OBJECTIVE In order to investigate the causes of necrosis of the retained flap after transplantation of the great nail flap, according to the principle of plastic surgery, the following operation was designed. METHODS A tongue-shaped great toe flap was made with its base on the tibial side of the great toe and the width of the base was 1 cm to 1.5 cm. The flap contained the supporting vessels and nerves and the periosteum was also preserved. RESULTS From June 1982 to November 1997, the flap was used to repair 267 case, 277 fingers defects. After operation, the retained flap on the tibial side developed necrosis in 13 sides, an incidence of 4.69%, and in 78 sides, there was necrosis on the grafted skin on the donor site, an incidence of 28.7%. Most of the wounds healed after changing dressing, while 37 wounds healed from another skin graft. Of these cases, 178 cases had been followed up for 5 months to 16 years. It was found that the retained tibial tongue-shaped flap showed hyperplasia which extended to the weightbearing area of metatarso-phalangeal of great toe. It showed that the taking off of great toe nail flap according to first dorsal metatarsal artery (FDMA) I, II or III type, the incidence of development of necrosis of retained flap on tibial side showed no significant difference (P gt; 0.05). CONCLUSION It was believed that the necrosis of the retained flap was not related to the FDMA classification but had relation with the design, operative technique and presence of infection.
ObjectiveTo observe the morphologic characteristics of color Doppler flow imaging (CDFI) and blood stream in patients with retinopathy of prematurity, and provide the new clinical diagnostic gist.MethodsCDFI was performed on 78 patients (156 eyes) with ROP at Ⅳ and Ⅴ stage, who had the diseases history such as prematurity and low birthweight which had been diagnosed by indirect ophthalmoscope, underwent the examination of CDFI. Morphologic characteristics of the results of CDFI and features of blood flow of the pathological changes were observed. ResultsIn the patients with ROP at the Ⅳ stage, a weak zonal echo originated from one side of peripheral wall of eye ball in the vitreous body, and extended to the echo of post pole and wall of eye ball and joined the echo of optic disc. In the patients with ROP at the V stage, lumplike echo connected closely with echo of lens and the circumambience was surrounded; the focus looked like lotus when combined with retinal detachment: the swelled “corona” wrapped and tightly connected with the lens, and the thin “caulis” showed weak zonal echo which attached to the optic disc. The features of blood flow showed the signal of blood stream connected with central retinal artery at the “caulis”, which was analyzed by Doppler spectrum as the bloodflow spectrum of artery and vein in the same direction which was the same as the central retinal artery and vein.ConclusionsIn patients with ROP at the IV and V stage, the results of CDFI mainly shows zonal or lumplike echo, in which the bloodflow signal extended with central retinal artery could be seen. The morphological changes of CDFI and the features of blood flow are useful in diagnosis of ROP. (Chin J Ocul Fundus Dis, 2005,21:282-284)