Objective To conduct preliminary differentiation of benign and malignant longitudinal melanonychia in the hand,the explore the flap repair methods for nail bed defects after surgical resection.Methods From September 2017 to May 2022,a total of 28 patients with hand melanonychia were treated.Among them,there were 6 cases under the age of 16 and 9 cases in thumbs.The preliminary differentiation of benign and malignant longitudinal melanonychia before surgery was conducted and the area of nail bed defects after melanonychia excision was estimated.For defects with a width less than 1/2 of the nail bed width,a transverse V-Y advancement flap was used for repair.For defects with a width greater than 1/2 of the nail bed width,a digital dorsal fascia flap was used for repair after nail unit total resection.Results All 28 flaps survived after surgery.The early postoperative venous reflux obstruction occurred in 5 cases of digital dorsal fascia flap.After appropriate treatment,all 5 flaps survived.The postoperative pathological report showed that 16 cases were nail matrix nevi,10 cases were junctional nevi,and 2 cases were melanoma in situ.24 patients were follow-up for a period of 9 to 24 months.17 cases in the V-Y advancement flap group were obtained follow-up.Among them,14 cases reacquired fine nail,and 3 cases had longitudinal ridges in their nails.7 cases in the digital dorsal fascia flap group were obtained follow-up.The appearance and texture of the flap were satisfactory.At the last follow-up,no recurrence was observed in all follow-up patients.Conclusion According to the different range of nail bed defects after longitudinal melanonychia resection,the use of transverse V-Y advancement flap or digital dorsal fascia flap for repair has achieved good clinical results,and also made meaningful exploration for the establishment of standardized treatment for longitudinal melanonychia.

Objective:To investigate the clinical effect of free anterolateral thigh perforator flap(ALTPF) in reconstruction of temporal scalp defect after blood circulation reconstruction surgery for moyamoya disease.Methods:From May 2020 to July 2022, 7 patients with scalp defect after revascularisation of moyamoya disease were treated in Department of Hand and Foot Microsurgery, Henan Provincial People’s Hospital (People’s Hospital of Zhengzhou University). The patients were 4 males and 3 females, aged 33-59 years old, at 43 years old in average. There were 5 defects in left tempus and 2 in right tempus. The sizes of scalp defect were 4.5 cm × 5.5 cm-7.5 cm × 9.5 cm. Debridement and VSD management were primarily performed. After wounds were stabilised, ultrasound location of perforator vessels of ALTPFs was performed. Having confirmed that the perforator vessels were suitable for the surgical requirements, flap transfers were then performed. The descending branch of the lateral femoral circumflex artery was end-to-side anastomosed with the superficial temporal artery, and the descending branch of the lateral femoral circumflex vein was end-to-end anastomosed with the superficial temporal vein. Postoperative follow-up was conducted through outpatient clinic visits, telephone and WeChat reviews. Appearance, texture of ALTPFs and the flap donor sites were observed in follow-ups. Comparisons of the changes of nervous system before and after surgery were made. Cognitive function of the patients was assessed with the Mini Mental State Examination (MMSE), together with the Activities of Daily Living (ADL) .Results:All 7 flaps survived. One flap had vascular compromise 6 hours after surgery, and was rectified after surgical intervention. All the patients were included in the postoperative follow-up for 7-33 (average 19) months. All flaps had good appearance with soft texture. There was no obvious difference in colour comparing with the skin around the recipient region. The donor sites healed well without hypertrophic scar. Examinations of nervous system of the patients were found the same as that before surgery. Using Manual Muscle Testing (MMT), the average limb muscle strength of the patients was 4 before surgery and 4 after surgery, without change; Using the Ashworth assessment scale, the average preoperative and postoperative limb muscle tension in this group of patients was 1, without change; The Berg balance scale was used to evaluate the patient's balance function, with an average score of 42 before surgery and 42 after surgery, without any changes; There was no change in limb sensation before and after surgery; Using the MMSE, the average preoperative score and postoperative score of this group of patients were 25 points, without any change. Using the modified Barthel index scoring standard, the average preoperative score for this group of patients was 75 points, and the average postoperative score was 79 points, and the ADL of the patient had improved to various levels.Conclusion:Reconstruction of scalp defect with free ALTPF after revascularisation of moyamoya disease has obvious advantages, such as it closes the wound quickly, prevents infection and achieves a good appearance. This surgical procedure can produce a good clinical effect.

目的 探讨应用指侧方皮瓣联合V-Y推进皮瓣接力修复同指末节指腹缺损的临床效果.方法 自2016年10月至2020年10月,我们采用携带指背神经的近节指侧方筋膜皮瓣逆行修复末节指腹缺损患者9例共9指,指侧方皮瓣携带的指背神经与指固有神经缝合,供区用指近节掌侧V-Y皮瓣横行推进修复,皮瓣供区直接缝合.手指末节皮肤软组织缺损面积为1.5 cm x1.6 cm～2.5 cmx3.0 cm.结果 术后9例18个皮瓣全部存活,皮瓣供、受区伤口均Ⅰ期愈合.术后随访时间为6～12个月,平均9.3个月,皮瓣外观饱满、不臃肿,色泽、质地良好,皮瓣供区无疼痛及关节活动障碍,末次随访时指侧方皮瓣两点分辨觉为4～9 mm,平均5.9 mm;指掌侧V-Y推进皮瓣两点分辨觉为5～9 mm,平均6.7 mm.指蹼无挛缩及瘢痕增生.根据手指总主动活动度(total active motion,TAM)系统评定手指功能:优7例,良2例.结论 采用携带指背神经皮支的指侧方皮瓣联合指近节掌侧横行V-Y推进皮瓣接力修复同指末节指腹缺损可重建良好的手指感觉及外形,不牺牲指动脉,术后疗效满意.

目的:介绍横形V-Y推进复合组织瓣修复甲母痣切除术后创面的临床效果。方法:自2017年9月至2020年5月，我们共收治甲母痣患者13例。手指10例(拇指4例，其他手指6例)，足趾3例( 趾2例，第三趾1例)，病灶切除后甲床组织缺损宽度为3~8 mm。术中均于残余甲床较少的一侧设计横形V-Y复合组织瓣修复缺损创面。 结果:本组13例推移的组织瓣均存活良好，无坏死。术后随访时间为6~30个月，平均11.2个月，甲板生长良好，有2例甲板上出现纵行的线性凹痕。患者均对外观满意。推移的复合组织瓣感觉恢复良好。术后病理结果显示，本组中9例为复合痣，4例为交界痣。所有病例最后一次随访，均未见复发。结论:应用横形V-Y推进复合组织瓣修复甲母痣切除术后创面改善了患者术后手指的外观，值得临床推广应用。

目的:探讨小腿严重创伤致胫前软组织缺损,受区胫前或胫后动、静脉无法吻合时,采用吻合腓肠内侧血管的股前外侧穿支皮瓣（ALTP）移植修复的临床效果。方法:2013年6月-2019年10月,应用吻合腓肠内侧血管的ALTP移植修复小腿软组织缺损18例,其中男15例,女3例,皮瓣面积为16.0 cm×7.0 cm~28.0 cm×10.0 cm。供区直接缝合或游离植皮修复。术后定期随访,分析和评估临床效果。结果:术后无血管危象发生。17例皮瓣及所有供区植皮均顺利成活；1例皮瓣远端出现1.0 cm的坏死,经清创后愈合。术后随访6~18个月,平均12.5个月。皮瓣外形满意,质地柔软,有弹性,颜色与周围正常皮肤相似。供区外形良好,功能无影响。末次随访时参照英国医学研究会（BMRC）感觉功能评定标准对皮瓣感觉进行评定,其中S 2 3例, S 3 12例,S 3+ 3例。 结论:对小腿严重创伤合并骨外露、胫前或胫后血管无法吻合时,采用吻合腓肠内侧血管的ALTP移植修复小腿软组织缺损,可获得较为理想的临床效果,更是一种安全的补救措施。

Objective:To investigate the surgical method and clinical effect of one-stage repair of soft tissue defects of dorsum of hand and multiple fingers by using the polyfoliate conjoined anterolateral thigh perforator flap (ALTP) .Methods:From November, 2015 to September, 2019, 9 cases of soft tissue defects of dorsum of hand and multiple fingers were treated, including 8 males and 1 female. The average age was 32 years old. Causes of injury: 4 cases of thermal injury, 3 cases of strangulation injury, and 2 cases of traffic accident injury. Location of injury: 7 cases of right hand, 2 cases of left hand. Three cases of dorsum of hand with 1st-4th fingers, 3 cases with 2nd-5th fingers, 2 cases with 2nd-4th fingers, and 1 case with 3rd-5th fingers; All with bone, joint and tendon exposure. There were 6 cases with fracture or joint dislocation. All of them had no obvious defect of bone and joint. VSD was used to cover them after debridement. According to the shape and size of the wound, all flaps were designed to repair the soft tissue defect as the polyfoliate conjoined ALTP. The flap size was 7 cm×13 cm-12 cm×17 cm. Regular outpatient, telephone and Wechat follow-up were carried out to evaluate the flap survival, appearance, color elasticity, donor scar, sensory recovery, finger function recovery and patient satisfaction.Results:Nine cases of flap survived well. The average followed-up time was 12 (6-18) months. The postoperative followed-up revealed satisfactory shapes of the flaps, protective touch and recovery of functions. The donor site had good healing and no effect on function. In the last followed-up, according to the trial criteria for function evaluation of upper limbs by Chinese Society of Hand Surgery, 5 cases were excellent, 3 cases were good, and 1 case was fair. The hand function recovered well and returned to work and daily life on average 6 weeks after operation.Conclusion:The polyfoliate conjoined ALTP can repair the soft tissue defect of hand dorsum with multiple fingers at one stage, and the flap is in good shape. There is no need to divide the fingers. It is one of the ideal methods to repair the soft tissue defect of hand dorsum.

Objective To introduce an improved method of reconstructing venous reflux in replantation of distally severed finger at nail root,and explore its clinical efficacy.Methods From January 2016 to September 2018,12 patients with 13 distally severed fingers at nail root were replanted.There were no veins to anastomose the two severed ends.The proximal bilateral proper digital artery was anastomosed with the distal digital artery or two branches.The proximal digital artery was cut off and anastomosed with the proximal dorsal digital vein to establish venous reflux.Results In 13 replanted fingers,1 finger had partial necrosis due to serious tissue contusion,and the other 12 fingers survived completely.No venous crisis occurred after operation.The postoperative follow-up time ranged from 3 to 9 months with an average of 6.0 months.The skin texture of replanted finger was good.the nail grew well,and the sensation recovered to over S3.The patient was satisfied with the appearance and function.Conclusion The modified arterial venalization can effectively solve the venous reflux problem in venous deficiency and improve the survival rate of replantation of distally severed finger at nail root.It is an effective way to reconstruct venous reflux in the absence of severed veins.

目的 探讨健指指动脉移植修复手指末节旋转撕脱离断伤指动脉缺损的临床疗效.方法 自2010年8月至2017年4月,我们对11例手指末节旋转撕脱离断伤患者进行断指再植,术中指动脉长段缺损,采用健指指动脉长段移植修复.结果 术后9例断指再植存活,1例因掌侧近端组织出现血管危象从而指体坏死,1例因指体挫伤较重坏死.术后指体存活9例随访时间为5～15个月,平均10.4个月.存活指体按中华医学会手外科学会断指再植功能评定试用标准评定:优6例,良2例,差1例.供血管健指外观及屈伸功能良好,指动脉切取处切口隐蔽,指体远端感觉正常,无冬季畏冷等缺血相关症状.结论 采用健指指动脉游离移植较好地解决了手指末节旋转撕脱离断伤再植中动脉长段缺损、血管口径悬殊的问题.移植血管两断端口径匹配度好,再植成活率较高,是一种有效的方法.