ABSTRACT
Objective:To investigate the efficacy of the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery to repair the composite tissue defect in the Achilles tendon area.Methods:From January 2016 to June 2021, 12 patients suffering from infectious wound with defect of Achilles tendon were treated in the Department of Trauma and Microscopic Orthopaedics, 988th Hospital of the Joint Logistics Support Force of PLA. The area of soft tissue defect around Achilles tendon was 2.5 cm× 4.5 cm-8.0 cm×12.5 cm, and the length of the defect of Achilles tendon was 3.0-7.0 cm. The defect around the Achilles tendon were repaired with the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric Achilles tendon flap (ATF) and the posterior perforating branch of peroneal artery was used as the vessel of blood supply. The size of flap was 3.0 cm×5.0 cm-9.0 cm×13.0 cm, and the size of the ATF was 3.0 cm×4.0 cm-3.0 cm×8.0 cm. The donor sites were sutured directly (8 cases) or repaired with skin graft (4 cases). External fixation were put on for 6 weeks after surgery. Then the external fixation was removed and the functional exercise gradually started. Outpatient clinic follow-ups were carried out regularly. Thermann Achilles tendon function assessment system was used to evaluate the last follow-up.Results:The chimeric ATF was harvested and the blood supply of each flap was good during the operation. There was no vascular crisis after surgery. The flaps survived smoothly and the wound achieved grade A healing. All patients were entered follow-up that lasted for 10-24 months. There was good appearance of flaps with minor bloating, and the colour of flaps was similar to the skin around the receiving site. The texture was soft with normal function of the lower legs and ankle. Tendon function was evaluated by Thermann Achilles tendon function assessment system, the result were 8 cases in excellent and 4 cases in good.Conclusion:The nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery can accurately repair a composite tissue defect in the Achilles tendon area, and it is one of the effective methods for the repair of a composite soft tissue wound with Achilles tendon defect.
ABSTRACT
Objective:To explore a surgical technique and treatment outcomes of the segmentle bridging reconstruction for severed fingers with single segmentle defect by using the free second toe bone-joint composite tissue combined with the great toe flap.Methods:From June 2010 to September 2017, 5 patients suffered from severed segmental defect of finger were treated. According to the defects of bone-joints, blood vessels, nerves, tendons and other soft tissues, the reconstruction surgery was designed to create a Flow-through bridging composite flap pedicled with the first dorsal metatarsal artery or the plantar artery. The blood vessles carried by the pedicle were anastomosed with the vessels in the finger to restore the blood supply to the distal finger while having the defected finger segment reconstructed. A Flow-through bridging composite flap was created by taking the second toe bone-joint composite tissue combined with a C-shaped or half-moon shaped flap from the fibular side of the great toe. Skin graft, retrograde lateral tarsal flap or free perforator flaps were used in 3 cases to repair the donor sites of the great and second toes. Iliac strip was implanted in 2 cases for toe salvage. Kirschner wires were removed 4-6 weeks after surgery followed by functional exercise.Results:All of the 5 reconstructed distal segments of the fingers survived with the healing of fractures in 8-12 week after surgery. The postoperative follow-up lasted 6-36 months and all the patients had the follow-ups at the outpatient clinic. It was found that the maximum flexion of the reconstructed interphalangel joint was 60 degrees together with dorsiflezion. According to the evaluation standard of the reconstructed function for thumb and finger issued by the Hand Surgery Society of the Chinese Medical Association, 3 fingers were in excellent and 2 in good. No obviouse affect on walking was found in all the patients.Conclusion:The free second toe joint composite tissue together with the great toe flap can be used to bridge the single segmental defect of a finger. It restores the blood supply to as well as the appearance of the distal finger, helps the recovery of the reconstructed distal finger. It is an ideal technique in the treatment of a severed distal segment of the finger.
ABSTRACT
Objective:To explore the feasibility and clinical results of absorbable antibacterial calcium sulfate combined with tissue flaps in the treatment of traumatic calcaneal osteomyelitis (CO) secondary to skin and soft tissue defects in children.Methods:From January 2007 to August 2020, 44 cases of children with heel skin and soft tissue defects associated with traumatic CO were treated and followed up effectively in the Third Affiliated Hospital of Xinxiang Medical University.Among them, 17 cases were treated with absorbable calcium sulfate cement combined with tissue flaps as the calcium sulfate group, and 27 cases were treated with antibiotic polymethylmethacrylate (PMMA) bead combined with tissue flaps as the membrane induction group.A comparison was drawn on the therapeutic effect, recurrence rate of postoperative infection, postoperative ankle mobility, number of operations, total length of hospital stays and hospitalization expenses between both groups.Results:The average follow-up time was 10.7 months in the calcium sulfate cement group and 9.3 months in the membrane induction group.All flaps were effective except for 3 cases who presented with small necrosis on the distal end of the sural neurovascular flaps.The recurrence rate of postoperative infection and the hospitalization expenses in the calcium sulfate group were lower than those in the membrane induction group, but the differences were not statically significant (all P>0.05). The postoperative ankle mobility [(63.6±9.3)°], number of operations [2(1.0, 2.0) times] and total length of hospital stay [6.1(4.5, 7.4) weeks] of the calcium sulfate group were significantly lower than those of the membrane induction group [(57.7±9.5)°, 2(2.0, 3.0) times, 7.0(5.0, 9.0) weeks], the difference were statistically significant (all P<0.05). Severe CO may cause structural damage to calcaneal tubercle or insertion site of achilles tendon, but the active plantar flexion function of ankles will be good despite the decrease in strength. Conclusions:The effect of absorbable antibacterial calcium sulfate cement combined with tissue flaps in the treatment of traumatic CO in children is favorable, and the number of operations, length of hospital stays and hospitalization expenses are relatively less compared with PMMA cement combined with tissue flaps.