Objective:To compare the arthroscopic autologous osteochondral transfer (AOT) and arthroscopic subscapularis augmentation (ASA) in the treatment of recurrent anterior shoulder dislocation complicated with scapular glenoid bone injury less than 20%.Methods:A retrospective analysis was conducted of the clinical data of 42 patients who had been treated at Department of Orthopaedics, The Second Hospital of Lanzhou University for recurrent anterior shoulder dislocation complicated with scapular glenoid bone injury less than 20% from January 2022 to January 2023. There were 30 males and 12 females, with an age of (32.2±15.2) years. Altogether 12 left shoulders and 30 right shoulders were affected. The patients were divided into 2 groups according to their surgical methods: an AOT group in which 15 cases were treated with AOT and an ASA group in which 27 cases treated with ASA. The Rowe score, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS), and shoulder range of motion were compared between groups at the last follow-up. All the above indexes were compared between pre-surgery and post-surgery in each group. The incidence of complications in the 2 groups was recorded.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, indicating comparability ( P > 0.05). A total of 42 patients were followed up for (17.2±5.9) months after surgery. At the last follow-up, in the ASA group and the AOT group respectively, the Rowe score was (97.0±4.4) points and (98.3±2.4) points, the ASES score (97.9±5.2) points and (99.1±3.7) points, and the VAS score 0 (0, 0) point and 0 (0, 1) point, showing no significant difference between the 2 groups ( P > 0.05). The above items in the 2 groups were significantly improved compared with those before surgery ( P < 0.05). At the last follow-up, in ASA group and AOT group respectively, shoulder abduction was 169.2°±3.0° and 168.3°±3.1°, and flexion 171.9°±4.0° and 173.3°±4.1°, showing no significant difference between the 2 groups ( P > 0.05); the abduction 90° external rotation was 67.3°±3.2° in the AOT group, significantly better than that in the ASA group (64.4°±3.5°) ( P < 0.05). The above items in the 2 groups were significantly improved compared with those before operation ( P < 0.05). Follow-ups revealed no infection or osteoarthritis. After surgery, 1 case of shoulder re-dislocation and 6 cases of shoulder pain occurred in the ASA group, while no cases of shoulder re-dislocation or shoulder pain occurred in the AOT group. There was no significant difference between the 2 groups in the incidence of complications ( P > 0.05). Conclusions:In the treatment of patients with recurrent anterior shoulder dislocation complicated with scapular glenoid bone injury less than 20%, both AOT and ASA can improve shoulder function, but AOT is superior to ASA in 90° external rotation.

Objective:To investigate the influence of the complexity metrics of the multi-leaf collimator (MLC) on the γ-pass rate of volumetric modulated arc therapy (VMAT) plans for nasopharyngeal carcinoma (NPC).Methods:A total of 60 VMAT plans for NPC were selected to measure the γ-pass rate. The MLC data across all control points (CPs) in each VMAT plan were analyzed to calculate the mean field area (MFA), average leaf gap (ALG), small aperture score (SAS), and their corresponding weighted metrics including MFAW, ALGW, and SASW, considering dose weight (W). Pearson′s bivariate correlation analysis was conducted to examine the correlations between MLC complexity metrics and the γ-pass rate. Moreover, the receiver operating characteristic (ROC) analysis was employed to assess the predictive efficacy of MLC complexity metrics on dose verification result.Results:Under the 3%/3 mm, 3%/2 mm, and 2%/2 mm criteria, the MFA in the 60 VMAT plans exhibited a positive correlation with the γ-pass rate ( r=0.82, 0.79, 0.72, P<0.05), and the MFAW was also positively correlated with the γ-pass rate ( r=0.83, 0.81, 0.75, P<0.05). The ALG manifested a positive correlation with the γ-pass rate ( r=0.82, 0.79, 0.74, P<0.05), as did the ALGW ( r=0.83, 0.81, 0.77, P<0.05). The SAS(0-1 cm), SAS(1-2 cm), SAS(2-3 cm), and SAS(3-4 cm) displayed negative correlations with the γ-pass rate ( r= -0.86, -0.82, -0.71, -0.84, -0.82, -0.72, -0.79, -0.79, -0.73, -0.30, -0.35, -0.42, P<0.05), whereas the SAS(4-5 cm), SAS(5-6 cm), and SAS(6-40 cm) showed positive correlations with the γ-pass rate ( r=0.49, 0.45, 0.33, 0.73, 0.71, 0.59, 0.79, 0.79, 0.76, P<0.05). The outcomes of SASW reveal slightly stronger correlations than those of SAS. In terms of correlations among complexity metrics, a positive correlation was observed between MFA and ALG ( r=0.98, P<0.05). ALG was negatively correlated with SAS(0-1 cm), SAS(1-2 cm), SAS(2-3 cm), and SAS(3-4 cm) ( r= -0.95, -0.94, -0.89, -0.39, P<0.05), and positively correlated with SAS(4-5 cm), SAS(5-6 cm), and SAS(6-40 cm) ( r=0.51, 0.77, 0.92, P<0.05). The weighted result mirrored these correlations. The ROC-derived analytical result indicate that MFA, MFAW, ALG, ALGW, SAS(0-1 cm), SAS(1-2 cm), SAS(2-3 cm), SAS(6-40 cm), SASW(0-1 cm), SASW(1-2 cm), SASW(2-3 cm), and SASW(6-40 cm) demonstrated exceptional predictive efficacy for dose verification result [Area under the curve (AUC) > 0.9, P<0.05]. Conclusions:The γ-pass rate of VMAT plans for NPC is strongly correlated with MLC complexity metrics, which demonstrate excellent predictive efficacy for dose verification result. The increased uncertainty in dose calculations and measurements caused by narrow fields generated by the MLC is a significant factor contributing to the reduced γ-pass rate of VMAT plans. This finding is associated with discrepancies in the precision of treatment planning system (TPS) modeling and the accuracy of dose verification tools, providing a reference for similar challenges.

OBJECTIVE: To investigate the effect of autologous osteochondral tissue and periosteum transplantation on tendon-bone healing of rotator cuff in rabbits. METHODS: Twenty-four male New Zealand white rabbits were randomly divided into autologous osteochondral tissue and periosteum transplantation group (experimental group, n=12) and simple suture group (control group, n=12). Both groups were subjected to acute supraspinatus tendon injury and repaired with corresponding techniques. At 4, 8, and 12 weeks after operation, 4 specimens from each group were taken from the right shoulder joint for histological examination (HE staining, Masson staining, and Safranin O-fast green staining), and the left shoulder was subjected to biomechanical tests (maximum tensile load and stiffness). RESULTS: Both groups of animals survived until the completion of the experiment after operation. At 4 weeks after operation, both groups showed less collagen fibers and disorder at the tendon-bone junction. At 8 weeks, both groups showed reduced inflammation at the tendon-bone junction, with more organized and denser collagen fibers and chondrocytes. The experimental group showed better results than the control group. At 12 weeks, the experimental group showed typical tendon-bone transition structure, with increased generation of collagen fibers and chondrocytes, and the larger cartilage staining area. Both groups showed an increase in maximum tensile load and stiffness over time ( P<0.05). The stiffness at 4 weeks and the maximum tensile load at 4, 8, and 12 weeks in the experimental group were superior to control group, and the differences were significant ( P<0.05). There was no significant difference in stiffness at 8, 12 weeks between the two groups ( P>0.05). CONCLUSION Autologous osteochondral tissue and periosteum transplantation can effectively promote the fiber and cartilage regeneration at the tendon-bone junction of rotator cuff and improve the biomechanical effect of shoulder joint in rabbits.
Animals ; Rabbits ; Male ; Wound Healing ; Transplantation, Autologous ; Periosteum/transplantation* ; Rotator Cuff Injuries ; Rotator Cuff/surgery* ; Tendons/surgery* ; Biomechanical Phenomena ; Chondrocytes/transplantation* ; Tendon Injuries/surgery* ; Tensile Strength

Objective:To investigate the influence of the complexity metrics of the multi-leaf collimator (MLC) on the γ-pass rate of volumetric modulated arc therapy (VMAT) plans for nasopharyngeal carcinoma (NPC).Methods:A total of 60 VMAT plans for NPC were selected to measure the γ-pass rate. The MLC data across all control points (CPs) in each VMAT plan were analyzed to calculate the mean field area (MFA), average leaf gap (ALG), small aperture score (SAS), and their corresponding weighted metrics including MFAW, ALGW, and SASW, considering dose weight (W). Pearson′s bivariate correlation analysis was conducted to examine the correlations between MLC complexity metrics and the γ-pass rate. Moreover, the receiver operating characteristic (ROC) analysis was employed to assess the predictive efficacy of MLC complexity metrics on dose verification result.Results:Under the 3%/3 mm, 3%/2 mm, and 2%/2 mm criteria, the MFA in the 60 VMAT plans exhibited a positive correlation with the γ-pass rate ( r=0.82, 0.79, 0.72, P<0.05), and the MFAW was also positively correlated with the γ-pass rate ( r=0.83, 0.81, 0.75, P<0.05). The ALG manifested a positive correlation with the γ-pass rate ( r=0.82, 0.79, 0.74, P<0.05), as did the ALGW ( r=0.83, 0.81, 0.77, P<0.05). The SAS(0-1 cm), SAS(1-2 cm), SAS(2-3 cm), and SAS(3-4 cm) displayed negative correlations with the γ-pass rate ( r= -0.86, -0.82, -0.71, -0.84, -0.82, -0.72, -0.79, -0.79, -0.73, -0.30, -0.35, -0.42, P<0.05), whereas the SAS(4-5 cm), SAS(5-6 cm), and SAS(6-40 cm) showed positive correlations with the γ-pass rate ( r=0.49, 0.45, 0.33, 0.73, 0.71, 0.59, 0.79, 0.79, 0.76, P<0.05). The outcomes of SASW reveal slightly stronger correlations than those of SAS. In terms of correlations among complexity metrics, a positive correlation was observed between MFA and ALG ( r=0.98, P<0.05). ALG was negatively correlated with SAS(0-1 cm), SAS(1-2 cm), SAS(2-3 cm), and SAS(3-4 cm) ( r= -0.95, -0.94, -0.89, -0.39, P<0.05), and positively correlated with SAS(4-5 cm), SAS(5-6 cm), and SAS(6-40 cm) ( r=0.51, 0.77, 0.92, P<0.05). The weighted result mirrored these correlations. The ROC-derived analytical result indicate that MFA, MFAW, ALG, ALGW, SAS(0-1 cm), SAS(1-2 cm), SAS(2-3 cm), SAS(6-40 cm), SASW(0-1 cm), SASW(1-2 cm), SASW(2-3 cm), and SASW(6-40 cm) demonstrated exceptional predictive efficacy for dose verification result [Area under the curve (AUC) > 0.9, P<0.05]. Conclusions:The γ-pass rate of VMAT plans for NPC is strongly correlated with MLC complexity metrics, which demonstrate excellent predictive efficacy for dose verification result. The increased uncertainty in dose calculations and measurements caused by narrow fields generated by the MLC is a significant factor contributing to the reduced γ-pass rate of VMAT plans. This finding is associated with discrepancies in the precision of treatment planning system (TPS) modeling and the accuracy of dose verification tools, providing a reference for similar challenges.

Objective:To compare the arthroscopic autologous osteochondral transfer (AOT) and arthroscopic subscapularis augmentation (ASA) in the treatment of recurrent anterior shoulder dislocation complicated with scapular glenoid bone injury less than 20%.Methods:A retrospective analysis was conducted of the clinical data of 42 patients who had been treated at Department of Orthopaedics, The Second Hospital of Lanzhou University for recurrent anterior shoulder dislocation complicated with scapular glenoid bone injury less than 20% from January 2022 to January 2023. There were 30 males and 12 females, with an age of (32.2±15.2) years. Altogether 12 left shoulders and 30 right shoulders were affected. The patients were divided into 2 groups according to their surgical methods: an AOT group in which 15 cases were treated with AOT and an ASA group in which 27 cases treated with ASA. The Rowe score, American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale (VAS), and shoulder range of motion were compared between groups at the last follow-up. All the above indexes were compared between pre-surgery and post-surgery in each group. The incidence of complications in the 2 groups was recorded.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, indicating comparability ( P > 0.05). A total of 42 patients were followed up for (17.2±5.9) months after surgery. At the last follow-up, in the ASA group and the AOT group respectively, the Rowe score was (97.0±4.4) points and (98.3±2.4) points, the ASES score (97.9±5.2) points and (99.1±3.7) points, and the VAS score 0 (0, 0) point and 0 (0, 1) point, showing no significant difference between the 2 groups ( P > 0.05). The above items in the 2 groups were significantly improved compared with those before surgery ( P < 0.05). At the last follow-up, in ASA group and AOT group respectively, shoulder abduction was 169.2°±3.0° and 168.3°±3.1°, and flexion 171.9°±4.0° and 173.3°±4.1°, showing no significant difference between the 2 groups ( P > 0.05); the abduction 90° external rotation was 67.3°±3.2° in the AOT group, significantly better than that in the ASA group (64.4°±3.5°) ( P < 0.05). The above items in the 2 groups were significantly improved compared with those before operation ( P < 0.05). Follow-ups revealed no infection or osteoarthritis. After surgery, 1 case of shoulder re-dislocation and 6 cases of shoulder pain occurred in the ASA group, while no cases of shoulder re-dislocation or shoulder pain occurred in the AOT group. There was no significant difference between the 2 groups in the incidence of complications ( P > 0.05). Conclusions:In the treatment of patients with recurrent anterior shoulder dislocation complicated with scapular glenoid bone injury less than 20%, both AOT and ASA can improve shoulder function, but AOT is superior to ASA in 90° external rotation.

Objective:To explore the mechanism of Jianpi Qingchang Decoction in the treatment of UC by integrating network pharmacology, bioinformatics, molecular docking and experimental verification.Methods:The effective components and targets of Jianpi Qingchang Decoction were obtained from TCMSP database, and UC data sets GSE16879, GSE48958 and GSE75214 were obtained from GEO database, and differentially expressed genes were screened; intersection targets were obtained through Venn diagram, and GO function and KEGG pathway enrichment analysis was performed. An intersection target PPI network was constructed using STRING database and topology analysis was performed; hub genes were screened through lasso regression and the expression consistency of core targets in the dataset was verified through logistic regression. A UC mouse model was established and hub genes were validated.Results:A total of 213 drug targets of Jianpi Qingchang Decoction were obtained, and 499 common intersection targets of GSE16879, GSE48958 and GSE75214 were obtained by differential gene expression analysis. Thirty intersection targets of Jianpi Qingchang Decoction and UC were obtained, mainly acting on IL-17 signaling pathway, TNF signaling pathway, AGE-RAGE signaling pathway in diabetic complications, etc. PPI network topology analysis obtained 7 common intersection targets, including PTGS2, IL-1B, IL-6, MMP9, CXCL8, CCL2 and MMP2. IL-6 and MMP2 were selected as hub genes by lasso regression. Logistics regression analysis showed that IL-6 and MMP2 were risk factors for the disease. Compared with the model group, the expressions of IL-6 and MMP2 mRNA and protein in the colon tissue of the TCM group decreased ( P<0.05), and the morphology of colon tissue was improved compared with the model group. Conclusion:IL-6 and MMP2 are risk factors for UC, the therapeutic effect of Jianpi Qingchang Decoction is to mediate Il-17 signal pathway, TNF signal pathway and AGE-RAGE signal pathway in diabetic complications through the targets of IL-6, and MMP2, thereby treating UC.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

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 investigate the clinical effects of Masquelet technique with the transfer of free iliac inguinal flap in reconstruction of infectious bone and soft tissue defect after metacarpal fracture surgery.Methods:From January 2014 to January 2020, 16 patients suffered from infectious bone and soft tissue defect after surgery of metacarpal fracture were treated in Department of Hand Surgery, Institute for Hygiene of Ordnance Industry (Weapon Industry 521 Hospital). Debridement and vacuume sealing drainage (VSD) coverage of wound were carried out in emergency surgery, and Masquelet technique combined with free iliac inguinal flap for reconstruction of infected metacarpal bone defect were performed in sub-emergency surgery. The patients were 14 males and 2 females with an average age of 38 (20-50) years old. Plates were removed in 10 patients and retained in 6 patients. Defects of metacarpal bone ranged from 0.8 cm×0.8 cm×2.0 cm to 1.5 cm×2.0 cm× 5.1 cm in size. Soft tissue defects ranged from 3.6 cm×6.8 cm to 7.8 cm×11.6 cm. Tendon defects were found in all 16 patients. After the primary procedure of Masquelet technique combined with free iliac inguinal flap, routine anti-infection, anticoagulant, antispasmodic and other treatments were offered to all patients. Then all patients were observed by fortnightly reviews. After infection was cleared, the second phase of Masquelet treatment began. The defects of metacarpal bone were reconstructed with autologous cancellous bone grafts, and measures to prevent from infection together with other therapies were offered after the surgery. Follow-up of the second phase surgery was carried out once per 1-2 weeks and then per 2-4 months after bone union. The follow-up review items included: wound infection and necrosis, appearance, shape, texture and sensory recovery of flap. Bone union of infectious metacarpal defect was evaluated, recurrence of infection was closely observed as well as the resorption or nonunion of bone by X-rays. Hand function was assessed according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. Donor sites healing and functional recovery were also included in the postoperative observation.Results:The follow-up time ranged from 1.5-3.0 (average 2.4) years. There was no necrosis of iliac inguinal flap, no recurrence of infection, and the flaps all healed well. The appearance, shape and texture of flaps were found close to the adjacent skin in all patients. Two-point discriminations (TPD) of the transferred iliac inguinal flaps were at 8-10 mm. X-ray reviews showed that bone union achieved in all patients. The time of bone union were 2.1-3.4 months (2.9 months in average) after bone grafting. There was no bone resorption, infection or nonunion. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 13 patients were excellent and 3 patients were good. All donor sites had primary healing with the motion of donor hips unaffected.Conclusion:Masquelet technique combined with free iliac inguinal flap is an effective, safe and feasible surgical procedure in reconstruction of infectious bone and soft tissue defect after metacarpal fracture surgery. It offers a satisfactory outcome with relatively less damage to the donor site.

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.