Objective To introduce the outcome of compound defect in the hand treated by compound flap transfer or combined flaps transfer. Method From Dec.1983 to June 2001,thirty-five cases with five kinds of compound defect in the hand were treated surgically.Among them,four cases with defect of skin and extensor tendon in the dorsum of hand were repaired by dorsalis pedis flap with tendons;Three cases with longitudinal subtotal loss of distal thumb and one case with longitudinal subtotal loss of distal middle finger were reconstructed with fibular segmental osteo-onychocutaneous flap from great toe or tibial segmental osteo-onychocutaneous flap from second toe;Eight cases with total or subtotal defect at middle part of thumb or fingers were reconstructed with segmental second toe; seventeen cases with defect of thumb and hand skin were reconstructed with combined transplantation of second toe and free skin flap;Two cases with middle finger defect at the base of proximal phalanx were reconstructed with bridging transplantation of bilateral second toe. Result Thirty-three cases were successful.Follow-up period ranged from 0.5 to 5 years postoperatively.The excellent and good rate was 82.9% assessed with provisional functional assessment criterion for upper limbs issued by Chinese Society of Hand Surgery. Conclusion The compound flap transfer or combined flaps transfer was an ideal method in repair of compound defect in the hand.

Objective To report the result of bilateral second toes transfer for reconstruction of total hand or total digits defect. Methods A series of 14 total hand or total digits defect were reconstructed by transplantation of 2nd toes from both feet forming a crab-shaped hand. Among 14 cases, 11 cases were males and 3 females. The patients were aged from 4-44 years, with an average of 22.7 years. One of the 14 cases was of congenital deformity and the other 13 were caused by trauma. The 14 cases were classified into three types according to the level of amputation; Type Ⅰ: defect at the distal end of the metacarpal bone with good function of abductor pollicis in 6 cases; Type Ⅱ: at the proximal end of carpus or the level of wrist joint in 5 cases; and type Ⅲ: at the forearm end stump in 3 cases. All the operations were successful. Results All 28 transferred toes survived uneventfully with good blood supply and pulp fullness and elasticity. Follow-up examination made at mean 6.6 years postoperative period (2-15 years) showed that mean total active motion (TAM) of IP joints of reconstructed digit was 57.5? (35?-105?). All the 14 cases had restored digital function, such as opposition of the fingers, pinching a pencil, a key, a needle or holding an ink-bottle. The mean distance between the two reconstructed digital pulps was 4.3 cm (2.6-6.5 cm). Judging by the evaluation standard of British Medical Institute, sensation recovery to S3+ was obtained in 20 digits of 10 cases. Based on the trial criteria of the function of hand reconstruction of hand surgery society of Chinese Medical Association, 2 were assessed as excellent, 7 good, 4 fair and 1 poor. Conclusion Reconstruction of crab-shaped hand for total hand or total digits defect by transfer of bilateral 2nd toes with metatarso-phalangeal joint can give the patient reasonable prehensile function without much impairment to foot function.

Objective To explore the operative approach, method,indication,and clinical feasibility of laparoscopic or retroperitoneoscopic treatment of ploycystic kidney.Methods The renal cyst unroofing(bilateral,9 cases;unilateral,4 cases) was performed under laparoscope(2 cases) or retroperitoneoscope(11 cases).The renal adipose capsule was dissected with a harmonic scalpel to fully visualize the whole kidney.According to preoperative positioning results,the cysts at all sizes were exposed.Then all visible cysts were unroofed or fenestrated with a margin 0.5 cm from the renal parenchyma.The cystic fluid was drawn out as much as possible.Results The operations were completed smoothly in the 13 cases.Pneumatothorax developed on the day of laparoscopic operation in 1 case,and then was cured by closed thoracic drainage.The operation time was 50～240 min(mean,139 min),and the blood loss was 10～200 ml(mean,58 ml).Patients began out-of-bed activities in 1～2 days after operation and were discharged from hospital at 3～10 days.The pathological findings were in accordance with changes of ploycystic kidney.Follow-up examinations were carried out for 1～30 months(mean,14.3 months).Back pain was relived in 8 out of 11 cases.In 3 patients with a high blood pressure,the systolic pressure was decreased by 16～19 mm Hg at 9 months after operation.Ten patients presented normal hepatic and renal functions,while the remaining 3 patients with preoperative increased creatinine levels of 194～301 ?mol/L had a drop by 20～40 ?mol/L.Conclusions Treatment of cyst unroofing under laparoscope or retroperitoneoscope is a safe and effective method in the treatment of ploycystic kidney,being worthy of clinical recommendation.

Objective To investigate the effect of partial nephrectomy of anatomical solitary kidney on tumor control and renal function preservation.Methods 10 patients with anatomical solitary kidney underwent partial nephrectomy from December 2007 to May 2016,including 6 males and 4 females ranged from 38 to 71 years old with an average of 57 years old.The PADUA score ranged from 6-10,with an average of 7.6.The tumor diameter ranged from 1.0 to 7.4 cm,with an average of 3.2cm.Results 7 cases underwent laparoscopic surgery.3 cases underwent open surgery.Mean operation time was 168min (ranged 103-217min).Mean blood loss was 135ml (ranged 20-400ml).The renal arteries were blocked in all patients.The ischemia time ranged from 9 to 33min,with an average of 20.6min.The mean estimated glomerular filtration rate at one week after surgery [40.7ml/(main · 1.73 m2)] decreased 44.7％ compared with pre-operation [73.6 ml/(min · 1.73 m2)].Acute kidney injury developed in 2 patients.One required temporary dialysis.The other improved after conservative treatment.There were no other complications such as urinary fistula and hemorrhage.The pathology analysis confirmed that 2 cases were angiomyolipoma,one case was benign cyst,6 cases were renal clear cell carcinoma,and one case was multilocular cystic renal cell carcinoma.4 cases were stage pT1a,one case was stage pT1b,one case was stage pT2a,and one case was stage pT4.Positive margin was found in one case.The average follow-up period was 28.2 months(ranged 3-58months).Only one patient need long-term dialysis 20 months after surgery at the latest follow up.Another patient had local recurrence and ipsilateral adrenal metastasis.Conclusions Satisfactory effect of tumor control and renal function preservation can be achieved by partial nephrectomy in solitary kidney,which prevent or delay the occurrence of hemodialysis effectively.

Objective To introduce our experience of organ transplant ethics committee in living related kidney transplantation.Methods To introduce the composition,operational procedure of ethics committee of transplantation.Results 45 living related kidney transplantation were inspected and censured before operation by organ transplant ethics committee,40 passed and 5 denied.Conclusion The responsibility of transplant ethics committee is highly important,ethics committee has the responsibility to ensure the safety and interests of both donor and recipient.

Objective To evaluate specific clinical and imaging features of osteogenesis imperfecta V and to improve diagnostic accuracy of this disease. Methods Data of 15 patients with osteogenesis imperfecta type V were retrospectively analyzed for their clinical and imaging features. There were 10 males and 5 females, aged from 1 year and 30 years old (median age,12.5 years ). All 15 patients had plain X-ray, and 4 of 15 had CT. All data were analyzed by 3 experienced deputy chief doctors in OI according to OI V standard. Results X-ray:calcification of the interosseous membrane between radius-ulna was detected in all patients and calcification of the interosseous membrane between tibia-fibula was detected in 2 of 15 patients. Dislocation of the radial head was seen in 13 of 15 patients,bilateral in 9 and utilateral in 4.All patients showed restriction in the pronation and supination of the forearm and restricton in the flexion and extention of the elbow joint. Patients with dislocation of raidal head were associated with large coronoid process and olecranon of the ulna. Hyperplastic callus of the extremities were detected in 7 of 15 patients (7 at femur , 3 at humerus, 1 at tibia.In early stage, hyperplastic callus showed thin cortice, and clear boundares with the diaphysis showing and low density, irregular, mesh-like lamellation inside. In the later stage, there were dense calcification inside hyperplastic callus, and no difference in density with the diaphysis. Diaphysis surrounded by hyperplastic callus had clear boundaries with the hyperplastic callus. No cortical destruction was detected. CT:there were sparse needle-dot calcification inside hyperplastic callus, with the patterns of granular, ring-and-arch,irregular streaky mineralization. The cross section of proximal femoral shaft showed irregular shape , flat square shape and tiny medullary cavity, with no calcification on the edge of hyperplastic callus. CT value:-91 HU inside hyperplastic callus; 283 HU in femoral shaft. Conclusions Interosseous membrane between radius-ulna or tibia-fibula, hyperplastic callus ,dislocation of the radial head are specific features in osteogenesis imperfecta V. X-ray can make a definitive diagnosis of osteogenesis imperfecta V. CT scan is helpful in the differential diagnosis of osteogenesis imperfecta V from osteosarcoma.

Objective To assess the safety and feasibility of pure laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus.Methods We retrospectively analyzed 6 cases of renal cell carcinoma with inferior vena cava tumor thrombus from December 2010 to October 2014.The patients were all male.Their age ranged from 50 to 69 years and the body mass index ranged from 21.6 to 30.9 kg/ m2.Clinical manifestations included painless hematuria in 4 cases,low back pain in 1 cases and physical examination noticing in 1 cases.Imaging suggested the right renal tumor in 4 cases and left renal tumor in 2 cases.The tumor size ranged from 4.0 to 10.6 cm.The inferior vena cava tumor thrombus was found in all patients,including type Ⅰ thrombus in 3 cases and type Ⅱ thrombus in 3 cases.The length of type Ⅱ tumor thrombus ranged from 4.0 to 4.2 cm.We completed pure laparoscopic nephrectomy and inferior vena cava tumor thrombectomy in all patients.We chose retroperitoneal laparoscopic surgery to treat right renal tumor with inferior vena cava thrombus and chose retroperitoneal combined with transperitoneal laparoscopic surgery to treat left renal tumor with inferior vena cava thrombus.Results All surgery were successful.Cancer embolus defluxion didn't occur during the opearation.The operation time was 224-873 min and the intraoperative blood loss was 200-5 000 ml.There were 4 patients get transfusion,which the transfusion volume ranged from 400 to 2 800 ml.For 1 case of left renal cell carcinoma with level Ⅱ inferior vena cava tumor,the operation time was 873 min,the blood loss was 5 000 ml,and the transfusion volume was 2 800 ml.Postoperative hospital stay was 7-14 days.And the pathological results were all renal clear cell carcinoma.In those patients,the Fuhrman grade classification was Ⅱ-Ⅲ.All patients were treated by targeted medicine to control tumor recurrence and metastasis.During the 6-48 months following up,no recurrence and metastasis were reported.Conclusions Pure laparoscopic surgery for right renal cell carcinoma with inferior vena cava tumor thrombus and left renal cell carcinoma with level Ⅰ inferior vena cava tumor thrombus is safe and feasible.However,long learning curve should be necessary for performing the left renal cell carcinoma with level Ⅱ inferior vena cava tumor thrombus.The effect of total laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus is definite.

Objective: To introduce our experience of ethical inspection of 130 living related kidney transplantations.Methods: From May 2007 to Oct 2009,130 living related kidney transplantations were inspected and censured by ethics committee of organ transplantation according to Regulations on Human Organ Transplantation.Results: 120 cases passed the inspection of ethics committee of organ transplantation and 10 cases were rejected because of different reasons.Conclusion: Under the circumstance of quantities of trading of organs,the responsibility of ethics committee is extremely important in ensuring the safety and interests of both donors and recipients.

Objective To explore small size toe tissue flap for aesthetic reconstruction of the thumb and / or finger. Methods Six kinds of small size toe tissue transplants had been applied in repairing skin-bone-joint composite tissue defects of the thumb or finger in 74 cases. Results Among 83reconstructed flaps of the 74 patients, 81 flaps survived completely. Follow-up examination made three to forty-eight months postoperatively showed that the outward appearance were excellent in most cases. The function of the thumbs or fingers were good. The donor feet can walk normally with no pain. Conclusion A variable combinations of toe tissues including skin, soft tissue, bone and joint can be harvested to form a lot of small size transplants for refined aesthetic reconstruction of thumb and finger. The functional and aesthetic results are good and the treatment course is shortened.

Objective To explore if it is essential to excise ipsilateral adrenal gland in radical nephrectomy.Methods Two hundred and sixty-three patients underwent radical nephrectomy were analyzed retrospectively.The duration of operation,bleeding volumn,complications and survival rates were compared between the adrenalectomy and adrenal preserved groups.The clinical data of the patients with adrenal gland involvement were analyzed as well.Results There were 214 clinical localized(T_(1-2)N_0M_0 )renal cell carcinoma (RCC) patients,26 local advanced RCC(T_(3-4)N_(0-2)M_0 ) patients and 23 metastatic RCC(T_(1-4)N_(0-2)M_1) patients in this study.In the 263 patients,146 cases received ipsilateral adrenal gland excisions,while 117 cases had the ipsilateral adrenal glands preserved.The duration of operation,estimated blood loss and the complications did not differ significantly between these two groups.Only 8 patients had adrenal gland involvement.The mean size of the 8 tumors was 9.7 cm and 5 of them had a diameter ≥8 cm.In the 8 patients,6 had the tumor in the upper pole and 2 had the whole kidney involved.One hundred and twenty-nine clinical stage Ⅰ and Ⅱ patients had ipsilateral adrenal excised,while only 4 (3.1%) had adrenal gland involvement.Seventeen clinical stage Ⅲ and Ⅳ patients had ipsilateral adrenal excised,and 4 (23.5%) had adrenal gland involvements.The clinical stages of these 8 patients were stage Ⅲand Ⅳ.The patients were followed up for 28 months (3-102 months).There was no significant difference of 5-year survival rates between the ipsilateral adrenal gland excised and preserved patients categorized according to pathological stage.Conclusion For patients with renal cancer larger than or equal to 8 cm,localized in upper pole of kidney or with the whole kidney involve and with a clinical stage higher or equal to Ⅲ,it is essential to excise ipsilateral adrenal gland in radical nephrectomy,otherwise the ipsilateral adrenal can be preserved.