Objective To choose the homodigital and the heterodigital flaps in the reconstruction of the distal finger injuries and to summarize the treatment results obtained in the clinical practice. Methods From August 2001 to June 2005, 112 injured fingers in 108 patients (68 males, 40 females; aged 16-63 years) were surgically treated. The injuries were due to remotion, crushing or avulsion, and they underwent operations 2 hours after the injuries. Nine kinds of flaps were taken from the dorsal or volar aspect of the injured fingers to cover the defects of the distal fingers. The flaps were divided into two kinds: ① The flaps were nourished by the main digital arterial branches, including the V-Y island flap based on the digital neurovascular bundles, the reversed digital artery flap, the modified Moberg flap, and the twins flaps based on the digital general neurovascular bundles (flaps ranging in area from 1.5 cm × 2.0 cm); and ② The flaps were nourished by the collateral digital arterial branches, including the dorsoulnar arterial retrograde flap of the thumb(flaps ranging in area from 1.5 cm×1.5 cm to 3.0 cm×2.5 cm) andthe reverse flap based on the dorsal branches of the digital artery (flaps ranging in area from 1.7 cm×1.0 cm to 4.5 cm×3.0 cm), the volar flap based on the transverse palmar branch of the digital artery (flaps ranging in area from 2.0 cm×1.0 cm to 2.5 cm×2.0 cm), and the island flap from the dorsum ofthe index finger and the digital local flaps. Results The follow-up for 2 weeks to 8 months revealed that all the flaps survived with an exception of flap necrosis in 3 patients and superficial necrosis in 3 patients. The sensation reached almost normal levels in the flaps based on collateral digital arteries and the twopoint discrimination was between 5 mm and 10 mm in the flaps based on the arterial branches. The finger motion ability was good and the finger appearance was satisfactory. Conclusion The choice of the above-mentioned skin flaps can repair the soft tissue defects of the distal parts of the fingers, which can have a satisfactory restoration contour.
Objective
To investigate the feasibility and application value of digital technology in establishing the micro-vessels model of cross-boundary perforator flap in rat.
Methods
Twenty 8-week-old female Sprague Dawley rats, weighing 280-300 g, were used to established micro-vessels model. The cross-boundary perforator flaps of 10 cm×3 cm in size were prepared at the dorsum of 20 rats; then the flaps were suturedin situ. Ten rats were randomly picked up at 3 and 7 days after operation in order to observe the necrosis of flap and measure the percentage of flap necrosis area; the lead-oxide gelatin solution was used for vessels perfusion; flaps were harvested and three-dimensional reconstruction of micro-vessel was performed after micro-CT scanning. Vascular volume and total length were measured via Matlable 7.0 software.
Results
The percentage of flap necrosis area at 3 days after operation was 19.08%±3.64%, which was significantly lower than that at 7 days (39.76%±3.76%;t=10.361, P=0.029). Three-dimensional reconstruction via the micro-CT clearly showed the morphological alteration of micro-vessel of the flap. At 3 days after operation, the vascular volume of the flap was (1 240.23±89.71) mm3 and the total length was (245.94±29.38) mm. At 7 days after operation, the vascular volume of the flap was (1 036.96±88.97) mm3 and the total length was (143.20±30.28) mm. There were significant differences in the vascular volume and the total length between different time points (t=5.088, P=0.000; t=7.701, P=0.000).
Conclusion
The digital technology can be applied to visually observe and objectively evaluate the morphological alteration of the micro-vessels of the flap, and provide technical support for the study of vascular model of flap.
ObjectiveTo explore the effectiveness of anterograde fascial flap of digital artery in reconstruction of Wassel Ⅳ-D thumb duplication.MethodsTwelve cases of Wassel Ⅳ-D thumb duplication were treated with anterograde fascial flap of digital artery between June 2014 and March 2017. There were 7 boys and 5 girls with an age of 9-32 months (mean, 13.3 months). Eight cases were on the left side and 4 cases on the right side. The main bunion bed width was 70%-85% of the healthy side (mean, 75.3%). The degree of fullness was 50%-75% of the healthy side (mean, 62.4%). The anterograde fascial flap with one proper digital artery was used to fill the nail fold on the radial side of the finger and increase the circumference of the finger. At last follow-up, the ratio of circumference of deformed finger to contralateral finger was measured at the base of nail. The appearance and function of all reconstructed thumbs were evaluated with Japanese Society for Surgery of the Hand (JSSH) scoring.ResultsAll the operations were successfully completed without early complications such as infection and skin necrosis. All children were followed up 7-27 months (mean, 14.3 months). At last follow-up, there was no recurrence of deformity in the digital body and no obvious change of scar contracture in the surgical wound. Pulp and nail fold symmetry improved in all cases. The ratio of circumference of deformed finger to contralateral finger was 93%-96% (mean, 94.7%). The JSSH score was 15-20 (mean, 17.9); the results were excellent in 8 cases, good in 2 cases, and fair in 2 cases.ConclusionThe anterograde fascial flap of digital artery is a safe and effective approach to restore symmetry for esthetic improvement in treatment of Wassel Ⅳ-D thumb duplication.
Objective To evaluated the application effect of reverse digital modeling combined with three-dimensional (3D)-printed disease models in the standardized training of orthopedic residents focusing on pelvic tumors. Methods From August 2022 to August 2023, 60 orthopedic residents from West China Hospital, Sichuan University were randomly assigned to a trial group (n=30) and a control group (n=30). The trial group received instruction using reverse digital modeling and 3D-printed pelvic tumor models, while the control group underwent traditional teaching methods. Teaching outcomes were evaluated and compared between groups through knowledge tests, practical skill assessments, and satisfaction surveys. Results Before training, there was no statistically significant difference in knowledge tests or practical skill assessments between the two groups (P>0.05). After training, the trial group showed significantly better performance than the control group in knowledge tests (90.5±5.2 vs. 78.4±6.8, P<0.05), skill assessments (92.7±4.9 vs. 81.3±6.2, P<0.05), and satisfaction surveys (9.40±1.10 vs. 7.60±1.20, P<0.05). One month after training, the trial group still showed significantly better performance than the control group in knowledge tests (88.1±6.4 vs. 72.3±7.1, P<0.05) and skill assessments (90.3±5.8 vs. 75.6±6.9, P<0.05). Conclusions Reverse digital modeling combined with 3D printing offers an intuitive and effective teaching approach that improves comprehension of pelvic tumor anatomy and strengthens clinical and technical competencies. This method significantly enhances learning outcomes in standardized residency training and holds promise for broader integration into medical education.
Objective To investigate the method and effectiveness of repairing fingertip defects with reverse island flappedicled with terminal dorsal branch of digital artery with sense reconstruction. Methods Between December 2008 and March2010, 32 patients (40 fingers) with fingertip defects were treated. There were 20 males (23 fingers) and 12 females (17 fingers), aged from 20 to 62 years (mean, 42 years). The time between injury and admission was from 1 to 8 hours. The injured fingers included thumb (2 cases), index finger (6 cases), index finger and middle finger (3 cases), middle finger (7 cases), middle finger and ring finger (3 cases),ring finger (8 cases), ring finger and little finger (2 cases), and little finger (1 case). The defect area ranged from 1.2 cm × 1.0 cm to 2.2 cm ×1.8 cm, and the flap area ranged from 1.5 cm × 1.0 cm to 2.5 cm × 2.0 cm. The fingertip defects were repaired by the reverse island flaps pedicled with terminal dorsal branch of digital artery and branch of digital nerve, and the branch of digital nerve was anastomosed withstump of proper digital nerve. The donor sites were repaired with free skin grafts. Results Bl isters occurred in 6 cases (9 fingers) andpartial necrosis of the flaps in 2 cases (2 fingers), which were cured after symptomatic treatment. The other flaps and skin grafts survived and the wounds healed by first intention. Thirty cases (38 fingers) were followed up 6 months postoperatively. The shape, contour of the reconstructed fingertip, and motivation of the fingers were satisfactory. The superficial sensation and deep pain sensation recovered after 6 months of operation. The two-point discrimination was 4-6 mm in 24 fingers, 7-10 mm in 13 fingers, and none in 1 finger. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, S3 was achieved in 1 finger, S3+ in 13 fingers, and S4 in 24 fingers. Conclusion It is simple and safe to harvest the reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction; at the same time, the blood supply of the flap is rel iable and its sense can be reconstructed. It is one of effective methods for repairing fingertip defects.
ObjectiveTo review the current status and progress of locking plate for the treatment of distal femoral comminuted fractures.MethodsThe related literature was extensively reviewed to summarize the current status and progress in the treatment of distal femoral comminuted fracture with locking plate from four aspects: the current treatment situation, the shortcomings of locking plate and countermeasures, the progress of locking technology, locking plate and digital orthopedic technology.ResultsTreatment of distal femoral comminuted fractures is challenging. Locking plates, the most commonly used fixation for distal femoral comminuted fractures, still face a high rate of treatment failure. Double plates can improve the mechanical stability of comminuted fractures, but specific quantitative criteria are still lacking for when to choose double plates for fixation. The far cortial locking screw has shown good application value in improving the micro-movement and promoting the growth of callus. The biphasic plating is a development of the traditional locking plate, but needs further clinical examination. As an auxiliary means, digital orthopedic technology shows a good application prospect.ConclusionThe inherent defect of locking plate is a factor that affects the prognosis of distal femoral comminuted fracture. The optimization of locking technology combined with digital orthopedic technology is expected to reduce the failure rate of treatment of distal femoral comminuted fracture.
ObjectiveTo study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap.MethodsBetween March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained.ResultsThe origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements (P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%.ConclusionThe digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.
ObjectiveTo analyze the effect of 3D simulation technique in thoracoscopic lobectomy.MethodsFrom June 2015 to January 2018, 124 patients with left lower lobe resection underwent thoracoscopy with single-port thoracoscopic surgery, including 64 males and 60 females, aged 42–83 years. They were randomly divided into two groups including an experimental group (preoperatively given 3D simulation surgery in 59 patients) and a control group (preoperatively not given 3D simulation surgery in 65 patients). The clinical effect between the two groups was compared.ResultsAll patients recovered without any death during hospitalization. In the experimental group, the operation time, intraoperative blood loss and postoperative hospital stay were significantly less than those in the control group (P<0.05). There was no significant difference in postoperative drainage volume, and duration of drainage tube retention and analgesic drug usage between the two groups (P>0.05).Conclusion3D simulation technique for thoracoscopic lobectomy has advantage in short operation time, minor trauma and quick recovery. It has a guiding role in the preoperative planning of lung cancer surgery and is worthy of popularization and application.
With the breakthroughs of digitization, artificial intelligence and other technologies and the gradual expansion of application fields, more and more studies have been conducted on the application of digital intelligence technologies such as exoskeleton robots, brain-computer interface, and spinal cord neuromodulation to improve or compensate physical function after spinal cord injury (SCI) and improve self-care ability and quality of life of patients with SCI. The development of digital intelligent rehabilitation technology provides a new application platform for the functional reconstruction after SCI, and the digital and intelligentized rehabilitation technology has broad application prospects in the clinical rehabilitation treatment after SCI. This article elaborates on the current status of exoskeleton robots, brain-computer interface technology, and spinal cord neuromodulation technology for functional recovery after SCI.
The digital defects which severely interfered with the hand functions must be reconstructed. The primary repair by vascularized skin flap with the dorsal branch of proper palmar digital nerve could be done. The vascularized flap was rich in blood circulation, perfect sensibility and a good contour, as well as preserving donor digital sensation. However, it was simple, safe, and with higher success. From 1989 to 1991, 10 cases of digital defects were treated, all of the patients gained very good results. The indication and technique of thismethod wasdiscussed in detail.
