Objective:To explore the clinical effect of free fibular great toe flap in reconstruction of digit-tip defect with only anastomosis of artery.Methods:From February 2022 to January 2023, a total of 8 patients with digit-tip defects received reconstruction surgery using free flap of fibular great toe with anastomosis of artery only in the Department of Hand Surgery, Shunde Heping Surgical Hospital. The patients were 5 males and 3 females, with an average age of 33 (14-55) years old. Two defected digit-tips were of thumbs, 3 of index fingers, 2 of middle fingers and 1 of little finger. The digit-tip defects were 1.5 cm×0.5 cm-2.0 cm×1.2 cm in size. During the surgery, a perforator flap of fibular great toe with fibular plantar digital artery and a branch of digital nerve was harvested. And the artery and nerve carried by the flap were anastomosed to the digital artery arch and nerve of the recipient site. No reflux vein was included in the free flap due to the small size of flap. The donor sites were directly closed. Postoperative anti-infection, anti-coagulation, and anti-vasospasm were offered. Scheduled postoperative follow-ups were conducted at outpatient clinics after surgery.Results:All flaps survived smoothly without any vascular compromise. All patients were included in the follow-up with an average of 7.1 (5-13) months. At the final follow-up, the appearances of the digit-tips were full and beautiful, with recovered finger print and good stability of flaps, as well as normal sweating. All flaps had good sensation recovery, with TPD at 6.0 mm to 7.5 mm and at 6.7 mm in average. There was no significant difference in skin temperature between the donor sites and the healthy sides. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 7 patients were rated as excellent and 1 as good.Conclusion:The clinical effect is excellent for the free flap of fibular great toe with anastomosis of artery only in the reconstruction of digit-tip defect. It not only has satisfactory reconstruction but also restores the appearance and function of the flap donor site. Worth promoting and applying in clinical practice.

OBJECTIVETo explore the effect and mechanism of sodium butyrate on expression of human clotting factor VIII in vitro.

METHODSMouse NIH/3T3 cell line was transfected with recombinant plasmid vector pRC/RSV-BDD-hFVIII, which enclosed B-domain deleted (760aa approximately 1 639aa) human factor VIII cDNA (BDD-hFVIII cDNA). Then cells were incubated in Dulbecco's modification of Eagle's medium (DMEM) containing sodium butyrate for 24 hours, hFVIII: C and hFVIII: Ag in the cell culture medium were measured by ELISA assay and one-stage method, respectively. In addition, the effect of sodium butyrate on transcription of cDNA encoding the whole hFVIII, heavy and light chain of hFVIII was also investigated by means of run-on assay.

RESULTSAfter stimulation of sodium butyrate, the levels of hFVIII: C and hFVIII: Ag increased 70% than those of control. Run-on assay showed that sodium butyrate enhanced the transcription of cDNA which encoded heavy chain of hFVIII.

CONCLUSIONSodium butyrate can improve the expression of hFVIII through enhancing the transcription of hFVIII heavy chain encoding cDNA. It demonstrated that sodium butyrate had potential utility in inducing the expression of hFVIII in vitro.

3T3 Cells ; Animals ; Butyrates ; pharmacology ; Factor VIII ; genetics ; Gene Expression Regulation ; drug effects ; Humans ; Mice

Objective:To explore the application of the superficial iliac perforator flap (SCIP) based on the concept of "Donor site under swimming wear" in the repair of wounds of extremities.Methods:From June, 2018 to March, 2019, a total of 20 patients with traumatic soft tissue defects of the extremities were treated. All defects were repaired with free SCIP, including 16 males and 4 females. Location of defects: 10 in the hand, 4 in the forearm, 4 in the shank, and 2 in the foot. Wound areas were 7.3 cm×5.6 cm-16.3 cm×7.7 cm. Patients received routine CTA and high-frequency CDU examinations before surgery to assist in identifying the location of the perforating vessels and the running of the superficial and deep branches of the superficial iliac circumflex artery (SCIA). Combined intraoperative light transmission experiments were used to determine the dominant branch. The superficial branch of SCIA was used as the dominant branch in 18 cases, and the flap was cut in the superficial layer of Scarpa's fascia. The deep branch of SCIA was used as the dominant branch in 2 cases and the flap was cut in the superficial layer of the deep fascia. The donor site was directly sutured. Regular postoperative follow-ups were conducted without lost.Results:All flaps had no vascular crisis after surgery and survived successfully. All patients were followed-up regularly for 8 to 16 months, with an average of 12 months. At the last followed-up, the appearance and texture of the flaps in the recipient area were good, and roughly similar to the healthy tissues around the affected limb. The function of the affected limb recovered well. There was only a linear scar in the donor area.Conclusion:The SCIP based on the concept of "Donor site under swimming wear" is soft in texture, moderate in thickness, and concealed in the supply area. The patient can directly hide the scars of the donor areas after wearing the swimming trunks, which meets the concept of minimizing the damage to the donor area. It deserves to be promoted.

Objective:To investigate the removal of ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery and its application in wound repair.Methods:From January, 2019 to March, 2021, 32 cases of limb wounds were repaired with ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery, including 25 males and 7 females. The age ranged from 21 to 63 years, with an average of 34 years. Injury mechanism: there were 12 cases of traffic accident injury, 8 cases of machine injury, 6 cases of heavy object crushing injury and 6 cases of chronic infectious wound. The area of soft tissue defect was 8.2 cm × 6.3 cm-18.6 cm × 11.2 cm. There were 25 cases of direct suture and 7 cases of free skin grafting. All patients who needed flap repair underwent CTA and high-frequency CDU before operation to judge the approximate direction of the lateral branch of the descending branch of the lateral femoral circumflex artery and the position of the perforating branch. All patients were followed-up regularly for 3 - 13 months, with an average of 11 months.Results:All patients who underwent free flap surgery had no vascular crisis and the flap survived smoothly. At the last follow-up, the appearance of the flap was beautiful without bloating and there were no complications in the donor area.Conclusion:Compared with the traditional ALTPF, the perforator flap of the lateral branch of the descending branch of the anterolateral femoral artery is relatively simple, which can replace the traditional ALTPF to a certain extent, and is worthy of popularization and application in clinic.

Objective:To evaluated the options in selection of surgical procedures for treatment of the patients suffering from diabetic feet with chronic refractory wounds.Methods:From January 2020 to June 2021, 23 patients with diabetic feet complicated with refractory wounds were treated in Department of Hand Surgery, Shunde Heping Surgical Hospital. The patients were 15 males and 8 females, aged 51-86 years old and with an average age of 65 years old. All the patients had Type-II diabetes for over 5 - 22 years. Average blood glucose of the patients was found at 15.6 mmol/L on admission. Free anterolateral thigh perforator flaps (ALTPF) were used for reconstruction of the wound of diabetic feet in 19 patients, 2 patients received vascular bypass surgery and 2 had amputations. Regular outpatient follow-up were conduct on all patients after surgery.Results:Follow-up time lasted for 8 to 30 months, 12 months in average. At the last follow-up, the donor and recipient sites healed well in the 19 patients who received flap reconstruction, without an infection, necrosis and wound recurrence. Pains were significantly relieved after the surgery in the 2 patients who received vascular bypass surgery, and wounds all healed well after symptomatic treatment and dressing change without recurrence of wounds at the last follow-up. Average Maryland score of foot function was 84 for the patients who had limb salvage, and 2 patients were in excellent and 19 in good at the last follow-up. The 2 patients who had amputation successfully survived through the perioperative period, and the wounds healed well at the last follow-up.Conclusion:The treatment is complicated in the patient suffering from diabetic foot with chronic refractory wounds due to factors such as advanced age, co-existing and complicated underlying diseases together with the complex wounds. Most patients can achieve good prognosis in wound treatment of free flap transfer or vascular bypass surgery. However, a limb salvage is recommended with caution for the patients who have severe infections and dry gangrene.