Objective:To retrospectively analyse the clinical effect of sensation reconstructed free medial plantar artery perforator flap in repair of digit-tip defects.Methods:From March 2017 to February 2021, 11 cases with digit-tip defect were repaired by medial plantar artery perforator flap in the Department of Hand Surgery of Xuzhou Renci Hospital. The cutaneous sensory nerves were separated when the flap was harvested, and then the sensory nerves were sutured to the palmar nerves of the digits to reconstruct the sensation of the flap. All wounds had exposure of phalangeal bones, the size of the digit-tip defects was 1.2 cm×1.0 cm-2.5 cm×2.2 cm, the size of the flaps was 1.6 cm×1.5 cm-3.0 cm×2.7 cm. Ten donor sites were directly sutured and 1 was repaired by skin grafting. All patients were included in the postoperative follow-up through outpatient clinic and WeChat reviews to collect relevant information, including texture, sweating, stability, sensation, degree of bloating, blood circulation, usage of the flaps and skin and scars at the donor sites.Results:All flaps survived besides 1 case had venous occlusion occurred 12 hours after the operation, and the venous occlusion was relieved by releasing the dressing and removing some of sutures, and the flap survived smoothly. The wounds in the donor sites healed well. The postoperative follow-up period lasted for 6-18 months, with an average of 10.7 months. The flaps were soft, wear-resistant, and stable. The skin texture was restored with a small amount or normal sweating. One flap had mild bloated, and another flap showed a slightly poor colour of the flap together with a lower temperature. The sensory recovery of the flaps was good, reaching S 3+ or above. The TPD had achieved 6.0-8.5 mm, with an average of 7.1 mm. One patient had concerns in using the affected digit and 3 cases were in protective use of the affected digits. There was no wear and ulcer in the foot donor sites. According to Wang Shuhuan's assessment of flap function and Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the patients in this group were scored excellent in 8 cases and good in 3 cases. Conclusion:The application of free medial plantar artery perforator flap in repair of digit-tip wounds can achieve good repairs. The donor site is hidden without effect on walking. It is one of the ideal donor sites for repairing digit-tip wounds.

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 explore the clinical effect of repairing fingertip defects with the great toe fibular flap.Methods:A retrospective analysis was conducted on the clinical data of patients admitted to the Department of Hand Surgery, Xuzhou Renci Hospital from March 2019 to June 2022 who underwent the repair of fingertip defects using the great toe fibular flap. Emergency debridement of the wound of digital defect, temporary cover with xenocortic, and flap repair after 4-7 d. According to the size of digital defect, the free flap (0.5 cm larger than the wound) on the fibular side of the toe was designed and harvested, and the nail bed and phalange could be carried when accompanied by nail bed and phalangeal defects. Remove excess fat under the flap under the microscope and cover it on the wound at the end of the finger, and the flap was anastomosed with the arteries, veins, and nerves of the finger. Fix the phalanges crosswise with two 0.8 mm Kirschner needles. The wound in the donor area was directly pulled and sutured, or the suture was reduced and then moistened and changed, and it was allowed to grow on its own, or the first plantar back full thick skin sheet was transplanted and repaired. Provide an appropriate description of the surgical method, including the management of the donor recipient area. Regularly follow up the patient’s injured finger and donor foot recovery after surgery, and investigate whether the patient was satisfied with the surgical effect. At the last follow-up, finger function was evaluated using the applicable standards for upper limb functional assessment of the Chinese Medical Association Society of Hand Surgery.Results:A total of 35 patients with fingertip defect and phalangeal bone exposure were enrolled, including 17 males and 18 females. Age range from 15 to 60 years old, with an average of 36 years old. There were 9 thumbs, 8 index fingers, 10 middle fingers, 5 ring fingers, and 3 little fingers. Defect area 1.0 cm × 1.5 cm-2.0 cm × 3.0 cm. Three patients underwent venous crisis after surgery and survived after bleeding at the edge of the flap. The remaining flaps survived smoothly. There was one case of poor wound healing after removing the suture in the donor area, which healed after changing the dressing for 3 weeks. The postoperative follow-up was 10-18 months, with an average of 13 months. The color, texture, and nail appearance of the repaired finger flap were similar to those of normal fingers, with clear skin lines and beautiful appearance. The two point resolution of the flap was 8-10 mm, and the sensation returned to S3 level. No significant impact on foot function and appearance. The patient expressed satisfaction with the surgical effect. Finger function evaluation results: 28 cases were excellent and 7 cases were good.Conclusion:After using the great toe fibular flap to repair the fingertip defect, the appearance and function of the finger are restored well, and the donor area of the flap is concealed, with little impact on the donor foot, which can achieve good repair results.

Objective:To explore the clinical effect of repairing fingertip defects with the great toe fibular flap.Methods:A retrospective analysis was conducted on the clinical data of patients admitted to the Department of Hand Surgery, Xuzhou Renci Hospital from March 2019 to June 2022 who underwent the repair of fingertip defects using the great toe fibular flap. Emergency debridement of the wound of digital defect, temporary cover with xenocortic, and flap repair after 4-7 d. According to the size of digital defect, the free flap (0.5 cm larger than the wound) on the fibular side of the toe was designed and harvested, and the nail bed and phalange could be carried when accompanied by nail bed and phalangeal defects. Remove excess fat under the flap under the microscope and cover it on the wound at the end of the finger, and the flap was anastomosed with the arteries, veins, and nerves of the finger. Fix the phalanges crosswise with two 0.8 mm Kirschner needles. The wound in the donor area was directly pulled and sutured, or the suture was reduced and then moistened and changed, and it was allowed to grow on its own, or the first plantar back full thick skin sheet was transplanted and repaired. Provide an appropriate description of the surgical method, including the management of the donor recipient area. Regularly follow up the patient’s injured finger and donor foot recovery after surgery, and investigate whether the patient was satisfied with the surgical effect. At the last follow-up, finger function was evaluated using the applicable standards for upper limb functional assessment of the Chinese Medical Association Society of Hand Surgery.Results:A total of 35 patients with fingertip defect and phalangeal bone exposure were enrolled, including 17 males and 18 females. Age range from 15 to 60 years old, with an average of 36 years old. There were 9 thumbs, 8 index fingers, 10 middle fingers, 5 ring fingers, and 3 little fingers. Defect area 1.0 cm × 1.5 cm-2.0 cm × 3.0 cm. Three patients underwent venous crisis after surgery and survived after bleeding at the edge of the flap. The remaining flaps survived smoothly. There was one case of poor wound healing after removing the suture in the donor area, which healed after changing the dressing for 3 weeks. The postoperative follow-up was 10-18 months, with an average of 13 months. The color, texture, and nail appearance of the repaired finger flap were similar to those of normal fingers, with clear skin lines and beautiful appearance. The two point resolution of the flap was 8-10 mm, and the sensation returned to S3 level. No significant impact on foot function and appearance. The patient expressed satisfaction with the surgical effect. Finger function evaluation results: 28 cases were excellent and 7 cases were good.Conclusion:After using the great toe fibular flap to repair the fingertip defect, the appearance and function of the finger are restored well, and the donor area of the flap is concealed, with little impact on the donor foot, which can achieve good repair results.

Objective:To explore the application effect of microsurgical thinning optimized anterolateral thigh flap in the repair of limb tumor wounds.Methods:A retrospective analysis was conducted on the clinical data of patients with limb tumors at the Microsurgery and Reconstruction Department of Xuzhou Renci Hospital from January 2019 to January 2021. All patients underwent surgical resection of the lesions and were repaired with microsurgical thinning optimized anterolateral thigh flap. The outpatient follow-up was conducted after surgery. One year after surgery, limb function and appearance were evaluated using the Musculoskeletal Tumor Society (MSTS) bone tumor limb salvage surgery limb energy scale and efficacy satisfaction score. The total score is 30 points, and a higher score indicates better function. The limb appearance was evaluated using a satisfaction score scale, with a total score of 5-10 points being satisfactory, 0-4 points being average, and -5 to -1 points considered unsatisfactory. Descriptive methods were used for statistical analysis, and normally distributed measurement data were expressed as Mean±SD.Results:A total of 11 patients were included, comprising 7 males and 4 females, aged between 19 and 55 years, with an average age of 31.5 years. Among them, there were 3 cases of dermatofibrosarcoma protuberans, 4 cases of invasive fibroma, 1 case of mucinous fibrosarcoma, 2 cases of malignant fibrous histiocytoma, and 1 case of squamous cell carcinoma of the skin. The tumor lesion ranged from 5.5 cm × 8.0 cm to 9.0 cm × 19.0 cm, and the tumor resection range during surgery was from 6.5 cm × 9.0 cm to 10.0 cm × 20.0 cm. The size of the skin flap ranged from 7.5 cm × 11.0 cm to 10.0 cm × 22.5 cm. The average thickness of the flap before thinning was 2.2 cm (1.6-3.5 cm), and the average thickness after thinning was 1.2 cm (0.9-1.7 cm). One case of superficial necrosis occurred at the edge of the flap measuring 1.5 cm × 2.0 cm after surgery, and the wound healed after dressing changes. One case of arterial crisis occurred 48 hours after surgery, and thrombus formation was detected at the distal end of the anastomosis during exploration. After reanastomosis, blood flow was restored. The remaining flaps survived well, and the incisions healed in one stage. The average postoperative follow-up period was 14.5 months (12-18 months) with no tumor recurrence. The MSTS score for limb function was (25.2±2.1) points, and the satisfaction score for limb appearance efficacy was (7.4±1.6) points, with a satisfaction rate of 10 out of 11.Conclusion:The application of microsurgical thinning optimized anterolateral thigh flap in the plastic surgery of limb tumors can restore satisfactory limb function and appearance, making it an ideal surgical method.

Objective:To explore the clinical effect of the modified double wing flap combined with medial plantar skin graft in the treatment of congenital syndactyly.Methods:The data of children with congenital syndactyly treated by modified double wing flap combined with medial plantar skin graft in the Department of Pediatric Orthopaedics of Xuzhou Renci Hospital from January 2019 to February 2022 were retrospectively analyzed. All of them had skin deficiency after separating syndactyly during the operation. The medial plantar was selected as the skin graft donor area. The patients were followed up through WeChat and outpatient review after operations, the contents include the shape of finger web, the shape of finger, the degree of scar contracture in the skin graft area and the medial plantar skin donor area, and the appearance of finger web was evaluated by the modified Withey correction score, and investigate the satisfaction of parents of the children.Results:A total of 10 children were included, including 5 males and 5 females, aged 1 year and 6 months to 4 years, with an average age of 2 years and 10 months. There were 8 cases of middle ring finger syndactyly, 1 case of ring little finger syndactyly, and 1 case of index middle finger syndactyly. After separating syndactyly, the skin defect area is about 1.0 cm×1.5 cm-1.5 cm×3.0 cm, and a medial plantar full-thickness skin graft with the same area is taken. The postoperative follow-up was 6-18 months, with an average of 11.3 months. All the flaps and grafts survived, and the wounds healed in primary stage. The depth, width and slope of the finger web were normal, there was no color difference between the skin graft and the surrounding skin, and the appearance of the finger was beautiful. The scar in the skin graft area and the medial plantar skin donor area was not obvious. The modified Withey correction score was 0-1, with an average of 0.1. The parents were all satisfied.Conclusion:The texture of the medial plantar skin is similar to that of the hand. After the treatment of congenital syndactyly with the modified double wing flap combined with the medial plantar skin graft, the shape of the finger web is normal, the shape of the hand is beautiful, the scar is not obvious, and the medial plantar skin donor area is hidden, which does not affect walking. After the operation, good function and shape can be obtained. It is one of the effective method to treat congenital syndactyly with insufficient skin.

Objective:To explore the application effect of microsurgical thinning optimized anterolateral thigh flap in the repair of limb tumor wounds.Methods:A retrospective analysis was conducted on the clinical data of patients with limb tumors at the Microsurgery and Reconstruction Department of Xuzhou Renci Hospital from January 2019 to January 2021. All patients underwent surgical resection of the lesions and were repaired with microsurgical thinning optimized anterolateral thigh flap. The outpatient follow-up was conducted after surgery. One year after surgery, limb function and appearance were evaluated using the Musculoskeletal Tumor Society (MSTS) bone tumor limb salvage surgery limb energy scale and efficacy satisfaction score. The total score is 30 points, and a higher score indicates better function. The limb appearance was evaluated using a satisfaction score scale, with a total score of 5-10 points being satisfactory, 0-4 points being average, and -5 to -1 points considered unsatisfactory. Descriptive methods were used for statistical analysis, and normally distributed measurement data were expressed as Mean±SD.Results:A total of 11 patients were included, comprising 7 males and 4 females, aged between 19 and 55 years, with an average age of 31.5 years. Among them, there were 3 cases of dermatofibrosarcoma protuberans, 4 cases of invasive fibroma, 1 case of mucinous fibrosarcoma, 2 cases of malignant fibrous histiocytoma, and 1 case of squamous cell carcinoma of the skin. The tumor lesion ranged from 5.5 cm × 8.0 cm to 9.0 cm × 19.0 cm, and the tumor resection range during surgery was from 6.5 cm × 9.0 cm to 10.0 cm × 20.0 cm. The size of the skin flap ranged from 7.5 cm × 11.0 cm to 10.0 cm × 22.5 cm. The average thickness of the flap before thinning was 2.2 cm (1.6-3.5 cm), and the average thickness after thinning was 1.2 cm (0.9-1.7 cm). One case of superficial necrosis occurred at the edge of the flap measuring 1.5 cm × 2.0 cm after surgery, and the wound healed after dressing changes. One case of arterial crisis occurred 48 hours after surgery, and thrombus formation was detected at the distal end of the anastomosis during exploration. After reanastomosis, blood flow was restored. The remaining flaps survived well, and the incisions healed in one stage. The average postoperative follow-up period was 14.5 months (12-18 months) with no tumor recurrence. The MSTS score for limb function was (25.2±2.1) points, and the satisfaction score for limb appearance efficacy was (7.4±1.6) points, with a satisfaction rate of 10 out of 11.Conclusion:The application of microsurgical thinning optimized anterolateral thigh flap in the plastic surgery of limb tumors can restore satisfactory limb function and appearance, making it an ideal surgical method.

Objective:To explore the clinical effect of the modified double wing flap combined with medial plantar skin graft in the treatment of congenital syndactyly.Methods:The data of children with congenital syndactyly treated by modified double wing flap combined with medial plantar skin graft in the Department of Pediatric Orthopaedics of Xuzhou Renci Hospital from January 2019 to February 2022 were retrospectively analyzed. All of them had skin deficiency after separating syndactyly during the operation. The medial plantar was selected as the skin graft donor area. The patients were followed up through WeChat and outpatient review after operations, the contents include the shape of finger web, the shape of finger, the degree of scar contracture in the skin graft area and the medial plantar skin donor area, and the appearance of finger web was evaluated by the modified Withey correction score, and investigate the satisfaction of parents of the children.Results:A total of 10 children were included, including 5 males and 5 females, aged 1 year and 6 months to 4 years, with an average age of 2 years and 10 months. There were 8 cases of middle ring finger syndactyly, 1 case of ring little finger syndactyly, and 1 case of index middle finger syndactyly. After separating syndactyly, the skin defect area is about 1.0 cm×1.5 cm-1.5 cm×3.0 cm, and a medial plantar full-thickness skin graft with the same area is taken. The postoperative follow-up was 6-18 months, with an average of 11.3 months. All the flaps and grafts survived, and the wounds healed in primary stage. The depth, width and slope of the finger web were normal, there was no color difference between the skin graft and the surrounding skin, and the appearance of the finger was beautiful. The scar in the skin graft area and the medial plantar skin donor area was not obvious. The modified Withey correction score was 0-1, with an average of 0.1. The parents were all satisfied.Conclusion:The texture of the medial plantar skin is similar to that of the hand. After the treatment of congenital syndactyly with the modified double wing flap combined with the medial plantar skin graft, the shape of the finger web is normal, the shape of the hand is beautiful, the scar is not obvious, and the medial plantar skin donor area is hidden, which does not affect walking. After the operation, good function and shape can be obtained. It is one of the effective method to treat congenital syndactyly with insufficient skin.