Dihydromyricetin regulates KEAP1-Nrf2 pathways to enhance the survival of ischemic flap.

In clinical flap practice, there are a lot of studies being done on how to promote the survival of distal random flap necrosis in the hypoxic and ischemic state. As a traditional Chinese medicine, dihydromyricetin (DHM) is crucial in preventing oxidative stress and apoptosis in a number of disorders. In this work, we examined the impact of DHM on the ability to survive of ischemia flaps and looked into its fundamental mechanism. Our results showed that DHM significantly increased the ischemic flaps' survival area, encouraged angiogenesis and blood flow, reduced oxidative stress and apoptosis, and stimulated KEAP1-Nrf2 (Kelch-like ECH-associated protein 1-nuclear factor erythroid 2-related factor) signaling pathways. Adeno-associated virus (AAV) upregulation of KEAP1 expression also negated the favorable effects of DHM on flap survival. By activating KEAP1-Nrf2 signaling pathways, DHM therapy promotes angiogenesis while reducing oxidative stress and apoptosis.

Design of AR system tracking registration method using dynamic target light-field.

In the process of tracking registration for an augmented reality (AR) system, it's essential first to obtain the system's initial state, as its accuracy significantly influences the precision of subsequent three-dimensional tracking registration. At this point, minor movements of the target can directly lead to calibration errors. Current methods fail to address the challenge of capturing the initial state of dynamic deformation in optically transparent AR systems effectively. To tackle this issue, the concept of a static light-field is expanded to a four-dimensional dynamic light-field, and a tracking registration method for an optical see-through AR system based on the four-dimensional dynamic light-field is introduced. This method begins by analyzing the relationship between the components of the optical see-through AR system and studying the impact of a dynamic target on the initial state model. Leveraging the fundamental principle of light-field correlation, the theory and model for four-dimensional dynamic light-field tracking registration are developed. A lot of experiments have confirmed the algorithm's accuracy, enhanced its stability, and demonstrated the superior performance of the three-dimensional tracking registration algorithm.

Identification and Functional Analysis of an Epsilon Class Glutathione S-Transferase Gene Associated with α-Pinene Adaptation in Monochamus alternatus.

Alpha-pinene is one of the main defensive components in conifers. Monochamus alternatus (Coleoptera: Cerambycidae), a wood borer feeding on Pinaceae plants, relies on its detoxifying enzymes to resist the defensive terpenoids. Here, we assayed the peroxide level and GST activity of M. alternatus larvae treated with different concentrations of α-pinene. Meanwhile, a gst gene (MaGSTe3) was isolated and analyzed. We determined its expression level and verified its function. The results showed that α-pinene treatment led to membrane lipid peroxidation and thus increased the GST activity. Expression of MaGSTe3 was significantly upregulated in guts following exposure to α-pinene, which has a similar pattern with the malonaldehyde level. In vitro expression and disk diffusion assay showed that the MaGSTe3 protein had high antioxidant capacity. However, RNAi treatment of MaGSTe3 did not reduce the hydrogen peroxide and malonaldehyde levels, while GST activity was significantly reduced. These results suggested MaGSTe3 takes part in α-pinene adaptation, but it does not play a great role in the resistance of M. alternatus larvae to α-pinene.

Curative effect of external fixation combined with kirschner wire versus hollow screw in the treatment of first metacarpal bone base fracture.

PURPOSE: This study was conducted aimed at comparing the curative effect of external fixation combined with Kirschner wire fixation versus hollow screw fixation in the treatment of first metacarpal bone base fracture. METHODS: The current retrospective study included a total of 80 patients diagnosed with first metacarpal bone base fracture who were admitted in Wuxi 9th People's Hospital Affiliated to Soochow University between October 2017 and October 2020. The patients enrolled were equally divided into the combined group (40 cases, receiving external fixation combined with Kirschner wire fixation), and the control group (40 cases, receiving hollow screw fixation). Perioperative indices were collected and compared between the two groups. Pain scores before operation and three months, six months, and one year after operation were compared. Additionally, we compared the finger function in the last follow-up visit ( the follow-up period was 1 year) and rate of complications. RESULTS: Operation time, amount of bleeding, length of incision, length of hospital stay, and fracture healing time did not differ between the two groups (all P > 0.05). Pain score was comparable between the two groups before operation (P = 0.704). Despite lower results showing at 3, 6, and 12 months after operation in both groups, the pain score did not significantly differ in any time point between the two groups (all P > 0.05). Additionally, no significant differences were observed in finger function and rate of complications at the last follow-up between the two groups (both P > 0.05). CONCLUSION: External fixation combined with Kirschner wire fixation and hollow screw fixation exhibited similar curative effect in treating first metacarpal bone base fracture, indicating both surgery methods may be considered as the preferred approach.

Numerical Analysis on Gas Production and Geomechanical Responses of Natural Gas Hydrate Reservoirs.

Natural gas hydrate (NGH) has attracted considerable global attention as a promising energy resource in recent years. To acquire valuable insights into regarding the interplay between mechanical properties and production outcomes during the production, in this study, a fully coupled thermo-hydro-mechanical-chemical (THMC) model based on the geological features of reservoirs in the Shenhu area of the South China Sea (SCS) was developed to analyze the response characteristics of various physical fields within the reservoir during the exploitation. Furthermore, the study examined the influence of mechanical behavior on hydrate exploitation and investigated the effects of varying initial hydrate saturation and seawater depth on production efficiency and reservoir deformation. The simulation results indicated that neglecting the impact of solid mechanics in the analysis of hydrate productivity can result in overestimated results, particularly during the initial production stage. Reservoirs with higher hydrate saturation experience lower initial production rates due to the influence of permeability and capillary force. Moreover, reservoirs with high hydrate saturation exhibit greater compression but lower wellhead subsidence during the long-term development. The impact of seawater depth on production capacity primarily arises from the pressure's influence on the gas-water ratio, where greater seawater depth corresponds to increased reservoir compression and wellhead subsidence.

Application of Damage Control Surgery Combined with Seamless Integrated Rescue Mode in Emergency Treatment of Severe Thoracic and Abdominal Trauma.

Objective: To analyze the application effect of damage control surgery (DCS) combined with seamless integrated rescue mode in emergency treatment of severe thoracic and abdominal trauma. Methods: The clinical data of 90 patients with severe thoracic and abdominal trauma admitted to the emergency room of our hospital from September 2020 to September 2021 were selected for the retrospective analysis. According to the different treatment methods, they were divided into the experimental group (EG) and the control group (CG), with 45 cases in each group. The CG was treated with seamless integrated rescue mode, and the EG received the DCS combined with seamless integrated rescue mode. The mortality, complication rate, mixed venous oxygen saturation (SvO2), cardiac index (CI), central venous pressure (CVP), prothrombin time (PT), active partial thromboplastin time (APTT), the content of arterial blood lactate (ABL), C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-10 (IL-10) were compared between the two groups. Results: Compared with the CG, after intervention, the levels of SvO2, CI, CVP, APTT and IL-10 in the EG were signally higher (all P < .05), while the levels of PT, ABL, CRP and IL-6 in the EG were memorably lower (all P < .05), and the mortality and complication rate in the EG were notably lower (all P < .05). Conclusion: The application of DCS combined with seamless integrated rescue mode in emergency treatment of patients with severe thoracic and abdominal trauma can effectively reduce the mortality of patients, improve their coagulation dysfunction, decrease the level of inflammatory factors and reduce the occurrence of complications, with a positive significance for improving disease prognosis.

Engineered Biomaterials Trigger Remineralization and Antimicrobial Effects for Dental Caries Restoration.

Dental caries is the most prevalent chronic disease globally, significantly impacting individuals' quality of life. A key reason behind the failure of implanted restorations is their biological inactivity, meaning they are unable to form crosslinks with the surrounding tooth structures, thus making patients susceptible to implant loss and recurrent tooth decay. For the treatment of caries, antibacterial medicine and remineralization are effective means of treating the recurrence of caries. Owing to the rapid progression in the biomaterials field, several biomaterials have been reported to display antimicrobial properties and aid in dentin remineralization. Bioactive materials hold considerable potential in diminishing biofilm accumulation, inhibiting the process of demineralization, enabling dentin remineralization, and combating bacteria related to caries. Bioactive materials, such as fluoride, amorphous calcium phosphate, bioactive glass, collagen, and resin-based materials, have demonstrated their effectiveness in promoting dentin remineralization and exerting antibacterial effects on dental caries. However, the concentration of fluoride needs to be strictly controlled. Although amorphous calcium phosphate can provide the necessary calcium and phosphorus ions for remineralization, it falls short in delivering the mechanical strength required for oral mastication. Resin-based materials also offer different advantages due to the complexity of their design. In this review, we delve into the application of advanced bioactive materials for enhancing dentin remineralization and antibacterial properties. We eagerly anticipate future developments in bioactive materials for the treatment of dental caries.

Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats.

Roxadustat (FG-4592) is a specific hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitor. We investigated the effects of FG-4592 pretreatment on survival and second choke vessels of multi-territory perforator flaps in rats. In total, 72 rats were divided into two groups (n = 36 each): the experimental (FG-4592) group and the control group. FG-4592 was administered orally as a single dose of 60 mg/kg every other day; the first drug solution was administered to the animals 7 days before the surgical procedure. On postoperative day 7, the surviving flap area was calculated. At 12 h post-surgery, in the second choke zone in the flaps, macrovascular hinges were compared by angiography and imaging, and microvascular changes were assessed by histology. Laser Doppler imaging was used to evaluate flap perfusion at the second choke zone at 12 h and 7 days after surgery. At 7 days after surgery, the flap survival area and perfusion were significantly greater in rats given FG-4592 compared with controls. At 12 h after surgery, the diameter of macrovascular and microvascular vessels, nitric oxide content, perfusion, and the protein levels of HIF-1α and inducible nitric oxide synthase were also significantly greater in FG-4592-treated rats than controls. In conclusion, pretreatment with roxadustat may improve initial flap survival and dilate the second choke zone vessels in a multi-territory perforator flap.

Functional and aesthetic recovery of the second toe defect using a wrap-around pedicled flap from the great toe.

We report the results of using a fibula-sided digital artery pedicled flap from the great toe to cover the second toe free flap donor site, which avoids delayed wound healing, and prevents pain and skin ulceration. This study included 15 patients who had second toe wrap-around free flaps to reconstruct thumb and finger defects. All 15 pedicled flaps used to cover the defect healed uneventfully. All patients were able to stand and walk and were satisfied with the postoperative aesthetic outcome at the 6-month follow-up. We conclude that this an effective procedure for preventing donor site defects after second toe wrap-around free flap transfer.Level of evidence: IV.

[Application of homemade antibiotic bone cement rod in tibial screw canal osteomyelitis].

Objective: To investigate the effectiveness of homemade antibiotic bone cement rod in the treatment of tibial screw canal osteomyelitis by Masquelet technique. Methods: A clinical data of 52 patients with tibial screw canal osteomyelitis met the criteria between October 2019 and September 2020 was retrospectively analyzed. There were 28 males and 24 females, with an average age of 38.6 years (mean, 23-62 years). The tibial fractures were treated with internal fixation in 38 cases and external fixation in 14 cases. The duration of osteomyelitis was 6 months to 20 years with a median of 2.3 years. The bacterial culture of wound secretions showed 47 positive cases, of which 36 cases were infected with single bacteria and 11 cases were infected with mixed bacteria. After thorough debridement and removal of internal and external fixation devices, the locking plate was used to fixed the bone defect. The tibial screw canal was filled with the antibiotic bone cement rod. The sensitive antibiotics were given after operation and the 2nd stage treatment was performed after infection control. The antibiotic cement rod was removed and the bone grafting in the induced membrane was performed. After operation, the clinical manifestations, wound, inflammatory indexes, and X-ray films were monitored dynamically, and the postoperative bone infection control and bone graft healing were evaluated. Results: Both patients successfully completed the two stages of treatments. All patients were followed up after the 2nd stage treatment. The follow-up time was 11 to 25 months (mean, 18.3 months). One patient had poor wound healing and the wound healed after enhanced dressing change. X-ray film showed that the bone grafting in the bone defect healed and the healing time was 3-6 months, with an average of 4.5 months. The patient had no recurrence of infection during the follow-up period. Conclusion: For the tibial screw canal osteomyelitis, the homemade antibiotic bone cement rod can reduce the recurrence rate of infection and obtain a good effectiveness, and has the advantages of simple operation and less postoperative complications.

Thumb fingertip injuries reconstruction using a dorsoulnar flap of the thumb combined with relay V-Y flaps for donor site repair.

PURPOSE: To assess the clinical value and feasibility of the dorsoulnar flap of the thumb combined with relay V-Y flaps for reconstruction of the thumb fingertip injuries. METHODS: In this retrospective study, we retrospectively reviewed 20 patients (13 men, 7 women; June 2014-June 2016) with thumb fingertip defects who underwent reconstructive procedures with transfer of the dorsoulnar flap of the thumb. The average size of the defects ranged from 1.8 cm × 2.0 cm to 2.0 cm × 3.0 cm, whereas the reconstructed dorsoulnar flap of the thumb ranged in size from 2.0 cm × 2.2 cm to 2.2 cm × 3.0 cm. A V-Y flap was used to repair the donor site at the same time. Sensation within the reconstructed thumb, the aesthetic appearance of both the donor and recipient sites, functional recovery, and return-to-work (RTW) time were measured. RESULTS: All 40 flaps survived without necrosis. The follow-up period ranged from 6 to 24 months. There were no complications reported. The mean static two-point discrimination values at the reconstructed thumb fingertip and donor site were 8.5 mm (range 8-10 mm) and 12.5 mm (range 12-14 mm), respectively. The average visual analog scores for the aesthetic appearance of the recipient and donor sites were 8.4 (range 8-9.5) and 9.6 (range 9-10), respectively. The average Michigan Hand Outcome Questionnaire score for the reconstructed hand was 9.4 (range 6-16). The average RTW time was 9.8 weeks (range 6-13 weeks). All patients were satisfied with the aesthetic outcome. CONCLUSION: The dorsoulnar flap of the thumb is an ideal alternative for reconstruction of the thumb fingertip injuries, and a V-Y flap was suitable for repairing the donor site with a reduced incidence of complications.

Notch-dependent DNA cis-regulatory elements and their dose-dependent control of C. elegans stem cell self-renewal.

A long-standing biological question is how DNA cis-regulatory elements shape transcriptional patterns during metazoan development. Reporter constructs, cell culture assays and computational modeling have made major contributions to answering this question, but analysis of elements in their natural context is an important complement. Here, we mutate Notch-dependent LAG-1 binding sites (LBSs) in the endogenous Caenorhabditis elegans sygl-1 gene, which encodes a key stem cell regulator, and analyze the consequences on sygl-1 expression (nascent transcripts, mRNA, protein) and stem cell maintenance. Mutation of one LBS in a three-element cluster approximately halved both expression and stem cell pool size, whereas mutation of two LBSs essentially abolished them. Heterozygous LBS mutant clusters provided intermediate values. Our results lead to two major conclusions. First, both LBS number and configuration impact cluster activity: LBSs act additively in trans and synergistically in cis. Second, the SYGL-1 gradient promotes self-renewal above its functional threshold and triggers differentiation below the threshold. Our approach of coupling CRISPR/Cas9 LBS mutations with effects on both molecular and biological readouts establishes a powerful model for in vivo analyses of DNA cis-regulatory elements.

Measurement of synovium and serum dual specificity phosphatase 22 level: Their inter-correlation and potency as biomarkers in rheumatoid arthritis.

BACKGROUND: Dual specificity phosphatase 22 (DUSP22), also named as Jun N-terminal kinase pathway associated phosphatase recently, is reported to be closely engaged in immune and inflammation regulation. This study aimed to investigate the interaction between synovium DUSP22 and serum DUSP22 levels and to explore their correlation with rheumatoid arthritis (RA) risk, inflammation, and disease activity. METHODS: Synovium and serum samples from 42 RA patients with knee involvement underwent arthroscopy, and 20 knee trauma patients were collected. Besides, serum samples from 40 healthy controls were also obtained. Synovium DUSP22 expression was detected by reverse transcription quantitative polymerase chain reaction, while serum DUSP22 level was detected by enzyme-linked immunosorbent assay. RESULTS: Synovium DUSP22 level was greatly decreased in RA patients compared to trauma controls (p < 0.001), and it was negatively correlated with tender joint count (TJC) (r = -0.318, p = 0.040), C-reactive protein (CRP) (r = -0.330, p = 0.033), and Lysholm score (r = -0.423, p = 0.005) in RA patients. Serum DUSP22 level was lowest in RA patients, followed by trauma controls, then highest in healthy controls (p < 0.001). Serum DUSP22 level was negatively associated with TJC (r = -0.438, p = 0.004), swollen joint count (SJC) (r = -0.372, p = 0.015), CRP (r = -0.391, p = 0.011), and disease activity score in 28 joints (DAS28ESR ) score (r = -0.406, p = 0.008), and it increased after treatment (p = 0.001) in RA patients. In addition, serum DUSP22 level positively related to synovium DUSP22 level in RA patients (r = 0.394, p = 0.010). CONCLUSION: Synovium and serum DUSP22 are intercorrelated and insufficiently expressed in RA patients; meanwhile, their deficiency correlates with increased systemic inflammation, disease activity, and joint dysfunction.

Clinical application of dorsal digital cutaneous branch flap with partial extensor tendon in repairing compound tissue defects of the dorsal finger.

Purpose: To investigate the clinical efficacy of using dorsal digital cutaneous branch flap with partial extensor tendon in repairing compound tissue defects of the dorsal digits of the hand. Methods: Between January 2018 and January 2020, ten patients with skin and soft tissue defects of the digits accompanied by extensor tendon defects underwent surgical repair using dorsal digital cutaneous branch flap with partial extensor tendon. The donor site was repaired with dorsal metacarpal artery flap. The smallest skin defect area was 2.0 × 1.5 cm, while the largest skin defect area was 4.0 × 3.0 cm. The length of tendon defect ranged from 1.5 to 3.0 cm. Sensation within the flap, aesthetic appearance of both the donor and recipient sites, functional recovery, and return-to-work time were measured. Results: All 10 flaps survived after surgery. All patients were followed up for 12-18 months, with an average follow-up period of 15.4 months. After flap repair, the digits had satisfactory shape and appearance along with a soft texture. Hand function was excellent in eight cases and good in two cases. Two-point discrimination was 6-9 mm with an average of 8 mm. No patient experience cold intolerance. The donor sites healed well with satisfactory appearance. Conclusion: Dorsal digital cutaneous branch flap with partial extensor tendon could be used to repair skin and tendon defects simultaneously. The advantages of this method include simple donor tissue harvesting; less donor-site morbidity; reliable blood supply; and satisfactory recovery of appearance, sensation, and function of the flap. Therefore, this method could be suitable for repairing soft tissue defects of the dorsal digits with extensor tendon defects.

[Modified induced membrane technique and pedicled skin (myocutaneous) flap for chronic tibial osteomyelitis in patients with diabetes].

OBJECTIVE: To investigate the effectiveness of modified induced membrane technique and pedicled skin (myocutaneous) flap for chronic tibial osteomyelitis in patients with diabetes. METHODS: A clinical data of 22 diabetic patients with chronic tibial osteomyelitis between January 2017 and March 2019 was retrospectively analyzed. There were 15 males and 7 females with an average age of 52 years (range, 44-65 years). The course of diabetes was 3-12 years (mean, 6.1 years). The course of chronic osteomyelitis was 4 months to 7 years (mean, 3.3 years). The chronic osteomyelitis was rated as type Ⅲ in 9 cases and as type Ⅳ in 13 cases according to the Cierny-Mader classification criteria. Bacterial culture showed 21 cases of single bacterial infection and 1 case of mixed bacterial infection. Preoperative color Doppler ultrasound and CT angiography confirmed that the anterior and posterior tibial arteries were unobstructed. In the first stage of treatment, the bone and soft tissue defects were filled with antibiotic bone cement after the lesion was thoroughly debrided; the length of bone defect was 4-9 cm (mean, 5.6 cm), and the size of soft tissue defect was 5 cm×2 cm to 10 cm×7 cm. After 7-10 days, the bone cement was removed and a new antibiotic bone cement was filled into the bone defect. Meanwhile, the pedicled skin (myocutaneous) flap was performed to repair the wound. After 7-12 weeks, the inflammatory indexes returned to normal, autogenous iliac bone or combined with artificial bone was used to repair the bone defect in the second stage of treatment. The wound healing, bone defect healing, complications, and the number of successful treatments were recorded. The satisfaction of the skin flap efficacy and the function of the affected limb were evaluated. RESULTS: Local necrosis of the skin flap occurred in 3 cases after operation, leading to delayed healing of the wound; the other 19 flaps survived successfully, leading to primary healing of the wound. The skin grafts survived completely and the incisions healed by first intention. All cases were followed up 13-28 months with an average of 20 months. The infection recurred in 2 cases within 12 months after operation, and the bone defects healed after treated by modified induced membrane technique. The bone defect healing rate was 100%; the bone healing time was 6-10 months, with an average of 8.9 months; the infection control rate and successful treatment rate were 90.9% (20/22) and 90.9% (20/22), respectively. At 12 months after operation, according to the satisfaction evaluation standard of skin flap efficacy formulated by ZHANG Hao et al., all were satisfied. According to Johner-Wruhs adjacent joint function method, the limb function recovery was excellent in 13 cases, good in 7 cases, and fair in 2 cases, with an excellent and good rate of 90.9%. CONCLUSION: For the treatment of chronic tibial osteomyelitis in patients with diabetes without vascular occlusion, the modified induced membrane technique and pedicled skin (myocutaneous) flap can repair bone and soft tissue defects, and control the infection at the same time, the short- and medium-term effectiveness are good.

[One-stage thumb opponensplasty and polygonal flap in congenital spade hand reconstruction].

Objective: To explore the effectiveness of one-stage metacarpal osteotomy, thumb opponensplasty and polygonal flap reconstruction in the treatment of congenital spade hand deformity. Methods: Eight cases of congenital spade hand were treated between January 2013 and March 2017. There were 5 males and 3 females, with an average age of 17.5 months (range, 13-35 months). The clinical manifestations of all the children were congenital spade hand and the affected hand was shorter than the healthy side. The contralateral hand was normal and there was no chest, skull, or facial deformity. The operation was performed with metacarpal osteotomy and thumb opponensplasty, and through the dorsal metacarpal rectangular flap to reconstruct the first web and through rotation of polygonal skin flap to reconstruct thumb web and lateral fold of thumb index nail. The dorsal ulnar and proximal radial segment of thumb were repaired by skin grafting. A vernier caliper was used to measure the first web space and the thumb function was evaluated by modified Tada score. Results: The reconstruction of palmar function and the formation of first web were completed in one stage in 8 children. Skin grafting on the dorsal ulnar side of thumb and radial side of index finger survived after operation. All the children were followed up 13-29 months, with an average of 16.1 months. There was no infection, skin flap necrosis, lateral deviation of thumb, scar contracture, or other complications. At last follow-up, there was no significant difference in skin color between the healthy side and the first web of the affected hand. The opening distance of first web space was 3.5-5.0 cm, with an average of 4.2 cm. According to the modified Tada scoring system, the results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. The thumb could grasp and pinch actively, and the palm opposition function was good. Conclusion: One-stage thumb opponensplasty combined with polygonal flap for reconstruction of congenital spade hand deformity can improve hand function very well. The reasonable designing of skin flap can effectively cover important areas, and the operation is safe and reliable.

[Application of anterograde fascial flap of digital artery in Wassel â £-D thumb duplication reconstruction].

Objective: To explore the effectiveness of anterograde fascial flap of digital artery in reconstruction of Wassel Ⅳ-D thumb duplication. Methods: Twelve cases of Wassel Ⅳ-D thumb duplication were treated with anterograde fascial flap of digital artery between June 2014 and March 2017. There were 7 boys and 5 girls with an age of 9-32 months (mean, 13.3 months). Eight cases were on the left side and 4 cases on the right side. The main bunion bed width was 70%-85% of the healthy side (mean, 75.3%). The degree of fullness was 50%-75% of the healthy side (mean, 62.4%). The anterograde fascial flap with one proper digital artery was used to fill the nail fold on the radial side of the finger and increase the circumference of the finger. At last follow-up, the ratio of abdominal circumference of deformed finger to contralateral finger was measured at the base of nail. The appearance and function of all reconstructed thumbs were evaluated with Japanese Society for Surgery of the Hand (JSSH) scoring. Results: All the operations were successfully completed without early complications such as infection and skin necrosis. All children were followed up 7-27 months (mean, 14.3 months). At last follow-up, there was no recurrence of deformity in the digital body and no obvious change of scar contracture in the surgical wound. Pulp and nail fold symmetry was improved in all cases. The ratio of abdominal circumference of deformed finger to contralateral finger was 93%-96% (mean, 94.7%). The JSSH score was 15-20 (mean, 17.9); the results were excellent in 8 cases, good in 2 cases, and fair in 2 cases. Conclusion: The anterograde fascial flap of digital artery is a safe and effective approach to restore symmetry for esthetic improvement in treatment of Wassel Ⅳ-D thumb duplication.

The use of arteriovenous anastomosis for venous drainage during Tamai zone I fingertip replantation.

PURPOSE: The purpose of this study was to evaluate outcomes for patients sustaining a distal fingertip amputation who underwent replantation witharteriovenous anastomosis for venous drainage over a one year period at our institution. This technique has been utilized when insufficient veins are identified in the amputated part for standard veno-venous anastomosis. METHODS: A retrospective study was performed on patients presenting from 2013 to 2014. Guillotine, crush, and avulsion/degloving injuries were included if they underwent fingertip (Tamai Zone I) replantation with arterial anastomosis for vascular inflow and arteriovenous anastomosis for venous drainage. The cases were further classified as Ishikawa subzone I and subzone II. RESULTS: Arteriovenous anastomosis for venous drainage during replantation was used in 45 digits in 35 patients. 41 of the 45 digits underwent successful replantation using this technique (91%). The mean active ROM in the DIP joint of the fingers and in the IP joint of thumbs was 65° and 57°, respectively. Sensory evaluation demonstrated a mean of 6.9 mm s2PD in digits where the digital nerves could be repaired. 11 replanted digits without nerve repair regained some sensory recovery with a mean of 9.6 mm s2PD. 91% of patients were highly satisfied with the appearance of the replanted digits based on Tamai criteria. CONCLUSIONS: Arteriovenous anastomosis for venous outflow should be considered during zone I fingertip replantation if sufficient veins are not identified in the amputated part. This technique may allow for more routine and successful distal replantation.

Outcomes of using a modified anteromedial thigh perforator flap for repairing the anterolateral thigh free flap donor site: A retrospective clinical review.

The anterolateral thigh (ALT) flap plays an essential part in plastic and reconstructive surgery. However, repair of the anterolateral donor site has not been the focus of the clinicians.To assess the clinical value and feasibility of using a modified anteromedial thigh (AMT) perforator flap for repairing the ALT free flap donor site.In this retrospective study, 16 ALT flaps were transferred to resurface large soft-tissue defects (ranged from 7 × 5 to 13 × 8 cm) in the foot or hand from June 2012 to March 2013. The donor sites were repaired with an advancement flap pedicled with an AMT perforator. Sensation within the advancement flap, return-to-work (RTW) time, the aesthetic appearance of the donor sites, and functional recovery were measured.All 15 flaps survived completely without necrosis. One flap developed partial necrosis in the tip but healed with dressing changes after 1 week. The medain follow-up period was 3.5 months (range, 3-6 months). The average median time was 9.5 weeks (range 8-13 weeks). There was no numbness of the advancement flap. Additionally, there was no specific complication at both the recipient and donor sites. Thigh quadriceps muscle strength and activities of the knee were normal. All patients were satisfied with the aesthetic outcome postoperatively at the 3-month to 6-month follow-up.The modified advancement flap pedicled with an AMT perforator is an ideal option for repairing the anterolateral donor site.