OBJECTIVE: To investigate the effectiveness of free palmaris longus tendon graft reconstruction in the treatment of gouty tophus erosion lesions in flexor tendon of wrist and hand. METHODS: A retrospective analysis was conducted on 8 patients with gouty tophus erosion lesions in flexor tendon of wrist and hand who underwent free palmaris longus tendon graft reconstruction between June 2017 and December 2023. All patients were male, aged 22-65 years, with an average of 45.9 years. The duration of gout history ranged from 2 to 18 years, with an average of 8.8 years. The duration from the discovery of gouty tophus to operation ranged from 12 to 26 months, with an average of 17.6 months. The gouty tophus eroded the flexor pollicis longus tendon in 4 cases, with Verdan flexor tendon zones being Ⅰ-Ⅱ in 1 case and Ⅳ-Ⅴ in 3 cases. The flexor digitorum profundus tendons were affected in 2 cases for the index finger, 1 for the middle finger, and 1 for the ring finger, all located in zone Ⅳ-Ⅴ. The long axis of the gouty tophus ranged from 2.3 to 4.5 cm, with an average of 3.4 cm. All 8 patients presented with limited finger flexion and extension. Among them, 4 cases were accompanied by median nerve compression symptoms, and 1 case had associated bone and joint destruction in the hand. The total active motion (TAM) of the affected finger was (81.3±30.2)° before operation according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, and the functional evaluation was poor. The harvested palmaris longus tendon intraoperatively was 7-9 cm in length. RESULTS: Surgical incisions in all 8 patients healed by first intention, with no infections, graft non-union, or significant adhesion complications. All patients were followed up 8-25 months, with an average of 14.8 months. Numbness symptoms resolved in all 4 patients who presented with median nerve compression symptoms. Patients did not experience wrist pain or other discomfort, and function was not compromised. At last follow-up, according to the hand function evaluation criteria for tendon repair by the Chinese Society of Hand Surgery of the Chinese Medical Association, the TAM of 8 patients was (197.5±55.8)°, which significantly improved when compared with that before operation ( t=11.638, P<0.001); the hand function of 1 patient with gouty tophus in zone Ⅰ-Ⅱ flexor pollicis longus tendon was good, and the other 7 patients were excellent. CONCLUSION Free palmaris longus tendon graft reconstruction demonstrates good effectiveness in treating gouty tophus erosion lesions in flexor tendon of wrist and hand.
Humans ; Middle Aged ; Male ; Adult ; Tendons/surgery* ; Retrospective Studies ; Aged ; Gout/complications* ; Wrist/surgery* ; Plastic Surgery Procedures/methods* ; Hand/surgery* ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore the effectiveness of multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repair of amputated palm injury distal to the superficial palmar arch. METHODS: Between September 2018 and July 2023, 5 patients with amputated palm injury distal to the superficial palmar arch were treated. There were 3 males and 2 females with an average age of 35.4 years (range, 29-52 years). The time from injury to admission was 1-6 hours (mean, 3.2 hours). The multi-segment inverted Y-shaped vein transplantation in the anterior lateral malleolar venous network were used to repair the common and proper palmar digital arteries; the another anterior lateral malleolar venous network was used to repair the dorsal vein of the hand. The soft tissue defect of dorsal hand in 1 patient was repaired with the pedicled ilioinguinal flap, and the wound at the donor site was directly sutured. Postoperative treatment included anti-infection therapy, antispasmodic therapy, and thrombosis prevention measures. RESULTS: The partial necrosis of the fingertip of the thumb occurred in 1 case, and the marginal necrosis of the abdominal flap after operation occurred in 1 case. The remaining fingers showed good blood supply with normal tension. The incision at donor site of the abdominal flap healed by first intention. All patients were followed up 8-41 months (median, 19 months). At last follow-up, the hand contour was satisfactory; the grasping function, opposition function, and proprioception recovered, and two-point discrimination ranged from 5 to 7 mm (mean, 6 mm). According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association, the functional outcomes were excellent in 3 cases, good in 1 case, and fair in 1 case. CONCLUSION The multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repairing defects in the common and proper palmar digital arteries distal to the superficial palmar arch offers advantages such as superficial location, flexible harvesting, and high compatibility. This technique has demonstrated favorable outcomes in complex transmetacarpal amputation reconstruction.
Humans ; Adult ; Male ; Female ; Hand Injuries/surgery* ; Middle Aged ; Plastic Surgery Procedures/methods* ; Veins/transplantation* ; Surgical Flaps/blood supply* ; Hand/surgery* ; Treatment Outcome ; Soft Tissue Injuries/surgery*

Objective:To investigate the clinical effect of free posterior tibial artery perforator flap in repair of forefoot soft tissue defect.Methods:From January 2017 to January 2021, a retrospective study was conducted on 13 patients with forefoot soft tissue defect, metatarsal head exposed, and forefoot transverse arch integrity, including 9 males and 4 females. The age was (40.0±13.0) years old. Cause of injury: 8 cases of traffic accident injury, 5 cases of heavy object smashing injury. Seven cases had forefoot skin defect and toe damage, and 6 cases had forefoot skin avulsion injury, open toe fracture with tendon, blood vessel and nerve injury. The wound area was 4.5 cm×3.0 cm-8.0 cm×6.0 cm. VSD treatment was performed in the first stage, and free posterior tibial artery perforator flap was used for the second stage. The flap area was 5.5 cm×4.0 cm-9.0 cm×7.0 cm. Outpatient reviews scheduled at 1, 2, 3, and 6 months after surgery, through outpatient clinic, telephone or WeChat. The flaps were evaluated according to appearance, texture, sensory recovery, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot function scoring system.Results:All 13 flaps survived. The follow-up lasted for 6 to 24 months. The feet were in good shape, walking with weight beries, and the flaps had satisfactory appearance without wear and tear. Five cases were S 3, 6 were S 2, and 2 were S 1. According to AOFAS ankle-hindfoot function score, 4 had excellent scores, 7 were in good, and 2 in fair. Conclusion:The free posterior tibial artery perforator flap has relatively constant perforators, and the pedicle of the middle and upper perforators is longer, and the flap can build part of the sensation. Posterior artery perforator flap is a good flat for repairing the soft tissue defects of the metatarsal head of the forefoot.

Objective:To summarise the clinical experience in replantation of the severed auricle distal to helix with microsurgical technique.Methods:From December 2018 to October 2021, a total of 5 patients with severed auricle injury were treated in the Department of Hand and Foot Surgery of The Affiliated Hospital of Qingdao University. They were 4 males and 1 female with 23-62 years old. After complete debridement of the auricular pinna, the retrograde replantation method was used. For arteries: a dorsal vein of the foot was used to bridge the posterior auricular artery. For veins: 2 patients had the veins directly anastomosed, 2 had the arteriovenous bridging to the posterior ear vein with dorsal foot veins, and the veins in 1 case were not anastomosed. Among the patients, 2 developed venous occlusions after severed auricle, and were treated with bloodletting through small incision at the skin margin. Two patients who received the arteriovenous of the severed auriclse achieved good blood supply. All the patients underwent treatments including anti-freezing, anti-spasm and anti-infection after the emergency surgery. The follow-ups were conducted regularly by telephone and by display photos via WeChat after surgery.Results:All 5 severed auricles were successfully replanted and survived. Postoperative follow-up ranged from 3 months to 2 years, with an average of 10 months. In the 2 cases with venous crisis, the auricles had mild atrophy. All auricles had no obvious pigmentation, and had the sensation recovery back to normal in 1 year after surgery.Conclusion:The pre-judgment of blood vessel quality and high-quality microsurgery skills are the necessary pre-conditions for auricle replantation. For replantation of severed auricle, it is the key to prevent vascular crisis by having the injured blood vessels thoroughly removed.

To report a case of completely amputated ear beyond the anthelix with a severe cross section contusion. After the inspection and exclusion of coronavirus disease (COVID-19) as per prevention and control procedure, an ear replantation surgery was performed under strict protective measures. At 2 week of followed-up, the replanted auricle survived well and the left ear showed a good appearance.

Objective To investigate the clinincal curative effects of superficial palmar branch of radial artery (SPBRA) flaps with anastomosed accompanying vein repairing soft tissues defects in fingers.Methods From January,2016 to June,2017,10 cases with soft tissues defects received the operation of superficial palmar branch of radial artery flaps transplantation.In the process of operation,the superficial palmar branch of radial artery (SPBRA) was carefully separated,accompanying vein and superficial vein.The SPBRA was anastomosed with the proper digital artery,while the accompanying vein of superficial palmar branch and superficial vein were anastomosed with the palm vein.The nerve supplied this flap was anastomosed with the proper digital nerve.Mesured the range of motion and two-points discrimination of fingers with following-up.Regular followed-up was performed after operation.Results All patients were followed-up ranged from 6 to 24 months,averaged of 13.8 months.All flaps survived.The shape of flaps was plump and the two-points discriminations ranged from 8 to 12mm.Conclusion Using SPBRA flaps with anastomosed accompanying vein to repair soft tissues defects in fingers,there were minor damage to donor and recipient sites,and the shape and sense of recipient site was perfect.It is a promising treatment choice for patients with soft tissues defects in fingers.

Objective To study the techniques and outcomes of using a retrograde pedicled vascularized radius bone flap based on the 1st,2nd intercompartmental supraretinacular artery (1,2ICSRA) for scaphoid nonunion through dorsal and palmar approaches.Methods Between March 2013 and April 2015,16 patients with scaphoid nonunion were treated by surgery through palmar and dorsal approaches.There were 14 males and 2 females with an average age of 29.1 years (range,19-51 years).The location of lesion was 6 cases on the left and 10 cases on the right.5 cases were treated with plaster fixation.11 cases weren't treated after wrists injured.The preoperative time was 6-26 months,with an average of 16.5 months.The operation was completed within one incision.The bone flaps based on 1,2ICSRA were taken through dorsal approach.The broken ends of the scaphoid fracture were cleaned,and the deformity was corrected with bone grafting and internal fixation through palmar approach.Time of fracture union and wrist pain resolution was evaluated.Wrist motion and grip strength were measured and compared.The result of the latest follow-up was used as the criterion for efficacy evaluation.The wrist pain was evaluated using visual analogue scale (VAS) and the postoperative wrist function based on the modified Mayo wrist score was recorded.Results Post-operative follow up ranged from 6-19 months,with an average of 11 months.Bone union was achieved in all the cases,so the healing rate was 100％.7 cases were healed in 11 weeks.5 cases were healed in 13 weeks.3 cases were healed in 15 weeks.1 case was healed in 17 weeks.The average healing time was 12.5 weeks.The humpback deformity of Scaphoid and DISI of 7 cases were corrected.The bending of wrist could reach 60.2°±3.2°,and the elongation could reach 51.3°± 3.5°.The radial deviation of wrist could reach 13.6°±1.42°,and ulnar deviation could reach 24.4°±1.8°.The range of grip strength was 29-64 kg,with an average of 45 kg.The 16 patients returned to normal work.The pain after wrist movement of 14 cases was completely disappeared,and the VAS was 0.Two cases felt slight pain when wrist was overworked,and the VAS were 0.9 and 1.2.The wrist joint function of patients recovered well.The modified Mayo score was 69-99,with an average of 90.75.The functional results were 12 excellent,2 good,and 2 fair,and the excellent and good rate was 87.5％ (14/16).No complications such as infection,failure of screws,orthopaedic arthritis or scaphoid necrosis were found during the follow-up period.Conclusion The technique of 1,2 ICSRA pedicled bone graft and palmar bone grafting for nonunion of scaphoid can provide convenience for us to deal with the broken ends of the scaphoid fracture,correct the malformation and graft bone through dorsal and palmar approaches.This method can protect the blood supply of the scaphoid,and promote scaphoid union.

Objective To evaluate the efficacy and safety of dorsal ligament reconstruction in treatment of old dorsal dislocation of distal radioulnar joint.Methods Seven patients with old dorsal dislocation of distal radioulnar joint were treated with dorsal ligament reconstruction using the palmaris longus tendon from March 2005 to May 2012 in our institute,including 4 males and 3 females with a mean age of 37 years.All patients had a history of wrist injury for more than 3 months and were diagnosed as isolated dislocation of distal radioulnar joint without fractures.During the operation a bone tunnel was made at dorsal ulnar side of radius near the ulnar notch,which was parallelized to long axial of ulna,two holes were drilled from dorsal to palmarulnaris side through the extensor carpi ulnaris sulcus of the ulna.The palmaris longus tendon was harvested and the strip of the tendon was penetrated through the radial hole.After the tips being crossed,put them through the holes of ulna,reduct the distal radioulnar joint by supinating the forearm,the strip of the tendon was sutured after being tightened,the reversed back the free end of the tendon to reconstruct the sheath of extensor carpi ulnaris tendon.Postoperatively,the upper extremity were kept in a long arm plaster in the position of elbow flexion 90° and forearm supination for 3 weeks,then the below elbow cast was replaced for another 3 weeks.Results Patients were followed-up for 1 year and 8 months 4 years and 2 months with the average of 2 years and 9 months.The rotation of wrist was improved and the handgrip strength was increased significantly.A functional evaluation was performed using the modified Mayo wrist scoring system.All patients had better wrists scores postoperatively (mean,93) compared to preoperatively (mean,68).All patients satisfied with the final result.Conclusion Dorsal ligament reconstruction should be a promise surgical modality for the old dorsal dislocation of distal radioulnar joint.