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The 8th World International Symposium on the Diabetic Foot (ISDF) Conference which was sponsored by the International Working Group on Diabetic Foot (IWGDF) was held in the Hague between May 22nd and May 25th, 2019. The conference issued the 2019 IWGDF guidelines on the prevention and management of diabetic foot disease. The update to the 2015 edition of the guidelines involves the following 6 chapters: prevention of foot ulcers in patients with diabetes; offloading foot ulcers in patients with diabetes; diagnosis, prognosis, and management of peripheral arterial disease in patients with a foot ulcer and diabetes; diagnosis and treatment of foot infection in patients with diabetes; interventions to enhance healing of foot ulcers in patients with diabetes; classification of diabetic foot ulcers. This guideline has been changed more than the previous edition. In this paper, the guidelines will be interpreted to provide cutting-edge information for domestic diabetic foot researchers.

Objective: To investigate the effectiveness of local injection of autologous platelet-rich plasma (PRP) in treatment of diabetic foot ulcer., Methods: Between October 2017 and October 2018, 90 diabetic foot ulcer patients who met the selection criteria were randomly divided into 3 groups: PRP injection group (group A, PRP was injected and hydrogel dressing covered the wounds), PRP covered group (group B, PRP gel and hydrogel dressing covered the wounds), and the control group (group C, hydrogel dressing covered the wounds), 30 cases in each group. There was no significant difference in gender, age, injured side, disease duration, preoperative glycosylated hemoglobin, wound size, and Wagner grading between groups ( P >0.05). The frequency of treatments and hospitalization day in all groups and the total amount of PRP application in groups A and B were recorded. The wound healing condition was recorded during the treatment, and the wound healing rate was calculated at 3 months after the first debridement., Results: The frequency of treatments in groups A, B, and C were (10.2±0.8), (11.4±0.6), (12.5±0.5) times, respectively. The total amount of PRP application of groups A and B were (306±24) and (342±18) mL, respectively. There was no significant difference in the frequency of treatments and the total amount of PRP application between groups ( P >0.05). The hospitalization days of groups A, B, and C were (40.5±1.8), (62.1±2.3), and (88.6±1.4) days, respectively, showing significant differences between groups ( P <0.05). In the course of treatment, the necrosis and exudation of the wounds gradually reduced, the areas of wounds gradually reduced; and the above conditions of group A were significantly better than groups B and C, and group B was better than group C. At 3 months after the first debridement, the wound healing rates of groups A, B, and C were 93.2%±0.8%, 52.1%±1.1%, and 21.3%±1.3%, respectively, with significant differences between groups ( P <0.05)., Conclusion: PRP can effectively promote the repair of diabetic foot ulcer. The effectiveness of local injection of PRP is superior to the local coverage.

Diabetic foot is one of the serious complications of diabetic patients. It is caused by diabetes combined with different degrees of lower extremity vascular lesions and neuropathy, and the wound can not heal for a long time. The serious results can cause bone marrow infection, bone destruction, and have high disability and death rate. At present, there are various treatment methods for diabetic foot chronic wound. On the basis of internal medicine controlling blood sugar, anti infection, lowering blood lipid, improving microcirculation and nourishment nerve, the surgical method is adopted, including the debridement of the necrosis in a short time to prevent the infection from spreading; maggot biological debridement and ozone chemical debridement will promote the growth of granulation tissue while controlling infection. Skin grafting, skin flap transplantation, skin distraction closure can be used to repair soft tissue defects, or fat transplantation, platelet-rich plasma, and rich blood are used for the refractory wound after infection control. In patients with diabetic foot, the reconstruction of lower limb blood supply is beneficial to the recovery of chronic ischemic wounds. It is feasible to improve the blood supply of the lower extremities, improve the blood supply of the lower extremity artery bypass grafting, and improve the microcirculation of the peripheral vessels around the lower extremities. Lower extremity vascular bypass pressure perfusion therapy for vascular network expansion, tibia lateral moving technique for lower limb microcirculation reconstruction. For diabetic foot ulcer caused by peripheral neuropathy, such as Charcot foot, while the application of external fixator, total contact cast technology of affected foot for reducing treatment to promote wound healing; the preparation of orthopedic shoes can play a maximum protective effect on the healing of diabetic foot wound healing.

Objective: To evaluate the clinical value of skin stretching device in repair of diabetic foot wound., Methods: A retrospective analysis was made on the clinical data of 48 cases with diabetic foot wound who were treated with skin stretching device (trial group, n =24) and with the vacuum sealing drainage combined with skin graft (control group, n =24) respectively between October 2015 and July 2016. There was no significant difference in gender, age, side, course of disease, TEXAS stage between 2 groups ( P >0.05). Both patients in 2 groups were treated with sensitive antibiotics according to the results of bacterial culture., Results: One case in control group was infected and the skin graft failed, and 1 case in trial group was infected after the treatment, and the two wounds healed after symptomatic treatment. The wounds of the other patients healed successfully, and the healing time of the trial group was significantly shorter than that of the control group [(12.8±11.6) days vs . (22.3±10.4) days; t =2.987, P =0.005). All patients were followed up 3-12 months after operation, and no wound dehiscence or recurrence occurred during follow-up., Conclusion: Compared with the vacuum sealing drainage combined with skin graft, the application of skin stretching device in the repair of diabetic foot wound has advantages, such as easy to operate, shorten the wound healing time, and the appearance of wound was similar with the adjacent skin.

Objective: To investigate the effect of simulated in vivo physiological environment severed limb fostering system applying remote ischemic conditioning (RIC) perfusion on preserving severed limb., Methods: Eighteen adult Bama mini pigs (24-30 kg in weight) were randomly divided into 3 groups (n = 6). No ischemic treatment was given in group A as normal control group; the right lower limbs were completely amputated and preserved at room temperature for 3 hours to make ischemic models in groups B and C, and then the severed limbs were put into the simulated in vivo physiological environment severed limb fostering system. Continuous blood perfusion was performed in group B, and continuous blood perfusion was performed after RIC perfusion in group C. After 8 hours of perfusion, the skeletal muscle samples were harvested for the morphology observation by transmission electron microscopy. The protein levels of B-cell lymphoma-2 (Bcl-2) and Caspase-3 were detected by Western blot. The content of cytochrome C in both mitochondria and cytoplasm was determined by ELISA., Results: Transmission electron microscopy results illustrated that the muscle fibers arranged more orderly and the mitochondria swelling was slighter in group C than group B. Western blot analysis showed that the protein levels of Bcl-2 and Caspase-3 were significantly higher in groups B and C than group A (P < 0.05); the protein level of Bcl-2 significantly increased and the protein level of Caspase-3 significantly decreased in group C when compared with those in group B (P < 0.05). ELISA detection implicated that mitochondrial cytochrome C significantly reduced and cytosolic cytochrome C significantly increased in group B when compared with those in groups A and C (P < 0.05), but no significant difference was found between group A and group C (P > 0.05)., Conclusion: The ischemia/reperfusion-induced injury to skeletal muscle could be considerably inhibited by RIG perfusion. The simulated in vivo physiological environment severed limb fostering system applying RIC perfusion can significantly prolong the severed limb preserving time.

Background: Radix Scutellariae, a few papers reported its pharmacology activities including alleviate small intestines smooth muscles spasm, sedation, antihypertensive effect. However, the inhibition of its different organic extracts on immediate hypersensitivity has not bee researched., Materials and Methods: To investigate the anti-immediate hypersensitivity of three extracts including ethanol extracts, acetone extracts, ethyl acetate extracts from Radix Scutellariae, four pharmacological screening model were chose, such as 4-Aminopyridine induced pruritus model, histamine-induced mouse paw edema model, PCA(passive cutaneous anaphylaxis) in ear of mouse, activie cutaneous anaphylaxismouse (mouse ear edema test), furthermore, total IgE level in the sensitized mice serum was evaluated deeply., Results: Ethanol group at 1.42 g/kg and 0.71 g/kg could greatly decrease the licking number to 1.2 and 12.7 respectively; also keep mice paw swelling at 0.29 ml and 0.51 ml at 15 min after injection of histamine. Both ear passive cutaneous allergic reaction and active cutaneous anaphylaxis-ear swelling test demonstrated that ethanol group exhibit great inhibition on immediate hypersensitivity.Low IgE level was found in ethanol group, but high in other two groups., Conclusion: The ethanol extracts exhibits obvious strong inhibition, however, the acetone ones and ethyl acetate showed a little.

Objective: To summarize the research progress of severed limb preservation by perfusion and to analyze difference in effect of severed limb preservation by different perfusate., Methods: The domestic and foreign related literature about severed limb preservation by perfusion was extensively reviewed and analyzed., Results: Currently the main perfusate includes organ perfusate, free radical scavengers, energy mixture, blood substitutes, and whole blood. They can reduce the skeletal muscle's ischemia-reperfusion injury in different degrees., Conclusion: Different perfusate can reduce the skeletal muscle's ischemia-reperfusion injury in different degrees, but the best effect of perfusate and personalized preservation method need further study.

Background: Folium Hibisci Mutabilis was one of the traditional Chinese medicines with pharmacological activities of wound healing, antibacterial and anti-inflammatory, normally applied to the clinical treatment of local purulent infection, scald, and epidemic parotitis. However, few people reported that its effects of extracts on RAW264.7, cells and TNF-α, IL-6, and NO levels in rats serum of inflammation rats., Materials and Methods: We mainly adopted the RAW264.7, macrophage cell line which was intervened by lipopolysaccharide (L PS), to establish the model of inflammatory cells. The secretion changes of TNF, and IL-6, level in the model cell acted by the FHMAEs, were detected by ELISA, NO level changes were determined by nitrate reductase method; Arthritis model induced by Collagen Type II were chose, and regulatory role of FHMAEs on IL-6 and NO level in serum were observed, FHMAEs mechanism of action were investigated in the treatment of rheumatoid arthritis. The states of the model rats were recorded., Results: Release of TNF-α, IL-6, and NO in LPS-induced RAW264.7, cells were significantly inhibited and has a clear dose-response relationship; The TNF-α, IL-6 and NO levels were reduced by FHMAEs in experimental arthritis rats serum, and the status of rats were improved. At last, we found that IL-6, NO and TNF-α levels in the inflammatory cells could be reduced by FHMAEs greatly., Conclusion: Both synovial inflammation and synovial proliferation could be reduced or inhibited by FHMAEs, all of this may provide experimental effective data for the novel drugs development and the clinical treatment of rheumatoid arthritis.

Objective: To evaluate the effectiveness of anterolateral thigh and groin conjoined flap in emergent repair of ultra-long complex tissue defects in forearm and hand., Methods: Between February 2009 and October 2011, 6 patients with complex tissue defect of dorsal forearm and hand were in adminsion. There were 5 male and 1 female with an average age of 38.5 years (range, 32-47 years). Injury reasons included machine injury in 5 cases and traffic accident injury in 1 case. Injury to admission time was from 3 to 16 hours (mean, 6 hours). All case were single limb injury, including right forearm and hand injury in 4 cases and left forearm and hand injury in 2 cases. The wound area was from 36 cm x 9 cm to 48 cm x 12 cm. The type of associated injury included elbow dislocation associated with open injury in 2 cases; fractures of the radial, ulnar, and metacarpal bone in 4 cases; defects of wrist dorsal skin and extensor tendons of fingers and wrist in 5 cases; and defects of ulnar artery and ulnar nerve in 1 case. The anterolateral thigh and groin conjoined free flaps were used to repair defects in the forearm and hand in emergency. The area of flap was from 36 cm x 9 cm to 48 cm x 12 cm. Meanwhile the partial functional reconstruction was performed. The donor site was repaired by skin grafts., Results: The anastomotic embolization of vascular pedicle and arteria interossea dorsalis occurred in 1 case, purulent secretion under the flap in 1 case, which were cured after symptomatic treatment; the skin flaps completely survived, and primary healing of the wounds were obtained in the other cases. The donor skin grafts survived in 2 cases, and partial necrosis of the skin graft of lower abdominal occurred in 4 cases, and healed after changing dressing. All of the 6 patients were followed up 3 to 18 months (mean, 10 months). The appearance and texture of the flaps were good. The protective sensation was recovered in 2 cases followed up for more than 14 months; no sensory recovery was observed in the other cases. At last follow-up, according to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 1 case, good in 4 cases, and poor in 1 case, and the excellent and good rate was 83.3%., Conclusion: It could get a good short-term effectiveness to use the anterolateral thigh and groin conjoined flap for emergent repair of the ultra-long and complex tissue defects in forearm and hand.

The objective of this study was to analyse the changes of inflammatory cytokines level in traumatic rat serum after maggot secretions intervention. Acute traumatic rats were randomly divided into three groups that included maggot secretions group, negative group, and the control group. TNF-α, IL-6, SOD, LPO levels were measured by radioimmunoassay. The experimental results showed that TNF-α, IL-6, and SOD levels in the model group were significantly increased; LPO level was decreased and showed significant differences. Thus, the content of inflammatory cytokines in acute skin wounds could be reduced by maggot secretions, which play a role in enhancing wound healing.

The objective of this paper was to study the anti-inflammatory and analgesic effects of Radix Angelicae Pubescentis (R.A.P) ethanol extracts. Three classic anti-inflammatory models and two analgesic models were used in this research. In anti-inflammatory tests, all the extracts have a certain inhibition on the acute inflammation induced by xylene, however, 60% ethanol extract significantly inhibited the inflammation in the three models. In analgesic experiment, compared with the blank control group, the comparisons between R.A.P. groups and control group had significant difference (p < 0.01). The incubation period in mouse writhing test or the tail-curl immersion tests could be extended greatly.

The objective of this paper was to study the extraction methods of tannin constituents from Semen Cuscutae and their anti-papilloma effects. Single factor test and orthogonal design methods were used to determine the optimal extraction method; the mouse skin papilloma model induced by DMBA/croton oil was established, which was a classic two-stage carcinogenesis model being used to observe and evaluate the anti-carcinogenic effects of tannins extracted from Semen Cuscutae in different stages. The optimal extraction method of Semen Cuscutae was a 20-fold volume of solvent, a temperature of 50 °C, three times of extraction, with 20 min each, skin papilloma experiment revealed that the number of bearing tumors gradually reduced, and the inhibition rate gradually increased with the increase of dose, in the high-dose group, its inhibition rate reached 70.2%. Tannin extract from Semen Cuscutae has an obvious inhibitory effect on skin papilloma development.

Objective: To investigate the effects of different temperatures on the system of in vitro physiological environment fostering limbs., Methods: Twenty-four limbs were harvested from 6 adult Bama mini pigs and were randomly divided into 4 groups (n=6) according to different temperatures: limbs were placed in in vitro physiological environment fostering limbs at 26 degrees C (group A), 4 degrees C (group B), 10 degrees C (group C), and 18 degrees C (group D). After 12 hours of perfusion, the morphology observation was done for the structure and ultrastructure changes of the skeletal muscle by light microscope and transmission electron microscope. The mRNA levels of tumor necrosis factor n (TNF-alpha) and interleukin 10 (IL-1beta) were detected by real-time fluorescent quantitative PCR (RT-qPCR)., Results: Histological results showed that the skeletal muscle exhibited mild edema, integrity of the sarcolemma, and occasional perivascular inflammatory cell infiltration in groups B, C, and D, meanwhile, the cells of group C had normal morphology; however, muscle fibers degenerated, muscle cells were seriously damaged, a great number of inflammatory cells infiltrated in the fractured muscle fibers in group A. Transmission electron microscope results showed as follows: the muscle fibers arranged in disorder, and many focal solubility necrosis occurred in group A; the muscle fibers arranged in order relatively and sarcolemma was still intact, with mild swelling and flocculent degenerative mitochondria in group B; a large number of muscle fibers arranged in order and regularity with clear sarcomere in group C; and the muscle fibers arranged in disorder and irregularity and partly dissolved in group D. RT-qPCR results showed that the expressions of inflammatory factor TNF-alpha and IL-1beta mRNA in group A were significantly higher than those in groups B, C, and D (P < 0.05); the expressions were significantly lower in groups B and C than in group D, and in group C than in group B (P < 0.05)., Conclusion: In the system of in vitro physiological environment fostering limbs, temperature plays an important role in the preservation of amputated limbs. It is suggested that 10 degrees C can significantly attenuate the reperfusion-induced skeletal muscle cell injuries in this system.

The interleukin-6 (IL-6) pathway is one of the mechanisms that link inflammation and angiogenesis with malignancy. Since nuclear factor-κB (NF-κB) is a potential sign for inflammation, NF-κB has been associated with the progression of disease in various types of cancer. In the present study, we investigated the effect of NF-κB on the IL-6 pathway in gastric carcinoma and their correlation with disease status and prognosis. The mRNA and protein levels of NF-κB, IL-6 and vascular endothelial growth factor (VEGF) were detected by western blotting and reverse transcription (RT) quantitative PCR (RT-qPCR). Using immunohistochemistry, we examined the expression of these proteins in normal and human gastric cancer tissue samples. The concentrations of IL-6 and TNF-α in collected blood samples were measured according to the enzyme-linked immunosorbent assay (ELISA). IL-6 and TNF-α were found to be expressed at high levels in human gastric cancer samples. A positive correlation was found between the expression of IL-6 and NF-κB by immunohistochemical and further correlation analysis. IL-6, NF-κB and VEGF protein and mRNA levels increased significantly in gastric cancer tissue compared with those in adjacent normal mucosa tissue samples. In conclusion, our findings demonstrate that NF-κB, IL-6 and VEGF mRNA and protein levels increase significantly in gastric cancer tissues. In addition, the expression of NF-κB was positively correlated with the expression of IL-6 according to immunohistochemical and further correlation analysis, which suggests that the suppression of NF-κB or IL-6 may be a potential target for clinical therapy of gastric cancer in the future.

Single-molecule fluorescence resonance energy transfer (smFRET) has emerged as a powerful tool for mechanistic investigations of increasingly complex biochemical systems. Recently, we and others have successfully used smFRET to directly investigate the role of structural dynamics in the function and regulation of the cellular protein synthesis machinery. A significant challenge to these experiments, and to analogous experiments in similarly complex cellular machineries, is the need for specific and efficient fluorescent labeling of the biochemical system at locations that are both mechanistically informative and minimally perturbative to the biological activity. Here, we describe the development of a highly purified, fluorescently labeled in vitro translation system that we have successfully designed for smFRET studies of protein synthesis. The general approaches we outline should be amenable to single-molecule fluorescence studies of other complex biochemical systems., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objective: To study the recovery method and effect of amputated foot after temporary ectopic implantation., Methods: Two male patients with amputated foot were treated with temporary ectopic implantation in July 2001 and January 2002. Amputated foot was caused by mechanical injury and crush injury. After 6 hours, temporary ectopic implantation of amputated foot was given and replantation was done 3 months after primary operation. The recovery methods were as follows: automatic and passive motion, high pressure oxygen, massage, protective and positional feeling training, etc. The effects of recovery was observed., Results: All amputated foots survived after operation, the time of follow-up was 6 years, and 5 years and 7 months. Extension degree of first metatarsal digital joint was 12 degrees and 15 degrees, flex degree of first metatarsal digital joint was 15 degrees and 13 degrees, and extension degree of other metatarsal digital joints was 8 degrees and 9 degrees. Force degree of extension muscle was 4, force degree of flex muscle was 4, and two-point discrimination was 20 mm and 18 mm. Patients recovered their superficial sensibility, touch sense, deep pain sense and topognosis. The skin color and temperature were normal. And the patients could do some housework., Conclusion: Temporary ectopic implantation of amputated foot can recover the function of amputated foot by motor and sensitive recovery methods.

Objective: To study the influence of maggot secretion on expression of bFGF and connective tissue growth factor (CTGF) in ulcer tissue of diabetes mellitus (DM) rats and its antibacterial function., Methods: There were 40 3-month-old SD male rats (weighing 300-350 g) which were randomly divided into 2 groups: control group and experimental maggot secretion group. The model of ulcer wound of DM rats was made. The ulcer wound of DM rats in maggot secretion group spread maggot secretions, but no secretion on ulcer wound was found in control group. The morphological and tissue changes of ulcer wound were observed at different times, and the conditions of bacterial infection on ulcer wound in the two groups were checked. Tissue slices were prepared on 7, 14 and 21 days, respectively; immunohistological detection of bFGF and CTFG in ulcer wound of the two groups was done; and the cell number of positive expression of bFGF and CTFG was counted., Results: It was found that the healing of ulcer was dominant in experimental group; the wound was clean; the tissue regenerated and no Staphylococcus aureus infection was seen. Bad healing was obtained in control group; tissue necrosis was found and the rate of Staphylococcus aureus infection was 60%. Positive expression cell number of bFGF in ulcer wound was detected on 7 and 14 days after operation with 23.76 +/- 3.34 and 52.76 +/- 4.84 in experimental group, and 18.88 +/- 2.16 and 46.04 +/- 4.00 in control group. Positive expression cell number of CTGF in ulcer wound was detected on 7 and 14 days after operation with 18.76 +/- 3.24 and 46.52 +/- 4.07 in experimental group, and 12.52 +/- 3.03 and 40.52 +/- 3.96 in control group. There was significant difference between positive expressions of bFGF and CTFG in the two groups (P < 0.05)., Conclusion: The maggot secretion can elevate the expressions of bFGF and CTFG in ulcers, promote healing and prevent bacterial infection.

Objective: To observe the clinical effect of repairing rectovaginal septum with graft of fascia flap with blood vessels., Methods: From August 2004 to August 2006, 12 female patients with rectocele were treated, aging 49-73 years. The disease course was from 5 to 30 years(mean, 5.6 years). All patients suffered dysporia. X-ray films showed severe rectocele (> or = 30 mm), or with the descendent perineum syndrome (> or = 40 mm), and inner pendant rectal mucosa (3 cases) and/or narrow anal canal (9 cases). The size of fascia flap ranged from 15 cm x 3 cm to 18 cm x 5 cm., Results: The bleeding amount was 800 ml in 2 cases, and 500 ml in 10 cases. All fascia flaps survived. In the 12 patients, 11 had a primary wound healing (Stage I), 1 had a delayed wound healing (Stage II). The donor sites healed at Stage II. Twelve patients could defecate normally 4-6 days after surgery. The legs edema occurred in 2 cases, urinary retention combined with infection occurred in 1 case. And all recovered completely after treatment. Eleven patients were followed up for 6 to 12 months. Digital anorectal examination showed prerectal pouch disappearance, glaze surface and good elasticity. X-ray films and CT showed that the rectocele disappeared., Conclusion: The operation of repairing rectovaginal septum with graft of fascia with blood vessels can effectively recover anatomy of rectovaginal septum and its normal biological function.

Objective: To study the effect of motor nerve implantation after ectopic transplantation of skeletal muscle on nerve regeneration in rat., Methods: Sixty Sprague-Dewley male 8-monthold rats were randomly divided into 3 groups: control group, in situ implantation group and ectopic transplantation group. In control group, obturator nerve controlling right gracilis was cut off. In in situ implantation group, the right gracilis was cut off and replanted to its original site, and the obturator nerve was implanted to the muscle. In ectopic transplantation group, the right gracilis was cut off and transplanted to the muscle of the left leg, and the obturator nerve was implanted to the muscle. After 25 weeks, the neurophysiological information was collected through electromyography and the weight of the muscle was measured., Results: The potential without control of the nerve existed in control group. There were no significant differences in latency, amplitude and conduct velocity between in situ implantation group and ectopic transplantation group (P > 0.05). The atrophy of gracilis was dominant in control group, the weight of the muscle was 158.0 +/- 19.3 mg. The weights of the muscle were 509.6 +/- 14.5 mg in ectopic transplantation group and 516.8 +/- 12.7 mg in in situ implantation group, showing no significant difference (P > 0.05). The weights of the muscle in in situ implantation and ectopic transplantation group were larger than that in control group, showing significant difference (P < 0.05)., Conclusion: Motor nerve implantation after ectopic transplantation of skeletal muscle could prevent the atrophy of the muscle and resume partial function of nerve.

Objective: To introduce the surgical procedure and indication of the dorsoulnar arterial retrograde flap of the thumb in repair of soft tissue defect., Methods: From March 2000 to March 2001, 12 cases of soft tissue defect with exposed bone at the distal thumb were involved. Ten flaps were pedicled distally at the proximal rotation point, 2.5 cm proximal to the cuticule. Two flaps were pedicled distally at the distal rotation point, 1.0 cm proximal to the cuticule. The flaps harvested in this study were 1.1 cm x 1.3 cm to 1.8 cm x 2.5 cm., Results: All the flaps survived. After an follow-up of 2 to 14 months postoperatively, the appearance of the thumbs were satisfactory, except those of 2 thumbs repaired by the flaps transferred at the distal rotation point, which were bulkiness because of the uncovered pedicle. In 6 cases, the defect of finger pulp was repaired, and the 2-point discrimination was measured 8-10 mm. The same range of motion of the thumb IP joint were observed in both sides in all cases., Conclusion: The optimal indication of the procedure is soft tissue defect at the distal thumb.