Objective To evaluate the classification and treatment methods of hand degloving in-juries.Methods Individualized treatment was adopted according to area and depth of degloving inju-ries.The injury was repaired from deep to shallow layer.New techniques such as segment blood vessel re-pair, alternative debridement, local fixation and suturing, local pressure bandaging and sporadic drainageof incision were applied.Results All 76 patients were followed up for 3-48 months, which showed that75 patients were cured, with good shapes of the skins and strong rub resistance.Conclusion Classifi-cation of hand degloving injuries simplifies diagnosis, as facilitates the individulized treatment.Five new techniques mentioned above may help solve the problems encountered during operation.Individulized treatment explores new ways for the treatment of hand degloving injuries.

Objective To investigate the characteristics and the effect of severed hallux replantation.Methods Eighteen completely severed halluces had been replanted since 1991.Injuried foot were kept in extending at 90?-120? position.The sequence of hallux replantation was opposed to the classical order and was so called"the retrograde replantating means(RRM)".The order of RRM was defined as follows: skin of toe abdomen→subcutaneous vein of toe abdomen→inhered toe nerve→inhered toe artery→flexor toe tendon→toe fixation by a single K-needle→extendor toe tendon→artery in the back of toe→subcutaneous vein of toe back→skin of bilateral and back.Results Sixteen of eighteen halluces survived replantation(89.9%).The total flexion degree in replanted halluces was 25?～70?.The appearance of amputated toes restored well.The two-point discrimination was 10～16 mm.Eleven cases walked as entirely usually in gait, and seven cases had basic normal gait.Conclusions Replantation of severed halluces could alleviate wound and remnant greatly.The recovery of foot function and aspect of replanted toes was satisfactory.The RRM gradation showed a distinctive advantage that there was no requiring for injuried foot be moved during operation.

Objective To analyze the effect of cigarette smoking on replantation of amputed digit, investigate the pathologic mechanism of vascular crisis(VC) caused by smoking. Methods 1)The replantation risk factor such as smoking to VC and blood insufficiency of replanted digit was reviewed in 1 685 cases of digit replantation. 2)The complications after digit replantation in short and long terms among patients smoking were compared with those not smoking after operation. The results of management and time of appearance VC was assayed. 3)The possible pathologic mechanism of VC caused by smoking was analyzed. Results 1)A significant correlation between the ratio of VC, blood insufficiency of replanted digit and smoking index(SI, the number of cigarette in a day multiplies the years of smoking) was found. 2)The rate of VC, wound infection and unhealing in short term and the feeling of pain, numbness and cool in the long term in patients smoking after operation (92.6%,55.6%,48.1% and 71.6%) was obviously more than that in non smoking patients(17.8%,9.3%,2.0% and 3.0%,P

Objective:To report the measures of preventing vein crisis during replantation of finger amputation.Methods:Reverse method of replantation,anastomosis of palm veins of finger,selec- tion the right outing point of Kirsehner wire,anastomosed the vein as many as possible,used drugs properly and putting rubber drain in the wound.Result:The measures were used in 135 fingers of 89 cases,129 fingers survived(95.6%).Vein crisis took place in 9 fingers(6.7%).Conclusion:The rate of vein crisis was 15.6% in replantation of finger amputation before,the rate was 6.7% in this group now.It was demonstrated that all the measures were effective.

From Nov 1980 to Dec 1983, severed distal segments of fingers were successfully replanted by the aid of surgical microscope in 8 children. The age ranged from 31 months to 12 years. 6 fingers were completely amputated and 2 were incompletely amputated. The level of amputation was situated from distal 1/3 of middle phalanx to the distal inlerphalangeal joints. 46 fresh specimens of fingers were dissected under microscope, and regional anatomy of blood vessels and nerves of distal segment of finger were carefully studied and their calibers measured, providing a useful knowledge for replantation. It was emphasized that meticulous and accurate anastomosis of tiny arteries, and veins with diameters ranging from 0.2 to 0.3mm was the key to success o replantation. Indications for digital replantation, careful debridement under operation microscope, and postoperative management were discussed.

Objective To summarize the clinical experiences in microsurgical treatment of severe children hand injuries caused by firecrackers. Methods 26 cases of children hand injuries caused by a firecracker blast were treated with microsurgical procedures. An emergency operation was done for 23 cases, and a delayed repair was done for 3 cases. Operative procedures differed from case to case, according to the injury type. Results All flaps and reconstructed thumbs survived completely by first intention. Of the 9 cases with 11 fingers replanted, 7cases with 9 fingers survived. The follow up for over two years showed that satisfactory restoration of hand function and shape was achieved and the replanted fingers also showed satisfactory restoration of holding and finger to palm and finger to finger functions. Conclusion Severe children hand injuries caused by a firecracker blast must be treated as soon as possible with microsurgical procedures. Preoperative planning of a proper repair or reconstruction approach is also of great importance.

From March 1982 through December 1083, free transplantation of the perichondrium was used to repair the cartilagenous surface of interphalangeal joints in 5 cases of traumatic comminuted fracture. Of these 5 cases, the injury involved proximal interphalangeal joint of index fingers in 2 cases, proximal interphalangeal joint of the middle finger in 2, and carpometacarpal joint of the thumb in 1. The perichondrium was harvested from the 8th or 9th costal synchondrosis.X-ray film showed growth of new smooth cartilage surface, and the movement of the joints ranging from 10 to 30 degrees was observed 3 months after operation. Points to be observed in operation are: (1) About 0.5 cm of the recipient site of the phalange should be bitten away to expose the cancellous bone, thus a surface with better blood supply was created to receive the perichondrial transplant; (2) The recipient surface was reshaped into an articular surface so that no dead space was left between the recipient surface and the graft: (3) The transplanted perichondrium should be anchored onto the bone under certain amount of tension to insure close contact with the bony surface; (4) Immobilization should be enforced for 3 weeks post-operatively.

Objectives:To compare the effect of glial cell line-derived neurotrophic factor(GDNF) and methylprednisolone(MP) on intracellular free calcium(［Ca2+］i) and capacity of containing water(CCW) after spinal cord injury(SCI).　Methods:Forty-two SD rats were divided into four groups： control, GDNF,MP and GDNF+MP.GDNF and MP were supplied through subarachnoid cavity, tail vein and both of the above after T12 segments spinal cord injury by modified Allen crush method. Animals were executed and specimens were collected at 24 h, 72 h and 168 h after SCI.［Ca2+］i and CCW were measured using Fura-2 method.　Results:Both ［Ca2+］i and CCW of injured spinal cord in GDNF,MP, and GDNF+MP groups were lower than that of the control group at 24 h and 72 h after SCI(P<0.01).Levels of ［Ca2+］i and CCW in GDNF group was much higher than that of MP and MP+GDNF groups(P<0.01),but there was no difference between MP group and MP+GDNF group(P>0.05) 24 hours after SCI. Seventy-two hours after SCI,［Ca2+］i in GDNF group was higher than that in MP group, MP group was higher than MP+GDNF group(P<0.05).CCW of GDNF group exceeded that of MP and MP+GDNF group(P<0.01).［Ca2+］i in GDNF group was higher than that in MP group, and MP group was higher than MP+GDNF group(P<0.01) 7 days postoperatively, but for CCW, there were no differences among GDNF,MP and MP+GDNF groups(P>0.05).　Conclusions: Both GDNF,MP and GDNF + MP groups might reduce ［Ca2+］i and CCW of injured spinal cord. The curative effect of MP for SCI preponderate over that of GDNF, the effect of MP could be enhanced by adding GDNF.

Objective To investigate the nursing of replantation methods of sea-water soaked rotated avulsion amputated fingers.Methods There were 8 cases (16 fingers) with sea-water soaked rotated avulsion amputated fingers.5 cases were replanted by synchronic replantation method,the other 3 cases were replanted by traditional replantation method.We adopted complete debridement and high quality vascular anastomosis during the operation,and give hyperbaric oxygen therapy and anticoagulant treatment post-operation.Results There were 15 survival fingers in 16 replanted fingers.The survival rate was 93.75％.After follow-up for three months to two years,the total good rate was 87.5％.No wound infection and nonunion of fracture occurred.The outline of the fingers was satisfying and patients felt well.The twopoint discrimination was 3～6 mm after 3～24 months follow-up.Conclusions The injury of sea-water soaked rotated avulsion amputated fingers is complicated and the replantation operation is difficult.but if we can adopt individual measure according to the actual circumstance,it is possible that the sea-water soaked rotated avulsion amputated fingers can survive.

Objective To develop a portable jet-flow device for preliminary debridement of wound mainly in battlefield,which can also be used for the treatment of nuclear or chemical weapon injury at wartime and peacetime.Methods The device was composed of a dynamic system,a servo system and consumable accessories,and developed based on a pneumaticpower scheme.Composite power unit free of dependence on electric power transferred the pneumatic power to three kinds of disinfectants through the four-way pipes.Results The device with easy operation consumed a few disinfectant and completed debridement within 30 minutes,with infection avoided effectively.Conclusion The device gains advantages in low weight,compact structure,function and low cost,and can be used for early debridement in field conditions.