OBJECTIVETo study the influence of estradiol on histomorphology of skin flaps with ischemia reperfusion injury.

METHODS48 adult male Wistar rats aged 12-14 weeks old, were randomly divided into control group (group I), ischemia-reperfusion group (group II), saline group (group III), estradiol group (group IV). Superficial epigastric artery axial flap, 3 cm x 6 cm in size, was made in the left lower quadrant abdominal of each rat. Flap model with ischemia-reperfusion injury was established by using the nondestructive micro vascular clamp to clamp the superficial epigastric artery. The general condition of the flap was observed after operation. At 7 days after operation, the survival rate of the flap was detected, the flaps were harvested to receive histology and ultrastructural observation. The neutrophils level of the superficial epigastric vein were tested.

RESULTS7 days after operation, the survival rate of the flap in group IV was significantly higher than that in group II, III (P < 0.05). The neutrophils level in group IV was lower than that in group II, III (P < 0.05). The histological observation showed that the degree of tissue swelling and inflammatory exudation in group IV was more slight than that in group II, III. Presence of high neutrophils density were observed in group II, III, while slight inflammation and necrosis were observed in group IV. In group I, collagen fibers in flap are regularly arranged with no significant necrosis. Oganelles structure disappeared and apoptotic bodies were shown in group II and group III, even the lysosome could be seen in the cell. Collagen fibers in flap are regularly arranged with slight swelling and no obvious ultrastructural necrocytosis was seen in the cell of group IV.

CONCLUSIONThe estradiol can significantly increase flap survival rate by inhibiting neutrophils infiltration and improving the pathological changes of organization structure in flap.

Animals ; Epigastric Arteries ; Estradiol ; Leukocyte Count ; Male ; Necrosis ; Neutrophil Infiltration ; drug effects ; Neutrophils ; cytology ; drug effects ; Random Allocation ; Rats ; Rats, Wistar ; Reperfusion Injury ; etiology ; pathology ; Sodium Chloride ; Surgical Flaps ; blood supply ; pathology

Objective To discuss the concrete method and clinical effects of the wound refers to multiple fingers and fingerweb.Methods Twenty-six patients were used four different flaps to repair the wound refers to multiple fingers and fingerweb.Dorsalis pedis flap in 18 cases,2 cases were distal dorsal foot flap,anterolateral thigh flap,3 cases,toe web flap,4 cases,dorsal carpal branch of ulnar artery flap,1 case in this group.Results All of 25 flaps survived,the distal part of 1 case got necrosis and use skin grafting to treat.6 cases of dorsal foot flap and 1 case of anterolateral thigh flap use the operation of spliting fingers and finger web deepen operation.Conclusion According to the specific injury of the patients' hands refers fingerweb,using the suitable flap to repair the wound,can make a satisfactory results in the appearance and function of patients' hands.

Objective To explore the treatment method with combined dorsal flap based on the second toe and tibial flap for repairing the finger distal degloving injury.Methods From March 2008 to September 2011,our department chose treatment with combined use of free dorsal flap based on the second toe and contralateral second toe tibial flap for repairing finger distal degloving injury.The 11 fingers in 11 cases were treated and followed up after surgery.Results The flaps in 11 cases all survived; The donor site with skin grafting successfully healed; The follow-up was 4-15 months,averaged of 6 months.There was not obvious atrophy for the toe dorsal flaps in the finger back side and toe tibial flaps in the palm side.The finger pulp was full,the nails grew well and the appearance of the fingers was good.There was satisfactory sensory function restoration for finger pulp,two cases for S4,five cases for S3,three cases for S2 and 1 case for S1.The protective sensation was restored in the finger back for all the cases; the finger function was restored to normal; the foot donor site was healing well without scarring.Walking was completely normal.Conclusion It is an ideal treatment with combined use of free dorsal flap based on the second toe and contralateral second toe tibial flap for repairing finger distal.

ObjectiveTo report the clinical results of applying free second toe hemiarthrosis to repair finger hemiarthrosis injury,and discussed the countermeasures of relative problems.MethodsFrom June 2005 to January 2010, thirteen fingers of 13 patients with traumatic finger joint injury had repaired by using vascularized second toe hemiarthrosis graft.ResultsAll 13 grafted fingers survived,and all wounds were primary healing.The time of follow-up was between 1.5 and 4.5 years,average of 3.2 years.All grafted joints were healed and the remaining joints were normal in morphology and structure,except for 1 patient subluxation with dorsal slightly convex.No degenerative changes happened to the grafted joints.No pain and no joint instability phenomenon.Nonunion and re-fracture phenomenon did not appear.The average extension of joint motion was 0°.The average flexion was 80°.Healing of the foot donate areas were satisfactory,and did not affect walking function.Using TAM assessment method of the hand joint function,the excellent rate was 90％.ConclusionThe way of using free second toe hemiarthrosis to repair finger hemiarthrosis injury could achieve satisfactory clinical efficacy.To completed set-up of transplanted joint structure and function units,a delicate surgery were improved to be important factors of the surgical treatment.

Objective To design a new type of field operation instrument for easy to spread a rescue surgery rapidly in field first -aid at the present stage. Methods The traditional field operation instrument set is innovated in its composition, structure and function. The packing instrument procedure can be omitted. The new field operation instrument set is made of four different operation instrument boxes, two of which can be put into a standard field medical case. Results It is designed to be convenient to have a rescue surgery rapidly and to be washed, sterilized, conveyed and kept in aseptic storage. Conclusion The new field operation instrument case has such advantages as compactness, reasonable allocation and function completed, so it can be used easily.

This paper aims to discuss the use and management of operation instrument in treatment of the wounded on the sea by using the new type of field operation instrument set so as to improve the rescue ability on the sea. The operation set has a new structure and is designed reasonably. It is easy to be washed and disinfected. It can be packed sterilizedly for a long time and deployed rapidly. All of the operation instrument is fixed in the box to prevent it from falling when it is used on the sea and it is convenient to count and arrange. The new type of field operation instrument set is fit for rescuing the wounded on the sea. It is convenient to be used, sterilized, stored and carried.

Objective To investigate clinical effects of evaluating the reoeonstructiun of wounds in the thumb-nail donor site using tibial of the second toe in reducing and preventing complications related to this are. Methods Surface of the thumb-nail flap donor site was pestoperatively recovered using tibial flaps of the second toe for 8 patients; conjunct full-thickness dermotaplasthy was performed for the sites which could not be completely covered by flaps. Full-thickness flaps were used to repair the second-toe doner sites. Results All flaps in the thumb-nail donor sites of the 8 patients survived; partial necrosis of base in the second toe was seen in one case, and the wonds healed with change of dreeings. A follow-up study beyon d4 to 14 months revealed favorable texture, normal shape of flaps and complete healing of the graft area without formation of ulcer. Foot-walking functions were not exposed to significant impact. Conclusion It is a safely and reliably effective method to repair the thumb-nail donor sites using tibiai flaps of the second toe such that complications in the donor sites are minimized.

Objective To explore the new operation method and clinical effect of treating degloving injuries of the whole thumb.Methods Nine cases of the whole thumb degloving injury caused by machine were treated with free wrap-around flap from the big toe and the flap from the opposite foot.The phalanges,joints and tendons of all injured thumbs were integral relatively,except that the interphalangeal joints in 3 cases were destroyed and the flexor and extensor pollicis longus were ruptured.The size of the dorsal tissue defects varied from 4.8 cm × 2.9 cm to 6.2 cm × 3.4 cm,and the volar tissue defects ranged from 4.7 cm × 3.2 cm to 6.1 cm × 4.0 cm.The area of the wraparound flap from the big toe harvested was from 5.0 cm × 3.2 cm to 6.7 cm × 3.9 cm.The flap from the opposite foot was tibial flap with dorsalis pedis flap from the opposite second toe,and the area of the flap was from 5.0 cm × 3.5 cm to 6.6 cm × 4.5 cm.Results All 9 combined flaps survived.The wound healed primarily.Skin grafts in the donor sites of the foot also survived.Postoperative follow-up ranged from 6 to 20 months,with an everage of 9 months.The pulp of the thumb was well-stacked.Sensory recovery ranged from S3 to S3 +.Thumb nail grew well.Thumbs performed good functions as grabbing,grasping and nipping.The range of motion of the MP joints of the reconstructed thumb was normal.The motion of interphalangeal joints were acceptable in 6 cases,but worse than the normal thumb.The interphalangeal joint in 3 cases destroyed was fused.There was no obvious influence on the function of the foot.Conclusion Applying combined wrap-around flap from the big toe with the tibial flap and dorsalis pedis flap from the opposite foot in treating degloving injuries of the whole thumb is a new operation method,which could achieve good appearance and function,but have a small influence on the donor site.It is worthy being used widely in clinical.

Objective To explore the surgical methods and clinical application effects of repairing hand soft tissue defect with free vascularized flaps based on the distal perforator of ulnar artery.Methods From March, 2001 to December, 2012 in our hospital, 90 patients with hand soft tissue defects were repaired by free vascularized flaps based on the distal perforator of ulnar artery, including 74 patients cases were repaired by Phase Ⅰ emergency surgery, 16 patients cases with scar contracture were repaired by Phase Ⅱ surgery.There were 34 cases were rebuild the sensory by repaired the continuity between the dorsal branch of the ulnar nerve and dorsal digital nerve or palmar digital nerve.The free vascularized flaps that used the emerging point of perforator of the ulnar artery as center of the flap was designed, which based on the distal perforator to repairing the hand soft tissue defect.Results All 89 patients postoperative flaps were survived.Necrosis was seen in 1 flap which was repaired by skin grafting.Follow-up ranged from 3 to 36 months with an average of 12 months.The appearance of flap was not clumsy, the quality was good.The sensation was S3-S3+ in 34 cases after nerve reconstruction surgery.The active and passive activity of 16 cases with scar contracture were improved significantly.The incision in 72 cases for direct suture were healed without scar contracture, 18 cases of skin grafts were all survived without contracture.Conclusion The free vascularized flaps based on the distal perforator of ulnar artery has constant perforating point, which can carry sensory nerves and leads to little donor site damage without major vascular injury.The flap serves as a simple approach to repair hand defects, and get satisfied skin flap appearance and texture, the fingers feel and function recovered well.

Objective To explore the operative technique and clinical outcomes of tiled flaps from foot with bone graft for reconstruction of thumb defects.Methods From January, 2008 to December, 2013, 8 cases of thumb defects with varying degrees were treated with tiled flaps from foot and iliac bone graft.Among them, 4 cases caused by emergency trauma, the other 4 cases was old defect after trauma, including 1 case of double thumb defect that caused by electrical burn.The thumb defects was caterorized as type Ⅰ A in 1 case, type Ⅰ B in 2 cases, type Ⅱ A in 1 case, type ⅡB in 2 cases and type ⅢA in 2 cases.Five cases in which were treated with free wrap-around flap from the ipsilateral big toe and tibial lateral-flap from the opposite second toe, 3 cases using free wrap-around flap with series connection of dorsal artery.Results All 8 reconstructed thumbs were survived.The wound healed primarily.In 1 case, the unhealed wound was healing after dressing where skin grafts in the donor sites of the foot were partial necrosis.Postoperative follow-up ranged from 6 to 72 months, the appearance of the thumb was satisfying when was compared with normal thumb.Thumb nail grew well, the blood supply was good, and sensory recovery from S2 to S4.According to the criteria issued by the Hand Surgery Society of Chinese Medical Association for functional assessment of reconstucted thumb and fingers, 5 were excellent and 3 were good.The donor site skin graft had no scar contracture and no ulceration.There was no apparent impairment on the foot function.Conclusion Combined tiled flaps from foot and iliac bone graft for reconstruction of thumb is a good method, which can recover the appearance of thumb without sacrificing toes of the donor foot.