Objective To investigate the effect of early limb movement on the motor function and the activities of daily life of stroke patients. Methods Eighty two stroke patients were divided into the control group(n=40)and intervention group(n=42). The former received conventional nursing care and the latter the intervention of early limb movement and routine nursing.The two groups were compared in terms of Fugl-Meyer movement function and Barthel index. Results After 12 weeks,the scores by Fugl-Meyer motor function and by Barthel index were significantly higher than those in the control group(all P<0.01).Conclusion The intervention by early limb movement is effective for promoting the recovery of limb motor function of stroke patients as well as their ability of daily life.

ObjectiveTo explore the relationship between serum uric acid and prehypertension and the effects of age,obesity,fasting glucose and lipids in Chinese adults.Methods14,451 non-hypertensive cases from a community-based health examination survey in Xuzhou,Jiangsu province of China were enrolled in this study.Blood pressure,BMI,and determination of fasting glucose,lipids and serum uric acid were measured in all cases.ResultsThe odds ratios ( OR,95％ CI ) of prehypertension across increased serum uric acid after adjusting for age,sex were 1.0,1.20 ( 1.07 - 1.35 ),1.55 ( 1.36 - 1.76),1.82(1.60-2.09),2.33(2.03-2.67) (Pfor trend ＜0.01).The odds ratios were 1.0,1,04(0.92-1.18),1.21(1.06-1.38),1.26(1.09 - 1.45),1.36(1.17 - 1.58),( Pfor trend ＜0.01) after adjusting for age,sex,BMI,glucose,and lipids.In addition,fasting glucose significantly interacted with uric acid ( P for interaction ＜ 0.01 ).Conclusions Serum uric acid was associated with prehypertension,which might be an independent metabolic risk factor.Fasting glucose may reinforce the associations.

Objective To investigate the prevalence and the transmission of oqxAB gene in clinical strains of Escherichia coli and Klebsiella pneumoniae .Methods Nonduplicate clinical isolates of E.coli (n=72)and K .pneumoniae (n=49)were col-lected.The oqxAB gene was amplified by PCR.The product was sequenced.Plasmid conjugation experiments were done in oqxAB-positive E.coli and K.pneumoniae strains to detemine whether oqxAB gene is located in plasmid.The MICs and mu-tant prevention concentrations (MPCs)for ciprofloxacin were determined in transconjugants with oqxAB gene by agar dilution method.Results The oqxA,oqxB and oqxAB were identified in 15,4,and 7 of the 72 strains of Escherichia coli and 4,1,and 34 of the 49 strains of K.pneumoniae,respectively.The oqxAB gene was positive in 2 (2/16)ciprofloxacin sensitive and 5 (5/56)ciprofloxacin resistant E.coli strains,in 8 (8/14)ciprofloxacin sensitive and 26 (26/35)ciprofloxacin resistant K. pneumoniae strains,respectively.The E.coli and K.pneumoniae strains with or without oqxAB did not show different sus-ceptibility to ciprofloxacin.The oqxA and oqxB sequences from E.coli and K.pneumoniae showed 99% similarity to the se-quences of GeneBank accession number AB601773.1 and accession number FJ975561.1,respectively.The oqxAB gene was successfully transferred in 4 of the 5 oqxAB-positive E.coli strains.The MIC of ciprofloxacin was 0.25-0.5 mg/L against the transconjugants,31-62 times higher than the MICs for the recipient strains.The MPC of ciprofloxacin was 8-16 mg/L against the transconjugants,32 times higher than that for recipient strain J53.The oqxAB gene were not transferred in K. pneumoniae. When the MIC of ciprofloxacin was ≤0.062 5 mg/L,the MPC of ciprofloxacin was 0.25-0.5 mg/L for K.pneumoniae strains with or without oqxAB.When MIC was 0.25-0.5 mg/L,the MPC of ciprofloxacin was 2-16 mg/L for K .pneumoniae strains with or without oqxAB .Conclusions oqxAB gene is present in E .coli and K .pneumoni-ae .The oqxAB gene spreads through plasmid in E .coli.The nonsiginificant difference of oqxAB prevalence between ciproflox-acin sensitive and ciprofloxacin resistant strains indicates that oqxAB gene may mediate low level resistance to ciprofloxacin in E.coli.The E.coli transconjugants of oqxAB gene can produce high level resistance under the selection pressure of ciproflox-acin.The high level resistance in K .pneumoniae under selection pressure of ciprofloxacin is not associated with oqxAB gene, but related to the ciprofloxacin MIC against these strains.

BACKGROUND: The injury of blood-brain barrier following cerebral ischemia reperfusion is a considerate pathological basis for injury caused by cerebral ischemia and reperfusion.OBJECTIVE: To investigate the effects of four most basic Chinese medicinal herbs, or safflower, peach seed, ligusticum and red peony with actions of activating blood and resolving the stasis on the contents of nitric oxide, immunoglobulins, C-reactive protein (CRP) and complements (immunological indices) of serum and cerebral homogenate, as well as the morphological and structural changes of cerebral tissue cells in rats with ischemia and reperfusion to vertify relationship between time effectiveness and quantitative effectiveness.DESIGN: A randomized controlled study, and evaluation by single blind.MATERIALS: The experiment was completed in the Laboratory of Traumatology Institute of Guangzhou Red Cross Hospital from January 2001 to De cember 2002. Safflower, peach seed, szechwan lovge rhizome and red peony are concentrated granules of single decocting pieces, the blood activating and stasis resolving decoction was prepared at 2.5 g/L according to 1:1:1:2 ratio.Totally 138 adult female SD rats were selected for the experiment,weighing 280-300 g, provided by Animal Center of Guangzhou University of TCM.INTERVENTIONS:The models rats with middle cerebral artery occlusion were set up by thread ligation(24 hours reperfusion after 2 hours middle cerebral artery occlusion).All 138 rats were randomly divided into 6 groups with 23 in each group.Sham operation group:The vessels were ligated but the middle cerebral artery was not occluded.No.1 medicated group: The BASR was by gavage given in a dose of 2 g/kg 30 minutes before operation. No. 2 medicated group: The BASR was by garage given in a dose of 2.5 g/kg 30 minutes before operation. No. 3 medicated group: The BASR was by garage given in a dose of 2 g/kg for consecutive 7 days be fore operation. No. 4 medicated group: The BASR was by gavage given in a dose of 2.5 g/kg for consecutive 7 days before operation.Control group:the same volume of saline was by gavage given for consecutive 7 days before operation. ① Scoring of dysneuria (5-score system: 0-1 score meant mild dysneuria, 2-4 scores meant severe dysneuria) for all rats were performed after consciousness following 2 hours ischemia and 24 hours reperfusion.② After 24 hours reperfusion,10 rats in each group were at random selected for assay of levels of CRP, complement 3 (C3) and complement 4 (C4) (rate nephelometry), and concentration of nitric oxide (nitrate reductase method)in both cerebral homogenate and serum.③ After 24hours reperfusion, 10 rats in each group were at random selected, and after anesthesia was completed, the brain was quickly collected through decapitation, put into a 110 ℃ drying oven till its constant weight, then the water content in brain was calculated.④ The cerebral cytomorphology in every group was observed under light microscope. ⑤ After reperfusion, 3 rats in each group were randomly selected for preparation of coronal section of cerebral tissue,the cerebral ultrastructure in each group was observed under transmission electronic microscope.MAIN OUTCOME MEASURES: ① The results of dysneuria scoring in each group. ② The levels of CRP, C3 and C4, and concentration of nitric oxide in both cerebral homogenate and serum.③ The water content in brain. ④ The cerebral cytomorphology and the cerebral ultrastructure. RESULTS: All 138 rats entered into the result analysis. ① Comparison of the extents of dysneuria of rats in each group: The ratio of severe dysneuria after 24 hours ischemic reperfusion in all medicated groups was obviously lower than that in control group(P ＜ 0.01),and the ratio in No.4 medicated group was lower than that in No.2 medicated group(P ＜ 0.05).② Comparison of water contents in brain of rats in each group:The water contents in sham operation group and all medicated groups were obviously lower than that in control group (P ＜ 0.05). ③ Comparison of the nitric oxide concentration in cerebral homogenate of rats in each group: The concentration in sham operation group and all medicated groups were obviously lower than that in control group (P ＜ 0.01). The concentration in No. 3medicated group was obviously lower than that in No. 1 medicated group (P ＜ 0.05).The concentration in No.4 medicated group was obviously lower than that in No. 2 medicated group (P ＜ 0.01). ④ Comparison of the nitric oxide concentration in serum of rats in each group:The concentrations in sham operation group and all medicated groups were obviously lower than that in control group(P ＜ 0.01).The concentration in No.3 medicated group was higher than that in No. 1 medicated group (P ＜ 0.05). The concentration in No. 4 medicated group was higher than those in No. 2 and in No. 3 medicated groups (P ＜ 0.05). ⑤ Comparison of the levels of CRP in cerebral homogenate and serum of rats in each group: The levels in sham operation group and all medicated groups were lower than that in control group(P ＜ 0.05-0.01).The level in No.3 medicated group was lower than that in No. 1 medicated group (P ＜ 0.01). The level in No. 4 medicated group was lower than those in No. 2 and in No. 3 medicated groups (P ＜0.05-0.01).⑥ Comparison of the levels of C3 in cerebral homogenate and serum of rats in each group:The levels in sham operation group and all medicated groups were lower than that in control group (P ＜ 0.05-0.01). The level in No.3 medicated group was lower than that in No.1 medicated group (P ＜ 0.05). The level in No. 4 medicated group was lower than those in No. 2 and in No. 3 medicated groups (P ＜ 0.01). ⑦ Comparison of the levels of C 4 in cerebral homogenate and serum of rats in each group:The levels in sham operation group and all medicated groups were lower than that in control group (P ＜ 0.05-0.01). The level in No. 3 medicated group was lower than that in No. 1 medicated group (P ＜ 0.05). The level in No.4 medicated group was lower than those in No. 2 and in No. 3 medicated groups (P ＜ 0.01). ⑧ Comparison of the condition of cerebral edema of rats in each group:In control group there was obvious cerebral congestive edema,indicating an obvious infection;while in medicated groups the extent of cerebral edema was milder than that in control group.⑨ Changes of cerebral ultrastructure of rats in each group:The ultrastructure in sham group was normal. In control group, there obvious edema of cells, capillaries and sheaths in the marginal zone of cortex necrosis,and reduction of organelles of neuron. As well. In No. 3 and No. 4 medicated groups, the limits of cell membranes were clear, the structure was integral, the chondriosomes were rich and even in size,the medullated fibers were morphologically normal.And in No.1 and No.2 medicated groups the changes were between the twoCONCLUSION:① The scoring of dysneuria in rats was decreased after the blood-activating and stasis-resolving medicine was given,and it was lower in rats that were given a longer period of medication,indicating that the improved extent for dysneuria is related to prolonged medication.②The nitric oxide concentration of cerebral tissue in rats that recevied the blood-activating and stasis-resolving medicine was decreased, and the nitric oxide concentration of serum in the rats was increased,indicating that the blood-activating and stasis-resolving medicine can reverse the anomalies of nitric concentration in different tissues after ischemic reperfusion so as to reduce cerebralinjury.③ The levels of C3 and C4 of cerebral tissue and serum in rats that received the blood-activating andstasis-resolving medicine were obviously decreased,indicating that the medicine may reduce the cerebral injury through triggering complement system;and the CRP was also get decreased,further suggesting that the medicine can inhibiting infective reaction.④ The longer the period of medication,the milder the cerebral injury, and the dose of 2.5 g/L was better in effect.

BACKGROUND: It has been known that re-recovery of blood flow after cerebral ischema may aggravate brain injury. It has been verified in some researches that the components for activating blood circulation and removing stasis in Chinese herbs can resist cerebral ischemic reperfusion injury.OBJECTIVE: To observe 4 most basic Chinese herbs for activating blood circulation and resolving stasis [honghua (Flos Carthami), taoren (Semen Persicase), chuanxiong (Rhizoma ligustici Chuanxiong) and chishao (Radix Paeoniae Rubra)] as the exertive factors on their influences on immune index changes in IgG, C-reactive protein (CRP) and complements of serum and homogenate in brain tissue so as to verify their graded and time effects.DESIGN: Randomized control experiment and single blind method.SETTING: Guangzhou Red Cross Hospital and Department of Neurology of the Fourth Hospital Affiliated to Jina University.MATERIALS: The experiment was performed from January 2001 to Decemb er 2002 in Experimental Room of Traumatic Institute of Guangzhou Red Cross Hospital. Totally 138 SD female adult rats were employed, mass weighted varied from 280 to 300 g, provided from Experimental Animal Center of Guangzhou University of Chinese Medicine. Honghua (Flos Carthami), taoren (Semen Persicase), chuanxiong (Rhizoma ligustici Chuanxiong)and chishao (Radix Paeoniae Rubra)] were the concentrated granules individually. At the ratio of 1:1:1:2, they were prepared into 2.5 g/mL raw herbal decoction (huoxue huayu tang).INTERVENTIONS: Thread embolic method was used to prepare cerebral medium sized artery obstruction model in rats (reperfusion for 24 hours after cerebral medium sized artery obstruction for 2 hours). Totally 138 rats were randomized into 6 groups, 23 rats in each. Sham operation group: ligature was done in each vessel without blocking medium sized artery of cerebrum.First perfusion group: 30 minutes before operation, gastric peffusion was done with 2 g/kg huoxue huayu tang. Second peffusion group: 30 minutes before operation, gastric perfusion was done with 2.5 g/kg huoxue huayu tang. Third perfusion group: before operation, gastric perfusion was done with 2 g/kg huoxue huayu tang continuously for 7 days. Fourth perfusion group: before operation, gastric perfusion was done with 2.5 g/kg huoxue huayu tang continuously for 7 days. In the control, physiological saline of all of the groups, when rats woke up, after 24 hours reperfusion and 2 hours ischemia, neural functional deficits were evaluated (5-score system, 0-1:After 24 hours reperfusion, 10 rats were randomized from each group for determination of the contents of CRP in homogenate and serum, complehours reperfusion, 10 rats were randomized from each group. After anesthetized, they were sacrificed rapidly to collect brains. Dried over heat in oven at 110℃ till constant weight, the water content of brain tissue was domized from each group to observe ultrastructure of brain tissue under transmission electron microscope (TEM) of rats in each group.and homogenate, complement C3 and C4 as well as serum IgG in rats of of severe neural functional deficits after 24 hours ischemic reperfusion in rats of each peffusion group was lower remarkably than the control (P ＜ 0.01),in which, that in fourth peffusion group was lower than second group (13%,group and each perfusion group was lower than the control (P ＜ 0.05), in which, that in third peffusion group was lower than first group (P ＜ 0.01).ment C3: That in sham operation group and each perfusion group was lower sham operation group and each perfusion group was lower than the control ( P ＜ 0.01), in which, that in third perfusion group was lower than first group (P ＜ 0.01); That in fourth perfusion group was lower than second and group and each perfusion group was lower than the control (P ＜ 0.01), in which, that in fourth perfusion group was lower than second group(P ＜ 0.05).each perfusion group was lower than the control (t=5.626-17.929, P ＜ 0.01),in which, that in third perfusion group was lower than first group (P ＜ 0.01),complement C3 in brain homogenate: That in sham operation group and each perfusion group was lower than the control (P ＜ 0.05-0.01), in which, third perfusion group was lower than first group (P ＜ 0.01), that in fourth group brain homogenate: That in sham operation group and each perfusion group was lower than the control ( P＜ 0.05-0.01), in which, that in third perfusion group was lower than first group (P ＜ 0.01), that in fourth group was lower tissue: The inflammatory reaction in the control was obvious. Brain edema and pathological damage in perfusion groups were milder than the control.Ulztrastructure was normal in sham operation group. The edema was obvious in cells, capillaries and myelin sheath in cortical necrosis margin area and neuronal cell organs were decreased in the control. In third and fourth peffusion groups, cellular membrane was clear in boundary line,integrative in structure, rich in mitochondria and even in size and the morphology of medullated fibers was normal. The situation of first and second perfusion was between two of them.deficits in the evaluation of rats and the score with long medication was lower, suggesting that long medication can even better improve neural funcplement C3 and C4 in brain bomogenate and serum and decreases serum IgG content, explaining that the medicine alleviates brain tissue injury by startup complement system. The remarkable decrease of C-reactive protein further suggests the inhibition of such medicine on inflammatory reaction.jury is, and the better result is achieved at dosage of 2.5 g/L.

Objective To explore effects of Naikan cognitive therapy on improving clinical symptoms in patients with convalescent schizophrenia. Methods The 69 convalescent schizophrenic patients with convalescent clinical state were consecutively recruited. All the patients were divided into Naikan cognitive therapy ( NCT) group an control group at random and were pretreated with antipsychotic agent therapy. In NCT group,the patients received NCT for successive 7 days. In control group,the patients only received antipsychotic agent therapy. Pre-and post-treatment positive and negative syndrome scale( PANSS) , Nurses'observation scale for inpatient evaluation (NOSIE) were administered to all subjects. Results ① A significant decrease occurred in PANSS total score, negative symptom score, positive symptom score, compound scale score, general psychopathology score, reaction retardation score and paranoid score in NCT group ( t = 2. 672～7. 370, P < 0. 05). In the post-treatment, PANSS total score, negative symptom score, positive symptom score, compound scale score, reaction retardation score and thought disorder score were significantly lower in NCT group than those in control group ( t ' = 2. 696, P = 0. 009; t = 5. 186, P=0.000; t = 3.757, P = 0.001; t = 2.634,P = 0.011; t ' =2.376, P = 0.021). ②A significant decrease occurred in NOSIE total negative score( 10.43 ± 9. 24 vs 13. 87 ± 8. 03, t = 3. 463 , P = 0. 002) , irritation score(3. 13 ±0.43 vs8.53 ±4.98, t = 6. 139, P=0.000) and retardation score(1.07 ± 1.64 vs 2. 20 ±2.85, t = 2.067, P = 0.048) in NCT group. Conclusion NCT can possibly improve part clinical symptoms of patients with convalescent schizophrenia to a certain extent,especially negative symptom,but need to further prove the effect of NaiKan cognitive therapy.

Objective To investigate errors and the mechanism of acalculia in patients with left or right hemisphere cerebral infarction.Methods Fifty-six patients with single hemisphere cerebral infarction and 56 normal adults who were matched in age,sex and years of education were tested with EC301-CR.The patients were divided into a left hemisphere cerebral infarction group(n =34)and a right hemisphere cerebral infarction group(n =22).Results The scores on 30 out of 32 EC301-CR items were significantly lower among the patients than in the normal control group.Scores on 14 EC301-CR items were significantly lower in the left hemisphere group than in the right hemisphere group.In the left hemisphere group the item scores of aphasia patients were significantly lower than those of no-aphasia patients except on digit identity.Conclusion Mathematical processing and calculation were impaired in patients with single hemisphere cerebral infarction.Calculation was significantly worse among left hemisphere patients compared with right hemisphere cerebral infarction.There was a highly significant correlation between acalculia and aphasia.

Whether to select one-tailed test or two-tailed test,how to establish null hypothesis and alternative hypothesis,how to improve the test efficacy were elaborated,and the common problems encountered when hypothesis was applied in scientific papers were pointed out with examples.

Objective: To investigate the regularity of sensory recovery after repairing the wounds on the wrist and back of hand with anterolateral femoral flap without nerve anastomosis. Methods: A cross-sectional study was conducted. From January 2018 to December 2020, patients who underwent free anterolateral femoral flaps without nerve anastomosis to repair wounds on the wrist and back of hand and met the inclusion criteria in Changshu Hai Yu Health Centre and Suzhou Ruihua Orthopedic Hospital were included in this study. Depending on the time interval between the day of the patient's surgery and the day of the cross-sectional survey, 80 patients were divided into 6-month group (15 males and 5 females, aged 22-63 years), 12-month group (16 males and 4 females, aged 21-65 years), 18-month group (15 males and 5 females, aged 25-61 years), and 24-month group (14 males and 6 females, aged 20-65 years), with 20 patients in each group. The area of skin and soft tissue defects after debridement ranged from 6.0 cm×4.5 cm to 18.0 cm×9.0 cm. Anterolateral femoral flaps were cut with areas of 7 cm×5 cm to 20 cm×10 cm and a thickness of 1.0 to 2.5 cm. Each transplanted flap was divided into A (proximal), B/D (bilateral), C (distal), and E (central) regions. The pain sensation, touch sensation, cold sensation, warmth sensation, and two-point discrimination (2-PD) in the aforementioned five regions and the differences in the five senses of the whole flap were tested and compared. Data were statistically analyzed with one-way analysis of variance, Fisher's exact probability test, chi-square test, or McNemar test. Results: In A region of anterolateral femoral flap without nerve anastomosis, compared with those in 6-month group, the pain sensation, touch sensation, cold sensation, and warmth sensation of flap of patients in 12-month group were significantly recovered (with χ² values of 10.10, 14.55, 12.13, and 4.29, respectively, P<0.05 or P<0.01); compared with that in 12-month group, the warmth sensation of flap of patients in 18-month group recovered significantly (χ²=5.23, P<0.05). In B region, compared with those in 6-month group, the pain sensation, touch sensation, and cold sensation of flap of patients in 12-month group recovered significantly (with χ² values of 5.58, 3.96, and 4.29, respectively, P<0.05); compared with those in 12-month group, the pain sensation, touch sensation, cold sensation, and warmth sensation of flap of patients in 18-month group recovered significantly (with χ² values of 5.58, 3.96, 7.03, and 12.38, respectively, P<0.05 or P<0.01). In C region, compared with that in 6-month group, the pain sensation of flap of patients in 12-month group recovered significantly (χ²=4.80, P<0.05); Compared with that in 12-month group, the warmth sensation of flap of patients in 18-month group recovered significantly (χ²=10.16, P<0.01). In D region, compared with those in 6-month group, the pain sensation, touch sensation, and cold sensation of flap of patients in 12-month group recovered significantly (with χ² values of 5.58, 4.29, and 3.96, respectively, P<0.05); compared with those in 12-month group, the pain sensation, touch sensation, cold sensation, and warmth sensation of flap of patients in 18-month group recovered significantly (with χ² values of 5.58, 4.29, 3.96, and 10.10, respectively, P<0.05 or P<0.01). In E region, compared with that in 6-month group, the cold sensation of flap of patients in 12-month group recovered significantly (χ²=4.80, P<0.05); compared with those in 12-month group, the pain sensation, touch sensation, and warmth sensation of flap of patients in 18-month group recovered significantly (with χ² values of 6.47, 4.91, and 9.23, respectively, P<0.05 or P<0.01). The five senses in the 5 regions of flap of patients in 24-month group were similar to those in 18-month group (P>0.05). The recovery of 2-PD in the 5 regions of flap of patients was similar between the two adjacent groups (P>0.05). In 12-month group, the recoveries of pain sensation, touch sensation, and cold sensation of flap of patients in A region were better than those in the other 4 regions (P<0.05 or P<0.01), the recovery of warmth sensation was better than that of B region, C region, and E region (P<0.05 or P<0.01); in 18-month group, the recovery of pain sensation, touch sensation, cold sensation, and warmth sensation of flap of patients in A region of was better than those in area C region (P<0.05). Compared with those in 6-month group, the pain sensation, touch sensation, and cold sensation of the whole flap of patients in 12-month group recovered significantly (with χ² values of 7.62, 7.03, and 5.58, respectively, P<0.05 or P<0.01). Compared with the 12-month group in which 10, 11, 10, and 4 patients had a recovery of pain, touch sensation, cold sensation, and warmth sensation in the whole flap, the 18-month group had significantly more patients with sensations recovered, which were 17, 17, 16, and 14, respectively (with χ² values of 5.58, 4.29, 3.96, and 10.10, respectively, P<0.05 or P<0.01). The five senses of the whole flap of patients in 24-month group were similar to those in 18-month group (P>0.05). Conclusions: In the anterolateral femoral flap without nerve anastomosis for repairing wounds on the wrist and back of hand, the sensation gradually recovered from the proximal end to the distal end. The sensation of touch, pain, and cold began to recover from 6 months after operation, and entered the stable recover period at 18 months after operation. Warmth sensation began to recover from 12 months after operation, and entered the stable recovery period at 18 months after operation. The 2-PD of most flaps was still not recovered 2-year after operation.
Male ; Female ; Humans ; Wrist ; Cross-Sectional Studies ; Touch/physiology* ; Pain ; Anastomosis, Surgical

Objective: To explore the clinical effects of free superficial peroneal artery perforator flaps in repairing skin and soft tissue defects of the hallux. Methods: A retrospective observational study was conducted. From January 2020 to January 2021, 13 patients with skin and soft tissue defects of the hallux who met the inclusion criteria were admitted to Department of Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, including 12 males and 1 female, aged 26 to 53 years. Before operation, the perforating point of the superficial peroneal artery perforator was located by color Doppler ultrasound on the calf on the same side of the affected hallux and marked on the body surface. The operation was performed under spinal anesthesia combined with continuous epidural anesthesia. The area of skin and soft tissue defect after debridement was 4.5 cm×2.5 cm to 12.0 cm×3.0 cm. According to the size and shape of the wound, the superficial peroneal artery perforator flap was designed with the line between the fibular head and the lateral malleolus tip parallel shifting 2 cm to the tibial side as the flap axis line, and the perforating point of the perforator near the midpoint of the axis line as the center. The cut area of the flap was 5.0 cm×3.0 cm to 13.0 cm×4.0 cm, and part of the deep fascia was cut when the pedicle was freed. The donor site wound was sutured directly. During the operation, the number and type of the perforator and the cutting time of the flap were recorded, and the length of the perforator pedicle and diameter of the perforator were measured. The survival of the flap, the healing time and the healing condition of the donor and recipient areas were recorded after operation. The color, texture, elasticity of the flap, standing and walking functions of patients, the recovery of the donor area, and the patients' satisfaction with the recovery of the donor and recipient areas were recorded during the follow-up. At the last follow-up, the sensation of the flap was evaluated by the British Medical Association sensory function evaluation standard, the function of the affected limb was evaluated by the American Society of Foot and Ankle Surgery scoring system, and the excellent and good rate of the function of the affected limb was calculated. Results: A total of 13 perforators of the superficial peroneal artery were detected during the operation, all of which were septocutaneous perforators, and the perforator diameter was 0.3 to 0.5 mm. The vascular pedicle length was 2 to 5 cm. Flap cutting time was 11 to 26 minutes. The flaps of 13 patients all survived completely. The wounds at the donor and recipient sites healed well 9 to 18 days after operation. During follow-up of 6 to 14 months, the flaps had good color, texture, and elasticity; 11 patients had no obvious bloated appearance, and the other 2 patients underwent flap thinning and plastic surgery in the second stage because of their bloated appearance; all the patients returned to normal walking and standing functions. There was only one linear scar left in the donor site, with no obvious scar hyperplasia or hyperpigmentation. All the patients were satisfied with the recovery of the donor and recipient areas. At the last follow-up, the sensation of the flap was evaluated as grade S₃ in 2 cases, grade S₂ in 9 cases, and grade S₁ in 2 cases; the function of the affected limb was evaluated as excellent in 7 cases and good in 6 cases, with an excellent and good rate of 100%. Conclusions: The free superficial peroneal artery perforator flap has relatively constant vascular anatomy, which is thin and wear-resistant, with less damage to the donor site after flap excision, and can preserve the shape and function of the hallux to the greatest extent. It is an effective method for repairing skin and soft tissue defect of the hallux.
Cicatrix ; Female ; Hallux/surgery* ; Humans ; Lower Extremity ; Male ; Perforator Flap/blood supply* ; Soft Tissue Injuries/surgery* ; Tibial Arteries/surgery*