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Objective To investigate the clinical effect of free second toe tibial flap in repairing fingertip skin and soft tissue defects. Methods From February 2016 to August 2019, 11 patients with fingertip skin and soft tissue defects were repaired with free second toe tibial flap at the Orthopaedic Trauma Center of PLA of The 988th Hospital of Joint Logistic Service of PLA. The area of soft tissue defect was 1.2 cm×2.0 cm to 2.0 cm×2.5 cm. The flap ranged from 1.3 cm×2.2 cm to 2.3 cm×2.8 cm. All donor site defects on the ipsilateral second toe were covered with full-thickness skin graft. There were 2 wounds in thumb, 4 in index finger, 4 in middle finger and 1 in ring finger. The wound defect area 1.2 cm×2.0 cm to 2.0 cm×2.5 cm. Skinflap cutting area 1.3 cm×2.2 cm to 2.3 cm×2.8 cm, the second toe on the same side of the donor site was selected and the full-thickness skin graft was transplanted. After the operation, the appearance, sensation and donor site recovery of the flap were regularly followed up by outpatient reexamination. Results All the flaps survived well in 11 cases and without any vascular crisis. Partial skin graft necrosis at the donor site was found in 1 case, and the wound healed gradually after daily dressing change. After 8 to 14 months of follow-up,the appearance and the texture of the recipient site flap was good, and no obvious dysfunction of the donor site was found. Thesensation of the 11 flaps was recovered to S2 to S3＋, and the two-point discrimination was 6 to 11 mm. The recovery of hand function was satisfactory. According to the trial criteria for evaluation of upper limb function of the Society of Hand Surgery of the Chinese Medical Association, 8 cases were excellent and 3 cases were good. The Vancouver Scar Scale was used to evaluate the fingertip scar. The scores of 11 cases in this group were 3 to 5, with an average score of 3.6. Conclusion The free second toe tibial flap is a rational therapeutic strategy for repairing the skin and soft tissue defect of fingertip. It has the advantages of constant bloodvessels, good sensory recovery, and concealed donor area. [ABSTRACT FROM AUTHOR]

: BackgroundWith the improvement in neuroimaging and microsurgical techniques, brain stem cavernous malformations are no longer considered inoperable. Surgical indications for brainstem cavernoma are evolving, with better understanding of its natural history and decreasing surgical complications.: MethodsDuring 1986 through 1998, a series of 137 patients (4 patients each with two brain stem lesions, total number of lesions, 141) with brain stem cavernous malformations were treated microsurgically at Beijing Neurosurgery Institute. The age distribution, lesion location, and clinical presentations were analyzed. The bleeding rate, surgical indications and microsurgical techniques were also discussed.: ResultsIn our series, 92 of 137 cases (67.2%) suffered more than one hemorrhage. Female patients had a higher risk of recurrent hemorrhage than that of male patients. Unlike cavernomas malformations from other locations, repeated hemorrhages from brain stem malformations are much more common and usually lead to new neurologic deficits. Among all 137 surgically treated patients, there was no operative mortality. Ninety-nine patients (72.3%) either improved or remained clinically stable postoperatively. The size of the cavernoma/hematoma does not necessarily correlate with the surgical result. While the acute hematoma can facilitate the surgical dissection, longer clinical history with multiple hemorrhages often makes total surgical resection difficult, partially because of the firmer capsule that may not shrink or collapse after hematoma is released. Pathologically those capsules were associated with more hyaline degeneration, fibrous proliferation and even calcifications. During the follow-up period between 0.5 to 11 years in 129 cases, 115 patients (89.2%) have been working, studying, or doing house work. Three patients (2.3%) suffered recurrent hemorrhages.: ConclusionSurgical indications of brain stem cavernoma include (1) progressive neurologic deficits; (2) overt acute or subacute hemorrhage on MRI either inside or outside cavernous malformations with mass effect; (3) cavernoma/hematoma reaching brainstem surface (<2 mm brain tissue between cavernoma /hematoma and pial surface). Grave clinical presentations like coma, respiratory, or cardiac instability are not surgical contraindications. Emergent surgical evacuation may lead to satisfactory outcome. Repeated hemorrhages will worsen the pre-existing neurologic deficits and possibly make the surgical dissections more difficult. Patients with minimum, stable neurologic deficits and lesion/hematoma that has not reached the brain stem surface should be followed conservatively. [Copyright &y& Elsevier]

Objective: To report the methods and clinical outcomes of microscopic minimally invasive keyhole technique for surgical resection of thoracic spinal meningiomas. Methods: Thirty-nine patients with thoracic spinal meningiomas received keyhole surgery from May 2013 to June 2017 in the Department of Spine Surgery, Fujian Provincial Hospital. A working channel with a diameter of 1.8 cm was inserted percutaneously about 2.0 to 3.5 cm away from the mid-line. Dorsally attached tumors were resected with hemilaminectomy fenestration; for the spinal meningiomas located in the lateral side of the spinal cord, hemilaminectomy combined with partial facetectomy were used; hemilaminectomy combined with hemifacetectomy fenestration were used for spinal meningiomas located ventrally. No internal fixation was performed in all cases. Clinical outcome was assessed using the visual analog scale (VAS) for pain relief and the American Spinal Injury Association (ASIA) scale for evaluation of the function of the spinal cord after surgery. The pre-and post-operative data were compared by paired t test. Results: Among the 39 patients, the tumors in 36 cases located in the thoracic spine and 3 in the cervicothoracic junction. Complete resection was achieved in all patients. Mean operative time was (148±21) min (range, 120-185 min). Mean blood loss during surgery was (101±27) ml (range, 50-200 ml). No infection or aggravation of spinal cord injury occurred after operation, except for 3 patients who had postoperative cerebrospinal fluid leakage that recovered after conservative treatment. The mean hospital stay was (6.1±0.8) days (range, 5-9 days). Patients were followed-up for a period of 9 to 57 months, with a mean follow-up time of (29±13) months. At the last follow-up, all patients had a reduced level of pain as suggested by an average VAS score that improved from (7.38±1.71) to (0.31±0.63), the ASIA grade improved in all patients except for 2 cases (5.1%), 24 cases (61.5%) improved by 1 grade, 9 cases (23.1%) improved by 2 grades, and 4 cases (10.3%) improved by 3 grades. No evidence of tumor recurrence or secondary spinal instability was observed in any patients during the postoperative follow-up. Conclusion: Microscopic minimally invasive keyhole technique can be used to completely resect the thoracic spinal meningiomas; such surgical procedures convey reliable clinical outcomes and good postoperative spinal stability.

Objective: To explore the efficacy and feasibility of the hemi-semilaminectomy microsurgical operation treatment of spinal dural arteriovenous fistula (SDAVF). Methods: The clinical data of 32 patients with SDAVF were analyzed retrospectively. Before operation all patients were diagnosed by spinal MRI and spinal angiography, 14 patients were treated by hemi-semilaminectomy approach and other 18 patients were by traditional laminectomy approach. All the data were analyzed by T test and P< 0.05 was considered to have significant difference. Results: The nidus of SDAVF located on thoracic segments in 18 cases, lumbar segments in 12 cases, and cervical segment in 2 cases, which was fed by single artery. The hemi-semilaminectomy microsurgical operation showed shorter operation time, less bleeding, less hospitalization time and cost. All the patients followed-up for 6 months-2 years. Symptoms of all the patients were improved compared with those before surgery. Conclusions: On the premise of spinal angiography accurately positioning the location of fistula, the hemi-semi-laminectomy approach microsurgery clipping operation is safe and feasible, and the operation has fewer traumas, also helps to maintain the stability of spine.