Objective To introduce the application of the pedicled anterolateral thigh flap transferring for coverage of the oversized skin defect of the hand. Methods The pedicled anterolateral thigh flap was transferred to cover the large skin defects of the hands or the skin defects of theabdomen after the abdominal flap transferred to the hand in 5 male patients aged 16-44 years from April 2002 to August 2005. The injured sites were as follows:4 right hands and 1 left hand, including 2 hands injured by a machine and 3 hands injured by burning.The mechanically injured patients underwent an operation within 6 hours after the injury. The burned patients were reconstructed by the flap transferring 4-7 days after the burn when the decayed tissues could be clearly indentified.The areas of the hand defects were 12.19 cm×18.22 cm.The areas of the pedicled anterolateral thigh flaps were 7.12 cm×16.24 cm. The areas of the abdominal flaps were 13.20 cm×19.23 cm.The pedicles were separated 3 weeks after the repairing operation. Results All the flaps survived well and there was no vascular crisis, with the wound healing of the first intention. The skin defects of the hand were covered completely. Five patients were followed up for 6-12 months. The texture of the flaps was soft and the flaps had a good blood circulation. Of the patients, 3 underwent the finger exclusion and degreasing operation 47 months after operation. All the flaps of the hands had protective sensation, which could meet the requirement of the daily life. Conclusion The pedicled anterolateral thigh flap can provide the large coverage for the skin defects of the hands. The risk of the operation can be greatly decreased by obviation of the vessel anastomosis. It can be an optimal choice for themanagement of the oversized skin defects of the hands.
From jan.1984 through dec.1991,65 cases of hand skin defects were primarily repaired by podicled groin flap. Four of the 65 cases had skin defects on both sides of the palms and dorsal aspot of the hands which were treated by the Y-shaped hypogastric groin flap .Five easec had thumb loss in which the lxdicled groin tubed flap was used to reconstruct the thumb.The time of division of the pedicles ranged from 14 to 28 days(averaged 16 days).All flape survived after division of the podicl...
Objective To investigate the value of monitoring cytokines in serum after human doublehand allotransplantation. Methods We detected solube interleukin-2 receptor(sIL-2R), interleukin-2(IL-2) and interleukin-6(IL-6) levels of the serum in the patient who were performed doublehand transplantation with immunosupressive from September 2000 to November 2000, and in15 healthy volunteers by using enzyme linked immunosorbent assays. Results TheIL-2 and IL-6 levels decreased quickly during inducing period （P＜0.05）, and then increased gradually. While the sIL-2R level increased. The IL-2 level was lower（P＜0.05）, the IL-6 and sIL-2R levels were slightly higher when compared with those before transplantation. There was significant difference in the IL-2level between the patient and healthy volunteers both before and after transplantation, in the IL6 level between the patient and healthy volunteers during inducing period.Conclusion IL-2, IL-6 and sIL-2R levels of serum may be useful in diagnosis of rejection, prevention of opportunistic infection, tumor and graft versus host disease.
OBJECTIVE This paper is aimed to observe the long-term result of reconstruction of wrist joint by replacing distal end of radius with vascularized fibular head in patient of giant tumor. METHODS From July 1978 to November 1993, 12 cases of giant tumor of distal end of radius were treated by this procedure and followed up for 6 months to 15 years, and the movement range of wrist, grip strength, and pain were evaluated. RESULTS The painful wrist released in 11 cases, only one case still existed mild pain and felt discomfortable. The average range of movement of wrist joint was 34.05 degree in volar flexion, 52.80 degree in dorsal extension, 26.25 degree in ulnar deviation, and 19.75 degree in radial deviation, and average grip strength was 44.6 kg. Compared with the contralateral side, there were accounted for 46.2%, 72.7%, 76.1%, 80.6%, and 76.7% respectively. CONCLUSION Replacement of distal end of radius with fibular head to reconstruct wrist joint can restore function of carpal joint, which is proved to be a safe and effective method.
OBJECTIVE: To explore a new surgical management of multiple fingers degloving injury. METHODS: In 1994 to 1997, 47 cases with multiple fingers degloving injury were sutured by two reverse "s"-type skin flaps on abdominal flank. RESULTS: The skin flaps in 46 cases survived and the wounds obtained primary heal. CONCLUSION: The application of abdominal flank "s"-type skin flap is reliable and convenient in the treatment of multiple fingers degloving injury.
Objective To investigate the etiology of the flexor contracture of the hand, to diagnose and to explore its surgical treatment. Methods From May 1997 to June 2004, 212 cases of flexor contraction of the hand were treated with scar excision, thorough loosening the contracture, covering the secondary skin defects with free skin grafting, “Z”plasty, double “V-Y” plasty, transposition of the palmar dorsum flap of the hand and iliac-inguinal flap. There were 163 males and 49 females, whose ages ranged from 3 to 61. There were 85 cases of left hands, 54 cases of right hands, and 73 cases of both hands. Contracture sites were as follow: 117 cases were in fingers, 32 cases located in palms and 63 cases were in both. Causes of deformity were as follow: 29 cases derived from burn and explosion, 127 cases came from contracture of palmar aponeurosis, 31 cases were because of traffic accident and machine extrusion, 5 cases for getting an electric shock, 14 cases for improper postoperative immobility, and 6cases for other reasons. Course of diseases lasted for 2 to 24 months.Results 149 cases were followed up for 4 to 30 months. One fingertip was in necrosis and ended in nub plasty because of inappropriate time to leave hospital. Flexion contracture recurred in 7 cases, skin necrosis occurred to 3 cases whose scars were healed in the end, poor restoration of function was observed in 2 children patients for lack of exercise, and 2 skins contracted after free cut skin grafting. Others got satisfactory results. Conclusion Once the pathogenesis and contrature factors are clearly known, timing and correct surgical measures are chosen, thorough contracture is loosened, and early postoperative exercises are performed, good effect will be achieved.
OBJECTIVE: To investigate the clinical effect of skin flaps repairing severe thermopressure injury of hand. METHODS: From January 1989 to December 1998, 112 patients with severe thermopressure injury of hand were repaired by various skin flaps transfer, the size of skin flaps was 6 cm x 8 cm to 12 cm x 18 cm. Postoperative patients were treated by combined rehabilitation in early stage. RESULTS: All the flaps were survived with satisfactory effect. Sixty-six patients were followed up 6 to 12 months, skin flaps all showed better colour and texture, and function of the hand was satisfactory. CONCLUSION: Different skin flaps are adopted to repair severe thermopressure injury of the hand according to different skin defects of the hand, combined early rehabilitation treatment, to achieve good recovery of function and appearance of the hand to the greatest extent.
Objective To investigate the effect of combined types in treating cases with 2 to 5 tissues transplantation. Methods 305 cases treated from December 1989 to December 2002 were analyzed and summarized. 214 cases were constructed with 2 combined tissues transplantation, the combined types were:toe combined flap,the second toe at both sides transplanted,2 flaps combined transferred; 75 cases were constructed with 3 combined tissues transplantation,the combined types were:the second toe at both sides combined flap,2 flaps combined toe,3 flaps combined transferred;11 cases were constructed with 4 combined tissues transplantation, the combined typeswere:2 flaps combined 2 toes,1 toes combined 3 flaps,4 flaps combined transferred; 5 cases were constructed with 5 combined tissues transplantation, the combined type was:the wrap flap and the second toe with 1 vascular pedicle and another second toe combined bilateral femoris anterior flaps were transferred.The principles of repair were:the thumb was reconstructed first,the wrap round flap was used for the thumb’s skin,the second toe transplantation was used for the thumb defect.The opposite toe was transferred to finger to reconstruct the pinch function.1 or 2 flaps were selected for repair according to the area of damage. The anterolateral thigh flaps were used for the large areas and the lateral arm flaps were usedfor the small areas in selecting the donor area. Results Of the 722 tissues in 305 cases, 14 of them were necrosis, in which the toe were 6 and the flap were 8,and other transferred tissues all survived, the survival rate of tissue transplantation was 98.1%.251 cases were followed up for 1 year to7 years(2.6 years in average).All the patients could care themselves in daily life. The pinch and oppositionfunctions of the constructed thumbs and fingers were recovered,the two-point discrimination was 6 to 14 mm,but 2 cases recovered adduction function only because the thumb was 6 degree defect without the thenar muscle and did not fix the reconstructed thumb in opposite side in operation.All transplanted flaps recovered protecting sensory with S2,56 flaps required plastical operation because of their swelling appearance.The donor areas gained primary stage heal in 285 cases,20 cases gained secondary stage heal, in which part grafted skin necrosis in donor of wrap round flap were 12 cases,the distal of donor big toe necrosis were 2 cases and grafted skin necrosis in donorofanterolateral thigh flap were 8 cases and skin grafted were sucessful. Conclusion Different combined types can be used according to the traumatic situation. Surgical operation and early rehabilitation is conducive to the final function.Combined tissue transplantation is the best way to repair complicated hand injuries.
Objective To study and summarize the clinical experience and significance of the skeleton reconstruction of human hand allografts. Methods From January 2001 to October 2003, human hand allografts were appliedto treat 4 cases of traumatic hand defect(6 hands) at different levels. During operation, the ulna and radius were reduced anatomically and fixed firmly with 3.5 mm AO-plates and screws according to AO internal fixation principle. The X-ray films were taken periodically andthe function recovery of hand allografts was observed and estimated. Results The 4 cases were followed up for 4-36 months postoperatively. The clinical healing of fracture in 4 cases(6 hands) was achieved after 9 weeks,and by means of comprehensive assessment including the joint function, muscle strength, sensation, appearance, sequela and the ability of work, the satisfactory effects were gained eventually. Conclusion It is significant forhuman hand allografts to reconstruct skeleton firmly.
Objective To investigate the procedure and applications ofantegrade and retrograde dorsal metacarpal flaps with cutaneous branches as pedicles in repairing soft tissue defects of wrist and fingers. Methods From 1995 to 2003, we observed that the proximal and distal branches, deriving from the dorsal metacarpal artery, formed a consistent anastomosis arc subdermally. The anastomosis arc was paralleled to the dorsal metacarpal artery. Antegrade and retrograde dorsal metacarpal flaps could be designed using proximal anddistal branches as pedicles. Twenty-seven cases of soft tissue defects were treated by use of dorsal metacarpal flaps with cutaneous branches as pedicles, including 3 cases of defects on dorsum of hand with antegrade flaps, and 24 cases of defects on fingers with retrograde flaps ( index finger:12 cases; middle finger: 6 cases; ring finger: 4 cases; and little finger:2 cases). The dimensions of the antegrade flaps were 2.0 cm×4.0 cm～4.0 cm×6.0 cm, and the dimensions of theretrograde flaps were 2.5 cm×3.5 cm～3.0 cm×7.0 cm.The incision of the donor site was closed directly. Results All flaps survived. After a follow-up of 13 years, the texture and color of the flaps were good, and the shape and function of the donors were normal. Conclusion The antegrade or retrograde flap pedicled with the distal or proximal cutaneous branches of thedorsal metacarpal artery, is an optimal flap in repairing finger or wrist softtissue defects.