Efficacy analysis of three kinds of surgery for trigger thumb.

PURPOSE: To study the efficacy of three kinds of surgery for trigger thumb. METHODS: A total of 60 cases of trigger thumb (Quinnell Grade IV) were randomly divided into three groups. The A1 pulley was disconnected at the middle in Group A, at the extreme radial side in Group B, excised in Group C. The following indicators were recorded pre-operatively (D0), and at one (D1), three (D3), seven (D7), 14 (D14), and 28 (D28) days post-operatively: 1. the pain visual analogue score (VAS) when flexing the affected thumb; 2. range of motion (ROM) of the interphalangeal joint with pain tolerance; 3. the time of pain disappearance when flexing the affected thumb. RESULTS: The differences of VAS and ROM between D1 and D0, D3 and D1, D7 and D3, D14 and D7, D28 and D14 were statistically significant (P < 0.05). There was no significant difference in changes of VAS (or ROM) at D1 or D28 in contrast to D0 among the three groups. The differences of VAS (or ROM) changes at D3, D7, and D14 in contrast to D0 among the three groups were statistically significant (P < 0.05). The difference of the time when the pain disappearing in the normal range of motion among the three groups were statistically significant (P < 0.05). CONCLUSION: Disconnecting the A1-pulley at the extreme radial side is better than another two methods for treating the trigger thumb (Quinnell Grade IV). It has been shown to effectively accelerate postoperative pain relief and functional recovery. TRIAL REGISTRATION: Clinical trial registry number: ChiCTR2100051193.

[Free grafting of big toe nail bed repairing defects of fingernail bed].

Objective: To investigate the feasibility and indication of free grafting of split big toe nail bed for defects of fingernail bed. Methods: From September 2008 to September 2011,13 cases (4 females and 9 males) with fingernail bed defects(aged 17-38,average,32) were treated with split big toe nail bed. The split big toe nail was harvested according to the defects size without bone exposure at donor site. Results: Three grafted nail beds were necrotic completely and reconstructed with flaps. The 2 grafted nail bed was partial loss and healed after dressing. All the other grafted nail bed survived completely with primarily healing both in donor sites and recipient sites. The patients were followed up for 6-30 months(average,14 months).The therapeutic effect was graded as excellent in 8 cases, good in 2 cases and poor in 14 cases(good rate,76.9％).The nail matrix was excellent in 8 cases,good in 1 case and poor in 1 case(good rate,90％).The toe nails in donor sites grew well. Conclusions: The single fingernail defect with intact nail matrix can be reconstructed by split toe nail bed graft with good cosmetic and functional effect. There is no malfunction at donor site. The indication should be selected.

[The experience of lateral arm free-flaps for hand thermal-crush injury: 15 cases].

Objective: To investigate the effect of lateral arm free-flaps for hand thermal-crush injury. Methods: 15 patients with hand thermal-crush injury were treated with emergency debridement and one-staged coverage with lateral arm free-flaps pedicled with deep brachial artery between January 2010 and December 2013. . Results: Good results were achieved. All 15 flaps survived Conclusions: Emergency debridement and reconstruction with lateral arm free-flap is a very effective method for hand thermal-crush injuries. Meanwhile, it also can reduce complications, shorten the duration of hospitalization and reduce health care costs.