ObjectiveTo investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger. MethodsBetween January 2020 and January 2022, 23 cases of old mallet fingers were treated. There were 17 males and 6 females with an average age of 42 years (range, 18-70 years). The cause of injury included sports impact injury in 12 cases, sprain in 9 cases, and previous cut injury in 2 cases. The affected finger included index finger in 4 cases, middle finger in 5 cases, ring finger in 9 cases, and little finger in 5 cases. There were 18 patients of tendinous mallet fingers (Doyle type Ⅰ), 5 patients were only small bone fragments avulsion (Wehbe type ⅠA). The time from injury to operation was 45-120 days, with an average of 67 days. The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release. The insertion of extensor tendon was reconstructed and fixed with absorbable anchors. After 6 weeks, the Kirschner wire was removed, and the patients started joint flexion and extension training. Results The postoperative follow-up ranged from 4 to 24 months (mean, 9 months). The wounds healed by first intention without complications such as skin necrosis, wound infection, and nail deformity. The distal interphalangeal joint was not stiff, the joint space was good, and there was no complication such as pain and osteoarthritis. At last follow-up, according to Crawford function evaluation standard, 12 cases were excellent, 9 cases were good, 2 cases were fair, and the good and excellent rate was 91.3%. Conclusion Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger, which has the advantages of simple operation and less complications.
ObjectiveTo investigate the feasibility and effectiveness of using a modified latissimus dorsi musculocutaneous flap for the treatment of upper limb injuries with complex tissue defects classified as Gustilo-Anderson type ⅢB and ⅢC. Methods Between January 2021 and January 2024, 19 cases of upper limb injuries with complex tissue defects classified as Gustilo-Anderson type ⅢB and ⅢC were repaired with a modified latissimus dorsi musculocutaneous flap. There were 14 males and 5 females, with an average age of 33 years (range, 8-65 years). Among these cases, 12 involved injuries to the upper arm and elbow, while 7 involved injuries to the forearm. The disease duration ranged from 2 hours to 10 days (mean, 2.6 days). The patients underwent emergency internal fixation or external fixation for fractures, along with repair of neurovascular injuries. Subsequently, based on the type and extent of tissue defect, 11 cases were treated with pedicled flap transplantation, while 8 cases underwent free flap transplantation. The size of the muscular flaps ranged from 16.0 cm×10.0 cm to 24.0 cm×14.5 cm, while the size of skin flaps ranged from 12.0 cm×5.0 cm to 27.0 cm×7.5 cm. All incisions at donor sites were sutured. Results All 19 flaps survived completely, with primary wound healing in 17 cases and secondary healing with skin grafting on the muscular flap in 2 cases. The incisions at donor sites healed by first intention. All patients were followed up 10-41 months (mean, 21 months), and limb salvage was successful in all cases. All fractures healed with a healing time of 8-14 weeks. At last follow-up, according to the functional evaluation criteria for upper limb replantation established by the Hand Surgery Branch of Chinese Medical Association, 15 cases demonstrated excellent functional recovery, while 3 cases showed good functional outcomes, 1 case showed poor recovery. Conclusion The modified latissimus dorsi musculocutaneous flap, through partial separation of the latissimus dorsi muscle and musculocutaneous perforators combined with a staggered arrangement of the muscle and skin components, enables flexible reconstruction of defects at different tissue levels. This technique demonstrates advantages including a high flap survival rate, satisfactory limb salvage outcomes, favorable functional recovery, and relatively low donor site morbidity, making it an effective method for reconstruction of Gustilo-Anderson type ⅢB and ⅢC upper limb injuries with composite tissue defects.