Brachioradialis tendon transfer and palmaris longus tendon graft for thumb avulsion:A case report and review of literature

BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.

Surgeon preferences in the treatment of thumb carpometacarpal osteoarthritis

BACKGROUND Primary thumb carpometacarpal(CMC)osteoarthritis is one of the most common conditions encountered by hand surgeons.Of the vast number of operations that have been proposed,none have demonstrated results significantly superior to trapeziectomy alone.AIM The purpose of our study was to determine why surgeons opt for their technique in treating CMC arthritis.METHODS A cross-sectional survey of active members of the American Society for Surgery of the Hand was conducted to evaluate the reasons behind their preferred technique in the treatment of isolated thumb CMC arthritis.Surgeons were contacted by email once and provided with a link to a de-identified survey consisting of 5 treatment questions and 5 demographic questions.RESULTS Of 950 responses were received.40.5%of surgeons preferred trapeziectomy+ligament reconstruction tendon interposition(LRTI),followed by trapeziectomy+suspensionplasty(28.2%),suture button suspension(5.9%),trapeziectomy alone(4.6%),prosthetic arthroplasty(3.2%),arthrodesis(1.1%),and other(6.6%).Proponents of trapeziectomy+LRTI cited familiarity(73.2%),exposure during fellowship(48.8%)and less proximal migration(60%)to be the main reasons affecting their decision.Surgeons who preferred trapeziectomy+suspensionplasty most reported simplicity(74.9%),fewer complications(45.3%),less proximal migration(43.8%),and avoidance of autogenous tissue harvest(42.7%).Advocates of suture button suspension cited avoidance of autogenous tissue harvest(80.4%),shorter immobilization(76.8%),and quicker recovery(73.2%)with their technique.Advocates of trapeziectomy alone cited simplicity(97.7%),fewer complications(86.4%),and avoidance of autogenous tissue harvest(59.1%).In their comments,45%of surgeons choosing trapeziectomy alone cited evidence as an additional rationale.Advocates of prosthetic arthroplasty cited improved pinch strength(83.3%)and improved range of motion(63.3%),while those preferring arthrodesis cited better pinch strength(90%)and frequently in their comments,durability.Of the surgeons who preferred a technique other than LRTI,41.8%reported they had tried LRTI in the past,citing complexity of the procedure,flexor carpi radialis harvest,and longer operative time as reasons for moving on.CONCLUSION Our study provides an update on current treatment trends and offers new insight into the reasons behind surgeons'decision making in the management of thumb carpometacarpal osteoarthritis.Despite strong Level 1 evidence supporting the use of trapeziectomy alone,our findings demonstrate that most surgeons continue to supplement trapeziectomy with other techniques such as LRTI or suspensionplasty.Several factors including familiarity,personal experience(Level 4 evidence),and comfort may be more influential than Level 1 evidence in determining the techniques in a surgeon's armamentarium.Further prospective studies are needed to determine the optimal technique for surgical management of Eaton stages II-IV CMC arthritis and how these studies will affect surgeons’choice.

Multi-Segmental Osteocutaneous Free Fibula Flap for Three-Dimensional Post-Traumatic Thumb and Wrist Reconstruction

Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.

Clinical Observation of Self-made Four-step Tendon Regulating Manipulation in the Treatment of 30 Cases of Thumb Stenotic Tenosynovitis

[Objectives] To observe the effectiveness of four-step tendon manipulation in the treatment of thumb stenotic tenosynovitis, under the guidance of "tendon first" theory. [Methods] 30 patients with stenotic tenosynovitis of thumb were treated with four-step tendon manipulation and traditional manipulation respectively, 3 times a week, a total of two weeks. The clinical efficacy, changes of visual analogue scale (VAS) and the recurrence rate after 15 d of follow-up treatment were observed before and after treatment. The differences were statistically significant ( P <0.05). [Results] After treatment, the VAS and the recurrence rate after 15 d of treatment in the observation group were significantly lower than those in the control group ( P <0.05). After treatment, the total effective rate was 73.33% in the control group and 93.33% in the observation group ( P <0.05). [Conclusions] The effect of four-step tendon regulating manipulation in the treatment of thumb stenotic tenosynovitis is ideal. The effect is significantly better than that of traditional Chinese medicine in improving thumb pain and function, which is worthy of clinical promotion.

Prevalence of Thumb Sucking Habits amongst Children at the Knust Basic School

Main Objective: To determine the prevalence of thumb sucking habits amongst children at the KNUST Basic School. Methodology: This study was quantitative and descriptive with the design being a cross-sectional type. The data was obtained from KNUST Basic School with a sample size of 200. Data was obtained through questionnaires and clinical examination. Results: Out of the 200 children studied, 19 (9.5%) were identified as thumb suckers, with a majority being females (13, 68.42%) and the rest being males (6, 31.58%). Most of the thumb suckers (47.37%) engaged in the habit due to hunger. The clinical manifestations observed among the thumb suckers included Class I malocclusion (94.7%), high arched palate (89.5%), anterior open bite (4), increased overjet (3, 15.8%), proclined maxillary incisors (4, 22.2%), linguoversion of mandibular incisors (1, 5.6%), unilateral posterior crossbite (2, 10.5%), speech changes (7, 41.2%), thinner thumb (7, 36.8%), elongated thumb (9, 47.4%), and callus formation on the thumb (2, 10.5%). Conclusion: Thumb sucking is a common oral habit which stimulates the growth of the orofacial complex from ages 0 to 3 years. The habit of thumb sucking is usually outgrown by age 3 but beyond this age, it turns out as a deleterious habit which has to be seen as such and measures put in place to stop thumb sucking.

基于Thumbs.db文件的数据恢复技术研究与开发

应用软件层的数据恢复,是对某些特殊的文件做分析,解读文件内蕴含的重要信息,恢复出被犯罪嫌疑人删除的作案痕迹、证据等。针对应用软件层的数据恢复研究,以研究Thumbs.db文件格式为例,研究出了怎样在应用软件层,恢复已删除图片的缩略图。并开发出Thumbs.db文件分析软件,通过分析隐藏的系统文件Thumbs.db,可以浏览并保存该文件中记录的包括已删除图片在内的所有图片的缩略图信息。

遗传算法和关键事件禁忌搜索相融合的ARM/Thumb处理器指令选择

面向嵌入式系统的编译器,往往需要同时考虑目标代码的性能、大小和功耗等相互冲突的目标.ARM双指令集处理器,在具备通常的32位ARM指令集基础上,还支持一个缩减的16位Thumb指令集,因而为代码优化提供了多个目标之间折衷的机会.由于同一个程序的Thumb代码比相应的ARM代码执行更多的指令,因此虽然前者常比后者占用更少的存储空间,但消耗更多的运行时间.针对这种现象,文中建议一个混合演化算法,通过把程序的不同部分有选择地编译成ARM或Thumb指令集代码,使得可灵活地权衡目标代码大小和运行时间.文中的方法基于遗传算法和关键事件禁忌搜索相融合,后者用来局部搜索.指令选择以函数为单位,从对程序动态行为的profiling分析求得程序运行时间.实验结果表明,文中的技术可有效地、灵活地权衡目标代码大小和性能,并且适用于其它的双指令集处理器.

ARM处理器中ARM和Thumb状态的切换

主要介绍了在ARM处理器中,ARM/Thumb状态切换的原因和方法。在基于ARM处理器的嵌入式开发中,为了增强系统的灵活性以及提高系统的整体性能经常需要使用16位的Thumb指令,所以需要在ARM和Thumb状态之间来切换(Interworking)微处理器状态,这部分内容也是实际项目设计中需要重点考虑的内容。

缙云山不同生境蝴蝶花(Iris japonica Thumb.)分株种群格局及对草本多样性的影响

运用空间格局、生态位及多样性分析,探讨了重庆缙云山自然保护区林缘旷地(OAFE)、竹林(BF)及常绿阔叶林(EBF)3类生境蝴蝶花(Iris japonicaThumb.)自然种群分株格局特征及对草本多样性的影响机制。结果表明:方差均值比(V/m)和Moristia指数(Iδ)的格局判别分析表明,3类生境中蝴蝶花分株种群从0.5m×0.5m至2m×2m尺度均为聚集分布;从林缘旷地-竹林-常绿阔叶林,种群分株密度逐渐降低,总体格局规模与格局强度(PI)在各尺度均呈下降趋势。林缘旷地与竹林生境中,蝴蝶花的分布,降低了原优势种的优势度,并显著降低草本层物种多样性(p<0.05),但在常绿阔叶林生境中对原优势种的优势度及草本物种多样性的影响很小。不同生境中蝴蝶花种群格局对草本多样性的影响机制各不相同:林缘旷地生境,通过强的更新生态位(地上空间与根生态位)与营养生态位(获取水分与养分资源)竞争,降低草本物种丰富度尤其是偶见种丰富度;竹林生境,通过更新生态位(根生态位)与营养生态位(获取光与养分资源)竞争,降低了草本偶见种丰富度;常绿阔叶林生境,物种间生态位重叠较低,表现一定的资源竞争,但对草本多样性影响很小。林冠决定蝴蝶花分株种群格局强度、克隆生长的强弱及林下土壤状况,从而影响蝴蝶花与草本层其它物种之间生态位竞争的强弱是决定蝴蝶花种群对草本层物种多样性影响机制的重要因素。

Molecular mechanisms of apoptosis in hepatocellular carcinoma cells induced by ethanol extracts of Solanum lyratum Thumb through the mitochondrial pathway

AIM To explore the induction effects and mechanism of Solanum lyratum Thumb(ST) on human hepatocellularcarcinoma SMMC-7721 cells through the mitochondrial pathway.METHODS The experiments were conducted on three groups: an experimental group (with ST ethanol extracts' concentration being 2.5, 5 and 10 mg/L), a negative control group (with only nutrient solution, 0 mg/L ST ethanol extracts), and a positive control group (2.5 mg/L DDP). The inhibition rate of cell proliferation was checked by using the methyl thiazolyl tetrazolium method, and cell apoptosis was tested by TUNEL method. Furthermore, RT-PCR was used to examine m RNA expression of Fas, Fas L, caspase-8, caspase-3, p53 and Bcl-2 genes.RESULTS Compared with the negative control group, the inhibition and apoptosis rates of the experimental group with different concentrations of ST extracts on human hepatocellular carcinoma SMMC-7721 cells significantly increased(P<0.05). Besides, the m RNA expression of Fas L and Bcl-2 significantly decreased(P<0.05) while the m RNA expression of Fas, caspase-8, caspase-3 and p53 increased significantly. When compared with the positive control group, the experimental groups with 5 mg/L ST ethanol extracts showed effects similar to the positive control group.CONCLUSION ST ethanol extracts induced the apoptosis of hepatocellular carcinoma SMMC-7721 cells through up-regulated Fas, caspase-8, caspse-3 and p53, and down-regulated Fas L and Bcl-2 in the mitochondrial pathway.

基于ARM内核的ARM与Thumb混合代码的生成

介绍了嵌入式系统领域中的常用RISC微处理器——ARM处理器的ARM指令集与Thumb指令集，分析了应用程序的ARM代码与Thumb代码的各自的优势与不足，研究了生成高密度、执行效率高的混合代码的方法。

Effects of Houttuynia Cordata Thumb on Expression of BMP-7 and TGF-β_1 in the Renal Tissues of Diabetic Rats

Objective： To explore the effects of Houttuynia Cordata Thumb （HCT 鱼腥草 Yu Xing Cao） on expression of transforming growth factor-β1 （TGF-β1） and bone morphogenetic protein-7 （BMP-7） in the renal tissues of diabetic rats. Methods： The diabetic rats induced by intravenous injection of streptozotocin（STZ） were randomly divided into a model group, a HCT group and a lotensin group, with normal rats designated as the controls. 8 weeks later, the ratio of kidney weight to body weight, the glomerular area, the excretion of β 2-microglobin （β2-MG） in 24-hr urine, the albumin excretion in 24-hr urine, and creatinine clearance rate （CCR） were investigated. The expression of TGF- β 1, BMP-7 and collagen I in the renal tissues was observed with the immunohistochemical method and by the semi-quantitative assay. Results： The overgrowth of glomerulus, the excretion of β 2-MG in 24-hr urine, the albumin excretion rate in 24-hr urine and CCR in the HCT group significantly reduced （P〈0.05）, and the expression of TGF-β1 and collagen I significantly decreased （P〈0.05）, but BMP-7 significantly increased （P〈0.05） in the HCT group as compared with those in the model group, with no significant difference as compared with the lotensin group （P〉0.05）. Conclusion： HCT has a protective effect on the renal tissues in diabetic rats, which is probably correlated with the decrease of the expression of TGF-β1 and collagen I and with the increase of the expression of BMP-7 in the renal tissues.

Photosynthetic Characteristics of Clerodendrum trichotomum Thumb. Responses to Drought, Salt and Water-logging Stresses

In order to reveal the photosynthetic characteristics of C. trichotomum responses to drought, salt and water-logging stresses, one-year-old potted seedlings were taken as materials, and the several stresses including natural drought, submergence stress, water-logging and different salt treatments （0.2%, 0.4%, 0.6% and 0.8% NaCl） were carried out on August 15, 2012. The morphological and photosynthetic characteristics were observed and determined. The results showed that adverse enviromental stress had a significant effect on the morphological changes and photosynthetic characteristics of C. trichotomum. On the 14th day after natural drought, the leaves wilted and could not recovery at night, and 60% of the seedlings could recover after re-watering. From the 7th day to the 10th day after submergence stress treatment, the 2nd and the 3rd leaves at the base of 60% seedling turned yellow and the lenticels were observed. At the early stage of water-logging stress, white lenticels appeared at the base of seedlings, and the leaves wilted, chlorina and fallen off on the 8th day. A large number of leaves fallen off under 0.6% NaCl or more salt stress, and even the whole plant died. The chlorophyll content, net photosynthetic rate （Pn） and transpiration rate （Tr） decreased gradually with the stress process, such as 8 days after natural drought, less than 0.4% salt stress and water-logging stress, but the changes were not significant compared with those of the control. With the increase of the stress intensity and the prolonged time, the changes of photosynthetic index were significant. All the results indicated that C. trichotomum had a certain degree of tolerance to drought, water and salt, but it was not suitable for living, in water-logging condition for a long time.

Surgical Repair of Dorsal Capsulo-Ligamentous Complex for Dislocation of the Thumb Carpometacarpal Joint

Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after surgical repair of the dorsal capsulo-ligamentous complex. Materials and methods: Eight patients with a mean age of 39.8 years (range, 23 - 56 years) treated for the thumb CMC joint were treated in our hospital between 2008 and 2018. The ruptured dorsal capsulo-ligamentous complex was repaired using suture anchors in all patients, and the joint was immobilized with a Kirschner wire pinning and splint for 3 weeks. The clinical outcome was assessed by measuring the range of motion of the thumb CMC joint and the Japanese Society for Surgery of the Hand version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH-JSSH) score. Results: The mean radial abduction of the thumb CMC joint was 66°, and the volar abduction was 63°. The mean Q-DASH-JSSH score was 4.8 (range, 0 - 15.6). There were no cases of infection, nerve disturbance, or osteoarthritis. Anatomical reduction was observed in seven patients at the final follow-up and in a rugby football player at 6 months of follow-up;however, subluxation of the thumb CMC joint at 12 months of follow-up due to reinjury was observed. Conclusion: Surgical repair of the dorsal capsulo-ligamentous complex with suture anchors is a reliable and simple treatment for acute unstable dislocation of the thumb CMC joint.

Process Optimization and Content Determination of Total Flavonoids of Zhuang Medicine Clerodendrum japonicum(Thumb.)Sweet

[Objectives]To optimize the extraction process of total flavonoids of Zhuang medicine Clerodendrum japonicum(Thumb.)Sweet and establish a method for its extraction and content determination.[Methods]The total flavonoids of C.japonicum were extracted by reflux extraction method.Through a single factor experiment,the effects of extraction method,extraction solvent concentration,extraction volume and extraction time on the total flavonoids content of medicinal materials were investigated to select the optimal extraction process of the total flavonoids of C.japonicum.[Results]The optimal extraction process of the total flavonoids of C.japonicum was 75%ethanol,1∶20 solid-to-liquid ratio,and 50 min reflux extraction time.[Conclusions]This method can effectively determine the content of total flavonoids in C.japonicum and provide a certain scientific basis for the study of the quality standard of this Zhuang medicine.This method has high reproducibility.It is stable and feasible in extraction of total flavonoids from Zhuang medicine C.japonicum.

Classification of congenital thumb hypoplasia and deformity

Background:Congenital thumb deformities account for one-third or more of all cases of congenital hand deformity.However,the current classification schemes of congenital thumb hypoplasia are no longer adequate due to their lack of adaptability to increasing knowledge in the field.Hence,a modified system with the potential to adapt to ongoing advances in knowledge and understanding is desperately needed.Methods:Based on the photographs collected from thousands of cases of congenital deformities of the hand and upper limb over multiple decades in our department,we subdivided thumb hypoplasia according to the variables of morphological characteristics,anatomical structures,functional status,the relationship between thumb deformity and hand deformity,the relationship between congenital hand deformity syndrome and thumb hypoplasia,and the selection of treatment methods.Results:A total of 10 types were presented,which were elucidated with nomenclatures as well as pathological feature and symptoms.Conclusion:This modified system may shed additional light on the classification of congenital thumb anomalies,which will assist in a more effective selection of treatment modalities and offers significant benefits to both patients and practice.

Reconstruction of thumb together with the first metacarpus of 10 cases using the modified method of free transfers of second toe and composite tissue

in the paper the results of reconstruction of thumb and first matacarpus of 10 cases are reported. All the 10 transplantations were successful and revealed fine recovery of function and appearance.It was considered that the method of simultaneous removal of the second toe and metatarsus,first web space of the foot and the dorsal pedis flap for reconstruction of thumb and metacarpus to be superior to traditional methods in many aspects.Revascularization by anastomosis between the dorsalis pedis artery and the proximal end of the radial artery and that between the first plantar metatarsal artery and the distal end of the radial artery is effective to overcome ischemia of transplants because of variation of the first dorsal metatarsal artery.

Pedicle complex tissue flap transfer for reconstruction of duplicated thumbs with unequal size

BACKGROUND Thumb polydactyly is one of the most common congenital hand deformities,and the Bilhaut-Cloquet procedure or a modified one is often used.However,controversy remains over the rare instances in which both thumbs are not of similar length or far apart in distance.AIM To evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal size.METHODS From January 2014 to December 2020,15 patients underwent duplicated thumb reconstruction by pedicle complex tissue flap transfer at our hand surgery center.The technique was used when it was necessary to combine different tissues from both severed and preserved thumbs that were not of similar length or far apart in distance.Subjective parents’evaluations and functional outcomes(ALURRA and TATA criteria)were obtained.The alignment deviation,instability,range of motion(percent of opposite thumb)of the interphalangeal and metacarpophalangeal joints,and the aesthetic aspects,including circumference,length,nail size,and nail deformity,were used to assess the clinical outcomes.RESULTS The average age of patients at the time of surgery was 13 mo,and the mean final follow-up occurred at 42 mo.An appropriate volume with a stable joint and good appearance was obtained in 14 reconstructed thumbs.An unstable interphalangeal joint occurred in one thumb.The flexion-extension arc at the metacarpophalangeal joint was good,while that at the interphalangeal joint was poor.Most of the parents were satisfied with the cosmetic and functional results of the reconstructed thumbs.The mean ALURRA score was 21.8(range:20-24),and the Tada score was 6.9(range:5-8).Compared with the non-operated side,the length of the operated thumb was approximately 95%,the girth was 89%,and the nail width was 82.9%.The mean ranges of motion were 62.1%of that of the unaffected thumb in the interphalangeal joint and 78.3%in the metacarpophalangeal joint.CONCLUSION Harvesting a pedicle flap from a severed thumb is a safe and reliable procedure.Defects of the preserved thumb,such as the skin,nail,and bone,can be effectively restored using the complex tissue flap.

Painting the Bodhisattva Guanyin with One Thumb Missing

Zhao Guang,a native of Hefei,had been a studio-boy at the home of the famous painter Li boshi during the Northern Song Dynasty.When Li Boshi