Objective To introduce a new technique for vascular pedicle elongation in island flap transplantation, and evaluate its clinical results. Methods From February 1994 to October 2001, 16 cases were treated with island flap transplantation with Y-V vascular pedicle elongation technique. There were 10 males and 6 females with the age ranging from 19 to 45 years ( average 26.8 years). The locations of the primary injury were as follows: the fingers in 6 cases, the great toe in 2 cases, the other toes in 2 cases, the knee joint in 3 cases and the proximal tibia in 1 case. The flaps vascularized by a branch of "Y" pattern bifurcation were used. Both branches of "Y" shaped vascular pedicle arising form the same main vessel trunk were dissected, then the main vessel trunk was severed at the division of the branches, the arc of "Y" bifurcations was then turned into "V" pattern, the length of pedicle was significantly elongated than the original pedicle. Results The operative procedures were smooth in the patients, and all of the flaps were successfully transferred, the elongated length of pedicle ranged from 3 cm to 12 cm, with the average length of 6 cm. The transplanted island flaps were rich in blood supply, and the vascular pedicle were not tight. No vascular crisis signs occurred, and the island flaps survived in all patients with stage I of wound healing. The quality and color of the flaps were similar to the skin of receptive area. Conclusion The lengthening technique of Y-V vascular pedicle can enlarge not only the scope of application for island flaps, but also improve the success rate of flap transplantation.

Objective To explore the effects of swan-like memory compressive connector(SMC) made of Ni-Ti shape memory alloy on stress shielding rate, struct ure and mechanical properties as well as the blood flow of cortical bone of expe rimental fracture healing. Methods Mid-shaft osteotomies of bilateral humerus we re performed in 56 rabbits. One side was randomly fixed with SMC, and the other side was plated with a 4-holes dynamic compressive plate (DCP). At 2, 4, 8, 12, 16,and 20 weeks after operations, the humeri in 8 rabbits were harvested. The st ress-shielding rate was measured using axial compressive test in situ samples. T he geometrical structure and bone density were examined by CT scans, and the mec hanical property was assessed by torsion tests. Blood flow was measured in real time using Laser-Doppler flowmetry. The cortical bone perfusion of 16 rabbits wa s measured at 10 time intervals (after periosteotomy, after fracture, instant af ter fixation, at 1, 3, and 7 days, and 2, 4, 8, and 12 weeks postoperatively). B lood flow was measured at outer and inner cortical bone beneath the fixation. Si multaneously, anteroposterior radiograph of the humerus was taken. Results The s tress-shielding rate in SMC group was significantly lower than that of DCP group (P

Objective To explore effect of swan-like memory connector (SMC) on bioelectric potential changes during the course of experimental fracture healing and its relation with fracture healing. Methods Bilateral humerus of 33 New Zealand rabbits were osteotomized in midshaft. One random side was fixed with SMC and the other one plated by the four-hole dynamic compression plate (DCP). The bioelectric potential changes of the fractured humerus in eight animals were determined using modified Friedenberg's technique,at eight time intervals (prefracture,postfracture,postfixation immediately,1, 2,4,8 and 12 weeks after surgery). The rabbits were killed at the 1st,2nd,4th,8th and 12th weeks respectively postoperatively and the humerus in 5 rabbits harvested for HE sections. Results The bioelectric potential of fracture site remained invariably negative all the time in the Group SMC. However,the bioelectric potential began to recover from the 2nd week after operation and reached the normal level of prefracture at the 4th week in the Group DCP,with a significant difference compared with the Group SMC ( P

Objective To investigate the characteristics and the effect of severed hallux replantation.Methods Eighteen completely severed halluces had been replanted since 1991.Injuried foot were kept in extending at 90?-120? position.The sequence of hallux replantation was opposed to the classical order and was so called"the retrograde replantating means(RRM)".The order of RRM was defined as follows: skin of toe abdomen→subcutaneous vein of toe abdomen→inhered toe nerve→inhered toe artery→flexor toe tendon→toe fixation by a single K-needle→extendor toe tendon→artery in the back of toe→subcutaneous vein of toe back→skin of bilateral and back.Results Sixteen of eighteen halluces survived replantation(89.9%).The total flexion degree in replanted halluces was 25?～70?.The appearance of amputated toes restored well.The two-point discrimination was 10～16 mm.Eleven cases walked as entirely usually in gait, and seven cases had basic normal gait.Conclusions Replantation of severed halluces could alleviate wound and remnant greatly.The recovery of foot function and aspect of replanted toes was satisfactory.The RRM gradation showed a distinctive advantage that there was no requiring for injuried foot be moved during operation.

Objective To investigate the effects of swan shaped memory connector(SMC) on the bone mineral density and mechanical properties of humeral fracture in rabbits in order to disclose the mechanism of SMC stimulating fracture healing. Methods Shafts of both humeri of 40 rabbits were osteotomized. One side was selected to fix with SMC, but the contralateral side was fixed with the 4 hole dynamic compression plate (DCP). Eight rabbits were sacrificed and the humeri were harvested respectively at 2, 4, 8, 12 and 16 weeks after operation. The bone mineral density(BMD) was examined by dual energy radiographic absorptiometry(DRA). The mechanical properties were assessed by mechanical traction test. Results From 4 to 16 weeks after operation, the BMD in SMC group was significantly higher than that in DCP group ( P

Objective To investigate the clinical effect of glutamine on parenteral alimentation in patients with severe craniocerebral injury in ICU. Methods 120 patients with severe brain injury in our hospital from November 2013 to November 2014 were selected as the research object.According to the random number table method, the 120 patients were divided into experimental group and control group, 60 cases in each group.The patients in the experimental group received glutamine parenteral nutrition support, while the control group received conventional parenteral nutritional support.The serum total protein, albumin, the complications and malnutrition-inflammation score(MIS) scores of the two groups were compared.Results The serum total protein and serum albumin levels of the experimental group post-treatment were significant higher than those in the control group (P<0.001).The complication rate in the experimental group was 15.0%, significantly lower than the control group of 55.0%(χ2 =21.099,P<0.001).The patients of normal MIS score in the experimental group were obviously superior to the control group ( 70.0% vs.33.3%, χ2 =16.151, P <0.001 ). Conclusion Adding glutamine to parenteral nutrition support therapy in the treatment of patients with severe craniocerebral injury can effectively improve the nutritional status after operation and strengthen nutrition support.

Objective To evaluate the outcomes of distraction osteogenesis with mini external fixation in management of metacarpophalangeal bone defects after hand trauma.Methods From June 2010 to December 2015,16 patients with metacarpophalangeal bone defects after hand trauma received distraction osteogenesis at our department.They were 11 men and 5 women,from 20 to 45 years of age (average,32.5 years).There were altogether 20 bone defects:8 cases had single metacarpal bone defect,2 unilateral second and third metacarpal bone defects and 6 phalangeal shortening after repair of digital stump (involving thumb in 4 cases,index finger in one and index and middle fingers in one).The metacarpophalangeal bone defects averaged 1.8 cm (from 1.0 to 3.1 cm).Under the fluoroscopic guide,4 or 6 mini half-pins in one line were directly drilled into the dorsal aspect of the involved metacarpophalangeal bone before the Orthofix fixator was mounted.The proximal (18 digits) or distal (2 digits) osteotomy between the second and third pinholes was performed via the dorsal approach,The external fixator and pins were removed without anesthesia after callus maturation.Results Average follow-up period was 12.2 months (range,from 9 to 26 months).All the metacarpal bone defects were reconstructed and all the phalangeal shortenings were lengthened;the bony callus was completely calcified at the lengthened part.The mean lengthening was 1.9 cm (from 1.0 to 3.1 cm);the percentage of lengthening ranged from 26％ to 51％ (average,34％).The bone lengthening index (time cost by average 1 cm) was 70.9 d/cm (from 60.0 to 87.1 d/cm).According to the Tentative Assessment Criteria for Upper Extremity Function by Hand Surgery Society,Chinese Medical Association,the total activity of motion (TAM) was excellent in 13 cases,good in 4,fair in 2,and poor in one,yielding an excellent to good rate of 85.0％.Conclusion Distraction lengthening using mini external fixation is a valid option with a minor rate of complications which allows for early functional exercise to help restore the appearance and function of the affected fingers.

Over the past several decades of innovation and development, Ilizarov technique has been widely recognized and applied in correction of limb deformity and post-traumatic sequelae with outstanding clinical outcomes, which making remarkable contributions to the development of orthopaedics. There is no doubt that tissue regeneration induced by tension-stress is the core of Ilizarov technique, and a series of biological cascades contributing to tissue regeneration could be triggered by mechanical stimulation through signal transduction including bone morphogenetic proteins regulations, inflammatory responses and immune responses, angiogenic activities, stem/progenitor cell homing and other systematic effects. One of main limitations of Ilizarov technique is slow rate of new bone mineralization. To facilitate this technique application better in clinical practices, a multitude of researches of means for promoting bone mineralization have become hot spots in this field in recent years, such as physical measures, chemicals and biological therapies. With better understanding of distraction histogenesis for promoting tissue regeneration, transverse tibial bone transport has been increasingly applied to vascular disease management in lower extremity, such as diabetic foot and thromboangitis obliterans. This review focuses on the recent advances in understanding the basic biological mechanisms of Ilizarov technique and new methods for promoting bone consolidation in distraction areas, providing evidence and ideas for further mechanism investigations and approach innovations.

Objective To explore the effect and mechanism of local administration of thymosin β4 (Tβ4) on bone regeneration in a distraction osteogenesis model of rat fenur.Methods Sixty Sprague-Dawley rats were randomly divided into groups A,B and C in this study.A distraction osteogenesis model was established in the left femur after osteotomy.At the end of distraction period,the bone regeneration area in group A was subjected to no treatment,that in group B to injection of phosphate buffer saline (PBS),and that in group C to injection of Tβ4.On days 22,29 and 43 postoperatively,the rats from each group were randomly sacrificed and processed for observation of bone regeneration in the distraction osteogenesis area using radiography,Micro-CT,histology and immunohistochemical staining.RT-PCR was used to detect the expression of related genes as well.Results Radiography revealed that the bone regeneration in group C was superior to that in groups A and B on days 22,29 and 43 postoperatively.Micro-CT examination showed significantly increased bone volume (BV),bone mineral density (BMD) and ratio of bone volume to tissue volume (BV/TV) in group C on days 22,29 and 43 postoperatively,and significantly decreased ratio of bone surface area to bone volume on postoperative day 43 in comparison with groups A and B(P ＜ 0.05).HE staining indicated that local capillary density was significantly higher in group C than in groups A and B after local administration of Tβ4 in the distraction osteogenesis.Immunohistochemical staining showed that the capillary density and osteoblasts in group C were higher than in groups A and B.RT-PCR results revealed significantly higher expression of eNOS and Osterix mRNA in the local callus in group C on postoperative day 22 than in groups A and group B (P ＜ 0.05).Conclusion Local administration of thymosin β4 may promote bone formation,which is probably related to the increased expression of eNOS and Osterix.

Objective To identify the practical microsurgical procedure for repairing in site of skin avulsion injury in hand, and evaluate the long-term following-up results. Methods From January 2001 to May 2005, 21 cases of skin avulsion injury in hand were treated in our department. The surgical procedures thumb skin was revascularized with vein graft from forearm, and the other part of injuried hand was resuffaced by the thickness skin graft taken from the original degloved skin, which was suitable for degloving injury in-graft, the dorsum and palm of hand was skin grafted by the original skin thinned, which was suitable for complete degloved injury at the proximal interphalangeal level. Results All the repaired skin were survival in 16 patients, partial necrosis occurred in 4 cases, which was severely crushed, required debridement and skin graft on the residual defect. Whole failure in 1 case, which underwent secondary amputation. Follow-up at 10-28 months shows acceptable cosmetic and sensible results, slight scarring was present on the volar as-pects of hand. The range of motion of the thumb and fingers was almost complete. All patients regained new jobs. Conclusion Individualization of mierosurgical methods for repairing in site of skin avulsion injury in hand does represent the best solution.