Objective To evaluate the clinical application value of the HC-900 fully automated urine dry chemistry analyzer and its matched test strip (HC-900 analysis system) for detecting urine microalbumin (U-mAlb) .Methods 660 urine samples were collected with the negative urine protein detected by the HC-900 analysis system as the standard ,among them ,159 samples with positive U-mAlb screened by the test strip and 106 samples with the partial negative were performed the quantitative analysis by the Immage 800 fully automatic specific protein analyzer for verifying the results screened by the HC-900 analysis system .The compari-son of the U-mAlb quantitative detection results between the screening positive group and the screening negative group adopted the two samples rank sum test .The comparison between the enumeration data was carried out by Kappa test for consistency .Results Among 660 samples ,159 samples with positive U-mAlb were quantitatively detected by the Immage 800 analyzer and 101 samples were confirmed positive U-mAlb with the real positive rate of 63 .5% .Among 106 samples of negative U-mAlb randomly extracted by the HC-900 analysis system ,9 samples were confirmed to be positive U-mAlb quantitatively detected by the Immage 800 analy-zer .By the consistency test ,the difference between the two methods had statistical significance (Kappa=0 .495 ,P<0 .01) .The U-mAlb level was 18 .02(8 .23-34 .89)mg/L in the screening positive group ,which was significantly higher than 4 .78(2 .51-8 .46) mg/L in the screening negative group ,the difference had statistical significance (Z= -8 .689 ,P<0 .01) .Relative to the detection by the Immage 800 quantitative analyzer ,the sensitivity and specificity of the U-mAlb for the rapid screening by the dry chemistry method was 91 .8% (101/110) and 62 .5% (97/155) respectively .Conclusion The HC-900 analysis system for screening U-mAlb has a certain clinical application value .

Objective:To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum.Methods:A total of 21 patients with degloving injury of fingertip at the 2nd to 5th finger were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females with ages ranging from 24 to 60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured fingers joint was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association.Results:All flaps survived after operation. Tension blisters appeared on surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and there was only linear scars in donor site of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured fingers joint was evaluated as excellent in 17 cases, good in 4 cases.Conclusions:The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal subsidiary-injury.

Objective:To investigate the clinical outcomes of homodigital reversed dorsal digital artery island flap innervated by the dorsal digital nerve to repair degloving injury of distal thumb.Methods:From July 2016 to June 2019, a total of 15 cases (15 thumbs) with degloving injury of distal part were admitted to the Department of Hand Surgery, the Second Hospital of Tangshan. Nine males and six females were involved, with an average age of 49 years (range, 41 to 69 years). There were twist injury in eight cases and crush injury in seven cases, with four cases of distal phalanx fracture. The defect dimensions after debridement ranged from 3.5 cm×1.8 cm to 4.6 cm×2.4 cm, and the dimension of the flaps ranged from 3.8 cm×2.1 cm to 5.0 cm×2.7 cm. All defects were repaired using homodigital reversed dorsal digital artery island flap innervated by the dorsal digital nerve. The survival, appearance and sensory recovery of the flaps and function of the injured fingers were observed at the follow-up after operation.Results:All the flaps survived without wound infection and blood supply disorder. The follow-up times ranged from 9 to 22 months (mean, 16 months). There was satisfactory appearance of the flaps with similar color and texture to the surrounding tissue. Fracture healing ranged from 4 to 6 weeks. At final follow-up, the values of static 2-PD test of the flaps ranged from 5 to 10 mm (mean, 7.8 mm). The results of range of motion of injured thumb joints were excellent in nine cases and good in five cases. There was slight linear scar left at the donor area of dorsal thumb.Conclusions:The innervated reversed dorsal digital artery island flap has a simple procedure and minimal donor-site cost, which is especially suitable for elderly patients who refuse to free toe transfers.

Objective:To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum.Methods:A total of 21 patients with degloving injury of fingertip at the 2nd to 5th finger were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females with ages ranging from 24 to 60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured fingers joint was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association.Results:All flaps survived after operation. Tension blisters appeared on surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and there was only linear scars in donor site of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured fingers joint was evaluated as excellent in 17 cases, good in 4 cases.Conclusions:The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal subsidiary-injury.

Objective:To explore the effect of venous anastomosis of the pedicled digital artery dorsal branch island flap in repairing fingertip or pulp defects of the same finger.Methods:From February 2016 to September 2018, a total of 56 emergency cases (67 fingers) with fingertip or pulp defects in 2-5 fingers were admitted to the Second Hospital of Tangshan (hereinafter referred to as the author′s affiliation), and the prospective research was conducted. The patients were divided into venous anastomosis group of 29 cases (35 fingers) and non-venous anastomosis group of 27 cases (32 fingers) by drawing lots. There were 18 males and 11 females in venous anastomosis group, aged 17 to 62 years, with wound area of 1.6 cm×1.3 cm-3.1 cm×2.4 cm after debridement. There were 17 males and 10 females in non-venous anastomosis group, aged 20 to 59 years, with wound area of 1.7 cm×1.2 cm-3.0 cm×2.4 cm after debridement. According to the location and size of the fingertip or pulp defect of patients in the two groups, the flap was designed on the dorsum of the middle or proximal phalanx of the injured finger. During the operation, the epineurium of dorsal branch of the proper digital nerve or the dorsal digital nerve carried by the flap was anastomosed end-to-end with the stump of proper digital nerve in the wound. One or two superficial vein (s) carried by the flap was/were interrupted end-to-end anastomosed with the superficial veins on the dorsum or palm of the wound surface in venous anastomosis group, and the venous anastomosis was not performed in non-venous anastomosis group. The flap size resected ranged from 1.8 cm×1.5 cm to 3.4 cm×2.6 cm in venous anastomosis group, and that ranged from 1.9 cm×1.4 cm to 3.3 cm×2.6 cm in non-venous anastomosis group. The donor site wounds in the two groups were resurfaced by free full-thickness skin graft harvested from the proximal forearm or the medial side of the upper arm. The blood circulation of the flap of patients in 2 groups was observed after operation. During follow-up after operation, the patients′ satisfaction for the appearance of the flap was evaluated by Michigan Hand Function Questionnaire, the flap color was observed by the chief physician of the Department of Hand Surgery in the author′s affiliation, and the incidence of flap pigmentation was calculated. Data were statistically analyzed with t test and chi-square test. Results:All the flaps of patients survived without tension blister in venous anastomosis group after operation. Tension blisters occurred in 6 cases (6 fingers) in non-venous anastomosis group due to venous reflux obstruction, and the flaps survived after removing some sutures of the pedicle and changing dressing. During follow-up of 8-20 months, with an average of 15 months, the patients′ satisfaction score for flap appearance in venous anastomosis group was (4.6±0.5) points, which was obviously higher than (4.3±0.6) points of non-venous anastomosis group ( t=2.482, P<0.05). The incidence of flap pigmentation in venous anastomosis group was 9% (3/35), which was significantly lower than 31% (10/32) of non-venous anastomosis group ( χ2=5.498, P<0.05). Conclusions:The pedicled digital artery dorsal branch island flap with venous anastomosis repairs the same fingertip or pulp defects, resulting in unobstructed venous reflux, low incidence of flap pigmentation, good appearance and high patient satisfaction.

Objective:To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum.Methods:A total of 21 patients with degloving injuries of fingertips at the 2nd to 5th fingers were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females aged 24-60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the three flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured finger joints was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association.Results:All the flaps survived after operation. Tension blisters appeared on the surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, the three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and with only linear scars in donor sites of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied with the appearance of hand, and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured finger joints was evaluated as excellent in 17 cases, good in 4 cases.Conclusions:The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal injury.