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REPAIR OF SKIN DEFECT ON WRIST AND HAND WITH DISTALLY PEDICELED COMPOSITE VASCULAR NET FLAP OF FOREARM

Objective To study the blood supply of the distally pediceled composite vascular net flap of forearm and its clinical effect. Methods From February 2000 to December 2003, the distally pediceled composite vascular net flap of forearm was used to repair a series of 26 skin defects with bone or tendon exposure on the hand and wrist.Of 26 patients, there were 17 males and 9 females at ages of 18 to 56 years; 16 received emergency operation and 10 received selective operation. The flap sizes ranged for 10 cm ×5 cm to 18 cm×7 cm. Results Allof the flaps survived. At followup of 3 to 8 months, there was no flap loss, even partial and the outcome was satisfactory in all patients.Twopoint discrimination was 6 to 10 mm. Conclusion Plexus around the cutaneous nerves and the superficial vein are connected with the superficial subdermal plexus and the deep facial plexus by perforators from the underling main arteries, forming a threedimensional vascular network and in a sort of longitudinal axiality, which is the anatomic base of blood supply for the flaps. Blood supply to the flap is provided by the perforators arising from the deeply situated radial or ulnar arteries in the distal pedical. The advantage of this flap is its constant and reliable blood supply without sacrifice of the main artery. The elevation of the flapis simple and rapid, and the flap has a higher survival rate.

RECONSTRUCTION OF WRIST JOINT BY TRANSPLANTING FIBULAR HEAD PEDICLED WITH LATERAL INFERIOR GENICULAR ARTERY

Objective To investigate a new operative method to reconstruct wrist joint for treating the defect of the distal radius after excision of tumor.Methods From October 1999 to December 2001, 3 cases of giant cell tumor in the distal radius were resected and the wrist joint was reconstructed by transplanting the fibular head pedicled with the lateral inferior genicular artery. ResultsAfter followed up for 6 to 18 months, all patients achieved the bony healing within 4 months without tumor relapse and had good function of the wrist joint. Conclusion This operation is simple and reliable. The fibularhead can be cut according to the tumor size of the radius.

腕掌侧软组织切割伤的治疗

报道43例腕掌侧软组织切割伤,共损伤动脉55条,神经67条,屈肌腱102条。均以显微外科技术进行修复。经平均10个月随访,手功能恢复优良率为90％。讨论了腕掌侧区软组织解剖与损伤关系,显微清创的作用,以及修复损伤血管的重要性。精细、准确地一期修复屈肌腱,是手功能恢复的重要保证。

THE EMERGENT REPAIR OF PERIPHERAL NERVE INJURY OF THE WRIST

OBJECTIVE To investigate the effect of the emergent repair of peripheral nerve injury of the wrist. METHODS From July 1993 to December 1997, 17 cases were admitted, which 21 injured peripheral nerves were repaired emergently. Among them, there were 11 cases of median nerve injury, 2 cases of ulnar nerve injury and 4 cases of median and ulnar nerve injury. All the nerves were ruptured completely except one which was partially ruptured. The emergent operation was taken and the injured nerves were repaired by microsurgical technique. RESULTS Followed up 6 to 18 months after operation, 95.25% injured nerves had good outcome. CONCLUSION Because of the specific structure of the wrist, nerve injury at this part need to be repaired emergently. It can enhance the regeneration of the injured nerve, preserve the function of the intrinsic muscle of hand, and decrease the local adhesion.

手掌侧小切口在腕管区指屈肌腱损伤修复中的应用

目的 总结腕管区指屈肌腱损伤后采用手掌侧小切口寻找肌腱远断端的方法及修复肌腱疗效。 方法 2002 年1 月－ 2007 年10 月，收治锐器切割伤致腕管区指屈肌腱损伤38 例。男29 例，女9 例；年龄22 ～ 48 岁，平均35 岁。伤后1 ～ 12 h 入院。损伤肌腱：拇长屈肌腱12 例，示指深、浅屈肌腱10 例，中指浅屈肌腱3 例，环指屈肌腱3 例，示、中指深、浅肌腱10 例。腕部均为横形伤口。合并正中神经损伤21 例，桡动脉损伤6 例，尺动脉、尺神经损伤3 例。术中于掌侧腱鞘区与手掌区间远侧掌横纹处作一横形长约0.5 cm 切口，寻找回缩肌腱远断端并逆行原路回送，与其近断端进行端端吻合。同时处理合并损伤。 结果 术后切口均Ⅰ期愈合，未出现手指缺血坏死，尺、桡动脉搏动均可触及。36例获随访，随访时间12 ～ 36 个月，平均14 个月。术后2 ～ 4 个月根据美国手外科学会推荐的总主动活动度法评价术后疗效，优23 例，良9 例，可2 例，差2 例，优良率83.3%。21 例正中神经损伤者功能均恢复；3 例尺神经损伤者中1 例尺神经功能改善，2 例尺神经功能未恢复。 结论 腕管区指屈肌腱损伤后，采用手掌侧小切口寻找回缩的屈肌腱远断端手术操作简便可行，且不影响肌腱修复效果。

RESTORATION OF SUPINATION OF FOREARM BY FLEXOR CARPI RADIALIS TRANSFER

The dysfunction of supination of forearm following injury of brachial plexus or poliomyelitis always affects the function of hand. To find the dynamic muscle for restoration of the supination, the flexor carpi radialis was investigated on fifty male cadavers. The blood supply of the muscle was polygenic, mainly derived from the humoral and radial arteries. The movement of the muscle was innervated by median nerve. If the proximal 1/3 belly of the muscle was reserved, the blood supply and innervation of the complete muscle was reserved. According to the anatomic data, the operative procedure was designed as following: transfer the distal 2/3 of flexor carpi radialis over the ulnar aspect of the forearm to the dorsal-radial side, the tendon was fixed on the radius shaft 6 to 10 cm proximal to the styloid process with forearm in full supination. Four patients were treated and after followed up for 3.2 years average, the supination restored. It was discussed that in case of paralysis of the flexor carpi ulnaris and pronator teres, the optimal choice to restore the supination would be flexor carpi radialis.

腕部神经锐器伤的初期处理失误探讨

高原腕关节结核的诊断与治疗

目的 总结高原地区腕关节结核的诊断及治疗方法。 方法 回顾分析2007 年10 月－ 2009 年10月25 例腕关节结核患者临床资料。男12 例，女13 例；年龄25 ～ 65 岁，平均34.6 岁。左腕15 例，右腕 10 例。其中15例有肺结核或既往有肺结核病史。腕关节结核发病至入院时间为2 ～ 8 个月，平均6 个月。单纯腕关节滑膜结核10 例行保守治疗；全腕关节结核12 例、腕部屈肌腱腱鞘结核3 例采用化疗联合手术病灶清除治疗。 结果 治疗后除2 例全腕关节结核及1 例腕部屈肌腱腱鞘结核患者切口Ⅱ期愈合外，其余患者切口均Ⅰ期愈合。患者均获1 年6 个月随访。随访期间无结核复发，切口周围均无再次窦道形成。10 例单纯腕关节滑膜结核者及3 例腕部屈肌腱腱鞘结核者腕关节、掌指关节及指间关节活动自如，均于治疗后2 个月完全恢复劳动。12 例全腕关节结核者前臂旋前平均70°、旋后70°，较术前明显改善，术后4 个月完全恢复劳动。 结论 早期诊断、手术前后联合化疗、及时手术清除病灶、术后腕关节石膏固定、同时加强各掌指及指间关节活动，是治疗腕关节结核的有效方法。

DORSAL INTERCARPAL LIGAMENT CAPSULODESIS FOR CHRONIC STATIC SCAPHOLUNATE DISSOCIATION

Objective To investigate the radiographic and clinical outcomes of dorsal intercarpal ligament capsulodesis (DILC) procedure for chronic static scapholunate dissociation. Methods Between January 2008 and January 2011, 12 patients with chronic static scapholunate dissociation were treated with DILC. Of 12 cases, 10 were male and 2 were female with an average age of 42 years (range, 20-66 years). All injuries were caused by falling. The interval from injury to surgery was 3-19 months (mean, 8 months). Physical examination at admission showed wrist tenderness and limited range of motion (ROM). Radiological examination showed that scapholunate gap was greater than 3 mm on posteroanterior view, and scapholunate angle more than 60° on the lateral view. Before operation, the grip strength was (25.4±8.2) kg; the wrist ROM was (56.7±11.5)° in flexion and (52.0±15.2)° in extension; visual analogue scale (VAS) score was 6.3±1.4; and disabilities of arm, shoulder & hand (DASH) score was 39.5±7.4. According to Garcia-Elias staging criteria, all cases were rated as stage 4, indicating that the scapholunate interosseous ligament was completely injured and reduction could easily be obtained. Eight patients had wrist instability. Results Primary healing of incision was achieved, no complication was found. All patients were followed up 13-34 months (mean, 15.9 months). During surgery, all deformities were corrected completely, but 7 patients (58%) recurred at 1 month after Kirschner wire removal. Compared with preoperative ones, the scapholunate gap, scapholunate angle, radiolunate angle, lunocapitate angle, and wrist height ratio at 1 month after Kirschner wire removal and last follow-up showed no significant difference (P > 0.05); the wrist flexion and extension ROM were significantly decreaed to (46.8±7.2)° and (42.0±9.0)° at last follow-up (P < 0.05); the grip strength was significantly increased to (32.7±9.6) kg at last follow-up (P < 0.05); VAS score and DASH score were improved to 1.7±1.0 and 8.1±8.7 (P < 0.05). Conclusion Carpal collapse will recur in short time after DILC. DILC is not the best way to treat chronic static scapholunate dissociation.

Anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex injury under wrist arthroscopy

ObjectiveTo explore the effectiveness of anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex (TFCC) injury under wrist arthroscopy. MethodsBetween March 2018 and March 2020, 16 patients with Atzei-EWAS type 2 TFCC injury were admitted, and the TFCCs were anatomically repaired with a three-dimensional suture with a thread anchor under wrist arthroscopy. There were 10 males and 6 females with an average of 40.2 years (range, 22-54 years). The disease duration ranged from 2 to 9 months (mean, 6.4 months). Preoperative grip strength of the affected limb was (20.06±3.38) kg, wrist range of motion in flexion and extension was (117.19±7.74)°, radial-ulnar deviation was (31.25±5.32)°, forearm rotation range of motion was (137.19±14.83)°, visual analogue scale (VAS) score was 5.6±1.2. At last follow-up, the effectiveness was evaluated by the grip strength of the affected limb, the range of motion of the wrist joint, the VAS score, and the modified Mayo wrist score. ResultsAll incisions healed by first intention. One case had paralysis of the dorsal branch of the ulnar nerve after operation, and no other complications occurred in other cases. All patients were followed up 12-18 months (mean, 14.5 months). The distal radioulnar joint stability of all patients recovered. At last follow-up, the grip strength of the affected limb was (24.88±3.26) kg, the range of motion in flexion and extension was (146.59±6.49)°, radial-ulnar deviation was (39.38±6.55)°, and forearm rotation range of motion was (152.50±11.55)°, which were significantly higher than those before operation (P<0.05); the VAS score was 0.9±0.8, which was significantly lower than that before operation (t=21.029, P=0.000). The modified Mayo wrist score was rated as excellent in 10 cases, good in 5 cases, and fair in 1 case. The excellent and good rate was 93.8%. MRI results showed that TFCC healed in all cases. ConclusionFor Atzei-EWAS type 2 TFCC injury, anatomical repair under wrist arthroscopy can restore the anatomical structure of TFCC, effectively relieve wrist pain, improve function, and obtain good effectiveness.