Objective Research reconstruction methods of complicated hand injury and transfer types of combined free tissues Methods Applying combined three free tissues to reconstruct extent hand injury 36 cases, there were total four types Results Thirty six cases with 108 free tissues were all survival, the wounds were healed After more than 1 year follow up, restoration of the sensation of pain and temperature were recovered in the transplantation toe and wrap around flap, the two point discrimination was 6～12 mm The function of pinch and opposed was restored The patients can comply the day of life Conclusion Utilization the combined three free tissue transfer to reconstruction complicates hand injuries The time of operation is long, more trauma, reasonable arrange of hand surgeons and have a good knowledge of microsurgery, but the times of operations is less, and shorted the therapy procedure and early rehabilitation

[Objective]To inrestigate the clinical outcomes of using bilateral tibial flap of the second toe nail flap combined with the fibulal flap of the big toe to repair the multi-finger degloving injury.[Method]A variety of different methods were used to repair the multi-finger degloving injury,six fingers in 3 cases were repaired by partial bilateral wrap-around flaps combined with the tibial flap of the second toe.Sixteen fingers in 8 cases were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe.Six fingers in 2 cases were repaired by bilateral second toenail flap,the fibulal flap of the big toe and the digital arterial island flap.Three fingers in l case were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe and the the lateral flap of dorsum of foot.Six fingers in 3 cases were repaired by bilateral second toe nail flap and the fibulal flap of the big toe and bilateral dorsum flap of foot.Four fingers in 1 case were repaired by partial bilateral wrap-around flaps and the tibial flap of the second toe and the anterolateral thigh flap.Six fingers in 3 cases were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe,and bilateral dorsum flap of foot and bilateral anterolateral thigh flap.[Result]Ninety-seven flaps of 98 flaps of 47 fingers in 21 cases were suvived well,with 1 flap developed necrosis.The follow-up duration ranged from 6 months to 9 years in 17 cases (37 fingers).In addition to the activities of DIP limited,the other interphalangeal joint activities were nearly normal.All of the fingernail grew well.Two point discrimination of the fingers was between 5mm and 11 mm.The donor site was hardly affected.[Conclusion]It is a better method using the big toe flap combined with the second toe flap to repair the the multi-finger degloving injury at one stage.

Objective To investigate the protective effect of adiponectin on angiotesin Ⅱ (Ang Ⅱ)-mediated cardiomyocyte apoptosis,and explore the related mechanism. Methods Cardiomyocytes isolated from neonatal rats were cultured in vitro. The identity of cardiomyocytes was confirmed by morphological examination and staining with anti-sarcomeric ?-actin antibody,and most (more than 95%) of the cells were identified as neonatal rat ventricular myocytes. After being placed in a serum-free medium for 24 hours,the ventricular myocytes were randomly grouped and received the following treatments respectively:placebo,or Ang Ⅱ (1?mol/L),or Ang Ⅱ (1?mmol/L) plus adiponectin (30mg/L). The protein levels of Bcl-2 and Bax were detected by Western blotting. The apoptotic rate and the levels of intracellular reactive oxygen species (ROS) in the ventricular myocytes were determined by flow cytometry. The survival rate of ventricular myocytes was evaluated by trypan blue staining. Results As compared with placebo group,the apoptosis of neonatal rat ventricular myocytes was significantly promoted in 1?mol/L angiotesin Ⅱ group,the survival rate of cardiomyocytes was significantly reduced,with the protein expression of Bax and the ROS level increased,and the protein expression of Bcl-2 decreased (P

Objective To investigate the methods and results of reverse island flap of the adjacent digit pedicled with the Y-V vascular of digital artery by anastomosis of superficial veins for repairing soft tissue defects of the fingers.Methods From March 2009 to June 2011,twenty cases with soft tissue defect distal to the proximal interphalangeal join of fingers were treated by reverse island flap of the adjacent digit pedicled with the Y-V vascular of digital artery by anastomosis of superficial veins.There were 12 cases of the index finger,eight of middle finger,the largest area of the flaps was 4.5 cm × 3.5 cm,and the smallest area was 3.5 cm × 2.5 cm,an average of the pedical length was 4.0 cm.All cases anastomosis one superficial vein,fourteen cases suture dorsal digital nerve,and the donor area covered with full-thickness skin graft.Results All flaps survived.Postoperative follow-up time ranged from 8 to 16 months,the appearance and texture of the flaps were excellent,the flaps with suture nerves,the two-point discrimination was 7 mm to 9 mm,the other flaps that the nerves were disconnected.The sensation of the flaps recovered to S2-S3,no morbidity of the donor fingers occurred.Conclusion Reverse island flap of the adjacent digit pedicled with the Y-V vascular of digital artery by anastomosis of superficial veins can form a longer vascular pedicle,to repair the soft tissue defect distal to the proximal interphalangeal joint,through anastomoses superficial venous can reduce the flap venous pressure obviously,improve the survival quality of the flap,the effect is satisfacted.

Objective To investigate the clinical effects,feasibility,points for attention and complications of treating distal radial fractures through minimally invasive palmar locking plate.Methods A total of 22 patients with distal radial fractures managed by minimally invasive palmar locking plate from August 2009 to August 2010 were enrolled in the study.According to AO classification,there were five patients with type A2 fractures,three with type A3,four with type B1,seven with type B3,two with type C1 and one with type C2.Two vertical or parallel palmar incisions of 2 cm long were performed.The distal transverse incision was along the proximal wrist crease,while the distal and proximal vertical incisions were close to the radial side of flexor carpi radialis.Then,palmar locking plate was inserted through deep pronator quadratus.Results Follow-up period was 10-18 months(mean,12 months).According to Dienst function evaluation criteria,the results were excellent in 13 patients,good in six,fair in three and poor in zero,with excellence rate of 86％.Complications were as follows:one patient had delayed healing of proximal wrist crease incision;one patient had numbness of thenar eminence and the symptom was disappeared three months postoperatively;two patients remained pain on ulnar side of the wrist joint;two patients had limited function of the wrist joint.Conclusions Minimally invasive palmar locking plate is safe,mini-invasive and reliable when treating distal radial fractures,which is conducive to early functional exercise.Furthermore,the method achieves satisfactory appearance of the incision which meets the minimal invasion and thus deserves clinical practice.

Objective To evaluate the clinical effects of free fibula and flap grafts on the repair of all the first metatarsal bone at one stage.Methods There were 9 cases with the first metatarsal bone defect from Janurary 2003 to December 2009 that treated with free vascularized fibular bone and free vascularized flap at one stage.In which 6 cases reconstructed at the primary stage and 3 cases reconstructed at the second stage.Seven cases reconstructed by free vascularized fibular combined with ALTPF,two cases reconstructed by free vascularized fibular combined with TAPF.The free vascularized fibular and flap restored the first metatarsal bone and the soft tissue defects respectively.Vascular anastomosis was the artery of flap anastomosis with anterior tibial artery and the vein of the flap anastomosis with great saphenous vein,the peroneal artery and accompany vein anastomosis with artery and vein of the flap.Results The grafted tissues survived smoothly in 8 cases,vein crisis happened in I case and the ALTPF necrosis after blood vessels expedition.So the TAPF was changed to cover the soft defect and survived smoothly.Followiy-up were done from 6 to 36 months in 9 cases.There were no ulcer on flaps and no fracture again,the fibulas had been bone healing.Evaluated by Maryland standards,six cases were excellent,two cases were fine,one case was good.Conclusion The fibula combined flap grafts provide a relatively better alternative to repair the first metatarsal bone compound tissue defects at one stage.In addition,the procedure decreased frequency of operations and short the course of treatment.Sensory function reconstruction of fibula flaps should be given full attention.As fine function of the reconstructed foot,it is a effective method for reconstruction the burdened area of the foot.

Objective To research the clinical outcomes of repairing donor site of abdomen flap by V-Y flap pedicled with deep circumflex iliac artery perforator musculocutaneous.Methods Nine cases with skin defects of hand were treated with lower abdomen flap from December, 2011 to March, 2013, abdominal donor sites could not be directly sutured, and pedicled with deep circumflex iliac artery perforator musculocutaneous.The flap was 8 cm × 16 cm-12 cm × 24 cm in size.Results The average healing time of the V-Y flap pedicled with deep circumflex iliac artery perforator musculocutaneous was 17 days.The patients were followed-up for 3 months to 18 months, averaged of 9 months.The appearance and the texture of the flaps were good.Abdominal wound healing was flat, with no significant depression and navel no significant skew.Patients were satisfied with function and appearance.Conclusion This procedure is easy and effective.The treatment result is satisfactory.It is improvement for repairing donor site of tradition abdomen flap.

Objective To investigate the method and result of repairing multi-fingers soft tissue defects using the dorsal metacarpal flaps with cutaneous branches as pedicle.Methods From February,2010 to January,2013,9 patients with multi-fingers tissue defects were treated with the 2nd,3rd,4th dorsal metacarpal flaps with cutaneous branches as pedicles.The area of flaps ranged from 1.2 cm × 2.5 cm to 2.5 cm × 5.0 cm.The donor sites were sutured with full thick skin graft.Results All flaps survived.After a followed-up of 8 months to 24 months(average 12 months),the texture and shape of the flaps were good and non-bloated.The flap sensibility as sessment were S3-S3+.The two-point discrimination testing were 10 to 13 mm (average 11.6 mm).The TAM score of range of motion was 60％ to 75％ of the healthy side.The skin graft of donor site were soft.Conclusion Procedure of dorsal metacarpal flaps with cutaneous branches as pedicles easy is a good method to repaire the soft tissue defects of muhi-fingers.

Objective Primitive neuroectodermal tumor ( PNET) is a small round cell tumor occurring mostly in children or young adults and categorized into the Ewing sarcoma family of tumors, the purpose of the study was to investigate the clinical features, treatment and prognosis of Children PNET. Methods A retrospective study was performed on clinical data of 13 children with PNET hospitalized in our hospital from March 2010 to Octorber 2014.In order to analyze the clinical effects and prognostic results, statistical analysis was made on their clinical manifestations, CT and ultrasonic results, therapeutic schemes, postoperative pathology and immu-nohistochemical staining results, along with telephone and outpaitient follow-up of average 19 months. Results Of the 13 patients, 4 cases were central nervous system PNET(CNS-PNET) and 9 cases were peripheral PNET(pPNET).The clinical manifestations of the former were headache, vomiting, convolsion, movement disorder or decreased muscle strength, while the latter mainly showed mas-ses and abdominal distention.3 cases with metastasis to lung, lymph nodes and bones respectively showed masses on surface or in cavi-ty in imaging.Homer-Wright pseudorosette textures were found in 12 patients.Immunohistochemical results showed 11 cases with CD99(+), 9 cases with VIM(+) and 8 cases Syn( +).Among 11 patients underwent chemotherapy, 2 cases were lost to follow-up, 7 cases were in stable condition without occurrence and the other 2 cases recurred 4-6 months after chemotherapy.3 of 4 cases with CNS-PNET survived with the sequelae of decreased muscle strength, convolsion and movement disorder.1 case with CNS-PNET and 1 case with pPNET died 7 months and 16 months after diagnosis respectively. Conclusion PNET in children is a very highly malignant tumor with low long-term survival rate.Immunohistochemi-cal examination including CD99 and VIM is of important diagnostic value and CNS-PNET is prone to sequelae.

Objective To investigate the clinical efficiency of repairing ankle and calf wounds by antegrade or retrograde perforating flap of posterior tibial artery. Methods 13 cases with skin defects of ankle and calf wounds were reviewd. The defects were repaired using antegrade or retrograde perforating flap of posterior tibial artery from January 2011 to February 2013, 8 males and 5 females; aged 19 to 65 years old. Wounds were located in the ankle and calf, area which the tibial artery support contu-sioned slightly;defects were associated with exposed bone or tendon, exposed blood vessels. Of the 13 cases, 5 cases have multiple ankle fracture with blood circulation disorders, internal and external fracture fixation were performed emergency with blood ves-sels and nerves exposed, at the same time emergency line wound repair by posterior tibial artery perforating flap. The other 8 cases have no blood vessels and nerves exposure, and accepted vacuum sealing drainage emergency external fixation and flap surgery. Seven cases accepted V-Y antegrade perforating flap of posterior tibial artery, 6 cases using retrograde tibial artery perforator flap. Whose defects were ranged from 1.5 cm×2.0 cm to 9.0 cm×5.0 cm. Antegrade or retrograde perforating flap of posterior tibial ar-tery with 1.5 cm×3.0 cm to 14.0 cm×7.0 cm was used to repair ankle or lower leg medial defect. Antegrade flap donor site sutured directly, but retrograde flap donor site take full thickness skin graft repair from abdomen. Results Circulations of the all 13 cases were stable, with wound healing well after 2 weeks. The patients were followed up for 6 months to 24 months, average of 13 months. All flap graft survived, pedicle no bloated andcat eardeformity. Flaps were soft, no bloated appearance;color was con-sistent with normal skin. Fracture line in the 5 patients was disappeared. Bone healing time was 3.0 to 4.0 months. At the direct su-ture skin donor sites, postoperative scar was small;skin graft donor sites had no obvious scar. Postoperative ankle dorsiflexion 10° to 25°, plantar flexion 15° to 45°. Patients were extremely satisfied with the results of repair. Conclusion Using antegrade or ret-rograde posterior tibial artery perforator flap without sacrificing the main vessel, it is a simple and effective method to repair the medial malleolus and calf wounds.