Free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap for repairing the complex tissue defect of dorsum wrist / 中华显微外科杂志

Objective To explore the clinical outcome of free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap for repairing the complex tissue defect of dorsum wrist. Methods From June, 2005 to March, 2014, free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap was used for repairing the complex tissue defect of dorsum wrist in 15 cases, which were 12 males and 3 females, and aged from 18 to 52 years old. The skin and soft tissue defect ranged from 8.0 cm×5.5 cm to 22.0 cm×12.0 cm. All ac-companied with extensor digitorum tendon loss. The tendon defect ranged from 5.0 cm to 12.0 cm (7.6 cm on average). The flap size ranged from 9.0 cm×6.5 cm to 23.0 cm×13.0 cm. The pedicle length ranged from 4.0 cm to 7.0 cm (5.3 cm on average). Results All flaps survived, and no postoperative complications occurred. The followed-up time ranged from 12 months to 36 months, and the texture of flap was flexible. No bulky was noted, and skin color was similar to the hand skin. The flexor and extensor function of wrist recovered satisfying. The 2-point discrimination of flap ranged from 9 mm to 15 mm (12.5 mm on average). Conclusion Free chimeric anterolateral thigh cutaneo-tendinous flap with rectus femoris muscular flap is a good option for repairing the complex tissue defect of dorsum wrist.

Repairing the defected volar finger with the free micro-flap based on the superficial palmar branch of radial artery / 中华显微外科杂志

Objective To discuss the clinical application of free micro-flap based on the superficial palmar branch of radial artery (SPBRA) to repair the palmar soft tissue defect of the finger.Methods From October,2012 to September,2015,this flap was used in 25 patients to repair the palmar soft tissue defect of the finger.The artery,the vein and the never in the flaps was anastomosed respectively with that in the recipient site.The donor area was sutured directly.Results All patients were followed-up for a mean of 11 months (range,6-20 months).All 25 flaps survived.The character of flap was good,the appearance and sensitive function obtained satisfactory resume.At the last follow-up,the two-point discrimination was 5-10mm on the affected side.According to the Standard of Evaluation of Thumb-Finger Reconstruction of the Chinese Medical Association,there were excellent in 17 cases,and good in 8 cases.The wounds of donor site healed by 1st intention with no visible scars.The function of thumb was not damaged.Conclusion The free micro-flap based on the SPBRA is feasible for soft-tissue defects of finger bacause the undamaged major blood vessels of donor site,the inconspicuous scar,and the good appearance and sensitive function of repaired fingers.

Deacetylation of TFEB promotes fibrillar Aβ degradation by upregulating lysosomal biogenesis in microglia

Microglia play a pivotal role in clearance of Aβ by degrading them in lysosomes, countering amyloid plaque pathogenesis in Alzheimer's disease (AD). Recent evidence suggests that lysosomal dysfunction leads to insufficient elimination of toxic protein aggregates. We tested whether enhancing lysosomal function with transcription factor EB (TFEB), an essential regulator modulating lysosomal pathways, would promote Aβ clearance in microglia. Here we show that microglial expression of TFEB facilitates fibrillar Aβ (fAβ) degradation and reduces deposited amyloid plaques, which are further enhanced by deacetylation of TFEB. Using mass spectrometry analysis, we firstly confirmed acetylation as a previously unreported modification of TFEB and found that SIRT1 directly interacted with and deacetylated TFEB at lysine residue 116. Subsequently, SIRT1 overexpression enhanced lysosomal function and fAβ degradation by upregulating transcriptional levels of TFEB downstream targets, which could be inhibited when TFEB was knocked down. Furthermore, overexpression of deacetylated TFEB at K116R mutant in microglia accelerated intracellular fAβ degradation by stimulating lysosomal biogenesis and greatly reduced the deposited amyloid plaques in the brain slices of APP/PS1 transgenic mice. Our findings reveal that deacetylation of TFEB could regulate lysosomal biogenesis and fAβ degradation, making microglial activation of TFEB a possible strategy for attenuating amyloid plaque deposition in AD.

Treatment of traumatic proximal interphalangeal joint defect with artificial joint replacement / 中华显微外科杂志

ObjectiveTo investigate the treatment efficacy of traumatic proximal interphalangeal (PIP)joint defects with prosthetic replacement.MethodsFrom September 2007 to November 2010, ten patients with joint defect injuries were treated by joint prosthetic replacement (5 index fingers,4 middle fingers,and 1 ring finger),including a reconstructed middle finger.Joint motion range and postoperative pain of all cases were measured to evaluate the treatment.ResultsAll cases went through a smooth operation with primary wound healing,and with neither intraoperative nor postoperative complications happened.The follow-up period was range from 8 months to 2 years.The active motion arcs of PIP joints ranged from 50° to 80°,and satisfactory appearances as well. According to assessment standard of upper extremity described by Chinese Hand Surgery Association,the treatment outcome were excellent in 6 fingers,good in 3 fingers,general in 1 finger.ConclusionJoint prosthetic replacement is a new effective method to treat traumatic proximal interphalangeal joint defect,which is a simple operation with advantages of little trauma and rapid recovery.

Clinical application of muliplefoliated flap combined with tendon graft from dorsal foot for repairing soft tissue defects of multi-fingers / 中华显微外科杂志

Objective To summarize clinical experience of application of muliplefoliated flap combined with tendon graft from dorsal foot for repairing soft tissue defects of multi-fingers. Methods Based on the results of microdissection researches, muliplefoliated flap including medial foot flap, the first metatarsal dorsal flap, lateral foot flap, extensor pollicis brevis of toe and extensor proprius of the fifth toe pedicled by anterior tibial vessels and dorsal pedis vessels as trunk, anterior medial malleolus vessels, the first metatarsal vessels and anterior lateral malleolus vessels as branches respective was designed for repairing soft tissue and tendon defects of multi-fingers. Results In all 12 cases, total survival of flap was 11 cases , 1 case had partial necrosis of distal flap and it was healed by dress changing. Conclusion Transplantation of muliplefoliated flap combined with tendon graft from dorsal foot is a good method to repair soft tissue and tendon defects of multi-fingers.