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Objective:To explore the clinical effect of keystone flap (KF) on repair of soft tissue defects at the donor site after flap transfer.Methods:From October 2020 to December 2022, in the Department of Microsurgical Rapair of First Affiliated Hospital of Xinjiang Medical University, 12 patients were repaired with KF after transfer of flaps. There were 3 donor sites for lateral thigh myocutaneous flap, 3 for sural nerve nutrient vascular flap, 4 for latissimus dorsi myocutaneous flap and 2 for medial supramalleolar island flap. Size of the KF was 15.0 cm × 12.0 cm-30.0 cm × 20.0 cm. Types of KF were: 3 of type I, 5 of type IIA, 2 of type IIB and 2 of type Sydney Melanoma Unit (SMU) modification KF design. Four patients were reviewed by telephone follow-up, 5 by WeChat and 3 with outpatient clinic visits to observe the appearance of the transferred KF and postoperative complications. Appearance of flaps was scored and analysed using Vancouver Scar Scale (VSS) and Scar Cosmesis Assessment and Rating (SCAR) .Results:The average follow-up period was 15.9 (2-27) months. The colour and texture of the transferred KF were similar to that of the surrounding skin, together with good sensation recovery. No complication such as osteofascial compartment syndrome, necrosis, wound dehiscence and venous congestion occurred in all patients. At the final follow-up, the scores for VSS was 2.17±0.58 and the score for SCAR was 5.33±1.23, with satisfactory repairing outcomes.Conclusion:As a relay flap, the KF is a simple and effective flap for reconstruction of the defects at the donor site and it can avoid complications that can be caused by direct closure of the soft tissue defect or a wound dehiscence after skin grafting.
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Objective:To discuss the pedicled perforator flap around ankle in complicated replantation of severed traumatic midfoot.Methods:From May 2017 to December 2020, a total of 4 patients with severed midfoot combined with severely traumatic soft tissue defects were treated in the Department of Micro-orthopaedics, The Second Affiliated Hospital of Luohe Medical Collage. The patients were all males and aged from 22 to 53 (mean, 44) years old. Two patients had left foot injured and 2 in right foot. Causes of injuries: One patient was injured by strangulation of a corn harvester belt, and 3 were crushed by a heavy steel bar. Three patients had the severed sites at the level of intertarsal joint and 1 at the base of metatarsus. The time from injury to admission was 2.0-5.0(mean, 3.5) hours. The severed feet were replanted by anterograde method. Pedicled perforator flaps around ankle were used to repair the soft tissue defects of feet in emergency surgery or post first-stage surgery. The sizes of the flaps were 7.5 cm×8.0 cm-9.0 cm×19.0 cm. Scheduled follow-ups were arranged at outpatient clinic or by online reviews. Appearance, texture, colour, blood supply and sensory-motor function of the replanted feet and flaps were observed. The function of the foot and ankle was evaluated according to the American Orthopaedic Foot Ankle Association (AOFAS).Results:All 4 patients engaged follow-ups lasted for 13-36(mean, 19.5) months. Three replantations survived after surgery. In the other case, a chronic necrosis of the broken foot was caused by skin necrosis, wound infection, and vascular embolism. And then the necrotic forefoot was released, and the wound was later repaired with a flap based medial supramalleolar branches. A total of 5 flaps in 4 patients survived. All flaps were in good appearance with good texture and colour. All flaps healed primarily, and all skin grafts survived. All of the 4 patients could walked without assistance. Sensation restored to S 3. The patient with a failed replantation had left with a mild claudication. According to AOFAS, 2 patients were in excellent, 1 in good and 1 in fair at the last follow-up. Conclusion:Replantation of severed midfoot with an early application of pedicled perforator flap around ankle for reconstruction of severely traumatic defect is an effective and feasible treatment strategy.
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Objective:To evaluate the efficacy of pedicled latissimus dorsi flaps in reconstruction of large soft tissue defects around elbow.Methods:From January 2012 to January 2022, 12 patients with large soft tissue defects around elbow received reconstructive surgery with pedicled latissimus dorsi flaps in Department of Microreconstructive Surgery, The First Affliliated Hospital of Xinjiang Medical University. Partial latissimus dorsi flaps were employed to reconstruct The soft tissue defects around the posterolateral side of elbow in 6 patients. Functional reconstruction of anteromedial soft tissue defect around elbow with functional latissimus dorsi myocutaneous flap combined with biceps muscle dynamic reconstruction was performed on other 6 patients. All patients were males and aged 18 to 57 years old, at 31.4 years old in average. Causes of injury: machine strangulation in 5 patients, traffic accident in 4 patients, machine crush in 2 patients, and fall from height in 1 patient. Injured sites: 5 patients had injury on right elbow and 7 on the left. The size of soft tissue defect ranged from 18.0 cm×10.0 cm to 51.0 cm×13.0 cm. The size of the flaps were at 30.0 cm×7.0 cm-55.0 cm×14.0 cm. The wounds at donor site were directly sutured. Follow-up included postoperative reviews via telephone, WeChat and visit to outpatient clinic. Mayo elbow performance scores(MEPS) at the last follow-up were recorded.Results:All 12 flaps survived, and all donor and recipient sites healed at stage I. The follow-ups lasted for 3 months to 2 years for all patients, with 18 months in average. Three months after operation, 1 patient underwent additional surgery for flap reduction due to a bloated flap and poor appearance. Six patients who received dynamic reconstruction myocutaneous flaps achieved grade IV in elbow flexion. Six patients with lateral elbow repaired with partial latissimus dorsi myocutaneous flap showed that the appearance of the flap was not bulky and had no effect on the flexion and extension function of the elbow joint. All flaps survived well at the last follow-up, with soft texture and colour close to the surrounding normal skin. All donor sites healed well, leaving only linear scars. Motion of all elbows was good. The MEPS at the final follow-up was(90.6±6.4), with 10 patients in excellent and 2 in good.Conclusion:According to the location of elbow joint soft tissue defect, different types of latissimus dorsi myocutaneous flaps are used for reconstruction, which can achieve good clinical results.
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Objective:To evaluate the effect and mechanism of bone regeneration in distraction osteogenesis zone after the repair of sciatic nerve in rats.Methods:Between January 2021 and August 2021, 60 healthy adult male Sprague-Dawley rats were divided randomly into 3 groups: Group A, B, and C. In groups B and C, right sciatic nerve transection and anastomosis were performed. Then after 8 and 12 weeks, the 3 groups were treated with extension external fixation (Ilizarov technique) of right femur osteotomy to make distraction osteogenesis model. Electrophysiological changes of peripheral nerves were monitored by electromyography (EMG) pre-and postoperatively in all the femoral lengthening rats. The formation of callus was examined by X-ray every week after operation. The rats were sacrificed on 2nd, 4th, 6th weeks after the bone transport operation. Four-point bending test and histological staining examination were carried out to determine the osteogenesis in the distracted area. SPSS 21.0 was used for statistical analysis. Data of measurement were expressed as (Mean±SD). A non-parametric test was used to assess the statistical difference between groups. Graphs were plotted by GraphPad Prism 8.0 and considered statistically significant when P<0.05. Results:The results of Sciatic nerve function index (SFI), Compound muscle action potential (CMAP) and Motor nerve conduction velocity (MNCV) in group A were better than the group B and group C in both of before and after the surgery. At the 2nd and 4th weeks of the consolidation stage, X-ray showed that bone formation in group B was superior to groups A and C; HE and Safranin O staining showed that local capillary and cartilage formation in group B was significantly more than in groups A and C; Immunohistochemical staining showed that the expression levels of Osteopontin(Opn) and Osteocalcin(Ocn) in the distraction area of group B were higher than that of groups A and C. At the 6th week of the consolidation stage, the four-point bending test showed that the bone quality of group B was better than groups A and C. The differences of the results between groups shown above had statistical significance ( P<0.05). Conclusion:Bone regeneration in the distraction area of the bone lengthening group with sciatic nerve injury was better than that of the bone lengthening group without a never injury. This might be in relation to the fact that a distractive osteogenesis caused the secondary injury to the repaired nerve. The electrophysiological results showed that periodic changes took place in the repaired sciatic nerve caused by the stretch of femoral lengthening, and the injurious changes of sciatic nerve would be gradually relieved in 6th week after surgery.
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Objective:To study the preoperative CTA and 3D medical reconstruction software, aiming to provide an imaging basis for the preoperative design of peroneal artery perforator flap.Methods:From January 2016 to January 2018, 13 patients with soft tissue defect on foot were studied. Of the patients, 7 injuries were caused by traffic accident, 2 by machine crush and 4 by heavy object crush. The size of defect ranged from 5.0 cm×3.0 cm to 17.0 cm×10.0 cm. CTA technology was used to obtain the images of the affected lower limb, and the 3D visual reconstruction of peroneal artery perforators was generated by using Mimics software. The distribution of peroneal artery perforator was observed. The preoperative design of the flap was completed with the tools come with the software package. The peroneal artery perforator flap was harvested according to the design by computer simulation. Data taken before the surgery were compared with the data taken in the operation. Then the flap was rotated 180° to repair the defect. Regular follow-ups were made in outpatient clinic or via internet after operation. The appearance, texture, colour and blood supply of the flap were observed. The function of foot and ankle was scored according to the American Orthopaedic Foot Ankle Association(AOFAS). Results:A visible 3D flap model of the peroneal artery perforator flap was successfully reconstructed by Mimics software. The anatomical characteristics and region of blood supply of the 13 cases were basically comparable to what were found in the operation. The size of the flap was 6.0 cm×4.0 cm-18.0 cm×11.0 cm. All the flaps survived completely. All the patients completed 6-17(mean, 8.1) months follow-up. The colour and texture of the flaps were good. At the last follow-up, according to the AOFAS score, 7 cases were in excellent, 4 in good and 2 in fair, with an excellent and good rate at 84.61%.Conclusion:Aided by digital technology, it provides a visual 3D morphological support for the design of peroneal artery perforator flap and overcomes the blind spot in the preoperative design, hence it leads to an accurate harvest of the flap in operation.
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Objective@#To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation.@*Methods@#A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014. Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases. The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery.@*Results@#All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recovered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the musculocutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3. In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively.@*Conclusion@#Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.
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Objective To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation. Methods A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014.Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases.The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery. Results All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recov鄄ered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the muscu鄄locutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3.In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively. Conclusion Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.
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To investigate the role of the bionic multi-channel nerve conduit by reducing mis-match of regenerated nerve fibers in the rabbit sciatic nerve defect. Methods The experiment was conducted from July, 2017 to February, 2019. A total of 55 New Zealand white rabbits were randomly divided into two groups (First group, n=30 and Second group, n=25).There were 5 subgroups (n=6) in the first group, which were autograft and cus-tom-anatomic nerve conduits (CANC) with different channel (1-CANC, 2-CANC, 3-CANC, 4-CANC) that implanted to repair the rabbit sciatic nerve defect (10 mm). The electrophysiological, triceps muscle wet weight recovery rate, histological study and ankle index analysis were used to evaluate the treatment of each group at 12 and 24 weeks postoperatively. There were 5 subgroups (n=5) in the second group. The simultaneous retrograde tracing method was applied to compare with the number of mismatched nerve fibers at 24 weeks postoperatively. All data were recorded and analyzed by One-way ANOVA method, the Turkey’s method was used to compare the differences between each subgroup. The difference was considered to be statistically significant if P＜0.05. Results The autograft group showed the best recovery in the electrophysiology, histology study and ankle index at 12 and 24 weeks postoperatively (P＜0.05).Histology results showed that the same number of myelinated nerve fibers in all CANC group (P＞0.05), but di-ameters of nerve fiber and myelin thickness were higher in 2-CANC and 3-CANC [(10.67±0.56) μm,(10.65±0.53) μm, respectively] compared with 1-CANC and 4-CANC groups [(8.43±0.63) μm, (9.03±0.55) μm, respectively].The differ-ences were similar in electrophysiological, wet weight recovery rate of triceps muscle, histological study and ankle index analysis.Simultaneous retrograde tracing showed that the autograft group had highest total number of labeled profiles, but no significant difference of the total number of labeled profile was showed among the CANC groups. However, the 1-CANC group[(7.1±2.4) %] showed highest percentage of the FB-NY-neurons than other CANC groups[(2.7±1.9)% in 2-CANC, (2.5±2.3) % in 3-CANC, and (2.2±1.2)% in 4-CANC](P＜0.05). Conclusion The autograft group showed the best results among all groups.Compared with the 1-CANC group, the 2-CANC and 3-CANC group obtained more mature regenerated nerve fibers and with a fewer mismatch rate.Moreover, that did not affect the number of regenerated fibers.
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Objective To compare the curative effects of Orthofix extended external fixator versus Ilizarov external fixator in the treatment of bone defects following post-traumatic tibial osteomyelitis.Methods During the period from January,1996 through January,2015,129 patients were selected for a retrospective analysis.They were 106 males and 23 females,aged from 14 to 60 years (average,36.5 years).Orthofix extended external fixator was used in 43 of them and Ilizarov external fixator in 86.Bone transportation started 7 to 10 dlays after surgery at a speed of 1 mm/d and was completed in 4 turns.The 2 groups were compared in terms of mineralization time for the extended bone,hone lengthening length,fixation time,union indexes,Activity of Daily Living Scale (ADL),Self-Rating Anxiety Scale (SAS),knee range of motion (ROM) and complications.Results The patients were followed up for 13 to 216 months (average,96 months).Orthofix group and llizarov group were not significantly different in mineralization time for the extended bone,bone lengthening length,fixation time or union indexes (P ＞ 0.05).In Orthofix group and Ilizarov group respectively,there were 6 versus 73 patients with mildly limited self-living abilities and 37 versus 13 patients with little limited self-living abilities by ADL scores;there were 33 versus 16 cases of mild anxiety,8 versus 63 cases of moderate anxiety and 2 versus 7 cases of grave anxiety by SAS scores;there were 39 versus 10 cases of limited knee ROM of 15° to 30° and 4 versus 76 cases of limited knee ROM of 30° to 60°.There were significant differences between the 2 groups in the above indexes (P ＜ 0.05).The rate of complications in Orthofix treatment group(79.1％,34/43) was significantly lower than in Ilizarov group (88.4％,76/86) (P ＜ 0.05).Conclusions In the treatment of bone defects following post-traumatic tibial osteomyelitis,the curative effects of Orthofix extended external fixator are similar to those of Ilizarov external fixator.However,they may have different effects on the life and psychology of the patients in the long run.Therefore,specific therapeutic scheme should be decided in consideration of the advantages of the 2 treatments as well as the conditions of specific patients.
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Objective To explore the possibility of reduce the treatment cycle of post-traumatic osteomyelitis patients treat with bone transportations. Methods In February, 2017, a patient was diagnosis as left tibial os-teomyelitis with soft tissue defects and treated. Before start trifocal bone transportation with Orthofix external fixator, we did preoperative practice with computer and model. Except this case we also had some article review in this report. Results This case not only finished 12.5 cm bone transportation in 45 days but also treated soft tissue defect before bone transportations. In this method we save almost 2/3 time to compare with monofocal bone transportations, and frame time were also faster than previous method. But because of some mishaps when we follow-up, the gap was occurred in docking side after 140 days follow-up that may need bone transplants. After 140 days of operation, the gap was disap-peared. Conclusion A new type bone transportations in this study and it may reduce treatment time of osteomyelitis.
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ObjectiveTo evaluate the radial rotation osteotomy and ulnadouble rotation osteotomy obstetric brachial plexus injury (obstetric brachial plexus palsy) forearm pronation deformity sequelae value.MethodsFrom August 2007 to August 2011, twenty cases of obstetric brachial plexus palsy sequelae in children with forearm pronation deformity, the implementation of a simple radial rotating radial osteotomy (5cases),double-rotation radius and ulna osteotomy (15 cases) and two surgical type,and by 6 to 54 months after surgery (mean 25 months) follow-up.The groupfunctions to forearm pronation angle and conscious function improvement as the evaluation criteria. ResultsThe 15 cases of radius and ulna osteotomy in children with dual function and appearance in 14 cases significandy improved,one case of supination deformity;five underwent simple radial pronation osteotomy,three patients had improved function and appearance,followed up for 6 months, eight months after the merger which radial head dislocation in 2 cases due to poor efficacy of dual-line radius and ulna osteotomy, twenty patients in this group did not appear nonunion.ConclusionSimple radial rotation osteotomy surgery in obstetric brachial plexus palsy forearm pronation deformity complications without radial head dislocation has some value, radius and ulna double osteotomy in forearm pronation deformity with radial head dislocation aftermath of the effect is more excellent.
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BACKGROUND: Bone tissue engineering materials/call complex has been able to live in the muscle, subcutanecus tissue, ano other heterotopic bones, or in small mammals to repair bone defect. However, there is still much practical and clinical gap, such as bone tissue engineering and technical ability to repair large bone defects in big mammals, as well as how to promote the in vivo tissue-angineerad bone revascularization process.OBJECTIVE: To observe the bone formation using beagle deep fascia pedicled flap and tissue-engineered bone.METHODS: Beagle bone marrow mesenchymal stem calls were isolated, cultured, and inoculated on poly-lactone (PCL).Bone/bone membrane defect was induced in middle tibia on the left side of beagle. Then, the defect was implanted with fascia-encapsulated bone marrow mesenchymal stem cells (BMSCs), considering as experimental group. The second defect was induced in the middle tibia on the right side of beagle and implanted with BMSCs/PCL, considering as control group. The third defect was induced in 2 additional beagles without any implantation, considering as blank control group. Gross observation, X-ray test, histology, and magnetic resonance perfusion imaging were performed on the models to observe growth and ostecblasts andvasculadzation. RESULTS AND CONCLUSION: There was no new bone formation and blood vessels growth in the blank control group, and the defect was filled by fiber scar tissues finally. After 8-16 weeks, the bone defect was gradually filled by bony tissue, and more calluses which grew in implants were observed. The broken ends of fractured bone were not intact, and pulp cavity was sclerotic.Bone formation in the experimental group was rapid than in the control group. After 6 weeks, a great quantity of calluses was observed; after 8 weeks, stant materials were completely degraded; after 12 weeks, bone defect was succassfully repaired. A greet quantity of cancallated bones was observed, the newborn cavitas medullaris was smooth, and cortical bone was successive and stable. The amount, pore diameter, and distribution of formed blood vessels in the experimental group were superior to those in the control group, suggesting that tissue-engineered bone was able to effectively and rapidly repair bone defect in some animal.Fascia flap could promote the revascularization in vivo of tissue-engineered bone.