Objective:To investigate the clinical effect of free fibular flap of great toe without vein in repairing soft tissue defect of finger pulp.Methods:From June 2020 to January 2021, 8 cases of finger pulp soft tissue defect were repaired with free flap of fibular side of great toe without vein, including 6 males and 2 females, with an average age of 32(18-42) years old. The defect area of finger pulp was 1.0 cm×0.5 cm-1.8 cm×0.8 cm. The proper digital artery and digital nerve of the affected finger were anastomosed. All flaps did not carry reflux veins. The donor site of the toe was directly sutured. Postoperative routine anti infection, anti spasm and anticoagulant treatment was performed. Postoperative outpatient regular follow-up.Results:All flaps survived without vascular crisis, and the donor and recipient sites healed in the first stage. All patients were followed-up for an average of 6.4(4-12) months. At the last follow-up, the TPD was 6-8 mm, the hand function was evaluated according to the Trial Standard of Upper Limb Function Evaluation of Hand Surgery Society of Chinese Medical Association. Seven cases were excellent and 1 case was good.Conclusion:The free fibular flap of the great toe can be used to repair the small wound of finger pulp without carrying the draining vein, the flap can still survive. And it can provide a certain reference for the failure of anatomic separation of the draining vein.

Objective To investigate therapeutic effects of β-TCP/PLGA scaffolds seeded bone marrow mesenchymal stem cells (BMSCs) combing with hyperbaric oxygen (HBO) on bone defect with seawater immersing in rabbit radius.Methods BMSCs were seeded into the β-TCP/PLGA scaffolds to construct tissue engineering bone.60 New Zealand rabbits were created 1.5 cm bone defect in bilateral radius,and then bilateral wound limbs were immersed in seawater for 3 h.After debridement,all rabbits were randomly divided into 4 groups.In group A nothing was implanted into the bone defect.Only BMSCs was implanted in group B.BMSCs + HBO was given in group C.β-TCP/PLGA BMSCs + HBO was given in group D.At postoperative 4,8,12 weeks rabbits were sacrificed after radiography radius.X-ray radiography,HE staining,immunohistochemical observation were used to evaluate repairing effect of bone defect with seawater immersing.Results Radiographic analysis demonstrated that the bone defects were completely repaired with recanalization of the medullary cavity in group D,bone defects were partially repaired with partal recanalization of the medullary cavity in group C,bone defects were incompletely repaired in group B;bone defect repair unfinished and the broken ends were sclerous in group A.Each time point group D＞group C＞group B＞group A in callus grey value (P＜0.05).HE staining indicated after 12 weeks,a small amount of lainellar bone formated in group A;a small amount of lamellar bone formated in group B;a large amount of lamellar bone formated in group C;a large amount of lamellar bone formated in group D.Immunohistoehemical result indicated at postoperative 4 weeks,the expressions of osteocalcin(OCN) in each group were at high levels,the expressions decreased significantly at Postoperative 8 weeks,the expressions were at a low level at postoperative 12 weeks.At postoperative 4 and 8 weeks,the expression levels of OCN were group D＞ group C＞ group B＞group A (P＜0.05),there was no significant difference at postoperative 12 weeks between the 4 groups (P＞0.05).Conelusion the β-TCP/PLGA composite BMSCs combined hyperbaric oxygen is the effective method to repair seawater immersed bone defect in rabbit.

Objective To explore the effects of HBO combined with percutaneous allogeneic bone marrow mesenchymal stem cells (BMSCs) grafting on the repair of rabbit radius open bone defect following seawater immersion.Methods Forty-eight New Zealand rabbits were randomly divided into 4 groups:the blank control group (group A),the(BMSCs) grafting group (group B),the HBO group (group C),and the HBO combined with BMSCs group (group D).A fifteen-millimeter bone defect was made in the mid-section of radius and then was immersed in the artificial seawater for 3 hours,then the wound was closed with debridement.The animals received HBO therapy the moment after completion of debridement.BMSCs grafting was administered 72 hours after debridement.The animals were sacrificed at week 4,8 and 12 to collect the samples (there were 4 rabbits from each batch of the group,and there were altogether 8 limbs).Repairs of the defect areas were compared between groups by means of radiographic scanning,histologic and immunohistochemical analyses.Results HE staining revealed that osteogenesis in the animals of group D at week 4 and 8 was the best,and group C was superior to group B.In the animals of group A,bone repair was not detected in the defect area,which was filled with scar tissue.At week 12 after injury,osteogenesis in the defect areas for the animals of group D was the best,which was mostly mature bone tissue.(2)Immunohistochemical detection indicated that VEGF and TGF-β1 were mostly expressed in the osteoblastic cells,cartilage cells and bone cell cytoplasm,and significant changes could be noted at different time points.At week 4 after injury,the expressions of VEGF and TGF-β1 all reached peak levels.At week 8,their expressions all decreased significantly,as compared with those at week 4 and 12,their expressions all decreased further to a low level.At week 4 and 8 after injury,the expression levels of VEGF and TGF-β1 for the 4 groups were in the following order:group D ＞ group C ＞ group B ＞ group A.Statistical significance could be seen,when comparisons were made between the groups (P ＜0.05).However,at week 12,no significant differences could detected when comparisons were made between the 4 groups (P ＞ 0.05).(3) Osteotylus measurement revealed that osteotylus grayness for the animals of group D,group C,group B and group A at week 12 after injury was 211.84 ± 4.31,200.31 ± 3.08,152.79 ± 4.43 and 80.88 ± 3.31 respectively,and statistical significance could be noted,when comparisons were made between the groups (P ＜ 0.05).Conclusions The effects of simple percutaneous allogeneic bone marrow mesenchymal stem cells grafting or simple HBO therapy on the repair of open bone defect following seawater immersion were not ideal.However,combined applications of these 2 treatment methods could produce synergistic effects,which could promote osteogenetic process of the affected bone and was an applicable method for the repair of open bone defect following seawater immersion.

Objective To explore the effects of HBO combined with percutaneous allogeneic bone marrow mesenchymal stem cells (BMSCs) grafting on the repair of rabbit radius open bone defect following seawater immersion.Methods Forty-eight New Zealand rabbits were randomly divided into 4 groups:the blank control group (group A),the(BMSCs) grafting group (group B),the HBO group (group C),and the HBO combined with BMSCs group (group D).A fifteen-millimeter bone defect was made in the mid-section of radius and then was immersed in the artificial seawater for 3 hours,then the wound was closed with debridement.The animals received HBO therapy the moment after completion of debridement.BMSCs grafting was administered 72 hours after debridement.The animals were sacrificed at week 4,8 and 12 to collect the samples (there were 4 rabbits from each batch of the group,and there were altogether 8 limbs).Repairs of the defect areas were compared between groups by means of radiographic scanning,histologic and immunohistochemical analyses.Results HE staining revealed that osteogenesis in the animals of group D at week 4 and 8 was the best,and group C was superior to group B.In the animals of group A,bone repair was not detected in the defect area,which was filled with scar tissue.At week 12 after injury,osteogenesis in the defect areas for the animals of group D was the best,which was mostly mature bone tissue.(2)Immunohistochemical detection indicated that VEGF and TGF-β1 were mostly expressed in the osteoblastic cells,cartilage cells and bone cell cytoplasm,and significant changes could be noted at different time points.At week 4 after injury,the expressions of VEGF and TGF-β1 all reached peak levels.At week 8,their expressions all decreased significantly,as compared with those at week 4 and 12,their expressions all decreased further to a low level.At week 4 and 8 after injury,the expression levels of VEGF and TGF-β1 for the 4 groups were in the following order:group D ＞ group C ＞ group B ＞ group A.Statistical significance could be seen,when comparisons were made between the groups (P ＜0.05).However,at week 12,no significant differences could detected when comparisons were made between the 4 groups (P ＞ 0.05).(3) Osteotylus measurement revealed that osteotylus grayness for the animals of group D,group C,group B and group A at week 12 after injury was 211.84 ± 4.31,200.31 ± 3.08,152.79 ± 4.43 and 80.88 ± 3.31 respectively,and statistical significance could be noted,when comparisons were made between the groups (P ＜ 0.05).Conclusions The effects of simple percutaneous allogeneic bone marrow mesenchymal stem cells grafting or simple HBO therapy on the repair of open bone defect following seawater immersion were not ideal.However,combined applications of these 2 treatment methods could produce synergistic effects,which could promote osteogenetic process of the affected bone and was an applicable method for the repair of open bone defect following seawater immersion.