Short- and mid-term effectiveness of unicompartmental knee arthroplasty for post-traumatic arthritis of knee / 中国修复重建外科杂志

OBJECTIVE@#To investigate the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA) for post-traumatic arthritis (PTA) of knee.@*METHODS@#The clinical data of 30 patients with PTA of unilateral knee between March 2014 and September 2021 was retrospectively analyzed. There were 14 males and 16 females with an average of 64.5 years (range, 33-81 years). The average body mass index was 26.7 kg/m 2 (range, 19.8-35.6 kg/m 2). The types of injuries that caused PTA included intra-articular fracture in 16 cases, extra-articular fracture in 8 cases, and soft tissue injury in 6 cases. The initial injuries were treated by conservative therapy in 12 cases and by surgical therapy in 18 cases. Ten cases were medial compartment osteoarthritis and 20 cases were lateral compartment osteoarthritis. According to Kellgren-Lawrence staging, there were 19 cases of grade Ⅲ and 11 cases of grade Ⅳ. The operative time, the length of hospital stay, complications, and subjective satisfaction were recorded. The Oxford Knee Function Score (OKS), Hospital for Special Surgery (HSS) score, and knee range of motion (ROM) were used to evaluate knee function. Weight-bearing X-ray films were taken to measure the femoro-tibial angle (FTA) and to assess alignment correction of the lower limb.@*RESULTS@#The operative time ranged from 50 to 95 minutes (mean, 63.7 minutes), the length of hospital stay ranged from 3 to 8 days (mean, 6.9 days). Superficial infection occurred in 2 patients, while the remaining incisions healed by first intention. There was no deep vein thrombosis or neurovascular injury. All patients were followed up 17-109 months (median, 70 months). At last follow-up, OKS score, HSS score, and ROM in 30 cases significantly improved when compared with those before operation (P<0.05). Lower limb alignment was significantly corrected and there was significant difference in FTA of the varus and valgus knees between pre- and post-operation ( P<0.05). The patient satisfaction rate was 86.7% (26/30). Two cases developed contralateral osteoarthritis progression during follow-up. No bearing dislocation, prosthesis loosening or sinking occurred and none required further revision.@*CONCLUSION@#For patients with PTA of knee, UKA can obtain definite short- and mid-term effectiveness with high patient satisfaction.

Comparison of filling ratio, alignment, and stability between ABG Ⅱ short-stem and Corail long-stem in total hip arthroplasty for Dorr type C femur / 中国修复重建外科杂志

OBJECTIVE@#Using the mono-energy reconstruction images and X-ray films to investigate whether the ABG Ⅱ short-stem could improve the filling ratio, stability, and alignment in the Dorr type C femur, compared with the Corail long-stem.@*METHODS@#Among patients who were with Dorr type C femurs and treated with total hip arthroplasty between January 2006 and March 2012, 20 patients with a Corail long-stem (Corail group) and 20 patients with an ABG Ⅱ short-stem (ABG Ⅱ group) were randomly selected. The differences in gender, age, body mass index, and preoperative diagnoses between the two groups were not significant ( P>0.05). The ABG Ⅱ group was with a mean follow-up of 142 months (range, 102-156 months), and the Corail group was with a mean follow-up of 107 months (range, 91-127 months). There was no significant difference in the Harris score and subjective satisfaction score between the two groups at last follow-up ( P>0.05). At last follow-up, dual-energy CT scans with mono-energy image reconstruction were used to calculate the prosthetic filling ratio and to measure the alignment of the prosthesis in the coronal and sagittal positions. Stability assessment was performed based on X-ray films, and the subsidence distance was measured using EBRA-FCA software.@*RESULTS@#X-ray film observation showed that the prostheses in the two groups were stable and no signs of loosening was found. The incidence of pedestal sign was significantly lower in the ABGⅡ group than in the Corail group ( P<0.05), and the incidence of heterotopic ossification was significantly higher in the ABGⅡ group than in the Corail group ( P<0.05). The subsidence distance of femoral stem in ABG Ⅱ group was significantly greater than that in Corail group ( P<0.05), and the subsidence speed of femoral stem in ABG Ⅱ group was also greater than that in Corail group, but the difference was not significant ( P>0.05). The overall prosthesis filling ratio was significantly higher in the ABG Ⅱ group than in the Corail group ( P<0.05), while the coronal filling ratio at the lesser trochanter, 2 cm below the lesser trochanter, and 7 cm below the lesser trochanter were not significant ( P>0.05). The results of prosthesis alignment showed that there was no significant difference in the sagittal alignment error value and the incidence of coronal and sagittal alignment error >3° between the two groups ( P>0.05), while the coronal alignment error value in the ABG Ⅱ group was significantly greater than that in the Corail group ( P<0.05).@*CONCLUSION@#Although the ABG Ⅱ short-stem avoids the distal-proximal mismatch of the Corail long-stem in the Dorr type C femur and thus achieves a higher filling ratio, it does not appear to achieve better alignment or stability.

Progress in evaluation of return to sports after anterior cruciate ligament reconstruction / 中国修复重建外科杂志

OBJECTIVE@#To summarize the evaluation methods of return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR) in recent years, in order to provide reference for clinical practice.@*METHODS@#The literature related to the RTS after ACLR was searched from CNKI, Wanfang, PubMed, and Foreign Medical Information Resources Retrieval Platform (FMRS) databases. The retrieval range was from 2010 to 2023, and 66 papers were finally included for review. The relevant literature was summarized and analyzed from the aspects of RTS time, objective evaluation indicators, and psychological evaluation.@*RESULTS@#RTS is the common desire of patients with ACL injury and doctors, as well as the initial intention of selecting surgery. A reasonable and perfect evaluation method of RTS can not only help patients recover to preoperative exercise level, but also protect patients from re-injury. At present, the main criterion for clinical judgement of RTS is time. It is basically agreed that RTS after 9 months can reduce the re-injury. In addition to time, it is also necessary to test the lower limb muscle strength, jumping, balance, and other aspects of the patient, comprehensively assess the degree of functional recovery and determine the different time of RTS according to the type of exercise. Psychological assessment plays an important role in RTS and has a good clinical predictive effect.@*CONCLUSION@#RTS is one of the research hotspots after ACLR. At present, there are many related evaluation methods, which need to be further optimized by more research to build a comprehensive and standardized evaluation system.

Clinical application of Flow-through bridge anterolateral thigh flap in repair of complex calf soft tissue defects / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of Flow-through bridge anterolateral thigh flap transplantation in the treatment of complex calf soft tissue defects.@*METHODS@#The clinical data of the patients with complicated calf soft tissue defects, who were treated with Flow-through bridge anterolateral thigh flap (study group, 23 cases) or bridge anterolateral thigh flap (control group, 23 cases) between January 2008 and January 2022, were retrospectively analyzed. All complex calf soft tissue defects in the two groups were caused by trauma or osteomyelitis, and there was only one major blood vessel in the calf or no blood vessel anastomosed with the grafted skin flap. There was no significant difference between the two groups in general data such as gender, age, etiology, size of leg soft tissue defect, and time from injury to operation ( P>0.05). The lower extremity functional scale (LEFS) was used to evaluate the sufferred lower extremity function of the both groups after operation, and the peripheral blood circulation score of the healthy side was evaluated according to the Chinese Medical Association Hand Surgery Society's functional evaluation standard for replantation of amputated limbs. Weber's quantitative method was used to detect static 2-point discrimination (S2PD) to evaluate peripheral sensation of the healthy side, and the popliteal artery flow velocity, toenail capillary filling time, foot temperature, toe blood oxygen saturation of the healthy side, and the incidence of complications were compared between the two groups.@*RESULTS@#No vascular or nerve injury occurred during operation. All flaps survived, and 1 case of partial flap necrosis occurred in both groups, which healed after free skin grafting. All patients were followed up 6 months to 8 years, with a median time of 26 months. The function of the sufferred limb of the two groups recovered satisfactorily, the blood supply of the flap was good, the texture was soft, and the appearance was fair. The incision in the donor site healed well with a linear scar, and the color of the skin graft area was similar. Only a rectangular scar could be seen in the skin donor area where have a satisfactory appearance. The blood supply of the distal limb of the healthy limb was good, and there was no obvious abnormality in color and skin temperature, and the blood supply of the limb was normal during activity. The popliteal artery flow velocity in the study group was significantly faster than that in the control group at 1 month after the pedicle was cut, and the foot temperature, toe blood oxygen saturation, S2PD, toenail capillary filling time, and peripheral blood circulation score were significantly better than those in the control group ( P<0.05). There were 8 cases of cold feet and 2 cases of numbness on the healthy side in the control group, while only 3 cases of cold feet occurred in the study group. The incidence of complications in the study group (13.04%) was significantly lower than that in the control group (43.47%) ( χ 2=3.860, P=0.049). There was no significant difference in LEFS score between the two groups at 6 months after operation ( P>0.05).@*CONCLUSION@#Flow-through bridge anterolateral thigh flap can reduce postoperative complications of healthy feet and reduce the impact of surgery on blood supply and sensation of healthy feet. It is an effective method for repairing complex calf soft tissue defects.

Reconstrucción microquirúrgica en pandemia por Covid-19 / MICROSURGICAL RECONSTRUCTION IN THE COVID - 19 PANDEMIC

Introducción: la Pandemia por SARS CoV ­ 2 (COVID ­ 19) tuvo un impacto significativo en el desarrollo de los servicios quirúrgicos en general y obligo a establecer protocolos de actuación para las distintas patologías a fin de cuidar al máximo los recursos humanos y la capacidad instalada de los hospitales para hacer frente a esta contingencia mundial. Objetivos: presentar una casuística de 7 pacientes con reconstrucción microquirúrgica de patología de cabeza y cuello en estadios avanzados y patología de miembros inferiores durante la pandemia por COVID - 19. Materiales y Métodos: trabajo retrospectivo, se revisaron las historias clínicas físicas y digitales. Se incluyeron 5 pacientes con patología avanzada de cabeza y cuello y 2 pacientes con patología de miembros inferiores. Resultados: cinco pacientes fueron operados por patología avanzada de cabeza y cuello: 3 pacientes con carcinomas escamosos de cavidad oral estadio IVa, 1 paciente con carcinoma escamoso de piel avanzado estadio IV y 1 paciente con fractura compleja de maxilar inferior por herida de arma de fuego con fistula oro-cutánea crónica, con exposición del material de osteosíntesis, mala oclusión y pérdida de peso importante por dificultad para alimentación. Dos pacientes fueron operados por patología de miembros inferiores en tercio inferior de pierna, uno por fractura expuesta grave con defecto de tejidos blandos y el otro por una ulcera arterial. Conclusión: la cirugía reconstructiva microquirúrgica puede realizarse con buenos niveles de seguridad para el personal de salud y para los pacientes afectados por patologías avanzadas de cabeza y cuello y otras patologías que requieran colgajos libres. Es fundamental respetar estrictamente los protocolos para evitar los contagios en el medio intrahospitalario, entendiendo que debe considerarse todo paciente que ingrese al hospital como COVID (+) hasta que se demuestre lo contrario

Introduction: the SARS CoV ­ 2 (COVID ­ 19) Pandemic had a significant impact on the development of surgical services in general and forced the establishment of action protocols for the different pathologies in order to take maximum care of human resources and capacity. installed in hospitals to deal with this global contingency. Objectives: to present a casuistry of 7 patients with microsurgical reconstruction of head and neck pathology in advanced stages and lower limb pathology during the COVID - 19 pandemic. Materials and Methods: retrospective work, physical and digital medical records were reviewed. Five patients with advanced head and neck disease and 2 patients with lower limb disease were included. Results: five patients underwent surgery for advanced head and neck disease: 3 patients with stage IVa squamous cell carcinoma of the oral cavity, 1 patient with stage IV advanced squamous cell carcinoma of the skin, and 1 patient with a complex fracture of the lower jaw due to a gunshot wound. with chronic oro-cutaneous fistula, with exposure of the osteosynthesis material, poor occlusion and significant weight loss due to difficulty feeding. Two patients underwent surgery for pathology of the lower limbs in the lower third of the leg, one for a severe open fracture with a soft tissue defect and the other for an arterial ulcer. Conclusion: microsurgical reconstructive surgery can be performed with good levels of safety for health personnel and for patients affected by advanced pathologies of the head and neck and other pathologies that require free flaps. It is essential to strictly respect the protocols to avoid contagion in the hospital environment, understanding that every patient who enters the hospital must be considered as COVID (+) until proven otherwise.

Impacto da COVID-19 no perfil cirúrgico dos pacientes de cirurgia vascular em serviço de referência em Curitiba / Impact of COVID-19 on the surgical profile of vascular surgery patients at a tertiary hospital in Curitiba, Brazil

Resumo Contexto Na pandemia de covid-19, os serviços de saúde diminuíram os atendimentos e procedimentos eletivos. Pacientes de cirurgia vascular são grupo de risco para adquirir formas graves da infecção, ao mesmo tempo que são suscetíveis a apresentar complicações de suas doenças de base caso não tenham acompanhamento rotineiro. Dessa forma, faz-se necessário entender os impactos e as consequências diretas e indiretas da pandemia com relação aos pacientes vasculares. Objetivos Avaliar o impacto de 1 ano de pandemia em um serviço de Cirurgia Vascular, assim como a mudança do perfil de cirurgias no mesmo período. Métodos Foi feita a análise de prontuários de pacientes submetidos a cirurgias eletivas e de urgência entre 2019 e 2021. Em conjunto, foi realizada uma revisão de literatura com as palavras-chave "cirurgia vascular", "covid-19" e "amputações". Os dados foram analisados com o programa computacional Stata/SE v.14.1 (StataCorpLP, EUA). Resultados Foram identificadas 1.043 cirurgias no período de estudo, sendo 51,6% pré-pandemia e 48,4% durante a pandemia. Observou-se redução no número de cirurgias eletivas e aumento no número de amputações de membros inferiores e desbridamentos cirúrgicos. Foi possível observar também aumento de pacientes com doença arterial obstrutiva periférica com classificação de Rutherford avançada, assim como de casos de pé diabético. Conclusões A diminuição dos atendimentos eletivos e o receio dos pacientes em procurar os serviços de saúde durante o período da pandemia são os prováveis motivos que justificam o aumento da gravidade dos quadros dos pacientes, com maior necessidade de amputação de membros inferiores, desbridamento cirúrgico e mudanças no perfil de cirurgia do serviço.

Abstract Background During the COVID-19 pandemic, healthcare services reduced the number of elective procedures performed. Vascular surgery patients are a group at risk of contracting severe forms of the infection, but are also susceptible to complications of their underlying diseases if they do not receive routine care. It is therefore necessary to understand the direct and indirect impacts and consequences of the pandemic on vascular patients. Objectives To assess the impact of 1 year of the pandemic on a vascular surgery service and changes to the profile of surgeries during the same period. Methods An analysis was conducted of the medical records of patients who underwent elective and emergency surgery from 2019 to 2021. A review of the literature was also conducted, using the search terms "vascular surgery", "COVID-19", and "amputations". Data were analyzed with Stata/SE v.14.1 (StataCorpLP, United States). Results A total of 1,043 surgeries were identified during the study period, 51.6% conducted pre-pandemic and 48.4% performed during the pandemic. There was a reduction in the number of elective surgeries and an increase in the number of lower limb amputations and surgical debridements. Increases were also observed in the proportion of patients with peripheral arterial occlusive disease with advanced Rutherford classifications and in the number of cases of diabetic foot. Conclusions The reduction in elective care and patients' reluctance to seek health services during the pandemic are the probable causes of increased severity of patient status, with greater need for lower limb amputation and surgical debridement and changes to the profile of the surgery performed at the service.

Clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower extremity / 中华烧伤杂志

Objective: To observe the clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower limbs. Methods: A retrospective observational study was conducted. From December 2017 to December 2020, 8 patients with large skin and soft tissue defect caused by degloving injury in lower extremity were admitted to Ningbo No.6 Hospital, including 5 males and 3 females, aged from 39 to 75 years, with wound area of 25 cm×12 cm-61 cm×34 cm. The free latissimus dorsi myocutaneous flap with latissimus dorsi muscle in the width of 12-15 cm and flap area of 20 cm×8 cm-32 cm×8 cm was used to repair the skin and soft tissue defect of bone/tendon exposure site or functional area. The other defect was repaired with bilayer artificial dermis, and the flap donor site was sutured directly. After the artificial dermis was completely vascularized, the split-thickness skin graft from thigh was excised and extended at a ratio of 1∶2 to 1∶4 and then transplanted to repair the residual wound, and the donor site of skin graft was treated by dressing change. The survival of latissimus dorsi myocutaneous flap, artificial dermis, and split-thickness skin graft after operation was observed, the interval time between artificial dermis transplantation and split-thickness skin graft transplantation was recorded, and the healing of donor site was observed. The appearance and function of operative area were followed up. At the last outpatient follow-up, the sensory recovery of flap was evaluated by British Medical Research Council evaluation criteria, the flap function was evaluated by the comprehensive evaluation standard of flap in Operative Hand Surgery, the scar of lower limb skin graft area and thigh skin donor area was evaluated by Vancouver scar scale, and the patient's satisfaction with the curative effects was asked. Results: The latissimus dorsi myocutaneous flap survived in 6 patients, while the distal tip of latissimus dorsi myocutaneous flap was partially necrotic in 2 patient and was repaired by skin grafting after resection at split-thickness skin grafting. The artificial dermis survived in all 8 patients after transplantation. The split-thickness skin graft survived in 7 patients, while partial necrosis of the split-thickness skin graft occurred in one patient and was repaired by skin grafting again. The interval time between artificial dermis transplantation and split-thickness skin graft transplantation was 15-26 (20±5) d. The donor site of latissimus dorsi myocutaneous flap healed with linear scar after operation, and the thigh skin graft donor site healed with scar after operation. The patients were followed up for 6-18 (12.5±2.3) months. The color and elasticity of the flap were similar to those of the surrounding skin tissue, and the lower limb joint activity returned to normal. There was no increase in linear scar at the back donor site or obvious hypertrophic scar at the thigh donor site. At the last outpatient follow-up, the sensation of the flap recovered to grade S2 or S3; 3 cases were excellent, 4 cases were good, and 1 case was fair in flap function; the Vancouver scar scale score of lower limb skin graft area was 4-7 (5.2±0.9), and the Vancouver scar scale score of thigh skin donor area was 1-5 (3.4±0.8). The patients were fairly satisfied with the curative effects. Conclusions: In repairing the large skin and soft tissue defect from degloving injury in lower extremity, to cover the exposed bone/tendon or functional area with latissimus dorsi myocutaneous flap and the residual wound with artificial dermis and extended split-thickness skin graft is accompanied by harvest of small autologous flap and skin graft, good recovery effect of functional area after surgery, and good quality of healing in skin grafted area.

Intraoperative IPC combined with 3M warming instrument to prevent lower extremity deep venous thrombosis in patients undergoing proximal femoral anti rotation intramedullary nailing / 中国骨伤

OBJECTIVE@#To explore the effect of intermittent pneumatic compression(IPC) combined with 3M thermometer on the prevention of deep venous thrombosis(DVT) in patients with femoral intertrochanteric fracture.@*METHODS@#From March 2016 to August 2019, 127 patients with femoral intertrochanteric fractures who underwent proximal femoral nail antirotation(PFNA) were retrospectively analyzed. They were divided into two groups according to different methods of thrombus prevention and treatment. Among them, 63 patients in group A did not use IPC and 3M thermometer;64 cases in group B were treated with IPC combined with 3M thermometer. Color Doppler ultrasound was used to dynamically monitor the DVT and changes of lower limbs during perioperative period. The venous thrombosis of lower limbs was monitored at 0, 24, 72 h and > 72 h after operation(recheck every 3 days until discharge).@*RESULTS@#Occurrence of DVT of lower limbs after PFNA operation in two groups:there were 5 cases (7.8%) in group B and 20 cases (31.7%) in group A, there was significant difference between two groups (P=0.001). There was no significant difference in lower limb DVT between two groups at 0, 72 and > 72 h after operation(P>0.05), but the formation rate of group A was significantly higher than that of group B at 24 h after operation (P=0.049). There was no significant difference in DVT formation between group A and group B(P>0.05). However, the formation of DVT in group A was significantly higher than that in group B(P=0.012).@*CONCLUSION@#Intraoperative IPC combined with 3M thermostat can effectively prevent DVT of lower limbs in patients undergoing PFNA surgery.

Two-year clinical outcomes following lower limb endovascular revascularisation for chronic limb-threatening ischaemia at a tertiary Asian vascular centre in Singapore

INTRODUCTION@#Percutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore.@*METHODS@#Patients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months.@*RESULTS@#A total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status.@*CONCLUSION@#PTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.

Pacientes amputados de miembros inferiores por causas vasculares en el municipio Cerro / Patients with amputation of lower limbs due to vascular causes in Cerro municipality

Introducción: La amputación provoca discapacidad física e invalidez como consecuencia de la enfermedad vascular periférica. Objetivo: Caracterizar a los pacientes amputados de miembros inferiores por causas vasculares en el municipio Cerro. Métodos: Se realizó un estudio descriptivo en los 114 amputados de miembros inferiores que estaban registrados, entre 2016 y 2018, en la Dirección Municipal de Salud del municipio Cerro. La muestra quedó constituida por los 64 amputados de causa vascular. Las variables de estudio fueron: edad, sexo, factores de riesgo, tipo de amputación y su nivel, miembro más afectado y causa vascular de amputación. Se estimaron las frecuencias absolutas y relativas, y la prueba de chi cuadrado, para identificar la asociación entre las variables. Resultados: Hubo predominio de los amputados de causa vascular (56,1 por ciento), el sexo femenino (54,7 por ciento), el grupo etáreo de 60 años y más (84,4 por ciento), y la HTA y el tabaquismo (ambos con 60,9 por ciento). La amputación supracondílea fue la más realizada (64,1 por ciento). El pie diabético isquémico y la aterosclerosis obliterante resultaron las causas vasculares que provocaron los mayores porcentajes de amputación. Se halló asociación altamente significativa entre el sexo masculino y la ateroesclerosis obliterante (X2 = 5,4; p = 0,113, OR = 2,68 y RR = 1,81), lo que señaló a este como un factor de riesgo de amputación. Conclusiones: Las amputaciones aparecieron con mayor frecuencia en las mujeres mayores de 60 años, del tipo supracondílea y por pie diabético como causa vascular. La ateroesclerosis obliterante en los hombres constituyó un factor de riesgo de amputación(AU)

Introduction: Amputation as a result of peripheral vascular disease causes physical disability and impairment. Objective: Characterize amputee patients of lower limbs due to vascular causes in Cerro municipality. Methods: A descriptive study was carried out in the 114 lower limbs amputee patients that were registered, between 2016 and 2018, in the Municipal Health Division of Cerro municipality. The sample consisted of the 64 vascular-cause amputees. The study variables were: age, sex, risk factors, type of amputation and its level, most affected limb and vascular cause of amputation. Absolute and relative frequencies were estimated, and the chi square test was used to identify the association between variables. Results: There was predominance of vascular-cause amputees (56.1 percent), the female sex (54.7 percent), the 60-year-old and older age group (84.4 percent), and HTA and smoking having (both 60.9 percent). Supracondylar amputation was the most performed one (64.1 percent). Ischemic diabetic foot and obliterating atherosclerosis resulted in the vascular causes that produce the highest percentages of amputation. A highly significant association was found between the male sex and obliterating atherosclerosis (X2 = 5.4; p = 0.113; OR = 2.68 and RR = 1.81), which pointed to this as an amputation risk factor. Conclusions: Amputations most often appeared in women over the age of 60, as supracondyle type and diabetic foot as a vascular cause. Obliterating atherosclerosis in men was a risk factor for amputation(AU)

Physical activity and quality of life in adults and elderly individuals with lower limb amputation

SUMMARY OBJECTIVE: The aim of this study was to investigate the levels of physical activity (PA) and quality of life (QOL) in adults and elderly individuals with lower limb amputation (LLA). METHODS: This was a cross-sectional observational study. Participants completed three surveys as follows: a demographic survey, the International Physical Activity Questionnaire, and the World Health Organization Quality of Life. Thirty-six individuals with lower limb amputation were separated into two different groups as follows: Adults-lower limb amputation (n=12), composed of individuals with lower limb amputation who aged from 18-59 years, and Elderly-lower limb amputation (n=24), composed of individuals with lower limb amputation who aged 60 years and above. Statistical differences were determined as p<0.05. RESULTS: Age and number of individuals with a low level of functional independency were higher in the Elderly-lower limb amputation group (p<0.05). The International Physical Activity Questionnaire scores were reduced in the Elderly-lower limb amputation group (p<0.05). The Pearson's correlation test between low metabolic equivalent task (MET), time since amputation, and family income presented positive significant results in the Elderly-lower limb amputation (p<0.05). Adults-lower limb amputation just presents a positive significant correlation with the low family income (p<0.05). CONCLUSION: Elderly individuals with lower limb amputation are more susceptible to present negative health outcomes than adults with lower limb amputation.

Factores de riesgo para amputación en pacientes manejados con fasciotomía de miembro inferior en un centro de alta complejidad / Risk factors for amputation in patients managed with lower limb fasciotomy in a high complexity center

Resumen Introducción: El síndrome compartimental del miembro inferior tiene el potencial de causar morbilidad devastadora en los pacientes y altos riesgos médico-legales para los médicos involucrados en su tratamiento. Una vez instaurado, la fasciotomía se constituye como el único tratamiento efectivo. La pérdida de la extremidad afectada es su complicación con mayor carga de enfermedad. Existen pocas descripciones sobre factores de riesgo para la necesidad de amputación de miembro inferior luego de haber sido sometido a fasciotomía en pacientes con lesiones traumáticas. Materiales y Método: Se realizó un estudio retrospectivo, observacional, analítico en el cual se recolectó información de pacientes con traumatismo de miembro inferior que requirieron fasciotomía de muslo o pierna durante un periodo de 10 años en busca de factores que pudieron influir en la pérdida de la extremidad. Resultados: 21 pacientes cumplían los criterios de inclusión de los cuales 6 (28,57%) fueron amputados y 2 fallecieron (9,52%). La mayoría de los individuos fueron menores de 30 años y casi la totalidad del sexo masculino. Encontramos que el porcentaje de amputación parece verse afectado de manera estadísticamente significativa por factores como un International Severity Score (ISS) elevado (media de 24), las parestesias al ingreso, la realización de fasciotomía tardía (> 6 h), la reactividad muscular al momento de la cirugía, la infección del sitio operatorio y la reintervención por trombosis del injerto vascular. Conclusiones: Existen factores de riesgo que pueden indicar la pérdida de la extremidad inferior luego de ser sometido a fasciotomía en el contexto de trauma. Un seguimiento prospectivo y un mayor número de pacientes podrían permitir dilucidar más de dichos factores.

Introduction: The lower limb compartment syndrome has the potential to cause devastating morbidity in patients and high legal medical risks for doctors involved in its treatment. Once established, fasciotomy is the only effective treatment. The loss of the affected limb is the complication with a greater burden of disease. There are few descriptions of risk factors for the need for lower limb amputation after having undergone fasciotomy in patients with traumatic injuries. Materials and Method: A retrospective, observational, analytical study was conducted in which information was collected from patients with lower limb trauma that required thigh or leg fasciotomy for a period of 10 years in search of factors that could influence limb loss. Results: 21 patients met the inclusion criteria of which 6 (28.57%) were amputated and 2 died (9.52%). The majority of the individuals were under 30 years old and almost all of the male sex. We found that the percentage of amputation seems to be affected statistically significantly by factors such as a high ISS (mean of 24), paresthesia at admission, performing late fasciotomy (> 6 h), muscle reactivity at the time of surgery, postoperative SSI and reintervention by vascular graft thrombosis. Conclusions: We found risk factors that may indicate the loss of the lower limb after being subjected to fasciotomy in the context of trauma. A prospective follow-up and a greater number of patients could make it possible to elucidate more of these factors.

Efficacy analysis of antibiotic bone cement in treating infectious wound of lower extremity / 中国骨伤

OBJECTIVE@#To discuss the clinical effect of antibiotic bone cement in the treatment of infectious wound of lower extremity.@*METHODS@#From January 2016 to January 2019, 28 patients who had infection wounds of lower extremity were treated by antibiotic bone cement, including 21 males and 7 females with age of 34 to 76 (53.8±16.5) years old. The wound area after the initial debridement was 4 cm×3 cm to 12 cm×8 cm. All patients were treated with the antibiotic bone cement, when infection was controlled and fresh granulation tissue grew on the wound surface, local sutures or skin grafts were performed. The changes of white blood cell (WBC), erythrocyte sedimentation rate(ESR), C reactive protein(CRP) and positive rate of bacterial culture of wound secretions were recorded andcompared before and after 2 weeks of the operation. The healing time, recurrence rate and complications of fresh granulation on wound surface were calculated.@*RESULTS@#All patients were followed up for 3 to 6(4.3±1.2) months. After the recurrence of diabetic foot wound infection, 3 patients presented different degree of rupture, and the remaining patients had good wound healing. No serious complications such as aggravation of infection and amputation occurred. The WBC, ESR and CRP of the patients were decreased significantly after operation compared with that before operation (9.1±1.2)×109/L vs. (11.4±2.2)×109/L, (23.5±7.6) mm/ h vs. (57.1±14.9) mg/L, (44.2±13.1) mg/L vs. (89.2±26.7) mg/L (@*CONCLUSION@#The antibiotic bone cement can control infection of lower extremity wound effectively, promote the growth of fresh granulation tissue and wound healing.

Treatment of open fracture of lower limb in high altitude area / 中国骨伤

OBJECTIVE@#To explore the treatment methods and experience of open fracture of lower limb in high altitude area.@*METHODS@#From January 2016 to January 2021, 62 patients with open fractures of lower limbs were treated by staged surgery with the concept of injury control orthopedics, emphasizing wound treatment and combining various fracture fixation methods. There were 51 males and 11 females, ranging in age from 14 to 59 years old, with a mean of (37.2±12.3) years old; and the course of disease ranged from 7 to 59 days, with a mean of (23.7±15.5) days. According to Gustilo Anderson classification, there were 14 cases of typeⅠ, 24 cases of typeⅡ, 14 cases of typeⅢA, 8 cases of typeⅢB and 2 cases of typeⅢC. The fracture repair and wound healing were observed, and the clinical efficacy was evaluated by Johner-Wruhs evaluation standard.@*RESULTS@#Fifty-five patients were followed up, and the duration ranged from 4 to 36 months, with a mean of (14.7±8.5) months, and 7 cases were lost to follow-up. According to Johner-Wruhs evaluation criteria, 33 cases got an excellent result, 16 good, 4 poor and 2 bad. The wound healing was poor in 2 cases, partial necrosis of Achilles tendon in 1 case, nonunion of fracture in 1 case and delayed healing of fracture in 2 cases.@*CONCLUSION@#It is an effective method to treat the open fracture of lower extremity in high altitude area to pay attention to the management of soft tissue injury, the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end. Paying attention to the treatment of soft tissue injury and the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end are effective methods for the treatment of open fracture of lower limbs in high altitude areas.

Cobertura con colgajos de dispositivos ortopédicos en el miembro inferior: experiencia clínica / Covering with Orthopedic Devices Flaps in the Lower Limbs: A Clinical Experience

RESUMEN Introducción: La cobertura de dispositivos ortopédicos expuestos y las infecciones en el hueso con colgajos es un tema controvertido. No existe un consenso claro sobre el tratamiento de esta complicación. En los últimos años se aprecia una tendencia a mantener el material de osteosíntesis y a controlar la infección aportando tejido bien vascularizado en forma de colgajo muscular o fasciocutáneo. Objetivo: Evaluar el éxito reconstructivo con colgajos de defectos de partes blandas en miembros que han precisado de una osteosíntesis, en función de la presencia de infección y el estado de los dispositivos de implante en el momento de la reconstrucción. Métodos: Estudio retrospectivo de una serie de 15 casos con un defecto de partes blandas en las extremidades inferiores secundario a la implantación de dispositivos ortopédicos en el hueso. Todos los casos recibieron cobertura con un colgajo muscular o fasciocutáneo con o sin retirada de los implantes. Se estudió la presencia o ausencia de infección previa a la reconstrucción (signos clínicos, resultado del cultivo microbiológico y exposición del material ortopédico), la retirada o mantenimiento del implante durante la reconstrucción, y la presencia de complicaciones posoperatorias. Se relacionaron estas variables con el éxito reconstructivo posoperatorio. El análisis de las variables se realizó con los estadísticos chi cuadrado, Wilcoxon y U de Mann Whitney, según el tipo de variable, y para una significación de 0,05. Resultados: La frecuencia de éxito reconstructivo fue mayor en aquellos pacientes con cultivo negativo sin exposición de material óseo (p = 0,038). Se encontró menor tasa de complicaciones en los pacientes que presentaban infección antes de la reconstrucción (p = 0,039), y en aquellos con cultivo positivo y exposición del material previos a la cirugía, cuyos implantes habían sido retirados durante la reconstrucción (p = 0,032). Conclusiones: El aporte de tejido bien vascularizado en forma de colgajo permite el mantenimiento del material ortopédico con una frecuencia de éxito de 66,67 %, y resultados favorables de mediano a largo plazo. La exposición y el resultado del cultivo son indicadores predictivos de los resultados de la cirugía(AU)

ABSTRACT Introduction: The covering of exposed orthopedic devices and bone infections with flaps are a controversial issue. There is no clear consensus concerning the treatment of this complication. In recent years, there has been a trend to maintain the osteosynthesis material and to control the infection by providing well vascularized tissue in the form of a muscular or fasciocutaneous flap. Objective: To assess the reconstructive success with flaps of soft tissue defects in limbs that have required osteosynthesis, based on the presence of infection and the status of the implant devices at the time of reconstruction. Methods: Retrospective study of a series of 15 cases with soft tissue defect in the lower limbs after implantation of orthopedic devices to the bone. All the cases were covered with muscle or fasciocutaneous flap, with or without removal of the implants. The presence or absence of infection prior to reconstruction (clinical signs, results of microbiological culture, and exposure of the orthopedic material), removal or maintenance of the implant during reconstruction, and the presence of postoperative complications were studied. These variables were associated with postoperative reconstructive success. The analysis of the variables was performed using the chi-square, as well as Wilcoxon and Mann Whitney U tests, according to the type of variable, and for a significance of 0.05. Results: The frequency of reconstructive success was higher in those patients with negative culture and without exposure of bone material (P=0.038). A lower rate of complications was found in patients with infection before reconstruction (P=0.039), and in those with positive culture and exposure of the material prior to surgery, whose implants had been removed during reconstruction (P=0.032). Conclusions: The provision of well vascularized tissue in the form of flap allows maintenance of the orthopedic material with a success rate of 66.67%, as well as favorable outcomes in the mid to long terms. The results of exposure and culture are predictive indicators of surgery outcomes(AU)

Colgajo bigemelar para lesiones extensas de rodilla / Bigemelar flap for extensive knee injuries

El traumatismo de miembros inferiores representa un reto para el cirujano plástico en cuanto a su reconstrucción cuando no se dispone de técnicas microquirúrgicas. En el presente trabajo se presentan tres casos de reconstrucción de rodilla con doble colgajo muscular de gemelo en donde se demuestra que la utilización simultánea de los dos gemelos puede ser aplicada sin dejar ninguna secuela en la parte funcional y estética en la deambulación de los pacientes. No existe en la literatura nacional ni internacional un reporte de casos con esta aplicación, ya que siempre se ha limitado al uso de un solo músculo precisamente por el temor de alterar la función en cuanto a la flexoextensión del pie.

Lower limb trauma is a challenge for plastic surgeons in their reconstruction when microsurgical techniques are available. In this paper we present three cases of reconstruction of the knee with twin double-muscle flap where it is shown that the simultaneous use of the twins can be applied without leaving any sequel partly functional and aesthetics in ambulation of patients. For there is in the national or international literature a repost of cases with this application as it has always been limited to using just a single muscle for fear of disrupting the function in terms of flexion and extension of the foot.

Dermolipectomia trocantérica em paciente pós-cirurgia bariátrica: relato de caso / Trochanteric dermolipectomy in a patient after bariatric surgery: case report

Introdução: Atualmente com o aumento das gastroplastias redutoras (cirurgia bariátrica) e grande perda ponderal, há também um aumento na procura destes pacientes pela cirurgia plástica. Uma das características destes pacientes é o excesso de tecido dermogorduroso que causa deformidades, principalmente nos membros inferiores, acometendo a região trocantérica. Objetivo: Relatar um caso de dermolipectomia trocantérica em paciente pós-cirurgia bariátrica, onde a lipoaspiração por si só não resolveria a correção da deformidade. Relato de caso: IPMS, sexo feminino, 55 anos, histórico de gastroplastia redutora (cirurgia bariátrica) com grande perda ponderal. Relata desconforto importante com a lipodistrofia e extensa flacidez em região trocantérica bilateral. Após avaliação pela equipe, foi optado por realizar dermolipectomia trocantérica bilateral, em janeiro de 2019, no Serviço de Cirurgia Plástica Osvaldo Saldanha. Discussão: Nos casos de lipodistrofia trocantérica com deformidades graves, a cicatriz da dermolipectomia em relação à deformidade é favorável quanto a escolha desta técnica, pois a lipoaspiração poderá agravar ainda mais a deformidade, sendo mandatório utilizar a técnica de dermolipectomia trocantérica para corrigila. Quanto à lipodistrofia com deformidade moderada há dúvida entre a relação do benefício e a deformidade resultante, sendo aplicada a técnica de acordo com a necessidade do paciente e, por fim, nos casos de lipodistrofia com deformidade leve, opta-se pela lipoaspiração devido à correção ser realizada sem grandes cicatrizes aparentes. Conclusão: Portanto, a lipoaspiração tem benefício nos casos de adiposidade localizada, limitando as indicações da técnica de dermolipectomia, em especial na região trocantérica, sem invalidá-la para casos selecionados, como o descrito neste relato de caso.

Introduction: Currently, with the increase in reducing gastroplasty (bariatric surgery) and the great weight loss, there is also an increase in the demand of these patients for plastic surgery. One of the characteristics of these patients is the excess of dermal adipose tissue that causes deformities, especially in the lower limbs, affecting the trochanteric region. Objective: To report a case of trochanteric dermolipectomy in a patient after bariatric surgery, where liposuction alone would not solve the correction of the deformity. Case report: IPMS, female, 55 years old, history of reducing gastroplasty (bariatric surgery) with great weight loss. She reports significant discomfort with lipodystrophy and extensive flacidity in the bilateral trochanteric region. After the team's evaluation, it was decided to perform bilateral trochanteric dermolipectomy, in January 2019, at the Plastic Surgery Service Osvaldo Saldanha Discussion: In cases of trochanteric lipodystrophy with severe deformities, the scar of dermolipectomy in relation to the deformity is favorable in terms of the choice of this technique, since liposuction may further aggravate the deformity, and it is mandatory to use the trochanteric dermolipectomy technique to correct it. Conclusion: Therefore, liposuction is beneficial in cases of localized adiposity, limiting the indications for the dermolipectomy technique, especially in the trochanteric region, without invalidating it for selected cases, as described in this case report.

Análisis y plan quirúrgico de deformidades en tobillo y retropié del adulto / Analysis and surgical planning in ankle and hindfoot adult deformities

La corrección de deformidades en extremidades inferiores del adulto sigue siendo un capítulo desafiante en ortopedia y traumatología. El conocimiento del alineamiento normal de las extremidades inferiores y su comportamiento son fundamentales para una adecuada planificación quirúrgica y éxito del tratamiento, especialmente en tobillo y retropié. El objetivo de esta revisión, es conocer los principios fundamentales de la corrección de deformidades, orientar en que factores fijarse al momento de corregir y poder dar una guía de cómo planificar la cirugía, particularmente en deformidades de tobillo y retropié. NIVEL DE EVIDENCIA: Nivel V.

Adult lower limb deformity corrections remain a challenging chapter in orthopedic surgery. The knowledge of the normal lower limb alignment and their behavior is essential for a proper surgical planning and treatment success, especially on foot and ankle surgery. The objective of this review is to show the main principles of deformity correction, to guide the factors to consider when correcting and to provide a surgical planning guide, particularly in the ankle and hind foot deformities.

Composite bone and skin flap transplantation combined with bone lengthening for repairing lower limb burn with soft tissue and bone defect / 中国骨伤

OBJECTIVE@#To compare the effect of traditional fibula flap combined with allogeneic bone transplantation and composite bone flap transplantation combined with bone lengthening in staged repair of severe soft tissue and bone defect caused by lower limb burn.@*METHODS@#Total 68 patients with severe soft tissue and bone defect caused by lower limb burn from March 2015 to January 2018 were retrospectively analyzed, and they were divided into control group (34 cases) and study group (34 cases) according to the treatment plan. All patients had different degrees of soft tissue and bone tissue defects. In the study group, 34 patients were treated with composite bone flap transplantation combined with bone lengthening. There were 22 males and 12 females; the age ranged from 32 to 46(39.18±6.01) years; the time from injury to treatment was (16.69±5.11) h;28 cases were caused by explosion injury and 6 cases were caused by firearm burn; the length of bone defect was (12.10± 2.34) cm;and 16 cases were on the left side of affected limb 18 cases were on the right side. In the control group, there were 24 males and 10 females, aged 31 to 47 (38.93 ± 5.81) years;the time from injury to treatment was(17.10±5.63) h;the causes of injury were explosive injury in 30 cases and firearm burn in 4 cases; the length of bone defect was (11.96±2.51) cm;19 cases were on the left side and 15 cases on the right side. All patients were followed up for 6 months. The FMA scores before operation and 3 and 6 months after operation, treatment satisfaction, curative effect and complications of the two groups were recorded.@*RESULTS@#Limb function:there was no significant difference in FMA scores between the two groups before operation (@*CONCLUSION@#the combined use of composite bone flap transplantation and bone lengthening staged repair in the treatment of severe soft tissue and bone defect caused by lower limb burn can achieve good therapeutic effect, improve limb function, and have high treatment satisfaction and certain safety.