ObjectiveTo introduce the clinical application of full reconstruction for 72 cases of Ⅳ to Ⅵ-degree finger defect.MethodsFrom December 1998 to December 2010, sixty-three cases (85 fingets) of Ⅳ-degree finger defect, thirty-three cases (49 fingers) of Ⅴ-degree finger defect and 17 cases (23fingers) with Ⅵ-degree finger defect were applied full reconstruction. The procedures of full reconstruction of Ⅳ to Ⅴ-degree finger defect were as follows:Harvest part of nail, skin which includes some skin harvested from dorsal and palmar metatarsal to ensure the length of the reconstructed finger,and dorsal part of distal phalanx from hallux to form a composite flap, which constitute the contour of a finger, and harvesting interphaalangeal joint from the second toes to reconstruct the proximal interphalangeal (PIP) joint. Bone transplantation from the iliac bone to the distal (for Ⅳ-degree and light Ⅴ-degree defect) or both proximal and distal (for severe Ⅴ-degree defect) stump of the reconstructed PIP joint was needed to get to an appropriate length.On the basis of the treatment of Ⅴ-degree defect, reconstruction of Ⅵ-degree finger defect was to harvest one more joint: the metatarsophalangeal joint of the second toe, and connect it with the proximal iliac bone rod.ResultsAbout half of the cases were conserved of 4 toes, and the donor wound of halluxes were covered with the composite flaps (composed of nail, skin) harvested from the second toes which had been sacrificed.The other cases were conserved of all the 5 toes,and the donor wound of halluxes were covered by free flap transplantation.The second toes were reconstituted by bone transplantation from the iliac bones.All of the 157 fingers survived completely, and 75 fingers underwent second-stage plastic surgeries. Sixty-seven fingers underwent second-stage tenolysis surgeries.Follow-ups 7 months to 11 years after surgery, and all the reconstructed fingers had realistic configurations, and the two-point discrimination of the finger pulps ranges from 5 mm to 12 mm. Dorsal extension of the PIP joints were -10°～10°, flexion of the PIP joints range from 55° to 85°,and the average was 76°. ConclusionThe full reconstruction is an ideal alteration for Ⅳ to Ⅵ-degree finger defect reconstruction for the realistic configuration and ideal function of the reconstructed fingers.The one disadvantage of the full reconstruction is that the surgery is much more complex.

[Objective]To observe the effect of the nonunion of humeral shaft fracture treated by bidentate intramedullary locking nails.[Method]Twenty-five cases of fracture nonunion of humeral shaft were cured by bidentate intramedullary locking nails from January 2000 to November 2004.and they received operations to remove their previous instruments.After the bidentate intramedullary nails was inserted via antegrade approach,and autogenous cancellous bone was grafted.[Result]Twenty of the 25 cases were available for follow up.The follow up lasted 10 to 26 months.All cases achieved solid union within 4 to 10 months.There were no complication such as incision infection or occurring of osteomyelitis.[Conclusion]Bidentate intramedullary locking nails can provide the effective control of harmful shearstress,it can provide firm internal fixation,And this methods is an ideal method for treatment of humeral shaft fracture nonunion.

Objective To investigate clinical effects of cutaneous branch flaps of the low medial leg for the repair of soft tissue defects on the foot and ankle.Methods A flap with pedical of cutaneous branches of the low medial leg was used for the repair of 7 cases of skin and soft tissue defects on the feet and ankle from March 2003 to October 2005.The cutaneous branches of the posterior tibial artery were identified along the medial border of the tibia and between the soleus muscle and the flexor digitorum longus muscle.The flap was mobilized according to the site and length of the cutaneous branches,and was transferred to soft tissue defects for skin grafting. Results The operating time was 3~5 hours(mean,4.2 hours).The flaps survived completely in all the 7 cases.Follow-up checkups were carried out for 5~18 months(mean,10 months).The appearance and functions of the foot were satisfactory and met the requirements for daily activities.Conclusions The procedure can effectively repair soft tissue defects on the foot and ankle and does not sacrifice the major arteries.This flap is easy to be prepared.

Objective To discuss the use of anterolateral thigh flap for the repair of large defects of soft tissues in dorsum of the foot.Methods A total of 38 cases of dorsal skin defects of the foot was repaired with the anterolateral thigh flap containing the lateral femoral cutaneous nerves.Corresponding vessels and sensory nerves were anastomosed. Results The flaps survived in all the cases.The sensation in dorsum of the foot recovered completely within 2~4 months after operation and the touch,pain,and temperature sensation of the donor area recovered within 3~6 months after operation.Follow-up observations in the 38 cases for 4~18 months(mean,9 months) showed flaps with normal color,texture,and appearance.Conclusions It is recommended to repair large-scale defects in dorsum of the foot with nerved anterolateral thigh flap.

Objective To investigate the feasibility of clinical use of reverse anterior tibial artery flap for the repair of foot skin defect.Methods With the perforating branch of the anterior tibial artery as turning point,a reverse flap was utilized to repair the foot skin defect.The donor site was directly sutured or covered by full-thickness skin grafting.Results The flap and skin graft survived in all the 7 patients.Follow-up observations for 2～24 months(mean,16 months) in 6 patients showed normal color,texture,and appearance of flaps.Conclusions The reverse anterior tibial artery flap can be used for the construction of foot skin defect,with advantages of simple performance and good safety.

Objective Investigate the methods of reconstituting the first web of hand Try to find some ways to make the the lst web more beautiful Method To design a flap including two flap (instep island flap and medial plantar island flap) to reconstitute the lst web of hand the instep flap reconstituted the back of the lst web of hand,the medial plantar flap reconstitute the volaris part of the lst web of hand Result All 9 cases were applied successfully with the transplanted tissue survived The function of hand recovered satisfactorily and the exterior look like original web of hand Conclusion Use combined flap on the medial foot to reconstitute the lst web of hand can recovered either function or original exterior of the lst web of hand

Objective To explore the method to reconstruct finger tip. Methods Transplanted the big toe tip to reconstruct the finger tip and anastomosed the artery and nerve of big toe with the artery and nerve of the finger.The venae digitales plantares of finger,toe and venae digitales volares of finger and toe were anastomosed with microsurgery. Results All the reconstituted finger tips were successful.The shape of the reconstituted finger tips were near to the normal finger tip.The shape of the big toes had only a little change. Conclusion Use the big toe tip can reconstruct a beautiful finger tip look like the normal finger.

Objective To investigate the effect of dorsal digital island advancement flaps accompanied with digital arteries in reconstruction of finger pulp defect.Methods The study enrolled 36 cases (43 fingers) of pulp soft tissue defect treated from October 2007 to July 2011.There were 25 males (30 fingers) and 1l females(13 fingers),at age of 12-62 years (mean 34.5 years).Causes of injury included crushing in 19 cases (16 fingers),squeezing in 13 (16 fingers) and cutting in 4 (5 fingers).The fingers involved were the index (11),the middle (18),the ring (9),and the little (5).All wounds revealed the exposed bone with defect area ranging from 1.2 cm × 1.0 cm to 2.6 cm × 2.0 cm.Dorsal digital island flaps accompanied with digital artery were used for finger reconstruction and sensation was restored by anastomosing to dorsal branch of digital nerve.Donor sites were closed using skin grafts.Results All flaps survived.Thirty-three cases (39 fingers) were followed up for 5-26 months (mean 14.5 months).The flaps revealed satisfactory appearance,soft texture and good elasticity.The injured fingers were pain-free.Two point discrimination was 5-8 mm (mean 6.7 mm).According to the upper limb function criteria formulated by Hand Surgery Branch of Chinese Medical Association,the results were excellent in 24 fingers,good in 13 fingers,and fair in 2 fingers,with the excellence rate of 95％.Conclusion Dorsal digital advancement island flap vascularized with digital artery is relatively the best for finger pulp coverage,for the procedure is easy and safe,with satisfactory result.

Objective To discuss the treatment and clinical efficacy of repair of soft tissue and nerve defect of thumb with island flap of first dorsal metacarpal artery based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve.Methods The skin and nerve defect in 14 thumbs were repaired by dorsal island flap of index fingers based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve.The size of skin defect ranged from 52 mm × 32 mm to 10 mm × 8 mm.The length of the nerve defect ranged from 9 mm to 22 mm.Results The average followup was 6-35 months.All 14 flaps survived with satisfactory appearance and function.The injured side of thumb pulp sensation recovered S3 + and the injured two-point discrimination ranged from 4 mm to 7 mm.No scar contracture or sensory dysfunction complication were observed in the donor sites.Conclusions The repair of soft tissue and nerve defect of thumb with dorsal island flap of index finger based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve is recommendable,since it can obtain satisfactory clinical efficacy and be easily and conveniently oerformed.

OBJECTIVETo investigate the application of the dorsal metacarpal perforator sliding flap for web-space reconstruction in congenital syndactyly.

METHODSAccording to the size and shape of skin defect at the web space after division operation of syndactyly, the corresponding intermetacarpal perforator sliding flap was designed. The edge of the flap was cut off, but its underlying tissue was not dissected. From May 2007 to November 2012, 28 web-spaces in 15 patients with syndactyly (10 male and 5 female) were reconstructed.

RESULTSAll the 28 flaps survived completely. The flap size ranged from 3 cm x 2 cm to 1.5 cm x 1.0 cm. 14 cases with 26 flaps were followed up for 10-22 months (average, 14.5 month). The reconstructed web spaces had normal appearance and movement range. The 2-point discrimination distance was 9-13 mm (average, 11 mm). According to the Swanson Standard, 18 fingers were graded as excellent, 8 as good and 2 as fair (excellent and good, 92.6%, 26/28).

CONCLUSIONSReconstruction of web-space in syndactyly with the dorsal metacarpal perforator flap has the advantages of easy handling, good cosmetic and functional results.