Minimally invasive treatment of Dupuytren's contracture by Pi needle percutaneous multi-segmental fasciotomy / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of Pi needle percutaneous multi-segmental fasciotomy as a minimally invasive treatment for Dupuytren's contracture.</p><p><b>METHODS</b>Sixteen patients(25 fingers: 4 middle fingers, 12 ring fingers, 9 little fingers) were involved in the study, including 11 males and 5 females. There were 2 cases on both hands and 14 cases of single hand disease, including 8 cases of left hand and 6 cases of right hand. The age ranged from 48 to 79 years old, with a mean age of 58.5 years old. The duration of the disease ranged from 1 to 15 years, with a mean time of 5.5 years. There were 12 cases of physical labor, 4 cases of non physical labor, with no family history of palmar fascial contracture. There were 9 cases of tobacco and alcohol addicts, 6 cases with hypertension history, and 3 cases of diabetes mellitus. According to Meyerding classification, 1 case was stage 0, 1 case was stage I, 10 cases were stage II, 4 cases were stage III and 0 case was stage IV. The postoperative function of Dupuytren's contracture patients was evaluated according to Adam efficacy evaluation criteria.</p><p><b>RESULTS</b>The time of incision healing time ranged from 7 to 14 days, 10 days on average. The 3 fingers incision skin cracked 3 to 4 mm during the loosening process, and 14 days after dressing changed, no skin necrosis and wound infection complication occurred. After treatment, fascia contracture of 24 fingers completely or almost disappeared. Limited extension of metacarpophalangeal joint and interphalangeal joint ranged from 0 to 10 degrees, 22 fingers showed normal function of finger extension, 2 fingers had more than 75% elongation function, and 1 finger recurred. According to the evaluation of Adam evaluable standard of curative effect on the postoperative function of Dupuytrens's contracture: 22 fingers got an excellent result, 2 fingers good and 1 finger recurred. The patients were satisfied with the results of the treatment.</p><p><b>CONCLUSIONS</b>Pi needle percutaneous multi-segmental fasciotomy for the treatment of Dupuytren's contracture is a simple, minimally invasive and effective method.</p>

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>