Objective To evaluate the outcome of the procedure of using the free flap vascularized by the dorsal artery of big toe to treat finger skin defect.Methods From August 2010 to April 2013,21 cases of finger shin defect were treated with the free flap vascularized by the dorsal artery of big toe in which emergency surgeries were conducted in 9 cases and sub emergency surgeries were conducted in 12 cases.The age of the 21 patients was 21 to 48 years old and 15 of them were males and 6 were females.Thumb was involved in 6 patients and index finger was involved in 15 patients.The skin defect occurred at dorsal in 7 patients and palm in 14 patients.The area of the flaps ranged from 2.2 cm × 1.6 cm to 4.0 cm × 3.2 cm.Observed the restoration of the affected fingers' appearance and function,investigated the clinical results and concluded the indication and advantages and disadvantages of this procedure by following up.Results All of the 21 flaps survived at the last office visit.The follow-up period ranged from 3 to 18 months.The shapes and the fingerprints of the flaps were satisfied.The color and texture of the flaps were similar to those of the finger skin.The 2 points discriminations of the flaps was 6-8 mm.No function deficits were found in the donor feet.Conclusion This free flap is satisfied in the shape,easy to harvested and the blood supply was constant in its location,and recommend it in treating the small of middle area skin defect in the finger.

Objective To evaluate effects of alimentary reconstruction procedures (integral continual jejunal interposition, Billroth Ⅱ and isolated jejunal interposition) after subtotal gastrectomy on postoperative plasma gastrin, motilin and cholecystokinin. Methods Twenty-four dogs were divided into 3 groups undergoing distal subtotal gastrectomy and three different digestive tract reconstruction (integral continual jejunal interposition, Billroth Ⅱ and isolated jejunal interposition). The concentration of plasma gastrin, motilin and cholecystokinin were detected by enzyme-linked immunosorbent assay before and after operation. Results Two months after operation, plasma gastrin level of the integral continual jejunal interposition group (2. 2 ±0. 7 ) ng/L, ( 3.9 ± 0. 8 ) ng/L was significantly lower than that of preoperative both in fasting and postprandial state (3.8 ± 1.0) ng/L, (5.3 ± 1.6) ng/L, all P ＜0.05, but was significantly higher than other two groups in postprandial state (2. 7 ± 1.0) ng/L, (3.6 ±0. 6) ng/L, P ＜0. 05. Two months after operation, plasma motilin concentration of integral continual jejunal interposition group (577 ±204) ng/L, (1003 ± 209) ng/L were significantly higher than that of preoperative both in fasting and postprandial (429 ± 128) ng/L, (854 ± 218 ) ng/L, P ＜ 0. 05. The postoperative plasma motilin of integral continual jejunal interposition group ( 1003 ± 209 ) ng/L was significantly higher than other two groups in postprandial state (840 ±205) ng/L, (986 ± 189) ng/L, P ＜0. 05. Two months after operation,plasma cholecystokinin concentration of integral continual jejunal interposition group ( 19.6 ± 2.0 ) ng/Lwere significantly higher than that of preoperative both in postprandial ( 19.0 ± 2. 0) ng/L, P ＜ 0. 05. The postoperative plasma cholecystokinin of integral continual jejunal interposition group ( 19. 6 ± 2. 0) ng/L was significantly lower than other two groups (22.2 ± 2. 1 ) ng/L, (20. 1 ± 2. 5 ) ng/L, P ＜ 0. 05. Conclusion Integral continual jejunal interposition after distal gastrectomy maintains the postoperative plasma motilin and gastrin in a relatively higher level and decreases the concentration of plasma cholecystokinin.

Objective Discuss the clinical efficacy by using two kinds of mini perforator free flap for digital injuries reconstruction. Methods From August, 2014 to February, 2017, 45 patients were managed randomly with either radial artery superficial palmar branch(RASPB)perforator free flap or digital artery(DA)perforator free flap for digital skin defects reconstruction, and they were therefore divided into two groups according to the flap type. There were 24 patients in RASPB group, with an average wound dimensions ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm, and an average harvested flap size ranged from 2.0 cm×1.7 cm to 4.2 cm×2.6 cm. Another 21 patients were in DA group, with an average wound dimensions ranged from 2.0 cm×1.5 cm to 3.8 cm×3.0 cm, and an average harvested flap size ranged from 2.2 cm×1.6 cm to 3.9 cm×3.2 cm. The survival rate, sensory function, donor site complications, hand function recovery and aesthetic outcomes of two groups were compared by the SPSS22.0 statistical software after surgery. Results The mean follow up period was 15 months. All flaps were primary survived without vascular crisis. The flaps were soft in texture,trimness in appearance and none of them overtop the normal skin for more than 0.5 cm. Both groups had a favorable sensory recovery.All cases recovery to S3+or better.In Group RASPB,the mean two point discrimination(2 PD)was 7.85±1.15 mm(ranged from 7.0 mm to 9.0 mm). And it was 6.02±0.94 mm(ranged from 6.0 mm to 8.0 mm)in DA group. The difference between two groups was statistically significant(P <0.05). Then we synthetically analyzed flap texture and sensory function,and calculated the qualified ratio of each group.There was no significant difference between two groups(P > 0.05). The degree of scar contracture demonstrated donor site compli cations in RASPB group was lesser than that in DA group(P<0.05).The range of motion of interphalangeal joint was used to reflect the hand function. And we calculated the ratio of repaired and contralateral sites. The difference of the mean ratio between two groups was not statistically significant(P>0.05). Conclusion On account of the characteristics of invariant anatomy position, sufficient blood supply, favorable aesthetic outcome and minimal donor site mobility, both RASPB perforator flap and DA perforator flap were optimal for digital skin defects reconstruction.Besides,incorporated with nerve and tendon,the RASPB perforator flap can also be used for complex tissue transplantation,and the surgery field was only on the arm.While the DA perforator free flap had an advantage of better sensory recovery and appearance.

Objective To investigate the differences in subchondral bone mineral density(BMD)between the femoral and tibial sides in patients of knee osteoarthritis(KOA)with normal lines of force and varus.Methods The data of 450 knee joints with a definite diagnosis of KOA were included in this study including weight-bearing full-length X-ray films and quantitative computed tomography(QCT)scans of both lower limbs.Among them,131 were in the normal force line group and 319 were in the knee varus group.The hip-knee-ankle(HKA)angle and BMD of the femoral medial condyle,femoral lateral condyle,tibial medial plateau and tibial lateral plateau were measured.BMD ratio of tibial medial plateau to tibial lateral plateau and the BMD ratio of femoral medial condyle to femoral lateral condyle were calculated.BMD in medial and lateral compartments of the femur and tibia were compared between the two groups,followed by subgroup analyses based on gender and age.Spearman correlation was used to analyze the correlation between the BMD ratio of tibial medial plateau to tibial lateral plateau,the BMD ratio of femoral medial condyle to femoral lateral condyle and the degree of varus in the knee varus group.Results The BMD of the medial femoral condyles and medial tibial platforms were higher in the knee varus group than those in the normal force line group.The BMD of femoral lateral condyle and lateral tibial platform was lower in the knee varus group than that in the normal force line group.The BMD ratio of the medial to lateral tibial plateaus was greater than one in both groups,and the ratio of the knee varus group was greater.The BMD ratio of femoral medial to lateral condyle in the knee varus group was significantly higher than that in the normal force line group.For women,these findings were more pronounced and were independent of age.Correlation analysis showed that the BMD ratio of medial tibial plateau to lateral tibial plateau was negatively correlated with HKA angle(rs=-0.436,P＜0.01),and the BMD ratio of the medial femoral condyle to lateral femoral condyle was also negatively correlated with HKA angle(rs=-0.394,P＜0.01).Conclusion The BMD of medial femoral and tibial compartment is increased and the BMD of lateral compartment is decreased in the genu varus group compared with the normal force line group.

Objective To explore the feasibility of robot-assisted radical prostatectomy(RARP)in the treatment of highly suspected prostate cancer without biopsy,in order to provide reference for clinical practice.Methods This study included 82 patients with highly suspected prostate cancer treated in our hospital during Jan.2021 and Dec.2022.The patients were divided into the puncture group(n=41)and non-puncture group(n=41)with random number table method.All patients underwent RARP.Biopsy was performed before operation in the puncture group while no biopsy was performed in the non-puncture group.The main outcome indicators(diagnostic accuracy,complications,hospital stay,hospital costs,urinary control rate)and secondary outcome indicators(operation time,intraoperative blood loss,number of blood transfusion,catheter indwelling time,positive incisal margin,anxiety and depression scores before and after treatment)were compared between the two groups.Results All 41 cases(100％)in the puncture group were prostate cancer,and 40 cases(97.56％)in the no-puncture group were pathologically confirmed as prostate cancer.The non-puncture group had significantly lower perioperative complication rate(19.52％vs.2.50％),shorter operation time[(75.31±20.35)min vs.(60.25±10.64)min],less intraoperative blood loss[(141.25±30.45)mL vs.(111.45±33.58)mL],shorter hospital stay[(7.89±1.21)d vs.(5.13±1.02)d],lower total hospital costs[(4.12±0.56)ten thousand yuan vs.(2.61±0.43)ten thousand yuan],and lower anxiety and depression scores[(7.02±1.25)vs.(1.99±0.42);(7.05±1.31)vs.(1.95±0.38)](P＜0.05).The no-puncture group had slightly higher urinary control rate 1,6 and 12 months after treatment than the puncture group(75.00％vs.58.54％;87.50％vs.80.49％;95.00％vs.92.68％),but with no statistical significance(P＞0.05).Conclusion RARP is feasible in the surgical treatment of prostate cancer without biopsy,which can shorten the postoperative rehabilitation time,reduce the hospital costs,and alleviate the anxiety and depression of patients.

Objective:The purpose of this study was to investigate the expression and role of N-myc downstream regulatory gene 2 (NDRG2) in radiation resistance of bladder cancer cells.Methods:T24 cells were cultured in vitro and irradiated with different doses of X-ray (0, 2, 4, 8, 10 and 20 Gy). The best dose of X-ray was selected for subsequent treatment. The radioresistant BCa cell line T24/R was established. The cytotoxicity of T24/R cells was detected by counting kit-8 (CCK-8) method. The proliferation and invasion ability of T24/R cells and T24 cells were detected by flow cytometry and transwell, respectively. Western blot was used to detect the expression of epithelial mesenchymal transition (EMT) related proteins. The survival rate of T24/R group (control group) and T24/R-NDRG 2 group was detected, and the migration ability of T24/R-NDRG 2 cells was detected after 2 Gy treatment. Results:The cell viability was inhibited significantly when the dose of X-ray was ≥2 Gy X-ray, so 2 Gy X-ray irradiation was chosen as the best condition for BCa cytotoxicity and T24/R radiation resistance cell line was successfully established; Apoptosis test showed that the number of S-phase cells was increased in T24/R group, and the proportion of S-phase cells in T24/R vs T24 was (26.49±4.5)% vs (14±2.6)% ( P<0.05); Transwell test showed that T24/R cells showed stronger migration ability than control group ( P<0.05), but there was no significant difference in EMT related protein expression between the two groups ( P>0.05). Overexpression of NDRG2 can significantly decreased the activity and migration ability of radiation-resistant T24/R cells ( P<0.05) when the radiation dose was gradually increasing in both groups. Conclusions:The radiation resistance of BCa cells is one of the causes of local tumor recurrence. Up-regulation of NDRG2 expression can inhibit the radiation resistance of T24 cells, so it can be used as a candidate for treatment of radiation-resistant BCa patients.

Objective:To explore the clinical effect of repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap.Methods:The clinical data included 15 patients with distal thumb degloving injury received in Yongkang Orthopedic Hospital from March 2015 to June 2018. These patients included 10 males and 5 females, aged between 24 and 61 years. For the injury, 7 cases were beyond the interphalangeal joint, 8 cases were beyond the nail root. The length of the distal segment of degloving finger was 1.8 to 2.3 cm, and the skin and soft tissue defect ranged from 1.8 cm × 4.6 cm to 2.3 cm × 5.6 cm. The distal thumb degloving injury was repaired with B-shaped first palmar dorsal neurocutaneous vascular flap. The radial dorsal metacarpal nerve of the first metacarpal was anastomosed with the ulnar proper digital nerve stump. And full-thickness skin graft transplantation was performed in donor area. After the operation, the shape and function of the thumb were followed up. The sensory function of the skin was determined by British Medical Research Association Sensory Function Evaluation Standard, and the function of the thumb was evaluated with reference to the total active movement (TAM) of fingers of the Chinese Medical Association Hand Surgery Branch.Results:The flap area was 2.0 cm × 5.0 cm-2.5 cm × 6.0 cm, and all the flaps were survived. Follow-up period was 5-18 months after the operation, with an average of 10 months. The flap at the thumb repair site was soft, wear-resistant, non-bloated, no obvious pigmentation. Its protective sensation was restored. The two-point discrimination of the flap reached 8-11 mm, with an average of 9.3 mm, basically restoring the original shape and function of the thumb. There were 13 cases reaching the S3 + flap sensory function, 2 cases reaching S3. The thumb function was evaluated as excellent for 9 cases, and good for 6 cases. There were no complications such as scar contracture and hypersensitivity in the donor area. Conclusions:The repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap can complete skin coverage and sensory reconstruction, with satisfactory postoperative effect.

Objective:To investigate the curative effect of transfer of free anteriolateral thigh flap (ALTF) with partial iliotibial tract on reconstruction of composite tissue defects in dorsal wrist/hand.Methods:Ten patients who were admitted in the Department of Hand Surgery of Yongkang Orthopaedic Hospital from March 2018 to August 2022 were entered in the study due to extensive composite tissue defects in dorsal wrists and hands. The patients were 24-48 (37 in average) years old. All patients had tendon defects in 3 or more digits with 35 digits in total. The length of the tendon defects were 5.0-11.0 cm in various digits. The soft tissue defects ranged from 6.0 cm×8.0 cm to 11.0 cm×21.0 cm in size. Six patients had defects accompanied with metacarpal and phalangeal bone fracture and joint capsule. In emergency surgery, all patients received thorough debridement and VSD coverage after internal fixation for combined fractures. At 3-5 days after the primary surgery, free ALTF transfer with partial iliotibial tract was employed to reconstruct the defects on dorsal wrists and hands and the digit extension function. The size of flap was 6.0 cm×9.0 cm-9.0 cm×17.0 cm, and the rest of defect wound was covered by skin graft. All the donor sites were sutured directly, except 1 that received abdominal skin graft. Patients had the follow-ups in outpatient clinics, or via telephone or Wechat, to observe the sensation and appearance of the flap, and the healing of the donor site. The recovery of the extension function of the hand was evaluated according to the totle active motion (TAM) system.Results:All flaps survived except one that had vascular compromise after the surgery and it survived after two explorations and a vascular transfer. Postoperative follow-ups lasted for 6 to 24 months, with 13 months in average. At the last follow-up, a all the flaps were found soft in texture and slightly swollen in appearance. There was no obvious pigmentation or rupture of skin and extensor tendon. Sensory recovery achieved to S 2 in 7 patients and S 3 in 3 patients. The hand function was evaluated according to TAM system and rated as excellent for 3 digits, good for 18 digits, fair for 9 digits and poor for 5 digits. There were linear scars in the donor sites. Conclusion:Free ALTF transfer with partial iliotibial tract in the reconstruction of composite tissue defect of dorsal wrists and hands can not only reconstruct the wound surface, but also the extension of digits, which cuts short the course of treatment.

Objective:To explore the clinical effect of repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap.Methods:The clinical data included 15 patients with distal thumb degloving injury received in Yongkang Orthopedic Hospital from March 2015 to June 2018. These patients included 10 males and 5 females, aged between 24 and 61 years. For the injury, 7 cases were beyond the interphalangeal joint, 8 cases were beyond the nail root. The length of the distal segment of degloving finger was 1.8 to 2.3 cm, and the skin and soft tissue defect ranged from 1.8 cm × 4.6 cm to 2.3 cm × 5.6 cm. The distal thumb degloving injury was repaired with B-shaped first palmar dorsal neurocutaneous vascular flap. The radial dorsal metacarpal nerve of the first metacarpal was anastomosed with the ulnar proper digital nerve stump. And full-thickness skin graft transplantation was performed in donor area. After the operation, the shape and function of the thumb were followed up. The sensory function of the skin was determined by British Medical Research Association Sensory Function Evaluation Standard, and the function of the thumb was evaluated with reference to the total active movement (TAM) of fingers of the Chinese Medical Association Hand Surgery Branch.Results:The flap area was 2.0 cm × 5.0 cm-2.5 cm × 6.0 cm, and all the flaps were survived. Follow-up period was 5-18 months after the operation, with an average of 10 months. The flap at the thumb repair site was soft, wear-resistant, non-bloated, no obvious pigmentation. Its protective sensation was restored. The two-point discrimination of the flap reached 8-11 mm, with an average of 9.3 mm, basically restoring the original shape and function of the thumb. There were 13 cases reaching the S3 + flap sensory function, 2 cases reaching S3. The thumb function was evaluated as excellent for 9 cases, and good for 6 cases. There were no complications such as scar contracture and hypersensitivity in the donor area. Conclusions:The repair of distal thumb degloving injury with B-shaped first palmar dorsal neurocutaneous vascular flap can complete skin coverage and sensory reconstruction, with satisfactory postoperative effect.

Animals ; Coronary Vessels ; Diabetes Mellitus ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Rats