Pollicization substitutes a functioning finger for a deficient thumb. The most indication is thumb hypoplasia with absence or instability of the carpometacarpal joint. However, there are additional causes that may negate thumb function, such as trauma, macrodactyly, multi-fingered hand, and a mirror hand. The technique of pollicization represents a consolidation of contributions from surgeons over the last 100 years. A meticulous stepwise approach from incision to closure is necessary to optimize outcome. Following pollicization, cortical plasticity and motor relearning play a pivotal role in function following pollicization with connections and adjacent sprouting from nearby cortical and/or subcortical territories. Occupational therapy is necessary to encourage large object acquisition followed by smaller objects and ultimately fine pinch. Pollicization is more reliable in patients with isolated thumb hypoplasia and a mobile index finger with robust extrinsic and intrinsic muscle-tendon units compared to and patients with radial forearm deficiencies and diminished index mobility.
Fingers/abnormalities/*surgery ; Hand Deformities, Congenital/rehabilitation/*surgery ; Humans ; Orthopedic Procedures/*methods/rehabilitation ; Reconstructive Surgical Procedures/*methods/rehabilitation ; Thumb/abnormalities/*surgery

Pollicization substitutes a functioning finger for a deficient thumb. The most indication is thumb hypoplasia with absence or instability of the carpometacarpal joint. However, there are additional causes that may negate thumb function, such as trauma, macrodactyly, multi-fingered hand, and a mirror hand. The technique of pollicization represents a consolidation of contributions from surgeons over the last 100 years. A meticulous stepwise approach from incision to closure is necessary to optimize outcome. Following pollicization, cortical plasticity and motor relearning play a pivotal role in function following pollicization with connections and adjacent sprouting from nearby cortical and/or subcortical territories. Occupational therapy is necessary to encourage large object acquisition followed by smaller objects and ultimately fine pinch. Pollicization is more reliable in patients with isolated thumb hypoplasia and a mobile index finger with robust extrinsic and intrinsic muscle-tendon units compared to and patients with radial forearm deficiencies and diminished index mobility.
Fingers/abnormalities/*surgery ; Hand Deformities, Congenital/rehabilitation/*surgery ; Humans ; Orthopedic Procedures/*methods/rehabilitation ; Reconstructive Surgical Procedures/*methods/rehabilitation ; Thumb/abnormalities/*surgery

Gunshot injuries are always known to cause severe morbidity and mortality when head and neck are involved. They vary in morbidity, which can occur in civilian surroundings. The wound largely depends on the type of weapon, mass and velocity of the bullet, and the distance from where it has been shot. Close-range gunshot wounds in the head and neck region can result in devastating aesthetic and functional impairment. The complexity in facial skeletal anatomy cause multiple medical and surgical challenges to an operating surgeon, demanding elaborate soft and hard tissue reconstruction. Here we presented the successful management of three patients shot by short-range pistol with basic life support measures, wound management, reconstruction and rehabilitation.
Adolescent ; Adult ; Child ; Facial Injuries ; rehabilitation ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Wounds, Gunshot ; rehabilitation ; surgery

OBJECTIVETo evaluate the effect of penile frenulum lengthening in the treatment of premature ejaculation (PE).

METHODSThirty-four males with PE were enrolled in this study, of whom 8 had received circumcision six months before and 4 had redundant prepuce, all with short frenulum. Those with a history of circumcision underwent reconstruction and lengthening of the frenulum, and those without received frenulum lengthening only.

RESULTSCompared with the baseline, the intravaginal ejaculation latency time (IELT) was significantly increased at 1 month after operation ([1.35 ± 0.49] vs [5.71 ± 2.69] min, t = -9.42, P <0.01), (1.42 ± 0.5) vs (5.31 ± 2.74) min in the patients without circumcision (t = -7.41, P <0.01), (1.12 ± 0.35) vs (7.00 ± 2.20) min in those with circumcision (t = -7.24, P <0.01), and (1.50 ± 0.58) vs (4.75 ± 1.71) min in those with redundant prepuce (t = -3.81, P <0.05). Totally, 94% of the patients were satisfied with their sexual intercourse postoperatively.

CONCLUSIONPenile frenulum plays an important role in penile erection. Reconstruction and/or lengthening of the frenulum can prolong penile erection and IELT in PE patients.

Adult ; Circumcision, Male ; rehabilitation ; Coitus ; Ejaculation ; Foreskin ; surgery ; Humans ; Male ; Penile Erection ; Premature Ejaculation ; surgery ; Reconstructive Surgical Procedures ; methods

OBJECTIVETo evaluate the anatomy of femoral tunnels created by simulated transtibial technique in double-bundle anterior cruciate ligament (ACL) reconstruction.

METHODSTwo tibial tunnels, anteromedial (AM) and posterolateral (PL), were drilled 45?and 55?to tibial plateau respectively. On the femoral side, the AM and PL tunnels were drilled through anteriomedial portal. After the four tunnels were established, the shaft of a reamer was introduced into the joint through tibial tunnel and reached against the lateral wall of intercondylar notch. The position that the reamer shaft can reach was marked and recorded.

RESULTSNeither femoral AM nor PL tunnel opening can be fully or partially reached by the reamer shaft through the tibial AM tunnel in all cases. The evaluation through the tibial PL tunnel showed that only in 8 of 50 cases (16%) the femoral AM tunnel opening and in 4 cases (8%) the PL opening can be fully reached. On the other hand, in 12 cases (24%) the femoral AM tunnel opening and in 10 cases (20%) the PL opening can be partially reached by the shafts through the tibial PL tunnel.

CONCLUSIONThe result strongly suggests that transtibial technique is not well competent for femoral tunnel drilling in anatomic double-bundle ACL reconstruction as we have hypothesized.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Female ; Femur ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; rehabilitation ; Tibia

OBJECTIVETo evaluate the application of the lateral arm free flap (LAFF) in the reconstruction for intraoral defects.

METHODSIntraoral reconstruction was performed using the LAFF for 10 patients with oral squamous cell carcinoma of the tongue (n = 3), cheek (n = 4), gingiva (n = 1) and oropharynx (n = 2). There were 8 men and 2 women (mean age, 52 years).

RESULTSNine LAFF healed uneventfully. One flap was lost on the second postoperative day due to venous insufficiency. The donor defect was closed primarily In all patients. There were no significant complications at the donor site.

CONCLUSIONSBecause of the thin and pliable nature, the lateral upper arm flap can be recommended as a choice for repair of moderate-sized defects of the oral maxillofacial area.

Adult ; Aged ; Carcinoma, Squamous Cell ; rehabilitation ; surgery ; Female ; Humans ; Male ; Middle Aged ; Mouth Neoplasms ; surgery ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply ; Treatment Outcome

OBJECTIVEThe purpose of this study was to evaluate the advantages and disadvantages of vascularized free fibula flap as a new method for mandibular reconstruction.

METHODS25 cases (17 male to 8 female) who have received mandibular reconstruction with free vascularized fibular flaps in our hospital were studied retrospectively. The average length of the fibula grafts is 10.0 cm (range from 5.5 to 16 cm). 3 cases received primary insertion of osteointegrated dental implants into the free fibula flap, and all these 5 implants survived.

RESULTSAll flaps except 1 were viable. 62% of the cases took normal diet postoperatively, and the remainder took soft diet as well. All patients spoke clearly. No ankle unstability was reported. And the aesthetic assessments in all patients were good or fair.

CONCLUSIONVascularized free fibular flap takes its distinct advantages to other autogeneous free bone flaps and is confirmed to be one of the optimal methods for mandible reconstruction by our study.

Adolescent ; Adult ; Aged ; Fibula ; blood supply ; transplantation ; Follow-Up Studies ; Graft Survival ; Humans ; Male ; Mandible ; surgery ; Mandibular Neoplasms ; rehabilitation ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps

OBJECTIVETo compare the postoperative recovery among patients undergoing orthotopic bladder substitution with sigmoid or ileal grafts.

METHODSThe clinical data and postoperative recovery (postoperative complications, continence recovery time and postoperative hospital stay) of 84 patients receiving orthotopic bladder substitution with sigmoid or ileal grafts after radical cystectomy for bladder cancer were analyzed.

RESULTSOf the 84 cases, 70 had continent urinary reservoirs constructed, among whom 58 (aged 48-89 years) received an ileal neobladder (IN) and 12 (aged 28-80 years) received a sigmoid neobladder (SN). The postoperative complications rate, continence recovery time and postoperative hospital stay in IN group was 29.3% (17/58), 91.4%, and 23.5 days, as compared to 58.3%(7/12) (P=0.04), 66.7% (P=0.03), and 25 days (P=0.04) in patients in SN group, respectively.

CONCLUSIONA neobladder constructed from ileal grafts achieves better postoperative recovery results compared to a neobladder constructed from sigmoid grafts.

Adult ; Aged ; Aged, 80 and over ; Colon, Sigmoid ; transplantation ; Female ; Humans ; Ileum ; transplantation ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; rehabilitation ; Urinary Bladder Neoplasms ; rehabilitation ; surgery ; Urinary Diversion ; methods ; rehabilitation

OBJECTIVETo find out the relationship between different rehabilitation procedures and the tibial tunnel widening after ACL reconstruction.

METHODSSixty-five patients undergone ACL reconstructions by using quadrupled semitendinosus and gracilis tendons were divided into two groups. Group A had 33 patients, 19 male, 14 female, average age (31.2 +/- 12.4) years, only ACL reconstruction was performed with Germanic Professor Paessler's technique, and aggressive rehabilitation procedure was used for functional recovery. Group B had 32 patients, 20 male, 12 female, average age (30.3 +/- 10.3) years. Besides ACL reconstruction, every patient in Group B accepted meniscus repair or cartilage repair with microfracture technique, then postoperative conservative rehabilitation procedure was used. Six months after operation, standard posterior-anterior radiographic plates were taken for each patient, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification of X-ray plates was taken out after measurement. Statistic analysis was done by t-test.

RESULTSSix months after ACL reconstruction, on both the posterior-anterior and lateral X-ray plates the tibial tunnel widening of the upper, middle and lower parts in Group B with aggressive rehabilitation procedure was significantly serious than in Group A with conservative rehabilitation.

CONCLUSIONSRehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It perhaps influences the functional recovery and long-term clinical result of the operated knee by affecting the tunnel widening.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Female ; Humans ; Joint Instability ; etiology ; Knee Injuries ; rehabilitation ; surgery ; Male ; Reconstructive Surgical Procedures ; methods ; rehabilitation ; Rehabilitation ; methods ; Retrospective Studies ; Tendons ; transplantation ; Transplantation, Autologous

OBJECTIVETo investigate clinical outcomes of tendon allograft reconstruction with arthroscopy minimally invasive technique at stage I for the treatment of knee dislocation with multiple ligaments injury.

METHODSForty-eight patients with knee dislocation were reconstructed anterior and posterior ligament under arthroscopy at stage I from January 2008 to January 2012, and repaired ligaments injury of knee joint by minimally invasive technique. There were 38 males and 10 females aged from 20 to 59 years old with an average of 35.6 years old; 22 cases on the left side and 26 cases on the right side; the time from injury to operation ranged from 2 d to 2 weeks. Two cases combined with anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and posterolateral complex injuries, 36 cases combined with ACL, PCL, and MCL injuries, 10 cases combined with ACL, PCL and PLC injuries; 4 cases combined with peroneal nerve injury. Lysholm scoring were used to compared the cases before operation and final following-up to evaluate knee function.

RESULTSAll patients were followed up from 12 to 30 months with an average of (18.2 ± 6.3) months. Activity and stability of joint were obviously improved. Lysholm score were improved from 40.3 ± 4.1 before operation to 87.0 ± 6.4 at final following-up.

CONCLUSIONReconstruction with arthroscopy minimally invasive technique at stage I for the treatment of knee dislocation with multiple ligaments injury could recover stability of joint better,reserve joint function. Preoperative training and postoperative individualized rehabilitation treatment is the key point of recover knee joint function.

Adult ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; Female ; Humans ; Knee Dislocation ; rehabilitation ; surgery ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Posterior Cruciate Ligament ; injuries ; Reconstructive Surgical Procedures ; methods