Application of dual intersecting trapezoid flap in the treatment of scar flexion contractures of fingers / 中华骨科杂志

Objective To explore the procedure method and treatment outcome for the dual intersecting trapezoid flaps for repairing flexion contractures of fingers.Methods From February 2013 to April 2015,data of 26 fingers in 11 patients with flexion contractures who were treated with dual intersecting trapezoid flaps and followed up for more than 1 year were retrospectively analyzed.There were 7 males (16 fingers) and 4 females (10 fingers) with an average age of 38.2 years old (ranged from 28 to 60 years old).17 cases of right finger,and 9 cases of the left.There were 8 fingers of mild contracture,14 fingers of moderate contracture,and 4 fingers of severe contracture.Take the scar wrinkle tension line as the central axis,the distance was from 0.5cm to 0.Scm,and decompose the medial axis evenly,form several symmetrical trapezoid skin flaps on the radial side and ulnar side of the fingers.The direction of the double arm of the trapezoid flap is relative to the angle of the central axis from 60° to 70°,and the double skin flap is interlaced.Incisions were designed in a dual intersecting trapezoid flap over the contracture.Coverd the wound with excess skin and scar folds on the dorsal side of the lateral and interphalangeal joints,and full thickness skin graft was utilized to repair skin defect.Results All 24 flaps survived without blood circulation disorders and infections.Only 2 cases appeared flap tip necrosis,delayed healing.The mean active extension and flexion of DIP joints in mild contracture patients were-3° (ranged from-8° to 0°) and 45° (range from 30° to 60°),respectively;and PIP joints were-5° (ranged from-10° to 0°)and 90° (ranged from 70° to 110°),respectively.Contracture scars were extended by an average of 150％.The mean active extension and flexion of DIP joints in moderate contracture in patients were-5° (ranged from-9° to 0°) and 35° (ranged from 20° to 50°),respectively;and PIP joints were-5° (ranged from-10° to 0°) and 85° (ranged from 75° to 120°),respectively.Contracture scars were extended by an average of 130％.The mean active extension and flexion of DIP joints in severe contracture patients were-8° (ranged from-15° to-5°) and 17° (ranged from 10° to 25°),respectively;and PIP joints were-8° (ranged from-10° to-5°) and 78° (ranged from 70° to 90°),respectively.Contracture scars were extended by an average of 220％.According to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association,mild contracture:the results were rated as excellent in 6 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 87.5％;moderate contracture:the results were rated as excellent in 12 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 92.9％;severe contracture:the results were rated as excellent in 2 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 75％.Conclusion The dual intersecting trapezoid flap plasty is easy to use,which has rich vascularity and mobility,and it is a good way to correct the cross-joint scar contracture flexion deformity with less complications.

Effects of valproic acid on axonal regeneration and recovery of motor function after peripheral nerve injury in the rat

Valproic acid [VPA] is used to be an effective anti-epileptic drug and mood stabilizer. It has recently been demonstrated that VPA could promote neurite outgrowth, activate the extracellular signal regulated kinase pathway, and increases bcl-2 and growth cone-associated protein 43 levels in spinal cord. In the present research we demonstrate the effect of VPA on peripheral nerve regeneration and recovery of motor function following sciatic nerve transaction in rats. The rats in VPA group and control group were administered with valproic acid [300mg/kg] and sodium chloride respectively after operation. Each animal was observed sciatic nerve index [SFI] at 2-week intervals and studied electrophysiology at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed 12 weeks after operation. Using the digital image-analysis system, thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index [motor-nerve conduct velocity], and morphometrical results [regenerated axon number and thickness of myelin sheath] in nerve regeneration between the VPA group and controls [P<0.05]. The results demonstrated that VPA is able to enhance sciatic nerve regeneration in rats, suggesting the potential clinical application of VPA for the treatment of peripheral nerve injury in humans

The application of absorbable self-enhancing cartilage nails in the treatment of radial head fractures / 中华骨科杂志

Objective To evaluate the clinical effect of absorbable self-enhancing cartilage nails in the treatment of radial head fractures.Methods Data of 22 patients with radial head fractures,who had undergone open reduction and internal fixation with absorbable self-enhancing cartilage nails from January 2008 to December 2011,were retrospectively analyzed.Among them,data of 18 patients were complete,including 10 males and 8 females.According to the Mason classification,there were 14 cases of Mason Ⅱ,3 cases of Mason Ⅲ and 1 case of Mason Ⅳ.Two patients were combined with radial neck fractures,9 with osteochondral fractures of capitellum,and 1 with posterior dislocation of the elbow and olecranon avulsion fracture.The radial head fractures were temporarily fixed with Kirschner wires after open reduction,then absorbable self-enhancing cartilage nails with length from 16 to 24 mm and diameters of 1.5 mm were applied to reach final fixation.The heads of nails were right underneath of cartilages without penetrating bone cortexes on the contralateral side.The radial neck fractures were reduced and fixed with T-plates or anatomical plates after the radial head fractures were fixed with cartilage nails.Four cases of osteochondral fracture of capitellum were fixed with absorbable sutures to external epicondyle of humerus.For other 5 cases of osteochondral fracture of capitellum,the bone fragments were removed due to too small to fix.Results All 18 patients were followed up for 6 to 54 months (average,31.3 months).All fractures achieved bone union,and the healing time ranged from 5 to 12 weeks (average,8.7 weeks).There were no complications,such as internal fixation failure,nonunion,hematoma,sinus formation,osteolytic changes of radial heads and so on.According to the Broberg-Morrey elbow performance score,13 cases were excellent,4 good,and 1 fair,with the total excellent and good rate of 94.44％ (17/18).At final follow-up,the elbow range of motion was 90° to 150° (average,123.8°),and the range of forearm rotation was 130° to 180° (average,152.5°).Conclusion Absorbable self-enhancing cartilage nails can be used to treat various kinds of radial head fractures,and the results are satisfactory.

A reverse dorsal digital island fascial flap with the dorsal branch from the proper digital nerve for repair of pulp defects / 中华骨科杂志

Objective To utilize a reversed digital dorsal fascial vascular pedicled island fa scial flap with the dorsal branch of the proper d igital nerve to repair finger pulp defect.Methods Based on the features of blood supply of the dorsa l skin of the finger,the flap was designed on the proximal phalanx at the middle and distal segments and the dorsum of the proximal interphalangeal joint.The lateral margins of the fl ap did not cross the midlateral line,th e axial point was designed on the ulnar or the radial dorsum of the distal interphalangeal joint.The axis was paralleled to the longitudinal axis of finger.The dorsal branch of the pr oper digital nerve in the flap was sutured to the end of the proper digital nerve of injured site.From November 1997to April 2001,28pulp defects in 27cases were repaired with this method.E mergency operations were per-formed in 24cases and selective operations in 3.The flaps measured 1.8cm?1.5cm -2.5cm ?2.2cm and the length of pedicle was 1.5-2.2cm.Results All flaps survived completely.The p atients were followed up for 7to 32months,with an average o f 21months.The pulps after reconstr uction had good appearance,soft texture with wear-resisting.T here was no touch pain.Static two-point discrimination was 3.5-6.5mm.Conclusion The operation does not damage the major artery and nerve of the wounded fin ger.It is simple and safe,and can be done at one settin g.It does not interfere with the function of other digits.The sensation of the reconstructed pulp can be satisfactorily recovered.[

Distal digital replantation with a venous drainage through medullary cavit / 中华骨科杂志

Objective To introduce a method of distal digital replantation with a venous drainage through medullary cavity.Methods Normal saline mixed with methylene b lue were perfused into digital arteries in 5fresh finger specimens and medullary cavities in 10fresh finger specimens.Then microanatomic al observation of vessels was performe d in the specimens.From April 1999to June 2000,15severed fingers in14cases were replanted with a venous drainage through medullary cavity.Medullary cavities of the distal and middle phalanx were drilled and made unobstructed after the distal joint of the finger was removed.The bones were fixed using only a single straig ht Kirschner wire in each finger.One or two digital arteries or the branch es of the terminal arteries were anasto mosed and two digital nerves sutured in each finger.Results Mi-croanatomical observation showed t hat a venous drainage through medullary cavity was dominating without su-perficial venous drainage and the di gital medullary cavity closely connected with the profunda digital vein s and the superficial digital veins by the venous system of the bone.All replan ted fingers survived in 14cases.The average postoperative follow-up wa s 7.8months,ranging from 6to 10mont hs.Nearly normal appearance and satisfactory sensation of the dista l phalanx were obtained with 2-PD of 5-9mm.Conclusion Distal digital replantation with a venous d rainage through medullary cavity is a new method.It has following advan-tages:simple and reliable operatio n,high survival rate and enlarged in dication of distal digital replanta tion.[

The common complications after the operation of congenital syndactyly and their prophylaxis and treatment / 临床外科杂志

Objective To analyze the reasons of the common complications happened after the operation of congenital syndactyly and to find the method of prophylaxis and treatment,and to improve the effects of treatment.Methods To classify the reasons of the complications happened after the operation of congenital syndactyly in 34 cases.Results The reasons of the complications included that the patients were not operated by special course of study doctors in 9; operation at an inappropriate opportunity in 8;the method of web taken shape was improper in 7;the method of nail taken shape was improper in 4; the fixation and training was unsuitable in 6. Conclusions The complications happened after the operation of congenital syndactyly will be reduced much , provided that grasping the right opportunity and selecting the proper method of web or finger tip taken shape before operation , taking care of the transformations of blood vessel and nerve in operation , fixing firmly and training appropriately after operation.