Objective to study the factors of delaying survival of the ankle and foot which were linked with leg only by skin, fascia and tibia after all the infected and inactivated muscles and intermuscular vessels had been removed, and to study the effect of artery blood supply reconstruction to avoid the necrosis and ischemia contracture of the foot. Methods The leg was linked with ankle and foot by the tibia which was covered only by skin and fascia after all the muscles, interosseous membrance, intermuscular vessels and fibula had been removed. And then the artery blood supply for the injured limb was reconstructed by stages. Results The sense of haphalgesia, with normal temperature and color, recovered in the injured limb 7 months after operation, no contracture and deformity happened in the food muscles and joint, and the patient may smooth stand and walk with a stick freely. Conclusion The necrosis and ischemia contracture of foot was delayed by reticular collateral circulation among skin, deep and superficial fascia and tibia of the injured limb, although the blood supply was very little after all the muscles and intermuscular vessels had been removed because of infection and necrosis. Finally the injured limb was reserved successfully by artery blood supply reconstruction. The clinical effect was satisfactory.

Objective To study the characteristics of toe-to-thumb transplantation in a group of infants who completely lacked the thumb.The mean age was 24.6 months,and the youngest was 10 months old,The operative technique and rehabilitation were studied.Methods In two infants with Ⅲ-Ⅳ? defects of the thumb together with multiple injuries of fingers,the wounds were debrided and toe-to-thumb transplantation was done later.In case 3 Ⅲ? defect of the thumb together with palm injury,one-stage toe-to-thumb transplantation and the palm injury was covered with an abdominal flap were done at the same time.Considering the characteristic physiological structure of a dorsalis pedis and the first metatarsal arteries.In the infant,minimally invasive operation under 10? microscope was employed.A series of early functional exercises was given for the reconstructed thumbs.Results The reconstructed thumbs completely survived,hand function was recovered 3-6 months after the operation.With follow-up for longer than 2 years in 2 cases,it was noted that the reconstructed thumb grew consistent with the wounded hand.The appearance and function thumb were satisfactory.Conclusion Toe to thumb transference was successful in infancy,with the combined technique of minimally invasive and plastic surgery.Reconstruction of the thumbs can be completed in two stages on immediately after injury.The appearance and function can be restored.[

Objective To investigate the efficacy of neoadjuvant chemotherapy combined with radical resection of cervical cancer in the treatment of stage IB2-ⅡB cervical cancer.Methods According to the treatment plan from October 2012 to October 2016 in the People′s Hospital of Luohu District of Shenzhen in 80 cases of stage IB2-II B cervical cancer patients were divided into observation group(n=43) and control group(n=37),the observation group was treated with neoadjuvant chemotherapy combined with radical surgery for cervical cancer,patients in the control group directly treated for radical resection of cervical cancer.Chemotherapy effect,operation time,intraoperative blood loss,postoperative pathological risk factor differences of two groups of patients were compared.Results (1)Evaluated the curative effect of neoadjuvant chemotherapy,squamous cell carcinoma group complete remission(CR) 4 cases,partial remission(PR) 22 cases,stable disease(SD),6 cases of disease progression(PD) in 0 cases,in adenocarcinoma group CR 1 cases,PR 3 cases,SD 5 cases,PD 2 cases of squamous cell carcinoma group adjuvant chemotherapy was significantly better than that of adenocarcinoma group,the difference was statistically significant(z=2.4968,P=0.0063).(2)The operation time((215±57) min) and intraoperative blood loss((682±145) ml) in the observation group were significantly lower than those in the control group(((259±62) min,(758±193) ml)),the difference was statistically significant(t=3.8780,2.2528,P=0.0002,0.0263).(3)The two groups of patients with ureteral fistula(P=0.5039),vesicovaginal fistula(P=0.3639),wound healing(P=0.5182),lower extremity deep venous thrombosis(P=0.4818) complications had no significant difference.(4)The positive rate of the observation group of lymph nodes(χ2=8.2005,P=0.0000),parametrial infiltration rate(χ2=8.1553,P=0.0000) was significantly lower than the control group,the difference was statistically significant.Two groups of patients with deep myometrial invasion rate(χ2=0.0991,P=0.7516),the incidence of cancer embolus(χ2=0.0130,P=0.9176) compared to no statistical significance.Conclusion The effect of neoadjuvant chemotherapy on cervical squamous cell carcinoma is better than that of adenocarcinoma.Compared with the direct for radical resection of cervical cancer,neoadjuvant chemotherapy combined with radical resection of cervical cancer patients for the treatment of stage IB2-ⅡB cervical cancer,operation time and blood loss are lower,node positive and parametrial invasion and postoperative pathologic risk factors in lymph node also can get better effect.

Objective To discuss the differences and causes of earlier and later complications of nitinol stent implantation for patients with benign or malignant tracheobronchial stenosis.Methods Sixty patients with tracheobronchial stenosis analyzed retrospectively the incidence of earlier and later complications of nitinol stent implantation.Results In the earlier period,the incidence rate of postoperative hemoptysis of patients with malignant tracheobronchial stenosis was higher than that of benign patients, but its incidence of granulation tissue formation in airway was less than that of benign ones.In the later period, the incidence of pulmonary infection and granulation tissue formation of patients with malignant tracheobronchial stenosis were higher than those of benign ones. Conclusions It is more effective modus with nitinol stent implantation for patients with airway stenosis, but there were great differences of postoperative complications between malignant and benign tracheobronchial stenosis.

Objective:To explore the clinical effect of repairing fingertip defects with the great toe fibular flap.Methods:A retrospective analysis was conducted on the clinical data of patients admitted to the Department of Hand Surgery, Xuzhou Renci Hospital from March 2019 to June 2022 who underwent the repair of fingertip defects using the great toe fibular flap. Emergency debridement of the wound of digital defect, temporary cover with xenocortic, and flap repair after 4-7 d. According to the size of digital defect, the free flap (0.5 cm larger than the wound) on the fibular side of the toe was designed and harvested, and the nail bed and phalange could be carried when accompanied by nail bed and phalangeal defects. Remove excess fat under the flap under the microscope and cover it on the wound at the end of the finger, and the flap was anastomosed with the arteries, veins, and nerves of the finger. Fix the phalanges crosswise with two 0.8 mm Kirschner needles. The wound in the donor area was directly pulled and sutured, or the suture was reduced and then moistened and changed, and it was allowed to grow on its own, or the first plantar back full thick skin sheet was transplanted and repaired. Provide an appropriate description of the surgical method, including the management of the donor recipient area. Regularly follow up the patient’s injured finger and donor foot recovery after surgery, and investigate whether the patient was satisfied with the surgical effect. At the last follow-up, finger function was evaluated using the applicable standards for upper limb functional assessment of the Chinese Medical Association Society of Hand Surgery.Results:A total of 35 patients with fingertip defect and phalangeal bone exposure were enrolled, including 17 males and 18 females. Age range from 15 to 60 years old, with an average of 36 years old. There were 9 thumbs, 8 index fingers, 10 middle fingers, 5 ring fingers, and 3 little fingers. Defect area 1.0 cm × 1.5 cm-2.0 cm × 3.0 cm. Three patients underwent venous crisis after surgery and survived after bleeding at the edge of the flap. The remaining flaps survived smoothly. There was one case of poor wound healing after removing the suture in the donor area, which healed after changing the dressing for 3 weeks. The postoperative follow-up was 10-18 months, with an average of 13 months. The color, texture, and nail appearance of the repaired finger flap were similar to those of normal fingers, with clear skin lines and beautiful appearance. The two point resolution of the flap was 8-10 mm, and the sensation returned to S3 level. No significant impact on foot function and appearance. The patient expressed satisfaction with the surgical effect. Finger function evaluation results: 28 cases were excellent and 7 cases were good.Conclusion:After using the great toe fibular flap to repair the fingertip defect, the appearance and function of the finger are restored well, and the donor area of the flap is concealed, with little impact on the donor foot, which can achieve good repair results.

Objective:To explore the clinical effect of repairing fingertip defects with the great toe fibular flap.Methods:A retrospective analysis was conducted on the clinical data of patients admitted to the Department of Hand Surgery, Xuzhou Renci Hospital from March 2019 to June 2022 who underwent the repair of fingertip defects using the great toe fibular flap. Emergency debridement of the wound of digital defect, temporary cover with xenocortic, and flap repair after 4-7 d. According to the size of digital defect, the free flap (0.5 cm larger than the wound) on the fibular side of the toe was designed and harvested, and the nail bed and phalange could be carried when accompanied by nail bed and phalangeal defects. Remove excess fat under the flap under the microscope and cover it on the wound at the end of the finger, and the flap was anastomosed with the arteries, veins, and nerves of the finger. Fix the phalanges crosswise with two 0.8 mm Kirschner needles. The wound in the donor area was directly pulled and sutured, or the suture was reduced and then moistened and changed, and it was allowed to grow on its own, or the first plantar back full thick skin sheet was transplanted and repaired. Provide an appropriate description of the surgical method, including the management of the donor recipient area. Regularly follow up the patient’s injured finger and donor foot recovery after surgery, and investigate whether the patient was satisfied with the surgical effect. At the last follow-up, finger function was evaluated using the applicable standards for upper limb functional assessment of the Chinese Medical Association Society of Hand Surgery.Results:A total of 35 patients with fingertip defect and phalangeal bone exposure were enrolled, including 17 males and 18 females. Age range from 15 to 60 years old, with an average of 36 years old. There were 9 thumbs, 8 index fingers, 10 middle fingers, 5 ring fingers, and 3 little fingers. Defect area 1.0 cm × 1.5 cm-2.0 cm × 3.0 cm. Three patients underwent venous crisis after surgery and survived after bleeding at the edge of the flap. The remaining flaps survived smoothly. There was one case of poor wound healing after removing the suture in the donor area, which healed after changing the dressing for 3 weeks. The postoperative follow-up was 10-18 months, with an average of 13 months. The color, texture, and nail appearance of the repaired finger flap were similar to those of normal fingers, with clear skin lines and beautiful appearance. The two point resolution of the flap was 8-10 mm, and the sensation returned to S3 level. No significant impact on foot function and appearance. The patient expressed satisfaction with the surgical effect. Finger function evaluation results: 28 cases were excellent and 7 cases were good.Conclusion:After using the great toe fibular flap to repair the fingertip defect, the appearance and function of the finger are restored well, and the donor area of the flap is concealed, with little impact on the donor foot, which can achieve good repair results.