Objective:To analyze and investigate the clinical efficacy on repairing soft tissue defects of the thumb distal with dorsal neurocutaneous vascular flap.Methods:Select 100 cases of patients with soft tissue defects of the thumb distal from January 2014 to December 2016,who were randomly divided into two groups,the control group and observation group.Take the abdominal skin flap to repair soft tissue defects of the thumb distal in the control group,with the thumb distal with dorsal neurocutaneous vascular flap in the observation group.The survival condition,the indicators of feelings,the appearance of skin flap,as well as the DASH score of the hand fimction have been recorded and analyzed through follow-up patients,to observe the effects on repairing soft tissue defects in the two groups.Results:All transplanted tisssues were all survived in the observation group and control group.Compared with control group,the sense of touch,temperature sense,monofilament,two-point discrimination,scar contracture of the observation group were better(P＜0.05),the incidence of bloat was lower (P＜0.05).The DASH scores were 29.56± 2.14,38.13± 3.12 in the observation group and control group,which was significantly lower in the observation group than that of the control group(P＜0.05).Conclusion:The clinical efficacy of the dorsal neurocutaneous vascular flap is better than that of abdominal skin flap on repairing soft tissue defects of the thumb distal.For no injury for major vascular nerves,little influence on donor area,being simple to operate,being better feelings of the finger pulp,appearance,dorsal neurocutaneous vascular flap on repairing soft tissue defects of the thumb distal is an ideal choice.

BACKGROUND:Existing evidence has shown endoscopic carpal tunnel release is superior to the open release in postoperative recovery time, grip and pinch strength, hospitalization time as wel as incidence of postoperative scar tissues. OBJECTIVE:To systematical y review the efficacy and safety of endoscopic release versus mini-open release for carpal tunnel syndrome. METHODS:A computer-based search of PubMed, the Cochrane Library, EMbase, Web of Science, CNKI, CqVip and Wanfang databases was performed. Randomized control ed trials comparing endoscopic release with mini-open release for patients with carpal tunnel syndrome were included, and the publishing time was up to November 1st, 2015. Two authors independently screened, extracted data and assessed the risk of bias of the included literatures. Then statistical analysis was conducted using RevMan 5.3 software. RESULTS AND CONCLUSION:A total of 11 randomized control ed trials involving 706 patients were included. The results of Meta-analysis demonstrated that:compared with mini-open release, endoscopic release could not only significanthy decrease the hospitalization time postoperative recovery time and complications (P<0.05), but also achieve better symptom relief (P=0.16). However, there were no significant differences in grip and pinch strength between the two treatments. These results suggest that compared with the mini-open release, the endoscopic release contributes to shorter hospitalization time and postoperative recovery time, better symptom relief and lower risk of complications. But large-sample and high-quality randomized control ed trials are needed to provide more reliable evidence for these findings.

Objective To observe the effect of two reverse pedicle flap repaired soft tissue defect of the finger.Methods From April,2011 to March,2015,46 patients were randomly divided into two groups.Twenty-eight cases were performed by dorsal metacarpal artery flaps with cutaneous branches as pedicle and the 18 cases were performed by reverse the proper palmar digital artery dorsal branches island flap.The complication,survival rate,hand function and appearance were analyzed.Results The dorsal metacarpal artery flaps with cutaneous branches as pedicle and reverse the proper palmar digital artery dorsal branches island flap were an average follow-up of 18 and 15 months,all flaps survived.For fingertip defects,8 cases were repaired with as pedicle as the dorsal metacarpal artery flaps with cutaneous branches as pedicle while 16 cases were repaired with reverse the proper palmar digital artery dorsal branches island flap.Among them,complication included 2 cases of early venous congestion and 2 cases of superficial skin necrosis.One case of reverse the digital artery dorsal branches island flap blistered;the flap sensibility was good recovery.The two-point discrimination testing of dorsal metacarpal artery flaps with cutaneous branches as pedicle was from 6.0 to 9.0 mm (average of 7.1 ± 0.5 mm);the two-point discrimination testing of dorsal metacarpal artery flaps with cutaneous branches as pedicle was from 4.0 to 7.0 mm (average of 5.2 ± 0.4 mm),but there were differences in two-point discrimination and there was statistically significant (P ＜ 0.05).There was no significant difference between the two groups each finger interphalangeal joint activity compared with the healthy side.The study found that 10 cases of dorsal metacarpal artery flaps appearance was 5 mm higher than normal skin and 1 patient of reverse the digital artery dorsal branches island flap appearance was 5 mm higher than normal skin,the difference was statistically significant (P ＜ 0.05),the latter was better than the former,especially repaired fingertip defect.Conclusion Dorsal metacarpal artery flaps with cutaneous branches as pedicle and reverse the proper palmar digital artery dorsal branches island flap were safe and reliable,it is the ideal flap finger defects.For finger fingertip defect repaired reverse the proper palmar digital artery dorsal branches island flap is superior dorsal metacarpal artery flaps with cutaneous branches as pedicle.

Objective To investigate the clinical effect of the treatment for hand trauma with free flap of radial artery superficial palmar branch.Methods Selected 100 cases of patients with hand trauma who were treated in our hospital from January 2013 to December 2015.All the patients were treated with free flap of radial artery superficial palmar branch.The postoperative necrosis rate,survival rate,and infection rate of flap of all the patients were observed.All the patients were followed up for 6 months,and the healing of fracture were evaluated by X-ray examination so as to evaluate the hand function recovery.Results After the treatment,there were 9 cases of flap local necrosis and 10 cases of local infection,and the necrosis rate and infection rate were 9% and 10% respectively.The infection was controlled effectively after the symptomatic treatment and the flaps all survived.The swelling degree of skin flap was slight and the appearance was good.After 6 months of follow-up, the 100 cases all get epithelization completely.The X-ray examination showed that the fracture healing is good,with 7 cases of hook nail deformity and 5 cases of slow nail regeneration.The hand function recovery was excellent in 73 cases (73%),good in 16 cases (16%),and medium in 10 cases (10%).Conclusion It is an effective treatment for hand trauma with free flap of radial artery superficial palmar branch,as it can receive high flap survival rate and good recovery of hand function.

Objective To investigate the use of free transplantation of peroneal artery perforator-based propeller to the repair of the front feet skin defect.Methods Thirteen cases with front foot skin defect patients repaired through transplation of propeller flap of the peroneal artery from January 2009 to September 2012.The wound range was 5 cm ×4 cm-11 cm × 14 cm.The propeller flap of the peroneal artery designed according to the position of the propeller of the peroneal artery in a leg.The wound of the leg were repaired through suture directly or transplantation of skin.Results All 13 cases of free propeller flap were survived,the wound healing goodly.One case with the postoperatie blood vessels were removed by the surgical exploration.The time of follow-up between 3 and 17 months(mean 9.4 months).The quality of free flap was good.The function of walk of the foot repaired were not significantly affect.The patients were satisfactory to the results.The wound of the leg healed well ; The leg had no obvious muscle cicatricial adhesion.According to the foot disease treatment effect evaluation standard (JOA) evaluation,the result for 77-100 points,an average of 85.5 points.Conclusion Using propeller flap of the peroneal artery to repair the skin defect of front feet with a little injury,the skin texture more close to the repaired area,it is a reasonable approach.