Hand surgery,as a specialty in China,was established and advanced by Wang Shu-huan who unceasingly cre ated innovative skills and trained a lot of talented hand surgeons.Later on,department s of hand surgery were established in Beijng,Tianjin and Shanghai.Hand surgery e xperienced great development after1978when the first classic Hand Surgery was published.Hand Surgery Group of Orthopaedic Associa-tion of China Medical Association wa s established in 1984,and changed its name to Hand Surgery Association of China Me dical Association in 1994.Journal of Hand Surgery was established in 1985,and changed its name to Chinese Journal of Hand Surgery in 1993.The survival rate of replant ed limbs(digits)was raised unceasingly.After replantation of limb,graftin g of phalanges of foot,and flap graft,more achieve-ments were made,such as antebrachia l flap transfer(Yang Guo-fan),reconstruction of hand(Yu Zhong-jia),and contralateral C7root transfer(Gu Yu-dong).2cases of xenoma limbs transplantation were c onducted by Professor Pei in Nanfang Hospital in September 2000.Although the history of hand surgery is not long,much has been achieved.It is well believed that hand surgery will see greater progress in the future. [

86 cases of defect of thumb with defect of metacarpal bone were operated by the second toe transfer to reconstruction of the thumb, of which 82 cases were successful occuping 95. 6% of total cases. The metacarpal-phalangal arthral reconstruction of the thumb was completed by the hemi-arthral and full-arthral transplantation of metatarsal-phalangee joint of second toe. The results of follow-ups after operation revealed that the degree of movement of the joint was 26 in the former, 36% in the latter. The reconstruction of the first web by means of the local flap of the dasalis manual; dasalis pealical flap and groin flap. Fair results were obtainded with 63.2 %; 87. 1% and 100%. respectively. The disadvantages of groinflap method are timeconsuming, and incomfortable in position. The operative methods vary with the degree of the defect of the matacarpal bone and the condition of the web space

Objective To detect whether there is neurotropism following end-to-side neurorrhaphy by means of the neuron retrograde tracing technique. Methods Forty female Sprague-Dawley rats were randomly divided into 4 groups: tracing main branch of musculcutaneous nerve(MC) of end-to-side group, tracing MC main branch of normal group, tracing MC motor branch of end-to-side group and tracing MC motor branch of normal group.In two end-to-side groups, the MC was transeeted, then an 1 mm epineukral window was created on the ulnar nerve. Distal end of MC nerve was sutured to the windowed ulnar nerve by means of end-to-side neurorrhaphy.In two normal control groups, MC and ulnar nerves were just exposed. Five months post operation, by means of retrograde Fluoro-Gold neuron tracing technique,the number of C5～ T1 anterior horn motoneurons and dorsal root ganglion sensory neurons of all groups were counted. Results In two tracing MC main branch groups: the motor neuron counts in end-to-side group was 245.2 ± 93.8, the motor neuron counts in normal group was 846.7 ± 264.8, and counts of end-to-side group was 30.0% of the normal control group (P＜ 0.01). The sensory neuron counts in end-to-side was 434.7 ± 160.4, the sensory neuron counts in normal group was 1545.2 ± 287.4, and counts of end-to-side group was 28.1% of the normal control group (P ＜ 0.01). The per-centage of motor neuron in end-to-side group was 0.36 ± 0.09, there was no difference between end-to-side group and normal control group(P＞ 0.05). In two tracing MC motor branch groups: the motor neuron counts in end-to-side group was 72.3 ± 35.3, the motor neuron counts in normal group was 189.7 ± 57.0, and counts of end-to-side group was 38.1% of the normal control group (P ＜ 0.01). The sensory neuron counts in end-to-side was 110.8 ± 52.5, the sensory neuron counts in normal group was 157.9 ± 50.0, and counts of end-to-side group was 70.2% of the normal control group (P ＞ 0.05). The percentage of motor neuron in end-to-side group was 0.40 ± 0.14, the difference between end-to-side group and normal control group was signifieant(P ＜ 0.01 ). Conclusion Neurotropism in collateral spouting after end-to-side neurorrhaphy is not significant.

Objective To detected the motor cortex reorganization and compared the influence on reorganization process as regard to different transfer modes of contralateral seventh cervical nerve root (C7)in young rats model of total brachial plexus root avulsion. Methods The young Sprague-Dawley rats model of total brachial plexus root avulsion was established. The left radix dorsalis and radix ventralis from the fifth cervical nerve root (C5) to the first thoracic nerve root (T1)were exposed and the roots from C5 to T1 were avulsed from the spinal cord. Then, the contralateral C7 transfer operation was performed. Three different operative modes were applied randomly which included contralateral C7 transference to anterior division of the upper trunk (group A, n=30), to both musculocutaneous and median nerves (group B, n=30), or to median nerve (group C, n=30). The movement evocation of motor cortex was measured by intracortical microstimula-tion in both hemispheres, and functional reorganization was assessed dynamically in 1.5, 3, 6, 9 and 12 months after operation. Results After contralateral C7 transference, the ipsilateral motor cortex initially acti- vated the injured limb at 1.5 month, and subsequently the motor cortex of both hemispheres activated the in-jured limb at the 3rd and 6th month. The injured limb was activated mainly by the contralateral motor cortex in group A at the 9th month. The contralateral motor cortex exclusively controlled the injured limb in all three groups at the 12th month after the operation. Meanwhile, the extent of functional reorganization was better in group B than that of group C. Conclusion After contralateral C7 transfer operation, motor cortex in charging injured limb developed a transhemispheric functional reorganization in young rats with total brachial plexus root avulsion. Different operative modes contributed to the functional reorganization of motor cortex. Transferring contralateral C7 to anterior division of the upper trunk or to both musculocutaneous and median nerves provided better functional reorganization than to median nerve.

Objective To disclose the relationship of the target muscle function and different time interval after nerve grafting reconstructed C5 root resection in young rats.Methods Model of C5 resection was set up in 48 18-day-old SD rats.The rats were randomly divided into C5 resection group,immediate repairing group,3 days delayed repairing group,and 6,9,12,15,18 days delayed repairing groups.Each group experienced nerve grafting bridged the C5 nerve root defection at its time interval.At 6 weeks postoperatively,electrophysiological and histochemical experiment were performed.Results There was no statistical difference among the data of CMAP amplitude and latency and weight of target muscles and number of distal myelinated fiber of immediate repairing group and those of 3,6 days delayed repair group at 6 weeks postoperatively,but compared with C5 resection group,the dates was statistically higher.There was no statistical difference between the data of C5 resection group and that of 15,18 days delayed repairing group.Conclusion Nerve reconstruction for C5 root injury in young rats within 0-6 days (equal to 0-4 months in human beings) has a satisfactory protective effect on target muscles.It suggests that the OBPP children who have the operation indication should undergo surgical management in 4 months after their birth.

Objective To disclose the relationship of neuronal protective effect and different time interval after nerve grafting reconstructed C5 root resection in young rats.Methods Model of C5 resection was set up in 18-day-old SD rats from Jauary 2009 to December 2009.Forty-eight rats with C5 resection were randomly divided into C5 resection group,immediate repairing group,three days delayed repairing group,and 6,9,12,15,18 days delayed repairing groups.Each group experienced nerve grafting bridged the C5 nerve root defection at its time interval.At 4 weeks postoperatively,the numbers of True Blue positively labeled neurons in all groups were counted respectively.Results There was no statistical difference among the number of proxinal neuron of immediate repairing group and those of 3,6 days delayed repair group (P ＞ 0.05),but compared with C5 resection group,the number of neurons was statistically higher (P ＜ 0.05).There was no statistical difference between the number of motoneurons of immediate repairing group and that of 9 days delayed repairing group(P ＞ 0.05),but there was statistical difference between sensory neurons of this two groups(P ＜ 0.05).The neuron number of inmediate repairing group was statistically higher than those of 12,15,18 days delayed repairing group(P ＜ 0.05).Conclusion Nerve reconstruction for C5 root injury in young rats within 0-9days (equal to 0-6 months in human beings) has a satisfactory protective effect on proximal neuron.It suggests that the OBPP children who have the operation indication should undergo surgical management in 6 months after their birth.

Peripheral nerve injury of a limb usually causes functional reorganization of the contralateral somatosensory cortex.However, the patients with an operation of the contralateral seventh cervical nerve (C7) transfer to an injured arm with brachial plexus root avulsions usually have the sole tactile sensibility of the healthy hand when the injured hand is touched at the early stage after the operation. Then, at later stage they gradually get normal sense from the injured and the normal hands independently. Mimicked the process in a rat model based on the above operation, representations of the injured forepaw and the healthy forepaw in the somatosensory cortex were studied by means of somatosensory evoked potential (SEP) recording. Somatosensory function shown in SEP response amplitude and peak latency of the injured forepaw gradually recovered with time after the operation due to the contralateral C7 regeneration toward the injured limb, accompanied with the recovery process of limb movement. The somatosensory representation of the injured forepaw was observed exclusively in the ipsilateral somatosensory cortex since the 5th month after the operation. Accordingly, the overlapped representation of the injured and healthy forepaws emerged in the ipsilateral somatosensory cortex of 13 rats studied except one with separated representation though the SEP latency and response amplitude were different in responding to stimuli on the two forepaws. It is concluded that the contralateral peripheral nerve transfer to the injured arm can cause dynamically functional reorganization in the ipsilateral somatosensory cortex suggesting a remarkable plasticity of the brain function induced by an alteration of sensory input between two sides of the body in adult rats.

Peripheral nerve injury of a limb usually causes functional reorganization of the contralateral somatosensory cortex.However, the patients with an operation of the contralateral seventh cervical nerve (C7) transfer to an injured arm with brachial plexusroot avulsions usually have the sole tactile sensibility of the healthy hand when the injured hand is touched at the early stage after theoperation. Then, at later stage they gradually get normal sense from the injured and the normal hands independently. Mimicked theprocess in a rat model based on the above operation, representations of the injured forepaw and the healthy forepaw in thesomatosensory cortex were studied by means of somatosensory evoked potential (SEP) recording. Somatosensory function shown inSEP response amplitude and peak latency of the injured forepaw gradually recovered with time after the operation due to thecontralateral C7 regeneration toward the injured limb, accompanied with the recovery process of limb movement. The somatosensoryrepresentation of the injured forepaw was observed exclusively in the ipsilateral somatosensory cortex since the 5th month after theoperation. Accordingly, the overlapped representation of the injured and healthy forepaws emerged in the ipsilateral somatosensorycortex of 13 rats studied except one with separated representation though the SEP latency and response amplitude were different inresponding to stimuli on the two forepaws. It is concluded that the contralateral peripheral nerve transfer to the injured arm can causedynamically functional reorganization in the ipsilateral somatosensory cortex suggesting a remarkable plasticity of the brain functioninduced by an alteration of sensory input between two sides of the body in adult rats.

[Objective]To observe the complications after surgical treatment of thoracic outlet syndrome and to analyze causes and prevention of complications.[Methods]A retrospective review was done for 62 cases of thoracic outlet syndrome which had been treated by operation from January 2002 to January 2006.All the complications occrred were collected in the following time.[Results]Follow up time was 14 months to 30 months.According to assessment standard described by Wood,treatment outcome was excellent in 26 cases,good in 16 cases,fair in 11 cases and poor in 9 cases.Nine of all the 62 patients had been found complications,including hematoma in 3 cases,lymphadenectomy in 2 cases,cervical plexus injury in 2 cases,phrenic nerve injury in 1 case,brachial plexus injury in 1 case and pneumothorax in 1 case.All the patients were successfully treated.[Conclusions]The occurrences of complications are related to the skill of operation and individual differences of patients.In order to decrease and finally prevent these complications,operative experiences and preventive measures are needed.

Objective To analyse the alterative characteristics of electrophysiology by detecting somatosensory evoked potential(SEP) during cerebral remodeling after transfer of healthy C7 nerve root both in patients and normal individuals. Methods From 2002 to 2003, 12 cases of the left total brachial plexus nerve root avulsion were surgically treated by transferring healthy C7 nerve root to impaired median nerve through bridged ulnar nerve. The waveform of SEP of bilateral cortical expressions were recorded after stimulating median nerve of impaired upper extremity at the wrist and elbow. Meanwhile, latent period and amplitude of wave of SEP, and nerve conduction velocity from the level of wrist to elbow were exhibited and compared. Results There were differences of the latency and amplitude of SEP in normal individuals between two sides of cerebrum to some extent. In the healthy sides (first group), difference of latency of SEP on two sides of cerebral cortex had no statistical significance but in the reverse for the amplitude of SEP. For the diseased sides(second group), difference of amplitude of SEP for both sides of cerebral cortex between the patients and the nonmal individuals were of statistical significance, but on the contrary for the change of latency of SEP. Conclusion Cerebral cortex dominating affected extremity is able to bring up functional remodeling electrophysiologically after nerve transfer of healthy C7 nerve root. Shortened latency and augmented amplitude discrepancy of SEP recorded on both sides of cerebral cortex were preliminary electrophysiological criterions. After contralateral C7 nerve root transfer, the examination of SEP can offer data of corresponding cortex "reinnervation", which provides objective evidence for further treatment to promote functional recovery and cortical plasticity.