ABSTRACT
Objective To probe the pathogenesis of long bone defects and damage to epiphysis as the result of postoperative infections following fractures in the childhood of patients, and to look for ideal ways to prevent and repair the defects and damages. Methods The treatment of the infected bone defect of a tibia had been continued for one year following fracture in one four-year old patient, and the treatment of the infected bone defect of a humerus had been continued for ten years following fracture in another seven-year old patient, but all the treatments had failed. The injured limbs developed bone infection, bone defect, bone exposure, shortening, and pseudoarthrosis deformities at last. Then the lesions were completely cleaned, and the deformities of the infected bones were corrected in one stage, with reconstruction of the bone and the repair of the wounds by transplantations of fibular free flaps. Results Both fibular free flaps survived in one stage transplantation. The bones of the injured limbs healed half a year after the operations, and weight-bearing and walking functions of the injured limbs recovered as well. Conclusion Transplantation of fibular free flap was an ideal way to treat a long bone defect as a result of postoperative infection following fracture in the childhood. The early appropriate treatment of postoperative infection following fracture is very important to avoid bone and epiphysis damages.
ABSTRACT
Objective to study the factors of delaying survival of the ankle and foot which were linked with leg only by skin, fascia and tibia after all the infected and inactivated muscles and intermuscular vessels had been removed, and to study the effect of artery blood supply reconstruction to avoid the necrosis and ischemia contracture of the foot. Methods The leg was linked with ankle and foot by the tibia which was covered only by skin and fascia after all the muscles, interosseous membrance, intermuscular vessels and fibula had been removed. And then the artery blood supply for the injured limb was reconstructed by stages. Results The sense of haphalgesia, with normal temperature and color, recovered in the injured limb 7 months after operation, no contracture and deformity happened in the food muscles and joint, and the patient may smooth stand and walk with a stick freely. Conclusion The necrosis and ischemia contracture of foot was delayed by reticular collateral circulation among skin, deep and superficial fascia and tibia of the injured limb, although the blood supply was very little after all the muscles and intermuscular vessels had been removed because of infection and necrosis. Finally the injured limb was reserved successfully by artery blood supply reconstruction. The clinical effect was satisfactory.
ABSTRACT
Objective To establish an effective technique in reservation and function reconstruction of a leg, in which all the muscles except gastrocnemius necrosed induced by the delayed necrosis of all the intermuscular vessels, the foot was linked only by skin, fascia and tibia. Methods The leg was linked with foot only by the skin, fascia, caput mediale of gastrocnemius and tibia when all the muscles, intermuscular vessels and fibula were removed. The direct island flap of tibialis posterior artery was cut from the healthy limb and used to cover the 4/5 length and 1/3 circumference of bone-fascia raw surface, then to anastomose the both arteries of the flap and the caput lateral gastrocnemius when dividing the pedicles. As soon as the raw surface healed, fuse the ankle in the functional situation and fix the flexor and extensor tendon in the proper situation. Results With sufficient blood supply from the skin and fascia of the flap, the raw surface healed soon, the severe ischemia pain relieved, and the circulation and sensation recovered gradually. The crutching and walking function of the leg reconstructed at last. Conclusion When all the necrotic intermuscular vessels and muscles except caput mediale of gastrocnemius were removed, the necrosis may be delayed by means of reticular collateral circulation among skin, deep and superficial fascia and tibia of the injured limb. However, the blood supply is very little, the severe ischemia wound and ischemia pain can't be healed. Through the tibialis posterior artery direct island skin flap of the healthy leg to cover the dystrophic wounds, the blood supply of the leg can be improved. As a result, the leg survives and its function is reconstructed, and an eternal axial-pattern artery for the wound leg through arteries anastomosis is rebuilt.
ABSTRACT
Objective To study the characteristics of toe-to-thumb transplantation in a group of infants who completely lacked the thumb.The mean age was 24.6 months,and the youngest was 10 months old,The operative technique and rehabilitation were studied.Methods In two infants with Ⅲ-Ⅳ? defects of the thumb together with multiple injuries of fingers,the wounds were debrided and toe-to-thumb transplantation was done later.In case 3 Ⅲ? defect of the thumb together with palm injury,one-stage toe-to-thumb transplantation and the palm injury was covered with an abdominal flap were done at the same time.Considering the characteristic physiological structure of a dorsalis pedis and the first metatarsal arteries.In the infant,minimally invasive operation under 10? microscope was employed.A series of early functional exercises was given for the reconstructed thumbs.Results The reconstructed thumbs completely survived,hand function was recovered 3-6 months after the operation.With follow-up for longer than 2 years in 2 cases,it was noted that the reconstructed thumb grew consistent with the wounded hand.The appearance and function thumb were satisfactory.Conclusion Toe to thumb transference was successful in infancy,with the combined technique of minimally invasive and plastic surgery.Reconstruction of the thumbs can be completed in two stages on immediately after injury.The appearance and function can be restored.[