Objective
To investigate the operative procedure and the clinical results of the island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery for repairing finger soft tissue defect.
Methods
Between January 2008 and March 2012, 28 cases of tissue defect of fingers (32 fingers) were repaired with the island flaps based on the vascular chain of the cutaneous branch of dorsal metacarpal artery. There were 20 males (23 fingers) and 8 females (9 fingers), with an average age of 29.5 years (range, 14-67 years). The injury causes included 14 cases of crush injury, 6 cases of pressing injury, 5 cases of cutting injury, and 3 cases of avulsion injury. The locations included 10 index fingers, 13 long fingers, 6 ring fingers, and 3 little fingers. There were 9 defects of proximal segment, 12 defects of middle segment, and 11 defects of distal segment. The area of defect ranged from 1.0 cm × 0.8 cm to 5.2 cm × 3.5 cm. The disease duration was 1 hour to 15 days. The area of flaps ranged from 1.2 cm × 1.0 cm to 5.5 cm × 3.8 cm. The donors were closed by suture or were repaired with skin graft.
Results
Tense blister occurred in 3 cases, which was cured after dressing change; the other flaps survived. Wound obtained primary healing. Twenty-five patients (27 fingers) were followed up 6-25 months (mean, 16.8 months). The flaps had soft texture and satisfactory appearance. Two point discrimination was 6-9 mm (mean, 7.7 mm) at 6 months after operation. The total active movement of fingers was 105-230° (mean, 204.6°). The results were excellent in 17 fingers, good in 8 fingers, and fair in 2 fingers with an excellent and good rate of 92.6%.
Conclusion
The island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery has the advantages of the deverting point from the dorsal point to the palm, the extended vessel pedicle, and expanded operation indications, so it is not necessary to cut the dorsal metacarpal artery. It can be used to repair finger tissue defect.
Objective To investigate the etiology, diagnosis, and treatment of acute carpal tunnel syndrome (ACTS) after reduction of Colles’ fracture. Methods Between December 2006 and June 2010, 22 patients with ACTS after reduction of Colles’ fracture were treated with expectant treatment and surgical treatment. There were 9 males and 13 females with an average age of 46.2 years (range, 23-60 years). Fractures were caused by traffic accident in 9 cases, fall ing in 8 cases, fall ing from height in 2 cases, hitting in 2 cases, and crushing in 1 case. The mechanism of fracture was direct violence in 3 cases and indirect violence in 19 cases. According to Gartland ＆ Werley classification, there were 2 cases of type I, 5 cases of type II, 14 cases of type III, and 1 case of type IV. Closed reduction was performed in 19 cases and open reduction and internal fixation (ORIF) in 3 cases. The average symptom time of ACTS after reduction of Colles’ fracture was 11.6 hours (range, 1 hour 30 minutes to 48 hours) in patients undergoing closed reduction and was 24 hours in 1 patient and 2 weeks in 2 patients undergoing ORIF. Expectant treatment was performed first, the forearms were put in neutral position in closed reduction cases; if there was no rel ief of ACTS symptom 1 week later, the mixture of 1 mL glucocorticosteroid and 1 mL 2% l idocaine was injected into carpal tunnel once a week for 2 weeks. The mixture was injected into carpal tunnel directly once a week for 2 weeks in ORIF cases. In the patients who failed to expectant treatments, ORIF was performed. Results In 7 cases of type III that failed expectant treatment, ACTS symptoms were rel ief completely after ORIF. All the 22 patients were followed up 12 months on average (range, 8-18 months). The average time of complete disappearance of median nerve compression symptom was 11 days (range, 2-25 days). All the patients had normal finger motion, sensation, and opposition of thumb with no sensation of anaesthesia and pinprick. The results of Tinel test, Phalen test, and Reverse Phalen test were all negative. The X-ray film showed good fracture reduction and heal ing with an average heal ing time of 6 weeks (range, 3-14 weeks). According to GU Yudong’s criteria for functionalassessment, the results were excellent in 18 cases and good in 4 cases; the excellent and good rate was 100%. Conclusion Malposition, displacement of fracture fragments, and ulnar deviation of the wrist after plaster immobil ization are the mostimportant risk factors for ACTS. Expectant treatments are recommended in patients with Colles’ fracture of types I, II, and IV,but surgical treatment is the first choice for Colles’ fracture of type III.
ObjectiveTo analyze the impact of resection margin length on postoperative clinical outcomes in patients with Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG) and to investigate the independent risk factors influencing postoperative positive resection margin. MethodsBased on sample size estimation, 173 patients with AEG admitted to the 980th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army from July 2022 to January 2025 were prospectively enrolled and divided into 3 groups according to the proximal resection margin length: <20 mm group, 20–30 mm group, and >30 mm group. Baseline data were compared among the 3 groups, and differences in clinical outcomes among patients with different resection margin lengths were analyzed. Multivariate logistic regression analysis was used to identify independent risk factors for positive resection margin, and receiver operating characteristic (ROC) curve was used to evaluate the discriminative ability of these independent factors for postoperative positive resection margin. Stratified analysis by resection margin length intervals was performed to quantify the association between proximal resection margin length and risk of positive margin, and subgroup analyses were conducted to explore the consistency of this association across different clinicopathologic subgroups. ResultsThere were no statistically significant differences in baseline data such as gender, age among the three groups (P>0.05). Among the three groups, patients in the 20–30 mm group had the shortest operative time and time to first postoperative ambulation (P<0.05), the lowest percentage of body weight loss (P<0.05) and the highest hemoglobin and albumin levels (P<0.05) on postoperative month 6. Multivariate logistic regression analysis showed that tumor length ≥5 cm [OR (95%CI)=4.500 (2.519, 8.038), P=0.008], poorly differentiated pathological type [OR (95%CI)=3.803 (2.098, 6.882), P=0.026], and resection margin length <20 mm or >30 mm [OR (95%CI)=3.997 (1.819, 8.793), P=0.037; OR (95%CI)=4.202 (1.906, 9.252), P=0.031, respectively] were independent risk factors for postoperative positive resection margin. The areas under the ROC curve for these three factors individually and their combination in predicting positive resection margin were 0.765, 0.726, 0.702, and 0.847, respectively. The risk-stratified analysis for positive resection margins revealed that, compared with a superior resection margin length of 20–25 mm, the risk of margin positivity significantly increased at lengths of 15–20 mm and 30–35 mm [OR (95%CI)=6.609 (1.816, 24.034), P=0.004; OR (95%CI)=6.618 (1.832, 23.973), P=0.004]. Subgroup analyses showed that the correlation between resection margin length and positive margin was more pronounced in patients with tumor length ≥5 cm and poorly differentiated pathology (Pinteraction<0.05). ConclusionsFor patients with Siewert type Ⅱ/Ⅲ AEG, maintaining the superior resection margin length within the 20–30 mm range during surgical resection can ensure oncological radicality while optimizing postoperative recovery and nutritional status. For patients with tumor length ≥5 cm and poorly differentiated pathology, greater emphasis should be placed on accurate measurement and frozen section confirmation during surgery.
