[Repairing degloving injury of distal phalanx with homodigital bilobed flaps tiled].

OBJECTIVE: To study the methods and effectiveness of repairing degloving injury of the distal phalanx with homodigital bilobed flaps tiled. METHODS: Between April 2008 and June 2011, 40 patients (40 fingers) with degloving injury of the distal phalanx were treated, which were caused by machine. There were 30 males and 10 females, aged from 18 to 56 years (mean, 30 years). The time from injury to operation was 1-5 hours (mean, 2.5 hours). Affected fingers included index in 13 cases, middle finger in 11 cases, ring finger in 9 cases, and little finger in 7 cases. The defect area ranged from 3.0 cm x 2.0 cm to 5.5 cm x 3.8 cm. All cases complicated by pollution and exposure of tendon and phalanx, 5 cases by phalangeal fractures, and tendon insertion had no rupture. The end dorsal branches of digital artery island flaps and digital arterial island flaps were used in 14 cases, the end dorsal branches of digital artery island flaps and near dorsal branches of digital artery island flaps in 18 cases, and the end dorsal branches of digital artery island flaps and superficial palmar digital veins arterilization island flaps in 8 cases. The area of the upper flaps ranged from 2.0 cm x 1.5 cm to 2.6 cm x 2.2 cm and the area of the next leaf flaps ranged from 2.5 cm x 2.0 cm to 3.5 cm x 2.5 cm. The donor sites were covered with free flaps. RESULTS: Flap blister occurred in 13 cases and vascular crisis in 3 cases. The flaps survived in 40 cases, wound healing by first intention was achieved in 38 cases, and by second intention in 2 cases. The donor skin-grafting was survival. After operation, 30 patients were followed up 8 to 20 months with an average of 10.6 months. The flaps had satisfactory appearance and soft texture, and the finger tip had no touch pain. The sensory function of the flaps was restored at 4-6 weeks after operation; two-point discrimination was 6.0 to 10.0 mm in 24 flaps at 12-15 months. According to the total active movement (TAM) evaluation system introduced by the American Society for Surgery of the Hand in 1975, the results were excellent in 27 cases, good in 2 cases, and fair in 1 case, and the excellent and good rate was 96.7%. CONCLUSION: The homodigital bilobed flaps tiled for degloving injury of the distal phalanx is simple and easy-to-operate with less injury.

Synthesis of a novel polymer bile salts-(polyethylene glycol)2000-bile salts and its application to the liver-selective targeting of liposomal DDB.

PURPOSE: The objective of this study was to achieve a sustained and targeted delivery of liposome to the liver, by modifying the phospholipid [phosphatidylcholine (PC)/cholesterol (10 : 1) liposomes with a novel polymer bile salts-(polyethylene glycol)(2000)-bile salts (BP(2)B). METHODS: First, we generated a novel BP(2)B by N,N'-dicyclohexylcarbodiimide/4-dimethylaminopyridine esterification method and confirmed by Fourier transform infraredand (1) H-NMR spectra. Second, we prepared the BP(2)B-modified liposomes (BP(2)BL) that included BP(2)B, and the effect of the weight ratios of BP(2)B/PC on entrapment efficiency was investigated and BP(2)B/PC = 3% (w/w) was determined as the optimum ratio for the 4,4'-dimethoxy-5,6,5',6'-bi (methylenedioxy)-2,2'-bicarbomethoxybiphenyl liposomes. And then, the ability of the liver target of BP(2)BL was studied by calculating the targeted parameters. RESULTS AND DISCUSSION: All the results revealed that the introduction of polyoxyethylene chains could control interactions of bile salt moieties on liposome surfaces with the receptor compared with traditional liposomes (CL), marking BP(2)BL as a suitable carrier for hepatic parenchymal cell-specific and sustained targeting. It was suggested that liposomes containing such novel BP(2)B have great potential as drug delivery carriers for the liver-selective targeting that has targeted and sustained drug delivery.