Reconstruction of Soft Tissue Defects in the Hand with a Free Anterolateral Thigh Deep Fascia Flap

ObjectiveTo report our experience in the reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From November 2016 to January 2020, six patients (four men and two women) with soft tissue defects in the hand were included in this study. The average age of the patients was 33.7 ± 12.7 years (range, 20 to 50 years). All patients underwent reconstructions with free anterolateral thigh deep fascia flaps. Relevant clinical characteristics were recorded prior to surgery. The size and thickness of the deep fascia flap and the thickness of the skin were measured intraoperatively. The survival of the flaps and skin grafts and the occurrence of infection were recorded after the operation. At follow‐up, donor site complications and postoperative effects were evaluated according to the outcome satisfaction scale. The pain in the injured hand was assessed using the visual analog scale.ResultsThe average body mass index (BMI) was 26.6 ± 1.7 kg/m² (range, 23.9 to 28.7 kg/m²). The defect sizes ranged from 5 cm × 5 cm to 13 cm × 8 cm (average, 53.1 ± 27.9 cm²). The six anterolateral thigh deep fascia flaps ranged from 7 cm × 6 cm to 14 cm × 9 cm in size (average, 71.8 ± 29.1 cm²). The thicknesses of skin ranged from 25 mm to 40 mm (average, 32.5 ± 4.8 mm), and the thicknesses of the deep fascia flaps ranged from 2 mm to 3 mm (average, 2.5 ± 0.5 mm). After the operation, the blood supply of the deep fascia flap was normal in all cases. The second‐stage skin grafts of most patients survived completely. The skin graft in one case was partially necrotic and healed after a dressing change. No infection occurred. At follow‐up (average, 16.3 ± 6.9 months), there was only a linear scar and no loss of sensation at the donor site of each patient. According to the outcome satisfaction scale, the outcome satisfaction score ranged from 6 to 8 (average, 7.2 ± 0.9), all of which were satisfactory. Apart from one patient who reported mild pain, all the other patients reported no pain. Three typical cases are presented in this article.ConclusionsThe free anterolateral thigh deep fascia flap, which is suitable for reconstruction of soft tissue defects in the hand, can provide very good outcomes both functionally and aesthetically.     

High resolution MRI of the normal finger at 0.1 T: anatomic correlations

Summary MR images of the fingers are obtained in a 128×128 or 256×256 matrix format using a prototype of a mini imager dedicated to the hand. The vertical field of 0.1 T is provided by an electro-magnet with an air gap of 15 cm equiped with a single solenoidal coil. No Faraday cage is used. The maximum in plane pixel resolution of 100 µ is obtained for a field of view of 2.5 cm with a slice thickness of 2 mm. The identification of fine structures of the finger is demonstrated by the anatomical and histological correlations. This type of imager which is adapted to very limited field of views demonstrate that high resolution MRI of limb extremities can be achieved at 0.1 T.

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IRM en haute résolution du doigt normal à 0,1 T. Corrélations anatomiques

Résumé Les images IRM des doigts sont réalisées dans un format de 128×128 ou 256×256 pixels par un mini imageur prototype spécialisé pour la main. Le champ magnétique vertical de 0,1 T est délivré par un électro-aimant dont l'entrefer de 15 cm est équipé d'une antenne solénoïdale simple. Il n'y a pas de cage de Faraday. La résolution maximale de 100 µ par pixel est obtenue pour un champ de vue de 2,5 cm et une épaisseur de coupe de 2 mm. L'identification de structures fines du doigt est démontrée par les corrélations avec des coupes anatomiques et histologiques. Ce type d'appareil, adapté à de si petits champs d'exploration, démontre que l'imagerie ostéoarticulaire périphérique en haute résolution est possible à 0,1 T.

     

Haptic localization and the internal representation of the hand in space

As the hand actively explores the environment, contact with an object leads to neuronal activity in the topographic maps of somatosensory cortex. However, the brain must combine this somatotopically encoded tactile information with an internal representation of the hand's location in space if it is to determine the position of the object in three-dimensional space (3-D haptic localization). To investigate the fidelity of this internal representation in human subjects, a small tactual stimulator, light enough to be worn on the subject's hand, was used to present a brief mechanical pulse (6-ms duration) to the right index finger before, during, or after a fast, visually evoked movement of the right hand. In experiment 1, subjects responded by pointing to the perceived location of the mechanical stimulus in 3-D space. Stimuli presented shortly before or during the visually evoked movement were systematically mislocalized, with the reported location of the stimulus approximately equal to the location occupied by the hand 90 ms after stimulus onset. This pattern of errors indicates a representation of the movement that fails to account for the change in the hand's location during somatosensory delays and, in some subjects, inaccurately depicts the velocity of the actual movement. In experiment 2, subjects were instructed to verbally indicate the perceived temporal relationship of the stimulus and the visually evoked movement (i.e., by reporting whether the stimulus was presented before, during, or after the movement). On average, stimuli presented in the 38-ms period before movement onset were more likely to be perceived as having occurred during rather than before the movement. Similarly, stimuli in the 145-ms period before movement termination were more likely to be perceived as having occurred after rather than during the movement. The analogous findings of experiments 1 and 2 indicate that the same inaccurate representation of dynamic hand position is used to both localize tactual stimuli in 3-D space and construct the perception of arm movement.     

某金矿凿岩工症状自评量表调查分析

探讨局部振动对工人心理,行为功能的影响。方法 应用ＳＣＬ－９０量表及一般症状查体资料,对４０名金矿井正业凿岩机工人及其对照组２０名工人进行了调查分析。结果 与对照组比较,凿岩组工人在耳鸣,听力下降,高血压等方面有显著性意义;症状量表听各项指标均与对照组有显著差异,且在工作后１０年内易发生。结论局部振动可造成工人心理,行为功能的改变及一些症状的出现,二者又可相互作用,进一步加重对工人身心健康的危害。     

High-frequency ultrasound examination of the wrist and hand

High-frequency ultrasound (US) is an efficient, rapid and inexpensive altenative to magnetic resonance imaging (MRI) for investigation of diseases in the soft tissues of the wrist and hand. US allows detection of foreign bodies and the reliable identification of a variety of traumatic lesions affecting tendons, annular pulleys, ligaments, vessels and nerves. Inflammatory diseases of tendons, including acute and chronic tenosynovitis and some degenerative conditions in the wrist and hand, can also be diagnosed. In entrapment neuropathies, US is able to identify nerve shape changes and possible extrinsic space-occupying lesions that may cause nerve compression within the tunnels. In patients with localized swelling of the hand or wrist, US is able to assess the presence of an expansile lesion and to characterize its nature in most cases. The objective of this article is to review the main findings and the primary indications of US in the investigation of disorders of the hand and wrist. Received: 10 September 1998 Accepted: 24 November 1998     

Clinical observations of juvenile nonprogressive muscular atrophy localized in hand and forearm

Summary Twenty-seven patients with juvenile nonprogressive muscular atrophy localized in the hand and forearm were analyzed. The clinical characteristics were juvenile male occurrence, insidious onset, specific distribution of localized muscular atrophy and a stationary course. On electromyography, denervation voltage (or giant NMU) is found in the atrophied muscles and sometimes in contralateral nonatrophied ones. Sensory disturbance was not remarkable. Although the etiological factor was not known, strenuous exercise of arms in sports was noted frequently in the history.

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Zusammenfassung 27 Patienten mit juveniler nonprogressiver Muskelatrophie, lokalisiert an der Hand und dem Vorderarm wurden analysiert. Klinisch charakteristische Merkmale waren Vorkommen bei jungen Männern, schleichender Beginn, lokalisierter Befall der erwähnten Muskelgruppe und stationärer Verlauf nach einer anfänglichen Progression. Elektromyographisch wurde eine Denervation in den atrophischen Muskeln und manchmal in den Muskeln der kontralateralen Seite bemerkt. Sensible Ausfälle waren nicht eindrücklich. Obgleich die Ätiologie nicht klar war, wurde häufiger Gebrauch der Hand im Sport in der Krankheitsgeschichte bemerkt.

     

手部外骨骼机器人辅助双侧对称性训练与镜像疗法对偏瘫患者手功能的康复效果比较

目的比较手部外骨骼机器人辅助双侧对称性训练与镜像疗法对脑卒中偏瘫患者手功能的康复效果。方法选取2018年6月至2019年7月在安徽医科大学第一附属医院康复医学科住院的脑卒中偏瘫患者36例,采用随机数字表法分为外骨骼组与镜像组,每组18例。外骨骼组患者利用手部外骨骼机器人进行双手同步对称性训练,镜像组给予镜像疗法。观察两组患者治疗前后手功能及日常生活活动能力的变化,比较两组患者治疗方法的疗效差异。结果治疗后,两组患者Fugl-meyer运动功能量表评分(FMA)及改良Barthel指数均较治疗前提高,差异有统计学意义(P<0.001)。治疗后,外骨骼组患者的FMA评分高于镜像组,差异有统计学意义(P=0.034)。治疗2周后,外骨骼组患者治疗有效率高于镜像组,差异有统计学意义(P=0.044),两组患者治疗显效率差异无统计学意义(P>0.05);治疗3、4周后,两组患者治疗有效率差异均无统计学意义(P>0.05),外骨骼组治疗显效率高于镜像组,差异均有统计学意义(P=0.035,P=0.022)。结论基于手部外骨骼机器人的双侧对称性训练能加速脑卒中患者手功能的恢复进程,对于手功能的改善程度优于镜像疗法。     

示指固有伸肌腱移位重建伸拇功能的疗效及解剖学研究

目的：探讨示指固有伸肌腱移位重建伸拇功能术后对拇指和示指功能的影响及其解剖学机制。方法对12例进行回顾性研究,男7例,女5例,年龄18～78岁,平均42.3岁,拇长伸肌腱损伤的平面为III区4例,IV区5例,V区3例。采用示指固有伸肌腱移位重建伸拇功能,术后8～83（33.5＆#177;29.9）个月进行电话随访。评价指标包括拇指和示指的功能。拇指功能评价指标：（1）患手手掌向下平置于桌面,能否主动将拇指指尖抬离桌面;（2）能否完成“挑大拇指”的动作;（3）在保持拇指掌指关节和指间关节伸直的情况下,能否完成以第一腕掌关节为支点的拇指划圈运动;（4）在拇指处于中立位时,能否较好地完成拇指指间关节屈曲动作。示指功能评价指标：（1）患手手掌向下平置于桌面时,能否主动将示指指尖单独抬离桌面;（2）在第3～5指呈握拳位时,能否将示指伸直至与手背同一平面,完成指示的动作;（3）能否完成“兰花指”的动作;（4）示指能否自如地使用鼠标,并完成连续双击左键的动作。另外,对5具成年男性尸体的前臂标本进行解剖学研究,重点测量了指总伸肌腱中示指和中指伸肌腱腱性起点的位置。结果术后所有患者都能使用患手较为顺利地完成日常生活和工作中的常用动作,年轻患者中除1例外,均恢复了原工作。12例中有11例主观评价手术疗效满意,1例表示对疗效不满意。其中有8例能完成全部4项拇指功能评价的动作,有3例可以完成拇指功能评价动作的3项,1例仅能完成拇指功能评价动作中的2项。12例均能使用示指自如地使用鼠标,有9例能够在患手手掌向下平置于桌面时主动将示指指尖单独抬离桌面。12例均能单独伸示指,完成指示动作,但仅有7例能在第3～5指呈握拳位时将示指伸直至与手背同一平面,另5例单独伸示指时为-20＆#176;和-30＆#176;。解剖学研究发现在指总伸肌腱中,示指的肌腹比较独立,示、中指的肌腱起点位置较高。结论示指固有伸肌腱移位重建伸拇功能在适应证恰当的情况下能够获得较好的伸拇功能,对示指的功能影响非常小。指总伸肌腱中的示指伸肌肌腹独立分化较好,去除示指固有伸肌腱后仍能完成独立伸示指的功能。     

针刺手厥阴经穴对缺血再灌注损伤心肌细胞蛋白激酶C表达的影响

目的研究针刺手厥阴经穴对缺血再灌注损伤过程中心肌细胞蛋白激酶C(PKC)表达的影响,探讨PKC介导的信号转导机制在心肌缺血再灌注损伤中的作用。方法电针大鼠手厥阴经穴位20分钟后,结扎左冠状动脉前降支40分钟,心电图监测,再电针穴位20分钟,松扎,恢复灌流60分钟,摘取心脏,免疫组化方法分析细胞蛋白激酶C的表达。结果缺血再灌注模型组PKC表达的阳性率明显增高,针刺手厥阴经穴后阳性表达率明显降低(P<0.01)。结论针刺手厥阴经穴对PKC表达有明显的抑制作用,从而发挥对心肌细胞的保护作用。