Objective:To explore the feasibility and clinical efficacy of in situ vessels anastomosis in treatment of severe degloving injury of hand, and long-term follow-up observation of the clinical efficacy.Methods:From January 2016 to December 2018, 11 patients of severe degloving avulsion injuries were treated in the Department of Hand and Microsurgery of Tianjin Hospital. Six patients had right hands injuried and 5 in left hands. The age of patients ranged from 16 to 51 years old, with an average age of 31.5 years old. All injuries accompanied with metacarpal or phalangeal fractures. In situ vascular anastomosis was applied to all patients in the replantation surgery. Long-time follow-ups and observation of postoperative appearance, sensory and hand function recovery were conducted through visits of outpatient clinic.Results:All operations were successful. All degloving tissues survived after replantation in 6 patients. Partial palm skin necrosis and thumb nail bed necrosis occurred in 1 patient, and treated with skin grafting and abdominal flap transfer. Thumb nail bed necrosis occurred in 2 patient, in which 1 patient repaired by abdominal pedicled flap transfer, and the other patient repair by local flap transfer. One patient had dorsal hand skin necrosis, and repaired with free anterolateral thigh flap(ALTF). One patient had palm hand skin necrosis, and repaired with free skin grafting. There were 1 patient had index and middle finger necrosis and 1 with little finger necrosis. And finger amputation was performed later. Mean follow-up period was 22 (15-36) months. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 6 patients were in excellent, 3 in good and 2 in fair. According to the standard of British Medical Research Council (BMRC), sensation recovered to S 4 in 5 patients, S 3 in 5 patients and S 2 in 1 patient. Conclusion:Using precise microsurgical techniques to directly anastomose in situ vessels in the treatment of severe hand degloving injuries can achieve satisfactory long-term recovery of hand function.

Objective:To investigate the clinical effect of superthin anterolateral thigh flap(ALTF) with retrograde dissection of perforator in the interface plane between the superficial and deep layer of superficial fascia for reconstruction of soft tissue defect in the foot.Methods:The study involved 24 Side of 23 patients with foot soft tissue defects in Department of Foot and Ankle Surgery in Wuxi Ninth People’s Hospital from August 2019 to July 2021. There were 15 males and 8 females with an average of 42(range, 22-59) years old, including 9 in left foot, 13 in right foot, and 1 in both feet. The size of soft tissue defects was 4 cm×4 cm-11 cm×17 cm. The dimension of the superthin ALTF was 4 cm×5 cm-12 cm×18 cm. CTA and high-frequency CDU were used to locate the perforator in the superficial fascia plane. The perforator was exposed and dissected retrograde in the adiposal layer. The superthin ALTF was harvested to repair the foot wound. The donor site was sutured directly. All patients enter follow-up reviews at outpatient clinic or by WeChat. The appearance of flaps were recorded.Results:The superthin ALTF survived in all patients. Two cases had partial epidermal necrosis at the distal part of the flap. The thickness of the flap averaged approximately 4(range 3-6) mm. During 8-16(mean 12) months of follow-up, all superthin ALTF were soft in texture without ulceration. Two flaps required secondary defatting procedures, others showed satisfactory appearance without bulky deformity. Only linear scars left in donor areas.Conclusion:The technique of harvesting superthin ALTF with retrograde dissection of perforator in the superficial fascia plane for repairing foot wounds is reliable and is able to achieve satisfactory functional and esthetic outcome.

Objective:To evaluate the anticontracture effect of injecting botulinum toxin Type A(BTX-A) at different sites after skin grafting.Methods:24 SD rats of SPF grade were divided into three groups. Two full-thickness skin grafts of the same size were performed on each rat’s back. One was randomly selected as the treatment side and the other as the control side. BTX-A was used for edge injection, substrate injection and intradermal injection on the treatment side of each group. No intervention was done on the control side.The area of grafts was measured at the end of the 2nd, 4th, 6th, 8th, 10th and 12th weeks after surgery. The differences between treatment groups were analyzed by repeated measures of variance, P<0.05 was considered statistically significant. Results:The area of skin grafts on the treatment side and the control side in the edge injection group was significantly different, except that there was no statistical difference at the end of the 2nd weeks( at 4, 6, 8, 10, and 12 weeks P<0.01). In the 12th week, the average area of the experimental side in this group was (4.106±0.320) cm 2, while the average area of the control side was (2.885±0.264) cm 2. There was no significant difference between the two sides in the intradermal injection group at each postoperative interval( P> 0.05). At the end of the 12th week, the average area of the experimental side in the intradermal injection group was (3.443±0.678) cm 2, while the average area of the control side was (3.503±0.577) cm 2. The results were different in the substrate injection group.The area of skin grafts on the treatment side was larger than that on the control side, but there was no statistical difference at the end of the 2nd, 4th and 6th weeks after the operation( P>0.05). At the end of the 8th, 10th, and 12th weeks, the differences were statistically significant( P<0.05, <0.01, <0.05). In the 12th week, the average area of the experimental side in this group was(3.660±0.434)cm 2, while the average area of the control side was (2.914±0.528) cm 2. Conclusions:The preliminary results showed that BTX-A injection at the edge and base of the wound could inhibit the contracture after skin grafting. The injection at the edge of the wound was more effective. Use of BTX-A for anticontracture after skin graft is worthy further study.

Objective:To evaluate the anticontracture effect of injecting botulinum toxin Type A(BTX-A) at different sites after skin grafting.Methods:24 SD rats of SPF grade were divided into three groups. Two full-thickness skin grafts of the same size were performed on each rat’s back. One was randomly selected as the treatment side and the other as the control side. BTX-A was used for edge injection, substrate injection and intradermal injection on the treatment side of each group. No intervention was done on the control side.The area of grafts was measured at the end of the 2nd, 4th, 6th, 8th, 10th and 12th weeks after surgery. The differences between treatment groups were analyzed by repeated measures of variance, P<0.05 was considered statistically significant. Results:The area of skin grafts on the treatment side and the control side in the edge injection group was significantly different, except that there was no statistical difference at the end of the 2nd weeks( at 4, 6, 8, 10, and 12 weeks P<0.01). In the 12th week, the average area of the experimental side in this group was (4.106±0.320) cm 2, while the average area of the control side was (2.885±0.264) cm 2. There was no significant difference between the two sides in the intradermal injection group at each postoperative interval( P> 0.05). At the end of the 12th week, the average area of the experimental side in the intradermal injection group was (3.443±0.678) cm 2, while the average area of the control side was (3.503±0.577) cm 2. The results were different in the substrate injection group.The area of skin grafts on the treatment side was larger than that on the control side, but there was no statistical difference at the end of the 2nd, 4th and 6th weeks after the operation( P>0.05). At the end of the 8th, 10th, and 12th weeks, the differences were statistically significant( P<0.05, <0.01, <0.05). In the 12th week, the average area of the experimental side in this group was(3.660±0.434)cm 2, while the average area of the control side was (2.914±0.528) cm 2. Conclusions:The preliminary results showed that BTX-A injection at the edge and base of the wound could inhibit the contracture after skin grafting. The injection at the edge of the wound was more effective. Use of BTX-A for anticontracture after skin graft is worthy further study.