Objective To discuss the clinical effect of thumb and fingers reconstruction with vascular anastomosis transplantation from toes.Methods From April 2009 to April 2013,166 cases of thumb and finger defect were treated,including 46 cases Ⅰ °-Ⅲ° thumb defect and 120 cases Ⅰ °-Ⅴ° finger defects.Sixty-two cases were emergency reconstructed by vascular anastomosis transplantation from toes,the other 104 cases were subemergency reconstructed.Early functional rehabilitation was carried out postoperative.Results All 208 thumb and fingers in 166 cases with these procedures were survived.Patients were followed up from 4 to 24 months,averaged of 1 l months.The reconstructed thumb and fingers were all with abundant blood supply,having similar shape to the normal thumb and fingers,good pain and temperature sensation,with two-point discrimination of 6-10 mm,with normal range of joint activity,flexible function of finger to finger and finger to palm.Most patients were satisfied with the thumb and finger shape,regained life and work ability as before.The donor sites had no obvious discomfort,and walking and weight-bearing function remained normal.Conclusion For patients with thumbs Ⅰ °-Ⅲ° and fingers Ⅰ °-Ⅴ ° degree of traumatic defect,emergency and subemergency reconstruction of fhumb and fingers by vascular anastomosis transplantation from toes have good clinical effect and less damage to the donor site.

Objective To investigate the hallux nail flap with the tibia lateral diamond shaped flap of the second phalange,joints,tendon combined tissue combination reengineering the surgical methods and clinical effects of thumb.Methods From May,2010 to February,2015,thcrc had fifteen cases of the thumb defect on Ⅱ-Ⅳ degree of the patients in our hospital,and we took anastomosis vascular pedicle of the hallux nail flap and thumb reconstruction with a second phalange with the tibia lateral diamond shaped flap,joint,and tendon composite tissue combination to reconstruct the thumb.The provided district of the second metatarsal was amputated to repair the ligaments between metatarsal bones.And we took the second toe bone nail flap covering the hallux toe area wound in anterograde shift.Results 15 cases of thumb reconstruction survived.The patients were followed-up for 6 to 30 months,the shape of the reconstructed thumb was closed to the contralateral thumb.The thumb to the finger and the palm function was good,two-point discrimination of the finger pulp were 0.6-1.0 cm.According to the upper limb function of the Chinese Medical Association Hand Surgery Society,the upper limb partial function of the evaluation trial standard:excellent in 11 cases,good in 4 cases.The district was recovered well,normal walking and running function were not restricted.Long term follow-up showed no blisters formation and skin ulceration.No nail deformity,good growth.Conclusion The hallux nail flap with the tibia lateral diamond shaped flap of the second phalange,joints,tendon combined tissue combination to reconstruct the thumb of the defect on Ⅱ-Ⅳ degree can restore good function and feeling,but also to have beautiful appearance.It is an effective method for reconstruction of thumb defect on Ⅱ-Ⅳ degree.

Objective To investigate the replantation and postoperative rehabilitation methods for simultaneous amputation of 10 fingers and both forearms.Methods A case of replantation for simultaneous amputation of both forearms and 10 fingers was carried out with microsurgery method in September,2014.The replantation involved 3 teams over 11 hours and 55 minutes to consequently conduct alternate anterograde and retrograde replantation and accurate blood vessels,nerve anastomosis and further followed with physical therapy and occupational therapy treatment in 2 weeks of the surgery.Results All the amputated arms and fingers revived after the surgery.After 14 months follow-up,function of wrist flexion and expansion was normal,superficial and deep sensory functions on hands were good,function of thumb and finger grip,pinch and opposition had partially recovered,the two-point discrimination was 8-10 mm,and all of above rated good according to the temporary criteria of the upper limb functionality set forth by Hand Surgery Branch of China Medical Association.Conclusion For the case of simultaneous amputation of both forearms and 10 fingers,it is very likely to carry out successful replantation as well as achieve satisfactory function restoration with excellent teamwork and accurate vessel and nerve anastomosis under microsurgery as well as rehabilitation treatment afterwards.

Objective:To investigate the clinical efficacy and feasibility of anterolateral thigh perforator flap with fascia lata in repairing hand and foot wounds complicated with extensor tendon defect.Methods:The clinical data of patients with hand and foot wounds complicated with extensor tendon defect who were repaired with anterolateral thigh perforator flap with fascia lata in Long Gang District Orthopedic Hospital of Shenzhen from May 2014 to December 2019 were analyzed retrospectively. During the operation, fascia lata was used to repair the defect of extensor tendon.The proximal and distal endof fascia lata were anastomosis with defect extensor tendon by figure 8 sutures.The soft tissue defects of hand and foot were repaired with anterolateral thigh (ALT)perforator flap. The donor site was closed primarily or covered by free skin graft. After operation, the sensory recovery of the flap was evaluated according to the evaluation standard of sensory function after peripheral nerve injury formulated by British Medical Research Association. According to the total active range of movement (TAM) of fingers recommended by the evaluation standard of hand tendon repair of Hand Surgery Society of Chinese Medical Association, the hand motor function was evaluated systematically. Foot motor function was evaluated according to the ankle-hind foot scoring system developed and recommended by the American Association of Foot and Ankle Surgeons.Results:A total of 23 patients were enrolled, including 19 males and 4 females, aged from 9 to 61 years old, with an average age of 26 years old. Causes of injury: there were 11 cases of crushinjury associated with machine, 4 cases of road traffic injury, 6 cases of injury by falling heavy object, 2 cases of saw injury. The area of wound defect ranged from 2 cm × 6 cm to 7 cm × 25 cm, and the length of tendon defect ranged from 1.0 cm to 10.0 cm. All cases were complicated with partial or complete defect of extensor tendon. There were 19 cases with fracture and nerve injury. All the injuries were successfully repaired. All the flaps survived well. The rande of flap harvest was 3 cm × 5 cm to 9 cm × 23 cm, and the fascia lata was 1.0 cm × 1. 5 cm to 4.5 cm × 11. 0 cm. There were no complications such as arteriovenous crisis, infection, fat liquefaction, etc. Andall the wounds were closed primarily. Follow-up period ranged from 3 to 36 months (average 14 months) showed that all flaps had aestheticappearance, good color, and texture. Sensory recovery: excellent in 19 cases and good in 4 cases. TAM system evaluation method and ankle-hind foot scoring system were used to evaluate the function of hand and foot: 21 cases were excellent and 2 cases were good.Conclusions:The application of anterolateral thigh perforator flap with fascia lata to repair the hand and foot wound with extensor tendon defect can restore the motor and sensory function of the injured limb while covering the wound surface.This method has less damage to the donor site and less postoperative complications, and can significantly improve the quality of life of patients. It is an effective method to repair the wounds of hand and footcombined with extensor tendon defect.

Objective:To investigate the clinical efficacy and feasibility of anterolateral thigh perforator flap with fascia lata in repairing hand and foot wounds complicated with extensor tendon defect.Methods:The clinical data of patients with hand and foot wounds complicated with extensor tendon defect who were repaired with anterolateral thigh perforator flap with fascia lata in Long Gang District Orthopedic Hospital of Shenzhen from May 2014 to December 2019 were analyzed retrospectively. During the operation, fascia lata was used to repair the defect of extensor tendon.The proximal and distal endof fascia lata were anastomosis with defect extensor tendon by figure 8 sutures.The soft tissue defects of hand and foot were repaired with anterolateral thigh (ALT)perforator flap. The donor site was closed primarily or covered by free skin graft. After operation, the sensory recovery of the flap was evaluated according to the evaluation standard of sensory function after peripheral nerve injury formulated by British Medical Research Association. According to the total active range of movement (TAM) of fingers recommended by the evaluation standard of hand tendon repair of Hand Surgery Society of Chinese Medical Association, the hand motor function was evaluated systematically. Foot motor function was evaluated according to the ankle-hind foot scoring system developed and recommended by the American Association of Foot and Ankle Surgeons.Results:A total of 23 patients were enrolled, including 19 males and 4 females, aged from 9 to 61 years old, with an average age of 26 years old. Causes of injury: there were 11 cases of crushinjury associated with machine, 4 cases of road traffic injury, 6 cases of injury by falling heavy object, 2 cases of saw injury. The area of wound defect ranged from 2 cm × 6 cm to 7 cm × 25 cm, and the length of tendon defect ranged from 1.0 cm to 10.0 cm. All cases were complicated with partial or complete defect of extensor tendon. There were 19 cases with fracture and nerve injury. All the injuries were successfully repaired. All the flaps survived well. The rande of flap harvest was 3 cm × 5 cm to 9 cm × 23 cm, and the fascia lata was 1.0 cm × 1. 5 cm to 4.5 cm × 11. 0 cm. There were no complications such as arteriovenous crisis, infection, fat liquefaction, etc. Andall the wounds were closed primarily. Follow-up period ranged from 3 to 36 months (average 14 months) showed that all flaps had aestheticappearance, good color, and texture. Sensory recovery: excellent in 19 cases and good in 4 cases. TAM system evaluation method and ankle-hind foot scoring system were used to evaluate the function of hand and foot: 21 cases were excellent and 2 cases were good.Conclusions:The application of anterolateral thigh perforator flap with fascia lata to repair the hand and foot wound with extensor tendon defect can restore the motor and sensory function of the injured limb while covering the wound surface.This method has less damage to the donor site and less postoperative complications, and can significantly improve the quality of life of patients. It is an effective method to repair the wounds of hand and footcombined with extensor tendon defect.

Objective:The defects of thumbs and fingers are common and devastating in hand injuries, which make both physical and mental affecets to the patients. With deeper understanding in anatomy and faster development in micro-surgical techniques, the reconstruction of thumbs and fingers from toes with vascular anastomosis became a mainstream in the hand surgeons. These procedures were acclaimed as methods with desired outcome in function, sensation and aesthetics. However, a multitude of modification is responsible for the lack of normalization. We expects this review would provide a reference in fulfilling the surgical strategies.

Objective:To explore the clinical efficacy and feasibility of applying a medial plantar vein flap to repair the great toenail flap donor site.Methods:A retrospective analysis was performed on the clinical data of patients who underwent great toenail flap or partial great toenail flap transplantation for finger reconstruction from January 2020 to June 2021 in Longgang Orthopedic Hospital of Shenzhen. During the operation, the donor site of the great toenail flap was repaired with medial plantar venous flaps, and the donor site of the medial plantar venous flaps was repaired with a free full-thickness skin graft. The survival of the flap was observed and the appearance, sensation, and complications of the flap were followed up. The foot function was evaluated by the Maryland foot function evaluation standard.Results:A total of 6 cases were enrolled, including 5 males and 1 female with an average of 22 years, ranged from 14-28 years old. The wound area of the great toenail flap was 2.2 cm×3.7 cm-5.5 cm×7.0 cm, and the skin flap was 2.5 cm×3.8 cm-5.5 cm×7.1 cm. All flaps survived. 2 cases developed tension blisters. All patients were followed up for 3-18 months, with an average of 9 months. And all flaps had no swollen appearance, good color, texture, and no ulcers or pain. Two-point discrimination was 7-10 mm, and the second/third donor area was concealed. According to the Maryland foot function evaluation standard, all 6 cases were rated as excellent.Conclusion:The application of the medial plantar vein flap to repair the donor area of the great toenail flap is an effective repair method. The donor area is concealed, the flap is not bloated, the texture is good, the survival rate is high, and the sensation recovered satisfactory.

Objective:To explore the clinical effect of medial plantar venous flow-through flap combined with vein transplantation to repair incomplete finger amputation with circularity soft tissue defect.Methods:A retrospective analysis was performed on the clinical data of patients with incomplete finger amputation injury with circularity soft tissue defect treated by medial plantar venous flow-through flap combined with vein transplantation from January 2016 to October 2020 in Longgang Orthopedic Hospital of Shenzhen. According to the length of the arterial and venous defects of the injured finger and the area of the circular wound, a venous flap (including 2-3 veins )was designed and harvested in the medial plantar. And then two superficial veins were harvested from the donor site to repair the dominant digital artery and distal digital vein of the severed finger. One vein in the flap was bridged to repair the non-dominant digital artery of the severed finger, and the other 1-2 veins were anastomosed with the subcutaneous vein of the proximal wound. The recipient site was closed. The donor site was repaired with full-thickness skin grafting. The appearance, two-point discrimination of the flap, as well as the shape, two-point discrimination, and the extension and flexion of the finger were followed up after the operation. The evaluation was performed by the trial standard for the replantation function of amputated fingers of the Chinese Medical Association Hand Surgery Branch.Results:In this study, a total of 11 patients with thermal crush injury were enrolled, including 7 males and 4 females, aged 16-46 years old. Cyclic skin and soft tissue defect was 1.4 cm×4.5 cm - 3.2 cm×5.4 cm in size after debridement, the arterial defect was 1.6-3.5 cm in length, and the venous defect was 1.7-3.3 cm in length. The flap was 1.6 cm×4.6 cm-3.3 cm×5.5 cm in size, and the harvested vein was 1.7-3.5 cm in length. All severed fingers and flaps survived. Eleven cases were followed up 11-18 months. The appearance of flap was not swollen, and the color and texture were close to the surrounding skin. The two-point discrimination was 7-11 mm. The shape of the finger was good, the two-point discrimination was 5-8 mm, and the extension and flexion activity of the finger was good. Ultimately, the hand function of 10 cases could be rated as excellent, and 1 case could be rated as good. There was slight pigmentation in the donor area, but no ulceration or pain, and no obvious abnormality in wearing shoes, walking, or running.Conclusions:The medial plantar venous flow-through flap combined with vascular transplantation is an ideal repair method to repair incomplete finger amputation with circularity soft tissue defect. It can not only reliably rebuild the blood supply of the distal finger, but also repair the annular defect of the proximal finger. The impact on the donor site is slight.

Objective:To explore the clinical efficacy and feasibility of applying a medial plantar vein flap to repair the great toenail flap donor site.Methods:A retrospective analysis was performed on the clinical data of patients who underwent great toenail flap or partial great toenail flap transplantation for finger reconstruction from January 2020 to June 2021 in Longgang Orthopedic Hospital of Shenzhen. During the operation, the donor site of the great toenail flap was repaired with medial plantar venous flaps, and the donor site of the medial plantar venous flaps was repaired with a free full-thickness skin graft. The survival of the flap was observed and the appearance, sensation, and complications of the flap were followed up. The foot function was evaluated by the Maryland foot function evaluation standard.Results:A total of 6 cases were enrolled, including 5 males and 1 female with an average of 22 years, ranged from 14-28 years old. The wound area of the great toenail flap was 2.2 cm×3.7 cm-5.5 cm×7.0 cm, and the skin flap was 2.5 cm×3.8 cm-5.5 cm×7.1 cm. All flaps survived. 2 cases developed tension blisters. All patients were followed up for 3-18 months, with an average of 9 months. And all flaps had no swollen appearance, good color, texture, and no ulcers or pain. Two-point discrimination was 7-10 mm, and the second/third donor area was concealed. According to the Maryland foot function evaluation standard, all 6 cases were rated as excellent.Conclusion:The application of the medial plantar vein flap to repair the donor area of the great toenail flap is an effective repair method. The donor area is concealed, the flap is not bloated, the texture is good, the survival rate is high, and the sensation recovered satisfactory.

Objective:To explore the clinical effect of medial plantar venous flow-through flap combined with vein transplantation to repair incomplete finger amputation with circularity soft tissue defect.Methods:A retrospective analysis was performed on the clinical data of patients with incomplete finger amputation injury with circularity soft tissue defect treated by medial plantar venous flow-through flap combined with vein transplantation from January 2016 to October 2020 in Longgang Orthopedic Hospital of Shenzhen. According to the length of the arterial and venous defects of the injured finger and the area of the circular wound, a venous flap (including 2-3 veins )was designed and harvested in the medial plantar. And then two superficial veins were harvested from the donor site to repair the dominant digital artery and distal digital vein of the severed finger. One vein in the flap was bridged to repair the non-dominant digital artery of the severed finger, and the other 1-2 veins were anastomosed with the subcutaneous vein of the proximal wound. The recipient site was closed. The donor site was repaired with full-thickness skin grafting. The appearance, two-point discrimination of the flap, as well as the shape, two-point discrimination, and the extension and flexion of the finger were followed up after the operation. The evaluation was performed by the trial standard for the replantation function of amputated fingers of the Chinese Medical Association Hand Surgery Branch.Results:In this study, a total of 11 patients with thermal crush injury were enrolled, including 7 males and 4 females, aged 16-46 years old. Cyclic skin and soft tissue defect was 1.4 cm×4.5 cm - 3.2 cm×5.4 cm in size after debridement, the arterial defect was 1.6-3.5 cm in length, and the venous defect was 1.7-3.3 cm in length. The flap was 1.6 cm×4.6 cm-3.3 cm×5.5 cm in size, and the harvested vein was 1.7-3.5 cm in length. All severed fingers and flaps survived. Eleven cases were followed up 11-18 months. The appearance of flap was not swollen, and the color and texture were close to the surrounding skin. The two-point discrimination was 7-11 mm. The shape of the finger was good, the two-point discrimination was 5-8 mm, and the extension and flexion activity of the finger was good. Ultimately, the hand function of 10 cases could be rated as excellent, and 1 case could be rated as good. There was slight pigmentation in the donor area, but no ulceration or pain, and no obvious abnormality in wearing shoes, walking, or running.Conclusions:The medial plantar venous flow-through flap combined with vascular transplantation is an ideal repair method to repair incomplete finger amputation with circularity soft tissue defect. It can not only reliably rebuild the blood supply of the distal finger, but also repair the annular defect of the proximal finger. The impact on the donor site is slight.