Objective:To investigate the effects of medial plantar artery perforator flap in the reconstruction of palmar scar contracture.Methods:This study was a retrospective observational study. From January 2016 to January 2023, 15 patients with palmar scar contracture who met the inclusion criteria were admitted to Guangzhou Peace Orthopedic Hospital, including 12 males and 3 females, aged 15 to 50 years. Before surgery, the Michigan Hand Outcomes Questionnaire (MHQ) scores for the affected hands ranged from 58 to 77, and the total active motion for the affected hands ranged from 190° to 220°. The skin and soft tissue defect area after scar excision on the palmar side of the affected hands was 5.2 cm×3.2 cm to 7.2 cm×6.0 cm. According to the location and area of the wounds, the defects were repaired using either medial plantar artery superficial perforator flaps or combined flaps of the cutaneous perforator of superficial branch of medial plantar artery and medial branch of medial plantar artery deep branch. The area of the harvested flaps was 5.5 cm×3.5 cm to 7.5 cm×6.8 cm. The donor site wounds on the feet were repaired using superficial circumflex iliac artery perforator flaps. Postoperatively, the survivals of the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps were observed. After survival of the flaps, patients were guided for rehabilitation exercises for the affected hands. Regular outpatient follow-up was conducted after surgery to observe the appearance, color, and texture of the medial plantar artery perforator flaps, and the recovery of foot function. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap was measured, the function of the affected hands was evaluated using the trial criteria for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association and the MHQ.Results:Postoperatively, two patients experienced vascular crisis of the medial plantar artery perforator flaps, while the flaps survived after emergency exploration; the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps survived in other patients. Follow-up for 6 to 18 months postoperatively showed that the medial plantar artery perforator flaps had no bulky appearance, similar color and texture to the surrounding skin, and the foot functions such as running and jumping were not affected. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap ranged from 7 to 10 mm, with an average of 8 mm; the affected hand function was rated as excellent in 12 cases and good in 3 cases; the MHQ scores of the affected hand function ranged from 81 to 95, and the patients were satisfied with the postoperative appearance, pain relief, and functional recovery of the affected hand.Conclusions:The medial plantar artery perforator flap is used for the reconstruction of palmar scar contracture. The flap is easy to harvest, and has a high survival rate, resulting in good postoperative recovery of the flap sensation and function of the affected hand, and minimal donor site injury in the foot. It is therefore worthy of clinical promotion.

Objective:To investigate the effects of medial plantar artery perforator flap in the reconstruction of palmar scar contracture.Methods:This study was a retrospective observational study. From January 2016 to January 2023, 15 patients with palmar scar contracture who met the inclusion criteria were admitted to Guangzhou Peace Orthopedic Hospital, including 12 males and 3 females, aged 15 to 50 years. Before surgery, the Michigan Hand Outcomes Questionnaire (MHQ) scores for the affected hands ranged from 58 to 77, and the total active motion for the affected hands ranged from 190° to 220°. The skin and soft tissue defect area after scar excision on the palmar side of the affected hands was 5.2 cm×3.2 cm to 7.2 cm×6.0 cm. According to the location and area of the wounds, the defects were repaired using either medial plantar artery superficial perforator flaps or combined flaps of the cutaneous perforator of superficial branch of medial plantar artery and medial branch of medial plantar artery deep branch. The area of the harvested flaps was 5.5 cm×3.5 cm to 7.5 cm×6.8 cm. The donor site wounds on the feet were repaired using superficial circumflex iliac artery perforator flaps. Postoperatively, the survivals of the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps were observed. After survival of the flaps, patients were guided for rehabilitation exercises for the affected hands. Regular outpatient follow-up was conducted after surgery to observe the appearance, color, and texture of the medial plantar artery perforator flaps, and the recovery of foot function. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap was measured, the function of the affected hands was evaluated using the trial criteria for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association and the MHQ.Results:Postoperatively, two patients experienced vascular crisis of the medial plantar artery perforator flaps, while the flaps survived after emergency exploration; the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps survived in other patients. Follow-up for 6 to 18 months postoperatively showed that the medial plantar artery perforator flaps had no bulky appearance, similar color and texture to the surrounding skin, and the foot functions such as running and jumping were not affected. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap ranged from 7 to 10 mm, with an average of 8 mm; the affected hand function was rated as excellent in 12 cases and good in 3 cases; the MHQ scores of the affected hand function ranged from 81 to 95, and the patients were satisfied with the postoperative appearance, pain relief, and functional recovery of the affected hand.Conclusions:The medial plantar artery perforator flap is used for the reconstruction of palmar scar contracture. The flap is easy to harvest, and has a high survival rate, resulting in good postoperative recovery of the flap sensation and function of the affected hand, and minimal donor site injury in the foot. It is therefore worthy of clinical promotion.

Objective:To explore the clinical characteristics and experiences in diagnosis and treatment of severe hand injuries caused by chaff cutters.Methods:A retrospective analysis was conducted on 60 patients (193 digits) who had mangled hand injuries caused by chaff cutters and admitted to the Department of Upper Limb Repair and Reconstruction, Beijing Jishuitan Hospital Guizhou Hospital between January 2015 and June 2022. The patients were 39 males and 21 females, with 10 to 72 (mean 42.6) years old of age. The injuries involved 41 right hands and 19 left hands. The extent of hand injuries of soft tissue and bones varied from digit-tips to wrist. Among them, 5 digits were completely destroyed in 8 cases, 3 digits including thumb were destroyed in 12 cases, 4 digits including thumb were destroyed in 10 cases, 3 or more fingers without thumb were destroyed in 8 cases, simple hand destroyed in 8 cases, digits and palm destroyed in 8 cases, and total hand destroyed in 6 cases. The sizes of wound ranged from 1.8 cm×2.0 cm to 6.8 cm×15.6 cm. Based on the wound contamination and conditions of tissue damage, surgical treatment included debridement, stump trimming, in-situ replantation, transpositional replantation, venous bridging flap transfer and emergency or phased free second toe and free flap transfers. The flap sizes were 3.0 cm×5.0 cm-7.0 cm×16.0 cm. Both the reconstructed and flap donor sites were primarily closed in one stage. Postoperative follow-ups were conducted through regular visits of outpatient clinic or via WeChat interviews. The survival and functional recovery of flap and finger were observed.Results:Of the 60 patients, emergency orthotopic replantation of 112 digits were performed with survival of 96 digits; 16 digits transposition replantation were carried out with 12 survived; 5 digits received venous bridging flap transfer with 4 survived; all 5 Flow-through anteriolateral thigh perforator flaps (ALTPFs) were survived; all of 12 phase II digit reconstructions with free second toe transfer survived; and all 18 phase II free flap transfers survived [10 ALTPFs and 8 superficial circumflex iliac artery perforator flaps(SCIAPFs)]. Postoperative complications such as wound exudation and fever happened in 8 patients, and all were rectified after debridement and symptomatic anti-infection treatment. The follow-up ranged 6 to 18 months, with 12 months in average. Hand functions were assessed using the Michigan Hand Outcomes Questionnaire (MHQ), and the scores achieved at 20.3 to 72.8 points, with 42.6 points ± 16.6 points in average.Conclusion:Severe hand injuries caused by chaff cutters are severe and complicated. A thorough assessment of wound contamination and residual digits and tissues are required. Successful surgical outcomes can be achieved through emergency and elective surgery with multiple microsurgical techniques and multi-phased surgical reconstructions, although overall functional recovery of the injured hand is often not quite realistic.

Objective:To evaluate the clinical effectiveness of the reconstruction of multiple digit-tip defects with transfer of polyfoliate perforator flaps of the fibular hallux.Methods:From January 2019 to June 2022, 15 patients had undergone reconstruction surgery for multiple digit-tip defects using polyfoliate perforator flaps of ipsilateral fibular hallux, with the first dorsal metatarsal artery as the pedicle, in the Department of Upper Limb Repair and Reconstruction Surgery, Guizhou Hospital of Beijing Jishuitan Hospital. The patients were 10 males and 5 females and aged 20 to 45 years old. Eight patients had the defects of thumbs and index fingers, 4 of thumbs and middle fingers, 2 of thumb, index and middle fingers and 1 of thumb, index and ring fingers. All the 15 digit injuries had nail bed defects to which reconstructive surgery were required. For the flaps of dorsal artery, flaps were 1.8 cm×2.0 cm-2.0 cm×3.1 cm in size and for those of plantar artery, the flaps sized 1.5 cm×2.0 cm-2.5 cm×3.0 cm. Donor site defects in the hallux were reconstructed with free superficial circumflex iliac perforator flaps. Postoperative follow-up lasted until 30th June 2023 and included visits to the outpatient clinic, WeChat and telephone reviews to assess the appearance, function and sensation recovery of the digits.Results:All the 15 flaps survived. During the 6 to 24 months (16 months in average) of postoperative follow-up, the appearance and texture of all flaps were found close to the healthy digits, with good nail growth and without deformity. TPD were found between 8.0 mm and 12.0 mm. The donor sites on the great toes that reconstructed with superficial circumflex iliac artery flaps were all survived well, and the incisions were satisfactorily healed without the functions of walking, running or jumping being significantly affected.Conclusion:The use of polyfoliate perforator flaps of fibular hallux for reconstruction of multiple digit-tip defects is an ideal surgical method due to the consistency of vascular anatomy, ease with flap harvest, similarity in the normal digital skin texture, and the capability to include a nail bed with the flap. A single donor from the hallux can simultaneously reconstruct two defects of digit-tip, making it an excellent treatment in the reconstruction of small-to medium-sized composite tissue defects in multiple digits.

In December 2020, a 39-year female was admitted in Guangzhou Heping Orthopaedic Hospital with severely and destructively mangled both forearms. There was a segmental destruction of left wrist and an oblique destruction of right palm together with the right thumb and index finger. In the emergency surgery, the left palm was split at the first web. Then the left thumb was transferred to the first metacarpal bone of right hand for reconstruction of right thumb. The 2nd to 4th metacarpal bones of the left palm were transferred to the distal carpal bones of right wrist for reconstruction of right hand. The superficial veins of forearm were freed and transferred to bridge the defects of arteries and veins in the right hand. A right anteriolateral thigh perforator flap (ALTPF) was taken to reconstruct the soft tissue defects of right hand. The ring and little fingers of right hand were amputated and transferred to the left distal ulna and distal radius of the stump of remaining left forearm, thereby a chimeric left "forearm-hand" was reconstructed. After 20 months of follow-up, the both reconstructed hands and the flaps survived well without obvious bloat, and the appearance of the digits was full. The two-point discrimination (TPD) of both reconstructed hands was restored to 10-12 mm, and a partial pinching and griping functions were restored. The reconstructed hands were able to fulfil the essential requirements of daily life. Only linear scars were left in the donor sites of right forearm and right thigh.

In December 2020, a 39-year female was admitted in Guangzhou Heping Orthopaedic Hospital with severely and destructively mangled both forearms. There was a segmental destruction of left wrist and an oblique destruction of right palm together with the right thumb and index finger. In the emergency surgery, the left palm was split at the first web. Then the left thumb was transferred to the first metacarpal bone of right hand for reconstruction of right thumb. The 2nd to 4th metacarpal bones of the left palm were transferred to the distal carpal bones of right wrist for reconstruction of right hand. The superficial veins of forearm were freed and transferred to bridge the defects of arteries and veins in the right hand. A right anteriolateral thigh perforator flap (ALTPF) was taken to reconstruct the soft tissue defects of right hand. The ring and little fingers of right hand were amputated and transferred to the left distal ulna and distal radius of the stump of remaining left forearm, thereby a chimeric left "forearm-hand" was reconstructed. After 20 months of follow-up, the both reconstructed hands and the flaps survived well without obvious bloat, and the appearance of the digits was full. The two-point discrimination (TPD) of both reconstructed hands was restored to 10-12 mm, and a partial pinching and griping functions were restored. The reconstructed hands were able to fulfil the essential requirements of daily life. Only linear scars were left in the donor sites of right forearm and right thigh.

Objective:To explore the method and effect of free thining anterolateral thigh perforator flap (ALTP) in repairing soft tissue defect of scar contracture deformity after hand trauma.Methods:From March, 2015 to August, 2019, 12 patients who suffered scar contracture after hand trauma were repaired with thin ALTP. First, completely resected the scar contracture tissue from the hands and restored the normal bone structure and force line of the hand. The area of hand wound defects were 5.0 cm×6.0 cm-8.0 cm×10.0 cm. The wound was repaired by free ALTP, and the flap was micro-thinned for the first time. The flaps did not carry broad fascia, and the donor sites were directly sutured. The wound healing, the flap appearance, texture, sensation, scarring of the donor area, and functional recovery of the affected hand were observed regularly after surgery. The patients were followed-up by outpatient review and WeChat.Results:All the flaps survived well after the operation. Two cases suffered crisis because hematoma entraps vein cause by bleeding from perforator branch. After surgical exploration, the flaps survived successfully. All 12 flaps were followed-up successfully, including 6 cases reviewed in outpatient clinic, 4 cases followed by WeChat video and 2 cases by telephone consultation. The follow-up time was 3-20 months, with an average of 11 months. The flaps were not bloated, soft, non-pigmented, and beautiful in appearance. Only linear scars remained in the donor sites. The gripp function, palm function, thumb opposition function and finger function of the affected hand were largely restored. According to the TAM method of Upper Limb Function Evaluation of the Chinese Medical Association: 7 cases were excellent, 4 cases were good, and 1 case was fair.Conclusion:The thinning ALTP can be used to repair the scar contracture deformity after hand trauma. It can carry different tissues for 3-dimensional repair. After operation, the flap has a beautiful appearance, the donor site can be closed directly, and the damage of donor site can be reduced. It is an effective method to repair the hand contracture deformity.

Objective: To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole. Methods: A retrospective cohort study was conducted of 526 women with hydatidiform mole who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and ChildHealth Care Hospital from Feb. 2013 to Feb. 2018, including 484 women with gestational age less than or equal to 12 weeks (the early group) and 42 women with gestational age greater than 12 weeks (the late group). The clinical characteristics between the two groups were compared, and the pathological diagnosis and pre-evacuation ultrasound examination of the early group were further discussed. Results: Compared with the late group, the clinical characteristics of the early group tended to be atypical, and the incidence of vaginal bleeding, excessive uterine size, theca lutein cysts (>6 cm) and pregnancy complications decreased significantly (all P<0.05). The serum level of β-hCG in the early group was significantly lower than that in the late group (Z=-2.382, P=0.017). While there was no significant difference in the pre-evacuation ultrasound detection rate between the two groups (53.5% vs 66.7%; χ²=2.697, P=0.101). Five hundred and fifteen patients completed the follow-up, and 38 patients with post-mole neoplasia were all cured. There was no significant difference in the malignant transformation rate of hydatidiform mole between the two groups (7.0% vs 11.9%; χ²=0.745, P=0.388). In the early group, 302 cases of complete hydatidiform mole (CHM), 179 cases of partial hydatidiform mole (PHM) and 3 cases of unclassified hydatidiform mole (UHM) were histologically diagnosed, according to pathological morphology combined with p57^KIP2 immunohistochemical staining. Compared with pathological diagnosis, the overall pre-evacuation ultrasound detection rate in the early hydatidiform mole was 53.5% (259/484), which was significantly better for complete (78.1%, 236/302) versus partial (11.7%, 21/179) hydatidiform moles (χ²=199.224, P<0.01). There was significantly weak negative correlation between the overall ultrasound detection rate and gestational age of hydatidiform mole (r=-0.211, P<0.01). The gestational age of early PHM was significantly longer than that of CHM (68.0 vs 58.5 days; Z=-8.048, P<0.01). Conclusions The clinical presentations of early hydatidiform mole are not typical. Although ultrasound examination identifies only about half of hydatidiform moles, ultrasonography is still an important auxiliary examination method. Morphological examination combined with p57^KIP2 immunohistochemical staining could effectively diagnose early hydatidiform mole, so as to reduce the missed diagnosis of hydatidiform mole.

Objective: To investigate the clinical outcomes and second-look arthroscopic findings after high tibial osteotomy (HTO) combined with medial meniscus posterior root (MMPR) repair. Methods: Twenty-five patients who underwent HTO combined with MMPR repair were subjected to second-look arthroscopy and retrospectively analyzed. Biplane HTO combined with MMPR repair was performed on these patients. Arthroscopic transtibial pullout repair was employed to repair the MMPR. The relative degree of the medial meniscus extrusion (MME) were measured. Cartilage regeneration and the healing of MMPR were evaluated at the time of second-look arthroscopy. Clinical outcomes were assessed based on Hospital for Special Surgery (HSS) scores and Lysholm scores. Results: The MMPRs were completely healed in 12 cases (48%), partially healed in 9 cases (36%), healed with scarring in 3 cases (12%), and no healed in 1 case (4%). Follow-up duration was 13.04±1.06 months (12-16 months). There were no statistically significant differences in the Kellgren-Lawrence classifications of the cases before and after surgery (χ²=0.786, P=0.675). The relative position of the mechanical axis of the lower extremity through the tibial plateau was 19.88%±6.44% preoperatively and 58.68%±7.71% after operation with significant difference (t=-18.561, P<0.001). The Lysholm scores was increased significantly from 34.76±3.62 points to 82.08±4.35 points after operation (t=-52.717, P<0.001). The HSS scores was increased significantly from 33.52±6.48 points to 81.52±4.79 points after operation (t=-38.685, P<0.001). The degree of MME was changed from 51.12%±13.55% to 50.48%±15.15% without statistical difference (t=0.550, P=0.588) . The comparison between different degrees of healing groups revealed no statistical differences in all variables (P>0.05). The comparison between different degree of cartilage regeneration groups revealed no statistical differences in all variables (P>0.05). Conclusion HTO combined with MMPR repair can effectively improve the lower limb alignment and patients' symptoms with a satisfactory healing rate of MMPR. The effects of post-root repair after a short period is not obvious. The longer-term clinical effects is worthy of further observation.

Objective To explore the clinical significance of centralized surveillance of hydatidiform mole.Methods From Feb.2013 to Feb.2017 all patients with hydatidiform mole,who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and Child Health Care Hospital,were registered centrally for serum hCG monitoring and treatment if necessary.Prophylactic chemotherapy was not administered regardless of risk factors for malignant transformation of hydatidiform mole.The risk factors included age of over 40 years,excessive uterine enlargement for presumed gestational age,a serum hCG level greater than 5 00 000 U/L,large theca lutein ovarian cysts (＞6 cm),and a history of previous hydatidiform mole.The centralized surveillance of hydatidiform mole was based on the central pathology review,team cooperation and service improvement.Their treatments and outcomes were analyzed retrospectively.Results A total of 407 women of hydatidiform mole were registered with histopathology confirmation,including 70 high-risk hydatidiform moles.The follow-up rate was 97.5％ (397/407).The incidence of post-mole neoplasia was 8.1％ (32/397),which was diagnosed in 22.9％ (16/70) of high-risk and in 4.9％ (16/327) of low-risk hydatidiform moles,showed statistically significant difference between high-risk and low-risk groups (x2=25.108,P＜0.01).Thirty-two patients with post-mole neoplasia were all at low risk of International Federation of Gynecology and Obstetrics (FIGO) score (range,0-6) and received complete remission with chemotherapy alone in 31 of them except one treated by hysterectomy.The primary cure rate of single-agent chemotherapy was 60.0％ (18/30).Patients with low-risk or high-risk post-mole neoplasia were both 16.There were no significant differences between the two groups in interval that was end of antecedent pregnancy to start of treatment,the serum level of hCG before treatment,clinical stage or risk factor score (all P＞0.05).Conclusions The risk of malignant transformation is increased in high-risk hydatidiform mole,however,the high risk factor itself does not affect the prognosis in patients with timely diagnosis and treatment of post-mole neoplasia.Therefore,prophylactic chemotherapy is not recommended to high-risk hydatidiform mole patients.Centralized surveillance of hydatidiform mole is practical in a local hospital of China and could greatly improve the prognosis of post-mole neoplasia.