A More Hygienic Method for Measuring Blood Pressure

Background : Blood Pressure (BP) measurement is the commonest test performed in any healthcare facility. The same BP cuff is used for measurement of BP in many patients. The BP cuff can get contaminated with microorganisms1. It may become a vector in transmission of communicable and infectious diseases. The Corona Pandemic has highlighted the needs to prevent transmission of infections by taking precautions in health care facilities. Disposable BP cuffs are available in Western Countries. Though they solve the contamination problem effectively, they are very expensive. To overcome the problem of contamination of the BP cuff, we propose to use a very thin plastic paper to cover the arm of the patient, to tie the BP cuff on the plastic paper so that the cuff does not come in contact with the patient’s body. Aim : To validate the accuracy of the BP measured after tying the cuff in such non contact manner. Settings and Design: The study was carried out at Dr Rajeev Raut Eye Clinic with consent obtained from Ethics Committee. 50 patients underwent BP measurement in supine position with and without the plastic wrap around the arm. The results of BP measurements thus obtained were statistically analysed. Results : The BP measurement obtained with the wrap and without the wrap were not found to be statistically significantly different. Conclusions : The BP measurements obtained using a Polyvinyl Chloride (PVC) cling film wrap covering the arm are similar to those obtained without the use of the wrap. However, further studies are needed to prove the reduction in contamination rate.

Emergency thumb reconstruction for traumatic thumb amputation with bone and tendon from the amputated part without replantation condition / 第二军医大学学报

Objective To investigate the feasibility of emergency thumb reconstruction for traumatic thumb amputation with bone and tendon from the amputated part, when the soft tissue is severely damaged and the amputated thumb is not replantable. Methods When the soft tissues of the amputated thumb was severely damaged and replantation was not applicable, thumb reconstruction as phase one emergency management was proceeded. The skin and nail bed of the amputated thumb was removed. The bone was in situ replanted, and the tendon was repaired. The nail flap from the ipsilateral toe was grafted and the bone and tendon was wrapped around to reconstruct the thumb. Results A total of 5 patients underwent surgical treatment. All reconstructed thumbs survived with an appearance similar to the contralateral sides. The patients were followed up for 10 months on average (range, 4 to 18 months). The result of two-point discrimination test was 10.1 mm on average (range, 9.2-12.0 mm). The preserved joints possessed partial function. The average range of motion of the metacarpophalangeal joint was 69.6° (range, 20° to 90°). The range of motion of interphalangeal joint was 15° and 20° in 2 patients, respectively. No infection or bone resorption occurred. The injury was healed successfully in 4 patients, and delayed union occurred in one patient. Conclusion Complete bone and tendon from the nonreplantable amputated part combined with wrap-around flap can be used for emergency thumb reconstruction and it can achieve good clinical results.

Effects of the use of bioceramic wraps in patients with lower limb venous ulcers: A randomized double-blind placebo-controlled trial / 中西医结合学报

BACKGROUND@#Venous ulcer represents the most advanced stage of chronic venous insufficiency. It is an important public health problem and has a significant impact on patients' quality of life due to chronic pain, inability to work, need for hospitalization and frequent outpatient follow-up.@*OBJECTIVE@#We investigated the treatment benefits of far-infrared ceramic (cFIR), in a 90-day study of lower limb venous ulcers and looked at ulcer healing scores, quality of life, serum bio-markers of oxidative stress and antioxidant defense enzymes.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS@#This is a randomized double-blind placebo-controlled study conducted in the Vascular Surgery Service of a hospital located in the northwest region of the State of Rio Grande do Sul, Brazil. We included patients with lower limb venous ulcers who were randomized to use either a bioceramics wrap or a placebo wrap for 90 days.@*MAIN OUTCOME MEASURES@#The following evaluations were conducted at baseline and after 15, 30, 60 and 90 days: ulcer healing score, quality of life, and serum markers of oxidative stress and antioxidant enzyme activity.@*RESULTS@#Patients (n = 24) with lower limb venous ulcers were randomized into two treatment groups. cFIR decreased the ulcer size on day 30 (P = 0.042) and 90 (P = 0.034) and the total ulcer healing scale scores on day 30 (P = 0.049) and 90 (P = 0.02) of the treatment, when compared to baseline. Additionally, cFIR improved tissue type (epithelial tissue) on day 60 (P = 0.022) when compared to baseline evaluation.@*CONCLUSION@#cFIR clinically improved ulcer healing in patients with lower limb venous ulcers.@*TRIAL REGISTRATION@#RBR-8c7xzn on ReBEC.

A study on the non-infectious complications of continuous ambulatory peritoneal dialysis

Introduction: Patients with end-stage renal disease (ESRD) are treated with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).Non-infectious complications of CAPD are increasing in relative importance due to success in decreasing the rate of peritonitis. Aims and objectives: Our aim was to study the non-infectious complications in patients of ESRD on CAPD and to study the impact of the non-infectious complications in the survival of CAPD catheters. Materials and Methods: A prospective study has been conducted at Regional institute of medical science, Imphal in a total of 71patients of ESRD who are already on CAPD or newly diagnosed ESRD who have undergone CAPD catheter implantation. Their detailed history, clinical examination and relevant laboratory investigations were done and the different non-infectious complications were identified and analysed. Result: Out of the 71 patients studied 39 patients had complications like hypokalemia (15 patients), omental wrap (10 patients), catheter tip migration (6 patients), haemoperitonium (2 patients), hydrothorax (2patients), exit site leak(2patients), abdominal wall edema (1patient), catheter block(1patient). Conclusion: In our study the most common non-infectious complication was hypokalemia followed by omental wrap and catheter tip migration. Knowledge about the common prevalent non-infectious complications of CAPD alerts the treating doctor to take up the specific corrective steps at an earlier stage, thus preventing the morbidity associated with the same. We conclude that the majority of non-infectious complications in these patients were treatable and did not interfere with the catheter survival.

Efficacy and Utility of Wet Wrap Dressing for Patients with Pediatric Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Management of atopic dermatitis (AD) involves the regular use of emollients together with topical steroids or calcineurin inhibitors for acute flares. However, the long-term use of oral medications in young children may have certain limitations. Wet wrap dressing (WWD) is an interesting alternative therapy for the short-term control of severe or refractory flares, thus avoiding the use of systemic treatments. OBJECTIVE: This study aimed to compare the efficacy between WWD and topical steroid agents and to control and estimate the utility of WWD in pediatric AD. METHODS: A total of 40 patients with mild-to-severe AD (eczema area and severity index of ≥3) aged <13 years were included in this study. Twenty patients were treated with WWD using two layers of cotton bandages or garments (Tubifast™), and the remaining were applied with topical steroid agents without cotton bandages. Improvement in severity of atopic dermatitis was evaluated using the eczema area and severity index (EASI). Improvement in skin barrier dysfunction was evaluated by measuring the transepidermal water loss (TEWL). We compared the two groups after 1 week of treatment using analysis of covariance and t-test. Furthermore, we surveyed the study groups using a questionnaire to estimate the utility of WWD and its adverse effects as well as to evaluate subjective outcomes of WWD. RESULTS: There were significant reductions in the mean EASI (−6.3, 95% confidence interval [CI]: −7.5 to −5.1, p=0.013) and TEWL (−26.7, 95% CI: −31.2 to −22.3, p=0.002) after 1 week of WWD treatment compared with the mean EASI (−4.0, 95% CI: −5.2 to −2.9) and TEWL (−15.4, 95% CI: −19.8 to −10.9) of the control group. Results of patient self-assessment and scores in the visual analogue scale (VAS) for pruritus were improved in both groups, but the differences were not statistically significant. Usefulness of WWD as an alternative therapy for the conventional therapy was satisfactory. CONCLUSION: This study is meaningful in that it estimates both the subjective and objective efficacy of WWD. In view of these findings, WWD showed superior therapeutic effects than conventional steroid application in the treatment of AD in children, with good compliance of patients and parent-caregivers.

The efficacy of wet wrap therapy in children with atopic dermatitis in a single center

PURPOSE: Wet wrap therapy is a well-known treatment for severe atopic dermatitis (AD). However, wet wrap therapy with usual bandage was a troublesome and time-consuming process of application. The aim of this study was to evaluate the efficacy, safety and convenience of wet wrap therapy with new garments in children with moderate-to-severe AD. METHODS: We compared 56 AD children treated with wet wrap therapy and 14 AD children treated with only conventional therapy. We retrospectively reviewed the clinical features, change of SCORing Atopic Dermatitis (SCORAD) index, adverse effects and parent's reports. RESULTS: The initial mean SCORAD index was 60.3±15.3 points. No significant differences in sex, age, initial SCORAD index, total eosinophil count, total IgE level, food allergen sensitization, inhalant allergen sensitization or associated allergic diseases were found between the wet wrap and conventional groups. The pharmacological and nonpharmacological interventions except wet wrap therapy were same in the 2 groups. Wet wrap therapy with garments or tubular bandage was easily done one time per day overnight in 10.6±3.5 days by parents. Improvement in total SCORAD index, intensity, subjective symptoms and pruritus were significantly higher in the wet wrap group than in the conventional group (36.2 vs. 26.9, 6.0 vs. 4.0, 9.9 vs. 7.4, and 4.8 vs. 3.6 points). No folliculitis and serious adverse effects were reported. CONCLUSION: Wet wrap therapy with new garments could be easily done by parents. Wet wrap therapy may be effective and safe in controlling moderate-to-severe AD in children.

Efficacy of wet-wrap treatment for 13 cases of severe childhood atopic dermatitis: a clinical observation / 中华皮肤科杂志

Objective To evaluate the efficacy and safety of wet-wrap treatment (WWT) for severe childhood atopic dermatitis (AD).Methods A total of 13 children with severe AD were enrolled from Department of Dermatology of Beijing Children's Hospital between September 2016 and March 2017,whose diagnosis was based on the Williams' diagnostic criteria and SCORing atopic dermatitis (SCORAD)score was more than 50.These patients received WWT daily for 3-5 days.The changes of SCORAD and visual analog scale (VAS) scores before and after treatment were evaluated.Moreover,3 patients with symmetrical skin lesions on bilateral limbs were selected,and received WWT (WWT group) and traditional topical treatment (control group) on the bilateral limbs respectively for 3 days.After the treatment,the severity of local skin lesions on the bilateral limbs were evaluated and compared.Results Before the treatment,the SCORAD and VAS scores of the 13 patients were 60.2 ± 9.7 and 7.3 ± 1.8 respectively.Three to five days after the WWT,the SCORAD and VAS scores significantly decreased to 24.7 ± 5.8 and 2.4 ± 1.0 respectively (t =15.128,9.385 respectively,P ＜ 0.001).Of the 13 patients,12 achieved a more than 50％ improvement in SCORAD.After 3-day treatment with WWT in the 3 patients,the severity score of skin lesions was significantly lower in the WWT group than in the control group (t =7.0,P ＜ 0.05).Mild adverse reactions to WWT occurred,and 3 patients reported discomfort induced by wetness during the treatment.Conclusion WWT shows rapid efficacy and less adverse reactions in the treatment of severe childhood AD,and its therapeutic effect is superior to that of traditional topical treatment.

Repair of the donor defect after wrap-around flap transfer with free thinned innervated anterolateral thigh perforator flap / 中国修复重建外科杂志

Objective: To explore the feasibility of harvesting free thinned innervated anterolateral thigh (ALT) perforator flap for repairing the donor defect after wrap-around flap transfer.

The Influence of Different Wrap Method on the Intracranial Pressure of Patients after Standard Craniectomy / 昆明医科大学学报

Objective To explore the influence of different methods of bandaging on the postoperative intracranial pressure of patients with severe brain injury patients after decompression craniectomy. Methods The standard decompressive craniectomy was use for the 36 cases of severe traumatic brain injury patients, and the intracranial pressure monitoring sensor probe was indwelled in operaion. Two different dressing methods of elasticity mesh cap and applicator were used for the patients respectively at 0h, 72h, 120h and 168h after operation, and the value of intracranial pressure was monitored and recorded. Result The intracranial pressure of elastic cap were significantly higher than the applicator respectively in operation immediate postoperative 72h, 120h and 168h (P<0.05), the difference was statistically significant. Conclusions The intracranial pressure of elastic cap is significantly higher than the applicator at different times after the surgery group.

Bilateral big toe wrap-around flap for reconstruction of the defects of the finger / 中华显微外科杂志

Objective To investigate the therapeutic effect of bilateral combined flap transfer in reconstruction and repairation of thumb and finger defects.Methods A partial fibular side wrap-around flap was harvested from both big toes.The flaps were tailored and designed based on measurements taken from the finger of the intact side.These two flaps were combined to reconstruct the defects of the finger.From March,2008 to December,2015,a total of 9 fingers (9 cases) which had defect degrees range from Ⅰ ° to Ⅲ° underwent reconstruction surgeries in this way.Appearance,sensation and function of the thumb and foot flap were followed-up.Simultaneously how to improve the outcoming and success rate were explored and investigated.Results All 9 thumbs and fingers in 9 cases with these procedures were survived.No vascular crisis happened.All patients were followed up from 3 to 24 months.The reconstructed thumbs and fingers were all with abundant blood supply,having similar shape to the normal thumbs and fingers,good pain and temperature sensation,with two-point discrimination of 4-8 mm.All patients were satisfied with the thumb and finger shape,regained life and work ability as before.The donor sites had no obvious discomfort,and walking and weight-bearing function remained normal.Judged by the tentative evalution standard of function of upper limb,which was made by Chinese Medical Association for Surgery of the Hand.The results were excellent in 6,good in 2,fair in 1.Conclusion There is less damage on foot and most hand function recovery using bilateral combined flap transplantation to repair multiple fingers defect.

Subemergency reconstruction of grade Ⅲ and Ⅳ thumb defect by great toe wrap-around flap combined with the tissue flap of second toe / 中华显微外科杂志

Objective To explore the surgical technique and clinical effect of combined great toe wraparound flap and second toe tissue flap transfer for subemergency reconstruction of grade Ⅲ and Ⅳ thumb defect.Methods From July,2011 to March,2014,12 patients of grade Ⅲ and Ⅳ thumb defect were treated by transfering combined great toe wrap-around flap and second toe tissue flap transfer.The second toe tissue flap was carried out to cover donor site defect of the big toe.Results All the 12 transplants survied and were followed up for 6 to 24 months.The reconstructed thumbs had near nomal appearace and good fuction,2-point discrimination ranged from 0.6 cm to 0.8 cm.According to the trial standard of upper limb part of functional assessment of the Hand Surgery Branch of Chinese Medical Association,among the 12 eases,there were excellent in 9,good in 3.Impact on the donor foot was minor with limited complications.The patients were able to weight-bearing walking after one months of operation.For long-term follow-up,no case had successive ulces,obvious pain and claudication.Conclusion The reconstructed thumbs by great toe wrap-around flap combined with the tissue flap of second toe had near nomal appearace and good fuction.

Long-Term Clinical and Angiographic Outcomes of Wrap-Clipping Strategies for Unclippable Cerebral Aneurysms

PURPOSE: To evaluate the efficacy and stability of the wrap-clipping methods as a reconstructive strategy in the treatment of unclippable cerebral aneurysms. MATERIALS AND METHODS: Twenty four patients who had undergone wrap-clipping microsurgery were retrospectively reviewed. Type and morphology of the treated aneurysm, utilized technique for wrap-clip procedure, and clinical outcome with angiographic results at their last follow-up were evaluated. RESULTS: Of 24 patients, eleven patients had internal carotid artery (ICA) blister-like aneurysms, three had dissecting type aneurysms, and ten had fusiform aneurysms. The follow-up period for the late clinical and angiographic results ranged from 10 to 75 months (mean 35 months). Wrap-clipping was performed in eleven, wrap-holding clipping was in ten, and combination of wrap-clip and wrap-holding clip was in three cases. At the last angiographic follow-up study, twelve aneurysms (50%) were found to have completely healed, and nine aneurysms (38%) were at least stable. However, wrap-holding clip for the elongated blister type of ICA aneurysm was found failed, leading to fatal rebleeding in one case, and two cases of combination of wrap-clip-wrap-holding clip revealed delayed branch occlusion and marked regrowing, respectively. CONCLUSION: Wrap-clipping strategy could be an easy and safe alternative for unclippable aneurysms. The wrapped aneurysm mostly disappeared, or at least remained stationary, after a long-term period. However, surgeons should be aware of that the wrapped aneurysm might become worse. Therefore, follow-up surveillance for an extended period should be mandatory.

Application of combined wrap-around flap from the big toe and flap from the opposite foot in treating degloving injuries of the whole thumb / 中华显微外科杂志

Objective To explore the new operation method and clinical effect of treating degloving injuries of the whole thumb.Methods Nine cases of the whole thumb degloving injury caused by machine were treated with free wrap-around flap from the big toe and the flap from the opposite foot.The phalanges,joints and tendons of all injured thumbs were integral relatively,except that the interphalangeal joints in 3 cases were destroyed and the flexor and extensor pollicis longus were ruptured.The size of the dorsal tissue defects varied from 4.8 cm × 2.9 cm to 6.2 cm × 3.4 cm,and the volar tissue defects ranged from 4.7 cm × 3.2 cm to 6.1 cm × 4.0 cm.The area of the wraparound flap from the big toe harvested was from 5.0 cm × 3.2 cm to 6.7 cm × 3.9 cm.The flap from the opposite foot was tibial flap with dorsalis pedis flap from the opposite second toe,and the area of the flap was from 5.0 cm × 3.5 cm to 6.6 cm × 4.5 cm.Results All 9 combined flaps survived.The wound healed primarily.Skin grafts in the donor sites of the foot also survived.Postoperative follow-up ranged from 6 to 20 months,with an everage of 9 months.The pulp of the thumb was well-stacked.Sensory recovery ranged from S3 to S3 +.Thumb nail grew well.Thumbs performed good functions as grabbing,grasping and nipping.The range of motion of the MP joints of the reconstructed thumb was normal.The motion of interphalangeal joints were acceptable in 6 cases,but worse than the normal thumb.The interphalangeal joint in 3 cases destroyed was fused.There was no obvious influence on the function of the foot.Conclusion Applying combined wrap-around flap from the big toe with the tibial flap and dorsalis pedis flap from the opposite foot in treating degloving injuries of the whole thumb is a new operation method,which could achieve good appearance and function,but have a small influence on the donor site.It is worthy being used widely in clinical.

Repairing donor site after harvested of wrap-around flap of toe by peroneal artery perforator flap / 中华显微外科杂志

Objective To investigate the prothetic effect of free grafting of microvascular anastomotic peroneal artery perforator flap when used to repair the donor tissue defects of wrap-around flap of toe.Methods From January 2008 to March 2013,twenty-six cases thumb avulsion at proximal and distal phalanx level with skin and nail bed defect caused by trauma were admitted to our hospital.After incising wrap-around flap of toe to repair the thumb defects,microvascular anastomotic peroneal artery perforator flap was transplanted freely to repair the donor site of it.Results The skin flaps of 26 cases all successfully survived.After a followed-up of 3 months to 4 years,the length of donor toes were the same as before.The appearance of skin flaps were no fat and clumsy and the abradability of their skin were well.Algesia,thalposis and thigmesthesia were partially recovery.Two point discrimination reached to 5-10 mm.There were no obvious uncomfortableness in donor feet when standing and walking except wearing flip-flops.Conclusion Free grafting of peroneal artery perforator flap is a good method to repair the donor defect caused by incising wrap-around flap of toe.

Polyethylene Wrap for Thermoregulation in the Preterm Infant: A Randomized Trial.

We compared the response of temperature adaptation in preterm infants using the polyethylene wrap with and without previous drying versus the sterile preheated field. Both groups of polyethylene use achieved a mean axillary temperature of 36.5°C at 30 minutes compared with 75 minutes for the group of traditional care. At 120 minutes, the incubator temperature was higher in those using preheated field, compared with infants in the polyethylene wrap with or without previous drying, (35.15°C, 34.20°C and 34.20°C respectively; P = 0.0001). No difference in axillary or incubator temperature was found between the groups using the polyethylene wrap.

Using modified great toe wrap-around flap to reconstruct degloved thumb and fingers / 中华显微外科杂志

Objective To explore the clinical outcome of using modified great toe wrap-around flap to reconstruct degloved thumb and fingers.Methods Eighteen patients were involved.Based on different types of injury,four procedures were carried on for reconstructing degloved thumb and fingers:①Unilateral modified great toe wrap-around flap to reconstruct 9 degloved thumbs of distal proximal level and 3 degloved fingers of proximal interphalangeal joint level.②Unilateral modified great toe wrap-around flap with second toe medial flap to reconstruct 2 total degloved fingers.③Bilateral modified great toe wrap-around flap to reconstruct 2 thumbs.④Bilateral modified great toe wrap-around flap and second toe medial flap with neurolized super thin anterolateral thigh flap to reconstruct 12 degloved fingers.This wrap-around flap carried with entire nail.A triangle flap was reserved at medial plantar of great toe.Results All free flaps were survived in one stage.Fifteen patients were followed up for 8 to 25 months.The contour of reconstructed digit was as same as contralateral digit with satisfactory motion arc and sensation.There was no extensive scar in donor toe.The width of medial plantar triangle flap increased significantly.All patients could walking,running,jumping without restricted.Conclusions With reconstructed by modified great toe wrap-around flap,degloved thumb or finger can be promised with excellent contour and function outcome.In the meantime,the loss of donor foot can be expected to minimal.This procedure is one of the best ways for reconstructing degloved thumb and finger.

Resurfacing of the donor defect after wrap-around toe transfer using the Y-V vascular pedicle lengthening technique / 中华显微外科杂志

Objective To explore the methods of Y-V vascular pedicle lengthening technique for cover-age of the defect of great toe after wrap-around flap transfer, and decrease the morbidity of donor site in great toes. Methods Fifteen patients received three kinds of flap for immediate resurfacing of donor defect of the great toes during wrap-around flap transfer, all flaps were harvested with Y-V vascular pedicle lengthening technique. Among them, 9 cases received the free lateral tarsal flaps transplantation for coverage of defect in donor great toes, 5 cases was repaired by medial tarsal flaps, and only one was treated by the medial plantar flap. Results All the flaps survived postoperatively. The medial plantar flap encountered the venous crisis in postoperative 3 days, and regained the normal blood supply after continuous bleeding for 2 days. All patients were satisfied with cosmetic and functional outcome in average 10- month follow-up. The appearance and sensory function of donor toe repaired by medial tarsal flaps was best among three ones. Conclusion Depending on the Y-V vascular pedicle lengthening technique, the local pedical flaps of foots are enlarged scope for coverage of great toe after wrap-around flap harvest, which can decrease the complication of donor site at the most.

Staged Reconstruction of the Mangled Hand with the Combined Use of Pedicled Groin Flap and Free Wrap Around Flap

PURPOSE: Despite the free tissue transfer using microsurgical technique being the current trend of soft tissue reconstruction of the hand, the pedicled groin flap has the advantage to provide coverage for the mangled hand without necessitating the use of a damaged arterial system and also providing the benefit of saving the arterial system for later free tissue transfer. This report presents the author's experience using pedicled groin flap in four cases of mangled hands with massive bone and soft tissue defects requiring later thumb reconstruction with the free wrap around flap. MATERIALS AND METHODS: The patients' age ranged from 30 to 51 years; three patients were male and one was female. The causes of mangled hand included two machinery crush injuries, one laboratory explosion and one motor vehicle accident. While evaluating the post-operative results, factors like flap survival, complications, stability in opposition, pinch power and 2 point discrimination were taken into account. RESULTS: All massive soft tissue defects of the hands were completely covered with pedicled groin flap successfully. The reconstructed thumb using free wrap around flap did not have any limitation in opposition. There was no occurrence of post-operative infection and all the flaps survived completely. The average pinch power was 70% of the contralateral intact thumb and average 2 point discrimination was 10 mm. CONCLUSION: The pedicled groin flap for the reconstruction of the massive soft tissue defects of the hand with subsequent reconstruction of the thumb with a wrap around flap is a very useful procedure. The combined use of pedicled groin flap and wrap around flap allows adequate coverage of sizable soft tissue defects and functional thumb opposition in cases of reconstruction of the mangled hands.

Treatment of the donor site after wrap around flap from toe / 中华显微外科杂志

Objective To investigate the methods to cover the donor site of wrap around flap from toe. Methods In 34 cases, 8 thumbs reconstructed with wrap around flap from great toe, 8 thumbs and 14 fingers reconstructed with half nail flap from fibular side of second toe, and 4 fingers reconstructed with dorsal nail flap from second toe. The donor site were covered with pedicle flap (first metatarsal dorsal flap, second toe digital flap, neighbor flap from dorsal of second toe, and lateral tarsus flap) or free flap (medical plantar flap, fibular artery flap, and lateral tarsus flap). Results Twelve cases were followed up after 2 months, normal gait were found, 6 cases were followed up after 4 months, (4 cases for first metatarsal dorsal flap, one for fibular artery flap and one for internal volar flap). 2 cases recovered defend sensibility and showed a bit dark, the cases which reconstructed with medical plantar flap and second toe digital flap had nearly normal sensibility. The outward appearance of the donor site were chubbiness, flexible, and no complaint were found. Conclusion Covered the donor site of wrap around flap from toe with these flaps can avoid complications like pain and ulcerate, and have a satisfactory appearance.

Microsurgical Distal Thumb Reconstruction Using a Mini Wrap-around Free Flap

PURPOSE: Free flaps from the great toe are an established method for reconstruction of absent or partially amputated thumbs. However, options differ as to which technique represents the ideal solution for each level of amputation. Various methods of distal thumb reconstruction have been proposed. We prefer to transplant the entire great toe nail complex with the almost all of the pulp rather than a portion of the nail. This paper reflects our experience in using the great toe mini wrap-around flap for distal thumb reconstruction. MATERIALS AND METHODS: In the period from October of 2005 to July of 2007, 9 patients were treated for traumatic thumb defects localized at the distal phalanx of the thumb. The patients included seven men and two women. The mean age was 44 years (range, 21~60) and the dominant right hand was involved in seven of nine patients. RESULTS: The transferred flaps have survived completely in all cases. The mean range of motion in the interphalangeal joints was 51o, with 73% of the normal uninjured opposite hands. The two-point discrimination was 10.5 mm (range, 5~13 mm). In Semmes-Weinstein monofilament test, the sensibility was 4.31 in 4 cases, 3.61 in 3 cases and 2.83 in 2 cases. The pinch power was 64% (range, 55~95%) of the opposite hand. All patients were satisfied with the appearance of the reconstructed thumb and felt comfortable at final follow-up. CONCLUSION: We have successfully reconstructed 9 cases of traumatic distal thumb defects using the mini wrap-around free flap. The mini wrap-around free flap in great toe is an excellent alternative method for distal thumb reconstruction in selected patients.