Comprehensive reconstruction of thumb by transplanting partial second toe combined with hallucis flap / 中华显微外科杂志

Objective:To introduce an improved method for reconstruction of thumb by transplanting partial second toe combined with hallucis flap.Methods:Since April, 2015 to December, 2019, 12 thumbs were reconstructed by transplanting partial second toe combined with hallucis flap. The average age of the patients was 28.5 years old. The severity of thumb defect was grade III-V. The compound tissue flap of common vascular pedicle was obtained from the hallux and the partial second toe of the contralateral foot, according to the condition of the defect of thumb. The hallucis flap was rotated transversely and connected with the partial second toe. Make up the characteristics and defects for the reconstructed thumb. The remaining skin and soft tissue of the second toe and the donor area were tiled to cover the wound. The patients were followed-up regularly.Results:All of the 12 transplantations completely survived. Postoperative follow-up period ranged from 6 to 26 months, 14 months in average. Appearances of all reconstructed thumbs and the donor toes was satisfactory. According to the Functional Assessment Criteria of the Upper Limb set by the Hand Surgery Society of Chinese Medical Association, the outcomes were graded excellent in 9 cases and good in 3 cases. All patients were able manage daily activities and living independently. Shape and function of donor foot were good.Conclusion:Part of the second toe combined with the hallucis flap transfer for thumb reconstruction may effectively improve the appearance of the reconstructed thumb. The reconstructed thumb is symmetrical, good in shape and satisfactory in function.

Investigation effect of induction time on proliferation rate of induced Schwann-like cells from adipose derived stem cells / 中华显微外科杂志

Objective Comparison of induction time on the proliferation of induced adipose-derived stem cells (ADSC) to differentiate into Schwann-like cells (iSC).Methods From March,2017 to October,2018,ADSCs were isolated from inguinal adipose tissue of healthy adult female SD rats.Flow cytometry was performed to detect ADSC positive markers CD29,CD90 and negative marker CD45.iSC induction medium was used to culture ADSC.S-100 and GFAP were detected by immunofluorescence staining to confirm that ADSC had differentiated into iSC.Morphological changes of cells were observed by inverted microscope on day 1st,4th,7th,10th,13rd,16th and 19th after induction.MTS assay was used to evaluate cell proliferation ability.Tunel staining was applied to assess cell apoptosis.Results Both S100 and GFAP were expressed in iSC.On day 7th,the cell proliferation rate was significantly slower than that before induction (A value was 0.330±0.020 vs.0.400±0.004,P＜0.05).It was negatively correlated with induction time.On day 19th,the proliferation rate of iSC was lower than 50％ of the proliferation rate before induction (A value was 0.016±0.003 vs.0.400±0.004,P＜0.05).Apoptosis of iSC was more obvious than ADSC at the same time point.Conclusion The proliferation ability of ADSC-induced iSC is optimal within 7 days after induction.

Reason analysis and care of free tissue transplant donor site incision healing / 中国实用护理杂志

Objective To propose the nursing measures with the analysis of free tissue transplant donor site poor healing.Methods 19 cases which suffered wound poor healing were analysed and gived donor site expansion training strengthen,nutrition support,reduce the tension of incision to reduce the incidence of complications.Results 19 cases which suffered wound poor healing with free tissue transplantation were all delayed healed.The reasons could be summed up in four aspects as high tension incision,incision liquefaction,incision hematoma,infection of incision.Conclusions Predictive nursing intervention,postoperative close observation of incision condition,early treatment can effectively prevent complications of donor site.

Perforator identification before DIEP dissection for the patient with abdominal scar: one case report / 中华显微外科杂志

Objective To investigate the effect of perforator identification before DIEP flap dissection for the patient with abdominal scar.Methods Preoperative multidetector-row computed tomography angiography was used to identify that the dominant perforators of the abdominal wall were not damaged completely.During the second stage breast reconstruction operation,the located dominant perforator and the DIEP flap were dissected.Results The dominant perforator located by MDCTA was identified with the exploration in operation.Follow-up for half a year,the flap survived well and the patient was satisfied with the appearance.Conclusion Abdominal scar was not the definite contraindication for DIEP flap.MDCTA provided a good quality evaluation of the perforator vessels.The located dominant perforator was dissected to confirm the blood supply of the DIEP flap.Identification of perforator can be used as a routine preoperative evaluation for patients with scar on donor site.

Efficacy of skin vascular diseases treated with 595 nm pulsed dye laser / 中华医学美学美容杂志

Objective To evaluate the efficacy and side-effects of 595 nm pulsed dye laser (PDL) in the treatment of cutaneous vascular diseases.Methods We analyzed 572 cases of cutaneous vascular diseases treated with 595 nm PDL retrospectively and compared the efficiency among different type of diseases.Results There were totally 243 cases of infantile hemangioma,186 cases of port wine stain,69 cases of telangiectasis,42 cases of spider angioma and 32 cases of rhinophyma.The efficiency was 93.8％,54.3％,95.7％,100％ and 56.3％,respectively,with 2.27％ of side-effect rate.The efficacy was correlated to age,type and location of the diseases.Conclusions 595 nm PDL is a safe option for cutaneous vascular diseases with high efficacy and low side-effect rate.

Transfer of ulnar nerve partial fascicles and brachial plexus extrinsic nerve for treatment of the brachial plexus injury / 中华显微外科杂志

Objective To evaluate the clinical effects of partial fascicle from the ulnar nerve to biceps branch of musculocutaneous nerve to treat brachial plexus injury. Methods Six cases of brachial plexus injury were involved in this group.3 cases were upper trunk injury and 3 cases were accompanied partial lower trunk injury.A partial fascicle of ulnar nerve transfered to repair biceps branch underwent in all cases,phrenic nerve or accessory nerve were transfered to repair suprascapular nerve.The mean time from injury to surgery was 2.8 months.Patients were evaluated with regard to elbow flexion and should abduction ansle,grip strengthen,morbidity of ulnar nerve function lose. Results Five cases out of six got follow up.The mean period of follow-up was 18 months(range from 9-30 months).The average reinnervation time for the biceps muscle was 3.3 months. All the patients' recovery of elbow flexion Was M_3~+-M_5; and the shoulder adduction was 90°-180°;the grip strength was not downgraded. No notable impairment of the donor site nerve function was observed in 4 cases,just 1 case with a little more fascicle been harvested had partial ulnar nerve impairments. Conclusion The use of ulnar nerve partial fascicle to biceps branch combined with phrenic nerve or accessory nerve to suprascapular nerve to reconstruct upper roots avulsion of the brachial plexus is a valid and convenient procedure.It can obtain good functional restoration in elbow flexion and shoulder adduction in a resonable time.The cases with partial lower trunk injury of brachial plexus,the partial fascicle of ulnar nerve can still be used for repair the musculocutaneous nerve.