Clinical efficacy of the topical application of tranexamic acid in tendon release in the hand: A randomized controlled trial.

PURPOSE: To study the clinical effectiveness of the topical application of tranexamic acid in hand tendon release. METHODS: This was a randomized controlled trial conducted after receiving approval from the local ethics committee according to guidelines from the Helsinki Declaration. Eighty patients who underwent hand tendon release operation in our hospital from January 2021 to December 2022 were included and randomly divided into 2 groups. Patients in the tranexamic acid group (40 cases) received intraoperative topical application of 2 g of tranexamic acid after tendon release, while patients in the conventional group (40 cases) did not receive topical application of tranexamic acid during operation. The operation time, perioperative hemoglobin changes, total blood loss, incidence of early postoperative complications, and total active movement (TAM) before surgery and 6 months after surgery were compared between the 2 groups. The continuous variable which follows normal distribution expressed by mean ± SD and used t-test to compare between groups. Meanwhile, categorical variables were used by Chi-square test, and a p < 0.05 indicated that the differences were statistically significant. RESULTS: Both groups were followed up for 7 - 18 months, with a mean of 10.3 months. Postoperative decrease in hemoglobin was significantly less in the tranexamic acid group than in the conventional group (t = 7.611, p < 0.001). The total blood loss in the tranexamic acid group (74.33 ± 20.50) mL was less than that in the conventional group (83.05 ± 17.73) mL, and the difference was statistically significant (p < 0.05). Both groups showed improvement in thumb/finger flexion and extension range of motion after surgery, and the TAM improved compared with those before surgery, and the difference was statistically significant (p < 0.001). The TAM improved more significantly in the tranexamic acid group (87.68° ± 10.44°) than in the conventional group (80.47° ± 10.93°) at 6 months after surgery, with a statistically significant difference (t = 3.013, p < 0.001). There was no significant difference in operation time and incidence of early postoperative complications between the 2 groups (p = 0.798, 0.499, respectively). CONCLUSION: The topical application of tranexamic acid during hand tendon release can significantly reduce postoperative bleeding and improve surgical efficacy, which is worth promoting.

Prognostic value of long noncoding RNA MALAT1 in various carcinomas: evidence from nine studies.

RNA-sequencing technology is progressing day by day. Numerous researches have showed that long noncoding RNAs (lncRNAs) play oncogenic or tumor suppressor roles in tumor biological processes. To our knowledge, many studies have identified a lot of lncRNAs with aberrant expression in several types of cancers. Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), a newly discovered lncRNA, has been reported that is overexpressed in several types of cancers. But the clinical value of MALAT1 in cancers remains unclear. Therefore, in this present study, we aimed to investigate potential clinical application role of MALAT1 as a prognostic biomarker in malignant tumors. We performed a detailed search in PubMed, Embase, Medline, and Cochrane Library until July 2015. According to the inclusion and exclusion criteria, nine studies with a total of 941 patients were selected to explore the relationship between high expression of MALAT1 and overall survival in cancers. The result showed that overexpression of MALAT1 could predict poor overall survival (OS) in cancer patients, with pooled hazard ratio (HR) of 1.90 [95 % confidence interval (CI) 1.68-2.16, P < 0.0001]. In conclusion, the present meta-analysis demonstrated that high expression of MALAT1 might be served as a novel prognostic biomarker in different types of cancers.

Muscle fiber types composition and type identified endplate morphology of forepaw intrinsic muscles in the rat.

The failure to accept reinnervation is considered to be one of the reasons for the poor motor functional recovery of intrinsic hand muscles (IHMs) after nerve injury. Rat could be a suitable model to be used in simulating motor function recovery of the IHMs after nerve injury as to the similarities in function and anatomy of the muscles between human and rat. However, few studies have reported the muscle fiber types composition and endplate morphologic characteristics of intrinsic forepaw muscles (IFMs) in the rat. In this study, the myosin heavy chain isoforms and acetylcholine receptors were stained by immunofluorescence to show the muscle fiber types composition and endplates on type-identified fibers of the lumbrical muscles (LMs), interosseus muscles (IMs), abductor digiti minimi (AM) and flexor pollicis brevis (FM) in rat forepaw. The majority of IFMs fibers were labeled positively for fast-switch fiber. However, the IMs were composed of only slow-switch fiber. With the exception of the IMs, the other IFMs had a part of hybrid fibers. Two-dimensional morphological characteristics of endplates on I and IIa muscle fiber had no significant differences among the IFMs. The LMs is the most suitable IFMs of rat to stimulate reinnervation of the IHMs after nerve injury. Gaining greater insight into the muscle fiber types composition and endplate morphology in the IFMs of rat may help understand the pathological and functional changes of IFMs in rat model stimulating reinnervation of IHMs after peripheral nerve injury.

Innervated Digital Artery Perforator Propeller Flap for Reconstruction of Lateral Oblique Fingertip Defects.

PURPOSE: To report our experience with the use of a digital artery perforator propeller flap based on a constant distal perforator in the middle phalanx for resurfacing of lateral oblique fingertip amputations. METHODS: Twelve fingertips in 10 patients underwent reconstruction, with a mean follow-up of 8 months (range, 8-12 mo). The size of the flaps ranged from 2.5 × 1.5 cm to 3.0 × 2.0 cm. RESULTS: All flaps survived entirely and restored a rounded fingertip contour. Mean static 2-point discrimination was 5 mm (range, 4-6 mm). With the exception of 1 patient with an amputation at the distal interphalangeal joint, the distal interphalangeal joint was preserved in all patients and had 30° to 60° of motion at final follow-up. No patients complained of cold intolerance or residual joint contracture. No hooked nail deformity occurred in patients who had remaining nailbed. CONCLUSIONS: The digital artery perforator propeller flap is particularly suited to coverage of a lateral oblique fingertip defect, because only a 90° rotation is required when inset, and the bulk of the flap serves to restore the rounded contour of the fingertip. The skin over the entire dorsal surface of the middle phalanx can be elevated as a flap, providing adequate tissue to resurface the defect and restore a rounded contour to the fingertip. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Effect of c-erbB2 overexpression on prognosis in osteosarcoma: evidence from eight studies.

C-erbB2 (HER-2/neu) plays an important role in the progression of several types of cancer by increasing tumor growth, migration, invasion, and metastasis and is associated with poor disease prognosis. Numerous studies examining the relationship between c-erbB2 expression and prognostic impact in patients with osteosarcoma have yielded inconclusive results. We therefore conducted a meta-analysis to provide a comprehensive evaluation of the prognostic role of c-erbB2 expression on 5-year survival, which compared the positive and negative expression of c-erbB2 in patients of the available studies. A detailed search was made in PubMed for relevant original articles published in English. Finally, a total of eight studies with 411 osteosarcoma patients were involved to estimate the relationship between c-erbB2 expression and 5-year overall survival. Positive expressions of c-erbB2 predicted poorer survival in osteosarcoma with the pooled RR of 1.53 (95 % CI 1.20-1.94, P = 0.0006). In conclusion, the findings from this present meta-analysis suggest that c-erbB2 overexpression is related to poor prognostic of osteosarcoma and can be a useful clinical prognostic factor for those patients.

Stem cell therapy for the treatment of parasitic infections: is it far away?

Stem cell therapy is an interventional treatment that introduces new cells into damaged tissues, which help in treating many diseases and injuries. It has been proved that stem cell therapy is effective for the treatment of cancers, diabetes mellitus, Parkinson's disease, Huntington's disease, cardiovascular diseases, neurological disorders, and many other diseases. Recently, stem cell therapy has been introduced to treat parasitic infections. The culture supernatant of mesenchymal stem cells (MSCs) is found to inhibit activation and proliferation of macrophages induced by the soluble egg antigen of Schistosoma japonicum, and MSC treatment relieves S. japonicum-induced liver injury and fibrosis in mouse models. In addition, transplantation of MSCs into naïve mice is able to confer host resistance against malaria, and MSCs are reported to play an important role in host protective immune responses against malaria by modulating regulatory T cells. In mouse models of Chagas disease, bone marrow mononuclear cell has been shown effective in reducing inflammation and fibrosis in mice infected with Trypanosoma cruzi, and transplantation of the bone marrow mononuclear cells prevents and reverses the right ventricular dilatation induced by T. cruzi infection in mice. Preliminary clinical trials demonstrate that transplantation of bone marrow derived-cells may become an important therapeutic modality in the management of end-stage heart diseases associated with Chagas disease. Based on these exciting results, it is considered by stating that it is firmly believed that, within the next few years, we will be able to find the best animal models and the appropriate stem cell type, stem cell number, injection route, and disease state that will result in possible benefits for the patients with parasitic infections, and stem cell therapy, although at an initial stage currently, will become a real therapeutic option for parasitic diseases.

Innervation of the lumbrical and interosseous muscles in hand: analysis of distribution of nerve fascicles and quantification of their surface projections.

We aimed to determine the surface locations of the nerve fascicles that innervate the lumbricals and interossei, re-examine the branching pattern of the deep branch of the ulnar nerve (dUN), and provide a clear description of their course. Eleven fresh-frozen adult cadaver hands were investigated. Nerve fascicles that innervate the lumbricals, interossei, and surface landmarks including the distal wrist crease and 2-5 proximal finger creases were marked by radio opaque fibers and subjected to X-ray. We analyzed the images and set a quadrant-linked hand surface. Subsequently, we measured the lengths of both axes and the coordinates of the branch locations in the quadrant. The surface locations of branches that innervated the lumbricals and interossei were clearly quantified. The branches of dUN exhibited a 4-group distribution pattern. Novel methods for quantitatively locating the surface anatomy of these branches and demonstration of a 4-group branching pattern of the dUN were established.

Thumb and first webspace reconstruction in nonsyndromic congenital mitten hand with symbrachydactyly.

INTRODUCTION: Nonsyndromic congenital mitten hand with thumb and index finger syndactyly is rare. Reconstruction of this condition is challenging, requiring repositioning of the thumb and creation of a wide and deep first webspace. The aim of this paper is to describe the characteristics of patients with this condition and also to describe our surgical technique. METHODS: We describe our technique in 16 consecutive children utilizing complete mobilization of the first metacarpal and thumb as an island flap on the neurovascular bundle, with a rotational osteotomy to reposition the thumb in pronation. In addition, a dorsal M flap was used to reconstruct the first webspace. Patients in this series also had varying degrees of symbrachydactyly with hypoplastic or aplastic phalanges of the central digits. RESULTS: There were 9 male and 7 female patients, with a mean age of 24.4 ± 22.4 months at the time of surgery. Mean follow-up was 19.1 ± 18.3 months. All reconstructions healed well. The mean thumb web distance in the affected hands was 4.2 cm (range 3.5 to 5). All reconstructed thumbs had a good opposition. Two children initially had mild hypertrophic scarring, which resolved with pressure gloves. No other complications were observed. CONCLUSION: One-stage reconstruction of the thumb and first webspace can be effectively achieved with our technique of complete mobilization of the thumb unit, rotational osteotomy, and a dorsal interdigitating M flap.

Congenital difference of the hand and foot: Pediatric macrodactyly.

BACKGROUND: Macrodactyly is a very rare congenital difference that affects hands and feet with significant developmental and psychological implications. Macrodactyly is attributed to a somatic mutation in PIK3CA, a component of the mTOR pathway-related overgrowth disorders. Other medical conditions have been associated with macrodactyly (e.g., neurofibromatosis and Proteus syndrome). A thorough investigation of the presence of these conditions should be undertaken by the multidisciplinary team. The aim of this study is to summarize the main clinical characteristics and associated conditions, with an emphasis on diagnosis and surgical treatment options. MATERIALS AND METHODS: We present several clinical cases after a retrospective chart review of macrodactyly cases and a comprehensive literature review. RESULTS: The indications for surgery include peripheral compressive neuropathies (e.g., carpal tunnel syndrome), grotesque enlargement interfering with function, psychosocial distress due to the deformity, and macrodystrophic lipomatosis with proximal upper limb involvement. The main surgical treatment options are categorized as follows: digit reduction (e.g., soft tissue debulking, skeletal shortening/ terminalization, Barsky procedure, and Tsuge technique), limitation of growth (digital nerve stripping and epiphysiodesis), and correction of deviation (wedge or angulation osteotomy, arthrodesis, Millesi procedure for thumb macrodactyly correction, toe-to-hand transfer, ray resection, and combination of bony reduction and soft tissue debulking). CONCLUSIONS: Macrodactyly correction requires surgical experience and an individualized approach. Treatment is primarily surgical; however, efforts are being made to delineate the root cause of macrodactyly and provide nonoperative management.

Composite flexion splint for the stiff hand.

The ability to make a full fist and grasp objects is a necessary motion for many everyday activities. For this reason, therapists continually create and modify splints in an attempt to achieve composite flexion in the hand. In this article, the authors describe their static progressive splinting approach to improve composite flexion in patients with hand stiffness due to trauma.

Changes in local bone mineral density can guide the treatment plan for patients with rupture of the anterior cruciate ligament.

BACKGROUND: Many factors affect the outcomes of anterior cruciate ligament (ACL) reconstruction surgery. However, few studies have examined the effects of local bone conditions on the reconstruction of the ACL. This study investigated the changes in the local bone mineral density (BMD) of the knee after rupture of the ACL with the view of using this information to guide treatment options. METHODS: Patients with ACL rupture treated in our department from January 2017 to April 2019 were enrolled in this study. Prior to surgery, local BMD measurements were obtained from all patients and used to determine the appropriate method of ligament fixation. If the local BMD of the affected knee was not significantly lower than that of the healthy side, extrusion fixation was conducted. If the BMD was significantly lower than that of the healthy knee, suspension fixation was applied. The conditions of tunnel cutting or screw splitting, and tunnel enlargement or screw pull-out were observed during the surgery. The post-surgical function of the knee joint was evaluated regularly by physical examination, imaging data, the IKDC scale score, and the Lysholm score. RESULTS: A total of 80 patients with unilateral ACL rupture were included. There were 64 males and 16 females. Decreased BMD was observed in the affected knee compared to the healthy knee for 68 patients. Patients with an ACL history of more than 3 months had lower BMD compared to patients with a history of less than 3 months. Tunnel enlargement and screw pull-out occurred in 2 patients, screw splitting occurred in 1 patient. The fixation mode was adjusted in real-time during the surgery for 3 patients. All patients were followed up for at least 12 months (mean 20.65±5.12 months). The IKDC score increased from 43.07±2.66 pre-surgery to 89.17±3.28 at the final follow-up, and similarly, the Lysholm score increased from 43.49±2.38 pre-surgery to 89.67±2.97 post-surgery. CONCLUSIONS: The measurement of local BMD before surgery may play a significant role in guiding the type of graft fixation. It is recommended that patients undergo surgical reconstruction within 3 months after injury.

Reconstruction of Wassel IV-D radial polydactyly with a boot-shaped neurovascular island flap: A Consecutive series of 91 thumbs.

INTRODUCTION: Reconstruction of Wassel IV-D radial polydactyly is challenging and requires a custom strategy dependent on the relative size and shape of the radial and ulnar duplicates. Herein, we describe a technique using a boot-shaped neurovascular island flap and review our outcomes. METHODS: Ninety-one consecutive patients had reconstruction with a boot-shaped neurovascular island flap. The flap was dissected out from the thumb to be removed. Specific flap modifications were inclusion of the lateral nail fold, Bruner incisions dorsally and volarly to reduce scarring at the interphalangeal (IP) joint and also complete mobilization of the island flap on its pedicle to allow easier inset. A flexor pollicis longus and extensor tendon rebalancing technique was used to correct the deviation of the reconstructed thumb IP joint. RESULTS: All boot-shaped neurovascular island flaps survived with good contour, shape, and symmetry. The average follow-up period was 25 months (range 6-60 months). Using the Japanese Society for Surgery of the Hand (JSSH) score for classification of outcomes, seven cases were classified as excellent and 84 cases as good. The median JSSH score was 18. The median Kapandji score for opposition was 9 (range 8-10). CONCLUSION: Using a boot-shaped neurovascular island flap completely mobilized on its pedicle with a custom strategy for each radial duplicate, good outcomes can be achieved in reconstruction of Wassel IV-D radial polydactyly. LEVEL OF EVIDENCE: Therapeutic Level IV.

Clinical observation of C3-type patellar fractures treated by operation methods with or without a turned-over patella.

OBJECTIVE: To evaluate the clinical efficacy of operation methods with or without a turned-over patella for treatment of C3-type patellar fractures. METHODS: A total of 68 patients with C3-type patellar fractures undergoing open reduction and internal fixation were retrospectively selected and treated with a turned-over patella surgery (turned-over patella group, n = 30) or conventional therapy without turning over the patella (conventional group, n = 38). The intraoperative and postoperative indicators of the two groups were assessed and comparatively analyzed. RESULTS: The bedridden time was significantly shorter in the turned-over patella group than in the conventional group (P = 0.002), while the range of motion (ROM) of knee joint was significantly higher in the turned-over patella group (P = 0.044). The Lysholm score was slightly higher in the turned-over patella group than in the conventional group, but the difference was not statistically significant (P = 0.055). No significant difference was observed between the two groups in terms of the operation time (P = 0.096), intraoperative blood loss (P = 0.543), time of weight bearing (P = 0.312), fracture healing time (P = 0.272), or complications (P = 1). CONCLUSION: The turned-over patella operation method exhibited some superiority to conventional reduction-fixation approach for treatment of C3-type patellar fractures in terms of efficacy and safety by enlarging the ROM of the knee joint and promoting functional recovery.

Outcomes of modified trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis: Two-year follow-up.

Numerous arthroplasty techniques had been reported for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis. The purpose of our study is to evaluate long-term clinical and radiographic outcomes of patients who underwent modified trapeziectomy with ligament reconstruction tendon interposition (LRTI).Our retrospective study included 20 consecutive patients with advanced thumb CMC arthritis receiving modified trapeziectomy with LRTI (20 thumbs). For clinical evaluation, we assessed visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) scores and Kapandji index. Additionally, the grip, pinch power and waist flexion power, radial and volar abduction angle were evaluated, As for radiologic evaluation, we just estimated height of the trapezial space.We took 2-year follow-up. All patients showed decreased VAS from 6.8 preoperatively to 1.4. Mean DASH and Kapandji scores were improved from 52.2 preoperatively to 21.6 and from 6.4 preoperatively to 7.4, respectively. Compared to preoperative range of motion (ROM) for radial abduction and volar abduction, both markedly increased at 2-year follow-up (from 61.2 to 80.1, from 60.6 to 78.3, respectively). Besides, mean power improved from 15.9 preoperatively to 21.7 kg at 2-year follow-up for grip power, from 1.9 preoperatively to 3.5 kg at 2-year follow-up for tip pinch; however, mean waist flexion power showed no significant change from 20.5 preoperatively to 19.7 kg at 2-year follow-up. Notably, there was no significant sinking in height of the trapezial space from 10.0 preoperatively to 9.6 mm at 2-year follow-up. NO case had a complication at final follow-up.Modified trapeziectomy with LRTI treating thumb CMC arthritis in Eaton stage III-IV had a satisfactory efficacy. This new procedure is able to provides enough support for thumb to prevents thumb sinking.

The protective effect of Irisin against ischemia-reperfusion injury after perforator flap grafting in rats.

BACKGROUND: Ischemia-reperfusion injury is one of the reasons for failure of flap grafting. In the present study, we investigated the protective effect of irisin on the survival of perforator flaps in rats. METHODS: A total of 48 adult Sprague-Dawley rats were divided into 2 groups and subjected to vascular clipping of perforator flap. Rats in the experimental group (n = 24) received daily tail intravenous injection of irisin (2 ng/g) for 3 days, while the rest rats in the control group (n = 24) received injection of saline solution of the same dose. On the 7th post-operative day, the surviving area of the flaps were recorded as the percentage of the total flap area. Histology study with haematoxylin and eosin staining were performed in all flaps. Flaps were also evaluated with lead oxide-gelatine-enhanced flap angiography. Immunohistochemical study was performed to evaluate the expression of ErG, a marker of vascular endothelial cells. The tissue of "choke vessels" was excised for quantification of p-Akt/Akt by western blot assay on the 7th post-operative day. RESULTS: On the 7th post-operative day, the percentage of surviving flap area was significantly larger in the rats with irisin administration (experimental group), compared with the control group (P = 0.011). The density of microvessels was significantly higher in the experimental group (P = 0.03) in the histological study and angiography, with a higher expression level of ErG in the immunochemical study (P = 0.01). The p-Akt/Akt was also higher in the experimental group in Western blotting analysis (P < 0.001). CONCLUSION: Irisin has a beneficial effect on protecting perforator flaps from ischemic-reperfusion injury following the flap grafting surgery. It was potentially achieved by promoting proliferation of vascular endothelial cells after flap revascularization. Upregulation of the PI3K/Akt signaling pathway was potentially related with this process.

Successfully treating hand primary tuberculous synovitis by synovectomy combined antituberculous therapy: A case report.

RATIONALE: Primary tuberculous infection in hand and wrist is a rare disease. Few articles reported on hand primary tuberculous synovitis. PATIENT CONCERNS: A 68-year-old Chinese male, without history of tuberculosis (TB), had complained of pain and swelling in right palm and little finger for 3 months. Patient came to our hospital on 9th Oct 2016. X-ray just showed soft tissue swelling in little finger. Magnetic resonance imaging (MRI) showed synovitis around flexor tendon of little finger, volar palm, and carpal tunnel. Notably, it also implied nodular images in little finger sizing 5 mm × 11 mm. Laboratory tests revealed C-reactive protein (CRP): 22 mg/L, erythrocyte sedimentation rate (ESR): 49 mm/h, and white blood cells (WBC): 11.8 × 10/L. DIAGNOSES: He was diagnosed with primary hand tuberculous synovitis. INTERVENTIONS: The patient received aspiration biopsy in right palm guided by ultrasound on 13rd Oct and pathological examination indicated Mycobacterium tuberculosis (MTB) infection. We performed radical synovetomy and collected abnormal tissue for pathological examination on 18th Oct. Finally, result showed MTB infection, which was the same with the result of first pathological examination. Then, this patient received antituberculous treatment. OUTCOMES: One year after operation, pain and swelling relieve and no recurrence of the clinical symptoms happened. LESSONS: Primary tuberculous synovitis of hand and wrist is rare, MTB infection should be considered as an infectious agent, especially in developing countries. Radical synovectomy and antituberculous treatment regain a satisfactory outcome.

Bilateral femoral posterior neurocutaneous perforater flap successfully treating Fournier gangrene: A case report.

RATIONALE: Necrotizing fasciitis (NF), characterized by widespread fascial necrosis, is a rare disease in clinic. Fournier gangrene (FG) is a special type of NF involved of perineum and scrotum. To our knowledge, no article has reported on bilateral femoral posterior neurocutaneous perforater flap treating for FG. PATIENT CONCERNS: A 61-year-old Chinese male complained of perineal skin necrosis for 19 days. The patient received treatment in other hospital due to chronic bronchitis on April 15th and body temperature ranged from 38 to 39 °C. Then he received antiinfection therapy. Perianal cutaneous occurred mild necrosis on May 08th. And the necrosis generally deteriorated. He came to our hospital for treating necrosis in area of perineum and scrotum on May 28th. DIAGNOSES: He was diagnosed with FG and chronic bronchitis. INTERVENTIONS: The patient underwent debridement on June 2nd and received bilateral femoral posterior neurocutaneous perforater flap on June 29th. Besides, the patient was treated with whole-body nutrition support and antibiotic treatment. OUTCOMES: One week after the 2nd operation, the flap showed normal color. The result shows good outcome and no recurrence of the clinical symptoms occur till now. LESSONS: FG is rare. Bilateral femoral posterior neurocutaneous perforater flap is an effective procedure to treat FG. The outcome of combined therapy is satisfactory.

Left extensive infection in the forearm caused by whitlow infected by mycobacterium tuberculosis: A case report.

INTRODUCTION: Whitlow is a common disease in clinic, characterized by pain and swelling of finger. However, few articles had reported on extensive infection in the forearm caused by whitlow infected by mycobacterium tuberculosis (MTB). PATIENT CONCERNS: A 70-year-old Chinese female complained of fester in back of left hand for 5 days. She had a history of recurrent whitlow for 14 months and pulmonary tuberculosis (TB). She received treatment in another hospital due to whitlow on July 2016. Then she was treated with incision and drainage. However, whitlow presented again several times before coming to our hospital. She came to our hospital on September 7, 2017 and x-ray of forearm showed that radius, ulna, and carpal were eroded. DIAGNOSES: She was diagnosed with left extensive infection in the forearm caused by whitlow infection by MTB. INTERVENTIONS: Considering her serious and extensive condition, we performed left forearm amputation on September 12, 2017. We collected some soft tissue cut down during surgery and conducted pathological examination. Finally, pathological result showed MTB infection. Then that patient was treated with antituberculosis therapy. OUTCOMES: Up to now, illness condition has not progressed. A recent x-ray of forearm showed no osteolysis in humerus. CONCLUSIONS: Extensive infection in the forearm after recurrent whitlow infection by MTB is rare. So when we face recurrent whitlow, a rapid diagnosis and treatment are required to prevent complications. This case reminds us that recurrent whitlow is dangerous. Attention must be paid to recurrent whitlow. If necessary, amputation should be considered.

Modified Great Toe Wraparound Flap with Preservation of Plantar Triangular Flap for Reconstruction of Degloving Injuries of the Thumb and Fingers: Long-Term Follow-Up.

BACKGROUND: The purpose of this article is to report the authors' experience with the use of the modified great toe wraparound flap with preservation of a plantar triangular flap for reconstructing degloving injuries of the thumb and fingers. METHODS: Between 2007 and 2012, 31 patients underwent reconstruction with 37 flaps. Twenty-seven patients underwent reconstruction with 31 flaps for a degloved thumb and fingers, and four patients underwent reconstruction with six flaps for degloved fingers only. A modified great toe wraparound flap with second toe medial toe hemipulp flap on a common pedicle was used for reconstruction of degloved fingers in four patients. Twelve patients had long-term follow-up, with a mean duration of 5 years (range, 2 to 8 years). RESULTS: All flaps survived. The contour of the reconstructed digits was similar to the contralateral one. In patients with long-term follow-up, mean two-point discrimination of reconstructed digits was 6.2 mm (range, 3 to 8 mm). Mean Disabilities of the Arm, Shoulder and Hand questionnaire score was 0.8 ± 1.0. Mean Michigan Hand Outcomes Questionnaire score was 87.3 ± 3.7. Mean Foot and Ankle Disability Index score was 95.5 ± 2.7. The width of the preserved plantar triangular flap expanded from 35 percent to 67 percent of the width of the great toe and completely covered the weight-bearing area. CONCLUSIONS: Reconstruction of degloved thumb and fingers with a modified great toe wraparound flap, preserving a plantar triangular flap, results in excellent contour and functional outcome. Donor-site morbidity in the foot was minimal. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.