Objective To study the injuries of avulsion and severance of upper extremity caused by flexion and rotation and application of tissues of chest side and back in functional reconstruction of the upper extremity. Methods The primary or fosterage replantations were performed from 2000 July to 2003 September for 6 cases of the injuries of avulsion and severance of upper extremity caused by flexion and rotation. After the operation, the shoulder joint was immobilized at abduction of 90 degrees and elbow joint was fixated at inflexion of 100 degrees. 4 weeks later, the fixation was removed and the regular functional training was started. Results Follow-ups ranging from 3 months to 2 years revealed that all the cases of replantation were successful. After operation, the shoulder joint could abduct 50?～90?, anteflect 50?～70?, extend backwards 20?～30?, and adduct 20?～40?. The elbow joint could flex 100?～140?and extend -20?～0?. 3 months after reconstruction, the muscle strength of elbow flexion recovered to Ⅳ～Ⅴdegrees. Conclusion Application of tissues of chest side and back to repair avulsion and severance of upper extremity stage by stages and layer by layer is an ideal method to resolve the contradiction between wound coverage and functional reconstruction because it can restore both the function and appearance.

Objective To explore the outcome of small external fixation devices combined with flap for fracture and dislocation of articulationes interphalangeaes.Methods Twelve cases (13 fingers) with fracture and dislocation of articulationes interphalangeae were treated with small external fixation devices combined with flap.Blood vessel grafting and crossing anastomosis were performed.The area of the flap was 1.0 cm ×1.5 cm -2.5 cm × 3.0 cm.Results Follow-ups lasting from 6 months to 2 years showed that all fingers and flaps were survived postoperatively.Fixation average time of small external fixation was 37 days.Fracture healing was found in all cases with satisfactory effect and with better apperance.Conclusion Small external fixation devices combined with flap was proper for fracture and dislocation of articulationes interphalangeae.