Objective To explore the effect for nerve regeneration with immunosuppresssant FK506 a-round the cut after end-to-side neurorrhaphy of peripheral nerve. Methods There were 40 adult SD rats and were divided into two groups randomly by means. In the experiment group, the right peroneal nerve of SD rat was cut off,then an 1mm epineural window was created on the neighboring tibial nerve,the distal end of peroneal nerve was sutured to the windowed tibial nerve by means of end-to-side attachment, application of slow-releasing diaphragm which was implanted around the nerve anastomosis with FK506. In the contrast group,there were not the FK506 around the cut after end-to-side neurorrhaphy. The tibial and peroneal nerve trunks were labeled by being in jected with fast blue ( KB) and fluorescence golden ( FG) respectively. The labeled cells in the dorsal root ganglia (DRG) and spinal cord were observed by fluorescence microscopy. Results There were a lot of FB labeled cells in the experiment group than in the contrast group in the DRG and spinal cord. Conclusion Immunosuppresssant FK506 could promote nerve regenerative speed and quality after end-to-side neurorrhaphy of peripheral nerve.

Objective To evaluate the toe flap repair of finger pulp defect of the clinical effects.Methods Of finger pulp defect using the first or second toe in 25 cases of free flaps, the flaps were cut size of 2.0 cm x 3.0 cm-3.5 cm x 4.5 cm, to toe at the end of artery-means the artery, subcutaneous veins-ve-nous anastomosis reconstruction of dorsal skin flap blood circulation, plantar digital nerve-refers to the inherent sensory nerve reconstruction.Results Twenty-five patients with flaps all survived, after vascular crisis occurred in 2 cases,surgical exploration and re-anastomosis of vascular survival, 3 months after flap reconstructive surgery in 12 cases.All patients were followed up for 2 months to 2 years, an average of 10 months,the fingers were satisfied with function and appearance, pulp full, two- point discrimination was 4-6 mm.Conclusion The toe plantar free flap repair of finger pulp defect may be a better clinical effects.

Objective:To investigate the application of self-designed wound measuring grid in the measurement of wound and the design of perforator flap.Methods:From February 2018 to February 2020, 31 cases of soft tissue defects of limbs were repaired by free transfer of perforator flap. During the operation, the self-designed membrane with measurement grid was used to measure the wound surface. The flaps were designed and harvested according to the accurate measurement of the wound. The flaps were reviewed at hospital clinic during follow-up.Results:All patients entered 3-15 months of follow-up with an average of 8 months. All 31 flaps survived, of which 2 flaps encountered vascular crisis and were rescued after surgical exploration. There was no infection of flaps and all flaps had stage I healing. The flaps were satisfactory in appearance with the sensation recovery to S 2 in 21 cases and S 3 in 10 cases. Only linear scars were left on the donor sites. Conclusion:The membrane with a measurement grid can accurately measure a wound, and help the design of the flap according to the measured size and profile of the wound. It can reduce the operation time and the risk as well as to improve the operation efficiency. The clinical application is satisfactory. Large scale and multi-centre studies are required to further prove the benefit of the measurement grid.

Objective:To explore the clinical effect of a self-designed wound measurement grid on the design of lobulated perforator flap.Methods:From January 2019 to December 2022, soft tissue defects in limbs of 9 patients were reconstructed by lobulated perforator flaps in the Department of Orthopaedics and Traumatology of Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine. The patients were 7 males and 2 females aged 21-55 years old with 40.3 years old in average. There were 6 upper limb defects and 3 lower limb defects. Self-designed wound measuring grids were applied to guide the design and excision of lobulated perforator flaps during surgery. Five patients were treated by lobulated perforator flap pedicled with the descending branch of lateral circumflex femoral artery and 4 by perforator flaps pedicled with dorsal interosseous artery. The areas of soft tissue defect were 4.0 cm×1.5 cm-26.0 cm×8.0 cm, and the sizes of the flaps were 4.5 cm×1.8 cm-22.0 cm×10.0 cm. After surgery, the blood supply of flaps, flap survival and wound healing were monitored. Flap survival, donor site recovery and limb function were observed at outpatient clinic over the postoperative follow-up, and the limb function was evaluated by the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association and Lower Extremity Measure(LEM).Results:In this study, a total of 17 of 18 lobes of the lobulated perforator flaps survived after surgery. One flap had venous occlusion and after exploration and further treatment, a necrosis occurred in 1 lobe of the lobulated flap and then a free flap transfer was performed again. All the wounds achieved stage-I healing. Postoperative follow-up lasted for 3-18 months with 8.6 months in average. All flaps had good colour and texture, satisfactory appearance and only linear scars remained in the donor sites, without pain and scar contracture. The reconstructed upper extremity defect were evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with 4 patients were in excellent and 2 in good. The reconstructed lower extremity defects were evaluated according to the LEM, and 2 patients were in excellent and 1 in good.Conclusion:The self-designed wound measurement grid was successfully applied in the design of lobed perforator flaps. It can accurately measure a wound surface and quickly extract a wound profile, and it is more convenient and intuitive to guide the design of flaps. It has a good effect in clinical application and further clinical trials are required.