Objective To describe the method and review the outcome of reconstruction ofⅠandⅡdegree defect of thumb and finger by p artial transplantation of distal to e tissue from the great and /or second toe.Methods A series of 65cases with 71ⅠandⅡdegree thumb and finger defect were r econstructed.Of those,49were thumb defect,12index finger,5middle finger and 5ring fin ger.In 6cases,two digits were reconstructed simultaneously at th e same setting.For thumb reconstruction,the donor transplants were har-vested from great toe in 14cases,fro m 2nd toe in 35cases.All finger recon struction cases were taken from2nd toe.Results Postoperative arterial crisis occu rred in 10digits and venous crisis in4.All digits survived after operative and medication trea tment.Twenty digits underwent seco ndary plastic operation for better c os-metic effect.Forty-two digits in 38cases followed-up from 6months to 13years revealed good pulp pinch function.Sensation recovery to S3 + and above in 30cases(34digits)and two-point discrimination from 6-8mm in 30digits.The patients were satisfied with the appearance of the reconstructed thumb and fingers.There were no major complication in the don or toes.Conclusion The defect of distal segment and finger tip of thumb and /or finger can be reconstru cted by transplantation of partial t issues from the great,2nd or /and 3rd toe.The operation will not be influenced by anomaly of the blood vessels.Both ultimate function and cosmetic effect can meet the patientsdesire.[

Since 1970, 13 cases of reconstruction thumb and finger utilizing the second toe were performed. 13 out of 14 reconstructed digits survied with no complication. All wounds healed by primary intention. Emergency reconstruction has the following merits: it is completed in one stage, hence less suffering and economic loss to the patients;it promises early rehabilitation, early return to work and better functional results, as compared with delayed operation. Traumatic amputation of the thumb at or near the metacarpo-phalangeal joint with the transected part so badly injured that replantation is no longer fet-sible, and severe crushing injury of the thumb or all fingers are indicated for emergency reconstruction. Patient's age, occupation, desire for operation and general health should be considered individually before operation. The method of dissecting the second toe with the preservation of vasculization pattern of dorsalis pedis artery-first plantar metatarsal artery should be adopted in case the anatomic pattern of dorsal metatarsal artery belongs to Gilbert type Ⅲ.

Objective To explore small size toe tissue flap for aesthetic reconstruction of the thumb and / or finger. Methods Six kinds of small size toe tissue transplants had been applied in repairing skin-bone-joint composite tissue defects of the thumb or finger in 74 cases. Results Among 83reconstructed flaps of the 74 patients, 81 flaps survived completely. Follow-up examination made three to forty-eight months postoperatively showed that the outward appearance were excellent in most cases. The function of the thumbs or fingers were good. The donor feet can walk normally with no pain. Conclusion A variable combinations of toe tissues including skin, soft tissue, bone and joint can be harvested to form a lot of small size transplants for refined aesthetic reconstruction of thumb and finger. The functional and aesthetic results are good and the treatment course is shortened.

Objective To study the effect of Corylin on A375 cells melanin synthesis,and explore its mechanism.Methods The cells were randomly divided into the control group, the estradiol group, and corylin group including 10-3μmol/L, 10-2μmol/L, 10-1μmol/L, 1μmol/L, 10μmol/L, 100μmol/L. Estradiol estradiol intervention group were given 10-3 mol/L. Corylin group (10-3μmol/L, 10-2μmol/L, 10-1μmol/L, 1μmol/L, 10μmol/L,100μmol/L) were given 10-3μmol/L, 10-2μmol/L, 10-1μmol/L, 1μmol/L, 10μmol/L, 100μmol/L corylin intervention. The activity of proliferation were detected by MTT, NaOH method, dopa oxidation , both melanin content and tyrosinase activity (tyrosinase, TYR). TYR, yrosinase related protein (tyrosinase related protein, TRP)-1 and TRP-2 expression levels of mRNA were determined by RT-PCR.Results Compared with the control group, 10, 100μmol/L of Corylin group cell proliferation rate significantly decreased (P<0.01). The 1μmol/L, 10-1μmol/L, 10-2μmol/L of Corylin group cell melanin content, TYR significantly decreased (P<0.01 or P<0.05). The 1μmol/L corylin group TYR (0.303 ± 0.003vs. 0.628 ± 0.012), TRP-1 (0.313 ± 0.008 vs. 0.677 ± 0.022), TRP-2 (0.456 ± 0.028vs. 0.687 ± 0.020) mRNA expression level significantly decrease (P<0.01).Conclusions The results showed that Corylin could inhibit melanin synthesis, which worked probably through inhibiting the activity of TYR and cutting the mRNA expressions of TYR,TRP-1/2.

Objective To introduce the concept of long length finger reconstruction and our corresponding three operative methods. Methods In a series of 10 finger defect cases with one of their long finger amputated at or proximal to proximal phalanx, long finger reconstruction were accomplished with one of the three methods. First method: For emergency patients whose proximal finger segment were demolished, the donor second toe was transplanted intercalatedly with microsurgical technique between the original proximal finger stump and the saved distal finger segment. Second method: Bilateral second toes were harvested and connected together to form a long transplant in order to reconstruct a normal length finger. Third method: From one foot, the donor second toe is harvested with its dorsal and plantar skin flap. From the other foot, the second toe is harvested with its metatarsophalangeal joint and skin flaps from neighbouring sides of great and third toes. The skin covering will be perfect. During transplantation of the proximal transplant, the MPJ should be fixed at 90°plantar rotation position for better flexion. Results Uneventful survival of reconstructed fingers were obtained in all ten cases. Postoperative functional evaluation of the patients with standard set by Chinese Society of Hand Surgery showed to be excellent in 1 case, good in 5 cases and fair in 4 cases. The overall excellent/good rate was 60%. Conclusion By application of these three reconstruction methods, the challenging problem of long length finger can be solved to reasonable extent.

Objective To determine the factors influencing the survival rate and then quantifying the indication in digital replantation. Methods From January 1999 to November 2002,1 231 digit replantations were reviewed retrospectively.Analysis of Logistic regression was carried out between survival rate and injury degree of artery,skin,tendon,bone and nerve,mechanism of injury,severed levels,repassing duration and haemoglobin levels. Records of 50 failed and 50 succeeded fingers were selected at random and discriminant equation was made according to the factor selected by Logistic regression. Results The factors of injury degree of artery and skin,mechanism of injury,severed levedls and haemoglobin levels affected the survival rate significantly.The discriminant equation was that Z=6.42X 1+5.31X 1+4.35X 3+3.26X 4+3.15X 5. Conclusions The five factors mentioned above affect the survival rate of digital replantation.The indication of digital replantation could be quantified with the discriminant equation.

Objective To explore the concept,denomination and technique of miniature tissue transplantation in hand clinic. Methods In 537 cases,local skin or composite tissue defect in 756 thumbs or fingers were repaired with 4 kinds of miniature island flap and 10 kinds of miniature vascularized composite tissue.Some of them were created in clinic practice.The precess,main points and indication of the operation were expounded and compared. Results In 639 fingers covered with miniature island flap,the transferred flaps were surviverd completely in 621 fingers(97.2%),survivered partly in 11 fingers(1.7%)and necrosised in 7 fingers(1%).In 117 fingers repaired with miniature vascularized composite tissue,all the transplanted tissues were survivered.In all the injuried fingers,beautiful outlook were recovered and no fat and clumsy were found,two-point difference was 6-8 mm,effctive sensibility and good function were restored,and all the patients were satisfied. Conclusion Miniature tissue transplantation were good methods to cover the local defect in fingers or thumbs,worth of generalization and aplication in hand clinic,and have an important significance for improve the trauma repair quality and treatment level in hand surgery.

Objective To observe any short-term analgesic effect of using heat stimulation at acupoints for treating migraine headaches without aura.Methods Totally 120 migraine patients were randomly divided into an observation group and a control group,each of 60.Both groups was given 5mg of Sibelium orally each night for 4 weeks.The observation group additionally received heat and pain stimulation at the Feng Chi,Shuai Gu,Yang Ling Quan,Wai Guan,Tai Yang and Yin Tang acupoints.The heat was in 0.3 s pulses at 54.5° with an inter-pulse interval of 10 s.Each acupuncture point was stimulated 5 times in rotation for a total of 20 min daily for 4 weeks.The frequency of headache attacks,their duration,their intensity rated using a visual analogue scale (VAS),accompanying symptoms and responses to a migraine-specific quality of life questionnaire (MSQ) were recorded before and after the treatment.Results After the treatment there was significantly greater improvement in the observation group compared to the control group in terms of headache frequency,headache duration,VAS ratings,and accompanying symptoms.The observation group also improved significantly more in terms of the average limitation dysfunction score,dysfunction score and emotion score on the MSQ.Moreover,the total effectiveness rate of the observation group (95.0％) was significantly higher than that of the control group (80.0％).During the treatment,no adverse reactions were found in terms of heart rate or blood pressure,and no abnormal manifestations such as infection,redness or swelling were observed at the stimulation sites.Conclusion Heat and pain stimulation at acupoints has a significant short-term analgesic effect on migraine without aura.Such treatment is safe and reliable,with few side effects.It provides a new treatment method for migraine patients and is worthy of clinical promotion and application.

Objective:To evaluate the disinfection effect of high-energy pulse ultraviolet disinfection equipment in medical institution settings.Methods:The disinfection effect was evaluated through field tests and laboratory tests. Among them, 135 high-frequency contact points were selected from nine departments in the field test. Samples were collected before and after disinfection, and the disinfection effects of 75% alcohol wipes wiping disinfection, high-energy pulse ultraviolet disinfection robot disinfection and high-energy pulse ultraviolet handheld disinfection instrument were compared. In the laboratory test, 30 infected areas of the simulated test table were exposed to vertical ultraviolet irradiation and the bacterial-killing rate before and after disinfection was calculated.Results:In the field test, the bacteria-killing rates of 75% alcohol wipes, high-energy pulse ultraviolet disinfection robot and high-energy pulse ultraviolet handheld disinfection instrument were 94.99%, 91.53% and 95.94%, respectively, and the difference was statistically significant. The disinfection effect of the high-energy pulse ultraviolet handheld disinfection instrument was better than that of the high-energy pulse ultraviolet disinfection robot ( P values <0.05). In the laboratory test, the killing log value of Staphylococcus aureus and Escherichia coli on the carrier were both greater than 3.00. In the simulated field test, the killing log value of Staphylococcus aureus on the surface samples were 4.99. Conclusion:Both the high-energy pulse ultraviolet handheld disinfection instrument and the high-energy pulse ultraviolet disinfection robot have good disinfection effects, which are similar to the disinfection effects of conventional 75% alcohol wipes.

Objective:To evaluate the disinfection effect of high-energy pulse ultraviolet disinfection equipment in medical institution settings.Methods:The disinfection effect was evaluated through field tests and laboratory tests. Among them, 135 high-frequency contact points were selected from nine departments in the field test. Samples were collected before and after disinfection, and the disinfection effects of 75% alcohol wipes wiping disinfection, high-energy pulse ultraviolet disinfection robot disinfection and high-energy pulse ultraviolet handheld disinfection instrument were compared. In the laboratory test, 30 infected areas of the simulated test table were exposed to vertical ultraviolet irradiation and the bacterial-killing rate before and after disinfection was calculated.Results:In the field test, the bacteria-killing rates of 75% alcohol wipes, high-energy pulse ultraviolet disinfection robot and high-energy pulse ultraviolet handheld disinfection instrument were 94.99%, 91.53% and 95.94%, respectively, and the difference was statistically significant. The disinfection effect of the high-energy pulse ultraviolet handheld disinfection instrument was better than that of the high-energy pulse ultraviolet disinfection robot ( P values <0.05). In the laboratory test, the killing log value of Staphylococcus aureus and Escherichia coli on the carrier were both greater than 3.00. In the simulated field test, the killing log value of Staphylococcus aureus on the surface samples were 4.99. Conclusion:Both the high-energy pulse ultraviolet handheld disinfection instrument and the high-energy pulse ultraviolet disinfection robot have good disinfection effects, which are similar to the disinfection effects of conventional 75% alcohol wipes.