To explore the clinical effect of microsurgery in the treatment of the tumor which was diagnosed with the plexiform neurofibroma (PN) of the forearm and palm. Methods From January, 2014 to June, 2017, 6 cases of the PN in the forearm and palm were removed by microsurgery such as neurovascular transplantation, separation and anastomosis under microscope, etc. There were 4 males and 2 females, with an average age of 9.2 (range, 2-18 )years. There was 1 case with PN of the median nerve, ulnar nerve and their branches in the right fore-arm and palm, 2 cases with PN of the median nerve and its branches in the right forearm and palm, 2 cases with PN of the median nerve and its branches in the left forearm and palm, and 1 case with PN of the ulnar nerve and its branches in the left forearm and palm.The postoperative function and feeling of the patients were evaluated by outpa-tient followed-up. Results The pathological results of 6 patients all showed PN, and their incisions healed primari-ly.The patients were followed-up for 6 to 36 months, with an average of 18 months. No obvious scar formation was observed in all incisions. Among them, PN of the palmar of the youngest patient recurred after the operation, and it was resected in a second operation.The remaining 5 patients had no recurrence during follow-up.The 2 point resolu-tion of each fingertip of the affected limb of the patients who had median and ulnar PN was 2-5 mm, with an average of 3.30 mm; the 2 point resolution of the thumb, indicator, middle and ring fingers of the affected limbs of the patients who had median PN was 2-5 mm, with an average of 2.95 mm; the 2 point resolution of the ring and little fingers of the affected limbs of the patients who had ulnar PN was 3-4 mm, with an average of 3.50 mm.According to the related evalu-ation criteria made by the American Orthopedic Foot and Ankle Surgery Society (AOFAS), the results of the forearm and hand functions were excellent in 5 cases, good in 1 case. Conclusion The application of microsurgical techniques in the treatment of PN in the forearm and palm can be effective separation of tumor and nerve fibers, effectively protect the branches of the median nerve and ulnar nerve and their blood circulation, prevent recurrence and reduce nerve damage after operation.

Objective:To observe the clinical effect of free perforator flap of deep medial plantar artery and with sensory nerve in reconstruction of soft tissue defect in heel.Methods:From May 2022 to June 2023, a total of 15 patients with soft tissue defect of heels that caused by various reasons were admitted to the Department of Orthopedics, Zhengzhou Orthopaedic Hospital. The patients were 6 males and 9 females aged 21 to 45 years old, at 32 years old in average. The size of defects was 5 cm×8 cm-10 cm×14 cm. Free perforator flaps of deep medial plantar artery with cutaneous medial plantar nerve were used, at 5 cm×8 cm-11 cm×14 cm in size. Cover the first phase of VSD dressing in the supply site, remove it after 1 week, fill the wound with granulation tissue, and then perform full-thickness skin graft.Results:All 15 flaps survived after surgery. Postoperative outpatient follow-up lasted for 8 to 15 (average 12)months. Appearance and texture of the reconstructed heels were satisfactory, the affected feet were able to bear normal weight without obvious tenderness or ulcer formation. The reconstructed heals were resistant to wear and cold with good sensation. TPD of the flaps achieved 5 mm to 7 mm, without sense of heterotopia after rehabilitation. There was no obvious pigmentation or cicatricial contracture.Conclusion:It is satisfactory to apply a free perforator flap of deep medial plantar artery with sensory nerve in reconstruction of soft tissue defect of heel.