Objective To explore clinical effects of local anesthesia non-tourniquet technique in surgery for the treatment of cubital tunnel syndrome.Methods Between July 2020 and June 2023,20 patients with severe cubital tunnel syndrome were treated by using local anesthesia non-tourniquet technique.The local anesthetic was prepared,consisting of lidocaine with epinephrine,and in situ ulnar release was performed.Based on the evaluation for ulnar nerve instability,a decision was made on whether to perform anterior transposition of the ulnar nerve or not.Results In situ ulnar release was performed in 13 cases and anterior subcutaneous transposition of the ulnar nerve due to ulnar nerve subluxation were conducted in 7 cases.During anesthesia injection,there was only mild pain in the first injection[Numerical Rating Scale(NRS)score of 2-3 points],mild pain during intraoperative procedures(NRS score of 1-2 points),and mild to moderate pain after surgery(NRS score of 1-6 points).No anesthetic complications were recorded and the wound healed well.All the cases were followed up for 8-22 months(mean,17.1 months).According to classification of cubital tunnel syndrome introduced by Gu Yudong,the results were excellent in 5 patients,good in 12 patients and fair in 3 patients,with an excellent and good rate of 85.0％(17/20).At the last follow up visit,the 2-point discrimination of the little finger was 4-7 mm(mean,5.1 mm).Conclusion The local anesthesia non-tourniquet technique is safe and effective in surgery for the treatment of severe cubital tunnel syndrome,being worthy of clinical application.

Peripheral nerve injury can lead to sensory, motor and autonomic dysfunctions in the corresponding innervated areas, seriously affecting patients′ quality of life. Current treatments for peripheral nerve injury include surgical repair, neurotrophic drug therapy, and physical rehabilitation, but their therapeutic effect is often unsatisfactory. Nerve and muscle electrical stimulation therapy is a technique that applies pulsed electrical stimulation to peripheral nerves or muscles. Electrical stimulation can accelerate nerve regeneration, attenuate denervated muscle atrophy and alleviate neuropathic pain. Admittedly, its efficacy remains controversial due to unclear mechanisms of action and lack of standardized parameter settings. To this end, the authors reviewed the research progress on the mechanism of electrical stimulation for peripheral nerve injury, aiming to provide valuable references for subsequent basic research and clinical transformation.

Peripheral nerve injury can lead to sensory, motor and autonomic dysfunctions in the corresponding innervated areas, seriously affecting patients′ quality of life. Current treatments for peripheral nerve injury include surgical repair, neurotrophic drug therapy, and physical rehabilitation, but their therapeutic effect is often unsatisfactory. Nerve and muscle electrical stimulation therapy is a technique that applies pulsed electrical stimulation to peripheral nerves or muscles. Electrical stimulation can accelerate nerve regeneration, attenuate denervated muscle atrophy and alleviate neuropathic pain. Admittedly, its efficacy remains controversial due to unclear mechanisms of action and lack of standardized parameter settings. To this end, the authors reviewed the research progress on the mechanism of electrical stimulation for peripheral nerve injury, aiming to provide valuable references for subsequent basic research and clinical transformation.

Objective To explore clinical effects of local anesthesia non-tourniquet technique in surgery for the treatment of cubital tunnel syndrome.Methods Between July 2020 and June 2023,20 patients with severe cubital tunnel syndrome were treated by using local anesthesia non-tourniquet technique.The local anesthetic was prepared,consisting of lidocaine with epinephrine,and in situ ulnar release was performed.Based on the evaluation for ulnar nerve instability,a decision was made on whether to perform anterior transposition of the ulnar nerve or not.Results In situ ulnar release was performed in 13 cases and anterior subcutaneous transposition of the ulnar nerve due to ulnar nerve subluxation were conducted in 7 cases.During anesthesia injection,there was only mild pain in the first injection[Numerical Rating Scale(NRS)score of 2-3 points],mild pain during intraoperative procedures(NRS score of 1-2 points),and mild to moderate pain after surgery(NRS score of 1-6 points).No anesthetic complications were recorded and the wound healed well.All the cases were followed up for 8-22 months(mean,17.1 months).According to classification of cubital tunnel syndrome introduced by Gu Yudong,the results were excellent in 5 patients,good in 12 patients and fair in 3 patients,with an excellent and good rate of 85.0％(17/20).At the last follow up visit,the 2-point discrimination of the little finger was 4-7 mm(mean,5.1 mm).Conclusion The local anesthesia non-tourniquet technique is safe and effective in surgery for the treatment of severe cubital tunnel syndrome,being worthy of clinical application.

Objective:To explore the clinical effects of end-to-side anastomosis of non-primary perforating vessels carried by free anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue of limb.Methods:Between February 2020 and July 2021, 14 patients with soft tissue defect of limb were admitted in the Department of Hand and Foot Surgery, the First Affiliated Hospital of Wannan Medical College. The patients were 12 males and 2 females, aged between 30 and 69 years old, with a median age of 52 years old. One defect was found in left hand, 7 in left foot and ankle and 6 in right foot and ankle. Wound sizes were 7 cm×7 cm-9 cm×22 cm, all accompanied with exposed tendons, nerves or bone tissue. The size of flaps ranged from 8 cm×8 cm to 10 cm×23 cm. ALTPFs carrying non-primary source vessels were applied in reconstruction of soft tissue defects. The non-primary perforating vessels of ALTPF was anastomosed with the artery in recipient site in an end-to-side fashion and the vein of ALTPF was end-to-end anastomosed with the accompanying vein of the recipient artery. All donor sites were sutured directly. The follow-up was conducted by online reviews via WeChat or by visit of outpatient clinics. Appearance of flap and donor site were observed and the aesthetic satisfaction of the patients recipient sites were assessed subjectively using Likert scale.Results:All 14 ALTPFs survived uneventfully. Wound exudation occurred in 1 flap, and healed after dressing change and drainage. All patients received 9-18 (mean 12.6) months of follow-up. The ALTPFs were in good texture and shape. According to the Likert scale, appearance were excellent in 4 flaps, good in 8 flaps and fair in 2 flaps.Conclusion:Application of free ALTPF of non-primary source vessels with end-to-side anastomosis is not only effective in the reconstruction of limb defects, but also has advantages of reliable blood perfusion and cosmetic appearance.

Objective:To explore the clinical effects of modified anterograde homodigital neurovascular island flap for repairing soft tissue defects in the distal part of the finger.Methods:The data of patients with fingertip defects in the Department of Hand and Foot Surgery, the First Affiliated Hospital of Wannan Medical College from September 2019 to June 2021 were analyzed retrospectively. All the patients were treated with double V-Y designed modified anterograde homodigital neurovascular island flaps. The survival of these flaps and wound healing were observed after operation. At the last follow-up, sensibility of the flap was assessed. Hand function was evaluated according to the upper limb function evaluation standard of the Chinese Society of Hand Surgery.Results:The patients comprised 12 males and 3 females with an average age of 46 years (26-67 years). Single-finger defects were noted in all cases. The injured included 7 thumbs, 4 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger. The area of wound defect was 1.0 cm×1.0 cm-1.3 cm×1.4 cm. All flaps survived in 15 cases and the wounds healed well. All cases were followed up 6-12 months (mean, 8.9 months). At last follow-up visited, the discrimination distance between the two points was 4-6 mm (mean, 5.1 mm), and the hand function was excellent in 9 cases and good in 6 cases.Conclusions:The modified anterograde homodigital neurovascular island flap has reliable blood supply, long advance distance and satisfactory sensation recovery, which is an effective method for reconstructing small-size finger tip defects.

Objective:To explore the clinical effects of modified anterograde homodigital neurovascular island flap for repairing soft tissue defects in the distal part of the finger.Methods:The data of patients with fingertip defects in the Department of Hand and Foot Surgery, the First Affiliated Hospital of Wannan Medical College from September 2019 to June 2021 were analyzed retrospectively. All the patients were treated with double V-Y designed modified anterograde homodigital neurovascular island flaps. The survival of these flaps and wound healing were observed after operation. At the last follow-up, sensibility of the flap was assessed. Hand function was evaluated according to the upper limb function evaluation standard of the Chinese Society of Hand Surgery.Results:The patients comprised 12 males and 3 females with an average age of 46 years (26-67 years). Single-finger defects were noted in all cases. The injured included 7 thumbs, 4 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger. The area of wound defect was 1.0 cm×1.0 cm-1.3 cm×1.4 cm. All flaps survived in 15 cases and the wounds healed well. All cases were followed up 6-12 months (mean, 8.9 months). At last follow-up visited, the discrimination distance between the two points was 4-6 mm (mean, 5.1 mm), and the hand function was excellent in 9 cases and good in 6 cases.Conclusions:The modified anterograde homodigital neurovascular island flap has reliable blood supply, long advance distance and satisfactory sensation recovery, which is an effective method for reconstructing small-size finger tip defects.

Objective:To evaluate the clinical outcome of the reconstruction of finger-pulp defects, using modified dorsal digital fasciocutaneous flap.Methods:Between June 2018 and March 2019, 14 patients with finger-pulp defects were admitted to the Department of Hand and Foot Surgery. There were 14 males and 2 females, aged from 27 to 63 years, with the mean age of 49 years. The defect areas of finger pulp were 1.6 cm × 1.4 cm-2.5 cm × 1.6 cm. All of the finger-pulp defects were treated by the modified dorsal digital fasciocutaneous flap and the inverted L-shaped incision was made at the distal part of the pedicle. The defects at donor sites were reconstructed with full-thickness skin grafts harvested from the forearm. Viability of the flap was recorded postoperatively. At the last follow-up, aesthetics, sensibility of the flap and hand performance were assessed.Results:All of the 14 flaps survived successfully, the areas were 1.8 cm×1.6 cm-2.7 cm×1.8 cm. Partial distal blister occurred on the flap in only one case, which was solved by aspiration without surgical intervention. All cases acquired follow-up visits for 5 to 12 months with a mean time of 8.9 months. The texture of flaps was similar to surrounding skin and the shape of reconstructed finger pulp was satisfactory. According to the assessment of total active movement, the results were excellent in 9 fingers, good in 5 fingers. The 2-point discrimination of flap was 8 to 11 mm (mean, 9.9 mm).Conclusions:It is an effective and simple method for the reconstruction of finger-pulp defects using modified dorsal digital fasciocutaneous flap. The clinical effectiveness is definite.

Objective:To evaluate the clinical outcome of the reconstruction of finger-pulp defects, using modified dorsal digital fasciocutaneous flap.Methods:Between June 2018 and March 2019, 14 patients with finger-pulp defects were admitted to the Department of Hand and Foot Surgery. There were 14 males and 2 females, aged from 27 to 63 years, with the mean age of 49 years. The defect areas of finger pulp were 1.6 cm × 1.4 cm-2.5 cm × 1.6 cm. All of the finger-pulp defects were treated by the modified dorsal digital fasciocutaneous flap and the inverted L-shaped incision was made at the distal part of the pedicle. The defects at donor sites were reconstructed with full-thickness skin grafts harvested from the forearm. Viability of the flap was recorded postoperatively. At the last follow-up, aesthetics, sensibility of the flap and hand performance were assessed.Results:All of the 14 flaps survived successfully, the areas were 1.8 cm×1.6 cm-2.7 cm×1.8 cm. Partial distal blister occurred on the flap in only one case, which was solved by aspiration without surgical intervention. All cases acquired follow-up visits for 5 to 12 months with a mean time of 8.9 months. The texture of flaps was similar to surrounding skin and the shape of reconstructed finger pulp was satisfactory. According to the assessment of total active movement, the results were excellent in 9 fingers, good in 5 fingers. The 2-point discrimination of flap was 8 to 11 mm (mean, 9.9 mm).Conclusions:It is an effective and simple method for the reconstruction of finger-pulp defects using modified dorsal digital fasciocutaneous flap. The clinical effectiveness is definite.