The management of extensive volar soft tissue defects in multiple fingers remains challenging for plastic surgeons. To date, although various types of flaps have been developed as reconstruction options, the applications remain limited by the shortcomings of bloated appearance, insufficient flap area, prolonged treatment time, persistent donor complications, and the sharply increased surgical complexity with the increased number of injured fingers. The superficial circumflex iliac artery perforator (SCIP) flap avoids the shortcomings of conventional flaps whilst allowing harvesting as a single-pedicle multiple-lobed form, rendering it the standout first-tier flap procedure in the repair of multiple soft tissue defects. To date, SCIP flaps with 1–4 lobes have been successfully applied, but a flap with more lobes for soft tissue defects in five fingers has not been documented. Herein, we report our experience of a single-pedicle five-lobed SCIP flap for the reconstruction of extensive soft tissue defects in digits 1–5. Two male patients were admitted after a crush injury to digits 1–5 on the left hand, which necessitated flap transfer to repair the defects after debridement. The single-pedicled five-lobed SCIP flap was designed and harvested according to the perforator distribution of the superficial circumflex iliac artery (SCIA) and the shapes of the defects. After flap coverage, the artery pedicle of the flap was anastomosed to the superficial palmar arch artery or digital artery by end-to-side anastomosis, while the veins were anastomosed to the accompanied veins by end-to-end anastomosis. Post-operative examination revealed the successful survival of the SCIP flap. During follow-up, the color and texture of the flaps were close to the normal finger skin, while only linear scars remained in the donor site. The patients reported no post-operative discomfort at the donor site and were satisfied with the appearance and functionality of the reconstructed fingers. Our study confirms that the SCIP flap can be harvested into a single-pedicle five-lobed form in clinical practice and indicates that the SCIP flap for addressing tissue defects in five fingers represents a simplified method with excellent contour, thus meeting the requirements of both functionality and aesthetics.

Background The application of end-to-side (ETS) anastomosis for flap transfer poses challenges, particularly in cases of significant size discrepancy between the donor and flap arteries. Herein, a novel ETS anastomosis technique, termed “sucker-like ETS anastomosis”, is developed to mitigate and rectify such vessel discrepancies. This study aims to evaluate the efficacy of this technique in tissue defect reconstruction through free flap transfer. Methods Between September 2018 and March 2023, the medical records and follow-up data of 78 patients who underwent free flap transfer using sucker-like ETS anastomosis for significant artery size discrepancies were collected and retrospectively analyzed. Results Among the 78 cases that received free flap transfer, the range of artery size discrepancy (flap artery vs donor artery) was 1:1.6–1:4 (mean: 1:2.5). Following anastomosis with the sucker-like ETS technique, 75 cases achieved flap survival without requiring additional surgical intervention, yielding a one-stage success rate of 96.2%. Three cases experienced post-operative venous crises, with two cases surviving after vein exploration and one case undergoing flap necrosis, necessitating a secondary skin graft. Seven cases faced delayed wound healing but eventually achieved complete healing following dressing changes. No arterial crisis was observed during hospitalization. With an average follow-up of 13 months, the surviving flaps exhibited excellent vitality without flap necrosis or pigment deposition. Overall, the application of sucker-like ETS arterial anastomosis for flap transfer resulted in a high overall surgical success rate of 98.7% (77/78). Conclusion The application of sucker-like ETS anastomosis for free flap transfer is highly effective, particularly in cases with significant size discrepancy between the recipient and donor arteries.

Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs), yet their efficacy compared to cast immobilization remains debated. This meta-analysis aimed to compare VLPs versus cast immobilization for DRFs across various follow-up durations. Randomized controlled trials reporting patient-reported functional scores, wrist range of motion (ROM), radiological assessments, and complications were included. Meta-analysis was performed for 6-week, 3-month, 6-month, 12-month, and >12-month follow-ups. Subgroup analysis stratified studies by age group, ≥ 60 years and < 60 years. VLPs showed significantly lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores at 6 weeks (p < 0.001), 3 months (p < 0.001), 12 months (p = 0.012), and > 12 months (p < 0.001), and lower PRWE scores at 6 weeks (p < 0.001), 3 months (p = 0.048), and >12 months (p = 0.032). Wrist ROM favored VLPs at 6 weeks (p < 0.05), with higher flexion and supination at 3 months (p = 0.027) and 12 months (p = 0.003). Radiologically, VLPs showed improved parameters at 3- and 12-month follow-up. Overall complications did not significantly differ. Subgroup analysis in patients < 60 years generally supported these findings, while in patients ≥ 60 years, radiological outcomes aligned, yet only lower DASH scores were observed with VLPs at 3 months (p < 0.001). VLPs may offer superior clinical, functional, and radiological outcomes compared to cast immobilization at 3- and 12-month follow-up for patients < 60 years, with comparable safety profiles. For patients ≥ 60 years, VLPs may yield better radiological outcomes at 3- and 12-month follow-up, though clinical benefits remain uncertain.

(文接上期) 3讨论 手作为人类生产、生活的主要工具,是最常受伤的部位之一.随着工业化进程,目前临床各种严重手外伤较为常见,且常合并神经、血管、肌肉肌腱、皮肤软组织及骨缺损.其中骨缺损的重建是手外科与显微外科治疗、研究的热点及难点.骨缺损即骨骼结构完整性被破坏,分为容积性骨缺损和结构性骨缺损.

目的 探讨肱骨髁上截骨联合外固定支架辅助复位固定治疗儿童肘内翻的临床方法及效果.方法回顾性分析2018年5月-2019年5月采用肘关节外侧小切口,肱骨髁上楔形截骨联合外固定支架骨钉作为操作杆进行复位固定,治疗20例儿童肘内翻的临床资料.术后均采用肘关节功能位石膏托固定,4周后拆除石膏进行功能训练.结果 所有患儿术后随访2～3年,截骨部位均于术后6～8周骨性愈合,术后2～3个月肘关节屈伸活动范围恢复正常.术后提携角由术前平均内翻30.恢复至术后平均外翻10°,肘内翻畸形无复发.结论 肱骨踝上楔形截骨术后,在截骨平面的远近端采用外固定支架的骨钉作为操作杆进行复位固定,治疗儿童肘内翻,具有切口小、操作简单、截骨角度准确、复位简单等优点,同时可一次性矫正尺偏、过伸、旋转畸形,固定牢固.该手术方法可以实现患儿早期的肘关节功能训练,加快关节活动度的恢复.

目的 探讨应用Mini Ilizarov外固定支架治疗大龄儿童先天性并指畸形的临床效果.方法 采用回顾性方法选取2019年1月至2021年11月该院收治的采用Mini Ilizarov外固定支架治疗的大龄儿童先天性并指畸形患儿7例,均为中环指先天性并指,其中单纯性完全并指5例,普通复杂并指2例.采用Mini Ilizarov外固定支架牵张对皮肤扩容,4周后二期并指分指,按总主动活动度标准评定手功能.术后通过门诊复查、网上发送图片、电话询问3种方式随访3～12个月,中位6.8个月.结果 7例并指畸形均分指成功,未植皮,外观、功能满意,效果好.分指手指瘢痕不明显,无瘢痕增生.结论 应用Mini Ilizarov外固定支架治疗大龄儿童先天性并指畸形效果满意,不需要植皮,值得临床推广应用.

目的 总结吻合血管再植治疗完全离断耳廓伤8例的体会.方法 回顾性分析8例不同平面耳廓完全离断伤通过吻合血管再植成功病例,8例术中予吻合1～2条动脉,1～3条静脉,均一次性通血成功.术后予镇静、密切观察血液循环.结果 8例耳廓离断再植术后Ⅰ期全部成活,术后随访1.5～31个月,平均10.8个月.7例耳廓保护性感觉恢复,生活质量获得显著改善,未遗留明显心理障碍.结论 耳廓血管薄、管腔细小,但其血供丰富.再植操作技术要求高,摆位困难,手术难度相对较大,但只要争取吻合血管,并保证吻合质量,成功几率较大.吻合血管再植是耳廓离断伤的首选治疗方法.

目的 探讨不同形式足内侧皮瓣的血供来源及修复前足软组织缺损的临床效果.方法 对12侧成人足标本的动脉内灌注红色乳胶进行解剖,观察拇趾胫侧底动脉与足内侧皮神经营养血管以及第1跖底动脉、足底内侧动脉浅支、内踝前动脉、跗内侧动脉间吻合关系.根据解剖的实际情况,对临床12例患者设计足内侧皮瓣,分别切取穿支螺旋桨皮瓣(5例)、皮神经营养血管筋膜蒂皮瓣(4例)、穿支+皮神经营养血管筋膜蒂皮瓣(3例)修复前足软组织缺损.结果 解剖显示拇趾胫侧底动脉与足底内侧动脉浅支、内踝前动脉、跗内侧动脉间的血管吻合以及与足内侧皮神经营养血管的吻合,共同构成足内侧皮瓣的血运基础.所有患者的皮瓣及植皮区均成活,供区创缘一期愈合.随访6～24个月,皮瓣外形及功能较满意,皮瓣色泽与周围皮肤一致,无溃疡发生,均恢复保护性感觉;其穿鞋行走及负重等功能均未受到影响.结论 根据足内侧穿支血管的实际情况,灵活设计并切取不同形式的足内侧皮瓣修复足前部皮肤缺损,血供可靠,操作简单,供区损伤较小,是修复前足软组织缺损较理想的皮瓣供区.

目的:观察在治疗lisfranc(跗跖关节)损伤患者治疗过程中分别实施关节融合术和切开复位内固定术的临床疗效有无本质上的不同.方法:随机将2016年3月-2018年1 0月于本院就诊的100例lisfranc损伤患者分为两组,各50例.对照组采用关节融合术,实验组使用切开复位内固定术.并观察两组患者临床疗效评价和并发症发生情况.结果:对照组总有效率和并发症均比实验组差,P＜ 0.05.结论:比起关节融合术,在治疗lisfranc损伤患者的过程当中,切开复位内固定术效果更理想,并发症发生情况也得到了大幅度的降低,推广价值高.

Objective To study the clinical methods and effects of fibula side flap of great toe in the repair of finger pulp defects. Methods 20 cases of finger pulp defects were repaired by using the free fibular flap of great toe, The skin flap donor areas were sutured directly repaired by skin grafts or repaired by the first dorsal metatarsal artery island flap transplantation. Results All the 20 cases of flaps survived completely , and the wound on donor area all survived after stitching up or skin flaps repairing or skin grafting. within a 6 month's follow-up, The flap color, texture, elasticity were good, the finger has a plump appearance of clear fingerprint, and a two-point discrimination abliity of 5~10mm. Finger flexion and extension function recovered well, according to the Chinese Medical Society of Hand Surgery hand function evaluation standard, excellent in 15 cases, good in 5 cases. Conclusion The great toe fibular flap is a hidden-area flap, is most similar to the cortex and the appearance of the finger pulp, after the neurorrhaphy of plantar digital flap and the proper nerve of the finger, the sensory recovery is well, which shows the advantages of constant fibular bottom proper artery of great toe, reliable blood supply, simple operation, short surgical time, high survival rate and excellent rate of shape and sensory recovery. Great toe fibular free skin flap is an ideal method of repairing finger pulp defect.

Objective To study the clinical method and effect of repairing Hallux wound by the planter medial artery reverse island flap. Methods From October 2014 to June 2015, 15 patients with hallux wound, were used the plantar medial artery heverse island flap, the donor zone for direct suturing or skin grafting. Results All the 15 cases survived completely, and the wound on donor zone were all survived after skin grafting. Within a 2 to 12 month's follow-up, flap blood supply was good, closed to the surro-unding normal skin color, no bloated appearance, medium thickness, some sensory recovery. Conclusion The flap area is between the plantar medial and dorsal medial, and is the non-weight-bearing area, hidden, with leather good, and multi-derived blood supply. Medial artery is more constant and reliable blood supply, high survival rate and good appearance with simple and short time operation. The ideal area for hallux wound is based on the first metatarsal head 2.0 cm proximal as the pivot point, to cut island flap.

目的 探讨应用胫后动脉穿支逆行岛状皮瓣修复小腿中下段胫前创面的临床效果.方法 对2013年5月-2014年5月收治的10例小腿中下段胫前创面采用胫后动脉穿支逆行岛状皮瓣修复,供区游离植皮.结果 术后10例皮瓣全部顺利成活,小腿供区创面植皮后全部成活,随访2～12个月,皮瓣血运良好,色泽接近周围正常皮肤,外形无臃肿,厚薄适中,有部分感觉恢复.结论 胫后动脉穿支逆行岛状皮瓣不牺牲胫后动脉主干、小腿深筋膜、大隐静脉和隐神经,以内踝尖上4.0～10.0 cm节段内穿支为蒂,可以修复小腿中下段胫前创面,适应证广,血管表浅恒定,手术操作简单,手术时间短,成活率高,外形佳,值得推广.

目的 探讨应用胫前动脉的前踝上皮支皮瓣逆行转移修复足部不同部位创面的临床效果.方法 对15例足部不同部位的创面,采用胫前动脉的前踝上皮支皮瓣逆行转移修复,供皮瓣区游离植皮.结果 15例皮瓣全部顺利成活,小腿供区创面植皮后全部成活.随访2～12个月,皮瓣血运良好,色泽接近周围正常皮肤,外形无臃肿,厚薄适中,有部分感觉恢复.结论 该皮瓣可以修复足部任何部位创面,适应证广,血管表浅,手术操作简单,成活率高,外形佳,值得临床推广.