Objective To investigate the feasibility of applying serial skin flaps through the perforator vessel chain of the peroneal artery to cover skin defects in two different parts of the wrist and report the clinical efficacy.Methods From July 2008 to December 2011,7 cases of soft tissue defects on both volar and dorsal aspects of the wrist were treated with the serial free peroneal artery perforator flaps.There were 4 cases of simple skin defects and 3 cases of skin defects combined with bone,joint,blood vessel,nerve and tendon injury.The area of skin defect on the volar wrist ranged from 5.8 cm × 4.5 cm to 8.2 cm × 7.0 cm,while that on the dorsal wrist 4.6 cm × 3.2 cm to 7.5 cm × 6.8 cm.All injuries were repaired sub-acutely.The two peroneal artery perforator skin flaps were connected via the vessel chain.When the width of the defect at the lower leg donor site was less than 4.0 cm,the wound was closed by direct suture.Larger defects at the donor site were covered with full thickness skin grafts.Results All 14 flaps of the 7 cases survived.Blisters occurred in the distal flap in 2 cases that healed after suture removal to reduce tension.Seven cases were follow-up for 6 to 24 months,with an average of 10 months.The flaps had satisfactory appearance and soft texture.Skin grafts at the donor sites healed well,with no blisters and ulceration.Conclusion Transfer of serial skin flaps based on peroneal artery perforator vascular chain to cover soft tissue defects on both volar and dorsal aspects of the wrist is a feasible and effective method that leads to good clinical results.

目的 总结拇指指端缺损与再造的方法及临床治疗效果. 方法 2003年1月至2009年12月,收治拇指末节不同部位组织缺损65例,依照Merle对拇指末节组织缺损的分度法,其中Ⅰ°a15例、Ⅰ°b19例、Ⅰ°c24例、Ⅰ°d7例.分别采用(足母)趾末节或第二足趾部分组织移植修复31例,拇指背侧逆行岛状皮瓣修复17例,带神经(或吻合神经)的邻近带蒂皮瓣修复13例,吻合血管的游离皮瓣(足趾皮瓣除外)移植修复4例.65例中63例为急诊或亚急诊手术,2例择期.切取皮瓣的面积:1.3 cm×1.5 cm～2.8 cm×3.2 cm,供区直接缝合或植皮修复. 结果 吻合血管的(足母)趾及第二足趾部分组织移植发生血管危象4例,及时探查血管成活3例,1例皮瓣远侧端小面积坏死;拇指背侧逆行岛状皮瓣术后静脉回流障碍2例,其中1例远端皮肤少量坏死；其余病例均顺利成活.术后获得随访31例,9～26个月.运动功能:指间关节活动度15°～ 75°,平均53°(指间关节功能位固定2例除外).感觉恢复:吻合神经的18例指腹部感觉均恢复较满意,指腹部达到S3+～S4,其中3例2PD＜6 mm,12例2PD为6～ 10mm.外形:以切取(足母)趾末节或部分组织者满意度得分为最高. 结论 拇指指端缺损的修复与再造,以采用显微外科技术治疗效果为最好.按照“缺什么补什么,缺多少补多少”的原则优先选用(足母)趾末节组织移植；指端小面积缺损采用吻合神经的拇指背侧逆行岛状皮瓣修复,临床效果良好。

目的 总结应用臂外侧下部游离皮瓣修复手背及手指皮肤软组织缺损的治疗效果.方法 应用吻合血管的臂外侧下部游离皮瓣用于修复手背、手指部的软组织缺损12例,皮瓣切取面积3 cm×5 cm～8 cm×15 cm.结果 术后移植皮瓣全部成活.结论 臂外侧下部游离皮瓣是修复手部皮肤软组织缺损较为理想的皮瓣之一。

目的 报道应用游离股前外侧穿支皮瓣修复四肢组织缺损的临床效果.方法 应用吻合血管的游离股前外侧穿支皮瓣用于修复前臂、小腿中下段、足跟部及足背部的皮肤软组织缺损18例;皮瓣面积最小5 cm×8 cm;最大15 cm×28 cm.结果 移植18例皮瓣术后全部成活,其中2例术后48 h内出现血管危象,经手术处理后循环恢复,皮瓣成活.随访6个月～2年,临床效果良好.结论 股前外侧穿支皮瓣,穿支解剖恒定,皮瓣厚度适宜,供区隐蔽,应用显微外科技术施行移植,可获得良好的临床效果。

目的 报道应用胸脐皮瓣修复四肢皮肤软组织缺损修复的治疗效果.方法 应用吻合血管的胸脐皮瓣用于修复前臂、小腿中下段、足跟部及足背部的皮肤软组织缺损22例,应用带蒂胸脐皮瓣修复前臂、肘关节皮肤软组织缺损5例.皮瓣切取面积最小10 cm×8 cm,最大28 cm×29 cm.结果 术后移植皮瓣全部成活,其中2例游离皮瓣术后发生血管危象,经探查处理成活.结论 胸脐皮瓣是修复四肢皮肤软组织缺损较为理想的皮瓣之一。

A new concept of esthetic reconstruction for partial loss of distal finger segment was introduced. In a series of 77 patients, 80 thumb or finger partial defects of lateral, dorsal, or volar half, or composite tissue defect of the finger body were reconstructed with lateral skin-nail flap, dorsal skin-nail flap, pulp flap, or composite tissue transplant taken from corresponding part of the toes. The blood circulations were reestablished by anastomosing digit arteries of the toe transplants and fingers. Seventy-eight fingers in 75 patients of this series were successfully reconstructed. The overall survival rate was 97.5%. Follow-up examinations made half to 12 years postoperatively showed normal length, outward appearance, and function of the reconstructed digits. Their nails are preserved or reconstructed. The pulps are full. Sweating is present. 2-PD was 4-6 mm. Esthetic reconstruction can achieve the goal of mending any part of tissue loss precisely with good result.

Objective To study the classification of thumb defect and the aesthetic principle of thumb reconstruction by toe-to-hand transfer. Method The classification of thumb defect is following the system of types and grades. The authors analysed 390 cases of toe-to-hand transfer for the thumb or finger reconstruction from 1973-2000 years. The principle for the aesthetic and functional thumb reconstruction is to selected good indications and good condition of the transferred second toe. One need to sculpture the transferred second toe and designed a new method for the bone and tendon repair during the procedure of thumb reconstruction, in order to arrange early stage physical functional training postoperatively. Result The classification of the thumb defect is divided six types and twelve grades, The reconstructive thumb can get full range of motion in the MP and/or PIP joint, and the shape of the thumb is near normal postoperatively. Conclusion The classification of thumb defect with six types and twelve grades could help to make good indication for the thumb reconstruction and its functional evaluation postoperatively . The reconstructive thumb can get full range of motion at the MP and/or PIP joint, and with good appearance near normally. It is very important that the transferred second toe to be sculptured and made a new design for the bone and tendon repair during the procedure of thumb reconstruction, in order to arrange early stage physical functional training post operation of thumb reconstruction.

OBJECTIVE:To investigate a method in repairing pulp defects of thumb and finger.METHODS:To examine and analyze 19 case of pulp defect of thumb and finger repaired with free pulp flap of toe since 1987.RESULTS:All the transplanted pulp flaps in 19 cases are survived and are followed up from 3 months to 12 years. All the digits recovered good out appearance with normal skin creases and ridges. The two-point discriminations are 6-8 mm. The repaired thumb or finger are free of paint during pinching and grasping. The split thickness skin grafts on the donor toes yield no hypertrophic scar and no callousity occurred on the donor feet. No detrimental influence occurred on the donor feet.CONCLUSION:The free pulp flap transfer has obvious advantages than any other methods in repairing pulp defects of single finger by, first, good outward appearance, second, quality of the skin over donor flap is almost as rub resistant as recipient finger, third, anastomosis of the digital nerves give functional influence, finally, short rehabilitation period however, the operation requires microsurgical technique and has a risk of failure.

Objective To reconstruct partial loss of distal thumb with five kinds of free flap or compound flap from great toe donor. Method Twenty-seven cases with five types of partial distal thumb loss were reconstructed with free transplantation of pulp flap, onychocutaneous flap, wraparound flap, soteo-onychocutaneous flap and fibular segmental osteo-onychocutaneous flap. Result All survived and the mean follow-up period was 2.1 years (0. 5～5 yerars). An average of 52 degrees of range of motion of interphalangeal joint was achieved. The two-point descrimination was 5～8 mm,and the appearance of reconstrcted thumb was excellent. Conclusion The transplantation of five kinds of free flpa or compound flap from the great toe was the optimal way to reconstruct distal partial defect of thumb.

Liu, Ya-ping M.M.; Tang, Hai-ping M.M.; Yang, Zhi-xian M.M.; Pan, Da-de M.D. Author Information

Objective To establish a new ultra deep low temperature technique that can maintain the activity of human allografting tendon and provide the tendons for clinical application. Methods The fresh donor tendon was preserved in the cryopreserved solution which included 10% dimethyl sulfoxide and fetal calf serum. Balanced at room temperature, the tendon was dropped into liquid nitrogen freezer for 6 hours and immersed no less than 3 months. It was quickly thawed and washed at 40℃temperature water and detached cryopreservation agent before use. Then the resuscitated tenocyte activity was examined .26 finger flexion and extension tendons in 11 cases were repaired. Results The tenocyte cell activity handled by ultra deep low – temperature was (78.7 ± 6.3)%.No rejection occurred after tendon allografting. Obvious adhesion was found in 3 cases after operation. Conclusions Tendon handled by ultra deep low temperature was active. It can be widely propagated due to its satisfactory treatment outcome.

Objective To analyze the long term results of vascularized fibular graft to repair defects of long bone. Methods Nineteen patients undergone vascularized fibular graft were followed up for 5－ 20 years(mean 10.79 years). Limb function was graded with Enneking s system, and presented as percentage of normal limb function. The changes of the vascularized fibular graft were evaluated radiographically according to the International Symposium on Limb Salvage. Results The long term results of the vascularized fibular graft varied in different types of bone defects. Nine patients with congenital pseudoarthrosis of tibia had the limb function restored in 65％ and one had nonunion of fibular graft, 3 fractures(7 times), and 5 angular deformities. Three patients with congenital radial deficiency had 62％ restoration of the limb function. All of them showed early closure of epiphyses of the grafted fibulae. Five cases with osteomyelitis and bone defects combined soft tissue deficiency had 94％ restoration of the limb function, and only one occurred fracture of fibular graft. One case with soft tissue defect and concomitant ulnar defect, ulnar nerve and median nerve injury, 67％ function of limb was recovered, and union of fibula graft was good. 100％ function of limb was recovered in 1 case with cavernoma of radius and without occurring valgus deformity of donor site. Conclusion The vascularized fibular graft is a good method for repairing long segmental defects of bone. Combined with other tissue flap, the operation can reconstruct bone defect and fulfil the cover of soft tissue. For congenital tibia pseudoarthrosis and radial deficiency, the long term results are not so satisfactory.

目的探索食管狭窄、闭锁或缺损的修复与重建、手术适应证、手术要点及并发症的防治。方法采用吻合血管的带蒂空肠、游离空肠、肠瓣及前臂皮瓣移植等手术对化学灼伤或其它原因致全食管、上胸段及颈段食管狭窄或闭锁的病人进行修复与重建。结果成功４４例，失败１例。结论吻合血管的带蒂或游离空肠及肠瓣移植修复与重建是治疗食管狭窄、闭锁、缺损的理想手术方法；经腹部多次手术的颈段食管缺损病人可采用吻合血管的皮瓣或皮管移植手术对食管进行修复与重建

用脱氧鸟苷培养处理鸡屈趾深肌腱5天,无创冻存于液氮贮存器(-196℃)中3个月,使用前将冻存腱在40℃溶液中融解并洗去腱中吸收的二甲基亚砜.即刻作同种异体移植,自体移植对照.混合淋巴细胞培养实验及腱细胞活力测定证实,脱氧鸟苷培养及无创冻存处理肌腱显著降低了肌腱抗原性并保留了肌腱活性.趾主动屈曲功能,大体、显微及超微观察,羟脯氨酸含量测定及生物力学分析等结果均显示,培养及冷冻处理的异体移植肌腱与自体移植肌腱差异无显著性意义.说明脱氧鸟苷培养及无创冻存处理肌腱可显著降低肌腱抗原性并保留了肌腱活性.培养处理及冷冻保存的肌腱异体移植可达到与自体移植相同的良好效果.

Objective To establish a new tissue bank technique for cryopreserved human tendon allograft and observe the result of clinical application. Methods The fresh tendons of the human donors were cultured in the medium RPMI 1640 containing deoxyguanosine (dGUA), and then were cryopreserved in liquid nitrogen freezer without affecting their survival. Before use, the tendons were quickly thawed and washed away the absorbed dimethyl sulfoxide for determination of the tenocyte activity, the morphological changes and the biomechanical features. The tendons were grafted afterwards. 30 tendon allografts were clinically used in 12 cases from August 1996 to December 1998. Results After cultured and cryopreserved, the tendon allograft remained (70.5 4.5) % of the original tenocyte activity. Histological observation and biomechanical analysis showed no significant differences between the cultured and cryopreserved tendons and the fresh tendon allograft. Clinically, the flexion function of the involved fingers was satisfactory. No tenolysis was needed according to our preliminary observation. Conclusions Cryopreserved human tendon allograft remained active after thawing. Its clinical application was successful, with rare incidence of tendon adhesion.

Since 1978 a series of 15 avulsively amputated thumbs were replanted with survival of the replantation in 14 patients. Good restoration of sensory and motor functions for these patients eradicates the old concept that replantation for avulsively amputated digits is contraindicated or a poor risk. We emphasize the importance of proper management of the transfer technique of the severed tendons, nerves, and blood vessels during the replantation. Details are described. The only failure was a result of technical faults. We conclude that replantation of an avulsively amputated thumb is worthwhile and will be beneficial to the patient.