Effects of subcutaneous embedding of thumb-tack needle on tear film in patients with dry eye / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of subcutaneous embedding of thumb-tack needle combined with mytear and simple mytear on tear film in patients with dry eye.</p><p><b>METHODS</b>Eighty patients of dry eye (160 eyes) were randomly divided into an observation group and a control group, 40 cases in each group. The 0.1% sodium hyaluronate eye drop (alice) was applied in the control group, four times per day for two weeks. On the basis of the control group, the subcutaneous embedding of thumb-tack needle was used at ① Cuanzhu (BL 2), Sizhukong (SJ 23), Sibai (ST 2), ② Yintang (EX-HN 3), Yuyao (EX-HN 4), Taiyang (EX-HN 5). The two groups of acupoints were used alternately. The thumb-tack needle was placed for 2 to 3 days, once a week for two weeks. The subjective symptom score, Schirmer Ⅰ test (SⅠT), tear break-up time (BUT) and corneal fluorescein staining (CFS) were compared before treatment, after treatment and during 2-week follow-up visit in the two groups. The effects of the two groups were compared.</p><p><b>RESULTS</b>Compared before treatment, the subjective symptom score and CFS were reduced but SⅠT and BUT were increased after treatment and during follow-up visit in the two groups (all <0.05), which in the observation group were superior to those in the control group (all <0.05). The total effective rate was 90.0% (36/40) in the observation group, which was superior to 85.0% (34/40) in the control group (<0.05).</p><p><b>CONCLUSION</b>The subcutaneous embedding of thumb-tack needle could increase the amount of SIT, prolong BUT and repair pathological damage of cornea, which could relieve the symptoms of dry eye and improve visual quality.</p>

Anatomy research and clinical application of reverse dorsoradial thumb flap of different rotation point in repairing defect of thumb / 中华显微外科杂志

Objective To investigate a anatomy research and clinic application of defect of thumb by reverse dorsoradial thumb flap of different rotation point.Methods The origin,course,distribution and vascular chain of the first metacarpal dorsoradial artery of thumb from 11 adult cadaveric hand specimens perfused by red latex were explored from September,2012 to December,2016.There were 3 different rotation points:the proximal of the metacarpophalangeal joint,proximal basal of the first proximal phalanx and distal of the first proximal phalanx.Each could be used as reverse flow flap to repair the defect of thumb.Results The first metacarpal dorsoradial artery of thumb originated from the radial artery and the initial diameter was (0.68±0.26) mm,diagonally across the extensor pollicis brevis tendon and then along the radialis part and terminated in the proximal of the first proximal phalanx of the vascular chain.There was a constant communicating branch among the proximal metacarpophalangeal joint,proximal basal of the first proximal phalanx and digital arterial dorsal branch.All the proximal of the metacarpophalangeal joint 4.3 mm to 10.2 mm and proximal basal of the first proximal phalanx 4.9 mm to 7.2 mm could be used as the rotation point of the flap.The flap of the first promixal phalanx blood supply was based on the vascular chain of neurocutaneous.There was a constant dorsal branch of the pollical artery,which was 8.6 mm to 10.3 mm far from the interphalangeal joint,could be used as the rotation point of the flap.Twenty-four cases with soft tissue defects of thumb were repaired by reverse dorsoradial flap.The flap size ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm.The follow-up period was 3 months to 12 months,protective sensations were restored,and skin flap two-point discrimination were 9.0 mm to 12.0 mm.The appearance of the thumbs was satisfactory.Conclusion Different rotation point of reverse dorsoradial flap can successfully repair the defect of thumb.The operation has advantages of simple,reliable blood supply,high success rate and is an ideal option for reconstruction the defect of thumb.

Effect of Early Pressure Therapy on Island Skin Flap for Vitia of Thumb Ventral / 中国康复理论与实践

@#Objective To explore the effect of early pressure therapy during sensory training on functional recovery after island skin flap repairing vitia of thumb ventral. Methods From January, 2016 to July, 2017, 63 patients accepted island skin flap repairing vitia of thumb ventral were divided into control group (n=31) and observation group (n=32) according to the order of hosptalization. The control group accepted routine sensory training, while the observation group accepted early pressure therapy in addition. Their swelling, scars and sensory function were observed after treatment. Results The swelling and scars were milder, and the sensory function was better in the observation group than in the control group (P<0.05).Conclusion Combination with early pressure therapy during sensory training may promote the recovery of sensory function and fadeaway of swelling, and alleviate the formation of scar.

A short series of rolled tendon arthroplasty in carpo-metacarpal joint arthritis of thumb.

Introduction: Trapezio metacarpal joint arthritis is the commonest of arthritis in hand. It occurs more in females after age of 40 years (post menopausal women). Pain appears in all thumb movements which incapacitates them to do their daily household work. There are various methods of treating this disease like conservative methods including NSAIDS and hot water fomentation; surgical methods like trapeziectomy, stabilizing ligamentoplasty, prosthetic replacement (silicon implats, steffee prosthesis etc, fusion of trapezio metacarpal joint and tapeziectomy with tendon interposition arthroplasty. Non surgical measures forms the first line of treatment with aim of preventing progression of disease, however, surgery becomes an option when symptoms are refractory to nonsurgical methods. Aim: To evaluate the outcomes of trapeziectomy with free rolled tendon palmaris longus interposition arthroplasty for moderate to severe osteoarthritis of trapezio metacarpal joint. Material and methods: We evaluated 10 patients (mean age 50, Eaton Littler stage 3 and 4) who underwent trapeziectomy and palmaris longus interposition arthroplasy for end stage osteoarthritis of thumb carpometacarpal joint. Clinical outcome parameters were determined preoperatively and at 3, 6, and 12 months postoperatively. Results: We have got excellent in 7 cases (9 thumbs), good in 2 cases, poor in 1 case. Conclusion: Rolled tendon arthroplasty using free rolled palmaris longus tendon with trapeziectomy is able to provide high quality results in moderate to severe osteoarthritis of trapezio metacarpal joint.

Anatomy and clinic application of reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle / 中华显微外科杂志

Objective To explore a surgical treatment of skin defects on the thumb by reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle.Methods The origin,courses and distribution of dorsoulnar artery of thumb from 70 adult cadaveric hand specimens perfused by red latex were explored.Skin defects on the thumb of 8 cases were repaired with reverse-flow island flaps on dorsal thumb web.The cut areas of flaps vary from 4.5 cm × 3.0 cm to 7.5 cm × 4.0 cm.Results There were 4 types of the dorsoulnar artery of thumb basing on the origin and courses.Type Ⅰ was outside the first dorsal interosseous muscle type,which was the dorsoulnar artery of thumb mainly originated from the first dorsal metacarpal artery and cross through the surface of the first dosal interosseous muscle(42.9％).Type Ⅱ was under the first dorsal interosseous muscle type,which was from the thumb principal artery or deep branch of radial artery and run under the first dorsal interosseous muscle(41.4％).Type Ⅲ was mixed type from the anastomose point of above two arteries at the level of the first metacarpophalangeal joint(11.4％).Type Ⅳ was absence type (4.3％).Eight flaps fully survived.Excellent texture and satisfying appearance of the flaps as well as normal thumb web function were verified after 8 months' follow-up.Conclusion It is significant to determine the type of dorsoulnar artery of thumb to decide different operations due to the artery's considerable variation.The reverse-flow island flap on dorsal thumb is an ideal method to repair soft tissue defect on the thumb for its convenient operating and little effect in the donor area.

Simultaneous Double Injury of the Interphalangeal Dislocation and Bony Skier's Thumb: A Case Report

Simultaneous double injury of the thumb at the interphalangeal joint and metacarpophalangeal joint occurring at the same time are seldom seen in medical practice. 72 year old male had posterior discation of interphalangeal joint and ulnar collateral ligament injury of metacarpophalangeal joint, as known as skier's thumb after he fell down from the bike. Open posterior dislocation of interphalangeal joint was stabilized by reduction and then skin suture was done. Metacarpophalangeal joint had totally ruptured ulnar collateral ligament with Stener lesion and bony fragment of base of proximal phalanx. The joint was subluxated and was not reduced due to jammed bony fragment. Displaced avulsion fracture of volar plate with ulnar collateral ligament injury was not reported by author's research. The author reduced bony fragment in joint and repaired ulnar lateral ligament. It has been 6 month after the operation and the patient is followed up. The patient has normal range of motion without instability of metacarpophalangeal and interphalangeal joint. We report our experience about simultaneous double injury of thumb and bony skier's thumb.

Thumb Reconstruction with a Free Neurovascular Wrap / 대한정형외과학회잡지

On the length, strength, free lateral motion, and perfect mobility of the thumb, depends the power of the human hand. The thumb is called pollex because of its strength and that strength is necessary to the power of the hand being equal to that of all the fingers."So stated Sir Chales Bell in the fourth Bridgewater Treatise, first published in 1833. Morrison and O'Brien advocated reconstruction of the thumb with a free wrap around flap from the big toe to recreate a stable, sensate and functional digit including the nail in 1980. From March, 1982 to July, 1988, Twelve thumb reconstructions were performed using the wrap around procedure at Hanyang University Hospital;12 successful thumb reconstructions were reviewed at an average of 16 months after surgery. There were several complications;these included skin necrosis(4), malunion(1), resorption of the bone graft(7). We considered that cosmesis and function were good;pinch grip averaged 68% of normal, sensibility returned in all patients as assessed by two-point discrimination(average 9.5mm). Over all the results are as follows. 1. The wrap around technic provides a good method of reconstruction. 2. The wrap around technic is one stage operation and can be used in the level of metacarpal amputation. 3. The surgeon should be familiar with microsurgical technic.

Thumb Reconstruction with a Osteocutaneous Free Flap Transfer with Partial 1 st Matatarsus (Case Report ) / 대한정형외과학회잡지

Thumb reconstruction with a free neurovasculsr wrap around flap from the great toe by microsurgery had been first reported by O'Brien, Macleod and Morrison in 1980. We have performed one case of thumb reconstruction with psrtial first metstarsus for loss of thumb except pulp and one digital vessel by microsurgery. The results were summerized as followings ; 1. This one stage procedure has the unique advantage to reconstruct a thumb almost identical to the origin. 2. This technique allows preservstion of the toe and the secondary defect results in no significant morbidity.

The Clinical Study of First Metacarpal Base Fracture / 대한정형외과학회잡지

The first metacarpal base fracture is classified as extra-articular fracture, intra-articular fracture and epiphyseal injury. Intra-articular fracture was firstly described in 1882 by Bennett and Rolando described about Y shape comminuted fracture in the first metacarpal base in 1910. In 1938, Robert wrote about oblique fracture injured by first metacarpal base fracture. First metacarpal base fracture can be adjusted easily by C/R, but it is difficult to maintain the good axis. In case of fail of reduction, malunion, joint stiffness and traumatic arthritis can be shown as complications and finally some problems in grasping and pinching are resulted. Therefore, firstly the most accurate reduction, secondarily effective method to maintain the condition and thirdly the protection of limitation of motion are goal of treatment. Authors reviewed 17 cases treated by 0/R & C/R for the past 5 years from 1975 to 1980 at National Medical Center, especially reviewed the cases of which observation more than 1 year was possible. The results were as followings: 1. The incidence of first metacarpal base fracture was 1.0% of all fractures & dislocations. 2. Out of 17 cases, there were 14 male and right side 9 cases and left side was 8 cases. 3. The most common case of fracture was injury at work and traffic accident, sports injury, slipping down and falling down. 4. The method of treatment were C/R & percutaneous pinning in 10 cases and 0/R & K-wire fixation were 7 cases. 5. The result of treatment showed 8 excellent, 1 good, 1 fair, out of 10 cases of C/R and percutaneous pinning. In 0/R and K-wire fixation, 4 excellent, 2 good, and 1 fair showed out of 7 cases. 6. Soft tissue infection was appeared from 1 case of open fracture which accompanied second metacarpal fracture as complication and it caused adduction contracture in first web space.