ABSTRACT
Objective:To describe the reconstruction of palmar soft tissue defect of digit using dorsal digital flaps including double dorsal branches of the proper palmar digital nerves (DBPPDN) and report the results of the application of the flaps.Methods:From May, 2005 to April, 2019, a retrospective study was conducted on 113 digits of 113 patients who had palmar soft tissue defects in single digit treated with 4 types of dorsal digital flaps with bilaterally DBPPDN. Flap types: ① Modified cross-digit flap in 29 digits of 29 cases; ②Dorsal digital flap based on the dorsal branch of proper palmar digital artery (DBPPDA) in 43 digits of 43 cases; ③First dorsal metacarpal artery flap in 23 digits of 23 cases; ④ Free dorsal digit flap in 18 digits of 18 cases. In control group, single-innervated flap was used for repair of the defects, only one of injured proper palmar digital nerves on both sides was repaired with DBPPDN. Static TPD, VAS and patient satisfaction of the injured digits were evaluated by means of outpatient follow-up. The t test was applied to compare the 2 groups in relation to the quantitative outcomes. P<0.05 was considered statistically significant. Results:In the dual-innervated flap group, flap ischemia was shown in 11 digits and venous congestion was noted in 7 digits. Partial necrosis was noted in 9 flaps and healed without surgical intervention. In the dual-innervated and single-innervated flap groups, the mean static TPD were (6.92±0.12) mm and (8.92±0.20) mm, the score of VAS were (0.46±0.08) and (1.11±0.28), and patient satisfaction were (4.45±0.06) and (4.00±0.16). Significant difference was found between the 2 groups in static TPD, VAS and patient satisfaction. Dual-innervated flaps presented better discriminatory sensation on the flap ( P<0.01) and lower pain incidence ( P=0.0032) and higher patient satisfaction ( P=0.0014). Conclusion:The 4 types of dual-innervated flap are useful in reconstruction of palmar soft tissue defects of digits, especially in prevention of neuropathic pain.
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Objective:To explore the characters of CDU imaging anatomy and results of clinical application of perforating branch of median cubital vein, and to find the evidence of utilizing perforating vein to establish high level hemodialysis access.Methods:From November, 2016 to October, 2019, 150 median cubital veins in 75 persons were observed by CDU. And the inner diameter and length of the perforating branch were measured Perforating branches of median cubital vein were categorized with ultrasonic imaging anatomy. Thirty-eight chronic kidney failure patients who can not build forearm fistulas were operated by end-to-side anastomosis between perforating branch vein and brachial artery to build hemodialysis access. The blood flow of fisultas was measured,the mature period of fisultas was recorded. The length of available vessels of fisultas was measured and the long-term utilization rate of fisultas was counted.Results:Perforating branch of median cubital vein was always located in a little below elbow near brachial artery, the rate of occurrence was 94.0%. It was sent out at intersection of veins. There were 4 types of perforating vein in image-anatomy. There was no significant difference in vessel length and vessel inner diameter between different types ( P>0.05) ; All the 38 patients with mature fistulas could meet the needs of hemodialysis. The available vascular length of fistulas in type I and type II patients was better than that in type III ( P<0.01), and the long-term utilization rates of fistulas in type I, type II and type III were 84.6%, 85.7% and 72.7%, respectively. There was no significant difference in blood flow and mature period between different types ( P>0.05) . Conclusion:It is most safe and reliable to use the type I and type II of perforating branch of median cubital vein to make the high level fistulas , which can provide a safe and efficient hemodialysis access for the patients with forearm vascular drain, elderly diabetes patients and difficult fistulas with repeatedly thrombosis.
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Objective To report the clinical result of repairing complex tissue defect in limb caused by traffic accident using both tissue flap transplantation and external fixer. Methods The vascular tissue flap including bone flap and muscular flap to repair the complex tissue defection(soft tissue, bones, joints) in forearm, hand, leg, ankle and foot were applied in 36 cases. At the same time in surgery, injured bones and joints were fixed by external fixer for stabilizing and accelerating cure. Results All 56 eases were applied successfully with transplanted tissue combined with external fixation. The external fixers were moved away about 10-16 weeks(upper extremity) or 6-8 months(lower extremity) later and all the cases recovered satisfactorily. Conclusion It is a reliable method for repairing the complex tissue defection in the limb caused by traffic accident by external fixer of traumarology and microsurgery technique. And it is also characterized as a minor injury method on transplanted bones, enables early exercise for joints, convenient observation of flap circulation and easy nursing.
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Objective We reported the rehabilitative nursing points of patients with pectoralis minor muscle transplantation for recovery of thumb oppositional function. Methods We selected 10 patients who underwent pectoralis minor muscle transplantation for recovery of thumb oppositional function and gave them perfect preoperative examination and psychological nursing. We also implemented rigorous monitoring postoperation and auxiliary electric stimulation and functional exercises. The emphasis was put on the exercise of thumb oppositional function. Results The thumb oppositional function of all the ten patients recovered. The myodynamia reached level 4 and the shape of thenar was satisfying after 6 to 12 months of follow-up visit. Conclusions Sufficient preoperative psychological nursing and effective postoperative rehabilitative treatment had pivotal significance for the success of operation and the recovery of thumb oppositional function.
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Objective The purpose is to report the clinical result of repairing defection in hand surgery by using both the vascular tissue flap and external fixators. Methods The vascular tissue flap including bone flap and joint flap to repair the complex defection (soft tissue, bones and joints) in hand and forearm were applied in 9 cases. At the same time in surgery,injured bones and joints were fixed by A-O and mini external fixators in order to keep the non-injured joint actively and accelerate the cure of bones. Result All 9 cases were applied successfully with the all transplanted tissue survived. Pulling about the external fixator about 10- 12 weeks after surgery showed bone union and the f unction of hand recovered satisfactorily' Conclusion it is a reliable method for repairing the complex tissue defection in hand and forearm by combining external fixation of traumarology and microsugery technique. And it is also characterized by a minor injury in transplanted bones,early exercise for joints,flap circulation observed conveniently,and nursing easily.
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Objective To investigate the effect of end to side arterial anastomosis in the transplantations of free tissue flap Methods The end to side arterial anastomosis were used in 47 free flaps of 46 cases in this series The arterial stomas were respectively prepared into the cross section (13/47),the inclined plane angled at 45 degree (26/47) and fish mouth shaped plane (8/47) The interrupture anastomosis and continuous anastomosis following two fixed point sutures,and the continuous anastomosis following four fixed point sutures were respectively used in 28,10 and 9 arterial anastomotic stomas Results There were not postoperative embolism in all end to side anastomotic stomas in this series During the operations the embolisms of the cutaneous branch caused by a detached mini thrombus from the anastomotic stomas were occurred in 2 cases,and the arterial crisis were eliminated by reversely milking out the detached mini thrombus All flaps survived except one due to venous embolism Conclusions It is a effective and safe method that the end to side arterial anastomosis are used in the transplantation of free flap