Objective To explore the method and effect of thumb and finger reconstruction and repair by emergent primary toes transplantation. Methods Three hundred and fourteen fingers of 282 cases including finger thumb defect and complex injury with hyperthena palm radid soft tissue of forearm were reconstructed and repaired by the second toes, wrap-around flap and the second third toes wrap-around flap combined with distal flap of leg or other complex tissue flap transplantation. Results Three hundred and eight reconstructed fingers survived, the survival rate was 98%. After a follow up to 6 months to 6 years, the reconstructed thumbs and fingers have accepted nip, grasp, opponent function. The result was graded as excellent in 214 fingers, good in 63, fair in 26, poor in 5. The excellent and good rate was 88%according to the upper limb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association. Conclusion Different type of toes and combined toes transplantation can obtain preferable clinical effect on emergent primary thumb and finger defect.

To investigate the clinical effect of repairing the electrical wound of upper limbs by using the perforator flap pedicled with the descending branch of lateral circumflex femoral artery. Methods From August, 2014 to July, 2018, the perforator flap pedicled with the descending branch of lateral circumflex femoral artery was used to repair the electrical wound of the upper limbs in 10 cases (11 sides), which were 9 cases (10 sides) in males, 1 case (1 side) in female. Three cases in the left side, 6 cases in the right side, and 1 case in both sides. The area of the flap was 12 cm ×6 cm-26 cm×11 cm.The arterial, venous and cutaneous nerves of the perforator flap were anastomosed with those of the recipient area, respectively. The patients were followed-up in outpatient depat-ment, including flap survival, texture, appearance, sensory recovery, donor site healing and scar hyperplasia. Results All the flaps survived without vascular crisis. Infection occurred in 1 case (1 side). The wound was healed 19 d after the operation by using effective antibiotics and dressing change. All cases were followed-up for 4-24 months after the operation. The blood supply of the flaps was good, the texture was similar to that of the recipient area, and the ap-pearance was satisfactory. There was no obvious bloat, and no ulceration of the flap was found. The anterolateral femoral cutaneous nerve was retained in the flap and anastomosed with the cutaneous nerve in the recipient area. The sensory recover to S3 in 3 flaps, S2 in 7 flaps, S1 in 1 flap. The donor site of the flap was sewn up with aesthetic treat-ment.After the operation, the donor sites presented a linear scar with a concealed position and no occurrence of oste-ofascial compartment syndrome. Conclusion The perforator flap pedicled with the descending branch of lateral cir-cumflex femoral artery has a constant anatomical position of perforator vessel, a wide excision range, abundant blood supply, a good appearance and a hidden donor site, which is a good choice for repairing the electrical wound.

Objective To explore the pathogenic bacterial distribution and drug sensitivity of cholangiitis in children who underwent hepatico-portoenterostomy for congenital biliary atresia in order to provide the guide for appropriate treatment. Methods The clinical data of 300 cases of congenital biliary atresia Kasai postoperative cholangitis in our hospital between 2007 and 2016 were included in the study to analyse the common pathogenic bacteria and antibiotics sensitivity according to its clinical types. Results(1)In the 300 children,cholangitis set on for 541 times,with blood culture positive in 128 cases.(2)The main pathogens of cholangitis after biliary atre-sia included escherichia coli,pseudomonas aeruginosa and enterococcus. Late cholangitis and frequent cholangitis contributed highly to enterococcus infections.(3)The sensitivity rates of escherichia coli and pseudomonas aerugi-nosa to cefoperazone sulbactam were 75% and 78%,respectively,and the rates to piperacillin tazobactam were 82% and 84%,respectively.The sensitivity rates to meropenem were 93% and 76%,respectively.The susceptibility of Enterococcus to vancomycin or linezolid was 100%.Conclusions Cefoperazone sulbactam and piperacillin tazo-bactam can be used as an option of antibiotics for biliary atresia Kasai postoperative cholangitis. In case of poor curative effect,timely replacement of meropenem is suggested.In case of late cholangitis and frequent cholangitis, enterococcus infection can be considered in its diagnosis.