BACKGROUND:This study evaluated early debulking combined with corrective osteotomy for the treatment of hand macrodactyly in young patients. METHODS:This retrospective study included 31 young patients (mean age, 12.7 years) with severe hand macrodactyly. All the patients underwent microsurgical debulking based on multiple pedicled flaps and osteotomy to reduce soft-tissue volume and correct finger deformity. The mean follow-up period was 3.1 years. Clinical evaluations included ratios of finger length, circumference, and nail dimensions compared with the intact fingers; metacarpophalangeal joint range of motion; and functional scores (Kapandji, Action Research Arm Test, and Barthel) before and after surgery. The Vancouver Scar Scale score, parent satisfaction, and complications were also assessed. RESULTS:The procedure preserved all the fingers, avoided ablation, and restored near-normal appearance. Preoperatively, affected fingers were 1.3 times longer, with proximal interphalangeal joint and distal interphalangeal joint circumferences 1.5 and 1.7 times larger than those of intact fingers. At the last follow-up, these ratios improved to 1.1, 1.2, and 1.2, respectively. Nail length and width, initially 1.7 and 1.6 times larger, normalized to 1.0 and 1.1 times larger. Metacarpophalangeal joint range of motion improved from 41 degrees to 69 degrees. Functional scores rose significantly: Kapandji from 6 to 9, Action Research Arm Test from 33 to 53, and Barthel from 95 to 98. The average Vancouver Scar Scale score was 2. All parents expressed satisfaction with the results. CONCLUSION:Early debulking combined with corrective osteotomy reduces finger volume, preserves digits, improves functional outcomes, and minimizes adverse effects on quality of life, offering a promising option for treatment of severe hand macrodactyly.

Although current penile enlargement techniques can improve appearance, it remains unclear whether these procedures increase sexual function. We aimed to systematically compare the surgical outcomes, with a particular focus on sexual function, in patients and their partners following silicone pearls implantation and fat grafting for penis enlargement. A single-site, retrospective study reviewed patients who underwent silicone pearls implantation or fat grafting for penis enlargement. In the operation, silicone pears were connected to form a ring-shaped implant, which was then implanted under the dartos fascia. For patients underwent fat grafting, a total of 40–55 ml of fat was injected for penis enlargement. Preoperative and 6-month postoperative data of patients and their partners were collected. The penis diameter, penis appearance score (PAS) and treatment satisfaction scale (TSS) were evaluated. Both pearls implantation (n = 28) and fat grafting (n = 27) led to an increase in penis diameter. The TSS scores of patients who underwent pearls implantation increased by 11.96 www.springer.com/00266 .

Background: We aimed to report our experience in treating ear amputations with microvascular replantation, with the largest sample to date. Methods: Twenty-two patients with complete ear amputation underwent microvascular ear replantation at three medical centers between May 2003 and May 2020. Arterial anastomoses, venous anastomoses, or vein graft were performed depending on different situations. Re-exploration was performed in four patients due to venous congestion (n = 3) or arterial compromise (n = 1). Results: Eleven patients had vascular complications (venous congestion: 10, arterial compromise: 1) and four of them required re-exploration. Three ears were completely salvaged (75%) and one case failed. Eighteen (81.8%) replanted ears survived completely, with 15 repaired ears demonstrating a good contour and 3 ears showing atrophy. Three replanted ears sustained partial loss, and one sustained total loss. Three extraordinary cases with the longest ischemic time, smallest tissue size, and youngest age reported thus far all survived and had cosmetically satisfactory appearances. Statistical analysis indicated no significant correlation between replanted ear survival and potentially influential factors, including ischemic time, number of arterial and venous anastomoses, presence of vein graft, and re-exploration. Conclusions: Microvascular replantation for ear amputations achieved excellent results. It may be considered the primary choice for surgeons with microsurgical skill.

The purpose of this study was to investigate the efficacy of surgery combined with triamcinolone acetonide injection in managing the difficult problem of keloid formation after syndactyly release. Twenty-two patients with keloid formation after syndactyly release were retrospectively reviewed. They were divided into a simple surgery group and a surgery plus injection group. Complications, web quality, scar score and satisfaction were assessed and compared. In the surgery plus injection group, three patients (3/13) experienced recurrence and ten webs were good, whereas in the simple surgery group, seven patients (7/9) experienced recurrence and five webs were poor. The mean Vancouver Scar Scale score was significantly lower (4.3 versus 7.8) and the mean Faces Questionnaire satisfaction score was higher (4.2 versus 2.6) in the surgery plus injection group. Combining surgical excision with early and repeated intralesional injection can achieve better results with low recurrence rate and side effects. Level of evidence: IV

Objective:To describe the effect of distraction lengthening to correct nail deformity in unilateral congenital brachydactyly type D (BDD).Methods:Patients with unilateral BDD who were treated by distraction lengthening between January 2020 and December 2021 in the Department of Plastic and Reconstructive Surgery of Shanghai 9th People’s Hospital were retrospectively reviewed. A transverse osteotomy was applied on the middle diaphysis of distal phalanx, and one pin was inserted percutaneously on both sides of the osteotomy site, then a mini external fixator was installed. Distraction lengthening was performed with a slow and sustained procedure. The aesthetic and functional results were compared preoperatively and postoperatively. Patient satisfaction questionnaires were recorded.Results:35 patients were enrolled, including 12 males and 23 females, with a mean age of 29.5 years. 17 thumbs were left and 18 thumbs were right. The time for distraction lengthening was 10-17 days, and the mean time was 12.3 days. The total time for external fixator maintenance was 55-70 days, with a mean time of 61.4 days. The mean follow-up was 18.6 months. The mean thumbnail length was increased from (9.2±0.6) mm to (14.2±0.4) mm [lengthening ratio, (54.4±7.5)%] after distraction lengthening ( P<0.05). The ratio of nail length to width changed from 0.63±0.05 to 1.05±0.04 [increase ratio, (68.2±10.5)%, P<0.05], which was equal to the normal value (1.07±0.03) ( P>0.05). Meanwhile, the distal thumb length increased from (22.6±0.7) mm to (29.6±1.0) mm ( P<0.05), with a mean increase of (6.9±1.0) mm, and the increase ratio was (30.8±4.8)%. The ratio of nail length to distal thumb length changed from 0.41±0.03 to 0.51±0.02 [increase ratio, (23.6±8.3) %, P<0.05]. The thumb function was not significantly influenced ( P>0.05). 33 patients (94.3%) were very satisfied with the results. Conclusion:Short nail deformity in BDD can be corrected by distraction lengthening with a good aesthetic appearance and without functional impairment.

Brachydactyly Type D is a congenital condition of the thumb in which there is a short and broad thumbnail. Although the thumb function is often unaffected, some patients seek surgery for cosmetic improvement. This study aimed to describe our method of distraction lengthening to correct nail deformity in brachydactyly Type D. A total of 163 thumbs in 95 patients underwent this surgery between 2018 and 2021.The mean thumbnail length improved from 9 mm to 15 mm, with a mean percentage increase of 62%. The ratio of nail length to width changed from 0.6 to 1.1, which was equal to normal. The mean increased fingernail length/width ratio was 0.5, with a percentage change of 78%. No obvious surgical scar was observed. The thumb function was not significantly affected. We conclude that aesthetic correction of short nail deformity in brachydactyly Type D can be achieved by distraction lengthening with high satisfaction and without functional impairment.Level of evidence: IV.

并指畸形是指相邻指间软组织和(或)骨骼不同程度的融合,是最常见的手部先天性畸形之一,手术分离是其最重要的治疗手段.通过引入精准康复理念,对并指畸形术后康复方案进行全面优化,可以进一步提高患者康复疗效.本共识以循证医学证据为依据,经过全国专家组反复讨论,同时借鉴和参考国内外近年来的研究成果,供全国手外科医师、康复医师、康复治疗师、康复工程师、护理人员等在临床工作中参考使用.本共识主要内容包括先天性并指畸形术后康复的目标、关注的问题、治疗的主要内容、团队的组成与职责、治疗手段与措施以及推荐康复方案等.

Objective:To explore the role of transgelin(TAGLN) in the occurrence and development of papillary thyroid carcinoma (PTC) and its possible signal pathway.Methods:One hundred cases of PTC tissues and corresponding paracancerous normal thyroid tissues were collected. Realtime quantitative PCR (RT-qPCR), Western blotting, and immunohistochemistry were used to analyze the expression of TAGLN in PTC tissues and corresponding paracancerous normal thyroid tissues. PTC cells were transfected with plasmid and shRNA lentivirus vector respectively to up-regulate or down-regulate the expression of TAGLN in order to detect the effects of them on the proliferation, invasion, and migration by cell proliferation assay(cell counting kit-8, CCK-8)and cell invasion and migration assays (Transwell). The effects of TAGLN on mitogen-activated protein kinase (MAPK)/extracellular-signal regulating kinase (ERK) signal pathway was detected with Western blotting.Results:RT-qPCR showed that there was no difference in the expression of TAGLN mRNA between PTC and corresponding paracancerous normal thyroid tissues ( P>0.05); Western blotting demonstrated that the expression of TAGLN protein in PTC tissues was significantly lower than that in corresponding paracancerous normal thyroid tissues ( P<0.01). Immunohistochemical results revealed that the expression of TAGLN in PTC tissues was significantly lower than that in corresponding paracancerous normal thyroid tissues. Overexpression of TAGLN inhibited the proliferation, invasion, and migration of PTC cells ( P<0.01), but knockdown of TAGLN promoted the proliferation, invasion, and migration of PTC cells ( P<0.01). Overexpression of TAGLN decreased the expression of phosphorylated ERK ( P<0.05), whereas silencing TAGLN increased phosphorylated ERK level in PTC cells( P<0.01). Conclusion:The expression of TAGLN in PTC is significantly decreased. It is related to the occurrence and development of PTC, and its mechanism may be related to MAPK/ERK signal pathway.

Ribosomal S6 kinase 4 (RSK4) is a putative tumor suppressor gene which is inactivated by epigenetic events in a number human malignancies; however, its role in papillary thyroid carcinoma (PTC) remains largely unknown. The aim of this study was to explore the methylation status of the RSK4 promoter in PTC, and to determine its potential role in thyroid carcinogenesis. Reverse transcription‑quantitative PCR (RT‑qPCR) and western blot analyses were performed to examine the RSK4 mRNA and protein levels, respectively. Methylation‑specific PCR (MSP) and bisulfite genomic sequencing (BGS) were used to analyze methylation status of the RSK4 gene. Sanger sequencing was further carried out to detect the BRAF V600E mutation. Cell proliferation assay was finally performed to evaluate the role of hypermethylation in the growth of PTC cells. The association between RSK4 methylation and the clinicopathological characteristics of patients with PTC was assessed. The methylation frequency of the RSK4 promoter in PTC tissues was higher than that in paired paracancerous tissues. Coincidentally, the RSK4 mRNA levels were also downregulated in PTC tissues when compared with the paracancerous counterparts. The hypermethylation of RSK4 was associated with tumor size and lymph node metastasis. Furthermore, the BRAF V600E mutation may influence RSK4 expression and methylation. Moreover, RSK4 hypermethylation was observed in thyroid cancer cell lines, which was consistent with a lack of RSK4 expression. Upon the 5‑Aza‑deoxycytidine treatment of thyroid cancer cells, RSK4 expression was significantly upregulated, while cell proliferation was inhibited. On the whole, the findings of the present study demonstrate that the hypermethylation of the RSK4 promoter may be one of the mechanisms responsible for the poor RSK4 expression in PTC. Thus, these data suggest that RSK4 may serve as a molecular target for the early diagnosis and treatment of PTC.

Background: Papillary thyroid carcinoma (PTC) represents the most frequent subtype of thyroid cancer (TC) with poor prognosis mainly due to the severe invasion and metastasis. As an oncogene, microRNA-421 (miR-421) is involved in the development of various cancers. This study was to investigate the clinical significance of miR-421 in PTC and its effects on the biological function of PTC cells. Methods: The expression level of miR-421 in all tissues and PTC cell lines was measured by quantitative real-time polymerase chain reaction (qRT-PCR). Subsequently, the relationship between miR-421 expression and the clinicopathological feature was detected by chi-square analysis in 106 patients with PTC. In addition, Kaplan-Meier and multivariate Cox regression analysis were used to detect the survival time and the prognostic value of miR-421. Finally, the regulatory effect of miR-421 on the proliferation, migration, and invasion ability of PTC cells was detected by Cell Counting Kit (CCK-8) and Transwell assay. Results: Compared with all control groups, the expression of miR-421 was significantly increased in 106 patients tissues and PTC cell lines ( p < 0.001). In addition, patients with miR-421 upregulated in PTC showed more positive lymph node metastasis ( p = 0.011), positive tumor infiltration ( p = 0.031), and TNM stage III/IV ( p = 0.019), and when miR-421 expression level was elevated, the survival rate of PTC patients was poor (log-rank test, p = 0.023). Furthermore, miR-421 might be an independent prognostic biomarker for PTC (hazard ratio [HR] = 3.172, 95% CI = 1.071-9.393, p = 0.037). Finally, increased levels of miR-421 can significantly promote cell proliferation, migration, and invasion ( p < 0.01). Conclusion: miR-421 is a novel oncogene of PTC and is a valuable prognostic biomarker. Moreover, the upregulation of miR-421 enhances the proliferation, migration, and invasion of PTC cells.

Hand burns are frequently seen in children, often resulting in digital flexion contractures. Traditional split-thickness or full-thickness skin grafts leave notably different skin texture and hyperpigmentation. The purpose of this study was to describe our operation for treating digital flexion contractures with full-thickness plantar skin grafts, and to evaluate the appearance and function outcomes. Hematoxylin and eosin staining, Masson trichrome staining and Melan A (marker of melanocyte) staining were used to evaluate palmar skin, plantar skin, groin skin and burn scars. Full-thickness plantar skin grafts were performed between 2008 and 2015 in 24 hand burn patients with digital flexion contracture. The average age at the time of surgery was 39.3 months and the average follow-up period was 5.5 years. The functional and cosmetic results were assessed. Plantar skin shared similar attributes with palmar skin histologically. Both plantar skin and palmar skin did not express melan A. All of the skin grafts survived well without hematoma, infection and necrosis. The grafts resembled the adjacent normal skin in regards to appearance and texture. The average TAM (total active movement) degree for the fingers was improved from 152.3 degrees to 238.5 degrees. The average VSS (Vancouver Scar Scale) score decreased dramatically from 10.4 to 1.1. Twenty one of twenty four patients (21/24, 87.5%) were very satisfied with function and appearance, and three in twenty four (3/24, 12.5%) were somewhat satisfied. This study indicates that full-thickness plantar skin grafts can achieve a satisfactory appearance and good function for hand burn child patients with digital flexion contractures.

BACKGROUND:The incidence of thyroid cancer is increasing rapidly and there is an urgent need to explore novel therapeutic targets for thyroid cancer. MiR-140 has been reported to affect the progression of various cancers, which makes it possible to play a role in thyroid cancer. This study aimed to investigate the expression and role of miR-140 in thyroid cancer.METHODS:The expression of miR-140 was investigated by reverse transcription-quantitative polymerase chain reaction (qRT-PCR) in thyroid cancer tissues and cell lines. The prognostic value of miR- 140 in thyroid cancer was evaluated by Kaplan-Meier survival and Cox regression. Moreover, the effects of miR-140 on cell proliferation, migration, and invasion of thyroid cancer were investigated by CCK-8 and Transwell assay.RESULTS:MiR-140 was downregulated in thyroid cancer tissues and cells, which correlated with TNM stage and lymph node metastasis of patients. Patients with low miR-140 expression had a shorter survival time compared with that in patients with high miR-140 expression. Furthermore, miR-140 acts as an independent factor for the prognosis of thyroid cancer. Overexpression of miR-140 inhibited cell proliferation, migration, and invasion of thyroid cancer.CONCLUSION:MiR-140 can serve as a potential prognostic factor for patients with thyroid cancer and suppress the progression of thyroid cancer, which provides new insight for the therapeutic target for thyroid cancer.

Abstract Papillary thyroid cancer (PTC) is a major kind of thyroid cancer with increasing recurrence and metastasis. MiR-127 has been demonstrated to play roles in many cancers with dysregulation. However, the function of miR-127 is still unknown. This study aimed to explore a novel biomarker for the progression and prognosis of PTC. A set of 118 patients with PTC were collected from the Affiliated Hospital of Qingdao University. qRT-PCR was used to detect the expression of miR-127 in PTC tissues and cells. The association between miR-127 expression and the clinicopathological features of patients were evaluated by the χ2 test, and the prognostic value of miR-127 was evaluated by Kaplan–Meier analysis and Cox regression analysis. The effect of miR-127 on cell proliferation, migration, and invasion of PTC was analyzed by CCK-8 and transwell assay. miR-127 was found to be upregulated in PTC tissues and cells correlated with the TNM stage and poor prognosis of PTC patients. MiR-127 and the TNM stage were considered as two independent prognostic indicators for PTC. Moreover, overexpression of miR-127 significantly enhanced cell proliferation, migration, and invasion of PTC by targeting REPIN1. miR-127 may be involved in the progression of PTC, which provides a new therapeutic strategy for PTC.

PBL是一种以问题为基础的学习,其教学模式以学生为主体,以小组讨论为形式.近年来,PBL教学法在各学科的教学中均得到了广泛应用.本文对手外科的学科特点、传统教学的局限性、PBL教学法的优势,以及PBL教学法在手外科教学中的应用进行阐述.

Objective In this report, we present our experience on the use of bilateral lateral hallux osteo-onychocutaneous free flaps for reconstruction of distal finger and the aesthetic and functional results of this technique in a series of cases. Patients and Methods From February 2005 to May 2015, 7 patients underwent finger reconstruction distal to the distal interphalangeal joint using the bilateral lateral hallux osteo-onychocutaneous free flaps. The mean age was 29.3 years (range, 24–33 years). The lateral hallux osteo-onychocutaneous flaps were harvested from bilateral donor sites. The size of each flap was designed based on the size of half distal finger defect. The lateral hallux osteo-onychocutaneous free flaps from both donor sites were combined to reconstruct the distal finger. More than 50% of hallux nail was preserved in each of donor sites, which was covered with a local flap. Results All flaps used for reconstruction survived without complications after surgery. The average length of follow-up was 93.4 months (range, 16–163 months). All reconstructed distal fingers showed good aesthetic appearance, except one that underwent a secondary debulking procedure. The average total active motion of the finger was 215.7 degrees (range, 200–230 degrees). Neither pain nor numbness sensation in the reconstructed fingers was complained by the patients. The donor site morbidity was minimal. All patients had pain-free and good function outcome in both feet. Conclusions The use of the bilateral lateral hallux osteo-onychocutaneous free flaps may provide an option for distal finger reconstruction with satisfactory function and anesthetic outcomes with minimal hallux donor site morbidity.

手及上肢先天畸形患者中约有1％存在多发畸形,致病机制复杂,表现多样,通常单一科室难以完成疾病的完整诊治及研究.多学科联合诊治模式(MDT)不仅为这部分患者的诊治带来希望,而且为手外科的教学引入了全新的模式.本文就手外科多学科联合诊治教学模式的建立与实施进行介绍.

目的 探讨3种不同甲状腺术式对甲状腺癌患者甲状旁腺素及血钙水平的影响.方法 回顾性分析2017年7月 —2018年6月在我院手术治疗的甲状腺癌患者175例,按不同术式分为3组,单侧腺叶切除+同侧中央区淋巴结清扫术42例(A组),甲状腺全切+单侧中央区淋巴结清扫术71例(B组),甲状腺全切+双侧中央区淋巴结清扫术62例(C组),分析术前2 d、术后3 d患者血钙及甲状旁腺素水平的变化.结果 C组低钙血症及低甲状旁腺素血症发生率明显高于A、B两组,差异具有显著性(χ2=40.042、53.159,q=-10.990～10.299,P<0.05);各组间术前血钙及甲状旁腺素水平比较差异无显著性(P>0.05);各组间术后血钙及甲状旁腺素水平比较差异有显著性(F=23.134、35.859,q=2.780～11.762,P<0.05);A组手术前后血钙及甲状旁腺素水平比较差异无显著性(P>0.05);B组 、C组手术前后血钙及甲状旁腺素水平比较,差异均有显著性(t=3.537～8.241,P<0.05).结论 单侧腺叶切除+同侧中央区淋巴结清扫术对术后血钙及甲状旁腺素水平无明显影响;甲状腺全切除术随淋巴结清扫范围扩大,术后低钙血症及低甲状旁腺素血症发生率增高,双侧中央区淋巴结清扫尤为显著.

目的 对我国一个短指家系进行致病基因进行鉴定.方法 应用全外显子测序对该短指家系进行基因突变检测,并用Sanger测序对突变位点进行验证.结果 该家系共有3名患者,均为短指表型,符合常染色体显性遗传.全外显子检测提示患者均存在GNAS基因(NM_001077488:exon13:c.A1145T:p.D382V)杂合错义突变,Sanger测序验证与全外显子结果一致.结论 GNAS基因第13号外显子上c.A1145T杂合错义突变是该短指家系的致病原因.

目的 通过分析甲状旁腺全切联合自体移植术在中国尿毒症继发甲状旁腺功能亢进(SHPT)病人中应用的全因病死率、术后并发症、术后复发率、1次手术成功率、术后症状缓解率,评价该术式的临床疗效.方法 检索万方、维普、中国知网、PubMed等中英文数据库.纳入关于甲状旁腺全切联合自体移植术在中国尿毒症SHPT病人中应用的随机对照试验、非随机对照试验、病例对照研究、队列研究、病例报告论文纳入Meta分析.结果 共纳入了12项研究,包含375例中国尿毒症病人.经过分析,甲状旁腺全切联合自体移植术在中国尿毒症SHPT病人中应用的术后并发症发生率P=0.15(95％ CI 0.04～0.31);1次手术成功率P--0.93(95％ CI 0.90～0.96);术后复发率P=0.11 (95％ CI 0.06～0.17);全因病死率P=0.04(95％ CI 0.01～0.07);术后症状缓解率P=0.86 (95％ CI0.61～0.99).结论 甲状旁腺全切联合自体移植术在中国尿毒症SHPT病人中应用的疗效较为显著,术后不易复发且并发症的发生率较低.

目的 探讨核糖体蛋白激酶A6(RSK4)在甲状腺乳头状癌(PTC)中的表达及其与临床病理因素的关系.方法 收集200例PTC(A组)和对应的癌旁组织(B组),40例甲状腺良性结节(C组)及其结节旁组织(D组)新鲜标本,提取相应RNA,并逆转录成cDNA,采用实时荧光定量PCR(RT-qPCR)检测RSK4的表达量,并分析其与PTC患者临床病理因素的关系.结果 A组中RSK4表达量显著低于B组(Z=-9.658,P＜0.01)和C组(Z=-5.648,P＜0.01),但C组RSK4表达量与D组比较差异无显著性(P＞0.05).肿瘤直径＞1 cm的PTC组织中RSK4表达量显著低于≤1 cm组(Z=-3.528,P＜0.01),有包膜侵犯的PTC组织中RSK4表达量显著低于无包膜侵犯组(Z=-2.822,P＜0.01).结论 RSK4在PTC组织中低表达,且与肿瘤大小、包膜侵犯相关,可能成为PTC诊断和预后评估的潜在生物标志物.