Objective To introduce a method of distal digital replantation with a venous drainage through medullary cavity.Methods Normal saline mixed with methylene b lue were perfused into digital arteries in 5fresh finger specimens and medullary cavities in 10fresh finger specimens.Then microanatomic al observation of vessels was performe d in the specimens.From April 1999to June 2000,15severed fingers in14cases were replanted with a venous drainage through medullary cavity.Medullary cavities of the distal and middle phalanx were drilled and made unobstructed after the distal joint of the finger was removed.The bones were fixed using only a single straig ht Kirschner wire in each finger.One or two digital arteries or the branch es of the terminal arteries were anasto mosed and two digital nerves sutured in each finger.Results Mi-croanatomical observation showed t hat a venous drainage through medullary cavity was dominating without su-perficial venous drainage and the di gital medullary cavity closely connected with the profunda digital vein s and the superficial digital veins by the venous system of the bone.All replan ted fingers survived in 14cases.The average postoperative follow-up wa s 7.8months,ranging from 6to 10mont hs.Nearly normal appearance and satisfactory sensation of the dista l phalanx were obtained with 2-PD of 5-9mm.Conclusion Distal digital replantation with a venous d rainage through medullary cavity is a new method.It has following advan-tages:simple and reliable operatio n,high survival rate and enlarged in dication of distal digital replanta tion.[

Objective To analyze the reasons of the common complications happened after the operation of congenital syndactyly and to find the method of prophylaxis and treatment,and to improve the effects of treatment.Methods To classify the reasons of the complications happened after the operation of congenital syndactyly in 34 cases.Results The reasons of the complications included that the patients were not operated by special course of study doctors in 9; operation at an inappropriate opportunity in 8;the method of web taken shape was improper in 7;the method of nail taken shape was improper in 4; the fixation and training was unsuitable in 6. Conclusions The complications happened after the operation of congenital syndactyly will be reduced much , provided that grasping the right opportunity and selecting the proper method of web or finger tip taken shape before operation , taking care of the transformations of blood vessel and nerve in operation , fixing firmly and training appropriately after operation.

Objective To utilize a reversed digital dorsal fascial vascular pedicled island fa scial flap with the dorsal branch of the proper d igital nerve to repair finger pulp defect.Methods Based on the features of blood supply of the dorsa l skin of the finger,the flap was designed on the proximal phalanx at the middle and distal segments and the dorsum of the proximal interphalangeal joint.The lateral margins of the fl ap did not cross the midlateral line,th e axial point was designed on the ulnar or the radial dorsum of the distal interphalangeal joint.The axis was paralleled to the longitudinal axis of finger.The dorsal branch of the pr oper digital nerve in the flap was sutured to the end of the proper digital nerve of injured site.From November 1997to April 2001,28pulp defects in 27cases were repaired with this method.E mergency operations were per-formed in 24cases and selective operations in 3.The flaps measured 1.8cm?1.5cm -2.5cm ?2.2cm and the length of pedicle was 1.5-2.2cm.Results All flaps survived completely.The p atients were followed up for 7to 32months,with an average o f 21months.The pulps after reconstr uction had good appearance,soft texture with wear-resisting.T here was no touch pain.Static two-point discrimination was 3.5-6.5mm.Conclusion The operation does not damage the major artery and nerve of the wounded fin ger.It is simple and safe,and can be done at one settin g.It does not interfere with the function of other digits.The sensation of the reconstructed pulp can be satisfactorily recovered.[

Objective To find out factors related to avascular necrosis (AVN) of femoral head through a retrospective study of patients with femoral neck fractures treated with cannulated screws.Methods Two hundred and thirty cases of femoral neck fracture whn had been treated with cannulated screws in our department from August 1994 to October 2003 were analyzed statistically.Six factors of patient,age,gender,fracture type (Garden clas- sification),reduction method (close or open),the quality of reduction (Garden Index) and time interval from injury to surgery were analyzed statistically with rank sum test and logistic multiple regression.Results Factors that might have an impact on avascular necrosis of femoral head were ranked in the following likelihood sequence: fracture type,quality of reduction,reduction method,time interval from injury to surgery and age.Gender was found to have little impact on the prognosis of femoral neck fracture (P＞0.05).Conclusions Fracture displacement is the most critical factor that influences the prognosis.Anatomical reduction (close or open) must be achieved to re- duce the risk of AVN.Timing of surgery shows its importance.High age will not lead to an increased incidence of AVN.

Erythropoietic protoporphyria(EPP)is an inherited metabolic disease caused by the deficiency in ferrochelatase(FECH)encoded by the FECH gene,and it is inherited in an autosomal recessive manner.EPP usually produces acute pain photosensitivity after exposure to sunlight in infancy or early childhood,and liver failure is the most serious associated complication.This article reported an adult female case of EPP complicated with thyrotoxicosis and liver dysfunction which is a rare condition.The patient's liver function improved after liver protection treatment,her thyroid function returned to normal,and her EPP symptoms improved significantly.Moreover,the c.286C＞T gene mutation may be the pathogenic locus of EPP.For patients with abnormal liver function,the possibility of EPP should be considered after the common causes are excluded,and FECH gene detection should be done to confirm the diagnosis in time.When EPP is associated with thyrotoxicosis and liver dysfunction,priority may be given to hepatoprotective therapy.