Reverse Island Research Articles

Island density scaling in reversible submonolayer growth with attachment barriers.

Island nucleation and growth play an important role in thin-film growth. One quantity of particular interest is the exponent χ, which describes the dependence of the saturation island density N_{sat}∼(D_{h}/F)^{-χ} on the ratio D_{h}/F of the monomer hopping rate D_{h} to the deposition rate F. While standard rate equation(RE) theory predicts that χ=i/(i+2) (where i is the critical island size), more recently it has been predicted that in the presence of a strong barrier to the attachment of monomers to islands, a significantly larger value χ=2i/(i+3) may be observed. While this prediction has recently been tested using kinetic Monte Carlo simulations for the case of irreversible growth corresponding to i=1, it has not been tested for the case of reversible island growth corresponding to i>1. Here we present a mean-field self-consistent RE method which we have used to study the dependence of the effective value of χ on D_{h}/F and barrier-strength for i=1,2,3, and 6. Both the no-nucleation-barrier case in which there exists a barrier for monomers to attach to islands larger than the critical island size (but not to smaller islands) and the nucleation-barrier case in which there is a barrier for monomers to attach to islands of all sizes are studied. In all cases, we find that the existence of attachment barriers significantly increases the effective value of χ for a given barrier strength. In addition, for i=1 we find good agreement between our extrapolated asymptotic value of χ and the theoretical strong-barrier prediction both with and without a nucleation barrier. In contrast, for i>1 the value of χ is significantly larger in the presence of a nucleation barrier than in its absence. In particular, while an asymptotic analysis of our results for i>1 also leads to excellent agreement with the strong barrier prediction in the presence of a nucleation barrier, in the absence of a nucleation barrier the asymptotic values are significantly lower.

Delayed Reverse Sural Artery Flap with Skin Pedicle Technique Versus Standard Island Sural Artery Flap for Reconstruction of Lower Leg, Ankle and Malleoli

Background and objectives: Standard reverse island sural artery flap is the most common usage for distal third defects of the leg. However many authors reported 36 % complication rate mainly partial or complete flap loss , that is attributed to venous congestion. Delayed reverse sural artery flap in two stages with skin pedicle technique is reliable and less complicated. In this study was compare between the results of both techniques.
 Patients & Methods: The study included forty patients presented to AL-Wahda University Hospital and 48 Military Hospital , after trauma of lower leg with complete loss of soft tissue and exposure of underlying structures ,within periods Oct 2013 to May 2017. The patients were thirty male and ten female , their age ranged between fifteen to sixty years old . Reverse island sural artery flap was used in twenty patients, while delayed sural artery flap was used in twenty patients too.The results of both techniques were compared.
 Results: In our study the standard reverse island sural artery flap is good option for reconstruction of lower leg , ankle and malleoli defect ,which is performed in twenty patients , the partial necrosis occur in 20% patients and three cases with flap failure ,the venous congestion occur in 35% of patients In this study, we performed reconstruction of the lower leg, heel , and malleoli in another twenty patients by delayed reverse sural artery flap with skin pedicle technique, the flap necrosis occur only in one case and partial flap necrosis occur in two cases only, in comparison with standard technique of reverse island sural artery flap, the venous congestion occur only in four patients 20% , two cases recovering the congestion by leg 
 elevation and improving the patients hydration , and two cases of venous congestion progressive to partial flap necrosis. Partial necrosis occur in two cases, complete flap necrosis occur in one case and 95% of patients satisfaction in discharge.
 Conclusion: The delayed reverse sural artery flap with skin pedicle is very important to avoid of venous congestion and flap failure , especially in old patients , DM , and in patients with peripheral vascular diseases. The goal of our study were achieved , and the patients improved functionally and attained their routine activity. By this technique and modification, make the delayed sural artery flap the first choice in reconstruction of the lower third defect of leg , heel and ankle. and is less postoperative venous congestion and flap failure. Delayed sural artery flap in two stages with skin pedicle technique is convenience and less complication particularly for old patients with diabetes mellitus and peripheral limb ischemia or venous insufficiency.

Repairing large skin defect of hand with modified dorsal metacarpal artery reverse island flap

To investigate the effectiveness of modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries in repairing large skin defect of the hand. Between September 2017 and March 2021, 15 cases of large skin defect of the hand were treated. There were 11 males and 4 females with an average age of 42 years (range, 24-66 years). The injury causes included machine twist injury in 6 cases, pound injury in 5 cases, and crush injury in 4 cases. The injured parts included 6 cases of finger skin defect and 9 cases of distal skin defect of palm and dorsum of hand, all of which had tendon, joint, and bone exposure. The interval from injury to operation ranged from 2 to 6 hours (mean, 4 hours). The defect sizes after thorough debridement ranged from 3.5 cm×3.0 cm to 8.0 cm×4.5 cm. The modified dorsal metacarpal artery reverse island flap with a range of 3.8 cm×3.3 cm to 9.0 cm×5.0 cm was used to repair the defect, and the flap donor site was repaired with full-thickness skin graft. All the flaps survived successfully after operation, and the wounds in the recipient site and the skin grafts in the donor site healed by first intention. All patients were followed up 9-24 months, with an average of 14 months. The appearance of the flap was good, and its texture and color were similar to those of the surrounding normal tissue. There was no obvious scar contracture, depression, and pigmentation in the donor site. At last follow-up, the static two-point discrimination of the flap was 8-20 mm, with an average of 13.6 mm. According to the Michigan Hand Outcome Questionnaire, 5 patients were very satisfied with the appearance of the flap, and 10 patients were satisfied. The modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries has reliable blood supply, larger harvested area, simple procedure, and minimal donor site damage, which is suitable for emergency repair of large skin defect of the hand.

Experimental Study of the Effects of Changes in Arteriovenous Pressure Difference on the Survival Area of a Reverse Island Flap

In this article, the effect of the change of arteriovenous pressure on the survival area of reverse island flap was studied. The vein and saphenous artery in rabbits were selected to design the reverse island flap experimental model. Rabbits were divided into 4 groups: A: Control Group; B: Part anastomosis of the saphenous artery group; C: Part anastomosis of the vein group; and D: No superficial veins group. After surgery, for all four groups, flaps were assessed by general observation, radionuclide scans for the survival rate, and histology. We found that the survival rate of flaps in Group B was overtop than the other three groups (P < 0.05). The radioactive material (RM) in group B could be seen clearly, whereas the RM in Groups A, C, and D existed transiently. At ten days post-operation. Group B had more capillary regeneration and blood cells contrast to the other three groups. Increasing blood supply can improve the survival rate of flaps, but simply promoting venous return has no significant effect on improving the survival rate of flaps.

Methods and effects of high-frequency color Doppler ultrasound assisted reverse island flap of dorsal digital artery of ulnar thumb for repairing skin and soft tissue defects in the distal end of the same finger

Objective: To explore the methods and effects of high-frequency color Doppler ultrasound assisted reverse island flap of dorsal digital artery of ulnar thumb for repairing skin and soft tissue defects in the distal end of the same finger. Methods: The retrospective cohort study method was applied. From March 2014 to January 2020, 43 patients with skin and soft tissue defects in the distal end of thumb were hospitalized in the Department of Hand and Foot Surgery of Yidu Central Hospital of Weifang, including 28 males and 15 females, aged 19-58 years. The time from injury to operation was 4 to 10 hours, and the area of wound defect was 1.5 cm×1.0 cm-5.0 cm×3.0 cm. The type and course of dorsal digital artery of ulnar thumb were detected by high-frequency color Doppler ultrasound before operation, based on which the reverse transfer of the island flap of dorsal digital artery of ulnar thumb was designed to repair the skin and soft tissue defects in the distal end of the same finger. The patients with absence of the dorsal digital artery of ulnar thumb were repaired by the greater fish reverse island flap pedicled with the radial palmar artery. The area of the flap was 2.0 cm×1.5 cm-5.5 cm×3.5 cm. The donor site wound was directly closed by suturing or covered with split-thickness skin graft from the inner side of the upper arm in the same arm. The status of dorsal digital artery of ulnar thumb detected by high frequency color Doppler ultrasound before operation was recorded. The type, course, and distribution of the dorsal digital artery of ulnar thumb detected before operation were compared with those observed during the operation. The survival of the flap was observed after operation. During the last follow-up, the appearance of the donor and recipient area of flaps was observed, the thumb function was evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association, and the sensory function of the area transplanted with flap was evaluated with the sensory function evaluation standard. Results: The results of high-frequency color Doppler ultrasound showed that the dorsal digital artery of ulnar thumb was absent in 2 patients, while 41 patients had the dorsal digital artery of ulnar thumb, among which 20 cases were type 1 that started from the first dorsal metacarpal artery and ran on the surface of the first interosseous dorsal muscle; 16 cases were type 2 that started from the deep branch of the radial artery or the main artery of thumb and ran in the deep surface of the first interosseous dorsal muscle, including 10 cases of type 2a with the starting point in the basal region of the first metacarpal bone and 6 cases of type 2b with the starting point in the first metacarpal bone region; 5 cases were type 3 that started from the confluence of the first dorsal metacarpal artery and the main thumb artery in the region of the first metacarpophalangeal joint. The outer diameter of the vessel at the beginning of the dorsal digital artery of ulnar thumb was (1.12±0.31) mm, and the outer diameter of the vessel at the beginning of the accompany vein was (0.63±0.21) mm. The dorsal digital artery of ulnar thumb was concentrated in the ulnar side of the first metacarpophalangeal joint and snuff box region. The type, course, and distribution range of the dorsal digital artery of ulnar thumb observed during the operation were consistent with the results detected by high-frequency color Doppler ultrasound before operation. After the operation, the flaps survived in 43 patients. The patients were followed up for 6 months to 1 year. During the last follow-up, only linear scars were left in the donor area; there were no obvious pigmentation in the area transplanted with reverse island flap of dorsal digital artery of ulnar thumb, with good texture and elasticity, and beautiful appearance; the thumb function was evaluated as excellent in 23 cases, good in 17 cases, and fair in 3 cases; the sensory function of the area transplanted with flap was evaluated as S4 level in 16 cases, S3 level in 22 cases, and S2 level in 5 cases. Conclusions: The reverse island flap of dorsal digital artery of ulnar thumb is one of the ideal methods to repair the skin and soft tissue defect in the distal end of the same finger, especially that beyond the distal interphalangeal joint. Preoperative detection with high-frequency color Doppler ultrasound can identify the type and distribution of dorsal digital artery of ulnar thumb, so as to design a personalized operation plan, resulting in good appearance of the donor and recipient area and thumb function after operation.

Use of Homodigital Reverse Island Flaps for Digital Reconstruction-The Perspective of a Reconstructive Surgery Unit in Accra, Ghana

Several Local flaps can be used for the reconstruction of digital soft tissue defects with exposure of tendons and/or phalanges. The homodigital flap is a versatile option. This article discusses the use of the homodigital reverse vascular island flap-a regional, axial-patterned skin flap in the reconstruction of distal digital defects. Methods: 6 patients with a soft-tissue defect at the distal part of the finger were treated by homodigital island flaps for reconstruction. We evaluated the active range of motion of the involved finger, and the patient's satisfaction with the appearance of the finger after reconstruction. Results: All patients admitted to a good functional outcome. The donor site morbidity was minimal. The take of the split-thickness skin graft to the flap donor site was generally good. However one patient complained of numbness of the finger over the donor site Conclusion: The Homodigital flap is a handy multipurpose flap that can be used. Notwithstanding its limitation, it is easy to raise and it can be used to a variety of defects

Use of homodigital reverse island flaps for digital reconstruction – the perspective of a reconstructive surgery unit in Accra, Ghana

Several Local flaps can be used for the reconstruction of digital soft tissue defects with exposure of tendons and/or phalanges. The homodigital flap is a versatile option. This article discusses the use of the homodigital reverse vascular island flap-a regional, axial-patterned skin flap in the reconstruction of distal digital defects. Methods: 6 patients with a soft-tissue defect at the distal part of the finger were treated by homodigital island flaps for reconstruction. We evaluated the active range of motion of the involved finger, and the patient's satisfaction with the appearance of the finger after reconstruction. Results: All patients admitted to a good functional outcome. The donor site morbidity was minimal. The take of the split-thickness skin graft to the flap donor site was generally good. However one patient complained of numbness of the finger over the donor site Conclusion: The Homodigital flap is a handy multipurpose flap that can be used. Notwithstanding its limitation, it is easy to raise and it can be used to a variety of defects

Finger reconstruction with dorsal metacarpal artery perforator flaps and dorsal finger perforator flaps based on the dorsal branches of the palmar digital arteries – 40 consecutive cases

Since the first description many variations of the dorsal metacarpal reverse island flap have been published but there is still uncertainty about which vascular component should be included for an optimal result. Therefore, it was the aim of this study to analyze vascular reliability and ischemic complications of dorsal metacarpal artery perforator (DMAP) flaps and dorsal finger perforator (DFP) flaps in our patient collective. We performed 40 of these flaps from the dorsum of hand and fingers for finger injuries. The choice of donor site was made according to the defect’s location. Patients were analyzed with respect to flap necrosis, ischemic complications and achievement of overall reconstruction goals. In addition, we divided our patients in two groups, one group where we raised the flap from the dorsum of the proximal phalanx and a second one where the flaps were raised from the intermetacarpal space to identify complication rates based on the pedicles location. Of the 40 flaps, 36 survived completely. 4 partial necroses were observed in flaps transferred to more distal defects and in one flap that was used in a wrap-around technique for both dorsal and palmar proximal phalanx. These perforator flaps are a reliable method to cover finger defects and the dorsal metacarpal artery is not necessary for their survival, since the blood supply comes from perforating branches of the palmar vascular system. There is a clear trend for a higher complication rate in flaps raised from the dorsum of the fingers compared to the intermetacarpal space.

Reconstruction of Defects of the Lower Third of the Leg and Foot With a Reverse Sural Island Flap

Background: Closure of lower limb defects asks for thorough knowledge of all the reconstructive options, starting with the use of local tissues. The scarce availability of such, makes this task difficult and demanding. Unique nature of blood supply to the leg, complicates this issue even more. Reverse sural island flap is what we found handy in solving the problem for defects of small to moderate size, on the lower leg and foot. Objectives: The aim of this study is to report our experience with the use of the reverse sural island flap in the reconstruction of complex soft tissue defects of the lower leg and the foot. Materials and methods: Following institutional review board approval, a database search was completed to identify all patients who underwent reconstruction of distal lower extremity and foot defects with a reverse sural island flap between 2011-2019. Data were collected from the medical records of patients, as regards: demographics, history of trauma or nature of the wound, personal medical history (accompanying diseases, smoking status), location of the defect, dimensions of the flap after being elevated, pedicle length etc. Results: 15 cases received a reverse sural island flap, all the cases except one, being acute trauma. The remaining one was a chronic wound after a previous burn. In one of the cases the flap was delayed. In three of them flap it was used to cover defects of the dorsum of the foot. Flap dimension varied from 7 × 4 cm to 15 × 12 cm, length of the pedicle from 6 to 16 cm, two of the flaps were very close to the distal popliteal crease. In all of the cases, except one, donor area of the flap needed be skin grafted. Only two of the flaps were complicated: one by a partial necrosis, the other by a venous stasis, which in the end were both treated successfully. In none of the patients a detailed examination of vascular supply of the area was needed, all of them being nondiabetic and nonischemic legs. Conclusions: Reverse sural island flap is a very useful tool for the reconstruction of small to moderate defects of the lower leg and foot, relatively easy to be raised, with no special needs for complicated vascular preoperative workup, and with a low rate of failure and complications in carefully selected patients.

Fixation of genetic variation and optimization of gene expression: The speed of evolution in isolated lizard populations undergoing Reverse Island Syndrome.

The ecological theory of island biogeography suggests that mainland populations should be more genetically divergent from those on large and distant islands rather than from those on small and close islets. Some island populations do not evolve in a linear way, but the process of divergence occurs more rapidly because they undergo a series of phenotypic changes, jointly known as the Island Syndrome. A special case is Reversed Island Syndrome (RIS), in which populations show drastic phenotypic changes both in body shape, skin colouration, age of sexual maturity, aggressiveness, and food intake rates. The populations showing the RIS were observed on islets nearby mainland and recently raised, and for this they are useful models to study the occurrence of rapid evolutionary change. We investigated the timing and mode of evolution of lizard populations adapted through selection on small islets. For our analyses, we used an ad hoc model system of three populations: wild-type lizards from the mainland and insular lizards from a big island (Capri, Italy), both Podarcis siculus siculus not affected by the syndrome, and a lizard population from islet (Scopolo) undergoing the RIS (called P. s. coerulea because of their melanism). The split time of the big (Capri) and small (Scopolo) islands was determined using geological events, like sea-level rises. To infer molecular evolution, we compared five complete mitochondrial genomes for each population to reconstruct the phylogeography and estimate the divergence time between island and mainland lizards. We found a lower mitochondrial mutation rate in Scopolo lizards despite the phenotypic changes achieved in approximately 8,000 years. Furthermore, transcriptome analyses showed significant differential gene expression between islet and mainland lizard populations, suggesting the key role of plasticity in these unpredictable environments.

Clinical application of Reading man flap for repair of the wound of donor site at the dorsum of the finger

Objective To introduce the surgical technique and clinical efficacy of Reading man flap for repair of the wound of donor site at the dorsum of the finger. Methods From February 2016 to August 2018, 9 cases (9 fingers) of fingertip defects were treated with reverse dorsal digital island flap of the same finger. The donor site of dorsal digital flaps was repaired with Reading man flap. After repair of fingertip defects, the defect area of dorsal digital donor site ranged from 2.0 cm×1.3 cm to 2.5 cm×1.6 cm. Results All the flaps survived uneventfully. The average hospitalization time was 10 days. The follow-up time was 3 to 9 months. The texture, color, plumpness and elasticity of the dorsal digital donor site were good. No tendon adhesion, interphalangeal joint and metacarpophalangeal joint stiffness occurred. All the patients were satisfied with the appearance and function of the injured fingers. Conclusion The repair of the dorsal digital donor site with Reading man flap takes into account both appearance and durability, which is beneficial to the early rehabilitation of injured finger and less damage to donor site. The method of operation is safe and simple. It is an improvement on the repair of the donor site of the reverse dorsal digital island flap of the same finger. Key words: Finger injuries; Surgical flaps; Reading man flap; Flap donor site

Reverse first dorsal metacarpal artery flap repair of a right thumb epidermis granuloma: A case study.

One case of epidermal granuloma of the right thumb was diagnosed by color Doppler ultrasonography and pathologic examination. Epidermal granuloma resection and reverse island skin flap transplantation were performed to determine the therapeutic effect of a reverse first dorsal metacarpal artery flap repair of an epidermal granuloma of the right thumb. After effective intravenous combined general anesthesia, the skin in the surgical field was disinfected and sterile drapes were placed. An oblique incision was made over the underlying epidermis granuloma. The right palm of the reverse first dorsal metacarpal artery flap was chosen. The pedicle was carefully protected, and the flap was transplanted to the defective skin area. The incision was sutured after hemostasis. A palpable mass with the dimension of the right thumb of the patient was measured by color Doppler ultrasonography and physical examination pre-operatively. The palpable mass was oval in shape and protruded from the skin surface. The palpable mass had an unclear boundary with the surrounding skin and therefore the skin should be removed. If the tendon is exposed after the resection, complications may occur after operation, such as skin necrosis and tendon exposure. Intra-operatively, the mass was 1.5×1.0 cm in size and multi-cystic. The boundary between the palpable mass and the surrounding skin could not be discerned. The skin area (1.5×1.0 cm in size) was completely invaded by the palpable mass, which was closely adhered to the surrounding tissue. The palpable mass was carefully dissected with appropriate protection to the finger nerves and arteries. The palpable mass and affected skin were completely removed, leaving a defect area of ~1.5 ×1.0 cm without skin. The reverse first dorsal metacarpal artery flap was used to repair the defect area. The repaired flap had a good blood supply and peripheral circulation. The operation was successful, and the anesthesia effect was satisfactory. Treatment of a thumb epidermis granuloma with reverse first dorsal metacarpal artery flap was shown to be a feasible strategy with a broad clinical application.

Efficacy of nasolabial flap in repairing inferior nasal defect

Objective To investigate the clinical effect of retrograde nasolabial fold flap pedicled with angular artery in the repair of inferior nasal defect. Methods According to the location and size of inferior nasal defect, the reverse island flap or axial flap pedicled with the inner canthus artery was designed to repair the defect at the nasolabial fold of the affected side. Results Eighteen patients were followed up for 6-36 months, of which 2 cases had partial necrosis at the distal part of the flap, healed by dressing change, and the rest of the flaps survived. The flaps were not bulky and the color and texture were similar to those of the surrounding skin. All patients were satisfied with the appearance improvement. Conclusions The blood supply of the retrograde nasolabial fold flap pedicled with the inner canthus artery is reliable, using flaps from the nasolabial sulcus is surgically convenient, flexible in design and covert in donor site. It is one of the ideal methods for the repair of inferior nasal defects. It is worthy of clinical application. Key words: Nose; Soft tissue injuries; Reconstructive surgical procedures; Angular artery; Retrograde nasolabial fold flap; Inferior nasal defect

Repair of donor site of reverse digital artery island flap with transverse V-Y fascial advancement flap of proximal dorsum of the finger

Objective To summarize the clinical efficacy of transverse V-Y fascial advancement flap of proximal dorsum of the finger for the repair of the donor site of reverse digital artery island flap. Methods From January 2017 to February 2018, 14 patients with fingertip defect were treated, including 4 emergency cases and 10 sub-emergency cases. The range of fingertip defect was 1.6 cm×0.6 cm to 2.5 cm×1.4 cm. The fingertip wound was repaired by reverse digital artery island flap and the donor site was covered by transverse V-Y fascial advancement flap of proximal dorsum of the finger. Results The flaps survived uneventfully after operation, and all the donor and recipient wounds achieved primary healing. The follow-up period ranged from 9 to 15 months with an average of 10.6 months. The skin flaps were of good texture, color, shape and no tenderness at the fingertips. At the last follow-up, the two-point discrimination of reverse digital artery island flaps was 7 to 12 mm, with an average of 8.6 mm. The two-point discrimination of V-Y advancement flaps of dorsal fingers was 5 to 9 mm, with an average of 6.2 mm. There was no web contracture, and the maximum abduction angle was 38° to 45° with an average of 42°. According to the total active range of motion (TAM) system, 12 cases were excellent and 2 cases were good. Conclusion The transverse V-Y fascial advancement flap of proximal dorsum of the finger was used to repair the donor site of reverse digital artery island flaps. The appearance, function and sensation of the fingers recovered well, and the related complications of free skin grafting were avoided. Key words: Finger injuries; Surgical flaps; Donor site; Wound repair

Angiolymphoid hyperplasia with eosinophilia in a hand treated with a reverse digital island flap and artificial skin: a case report

BackgroundAngiolymphoid hyperplasia with eosinophilia is a rare nodular skin tumor characterized by eosinophilic invasion and vascular proliferation. Previous reports suggested that irritation and inflammation are the causative factors of this disease. Most cases of angiolymphoid hyperplasia with eosinophilia occur around the auricle, forehead, and scalp; the hand is rarely affected. Moreover, the tumor seldom presents as multiple nodules.Case presentationA 67-year-old Japanese woman presented with a complaint of skin masses on her left thumb and index finger, which had gradually grown in size over the past few months. A biopsy was performed confirming a diagnosis of angiolymphoid hyperplasia with eosinophilia. The aponeurosis on her index finger was resected and tissue was reconstructed using a reverse palmar digital island flap harvested from the base of her index finger. The thumb lesion was also resected and covered with collagen-based artificial skin. Gradual progression of skin epithelialization followed by healing was noted 2 months after the surgery.ConclusionAngiolymphoid hyperplasia with eosinophilia is a rare tumor; it is seldom seen in the hands. It is generally treated by surgical resection. It is important to resect a sufficiently large area of the tissue due to the possibility of relapse in some cases. Furthermore, appropriate reconstruction is mandatory after wide margin tumor resection.

Two (non-) islands in Slovenian: A study in Experimental Syntax

AbstractThere exists a controversy in the literature and among the speakers of Slovenian concerning the grammaticality of wh-island and subject island constructions in this language. We conducted an acceptability rating study of wh-islands and subject islands in Slovenian, using the factorial definition of island. This definition provides for a possibility to isolate a true island effect while controlling for two complexity factors that potentially interfere in speakers’ evaluation of the relevant sentences: thelengthof the respective movement dependency and the presence of anisland structureitself. We found that (i) Slovenian speakers do judge the wh-island sentences worse than the respective controls, but the observed degradation cannot be attributed to a true island effect; (ii) subject extraction out of a wh-island leads to a so calledreverse island effectwhereby the acceptability is higher than expected even if the above two complexity factors are taken into consideration; and (iii) speakers are sensitive to the subject island effect, as predicted by the mainstream theories of syntactic locality. The results of our study contribute to establishing a solid empirical base for further theoretical investigations of the island effects and raise new questions about the role of processing factors in speakers’ evaluations of island constructions.

Clinical analysis of repairing the defect of hand with reverse island skin flap of upper carpal cutaneous branches of ulnar artery

To investigate the clinical effect of repairing soft tissue defect after hand wound using reverse island skin flap of upper carpal cutaneous branches of ulnar artery. From June 2010 to November 2016, 12 patients with hand soft tissue defects were repaired by reverse island skin flap of upper carpal cutaneous branches of ulnar artery, including 9 males and 3 females with an average age of (35.2±9.4) years old ranging from 22 to 58 years. The defect area varied from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm. Time interval from injury to operation ranged from 3 to 15 days with an average of (8.4±2.6) days. The flap was designed beforehand according to the size of the defect, sharply dissected the aponeurotic fascia from the proximal to the distal, abscised the communicating branch between the flap and the ulnar artery at the wrist epithelial branch, repairing the defect of flap with method of metastasis retrograde. The sensation, shape of the flap and hand function were observed, and the upper extremity function was evaluated according to the standard of hand surgery branch from Chinese Medical Association to assessment of functional recovery. The flaps in 10 patients obtained primary healing, the healed time was 14 to 18 days with an average of(15.0±1.5) days. Two patients occurred distal flap necrosis, and wound surface healed after change dressing and skingrafting cover. All patients were followed up from 3 to 15 months with an average of(7.0±3.8) months. According to the upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, 2 cases got excellent results, 7 good, 2 fair and 1 poor. Reverse island skin flap of upper carpal cutaneous branches of ulnar artery for the treatment of soft tissue defect caused by hand wound has advantages of concealed donor area, no need sacrifice the main blood vessel, flap thin and no need repair it for thick and thin.

Experimental research of reverse island flaps in fasciocutaueous-pedicled form in rabbit model

Objective To explore the influence of the fasciocutaneous pedicle on the survival of the reverse island flaps and the role of the fasciocutaneous pedicle in the venous return of the flap. Methods According to the different pedicles, 12 New Zealand rabbits were divided into four groups: group A (retrograde island flap without fasciocutaneous pedicle); group B (retrograde island flap with 0.5-cm-wide fasciocutaneous pedicle); group C (retrograde island flap with 1.5-cm-wide fasciocutaneous pedicle); group D (retrograde island flap with 1.5-cm-wide fasciocutaneous pedicle but without saphenous vein). All the flaps were designed with the dimension of 7.0 cm×3.0 cm, the pedicle length of 3.0 cm, and the pivot point locating at 2.0 cm above the medial malleolus. On the postoperative day 7 to 10 day, the survival rate of all the flaps was recorded. All the data were analyzed by SPSS 17.0. The venous drainage of various flaps was observed and recorded when the flaps were injected with methylene blue. Results Twenty-four retrograde island flaps with various pedicles were divided into four groups (6 flaps in each group). In group A, 3 flaps survived uneventfully and the rest 3 flaps developed partial necrosis, and the average survival rate was 85.57%. In group B, 4 flaps survived uneventfully and the rest 2 flaps developed partial necrosis, and the average survival rate was 88.10%. In group C, all the flaps survived uneventfully and no flap developed partial necrosis. In group D, 4 flaps survived uneventfully, one flap developed partial necrosis, complete necrosis occurred in one flap, and the average survival rate was 73.83%. Comparison between every two groups was performed using Mann-Whitney U test, and there was no significant difference in the survival rate. Among groups A, B and C, the survival rate increased along with the increased width of the fasciocutaneous pedicle. Through the injection of methylene blue, puzzle anastomosis and anastomosis between perforator veins could be observed on the fasciocutaneous pedicle. Conclusion In the rabbit model, the fasciocutaneous tissue along with the main vessel can improve the reliability of the retrograde island flap. The fasciocutaneous pedicle could play partial role in drainage of the veneous blood in the flap, by means of anastomosis between perforator veins. Key words: Island flap; Fasciocutaneous flap; Pedicle of the flap; Rabbit

Reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip

Objective To explore the clinical outcomes of reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip. Methods From March 2014 and June 2016, 25 patients (30 fingers) of fingertip soft tissue defects were treated using reverse dorsal digital island flap with cutaneous branches of proper digital nerve. The proper digital cutaneous branches of the flap were sutured with the digital nerve of the wound. The fingertip defect area ranged from 1.4 cm×1.6 cm to 2.0 cm×3.5 cm (average, 2.1 cm×2.5 cm). The flap area was enlarged by 10%. The donor sites were covered with autologous full-thickness skin. Results All the flaps survived. All the donor and recipient wounds achieved primary healing. Venous crisis occurred in one case which healed after the removal of some sutures. Postoperative follow-up period ranged from 6 to 18 months. The shape of the flaps was plump and the texture was soft. Partial superficial sensation of the flaps recovered without donor site pain and interphalangeal joint dysfunction. The two-point discrimination ranged from 5 to 8 mm, with the average being 5.7 mm. According to the functional evaluation standards issued by Hand Surgery Society of the Chinese Medical Association, the results were excellent in 17 cases, good in 8 cases. Conclusion The application of reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip can achieve good sensory recovery. Key words: Finger injuries; Surgical flaps; Treatment outcome; Sensory reconstruction

Dorsal thumb rotated single pedical reverse island flap repaired thumb tip defect

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. Key words: Hang injuries; Surgical; Microsurgery