ABSTRACT
Objective To explore the clinical efficacy of anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair or first web reconstruction.Methods A total of 13 cases were underwent anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair from June,2008 to January,2016.There were 9 males and 4 females.The average age was 25 years old,ranging from 18 to 52.There were 3 cases of Ⅲ-degree thumb defect with soft tissue defect of hand,6 cases of Ⅳ-degree thumb defect with soft tissue defect of hand,3 cases of single Ⅴ-degree thumb defect and 1 Ⅴ-degree thumb defect with soft tissue defect.There were 5 patients accompanied with injury of other fingers of the affected hand.And the thenar muscles were also damaged to a varied degree.There were 10 patients with soft tissue defect before surgery,with the wound surface ranging from 3 cm × 5 cm-6 cm × 13 cm.And the wound of other 3 cases was closed.After the surgery,follow-up visit was conducted on the appearance,sensation,function,daily life and working condition of reconstructed thumb,the appearance and function condition of donor site.Results The reconstructed thumbs and anterior superior malleolus flaps in 13 cases survived and healed primarily.The average post-operative followed-up time was 5.5 years,ranging from 2.5 to 10.0 years.The appearance of reconstructed thumb was satisfactory,and the temperature sensation,pain sensation and touch sensation were recovered.The two-points discrimination was 8-18 mm.Moreover,the flexion and extension function,opposing function and finger-to-thumb function was recovered,which could meet the demand of daily life and work.The appearance of donor site was satisfactory,without claudication,pain or dysfunction.The survival of transplanted skin area in the calf was good,with no ulcer noticed.According to the Trial Standard for Thumb and Finger Reconstitution Functional Assessment of Hand Surgery Society of Chinese Medical Association,there were 10 cases excellent results,2 good and 1 fair.Conclusion Application of anterior superior malleolus flap and second toe transplantation for first-stage thumb reconstruction and soft tissue defect repair or thenar muscles and first web reconstruction is an effective therapeutic approach.
ABSTRACT
Objective To investigate the value of soluble triggering receptor expressed on myeloid cells-1(sTREM-1) in the diagnosis of bacterial pleural effusion. Methods The levels of sTREM-1 in pleural effusion were determined in 30 patients with bacterial pleural effusion, 33 patients with malignant pleural effusion,31 patients with tuberculous pleural effusion and 28 patients with transudate by quantitative ELISA assay. The levels of CRP in pleural effusion were assayed using immunonephelometry method. The diagnostic value was assessed by receiver operating characteristic ROC curve analysis. Results The levels of sTREM-1［(1255.2±248.6)ng/L］ in bacterial pleural effusion were significantly higher than those in malignant ［（125.6±22.4）ng/L］, tuberculous［（184.5±36.5）ng/L］ and transudate groups［（92.5±20.8）ng/L］ (P＜0.05). For ROC curve, when the cut off value of sTREM-1 was set at 425 ng/L, the sensitivity , specificity ,accuracy, positive predictive value and negative value was 93.3%,90.3%,91.9%,93.2% and 93.3%, respectively. Conclusions Detection of sTREM-1 in pleural effusion is helpful to differentiate pleural effusion of bacterial origin from those with other etiologies.