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Objective: To explore the surgical method and effectiveness of the great toenail bed flap supplied with the fibular dorsal artery of great toe in repair of the finger nail bed central longitudinal defect. Methods: Between May 2012 and February 2017, 7 cases (7 fingers) with the finger nail bed central longitudinal defects were repaired with the great toenail bed flap supplied with the fibular dorsal artery of great toe. There were 3 males and 4 females; the age ranged from 17 to 35 years (mean, 27 years). The cause of injury included cutting injury in 2 cases, electric shaving injury in 3 cases, and frictional injury in 2 cases. The defect located at thumb in 3 cases, index finger in 3 cases, and middle finger in 1 case. The defect area ranged from 12 mm×8 mm to 21 mm×13 mm. The time from injury to admission was 1-2 hours (mean, 1.5 hours). The area of the great toenail bed flap ranged from 14 mm×10 mm to 23 mm×15 mm. The wound of donor site was directly sutured in 3 cases and repaired with full thickness skin graft in 4 cases. Results: All the great toenail bed flaps and skin grafts at the donor sites survived; and all wounds healed by first intention. All patients were followed up 9 to 36 months (mean, 23 months). The finger nails were smooth and shiny and recovered ideal appearance. At 9 months after operation, the two-point discrimination of the skin ranged from 7 to 9 mm (mean, 8 mm). According to the standard evaluation for nail bed repair issued by Zook etc., 6 cases were rated as excellent and 1 case as good, and the excellent and good rate was 100%. Conclusion: It is an ideal method to repair the finger nail bed central longitudinal defect with the great toenail bed flap supplied with the fibular dorsal artery of the great toe.
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Objective To study the first metacarpal dorsal artery anatomy,and explore the flap based on the branch chain of the first metacarpal dorsal artery.To provide anatomical basis for clinical application of the flap.Methods The origin,courses and distribution of the branch chain of the first metacarpal dorsal artery from 8 fresh hand specimens perfused by red latex were explored from January,2015 to December,2016.Results There was a dorsal artery network in the dorsal side of the first metacarpal.The radial and ulnar dorsal artery of the first metacarpal originated from the radial artery and along the first metacarpal lateral margin to go down.The initial diameter of the radial dorsal artery was (0.82±0.06)mm.The initial diameter of the ulnar dorsal artery was (0.74±0.05) mm.And anastomosed with the dorsal branches of the thumb inherent arteries.The both inherent arteries of thumb give off dorsal branches count (2.62±0.34).The initial diameter of proximal dorsal branch was (0.32±0.03) mm.The initial diameter of distal dorsal branch was (0.24±0.08) mm.Conclusion The radial and ulnar dorsal vascular chain of the first metacarpal were constant.The anastomosed branches with the dorsal branches of the thumb inherent arteries were abundant.The free flap or retrograde flap based on the vsscular chain has reliable blood supply.And without destroyed the main artery of thumb.
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Objective To study the anatomic data of the first metatarsal dorsal artery and to provide anatomical basis for clinical tissue transplantation based on the first metatarsal dorsal artery.Methods The 16 adult cadaver specimens with 32 feet were dissected and meas-ured by vernier caliper.Then the anatomic data of the first metatarsal dorsal artery were analyzed.Results Through the examinations of 32 feet sample,the first metatarsal dorsal artery were classified into 5 types.Type Ⅰ:the first metatarsal dorsal artery runs at the surface of the first dorsal interosseous muscle (13 sides,40.6%).Type Ⅱ:the first metatarsal dorsal artery runs in the interior of the first dorsal interosse-ous muscle (11sides,34.4%).Type Ⅲ:the first metatarsal dorsal artery runs underneath the first dorsal interosseous muscle (6 sides, 18.8%).Type Ⅳ:the first metatarsal dorsal artery is slender (1 side,3.1%).TypeⅤ:the first metatarsal dorsal artery is absent (1 side, 3.1%).Distance relationship was measured between the first metatarsal bone and the first metatarsal dorsal artery:the vertical distance be-tween the origin of the posterior branch of the first metatarsal dorsal artery and base of the first metatarsal bone was (2.4 ±0.3)mm,the ver-tical distance between the origin of the posterior branch of the first metatarsal dorsal artery and head of the first metatarsal bone was (10.1 ±1.0)mm;the vertical distance between the origin of the anterior branch of the first metatarsal dorsal artery and the first metatarso-phalangeal joint was (7.6 ±2.7)mm.Conclusion The first metatarsal dorsal artery has clinical reference significance for the hands and feet’s trauma and skin flap transplantation such as thumb reconstruction.
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Objective To explore the effect of Mudan granule combined with zinc sulfate on ankle brachial index in the treatment of diabetic foot dorsal artery sclerosis and its efficacy.Methods 66 cases of patients with diabetic foot dorsal artery sclerosis in this study were selected and divided into 2 group, 33 cases in each group.Control group received mecobalamin injection and zinc sulfate tablet and treatment group received Mudan granule on the basis of control gorup.7 days for a course of treatment and patients received continuous treatment of 4 courses.Clinical efficacy, blood glucose, blood lipids, blood rheology, blood flow dynamics of the dorsal artery of the foot, ankle brachial index, and adverse reactions were compared after the treatment.Results Compared with the control group after the treatment, the total effective rate of the treatment group was higher(P<0.05).Compared with the control group, the serum postprandial 2h blood glucose, total cholesterol, triglyceride, low density lipoprotein cholesterol levels were lower(P<0.05), and high density lipoprotein were higher(P <0.05), the levels of whole blood viscosity high, middle and low shear, plasma viscosity, hematokrit and fibrinogen were lower(P<0.05), the serum levels of appeal index were lower(P<0.05), the blood flow of the dorsal artery, the diameter of the blood vessels and the ankle brachial index were higher (P<0.05), the peak velocity of the dorsal foot artery was lower(P<0.05) .There was no significant difference in the incidence of adverse reactions between the 2 groups.Conclusion Mudan granule combined with zinc sulfate tablet in the treatment of diabetic foot dorsal artery sclerosis was effective with high safety and it could improve ankle brachial index.
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Objective To investigate the feasibility of MR angiography of the dorsalis pedis artery (DPA),the first dorsal metatarsal artery (FDMA) and the branches at the first toe web by threedimensional time-resolved imaging of contrast kinetics (TRICKS) sequence.Methods Forty three patients with suspected or known soft tissue diseases of the ankle and foot were examined retrospectively by MR TRICKS sequence.Two experienced radiologists independently evaluated the visualization performance of DPA,FDMA and its branches with maximum intensity projection.Kappa analysis was performed for the image evaluation of the two radiologists.Consensus scores were obtained if the two radiologists had different scores.Clinical classification of FDMA was carried out for patients with scores equal to,or more than 2 points after imaging evaluation.FDMA was categorized according to its location (superficial,intramuscular,infra-muscular,absent),diameter (large,medium and small) and branching pattern at the toe web (ramifying type,main trunk type and fine small branch).Results The scoring results of the two radiologists indicated a high agreement (Kappa value =0.895,P ＜ 0.05).TRICKS images can clearly show the arterial filling of DPA,FDMA and its branches.The final consensus scores were as follows:8 patients had 4 grade and 22 patients 3 grade,8 patients 2 grade and 5 patients 1 grade.Clinical classification of FDMA for 38 patients(arterial scales ≥2 point):(1) Location:superficial (8 patients),intramuscular (23 patients),intramuscular (7 patients) ; (2) Diameter at the midpoint of FDMA:large (2 patients),medium (25 patients),and small (11 patients); (3)Branching pattern at the toe web:ramifying type (11 patients),main trunk type (5 patients),fine branch (14 patients).Conclusion MR TRICKS sequences are valuable in the evaluation of the DPA and FDMA and its branches,which can provide useful anatomical information for classification of FDMA.
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Subject(s)
Humans , Arteries , Canada , Curriculum , France , Glycosaminoglycans , Human Body , Japan , Muscles , Organic Chemicals , Perforator Flap , Skin , Subcutaneous Tissue , Surgery, Oral , Thigh , Tissue DonorsABSTRACT
lerosis of the lower extremity artery in patients with type 2 MD.