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Objective:To analyse the effect of the exposed bone cement technique combined with pectoralis major muscle flap in the treatment of chronic sternal osteomyelitis after coronary artery bypass surgery(CABS), and to summarise the clinical experience of staged surgery and comprehensive treatment.Methods:A retrospective analysis were carried out on 5 patients who had chronic sternal osteomyelitis and treated with exposed bone cement after the CABS from October 2017 to October 2020. Five patients(4 males and 1 female) met the inclusion criteria with a mean age of 65(range from 54 to 72) years old. Duration of all the chronic sternal osteomyelitis was 3 weeks to 3 months at admission. During the perioperative period, the general condition of the patients was controlled and systemic nutritional support was given. At the first stage, all patients underwent complete debridement. Then all the wounds were treated with exposed bone cement and covered by vacuum sealing drainage(VSD) to control the infection. At the second stage, bone cement was removed, and the dead cavity was packed with pectoralis major advancement muscle flap. Close attention was paid to the tension of wound, the patency of drainage catheter and the drainage after surgery. The wound healing, scar hyperplasia and complications were observed during the follow-up.Results:The suture tension was moderate, the drainage catheter was unobstructed, and a little liquid was drawn without turbid. All patients were clinically cured and entered follow-up for 6 to 15 months. During the follow-up, there was neigher recurrence of osteomyelitis nor sinus tract formation. No significant complication occurred at the last follow-up. The quality of life of the patients was significantly improved and all the patients were satisfactory to the treatment.Conclusion:Exposed bone cement technique combined with pectoralis major muscle flap is an effective method in the treatment of chronic sternal osteomyelitis after CABS. It has a good short-term treatment efficacy and is worthy for further clinical trials.
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Objective:To investigate the effect and indications of pedicled myocutaneous flap and modified Masquelet technique in the repair of diabetic soft tissue and tibial bone defects.Methods:From January, 2017 to October, 2019, data of surgical treatment of 20 patients with diabetic soft tissue and tibial bone defects were retrospectively studied. The detects were repaired by the pedicled myocutaneous flap combined with modified Masquelet technique. There were 13 males and 7 females aged 40 to 65(average 51) years old. Preoperative ultrasound and CTA had confirmed that there was no occlusion in anterior and posterior tibial arteries. After debridement, the bone defect was 4-9 cm in length and the soft tissue defect was 3 cm×6 cm to 7 cm×10 cm. The initial antibiotic loaded bone cement filling of the bone and soft tissue defects was carried out. Then at 7-10 days later, had the bone cement placed earlier removed the remaining spaces of bone defect were again filled by antibiotic loaded bone cement. Meanwhile, the pedicled myocutaneous flap was transferred to repair the wound. The second stage of Masquelet technique was performed later, with an interval of 8-12(mean 9) weeks. The healing of wound and bone defect, and the complications were recorded. At 12 months after the surgery, the healing and appearance of the flap were evaluated by the standard proposed by Zhang Hao, and the functional recovery of the adjacent joint was evaluated by Johner-Wruhs standard. The treatment was considered successful when the symptoms were disappeared and no recurrence occurred.Results:All patients entered 13 to 28 months of follow-up, 20 months in average. The healing time for bone defect was 6-11 (average 9.0) months. All myocutaneous flaps survived with 18 flaps healed in the stage one and 2 delayed healing. Nine flaps appeared almost normal and 11 shown bloating. Seventeen flaps were found with partial sensation and 3 without sensation at all. The temperature of 7 flaps was found normal and 13 were slightly lower. Fourteen donor site scars were mild and 6 were obvious. The overall curative effect was satisfactory. Two patients had recurred infection. The rates of excellent and good functional recovery, infection control and success of treatment were at 90%(18/20) for each.Conclusion:Pedicled myocutaneous flap combined with modified Masquelet technique can repair diabetic soft tissue and tibial bone defects. It has a good therapeutic effect for short and medium terms.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical application of V-Y flap pedicled with the lateral superior genicular perforator for donor site defect after harvesting anterolateral thigh flap.</p><p><b>METHODS</b>From June 2011 to June 2012, 9 cases with defects at hands and feet were treated with anterolateral thigh flaps. The defects left at the donor sites were consequently reconstructed with V-Y flap pedicled with the lateral superior genicular perforator. The defects left by V-Y flap were closed directly.</p><p><b>RESULTS</b>All the 9 anterolateral thigh flap survived completely. 5 flaps underwent thinning surgery 6-8 months after operation. The flaps had a good appearance, texture, color and elasticity. The 8 perforator flaps survived completely with partial necrosis in 1 flap at the proximal end. The average healing time was 17 days. There was no obvious depression at donor sites with normal function.</p><p><b>CONCLUSIONS</b>The method is easily performed with optional therapeutic effect. It is a modified improvement for the anterolateral thigh flap.</p>