Reconstruction of partial defects at the end of the fingers / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the reconstruction of partial defects at the end of the thumbs and other fingers with microsurgical free toe flaps.</p><p><b>METHODS</b>21 partial defects (19 cases) at the end of thumbs and other fingers were reconstructed with microsurgical free toe flaps taking from the corresponding toe part.</p><p><b>RESULTS</b>All the free flaps survived. The patients were followed up for 3 - 6 months. The aesthetic and functional results were both satisfactory. The two-point-discrimination distance was 4 - 6 mm.</p><p><b>CONCLUSIONS</b>The microsurgical free toe flaps have good therapeutic effect for the reconstruction of partial defects at the end of the fingers.</p>

Emergency repair of severe complex defect in forearm by transplantation of free flap and functional reconstruction / 中华显微外科杂志

Objective To report the outcome of emergency repair of severe complex defect in forearm by transplantation of free flap and simultaneous functional reconstruction.Methods From Mar.1994 to Aug.2003,4 cases with severe complex defect in forearm was repaired by transplantation of free skin flap, free skin flap combined with fibula flap,or fibula osteocutaneous flap in emergency.Simultaneously the flexion and extension function were repaired by muscle transfer and/or tendon grafting,tenonectomy.Results All the cases were successful.Follow-up period ranged from 1 to 3 years postoperatively.The blood-supply,tex- ture and elasticity of transferred flaps were excellent with good bone healing.Opposition of thumb with four fin- gers was good.Sensory recovery of the hand was satisfactory.Conclusion Transplantation of free flap com- bined with simultaneous functional reconstruction is an ideal method in emergency repair of severe complex de- fect in forearm.

Application of separating brachial plexus block combined with preoperative analgesia by patient controlled intravenous analgesia in tendon repair / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate whether the separating brachial plexus block combined with preoperative analgesia by patient controlled analgesia (PCA) can be applied in tendon repair and postoperative active or passive functional exercise.</p><p><b>METHODS</b>Two hundred and ten cases with tendon injury were randomly divided into 3 groups and all of the patients were administered Bupivacaine (0.25%), Papaverine (0.0625 mg/ml), and Dexamethasone (0.25 mg/ml) in separating brachial plexus block through axillary approach. Group A was control group, and preoperative analgesia was not applied. Preoperative analgesia was applied in group B and C. Tramadol and Ondansetron were administered in group B, Midazolam was administered besides Tramadol and Ondansetron in group C. The injection volume in the PCIA pump was increased to 100 ml by mixing physiologic saline. The pump was started after separating brachial plexus block in velocity of 2 ml/h, and its maintenance time was 48 h. The effect of separating brachial plexus block at 1, 2, 3, 6 and 12 h after finishing brachial plexus block was compared. The VAS, Ramesay assessment scoring were recorded at 0, 12, 24 and 48 h after starting pump.</p><p><b>RESULTS</b>In each group, the effect of motor block became greater in the ascending order from 1, 2 to 3 h after finishing brachial plexus block, and less in the descending order from 3, 6 to 12 h after finishing brachial plexus block. Only at 6 and 12 h after finishing brachial plexus block, the effect of motor block of group B and group C was significantly less than that of group A (P < 0.05, < 0.01), the effect of motor block of group C was less than that of group B (P > 0.05). The effect of sensory block in the patients of all 3 groups was satisfactory. The VAS, Ramesay assessment scoring, effect of analgesia and sedation at 24 and 48 h after starting pump became greater in the ascending order from group A to group C, in which group B and group C were significantly greater than group A (P < 0.01).</p><p><b>CONCLUSIONS</b>The separating brachial plexus block combined with preoperative analgesia by 2 kinds of PCIA dispensation can be both applied in tendon repair, but the separating effect of brachial plexus block of group B was superior to the group C.</p>