Objective To investigate effect of double end-to-side neuroanastomosis for bilateral obsolete proper digital nerve injuries.Methods From November 2000 to October 2009,40 patients with bilateral obsolete proper digital nerve injuries were admitted to our center.Fifteen patients underwent double end-to-side neuroanastomosis.During operation,the injured digital nerve was excised,then bilateral distal ends and proximal ends were sutured,respectively; consequently,the distal and proximal nerve bows were formed.A cutaneous antebrachii lateralis nerve was freed and obtained from the homolateral forearm,then divided equally to 2 parts which were used to bridge the 2 nerve bows.Thirteen patients underwent single end-to-side neuroanastomosis,while other 12 patients underwent end-to-end neuroanastomosis.Results Thirty one patients were successfully followed up for 6 to 8 months.In double end-to-side neuroanastomosis group,12 patients were successfully followed up; anaesthesia and pain of the injured fingers disappeared completely; finger pulp was plump with good flexibility; the average result of sensation measurement was S(4.21 ±1.97),which was significantly higher than those of the other 2 groups; the average result of two point discrimination was 5.4±0.9 mm which was significantly lower than those of the other 2 groups.In single end-to-side neuroanastomosis group,10 patients were successfully followed up; anaesthesia relieved and spontaneous pain disappeared completely,but there was still tenderness; the average result of sensation measurement was S(1.57±0.72); the average result of two point discrimination was 7.2±1.2 mm.In end-to-end neuroanastomosis group,9 patients were successfully followed up; anaesthesia and pain relieved; the average result of sensation measurement was S(3.19± 1.04); the average result of two point discrimination was 7.68±0.8 mm; there were significant differences in results of sensation measurement and two point discrimination between the latter two groups.Conclusion The double end-to-side neuroanastomosis is a valuable method for repairing bilateral obsolete proper digital nerve injuries.

OBJECTIVETo investigate effect of veno-arteriolization of finger lateral vein for repairing severed finger tips.

METHODSFrom March 2007 to April 2012, 20 patients with severed finger tips were treated with veno-arteriolization of finger lateral vein after failure in anastomosing artery of finger over times. During operation, the dominant digital artery at proximal end and the dominant finger lateral vein at distal end was anastomosed as the blood supply, the non-superiorty finger lateral vein was anastomosed as the blood drainage.

RESULTSAll flaps survived completely and achieved primary healing. 18 patients were successfully followed up for 6 to 12 months with satisfactory appearance and nail growth. Finger pulp was plump with good flexibility. The average length of nail was (15.6 +/- 2.7) mm and the average motion of DIP joint was (62 +/- 4) degrees. The average two point discrimination was (4.6 +/- 0.3) mm and the average sensation measurement was S3+.

CONCLUSIONThe veno-arteriolization of finger lateral vein is a valuable method for repairing severed finger tips, which can promote nail growth, and restore fingers motion and sensation.

Anastomosis, Surgical ; methods ; Arteries ; surgery ; Finger Injuries ; surgery ; Fingers ; blood supply ; Humans ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps ; Veins ; surgery ; Wound Healing

Objective To explore the clinical effect of Veno-arteriolization in digit replantation and reconstruction and transplantation of flap.Methods All clinical data of 49 cases of vascular special conditions were divide which received surgical treatment,21 cases in replantation group,5 cases in reconstruction group,23 cases in transplantation of flap group.All patients underwent veno-arterionlization.Results Two cases necrosis in transplantation of flap group,all the other fingers survived uneventfully.The patients were followed up for (4.5 ± 0.6)months.The outcome was satistactory both functionally and cosmetically in replantation and reconstruction groups.2-PD was (9.5 ±0.5) mm in replantation group,2-PD was (10.5 ± 1.0) mm in reconstruction group.The flaps had excellent appearance,good texture and color match in transplantation of flap group.According to the total active movement (TAM) evaluation system introduced by the American Society for Surgery of the Hand in 1975,the results of this series showed excellent in 42 cases,good in 5 cases and fair in 2 cases,the excellent and good rate was 95.9％.Conclusions Veno-arteriolization was a new method for hand surgery trauma in specially circumstances.Owing to its simple procedure,reliable effect,it worth to be spreading.

Objective To investigate effect of finger lateral veins anastomosis for restoring venous return of severed fingertip.Methods From March 2008 to December 2012,36 patients underwent finger lateral veins anastomosis,including 21 males and 15 females,aged from 15 to 52 years (average,29.5±6.6 years).The thumb was involved in 3 cases,the index finger in 9 cases,the middle finger in 9 cases,the ring finger in 7 cases,and the little finger in 8 cases.The causes of injury included crush injury in 12 cases,electric saw injury in 8 cases,and incised injury in 16 cases.According to type of fingertip injury,there were 14 cases of type Ⅰ,5 cases of type Ⅱ,10 cases of type Ⅲ,and 7 cases of type Ⅴ.The ratios of anastomotic artery and veins were 1∶1,1∶2 or 2∶2 (average,1∶2).Results Thirty-six fingertips survived completely and no venous return obstruction happened,arterial crisis occurred in 3 cases after operation,which were cured after operative and medication treatment.Thirty patients were successfully followed up for 6 to 24 months (average,12.4±2.8 months).The fingers' appearances were satisfactory,finger pulps were plump with good flexibility,and no obvious atrophy of finger was found.The nails were nearly smooth,and the length of nails ranged from 10.5 to 18.9 mm (average,14.4±3.2 mm).The motion of distal interphalangeal joints,the two point discrimination,and the results of sensation measurement ranged from 0° to 70° (average,63°±5°),4.2 to 6.0 mm (average,4.6±0.4 mm),and S3 to S4,respectively.According to Tamai's classification,Tamai score increased from 68 to 100 at final follow-up,the results were excellent in 28 cases,good in 2 cases,with an excellent and good rate of 100％.Conclusion The finger lateral veins anastomosis is an effective method for restoring venous return of severed fingertip,which can avoid venous return obstruction,promote growth of nail,and restore motion and sensation of fingers.

Objective:To explore the factors affecting bone mineral density (BMD) in adult males with low-to-moderate fluoride exposure in Henan Province.Methods:Adult male villagers from low-to-moderate fluoride exposure areas in Tongxu County, Kaifeng City, Henan Province were recruited from April to May 2017 based on cluster random sampling. Questionnaire survey, physical measurements and urinary samples collection were conducted respectively. Urinary fluoride (UF) was determined by fluoride ion-selective electrode. Ultrasound bone densitometer was used to measure BMD (T-score). Partial correlation analysis and multiple linear regression were used to analyze the influence factors of BMD.Results:A total of 439 adult males were included in this study. Age, body mass index (BMI), UF content, and T-score of the participants were (47.99 ± 8.49) years, (25.77 ± 3.23) kg/m 2, (1.34 ± 0.74) mg/L, and-1.79 ± 0.79, respectively. Partial correlation analysis showed a significantly positive correlation between BMI and T-score after age adjustment ( r = 0.194, P < 0.05). Multiple linear regression showed that T-score decreased by 0.015 (95% CI:-0.024 -- 0.005, P < 0.05) for each 1-year increase in age and T-score increased by 0.034 (95% CI: 0.009-0.059, P < 0.05) for each 1.0 kg/m 2 increase in BMI. Interaction analysis showed that T-score was closely related to the interaction between overweight (≥24.0 kg/m 2), non-smoking, tea drinking and UF [ β (95% CI): 0.134 (0.001-0.269), 0.163 (- 0.015-0.337), 0.215 (- 0.006-0.436), P < 0.10]. Conclusions:Our findings reveal a negative correlation between age and BMD, and a positive correlation between BMI and BMD in adult males with low-to-moderate fluoride exposure in Henan Province. In addition, low-to-moderate fluoride exposure is more likely to damage the BMD of smokers.

Objective:To discuss the clinical curative effect of the minimally invasive percutaneous suture technique of eight times for repairing closed injury extensor tendon zone I of finger.Methods:From February 2017 to January 2020, 12 patients (male 8, female 4) with mallet finger deformity were retrospectively studied, with an average age of 35 years (range, 18-50 years). And all the affected fingers were acute closed rupture of extensor tendon in zone I of single finger, 5 cases of the left finger and 7 cases of the right finger. There were 1 case of the thumb finger, 2 cases of the index finger, 3 cases of the middle finger, 4 cases of the ring finger and 2 cases of the little finger. 12 patients with fresh sputum mallet fingers were with 3-0 thread monofilament suture on extensor tendon zone I of finger in the minimally invasive percutaneous suture technique of eight times, and the distal end of the tendon was fixed to the base of the distal phalanx through the bone hole. Removal of the Kirschner wire 6-8 weeks, the brace was used to fix the affected finger in the dorsal extension. The flexion and extension of the affected finger was gradually strengthened. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up. The active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total action movement (TAM) of the finger were recorded. Finger function was evaluated according to TAM of the American Association of Hand Surgeons.Results:All operations were successfully completed, the operation time of the patients ranged from 18 to 25 min, with an average of 20.1±0.2 min. There was only a small amount of bleeding in the surgery. All 12 cases were followed up and the follow-up periods ranged from 6 to 14 months, with an average of 10.2±1.1 months. Mallet finger deformities were all corrected postoperatively; there were no knot exposure, skin necrosis and other complications. According to the Crawford standard, 9 cases were excellent, 2 cases were good, and 1 case was fair. The excellent and good rate was 91.7% (11/12). The mean active flexion of distal interphalangeal joints on the wounded finger and healthy finger were 82.11°±2.02° and 84.09°±2.01°, the mean active extension of distal interphalangeal joints on the wounded finger and healthy finger were -2.04°±3.01° and 0.02°±1.02°, there were significant differences between them ( t=2.447, 3.246; P=0.019, 0.004). The degrees of active joint activity of wounded finger were: 91.02°±4.01° of the metacar-pophalangeal joint, 94.04°±2.11° of the proximal interphalangeal joint, 83.01°±2.02° of the distal interphalangeal joint, and 265.05°±13.04° of total active activity; the degrees of active joint activity of healthy finger were: 93.01°±3.21° of the metacar-pophalangeal joint, 94.03°±3.07° of the proximal interphalangeal joint, 85.02°±2.01° of the distal interphalangeal joint, and 269.02°±12.10° of total active activity. The TAMs of the healthy side were 269.02°±12.10°, and the TAMs of the affected side were 265.05°±13.04°, there was no significant difference between them ( P>0.05). According to TAM system assessment criteria: excellent in 9 patients, good in 3 patients, and the excellent and good rate was 100% (12/12). Conclusion:The minimally invasive percutaneous suture technique of eight times can well repair closed injury extensor tendon zone I of finger, can have satisfactory treatment outcome in mallet finger with a simple procedure and good outcome. It is a simple, safe, effective method with minimal invasion.

Objective:To evaluate the clinical efficacy of the treatment of boutonniere deformity by tenodesis of the bilateral slips of the flexor digitorum superficialis (FDS) tendon.Methods:From February 2021 to May 2022, the boutonniere deformity was retrospectively analyzed, by tenodesis of the bilateral slips of the FDS in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital.During the operation, the lateral side of the bilateral FDS was split at the distal end separately. Then the two bundles were tunneled through the bone of the middle phalanx and weaved with the central band of the extensor tendon. The involved finger was stabilized in extension with splinting for 4 weeks after surgery. Extension and flexion of the proximal interphalangeal joint(PIPJ) of the finger should be gradually strengthened. Finger function was evaluated according to the total action movement (TAM) system of the American Association of Hand Surgeons.Results:A total of 7 patients (7 digits) were enrolled, including 5 males and 2 females, and the age ranged from 22 to 64 years old, with an average age of 42 years old. The injured included 1 index finger, 2 middle fingers, 2 ring fingers, and 2 little fingers. These patients were follow-up for 6 to 8 months with an average of 7 months. All wounds healed by primary intention. This operation can obtain the complete correction of the boutonniere deformity. The PIPJ was stable and capable of active flexion and straightness. The straightness of PIPJ and distal interphalangeal joint was improved. The mean active motion of the PIPJ of the affected finger was 92.4°, and the mean TAM of the affected finger was 271.3°. According to TAM system assessment criteria: excellent in 6 patients, good in 1 patient.Conclusion:It is a safe and effective new method for the correction of boutonniere deformity, which can be effectively treated with tenodesis of the bilateral slips of the FDS.

Objective:To evaluate the clinical efficacy of the treatment of boutonniere deformity by tenodesis of the bilateral slips of the flexor digitorum superficialis (FDS) tendon.Methods:From February 2021 to May 2022, the boutonniere deformity was retrospectively analyzed, by tenodesis of the bilateral slips of the FDS in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital.During the operation, the lateral side of the bilateral FDS was split at the distal end separately. Then the two bundles were tunneled through the bone of the middle phalanx and weaved with the central band of the extensor tendon. The involved finger was stabilized in extension with splinting for 4 weeks after surgery. Extension and flexion of the proximal interphalangeal joint(PIPJ) of the finger should be gradually strengthened. Finger function was evaluated according to the total action movement (TAM) system of the American Association of Hand Surgeons.Results:A total of 7 patients (7 digits) were enrolled, including 5 males and 2 females, and the age ranged from 22 to 64 years old, with an average age of 42 years old. The injured included 1 index finger, 2 middle fingers, 2 ring fingers, and 2 little fingers. These patients were follow-up for 6 to 8 months with an average of 7 months. All wounds healed by primary intention. This operation can obtain the complete correction of the boutonniere deformity. The PIPJ was stable and capable of active flexion and straightness. The straightness of PIPJ and distal interphalangeal joint was improved. The mean active motion of the PIPJ of the affected finger was 92.4°, and the mean TAM of the affected finger was 271.3°. According to TAM system assessment criteria: excellent in 6 patients, good in 1 patient.Conclusion:It is a safe and effective new method for the correction of boutonniere deformity, which can be effectively treated with tenodesis of the bilateral slips of the FDS.

Objective:To discuss the clinical curative effect and feasibility of the combination therapy of the minimally invasive percutaneous quantitative suture technique eight times and Kirschner wire elastic fixation in the treatment of mallet finger.Methods:A retrospective analysis was performed on patients with tendon zone Ⅰ rupture of tendinous mallet fingers who underwent surgery in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from July 2021 to June 2023. During the procedure, firstly, the extensor digitalis tendon in the zone Ⅰ was sutured percutaneous with 3-0 thread monofilament sutures in the "quantitative 8-stitch method " according to the pre-marked number sequence of 1 to 8, and fixed at the base of the distal phalanx via a constructed bone tunnel. Secondly, the distal interphalangeal joint (DIPJ) was fixed elastically with Kirschner wire, without damage to the articular surface. Four to five weeks after the operation, the Kirschner wire was removed, and flexion and extension of the affected finger were gradually increased. At the last follow-up, the range of motion (ROM) and the total action motion (TAM) of the finger were recorded, and the healthy side of the ROM and TAM slightly differed. Finger function was evaluated following the American Association of Hand Surgeons TAM system. It was divided into four grades: excellent, good, fair and poor. SPSS 15.0 software was used for statistical analysis. Measurement data conforming to normal distribution were expressed as Mean±SD, and a paired sample t-test was used for comparison between the affected finger and the corresponding healthy finger. Results:A total of 30 patients (30 digits) were enrolled, including 19 males and 11 females with the age of (38.5±4.3) years (14 to 71 years). All were single closed injuries. Time from injury to operation was (1.1±0.4) d (3 h to 7 d). The distance of tendon break was (8.4±0.5) mm (4 to 12 mm). Mallet finger deformities were all corrected postoperatively. There were no complications such as scar, exposed suture, nail tract infection, or nail removal on the dorsal side of the affected finger. All patients were followed up for (7.5±1.3) months (6-13 months). At the last follow-up, the ROM of DIPJ of the affected finger and the corresponding healthy finger were 43.28°±2.03° and 44.15°±1.12°, respectively, with no statistical significance ( t=1.32, P=0.084). TAM of the affected finger and the corresponding healthy finger were 240.15°±5.13° and 242.13°±3.11°, respectively, with no significant difference ( t=2.12, P=0.135). According to TAM system evaluation criteria, excellent in 27 cases, good in 3 cases, excellent and good rate was 100% (30/30). Conclusion:The combination of the minimally invasive percutaneous quantitative suture technique eight times and Kirschner wire elastic fixation has a satisfactory treatment outcome in the mallet finger, and there is no damage to the DIPJ surface. It is a simple, safe, effective method with minimal invasion.

Objective:To explore the effect of the treatment of tendinous mallet finger deformity by the minimally invasive percutaneous quantitative suture technique eight times.Methods:A retrospective analysis was performed on patients with fresh tendinous mallet fingers who underwent surgery in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from April 2021 to April 2022. During the procedure, the extensor digitalis tendon in the zone Ⅰ was sutured percutaneous with 3-0 thread monofilament sutures in the "quantitative 8-stitch method" according to the pre-marked number sequence of 1 to 8, and fixed at the base of the distal phalanx via a constructed bone tunnel. Removal of the Kirschner wire 8 weeks, the brace was used to fix the affected finger in the dorsal extension. The flexion and extension of the affected finger were gradually strengthened. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up: the active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger was measured, and the total active ranges of motion of the finger were recorded. Finger function was evaluated according to the total active range of motion (TAM) system of the American Association of Hand Surgeons.Results:A total of 10 patients (10 digits) were enrolled, including 7 males and 3 females, and the age ranged from 20 to 52 years old, with an average age of 36.5 years old. The distance of tendon break was ≤10 mm. The operation time of the patients was 20-30 min, with an average of 24.5 min. The intraoperative blood loss was minimal. All 10 cases were followed up and the follow-up period was 6 to 12 months, with an average of 7 months. Mallet finger deformities were all corrected postoperatively, dorsal skin of fingers without a scar, there were no knot exposure, skin necrosis and other complications. At the last follow-up, the mean active range of motion of the distal interphalangeal joint was 84.4° and the mean TAM of the injured finger was 265.6°. According to TAM system assessment criteria: 8 cases were excellent, and 2 cases were good.Conclusions:Satisfactory therapeutic outcome for the treatment of tendinous mallet finger deformity can be achieved by the minimally invasive percutaneous quantitative suture technique eight times. It is a simple, safe, and effective method with minimal invasion.