Open Reduction and Internal Fixation for Supination-External Rotation Type IV Ankle Fractures by Means of Anterolateral and Posterolateral Approaches.

BACKGROUND: The present study aimed to analyze and compare the efficacy of the anterolateral and posterolateral approaches for surgical treatment of supination-external rotation type IV ankle fractures. METHODS: This retrospective study enrolled 60 patients (60 feet) with supination-external rotation type IV ankle fractures, including 30 patients (30 feet) treated by means of the anterolateral approach and 30 patients (30 feet) treated by means of the posterolateral approach. Postoperative clinical efficacy was compared between the groups based on operation time, intraoperative blood loss, postoperative complications, fracture healing time, visual analog scale scores, Short Form-36 Health Survey scores, and American Orthopedic Foot and Ankle Society scores. Comparisons between the two groups were performed using independent-samples t tests and analyses of variance. Intragroup differences were compared using paired t tests, and the χ2 test was used to compare categorical variables. RESULTS: All 60 included patients completed follow-up ranging from 12 to 18 months (mean duration, 14.8 ± 3.5 months). Although baseline characteristics were similar in the two groups, there were significant differences in operation time (86.73 ± 17.44 min versus 111.23 ± 10.05 min; P < .001) and intraoperative blood loss (112.60 ± 25.05 mL versus 149.47 ± 44.30 mL; P < .001). Although fracture healing time (10.90 ± 0.66 weeks versus 11.27 ± 0.94 weeks; P = .087) was shorter in the anterolateral group than in the posterolateral group, the difference was not significant. Postoperative complications occurred in one and three patients in the anterolateral and posterolateral approach groups, respectively. Visual analog scale scores were significantly lower in the anterolateral group than in the posterolateral group (1.43 ± 0.50 versus 1.83 ± 0.75; P = .019), although there was no significant difference in Short Form-36 Health Survey scores between the groups (73.63 ± 4.07 versus 72.70 ± 4.04; P = .377). However, American Orthopedic Foot and Ankle Society scores were higher in the anterolateral group than in the posterolateral group (80.43 ± 4.32 versus 75.43 ± 11.32; P = .030). CONCLUSIONS: Both the anterolateral and posterolateral approaches can achieve good results in the treatment of supination-external rotation type IV ankle fractures. Compared with the posterolateral approach, the anterolateral approach is advantageous for the treatment of supination-external rotation type IV ankle fractures given its safety and ability to reduce trauma, clear field of view revealed, and allow for exploration and repair of the inferior tibiofibular anterior syndesmosis within the same incision.

Direct fixation of fracture fragment with modified double Kirschner wires for the treatment of old bony mallet finger.

BACKGROUND: The management of old bony mallet fingers is complicated. The purpose of this study was to describe direct fixation of fracture fragment with modified double Kirschner wires (K-wires) for treatment of old bony mallet finger, and to evaluate the functional outcomes during long-term follow-up. METHODS: Forty-nine patients with old bony mallet finger were enrolled and underwent surgical treatment from August 2014 to January 2021 in our hospital. Patients were divided into two groups according to whether they had undergone triple K-wires fixation or modified double K-wires with a dorsal brace fixation. The operation time, mean number of intraoperative fluoroscopy, bone union time, functional recovery and incidence of complications were monitored. RESULTS: Neither QuickDASH nor visual analogue scale measurement found statistically significant difference between the two groups (P > 0.05). However, the patients that underwent fixation with double K-wires and a dorsal brace required a shorter operation time and fewer intraoperative fluoroscopy, and exhibited a significantly greater mean final active range of the distal interphalangeal joint flexion, compared to those treated with triple K-wires (P < 0.01). CONCLUSION: Direct fixation of fracture fragment with modified double K-wires was an easy and feasible procedure which could achieve anatomical reduction and stable fixation of the dorsal fracture block of old bony mallet finger with relatively few complications.

Effects of arterial blood supply on the survival of reverse-flow island flaps: an experimental study.

OBJECTIVES: This study aimed to investigate the effect of arterial blood supply on the survival area of retrograde island flap. METHODS: The vein and saphenous artery in rabbits were selected to design the reverse-flow island flap experimental model. Forty rabbits were randomly divided into four groups: control group (group A), partial anastomosis of the saphenous artery group (group B), partial anastomosis of the vein group (group C), and no superficial vein group (group D). Flap survival was observed postoperatively, the survival area was measured, and the survival rate was compared. Blood distribution in the flap at different time points was observed by radionuclide imaging. RESULTS: The blood vessel distribution and blood cell status were observed histologically. The survival rate of flaps in group B was higher than that of the other three groups (P < 0.05). The radioactive material (RM) could be seen clearly in group B, whereas those in groups A, C, and D existed transiently. The RM in group B was higher than that in groups A, C, and D (P < 0.05). On postoperative day 10, group B had more capillary regeneration and blood cells than the other three groups (P < 0.05). CONCLUSIONS: Increasing blood supply can improve the survival rate of flaps, but simply promoting venous return has no significant effect on the survival rate of flaps.

Efficacy of two different types of island flaps for the repair of diabetic foot ulcers on the heel.

Background: Heel ulcer of diabetic foot (DF) is a difficulty in clinical repair. The current study aimed to investigate the clinical efficacy of the medial plantar island flap (MPIF) and the sural nerve nutritional artery island flap (SNNAIF) for the repair of chronic diabetic foot ulcers (DFU) on the heel. Methods: Twelve patients with chronic DFU on the heel were admitted to our department from August 2018 to August 2020. Upon admission, ulcer debridement and bone cement filling were performed for 2-3 weeks to control infection. Digital subtraction angiography (DSA) or computed tomography angiography (CTA) of the lower limb was performed to assess vascular status. Then, 5 patients were repaired with MPIF and 7 patients with SNNAIF. Results: The MPIF survived completely in 5 cases; SNNAIF was used in 7 cases, and 6 cases survived completely. Meanwhile, 1 patient who underwent SNNAIF presented with partial necrosis of the distal end of the flap. Then, it healed after debridement and dressing changes. All 12 flaps were followed up for 6-12 months. The flaps had a soft texture, and their shape was satisfactory. In 2 cases, SNNAIFs re-ruptured 8 months after surgery. However, they healed after dressing changes and weight-bearing reduction. During the 10-month follow-up, the sensory recovery of MPIF in 5 cases was satisfactory because the flap contained medial plantar cutaneous nerve. Meanwhile, 7 patients who underwent SNNAIF repair had poor sensory recovery. All patients had good dorsiflexion and plantarflexion of the ankle with satisfactory function. Conclusions: Both the MPIF and SNNAIF flaps had a high survival rate and are feasible for DFU repair with good clinical outcomes. If DSA or CTA shows that the medial plantar artery is unobstructed and the heel wound is small, MPIF can retain sensory function and wear resistance. It is the first choice for repairing diabetic foot ulcers on the heel. If the heel wound are large or DSA or CTA shows that the posterior tibial artery is occluded and the peroneal artery is unobstructed, SNNAIF repair is safer.

Repair of tophus wound of the heel with sural nerve nutrition flap with peroneal artery perforating branch: a retrospective study.

BACKGROUND: This study was to investigate the clinical effect of a sural nerve nutrition flap with peroneal artery perforator for repairing tophus wound of the heel. METHODS: Over a 5-year period, 7 elderly male patients with tophus ulceration of the heel were admitted with exposed Achilles' tendon, and a chronic unhealed wound. Debridement, expansion and vacuum sealing drainage (VSD) lavage were performed initially, with simultaneous uric acid-lowering treatment. A 4×6-8×10 cm sural nerve nutrition flap with peroneal artery perforator was the secondary repair after further debridement of the wound. Preoperative Doppler ultrasound located the penetrating point of the peroneal artery perforator as the rotation point of the flap, and the line between the midpoint of the Achilles' tendon and the lateral malleolus and the midpoint of the popliteal fossa 5° above the front of Achilles' tendon was the axis. The patients were treated postoperatively with anti-inflammatory, anticoagulant and spasmolytic drugs and other rehydration therapy, and allopurinol was continued to control uric acid. The blood supply and temperature of the flap and wound healing were monitored. RESULTS: All 7 flaps survived completely after operation, with 1 case of postoperative wound discharge that finally healed after dressing change and 1 case of skin flap redness and swelling, which improved after strengthening anti-infection treatment. All 7 patients were followed up for 6-12 months (average 10 months). The skin flaps were soft in texture, with good color and appearance, and no recurrence of ulceration. The dorsal extension and plantar flexion of the ankle joint were good, and function was satisfactory. CONCLUSIONS: The sural nerve nutrition flap with peroneal artery perforator has double blood supply, strong anti-infective ability, relatively fast tissue healing process, simple operation and high survival rate, making it ideal for repairing tophus wounds of the heel.

First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes.

BACKGROUND: The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves. METHODS: This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes-Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared. RESULTS: All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes-Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p < 0.05). CONCLUSION: There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Increased hexokinase-2 as a novel biomarker for the diagnosis and correlating with disease severity in rheumatoid arthritis.

ABSTRACT: Abnormal glucose metabolism brings out joint inflammation and destruction in rheumatoid arthritis (RA). The aim of this study was to evaluate the potential of circulating hexokinase-2 (HK2) in peripheral blood mononuclear cells (PBMCs) of rheumatoid arthritis (RA) patients.PBMCs were obtained from patients with RA or osteoarthritis (OA) and healthy controls (HCs). The expression of HK2 was assessed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). The C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), Calprotectin, rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP) antibody level and 28-joint Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) were measured. Spearman's analysis was performed to determine the association between the level of HK2 and clinical characteristics. A receiver operating characteristic (ROC) curve was employed to evaluate the diagnostic value of HK2 in PBMCs. Logistic regression was used to identify risk factors. Sixty-five RA patients, 35 OA patients, and 40 HCs were included in the study.HK2 was upregulated in RA and OA patients compared with that in HCs (P < .05). The area under the ROC of HK2 for diagnosing RA and OA was 0.808 and 0.640, respectively. In addition, HK2 levels were increased in active RA compared with those in remittent RA (P = .03). Furthermore, HK2 correlated positively with the DAS28-ESR (P < .001), CDAI (P = .02) and SDAI scores (P = .02). Moreover, HK2 was independently associated with an increased risk of disease activity (DAS28-ESR>3.2, P = .02; CDAI score>10, P = .03; SDAI score>11, P = .04). Additionally, HK2 positivity was more frequently detected in patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) than in those not treated with bDMARDs.HK2 levels in PBMCs can be considered an ideal biomarker for diagnosing RA and involved in disease activity in RA. Dysregulation of HK2 may participate in the molecular mechanism of RA and could be an attractive selective metabolic target for RA treatment.

Comparison of the modified sinus tarsi approach versus the extensile lateral approach for displaced intra-articular calcaneal fractures.

BACKGROUND: This study sought to assess and compare the clinical efficacy and complications of a modified sinus tarsi approach (MSTA) and the extensile lateral approach (ELA) in the treatment of displaced intra-articular calcaneal fractures. METHODS: This retrospective study enrolled 108 patients (117 feet) with Sanders II-IV calcaneal fractures, including 52 patients (56 feet) in the MSTA group and 56 patients (61 feet) in the ELA group. The functional and radiological results of the affected feet were analysed retrospectively. Functional evaluation included American Orthopaedic Foot and Ankle Society (AOFAS), visual analog scale (VAS), and Short Form-36 Health Survey (SF-36). Radiological evaluation included preoperative and postoperative changes in the Bohler Angle, Gissane Angle, length, width, and height of the calcaneus. The postoperative complications were also collected and analysed. The independent-samples t-test and analysis of variance (ANOVA) were employed to compare differences between the two groups. Differences within the same group were compared by paired Student's t-test, and categorical variables were compared using the chi-square test. RESULTS: The postoperative functional and radiological results showed that the mean AOFAS, VAS and physical component summary of SF-36 scores in the MSTA group were higher than those in the ELA group (P<0.05). After surgery, the Bohler and Gissane angles were significantly improved in both groups, as were the length, width, and height of the calcaneus; no statistically significant differences existed between the two groups. The incidences of wound healing complications and postoperative sural nerve injury were lower in the MSTA group than in the ELA group (P<0.000). CONCLUSIONS: The MSTA can achieve similar effects to the ELA in terms of anatomical reconstruction and functional recovery. It also can also effectively reduce the incidences of wound healing complications and postoperative sural nerve injury, and shorten the length of hospital stay.

An efficient approach to eliminate steryl ethers and miscellaneous esters/ketones for gas chromatographic analysis of alkenones and alkenoates.

Long-chain alkenones (LCAs) and alkenoates (LCEs) are highly valuable biomarkers for paleotemperature reconstructions. A major problem, however, for accurate quantification of these compounds using gas chromatography (GC) is co-elution with steryl ethers, wax esters, saturated ketones and other numerous mid-polarity compounds frequently encountered in marginal marine and lake sediments. Co-elution during GC separation is prevalent, particularly if the full homologous series of alkenones and alkenoates are to be analyzed. Taking advantage of the presence of two or more double bonds in LCAs and LCEs, the conventional silica gel impregnated with silver nitrate has previously been used to remove co-eluting compounds for LCAs. However, this conventional argentation chromatography is hampered by the extreme instability of silver nitrate, poor reproducibility, low recovery and short lifetime. Here we demonstrate a highly efficient flash chromatographic approach based on silver thiolate chromatographic material (AgTCM) that overcomes the shortcomings of the traditional argentation chromatography and allows repeated sample preparation (up to 62 samples in one test) with little loss in separation efficiency. AgTCM selectively extracts LCAs and LCEs and effectively eliminates co-eluting compounds including steryl ethers and wax esters for the subsequent gas chromatography (GC) analysis. This new method, therefore, allows low-cost and high-throughput sample preparation for comprehensive quantification of the full homologous series of LCAs and LCEs in marine and lake sediments.

Integrated DNA methylome and transcriptome analysis reveals the ethylene-induced flowering pathway genes in pineapple.

Ethylene has long been used to promote flowering in pineapple production. Ethylene-induced flowering is dose dependent, with a critical threshold level of ethylene response factors needed to trigger flowering. The mechanism of ethylene-induced flowering is still unclear. Here, we integrated isoform sequencing (iso-seq), Illumina short-reads sequencing and whole-genome bisulfite sequencing (WGBS) to explore the early changes of transcriptomic and DNA methylation in pineapple following high-concentration ethylene (HE) and low-concentration ethylene (LE) treatment. Iso-seq produced 122,338 transcripts, including 26,893 alternative splicing isoforms, 8,090 novel transcripts and 12,536 candidate long non-coding RNAs. The WGBS results suggested a decrease in CG methylation and increase in CHH methylation following HE treatment. The LE and HE treatments induced drastic changes in transcriptome and DNA methylome, with LE inducing the initial response to flower induction and HE inducing the subsequent response. The dose-dependent induction of FLOWERING LOCUS T-like genes (FTLs) may have contributed to dose-dependent flowering induction in pineapple by ethylene. Alterations in DNA methylation, lncRNAs and multiple genes may be involved in the regulation of FTLs. Our data provided a landscape of the transcriptome and DNA methylome and revealed a candidate network that regulates flowering time in pineapple, which may promote further studies.

Illumina deep sequencing reveals conserved and novel microRNAs involved in the response to X-ray irradiation after peripheral nerve injury in rats.

Peripheral nerve injury is a common disease in clinic practice. Low-dose radiation exposure can increase recovery from peripheral nerve injury, but the mechanism is unclear. The objective of this study was to explore the ways that microRNAs participate in the recovery from peripheral nerve injury in rats. To explore the function of miRNAs in this process, we performed Illumina deep sequencing to investigate miRNA expression in spinal cords after X-ray irradiation. Two miRNA libraries (0 GY and 1 GY) were constructed for Illumina sequencing. The sequencing results showed that a total of 53,342,744 raw reads for the control group -0Gy and 48,453,367 raw reads for treated group -1Gy were obtained. After a series of selections, a total of 804 miRNAs were identified. One hundred fifty miRNAs were differentially expressed between the treated group -1Gy and control group -0Gy. A total of 23,652 target genes and 48,157 target sites were predicted for the 150 differentially expressed miRNAs. GO and KEGG enrichment analyses revealed that the PI3K-Akt-signaling pathway, neuroactive ligand-receptor interaction, and the MAPK signaling pathway were enriched. We demonstrated that the novelmiRNAs-360,-301,-239, and -400 targeted Vegfa and regulated its expression after irradiation. Our study revealed that many novel miRNAs were induced by X-ray irradiation, and were involved in the recovery from peripheral nerve injuries. This study provides a framework for understanding the molecular mechanisms underlying the recovery from peripheral nerve injury following exposure to X-ray irradiation.

Effects of Localized X-Ray Irradiation on Peripheral Nerve Regeneration in Transected Sciatic Nerve in Rats.

Low-dose radiation has been used in clinical and experimental models for the prevention of scarring and for fracture healing. There is evidence that low-dose radiation improves the hormesis of various cell types but little is known about its effects on peripheral nerve tissue. In this study, we investigated the beneficial effects of low-dose radiation on the regeneration of transectional peripheral nerve injury in an experimental rat model. Seventy-two male Sprague-Dawley rats received transection injury to the left sciatic nerves, and the nerves were subsequently sutured by epineurium end-to-end anastomosis to restore continuity. Animals were randomly assigned to one of two treatment groups (n = 36/group): 1 Gy X-ray irradiation or control (sham irradiation). Gait analysis, electrophysiological examination and morphological investigations were performed. In addition, Western blot and qRT-PCR were performed to determine the level of vascular endothelial growth factor (VEGF) and growth-associated protein-43 (GAP-43). Content of VEGF and GAP-43 in the regenerated sciatic nerve of the irradiated group was higher than the control group. At 4 to 12 weeks after surgery, the irradiated animals exhibited a significantly improved functional recovery relative to controls. At 12 weeks after surgery, amplitude and conduction velocity of the irradiated group were higher than the control group (P < 0.05). The number of nerve fibers, diameter of axons and morphological structure of the myelin sheath in the irradiated group were superior to those of the control group. These results suggest that low-dose radiation contributed to regeneration and functional recovery after transverse peripheral nerve injury by inducing increased production of VEGF and GAP-43, which promote the axonal regeneration and myelination.

X-ray irradiation has positive effects for the recovery of peripheral nerve injury maybe through the vascular smooth muscle contraction signaling pathway.

INTRODUCTION: It is well known that moderate to high doses of ionizing radiation have a toxic effect on the organism. However, there are few experimental studies on the mechanisms of LDR ionizing radiation on nerve regeneration after peripheral nerve injury. METHODS: We established the rats' peripheral nerve injury model via repaired Peripheral nerve injury nerve, vascular endothelial growth factor a and Growth associated protein-43 were detected from different treatment groups. We performed transcriptome sequencing focusing on investigating the differentially expressed genes and gene functions between the control group and 1Gy group. Sequencing was done by using high-throughput RNA-sequencing (RNA-seq) technologies. RESULTS: The results showed the 1Gy group to be the most effective promoting repair. RNA-sequencing identified 619 differently expressed genes between control and treated groups. A Gene Ontology analysis of the differentially expressed genes revealed enrichment in the functional pathways. Among them, candidate genes associated with nerve repair were identified. DISCUSSION: Pathways involved in cell-substrate adhesion, vascular smooth muscle contraction and cell adhesion molecule signaling may be involved in recovery from peripheral nerve injury.

Transfer of the extensor indicis proprius branch of posterior interosseous nerve to reconstruct ulnar nerve and median nerve injured proximally: an anatomical study.

Proximal or middle lesions of the ulnar or median nerves are responsible for extensive loss of hand motor function. This occurs even when the most meticulous microsurgical techniques or nerve grafts are used. Previous studies had proposed that nerve transfer was more effective than nerve grafting for nerve repair. Our hypothesis is that transfer of the posterior interosseous nerve, which contains mainly motor fibers, to the ulnar or median nerve can innervate the intrinsic muscles of hands. The present study sought to investigate the feasibility of reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve by transferring the extensor indicis proprius branch of the posterior interosseous nerve obtained from adult cadavers. The results suggested that the extensor indicis proprius branch of the posterior interosseous nerve had approximately similar diameters and number of fascicles and myelinated nerve fibers to those of the deep branch of ulnar nerve and the thenar branch of the median nerve. These confirm the feasibility of extensor indicis proprius branch of posterior interosseous nerve transfer for reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve. This procedure could be a novel and effective method for the functional recovery of the intrinsic muscles of hands after ulnar nerve or median nerve injury.

Compound grafting of residual vascularized fibular head flap to reconstruct contralateral lateral malleolus: A case report.

RATIONALE: Serious external ankle injuries caused by high-energy trauma are often associated not only with bone defect but also with a loss of skin and soft tissue that seriously affects ankle function. Therefore, it is particularly important to reconstruct the external ankle. PATIENT CONCERNS: The patient was a 64-year-old man with destructive injury of both lower extremities due to a machine accident. His left ankle and heel bone, along with the soft tissue, were torn off, and the peripheral blood supply and sensation to the toes of the left foot were lost concerns. DIAGNOSES: Complicated lateral malleolus defect. INTERVENTIONS: We used a composite tissueflap taken from thefibular head on the left side to reconstruct the rightfibular lateral malleolus. OUTCOMES: With the help of a prosthesis, the patient regained basic walking function by the 1 year follow-up. LESSONS: Using a combined compositeflap of the vascularizedfibular head to reconstruct the lateral malleolus is a good choice.

The superior gluteal artery perforator flap for reconstruction of sacral sores.

This report describes our experiences using the superior gluteal artery perforator (SGAP) flaps for reconstruction of 2 sacral sore cases. A 47-year-old female patient and a  38-year-old man with sacral sores were treated in our unit. The size of the defects were approximately 5×6 cm2  and 8×9 cm2, the  defects were repaired by SGAP flaps. The size of designed was  SGAP flaps varied from  7×20 to 9×16 cm2. All flaps survived and healed primary, the texture, functions, and appearance of flaps were satisfactory, and also without region dysfunction of donor and recipient sites. The SGAP flap, which has reliable blood supply,  preserves the gluteus maximus muscle and could be transferred simply and safely, is an ideal and reusable method to reconstruct sacral sores with low rate of postoperative recurrence and satisfactory appearance.

Use of small gap anastomosis for the repair of peripheral nerve injury by cutting and sleeve jointing the epineurium.

BACKGROUND: Although epineurium neurorrhaphy is the most reliable and conventional method for the repair of peripheral nerve injury and is accepted as the gold standard, it is still far from ideal. Many attempts have been made to develop nerve anastomosis techniques. The aim of this study was to investigate the use of small gap anastomosis performed by cutting and sleeve jointing the epineurium for nerve repair. METHODS: A 12-week study was performed using small gap anastomosis via cutting and sleeve jointing the epineurium, compared with epineurium neurorrhaphy in situ, to repair a rat sciatic nerve rupture. Three experimental groups were included: sham control (n = 8), small gap anastomosis (n = 16), and epineurium neurorrhaphy (n = 16). About 12 weeks after surgery, recovery was assessed with walking track analysis, electrophysiology, hematoxylin and eosin staining, immunohistochemistry, and electron microscopy. RESULTS: The sciatic nerve functional index observed in the small gap anastomosis group was significantly higher than that in the epineurium neurorrhaphy group (p < 0.05). In vivo electrophysiological analysis confirmed that the small gap anastomosis group showed a significantly higher conduction velocity than the epineurium neurorrhaphy group (p < 0.05). Postoperative morphometric analysis revealed better results after small gap anastomosis compared with epineurium neurorrhaphy. CONCLUSION: Small gap anastomosis via cutting and sleeve jointing the epineurium could be an alternative to epineurium neurorrhaphy for the repair of peripheral nerve injury, particularly, considering that the epineurium originates from native tissue that provides a suitable microenvironment for the selective regeneration of axons.

Modification of the internal suture technique for mallet finger.

This article describes a treatment of tendinous mallet finger deformities using a modified internal suture technique for the stable fixation of the terminal extensor tendon and bone.Between March 2011 and July 2013, 15 patients with mallet fingers who had been treated using this modification were included in this study. The patients included 10 men and 5 women with a mean age of 33 years (range, 19-50 years). Of these patients, 9 had chronic mallet fingers, 3 were unable to comply with a splinting regimen, and 3 had a history of unsuccessful splinting therapy. The mean time between the injury and surgery was 5.5 months (range, 1-15 months). We graded the results using Crawford criteria.The mean follow-up period was 12 months (range, 9-16 months). The mean final active range of motion of the distal interphalangeal joint flexion was 73° (range, 60°-90°). Based on Crawford evaluation criteria, 8 patients were graded as excellent, 6 were graded as good, and 1 was graded as fair. Apart from 2 documented mild nail deformities, no complications were encountered.This modified technique should be considered for the management of a tendinous mallet finger deformity when the internal suture technique is planned.

Intramuscular injection of bone marrow mesenchymal stem cells with small gap neurorrhaphy for peripheral nerve repair.

We had previously reported that small gap neurorrhaphy by scissoring and sleeve-jointing epineurium could enhance the rate and quality of peripheral nerve regeneration. To date, local implantation and systemic delivery of bone marrow mesenchymal stem cells (BMSCs) have been routinely used in nerve tissue engineering, but they each have some intrinsic limitations. We hypothesised that targeted muscular administration of BMSCs capable of reaching the damaged nerve would be advisable. Here, we investigated the therapeutic efficacy of transplantation of BMSCs through targeted muscular injection with small gap neurorrhaphy by scissoring and sleeve-jointing epineurium on repairing peripheral nerve injury in a rat model. One week after a rat model of peripheral nerve injury was established by small gap neurorrhaphy, thirty-six Sprague-Dawley rats were randomly divided into three groups (n=12): the intramuscular injection of BMSCs group (IM), the intravenous injection of BMSCs group (IV) and the intramuscular injection of phosphate-buffered solution group (PBS). The process of the nerve regeneration was assayed functionally and morphologically. The results indicated that compared to the IV-treated and PBS-treated groups, the targeted muscular injection therapy resulted in much more beneficial effects, as evidenced by increases in the sciatic function index, nerve conduction velocity, myelin sheath thickness and restoration rate of gastrocnemius muscle wet weight. In conclusion, the combination therapy of small gap neurorrhaphy and BMSC transplantation through targeted muscular injection can significantly promote the regeneration of peripheral nerve and improve the nerve's functional recovery, which may help establish a reliable approach for repairing peripheral nerve injury.

Treatment of subungual glomus tumors using the nail bed margin approach.

BACKGROUND: Subungual glomus tumors are rare soft-tissue tumors. The only effective treatment is complete surgical excision. Many surgical approaches had been reported to excise the tumor, but they all have limitations. OBJECTIVES: To evaluate the feasibility and efficacy of curing subungual glomus tumors using the nail bed margin approach. MATERIALS AND METHODS: From June 2005 to January 2012, 17 patients diagnosed with subungual glomus tumors underwent complete excision using a nail bed margin approach under a surgical microscope. Recurrence of symptoms, local complications, and tumor recurrence were evaluated through long-term follow-up. RESULTS: Histopathologic reports confirmed the diagnosis of glomus tumor in all patients. At a mean follow-up of 31.4 months, all patients had complete postoperative relief of pain, the nails recovered completely with normal shape, and no complications or recurrences were observed. CONCLUSION: In the treatment of subungual glomus tumors, the nail bed margin approach is a simple, feasible, effective new method with a low complication and recurrence rate. It can sufficiently expose and completely excise tumors at any subungual region. This approach is expected to be an excellent alternative approach for the excision of subungual glomus tumors.