Proximal thumb dorsal transverse flap for tissue defects at thumb pulp and fingertip / 中华创伤骨科杂志

Objective:To report our clinical efficacy of pedicled transplantation of proximal thumb dorsal transverse flap to repair tissue defects at thumb pulp and fingertip.Methods:From February 2010 to November 2020, 97 patients with tissue defects at thumb pulp and fingertip were treated by pedicled transplantation of proximal thumb dorsal transverse flap at Department of Orthopedics, People's Hospital of Renqiu. They were 55 men and 42 women, aged from 17 to 66 years (average, 41.3 years). Altogether 55 right and 42 left sides were affected. The size of soft tissue defects ranged from 2.8 cm×1.8 cm to 3.9 cm×2.8 cm. Postoperatively, flap survival, shape, color and sensory recovery at the recipient area were observed; wound healing, function and complications at the donor site were also observed.Results:All the 97 flaps survived and all the wounds healed at the first stage. Blisters appeared at the distal end of the flap in only 2 cases but subsided 7 days after operation with no special treatment and the flaps survived smoothly. All the skin grafts at the donor site survived uneventfully. The 97 patients were followed up for 6 to 26 months (average, 10.7 months). Their flaps were not swollen, finger abdomen was full, finger appearance satisfactory, and finger feeling recovered well. The two-point discrimination at the last follow-up ranged from 4 to 11 mm (average, 7.6 mm). By the trial criteria for assessment of upper limb function suggested by Hand Surgery Society of Chinese Medical Association, sensory function of the affected finger was assessed as S 4 in 21 cases and as S 3+ in 76 cases at the last follow-up. No scar contracture was observed at the donor site and no movement restriction at the interphalangeal joint. Conclusion:Proximal thumb dorsal transverse flap is a reliable choice for reconstruction of complex tissue defects at thumb pulp and fingertip because of the advantages of easy harvest, constant vascular anatomy, full appearance and good sensory function at the recipient site, and limited damage to the donor site.

Reverse proximal dorsal island flap pedicled with the radial digital artery of the thumb for repair of thumb tip defects / 中华创伤杂志

Objective:To investigate the therapeutic effect of reverse proximal segment dorsal flap of radial digital artery of the thumb in repairing thumb tip defects.Methods:A retrospective case series study was conducted to analyze the clinical data of 56 patients with thumb tip defects admitted to Renqiu People 's Hospital from February 2010 to October 2020. There were 37 males and 19 females，aged 17-66 years［（37.8±12.2）years］. The injury on the right side was observed in 35 patients and on the left side in 21 patients. All of them were thumb tip defects with exposed distal phalanx. Dimension of skin defects was 2.9 cm×1.8 cm-3.3 cm×2.6 cm.The reverse proximal segment dorsal flap of thumb radial digital artery was used，with the dorsal digital nerve sutured with the proper digital nerve. The donor site was repaired with free skin graft from the ulnar side of the affected forearm. The time of flap harvesting，operation time and healing of the flap were measured. At the last follow-up，the shape，texture，sensory recovery and complications of the flap were observed. One month after operation and at the latest follow-up，the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association and Vancouver Scar Scale（VSS）score were used to evaluate the recovery of sensory function of the flap and scar formation of the donor sites，respectively. Results:All patients were followed up for 6-26 months［（13.2±6.4）months］. The time of flap harvesting ranged from 20 to 35 minutes［（26.0±5.3）minutes］. The operation time was 1-2 hours［（1.3±0.3）hours］. Blisters appeared at the distal end of the flap in 2 patients after operation，but they were not treated. After 7 days，the blisters subsided and the flaps survived. The other flaps survived successfully. The donor sites healed by first intention. At the last follow-up，the flaps showed relatively cosmetic appearance，similarities in texture，elasticity and color to the surrounding area and good sensory recovery，without scar contracture and dystrophy of interphalangeal joint. According to the upper limb function evaluation standard set up by hand surgery branch of Chinese Medical Association，56 patients exceeded S3 grade compared to none at postoperative 1 month（ P<0.01），and the VSS score was 3-7 points［（5.0±1.4）points］compared to 6-12 points［（8.8±1.5）points］at postoperative 1 month（ P<0.01）. The donor site left a linear scar，which had no significant effect on its shape and function. Conclusion:The reverse proximal segment dorsal flap of the radial digital artery of the thumb can be used to repair thumb tip defects，for it has advantages of easy operation，a high survival rate as well as good appearance and sensory function recovery，with less damage to the donor area.

Transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion / 中国修复重建外科杂志

Results: All incisions healed by first intention. Ten cases of thumb reimplantation were successful. All the patients were followed up for 5 months to 2 years and 8 months, with an average of 1 year and 4 months. Two-point discrimination was 3-9 mm (mean, 6.8 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the sensory of the thumb was rated as S 4 in 18 cases and S3+ in 5 cases; the sensory at donor sites recovered to S3. Conclusion Transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion is a simple and effective method to restore sensory function of the thumb pulp.

Transferring the radialis proper digital nerve of index finger and its dorsal branch to repair the thumb nerve evulsion / 中国基层医药

Objective To investigate the clinical curative effect of the surgical method of transferring the radialis proper digital nerve of damaged index finger and its dorsal branch to repair the thumb nerve evulsion.Methods 13 patients with thumb nerve evulsion were treated.There were 8 males and 5 females with an average age of 28 years (ranged 18-52 years old).The injuries were caused by machine twist (8 cases),gear(4 cases),electric saw (1 case).And thumb rotational avulsion amputation (10 cases),thumb incompleteness amputation(3 cases).The time from injury to admission was 1-3.5 h (mean 2.2 h).The average time from injury to admission was (1.1 ± 1.5) h.The amputate level of skin was at the juxtra-articular of metacarpophalangeal joint.The amputate level of bone was at the base of proximal phalanx (6 patients) and metacarpophalangeal joint (4 patients),interphalangeal joint(3 patients).Using transferring the radialis proper digital nerve of index finger without reimplantation and its dorsal branch to.repair the both side injuries of thumb nerve evulsion.According to routine method to repair digital bone,veins,arteries and tendons.Results All 13 chases were followed up for 6 months to 2 years and 7 months postoperatively,with an average of 22 months.The wounds and incisions at donor sites were healed by first intention.All 13 cases of thumb reimplantation were successful.Two-point discrimination of ulnaris finger pulp was 2 to 6mm,average 4.2mm,and the radialis was 5 to 9mm,average 7.8mm.Sensory function was rated as S4(the ulnaris in 12 cases and the radialis in 2 cases) and S3 + (the radialis in 11 cases and the ulnaris in 1 cases).Conclusion Transferring the radialis proper digital nerve of damaged index finger and its dorsal branch to the digital nerve on the neighboring thumb is a simple and effective method to restore sensory function of the pulp.

Advances in the research of chemotherapy for colorectal cancer / 国际外科学杂志

In recent years, chemotherapy is an important treatment for colorectal cancer, but the therapeutic effect of chemotherapy drugs is still poor, adverse reactions, and there are individual differences, studies have found that chemotherapy sensitizer in colorectal cancer is important, it is not only can improve the efficacy of chemotherapy drugs can reduce the toxicity of the neoadjuvant chemotherapy is to becomne a research focus in recent vears.Chemotherapy sensitizer will lead people to explore various combinations of different drugs and chemotherapy for the treatment of diseases and bring better outcomes, it will usher in a new era.The efficacy, mechanism, research status and safety of the colorectal cancer for enhancing its chemotherapy sensitivity of these representative drugs were reviewed in these article.

Design and application of the reversed dorsal metacarpal island flap pedicled on the digital proper artery / 中华创伤骨科杂志

objective To explore a new method of repairing skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers. Methods The reversed dorsal metacarpal island flap was designed to be pedicled on the digital proper artery-common digital artery-fingerweb artery-dorsal metacarpal artery-cutaneous branch of dorsal metacarpal artery.In repairing digital palmar skin defects,after the flap was dissected,the proximal incision was extended along the direction of dorsal metacarpal nerve to harvest an enough length of the nerve so that the dorsal metacrppal nerve can be anastomosed with the digital proper nerve to restore the sensation of finger pulp.From the June 2003 to March 2009,the flap was used to repair 26 fingers in 24 patients with middle and distal digital skin defects complicated with fracture and tendon rupture.They were 17 men and 7 women,aged from 16 to 63 years (average,37 years).There were 15 cases of palmar skin defect and 9 cases of dorsal skin defect.In the 2 cases of combined tendon defects,a section of the extensor tendon of index(or little) finger was dissected together with the flap to repair the tendon rupture. Results The areas of the flap ranged from 3.1 cm ×1.6 cm to 6.0 cm × 4.0 cm.The flaps survived in all 24 cases without any vascular crisis.Twenty-two patients obtained an average follow-up of 14 months (from 4 to 32 months) but 2 were lost to the follow-up.The flaps were fine in texture,colour and appearance.The finger pulps appeared full and recovered sensations of pain and temperature.The average two-point discrimination was 7.5 mm (from 5 to 9 mm).Sensory function evaluation revealed an outcome of S3 + ～ S4.Tendon adhesion occurred in 4 cases which recovered digital function following secondary lysis 3 to 6 months postoperation. Conclusion Application of the reversed dorsal metacarpal island flap pedicled on the digital proper artery is a good way to repair skin defects complicated with fracture and tendon rupture at the middle and distal sections of the second to fifth fingers.