ABSTRACT
Methods:A retrospective case-series study was performed to analyzed the data of 38 patients (38 feet) with displaced intra-articular calcaneal fractures admitted to Xuzhou Central Hospital from January 2016 to May 2018. There were 21 males (21 feet) and 17 females (17 feet), with the age of (33.7±6.2)years (range, 21-53 years). According to the Sanders' classification, 7 patients were classified as type II, 27 as type III and 4 as type IV. All patients underwent the procedure of subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon procedure. The operation time, intro-operative management, incision healing, and post-operative complications (nerve, vessels and tendon injuries)were recorded. B?hler angle, Gissane angle, length, width and height of the calcaneus, and bone healing time were recorded at postoperative 2 days and at final follow-up. The visual analogue score (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scale, and Foot and Ankle Outcome Score (FAOS) were recorded at final follow-up, and were used to evaluate the clinical and functional outcomes.Results:All patients were followed up for 12-42 months [(18.7±5.3)months]. The operation time ranged from 45 to 100 minutes [(72.4±22.6)minutes]. Bone grafting was not observed, and microfracture of the posterior articular surface of the calcaneus were involved in 9 patients. The first-stage incision healing was achieved in all patients, without early complications of nerve, vessel and tendon injuries. The post-operative angles of B?hler and Gissane, length, width and height of the calcaneus were significantly improved compared to preoperative values ( P<0.01), while there were no significant difference at postoperative 2 days and at final follow-up ( P>0.05). At final follow-up, the VAS decreased from 5(3, 9)points to 0(0, 3)points, AOFAS improved from (68.3±10.5)points to (90.6±5.0)points, and FAOS improved from (66.9±9.1)points to (89.8±4.3)points, respectively ( P<0.01). According to the AOFAS ankle and hindfoot scale, the result was excellent in 27 patients, good in 8, and fair in 3, with the excellent and good rate of 92%. Conclusions:For displaced intra-articular calcaneal fractures, subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon has advantages of precise fracture reduction, low postoperative complications and reliable functional outcomes.
ABSTRACT
Objective@#To examine the clinical effect of all-inside endoscopic treatment of recalcitrant plantar fasciitis through two medial portals.@*Methods@#The recalcitrant plantar fasciitis data of 67 cases (79 feet) that underwent two medial portals all-inside endoscopic treatment at Department of Hand and Foot Microsurgery, Xuzhou Central Hospital from October 2016 to June 2018 were retrospectively analyzed.There were 24 males (30 feet) and 43 females (49 feet) aged 44.3 years old(range:24-76 years).The mean disease duration from the specialist doctor intervention to operation was (23.7±11.0) months (range: 12-60 months). All the patients were treated with the two medial portals all-inside endoscopic procedure when the 6 months conservative treatment had failed.The endoscopic procedure including debridement and partial plantar fasciotomy.The clinical results,including pain,activity,gait and foot health quality,were scored using visual analogue pain scale (VAS),American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale (AOFAS) and SF-36.@*Results@#All the patients were followed up for (15.2±6.7) months (range: 12-24 months). All cases achieved primarily healing of the wound without postoperative complications of nerve,vessel and tendon.At the last follow-up,the VAS decreased from (5.3±2.0) preoperative to 0 prooperative (t=21.60, P=0.000), AOFAS increased from (72.6±9.4) to (97.3±4.6)(t=19.43,P=0.000),SF-36 increased from (93.6±8.4) to (119.1±7.3) (t=18.78, P=0.000), non-recurrent calcaneal spur, normal foot and ankle activity was recorded.@*Conclusion@#The two medial portals all-inside endoscopic procedure is effective for the treatment of recalcitrant plantar fasciitis.
ABSTRACT
Objective@#To analyze the clinical effects of all-inside arthroscopic treatment for the patients of avulsion fracture of tibial origin withⅠdegree supination and external rotation injury according to the Lauge-Hansen classification.@*Methods@#A retrospective analysis of 34 patients (34 feet) who had underwent all-inside arthroscopic for avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury from September 2015 to September 2017 in Department of Hand and Foot Microsurgery, Xuzhou Central Hospital. There were 20 males and 14 females, aged (24.7±11.3)years (range:14-43 years). The duration from injury to operation was (4.3±2.5) d (range: 6 h-7 d). The pro-operation visual analogue scale(VAS) of pain was 6.8±1.4(range: 4-8). All the patients were treated with the all-inside arthroscopic procedure by using the anterolateral and near-anterolateral portals and the fractures were fixed with cannulated screws. Main outcome measures included the pain, foot appearance, and patients were scored using the American Orthopaedic Foot & Ankle Society Lesser Toe Metatarsophalangeal-Interphalangeal Scale(AOFAS).@*Results@#Primarily healing of the wound was achieved in all cases without postoperative complications of nerve, vessel and tendon injury. The follow-up period was (16.9±6.6)months(range: 8-24 months). Postoperatively X-ray films showed complete fracture healing at (11.2±2.1)weeks after surgery.At the last follow-up, the ankle movement and appearance were good, and no ankle joint traumatic arthritis were found. The VAS and AOFAS was 0 and 95.7±9.4 respectively.@*Conclusion@#The all-inside arthroscopic treatment of Lauge-Hansen type avulsion fracture of tibial origin with Ⅰ degree supination and external rotation injury is an effective and precise method, with accurately outcomes, precise reduction and minimally postoperative complications.
ABSTRACT
Objective To investigate the application of a narrow pedicle cross-finger flap in the treatment of fingertip degloving injuries.Methods Between June 2011and May 2013,23 patients (23 fingers) suffered from fingertip degloving injuries were treated with a narrow pedicle cross-finger flap.There were 15 males (15 fingers) and 8 females (8 fingers).Defects were caused by machine crush injury in 11 cases,girdle crush injury in 7 cases and punch press injury in 5 cases.The defects were located on the index finger in 10 cases,long finger in 2 cases,ring finger in 7 cases,and little finger in 4 cases.The flaps sized 2.6 cm × 1.9 cm to 6.5 cm × 2.2 cm.After six months,according to Zhang's curative effect satisfaction score method,the efficacy of the treatment was evaluated by five aspects of skin flap healing:flap fleeing,skin flap,flap outline,flap temperature and donor site scar.Results The island flaps were survived completely in 23 patients.After followed-up for 6 to 18 months (one case was lost to follow-up).The color and texture of the flap were the same to the surrounding normal skin,and the finger shape was satisfactory.There was no pigmentation and contraction relapse ofthe injured finger.The mean values of static 2-point discrimination were (6.1 ± 1.3) mm (range,5-8 mm) of the flap.Conclusions The narrow pedicle cross-finger flap can be used to repair the fingertip degloving injuries with the flexible flap design and reliable blood supplement.The flap survives well and the repair area is good.Therefore,it is a good method and strongly recommended for fingertip degloving injuries repair in clinics.
ABSTRACT
Objective To investigate the clinical outcomes of using modified antegrade digital artery island flap for the treatment of the severely flexion contracture of the burned finger.Methods Between August,2013 to August,2015,21 patients (21 fingers) with severely flexion contracture of the burned finger were hospitalized for treatment.According to the Stren classification standard for the interphalangeal joint flexion contracture,all the patients were rated as type Ⅲ.The volar soft-tissue defect with exposed tendons,nerves,vessels or bone ranged from 1.0 cm × 2.0 cm to 2.5 cm × 4.0 cm after scar relaxation.The artery and the nerve defect were 1.5 to 4.5 cm and 2.0 to 4.2 cm,respectively.The wound were reconstructed with the modified antegrade digital artery island flap.The dorsal branches of the proper digital nerve of the flap were anastomosised with the proper digital nerve of the wound.The flap donor site was resurfaced with full-thickness skin grafting from inner aspect of the forearm.All the cases were called back for postoperative follow-up.Results All the reconstructed fingers and flaps survived completely without vascular problems.The donor skin graft survived and wound healed by first intention.All the patients were followed up with 11.5 months (range,6-22 months).The finger appearance was satisfactory.The texture and color of flaps in all cases were good.There was no pigmentation and contraction relapse.The contracted fingers received no cold intolerance.At the final examination,the average values of static 2-point discrimination were 5.2 mm (range,4.3-6.5 mm) of the flap.In the series,based on the Michigan Hand Outcome Questionnaire,18 patients were strongly satisfied with the injured finger appearance and 3 patients satisfied with the appearance.Conclusion The modified antegrade digital artery island flap,which is easy to raise with large flap size and can result with the good finger appearance and function,is an ideal technique for reconstruction of the severe flexion contracture of the burned finger.
ABSTRACT
Objective To construct a shRNA lentiviral vector targeting the gene encoding tumor necrosis factor alpha-induced protein 8 (TNFAIP8) in RAW264. 7 cells, a mouse macrophage cell line, and to investigate the effects of TNFAIP8 gene silencing on the functions of mouse macrophages. Methods The shRNA sequence targeting TNFAIP8 gene was designed and DNA oligos containing small hairpin frame was synthesized. The double-stranded DNA was cloned into pLKO. 1-TRC vector after annealing. The recombi-nant vector was verified by using double enzyme digestion and gene sequencing. Lentiviruses were prepared by transfecting the constructed vector into 293T cells. Fluorescent quantitative RT-PCR and Western blot as-say were performed to detect the expression of TNFAIP8 at mRNA and protein levels after infecting the RAW264. 7 cells with lentiviruses. Flat dish adhesion experiment and wound-healing assay were used to evaluate the effects of TNFAIP8 gene silencing on the adhesion and migration of RAW264. 7 cells. Results The recombinant lentiviral vector was successfully constructed as indicated by double enzyme di-gestion and gene sequencing analysis. The expression of TNFAIP8 in RAW264. 7 cells at both mRNA and protein levels were significantly down-regulated after lentivirus infection (P<0. 05). Moreover, TNFAIP8 gene silencing significantly impaired the cell adhesion ability of RAW264. 7 cells after 15 min, 30 min or 2 hours of culture. Compared with the cells in control group, the RAW264. 7 cells harboring silenced TN-FAIP8 gene looked round with a smaller number of cellular extensions. The wound-healing assay showed that less TNFAIP8 gene-silenced RAW264. 7 cells migrated into the wounded area as compared with the cells in control group after 24 hours of culture (P<0. 05). The wound-healing rates of the experimental and control groups were 25% and 50%, respectively. Conclusion The recombinant lentiviral vector containing shRNA targeting the TNFAIP8 gene was successfully constructed. Transfecting the RAW264. 7 cells with the con-structed vector significantly silenced the expression of TNFAIP8 gene and inhibited the adhesion and migra-tion of these cells.
ABSTRACT
Objective To investigate the clinical result of treating Tillaux-Chaput fractures using the full ankle arthroscopy technique.Methods A retrospective analysis was made on 21 patients with Tillaux-Chaput fractures followed up after treatment by the full ankle arthroscopy technique from May 2013 to May 2015.There were 16 males and 5 females,with the age range of 6-55 years [(25.5 ± 12.8)years].Right ankle was involved in 12 patients and left ankle in 4 patients.Sixteen patients had single TillauxChaput fractures and 5 patients had combined proximal fibular fractures.Diagnosis of Tillaux-Chaput fractures was confirmed by X-rays in 18 patients an CT in 3 patients.Ankle arthroscopy was used through the anterolateral and anteriormedal approaches for closed reduction and internal fixation using one or two Herbert screws.Wound healing,bone union and visual analogue score (VAS) were detected postoperatively.Function assessment was performed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring system.Results All incisions healed by first intention,without evidence of nerve,vessel and tendon injuries.Period of follow-up was (15.3 ± 7.1) months (range,12-25 months).Fracture healed within 12 to 36 weeks [(22.6 ±4.6)weeks] after operation.VAS was (0.8 ± 0.3) points after operation,obviously lower than preoperative (8.3 ± 1.3) points (P ＜ 0.05).At the final follow-up,all patients regained normal ankle function and normal walking gait,without the presence of ankle pain and weight-bearing walking pain.AOFAS score was improved from preoperative (51.2 ± 12.5) points to postoperative (92.7 ± 16.5) points (P ＜ 0.05).Based on the AOFAS score,the results were excellent in 19 patients and good in 2 patients,with the excellent-good rate of 100％.Conclsion Full ankle arthroscopy by the anterolateral and anterionnedal approaches provides a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures and deserves clinical application.
ABSTRACT
Objective To evaluate the effects and security of PFNA and DHS in the treatment of unstable intertrochanteric fractures through meta analysis .Methods The randomized controlled trials(RCT) for comparing PFNA and DHS in the treatment of unstable intertrochanteric fracture were retrieved from MEDLINE ,EMbase ,Pubmed ,Cochrane library ,CBM ,CNKI ,VIP data‐bases by computer .The related orthopedic relevant documents and conference papers were collected by manual retrieval .The Rev‐Man5 .1 statistical software was used for conducting the meta analysis .Results Nineteen RCT were included ,involving 1 690 pa‐tients ,in which 871 cases were treated by using PFNA and 819 cases were treated by using DHS .Compared with DHS ,PFNA had the advantages of little trauma ,less blood loss ,short operation time ,short fracture healing time and postoperative bed time ,good hip function and low incidence of postoperative coxa vara and screw cutting ,but there were no statistical differences in the aspects of length of hospital stay ,fatality rate ,and incidences of fracture nonunion ,breakage of internal fixation ,femoral head necrosis ,short‐ening of the femoral neck ,femoral shaft fractures ,deep vein thrombosis ,urinary tract infection and other complications between the two groups(P>0 .05) .Conclusion The retrieved literatures show that PFNA internal fixation is superior to DHS internal fixation in treatment of unstable intertrochanteric fractures .
ABSTRACT
Objective To assay the clinical effect of proximal dorsal digital artery pedicled island flap in treatment and sensory reconstruction of adjacent finger soft-tissue defect.Methods The study enrolled 21 cases of soft-tissue defect in 21 fingers treated from January 2013 to January 2014.All the defects were covered with the proximal dorsal artery pedicled island flaps raised from the adjacent finger.Index finger was injured in 7 patients,middle finger in 9 patients,ring finger in 4 patients,and little finger in 4 patients.Defect and flap dimensions varied from 1.9 cm × 1.5 cm to 4.3 cm × 2.3 cm and from 2.0 cm × 1.7 cm to 4.5 cm × 2.5 cm respectively.Donor site was resurfaced with a fullthickness skin harvested from medial side of the upper arm.Postoperative flap appearance and two-point discrimination were evaluated.Total active motion (TAM) of the finger was evaluated after operation.Results All the flaps and skin grafts survived after operation.Duration of the follow-up was 6-18 months (mean,14.7 months).Through the final follow-up,appearance and function of the flap were satisfactory,donor site healed well,and two-point discrimination was 5-9 mm (mean,6.3 mm).TAM evaluation was excellent in 19 patients and good in 2 patients with the excellent-good rate of 100％.Conclusion The proximal dorsal artery pedicled island flap raised from the adjacent finger is an ideal choice in finger soft-tissue reconstruction,for the technique has advantages of high survival rate,satisfactory appearance and sensory function as well as few complications.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the effect of dorsalis pedis parallel flaps in repairing perforating skin and soft tissue defects of the palms.</p><p><b>METHODS</b>Eighteen patients with perforating skin and soft tissue defects of the palms were hospitalized from July 2008 to November 2010. The area of skin defect ranged from 2.0 cm x 1.5 cm to 5.0 cm x 2.5 cm. The dorsalis pedis parallel flaps were used to repair these defects, with the area ranging from 2.0 cm x 2.0 cm to 5.5 cm x 3.0 cm. The donor sites were covered with autologous full-thickness skin from inner thigh.</p><p><b>RESULTS</b>All the 18 flaps and skin grafts of donor sites survived completely. Seventeen patients were followed up for 6 to 23 months, with mean time of 10 months, and one patient was lost to follow-up. The texture, elasticity, and appearance of all the 17 flaps were satisfactory, with no obvious pigmentation or cicatricial contracture. At the last follow-up, the distance of two-point discrimination of flaps ranged from 6 to 9 mm, with mean distance of 7.4 mm, and the sensation of flaps reached S3 in 13 patients who had nerve anastomosis.</p><p><b>CONCLUSIONS</b>The dorsalis pedis parallel flap, with reliable blood supply and flexible design, is a good choice for repairing perforating skin and soft tissue defects of the palms.</p>
Subject(s)
Humans , Male , Middle Aged , Young Adult , Contracture , Foot , General Surgery , Hand Injuries , General Surgery , Plastic Surgery Procedures , Methods , Skin , Skin Transplantation , Soft Tissue Injuries , General Surgery , Surgical Flaps , Treatment Outcome , Wound HealingABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical outcomes of the use of the perforator propeller flaps based on the end dorsal branch of digital proper artery in the same finger in repair of finger pulp defects and sensory reconstruction in children.</p><p><b>METHODS</b>Twenty-three children (31 fingers) with index, middle, ring or little finger pulp defects were hospitalized from September 2012 to December 2013. The area of finger pulp defects ranged from 1.2 cm × 1.0 cm to 2.0 cm × 1.5 cm. The perforator propeller flaps based on the end dorsal branch of digital proper artery in the same finger were used to repair the defects, with the flap size ranging from 1.3 cm × 1.2 cm to 2.2 cm × 1.6 cm. The dorsal branch of the digital proper nerve of the flap was conducted end-to-end anastomosis with the broken end of the nerve of the wound to reconstruct sensation. The donor sites were covered with autologous full-thickness skin obtained from inner aspect of the thigh.</p><p><b>RESULTS</b>Primary healing of the wounds and donor sites were achieved in all 23 children. All the flaps and skin grafts of donor sites survived. All the patients were followed up for 6 to 20 months, with mean time of 14 months. At the last follow-up, the flaps and donor sites were in good appearance, the finger pulps were mellow and plump, with no obvious pigmentation or cicatricial contracture. The sensation of finger pulps reached S3(+), and the distance of two-point discrimination ranged from 4.5 to 6.0 mm, with mean distance of 5.1 mm. Twenty-one parents of the patients were strongly satisfied with the appearance of the repaired fingers, and the other 2 parents also expressed satisfaction.</p><p><b>CONCLUSIONS</b>Transplantation of the perforator propeller flap based on the end dorsal branch of digital proper artery in the same finger is a safe and reliable method for the repair of index, middle, ring, and little finger pulp defects and sensory reconstruction of children. The flaps are with good blood supply, appearance and sensory function after operation.</p>
Subject(s)
Child , Humans , Arteries , Contracture , Finger Injuries , General Surgery , Fingers , General Surgery , Perforator Flap , Plastic Surgery Procedures , Methods , Skin , Skin Transplantation , Methods , Soft Tissue Injuries , General Surgery , Surgical Flaps , Treatment Outcome , Wound HealingABSTRACT
<p><b>OBJECTIVE</b>To investigate the hemodynamics evidence of the descending branch of lateral circumflex femoral artery in a reversed way. To explore the clinical result of using the reversed descending branch of the lateral circumflex femoral artery as the receipt artery for free flaps for reconstruction of the leg soft-tissue defect.</p><p><b>METHODS</b>From October 2005 to February 2012, 38 patients with severe leg soft-tissue defects were treated. The proximal antegrade and retrograde mean artery pressure of the descending branch of the lateral circumflex femoral artery in 16 of 38 patients were recorded during operation. All wounds had osteomyelitis, bone and tendon exposure requiring coverage reconstruction. And there was no recipient artery in the injured lower leg for free flaps in all 38 patients. Reversed descending branches of lateral femoral circumflex arteries were used as recipient arteries for free flaps (free latissimus dorsi flap, free thoracoumbilical flap, and free anterolateral thigh flap) in all patients. The flap donor site was closed directly or with the skin graft.</p><p><b>RESULTS</b>The proximal antegrade mean artery pressure of the descending branch of lateral circumflex femoral artery was(81.6 +/- 12.4) mmHg. The proximal retrograde pressure was(48.2 +/- 10.7) mmHg. The proximal retrograde mean artery pressure was 59.07 percent of the proximal antegrade pressure. The donor skin graft survived and wound healed primarily. After operation, 2 flaps had distal partial necrosis and healing was achieved after dressing change. All the other flaps survived completely without vascular problems. All the patients were followed up for 11 months to 2.5 years (mean, 1.6 years). The flap appearance was satisfactory. The texture and color of flaps in all cases were good.</p><p><b>CONCLUSIONS</b>The reverse descending branch of lateral circumflex femoral artery is a reliable recipient artery for the free flaps. It is an easy and simple technique that can be used for reconstruction of the defects in the lower leg, with the reversed descending branch of lateral circumflex femoral artery as recipient artery.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Blood Pressure , Femoral Artery , General Surgery , Free Tissue Flaps , Hemodynamics , Lower Extremity , Wounds and Injuries , Soft Tissue Injuries , General SurgeryABSTRACT
Objective To investigate the application and clinical result of treatment soft tissue defect in the lower leg after severe trauma by using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery for free flaps.Methods Twenty-three patients with soft tissue defect of the lower leg after severe trauma from February 2007 to October 2012 were retrospectively analyzed.The patients were treated with the free flaps (the latissimus dorsi flap or the anterolateral thigh flap) using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery.There were 14 males and 9 females,with an average age of 31.7 years (range,22-49 years).The causes of injury were traffic accidents in 12 cases,crushing injury in 8 cases,and machinery injury in 3 cases.The defect located at the proximal in 4 cases,the proximal and middle in 12 cases,middle and distal in 7 cases.Sizes of the tissue defect were 14 cm×5 cm to 32cm×12 cm,and the flap sizes were 15 cm×7 cm to 34 cm×13 cm.The donor defect was closed directly or resurfaced with a splitthickness skin graft taken from the thigh.Results Twenty-three flaps survived completely.Partial necrosis at the distal edge of the flap occurred in one case,and was healed by secondary intention.No patient needed urgent operative revision due to postoperative thrombosis of the vessels.All flaps completely survived,without evidence of postoperative insufficiency of the blood supply or venous congestion.The donor skin graft survived and the incision healed by first intention.The mean follow-up period was 12.4 months (range,6-21 months).The appearance,texture,color and thickness of flaps in all cases were good at the last followup.The flap achieved protective sensation with the two-point discrimination ranging between 10-25 mm.Conclusion Due to the advantages of reliable blood supply,short treatment cycle,and without postoperative forced position,the reversed descending branch of the lateral circumflex femoral artery of the injured leg can be an ideal choice as the recipient artery for free flaps in repairing the soft tissue defect in the lower leg after severe trauma.