Flow-through arterialized venous free thenar flaps for palmar soft tissue defects in fingers

ObjectiveTo evaluate the efficacy of venous free thenar flaps for reconstructing palmar soft tissue defects in fingers.MethodsFrom December 2018 to October 2019, 11 patients with palmar soft tissue defects in fingers were treated using venous free thenar flaps. At the final follow-up, the range of thumb radial and palmar abduction on the injured side and opposite side was calculated. The total active movement (TAM) of the injured and opposite fingers and flap sensibility recovery were also recorded.ResultsThe mean follow-up time was 13.4 months, all flaps survived, and all wounds at the donor sites healed with no skin necrosis. At the last follow-up, the average range of thumb radial abduction and thumb palmar abduction on the injured side was 96.6% and 95.9% of the value on the opposite side, respectively. The average TAM of the injured fingers was 98.2% of the value of the opposite fingers. Sensation in the flaps was restored to grade S2 to S3.ConclusionVenous free thenar flaps can be alternatives for reconstructing palmar soft tissue defects in fingers.     

A novel TMEM16A splice variant lacking the dimerization domain contributes to calcium‐activated chloride secretion in human sweat gland epithelial cells

Sweating is an important physiological process to regulate body temperature in humans, and various disorders are associated with dysregulated sweat formation. Primary sweat secretion in human eccrine sweat glands involves Ca²⁺‐activated Cl^? channels (CaCC). Recently, members of the TMEM16 family were identified as CaCCs in various secretory epithelia; however, their molecular identity in sweat glands remained elusive. Here, we investigated the function of TMEM16A in sweat glands. Gene expression analysis revealed that TMEM16A is expressed in human NCL‐SG3 sweat gland cells as well as in isolated human eccrine sweat gland biopsy samples. Sweat gland cells express several previously described TMEM16A splice variants, as well as one novel splice variant, TMEM16A(acΔe3) lacking the TMEM16A‐dimerization domain. Chloride flux assays using halide‐sensitive YFP revealed that TMEM16A is functionally involved in Ca²⁺‐dependent Cl^? secretion in NCL‐SG3 cells. Recombinant expression in NCL‐SG3 cells showed that TMEM16A(acΔe3) is forming a functional CaCC, with basal and Ca²⁺‐activated Cl^? permeability distinct from canonical TMEM16A(ac). Our results suggest that various TMEM16A isoforms contribute to sweat gland‐specific Cl^? secretion providing opportunities to develop sweat gland‐specific therapeutics for treatment of sweating disorders.     

不同剂量A型肉毒毒素皮内注射治疗腋部多汗症效果观察

目的 评估不同剂量A型肉毒毒素治疗腋部多汗症的时效.方法 腋部多汗症患者86例,患者左右侧腋窝自身对照:左侧为小剂量A型肉毒毒素注射组,皮内注射生理盐水稀释的A型肉毒毒素50U;右侧为大剂量A型肉毒毒素注射组,皮内注射生理盐水稀释的A型肉毒毒素200U;随访3～29个月,观察两组并发症,并建立两组等级资料,行x2检验,评价患者两侧腋窝维持疗效的时间差异.结果 两组疗效进行对比,大剂量与小剂量的A型肉毒毒素的疗效维持时间的差异有统计学意义(P＜0.05).结论 大剂量A型肉毒毒素能够显著延长腋部多汗症疗效时间.     

不同节段胸交感神经干切断术治疗手汗症疗效及术后代偿性多汗的比较（附1040例报告）

目的：比较胸腔镜下不同节段胸交感神经干切断术治疗手汗症的疗效和术后代偿性多汗的差异。方法本院自1995年7月至2011年12月,收治的原发性手汗症患者共1040例。依据切断胸交感神经节段的不同分为两组比较分析。A组（不保留T2神经节段）503例, B组（保留T2神经节段）537例。对上述两组病例进行随访观察,评定与比较两组之间的疗效以及代偿性多汗的发生情况。结果1040例患者随访到834例,随访率80.2%。到访两组手术成功率均为100%,术中、术后无严重并发症发生,术后12个月内两组代偿性多汗总体发生率37.8%（315/834）。两组代偿性多汗和重度代偿性多汗发生率的差异均有统计学意义（P＜0.01或＜0.05）。结论与经典的A组（不保留T2神经节段）胸交感神经干切断术相比,B组（保留T2神经节段）T3或T4胸交感神经干＋旁路切断术式疗效确切,且能明显减少代偿性多汗的发生率,是一种较为合理的术式。     

Aluminium salt-based antiperspirant coated prosthesis liners do not suppress local sweating during moderate intensity exercise in hot and temperate conditions

ObjectiveTo determine whether coating prosthesis liners with a 5% aluminium zirconium tetrachlorohydrate antiperspirant solution (AZCH) reduces local sweating on the thigh.DesignDouble-blinded counter-balanced crossover designMethodsFourteen able-bodied participants (age: 28 ± 5 y; body mass: 73.9 ± 7.9 kg, height: 1.73 ± 0.09 m; peak oxygen consumption [VO_2peak]: 50.7 ± 9.1 mlO₂⋅ kg⁻¹⋅ min⁻¹) simultaneously wore a prosthesis liner on each leg, one treated with AZCH and one untreated, for four days prior to running at 50% of VO_2peak for 60 min in a temperate (23.7 ± 0.7 °C and 42.2 ± 2.6% relative humidity) or hot (34.0 ± 1.6 °C and 40.8 ± 6.1% relative humidity) environment. Rectal temperature (T_re) and whole-body sweat rates (WBSR) were measured to characterize thermal strain. Local sweat rate (LSR) was measured bilaterally underneath the liners, continuously, and heat-activated-sweat gland density (HASGD) was measured bilaterally every 15 min.ResultsIn temperate condition, the mean change in T_re was 1.2±0.4 °C and WBSR was 723 ± 129 g⋅ h⁻¹, whereas in the hot condition, change in T_re was 1.2±0.5 °C and WBSR was 911 ± 231 g⋅ h⁻¹. In the temperate condition, AZCH treatment did not alter LSR (treated: 0.50±0.17 mg·cm^–2 min^–1, untreated: 0.50±0.17 mg·cm^–2 min^–1; P = 0.87) or HASGD (treated: 54±14 glands·cm^–2, untreated 55±14 glands·cm^–2; P = 0.38). In the hot condition, AZCH treatment paradoxically increased LSR (treated: 0.88 ± 0.38 mg·cm^–2 min^–1, untreated: 0.74 ± 0.28 mg·cm^–2 min^–1; P = 0.04) but not HASGD (treated: 52 ± 17 glands·cm^–2, untreated: 48 ± 19 glands·cm^–2; P = 0.77).ConclusionThese results indicate coating prosthesis liners with 5% AZCH is ineffective at reducing local sweating.     

Brachial plexus injury after microwave-based treatment for axillary hyperhidrosis and osmidrosis

Axillary hyperhidrosis combined with osmidrosis is a common problem, especially in Asian communities, that patients find annoying. Even though several surgical techniques have been reported to treat hyperhidrosis/osmidrosis permanently, patients would prefer a non-surgical approach. A microwave-based device was invented during this decade, and it has proven to be a safe and efficient way to treat axillary hyperhidrosis/osmidrosis without major complications. Mild complications reported are vacuum-associated marks, oedema, tenderness and temporary altered skin sensation. We herein report a rare case of brachial plexus injury with sensory and motor dysfunction that occurred after microwave-based treatment. The patient did not fully recover after 6 months of rehabilitation. Our case suggests that a lower initial energy level should be used for thin patients with less fat tissue on the underarm areas, regardless of the patient’s sex.