Objective:To investigate the anatomy of the perforator flap of a perforating branch in the middle segment of ulnar artery and explore the surgical procedure and clinical effects on reconstruction of soft tissue defects in digits.Methods:From January 2021 to December 2022, an preliminary anatomical study on 8 upper limbs of 4 chilled fresh specimen of adults were carried out at the Department of Hand Surgery, Ningbo First Hospital Longshan Hospital Medical and Health Group. The anatomical study investigated the perforating branches in the middle segment of ulnar artery, and the location, quantity, outer diameter, course and distribution of the perforating branches were all recorded. SPSS 26.0 software was used for statistical process of the data, and t-test was performed according to the left and right sides. P<0.05 was considered statistically significant. Over the same period, 10 patients with soft tissue in digits defects were reconstructed with transfer of free perforator flap of the middle segment perforator of ulnar artery. All the digital injuries accompanied with various degrees of tendon or phalangeal exposure. The sizes of soft tissue defects were 1.5 cm×1.8 cm to 2.8 cm×3.5 cm. The flaps of the middle segment perforator of ulnar artery sized 1.8 cm×2.0 cm-3.0 cm×3.8 cm. Donor sites were directly sutured. Outpatient follow-up and home visit were conducted after surgery. Patients who were from other regions and not convenient to pay a visit to the hospital were reviewed through WeChat or smartphone to observe the appearance, texture, sensory recovery, and digit function. Results:There was a constant perforating branch in the middle segment of ulnar artery, at 9.89 cm±0.40 cm from the proximal end of pisiform bone, with an outer diameter of 0.71 mm±0.13 mm at the root and there was a length of 2.10 cm±0.32 cm available for vascular pedicle. There was no significant difference between the data of left and right. After surgery, 8 flaps survived smoothly with stage-I healing, and 2 flaps appeared venous occlusion on the second day after surgery and after a symptomatic treatment, the flaps survived with minor pigmentation. All 10 donor sites had stage-I healing. Follow-ups were conducted for 3-20 months, with an average of 10.5 months. The appearance, elasticity, texture, and colour of the flaps were all satisfactory. Four flaps were sutured with nerves, and the sensation recovery of these flaps achieved to S 3+ with TPD at 9-14 mm, at 11.25 mm in average. The 6 flaps without nerves suture had the sensation recovery to S 3. According to the Dargan functional evaluation criteria, the function of 6 digits were in excellent, 3 in good and 1 in poor. The Vancouver Scar Scale (VSS) was employed to evaluate the postoperative scars, and the scores were 3-6 points and at 4.08 points in average. Conclusion:Free perforator flap of the perforating branch in middle section of ulnar artery has a constant vascular pedicle, and it offers a satisfactory skin texture and appearance. It is simple to operate, does not have to sacrifice the main blood vessel, and there is a concealed donor site. It is an ideal flap for reconstruction of digital defects.

Objective:To explore the effect of intraoperative local application of thrombin on postoperative blood loss in internal fixation of femoral intertrochanteric fracture with proximal femoral nail antirotation (PFNA).Methods:A retrospective study was conducted to analyze the 50 patients with intertrochanteric femur fracture who had been treated at Department of Orthopaedics, The First Ningbo Hospital & Longshan Hospital Medical Health Group between January 2021 and December 2023. The patients were divided into 2 groups according to whether local thrombin was applied intraoperatively or not. In the treatment group of 25 cases [9 males and 16 females aged (76.5±10.1) years], after PFNA implantation, 6 pieces of thrombin freeze-dried powder were dissolved in 60 mL of sterile physiological saline, 30 mL of which was sprayed inside the main nail incision, 20 mL of which inside the spiral blade incision, and 10 mL of which inside the distal locking nail incision. In the control group of 25 cases [11 males and 14 females aged (71.1±10.1) years], after PFNA implantation, the incisions were rinsed only with the same doses of physiological saline. The hemoglobin (Hb) and hematocrit (Hct) on the 1st, 3rd, and 7th days after surgery, total blood loss, occult blood loss, transfusion rate, and deep vein thrombosis (DVT) were compared between the 2 groups.Results:There were no significant differences in the preoperative general data or operation time between the 2 groups, indicating comparability ( P>0.05). On the 1st, 3rd, and 7th days after surgery, respectively, the Hb was (101.48±12.15) g/L, (102.96±12.76) g/L, and (107.24±13.47) g/L, and the Hct 0.31±0.03, 0.32±0.03, and 0.33±0.04 in the treatment group, significantly higher than those in the control group [(92.72±10.95) g/L, (86.52±7.43) g/L, and (91.56±10.24) g/L; 0.28±0.03, 0.26±0.03, and 0.27±0.03] ( P<0.05). In the treatment group, the total postoperative blood loss was (364.60±134.27) mL, and the occult blood loss was (258.04±112.59) mL, both significantly lower than those in the control group [(481.72±218.69) mL and (355.84±176.97) mL] ( P<0.05). In the treatment group and the control group, respectively, 2 patients and 1 patient developed DVT after surgery, showing no statistically significant difference in the incidence ( P>0.05). Conclusion:Intraoperative local application of thrombin can significantly reduce postoperative blood loss but may not increase postoperative thrombosis or other complications in PFNA internal fixation of femoral intertrochanteric fracture.

Objective:To explore the surgical procedure and clinical efficacy of free chimeric tendon mini-flap pedicled with superficial palmar branch with flexor carpi radialis of radial artery in reconstruction of the dorsal finger composite tissue defects.Methods:From January 2020 to December 2022, 6 fingers (6 patients) with combined dorsal soft tissue and extensor tendon defects were treated in the Department of Plastic and Reconstructive Surgery, the First Affiliated Hospital of Ningbo University. The ipsilateral free chimeric flexor carpi radialis tendon mini-flap pedicled with superficial palmar branch of radial artery was used to reconstruct the soft tissue defects that sized 1.5 cm×1.8 cm - 2.5 cm×3.0 cm and the extensor tendon defects ranged 1.5 - 2.5 cm in length. The flap donor sites were directly sutured. Blood supply and survival of the flaps were observed after surgery. Postoperative follow-ups were scheduled at the 1, 3, 6, 12, 18 and 24 months after surgery and mainly conducted at the outpatient clinic and by home visits. Patients who were inconvenient to visit the hospital were reviewed through WeChat or telephone interviews. The follow-up included the colour, texture, appearance, sensation of the flap and functional status of the affected fingers.Results:After surgery, all 6 flaps survived without any incidence. All flap donor sites achieved stage I healing. The postoperative follow-up lasted 6-22 (mean 11.3) months. The colour and texture of the flaps were similar to those of the skin of dorsal finger, without bulky appearance. For the 3 flaps that had nerve anastomoses, the sensation recovery of the flap achieved to S 3+, with TPD at 7.6 mm, 7.9 mm and 8.3 mm, respectively, and 7.93 mm in average. For the 3 flaps without nerve anastomosis, the sensation recovery of the flap achieved S 3. No complication occurred at the donor sites. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 4 patients were in excellent and 2 in good. Conclusion:Transfer of free chimeric flexor carpi radialis tendon mini-flap pedicled with superficial palmar branch of radial artery in reconstruction of the soft tissue defect in dorsal finger offers the advantages of reliable blood supply, sufficient blood reflux, bridging blood vessels, nerves and tendons, a minimal damage to the donor site and satisfactory postoperative outcome. It is an ideal surgical procedure for reconstruction of the composite tissue defects in dorsal finger.

Objective:To investigate the anatomy of the perforator flap of a perforating branch in the middle segment of ulnar artery and explore the surgical procedure and clinical effects on reconstruction of soft tissue defects in digits.Methods:From January 2021 to December 2022, an preliminary anatomical study on 8 upper limbs of 4 chilled fresh specimen of adults were carried out at the Department of Hand Surgery, Ningbo First Hospital Longshan Hospital Medical and Health Group. The anatomical study investigated the perforating branches in the middle segment of ulnar artery, and the location, quantity, outer diameter, course and distribution of the perforating branches were all recorded. SPSS 26.0 software was used for statistical process of the data, and t-test was performed according to the left and right sides. P<0.05 was considered statistically significant. Over the same period, 10 patients with soft tissue in digits defects were reconstructed with transfer of free perforator flap of the middle segment perforator of ulnar artery. All the digital injuries accompanied with various degrees of tendon or phalangeal exposure. The sizes of soft tissue defects were 1.5 cm×1.8 cm to 2.8 cm×3.5 cm. The flaps of the middle segment perforator of ulnar artery sized 1.8 cm×2.0 cm-3.0 cm×3.8 cm. Donor sites were directly sutured. Outpatient follow-up and home visit were conducted after surgery. Patients who were from other regions and not convenient to pay a visit to the hospital were reviewed through WeChat or smartphone to observe the appearance, texture, sensory recovery, and digit function. Results:There was a constant perforating branch in the middle segment of ulnar artery, at 9.89 cm±0.40 cm from the proximal end of pisiform bone, with an outer diameter of 0.71 mm±0.13 mm at the root and there was a length of 2.10 cm±0.32 cm available for vascular pedicle. There was no significant difference between the data of left and right. After surgery, 8 flaps survived smoothly with stage-I healing, and 2 flaps appeared venous occlusion on the second day after surgery and after a symptomatic treatment, the flaps survived with minor pigmentation. All 10 donor sites had stage-I healing. Follow-ups were conducted for 3-20 months, with an average of 10.5 months. The appearance, elasticity, texture, and colour of the flaps were all satisfactory. Four flaps were sutured with nerves, and the sensation recovery of these flaps achieved to S 3+ with TPD at 9-14 mm, at 11.25 mm in average. The 6 flaps without nerves suture had the sensation recovery to S 3. According to the Dargan functional evaluation criteria, the function of 6 digits were in excellent, 3 in good and 1 in poor. The Vancouver Scar Scale (VSS) was employed to evaluate the postoperative scars, and the scores were 3-6 points and at 4.08 points in average. Conclusion:Free perforator flap of the perforating branch in middle section of ulnar artery has a constant vascular pedicle, and it offers a satisfactory skin texture and appearance. It is simple to operate, does not have to sacrifice the main blood vessel, and there is a concealed donor site. It is an ideal flap for reconstruction of digital defects.