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Objective:To establish a model of epiphyseal plate injury in juvenile rabbits and explore the effect of periosteum flap with saphenous artery on preventing the formation of bone bridge after epiphyseal plate injury.Methods:From July 2017 to January 2018, 30 young New Zealand immature rabbit were randomly grouped into 3 groups (group A, B and C, with 10 rabbits per group). The blood vessels of knee joint were dissected and a periosteum flap with saphenous artery were designed. A model of distal femoral epiphyseal plate injury was established in immature rabbits with a 3.0 mm Kirschner wire on one side of the distal femoral epiphyseal plate as experimental side, and the other side of the distal femoral epiphyseal plate was assigned as control side. The injured epiphysis were prepared and described as follow: in experimental side of group A, a piece of periosteum with the same size as that in group C was resected and discarded. In experimental side of group B, a periosteal flap without vascular pedicle was filled in the injured area. And in experimental side of group C, a periosteum flap with saphenous artery was filled in the injured area. The length and varus angle of femur specimens of length and varus angle of femur specimens wihthin groups were measured at 24 weeks after surgery to evaluate the effect on bone growth in epiphyseal plate injury. The effect of the periosteum flap with saphenous artery on preventing a formation of bone bridge was assessed by section view of decalcified specimens, HE staining and toluidine blue staining. The measured data were expressed as Mean and standard deviation (Mean±SD), and data were compared within and between the groups using one-way analysis of variance (ANOVA). P<0.05 was considered as statistically significant. Results:The femur of experimental side of group A and B showed obvious short with valgus deformity compared with that of control side, and the difference of length and varus angle of femur specimens wihthin groups was statistically significant ( P<0.05). There were no significant differences in the length and valgus angle of the femur between experimental side and its control side in group C ( P>0.05). In experimental side of group A, there were bone bridges in the epiphyseal lesion area, with a clear boundary to the surrounding epiphyseal plate. In experimental side of group B, the periosteum flap in the injured area was absorbed, accompanied by the formation of a few pale white bone tissue, and with a clear boundary to the surrounding epiphyseal plate. In experimental side of group C, the lesion area was filled with milky white cartilage tissue with the same colour as the epiphyseal plate, and with an unclear boundary with the epiphyseal plate. HE stain and toluidine blue staining showed that the injured area of group A was filled with a large number of bone tissue, but no obvious cartilage tissue was observed. In group B, the area of lesion was filled mainly with fibrous tissue, with a small amount of bone tissue. In group C, a large number of hyaline cartilage tissues were formed along the tunnel of the injury area, and closely connected with the normal epiphyseal plate. Conclusion:Filling a periosteum flap with saphenous artery after epiphyseal plate injury can prevent the formation of bone bridge and prevent the affected limb form shortening and angulation.
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Maxillary defects result in esthetic and functional defects in patients. Several techniques are available for ma-xillary reconstruction. Herein, we present a case of maxillary reconstruction with medial femoral condyle periosteal flap by intraoral anastomosis. The characteristics of medial femoral condyle periosteal flap and the advantages of intraoral anasto-mosis are introduced.
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Humans , Anastomosis, Surgical , Esthetics, Dental , Femur , Maxilla , Plastic Surgery Procedures , Surgical FlapsABSTRACT
Objective To investigate the clinical effect of using uninterrupted vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis in treating frontal sinusitis after craniotomy.Methods The clinical data in 31 cases of frontal sinusitis after craniotomy in our hospital from January 2006 to December 2014 were retrospectively analyzed.Seventeen cases adopted simple debridement and drainage treatment and 14 cases were treated with continuous vacuum sealing drainage combined with routine debridement treatment.Postoperative follow up lasted over 1 year.Results In simple debridement and drainage,12 cases were cured,the other 5 cases recurred after operation,and the cure rate was 70.6 ％.But in the continuous vacuum sealing drainage combined with routine debridement treatment,14 cases were cured,no case recurred after operation,and the cure rate was 100％.Therefore,the cure rate of continuous vacuum sealing drainage treatment combined with routine debridement was higher than that of simple debridement and drainage treatment(P＜0.05).Conclusion Adopting vacuum sealing drainage combined with routine debridement and pedicled periosteal flap sealing frontal sinusitis can promote the infection focus clearance and wound healing,and increases the cure rate.
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Objective To assess the effectiveness of pedicled iliac periosteal flap graft for treatment of old femoral neck fracture in adolescents.Methods Between June,2005 and December,2013,15 patients (15 hips) of old femoral neck fracture in adolescents treated with vascular pedicled iliac periosteal.There were 11 males and 4 females with an average age of 15.8(range 12 to 18) years.Based on the location of fracture,there was 5 cases of subcapital,8 cases of transcervical and 2 cases of basal.6 cases were treated with lower limb traction,3 cases with internal fixation and 6 just without any treatment.The average duration from injury to the second operation was 4.8 (range 1 to 19) months.There were 2 cases of femoral head necrosis after femoral neck fracture.Open reduction,pedicled iliac periosteal flap grafting and cannulate screw fixation were performed.Results All incisions healed by first intention.All patients were followed up 12 to 90 months (mean,46 months).The HHS was increased from (48.7 ± 8.3) pre-operation to (91.3 ± 6.1) at last followed-up,indicating a significant difference between before and after operation (P ＜ 0.01).One patient underwent total hip arthroplasty at 10 months after operation because of fracture nonunion and femoral head necrosis.Fracture healed successfully in 14 cases and the average time of fracture healing was 4 (range 3 to 6) months.Certain extent of remodelling and bulge of the head were observed in 2 cases of collapsed heads.Conclusion Pedicled iliac periosteal flap graft can provide good osteogenesis and vascular reconstruction for femoral head and promote fracture healing in treatment for old femoral neck fracture in adolescents.
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Objective To investigate the clinical effect of the iliac periosteal flap with ascending branch of lateral femoral circumflex artery for the treatment of Legg-Calvé-Perthes disease.Methods Followed-up 18 patients with Legg-Calvé-Perthes disease who had undergone the treatment of iliac periosteal flap with ascending branch of lateral femoral circumflex artery from January,2008 to May,2012 in our hospital.Minimum follow-up time was from 24 to 60 months,and the average time was 38 months.The followed-up period ended in May,2014.Assessed the effect of surgery by X-ray,clinical examination and Harris scoring system.Results Sixteen patients had good healing with iliac periosteal flap according to X-ray show.Their epiphyseal height recovered and the femoral head rounded gradually.Two cases became flat and collapse.The result of excellent and good rate was 88.9％ by Mose method combined with the results of X-ray.The average Harris hip score improved from 72.3 ± 4.9 points preoperatively to 91.3 ± 2.4 points postoperatively.The difference of the result was statistically significant (P ＜ 0.05).Conclusion The transfer of iliac periosteal flap with ascending branch of lateral femoral circumflex artery is an effective treatment for Legg-Calvé-Perthes disease.
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Objective To investigate the surgical techniques and clinical efficacy of cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures.Methods From March 2008 to June 2011,12 cases with talus neck fractures were treated with cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery.External fixation in functional position for 12-14 weeks,and the load time was determined by X-ray fracture healing.Functional results were assessed according to AOFAS (American Orthopaedic Foot and Ankle Society) score at last follow-up.Results Twelve cases were followed up for an average of 24 months (12 to 48 months).One case of skin flap necrosis healed by dressing.All the fractures healed,and the mean healing time was 20 weeks (16 to 24 weeks).AOFAS ankle and hindfoot mean postoperative score was 82.5 (ranging from 55 to 96) points.Among them 4 cases were excellent,good in 5 cases,fair in 3 cases.Two cases presented with mild posttraumatic subtalar arthritis and pain relief after oral anti-inflammatory analgesic.One case with avascular necrosis of talus body,and X-ray displayed sclerosis of talus body,but no collapse,and the patient was told to reduce weight and regularly followed up.Conclusion The application of cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery for the treatment of talus neck fractures is an effective treatment,which can improves the blood supply of the talus body and reduces the occurrence of avascular necrosis of the talus.
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Objective To investigate the clinical effects of the surgery of mastoid muscle periosteum valvuloplasty after modified radical mastoidectomy treatment of cholesteatoma otitis media.Methods 52 cases (52 ears)cholesteatoma otitis media patients for the observation group were collected.The patients in the observation group were treated by mastoid muscle periosteum valvuloplasty after modified radical mastoidectomy.49 cases (49 ears) for the control group were treated by concomitant mastoidectomy and the classic conchaplasty cavity angioplasty.Results Patients were followed up for 1 year.38 ears were dry in control group(77.6％),8 ears were recurrenced(16.3％),regular clean-up of surgical cavity at least 3 months postoperative.50 ears were dry in observation group (95.2％),dry ear rate was significantly higher (x2 =12.374,P =0.000) ;1 ears was recurrenced(2.4％),the recurrence rate was significantly reduced (x2 =11.966,P =0.000) ; Operative cavity after complete epithelialization no longer need to be cleaned regularly; No postoperative complications (such as periosteal flap or pinna cartilage of the mastoid muscle necrosis,facial paralysis,dizziness)were occurred,the prognosis was good.Conclusion The surgery of mastoid muscle periosteum valvuloplasty after modified radical mastoidectomy treatment of otitis media with cholesteatoma is safe and effective,which is worthy of promotion.
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Tibialis anterior muscle hernia is the most common hernia among lower extremity muscles. This condition can be diagnosed by physical examination and radiologic findings, especially by dynamic ultrasonography. There are surgical methods of treatment for muscle hernia, including direct repair, fasciotomy, fascial patch grafting using autologous fascia lata or synthetic mesh. We report a case of tibialis anterior muscle hernia treated with local periosteal rotational flap. Because there are several advantages to the local periosteal rotational flap, such as lack of donor site morbidity, lack of skin irritation, low cost, simplicity, and an easy approach, this technique could be an option for tibialis anterior muscle hernia.
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Humans , Fascia Lata , Hernia , Lower Extremity , Muscle, Skeletal , Muscles , Physical Examination , Skin , Tissue Donors , TransplantsABSTRACT
Objective To investigate the clinical characteristics of clavicular defect and nonunion after operation and evaluate the clinical effects of vascularized pedicled pectoralis major clavicular periosteal flap and locking plate fixation plus bone morphogenetic protein (BMP) implantation. Methods From January 2004 to April 2008, 12 patients (mean age, 42.8 years old) with clavicular defect and nonunion were treated in Zhongshan Hospital. The internal fixators were removed, and then fibrous scars and sclerotic bones were cleared. The clavicular detects were fixed with locking plate, with implantation of the BMP. The wound was covered with vascularized pedicled pectoralis major clavicular periosteal flap. Postoperative functional rehabilitation exercises were performed. Results All patients were followed up for 8-24 months (mean 1.2 years). The clinical results were evaluated by Constant-Murley scoring system. The clavicular defects were healed in all patients within 4-7 months, and the internal fixators were successfully removed from some of the patients. Conclusions Vascularized pedicled pectoralis major clavicular periosteal flap combined with locking plate fixation plus BMP implantation is effective in the treatment of clavicular defect and nonunion.
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PURPOSE: To evaluate the results of surgical reconstruction of lateral capsule-ligament complex with reinforcement by periosteal flap of distal fibula and inferior extensor retinaculum for chronic lateral ankle instability. MATERIALS AND METHODS: From April 2003 to August 2006, 62 patients with chronic lateral ankle instability were operated. There were 38 males and 24 females with a mean age of 39.6 years (range, 18~61 years). Mean follow-up period was 32 months (range, 10~48 months). All patients were checked with preoperative ankle anteroposterior and lateral view, stress anterior drawer and varus test using Telos device. The clinical results were graded according to the VAS and AOFAS scale. RESULTS: VAS score improved from preoperative 8.2 points to 3.1 points. There were 38 patients who were excellent (above 90 points), 18 who were good (between 76 and 90 points), 5 who were fair (between 60 and 75 points), and 1 who was poor (below 60 points) according to the AOFAS ankle and hindfoot scale. The excellent and good results amounted to 90.3%. CONCLUSION: Surgical reconstruction of lateral capsule-ligament complex with reinforcement by periosteal flap of distal fibula and inferior extensor retinaculum is believed to be a effective method for chronic lateral ankle instability.
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Female , Humans , Male , Ankle Joint , Ankle , Fibula , Follow-Up StudiesABSTRACT
Objective This paper provides an anatomical and theoretic basis for the reverse transposition of proximal ulnar or radial periosteal flap to repair non-union in distal humerus.Methods The origin,course,meanwhile,the outside diameter and length of relevent vessels were measured,on 30 upper limb cadaveric specimens.Results The recurrent interosseous,radial recurrentand the posterior branch of radial collateal arteries,their origin outside diameter and length from the origin to the humerus extermal epicondyle were (1 47?0 2)mm,(65 1?9 5)mm,(2 1?0 3)mm,(63 7?0 8)mm,(1 48?0 22)mm and (104 5?8 9)mm,respectively.Anastomoses pattern existed 3 types: in vicinity of the external epicondyle"Reverse Y"73 3%(22 cases)."Meeting in one point 13 3%(4 cases)"."Arteries networks"13 3%(4 cases).Conclusions It's possible that the reverse transposition of proximal ulnar or radial periostea flap pedicled with recurrent interosseous membrane or radial recurrent vessel for repairing non-union in distal humerus.
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Objective To provide an effective and convenient microsurgical method for ischemic necrosis of femoral head in children (Perthes disease) Method Basing on anatomic study, two periosteal flap pedicled with anterior superior iliac and anterior inferior iliac branches of lateral femoral circumflex vessel transposition was designed for the treatement of Perthes disease Result Eleven patients were performed with this method, and the average period of follow up was 2 1 years (range 1～3 5 years) The good and excellent rate was 82 percent Conclusion The operative method can not only provide with plenty of blood supply,but also increase osteogenic ability of the femoral head So, it is an effective method for the treatment of Perthes disease
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PURPOSE: The lack of vascularity in the hyaline cartilage is thought to be the main cause of why the cartilage can not repair itself. Therefore, authors designed the reversed intraarticular periosteal flap which preserves the vascular system to the periosteum and assesses neochondrogenesis. MATERIALS AND METHODS: The subjects used were 90 white New Zealand rabbits. Reversed intraarticular periosteal flap, intraarticular periosteal free flap and inducing articular cartilage defect only were performed in 30 rabbits, respectively. We compared the results of each groups according to gross morphology of regenerated tissue, histology and histochemical findings. RESULTS: Reversed intraarticular periosteal flap group and intraarticular periosteal free flap group resulted in better cartilage formation than in the articular cartilage defect only group and the reversed intraarticular periosteal flap group had better results than intraarticular periosteal free flap group even though the difference was not statistically significant. CONCLUSION: The reversed intraarticular periosteal flap was thought to be one of the methods which preserves the vascular system in the process of cartilage regeneration with periosteum.
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Rabbits , Cartilage , Cartilage, Articular , Free Tissue Flaps , Hyaline Cartilage , Periosteum , RegenerationABSTRACT
Objective To provide an new operative method for ischemic necrosis of femoral head in children Method The disease was treated by comprehensive operation,which are transposition of posterior great trochanter periosteal flap pedicled with profound branches of medial circumflex femoral vessels and decompression of epiphasis of femoral head Results Forty two patients were performed in seven years The period of follow up is above one year in 37 cases and average three years and six months The good and excellent rate is 86 percent Conclusions This new operation can provide with effective decompression and blood circulation and various osteogenic factors It is suitable with patients of Catterall Ⅰ～Ⅳ
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Objective To provide a new method to repair nonunion or bone defect of femur Methods The descending branch of lateral circumflex femoral artery anastomosis with the lateral superior genicular artery and the branches distribution of the lateral genicular artery were obsereved on 30 sides of adult cadaveric lower limbs The bone (periosteal) flap of the lateral condyle of femur with the pedicle of the descending branch of lateral circumflex femoral artery was designed and appdied in clinical to repair nonunion or defect in the middle or inferior of femur of 13 patiens Results The follow up period was 14～20 weeks All fracture were unionized and union periods were 13～20 weeks, the results were excellent Conclusion The anatomical location of vessels of this bone (periosteal) flap is enduring, the surgery is simply, the transposition is simble, the influence of donor is very small This bone (periosteal) flap adapt to repair nonunion or bone defect in the middle or inferior of femur
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Surgical method for blow out fracture of medial orbital wall is performed by medial canthotomy and subciliary incision or transconjunctival incision. However, these approaches can leave cosmetic problem due to skin incision and have a risk of infection and absorption of prosthetic implant for a large medial wall fracture. The authors performed endoscopic intranasal reconstruction of the isolated medial wall fracture in a case with significant functional impairment of extraocular muscle. After the incision of the middle turbinate, medial wall fracture was reconstructed with muco-periosteal flap under endoscopic control. We had a good result without intraoperative or postoperative complications caused by prosthetic implant. There was no disadvantage seen with the traditional approaches by medial canthotomy. Endoscopic intranasal reconstruction with muco-periosteal flap appears to be a new safe method for especially large defect.
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Absorption , Orbit , Postoperative Complications , Skin , TurbinatesABSTRACT
Objective:In order to provide a new area of bone flap were supplied for non-unions, osseous defect of upper limbs and chondral defect of elbow joint.Methods:The origin,course,distribu- tion and anastomosis of inferior ulnal collateral artery and ulnal recurrent artery were observed on 40 adult cadaver upper limbs.Based on the results,transposition of pedicled medial lower part of humerus bone flap with vessels was designed.Results:Satisfactary results were achieved in 9 case of patients (non-unions of 3 case and osseous defect of 2 case on medial part of humerus bone;non-unions of 3 case on medial upper part of ulna and radius;chondral defect of 1 case on elbow joint.)Conclusion:This pe- riosteal flap that there are constant vessels and abundant anastomosis with inferior ulnar collateral artery form many area of bone flap were supplied with blood supply for repairing the non-unions,os- seous defect of humerus,ulna,radius and chondral defect of elbow joint.
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Objective To provide anatomical basis for transposition for the periosteal flap pedicled with the lateral anterior malleolus vessel on the anterior external of tibia distally based. Methods The origins, course, branches distribution, and anastomosis of lateral anterior malleous artery and periosteal vessels of the anterior external of tibia distally based were observed on 30 adult cadaveric feet. Results Lateral anterior malleolus arteies had 1～2 branches, whose diameters were(1.6?0.4)mm and the distances the above cusp of extrnal malleolys cusp were(1.1?0.4)cm, the arteries sent off the 1～3 pieces periosteum branches with diameter 0.4 to 0.8 mm, which distribute to the periostalr of anterior external of tibia distally based. To circulate anterior external of lateral malleouls of perforating descending branch of peroneal artery [the distances the above cusp of external malleolys cusp were (5.6?0.5)cm],the arteries sent off the 2～6 pieces periosteum branches with diameter 0.5 to 1.0 mm, which distributed to the periostealr of anterior external of tibia distally based and lateral malleolus. Both anastomosis site in the above cusp of external malleolys cusp were(1.7?0.6)cm, the distances the point of lateral anterior malleolus artery were(2.5?0.6)cm. The artery of anastomosis to undergo posterior of extensor digitorum brevis, along anterior border of tendon of short peroneal muscle, anastomosed with the lateral tarsal artery and the medial taesal atery. Conclusion It is an easy practical for repairing fracture of neck of talus fracture and ischemic necrosis of talus body to achieve the transposition of periosteal flap pedicled with the lateral anterior malleous vessel on the anterior external of tibia distally based.
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Objective To discuss the clinical value of transposition of the pedicled anterolateral femoral periosteal flap. Methods The blood supply of anterolateral femoral periosteum were dissected on 38 adult cadaveric lower limber specimens injected with red dye. The origins, distributions and anastomosis of periosteal breanches were observed and measured. Based on these anatomic investigations, the transposition of pedicled anterolateral femoral periosteal flap was designed to repair the bone nonunion and lesion of femur. Results Twenty-two cases were treated in the satisfactory results, and followed-up from 1 to 5 years. The size of the periosteal flap ranged from 8cm?4cm to 10cm?5cm. Conclusions The periosteal flap could be operated so conveniently and safely as to be spread easily, treatment of lesion and incision of periosteal flap can be finished in the same operative approach. The periosteal flap have been proved to be powerfully clinical value.