ABSTRACT
Objective To investigate the clinical efficacy of microsurgical repair of soft tissue necrosis after beak-type calcaneal fracture.Methods From January,2012 to March,2017,surgically flaps were used to repair wounds in 8 patients with soft tissue necrosis after calcaneal beak fracture.Five patients underwent sural neurovascular flap in the first stage of repair,2 patients were treated with peroneal perforator propeller flap,and 1 patient was treated with posterior tibial artery perforator propeller flap.The donor sites of 3 flaps were directly closed,and donor areas of the remaining 5 were covered with medium-thickness skin grafts without being sutured directly.The size of flap was 5.0 cm× 3.0 cm-7.0 cm × 5.0 cm.Through postoperative outpatient and WeChat follow-up.The patient's flap survival,infection,flap shape,sensation and ankle function were evaluated.Results All flaps and skin grafts survived post-operatively.All patients were followed-up for 6-12 (mean,8.4) months.All patients had good flap survival and no complications such as soft tissue and calcaneal infection.The flaps were good in texture,shape and function of ankle.At the last follow-up,according to the British Medical Research Institute (BMRI),the sensory function was divided into 6 levels.The flap sensory function recovered to S2 in 3 cases,and the remaining 5 cases was S1.According to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-hindfoot Scale (AHS),the results were excellent in 5 cases,and good in 3 cases.All patients had good clinical results and satisfaction at the last followedup.Conclusion The treatment of soft tissue necrosis after calcaneus beak fractures can be completed in one stage by using flaps,which avoided the occurrence of calcaneal osteomyelitis.It is easy to perform early rehabilitation exercise and the ankle function is well restored.
ABSTRACT
Objective To investigate the effects of changing the arteriovenous pressure difference on the survival area of reverse island flap in New Zealand white rabbits models.Methods The saphenous artery and saphenous vein of New Zealand rabbits were selected to design experimental models of reverse island flap.Experi mental rabbits were randomly divided into 4 groups:group A:control group (reserved pedicle integrity of superficial veins);group B:part anastomosis of saphenous artery group (the distal saphenous artery of the flap was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group C:part anastomosis of vein group (distal superficial veins was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group D:ligated superficial veins group (pedicle superficial veins was ligated).After surgery,the flaps were measured by general observation.Blood distribution at different times of the flaps was detected by radionuclide scans.Survival area of the flap was measured to compare the survival rate of flap.Distribution of blood vessels and the state of blood cells were observed by Histological examination.Results The flap survival rate was (82.27-± 11.71)％ in group B,showing significant differences when compared with that group A (47.70-± 11.18)％,group C (47.70 ± 11.18)％ and group D (47.70 ± 11.18)％ (P ＜ 0.05).Radionuclide scans showed that the radioactive material in group B could be seen clearly,the radioactive material in groups A,C and D were a transient existence.Ten days postoperatively,histological observation showed that group B had more capillary regeneration and blood cells remain compared with other groups.Conclusion Increase the blood supply can increase the survival area of the reverse island flap,and simply promote the venous drainage can not effectively improve the survival rate of the flap.
ABSTRACT
Objective To explore the effects of low-dose X-ray irradiation effects on ischemic flap survival and its possible mechanism.Methods From June, 2014 to December, 2014, 80 SD rats were include in the study, the rats were randomly divided into 2 groups: the experimental group A and control group B.There were 40 rats in each group.The ischemic flaps with the size of 9 cm × 3 cm were designed on the back of the rats.The pedicle of the flaps was near to the tail.A sterile biological isolating membrane was placed under the flap to block the blood supply between muscular layer and flaps.The flaps were intermittently sutured into their original position.The group A was immediately received single and local irradiation of 0.2 Gy after surgery, The group B was not treated.On days 1 to 14 after operation,general observation,HE staining and the western blot of the flaps were performed to calculate the survival vate of the flaps, observe neovascularization and determin the content of VEGF and MMP-9, respectively.Results On the third, seventh and fourteenth days, survival rates of the flaps in the experimental group [(66.46 ± 4.37)％, (44.30 ± 3.86)％, (32.20 ± 4.22)％, respectively] were higher than the control group [(43.15 ± 5.03)％, (27.71 ± 3.20)％, (16.40 ± 5.34)％, respectively] after inspection, there were statistically significant differences between these indices (P ＜ 0.01), HE staining of the flaps in the experimental group were seen in the fibroblast infiltration and neovascularization were higher than that of control group, and experimental group within the lumen of blood vessels were arranged in order, the groups were visible tissue edema obviously control, neovascularization in small numbers, the lumen was irregular.On the third and seventh days, MVD rates of the flaps in the experimental group (85.54 ± 6.12, 44.32 ± 3.56, respectively) were higher than the control group (49.35 ± 4.75,18.75 ± 2.89,respectively) after inspection, there were statistically significant differences between these indices (P ＜ 0.01).VEGF and MMP-9 protein content in the flap for the seventh day in the experimental group were significantly higher than that of the control group.Conclusion Low-dose X-ray irradiation can promote the survival rate of ischemic flap, the mechanism may be related to the expression of VEGF and MMP-9 increased and promoted angiogenesis of the flaps after low-dose X-ray irradiation.