Objective:In order to provide a new area of bone flap were supplied for non-unions, osseous defect of upper limbs and chondral defect of elbow joint.Methods:The origin,course,distribu- tion and anastomosis of inferior ulnal collateral artery and ulnal recurrent artery were observed on 40 adult cadaver upper limbs.Based on the results,transposition of pedicled medial lower part of humerus bone flap with vessels was designed.Results:Satisfactary results were achieved in 9 case of patients (non-unions of 3 case and osseous defect of 2 case on medial part of humerus bone;non-unions of 3 case on medial upper part of ulna and radius;chondral defect of 1 case on elbow joint.)Conclusion:This pe- riosteal flap that there are constant vessels and abundant anastomosis with inferior ulnar collateral artery form many area of bone flap were supplied with blood supply for repairing the non-unions,os- seous defect of humerus,ulna,radius and chondral defect of elbow joint.

Objective To provide anatomical information and clinical application of flaps based on the proximal ulnar artery perforators.Methods Ten fresh cadavers who underwent injected with artery imaging technology and dissected with layer by layer;Eighteen patients who sought surgical treatment with proximal ulnar artery perforator flap for soft tissue defects of the finger and dorsum wrist at our hospital between October 2011 and November 2012 were included in this study.Results The diameter and superficial length of the main perforator respectively were 0.5-0.9 mm and 33.0-47.0 mm in our dissection.There were 5-9 perforators given from the ulnar artery to supply skin over the medial side of the forearm.All of the 18 flaps survived after surgeries.The flap size ranged from 3.0 cm × 2.5 cm to 10.0 cm × 5.5 cm.All of the transplanted flaps presented favourable contours and good functions at 6 to 12 months' followed-up.Conclusion Proximal ulnar arter perforator flap has favourable appearance,constant vascular pedicle,reliable blood supply,and large diameter.The free transplantation of this flap offers a satisfactory alternative for repairing the small and medium-sized area of soft tissue defects of forearm and hand.

Objective:To explore the clinical effect of ulnar artery conjoined perforator flap for repair of multiple finger damage.Methods:12 cases of multiple finger injuries were repaired by ulnar artery conjoined perforator flap from March, 2011 to October, 2017 in our hospital, with 4 finger damages in 2 cases, 3 finger damage in 4 cases, 2 finger damage in 6 cases. The position of soft tissue injury were from the palm to the fingertip and the phalanx defect were from proximal to the fingertip. The total area of skin defect was (135.6±12.3) cm 2 (6.0 cm×16.0 cm to 6.0 cm×35.0 cm). The total area of skin flaps was (143.5±11.2) cm 2 (5.0 cm ×20.0 cm to 3.2 cm×47.0 cm) (bilateral forearm). The perforator flaps of bilateral forearm ulnar artery were used in 5 cases and unilateral in 7 cases. All flaps had more than 2 perforator pedicles. The flaps were designed as long strips and wrapped in wounded phalanges by spiral winding. The perforator artery of the flap was anatomized with the proper digital artery or dorsal metacarpal artery, the accompanying vein was anatomized with the corresponding digital palmary or dorsal metacarpal vein, the superficial vein of the flap was anatomized with the corresponding dorsal digital vein or dorsal metacarpal vein, and the nerve of the flap was anastomosed with the corresponding proper digital nerve or dorsal metacarpal corresponding sensory nerve. The donor site was sutured directly except for 1 case of skin graft, and the curative effect was observed after operation. The follow-up included skin flap sensation, appearance, blood circulation, bone absorption and hand movement function, daily life, recovery of work, etc. The evaluation standard is the upper limb function evaluation trial standard of Hand Surgery Society of Chinese Medical Association. Results:All flaps survived. One case had skin necrosis of about 1.5 cm×1.5 cm at the end of the flaps, which was repaired by second-stage suture. All cases were followed up for 6 months to 6.5 years, with an average of 16.7 months. The flaps had good texture, no pigmentation, no swelling, no scar or abrasion on the fingertips, and the two-point discrimination was 6-10 mm, with an average of 8.6 mm. The incidence of bone obsorbtion was 59.4%(19/32) and the mean finger shortening was 0.8 cm. Among them, iliac bone grafting was performed in 5 cases and 6 fingers. The function of holding and pinching of the injured finger was partly restored, there was no significant effect on daily life. The average grip strength of the injured hand reached 60.3% of the healthy side. Evaluation of hand function according to the trial standard of replantation function of severed fingers of Hand Surgery Society of Chinese Medical Association. The motor function of the affected hand was excellent in 2 cases, good in 5 cases, poor in 4 cases and had in 1 case. The excellent and good rate was 58.3%(7/12). The appearance of donor site is acceptable.Conclusions:The ulnar artery conjoined perforator flap provides a useful way of thinking and effective operation for repair of patients with multiple finger damage or degloving injury.

Objective:To investigate the clinical effect on bridging replantation of defective severed fingers with the anterior tibial artery perforator bone-skin flap.Methods:In the Department of Hand and Foot Microsurgery of Dongguan Chang’an Xin’an Hospital, 6 cases of finger defect were repaired and replanted utilizing proximal tibial artery perforator bone-skin flap from March, 2015 to December, 2019. There were 5 males and 1 female with an average age of 35.8 years (range, 16-55 years). Among them, there were 2 cases with crush injury, 1 case with wringer injury, 1 case of with thermal crush injury, 1 case with power saw injury and 1 case of traffic accident injury. Of which, 3 cases of middle phalanx defect and 3 cases of proximal phalanx defect. 1 case of thumb and ring finger, respectively, 2 cases of index and middle finger. 2 cases of left hand and 4 cases of right hand/side. There were 6 cases with tendon defect and 3 cases with other finger injury. Soft tissue defect area: 5.5 cm × 2.0 cm to 6.0 cm × 3.0 cm. The length of phalangeal defect: 1.5 cm to 2.2 cm. The area of flap: 6.5 cm × 2.0 cm to 7.0 cm × 3.0 cm. The size of bone-flap: 1.8 cm × 1.0 cm × 0.8 cm to 2.2 cm × 1.0 cm × 1.0 cm. The donor site was either directly sutured or covered by transposing local flap. Follow-up plan was setafter operation. All patients were followed-up by outpatient service telephone, wechat and home visit etc. The dimensions of follow-up included the appearance, function, living and working conditions regarding the injured finger after operation. The evaluation was carried out according to the evaluation criteria of the society of hand surgery, Chinese Medical Association and the Michigan hand function evaluation criteria.Results:All the flaps survived. The flaps were followed-up for 9 to 24 months, with a small amount of pigmentation, good texture, moderate thickness and the two-point discrimination of the flaps ranged from 8 to 11 mm. There was no functional effect on the lower leg. The healing time of transplanted bone flaps ranged from 2.0 to 4.0 months, with an average of 2.6 months. According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association, the results were as follows: excellent 3 fingers, good 3 finger, excellent rate was 100%. According to Michigan Hand Function Evaluation Criteria, 6 fingers scored from 71.5 to 91.8 points, with an average of 80.6 points.Conclusions:Using the anterior tibial artery perforator bone-skin flap to bridge the defect and replantation can restore the appearance and function of the fingers to a large extent, with little damage to the donor site. It is an effective surgical method to repair bone-skin defects and restore the length in the replantation of defective severed fingers.

Objective:To investigate the clinical effect of fingertip reconstruction using the toenail osteocutaneous flap without vascular anastomosis.Methods:From January 2015 to October 2020, the clinical data of patients with fingertip injuries were analyzed retrospectively, which were treated with the toenail osteocutaneous flap without vascular anastomosis in Chang’an Xin’an Hospital. The donor site was closed primarily or covered by a local flap. The appearance and function of the patients’ fingers were followed up. All cases were evaluated by the standard of thumb finger reconstruction function evaluation of the Chinese Medical Association of Hand Surgery. Appearance and function of nail bed after reconstruction was evaluated from four aspects.Results:A total of 11 cases (12 fingers) were enrolled, including eight males and three females. The average age was 35.6 years (range, 17-50 years). The etiologies included crush-related injury, cutting injury, mangled injury, and chemical corrosion injury. The injuries were found in thumb, index finger, middle finger, ring finger, or combined with multiple fingers. All fingertip defects were located distal to the nail root, including the defects distal to lunula in four cases, the defects distal to middle of the nail in five fingers , and the defects distal to 1/3 of the nail in three cases. Elective surgery was performed in 7 cases and emergency surgery in 4 cases. The defects ranged from 0.2 cm/0.5 cm/0.5 cm to 0.6 cm/0.8 cm/1.0 cm (phalanx/nail/finger pulp). The size of the toenail osteocutaneous flap ranged from 0.2 cm/0.5 cm/0.7 cm to 0.6 cm/0.8 cm/1.0 cm (phalanx/nail/flap). The defects length of the finger pulp were less than 1.0 cm. All reconstructed fingers survived, and the follow-up was 6-30 months (average, 12.5 months). The appearances of the reconstructed fingers were pulmp and ruddy, and the nails were flat. There was no dysfunction in the donor site. The average healing time of bone was 2.1 months (range, 1.5-3.0 months). According to the evaluation of index function, seven cases were excellent, four cases were good. The appearance and function of the nail bed were excellent in six fingers, good in five fingers, and poor in one finger.Conclusion:It is a simple and effective way to reconstruct the fingertip using the toenail osteocutaneous flap without vascular anastomosis.

Objective:To explore the clinical effect of ulnar artery conjoined perforator flap for repair of multiple finger damage.Methods:12 cases of multiple finger injuries were repaired by ulnar artery conjoined perforator flap from March, 2011 to October, 2017 in our hospital, with 4 finger damages in 2 cases, 3 finger damage in 4 cases, 2 finger damage in 6 cases. The position of soft tissue injury were from the palm to the fingertip and the phalanx defect were from proximal to the fingertip. The total area of skin defect was (135.6±12.3) cm 2 (6.0 cm×16.0 cm to 6.0 cm×35.0 cm). The total area of skin flaps was (143.5±11.2) cm 2 (5.0 cm ×20.0 cm to 3.2 cm×47.0 cm) (bilateral forearm). The perforator flaps of bilateral forearm ulnar artery were used in 5 cases and unilateral in 7 cases. All flaps had more than 2 perforator pedicles. The flaps were designed as long strips and wrapped in wounded phalanges by spiral winding. The perforator artery of the flap was anatomized with the proper digital artery or dorsal metacarpal artery, the accompanying vein was anatomized with the corresponding digital palmary or dorsal metacarpal vein, the superficial vein of the flap was anatomized with the corresponding dorsal digital vein or dorsal metacarpal vein, and the nerve of the flap was anastomosed with the corresponding proper digital nerve or dorsal metacarpal corresponding sensory nerve. The donor site was sutured directly except for 1 case of skin graft, and the curative effect was observed after operation. The follow-up included skin flap sensation, appearance, blood circulation, bone absorption and hand movement function, daily life, recovery of work, etc. The evaluation standard is the upper limb function evaluation trial standard of Hand Surgery Society of Chinese Medical Association. Results:All flaps survived. One case had skin necrosis of about 1.5 cm×1.5 cm at the end of the flaps, which was repaired by second-stage suture. All cases were followed up for 6 months to 6.5 years, with an average of 16.7 months. The flaps had good texture, no pigmentation, no swelling, no scar or abrasion on the fingertips, and the two-point discrimination was 6-10 mm, with an average of 8.6 mm. The incidence of bone obsorbtion was 59.4%(19/32) and the mean finger shortening was 0.8 cm. Among them, iliac bone grafting was performed in 5 cases and 6 fingers. The function of holding and pinching of the injured finger was partly restored, there was no significant effect on daily life. The average grip strength of the injured hand reached 60.3% of the healthy side. Evaluation of hand function according to the trial standard of replantation function of severed fingers of Hand Surgery Society of Chinese Medical Association. The motor function of the affected hand was excellent in 2 cases, good in 5 cases, poor in 4 cases and had in 1 case. The excellent and good rate was 58.3%(7/12). The appearance of donor site is acceptable.Conclusions:The ulnar artery conjoined perforator flap provides a useful way of thinking and effective operation for repair of patients with multiple finger damage or degloving injury.

Objective:To investigate the clinical effect on bridging replantation of defective severed fingers with the anterior tibial artery perforator bone-skin flap.Methods:In the Department of Hand and Foot Microsurgery of Dongguan Chang’an Xin’an Hospital, 6 cases of finger defect were repaired and replanted utilizing proximal tibial artery perforator bone-skin flap from March, 2015 to December, 2019. There were 5 males and 1 female with an average age of 35.8 years (range, 16-55 years). Among them, there were 2 cases with crush injury, 1 case with wringer injury, 1 case of with thermal crush injury, 1 case with power saw injury and 1 case of traffic accident injury. Of which, 3 cases of middle phalanx defect and 3 cases of proximal phalanx defect. 1 case of thumb and ring finger, respectively, 2 cases of index and middle finger. 2 cases of left hand and 4 cases of right hand/side. There were 6 cases with tendon defect and 3 cases with other finger injury. Soft tissue defect area: 5.5 cm × 2.0 cm to 6.0 cm × 3.0 cm. The length of phalangeal defect: 1.5 cm to 2.2 cm. The area of flap: 6.5 cm × 2.0 cm to 7.0 cm × 3.0 cm. The size of bone-flap: 1.8 cm × 1.0 cm × 0.8 cm to 2.2 cm × 1.0 cm × 1.0 cm. The donor site was either directly sutured or covered by transposing local flap. Follow-up plan was setafter operation. All patients were followed-up by outpatient service telephone, wechat and home visit etc. The dimensions of follow-up included the appearance, function, living and working conditions regarding the injured finger after operation. The evaluation was carried out according to the evaluation criteria of the society of hand surgery, Chinese Medical Association and the Michigan hand function evaluation criteria.Results:All the flaps survived. The flaps were followed-up for 9 to 24 months, with a small amount of pigmentation, good texture, moderate thickness and the two-point discrimination of the flaps ranged from 8 to 11 mm. There was no functional effect on the lower leg. The healing time of transplanted bone flaps ranged from 2.0 to 4.0 months, with an average of 2.6 months. According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association, the results were as follows: excellent 3 fingers, good 3 finger, excellent rate was 100%. According to Michigan Hand Function Evaluation Criteria, 6 fingers scored from 71.5 to 91.8 points, with an average of 80.6 points.Conclusions:Using the anterior tibial artery perforator bone-skin flap to bridge the defect and replantation can restore the appearance and function of the fingers to a large extent, with little damage to the donor site. It is an effective surgical method to repair bone-skin defects and restore the length in the replantation of defective severed fingers.

Objective:To investigate the clinical effect of fingertip reconstruction using the toenail osteocutaneous flap without vascular anastomosis.Methods:From January 2015 to October 2020, the clinical data of patients with fingertip injuries were analyzed retrospectively, which were treated with the toenail osteocutaneous flap without vascular anastomosis in Chang’an Xin’an Hospital. The donor site was closed primarily or covered by a local flap. The appearance and function of the patients’ fingers were followed up. All cases were evaluated by the standard of thumb finger reconstruction function evaluation of the Chinese Medical Association of Hand Surgery. Appearance and function of nail bed after reconstruction was evaluated from four aspects.Results:A total of 11 cases (12 fingers) were enrolled, including eight males and three females. The average age was 35.6 years (range, 17-50 years). The etiologies included crush-related injury, cutting injury, mangled injury, and chemical corrosion injury. The injuries were found in thumb, index finger, middle finger, ring finger, or combined with multiple fingers. All fingertip defects were located distal to the nail root, including the defects distal to lunula in four cases, the defects distal to middle of the nail in five fingers , and the defects distal to 1/3 of the nail in three cases. Elective surgery was performed in 7 cases and emergency surgery in 4 cases. The defects ranged from 0.2 cm/0.5 cm/0.5 cm to 0.6 cm/0.8 cm/1.0 cm (phalanx/nail/finger pulp). The size of the toenail osteocutaneous flap ranged from 0.2 cm/0.5 cm/0.7 cm to 0.6 cm/0.8 cm/1.0 cm (phalanx/nail/flap). The defects length of the finger pulp were less than 1.0 cm. All reconstructed fingers survived, and the follow-up was 6-30 months (average, 12.5 months). The appearances of the reconstructed fingers were pulmp and ruddy, and the nails were flat. There was no dysfunction in the donor site. The average healing time of bone was 2.1 months (range, 1.5-3.0 months). According to the evaluation of index function, seven cases were excellent, four cases were good. The appearance and function of the nail bed were excellent in six fingers, good in five fingers, and poor in one finger.Conclusion:It is a simple and effective way to reconstruct the fingertip using the toenail osteocutaneous flap without vascular anastomosis.

Objective To provide anatomical information and clinical application of periosteal perforator bone-skin flap of proximal lateral tibia. Methods From March, 2015 to March, 2017, 15 fresh cadavers who underwent injected with imaging technology and dissected with layer by layer. The origins, branches, distribution and anastomosis of periosteal perforator vessels in the proximal lateral tibial were observed. Sixteen patients of composite tissue defect in hands and feet were repaired with the method of free transplantation of this flap from March, 2015 to March, 2017. Injured area was from 3.0 cm × 0.8 cm to 6.0 cm × 5.5 cm. Bony defect size was from 1.7 cm × 1.5 cm × 1.0 cm to 5.0 cm × 1.0 cm × 1.0 cm. The bone-skin flap size ranged respectively from 3.0 cm × 0.8 cm to 6.0 cm × 5.5 cm and 1.6 cm ×1.0 cm × 0.8 cm to 5.0 cm×1.0 cm × 1.0 cm. Postoperative followed-up was done termly. Results The diameter and superficial length of the main perforators respectively were 0.5 to 1.2 mm and from 2.5 to 4.3 cm. The followed-up time was from 6 to 24 months in 14 cases, with the results of the bone-skin flaps presented favourable contours and good functions. The healing time of bone flap was 2 to 4 months. The function of shank was normal. Conclusion The periosteal perforator of proximal lateral tibia has favourable appearance, constant vascular pedi-cle, reliable blood supply and large diameter. The free transplantation of this flap offers a satisfactory alternative for repairing the small and medium-sized area of composite tissue defects of hands and feet.

Objective: To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis. Methods: From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting. Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anastomoses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds. Sizes of artery exposed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured. Postoperative follow-up was conducted to observe the postoperative effect. Results: Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites. Conclusion The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.