Objective To investigate the clinical effects of large flow-through venous flap for salvaging the limb on the verge of amputation complicated with arterial defect.Methods Between March 2012 and January 2015,large flow-through venous flap was used in 10 patients with upper limb on the verge of amputation to reconstruct artery defect and large-area skin and soft tissue defect,including 6 males and 4 females with a mean age of 27.9 years (range,18 to 41 years).Injury was caused by machine crush in 4 patients,twisting belt pulley in 4,and traffic accident in 2.The dimension of skin defect ranged from 6.5 cm× 10.0 cm to 10.5 cm × 18.0 cm (mean,9.0 cm × 12.0 cm).Vascular defect length ranged from 6.0 to 16.0 cm (mean,12.3 cm).Time from injury to operation was 1.5-5.5 h (mean,3.5 h).After operation,flap survival,appearance,texture and sensation were recorded.Upper limb function was evaluated using the standard set up by hand surgery branch of Chinese Medical Association.Results The flap varied in size from 8.0 cm×12.0 cm-12.0 cm ×20.0 cm (mean,10.0 cm × 13.5 cm).One patient was amputated due to severe postoperative infection,and 9 patients were successfully operated.The flap showed small-area necrosis on the distal end in 2 patients,which was cured after dressing change,while survived completely in 7 patients.The donor wounds healed in one stage.After 12-27 months of follow-up (mean,13.7 months),the thickness,texture and appearance of the flap were close to the surrounding normal tissues and the skin protective sensation was restored.The functional results were excellent in 6 patients,good in 2 and poor in 1,with the excellent and good rate of 89％.Conclusion Large flow-through venous flap can reconstruct upper-limb vascular defect while repairing large-area wound,and has advantages of easy operation,less damage to the donor site and good appearance.

Objective To analyze the outcome of applying venous flow-through flap in replantation of complex severed finger.Methods From March,2011 to August,2012,15 cases of complex severed fingers were repaired by flow-through flap with two sets of venous system of forearm vein and one stage repair of wound.The time from injury to operation was 1.5-5.5 h (mean 2.5 h).Vascular defect length ranged from 1.5 to 11.0 cm (mean 3.6 cm);and soft tissue defect of 1.5 cm × 3.0 cm to 11.0 cm × 11.0 cm.All digits had severe soft tissue defect and segmental defect of blood vessels.All the finger blood circulation was disorder.Results All flaps and replanted fingers survived completely,except 1 case of postoperative venous crisis occurred which was remission after the vascular transplantation,and 1 case of skin flap necrosis at the distal part which was healed after skin grafting; Fourteen cases were followed-up from 7 to 20 months.At the final followed-up the flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases,good in 5 cases,and poor in 2 cases.All flaps and replanted fingers survived completely over a period of 12 to 30 months follow-up.The flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases and good in 5 cases.Conclusion With less injury at donor site,and good repair results,venous flow-through flap is well indicated in complex finger replantation with soft tissue defect and vascule defect.

Objective To explore the operative method and effect of replantation of complex severed thumb with the pedicled flap from the rasceta area.Methods From March,2015 to March,2017,12 cases of complicated thumb injury were treated by retrograde transfer flap pedicled with the superficial palmar branch of the radial artery.All digital arteries defective with soft tissue defect,the area was 1.5 cm×3.0 cm to 5.5 cm ×7.0 cm.The wound of the wrist donor site was sutured directly.Postoperative followed-up was performed to review if the flap survival.Results There was 1 case of venous reflux disorder.After removal of some sutures,the symptoms were relieved.All other fingers survived successfully,and the flap survived completely.The donor site incision healed at Ⅰ stage.The followed-up period was 12-18 (average,13.5) months.The appearance of the thumb and flap was satisfactory,and the scar in the donor site was not obvious.The thumb function was evaluated according to the evaluation standard of thumb and finger reconstruction function of the Chinese society of medical surgery.Eight cases were excellent,3 cases were good,and 1 case was medium.Conclusion The pedicled flap from the rasceta area has the advantages of simple operation and reliable blood supply.It can reconstruct the defect vessels and repair the wound at the same time.It is a new method for replantation of complicated severed thumb.

Objective To explore the clinical effect of free chimeric bone flap based on the superficial pal-mar branch of radial artery to repair finger composite tissue defects. Methods From July, 2013 to January, 2016, 9 cases of finger composite tissue defect were repaired by free chimeric bone flap from the wrist crease area. The flap and bone flap were taken with the superficial palmar branch of the radial artery during the operation. The area of the flap was 1.5 cm×4.0 cm to 3.5 cm×6.5 cm, and the size of the bone flaps were 0.5 cm×1.0 cm×1.5 cm to 1.0 cm × 2.5 cm × 3.5 cm. Regular followed-up was done after the operation. Results Nine cases of chimeric bone flap survived well, and the average healing time of bone flap was 1.6(1.5-3.0) months. The function and appearance of the patients recovered well. The scars on the donor area was slight. The average two-point discrimination of flap was 6.6 (5.3 to 8.6) mm at 6 months after operation. According to the Evaluation Criteria of Thumb and Finger Reconstructive Function Assessment of the Upper Limb of the Chinese Medical Association, 7 cases were superior, 1 was good, 1 was medium. Conclusion The free chimeric bone flap pedicled with superficial palmar branch of radial artery can si-multaneously repair soft tissue and bone defects. It helps shorten the course of disease and speed up the recovery of finger function.It is a new choice to repair finger tissue defects.

Objective To investigate the surgical method and clinical effect of chimeric flap pedicled with the palmar branch of the radial artery from the wrist crease area for repairing the complex defect of the thumb.Methods Data of 11 cases with thumb complex tissue defects admitted during June 2013 to June 2015 were retrospectively analyzed.There were 7 males and 4 females,aged from 16 to 56 years,with an average age of 31.5 years.The soft tissue defect of the affected finger ranged from 3.0 cm×1.3 cm to 6.3 cm×2.0 cm,and the bone defect ranged from 1.3 cm×0.8 cm×0.4 cm to 2.8 cm×1.3 cm×0.8 cm.All the cases were repaired by chimeric flap pedicled with the superficial palmar branch of radial artery of the wrist crease area.The chimeric flap was transferred through the thenar part of the subcutaneous tunnel to the thumb surface to repair the defect of the composite tissue.The flap area ranged from 4.0 cm×1.5 cm to 7.0 cm×3.0 cm and the bone flap size ranged from 1.5 cm×1.0 cm×0.5 cm to 3.0 cm× 1.5 cm× 1.0 cm.The function of the finger was evaluated postoperatively according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association.Results All 11 cases of wrist transverse bone flap survived.The average healing time of the bone flap was 1.6 (range,1.5-3) months,and the bone graft was not absorbed.The function and appearance of the finger was good with only a linear scar;6 months after surgery,the two-point discrimination on average was 7.1 mm (range,5.5-9.0 mm).At the latest follow-up according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association,finger function were excellent in 9 cases,good in 1 case,with the excellent rate of 90.9％ (10/11).Conclusion The chimeric bone flap pedicled with the superficial palmar branch of radial artery can repair skin,soft tissue and bone defects of thumb simultaneously.It has the advantages of simple operation,safe blood supply,speeding up fracture healing,good functional recovery and concealed scar in donor area.It is a new choice to repair the complex tissue defect of thumb.

Objective:To investigate the clinical efficacy of a new 3D printed guide plate in the minimally invasive treatment of fresh closed Achilles tendon rupture.Methods:From January 2019 to January 2020, 14 fresh closed Achilles tendon ruptures were treated by minimally invasive surgery at Department of Foot and Ankle Surgery, Xuzhou Renci Hospital. There were 13 males and one female, with an average age of 39.1 years (from 18 to 63 years). The rupture of the Achilles tendon body, 3 cm in length on average, was located 2 to 6 cm above the attachment of the calcaneal tuberosity. The ruptured Achilles tendon was repaired by suture with the aid of the new 3D printed guide plate. After operation, in cooperation of the Rehabilitation Department, we performed rehabilitation exercise under the guidance of the concept of Enhanced Recovery After Surgery (ERAS). The length of incision, operation time, intraoperative blood loss, ankle function at the last follow-up and follow-up complications were recorded.Results:In this cohort, incision length averaged 2.5 cm (from 2.0 to 3.5 cm), operation time 45 min (from 30 to 60 min), and intraoperative blood loss 15 mL (from 10 to 20 mL). The 14 patients were followed up for 13 to 16 months (average, 14 months) after operation. In one patient, the epidermis at the incision edge became black and necrotic, which was healed after dressing change. Follow-ups observed no such complications as suture rejection, sural nerve injury, or Achilles tendon re-rupture. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores at the last follow-up averaged 98 points (from 93 to 99 points), yielding 13 excellent cases and one good case; according to the Arner-Lindholm evaluation, the efficacy was excellent in 12 cases, good in one and poor in one.Conclusion:The minimally invasive treatment of fresh closed Achilles tendon rupture with our new 3D printed guide plate has exhibited advantages of minimally invasive incision, limited complications, simple manipulation, good functional recovery of the ankle joint and strong reproducibility of surgical operations.

Objective:To summarise the experience in use of sural neurouascular flap in repair of the soft tissue defects of foot and ankle, and explore the methods in promoting the survival and appearance of the flap.Methods:Data of 10 patients who underwent sural neurocutaneous flap surgery for repairing soft tissue defects in the foot and ankle in the Department of Foot and Ankle of Xuzhou Renci Hospital from October 2019 to June 2020 were retrospectively analysed. Among the 10 patients, 8 were males and 2 were females, and the age ranged from 18 to 54 years old, with an average age of 42.5 years old; Causes of injury: 8 patients injured by traffic accident and 2 by incision necrosis after calcaneal fracture operation. The areas of soft tissue defect were 4.0 cm×6.0 cm-16.0 cm×10.0 cm. Sural neurouascular flap was used for the defect repairs. Method of optimisation: ①The small saphenous vein in the flap was separated and retained in the limb to optimise the venous circulation. ②Freed peroneal perforator vessels that entered the pedicle, and made the point where the vessels entering the pedicle as the rotation point. The pedicle contained the sural neurovascular bundle, the main trunk of the small saphenous vein and the fascia tissue, with a width about 2.0 cm. It not only increased the blood supply of the flaps, but also a good appearance of the pedicle. ③ The torsion of the pedicle was covered by an arc-shaped flap and transferred through an open channel to prevent compression. ④The donor site was covered with relay flap. According to the location of the donor site, a proximal peroneal artery perforator flap or medial and lateral sural artery perforator flap was selected. ⑤Sural nerve was anastomosed with the peripheral sensory nerve in some cases. The survival of the flap, Maryland Foot Function Score and British Medical Research Council (BMRC) sensory function evaluation were investigated in the follow-up to evaluate the functional recovery of the flap and limb.Results:All the 10 patients received the follow-up for 6 to 12 months, with an average of 8.5 months. The donor and recipient flaps survived completely with good appearance in lower limb, good soft texture, good elasticity and wear resistance. The sensation of the flap with nerve anastomosis in 3 cases was evaluated according to BMRC, and they achieved sensation recovery up to level of S 3 or above. The patients had great satisfactions. At the last follow-up, the curative efficacy was evaluated according to the Maryland scoring system. It ranged from 85 to 98 points, with an average of 91.6 point, 8 patients in excellent and 2 in good. Conclusion:Sural neurouascular flap can achieve a sufficient blood supply, a reasonable venous circulation and a high survival rate. The donor site was covered with relay flap to obtain a good appearance, and the anastomosed sensory nerve offered a good sensation. The function of foot and ankle recovered well, and the clinical effect was satisfactory.

Objective:To investigate the clinical effect of perforator flap of distal cutaneous perforator of medial plantar artery in recon struction of destructive defect in the base plane of proximal phalange of great toe.Methods:Twenty-six patients were treated in the Department of Foot and Ankle Surgery of Xuzhou Renci Hospital from September 2017 to December 2021. The patients were 24 males and 2 females, aged 26 to 60 years old. There were 12 defects in left foot and 14 in right foot. All the defects were the residual wounds at the first metatarsophalangeal joint with the defect at 2.0 cm × 3.0 cm - 4.0 cm × 5.0 cm in size. The flaps pedicled with distal cutaneous perforator of the medial plantar artery were used to repair the defects, with a size at 3.2 cm× 4.2 cm in average. Skin grafts were employed to repair the donor sites. Postoperative patient management including lifting the affected limbs and keeping warm, anti-infection, detumescence, anti-coagulation and pain relief.Results:All patients were entered in postoperative follow-up at outpatient clinic for 1-3 years. Twenty-two flaps survived after surgery, except 4 that had dark purple edge indicating venous congestion. Blood supply of the flap was regained after the tension of the flap was relieved by interval suture removal. Appearance of flaps was good, without obvious swelling nor pigmentation, good in elasticity, in hard texture and with good wear resistance. Patients showed no limp of the affected limbs, and without restriction in wearing shoes or walking. The function of feet was evaluated according to the American Orthopedic Foot and Ankle Societ (AOFAS) I50, with 24 patients in excellent and 2 in good.Conclusion:The anatomy of the flap pedicled with distal cutaneous perforator of the medial plantar artery is relatively constant. It provides a blood supply and does not affect the trunk of major artery. The flap has a thick skin cuticle hence it is wear-resistant. This flap provides a choice to the repair of a defect at proximal segment of great toe.

Objective:To explore the effect of preliminary application of a surgical microscope with a measuring system in measurement of the outer diameter of blood vessels in the super-microsurgical model of chicken wing.Methods:From November 2022 to January 2023, 12 chicken wing models were established by having the main blood vessels of chicken wings dissected and separated. Outer diameter of blood vessels were measured by the surgical microscope with an installed measuring system and a digital vernier calliper. Results of the 2 measuring methods and measuring time were compared. SPSS 26.0 was used for statistical analysis of the data. The comparison between the 2 measuring methods with continuity data consistent with the homogeneity of normal distribution variance was performed by paired t test, and expressed by Mean ± SD. The difference between the 2 measuring methods was statistically significant ( P<0.05). Results:Results measured by the microscope with a measuring system and a digital vernier calliper were 1.29 mm± 0.08 mm and 1.28 mm± 0.07 mm for chicken wing brachial artery, 1.11 mm± 0.11 mm and 1.09 mm ± 0.11 mm for radial artery, 0.98 mm± 0.09 mm and 0.99 mm± 0.12 mm for ulnar artery, 0.63 mm ± 0.06 mm and 0.64 mm± 0.07 mm for dorsal metacarpal artery, and 0.39 mm± 0.06 mm and 0.40 mm± 0.09 mm for palmar artery, respectively. No significant difference was found between the 2 measuring methods ( P>0.05). The time of measurement for the 2 measuring methods was 5.90 s± 1.12 s and 8.86 s± 1.74 s, respectively. The time for the microscope with a measuring system was less, with statistically significant difference ( P<0.05). Conclusion:It is accurate, convenient and intuitive to use a surgical microscope installed with a measuring system to measure the outer diameter of tinny vessels. It is worth to popularise and apply the surgical microscope equipped with a measuring system in super-microsurgery.

Objective To investigate the clinical effects of a large flow-through venous flap.Methods Between January 2012 and January 2015,this flap was used in 9 patients with upper limb injury to reconstruct artery defect and large skin and soft tissue defect.The donor sites were covered with free skin grafts.The skin and soft tissue defects size ranged from 7.0 cm × 10.0 cm to 9.5 cm × 18.0 cm (average 9.2 cm× 12.0 cm).Results The flaps size ranged from 9.0 cm × 12.0 cm-11.5 cm × 20.0 cm (average 10.3 cm × 13.5 cm).Except 2 cases of small area necrosis occurred in the distal end of the flap,which healed after dressing change;the other 7 flaps survived completely.The donor wounds healed primarily.Postoperative patients were followed up for 12-26 months (mean 14.5 months).Flap appearance,texture and thickness were similar to the surrounding normal tissue.According to the sensory function evaluation standard formulated by the British Medical Research Council in 1954,the result of skin flap sensory evaluation was assessed as S2 in two cases,S3 in four cases,S3 in three cases,with excellent and good rate as 77.8％.According to the assessment standard for upper limb function issued by Chinese Medical Association of hand surgery,the limb function were assessed as excellent in 6 cases,good in 2 cases,poor in 1 case,with the excellent and good rate as 88.9％.Conclusions The large flowthrough venous flap has the advantages of simple operation,minimal donor site morbidity and satisfactory appearance.It is a feasible method to repair the wound at upper limb with artery defect.