Objective To report our usage of a combined flap which is constituted of bilateral hallux nails, skins, bones to reconstruct a finger, and to introduce the method and outcome of this way. Methods Combine two halves of halluxes harvested from both feet to reform a fabricated finger and then transplant it to the finger stump to reconstruct the defect part of the finger. Plantar flaps or some other flaps near the donor sites were transposed to cover them. From June 2003 to June 2009, a total of 20 fingers (20 cases) which had defect degrees range from I to Ⅲunderwent reconstruction surgeries in this way. Results All the 20 fingers transplanted survived completely. Follow-ups 1 to 5 years after each surgery: all the fabricated fingers had very realistic configurations. The MP joints of the reconstructed thrumbs got to the normal range of motion, and the other reconstructed fingers' total ROM were 203 degree on average. All the reconstructed fingers had the sensation function above S3,and their two-point discriminations ranged from 6mm to 10mm. Both halluxes of each case were conserved major parts of nails and had nice, symmetric appearances. All the flaps for the donor halluxes survived completely, and none of the cases showed pains, ulcers or abrasions of their feet. All the cases showed normal gaits during follow-ups. Conclusion The combined flap by bilateral hallux nails, skins, bones is an ideal alteration for finger defect reconstruction for the important advantages of realistic configuration as well as minor destructions to donor sites.

e advantages as those of digital artery flap, but also has proper digital artery and nerve being untouched.

BACKGROUND: A lot of important organs are worthless for clinical application because they are hard to store for a long time. In addition, tissues or organs which are dealt with cryopreservation also attack ischemia/reperfusion injury with the recovery of blood flow; especially, skeletal muscle is the most involved tissue.OBJECTIVE: To observe the protective influence of edaravone on cellular membrane and mitochondria of replanted rat extremities following ischemia/reperfusion injury due to cryopreservation and rewarming.DESIGN: Randomized contrast animal study.SETTING: Basic Medical College of Southern Medical University; Department of Hand and Foot Surgery, Shandong Provincial Hospital.MATERIALS: The experiment was carried out in the Cryopreservation Laboratory, Shandong Provincial Hospital from April to November 2006. A total of 36 healthy adult male Wistar rats were provided by Experimental Animal Center of Medical College of Shandong University. All rats were randomly divided into control group, cryopreservation group and edaravone group with 12 in each group.METHODS: Femoral artery and vein of rats in control group were exposured, but extremities were not blocked. Rats in other two groups were used to establish ischemia/reperfusion injury models of replanted extremities. Before cryopreservation, their right hindlimbs were cut off and maintained in liquid nitrogen container for 1 month. After the operation mentioned above, the broken limbs were rewarmed, perfused with routine eluant and replanted. Four hours later, blood supply of extremities was recirculated and the samples were selected. Eluant in edaravone group contained 0.5 mg/kg edaravone. Samples of skeletal muscle were selected at the same time point to establish cellular membrane and extract mitochondria. Furthermore, fluorescence polarization of cellular membrane (reflecting liquidity in cellular membrane lipid area), malondialdehyde (MDA) content of mitochondria, superoxide dismutase (SOD) activity and respiratory controlling rate were measured; meanwhile, mitochondrial ultrastructure of skeletal muscle was observed under transmission electron microscope.MAIN OUTCOME MEASURES:①Fluorescence polarization of cellular membrane, MDA content of mitochondria, SOD activity and respiratory controlling rate of skeletal muscle; ②mitochondrial ultrastructure of skeletal muscle.RESULTS: All 36 rats were involved in the final analysis without any loss. ①SOD activity and respiratory controlling rate of mitochondria in skeletal muscle: The values of these two items were higher in edaravone group that those in cryopreservation group (P＜0.05).②Fluorescence polarization of cellular membrane and MDA content of mitochondria in skeletal muscle: The values of these two items were lower in edaravone group than those in cryopreservation group (P＜0.05). ③Mitochondrial ultrastructure of skeletal muscle: Injured degree of skeletal muscle was milder in edaravone group than that in cryopreservation group.CONCLUSION: Edaravone can relieve ischemia/reperfusion injury of skeletal muscle and protect cellular membrane and mitochondria of skeletal muscle. Its mechanism may be related to directly inhibiting hydroxy free radicals, increasing SOD activity of skeletal muscle, reducing generation of MDA and promoting normal oxidative phosphorylation.

Objective To research the clinical application of split dorsal pedal flap for the repair of round-like soft tissue defect. Methods Design a long-strip dorsal pedal flap with slightly larger area than cutaneous deficiency,cut off the flap to the layer of superficial fascia along the suitable line degined in the middle of flap,and then rotate and reshape the split flap to resemble recipient area,and cover the wound surface based on pedical flap or free grafting;Meanwhile,donor area in dorsum of foot can be sutured directly.Results All the 5 cases of flap were survived,including one case which was free grafted and the others which were rotated locally, as well,donor area in dorsum of foot was satisfied because the cutting edge could be sutured directly. Conclusion It is a laudable modus operandi on account of beautiful outlook of both recipient and donor area.

BACKGROUND:The therapeutic effectiveness on tendon injury is closely related to the material of tendon suture.
OBJECTIVE: To review the progress of tendon suture materials and tendon biomechnics in recent years.
METHODS:A computer-based search of CNKI (January 1999 to December 2014), and PubMed (January 1950 to December 2014) was performed for relevant articles using the keywords of “tendon, suture materials,
biomechanics” in Chinese and English, respectively.
RESULTS AND CONCLUSION:Ideal tendon repair refers to the restoration of the continuity of its anatomical structure, tensile strength and sliding function in physiology, which is influenced by many factors. Suture technique and choice of suture materials are two steps that cannot be ignored. With the development of surgical tendon suture technique, in order to improve the quality of tendon healing, ideal tendon suture is first to have sufficient strength to avoid an early tensile fracture; secondly, the elasticity cannot be too large that can cause a gap between suturing ends and affect tendon healing, and time for protecting the tendon strength is as long as possible. Therefore, the optimal choice of tendon suture materials should be based on suture methods and biomechanical characteristics of suture lines, thereby to promote tendon healing.

Objective Corruption is the most common cadaver phenomenon in forensic practice and an important basis for inferring time of death(PMI),but the definition of corruption degree and the construction of model inference models have always been difficult in the practice of forensic science.Methods In this study,the late postmortem phenomena were observed.Meanwhile,the microbial flora structure of gut and gravesoil and the nature of gravesoil were detected,for analyzing the changes before and after the key moment of abdominal rupture which naturally happened during the cadaver decay.Results The results found that from the macroscopic and microscopic levels,there were significant differences in cadaver decay,including microbial flora structure and gravesoil properties before and after the key moment of the natural abdominal rupture during cadaver decay.The phenomena are highly observable and can be accurately judged by forensic examinations,as well as related means in the field of biology and physiochemistry.In this study,this critical event was called Rupture Point.Conclusion The Rupture Point can be used as an important node for the assessment of cadaver decay degree in the practice of forensic medicine.It can be utilized for a cut-off point as well when constructing PMI inference models based on microbial flora structure changes.The accuracy of PMI inference models can be improved when the models were constructed in segments.

Objective: To report the effects of operative treatment of Sneppen Ⅴ talus fracture through the approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation. Methods: From January 2015 to January 2019, 16 patients with Sneppen Ⅴ talus fracture were treated at Department Ⅱ of Hand & Foot Microsurgery, The Second Affiliated Hospital to Inner Mongolia Medical University. They were 14 men and 2 women with a mean age of 38.4 years (range, from 20 to 55 years). All fractures were fixed with hollow compression screws through the approach for malleolus medialis Ⅴ osteotomy. The ankle and hindfoot functional scoring system developed by American Orthopaedic Foot and Ankle Society (AOFAS) was used to evaluate the clinical outcomes. Results: All patients were followed up for a mean time of 12.6 months (range, from 6 to 30 months). The mean operation time was 68.4 minutes (range, from 52 to 96 minutes); the mean amount of hemorrhage during operation was 96.8 mL (range, from 48 to 122 mL); the mean period of bone union was 4.8 months (range, from 3 to 8 months). The postoperative mean AOFAS score was 75.3 points (range, from 43 to 91 points). Complications occurred in 4 cases, including one case of talus ischemic necrosis, one case of partial talus ischemic necrosis accompanied by tibial arthritis, one case of subtalar arthritis, and one case of combined tibial, talar and subtalar arthritis. All incisions obtained primary healing, with no complications like infection, screw breakage, delayed union or nonunion. Conclusion Operative treatment of Sneppen Ⅴ talus fracture through the approach for malleolus medialis Ⅴ osteotomy plus hollow compression screw fixation can provide sufficient operative exposure to facilitate reduction and fixation of the talus fracture so that the ischemic necrosis of the talus and traumatic arthritis can be effectively reduced.