Introduction: The mangled limb is a term of an injury caused by major trauma and often combines significant injuries to the bone, skin, arteries, and nerves. criteria for amputation and salvage in mangled limbs still debatable. even hospitals as trauma centers still had difficulties evaluating mangled limbs. We present the case of a patient with a mangled limb upper extremity injury criteria amputation.
Case illustration: A male, 22-year-old history of a traffic accident with mangled limb upper extremity. an initial evaluation found closed fracture of right shaft humerus and open degloving injury anterior arm with an avulsion fracture of medial condyle humerus with rupture of the several forearm muscle belly, total rupture of brachialis artery, and total rupture of the cephalic vein. Performed limb salvage surgery with the microsurgical procedure and other serial operation. One-year postoperative evaluation patient can regain good physical function
Discussion: Optimal management of patients with mangled upper extremity after trauma remains challenging, An accurate initial salvageability evaluation is critical. The application of microsurgical techniques has been responsible for significant success in terms of extremity salvage and secondary reconstruction. The upper limb has more rich vascularity and efficient collaterals, small muscle mass, that is increasing the success rate
Conclusion: the success key of limb salvage surgery in mangled ischemic limb had several factors and must be evaluated based on patient individual not depend on the scoring system only. The microsurgical procedure had an important key role in the success rate of limb salvage

Introduction: Traumatic high ulnar nerve injuries have historically resulted in long-term loss of hand function due to the long re-innervation distance to the intrinsic muscles. Transfer of the anterior interosseous nerve (AIN) to the deep motor branch of the ulnar nerve (MUN) is proving promising in these patients. The purpose of this study was to evaluate the outcomes and efficacy of this procedure in our series.

Methods: Eligible high ulnar nerve injury patients who underwent AIN to MUN nerve transfer were evaluated with a mean follow-up of 17 months. Data including demographics, injury details, surgical procedures, and outcomes were collected. A review of the current literature was performed for comparison.

Results: Sixteen patients had AIN to MUN transfer, mean age of 39.4 years and a median delay from injury to nerve transfer of 0.8 months. The injury site was above the elbow in 5 cases, at the elbow in 8 cases, and in the proximal forearm in 3 cases. The majority were sharp transection, with the remaining from blast injuries, traumatic traction, and one post neuroma resection. The nerve transfer was performed end-to-end in 7 cases, hemi end-to-end in 7 cases, and supercharged end-to-side in 2 cases. Five patients achieved intrinsic muscle recovery of MRC 4+ and thirteen gained MRC 3 or above.

Conclusion: The AIN to MUN nerve transfer provides meaningful intrinsic recovery in the majority of traumatic high ulnar nerve injuries. This procedure should be routinely considered, however, warrants further research to validate the optimum technique.

This report shares our experience in designing different extended latissimus dorsi musculocutaneous (LD) flaps for large wounds in the extremities. From January 2004 to December 2018, 72 consecutive patients received extended LD flaps. Patients’ age ranged from 2 to 68 years with 37 males and 35 females. All wounds were extensive in either the upper or lower limbs, while the skin defect area ranged from 18 × 10 cm2 to 37 × 21 cm2. Single- and double-wing extended LD flaps were designed and harvested according to the shape of the wounds. Seventy-two flaps were successfully harvested; namely, 5 pedicled flaps and 67 free flaps. The mean flap harvest time was 56.2 min, and the donor sites were closed primarily in all patients. Venous compromise was noticed on the first postoperative day in four cases. Two flaps were salvaged after emergency re-exploration, and another two patients’ flaps totally necrosed. One patient underwent lower limb amputation, and another patient underwent extended LD flap on the other side. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Five patients were lost to follow-up (range, 10–56 months; mean, 15.7 months). No significant donor site morbidities limiting patients’ daily activities occurred during follow-up. Single- and double-wing extended LD flaps are simple and reliable methods for large skin and soft tissue defects in the extremity.

Introduction: The quadra-paddle groin flap can be used for multifinger defect resurfacing, but interpatient variations in perforator distribution remain an ongoing challenge when using this approach. This study aims to evaluate the efficacy of groin perforator flap designs according to the groin perforator distribution for the repair of 4-finger defects.
Methods: In accordance with the size of the 4-finger defects and the position of the perforators, a quadra-paddle flap was designed on the multiple perforators of the superficial/deep iliac circumflex artery. Patients received one of quadra-paddle groin perforator flap designs based on perforator distributions of the superficial/deep iliac circumflex artery.
Results: 11 cases of 4-finger defects were repaired with quadra-paddle groin perforator flap. All flaps survived except 2 paddles with tip necrosis. After 12.6 months of mean follow-up, 10 of the 11 cases demonstrated satisfactory cosmetic appearance, whereas the last case required a debulking procedure in the second stage.
Conclusions: The free quadra-paddle groin perforator flap is an effective option for repairing 4-finger skin defects. Various flap designs based on the grion perforator distribution allow for more individualized treatment approaches.

Introduction: isolated traumatic palsy of the axillary nerve is a rare entity. Blunt trauma to the scapulohumeral region is the most frequent mechanism, usually associated with osteoarticular injuries. Case presentation:A 51-year-old man suffered a comminuted scapula fracture associated with axillary nerve injury. The physical examination revealed deltoid atrophy and active abduction of 0º. Electromyogram revealed severe axonal lesion in the territory of the left axillary nerve with signs of active denervation. Triceps strength was preserved. 6 moths after the trauma, recovery was not verified so radial nerve transfer was indicated. The anterior branch, the major motor branch to deltoid muscle, was identified, dissected, and transected as proximally as possible. Then the branch to the long head of the triceps was identified. It was the first branch of the radial nerve. It was cut as distally as possible before entering the long head of the triceps muscle. Coaptation of the donor nerve and the anterior branch of the axillary nerve was done. Results: Clinical follow – up, the patient´s arm was placed in sling for 3 weeks after surgery. At sixth week passive assisted exercises were initiated. At fourth month he presented 70º of abduction. Discussion: Isolated injuries of the axillary nerve should be treated with surgery when spontaneous recovery is not verified 6 months after the trauma. Neurotization with the radial nerve permits a neurorrhaphy without graft because of anatomical proximity. The functional synergy in abduction and rotation with the axillary nerve make it a good treatment option.

Introduction: Collateral ligament injury of the metacarpophalangeal joint is uncommon because this joint is inherently resistant to ligament tears due to its protected position at the base of the fingers. This lesion occurs more commonly in thumb and rarely in the other fingers. The treatment is usually non-surgical but, in some cases, there can be severe instability, or the ligament may have interposed tissue which prevents it from healing or there can be bony fragments inside the joint, which are indications for the need of surgery. Methods: The authors report the clinical case of a patient who suffered a fall from a standing height, which resulted in a hand trauma. After performing a clinical evaluation, a collateral radial ligament rupture of the metacarpophalangeal joint of the fifth finger was suspected and confirmed with imaging studies. The lesion was surgically repaired using a mini suture anchor. Results and Discussion: The diagnosis of these lesions is sometimes difficulted by the pain that is caused during stress testing. Radiographs provide information about bone avulsion or intra-articular bodies but ultrasound and magnetic resonance are needed to distinguish the type of lesion and the need for surgical treatment. Conclusion: Early diagnosis and referral for a Hand Surgeon is needed because an acute surgical repair is associated with a good functional outcome and return to the previous level of function. These lesions are highly underdiagnosed by primary care physicians and general trauma surgeons and if neglected can result in a painful, unstable and nonfunctional finger.

Backgroud Anterolateral thigh perforator flap was one of most popular option for extremities defects reconstruction in the past two decades because of its limitation of donor site morbidity and aesthetically contours. However, high energy trauma and extension excision tumor often caused various types of soft tissue defects (eg. extensive defect, irregular defect, multiple adjacent defects and three-dimensional defect) which cannot be reconstructed precisely and effectively through using a traditional fashion design of perforator flap. In this context, it is necessitated to optimal design the anterolateral thigh perforator flap to provide customized reconstruction of complex soft tissue defect. In this article, we presented the progress of anterolateral thigh perforator flap for the customized reconstruction of complex soft tissue defect in the extremities.
Methods: we respective analysis paper and our experiences with using the individual design of anterolateral thigh perforator flap. We performed the optimal design of anterolateral thigh perforator flap through the graphic design, hierarchy structure and carrying tissue based on characterize of soft tissue defect.
Results: Various types of perforator flaps including flow-through anterolateral thigh perforator flap, chimeric anterolateral thigh perforator flap, conjoined anterolateral thigh perforator flap, microdissected anterolateral thigh perforator flap and multi-lobed anterolateral thigh perforator flap were performed for the reconstruction of complex soft tissue defect.
Conclusion the optimal design of anterolateral thigh perforator flap provided more aesthetically contour and minimized donor site morbidity. It further expended application and indication of anterolateral thigh perforator flap.

Background: A high incidence of osteonecrosis of the femoral head (ONFH), a com- monly seen and intractable disease, has been reported. This retrospective study aims to present the reconstructive outcomes by free vascularized iliac bone flap (FVIBF) to determine which one is better for ONFH patients. Methods: From January 2010 to December 2017, 35 patients (40 hips) were treated by PIBF grafting, and 32 patients (36 hips) were treated by FVIBF grafting. The two groups were then compared in terms of the preoperative baseline conditions, intraoperative data, and postoper- ative Harris hip score. Results: In the PIBF group, the operating time was significantly longer than the FVIBF group (195.5 ±26.4 vs 147.2 ±17.7 min, respectively), and the intra-operative blood loss was signif- icantly heavier (330.0 ±63.9 vs 240.3 ±37.5 ml, respectively). Meanwhile, the recipient site morbidity rate in the PIBF group outnumbered that in the FVIBF group (27.5% vs 8.3%, respec- tively), and a higher rate of lateral femoral cutaneous nerve (LFCN) injury was observed in the PIBF group than in the FVIBF group (27.5% vs 8.3%, respectively). No difference was found in postoperative HHS score between the two groups. In both groups, the recovery effect of the patients in stage II was better than that in stage III. Conclusion: While maintaining a similar clinical effect, the FVIBF grafting exhibited a distinct advantage over the PIBF grafting, in terms of shorter operative time, less blood loss, and lower risk of LFCN injury.

Double skin paddle anterolateral thigh perforator (ALTP) flap is a reliable methods for reconstruction of complex soft tissue defect of extremities. However, the variable perforators may limit the application of this flap. The purpose of this study was to compare outcomes between catheter-based computed tomography angiography (C-CTA)-assisted and traditional CTA (T-CTA)-assisted the free double skin paddle ALTP flap techniques for reconstruction of complex soft tissue defect of extremities.
Methods retrospective review was carried out on patients who underwent complex extremities defect reconstruction using a free double skin paddle ALTP flap. These patients were categorized into two groups depending on with preoperative C-CTA or T-CTA guidance. Demographics, intraoperative outcomes, flap-related complications and donor-site morbidity were compared.
Results A total of 36 patients underwent reconstruction with the double skin paddle ALTP flap. The C-CTA group comprised with 18 patients. 18 patients were included in the T-CTA group. The application of preoperative C-CTA was associated with a significant reduction in intraoperative bleeding (538±69.08 vs 625.27±120.64 ml in the T-CTA guidance group; p=0.046) and length of operative time (291.2±51.82 vs 356.11±85.07 min in the T-CTA group; p=0.038). There was no significant difference in the flap-related complications and donor-site morbidity between the two groups.
Conclusion The application of C-CTA for preoperative guidance of double skin paddle ALTP flap in reconstruction of complex extremities defect is associated with shorter operative time and reduction intraoperative bleeding. It is a reliable method for surgeon to choose suitable perforators, perform flap design preoperative and develop a dissection strategy.

Objectives: Lipoma is the most common benign tumor in the human body, present in 19% of cases in the upper limb, its localization in the hand remains rare less than 5% and exceptional inside the carpal tunnel.
Materials and methods: We report the case of a 65-year-old patient with typical chronic carpal tunnel syndrome with neurological disorders confirmed by electromyography. An ultrasound was performed in order to rule out secondary compression, she returned in favor of intra-carpal fat formation.
Results: An excisional biopsy was performed in her as well as neurolysis of the median nerve. The evolution was spectacular with disappearance of the neurological deficit and a good functional recovery the anatomopathological study of the operative specimen came back in favor of a lipoma.
Discussion: Lipoma of the hand is a rare lesions, often expressed by tumor syndrome and signs of compression of the median nerves. MRI is the exam of choice for studying the local extent of the tumor. The main differential diagnoses are median nerve lipofibroma and low-grade liposarcoma.
Conclusion: The very high frequency of Carpal Tunnel Syndrome and its usual ease of diagnosis should not alter the vigilance of the clinician. The various diagnostic wanderings are numerous. care must be taken in interpreting clinical and electrophysiological data so as not to overlook an underlying local or general pathology.

Purpose: Generally, Gustilo ⅢB, ⅢC injury, limb amputation accompanied by a large area of soft tissue defects is a complicated problem. The purpose of this article is to research the feasibility and significance of maintaining limb replanted length with those kind of injury.
Method: 23 cases were included: 1 upper arm case; 13 lower limb injury cases which include 7 Gustillo IIIB cases, 2 GustilloIII C cases, 4 limb amputation cases ; 9 forearm cases include 2 GustilloIIIB cases, 2 Gustillo IIIC cases, 5 amputation cases. The length of exposed bone and soft tissue defects is 5.0cm-17.0cm. Tissue flaps are formed by lateral femoral circumflex artery passing through the flap, fascia and muscle. The size of the flap is 40.0cm × 13.0cm ~ 5.0cm × 6.0cm,and the size of muscle flap is 10.0cm × 6.0cm ~ 3.0cm × 4.0cm, the size of fascia flap is 15.0cm × 6.0cm ~ 5.0cm × 6.0cm.After fracture fixation, each flap were used to cover the exposed bone and blood vessels. In order to restore or increase the blood supply ,we connected the descending branch of the lateral femoral circumflex artery to the limb and rebuild blood supply of the flap.There are 22 cases survived: 16 cases are healing by first intention , 6 cases are healing after one month. One patients hand temperature is lower than the healthy side, other distal limb is well. 10 cases are following up more than two years

Methods ：From March 2011 to April 2018, 12 cases of severe palm injury caused by various reasons,emergency repaired of severe palm injury were in counted.All case used the muscle flap topreconstruct the avulsion skin of the palm of the hand, the flap covered the back of the hand, the blood vessels of the flap bridge between the flexor or ulnar artery and the finger artery to build the blood supply of the finger.Then observe the survival, color, texture of the avulsed palm skin and postoperative function of hand.Results :1 case was failed, 11 cases were success to resereve limb.All flaps were survived.All the preconstruct the avulsion skin of the palm were survived except that 1 case necrosis about one third and 1 case necrosis about 4.0cm × 1.0cm liked a strip.After follow-up for 4 months to 6 years , palm avulsion skin was texture soft , thick and visibleddermatoglyph.From 3 to 6 months later, the palm of hand gradually regained my feeling.37 finger were replanted by flow-though(including 4 thumbs), 26 fingers survived(including 2 thumbs). bone healing time was about 4 months.The grade of sensory recovery in 7 cases wass4, 3 cases was s3, 2 cases was s1. 11 cases can complete opposition, prehension and the daily work with comassisted health hand.According to The Chinese Medical Association Hand Surgery Society Upper Limb Replantation Function Evaluation Standard, the function is excellent in 6 cases, good in 4 cases and fair in 2 cases.

Introduction: The reconstruction of extensive three-dimensional defects in the extremities is a difficult challenge. The anterolateral thigh (ALT) chimeric flap is one of the most useful tools for the reconstruction of complex threedimensional defects in the extremities. Methods: From January 2010 to March 2012, Twenty-two patients underwent extremity reconstruction using chimeric ALT perforator flaps, which consists of a skin component on its isolated perforator and a portion of the fascia and muscle flaps on the same pedicle from the descending branch of the lateral circumflex femoral artery (LCFA). The defects were in either a lower (n =10) or an upper extremity (n =12). The area of the soft tissue defects ranged from 43×35 cm to 19×9 cm (mean, 25×18 cm), containing extensive, irregular, ring-like soft tissue defects or degloving injuries. Results: The mean dimension of skin flap was 19.8 11.2 cm. The mean dimension of fascia flap was 8.9×7.1 cm. The mean dimension of muscle flap was 11.1×7.5 cm. No total flap loss occurred. One patient presented with venous thrombosis, and re-anastomosis and vein grafting were performed. Two
cases exhibiting partial skin graft loss at the site at which the fascia flap was inset were treated via secondary skin grafts. During a follow-up period of 18 monthse—30 months, patients were satisfied with the functional and aesthetic outcome. No serious donor-site complications occurred. Discussion: Chimeric anterolateral thigh perforator flap can be one of the best choice for reconstruction of complex soft-tissue defects in the extremities.

Abstract：Objective To investigate the feasibility and problem for semi hallux nail flap in fingertip
reconstruction．Methods 69 fingers in 64 cases with complete or partial defect，distal skin avulsion，skin
tube anaplastic and replantation failure were included．All cases were used semi hallux nail flap for
reconstruction．Function and appearance of the hallux and finger were documented．Results After followed for 2～10 years，the pulp Wass plump and flexible，nail length，width were similar to the uninjured side，the appearance wass nice，skin sensation recovered，two—point discrimination reached to 4～5 mm，finger mnction was well．7 cases were bilateral asymmetry without nail fold，nail edge exposure，8 cases showed shallow nail groove compared with the contralateral side，which were analyzed the reason and improved the method．Donor site showed nail growth，with fibular flap coverage．No discomfortable were noticed in long—term walking．Patienu were satisfied with the shape of the toes and the reconstructed fingers．Conclusion Semi hallux nail flap is an ideal method for repairing distal finger defect．

Purpose: Generally, Gustilo ⅢB, ⅢC injury, limb amputation accompanied by a large area of soft tissue defects is a complicated problem. The purpose of this article is to research the feasibility and significance of maintaining limb replanted length with those kind of injury.
Method: 23 cases were included: 1 upper arm case; 13 lower limb injury cases which include 7 Gustillo IIIB cases, 2 GustilloIII C cases, 4 limb amputation cases ; 9 forearm cases include 2 GustilloIIIB cases, 2 Gustillo IIIC cases, 5 amputation cases. The length of exposed bone and soft tissue defects is 5.0cm-17.0cm. Tissue flaps are formed by lateral femoral circumflex artery passing through the flap, fascia and muscle. The size of the flap is 40.0cm × 13.0cm ~ 5.0cm × 6.0cm,and the size of muscle flap is 10.0cm × 6.0cm ~ 3.0cm × 4.0cm, the size of fascia flap is 15.0cm × 6.0cm ~ 5.0cm × 6.0cm.After fracture fixation, each flap were used to cover the exposed bone and blood vessels. In order to restore or increase the blood supply ,we connected the descending branch of the lateral femoral circumflex artery to the limb and rebuild blood supply of the flap.
Result: There are 22 cases survived: 16 cases are healing by first intention , 6 cases are healing after one month. One patients hand temperature is lower than the healthy side, other distal limb is well. 10 cases are following up more than two years.

Objective: To explore the effect of degree of primary internal fixation flap covering the wound healing and function of lower limb Gustilo Ⅲ B-Ⅲ C injury. Methods: There are 14 cases of GustiloⅢC injury,11cases of GustiloⅢB11 injury, 5 middle segment injury cases and 20 lower segment injury cases (including 3 ankle injury cases). The maximal area of skin defect was 40cm × 13cm, the smallest area was 15cm × 8cm,and 6 bone defect cases. Twenty-one cases were treated with free tissue transplantation, including 20 cases of free forefoot flap, 1 case of dissociated medial skin flap, 7 cases of flap of femoral anterolateral flap and 13 cases of myocutaneous flap; 4 cases of pediculated skin grafting, including 3 pedicle gastrocnemius muscle flap cases and 1 posterior tibial perforator flap case. 20 cases were followed up for 6 months to 54 months, and the function was evaluated.
Results: One case of free skin flap was explored. 17 pedicle flap cases was partially necrotic and the wound was healing in one stage (except for skin grafting on skin) . The wounds of 2 cases healed with a little secretions in 2 weeks. Three flaps were healed by secondly lavage.23 cases’ limb salvage had succeed,but three of them were lost. The last 20 cases can be classified by loway score: wonderful 15,excellent 3,good 2. All of them had no abnormal feeling. They had walked before 3 months to 7 months.

Objective: To investigate the feasibility and clinical effect of multi-method with vascularized fibula and chimeric transplantation or flow-through in repairing complex tissue defects of extremities.
METHODS: According to different bone and soft tissue defects, single、 demifacet、folded and a pair of fibulas(two single bones are took from a fibula that have the same pedicled artery) were combined with the fibula artery flap or use fow-though to restore the blood supply to the distal end of the extremities.Twenty-seven partients with extremities defects treated in our hospital from Jan 2010 to May 2018,include 2 cases of phalanges, 3 cases of first metacarpal, 1 case of metatarpal, 9 case of tibula,4 case of radius, 2 case of ulna,3 case of femur, 3 case of calcane, and 1 case of medial malleolus with different degrees of soft tissue defects. 3 cases of no blood supply to the distal limb, flow-through vascular anastomosis ( fibula artery and the distal limb vascular). All include 24 cases of traumatic, and 3 cases of osteomyelitis.The methods include 16 cases of single fibula graft, 6 cases of folded fibula(2 cases of repair of lower femur defect, 1 case of middle femur, 3 cases of calcaneus defect) ,3 cases of demifacet fibula( 1 case of repairing phalanx,1 case of pediatric metacarpal,1 case of head fubula) ,1 case of both ulnar and radius bone defects was treated with a pair of fibulas.Conclusions: Multi-method chimeral transplantation combined flow-though to repair of extremities bone and soft tissue injury is a feasible and effective method

Introduction: The reconstruction of extensive three-dimensional defects in the extremities is a difficult challenge. Many attempts have been made to reconstruct such defects using the chimeric flap concept, enabling flaps with larger surface areas to be used while maintaining economical tissue use. The anterolateral thigh (ALT) chimeric flap is one of the most useful tools for the reconstruction of complex threedimensional defects in the extremities. Methods: From January 2010 to March 2012, Twenty-two patients underwent extremity reconstruction using chimeric ALT perforator flaps, which consists of a skin component on its isolated perforator and a portion of the fascia and muscle flaps on the same pedicle from the descending branch of the lateral circumflex femoral artery (LCFA). The defects were in either a lower (n =10) or an upper extremity (n =12). The area of the soft tissue defects ranged from 43×35 cm to 19×9 cm (mean, 25×18 cm), containing extensive, irregular, ring-like soft tissue defects or degloving injuries. Results: The mean dimension of skin flap was 19.8 11.2 cm. The mean dimension of fascia flap was 8.9×7.1 cm. The mean dimension of muscle flap was 11.1×7.5 cm. No total flap loss occurred. One patient presented with venous thrombosis, and re-anastomosis and vein grafting were performed. Two cases exhibiting partial skin graft loss at the site at which the fascia flap was inset were treated via secondary skin grafts. During a follow-up period of 18 monthse—30 months, patients were satisfied with the functional and aesthetic outcome. No serious donor-site complications occurred.

Objective: To explore the effect of degree of primary internal fixation flap covering the wound healing and function of lower limb Gustilo Ⅲ B-Ⅲ C injury. Methods: There are 14 cases of GustiloⅢC injury,11cases of GustiloⅢB11 injury, 5 middle segment injury cases and 20 lower segment injury cases (including 3 ankle injury cases). The maximal area of skin defect was 40cm × 13cm, the smallest area was 15cm × 8cm,and 6 bone defect cases. Twenty-one cases were treated with free tissue transplantation, including 20 cases of free forefoot flap, 1 case of dissociated medial skin flap, 7 cases of flap of femoral anterolateral flap and 13 cases of myocutaneous flap; 4 cases of pediculated skin grafting, including 3 pedicle gastrocnemius muscle flap cases and 1 posterior tibial perforator flap case. 20 cases were followed up for 6 months to 54 months, and the function was evaluated.
Results: One case of free skin flap was explored. 17 pedicle flap cases was partially necrotic and the wound was healing in one stage (except for skin grafting on skin) . The wounds of 2 cases healed with a little secretions in 2 weeks. Three flaps were healed by secondly lavage.23 cases’ limb salvage had succeed,but three of them were lost. The last 20 cases can be classified by loway score: wonderful 15,excellent 3,good 2.
Conclusion: Open fracture with large area soft tissue defect, accompanied by limb blood supply disorders , can be treat with a fixed internal flap cover.

Objective：To investigate the feasibility and clinical effect of uniting transplantation ALTF chimeric and preconstruction avulsion of palm skin in situ or Flow-through technique in the treatment of severe palm injury.
Methods ：From March 2011 to April 2018, 12 cases of severe palm injury caused by various reasons,emergency repaired of severe palm injury were in counted.All case used the muscle flap to preconstruct the avulsion skin of the palm of the hand, the flap covered the back of the hand, the blood vessels of the flap bridge between the flexor or ulnar artery and the finger artery to build the blood supply of the finger. Then observe the survival, color, texture of the avulsed palm skin and postoperative function of hand.
Results :1 case was failed, 11 cases were success to resereve limb.All flaps were survived.All the preconstruct the avulsion skin of the palm were survived except that 1 case necrosis about one third and 1 case necrosis about 4.0cm × 1.0cm liked a strip. After follow-up for 4 months to 6 years , palm avulsion skin was texture soft , thick and visibled dermatoglyph. From 3 to 6 months later, the palm of hand gradually regained my feeling.37 finger were replanted by flow-though(including 4 thumbs) , 26 fingers survived(including 2 thumbs). bone healing time was about 4 months. The grade of sensory recovery in 7 cases was s4, 3 cases was s3, 2 cases was s1. 11 cases can complete opposition, prehension and the daily work with comassisted health hand

Abstract：Objective To investigate the feasibility and problem for semi hallux nail flap in fingertip
reconstruction．Methods 69 fingers in 64 cases with complete or partial defect，distal skin avulsion，skin
tube anaplastic and replantation failure were included．All cases were used semi hallux nail flap for
reconstruction．Function and appearance of the hallux and finger were documented．Results After followed for 2～10 years，the pulp Wass plump and flexible，nail length，width were similar to the uninjured side，the appearance wass nice，skin sensation recovered，two—point discrimination reached to 4～5 mm，finger mnction was well．7 cases were bilateral asymmetry without nail fold，nail edge exposure，8 cases showed shallow nail groove compared with the contralateral side，which were analyzed the reason and improved the method．Donor site showed nail growth，with fibular flap coverage．No discomfortable were noticed in long—term walking．Patienu were satisfied with the shape of the toes and the reconstructed fingers．Conclusion Semi hallux nail flap is an ideal method for repairing distal finger defect．