of the arteries and veins in the donor site for 22 various defected thumbs which were going to have toe free flap transplantation operation,thus indentifyed the types of FDMA and the distribution and course of the toe vein from June,2012 to March,2013.Used computer assisted anatomical modeling to analyze three-dimensional images of blood supply of the donor site and degree of defect of the recipient site and guide the operative design in the donor site according to the digital three-dimensional reconstruction technology.Conducted toe free flap transplantation for thumb reconstruction in accordance with the design.Results It shows that 64-slice dual-source spiral CT could well display the size,distribution and course of toe vein.The toe veins were clarified to two groups,deep one and superficial one whose diameter was larger and was the main reflux vein of the toe.Dorsal vein of the toe origind from venous plexus in the nail bed and it travels along the back of the toe to reach to the near side of metatarsophalangeal joint.And then it beeomes three to four dorsal metatarsal veins to infused dorsal venous arch of foot.The rule of its course was:centralize-decentralize-connect-decentralize again.The great saphenous vein origins from the inner side of dorsal venous arch of foot,rises along the crus before malleolus medialis and collect three larger tributaries:medial malleolar branches-anterior crural branch-outside crural branch.The small saphenous vein derives from the outside of dorsal venous arch of foot and winds behind lateral malleolus up to the back of the curs and infuses to the vein.Conclusion It is useful for venous return,reducing the incidence of vascular crisis by applying toe flap to reconstruct thumbs and clarifying the course and distribution of toe vein with the aid of digital three-dimensional technology to design operation,thus improving the survival rate of toe flap transplantation.
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To introduce our experience of using the free neurovascular flap from great and second toe. Thirteen patients [fifteen fingers] sought surgical treatment for soft tissue defects of the hand at our medical institutin between March 2006 and September 2009. In two patients, fibular side skin-nail flaps of great toe were applied to cover the dorsal defect of distal thumb. In twelve, in the treatment of pulp defect of finger with fibular side flap of great toe or tibial side flap of second toe. In one, in the treatment of defect of distal middle with composite flap with distal digital bone of second toe. All flaps were survived. The average subjective satisfaction score was 8.08 [range 4-10]. Nine patients [69%] experienced cold intolerance, and 2 patients [15%] dysesthesia. The Semmes-Weinstein sensitivity score was between 3.47and 4.72 on the flap, and 0-4.18 on the donor site. The mean two-point discrimination was 6.8mm [range 4-12]. Grip strength was 10% less than in the unaffected hand. The proximal interphalangeal mobility loss was less than 15 degrees. Our results indicated that these free flaps from toe are useful for patients with a small soft-tissue defect in hand
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Objective To investigate the effects of comprehensive pain management on pains and recovery of knee function of patients who hadundergone total knee arthroplasty(TKA).Methods A total of 50 patients who had undergone single-knee TKA surgery were selected and divided into 2 groups of 25 patients each:the study group and the control group.The control group was given patient-controlled epidural analgesia while the study group was given comprehensive pain management.The two groups were compared in terms of score on pain within 7 days after operation,knee joint activity and the incidence of adverse reaction within 10 days after operation(the 1st,3rd,7th,10th day).Results Within 7 days,the scores on pain in the study were significantly lower than those in the control group(P<0.05).The scores on the knee joint activity in the study group on the 1st,3rd,7th,10th day were significantly higher than those in the control group(P<0.05)and the incidences of adverse reaction were significantly lower as well (P<0.05).Conclusion Comprehensive pain management is effective for post-surgery pain control and the hastened TKA patients, and the improved quality of life.
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Objective To investigate the therapeutic effect of toe transfer in reconstruction and repairation of thumb and finger defcts. Methods From December of 1996 to September of 2010,thirty-five partial thumb and finger defcts in 33 cases were treated with toe tissue for reconstructing and repairing.The transfer indication,surgery procedure,operative technique and treatment effect were retrospectively analyzed.Simultaneously how to improve the outcoming and success rate were explored and investigated.Results All 35 toe tissue were alive with aesthetic appearance and finefunction.Followed-up from 3 months to 12 years,and judged by the tentative evalution standard of function of upper limb,which was made by Chinese Medical Association for Surgery of the Hand.The results were excellent in 14,good in 16,fair in 3 and poor in 1.The rate of excellence and good was 85.7%. Conclusion Toe tissue transplantation is an ideal treatment for reconstructing and repairing partial thumb and finger defcts.
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Objective To review clinical experience of free flap transferring in the reconstruction of head and neck defects. Methods Fifteen free anterolateral thigh flaps, 5 free deep inferior epigastric flaps and 3 free lateral arm flaps were used to reconstruct large area head and neck defects. Results All 23 free flaps were alive with good appearance. 1 case survived by performing embolectomy after suffering arterial crisis and delayed recovery of wound took place in 2 cases. Conclusion Free flap transplantation is an ideal choice for reconstructing large area cranio-facio-cervical defects.
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Objective To discuss the surgery procedure and treatment effect of reconstruction of the soft tissue of the thumb/finger defects by the second toe tibial toe pulp skin flap. Methods Ten patients with the soft tissue of pulp of the thumb/finger defects were treat by the same side of the second toe tibial toe pulp skin flap, all the patients have the soft tissue defect of finger pulp with exposed phalanx. Crush them in 4 cases, the machine cut wound in 6 cases. A fixed 2 cases, delayed operation 3-7d after injury to repair in 8 patients. The side of skin flap varied from 2.0 cm × 2.2 cm to 2.0 cm × 3.5 cm. Results Ten fingers in 10 cases all survived. Necrosis in edge part of the shin graft occurred in 2 cases, which was healed through changing of dressing. All cases were followed form 4 months to 16 months. The blood-supply, texture and elasticity of transferred flaps and the shape of fingers pulp were excellent. Good function recovery of the fingers was achieved. Pain and temperature sence were regained. Two point discrimination of the finger pulp was 5-9 mm.Primary healing occurred in all cases. It did not disturb dressing shoes and walking. Conclusion It is a reliable approach for soft-tissue coverage of the thumb/finger using the second toe tibial toe pulp skin flap based on distal perforators of digital artery or ulnar artery. The advantages include simply procedures, reliable blood supply without sacrificing main aneries and possibilities of sensoly recovery.
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Objective To evaluate the short-term results o f reconstruction of PCL(posterior cruciate liga-ment )with quadruple-stranded semitendi nosus tendon and bi-stranded gracilis tendon and to discuss the key point s of the surgery and postoperative rehab ilitation.Methods 12cases of PCL ruptures were reconstructed arthroscopically with quadruple-stranded semitendi nosus tendon and bidruple-stranded gracilis tendon.Results No patients had symptoms of knee instability.The sa g sign and posterior drawer test were negative in all.According to Lysholm knee function scale,10patients were rated as excellent and 2as good 1year after operation,with an average Lysholm score of 85?4.1.Conclusion Arthroscopic reconstruction of posterior cruciate ligament with quadr uple-stranded semitendinosus tendon and bi-stran ded gracilis tendon can result in lim ited invasion,strong graft and satisfactory clinical results.[