ObjectiveTo explore the clinical application of the flap supported by perforating branch of the radial artery superior wrist catena-form blood vessel in repairing hand and wrist wound. MethodsBetween March 2010 and March 2013, 24 cases of severe wounds in wrist were repaired with the flap supported by perforating branch of forearm radial artery and catena-form blood vessel. There were 15 males and 9 females, aged 19-54 years (mean, 37 years). In 22 patients with trauma, there were 9 cases of machine injury, 5 cases of traffic accident injury, 5 cases of crash injury of heavy objects, 1 case of sharp instrument injury, and 2 cases of electrical injury, with a mean disease duration of 11 days (range, 2-20 days). In 2 patients with tumor excision wound, there were 1 case of right forearm liposarcoma and 1 case of left forearm squamous-cell carcinoma, with the disease duration of 7 days and 3 months, respectively. All cases complicated by bone and tendon exposure. The size of defect was 4.5 cm×4.0 cm to 10.0 cm×7.5 cm, and the size of the flap was 6.0 cm×4.0 cm to 20.0 cm×8.5 cm. The donor site was directly sutured or repaired by skin graft. ResultsPartial flap necrosis occurred in 1 case, and was cured after dressing change; the other flaps survived, and primary healing of incision was obtained. The patients were followed up 6-36 months (mean, 20 months). The flap featured good color and texture, and also recovered protective sensation at 6 months after operation, with a mean two-point discrimination of 12 mm (range, 11-14 mm). No ulcers of the flap was observed. At last follow-up, according to Hand Surgery Society of Chinese Medical Association for functional evaluation of upper limb, the function was rated as excellent in 19 cases, good in 4 cases, and fair in 1 case. ConclusionThe flap supported by perforating branch of forearm radial artery and catena-form blood vessel can be used to repair wound in wrist, which has no injury to the radial artery, and it also could be used for the patients with ulnar and radial artery injuries. Thus it is an ideal method to repair wound in the wrist because the operation is simple, and the flap has good appearance and texture.
ObjectiveTo investigate The role of tumor necrosis factor-α (TNF-α) in pancreatitis-associated adrenal cells' apoptosis of severe acute pancreatitis (SAP). MethodsForty Wistar rats were randomly divided into sham operation group (SO group) and SAP group by random number method, the SAP group was divided into 3, 6, 12, and 24 h 4 subgroups, 8 rats in each group. SAP model was induced by retrograde injection of 5% sodium taurocholate into the bilipancreatic duct. At 3, 6, 12, and 24 h after operation, serum amylase and lipase was measured, adrenal injury was evaluated by histological examination, apoptosis of the adrenal cells was observed by TUNEL method, and expressions of TNF-α and Caspase-3 protein were detected by Western blot. ResultsThe levels of serum AMY and LIP, histopathological scores of pancreatic tissues and adrenal tissues at each time point after operation in SAP group increased significantly than SO group (P < 0.05). With the duration extension of SAP, the apoptosis index of adrenal cells in SAP group progressively heightened, and were higher than those in the SO group (P < 0.05). And the expressions of TNF-α and Caspase-3 protein in adrenal tissues of SAP group gradually increased, at 24 h this data slightly decreased, but still higher than SO group (P < 0.05). ConclusionTNF-α may be involved in the pathogenesis of adrenal injury in SAP rats by activate the protein expression of Caspase-3.