Repair Of The Big Extent Multiple Tissue Defect Of Hand By Combine Tissue Grafting: Clinical Application

Objecctive : (l)to introduce a surgical flap method to repair and reconstruct the function of thenar after complicated Smashed Wound Injury of hand and then analyze its clinical feasibility and application. (2)to explore the influence that Buyanghuanwutang stimulated restore of peripheral nerve injury.Methods: (l)We adopted the surgical flap method:anatomy no.2 toe affiicated with extensor digitorum brevis with relevent artery and vein and deep peroneal nerve branch for being with reciptors . We treated 10 patients with Smashed Wound Injury of hand and observed survival rate of flap and restore hand function. (2) 20 healthy adult female SD rats 300g-weight were randomly divided into trial group and control group. All rats were cut away 6mm-long part from sciatic nerves and then grafted the nerves with silicon implant tubes.Results: grafted complicated or combined tissues of the 10 patients survived completely .After operatiom, rats in control group were feed routinely while rats in trial group were fed routinely and extra Gastric infusion of Buyanghuanwutang, after 4 ,16 weeks long interference ,we observed the targets of two groups. After following-up 1-10 years,restored thumbs and grafted flaps restore very good function of sensor, the static two - point discrimination were between 3-10mm. the time duration of motor potential of the grafted muscles were detected by EMG,the shortest was three months while the longest was 7months.the average is 5months.there were 7 patients who were excellent and 3 patients who were good judging by hand functional evaluation standard of hand surgery society of china mecical society.We observed sciatic nerves-injuried Rats model by general observation, electrophysiology detection , image of vessels area of regeneration nerves, optics and electron scanning detection. After 4 weeks,all rats improved their claudication,but rats of trial group claued less than rats of control group.after 16weeks,rats back limb muscle atrophy of trial group better restored than control group. Diameter of Regenerate nerves of trial group more thick than that of control group,what is more, regenerate nerves of trial group were feasible but the other were crispy. sciatic nerve conduction potential velocity of trial group were average (23.11±6.27)m/s, that of the other were (16.97±4.91)m/s,there was statistical difference between groups. after 4 weeks , there were more microvessels of regenerate nerves of trial group rats than that of control group rats (P<0.001).and after 16weeks ,the situation still so existed. After 4 weeks and 16 weeks,regenenrated nerve fibres and myelin of trial group were thicker than that of control group, There were more mitochondrotes in avon and myelinated fibres of regenerate nerves of trial group rats than that of control group.Conclusion: It is an ideal method to repair of the big extent multiple tissue defect of hand and the sufferer can accept this mothod.