Objective:To investigate a surgical method and clinical effect on reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients with free perforator flap of peroneal artery.Methods:From March 2016 to June 2022, 13 elderly patients with infective ulcer and soft tissue defects in dorsal fingers were reconstructed with free perforator flaps of peroneal artery. The patients were 65-70 years with an average age of 66.5 years. Cause of infection: 10 ulceration and soft tissue defects were caused by diabetes and 3 by injury. Seven infective ulceration and soft tissue defects were in dorsal index fingers, 3 in dorsal middle fingers and 3 in dorsal ring fingers with the size of soft tissue defects at 2.0 cm×4.5 cm-2.0 cm×5.5 cm with an exposure of tendon and phalange. The donor site of the flaps was of contralateral calf and the flaps were 2.5 cm×5.0 cm-2.5 cm×6.0 cm in size. All donor sites were sutured directly. All patients were included in the postoperative follow-up at outpatient clinic to observe the appearance and sensation of the flap as well as finger movement.Results:All flaps survived and all wounds achieved stage I healing, without recurrence of infection. Twelve patients had the postoperative follow-up for 12 to 27 months, with an average of 21.6 months. There were satisfactory appearance of flaps and the function of fingers. Sensation of flaps recovered to S 2 in 5 patients and S 3 in 7 patients. The recovery of hand function was evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with 8 hands in excellent and 4 in good. Conclusion:The free perforator flap of peroneal artery has advantages of constant vascular anatomy, reliable blood supply, moderate thickness and direct closure of donor site. It is a useful clinical method in reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients.

Objective:To explore the therapeutic effect of micro-flaps carrying sensory nerve in treatment of high-pressure injection injuries of the digit (HPIID).Methods:From January 2022 to June 2024, retrospective analysis of 7 patients who had HPIID were admitted to the Department of Hand Surgery Division 1, Norinco General Hospital. The patients were 5 males and 2 females with ages from 25 to 59 years. The digital injuries were: 3 index fingers, 2 middle fingers and 2 thumbs. All patients received debridement under microscope in primary surgery, with the defects at 1.5 cm×2.4 cm - 2.5 cm×5.5 cm in size after debridement. In stage Ⅱ surgery, 5 patients received the treatment of free fibular great toe flap carrying peroneal nerve of the great toe, with the flap size at 1.8 cm× 2.0 cm - 2.7 cm×4.0 cm. Two patients received the treatment of transfer of free fibular medial plantar flap carrying medial plantar nerve, with flap size at 1.9 cm×2.6 cm - 4.5 cm×5.7 cm. Donor sites were directly sutured in 5 patients, and 2 patients received skin grafting. Five patients received postoperative follow-up at outpatient clinic, 1 patient via telephone interview and 1 via WeChat review.Results:All 7 flaps survived and all wounds had primary healing. All donor and recipient sites and skin grafting sites healed primarily. Postoperative follow-up lasted for 4 to 9 months, with an average of 6.4 months. All the affected digits had satisfactory appearance and function, except 1 which was slightly slimmer than the healthy side. Range of motion of the affected digits was evaluated according to total active movement (TAM): 5 were in excellent and 2 in good. Sensory recovery of the digits was evaluated according to the British Medical Research Council (BMRC): 1 digit was at S 2, 2 at S 3 and 4 at S 4. One patient had two-point discrimination (TPD) at 9.0-15.0 mm, 2 at 6.0-10.0 mm, and 4 at 3.0-6.0 mm. Conclusion:For HPIID with a defect, surgical treatment with transfer of micro-flap carrying sensory nerve should be a preferred treatment option.

Objective:To investigate a surgical method and clinical effect on reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients with free perforator flap of peroneal artery.Methods:From March 2016 to June 2022, 13 elderly patients with infective ulcer and soft tissue defects in dorsal fingers were reconstructed with free perforator flaps of peroneal artery. The patients were 65-70 years with an average age of 66.5 years. Cause of infection: 10 ulceration and soft tissue defects were caused by diabetes and 3 by injury. Seven infective ulceration and soft tissue defects were in dorsal index fingers, 3 in dorsal middle fingers and 3 in dorsal ring fingers with the size of soft tissue defects at 2.0 cm×4.5 cm-2.0 cm×5.5 cm with an exposure of tendon and phalange. The donor site of the flaps was of contralateral calf and the flaps were 2.5 cm×5.0 cm-2.5 cm×6.0 cm in size. All donor sites were sutured directly. All patients were included in the postoperative follow-up at outpatient clinic to observe the appearance and sensation of the flap as well as finger movement.Results:All flaps survived and all wounds achieved stage I healing, without recurrence of infection. Twelve patients had the postoperative follow-up for 12 to 27 months, with an average of 21.6 months. There were satisfactory appearance of flaps and the function of fingers. Sensation of flaps recovered to S 2 in 5 patients and S 3 in 7 patients. The recovery of hand function was evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with 8 hands in excellent and 4 in good. Conclusion:The free perforator flap of peroneal artery has advantages of constant vascular anatomy, reliable blood supply, moderate thickness and direct closure of donor site. It is a useful clinical method in reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients.

Objective:To explore the therapeutic effect of micro-flaps carrying sensory nerve in treatment of high-pressure injection injuries of the digit (HPIID).Methods:From January 2022 to June 2024, retrospective analysis of 7 patients who had HPIID were admitted to the Department of Hand Surgery Division 1, Norinco General Hospital. The patients were 5 males and 2 females with ages from 25 to 59 years. The digital injuries were: 3 index fingers, 2 middle fingers and 2 thumbs. All patients received debridement under microscope in primary surgery, with the defects at 1.5 cm×2.4 cm - 2.5 cm×5.5 cm in size after debridement. In stage Ⅱ surgery, 5 patients received the treatment of free fibular great toe flap carrying peroneal nerve of the great toe, with the flap size at 1.8 cm× 2.0 cm - 2.7 cm×4.0 cm. Two patients received the treatment of transfer of free fibular medial plantar flap carrying medial plantar nerve, with flap size at 1.9 cm×2.6 cm - 4.5 cm×5.7 cm. Donor sites were directly sutured in 5 patients, and 2 patients received skin grafting. Five patients received postoperative follow-up at outpatient clinic, 1 patient via telephone interview and 1 via WeChat review.Results:All 7 flaps survived and all wounds had primary healing. All donor and recipient sites and skin grafting sites healed primarily. Postoperative follow-up lasted for 4 to 9 months, with an average of 6.4 months. All the affected digits had satisfactory appearance and function, except 1 which was slightly slimmer than the healthy side. Range of motion of the affected digits was evaluated according to total active movement (TAM): 5 were in excellent and 2 in good. Sensory recovery of the digits was evaluated according to the British Medical Research Council (BMRC): 1 digit was at S 2, 2 at S 3 and 4 at S 4. One patient had two-point discrimination (TPD) at 9.0-15.0 mm, 2 at 6.0-10.0 mm, and 4 at 3.0-6.0 mm. Conclusion:For HPIID with a defect, surgical treatment with transfer of micro-flap carrying sensory nerve should be a preferred treatment option.

Objective:To explore a better measurement mode of shear wave elastography (SWE) in the skin of lymphedema limbs, and to test its diagnostic efficacy in lymphedema.Methods:Between 1st and 10th August, 2023, 22 healthy volunteers were recruited in the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ulrasound, the First Afiliaed Hospital of Sun Yat-Sen University to measure the Young's modulus (E-value) of limb skin by SWE using a gel pad (GP group) and the thick-layer coupling gel (CG group) respectively. Then between 15th August and 28th September, 2023, 11 patients with 13 lower limb lymphedema, who were treated in the Department of Microsurgery, Orhopaedic Trauma and Hand Surgery, the First Affiliaed Hospital of Sun Yat-Sen University, were consecutively enrolled to find out the E-value of skin in oedematous limbs. The receiver operating characteristic curve (ROC) was constructed and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated to evaluate the diagnostic efficiency. SPSS 26.0, R studio and GraphPad Prism 8 software were used for statistical analysis. Paired sample non-parametric test (Wilcoxon signed rank test) was used to compare the difference in E-value between the 2 groups. P<0.01 was considered statistically significant. Spearman correlation test was used to analyse the correlation of E-value values between the GP group and CG group. Results:Overall, it was found from the healthy volunteers that E-value of skin in distal limbs were higher than that in proximal limbs, especially in lower extremities. E-value of all scanned location in GP group were found higher than those of CG group with statistically significant difference ( P<0.01), and the values of interclass correlation coefficient (ICC) showed a good repeatability. The 11 patients with lymphedema in 13 lower extremities were examined with the thick-layer coupling gel. The skin E-value in calf of patients with lymphedema were significantly higher than that of the healthy volunteers ( P<0.01), except the skin of thighs ( P>0.01). A lymphedema was diagnosed while either a skin E-value was 27.6 kPa calculated by Youden index or with the thickness of skin was 2.3 mm. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy in the diagnosis of a lymphedema were found at 92.3%, 100%, 100%, 95.7% and 97.1%, respectively. The area under curve (AUC) of ROC was 0.962. The correlation coefficients (R) of E-value in arm, forearm, thigh and lower leg in the GP group and CP group were 0.665, 0.882, 0.850 and 0.815, respectively, which were all significantly correlated. Conclusion:Application of thick layer coupler in ultrasound skin SWE is highly feasible, and the combination of ultrasound skin SWE and skin thickness has higher diagnostic efficiency in the diagnosis of lower extremities lymphedema. It allows more accurate ultrasonic image technical support for early monitoring and diagnosis of lymphedema, microsurgical treatment and a quantitatively perioperative evaluation.

OBJECTIVE: To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury. METHODS: Between July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise. RESULTS: All flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor. CONCLUSION The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.
Humans ; Male ; Adult ; Female ; Perforator Flap ; Upper Extremity ; Fingers/surgery* ; Ulnar Artery ; Skin Transplantation

Objective:To explore the clinical effect of cosmetic reconstruction for partial defect of distal segment of digits.Methods:Form January 2018 to January 2021, the Department of Hand Surgery of Institute for Hygiene of Ordnance Industry(The 521 Hospital of Weapon Industry) admitted 129 patients with partial defect of distal segment of thumb or fingers with phalange or tendon exposure. The patients were 111 males and 18 females with an average age of 34(17-59) years old. The sizes of nailbed defect were 0.4 cm×1.1 cm-1.8 cm×2.0 cm, the length of phalange defect was 0.4-1.8 cm, and the sizes of the soft tissue defect were 1.6 cm×1.8 cm-3.2 cm×4.8 cm. Great toe tissue flaps were used to reconstruct the partial defect of distal segment of thumb or fingers after debridement. Wounds of fibular flap of great toe in 77 cases were directly sutured in 17 patients. The donor sites in rest 60 great toes were narrowed first and then repaired with skin grafts in 10 cases, with artificial dermis in 28 cases and with transverse V-Y advancement flaps of ipsilateral great toes for 22 cases. Forty-nine of 52 donor site wounds for hallux toenail flap were repaired with artificial dermis and 3 with free peroneal artery perforator flaps. The method was outpatient follow-up. Postoperative follow-up lasted until July 2022. The check-items for follow-up included: occurrence of necrosis, appearance, shape and texture of the flap, appearance of the reconstructed nails, TPD of the reconstructed digit pulps, tolerance to cold on the scars of flaps, flexion and extension of the reconstructed digits. The healing time of phalanges of the reconstructed digits was evaluated by X-rays. The appearance, sensation, the tolerance to cold of great toe and the movement of donor foot were also assessed.Results:Postoperative follow-up lasted for 18 to 24 months, with an average of 21 months. A total of 128 flaps survived. Necrosis occurred in 1 fibular hallux flap, the necrosis was cured with a reverse digital proper artery island flap. Thereafter, all flaps healed well. The appearance, shape, texture and nails of reconstructed digits were close to the contralateral digits. The reconstructed thumb and finger were evaluated according to Zook, 127 cases were excellent and 2 cases were good.TPD of the pulps of the reconstructed digits was 4-10 mm. The mean score of the Vancouver scar scale(VSS) was 0.6 for scars of the reconstructed digits. The mean score of the Visual analog scale(VAS) was 0.3 for the tolerance to cold. Flexion and extension function recovered well in all the reconstructed digits. According to the Evaluation Criteria of Upper limb Function Hand Surgery Society of Chinese Medical Association, the function of hand was excellent in 127 cases and 1 in each of good and fair. X-rays of all digits showed the phalange healing of the reconstructed digits, with an average healing time of 2 months after surgery, without phalange resorption, infection, nonunion nor stress fracture. There was no difference between the length of the donor great toe and the contralateral toe, except the donor site of the great toe nail root. There was no significant visual difference between the appearance of the donor great toe and the contralateral toe. TPD of the pulps of donor great toe was 4-8 mm. The mean score of the VSS was 1.4 for scars in the donor great toe. The mean score of the VAS was 0.7 for the tolerance to cold of the donor great toe. There was no stress fracture at donor site, and the functions of donor foot were not affected when walking, running, jumping and tiptoeing in all patients.Conclusion:It is an ideal method for reconstructing a partial defect of distal segment of digit by great toe flap. It can not only reconstruct the partial defect of distal segment of the digit, but also results in a good appearance and satisfactory functions of the reconstructed digit. Damage to the donor site is minimum. The length of the donor great toe is unchanged, and it has little impact on sensation and appearance of the donor great toe. Meanwhile, there is no adverse effect on walking, running and jumping with the donor foot.

Posttraumatic stress disorder (PTSD) is a kind of mental disorder associated with traumatic experiences. The core symptoms of PTSD include intrusions, avoidance of trauma reminders, negative alterations in cognitions and mood and alterations in arousal. Cognitive processing therapy (CPT) may reduce PTSD symptoms by changing the connectivity of cerebellum, central executive network, and default mode network through the core therapeutic steps of preventing avoidance, releasing true emotion, and recognizing and challenging "stuck points". At present, a large number of empirical studies abroad have certified the significant efficacy of CPT, but it has not been widely promoted in China. Therefore, this article intends to summarize the clinical application of CPT in different populations and its possible therapeutic mechanism, in order to provide evidence-based medical evidence for the localization and clinical application in China.

Posttraumatic stress disorder (PTSD) is a kind of mental disorder associated with traumatic experiences. The core symptoms of PTSD include intrusions, avoidance of trauma reminders, negative alterations in cognitions and mood and alterations in arousal. Cognitive processing therapy (CPT) may reduce PTSD symptoms by changing the connectivity of cerebellum, central executive network, and default mode network through the core therapeutic steps of preventing avoidance, releasing true emotion, and recognizing and challenging "stuck points". At present, a large number of empirical studies abroad have certified the significant efficacy of CPT, but it has not been widely promoted in China. Therefore, this article intends to summarize the clinical application of CPT in different populations and its possible therapeutic mechanism, in order to provide evidence-based medical evidence for the localization and clinical application in China.

Objective:To explore the clinical application and effect of repairing the donor site of ipsilateral fibular hallux flap with the transverse V-Y advancement flap of the great toe.Methods:Form January 2017 to January 2020, the donor sites of the ipsilateral fibular hallux flap were repaired by the transverse V-Y advancement flap of the great toe in the Department of Hand Surgery, 521 Hospital of Weapon Industry on 20 patients, including 16 males and 4 females with an average age of 33 (18-52) years old. First, the donor site of the fibular hallux flap was sutured to reduce the size of wound. The width of the remaining wound was 0.4 to 1.6 cm, and the area of the remaining wound was 0.5 cm×0.8 cm-1.6 cm×1.8 cm. Then the remaining wound was repaired with the transverse V-Y advancement flap of the ipsilateral great toe. The distance for transfer of transverse advancement V-Y flap was 0.2-0.8 cm, and the area of the transverse V-Y advancement flap was 1.0 cm×1.4 cm-1.8 cm×2.4 cm. The end of postoperative follow-up was scheduled in July 2021. The follow-up items included: survival of the transverse V-Y advancement flap, wound infection, appearance, shape, texture and sensation of the V-Y advancement flap, pain on the V-Y advancement flap and the great toe, cold tolerance and the scar condition at the donor site of the ipsilateral fibular hallux flap and the V-Y advancement flap, the appearance, sensation and flexion and extension of the great toe at the donor site, other discomforts in the donor site of great toe, walking and other functions affected by the discomforts.Results:The postoperative follow-up lasted from 12 to 18(average of 14) months. All the V-Y advancement flaps survived without infection at the donor sites of the great toe, and donor sites healed primarily. The appearance, shape and texture of the advancement V-Y flap were close to the skin of the same area of the contralateral great toe. The TPD of the V-Y advancement flap and the ipsilateral great toe ranged from 4 to 7 mm. The average score of the Visual analog scale(VAS) was 0.3 and 0.6 respectively in the evaluation of cold tolerance of the advancement V-Y flap and the ipsilateral great toe. The average score of the Vancouver scar scale(VSS) was 0.2 and 1.2 respectively in the scar evaluation of the V-Y advancement flap and the ipsilateral great toe. There was no visual difference between the appearance of the great toe at the donor site and the contralateral toe. There was no pain and other discomfort on the V-Y advancement flap and the ipsilateral great toe. The functions of the donor foot were not affected in walking, running, jumping and tiptoeing in all cases.Conclusion:It is a simple, safe and effective method to repair the donor site of the small-area ipsilateral fibular hallux flap by the transverse V-Y advancement flap of the great toe. It only causes a small wound but the appearance and function of the ipsilateral great toe can be repaired with a transverse V-Y advancement flap of the great toe.