Societies For Surgery Of Hand Research Articles

Effectiveness of combined tissue transplantation to repair serially damaged injuries on radial side of hand

To investigate the effectiveness of combined tissue transplantation for repair of serially damaged injuries on radial side of hand and function reconstruction. Between May 2013 and May 2017, 34 cases of serially damaged injuries on radial side of hand were treated. There were 29 males and 5 females; aged 17-54 years, with an average of 32.1 years. There were 23 cases of crushing injuries, 5 cases of bruising injuries, 4 cases of machine strangulation injuries, and 2 cases of explosion injuries. The time from injury to admission was 40 minutes to 3 days, with an average of 10 hours. According to the self-determined serially damaged injuries classification standard, there were 1 case of typeⅠa, 2 cases of typeⅠb, 10 cases of typeⅡa, 5 cases of type Ⅱb, 3 cases of type Ⅱc, 1 case of type Ⅱd, 7 cases of type Ⅲa, 3 cases of type Ⅲb, 1 case of type Ⅲc, and 1 case of type Ⅲd. According to the classification results, the discarded finger, nail flap, the second toe, anterolateral thigh flap, ilium flap, fibula flap, and other tissue flaps were selected to repair hand wounds and reconstruct thumb, metacarpal bones, and fingers. After operation, 2 cases of flaps developed vascular crisis and survived after symptomatic treatment; the other transplanted tissue survived smoothly. All cases were followed up 1 to 7 years, with an average of 2.4 years. The average fracture healing time was 7.4 weeks (range, 5.3-9.0 weeks). At last follow-up, the reconstructed fingers and the grafted flaps recovered good sensory function, with a two-point discrimination of 5 to 11 mm (mean, 9 mm). According to the evaluation standard of the upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the reconstructed thumb was rated as excellent in 24 thumbs, good in 8 thumbs, and fair in 2 thumbs; the reconstructed finger was rated as excellent in 18 fingers, good in 2 fingers, and fair in 1 finger. For the serially damaged injuries on radial side of hand, according to its classification, different tissues are selected for combined transplantation repair and functional reconstruction, which can restore hand function to the greatest extent and improve the quality of life of patients.

Effect of gadolinium perfusion magnetic resonance imaging on surgeons’ management preferences in kienböck’s disease. A survey study

In literature, the use of gadolinium perfusion magnetic resonance imaging (GP-MRI) is recommended in Kienböck's disease to evaluate the lunate bone’s perfusion. This survey study sought to assess how GP-MRI findings affect the management preferences of hand surgeons. A questionnaire consisting of 11 scenarios differing in ulnar variance, GP-MRI findings and management preferences was developed. The scenarios were designed based on the last published clinical guidelines. The questionnaire was sent to the members of a national hand surgery society consisting of 160 hand surgeons. Sixty-six surgeons completed the questionnaire. The surgeons’ preferences changed significantly by ulnar variance in stages II and IIIA, and by GP-MRI in stages I and II. No need for other diagnostic tools was found in any of the scenarios. Management preferences of the study participants related to alterations in ulnar variance and treatment choices in all stages were in accordance with previously published clinical and survey studies. This study showed that GP-MRI findings significantly changed the management preferences of hand surgeons in early stages of Kienböck's disease. There was no significant tendency among the participants to use further assessment tools beyond direct radiography, MRI, and GP-MRI. Given the study results and the literature, we emphasize the limited and well-defined indications of GP-MRI in Kienböck’s disease.

Repair of distal phalanx finger wound with modified great toe fibular flap with distal artery pedicle as reflux vein

To investigate the effectiveness of the modified great toe fibular flap using the distal artery pedicle as reflux vein for repairing distal phalanx finger wound. Between June 2018 and January 2020, 15 patients who suffered tissue defect of the distal phalanx finger were treated, including 12 males and 3 females, the average age was 40.2 years (range, 24-56 years). All of them were caused by machine crush injury. There were 2 cases of thumb, 6 cases of index finger, 3 cases of middle finger, 3 cases of ring finger, and 1 case of little finger. The defects ranged from 1.7 cm×1.3 cm to 3.0 cm×2.0 cm. The time from injury to admission was 0.6-4 hours, with an average of 2.3 hours. The medial fibular proper digital artery was further dissociated to the distal end and anastomosed with the recipient vein as the reflux vein. The area of flaps ranged from 2.0 cm×1.5 cm to 3.2 cm×2.2 cm. All the flaps survived without vascular crisis, and the wounds healed by first intention. Except for 1 case that the suture was too tight, the incision was partially split after the stitches were removed, and it healed spontaneously after dressing change, the other patients had good healing of the donor site incision and normal foot function. All 15 patients were followed up 3-18 months, with an average of 9.3 months. The appearance of finger pulps were satisfactory with full and threaded. The color, texture, and elasticity of the flaps were good, and the two-point discrimination was 6-8 mm at last follow-up. The flexion and extension of fingers were normal. At last follow-up, hand function was evaluated according to the upper limb function evaluation trial standard of the Chinese Medical Association Hand Surgery Society, and the results were 13 cases of excellent and 2 cases of good. Modified great toe fibular flap using the distal arterial pedicle as a reflux vein can improve the venous drainage of the flap and contribute to increase the success rate of the flap without additional injury.

Effects of three kinds of proximal pedicled flaps of hand for relaying repair of degloving injuries of fingertips and the soft tissue defects in the donor sites

Objective: To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum. Methods: A total of 21 patients with degloving injuries of fingertips at the 2nd to 5th fingers were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females aged 24-60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the three flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured finger joints was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results: All the flaps survived after operation. Tension blisters appeared on the surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, the three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and with only linear scars in donor sites of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied with the appearance of hand, and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured finger joints was evaluated as excellent in 17 cases, good in 4 cases. Conclusions: The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal injury.

Dupuytren Disease Management Trends: A Survey of Hand Surgeons.

Background: Management of Dupuytren Disease is variable, and influenced by multiple factors including location, extent of disease, surgical preference and familiarity with different treatment techniques. The objective of this study was to determine current Dupuytren Disease management trends in Australia. Methods: A questionnaire was sent through The Australian Hand Surgery Society to all members. In addition to demographic data, indications and preferences for different management interventions were surveyed on location of disease, age and activity level of the patient. Results: 99 (48%) of the Australian Hand Surgery Society members completed the survey. Respondents were primarily Orthopaedic (50%) or Plastic (49%) Surgeons, and most worked in private (99%) and public (71%) practice. Surgeon's believed that Tubiana's treatment goals to correct deformity was the most important (60%) and to shorten post-operative recovery (60%) was the least important. Only 42% of respondents perform needle aponeurotomy for Dupuytren Disease. In contrast 70% of respondents perform collagenase injections, with manipulation most commonly undertaken on the second day (46%) and skin tears (52%) the most common complication. Seventy-five percent of the respondents feel there is sufficient evidence to support the treatment of Dupuytren disease with collagenase injections. Ninety nine percent of all respondents perform fasciectomes for Dupuytren Disease, with Limited (without graft) (76%) the most routine performed. Conclusions: Several procedural options for the treatment of Dupuytren Disease exist within Australia. This study shows current Australian practice trends and highlights the increasing use of collagenase.

Development of Hand Surgery in Ukraine

Summary. During the period of rapid industrialization, there was a need to create a new approaches to treat hand injuries due to rapid development of metallurgical, mining and engineer industry, which were accompanied by a high level of injuries with a significant amount of disability in the second half of 20th century, in Donetsk, Dnipropetrovsk and Kharkiv regions. New stage in the development of hand surgery and microsurgery in Ukraine began in the 80’s: the Department of Microsurgery and Reconstructive Surgery of the Upper Extremity under the direction of I. Antoniuk was opened on the basis of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” in Kyiv in 1982. Development of hand surgery in the western regions of Ukraine began in the 90’s. In Lviv, on the initiative of O. Toropovskyi, on the basis of the City Hospital No 8, a Center of Microsurgery and Surgery of the Hand was created. In Zakarpattia (Uzhhorod) since 1997, on the initiative of V. Haiovich and A. Pogoriliak, microsurgery and hand surgery service was established, which is now under the care of the Combustiology Department. In Volyn (Lutsk), hand surgery service is transmitted to the initiative group, also working at the City Combustiology Center. In Ivano-Frankivsk, Chernivtsi, Ternopil and Rivne, initiative groups in the field of hand surgery service have been formed in the structure of orthopedics and traumatology departments. 2005 was marked by the opening of another center for surgery of the hand in Luhansk on the initiative of V. Ivchenko and under the guidance of V. Golovchenko, whose surgeons owned microsurgical equipment and provided highly skilled assistance to the population of this region. Ukrainian Hand Surgery Society (UHSS) was created in 2012, and led by Professor S. Strafun, as a result of collaboration of all hand surgery centers. In 2014, UHSS was accepted into the Federation of European Societies for the Surgery of the Hand (FESSH).

Clinical effects of modified fascia flap from cutaneous branch of dorsal metacarpal artery in repairing the wound at the proximal and middle finger segments

Objective: To investigate the clinical effects of modified fascia flap from cutaneous branch of dorsal metacarpal artery in repairing the wound at the proximal and middle finger segments. Methods: From January 2017 to September 2018, 12 patients with wounds at the proximal and middle finger segments were admitted to the Affiliated Hospital of Zunyi Medical University, including 8 males and 4 females, aged 35-70 years. The areas of wounds ranged from 3.4 cm×2.4 cm to 6.5 cm×4.0 cm. The modified fascia flaps from cutaneous branch of dorsal metacarpal artery were resected to repair the wounds, with the size ranging from 3.5 cm×2.5 cm to 6.7 cm×4.1 cm. The flap donor sites of 5 patients were repaired with direct intermittent suture, the flap donor sites of 4 patients were repaired with full-thickness skin grafts from ipsilateral medial forearm, and the flap donor sites of 3 patients were repaired with wrist pedicled flaps. The survival of the flaps was recorded. Healing of donor site and recipient site was followed. The hand functions were evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results: All the flaps survived in 12 cases. During 3 to 12 months of follow-up, the flaps recovered satisfactorily in texture and shape. The donor sites of 11 patients were healed, and the skin graft edge area was partially necrotic in the other patient but healed later after dressing change. The distances of two-point discrimination of the patients ranged from 5.6 to 9.0 mm. Hand functions were evaluated as excellent in 5 cases, good in 4 cases, and fair in 3 cases. Conclusions: Modified fascia flap from cutaneous branch of dorsal metacarpal artery for repairing the wounds at the proximal and middle finger segments has reliable blood supply. The operation is simple and safe with short course of treatment, which is worthy of clinical promotion.

Clinical effectiveness of simultaneous reconstructions of multiple joint scar contracture deformity of limb

Objective: To explore the clinical effects of simultaneous reconstruction of multiple joint scar contracture deformity of limb. Methods: From January 2010 to June 2018, 24 patients with multiple joint scar contracture deformity of the same limb were reconstructed in simultaneous operations in Xiangya Hospital of Central South University, including 16 males and 8 females, aged 3-42 years, with 15 patients having deformities in the upper limbs and 9 patients having deformities in the lower limbs. One operation was performed to repair contracture deformity of axillary fossa and elbow in 3 patients, cubital fossa and palmar of wrist in 4 patients, cubital fossa and hand in 5 patients, palmar of wrist, palm, and palmar of finger in 3 patients, groin and medial knee in 2 patients, popliteal fossa and posterior ankle in 1 patient, and anterior ankle and dorsum of foot in 6 patients. After the release of various joint scar contractures, the area of skin defect was 140 to 580 cm(2). Autologous full-thickness skin grafts were used in 7 patients, autologous medium-thickness skin grafts were used in 4 patients, autologous full-thickness skin grafts combined with local skin flaps were used in 9 patients, and allogeneic acellular dermal matrix and autologous thin skin grafts were used in 4 patients. Comprehensive measures for rehabilitation were taken and the survival of the skin graft was observed after operation. Six months to eight years after the operation, all the patients were followed up for the functions of the affected limbs, among which the functions of the upper limbs were evaluated according to the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. The joint mobility, walking, and squatting function of lower extremity were examined after operation. Recurrence of contractures in all the affected limbs and reoperation were recorded. Results: The grafts survived after operation in 22 patients. Two patients had necrosis in small full-thickness skin area, of which one was healed by skin grafting after debridement, and the other one was healed after dressing changes. The deformity of scar contracture at each repaired joint was completely or partially corrected. During a follow-up for 6 to 96 months, the upper limb functions of 15 patients were rated excellent in 12 patients and good in 3 patients. Among the 9 patients of lower limb scar contractures, except for one 3-year-old child who experienced recurrence of medial knee scar contracture and underwent surgical release and skin grafting 5 years later, the remaining 8 patients basically recovered normal joint functions with pretty good outcomes. Conclusions: For continuous scar contracture deformity of multiple joints of the same limb, simultaneous surgical release and skin grafting can reduce operation frequency and obtain better outcomes of surgical operation.

Effect of free medial plantar perforator flap in repairing deep burn wound on palm with the assistance of three dimensional computed tomography angiography

Objective: To explore the effect of free medial plantar perforator flap in repairing deep burn wound on palm with assistance of three dimensional computed tomography angiography (CTA). Methods: From March 2015 to January 2018, 11 patients with deep burn wounds of palm were admitted to the Department of Burns and Plastic Surgery of Yidu Central Hospital of Weifang City, including 6 males and 5 females, aged 19-53 years. The wound area after debridement was 3.0 cm×2.5 cm-8.0 cm×6.0 cm. Before the operation, CTA of the foot was performed, and the three dimensional digital model was reconstructed by computer software to observe the initial position, course, and distribution of the arteries and veins in the donor site. The medial plantar perforator flap was designed according to the area and shape of the wound, with area of 3.5 cm×3.0 cm-8.5 cm×6.5 cm. After the wound was covered by the flap, the perforating branch of the medial plantar artery was anastomosed end to end with the carpal epithelial branch of the ulnar artery, the accompanying vein or the branch of the great saphenous vein was anastomosed end to end with the accompanying vein of the carpal epithelial branch of the ulnar artery, and the terminal branch of the saphenous nerve or the medial dorsal cutaneous nerve was anastomosed end to end with the superficial palmar branch of the ulnar nerve. The wound of donor site was covered with full-thickness skin graft from the outer thigh of the same side. The perforators of the medial plantar artery observed during the operation were compared with the reconstructed three dimensional CTA images. The survival of flap was observed, and the appearance and function of the flap were followed up and evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results: The initial position, course, and distribution of the perforator of the medial plantar artery during the operation were basically the same as those of the reconstructed three dimensional CTA images before the operation. All the flaps of patients survived after the operation. During the 6 months to 1 year follow-up, the appearance of flap was good, with no obvious swelling or pigmentation, but with good elasticity. The discrimination distance between the two points was 5.0-8.0 mm, and the flaps were evaluated as excellent in 4 cases, good in 6 cases, and fair in 1 case. Conclusions: The free medial plantar perforator flap is an ideal choice for repair of the deep burn wound on palm. Three dimensional CTA before the operation can detect condition of vascular variation, with high accuracy of vascular anastomosis during operation.

Reconstruction of thumb defect by transplanting second toe combined with hallucis flap: 9 cases report

Objective To introduce the method for reconstruction of thumb defect by transplanting free flap of second toe combined with the hallucis flap. Methods From June, 2012 to February, 2017, a total of 9 cases of thumb defect were treated. The average age of these 9 patients was 26 years. The plane of thumb defect was class II area A to class III area A. According to the condition of thumb defect, designed the incision on the hallux and the second toe of the contralateral foot, and cut the 2nd digit and big-toe nail flap with a common arterial trunk. The nail of hallucis flap was rotated 90 degree and connected to the distal end of the 2nd toe. The hallucis flap covered the narrow neck of the 2nd toe. Thus, the circumference of the reconstructed finger and the length of the toenail were increased. Regular followed-up was made after operation. Results All 9 transplantation flaps survived, and donor sites healed primarily. Postoperative followed-up period ranged from 4 to 12 (averge,7) months. All the reconstructed thumbs survived and donor toes were in satisfactory appearances. According to the Functional Assessment Criteria of the Upper Limb Formulated by the Hand Surgery Society of Chinese Medical Association, the outcomes were graded as excellent in 6 cases and good in 3 cases. All the patients were able to manage their daily activities independently. Donor toe injury was small, and their shape and function was good. Conclusion Free flap of second toe combined with hallucis can effectively improve the appearance of the reconstructed thumb. The appearance of the reconstructed thumb is symmetrical, beautiful, and the function is good. Key words: Thumb reconstruction; Second toe; Hallucis flap; Tissue transplantation; Thumb defect

FUNCTIONAL OUTCOME OF MINI IMPLANTS IN CLOSED METACARPAL FRACTURES

Background: The incidence of Hand and Forearm fractures accounts for 1.5% of all Emergency cases. They are the 3rd commonest hand fractures next to distal forearm and phalanges. Closed multiple metacarpal fractures are found to be highly unstable and are more prone for poor functional outcome when they are managed conservatively. In this study we assessed the functional and radiological outcome of Mini Implants for closed metacarpal diaphyseal fractures. Patients And Methods: In our study we had 22 patients with closed metacarpal fracture which were treated with open reduction and internal fixation with mini screws and plates. Functional outcomes were assessed clinically using TAF (Total Active Flexion) and ASSH(American Society for Surgery of Hand) Scoring system and radiologically using RUST scoring system at 6 weeks, 3rd month and 6th month. Result: Union rates of 100% were achieved in all cases. The average time period of union in our study was 13.3 weeks. Functional outcomes were excellent in all cases with an active range of movement >220 degrees. Twocases developed infection, one was superficial and the another was deep infection. Infection got resolved for both the patients with adequate antibiotics and regular dressings. Conclusion: In this study we concluded that mini screws and plates is a good option for treating closed diaphyseal metacarpal fractures as it provided a rigid fixation for early mobilization and had a good functional outcome. Keywords: Hand, Metacarpal fracture, mini implants

Replantation of forearm with abandoned fingers for emergency finger reconstruction

Objective To explore the surgical method and clinical efficacy of emergency finger reconstruction with forearm replantation using abandoned fingers. Methods From February 2003 to February 2019, 15 patients with only 2 or 3 finger intact were treated by forearm replantation using abandoned fingers for finger reconstruction. Among them, 3 fingers were reconstructed in 2 cases and 2 fingers were reconstructed in 13 cases. Results All reconstructed fingers survived and the wounds achieved primary healing. The follow-up time was 3 to 12 months with an average of 6 months. The reconstructed finger was similar to the original finger in shape, with good function, grasping and other basic functions. The pulp sensation recovered well. The two-point discrimination was 5 to 10 mm. The patients were satisfied. According to the evaluation criteria of thumb and finger reconstruction function issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 3 cases, good in 9 cases and fair in 3 cases. Conclusion Emergency replantation of forearm with abandoned fingers to reconstruct finger is an ideal method for emergency treatment of wrist injury, reconstruction and recovery of some hand functions. Key words: Finger injuries; Replantation; Microsurgery; Hand reconstruction

Clinical application of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers of Urbaniak III type in children

Objective To report the clinical application and efficacy of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers in children. Methods From May 2012 to July 2018, 16 children with 17 fingers of degloving amputated injuries were replanted. According to Hou Ruixing's classification method of finger degloving injury type Ⅲ, the cases were classified intoⅠ degree of 6 fingers,Ⅱ degree of 11 fingers base on different skin avulsion planes. Three kinds of anastomosis methods of digital artery were in situ anastomosis of bilateral digital artery in 7 cases 8 fingers, cross anastomosis of a digital artery in 7 cases 7 fingers and transposition anastomosis of adjacent digital artery in 2 cases 2 fingers. Results The replantation of 17 fingers in 16 cases was successfully completed. The postoperative blood circulation was good. Among them, 7 cases 8 fingers with bilateral digital artery anastomosis survived, 3 cases 3 fingers with cross anastomosis of a digital artery occurred necrosis, and 2 cases 2 fingers with transposition anastomosis of digital artery survived. Thirteen patients with 14 fingers survived were follow-up for 3 to 36 months, with an average of 18 months. The growth of nails was found in all the fingers anastomosed with bilateral phalangeal arteries, including 2 cases of nail growth deformity, 1 case of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, while the function of pinching and the skin color and temperature were normal. The growth of nails was found in 4 surviving affected fingers with cross anastomosis of a digital artery, including 2 cases of nail growth deformity, 2 cases of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, which did not affect the holding function with slightly poor skin color, low temperature and finger body atrophy. The growth of nails was found in all the fingers with transposition anastomosis of digital artery, including 1 case of nail growth deformity. The finger was shorter and thicker than the healthy side. The flexion and extension of the finger were good. The skin color was normal and the skin temperature was slightly lower. According to the functional evaluation criteria of replantation of severed fingers issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 7 cases, good in 4 cases and poor in 2 cases. Conclusion For Urbaniak Ⅲ type amputated finger, replantation should be performed as long as the finger body is relatively intact, and the blood supply should be reconstructed by in situ anastomosis of bilateral digital arteries as far as possible. This method has high survival rate and good recovery of finger shape and function after replantation. Key words: Replantation; Treatment outcome; Child; Degloving injury

Application of free big toe nail bone flap combined with second toe tibial flap for reconstruction of thumb defect

Objective To introduce a modified method of thumb reconstruction by combined transplantation of free big toe nail bone flap and second toe tibial flap. Methods According to the condition of thumb defect, free big toe nail bone flap and second toe tibial flap with the common vascular pedicle were cut from the first and second toes of the ipsilateral foot. The second toe tibial flaps were transversely transferred to the tibial side of the toe nail bone flap to reconstruct the toe nail flap belly and nail folds, improve the shape of the reconstructed thumb and reduce the damage of the donor site. Results All the 7 cases survived and the donor and recipient wounds achieved primary healing. The postoperative follow-up period ranged from 3 to 15 months. The reconstructed thumb had good appearance and normal function. According to the functional evaluation criteria of the upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 5 cases and good in 2 cases. All the patients could manage their activities of daily living independently. The donor site had little injury, good shape and function. Conclusion The method of reconstructing thumb defect with free big toe nail bone flap combined with second toe tibial flap can effectively improve the appearance of reconstructed thumb, make the reconstructed thumb symmetrical, beautiful and functional, and reduce the damage of donor toes. Key words: Thumb; Surgical flaps; Second toe; Reconstruction

Repair of digital volar complex soft tissue defect with heterodigital antegrade digital artery island flap innervated by digital nerve

To investigate the effectiveness of heterodigital antegrade digital artery island flap innervated by proper digital nerve and the dorsal branch of proper digital nerve for repairing digital volar complex soft tissue defects. Between May 2014 and January 2018, 27 patients with digital volar complex soft tissue defects were treated. There were 17 males and 10 females with an average age of 37 years (range, 18-60 years). The causes included electric saw injury in 8 cases, twisted injury in 12 cases, and heavy pound injury in 7 case. There were 9 thumbs, 5 index fingers, 6 middle fingers, 3 ring fingers, and 4 little fingers. The interval between injury and admission ranged from 1 to 4 hours (mean, 2.5 hours). The defect size ranged from 2.2 cm×1.4 cm to 3.8 cm×2.3 cm. The mean length of unilateral proper digital nerve defect was 2.9 cm (range, 2-4 cm). All defects were repaired with heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve. The proper digital nerve and the dorsal branch of the proper digital nerve in the flap were anastomosed with the proper digital nerve stumps in the wound. The flap size ranged from 2.4 cm×1.6 cm to 4.1 cm×2.6 cm. A segment of dorsal branch of the proper digital nerve was intercalated into the defect of the proper digital nerve in donor site. And the defect of donor site was repaired with the full-thickness skin graft. All flaps and skin grafts survived, and the wounds healed by first intention. All patients were followed up 12-24 months (mean, 17 months). The appearance, color, and texture of the flaps were similar to the surrounding tissue. There was no pain and double sensibility in any flap. At last follow-up, the static two-point discrimination of the flaps ranged from 4 to 8 mm (mean, 5.3 mm). And the two-point discrimination of digital pulps of recipient and donor fingers ranged from 4 to 10 mm with the average of 6.2 mm and 6.0 mm, respectively. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 18 cases and good in 9 cases. No scar contracture was observed in donor site. The heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve provides a safe and simple technique with minimal donor site cost and satisfactory effectiveness, which could be an ideal option for repairing digital volar defect, especially for the defect complicated with digital nerve defect.

Clinical application of the technology of supercharging and making flap in Yamano area I type II replantation of broken finger

Objective To investigate the clinical efficacy of the use of the technology of supercharging and making flap on Yamano area I type II replantation of broken finger. Methods From January, 2016 to June, 2018, 15 cases (16 fingers) of type II replantation of severed fingers in Yamano area I were treated. During the operation, 2 arteries in the severed fingers were anastomosed and supercharged outside the arteries. Bone fragments in the severed fingers were removed to make them flaps. The blood supply and long-term healing of replanted finger were observed after routine treatment including antiinfection, anticoagulation and antispasm in outpatient follow-up. Results Sixteen fingers of replantation of severed fingers survived smoothly. Followed-up for 6-12 months showed that there were no deformities in the surviving finger, good nail growth, full abdomen and recovery of pain and temperature. The static 2-PD was 7-9 mm. According to the Evaluation Criteria of Replantation Function of Severed Finger of Chinese Medical Association Hand Surgery Society, 13 fingers were excellent and 3 fingers were good. Conclusion In the replantation of Yamano area I type II amputated finger, high survival rate and good healing effect can be achieved by using the technology of supercharging and making flap. Key words: Replantation of broken finger; Yamano I area; Supercharging; Making flap

Effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand

Objective: To summarize the effects of medial upper arm bilobed free flaps in the repair of two skin and soft tissue defects of hand. Methods: From May 2014 to May 2016, 7 patients of two skin and soft tissue defects of hand with exposures of phalanges and tendons were treated in Xuzhou Renci Hospital, including 5 males and 2 females, aged from 19 to 41 years. Each defect area ranged from 3.0 cm×1.5 cm to 6.0 cm×3.0 cm. The medial upper arm bilobed free flaps were used to repair the defects, and the area of each lobe of the flaps ranged from 4.0 cm×2.0 cm to 8.0 cm×3.5 cm. The donor sites were sutured directly. The survival of the flaps was recorded. During follow-up, the recovery of donor and recipient sites was observed, the two-point discrimination distance of the flaps was measured, and the hand function was assessed by the trial criteria of the upper limb functional assessment of the Hand Surgery Society of the Chinese Medical Association. Results: All flaps survived smoothly, and the wounds and donor site incisions were healed. All patients were followed up, and the follow-up time lasted for 6 to 15 months. The color and texture of the flaps were similar to the surrounding normal skin, and the shape of the flaps was good. There was no obvious scar in the donor site, and the elbow joint function was normal. One patient developed ulnar numbness one month after operation and relieved after 3 months of treatment with neurotrophic drugs and local physiotherapy, etc. Six months after operation, the two-point discrimination distance of the flaps was 5.5-8.0 mm, and the hand function evaluation was excellent in 3 cases, good in 3 cases, and middle in 1 case. Conclusions: The medial upper arm bilobed free flap has both good texture and good appearance, and the scar of donor site is concealed. It is a good method to repair two skin and soft tissue defects of hand.

Modified venous grafting to replant an amputated thumb with obstinate arteriospasm

Objective To evaluate the therapeutic effects of bridging the proper digital artery and the radial artery with a vein graft in replantation of an amputated thumb with obstinate arteriospasm. Methods From June 2011 to May 2017, 9 patients received replantation of an amputated thumb at Department of Hand Surgery, The Second Hospital of Tangshan. They were all male, aged from 21 to 55 years (average, 39.2 years). Two right thumbs were involved in 2 cases and 7 left thumbs in 7 cases. During replantation, obstinate arteriospasm which could not be alleviated occurred of their bilateral proper digital arteries. A free forearm superficial vein graft was used to bridge the distal end of ulnar proper digital artery of thumb and the radial artery in tabatiere anatomique to establish blood supply by end-to-end or end-to-side anastomosis. At final follow-up, the outcomes were assessed by the tentative criteria set by The Hand Surgery Society of Chinese Medical Association. Results All the 9 replanted thumbs survived with primary wound healing. They were followed up for 6 to 12 months (mean, 7.9 months). All the patients were satisfied with the appearance and function of the replanted thumb except that mild atrophy was observed in 2 digits with preoperative rotatory avulsion. According to the tentative criteria set by The Hand Surgery Society of Chinese Medical Association at final follow-up, the outcomes were rated as excellent in 7 cases and as good in 2. The pulp two-point discrimination was between 3 and 8 mm, with an average of 5.3 mm. Conclusions An amputated thumb with obstinate arteriospasm can be replanted by bridging the ulnar proper digital artery of thumb and the deep branch of radial artery using a vein graft to establish adequate blood supply to the replanted thumb, leading to satisfactory efficacy. As the technique is easy, it is worthy of popularization. Key words: Thumb; Replantation; Vasospasm; Vascular Grafting

Clinical application of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot

Objective To explore the clinical efficacy of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot. Methods From January 2014 to March 2018, 18 patients with dorsal skin and tendon defects of hand and foot were repaired with single or bilobed free anterolateral thigh flaps with fascia lata, including 14 cases of dorsal hand wound and 4 cases of dorsal foot wound. Among them, 1 case was accompanied with 1 tendon defect, 5 cases with 2 tendon defects, 8 cases with 3 tendon defects, 3 cases with 4 tendon defects, and 1 case with 5 tendon defects. There were 12 cases of single lobed flaps and 6 cases of bilobed flaps. 6 cases underwent secondary flap plastic surgery and tenolysis after operation. Results All the 18 flaps survived and the wound achieved primary healing. The donor site of thigh healed well with only linear scar. The follow-up period was 6 to 24 months with an average of 13 months. 14 cases of dorsal skin defects in hand were evaluated according to the criteria issued by the Hand Surgery Society of the Chinese Medical Association with the results being excellent in 6 cases, good in 7 cases, poor in 1 case. 4 cases of dorsal skin defects in foot had good functional recovery, no toe droop and no limitation of walking function. The appearance and texture of the flaps were excellent in 11 cases. No re-rupture or adhesion of extensor tendon occurred. 6 cases underwent second operation to thin the skin flaps 3 months after operation because of unsatisfactory shape. 4 of them had tendon adhesion after hand wound repair. The tenolysis was performed at the same time of skin flaps thinning. The appearance and function of the flaps recovered satisfactorily. Conclusion The single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot have little damage to donor site. It is an ideal method for repairing such injuries for good recovery of hand and foot function. Key words: Surgical flaps; Treatment outcome; Fascia lata; Skin defects; Tendon defects

Reconstruction of volar plate avulsion injury of proximal interphalangeal joint with mini-anchor

Objective To investigate the clinical efficacy of mini-bone anchor in the treatment of volar plate avulsion injury of proximal interphalangeal joint. Methods From June 2015 to May 2018, 5 patients with dorsal dislocation of proximal interphalangeal joint caused by finger hyperextension injury were treated. The volar plate avulsion accompanied by articular surface avulsion fracture at the base of middle phalanx occurred. The volar approach was used to remove fragments and reconstruct the insertion of volar plate avulsion with mini-anchor. Results All the wounds achieved primary healing. The follow-up period ranged from 4 to 26 months with an average of 12 months. The flexion and extension of the proximal interphalangeal joint ranged from 50° to 85°. The joint was stable and had no lateral abnormal movement. There was no obvious pain and discomfort during the joint movement. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 2 cases and good in 3 cases. Conclusion The reconstruction of volar plate insertion with mini-bone anchor can provide the initial stability of the proximal interphalangeal joint, help early functional exercise, and help to reconstruct the basal articular surface of the middle phalanx. It is one of the ideal choices for the treatment of volar plate avulsion injury of proximal interphalangeal joint. Key words: Volar plate; Treatment outcome; Proximal interphalangeal joint; Mini-anchor