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Objective To explore the possibility of treating tibial osteomyelitis with transfer of a compound flap composed of the sural nerve fasciocutaneous flap and the lateral gastroenemius muscle.Methods We observed in cadaver specimens the anatomical structure of the sural nerve fasciocutaneous flap and the lateral gastrocnemius muscle to design a compound flap. Fifteen cases of tibia] osteomyelitis were treated with sinus excision and thorough debridement before the skin defect area was covered with a sural nerve compound flap whose muscle was stuffed into the tibia] channel. Plates were replaced with unilateral fixators in 3 cases of tibial nonunion. Results We observed 5 to 6 perforating branches of blood vessels between the sural nerve fascioeutaneous flap and the lateral gastroenemius muscle, indicating that the two can be harvested simultaneously in one compound flap. The transferred compound flaps survived in 15 cases. Tibial os-teomyelitis was completely cured in 14 cases, 1 case healed after second debridement, and 3 cases of tibial nonunion healed 6 months later after a second stage iliac bone graft. No recurrence was found after a mean follow-up of 18 (10 to 26) months. Conclusion A compound flap composed of the sural nerve fascio-cutaneous flap and the lateral gastrocnemius muscle can be used to treat tibia] osteomyelitis effectively.
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Objective To explore the feasibility and effects of one stage vascular free fibular transplantation or combination of bone transport two-stage technique for reconstruction of adversity congenital pseudarthrosis of the tibia. Methods Vascularised free fibular reconstruction operations for adversity congenital pseudarthrosis of tibia were performed in 16 cases, including male in 9 and female in 7,age ranged from 6 to 14 years with the mean in 8.5 years. 2 to 6 operations history were documented in all cases with the mean in 3.2 before went to our hospital, with 3 to 12 cm and mean 5.8 em short of the tibia. Mean9.2 cm (from 6.0 to 16.0 cm) vascular free fibular were harvested and transplanted to reconstruct the bone frame in 16 cases, bone transport operation were performed in 4 cases 1 year later. Results Fourteen cases were followed up for mean 4.5 years, bone union could be found by radiology examination, mean 7.8cm (from 4.0 to 11.5 cm) elongation of the low limb were obtained in 4 cases. Basic walking function was obtained in all cases. Conclusion It is an effective method to treat adversity congenital psuedarthrosis of the tibia by thoroughly resection of the focus and enough length of vascular fibular transplantation, deficiency of low limb can be ameliorated by bone transportation technique in those patients.
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BACKGROUND: Basic flbroblast growth factor (bFGF) can promote tendon proliferation, collagen secretion,and out-sheathed tendon healing; however, effects on in-sheathed tendon are still unknown.OBJECTIVE: To explore the effects of exogenous bFGF on in-sheathed tendon healing and adhesion formation. DESIGN,TIME AND SETTING: A randomized controlled animal study, which was carried out in Experimental Animal Center, Shanghai Sixth People's Hospital from May 2004 to February 2005.MATERIALS: Ninety Leghorn chickens were randomly divided into 3 groups with 30 animals for each, and the right third digitorum longns tendon of the chicken was transected. METHODS: In the control group, the tendon was sutured in situ after transection. In the fibrin group,the tendon was sutured after 0.6 μL fibrin sealant (FS) was applied at repair site. In the bFGF group,the tendon was sutured after 0.6 μL FS mixed with 500 ng bFGF was applied at repair site. MAIN OUTCOME MEASURES: At 1,2,4 and 8 weeks postoperatively, the tendons of 6 chickens in each group were harvested for morphological and histological evaluation.Another six specimens of each group was obtained for biomechanical test at 8 weeks.RESULTS: There were no significant differences between control group and fibrin group. In bFGF group compared with control and fibrin groups, appearance of the angiogenesis,fibroblast proliferation and collagen production in the sheath, epitenon and parenchyrna at repair site occurred earlier and were more in quantity,the gliding excursion of the tendon was shorter, and the work of flexion and the ultimate tensile strength of the tendon were greater. CONCLUSION: The exogenous bFGF at tendon repair site can facilitate in-sheathed tendon healing, but also increase the tendon adhesion.
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BACKGROUND: The articular surface of interphalangeal joint and metacarpophalangeal joint is destroyed or defected, that would remain serious sequela in many patients and affect patient's routine work and living. Therefore, therapeutic efficacy of finger joint damage determines the functional recovery of hands. Tissue engineering provides a novel pathway for finger joint damage. OBJECTIVE: To summarize the research progress on the repair and reconstruction of finger joint damage. RETRIEVAL STRATEGY: The researcher of this article used the computer to retrieve literatures of Pubmed database with docuterms of "Interphalangeal joints fractures, Metacarpophalangeal joints fractures, Finger osteoarticular, Reconstruct", and the language was defined to English. Meanwhile China Academic Journals Full-Text Database from 2000 to 2007 was also retrieved with docuterms of "Interphalangeal joints, Metacarpophalangeal joints, Fractures, Repair and reconstruct", and the language was defined to Chinese. Totally 106 correlated articles were screened out and the data were firstly checked. Inclusion standard: ①closely correlated to the repair and reconstruction of finger joint damage; ②those published in the near future or authorized journal in the same field were preferred. Exclusion standard: repetitive investigation. LITERATURE EVALUATION: The resource of literatures was the clinic empirical studies of the repair and reconstruction of finger joint damage. Among 32 included articles, 3 of them were reviews and the others were clinic or empirical studies. DATA SYNTHESIS: The homogeneity variant bone-joint transplantation has got some successes in clinic, but how to prolong the survival time of transplanting joints would be a new research topic. Autoallergic joint transplantation is a good method to treat the defects of finger joints, but how to make handling conveniently, diminish secondary damage and search new donor site, all deserve to research. The ideal therapeutic efficacy of the finger joint damage is anatomical reset of the joint profile, that can reduce traumatic arthritis and anchylosis at the minimal level. But it is still a tough problem in the fingers joint's repairs, because of the multiple structure of bone-joint in hands and trauma factors. Open reduction and internal fixation, skeletal traction, arthroplasty, fusion of joint, prosthetic replacement of joint, articular transplantation and bone-joint tissue engineering have all obtained success, but none can fully succeed or be generally adopted. CONCLUSION: There are many treatments of the finger joint damage, but their results are not very well. With the research of homogeneity variant bone-joint transplantation, autoallergic joint transplantation and tissue engineering development, bone-joint transplantation will have a wide prospect in treatment of finger joints damage.
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0.01). CONCLUSION: The 5th CMC joint of the hamatum can be considered to be a new and well joint donor site, and it can be used to repair and reconstruct the base joints of the proximal phalanx.
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Objective To report the technique of functional reconstruction for knee joint following destructive injury and its outcome. Methods In the period from June 1991 to April 2001, microsurgery was done for 4 cases to reconstruct functions of the damaged knees. The operations were combined with transplantation of bilateral latissimus dorsi myocutaneous flaps, emergency transplantation of latissimus dorsi myocutaneous flap, emergency transplantation of useless leg composite tissue and emergency rotation- plasty, respectively. Results All the transplants survived completely. The follow- ups, ranging from 4 to 14 years, revealed normal or nearly normal functions in all the repaired knees. Conclusion Whenever possible, a knee with destructive injury should be repaired and reconstructed, and microsurgery may offer an effective solution.
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Objective To report the preliminary clinical results of treatment of severely comminuted radial head fractures by replacement with floating cup radial head prosthesis. Methods In the period from August 2002 to June 2005, replacement with floating cup radial head prosthesis was performed to treat 10 cases of Mason Ⅲ , Ⅳ radial head fractures, of whom 9 were acute fractures and 1 old. Results All the patients were followed up for 6 to 40 months (mean 14.9 months). The mean flexion/extension of the elbow was 133.5? /9.0? , while the mean pronation/supination of the forearm was 78.5? /84.0? . There were 3 cases of mild pain, 1 case of mild valgus instability in the elbow and 3 cases of mild weakness. The Broberg and Morrey elbow scores averaged 93. The result was excellent in 6 cases, good in 3 and fair in 1, the excellent and good rates were 90% . Conclusion The replacement with floating cup prosthesis shows satisfying preliminary clinical outcome in the treatment of radial head fractures unable to be reduced, while its long- term result needs further follow- up
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Progress in the metacarpophalangealgeal joint implantation has drawn increasing attention to its role in treatment of chronic arthritis of the hand. This paper summarizes the biomechanic research and devolvement of the prosthesis, preoperative evaluation and plan for metacarpophalangealgeal joint implantation and the clinical results of different designs of the MCP prosthetic joint in the past decade. With improvement of prosthesis designs and operative technology, the MCP implantation will play a better role in clinical treatment of chronic arthritis of the hand, such as relief of pain, rectification of abnormality and functional recovery of the hand.