Repair of complex digital soft-tissue defects using a free composite ulnar artery perforator flap from the volar wrist.

Digital skin defects resulting from trauma are often associated with dysfunction of the digital nerve and the extensor and flexor tendons in the affected fingers. The repair of these complex tissue defects requires a graft containing multiple tissues that can be used to reconstruct the tendons and nerves and restore the skin. Such procedures can cause multiple injuries and significant damage to the donor site. The current study used a novel technique to repair complex dorsal and palmar digital soft-tissue defects. First, multiple tissues were cut and collected from the donor site. Then, part of the flexor carpi ulnaris tendon was transplanted to repair the tendon defect, and a medial antebrachial cutaneous nerve graft was used to repair the digital nerve defect. Finally, a skin flap was used to cover the skin defect. This paper reports on 31 cases of complex soft-tissue digital defects, with defect areas of 2-18 cm2 . One patient presented with a postoperative arterial crisis in the flap. All other patients recovered without experiencing a vascular crisis, flap necrosis, or wound infection. The postoperative flaps were similar in texture to the original digital skin. The sensation and the extension/flexion functions in the affected fingers recovered well. The effect on grip strength, wrist flexion, and forearm sensation was minor and the postoperative total active motion scores of the affected digits were good or excellent in 96.77% of the cases. The flap sensation recovery rate was also excellent in 83.87% of the cases. The present technique facilitates the repair of multiple dorsal and palmar digital soft-tissue, tendon and nerve defects, reduces the damage to the donor site, and significantly improves the success of surgical repair.

Evaluation and Strategic Response of Sustainable Livelihood Level of Farmers in Ecological Resettlement Area of the Upper Yellow River-A Case Study of Liujiaxia Reservoir Area, Gansu Province.

The level of sustainable livelihoods, as a yardstick for measuring the social development of migrants, is of great importance to the sustainable development of the region. Based on the analysis of the policy logic of ecological protection and high-quality development in the Yellow River basin, this paper constructs a "ternary" system model and evaluation index system for sustainable livelihoods of farm households in the ecological resettlement areas of the upper Yellow River, and proposes that the harmonious relationship between the three basic dimensions of economy, society and environment is the key to evaluate the sustainable livelihood level of farm households in ecological resettlement areas. Based on the comprehensive evaluation index to assess the comprehensive development level of ecological resettlement areas, we introduced the coupling coordination degree and constructed the coordinated development degree model of "economic-social-environmental" system to characterize the sustainable livelihood level. Through the data of 1116 questionnaires and in-depth interviews in the ecological migrant resettlement area of Liujiaxia reservoir in the upper reaches of the Yellow River basin, the sustainable livelihood status and spatial distribution differences of farm households in 14 townships in the region were evaluated, and the validity of the indicator system was empirically tested. Finally, sustainable livelihood strategies for farm households in the ecological resettlement areas of the upper Yellow River are proposed for the economic, social and environmental dimensions, and the indicator system is further revised. The evaluation system can not only advance the research paradigm of sustainable livelihood assessment for farmers in ecological migrant resettlement areas but can also be widely guided and applied to the sustainable development of ecological migrant practices in China.

The spatial and temporal differentiation characteristics of cultural heritage in the Yellow River Basin.

Understanding the temporal and spatial distribution characteristics of the cultural heritage of the Yellow River Basin can effectively improve the scientific understanding of the historical changes, environmental evolution, and cultural and economic development of the Yellow River Basin and thus provide a scientific and reasonable decision-making basis for the protection and development of its cultural heritage. The research object of this paper are the national cultural relic protection units. These are examined using the GIS spatial analysis method to explore the spatial and temporal distribution characteristics and spatial structure of 2,102 national material cultural heritage sites in the Yellow River basin. The results show that the spatial distribution of cultural heritage has a significant spatial agglomeration effect. The whole basin is concentrated in stable high- and low-value areas, and the difference between the high- and low-value areas is clear. Some aspects of the spatial structure heterogeneity are strong, showing a low value dispersion distribution trend. In different periods, the distribution direction and scope of cultural heritage have low ranges of rotation, a clear direction, and a high degree of centripetal distribution. The spatial and temporal distribution of cultural heritage is the result of the combined action of natural geographical environment such as climate change, topography, river hydrology, and human environment such as administrative institutional changes, ideological evolution, and social and economic development.

[Anatomy of the free descending genicular artery perforator flap and its clinical application for soft-tissue defects at extremities].

OBJECTIVE: To investigate the feasibility of free descending genicular artery perforator flaps in the soft tissue defects at extremities. METHODS: Ten fresh cadavers were injected with lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized volume-rendering software ( Materiaise's interactive medical image control system, MIMICS). The origin, course and distribution of the perforators in the thigh and leg region were observed. 11 patients with skin defects at the distal part of extremities were treated. The flap size ranged from 5 cm x 8 cm to 6 cm x 15 cm. Six flaps were pedicled with the descending genicular artery and the others were pedicled with the perforator of the descending genicular artery. All flaps were transferred by end to end anastomosis. RESULTS The follow-up period ranged from 6 to 18 months. All the flaps survived. The appearance and texture of the flaps were good with sensory recovery of S3. CONCLUSIONS: Free descending genicular artery perforator flap has a reliable blood supply and suitable thickness for the treatment of soft tissue defects at extremities. The technique is easily performed with reliable results.