The Effect of Modified Postoperative Treatment on Finger Replantation Survival Rate

Objective:To explore the clinical effect of modified treatment after finger replantation and its impact on the survival rate of replantation.Methods:The research was conducted from March 2022 to March 2023.A total of 58 patients who underwent finger replantation at our hospital were selected.These patients were divided into two groups using the digital table grouping method:the research group(n=29)and the control group(n=29).Patients in the control group received standard treatment following finger replantation,while patients in the study group received modified treatment after the procedure.The incidence of vascular crisis and the survival rate of replantation were compared between the two groups.Results:The incidence of vascular crisis in the study group was lower than that in the control group(P<0.05);the replantation survival rate in the study group was higher than that in the control group(P<0.05).Conclusion:Modified treatment after replantation of severed fingers can reduce the incidence of vascular crisis replantation and improve the survival rate of replantation,so it should be popularized and applied in medical institutions.

Inactivated Bone Replantation with Preservation of the Epiphysis in Children with Osteosarcoma:Clinical Report of Two Cases

Objective: To evaluate the value of inactivated bone replantation with preservation of the epiphysis following the effective chemotherapy in avoiding postoperative discrepancy of the affected limb in children with osteosarcoma. Methods: Two children (aged 5 and 10 years, 1 male and 1 female) with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy (MMIA protocol, including high-dose methotrexate, adriamycin and ifosfamide). After two cycles of preop-erative chemotherapy, pain vanished, the local mass shrank and there was no pain on pressing the affected parts. Sera AKP and LDH were reduced to normal levels; marked shrinkage and sclerotic changes and good margin of lesions were seen on plain radiographs and MR images. Two courses of the same protocol as preoperative chemotherapy were administered postoperatively. Results: Postoperative histological examination of the specimens demonstrated absence of vital tumor cells. Incisions healed well and no complications occurred. The replanted inactivated bone healed with host at 6 months after operation. In the two patients, no evidence was seen of metastasis and recurrence and discrepancy of the affected limbs in postoperative 36 and 48 months. Functions of the affected limbs were satisfactory. Conclusion: Inactivated bone replantation with preserving epiphysis was a viable option for osteosarcoma in children. The long-term outcomes remain to be further proven.

Evaluation of sensory function and recovery after replantation of fingertips at ZoneⅠin children

Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function af- ter replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July 2014 to January 2016. Variations in the extent of damage, with the residual vessels or nerves in some fingers being too short or even missing, prevented tension-free suture repair in some patients. Thus, re- pair of four of the nine fingertips included arteriovenous anastomosis, the remaining five undergoing arterial anastomosis during replanta- tion of the amputated fingers. Three patients underwent nerve repair, whereas the remaining six cases did not. Fingertip replantations were successful in all eight patients. Compared with the patients without vascular anastomosis, no obvious atrophy was visible in the fingertips of patients who did undergo vascular anastomosis during replantation and their sensory function did recover. Fingertip replantation pro- vides good sensory function and cosmetic outcomes when good artery and vein anastomoses have been created, even when digital nerves have not been repaired.

Intentional replantation combined root resection therapy for the treatment of typeⅢradicular groove with two roots:A case report

BACKGROUND A radicular groove is an anatomic malformation that usually initiates at the central fossa,extending along the root at varying lengths and depths and predisposes the involved tooth to a severe periodontal defect.Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions.They are a serious challenge for doctors to diagnose and treat.CASE SUMMARY In this report,we described a patient with a maxillary lateral incisor with a deep palatogingival groove with two roots,which led to complex combined periodontal-endodontic lesions.Suggested treatment modalities included curettage of the affected tissues,elimination of the groove by grinding and/or sealing with a variety of filling materials,and surgical procedures.In this case,a combination of endodontic therapy,intentional replantation,and root resection were used,which resulted in periodontal/periradicular healing after 12 mo.CONCLUSION Intentional replantation and root resection offer a predictable procedure and should be considered a viable treatment modality for the management of palatogingival grooves,especially for two-rooted teeth.

Supermicroscopy and arterio-venolization for digit replantation in young children after traumatic amputation: Two case reports

BACKGROUND To report the application of supermicroscopy combined with arterio-venolization without venous anastomosis for replantation of digits following traumatic amputation in young children.CASE SUMMARY In March 2016,we treated two children aged 2 years and 7 years with traumatic digit amputation,no venous anastomosis,and bilateral digital inherent arteries on the palmar side.Supermicroscopy combined with an arteriovenous technique was adopted to improve the replantation surgery.Postoperative management involved auxiliary treatments such as anticoagulation,composure,antiinflammatory drugs,and insulation.After treatment,the amputated fingers survived completely without major complications,with good recovery.CONCLUSION Supermicroscopy combined with arterio-venolization is a safe and effective approach to treat traumatic digit amputation in young children without venous anastomosis.

Management of type IIIb dens invaginatus using a combination of root canal treatment,intentional replantation,and surgical therapy:A case report

BACKGROUND TypeⅢb dens invaginatus(DI)with a lateral canal located at the mid-third of the root is rarely reported.Here,we report a rare case of typeⅢb DI in the left upper anterior tooth with a lateral canal that led to persistent periodontitis.CASE SUMMARY A 15-year-old female patient presented with a chief complaint of pain associated with recurrent labial swelling in the area of the left anterior tooth.A diagnosis of typeⅢb DI and chronic periodontitis was made.Intentional replantation was performed after conventional endodontic treatment failed.After 6 mo,the patient was asymptomatic,but a sinus tract was observed.Cone-beam computed tomography images showed bone loss in the mesial of the mid-root.Based on methylene blue staining and microscopy images,the lateral foramen located at the middle third of the root was surgically treated.After 3 years of follow-up,the clinical findings and radiographic assessment presented a favorable prognosis of bone healing without root absorption or ankylosis.CONCLUSION TypeⅢb DI with a lateral canal can be successfully treated by root canal treatment,intentional replantation,and surgical therapy.

Clinical Investigation and Experience with Distal phalanx Replantation

Objective： To explore the measures and methods for improving distal phalanx replantation. Methods： One hundred and forty-eight cases with distal phalanx replantation from Sep 2004 to Sep 2007 were investigated. The indication for surgery and the operative program was determined by the trauma type and the degree of injury. As many microcirculation pathways as possible were reconstructed during the operation, and postoperative tissue decompression was also performed. Results： The survival rate of distal phalanx replantation was 89.9% （169/148）. Conclusion： To improve the survival rate of distal phalanx replantation it is essential to reconstruct an effective local blood circulation, determine the degree of injury in cases with ecchymosis, and employ comprehensive postoperative measures.

Mechanism of the inhibition of neuroma formation by autogenous nerve replantation in situ after amputation in rabbits

Two experimental patterns of autogenous nerve replantation in situ and centrocentralnerve suture were performed on the rabbit median and ulnar nerves.The results of light andtransmission electron microscopy as well as immunohistochemistry showed that autogenous nervereplantation in situ could inhibit the formation of neuroma.The mechanism might be that twoproximal stump axons could touch within the interpolated graft segment.Simple end-to-endnerve suture failed to inhibit neuroma development because of a lack of proper environment forthe touching between two proximal stump axons.

Two-stage transcrestal sinus floor elevation-insight into replantation: Six case reports

BACKGROUND Transcrestal sinus floor elevation(TSFE)has been widely used in the oral clinic when the residual bone height(RBH)exceeds 5 mm.However,when there is insufficient RBH in the posterior maxilla,two-stage TSFE may be an option.CASE SUMMARY This article introduces the concept of two-stage TSFE.Six patients had osseointegration failure after TSFE.For the first-stage surgery,we restricted the vertical bone augmentation as much as possible.At the second-stage surgery,the increased RBH was 3.28±1.55 mm,which was beneficial for surgery.Five implants functioned successfully on schedule,but one implant failed again during the healing period.A third surgery was performed,and the implant functioned successfully.CONCLUSION When RBH was less than 5 mm,two or more procedures of TSFE might result in a higher RBH.

Using the parietal branch of superficial temporal vessels:A good approach to total ear replantation

Although ear reconstruction is a mature procedure,emergency microsurgical replantation has still been regarded as the optimal treatment for ear amputation due to its cost-effectiveness and aesthetically pleasing results.Successful microsurgical ear replantation is rare because of the difficulty in identifying suitable vessels for anastomosis.We describe two cases of total ear microsurgical replants using the parietal branch of the superficial temporal vessels(STV)as the recipient vessels.The STV parietal branch was dissected up to a sufficient length after thorough debridement,and the amputated ears were revascularized using end-to-end anastomosis.Our experience shows that the parietal branch of the STV is an ideal recipient vessel option for total ear replantation.

Replantation of the amputated complex mass of fingers.

Objective To study the replantation methods of the amputated complex tissue mass of fingers. Methods Nine cases were replanted using the routine method and the artery-vein bridge grafting method respectively. Results All 9 cases survived. At 1 year postoperation, the length of the replanted finger was comparable to that of the healthy side with satisfactory appearance. The average finger function increased 30% when compared with pre-operation one. Conclusion For the amputated complex tissue mass of fingers, routine replantation should be carried out if there was one or two digital proper arteries. If a defect was present, the artery-vein bridge grafting method was chosen accordingly. 5 refs,2 figs.

Analysis of the Effect of Intensive Nursing Care on Improving Sleep Quality During the Perioperative Period of Severed Finger Reimplantation

Objective:To investigate the clinical effect of perioperative intensive nursing on patients who underwent severed finger reimplantation and its influence on sleep quality.Methods:62 patients who underwent severed finger reimplantation between January 2023 and December 2023 were included.They were divided into two groups:the observation group(n=31)and the control group(n=31).The control group received basic nursing interventions,while the observation group received intensive nursing care.The comparison parameters included visual analog pain score(VAS),incidence of vascular crises,length of hospitalization,Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Score(HAM-D),Hamilton Anxiety Score(HAM-A),and patient satisfaction.Results:Postoperative VAS score,incidence of vascular crisis,hospitalization time,PSQI score,and HAM-A and HAM-D scores of the observation group were lower than those of the control group(P<0.05).Meanwhile,the patient satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Perioperative intensive nursing care for patients undergoing severed finger reimplantation demonstrates significant benefits.It reduces postoperative pain,lowers the incidence of vascular crises,shortens hospitalization durations,enhances sleep quality,alleviates negative emotions,and improves nursing satisfaction.These findings underscore the importance and applicability of such care practices.

Rand reconstruction using heterotopic replantation of amputated index and little fingers

In cases of severe segmental injury across the hand and wrist, but one or other fingers are still in peak condition, the fingers can be selected for replantation at the forearm bones to restore pinch function. Here we reported an unusual case with a severe crush-avulsion amputated injury to the right hand caused by a machine accident. We conducted hand reconstruction using heterotopic replantation of the amputated index and little fingers.During 19 months follow-up, the bone union healed well with satisfactory outcome. The interphalangeal and metacarpophalangeal joint of the fingers after the heterotopic replantation had a good holding activity. This is a worthwhile procedure and the patient is satisfied with the result. The major disadvantage of this method is the poor appearance of the reconstructed fingers.

Efficacy evaluation for the treatment of unstable lumbar disc herniation by traditional and modified lamina osteotomy replantation

Background The traditional lamina osteotomy replantation method is prone to nerve root injury and low back pain recurrence. Our team has proposed a modified approach that improves the osteotomy site and its fixation procedure. The aim of this study was to evaluate the clinical efficacy of traditional and modified lamina replantation methods in treating unstable lumbar disc herniation. Methods From March 2008 to August 2011, 124 patients with unstable lumbar disc herniation were enrolled and randomly divided into the following two groups according to random digital table： group A （traditional group） consisting of 61 patients who underwent traditional laminectomy replantation, and group B （modified group） consisting of 63 patients who underwent modified lamina replantation. Both surgeries were performed by the same surgeons. The two groups had no significant difference in gender, age, symptoms, time of onset and the prominent segment. Visual analogue scale （VAS）, Oswertry disability index （ODI）, and Japanese Orthopaedic Association （JOA） scores, operative time, blood loss, complication rate, radiographic healing rates, and low back pain recurrence rates were compared between the two groups. Results There were 121 patients followed up for more than one year, and the follow-up rate was 97.6%. Nerve injury occurred in two patients （3.3%） in the modified group and 12 patients （20.0%） in the traditional group. Dural injury occurred in one patient （1.6%） in the modified group and seven patients （11.7%） in the traditional group. Pseudarthrosis occurred in two patients in the modified group and in 18 patients in the traditional group with 1-year fusion rates of 96.7% and 70.0%, respectively. Recurrence of lower back pain after one year was noted in three patients （4.9%） in the modified group, and in 15 （25.0%） in the traditional group. Leg pain recurrence was noted in one patient （1.6%） in the modified group and in three cases （5.0%） in the traditional group. The one-year healing rates of nerve injury, dural injury, replantation lamina and low back pain recurrence rates after one year were significantly different （P〈0.05） between the two groups. At two weeks, three months, six months and one year postoperatively, both groups had significant improvement in VAS, ODI, and JOA scores from their preoperative values （P〈0.05）. No significant difference was detected between the short term postoperative scores between groups A and B （P〉0.05）. However, a significant difference was found one year later （P〈0.05）. Conclusions Compared to the traditional approach, the modified technique for lamina replantation showed lower rates of dural and nerve damage, a higher lamina healing rate, a lower back pain recurrence rate, and better clinical scores. It is a safe and effective operation for lumbar spine surgery.

Use of digital subtraction angiography for assessment of digital replantation

Objective: To assess the blood flow of the proper digital artery using digital subtraction angiography (DSA) in the early stage after replantation. Methods: From January 2006 to October 2010, 27 anastomosed arteries in 27 replanted digits were included in the study. The patients included nine males and four females. The patients received DSA at 48 to 96 h after digital replantation. Based on DSA image, the blood flow was classified into normal, slow-running, and flow-stopping types. The patients with normal digital blood flow were given continuous routine treatments; the patients with slow-running flow were given the conservative treatments, such as release of the tight dressings, removal of stitches, keeping warm, the use of massage, and the use of anticoagulants and anti-inflammatory drugs; the patients with flow-stopping received immediate surgical re-exploration. Results: In this series, 23 digits in 11 patients showed a normal blood flow, and these digits all survived. In one of 13 patients, two digits which displayed slow-running flow also survived after conservative treatments. In two of 13 patients, two digits showed flow stopping, with one surviving and one failing after re-exploration and arterial revision. Conclusions: The DSA can be used to assess the blood flow of the proper digital artery in the early stage after replantation. It provides essential information for salvaging the replanted finger.

Penile replantation： report of two cases and review of the literature

Penile amputation and successful replantation is very uncommon, and there is no routine standardized procedures for dealing with this medical condition. Here we report two cases of penile amputation and replantation involving different degrees of vascular insult leading to different pathogenesis, clinical presentation, surgical approach and prognosis. This report described the microsurgical procedure and postoperative care using bipedicled scrotal flap to achieve successful engraftment and function. A review of the published data and future methods to increase success of such surgical procedures is provided.

A case of functional rehabilitation after replantation of a severed limb

A patient with functional impairment after replantation of severed limb was treated by electroacupuncture in combination with rehabilitation training, and needling was carried out on Quchi （曲池 LI 11）, Shousanli （手三里 LI 10）, Waiguan （外关 TE 5）, Yangxi （阳溪 LI 5）, Yangchi （阳池 TE 4）, Yanggu （阳谷 SI 5）, Hegu （合谷 LI 4）, Baxie （八邪 EX-UE 9）, wailaogong （外劳宫 EX-UE 8） and Yemen （液门 TE 2）. Electroacupuncture was carried out on TE 5, EX-UE 8, LI 12 and LI 4. After treatments for four months, except the opposition of thumb was not satisfactory, the active exercises of the remaining four fingers almost recovered.

Transient bone resorption following finger replantation： a report of 3 cases

Radiographic changes consisting of al- terations in mineral content, osteopaenia or destructive neuropathy that occur following successful finger replantation have already been described. We report our experience about four fingers in three individuals in whom bone changes developed in the first three months postoperatively with complete ＂restitution ad integrum＂. Three patients, 21-49 years old （average 36 years） sustained a clean-cut amputation of four fingers. The first patient had an amputation at the base of the middle phalanx of the index finger and the second patient at the base of the proximal phalanx of the ring finger. The third had an amputation at the base of the first metacarpal bone and the proxi- mal phalanx of the small finger in a five finger amputation. In the first case, two dorsal veins and two palmar digital arteries and nerves were repaired. In the second case, one pal- mar artery and one dorsal vein were reanastomosed. In the third case at the thumb, two dorsal veins and two palmar digital arteries and nerves were reconstructed. At the small finger, one dorsal vein, one palmar digital artery and twodigital nerves were reconstructed. Bone fixation was achieved with two and three K-wires or tension-band wiring. Replantation was successful in all cases. Three weeks after replantation, the X-rays showed rapid development of osteopaenia in the juxtaarticular region and metaphyses of the bone. These changes were followed by subperiosteal, intracortical and endosteal bone resorption. No further surgical procedures or splintage were needed and hand therapy was not discontinued. At 10-13 weeks （average 12 weeks） postoperatively, the X-rays showed a complete recovery with new periosteal bone formation. We suggest that the radiographic changes after finger replantation are transient, first evident subperiosteally and progressing centrally. They may reflect small-vessel compromise and microinfarction and transient hyperemia secondary to neurovascular damage or to sympathetic progressive recovery.

Silencing of early auxin responsive genes MdGH3-2/12 reduces the resistance to Fusarium solani in apple

Apple replant disease(ARD)has led to severe yield and quality reduction in the apple industry.Fusarium solani(F.solani)has been identified as one of the main microbial pathogens responsible for ARD.Auxin(indole-3-acetic acid,IAA),an endogenous hormone in plants,is involved in almost all plant growth and development processes and plays a role in plant immunity against pathogens.Gretchen Hagen3(GH3)is one of the early/primary auxin response genes.The aim of this study was to evaluate the function of MdGH3-2 and MdGH3-12 in the defense response of F.solani by treating MdGH3-2/12 RNAi plants with F.solani.The results show that under F.solani infection,RNAi of MdGH3-2/12 inhibited plant biomass accumulation and exacerbated root damage.After inoculation with F.solani,MdGH3-2/12 RNAi inhibited the biosynthesis of acid-amido synthetase.This led to the inhibition of free IAA combining with amino acids,resulting in excessive free IAA accumulation.This excessive free IAA altered plant tissue structure,accelerated fungal hyphal invasion,reduced the activity of antioxidant enzymes(SOD,POD and CAT),increased the reactive oxygen species(ROS)level,and reduced total chlorophyll content and photosynthetic ability,while regulating the expression of PR-related genes including PR1,PR4,PR5 and PR8.It also changed the contents of plant hormones and amino acids,and ultimately reduced the resistance to F.solani.In conclusion,these results demonstrate that MdGH3-2 and MdGH3-12 play an important role in apple tolerance to F.solani and ARD.

Biochar alleviates apple replant disease by reducing the growth of Fusarium oxysporum and regulating microbial communities

Apple replant disease(ARD)negatively affects plant growth and reduces yields in replanted orchards.In this study,biochar was applied to apple replant soil with Fusarium oxysporum.Our aim was to investigate whether biochar could promote plant growth and alleviate apple replant disease by reducing the growth of harmful soil microorganisms,changing soil microbial community structure and improving the soil environment.This experiment included five treatments:apple replant soil(CK),methyl bromide fumigation apple replant soil(FM),replant soil with biochar addition(2%),replant soil with F.oxysporum spore solution(8×10^(7)spores·mL^(-1)),and replant soil with biochar and F.oxysporum spore solution addition.Seedling biomass,the activity of antioxidant enzymes in the leaves and roots,and soil environmental variables were measured.Microbial community composition and community structure were analyzed using 16SrDNA and ITS2 gene sequencing.Biochar significantly reduced the abundance of F.oxysporum and increased soil microbial diversity and richness.Biochar also increased the soil enzyme activities(urease,invertase,neutral phosphatase,and catalase),the biomass(plant height,fresh weight,dry weight)and the activity of antioxidant enzymes(superoxide dismutase,peroxidase,and catalase).The root indexes of apple seedlings was also increased in replant soil by biochar.In sum,biochar promoted the growth of plants,improved the replant soil environment,and alleviated apple replant disease.