Orthopaedic Replantation and functional reconstruction of an amputated lower extremity / 中华创伤骨科杂志

Objective@#To evaluate our replantation and functional reconstruction of amputated lower extremities.@*Methods@#From February 2013 to October 2017, 13 patients with an amputated lower extremity were treated at Orthopaedic Department, The 960th Hospital of the PLA Joint Logistics Support Force. They were 10 males and 3 females, aged from 15 to 63 years (average, 39 years). In all the patients, large segmental shortening and extremity replantation was conducted at the first stage and Ilizarov extremity lengthening at the secondary stage. After desired extension was achieved, the frame of Ilizarov external fixator was removed and replaced by external fixation with a locking plate under closed reduction. Postoperatively, functions of the knee and ankle joints, sensory recovery of the foot sole, length and appearance of the extremity were observed.@*Results@#All the 13 patients were followed up for 12 to 24 months (average, 16 months). All the limb replants survived well. Of them, 12 were satisfied with their weight-bearing walking and therapeutic outcomes.@*Conclusions@#For an amputated lower extremity, the first-stage shortening and replantation can result in fine extremity salvage and the secondary Ilizarov extremity lengthening can lead to fine therapeutic outcomes.

Replantation and functional reconstruction of an amputated lower extremity / 中华创伤骨科杂志

Objective To evaluate our replantation and functional reconstruction of amputated lower extremities.Methods From February 2013 to October 2017,13 patients with an amputated lower extremity were treated at Orthopaedic Department,The 960th Hospital of the PLA Joint Logistics Support Force.They were 10 males and 3 females,aged from 15 to 63 years (average,39 years).In all the patients,large segmental shortening and extremity replantation was conducted at the first stage and Ilizarov extremity lengthening at the secondary stage.After desired extension was achieved,the frame of Ilizarov external fixator was removed and replaced by external fixation with a locking plate under closed reduction.Postoperatively,functions of the knee and ankle joints,sensory recovery of the foot sole,length and appearance of the extremity were observed.Results All the 13 patients were followed up for 12 to 24 months (average,16 months).All the limb replants survived well.Of them,12 were satisfied with their weight-bearing walking and therapeutic outcomes.Conclusions For an amputated lower extremity,the first-stage shortening and replantation can result in fine extremity salvage and the secondary Ilizarov extremity lengthening can lead to fine therapeutic outcomes.

Improved anatomical study in posterior tibial artery perforator flaps / 中华显微外科杂志

Objective To explore a modified technique of perforator flap anatomical study,in an attempt to understand the vascular territory of the specific perforator vessel in flaps,and determined its application in posterior tibial artery perforator flaps.Methods From October,2013 to October,2014,6 corpse were used in this study.A full-thickness posterior tibial artery perforator flap was excised from the crus of a fresh adult corpse.The anatomical measurements were synchronized with the procedure.The isolated skin flaps were fixed in a frame made of silk screen and batten and subsequently photographed.In vitro skin flaps were divided into 3 groups:full-thickness,without deep fascia,and without subcutaneous adipose layer.The skin flaps were perfused with barium sulfate silicone,and photographed using mammography after coagulation of the silicone.The imaging data were processed by digital software system.Results The mean number of posterior tibial artery perforators in the lower medial leg was 4.17 ± 0.94.The projection points of perforated sites were located in the area 2-3 cm lateral to the A-C line.The proximal border was (4.51 ± 1.84)cm distal to the plane of tibial medial condyle;the distal border reached the medial malleolus plane;and the anterior and posterior borders reaching the anterior and posterior midline of the crus respectively.And according to the comparison of the 3 group processed images,vascular territory change could be obtained.And this could provid clinicians with reliable anatomical information,guiding the acquisition and trimming of perforator flaps.Conclusion The modified strategy intuitively indicated the blood vascular areas of different artery perforator flaps of varying thickness and the vascular branches as well as their courses.The approach is profoundly significant in guiding the acquisition of skin flaps and for the trimming and reconstruction of flaps.The deep fascia of posterior tibial artery perforator flaps plays a negligible role in the blood supply of flaps.Furthermore,the subcutaneous adipose tissues in the distal portion of flaps can be thinned appropriately,with limited vascular consequences.

Perioperative management in traumatic soft tissue defects with revascularized flaps / 中国组织工程研究

BACKGROUND:Traumatic soft tissue defects of the limbs are usual y accompanied with the exposure of tendon, joint capsule, bone or internal fixator, which can be reconstructed by skin flap. Previous research has shown that it is an important method to repair traumatic tissue defects with flaps. However, rarely research reports perioperative management about flap bed so far. OBJECTIVE:To explore the perioperative strategy for repairing traumatic soft tissue defects with revascularized flaps. METHODS:Total y 94 cases undergoing secondary skin flap repair were enrol ed. Intraoperative debridement using tourniquet was performed, and the wound was washed with mass of physiological saline. Whether the tissues, including bone, tendon, joint capsule and internal fixator, were reserved or not depended on their viability, and then the flaps were harvested to repair defects, and drainage was placed properly at last. RESULTS AND CONCLUSION:The flaps survived in al cases. Exudation occurred in 5 cases with the exposure of bone, and 28 cases with the exposure of tendon or joint capsule healed normal y. No complications were associated with the reservation of the internal fixators, but delayed-union occurred in three cases and nonunion in one case. These findings indicate that the perioperative treatment of the application of skin flap is worthy of attention. Careful debridement, advisable choice of the flap, efficient drainage and using antibiotic normatively are al keys. Treatment of the bone, tendon, joint capsule and internal fixator which are exposed should not only weigh the advantage and disadvantage, but also relax the indication of reserving them.

Studies on optimizing extraction technology of Euphorbia hirta L.by central composite design-response surface methodology / 中国生化药物杂志

Objective To optimize the extraction process of Euphorbia hirta L.by Central composite design/response surface methodology with ethanol by the ultrasonic extraction technology.Methods Based on the single factor experiment and central composite design-response surface methodology,the content of quercitroside was regarded as evaluation index,select ethanol concentration,extraction time,and solid-liquid ratio as three evaluation factors to achieve the purpose. Results The results indicated that the optimal extraction process was obtained as follows:10 times the amount of 60% ethanol under ultrasound for 2 times,50 min each;the average content of the quercitroside was 2.39 mg/g.Conclusion The method to optimize the extraction process is simple and reasonable.

Clinical outcome contrast of using Hukou artery and ulnar proper digital arteries of index finger translocation to reconstruct artery supply in replanting of rotated and avulsed thumbs / 中华显微外科杂志

Objective To compare the clinical outcomes of using the Hukou artery and ulnar proper digital artery of index finger translocation to reconstruct artery supply in replanting of rotated and avulsed thumb.Methods From January 2011 to May 2012,replantation surgery were carried out in 16 patients with rotated and avulsed injury of thumb.In group A,all cases were replanted by Hukou artery translocation,in which 6 males and 2 females and (27.0 ±9.5) years old in average.The causes of injury were machine strangulation (7 patients) and traffic accident (1 patient).The average time from injury to operation were(6.1 ± 3.1) hours.The amputed level were at the base of proximal phalanx (5 patients) and metacarpophalangeal joint (3 patients).In group B,all patients were replanted using ulnar proper digital artery of index finger translocation,in which 5 males and 3females and (29.7 ± 13.7) years old in average.The causes of injury were machine strangulation (6 patients) and cord wring injury (2 patient).The average time from injury to operation were(7.1 ±2.2) hours.The amputed level were at the base of proximal phalanx (4 patients) and metacarpophalangeal joint (4 patients).Results The operation time were (3.2 ± 0.8) minutes in group A and (5.3 ± 0.6) minutes in group B.All fingers were survived in both groups.All patients were followed up 3-10 months (6.9 months on average).Excellent rate reached 75.0％ in group A and 75.0％ in group B according to Criterion on Functional evaluation on Finger Reconstruction issued by Chinese society of hand surgery.There were significant differences between the two groups in operation time (P ＜ 0.05),and without differences in excellent rate (P ＞ 0.05).Conclusion There are same outcome by using the Hukou artery and ulnar proper digital artery of index finger to reconstruct artery supply in replantation of rotated and avulsed thumb.However,using the Hukou artery translocation were more simple and minimally invasive.

Use of cross-leg fibula flap for difficult reconstruction of extensive injuries in the lower extremities / 中华骨科杂志

Objective To study clinical outcomes of cross-leg fibula flap for difficult reconstruction of an extensive injury in the lower extremity,which included large soft-tissue defects and long infected bone and tibia defects combined with vascular injury.Methods From September 2004 to September 2008,8 cases with an extensive injury in the lower extremity,which included large soft-tissue defects and long infected bone and tibia defects with vascular injury,were retrospectively analyzed,including 6 males and 2 females with an average age of 36 years (range,19-55 years).The course of disease ranged from 2 weeks to 3 months (average,2 months).The bone defect length ranged from 8 to 20 cm (average,13 cm),and the skin defect area varied from 10 cm×7 cm to 22 cm×12 cm.After thorough debridement,cross-leg fibula flap was used to repair the tibial defect and concomitant soft tissue defect.The pedicles were divided at 4-6 weeks after the initial surgery.The important technical considerations were outlined.Results All 8 patients were followed up for 6 to 36 months (average,24 months).The flaps survived in all 8 patients,and no infection and osteomyelitis happened.The flap transplantations healed at two weeks after operation with good shape.The fractures healed in all of patients with an average period of 11 months (range,6-15 months).All of patients recovered to walk without aid.According to Edwards classification of tibial fractures,4 cases were classified as good,2 as acceptable,and 2 as poor.Conclusion The cross-leg fibula flap is relatively simple,liable for the treatment of an extensive injury in the lower extremity.

Distal pedical fibular osteoseptocutaneous flap transfer for the lateral forefoot defect / 中华显微外科杂志

Objective The anterior-lateral defect of foot that lost one of the three supporting point of foot can lead to collapse of the lateral longitudinal arch, overload of the first metatarsal heads, and painful callus formation. It is meaningful to investigate the effect of reconstructing the lateral forefoot defect with pedical fibular osteoseptocutaneous flap. Methods From March 1989 to June 2008, there were 38 patients with anterior-lateral defect of foot were constructed. The supporting point with the local distal based pedical fibular osteoseptocutaneous flap was constracted. Results All the 38 flaps survived. All 38 patients had been followed up from 6 months to 10 years (mean 23.5 months) postoperatively. The constructed supporting point of the foot was functional. The patients could walk freely with no pain, and was satisfied with the operation. Assessed with the rating system for foot and ankle established by the American Orthopaedic Foot And Anke Society, 8 patients got a score above 85, 23 patients between 75 to 85, 7 patients between 60 to 75. Conclusion It is effective that transferring local distal based pedical fibular osteoseptocutaneous flap to repair the anterior-lateral defect of foot.

The correlation between of mtrixmetul-loproteinase2 and reactal cancer / 国际肿瘤学杂志

Objective Studing the relationship among matrixmetal-loproteinnse2 (MMP2), the tissue inhibitors of metalloprotein-ase2 (TIMP2) and chnicopathological characteristics such as histological grade, clinicopathological stage of the rectal cancer. Assessing the significance of MMP2 and TIMP2 expression in rec-tal cancer for prognosis and treatment. Methods To test the expression level of MMP2 and TIMP2 in rectal caneer patients with immunohistochemisty method. Results were analysised with χ2 test. The Kaplan-Meier (Log-rank test) was used for univariate survival analysis. Results The positive rates of MMP2 and T1MP2 ex-pression in rectal cance are higher in comparison with normal tissues. With MMP2 have a trendence of increas-ing the positive expression of TIMP2 decreases. Conclusion MMP2 and TIMP2 relate obviously with the clini-copathological character of the rectal cancer. They may play an important role in the proliferation, invasion and of the cancer. Testing the level of expression of MMP2 and TIMP2 may be helpful to prejudge the prognosis of the patients with rectal cancer. Some new therapic methods relating to MMP2 and TIMP2 may give patients with rectal cancer a more satisfying treatment.

Mechanical features of screw internal fixation technique for acetabular anterior column fracture:Quantitative anatomic observation / 中国组织工程研究

BACKGROUND:Recently,open reduction and internal fixation has become an important therapy for pelvic and acetabular fracture. However,screw penetration sometimes occurs,which damage vessels or nerves in the pelvic cavity. OBJECTIVE:To measure the best entry points,direction and length of screw in acetabular anterior column fracture lag screw internal fixation technique. DESIGN,TIME AND SETTING:Measurement experiment was performed at the Department of Anatomy,Medical School of Shandong University from June to October 2008. MATERIALS:A total of 20 semi-pelvic specimens of adult male cadavers were used to make serial cross-sections of the acetabular anterior column. METHODS:In single screw technique,the horizontal distance OP and vertical distance PQ from entry point O to apex of greater sciatic notch Q were measured,and screw length was measured. In double screw technique,the horizontal distance O1P1,O2P2 and vertical distance P1Q,P2Q from entry point O1 of the inner screw and entry point O2 of the outer screw,respectively to apex of greater sciatic notch Q were measured. The length of inner screw and outer screw were measured respectively. Angle ? on sagittal plane and the angle ? on coronal plane of the screw were determined. All data were put into software SPSS 10.0 for statistical analysis. MAIN OUTCOME MEASURES:The entry points,direction and length of screw in acetabular anterior column fracture lag screw internal fixation technique RESULTS:Single screw technique:the length of OP and PQ was (23.5?2.2) mm and (16.8?1.6) mm respectively; the length of lag screw was (84.9?4.7) mm. Double screw technique:the length of O1P1 and P1Q was (26.3?2.3) mm and (13.6?1.4) mm,respectively,and the length of medial lag screw was (69.8?4.1) mm; the length of O2P2 and P2Q was (20.7?2.1) mm and (20.1?1.8) mm,and the length of lateral lag screw was (61.2?3.7) mm. Angle ? was (123.4 ? 4.1)? and angle ? (62.2 ? 5.8)?. CONCLUSION:The entry point of single screw technique lies in the summit of greater sciatic notch 17 mm outward,vertical to the medial margin of the posterior column,24 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 85 mm. The entry point of medial screw in double screw technique lies in 14 mm outward,vertical to the medial margin of the posterior column,and 26 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 70 mm. The entry point of lateral screw in double screw technique lies in 20 mm outward,vertical to the medial margin of the posterior column,and 21 mm upward,parallel to the medial margin of the posterior column; the length of the screw is 61 mm. The angle of lag screw with respect to the parallel line of the medial margin of the posterior column is 123?,and the angle lag screw with respect to the vertical line of the medial margin of the posterior column is 62?. The position of the lag screw must be confined by intraoperative fluoroscopy in multiple projections.

Use combined flap on the medial foot to reconstitute the first web of hand / 中华显微外科杂志

Objective Investigate the methods of reconstituting the first web of hand Try to find some ways to make the the lst web more beautiful Method To design a flap including two flap (instep island flap and medial plantar island flap) to reconstitute the lst web of hand the instep flap reconstituted the back of the lst web of hand,the medial plantar flap reconstitute the volaris part of the lst web of hand Result All 9 cases were applied successfully with the transplanted tissue survived The function of hand recovered satisfactorily and the exterior look like original web of hand Conclusion Use combined flap on the medial foot to reconstitute the lst web of hand can recovered either function or original exterior of the lst web of hand