Heme oxygenase-1 therapy attenuates muscle atrophy following global brachial plexus avulsion in juvenile rats.

INTRODUCTION/AIMS: Brachial plexus injury can seriously affect distal target muscle function, and long-term denervation leads to irreversible structural damage. In the present study, we examined the effect of hemin, a heme oxygenase-1 (HO-1) inducer, on intrinsic forepaw muscle atrophy induced by pan-plexus injury in juvenile rats, as well as its underlying mechanism. METHODS: A global brachial plexus avulsion (GBPA) model of rat was established, and thirty 6-wk-old male rats were randomly divided into five groups: control, GBPA plus scramble small intering RNA (siRNA), GBPA plus scramble siRNA plus hemin, GBPA plus HO-1 siRNA, and GBPA plus HO-1 siRNA plus hemin. Hemin (50 mg/kg) was administered intraperitoneally once daily and the siRNA (5 µg) was injected intramuscularly twice a week. Intrinsic forepaw muscles were used for analysis. Myofiber cross-sectional area (CSA), capillary-to-fiber ratio (C/F), and fiber-type composition were assessed. The levels of inflammatory factors, ubiquitin-protein ligases, and autophagy-related proteins were also measured. RESULTS: We found that hemin treatment could effectively ameliorate denervated intrinsic forepaw muscle atrophy and suppress type I to II myofiber-type conversion. Hemin treatment failed to prevent muscle capillary loss after denervation. The levels of inflammatory factors (tumor necrosis factor alpha [TNFα] and interleukin 6 [IL-6]), ubiquitin-protein ligases (MuRF-1 and MAFbx), and autophagy-related proteins (BNIP3 and LC3B-II/I ratio) were increased by denervation and HO-1 therapy attenuated the increment. DISCUSSION: Upregulation of HO-1 might potentially be an effective strategy to alleviate denervation-related muscle atrophy and might be a promising adjunctive treatment to improve hand function in children with pan-plexus injury.

The effect of intraoperative nerve identification technique on distally-based dorsal fasciocutaneous flap for thumb and fingertip reconstruction.

INTRODUCTION: Thumb and fingertip resurfacing continues to be a challenge for hand surgeons, as the treatment varies widely. Being donor nerves in the flap for sensory restoration, the dorsal cutaneous nerves in hand have been widely described in the literature. However, their applications in providing anatomical information to sufficiently harvest the longitudinal axis of a robust flap are usually underestimated. This study reports reconstruction of thumb and fingertip defects with the distally based dorsal fasciocutaneous (DDF) flap and explores the effect of intraoperative nerve identification technique on clinical outcomes. HYPOTHESIS: The nerve identification technique can contribute considerably to the improvement of flap circulation, with less risk of poor venous return. MATERIALS AND METHODS: A retrospective study was conducted in 89 patients who had thumb or fingertip defects treated with the DDF flap from February 2014 to June 2020. Patients were divided into two groups based on whether intraoperative nerve identification technique was used. Flap survival was evaluated. The follow-up was conducted by using smartphone or by face-to-face visit. Time for complete wound healing, time to return to work, hand performance, the total active motion of the joints and static two-point discrimination of flaps were analyzed. RESULTS: The 46 flaps (group A) that underwent intraoperative nerve identification technique had an 8.7% venous congestion rate versus a 27.9% venous congestion rate in the 43 flaps (group B) without using nerve identification technique (p=0.018). The mean follow-up was 11.08 (range 6-26) months. Time for complete wound healing and time to return to work were significantly shorter in group A (p=0.026 and p=0.012). Michigan Hand Outcomes Questionnaire (MHQ) scores were similar between groups. In the face-to-face follow-up, there was no significant difference in the total active motion of the injured fingers and static two-point discrimination between the two groups (p=0.657 and p=0.182). DISCUSSION: The use of nerve identification technique could decrease the odds of postoperative venous congestion in DDF flap for thumb and fingertip reconstruction, and result in improved outcomes in terms of time for complete wound healing and time to return to work. LEVEL OF EVIDENCE: III; retrospective comparative study.

Wide awake surgery for rupture of the lateral expansion of the long-finger extensor tendon: A case report.

Spontaneous extensor digitorum communis (EDC) tendon rupture is uncommon but easily confusing injury that lead to functional impairment. There is no any strict first-line treatment for nonrheumatoid EDC tendon rupture. We report a kidney transplant recipient with spontaneous rupture of the lateral expansion of the long-finger extensor tendon treated by wide awake surgery. Surgical repair with wide-awake local anesthesia was performed to realign the tendon for the patient. Three months following surgery, the patient obtained a full pain-free range of motion of the hand without recurrent dislocation.

Comparison of reading man flap and skin grafting for closure of resultant donor defects in homodigital reverse flow flaps.

BACKGROUND: The reading man procedure is a valuable treatment option for circular defects of different parts of the body. The aim of this study was to compare reading man procedure and skin grafting for coverage of resultant donor defects in homodigital reverse flow flaps. METHODS: From January 2018 to October 2020, 38 patients underwent fingertip reconstruction using homodigital reverse flow flaps. The donor sites were resurfaced with full-thickness skin grafts in 20 patients and with reading man flaps in 18 patients. Flap survival, postoperative complications, operative time for closure of donor site, return work time, range of motion of the injured fingers, static two-point discrimination, and aesthetic results were evaluated. RESULTS: All the outcomes, including flap survival, postoperative complications, operative time for closure of donor site, return work time, range of motion of the injured fingers, static two-point discrimination, and aesthetic results, were similar between the two groups. No patients complained of cold intolerance or hypersensitivity. CONCLUSION: The reading man flap is useful and reliable for covering resultant donor defects in homodigital reverse flow flaps. The functional and aesthetic outcomes in both groups are similar.

Administration of Tranexamic Acid in Proximal Humeral Fractures.

INTRODUCTION: This study aimed to analyze the efficacy of intravenous administration of tranexamic acid in complex proximal humeral fractures. MATERIALS AND METHODS: Sixty-seven patients with displaced 3 and 4 part proximal humerus fractures were randomized into the control (n = 33) and TXA (n = 34) groups. Fifteen minutes before the skin incision, 15 mg/kg body weight of 0.9% sodium chloride solution or TXA was injected intravenously. Open reduction and internal fixation was conducted through a deltoid-pectoral approach with fixed angle locked plating (PHILOS) for all the patients. The patients were followed up 2 months after surgery. Total blood loss, blood test results, blood transfusion rate, and wound complications were analyzed between the two groups. RESULTS: Significant differences were observed in intraoperative blood loss and postoperative blood loss during the first 24 h between the two groups. There were no significant differences in postoperative blood loss during the second 24 h, wound complication rates, blood transfusion rate and adverse side effects. And thromboembolic events related with the application of TXA were not noted in the TXA group. CONCLUSION: Preoperative administration of tranexamic acid could reduce intraoperative and postoperative blood loss in patients with complex proximal humeral fractures. LEVEL OF EVIDENCE: II, prospective comparative study.

Modified homodigital dorsolateral proximal phalangeal island flap for the reconstruction of finger-pulp defects.

BACKGROUND: Reconstruction of finger-pulp defects remains a challenge, although the treatment varies widely. The homodigital island flap based on dorsal branches of the proper digital artery (PDA) is one of the most popular methods for repair of finger-pulp defects. The aim of this study was to introduce our experiences of using modified dorsolateral proximal phalangeal island flaps for reconstruction of finger-pulp defects. METHODS: From July 2016 to November 2018, 16 modified dorsolateral proximal phalangeal (MDPP) island flaps were performed for finger-pulp reconstruction. The comparison group included 11 patients treated with homodigital dorsal perforator (HDP) flaps. Flap survivals were assessed and active range of motion (ROM) of the joints, time to return to work, static 2-point discrimination and hand performance were analysed at final follow-up. RESULTS: Both the Group MDPP and the Group HDP had similar satisfactory flap survival. There were no differences in static 2-point discrimination, time to return to work and the ROM of the injured fingers. However, the Michigan Hand Outcomes Questionnaire (MHQ) summary scores of the satisfaction and aesthetics were much better in Group MDPP. CONCLUSIONS: The modified homodigital dorsolateral proximal phalangeal island flap is a reliable alternative for finger-pulp reconstruction with good functional and cosmetic outcome.

[Clinical application of wide awake technique in carpal tunnel syndrome].

OBJECTIVE: To explore the application and clinical effect of wide awake local anesthesia no tourniquet technique in the surgery of bilateral carpal tunnel syndrome. METHODS: From March 2016 to August 2018, 20 patients (40 sides) with bilateral carpal tunnel syndrome were treated by wide awake technique. All patients were female, aged from 32 to 56 (50.8±6.4) years old. The anesthetic, intraoperative and postoperative pain and anxiety were evaluated, operative field bleeding in operation were assessed, postoperative skin healing of surgical area and anesthetic complications were observed, and Kelly grading were used to evaluate recovery of function. RESULTS: Twenty patients were followed up from 6 to 9 months with an average of 7.8 months. There was light anxiety before injection (NRS score rangedfrom 1 to 3), slight pain occurred during injection on the first poke (NRS ranged from 2 to 3);no pain and anxiety during operation (NRS score was 0);mild or moderate pain (NRS score ranged from 1 to 6) without anxiety(NRS score was 0) after operation was occurred. Surgical skin healed well at the stageⅠwithout side effect of anesthetic. At final follow-up, according to Kelly grading, 30 sides got excellent results, 8 sides good and 2 sides fair. CONCLUSION: Wide awake technique is safe and effective in treating neurolysis of bilateral carpal tunnel syndrome, and could receive good clinical effects.

Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle.

INTRODUCTION: The reverse homodigital dorsoradial flap remains a useful alternative for covering thumb defects. However, the description of pedicle width of dorsoradial flap is not clear. The aim of this study was to compare the results of narrow pedicle with wide pedicle in dorsoradial flaps and describe our experience with the thumb reconstruction. MATERIALS AND METHODS: From July 2014 to February 2019, 42 patients were treated with the reverse dorsoradial flap for thumb reconstruction. The patients were divided as Group A (pedicle width ≤ 0.8 cm) and Group B (pedicle width > 0.8 cm). Flap survival, time to return to work, flap sensibility, the range of motion (ROM) of the joints, and final aesthetic outcomes were evaluated. RESULTS: Respectively in the Group A (17 cases) and Group B (25 cases), 14-19 flaps survived uneventfully, whereas 3-6 flaps experienced venous congestion with no or partial flap loss. No significant difference was identified between the two groups for the incidence of venous congestion, static 2-point discrimination and ROM of the injured thumbs. Time to return to work was significantly shorter in Group A. The aesthetic satisfaction of the patients in Group A was significantly better comparing with that in Group B. CONCLUSIONS: The reverse homodigital dorsoradial flap with narrow pedicle width is associated with more favorable outcomes in terms of time lost from work and aesthetic satisfaction of the patients.

[Repair of thumb defects with modified radial dorsal fasciocutaneous flap of thumb].

Objective: To investigate the operative method of repairing soft tissue defect of the thumb with modified radial dorsal fasciocutaneous flap and its effectiveness. Methods: Between June 2015 and December 2016, 15 patients with volar or dorsal defects of the thumb were treated with modified radial dorsal fasciocutaneous flaps which distal pedicles were cut off. Of 15 cases, 11 were male and 4 were female, aged 35-70 years (mean, 46 years). The causes of injury included crush injury in 12 cases and avulsion injury in 3 cases. Because all patients had volar or dorsal defects of the thumb which were accompanied by tendon or bone exposure, they had no condition or desire to replant. There were 12 cases of volar defect of thumb and 3 cases of dorsal defect. The area of defects ranged from 2.0 cm×1.2 cm to 3.0 cm×2.5 cm. The time between injury and operation was 16 hours to 2 days (mean, 30.4 hours). The radial dorsal fascio-cutaneous flaps of 2.3 cm×1.5 cm to 3.3 cm×2.8 cm in size were adopted to repair defects. The donor sites were directly sutured. Results: All flaps survived, and no severe swelling or tension blister occurred. The donor sites and wounds healed by first intention. All patients were followed up 3-12 months (mean, 6 months). The color and texture of the grafted flaps were similar to those of normal skin, with no bloated appearance. According to total active motion standard at last follow-up, the finger function was excellent in 8 cases and good in 7 cases. Conclusion: Modified radial dorsal fasciocutaneous flap of the thumb is a reliable flap with easy dissection and less trauma in repair of soft tissue defects of the thumbs, and satisfactory clinical outcome can be obtained.

Temporal-spatial expression of ENOLASE after acute spinal cord injury in adult rats.

ENOLASE enzymes are abundantly expressed, cytosolic carbon-oxygen lyases known for their role in glucose metabolism. Recent accumulation of evidence revealed that, in addition to its glycolytic function, enolase is also associated with ischemia, hypoxia and to be a neurotrophic factor. To analysis the certain expression and biological function in central nervous system, we performed an acute spinal cord contusion injury model in adult rats. Western blot analysis indicated a marked upregulation of ENOLASE after spinal cord injury (SCI). Immunohistochemistry revealed wide distribution of enolase in spinal cord, including neurons and glial cells. Double immunofluorescent staining for proliferating cell nuclear antigen and phenotype-specific markers showed increases of enolase expression in proliferating microglia and astrocytes. Our data suggest that enolase may be implicated in the proliferation of microglia and astrocytes after SCI.