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Objective:To investigate the effect of free anterolateral thigh perforator flap in repair of forefoot injuries combined with multiple tissue defect.Methods:A retrospective case series study was conducted on 26 patients who suffered from forefoot injuries combined with multiple tissue defect admitted to 920th Hospital of Joint Logistic Support Force of PLA from January 2015 to December 2019. There were 21 males and 5 females, aged 15-61 years [(31.6±12.5)years]. The combined injuries were fracture in 10 patients, arsometatarsal joint dislocation in 3, bone defect in 9, tendon injury in 5, and ligament injury in 3. Management of multiple tissue defect of the forefeet: soft-tissue defect of the forefeet was resurfaced with free anterolateral thigh perforator flaps with the dimension of 6.0 cm×3.5 cm to 26.5 cm×10.0 cm; fracture was fixed by Kirschner wires; joint dislocation was treated by open reduction and Kirschner wires fixations; bone defect was reconstructed either by one-stage bone graft or by use of membrane-induced technique and secondary bone graft, according to the wound conditions; tendon injury of extensor digitorum longus was repaired by direct tendon suture or by tendon transfer; tarsometatarsal ligament injury was primarily sutured. The flap survival rate was observed within 2 weeks after operation. The fracture healing, bone-defect repair, foot appearance, and donor-site healing were detected at 1 month, 3 months, 6 months, 1 year post-operatively and at the last follow-up. The postoperative complications were recorded. The foot function was assessed using American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before operation and at the final follow-up.Results:All patients were followed up for 6-36 months [(20.5±4.6)months]. All flaps survived uneventfully. The fracture healing and bone defect repair were acquired. The flap showed good texture, including primary flap thinning in 11 patients and secondarily thinning in 15 patients at 3-6 months postoperatively. The donor sites showed good healing, leaving only a linear scar. The flap venous crisis developed in 1 patient and survived after emergency vascular exploring. Local infection of flap occurred in 3 patients and was cured after further debridement and the use of sensitive antibiotics. The AOFAS ankle-hindfoot score was 54-94 points [(76.6±10.4)points] at the last follow-up, compared to preoperative 11-51 points [(27.2±11.3)points] ( P<0.01). The results were excellent in 5 patients, good in 11, and fair in 10, with the excellent and good rate of 62%. Conclusions:For forefoot injuries combined with multiple tissue defect, anterolateral thigh perforator flap transplantation with additional techniques to treat fractures, bone defect, tendon and ligament injuries can achieve satisfactory results in aesthetic appearance of the flap and donor site and foot function recovery.
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Objective To explore the clinical efficacy of Ilizarov technique for infected-bone defect in lower extremity.Methods From January 2013 to December 2016,data of 31 consecutive patients with lower limb infected bone defect were retrospectively analyzed.There were 23 males and 8 females,with an average age of 35.8 years (range,5-57 years).16 cases of infected bone defect were on femur while the other 15 were on tibia.The infected bone defects were developed from blood-borne osteomyelitis in 3 cases,from open fracture (according to Gustlio classification,Gustilo Ⅱ 8,Ⅲ a 5,Ⅲ b 4) surgery in 17 cases (12 cases after external fixation and 5 cases after internal fixation),and from closed fracture surgery of plate or intramedullary nail fixation in 11 cases.Soft-tissue defects were observed in 5 cases,including 1 femur and 4 tibia.The previous operations were performed with an average operation time of 3.2 (range,2-5 times) and treatment duration of 9.6 months (range,3-21 months).The operation process was one stage debridement,external fixation,combined with bone osteotomy and transportation.Bone transportation started 7 to 10 days after osteotomy with a speed of 1 mm/d,and 0.25 mm/time.Healing rate and complications were recorded during the follow-up period and were assessed by Paley fracture healing score.Results The length of bone defect after debridement was 6.9 cm (range,3-13.5 cm).There were 27 cases positive in bacterial culture,who were treated by sensitive antibiotics.The other 4 cases were negative and treated by broad-spectrum antibiotics.The bone lengthening speed was 0.76 mm/d (range,0.56-0.86 mm/d).All bone and soft-tissue defects healed,with average bone healing time of 11.5 months (range,6-18.5 months).All patients were followed-up for 12 to 48 months (average,25.5 months).Pin infection appeared in 11 cases (8 cases on femur and 3 cases on tibia)who were cured by oral antibiotics,serial dressing and debridement.Axial displacement was presented in 4 cases on femur and were corrected by external fixation adjustment.No recurrent infection was observed and the limb length restored normal.Postoperative complications in femur were 106.3％ (17/16) comparing 46.7％ (7/15) in tibia.According to Paley fracture healing score,12 cases were excellent,14 were good and 5 were fair,yielding an excellent to good rate of 83.9％ (26/31).Conclusion Ilizarov technique is an effective way in the treatment of infected-bone defects.The complication rates on femur observed in this study were slightly higher than that on tibia.
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Objective:To investigate the mainstream view and statusof people on body donation in Yunnan province, and provide references. Methods:Random sampling questionnaire survey was used, the obtained data was statistically analyzed. Results:Only 48. 0% of the people understand the body donation, 20. 6% of people know body donation ways and procedures, 27. 8% of people have heard of body receiving station, 11. 4% of people know the body receiving station in yunnan province, 17. 2% of the people to understand body donation of relevant laws and regulations. 47. 4% of people that are willing to donate his body. Conclusion:Make perfect laws and reg-ulations, respect for the body, giving donors and their families allowance, body donation monument, to carry out education and publicity of the body donation form to the whole society support and participate in the good atmos-phere of body donation has great benefits.
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Objective To understand the mainstream view of ethnic minorities and Han nationality in Yunnan province on Body donation, understand the present status and possible issues about body donation in Yunnan province, so as to provide reference for Yunnan province on body donation. Methods We conducted questionnaire survey by random sampling. Results Yi,Dai,Han on the body donation knowledge and Donation rate was low,and the Yi, Dai was lower than Han.promoting development of medicineandthat is the continuation of lifebecame the main factors affecting the willing to donate body,there was significant difference between the three ethnic groups ( <0.05) .After death should be laid to rest,family and public pressure,fear of being free to use,religious beliefbecome the main factors affecting the unwilling to donate body, three nations also had significant difference ( <0.05) .Conclusions Most people think that the whole society should pay close attention to body donation, that body donation is a very meaningful thing. Joint effort should be made by both the government and civil society for body donation programs in Yunnan Province.