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Objective:To explore clinical results in reconstruction of finger C-shape soft tissue defect with the wrist crease free flap carrying cutaneous nerve.Methods:From June, 2017 to April, 2019, 7 fingers(7 patients) with C-shape defect were treated with the wrist crease free flap carrying cutaneous nerve. The size of defect ranged from 1.0 cm × 2.5 cm-2.2 cm × 4.0 cm; the flap sizes were 1.3 cm × 2.7 cm-2.5 cm × 4.5 cm. Five fingers had unilateral defect of proper palmar digital artery. Two fingers that had bilateral defect of proper palmar digital artery with poor blood circulation were re-established with blood supply by Flow-through flaps. Four fingers had unilateral defect of proper palmar digital nerves, and 3 had bilateral defect of proper palmar digital artery. Five of the fingers were repaired by the superficial branch of the radial nerve and 2 repaired by palmar cutaneous branch of median nerve. Regular outpatient follow-up was conducted after surgery for 8 to 15 (mean 11) months.Results:All the fingers and flaps survived with primary healing. Numbness existed in the areas of functional dominance of the cutaneous nerve. At the end of follow-up, the flaps showed good texture without significant bloated appearance with the recovery of protective sensation. The sensation of fingertip recovered to S 4 in 5 fingers and S 3+ in 2 fingers. Finger pulps were plump. All of the fingers moved freely. Linear scars were observed at donor sites and the wrists moved freely. Numbness feeling in the areas of cutaneous nerve disappeared at 6 to 8 weeks after surgery. According to the Functional Evaluation Criteria of the Finger Replantation published by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 6 fingers and good in 1 finger. Conclusion:The wrist crease free flap carrying cutaneous nerve is constant and can be dissected transversely to reconstruct and fit the C-shape defect of finger. It can re-establish the blood supply as well as to repair the proper palmar digital nerve defect at the same time.
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Objective To evaluate the outcomes of thumb reconstruction with dorsal thumb rotated single pedicel reverse island flap.Methods 49 thumb-tip defects cases with dorsal thumb rotated single pedicel reverse island flap were analyzed retrospectively.37 dorsal thumb reverse island flap were performed,and 12 ulnar-dorsal reverse island flaps were performed.Results The operation time was 40-60 minutes.The mean time was 45 minutes.All 49 cases survived completely.The color of the flaps was purple,and blisters in the surface of the flaps after 1-2 days in 2 cases.After took out stitches partly,the blisters were dried and crusted,the color of the flaps with better blood circulation was normal.The follow-up period was 3-24 months,all thumbs had satisfactory appearances and functions.The two-point discrimination was 6-9mm in flaps inosculated with nerve,that was 8-10 mm in flaps inosculated without nerve.The color,texture and elasticity of flaps were excellent,and the donor sites had not been defected.Conclusion Dorsal thumb rotated single pedicel reverse island flap is a reliable option to restore function as well as appearance,long vascular pedicle with skin strap,wide rotation angle,high rate of survival.It avoided damages to the well-known arteries and nerves.It is a relatively facile procedure that can be applied toward resurfacing thumb tip defects.
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Objective To recognize the relationship between high cutantous artery branches and descending branch of lateral femoral circumflex artery artery,and to investigate the blood supply of anterolateral thigh flap in clinical.Methods Retrospective analysis 152 cases of anterolateral thigh flap from November,2003 to December,2016.It contains cutting with descending branchs in 99 cases,cutting with lateral branchs in 43 cases,the union of them in 8 cases and high cutantous artery branches in 2 cases.Results The flaps survival in 147 cases,cutting necrosis in 3 cases and partly necrosis in 2 cases.Descending and lateral branchs were both dominance neurovascular bundle of vastus lateralis muscle,independently or commonly dominate the skin of anterolateral thigh,occurrence rate was 33.5％.Conclusion The descending branch of lateral femoral circumflex artery include lateral branch,all of which are the neurovascular bundles,supply the anterolateral thigh muscle,and divid into some perforator branches crossing the musle to the anterolateral thigh skin subsequently,which constitute "the anatomical functional unit".High cutantous artery branche is the one of all of the branches,its origin lies hight and arise from lateral branch.
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<p><b>BACKGROUND</b>Primary systemic light chain amyloidosis (AL) is a rare plasma cell disease, our purpose was to analyze the immunophenotypic characteristics of the plasma cells in bone marrow in AL patients, and explore whether the detection of abnormal plasma cell clones in bone marrow by flow cytometry (FCM) could be used as an important indicator of AL diagnosis.</p><p><b>METHODS</b>Fresh bone marrow samples were collected from 51 AL, 21 multiple myeloma (MM), and 5 Waldenström's macroglobulinemia (WM) patients. The immunophenotype of bone marrow cells were analyzed and compared by FCM using a panel of antibodies including CD45, CD38, CD138, CD117, CD56, and CD19.</p><p><b>RESULTS</b>In AL, light chain restriction could be identified in 31 cases (60.9%), in which the λ light chain restriction was found in 24 cases (77.4%). In MM, κ light chain restriction was found in 13 cases (61.9%), and λ light chain restriction in eight cases. CD45 on abnormal plasma cells was negative to weakly positive in both AL and MM, but was positive to strongly positive in WM. In the bone marrow plasma cells of the 51 AL, 78.4% were CD56+, 68.6% were CD117+, and 88.2% were CD19-. While in the 21 MM cases, 66.7% were CD56+, 38.1% were CD117+, and 90.4% were CD19-. The plasmacytoid lymphocytes in the five WM patients were CD19+ and CD56-, CD117-.</p><p><b>CONCLUSION</b>Detection of abnormal plasma cell clones in bone marrow by FCM is valuable for the diagnosis of AL.</p>