Objective:To simulate the neuroendoscopy assisted contralateral cervical 7 (C 7) nerve transfer via prespinal route and measure its relevant anatomical landmarks to explore the clinical feasibility and efficacy of this surgical approach for central upper limb spastic paralysis. Methods:(1) Six fresh cadaver specimens of the head and neck were obtained. Linear incisions of approximately 5 cm were made above the midpoint of the bilateral clavicles to simulate neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route. With the superior margin of midpoint of the clavicle as central point, distance to the distal bifurcation of the C 7 nerve, distances to the superior or inferior trunks of the proximal brachial plexus nerves, and distances to the exit of the intervertebral foramina of the C 6, C 7, and C 8 nerves were measured. (2) One patient with upper limb spastic paralysis after intracerebral hemorrhage accepted neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route; the clinical data and efficacy of the patient were retrospectively analyzed. Results:(1) The C 7 nerve, the upper trunk of brachial plexus formed by the C 5 and C 6 nerves and the lower trunk of brachial plexus formed by the C 8 and T 1 nerves could be exposed after neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route. The distance between the superior margin of midpoint of the clavicle and the distal bifurcation of the C 7 nerve is (2.20±0.11) cm, and its distance to the superior trunk of the proximal brachial plexus is (2.62±0.10) cm, and its distance to the inforior trunk of the proximal brachial plexus nerve is (2.72±0.11) cm. The distance between the superior margin of midpoint of the clavicle and the proximal C 7 nerve (at the exit of the intervertebral foramen) is (7.22±0.15) cm, its distance to the proximal C 6 nerve (at the exit of the intervertebral foramen) is (7.84±0.12) cm, and its distance to the proximal C 8 nerve (at the exit of the intervertebral foramen) is (6.96±0.12) cm. (2) The patient with central upper limb spastic paralysis accepted neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route successfully, with surgical time lasting for 2 h and bleeding amount of 20 mL. After surgery, the incision healed well, and the patient experienced pain and numbness in the healthy side of the upper limb with subsided symptoms one month after surgery. The spasticity symptoms of the affected upper limb obviously improved after surgery with decreased muscle tone. Follow-up after discharge was performed for 14 months, and the muscle strength of the affected upper limb recovered to level 1 +. Conclusion:Neuroendoscopy assisted contralateral C 7 nerve transfer via prespinal route can expose the proximal and distal C 7 nerves, with minimal invasion; this clinical study has preliminarily confirmed the safety and effectiveness of this transfer via prespinal route in central upper limb spastic paralysis.

Objective:To investigate the clinical effect of super-thin free anterolateral thigh (ALT) flap at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defects of the foot.Methods:The clinical data of patients with foot soft tissue defects admitted to Northern Jiangsu People’s Hospital Affiliated to Yangzhou University from June 2017 to December 2022 were retrospectively analyzed. During the operation, the super-thin free ALT flap on the affected side was harvested at the junction of superficial and deep fat of superficial fascia to repair the foot wound. The donor site wound was sutured directly or repaired with full-thickness skin graft. The flap survival and complications were observed after the operation, and the operation effect was evaluated from the following five aspects. (1) The Maryland foot function score was used to evaluate the recovery of foot function. The full score was 100 points, of which 90-100 points were excellent, 75-89 points were good, 50-74 points were fair, and < 50 points were poor. (2) The Vancouver scar scale (VSS) was used to evaluate the scar condition of the foot. The total score was 0-15 points. The higher the score, the more serious the scar. (3) The cold intolerance symptom severity (CISS) scale was used to evaluate the cold tolerance of the affected foot. The total score was 4-100 points. The higher the score, the more serious the symptoms. (4) Measuring static two-point discrimination to evaluate foot sensation, the smaller the measured value, the better the sensory recovery. (5) The satisfaction of patients with foot appearance was investigated, which was divided into five grades: very satisfied, satisfied, general, dissatisfied and very dissatisfied. Descriptive analysis of the data was performed using SPSS 26.0 software.Results:A total of 13 patients with foot soft tissue defects were enrolled, including 8 males and 5 females. The mean age was 54.7 years (range, 39-70 years). There were 10 cases of left foot and 3 cases of right foot. The wound area after thorough debridement ranged from 5.5 cm ×5.0 cm to 22.0 cm ×18.0 cm. The operation time was (145.1 ± 30.6) min. The area of the flap was 6.0 cm×5.5 cm to 23.5 cm×19.0 cm, and the thickness was (5.2 ± 1.1) mm (range, 3.0- 6.5 mm). The wound at the donor site was sutured directly in 9 cases, and coverd with the abdominal full-thickness skin graft in 4 cases. After the operation, 1 patient had partial epidermal necrosis at the distal end of the flap, 1 patient had venous crisis.The flaps survived after symptomatic treatment. The remaining 11 flaps survived smoothly. The patients were followed up for 12 to 20 months, with an average of 16 months. The foot flaps were soft and free of damage, and no secondary fat reduction or plastic surgery was required. There were no complications such as wound dehiscence, skin graft necrosis, muscle hernia, and quadriceps weakness in 13 cases of donor site except for hypoesthesia caused by scar hyperplasia in 4 cases with skin graft. At the last follow-up, the Maryland foot function score was (87.4±7.3) points, of which 7 cases were excellent, 4 cases were good, and 2 cases were fair. The excellent and good rate was 11/13. The foot scar was not obvious, the VSS score was (3.2±1.2) points. The foot was more tolerant to cold and the sensory recovery was better, the CISS score was (37.5±7.1) points and the static two-point discrimination was (13.9±1.0) mm. One month after the operation, the results of patients’ satisfaction with foot appearance were as follows: 11 cases were very satisfied and 2 cases were satisfied.Conclusion:The super-thin free ALT flap is obtained at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defect of the foot, which can optimize the operation time. The appearance and function of the foot recover well after the operation, avoiding the secondary shaping operation, reducing the damage to the donor site, and the patients are satisfied.

Objective:To investigate the clinical effect of super-thin free anterolateral thigh (ALT) flap at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defects of the foot.Methods:The clinical data of patients with foot soft tissue defects admitted to Northern Jiangsu People’s Hospital Affiliated to Yangzhou University from June 2017 to December 2022 were retrospectively analyzed. During the operation, the super-thin free ALT flap on the affected side was harvested at the junction of superficial and deep fat of superficial fascia to repair the foot wound. The donor site wound was sutured directly or repaired with full-thickness skin graft. The flap survival and complications were observed after the operation, and the operation effect was evaluated from the following five aspects. (1) The Maryland foot function score was used to evaluate the recovery of foot function. The full score was 100 points, of which 90-100 points were excellent, 75-89 points were good, 50-74 points were fair, and < 50 points were poor. (2) The Vancouver scar scale (VSS) was used to evaluate the scar condition of the foot. The total score was 0-15 points. The higher the score, the more serious the scar. (3) The cold intolerance symptom severity (CISS) scale was used to evaluate the cold tolerance of the affected foot. The total score was 4-100 points. The higher the score, the more serious the symptoms. (4) Measuring static two-point discrimination to evaluate foot sensation, the smaller the measured value, the better the sensory recovery. (5) The satisfaction of patients with foot appearance was investigated, which was divided into five grades: very satisfied, satisfied, general, dissatisfied and very dissatisfied. Descriptive analysis of the data was performed using SPSS 26.0 software.Results:A total of 13 patients with foot soft tissue defects were enrolled, including 8 males and 5 females. The mean age was 54.7 years (range, 39-70 years). There were 10 cases of left foot and 3 cases of right foot. The wound area after thorough debridement ranged from 5.5 cm ×5.0 cm to 22.0 cm ×18.0 cm. The operation time was (145.1 ± 30.6) min. The area of the flap was 6.0 cm×5.5 cm to 23.5 cm×19.0 cm, and the thickness was (5.2 ± 1.1) mm (range, 3.0- 6.5 mm). The wound at the donor site was sutured directly in 9 cases, and coverd with the abdominal full-thickness skin graft in 4 cases. After the operation, 1 patient had partial epidermal necrosis at the distal end of the flap, 1 patient had venous crisis.The flaps survived after symptomatic treatment. The remaining 11 flaps survived smoothly. The patients were followed up for 12 to 20 months, with an average of 16 months. The foot flaps were soft and free of damage, and no secondary fat reduction or plastic surgery was required. There were no complications such as wound dehiscence, skin graft necrosis, muscle hernia, and quadriceps weakness in 13 cases of donor site except for hypoesthesia caused by scar hyperplasia in 4 cases with skin graft. At the last follow-up, the Maryland foot function score was (87.4±7.3) points, of which 7 cases were excellent, 4 cases were good, and 2 cases were fair. The excellent and good rate was 11/13. The foot scar was not obvious, the VSS score was (3.2±1.2) points. The foot was more tolerant to cold and the sensory recovery was better, the CISS score was (37.5±7.1) points and the static two-point discrimination was (13.9±1.0) mm. One month after the operation, the results of patients’ satisfaction with foot appearance were as follows: 11 cases were very satisfied and 2 cases were satisfied.Conclusion:The super-thin free ALT flap is obtained at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defect of the foot, which can optimize the operation time. The appearance and function of the foot recover well after the operation, avoiding the secondary shaping operation, reducing the damage to the donor site, and the patients are satisfied.

Congenital insensitivity to pain with anhidrosis (CIPA)is a rare disease which mainly affects infants, children and adolescents. As an autosomal recessive disorder, CIPA is also known as familial autonomic dysfunction type 2. The diagnosis of CIPA mainly relies on clinical observation and genetic testing. Currently there is a lack of effective treatment, and it is mainly treated by cooling, anti-inflammatory and strengthened guardianization. This article has reviewed the literature and summarized the research on CIPA and progress made in its diagnosis and treatment, with an aim to improve the understanding of this disorder.

Objective:To discuss the effect of fingertip reconstruction with V-Y advancement flap and nailbed suture treating Allen’s type Ⅲ amputations unsuitable for vascular anastomosis.Methods:From September 2018 to December 2020, clinical data of patients with Allen’s type Ⅲ fingertip amputations treated in Northern Jiangsu People’s Hospital were analyzed retrospectively. The fingertips were reconstructed with V-Y advancement flap and nailbed suture. The infeasibility of vascular anastomosis was checked under the microscope. Following fixation of the distal phalanx, the nailbed was stretched as flat as possible and sutured. If the nail plate was missing, a manual nail plate made from a plastic transfusion pipe would be fixed to cover the exposed nailbed. The palmar soft tissue of the amputated fingertip was excised, and periosteum, hyponychium, nailbed, and dorsal soft tissue were retained. The proximal volar skin was incised until the subcutaneous adipose layer to get a V-Y advancement flap. The volar defect was repaired with the V-Y advancement flap distally sutured with the pre-retained hyponychium. Postoperatively, burn cream was smeared on the nail for moisturizing, without lamp heating, and intravenous antibiotics was administered routinely. The main indexes were collected including nail appearance, pulp plumpness, static two-point discrimination, motion loss of the distal interphalangeal joint, and patients’ self-evaluation of the appearance. Chinese Medical Association trial standard of upper limb partial function assessment (CMA evaluation) was used to evaluate finger function.Results:A total of 16 patients with 18 fingertips were included. There were 9 males and 7 females, aged (31.5±6.1) years (21-52 years). There were 14 cases of single fingertips injury and 2 cases of multiple fingertips injury. Damaged finger: 2 of thumb, 3 of indicator finger, 6 of middle finger, 5 of ring finger, 2 of little finger. All 18 fingertips survived postoperatively and followed up for 7-16 months (median 12 months). One case underwent a second surgery due to infection and mild bone exposure followed by good healing. One case had a slightly hooked nail. The fingertip appearance was satisfying or acceptable by all the patients except the above two. Good results were got for all patients such as bone healing, smooth nail, plump pulp, and flexible distal interphalangeal joint. At the latest follow-up, motion loss of the distal interphalangeal joint was 0°-3.6° (mean 2.4°) for extension and 2.0°-12.0° (mean 7.6°) for flexion. The static two-point discrimination was 2.5-4.6 mm (mean 3.8 mm). Respectively, the functional evaluation of the affected finger was excellent in 11 cases, good in 3 cases and fair in 2 cases according to the CMA evaluation.Conclusion:Fingertip reconstruction with V-Y advancement flap and nailbed suture is a good technique to treat Allen’s type Ⅲ amputations, with advantages of preserved fingertip length, smooth nail, plump pulp, good sensory and flexible distal interphalangeal joint. The technique is simple with a high success rate and good results.

Hand hemangioma combined with aneurysm is rare and its specific clinical diagnosis and treatment method are not yet clear. In February 2021, a 49-year-old female patient with a right small finger hemangioma and aneurysm was diagnosed and treated in the Department of Hand and Foot, Northern Jiangsu People’s Hospital. The patient was admitted to the hospital due to a tumor in the right little finger for 1 year. A low-echo mass with blood flow in the subcutaneous layer of the right little finger was detected on Doppler ultrasound and considered a hemangioma. Other laboratory tests and physical examinations showed no obvious abnormalities. The preoperative diagnosis was a right little finger mass (hemangioma). After completing the preoperative examination, we performed a resection of the hemangioma of the right little finger. Postoperative pathology showed that the mass located on the volar side of the right little finger was consistent with an aneurysm, and the one on the dorsal side of the right little finger was consistent with a venous aneurysm. After 2 years of follow-up, there was no recurrence of the lesion.

Objective:To introduce the therapeutic effect of forearm radial artery perforator propeller flap for repair of hand and wrist soft tissue defects.Methods:The clinical data of patients with soft tissue defects of hand and wrist who received the treatment with forearm radial artery perforator propeller flap in Northern Jiangsu People’s Hospital from January 2018 to September 2020 were collected. The radial artery of the forearm was projected on the skin surface as the axis, and the nearest perforator was selected as the rotation point according to the location of the soft tissue defect. The radial artery perforator propeller flap was designed based on the location, area and shape of soft tissue defect. The length of the large paddle of the flap is equal to the distance between the proximal side of the wound edge and the rotation point plus the length of the wound, and the length of the small paddle of the flap is equal to the distance between the proximal side of the wound edge and the rotation point. The donor site was closed directly or with full-thickness skin graft from the ipsilateral upper arm. The survival, appearance of the flap and skin graft, hand and wrist function and patients satisfactory rate were observed and recorded.Results:A total of 6 patients were included, including 4 males and 2 females; the mean age was 40.5 years (range, 25-65 years ). There were 1 case on the palm side of the hand, 1 case on the dorsal side of the hand, 3 cases on the volar side of the wrist, and 1 case on the dorsal side of the wrist. The area of soft tissue defect after debridement was 2 cm × 3 cm-7 cm × 10 cm. The forearm radial artery perforator propeller flap ranged from 3 cm × 4 cm to 8 cm × 11 cm. The donor site was closed directly in 3 cases, and with full-thickness skin graft in 3 cases. The flaps in all 6 patients survived completely with primary healing. The skin grafts for the donor site in 3 cases survived completely. The patients were followed up for 3 months to 1 year, with an average of 5 months. The function of the hand and wrist recovered well. The texture of the flap was similar to that of the surrounding tissue with good appearance, no swelling or slight swelling, no obvious color difference. The donor site healed well without scar hyperplasia. The patients were satisfied with the surgical results.Conclusion:Propeller flap pedicled with forearm radial artery perforator is a simple and effective method to repair soft tissue defects of wrist and hand with reliable recovery of appearance and function. The patients’ satisfactory rate is also high.

Objective:To discuss the effect of fingertip reconstruction with V-Y advancement flap and nailbed suture treating Allen’s type Ⅲ amputations unsuitable for vascular anastomosis.Methods:From September 2018 to December 2020, clinical data of patients with Allen’s type Ⅲ fingertip amputations treated in Northern Jiangsu People’s Hospital were analyzed retrospectively. The fingertips were reconstructed with V-Y advancement flap and nailbed suture. The infeasibility of vascular anastomosis was checked under the microscope. Following fixation of the distal phalanx, the nailbed was stretched as flat as possible and sutured. If the nail plate was missing, a manual nail plate made from a plastic transfusion pipe would be fixed to cover the exposed nailbed. The palmar soft tissue of the amputated fingertip was excised, and periosteum, hyponychium, nailbed, and dorsal soft tissue were retained. The proximal volar skin was incised until the subcutaneous adipose layer to get a V-Y advancement flap. The volar defect was repaired with the V-Y advancement flap distally sutured with the pre-retained hyponychium. Postoperatively, burn cream was smeared on the nail for moisturizing, without lamp heating, and intravenous antibiotics was administered routinely. The main indexes were collected including nail appearance, pulp plumpness, static two-point discrimination, motion loss of the distal interphalangeal joint, and patients’ self-evaluation of the appearance. Chinese Medical Association trial standard of upper limb partial function assessment (CMA evaluation) was used to evaluate finger function.Results:A total of 16 patients with 18 fingertips were included. There were 9 males and 7 females, aged (31.5±6.1) years (21-52 years). There were 14 cases of single fingertips injury and 2 cases of multiple fingertips injury. Damaged finger: 2 of thumb, 3 of indicator finger, 6 of middle finger, 5 of ring finger, 2 of little finger. All 18 fingertips survived postoperatively and followed up for 7-16 months (median 12 months). One case underwent a second surgery due to infection and mild bone exposure followed by good healing. One case had a slightly hooked nail. The fingertip appearance was satisfying or acceptable by all the patients except the above two. Good results were got for all patients such as bone healing, smooth nail, plump pulp, and flexible distal interphalangeal joint. At the latest follow-up, motion loss of the distal interphalangeal joint was 0°-3.6° (mean 2.4°) for extension and 2.0°-12.0° (mean 7.6°) for flexion. The static two-point discrimination was 2.5-4.6 mm (mean 3.8 mm). Respectively, the functional evaluation of the affected finger was excellent in 11 cases, good in 3 cases and fair in 2 cases according to the CMA evaluation.Conclusion:Fingertip reconstruction with V-Y advancement flap and nailbed suture is a good technique to treat Allen’s type Ⅲ amputations, with advantages of preserved fingertip length, smooth nail, plump pulp, good sensory and flexible distal interphalangeal joint. The technique is simple with a high success rate and good results.

Hand hemangioma combined with aneurysm is rare and its specific clinical diagnosis and treatment method are not yet clear. In February 2021, a 49-year-old female patient with a right small finger hemangioma and aneurysm was diagnosed and treated in the Department of Hand and Foot, Northern Jiangsu People’s Hospital. The patient was admitted to the hospital due to a tumor in the right little finger for 1 year. A low-echo mass with blood flow in the subcutaneous layer of the right little finger was detected on Doppler ultrasound and considered a hemangioma. Other laboratory tests and physical examinations showed no obvious abnormalities. The preoperative diagnosis was a right little finger mass (hemangioma). After completing the preoperative examination, we performed a resection of the hemangioma of the right little finger. Postoperative pathology showed that the mass located on the volar side of the right little finger was consistent with an aneurysm, and the one on the dorsal side of the right little finger was consistent with a venous aneurysm. After 2 years of follow-up, there was no recurrence of the lesion.

Objective:To introduce the therapeutic effect of forearm radial artery perforator propeller flap for repair of hand and wrist soft tissue defects.Methods:The clinical data of patients with soft tissue defects of hand and wrist who received the treatment with forearm radial artery perforator propeller flap in Northern Jiangsu People’s Hospital from January 2018 to September 2020 were collected. The radial artery of the forearm was projected on the skin surface as the axis, and the nearest perforator was selected as the rotation point according to the location of the soft tissue defect. The radial artery perforator propeller flap was designed based on the location, area and shape of soft tissue defect. The length of the large paddle of the flap is equal to the distance between the proximal side of the wound edge and the rotation point plus the length of the wound, and the length of the small paddle of the flap is equal to the distance between the proximal side of the wound edge and the rotation point. The donor site was closed directly or with full-thickness skin graft from the ipsilateral upper arm. The survival, appearance of the flap and skin graft, hand and wrist function and patients satisfactory rate were observed and recorded.Results:A total of 6 patients were included, including 4 males and 2 females; the mean age was 40.5 years (range, 25-65 years ). There were 1 case on the palm side of the hand, 1 case on the dorsal side of the hand, 3 cases on the volar side of the wrist, and 1 case on the dorsal side of the wrist. The area of soft tissue defect after debridement was 2 cm × 3 cm-7 cm × 10 cm. The forearm radial artery perforator propeller flap ranged from 3 cm × 4 cm to 8 cm × 11 cm. The donor site was closed directly in 3 cases, and with full-thickness skin graft in 3 cases. The flaps in all 6 patients survived completely with primary healing. The skin grafts for the donor site in 3 cases survived completely. The patients were followed up for 3 months to 1 year, with an average of 5 months. The function of the hand and wrist recovered well. The texture of the flap was similar to that of the surrounding tissue with good appearance, no swelling or slight swelling, no obvious color difference. The donor site healed well without scar hyperplasia. The patients were satisfied with the surgical results.Conclusion:Propeller flap pedicled with forearm radial artery perforator is a simple and effective method to repair soft tissue defects of wrist and hand with reliable recovery of appearance and function. The patients’ satisfactory rate is also high.