Objective:To compare clinical effectiveness of the ulnar flap of dorsal cutaneous branch of proper palmar digital artery (PPDA) of little finger and the perforator flap of the 4th dorsal metacarpal artery (DMA) for reconstruction of small and medium-sized defects of ulnar palm.Methods:A retrospective case-control study method was employed in this study. From March 2017 to February 2024, a total of 42 patients of small and medium-sized defects of ulnar palm were treated in the Department of Hand Surgery, the Second Hospital of Tangshan. Twenty-four defects were reconstructed by the ulnar flaps of dorsal cutaneous branch of PPDA (PPDA group) of little finger and the rest of 18 defects were reconstructed by the perforator flap of the 4th DMA (DMA group). Sizes of the defects and flaps in PPDA group were 1.5 cm×1.2 cm-5.2 cm×2.3 cm and 1.6 cm×1.3 cm-6.0 cm×2.5 cm, respectively. Dimensions of the defects and flaps in DMA group ranged from 1.7 cm×1.2 cm-5.0 cm×2.4 cm and 2.0 cm×1.5 cm-6.2 cm×2.7 cm, respectively. Donor sites in both groups were all directly closed. Survival of the flaps and wound healing of donor sites were observed between the 2 groups after surgery. And the surgical time, intraoperative blood loss and duration of follow-up of the 2 groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone interviews and WeChat video-clips. Static two-point discrimination (TPD) of the flaps were measured, and appearance of flaps and donor sites were evaluated based on the Michigan Hand Function Questionnaire (MHQ) evaluation criteria and Vancouver Scar Scale (VSS), respectively. The measurement and count data acquired from both groups were compared by independent sample t-test and χ2 tests or Fisher's exact test, respectively. P<0.05 was considered statistically significant. Results:All 24 flaps in PPDA group and 14 flaps in DMA group survived primarily, except 4 flaps in DMA group that had blisters and healed by dressing changes. Primary survival rate of the flaps in PPDA group (100%) was higher than that of DMA group (78%), and the difference was statistically significant ( P<0.05). Donor site incisions in both groups all healed primarily. The surgery time, intraoperative blood loss and duration of follow-up in PPDA and DMA groups were 64.50 min±7.70 min, 87.08 ml±25.11 ml, 15.46 months±3.83 months, and 62.44 min±8.28 min, 91.67 ml±27.28 ml, 16.39 months±3.24 months, respectively, and of which there was no statistically significant difference between the 2 groups ( P>0.05). At the final follow-up, static TPD and MHQ scores for flap appearance in PPDA group were 13.71 mm±2.91 mm and 4.63±0.50, which were better than 15.78 mm±2.78 mm and 4.28±0.46 in DMA group with a statistically significant difference ( P<0.05). VSS scores of donor site appearance in PPDA and DMA groups were (3.38±0.97 and 3.89±1.02, respectively. Although there was no statistically significant difference between the 2 groups ( P>0.05), the donor sites in PPDA group were more concealed and easier accepted by patients. Conclusion:The ulnar flap of dorsal cutaneous branch of PPDA of little finger and the perforator flap of the 4th DMA are both suitable for reconstruction of small and medium-sized defects of ulnar palm. Compared with the perforator flap of the 4th DMA, the ulnar flap of dorsal cutaneous branch of PPDA of little finger has advantages in higher primary survival rate, better flap sensation and appearance with more concealed donor site.

Objective:To compare clinical effectiveness of the ulnar flap of dorsal cutaneous branch of proper palmar digital artery (PPDA) of little finger and the perforator flap of the 4th dorsal metacarpal artery (DMA) for reconstruction of small and medium-sized defects of ulnar palm.Methods:A retrospective case-control study method was employed in this study. From March 2017 to February 2024, a total of 42 patients of small and medium-sized defects of ulnar palm were treated in the Department of Hand Surgery, the Second Hospital of Tangshan. Twenty-four defects were reconstructed by the ulnar flaps of dorsal cutaneous branch of PPDA (PPDA group) of little finger and the rest of 18 defects were reconstructed by the perforator flap of the 4th DMA (DMA group). Sizes of the defects and flaps in PPDA group were 1.5 cm×1.2 cm-5.2 cm×2.3 cm and 1.6 cm×1.3 cm-6.0 cm×2.5 cm, respectively. Dimensions of the defects and flaps in DMA group ranged from 1.7 cm×1.2 cm-5.0 cm×2.4 cm and 2.0 cm×1.5 cm-6.2 cm×2.7 cm, respectively. Donor sites in both groups were all directly closed. Survival of the flaps and wound healing of donor sites were observed between the 2 groups after surgery. And the surgical time, intraoperative blood loss and duration of follow-up of the 2 groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone interviews and WeChat video-clips. Static two-point discrimination (TPD) of the flaps were measured, and appearance of flaps and donor sites were evaluated based on the Michigan Hand Function Questionnaire (MHQ) evaluation criteria and Vancouver Scar Scale (VSS), respectively. The measurement and count data acquired from both groups were compared by independent sample t-test and χ2 tests or Fisher's exact test, respectively. P<0.05 was considered statistically significant. Results:All 24 flaps in PPDA group and 14 flaps in DMA group survived primarily, except 4 flaps in DMA group that had blisters and healed by dressing changes. Primary survival rate of the flaps in PPDA group (100%) was higher than that of DMA group (78%), and the difference was statistically significant ( P<0.05). Donor site incisions in both groups all healed primarily. The surgery time, intraoperative blood loss and duration of follow-up in PPDA and DMA groups were 64.50 min±7.70 min, 87.08 ml±25.11 ml, 15.46 months±3.83 months, and 62.44 min±8.28 min, 91.67 ml±27.28 ml, 16.39 months±3.24 months, respectively, and of which there was no statistically significant difference between the 2 groups ( P>0.05). At the final follow-up, static TPD and MHQ scores for flap appearance in PPDA group were 13.71 mm±2.91 mm and 4.63±0.50, which were better than 15.78 mm±2.78 mm and 4.28±0.46 in DMA group with a statistically significant difference ( P<0.05). VSS scores of donor site appearance in PPDA and DMA groups were (3.38±0.97 and 3.89±1.02, respectively. Although there was no statistically significant difference between the 2 groups ( P>0.05), the donor sites in PPDA group were more concealed and easier accepted by patients. Conclusion:The ulnar flap of dorsal cutaneous branch of PPDA of little finger and the perforator flap of the 4th DMA are both suitable for reconstruction of small and medium-sized defects of ulnar palm. Compared with the perforator flap of the 4th DMA, the ulnar flap of dorsal cutaneous branch of PPDA of little finger has advantages in higher primary survival rate, better flap sensation and appearance with more concealed donor site.

Objective:To investigate the impact of aging on the correlation between the intestinal microorganism Akkermansia and obesity, and to analyze the features of the correlation in the elderly population. Methods:This was a cross-sectional study.A total of 6896 cases were collected from the Guangdong intestinal microbiome in 2018, aged 18-94 years old, including 3806 females, 1641 cases with abdominal obesity(23.7%)and 707 cases with systemic obesity(10.3%). The 16S rRNA sequencing data were from individuals of Cantonese descent.The abundance of Akkermansia was calculated after data cleaning, clustering and annotation.The type of abdominal obesity or systemic obesity was diagnosed based on the standards of the Working Group on Obesity in China(2002). According to the five quintiles of the abundance of Akkermansia, subjects were divided into Q1~Q5(Q1-Q4: n=1379, Q5: n=1380). Logistic regression was used to study the relationship between Akkermansia and obesity after adjusting for common confoundors such as gender.Subjects were subgrouped into two types of age groups: the <65 group(n=5467)and the ≥65 group(n=1519); the <70 group(n=6136)and the ≥70 group(n=850). Age windows were used to analyze changes in characteristics of this relationship with increasing age. Results:There were significant differences in age and gender among different Akkermansia groups( t/ χ2=3.51, -5.03, P<0.01). Logistic regression analysis showed that after adjusting for two main confounding factors, age and gender, the risk of systemic obesity and abdominal obesity gradually decreased from Q2 to Q5 group, compared with Q1 group( P<0.001). The correlation between Akkermansia and obesity decreased with age.The protective effect of Akkermansia on obesity was weaker in the ≥65 and ≥70 groups, respectively, than in the <65 and <70 groups. Conclusions:Akkermansia is a protective factor for obesity, but the protective effect is affected by aging and weakened in the elderly.

Objective:To investigate the clinical application of the free medial plantar artery perforator flap for soft tissue defect reconstruction of the weight-bearing surface of the heel.Methods:The clinical data of patients with soft tissue defects in the weight-bearing surface of the heel were analyzed retrospectively, which were reconstructed with the free medial plantar artery perforator flaps in the Second Hospital of Tangshan from April 2011 to November 2017. The medial plantar artery was anastomosed with the posterior tibial artery. The venae comitantes were anastomosed with the great saphenous vein. The cutaneous branch of the medial plantar nerve was also anastomosed with the saphenous nerve. The donor sites were covered with full-thickness skin grafting. The survival condition, sensory function, countour, stability, and donor site scars were observed during follow-up.Results:A total of 11 patients with soft tissue defects in the weight-bearing surface of the heel were enrolled. There were six males and five females aged 24-41 years (mean, 31.3 years). All flaps survived uneventfully. Patients were followed up 11-56 months (mean 18.5 months). The appearance and function recovery of the flaps were satisfactory with 6-13 mm two-point discrimination(2-PD). No ulcer occurred. All patients returned to a normal walk.Conclusions:It is a feasible way for one-staged reconstruction of the combined loss of Achilles tendon and soft tissue in the heel by using free anterolateral femoral artery perforator flap with fascia lata, which has the advantages of good functional recovery, less trauma, short curing course, the satisfactory contour, and protective sensation achievable.

Objective:To investigate the clinical application of the free medial plantar artery perforator flap for soft tissue defect reconstruction of the weight-bearing surface of the heel.Methods:The clinical data of patients with soft tissue defects in the weight-bearing surface of the heel were analyzed retrospectively, which were reconstructed with the free medial plantar artery perforator flaps in the Second Hospital of Tangshan from April 2011 to November 2017. The medial plantar artery was anastomosed with the posterior tibial artery. The venae comitantes were anastomosed with the great saphenous vein. The cutaneous branch of the medial plantar nerve was also anastomosed with the saphenous nerve. The donor sites were covered with full-thickness skin grafting. The survival condition, sensory function, countour, stability, and donor site scars were observed during follow-up.Results:A total of 11 patients with soft tissue defects in the weight-bearing surface of the heel were enrolled. There were six males and five females aged 24-41 years (mean, 31.3 years). All flaps survived uneventfully. Patients were followed up 11-56 months (mean 18.5 months). The appearance and function recovery of the flaps were satisfactory with 6-13 mm two-point discrimination(2-PD). No ulcer occurred. All patients returned to a normal walk.Conclusions:It is a feasible way for one-staged reconstruction of the combined loss of Achilles tendon and soft tissue in the heel by using free anterolateral femoral artery perforator flap with fascia lata, which has the advantages of good functional recovery, less trauma, short curing course, the satisfactory contour, and protective sensation achievable.