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Objective:To describe the treatment of the first carpometacarpal arthritis in Eaton Ⅱ, Ⅲ combining the hemi excision of trapezium with tendon ball and evaluate its clinical efficacy.Methods:Data of patients with the first carpometacarpal arthritis who were treated by hemi excision of trapezium and tamponade of the tendon ball from March 2013 to October 2018 were retrospectively analyzed. Twelve patients were all females with an average age of 55±2.8 years (range, 48-61 years). There were 3 cases of left thumbs and 9 cases of right. The study was only researched with primary osteoarthritis patients, preoperative imaging Eaton stages, including 8 cases inⅡstage, 4 cases in Ⅲ stage. Postoperative X-ray examination was performed, and the subsidence rate of the first metacarpal bone was evaluated according to height of arthroplasty. Preoperative and postoperative pain was evaluated according to visual analogue scales (VAS) score and DASH score. Preoperative and postoperative finger movement was evaluated according to the changes in preoperative and postoperative grip and pinch force.Results:The average follow-up period was 12±4.8 months (range, 6-17 months). The mean score of VAS after operation was 1.2±1.0 which was lower than 6.3±1.5 before operation ( t=13.4, P=0.0001); DASH score after operation was 26.2±9.6 which was lower than 48.9±13.0 before operation ( t=5.7, P=0.0001); Grip force after operation was 25.5±6.8 kg which was higher than 15.0±2.9 kg before operation ( t=7.3, P=0.0001); Pinch force after operation was 3.2±0.8 kg which was higher than 2.1±0.4 kg before operation ( t=3.6, P=0.0045), and all of these four above data has statistic difference. At the latest postoperative follow-up, the height index of arthroplasty was 0.299±0.022, and there was no significant change ( F=1.337, P=0.276) when compared with 0.306±0.021 before surgery and 0.313±0.024 after surgery. After the operation, 2 patients presented with incision redness and swelling and exudation. It was considered that local hematoma in the intra-articular operation could not be completely absorbed. After several dressing changes, the redness and swelling subsided and the exudation was controlled. Conclusion:Preserving the proximal joint surface of trapezium and tamponading tendon ball, could reduce the subsidence rate of the first metacarpal bone and alleviate the pain of the first carpometacarpal joint, thus may effectively improve the joint function. It has a significant effect on the treatment of Eaton Ⅱ,Ⅲ stage of the first carpometacarpal arthritis.
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Objective To investigate the clinical effects of reparing the complicated soft tissue defects of limbs with free thoracodorsal artery perforator (TDAP) flaps.Methods From April,2009 to March,2014,19 limbs (including 8 upper limbs and 11 lower limbs) soft tissue defects with bone and tendon exposure were repaired with free TDAP flaps in the secondary stage.There were 12 thoracodorsal artery perforator flaps,5 polyfoliate perforator flaps,1 chimeric muscle flap,and 1 chimeric muscle polyfoliate flap.The sizes of the flaps ranged from 5.0 cm×6.0cm-20.0 cm×l 1.0 cm.Seventeen wounds of the dornor site were closed directly,and the other 2 were closed with skin grafts.Results Sixteen flaps survived successfully.Two flaps had venous congestion and survived at last after taking the stitches out.One flap had partial necrosis and repaired by skin graft finally.The clinical results were satisfactory after 12-18 months following-up,and the scars of the dornor sites of all but 3 patients were not obvious.All the shoulder function were normal.Conclusion The TDAP flap has dependable blood supply,good texture,less dornor site morbility.The polyfoliate TDAP flap can be used for repairing irregular defect.The chimeric latissimus TDAP flap can be used for the function reconstruction.The free TDAP flap is suited for repairing soft tissue defects of the limbs.
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Objective To evaluate the clinical outcome of the method of repairing donor site of foot after improved toe-to-thumb reconstruction utilizing superficial circumflex iliac artery perforator (SCIAP) chimeric flap.Methods Fourteen cases of thumb defect were recruited from April,2012 to January,2016.According to Gu Yudong's classification,5 cases met the criterion of type Ⅰ,4 cases met the criterion of type Ⅱ,and 5 cases met the criterion of type Ⅲ.For type Ⅰ,the thumb was reconstructed with the great toe wrap-around flap.For type Ⅱ and Ⅲ,the thumb was reconstructed by the combined tissue with mutual artery (great toe wrap-around flap,and the bonetendon tissue of the second toe).All the donor sites of foot were repaired utilizing SCIAP chimeric flap.Results All the reconstructed thumbs survived.Among 14 free flaps of donor site,1 case suffered venous crisis and survived after exploration and rescue surgery.Dorsal skin necrosis of the second toe was found in 1 case,which was healed by local skin flap transposition.All patients were followed-up ranged from 3 to 30 months (averaged at 16 months).In spite of slightly bloated,the color and texture of all the flaps' was satisfied,and the average healing time of the bone in the donor sites was 2.5 months.All patients did not feel painful and had no adverse effect when walking and running.Three months after the operation,5 slightly bloated flaps in the donor sites under went flap plastic and achieved better appearance.On the part of iliaca,there was only one inconspicuous linear scar without any discomfort.Conclusion Repairing donor site of foot after improved toe-to-thumb reconstruction utilizing SCIAP chimeric flap was an ideal method.Using this method,the reconstructed thumb can achieve good appearance and function,all the toes of donor site were reserved,and the disability of the donor site is minimized.
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Objective To explore the anatomic characteristics of the peroneal perforator branches and its clinical application as vascularized flap transfer. Methods Twenty fresh cadaver specimen with 40 sides lower limbs were used in this study.Lead oxide gelatin was injected to the whole body,lower extremity radiaograph, spiral CT scan was then used to construct three demention visual model. The peroneal artery and its perforators were dissected,number of peferators,distance to fibular head,diameter and the length of the vascular pedicles were measured and analyzed. From July 2005 to October 2009, forty-three cases with skin defects were performed vascularized transfer in our study,surviving rate and postoperative function were followed up for 6 months to 2 years.Results Perforators were seen most at (9.80 ± 0.93)cm,(13.40 ±0.90) cm,(17.20 ± 1.13)cm,and (21.30 ± 0.77)cm beneath the fibular head with the artery branch diarneter(1.33 ± 0.39) mm,(1.30 ± 0.46)mm,(1.17 ± 0.30)mm,and (1.22 ± 0.23)mm,respectively,while the pedicle length was (5.87 ± 0.73)cm,(5.83 ± 1.73)cm,(5.44 ± 1.09)cm,and (5.10 ± 1.93) cm respectively.In clinic,42/43 free flaps survived.Postoperative outlook were satisfied except in 7 cases,the flaps looked bulky and needed secondary revision.All the donor calves showed good apperaence and function.Conclusion There are 4 regular perferators in lateral calf, while perforators in the middle 1/3 are bigger with relatively longer vascular pedicles which are appropriate for vascularized transfer.