Objective:To explore the clinical effect on reconstruction of the soft tissue defects after resection of mucous cysts of distal interphalangeal joint (DIP) with transfer of the flap of dorsal branch of proper palmar digital artery.Methods:From September 2021 to September 2023, 8 patients (8 digits) with mucous cysts on DIP were treated in the Department of Hand and Microsurgery, the Affiliated Hospital of Binzhou Medical University. All 8 cases were females, aged 55-65 years old, with an average age of 60 years old. The cyst was located in the thumb in 1 case, in the index finger in 3 cases, in the middle finger in 3 cases, and in the ring finger in 1 case. After extensive resection of the mucous cysts, the size of soft tissue defects was at 0.8 cm×0.6 cm-1.7 cm×0.9 cm. Pedicled with the dorsal branch of proper palmar digital artery, the flaps adjacent to the defects were designed to cover the wounds. The size of the flaps was 1.2 cm×1.0 cm-2.0 cm×1.2 cm. Donor sites of the flap were covered by the full thickness skin grafts of medial upper arm. The postoperative follow-up was conducted by the combination of outpatient revisits and telephone reviews to observe the survival of the flap, and the functional recovery was evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:All flaps survived well after surgery. Postoperative follow-up ranged from 4 to 12 months, with a mean of 10 months. At the final follow-up, there was no recurrence of mucous cyst and all symptoms disappeared. All flaps healed well, with good appearance, soft texture and without obvious difference in colour from the surrounding skin. All skin grafts healed in one stage. The range of motion of the affected DIP was 0°-70°, and the TPD was at 7-8 mm, both caused no impact on daily life. The outcomes were excellent according to the evaluation criteria set by the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Conclusion:The flap pedicled with dorsal branch of proper palmar digital artery has obvious advantages with less damage and simple operation in the treatment of a mucous cyst of DIP. It is an ideal surgical procedure.

Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.

Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.

To apply preventive T-shaped enterostomy in protective defunctioning stoma.Technique of enterostomy closure was only made in abdominal wall rather than abdominal cavity.A total of 78 patients undergoing protective ostomy from January 2005 to April 2012 were divided into two groups of routine enterostomy (group A,n =52) and protective T-shaped enterostomy (group B,n =26).The length of operation and average hospital stay in group A with stoma closure were(98 ± 16) min and (15.3 ± 5.2)days while those of group B (52 ± 9) min and (9.5 ± 2.3) days.The inter-group differences were statistically significant respectively (P ＜ 0.05).Therefore protective T-shaped enterostomy,showing advantages in operative skills,operative trauma and postoperative recovery time,is an effective technique and its application should be further promoted.

10.3969/j.issn.2095-4344.2013.26.018