Objective To explore the efficacy of simultaneous reconstruction of composite tissue defects in two adjacent metacarpophalangeal joints of hand by split the 2nd toes.Methods From December 2006 to December 2011,the second toe composite flap pedicled with the dorsalis pedis artery-first,second metatarsal dorsal artery-dorsal artery were designed,and split it into the second metatarsophalangeal joint composite flap pedicled with the dorsalis pedis artery-first dorsal metatarsal artery-tibial artery and the proximal interphalangeal joint composite flap pedicled with dorsalis pedis artery-second dorsal metatarsal arteryfibular dorsal artery.Then they were used to repair composite tissue defects in two adjacent metacarpophalangeal joints of hand at the same time after reconstruction.Results This group includes 14 metacarpophalangeal joints of 7 cases,twelve joints was successful,two joints of 1 case to give up because the first dorsal metatarsal artery variation.At 6-24 months follow-up study in 12 out of 14 cases showed that there was no joint degeneration in X-ray manifestation and the recovering of joint function was satisfying.According to the function evaluation standard of reconstraction of thrumb and finger issued by Hand Surgery Society Chinese Medical Association,the excellent and good rate was 83.3％.Conclusion It is feasible to reconstruct of composite tissue defects in two adjacent metacarpophalangeal joints of hand at the same time by split the 2nd toes,and can effectively improve the functions of injury metacarpophalangeal joint.

Objective To investigate the characteristics of mid-long term pituitary hormone abnormalities in patients after severe traumatic brain injury (TBI) and its influencing clinical factors.Methods A total of 79 patients with severe TBI,admitted to our hospital from January 2011 to December 2013,were chosen in our research.Their basal levels of pituitary hormones,cortisol,testosterone,estradiol and free thyroxine 4 were detected in 6 months to 2 years after injury;and their clinical data were retrospectively analyzed by Chi-square test and multivariate Logistic regression analysis was employed to explore the incidence and types of pituitary hormone abnormalities,and the possible influencing factors.Results There were 35 patients with pituitary hormone abnormalities in 79 patients,with an incidence of 44.30％;the types of pituitary hormone abnormalities included prolactin in 18 patients (26.87％),thyroid stimulating hormone in 16 patients (23.88％),adrenocorticotropic hormone in 9 (13.43％),growth hormone in 8 (11.94％),and follicle stimulating hormone in 10 (14.93％) and luteinizing hormone in 6 (8.96％).Multivariate Logistic regression analysis showed that factors associated with pituitary hormone abnormalities following severe TBI in the mid-long term were diffused injury (OR=5.252,95％CI:1.176-23.465,P=0.030),brain hernia (OR=4.119,95％CI:1.261-13.452,P=0.019),subarachnoid hemorrhage (OR=3.966,95％CI:1.179-13.337,P=-0.026) and skull fracture (OR=4.222,95％CI:1.087-16.396,P=0.037).Conclusion Pituitary hormones following severe TBI are likely to be abnormal,and diffused injury,brain hernia,subarachnoid hemorrhage and skull fracture are the risk factors.