Repair, protection and regeneration of peripheral nerve injury

Reading guide 1778Repair of long-segment peripheral nerve defects1779Bionic reconstruction of hand function after adult brachial plexus root avulsion1780Optimized design of regeneration material for the treatment of peripheral nerve injury1781Synergism of electroactive polymeric materials and electrical stimulation promotes peripheral nerve repair1783Schwann cell effect on peripheral nerve repair and regeneration .

Reversed vascularized second metatarsal flap for reconstruction of Manske type ⅢB and Ⅳ thumb hypoplasia with reduced donor site morbidity

Background:The predominant method for Manske type ⅢB and Ⅳ thumb hypoplasia is pollicization.However,for those who are not willing to sacrifice the index finger,a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable.This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative.Methods:From May 2014 to January 2017,15 patients with Manske type ⅢB or Ⅳ thumb hypoplasia who were admitted to the Department of Hand Surgery,Beijing Jishuitan Hospital were included in this study.An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint.The donor site was reconstructed by a split half of the third metatarsal.Various functional reconstructions were commenced at second stage.The reconstructed thumbs were evaluated using the Kapandji score,pinch force,and the capacities of performing daily activities through a detailed questionnaire.Results:Among these 15 patients(seven type ⅢB and eight type Ⅳ),there were ten boys and five girls with median age of 4.2 years(range:2.0–7.0 years).There were seven right,three left,and five bilateral thumbs for whom only the right thumb received surgery.There were 14 metatarsal flaps survived(14/15).With an average follow-up of 19.2 months,the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function.All 15 children have improved the Kapandji score(from 0 to an average of 6.7),pinch force(from 0 to an average of 1.5 kg),with ability of grip and pen holding.X-ray indicated continuous bone growth.Patients and parents had good acceptance of the new thumb.Conclusions:Reconstruction of an unstable hypoplastic thumb(Manske type ⅢB and Ⅳ)with use of a vascularized metatarsal is an effective strategy.It offers an alternative solution for parents insisting on saving the thumb.

Contralateral C7 Nerve Root Transfer for Function Recovery in Adults： A Meta-analysis

Background：Root avulsion to all 5 roots of the brachial plexus is a common presentation and keeps a major reconstructive challenge.The contralateral C7 （CC7） nerve transfer has been used in treating brachial plexus avulsion injury （BPAI） since 1986.However,the effectiveness of the procedure remains a subject of controversy.The aim of this meta-analysis was to study surgical outcomes regarding motor and sensory recovery after CC7 nerve transfer.Methods：Chinese or English （i.e.,＂contralateral c-7＂,＂contralateral c7＂,＂c7 nerve root＂,and ＂seventh cervical nerve root＂） keywords were used for a literature search for articles related to CC7 nerve transfer in several databases （i.e.,PubMed,Cochrane,Embase,CNKI,CQVIP,and Wanfang Data）.Clinical research articles were screened,and animal studies as well as duplicate publications were excluded.Muscle strength and sensory recovery were considered to be effective only when the scores on the United Kingdom Medical Research Council scale were equal to or higher than M3 and S3,respectively.Results：The overall ipsilateral recipient nerve recovery rates were as follows：the efficiency rate for muscle strength recovery after CC7 nerve transfer was 0.57 （95% confidence interval [CI]：0.48-0.66） and for sensory recovery was 0.52 （95% CI：0.46-0.58）.When the recipient nerve was the median nerve,the efficiency rate for muscle strength recovery was 0.50 （95% CI：0.39-0.61） and for sensory was 0.56 （95% CI：0.50-0.63）.When the recipient nerve was the musculocutaneous nerve and the radial nerve,the efficiency rate for muscle strength recovery was 0.74 （95% CI：0.65-0.82） and 0.50 （95% CI：0.31-0.70）,respectively.Conclusions：Transfer of CC7 nerves to musculocutaneous nerves leads to the best results.CC7 is a reliable donor nerve,which can be safely used for upper limb function reconstruction,especially for entirely BPAI.When modifying procedures,musculocutaneous nerves and median nerve can be combined as recipient nerves.

Anatomical and clinical study of a new mallet fracture classification method

Background:Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a fragment.This study was performed to evaluate the anatomical characteristics of mallet fractures,invest电ate a new mallet fracture classification system using anatomical and imaging methods,and discuss the treatment schemes for different types of mallet fracture.Methods:Sixty-four fresh cadaveric fingers were divided into four groups,and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%,50%,75%,and 100% of the bilateral collateral ligaments.The the stability of the distal interphalangeal joint was them observed.The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture,the thickness of fracture,the untreated time after injury,and the complication of distal interphalangeal joint palmar subluxation.Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion,the Ishiguro method,or single Kirschner wire fixation.Results:The established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral effect of mallet fractures on was then observed.The lateral radiographs of mallet ligaments were cut off by 25%(t=-0.415,P=0.684)and significantly unstable when this range was≥50%(50% transection:t=-6.363,P<0.001;75% transection:t=-17.036,P<0.001;100%transection:t=-30.977,P<0.001,respectively).The mallet fractures were divided into Types Ⅰ,Ⅱ,and Ⅲ(fracture involving<20%,20%-50%,and>50% of the joint surface,respectively).Type Ⅱ was further divided into Tpes Ⅱa and Ⅱb according to whether the course of injury was<or≥2 weeks,respectively.The mean post-operative flexion of the distal interphalangeal joint was 63.4°±7.9°,and the mean extension lag was 6.7°±4.6°.Conclusions:The lateral collateral ligament is the main factor that maintains the stability of the distal interphalangeal joint.Type Ⅱ was further divided into Types Ⅱa and Ⅱb according to whether the course Classification that combines the involvement of the joint surface in the fracture,the thickness of the fracture,and the untreated time after injury is reasonable and will help to choose an appropriate operational method.