Investigation into the application of remimazolamin conjunction with low-dose propofolfor pediatricfiberoptic bronchoscopy.

This study delves into the effectiveness of combining remimazolam with low-dose propofol in pediatric fiberoptic bronchoscopy. Ninety children scheduled for fiberoptic bronchoscopy in our hospital were enrolled as research participants. Based on the intraoperative anesthetic drug regimen, the children were divided into three groups: group R (remimazolam 0.2-0.4 mg/kg), group P (propofol 1-3 mg/kg), and group RP (remimazolam0.2 mg/kg, propofol 0.5 mg/kg). Immediately post-anesthesia, group P exhibited lower blood pressure and heart rate (HR) compared to both group R and group RP (P < 0.05). As bronchoscope approached the glottis and epiglottis, group P continued to display lower blood pressure and HR compared to group R and group RP (P < 0.05). During lavage, group P maintained lower blood pressure and HR compared to both the R and RP groups (P < 0.05). Immediately post-anesthesia, group P demonstrated lower SpO2 compared to the R and RP groups (P < 0.05).During lavage, group P maintained lower SpO2 than group R and group RP (P < 0.05). In comparison with group R and group PR, group P showed shortened induction and recovery times (P < 0.05). The one-time entry success rate into the microscope was higher in group R than in group P, with the RP group showing an intermediate decreased (P < 0.05). Moreover, the cough score in R group was higher than in the P and RP groups (P < 0.05). Furthermore, the satisfaction rates of the RP group exceeded those of the R and P groups (P < 0.05). Remimazolam combined with low-dose propofol effectively balances the strengths and weaknesses of remimazolam and propofol, ensuring more stable hemodynamics, a lower incidence of adverse reactions, and optimal surgical conditions in pediatric fiberoptic bronchoscopy.

Flexible Symmetric-Defection Antenna with Bending and Thermal Insensitivity for Miniaturized UAV.

Flexible conformal-enabled antennas have great potential for various developable surface-built unmanned aerial vehicles (UAVs) due to their superior mechanical compliance as well as maintaining excellent electromagnetic features. However, it remains a challenge that the antenna holds bending and thermal insensitivity to negligibly shift resonant frequency during conformal attachment and aerial flight, respectively. Here, we report a flexible symmetric-defection antenna (FSDA) with bending and thermal insensitivity. By engraving a symmetric defection on the reflective ground, the radiated unit attached to the soft polydimethylsiloxane (PDMS) makes the antenna resonate at the ISM microwave band (resonant frequency = 2.44 GHz) and conformal with a miniaturized UAV. The antenna is also insensitive to both the bending-conformal attachment (20 mm < r < 70 mm) and thermal radiation (20~100 °C) due to the symmetric peripheral-current field along the defection and the low-change thermal effect of the PDMS, respectively. Therefore, the antenna in a non-bending state almost keeps the same impedance matching and radiation when it is attached to a cylinder-back of a UAV. The flexible antenna with bending and thermal insensitivity will pave the way for more conformal or wrapping applications.

High-Sensitivity Flexible Pressure Sensor-Based 3D CNTs Sponge for Human-Computer Interaction.

Researchers are showing an increasing interest in high-performance flexible pressure sensors owing to their potential uses in wearable electronics, bionic skin, and human-machine interactions, etc. However, the vast majority of these flexible pressure sensors require extensive nano-architectural design, which both complicates their manufacturing and is time-consuming. Thus, a low-cost technology which can be applied on a large scale is highly desirable for the manufacture of flexible pressure-sensitive materials that have a high sensitivity over a wide range of pressures. This work is based on the use of a three-dimensional elastic porous carbon nanotubes (CNTs) sponge as the conductive layer to fabricate a novel flexible piezoresistive sensor. The synthesis of a CNTs sponge was achieved by chemical vapor deposition, the basic underlying principle governing the sensing behavior of the CNTs sponge-based pressure sensor and was illustrated by employing in situ scanning electron microscopy. The CNTs sponge-based sensor has a quick response time of ~105 ms, a high sensitivity extending across a broad pressure range (less than 10 kPa for 809 kPa-1) and possesses an outstanding permanence over 4000 cycles. Furthermore, a 16-pixel wireless sensor system was designed and a series of applications have been demonstrated. Its potential applications in the visualizing pressure distribution and an example of human-machine communication were also demonstrated.

Current Opinions on the Management of Non Thumb Metacarpal Fractures.

Metacarpals are unique bones that support the finger to aid hand function. Metacarpals are also the commonest bones to get fractured in the hand. Historically, most metacarpal fractures were managed conservatively. Due to increased patient expectations as well as advancements in diagnosis and osteosynthesis, various surgical options are now available for metacarpal fractures. The goal of operative management of metacarpal management is no longer limited to achieving clinical or radiological union. To restore hand function to a preinjury level, the surgeon must achieve adequate anatomical reduction and stable fixation with minimal soft tissue damage. Similar to tendon repair, to start early active motion should be the goal after metacarpal fracture fixation. Intraoperative consideration should also include minimizing soft tissue damage and avoiding tendon, ligament or capsular entrapment. The aim of this article is to explain the principles of surgical management, the different options available for metacarpal fractures, the techniques, pearls, advantages and disadvantages of each technique, so the surgeon can choose the ideal option to achieve the best result.

Ecological Study on Differences in COVID-19 Fatality among Wuhan, Rest of Hubei, and Rest of China.

BACKGROUND: China's vigorous anti-COVID-19 campaign has been going on for three months since January 20, which has contained the spread of the virus across China. OBJECTIVES: Epidemiological investigations found that COVID-19 fatality rates in Wuhan, rest parts of Hubei province except Wuhan (Rest of Hubei) and rest parts of Mainland China except Hubei province (Rest of China) were different. An ecological study was conducted to analyze the reasons and provide the world with China's anti-COVID-19 epidemic experiences. METHODS: Infected cases from Mainland China were divided into three populations: Wuhan, Rest of Hubei and Rest of China. Methods were based on The Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Standards. Total confirmed cases, daily severe cases, total deaths from February 12 to April 20 were collected for statistical analysis. RESULTS: 50,333 total confirmed cases in Wuhan made up the most substantial part by comparison with 17,795 in Rest of Hubei and 14,630 in Rest of China, respectively. In the early stage of the COVID-19 epidemic, daily severe cases in Wuhan accounted for the majority, and as the epidemic controlled, severe cases in all three populations decreased. Total deaths in Wuhan constituted the most significant proportion, with the highest 3869 in contrast to 643 in Rest of Hubei and 120 in Rest of China. The fatality rates in Wuhan ranged from 2.82% to 7.69%, much higher than 1.80-3.61% in Rest of Hubei, and 0.49-0.88% in Rest of China. Pearson chi-square test for fatality rates in the three populations demonstrated significant differences (p < 0.01). CONCLUSION: The ecological comparison study among the three populations have proved that social distancing, quarantine, lockdown, cutting off sources of infection and transmission routes, early detection, early isolation, early treatment are all vital to control the epidemic by reducing COVID-19 confirmed cases, severe cases and the fatality rate.

Highly Stretchable Micro/Nano Wrinkle Structures for Infrared Stealth Application.

We demonstrate a novel infrared stealth structure consisting of SiO2/TiO2 film, which was manufactured as the highly stretchable triangular wrinkle structures. The triangular wrinkle structures have firstly been transferred to the flexible substrate from the surface of Si-substrate, which was manufactured by the MEMS technology. Then, the infrared reflective film have been manufactured to be the triangular wrinkle structures by depositing the materials (noble metal (Ag or Au) or multilayer oxide (SiO2/TiO2)) on the surface of flexible substrate. Due to the lower reflection effect of curved surface, the infrared reflectivity of these structures has been tuned down to 5%. And, compared to the flat surface, the reflection-to-diffuse ratios improved approximately one order of magnitude. These structures can adapt to the environment by changing the reflectivity of triangular wrinkle structures under stretching. Finally, an Au-modified infrared stealth structure has been fabricated as the array structures, which disappeared and then display by stretching the triangular wrinkle structures at room temperature. It features high reflection-to-diffuse ratios, stable repeatability, low-cost, and easy to manufacture. It may open opportunities for infrared camouflage for military security and surveillance field application.

Internal fixation with Kirschner wires is as efficient as rigid screw fixation in scaphoid fracture: long-term functional outcome.

This study aimed to compare the long-term efficacy of Kirschner wires and Herbert screw internal fixation in scaphoid fracture. A retrospective chart with radiographic review and functional follow-up was conducted for patients with the scaphoid fracture. 65 patients (40 for K-wire fixation and 25 for Herbert screw) were enrolled. The nonunion rate for K-wire fixation and screw method were indifferent comprehensively and for iliac graft subgroup. Less bone necrosis was found with K-wire fixation (2.5% vs 16%, P=0.049). There's no difference between groups in Mayo scores, post-operation pain and grid strength. Patients with K-wire fixation have larger range of motion on radial/ulnar deviation (35.25±11.32 vs 28.00±8.66, P=0.007). The results support the use of Kirschner wires in the treatment of scaphoid fractures. Advantages such as high union rates and good function recovery of wrist could be expected from minimal invasion, multi-axial stable fixation.

High Expression of Ubiquitin-Specific Protease 8 (USP8) Is Associated with Poor Prognosis in Patients with Cervical Squamous Cell Carcinoma.

BACKGROUND Cervical cancer is one of the most common female malignancies in the world. The ubiquitin-specific protease 8 (USP8) functions by removing ubiquitin from protein substrates, and its potential role in cancer development was recently uncovered in lung cancer. The aim of this study was to investigate the expression and function of USP8 in cervical squamous cell carcinoma (CSCC). MATERIAL AND METHODS Immunohistochemical staining and quantitative PCR were performed to explore the expression of USP8 in both CSCC tissues and adjacent normal cervical tissues. Univariate and multivariate analyses were conducted to evaluate the clinical significance of USP8 in CSCC. Proliferation, migration, and invasion abilities of 2 CSCC cell lines were assessed after overexpression or silencing USP8, respectively. RESULTS Both the RNA and protein levels of USP8 were upregulated in CSCC tissues compared to normal cervical tissues. High expression of USP8 was correlated with advanced tumor stage and high recurrence risk. Moreover, USP8 was identified as a novel independent prognostic factor for CSCC patients. Cellular studies showed that USP8 can enhance the proliferation, migration, and invasion abilities of CSCC cells, thereby promoting tumor progression. CONCLUSIONS High expression of USP8 is frequent in CSCC tissues, which promotes tumor proliferation and invasion, and is correlated with a poor overall survival. Targeting USP8 may be a novel direction for drug development for CSCC therapy.

Long noncoding RNA H19 mediates LCoR to impact the osteogenic and adipogenic differentiation of mBMSCs in mice through sponging miR-188.

The research aimed to examine the expression of lncRNA H19, miR-188, and LCoR in mouse bone marrow stromal stem cells (mBMSCs), and to investigate the regulatory mechanism of lncRNA H19/miR-188/LCoR in osteogenic and adipogenic differentiation of mBMSCs. The expression of miR-188 in mBMSCs and osteogenesis induced mBMSCs was detected by stem-loop RT-PCR, while the expression of H19 and LCoR in mBMSCs and adipogenesis induced mBMSCs was examined by qRT-PCR. Luciferase reporter assay verified the targeted relationship between miR-188 and H19 or LCoR. Cell proliferation ability was determined by MTT assay, while cell surface markers of mBMSCs were analyzed via flow cytometry. Alkaline phosphatase staining and Alizarin red staining was utilized to detect the osteogenic differentiation capability of mBMSCs, whereas Oil red O staining was applied to examine the ability of adipogenic differentiation of mBMSCs. The expression of miR-188 was lower in osteogenesis induced mBMSCs compared with normal mBMSCs, while H19 and LCoR were downregulated in adipogenic induced mBMSCs. Si-H19 could significantly increase the mRNA level of miR-188. Meanwhile, miR-188 directly regulated LCoR in mBMSCs. Overexpression of miR-188 and knockdown of LCoR suppressed osteogenic differentiation and induced adipogenic differentiation in mBMSCs. Long noncoding RNA H19 mediates LCoR to regulate the balance between osteogenic and adipogenic differentiation of mBMSCs in mice through sponging miR-188.

Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis.

BACKGROUND: Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. METHODS: For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. RESULTS: Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. CONCLUSION: Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction.

A Micro-Pressure Sensing Method Based on the Micropatterned Electrodes Filled with the Microspheres.

As the core component of the sense of touch, flexible pressure sensors are critical to synchronized interactions with the surrounding environment. Here, we introduce a new type of flexible capacitive pressure sensor based on a template of electrodes, with a one-dimensional pyramid micropatterned structure on a Polydimethylsiloxane (PDMS) substrate and a dielectric layer of polystyrene (PS) microspheres. The proposed sensor exhibits a stable and high sensing sensitivity of 0.741 kPa-1 to capacitance, good durability over 1000 cycles, and fast response time (<150 ms). Our flexible capacitive sensor responds not only to pressure but also to bending forces. Our device can be used to monitor the location and distribution of weight pressure. The proposed capacitive pressure sensor has itself been applied foreground in lots of aspects, such as electronic skins, wearable robotics, and biomedical devices.

Comparison of perioperative complications of pedicled island flap in reconstruction of extremities.

PURPOSE: The aim of this study was to analyze the differences in perioperative complications for pedicled island flaps in the reconstruction of extremities and to identify the factors contributing to pedicled island flap necrosis. Furthermore, the flap indications based on these outcomes are summarized. METHODS: Based on the inclusion criteria, 228 skin flaps were included in this study. Univariate and multivariate analyses were used to identify the risk factors for pedicled island flap necrosis. Differences in perioperative complications between upper and lower extremities were analyzed using the chi-square test or Fisher's exact test. RESULTS: The average age of the patients was 38 years. The overall complication rate was 21.93%, including partial flap necrosis (10.09%) and total flap necrosis (5.70%). The overall complication rate and flap necrosis rate in upper extremity reconstruction were significantly lower than the rates in lower extremity reconstruction. Flap area and postoperative wound infection were statistically significant risk factors for pedicled island flap necrosis in extremity reconstruction. Preoperative contamination of the wound bed was a statistically significant risk factor for postoperative wound infection. CONCLUSIONS: The flap area and postoperative wound infection were both independent risk factors for pedicled island flap necrosis in extremity reconstruction. The causes contributing to the differences in perioperative complications between upper and lower extremities reconstruction included preoperative contamination of the wound bed, postoperative wound infection, and the flap area but were also related to anatomical factors of the skin flap. Pedicled island flaps are more suitable for small- and medium-sized soft tissue defects.

Analogous self-assembly and crystallization: a chloride-directed orientated self-assembly of Cu nanoclusters and subsequent growth of Cu2-xS nanocrystals.

Self-assembly and crystallization are two common methods to control the morphologies of nanomaterials, which have many similarities. In this work, chloride is used to direct the self-assembly process of Cu nanoclusters and the subsequent growth of Cu2-xS nanocrystals. Meaningfully, chloride both promotes the transformation of Cu nanocluster self-assembled architectures from one-dimensional (1D) to 2D, and facilitates the transformation of Cu2-xS nanocrystals from nanorods to nanosheets. Such an influence is attributed to the selective adsorption of chloride ions on the specific facets of nanoclusters and nanocrystals, which alters the inter-nanocluster weak interactions during self-assembly and suppresses the activity of Cu2-xS facets during nanocrystal growth. The current results indicate that the method used to direct the morphologies of nanocrystals is extendable to control the tendency of nanocluster self-assembly.

Lady with wings: a case report of giant neurofibromatosis type I.

RATIONALE: Neurofibromatosis type I (NF-I) accounts for approximately 90% of neurofibromatosis. NF-I is an autosomal dominant genetic disease which results from the gene mutation of NF-I situated in chromosome 17q11.2. PATIENT CONCERNS: A 32-year-old lady presented with a giant wing like structure on her back which started growing from her childhood. DIAGNOSIS: A diagnosis of NF-I was confirmed as she presented with multiple cutaneous nodules, multiple café-au-lait macules of different sizes, scoliosis deformity, and positive family history of neurofibroma. INTERVENTIONS: Surgical excision of tumor and multiple Z plasty reconstruction of the back was carried out. OUTCOMES: The excised neurofibroma weighed 6.7 kg containing thickened nerves, nerve roots, and circuitous vessels. The histopathological report confirmed plexiform and diffuse type cutaneous neurofibroma without any malignant transformation. Surgical excision and reconstruction with regular follow-up is an excellent choice of treatment for such a giant neurofibroma as in this case. LESSONS: NF-I is a genetic disease which could present as a giant cutaneous neurofibroma. One of the treatment options for giant neurofibromas causing deformity and physical disability is by surgical excision and histopathological examination with regular follow-up for NF-I recurrence.

Clinical Application and the Free Posterior Thigh Perforator Flap.

OBJECTIVE: The posterior thigh region has been neglected as a donor site for free perforator flaps, likely due to difficulties in positioning the patient during surgery. This study describes the clinical application of the posterior thigh perforator flap based on the third perforating artery of the profunda femoris artery (PFA). METHODS: The free posterior thigh perforator flap based on the third perforating artery of the PFA was used for reconstruction of soft tissue defects in nine patients between February 2010 and May 2014. RESULTS: Flap sizes ranged from 12 × 7 cm to 20 × 13 cm. The length of the vascular pedicle averaged 10.28 cm, and the mean diameters of the third perforating artery and venae comitantes were 1.68 and 1.14 mm, respectively. All of the perforators originated from the PFA. Of the 9 free flaps used in 9 patients, 7 flaps survived completely. There were no early complications in these flaps. During the follow-up period, no patient experienced cold intolerance, scar contracture, or scar pain. There were no functional impairments at the donor or recipient sites. CONCLUSIONS: The posterior thigh flap based on the third perforating artery of the PFA is an excellent option for reconstructing soft tissue defects. The anatomical location of the third perforating artery is relatively consistent. The vascular pedicle is relatively longer and has large caliber vessels. The scar at the donor site can be well concealed with low morbidity. The skin color and texture of this flap show satisfactory results.

Flexible Pressure Sensor with Ag Wrinkled Electrodes Based on PDMS Substrate.

Flexible pressure sensors are essential components of electronic skins for future attractive applications ranging from human healthcare monitoring to biomedical diagnostics, robotic skins, and prosthetic limbs. Here we report a new kind of flexible pressure sensor. The sensors are capacitive, and composed of two Ag wrinkled electrodes separated by a carbon nanotubes (CNTs)/polydimethylsiloxane (PDMS) composite deformable dielectric layer. Ag wrinkled electrodes were formed by vacuum deposition on top of pre-strained and relaxed PDMS substrates which were treated using an O2 plasma, a surface functionalization process, and a magnetron sputtering process. Ultimately, the developed sensor exhibits a maximum sensitivity of 19.80% kPa-1 to capacitance, great durability over 500 cycles, and rapid mechanical responses (<200 ms). We also demonstrate that our sensor can be used to effectively detect the location and distribution of finger pressure.

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis.

OBJECTIVE: The purpose of this study is to determine the correlation between non-technical risk factors and the perioperative flap survival rate and to evaluate the choice of skin flap for the reconstruction of foot and ankle. METHODS: This was a clinical retrospective study. Nine variables were identified. The Kaplan-Meier method coupled with a log-rank test and a Cox regression model was used to predict the risk factors that influence the perioperative flap survival rate. The relationship between postoperative wound infection and risk factors was also analyzed using a logistic regression model. RESULTS: The overall flap survival rate was 85.42%. The necrosis rates of free flaps and pedicled flaps were 5.26% and 20.69%, respectively. According to the Cox regression model, flap type (hazard ratio [HR] = 2.592; 95% confidence interval [CI] (1.606, 4.184); P < 0.001) and postoperative wound infection (HR = 0.266; 95% CI (0.134, 0.529); P < 0.001) were found to be statistically significant risk factors associated with flap necrosis. Based on the logistic regression model, preoperative wound bed inflammation (odds ratio [OR] = 11.371,95% CI (3.117, 41.478), P < 0.001) was a statistically significant risk factor for postoperative wound infection. CONCLUSION: Flap type and postoperative wound infection were both independent risk factors influencing the flap survival rate in the foot and ankle. However, postoperative wound infection was a risk factor for the pedicled flap but not for the free flap. Microvascular anastomosis is a major cause of free flap necrosis. To reconstruct complex or wide soft tissue defects of the foot or ankle, free flaps are safer and more reliable than pedicled flaps and should thus be the primary choice.

Posterior Thigh Flap Pedicled on the Cutaneous Vessels Arising From the Popliteo-posterior Intermediate Artery: A Report of 5 Cases.

Surgical repair of soft tissue defects of the knee and leg remains challenging. Using a case study approach, the anatomy of the popliteo-posterior intermediate cutaneous artery was examined, and a reverse island flap method was developed and implemented. After obtaining informed consent, 5 patients (1 woman, 4 men, age range 31 to 57 years) underwent the experimental use of a reverse island flap with a posterior thigh flap pedicled on the cutaneous vessels arising from the popliteo-posterior intermediate artery to repair soft-tissue defects of the knee and leg. The defects were caused by burned skin below the knee (n = 1), progressive skin necrosis in the knee after fracture surgery (n = 2), and skin infections associated with diabetes mellitus (n = 2). Skin defect sizes ranged from 15 cm x 5 cm to 30 cm x 12 cm. These large defects did not heal spontaneously; wound duration ranged from 1 week to 1 year, and all patients had refused defect repair with free flaps. Patients received posterior thigh flaps pedicled on the popliteo-posterior intermediate artery with areas ranging from 17 cm x 6 cm to 25 cm x 12 cm. All patients were treated with antibiotics and local dressings (iodoform and alcohol) changed daily post surgery, and blood supply was monitored by assessing the texture and color of the flap and venous regurgitation (ie, vein drainage disturbance). Four (4) of the five flaps survived completely. In 1 patient, partial survival of the flap, which had a good blood supply despite a venous circulation disorder, occurred: in this case, complete survival was achieved after treatment with a retrograde fascial flap and skin grafting. The appearance and texture of all flaps were satisfactory (ie, patients underwent only 1 operation, healing time was approximately 2 weeks, flap quality was close to normal skin, the donor site closed directly, and the shape and function of the knee and leg recovered well). No donor site abnormality was observed, and no postsurgical infection occurred. More research is needed, but the use of a reverse island flap with a posterior thigh flap pedicled on the cutaneous vessels arising from the popliteo-posterior intermediate artery may be a feasible option to repair soft tissue defects of the knee and leg.

Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps.

PURPOSE: Functional reconstruction of mutilating hand injuries poses a challenge to the surgeon. We present our experience with use of multiple composite tissue flaps transplant for functional reconstruction of hand in patients with mutilating hand injuries. The associated merits and demerits of these surgical approaches are briefly discussed. METHODS: From August 2004 to October 2014, functional reconstruction of hand with transplantation of multiple composite tissue flaps was performed in 8 patients. These included the toe with dorsal pedis artery flap, the reverse posterior interosseous artery flap, and the anterolateral thigh flap. Mean interval from injury to functional reconstruction was 10.6 days. RESULTS: All transplanted skin flaps and reconstructed neofingers survived completely. Only 1 patient developed wound infection at the recipient site (hand), which resolved without any debridement or revision surgery. At the donor site (foot), partial skin necrosis was observed in 1 patient, which healed with local wound care. In other patients, all wounds healed without any complications. The average range of movement at the neofinger metacarpophalangeal and interphalangeal joints was 38° and 73°, respectively. None of the patients required revision surgery. CONCLUSION: Use of negative pressure wound therapy and multiple composite tissue flap transplantation appears to be an effective strategy for hand functional reconstruction in patients with mutilating hand injuries. Among the multiple composite tissue flaps, use of toe transplantation combined with reverse posterior interosseous artery flap appears to be the best option.