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 explore the preliminary clinical application efficacy of the side branch protection (SBP) technique in single stent-assisted coiling (SSAC) for the treatment of intracranial acute-angulated absolute wide neck bifurcation aneurysms (aWNBA).Methods:The clinical data of 23 patients with aWNBA treated at the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2024 were retrospectively collected. Patients were divided into two groups based on the stent type used: 11 in the side branch protection (SBP) group and 12 in the double stent-assisted coiling (DSAC) group. The characteristics of aWNBA including the size, the first and second angles between side branches and main artery, and the diameter of aneurysm, were analyzed preoperatively. Stent thromboembolism was recorded during the operation, and Raymond-Roy Occlusion Classification (RROC) and the modified Rankin Scale (mRS) were used to evaluate the treatment efficacy postoperatively. During the follow-up period the RROC and mRS were reevaluated and the stent stenosis was recorded. Mann-Whitney U test was used to compare the two groups′ data of skewed distribution, χ2 test and Fisher′s exact test were used to compare the two groups′ categorical data. Results:The 23 patients with aWNBA included 11 with aneurysms at the bifurcation of the middle cerebral artery, 6 at the top of the basilar artery, and 6 at the bifurcation of the anterior communicating artery. There was no statistically significant difference between the two groups in terms of aWNBA basic characteristics before operation (all P>0.05). The SBP group had a lower incidence of intraoperative stent thromboembolism and a lower mRS postoperatively compared to DSAC group (all P<0.05); meanwhile, there was no statistically significant difference between two groups on RROC after the operation ( P=0.949). During the follow-up period, the SBP group had lower rates of stent stenosis and mRS compared to the DSAC group (all P<0.05) and there was no statistically significant difference between two groups in RROC ( P=0.527). Conclusions:In cases of dense coiling on aWNBA, the SBP technique in SSAC is able to reduce incidence of the stent thromboembolism, stent stenosis as well as neurological injury; therefore, it is a safe and feasible therapeutic strategy for the aWNBA.

Objective To evaluate the effect of target oriented infusion guided by stroke volume variation(SVV)in elderly lumbar surgery.Method From January to December 2023,80 elderly patients undergoing elective general anesthesia for prone lumbar surgery were divided into two groups by random number table method:SVV guidance target-oriented infusion group(SVV group)and conventional infusion group(conventional group),with 40 cases in each group.The amount of infusion,blood loss,urine volume and use of vasoactive drugs in the two groups were recorded.MAP,HR,blood lactate concentration(Lac),base residual value(BE),and PaO2 were recorded at the time of entry(T1),before cuticle(T2),1 hour after prone position(T3),and after surgery(T4).Pulmonary ultrasound examinations were performed at 4,8,12 and 24 hours after surgery,and B-line scores were calculated,as well as the incidence of cardiac insufficiency,nausea,vomiting,delirium and hospital stay at 24 hours after surgery.Result Compared with normal group,in group SVV,intraoperative infusion volume[(1123+532)ml],vascular active drug utilization rate(15.0％),postoperative each point B line score[(1.55±1.32),(1.22±0.94),(1.01±0.93),(1.07±0.90)]were reduced(P＜0.05).HR at T2～T4[(67±8,71±11,73±12)times/min]、PaO2 at T3,T4[(438±41,423±44)mmHg]were increased,Lac and BE at T2～T4 were(0.3±0.5,1.4±0.5,1.4±0.3)mmol/L.(0.3±0.6,0.3±1.0,0.3±1.1)was decreased(P＜0.05).There were no significant differences between the two groups in cardiac dysfunction,nausea,vomiting,delirium and hospital stay after a 24-hour postoperative period(P＞0.05).Conclusion SVV guided target oriented infusion in elderly lumbar surgery is beneficial to circulation stability and tissue perfusion,and reduces the production of lung water.

Objective To evaluate the effect of target oriented infusion guided by stroke volume variation(SVV)in elderly lumbar surgery.Method From January to December 2023,80 elderly patients undergoing elective general anesthesia for prone lumbar surgery were divided into two groups by random number table method:SVV guidance target-oriented infusion group(SVV group)and conventional infusion group(conventional group),with 40 cases in each group.The amount of infusion,blood loss,urine volume and use of vasoactive drugs in the two groups were recorded.MAP,HR,blood lactate concentration(Lac),base residual value(BE),and PaO2 were recorded at the time of entry(T1),before cuticle(T2),1 hour after prone position(T3),and after surgery(T4).Pulmonary ultrasound examinations were performed at 4,8,12 and 24 hours after surgery,and B-line scores were calculated,as well as the incidence of cardiac insufficiency,nausea,vomiting,delirium and hospital stay at 24 hours after surgery.Result Compared with normal group,in group SVV,intraoperative infusion volume[(1123+532)ml],vascular active drug utilization rate(15.0％),postoperative each point B line score[(1.55±1.32),(1.22±0.94),(1.01±0.93),(1.07±0.90)]were reduced(P＜0.05).HR at T2～T4[(67±8,71±11,73±12)times/min]、PaO2 at T3,T4[(438±41,423±44)mmHg]were increased,Lac and BE at T2～T4 were(0.3±0.5,1.4±0.5,1.4±0.3)mmol/L.(0.3±0.6,0.3±1.0,0.3±1.1)was decreased(P＜0.05).There were no significant differences between the two groups in cardiac dysfunction,nausea,vomiting,delirium and hospital stay after a 24-hour postoperative period(P＞0.05).Conclusion SVV guided target oriented infusion in elderly lumbar surgery is beneficial to circulation stability and tissue perfusion,and reduces the production of lung water.

Objective:To explore the preliminary clinical application efficacy of the side branch protection (SBP) technique in single stent-assisted coiling (SSAC) for the treatment of intracranial acute-angulated absolute wide neck bifurcation aneurysms (aWNBA).Methods:The clinical data of 23 patients with aWNBA treated at the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2024 were retrospectively collected. Patients were divided into two groups based on the stent type used: 11 in the side branch protection (SBP) group and 12 in the double stent-assisted coiling (DSAC) group. The characteristics of aWNBA including the size, the first and second angles between side branches and main artery, and the diameter of aneurysm, were analyzed preoperatively. Stent thromboembolism was recorded during the operation, and Raymond-Roy Occlusion Classification (RROC) and the modified Rankin Scale (mRS) were used to evaluate the treatment efficacy postoperatively. During the follow-up period the RROC and mRS were reevaluated and the stent stenosis was recorded. Mann-Whitney U test was used to compare the two groups′ data of skewed distribution, χ2 test and Fisher′s exact test were used to compare the two groups′ categorical data. Results:The 23 patients with aWNBA included 11 with aneurysms at the bifurcation of the middle cerebral artery, 6 at the top of the basilar artery, and 6 at the bifurcation of the anterior communicating artery. There was no statistically significant difference between the two groups in terms of aWNBA basic characteristics before operation (all P>0.05). The SBP group had a lower incidence of intraoperative stent thromboembolism and a lower mRS postoperatively compared to DSAC group (all P<0.05); meanwhile, there was no statistically significant difference between two groups on RROC after the operation ( P=0.949). During the follow-up period, the SBP group had lower rates of stent stenosis and mRS compared to the DSAC group (all P<0.05) and there was no statistically significant difference between two groups in RROC ( P=0.527). Conclusions:In cases of dense coiling on aWNBA, the SBP technique in SSAC is able to reduce incidence of the stent thromboembolism, stent stenosis as well as neurological injury; therefore, it is a safe and feasible therapeutic strategy for the aWNBA.

OBJECTIVE To explain the material basis and biological mechanism of Astragali Radix’s “invigorating Qi” effect to regulate energy metabolism. METHODS The TCMSP database and literature search collected potential active components of Astragali Radix, the SEA database performed target prediction based on structural similarity, and the GeneCards, OMIM, and TTD databases obtained energy metabolism targets. Cytoscape software was used to construct protein-protein interaction network maps of Astragali Radix regulated energy metabolism targets, and GO and KEGG enrichment analyses were performed. Molecular docking and hierarchical cluster analysis were performed to evaluate the target-component affinity between the whole constituents of Astragali Radix and key targets, and the effects of representative compounds of Astragali Radix on the energy metabolism of H9C2 cardiomyocytes and GES-1 gastric epithelial cells were detected, and the binding mode analysis was conducted. RESULTS Network pharmacology results showed that there were 126 potential targets of Astragali Radix regulating energy metabolism. GO and KEGG enrichment analysis showed that Astragali Radix regulating energy metabolism might be related to gene expression of oxidation-reduction process, protein and enzyme synthesis. Among them, SIRT1 and PPARγ were key targets involved in the regulation of energy metabolism. Molecular docking and hierarchical clustering showed that Astragali Radix components had superior targeting to SIRT1 and PPARγ, and three representative compounds were selected for in vitro experimental verification in combination with molecular docking scores. Quercetin and kaempferol could promote energy metabolism in H9C2 cardiomyocytes and GES-1 gastric epithelial cells. The binding mode analysis showed that quercetin and kaempferol had preferable binding ability to SIRT1 and PPARγ. CONCLUSION In this study, the material basis and biological mechanism of Astragali Radix regulating energy metabolism are preliminarily explained by traditional Chinese medicine chemo-bio informatics methods, which provide a scientific basis for the connotation of Astragali Radix exerting the effect of stagnation and arthralgia through “invigorating Qi” in traditional Chinese medicine.

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.