Traditionally free vascularized flap transfers to the fingers connect to the proper digital artery and dorsal veins. We report our experience using the volar digital veins as recipient veins for free vascularized flap transfers in 14 fingers of 12 patients. One or two veins (three flaps with two veins, 11 flaps with one vein) of the flap were anastomosed to volar digital veins in the recipient site. The arteries of these flaps were connected to the proper digital arteries. All the transferred flaps survived. No vessel crisis occurred. Our patients demonstrated that volar veins can be the recipient veins for free flap transfers in the fingers without increased risk of venous crisis and flap loss. Level of evidence: IV

Severe edema in the endoneurium can occur after non-freezing cold injury to the peripheral nerve, which suggests damage to the blood-nerve barrier. To determine the effects of cold injury on the blood-nerve barrier, the sciatic nerve on one side of Wistar rats was treated with low temperatures (3–5°C) for 2 hours. The contralateral sciatic nerve was used as a control. We assessed changes in the nerves using Evans blue as a fluid tracer and morphological methods. Excess fluid was found in the endoneurium 1 day after cold injury, though the tight junctions between cells remained closed. From 3 to 5 days after the cold injury, the fluid was still present, but the tight junctions were open. Less tracer leakage was found from 3 to 5 days after the cold injury compared with 1 day after injury. The cold injury resulted in a breakdown of the blood-nerve barrier function, which caused endoneurial edema. However, during the early period, the breakdown of the blood-nerve barrier did not include the opening of tight junctions, but was due to other factors. Excessive fluid volume produced a large increase in the endoneurial fluid pressure, prevented liquid penetration into the endoneurium from the microvasculature. These results suggest that drug treatment to patients with cold injuries should be administered during the early period after injury because it may be more difficult for the drug to reach the injury site through the microcirculation after the tissue fluid pressure becomes elevated.

The current study aims to investigate the effect of anti-osteoporotic agents of collared and non-collared femoral stem prostheses on periprosthetic bone mineral density (BMD) after total hip arthroplasty (THA). 80 patients who received THA due to femur neck subcapital fractures were involved. The treatment groups were given fosamax, caltrate D and Xianlinggubao for oral administration, whereas the control groups were only given caltrate D. BMD at the greater trochiter around the femoral stem prosthesis and at the femoral shaft 1.5-1.0 cm away from the distal femoral stem was tested using dual-energy X-ray absorptiometry (DEXA) scan. Meanwhile, BMD at the same sites on the uninjured side was also tested. The BMD at both sites in all groups decreased after implantation. In the collared groups, no significant difference was shown between the injured and uninjured sides at 12 days or 3 months (p > 0.001). At 6 months after implantation, significant differences were displayed at both sites between the treatment and control groups (p < 0.001). In the non-collared groups, significant differences were displayed at both sites between the treatment and control groups at 6-months postimplantation (p < 0.001). No significant difference showed between the collared and non-collared groups show any at either site on either side (p > 0.05). DEXA scan can quantitatively determine bone loss around the prosthesis after THA. BMD around the prosthesis is correlated with administration of anti-osteoporotic agents. Fosamax + caltrate D + Xianlinggubao can prevent early bone loss around the prosthesis.

No abstract