Objective:To scientifically measure and morphologically evaluate the anatomical shape of the skin in the first web space based on cadavers, and to guide the design of flap in this area.Methods:Sixteen human cadavers fixed with 10% formaldehyde without injury or deformity on the hand were selected in the Department of Hand Surgery, the Third Hospital of Suqian. According to the characteristics of the first web area, marker points were selected for measurement and morphological observation. Morphological characteristics of the first web with thumb radial abduction(r) or palmar abduction(p) were measured and compared. The t-test was used for statistical analysis. P<0.05 was considered statistically significant. According to the results of measurement, standardised shapes and parameters of the skin were obtained for flap repair of defect of the first web. Results:When the thumb was in palmar abduction, the maximum distance [a(p)] of the first web of female(F) and male(M) was 5.78/8.42 cm(F/M), and the skin [S(p)] was 17.09/23.63 cm 2(F/M), both were significantly greater than the distance [a(r)] at 4.86/6.28 cm and the area of skin area [S(r)] at 14.39/20.15 cm 2 when thumb was in the radial abduction position( P<0.05). There was no significant difference in the length of [b(r)] and [b(p)] alone the long axis of flap between palmar and radial abductions(7.54/9.38 cm and 7.34/9.74 cm, respectively) of the thumb( P>0.05). It was found that the area of first web was not shaped as a symmetrical spindle, but an irregular quadrilateral inclined to the index finger. Conclusion:Design and measurement of a flap for the first web space should take the maximum palmar abduction of a thumb as a reference. The asymmetric quadrilateral flap design is more in line with the anatomical and characteristics in the region.

Objective:To investigate the clinical effect of the relaying perforator flap for repairing the donor site of the anterolateral thigh flap.Methods:From March 2019 to June 2020, 28 consecutive patients who underwent anterolateral thigh free flap reconstruction for limb soft tissue defects were retrospectively reviewed. A relaying perforator flap was selected from one of the four areas adjacent to the donor site of the anterolateral thigh flap for covering the donor site of the anterolateral thigh flap. The secondary donor site was closed directly. The followed-up contents included the appearance and texture of the flaps. The postoperative followed-up was performed through outpatient visits, telephone, and WeChat interviews.Results:A total of 28 patients were included, with an average age of 37.3 (ranging from 15 to 65). The relaying perforator flap was selected from the anteromedial thigh region ( n=13), the proximal anterolateral thigh region( n=6), the distal anterolateral thigh region ( n=5), and the ilioinguinal region ( n=4). The size of the anterolateral thigh flap ranged from 12.0 cm×10.0 cm to 20.0 cm×13.0 cm, and the size of the relaying perforator flap ranged from 6.0 cm×5.0 cm to 11.0 cm×7.5 cm. The followed-up time ranged from 1 to 6 months (mean 4.8 months). The color, texture, and contour of the flaps were good. Only one linear scar is left in the donor site. Two cases with small necrosis (1.0 cm×2.0 cm and 1.5 cm×1.5 cm, respectively) were found in the distal edge of relaying perforator flaps. Conclusions:The relaying perforator flap is considered as an optimized and reliable method for repairing the donor site of an anterolateral thigh flap and should be recommended.

目的:探讨 甲瓣移植再造拇指时受区血管的选择及其效果。 方法:自2018年5月至2020年1月对24例拇指组织缺损的患者，采取 甲瓣或 甲瓣联合其他组织游离移植再造，其中趾-指动脉的短血管蒂移植吻合7例，跖背-虎口区动脉的中血管蒂移植吻合12例，足背-桡动脉的长血管蒂移植吻合5例。 甲瓣供区全部行皮瓣修复，岛状皮瓣修复7例，游离皮瓣修复17例。 结果:术后24例再造拇指和24例供瓣区皮瓣均存活。22例患者随访6~18个月，再造的拇指功能外形满意，感觉恢复良好，指腹两点分辨觉为6~8 mm。按中华医学会手外科学会上肢部分功能评定试用标准评定：优17例，良5例。供足恢复良好，远期随访无明显疼痛及跛行，无糜烂破溃。手部受区与足部供区的切口小，远期随访瘢痕小且隐蔽，外形良好。结论:根据不同大小的 甲瓣，分别合理设计切取短、中、长血管蒂，与受区相应的血管吻合，既能提高手术成功率，又能减少供受区损伤。利用虎口区动脉作为中血管蒂 甲瓣的供血动脉，血供可靠，操作更简便，创伤更小。

Objective:To evaluate the clinical effect of the modified transfer of the proximal interphalangeal joint (PIPJ) from the second toe in the treatment of a finger PIPJ defect.Methods:A total of 13 patients with finger PIPJ defects caused by traumatic injury were enrolled from May, 2017 to March, 2020. All the PIPJ defects had primary traumatic repairs. The causes of injury: 5 patients were caused by strangulation, 4 by chainsaw, 2 by strangulation and 2 by crushing. Of which, 7 patients had index finger injury, 3 middle fingers and 3 ring fingers. The operations were carried out 3-7 months after the first stage of treatment. The grafting of the PIPJ of the second toe with modified vascular anastomosis were performed. The ipsilateral second toe was taken in 10 patients, and the contralateral second toe in 3 patients. The grafted joints all carried observation skin islands, with an area of 1.0 cm×1.5 cm-1.0 cm×2.0 cm. All the secondary bone defects in the donor site of the toe were reconstructed with iliac bone grafts, and the length of the iliac bone strips was 4.0-6.0 cm. At the same time, the island flap on the fibular side of the great toe was removed and repaired at the donor site, with an area of 1.1 cm×1.6 cm - 1.1 cm×2.1 cm. Early postoperative rehabilitation was performed. The patients were followed-up through outpatient visits, telephone and WeChat interviews.Results:All the 13 finger PIPJ and donor site island flaps survived. Bone healing were observed in all patients with the healing time in 8-12(average 10) weeks. Three patients with severe adhesion of joint and tendon were treated with secondary release. All the patients were followed-up for 10 - 18 months without degeneration of PIPJ. Active range of motion of PIPJ ranged: 45°-90° in flexion and 0°-10° in extension, the average motion activity was 66.3°. Seven patients were in excellent, 4 in good and 2 in fair, according to the function assessment proposed by the Society of Hand Surgery of Chinese Medical Association. The appearance on donor site was good and the walking was normal in the longterm follow-up. Only one linear scar was left in the ilioinguinal donor site without obvious discomfort.Conclusion:It was possible to use the modified transfer of the PIPJ from the second toe in the treatment of a finger PIPJ defect. An iliac bone graft and an island flap of the first toe transfer can preserve the appearance and function of the toes.

目的 对比分析应用指侧方皮瓣和静脉皮瓣修复伴有皮肤缺损的断指再植的效果.方法 选取江苏省宿迁市第三医院2016年5月至2019年2月收治的40例伴有皮肤缺损的断指再植患者,随机分为对照组和试验组,各20例.对照组使用指侧方皮瓣进行修复,试验组使用静脉皮瓣进行修复.评估并比较两组修复效果、修复效果满意度、手功能及日常生活活动能力.结果 试验组修复总有效率为95.00％,与对照组的90.00％,差异无统计学意义(P＞0.05).试验组患者的修复效果的满意度为90.00％,与对照组的85.00％,差异有统计学意义(P＞0.05).治疗后,两组手功能及日常生活活动能力评分均高于本组治疗前,差异均有统计学意义(P＜0.05).结论 应用指侧方皮瓣和静脉皮瓣修复伴有皮肤缺损的断指再植均能取得较好的效果,但两种方式的应用会因为损伤不同而存在一定差异,可根据患者的实际情况选择合适的方式完成对患者的修复.

目的 探讨带掌长肌腱的腕横纹游离皮瓣在手指复合组织缺损中的应用及疗效.方法 2015年1月至2017年1月,7例手指复合组织缺损患者,通过急诊或择期手术,采用同侧带掌长肌腱的游离腕横纹皮瓣修复创面,皮瓣根据需要可携带正中神经掌皮支,供区创面直接拉拢缝合.结果 7例皮瓣均成活,供区创面一期愈合.术后随访6～12个月,皮瓣色泽好,无臃肿,质地柔软,静止两点辨别觉为3～5 mm;按照中华医学会手外科学会上肢部分功能评定试用标准,本组中手指功能优6例,良1例,优良率100％.结论 本方法可一次性修复患指创面和肌腱缺损,重建患指运动及感觉功能,且皮瓣外形、质地较好,是目前修复手指复合组织缺损较好的方法.

目的 探讨延续性自我管理教育在冠心病介入治疗患者心脏康复中的效果.方法 选择我院2017年6月-2018年1月90例冠心病介入治疗患者,数字表法分组,对照组用普通护理,试验组执行延续性自我管理教育.比较效果.结果 试验组满意值、心脏功能相关指标、6分钟步行距离指标、冠心病介入术后康复知识掌握度、戒烟依从性、运动依从性、用药依从性、心绞痛以及急性心梗的发生率方面相较于对照组更好,P<0.05.结论 冠心病介入治疗者实施延续性自我管理教育效果确切.

目的 研究游离尺动脉腕上皮支下行支皮瓣在临床上的应用价值.方法 以2014年1月-2017年2月本院接诊的手指创面病患15例为研究对象,采取游离尺动脉腕上皮支下行支皮瓣修复疗法对所选病例进行治疗,并对患者的治疗效果进行综合分析,了解皮瓣的存活情况.结果 本组15例病患在术后皮瓣都成活,成活率高达100.0％.经为期1-1.5年的随访发现,15例病患皮瓣的质地十分优良,且外观比较薄,患者对治疗效果十分满意.结论 积极采取游离尺动脉腕上皮支下行支皮瓣修复疗法对手指创面病患进行施治,可取得较为理想的,建议推广和使用.

目的 研究分析健康教育在小儿先天性心脏病护理中的应用.方法 选取我院2015-2月到2017-2月共86例小儿先天性心脏病手术患者.参照组:对患儿实施优质的护理.观察组在优质护理的基础上开展健康教育护理.结果 观察组的各项指标明显高于参照组,两组比较,存在较大差距,具有统计学意义(P<0.05).观察组护理满意率95.35％明显高于参照组护理满意率81.40％,两组比较,存在较大差距,具有统计学意义(P<0.05).结论 在小儿先天性心脏病手术治疗的常规护理基础上,实施健康教育护理不仅可以使患儿家属了解疾病的相关知识,还可以明显的降低患儿合并症的发生,提高患儿家属护理的满意率,促进护患关系,值得应用推广.