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Objective:To evaluate the efficacy of a calf tissue flap combined with antibiotic-loaded calcium sulfate (artificial bone or mixed iliac bone graft) in the treatment of foot and ankle osteomyelitis.Methods:A retrospective study was conducted to analyze the 11 cases of foot and ankle osteomyelitis which had been treated at Department of Hand and Microsurgery, The Third Hospital of Baoji from October 2018 to October 2021. There were 8 males and 3 females, aged (42.3±23.7) years. The chronic hypotoxic osteomyelitis was repaired and reconstructed after thorough debridement at one stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound. The acute infected trauma was repaired and reconstructed after thorough debridement at the second stage with a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone to fill the cavity and cover the wound only after the acute infection was controlled by local dressing, drainage or negative pressure therapy and systemic anti-infection treatment at the primary stage. The flap size ranged from 3.5 cm × 2.0 cm to 12.0 cm × 6.0 cm. Four cases were treated by a peroneal artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone, 3 cases by a flap with peroneal artery perforator and peroneal nerve trophic vessel combined with antibiotic-loaded calcium sulfate artificial bone, 3 cases by a posterior tibial artery perforator flap combined with antibiotic-loaded calcium sulfate artificial bone, and one by a peroneus longus muscle flap combined with antibiotic-loaded calcium sulfate artificial bone. Postoperatively, the flap survival, bone union time, ankle function and complications were observed; the therapeutic efficacy was evaluated by comparing infection control indexes at the final follow-up [clinical manifestations like local redness, swelling, pain, ulceration, and exudation, and white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and calcitoninogen (PCT)].Results:All the flaps survived except for one which developed necrosis at the distal 1/3 of the flap but responded to dressing change. All the patients were followed up for (22.6±11.5) months. The 6-month follow-up revealed that all the flaps were fine in shape and texture. Re-examinations showed that WBC, CRP, ESR and PCT were normal or close to normal, the local skin was free of redness, swelling or ulceration, and protective sensation was restored to varying degrees. X-ray at (12.1±2.3) months showed that lesions disappeared, bony union was achieved, the ankle joint regained basic flexion and extension, and the affected limb also regained weight-bearing and walking functions in all the patients but one whose X-ray at 18 months showed poor bony union but no other symptoms or signs.Conclusion:In the treatment of foot and ankle osteomyelitis, a calf tissue flap combined with antibiotic-loaded calcium sulfate artificial bone can promote bone healing and restore the function of the foot and ankle because it not only fills the cavity and covers the wound but also effectively controls the infection.
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Objective:To observe the surgical method and clinical efficacy of applying calf tissue flap combined with artificial bone of antibiotics loaded calcium sulphate in treatment of tibia osteomyelitis.Methods:From July 2018 to January 2021, calf tissue flaps combined with artificial bone of antibiotics loaded calcium sulphate (or mixed with iliac bone) were applied to treat 16 cases with tibia osteomyelitis in the Department of Hand and Microsurgery of Baoji Third Hospital. There were 10 males and 6 females, aged 15 to 64 years old, with a mean age of 41 years old. For the 5 cases with acute osteomyelitis caused by wound infection, local dressing changes and drainage or VSD wound management were applied after debridement, together with primary systemic anti-infection treatment. After the acute infection period had been under control and stabilised, the wounds were then thoroughly exposed and cavities were filled and covered with the surgical reconstruction procedure with antibiotics-loaded artificial bone of calcium sulphate in combination with calf tissue flaps. For the 11 cases with chronic and hypotoxicity osteomyelitis, calf tissue flaps combined with antibiotics-blended artificial bone of calcium sulphate were applied to fill the cavity and cover the wound in phase I surgical reconstruction after thorough debridement. For the 7 cases with large bone defects or larger cavities after debridement, a mixed bone grafts of antibiotics-loaded artificial bone of calcium sulphate and autologous iliac bone were employed, with muscle flaps or myocutaneous flaps for an embedding repair. Sizes of the tissue flaps were 2.0 cm×3.5 cm to 12.0 cm×23.0 cm. Clinical outcomes were evaluated through follow-ups at outpatient clinic. The therapeutic effect was evaluated by the method described by McKee et al.Results:Except for 1 case of distal necrosis of tissue flap and survived after dressing change, the other tissue flap survived successfully. Postoperative follow-ups lasted for 12 to 40(mean 18) months. All the osteomyelitis were successfully cured, except 1 that had recurrence of osteomyelitis 1 year later, and treated with antibiotics-loaded artificial bone of calcium sulphate combined with autologous iliac bone implants after thorough debridement, and then healed well. The shape and texture of flaps were good. Protective sensations were restored to vary levels after 6 months. The calf regained weight-bearing and walking functions at 1 year after surgery. According to McKee et al., the therapeutic effect was evaluated: 11 cases were cured, 4 cases were improved, and 1 case relapsed, with an effective rate of 93.8%.Conclusion:Application of calf tissue flap combined with antibiotics-loaded artificial bone of calcium sulphate in the treatment of tibia osteomyelitis has a high cure rate and remarkable efficacy. It can significantly reduce the number of surgeries and shorten the course of disease.
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Objective:To investigate the clinical effect of propeller flap pedicled with perforating branch of peroneal artery in repairing soft tissue defects of ankle and foot.Methods:From August 2018 to August 2021, 15 cases of soft tissue defect of ankle and foot were repaired with propeller flap pedicled with perforating branch of peroneal artery in the Department of Hand and Microsurgery, Baoji Third Hospital. Among them, there were 7 cases with soft tissue defect in heel, 6 cases in lateral ankle and 2 cases in front of ankle. The size of defects was 3.0 cm×3.5 cm-5.5 cm×4.0 cm, and the size of flaps was 5.0 cm×4.5 cm-12.0 cm×6.0 cm. In 7 cases, the donor sites were closed directly with the aid of small paddle. The donor sites in other cases were covered with medium thickness skin graft after the wounds were narrowed by pull-up suture. The clinical efficacy was evaluated by follow-up at outpatient clinic and via telephone or WeChat interviews. Functional recovery was evaluated according to the American Orthopedic Foot Ankle Society (AOFAS) -Marylad.Results:Among the 15 flaps, 2 had distal necrosis and healed after dressing change; One flap was swelling and had venous osculation, but relived 2 weeks later. The rest of the 12 flaps survived smoothly. At the final follow-up: the shape and texture of the flap were good, and the protective feeling was restored; The ankle also recovered the normal flexion, extension and weight-bearing. According to the AOFAS-Marylad, function recovery were excellent in 9 cases, good in 4 cases, and fair in 2 cases.Conclusion:It is simple, safe and reliable to repair the soft tissue defect of foot and ankle with propeller flap pedicled with perforating branch of peroneal artery. It does not sacrifice the main blood vessels of limb, and the blood supply of the flap is reliable. It is an ideal operation for repairing the soft tissue defects of ankle and foot.
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Objective:To investigate the surgical technique and clinical effect of the island flap of dorsal branch of proper palmar digital artery in repair of the soft tissue defect of digits.Methods:From March 2013 to March 2021, 22 cases of digit soft tissue defects were repaired with dorsal branch of proper palmar digital artery island flap. The digit defects involved: 9 thumbs, 5 index fingers, 3 middle fingers, 3 ring fingers and 2 little fingers. The repair of defects covered 8 digit-tips, 7 pulps and 7 dorsal and nail beds. The defected area of soft tissue was 0.8 cm×0.5 cm-1.5 cm×8.0 cm, and the size of flap was 1.0 cm×0.7 cm-1.8 cm×1.0 cm. The donor site in 6 cases was closed directly. The other 16 cases were covered with medium thickness skin graft and pressurised bandaging. The follow-up reviews were carried out via the outpatient clinic visit, telephone or WeChat interview. Results:After operation, 1 flap had cyanosis due to a tight suture and it was relieved after the removal of intermittent suture; Tension blisters appeared in 2 cases and disappeared after 1 week; One case had necrosis at distal flap and healed after dressing change. Other flaps survived successfully and the incision and donor site healed in the first stage. All patients were entered to 6 to 18(mean 10) months of follow-up. At the final follow-up, the appearance and texture of the flaps were good and the protective sensation was restored. The flexion and extension function of the affected digit was normal with the TPD at 7-11 mm. The original shape and function of the digit body were basically reconstructed, except the failure in reconstruction of the special structure of digit body, such as nail, finger pulp thread and fine sensation. According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society, 11 cases were in excellent, 9 in good and 2 in fair. The excellent and good rate was 91%. The function at donor sites was not affected.Conclusion:Repair of digit soft tissue defect with dorsal branch of proper palmar digital artery island flap is easy to operate, and with a low risk, high success rate and satisfactory curative effect.
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Objective:To summarise the clinical efficacy and surgical indications for free hallux toe nail flap and adjacent island flap of the middle and ring fingers in repair of distal thumb degloving injuries.Methods:From May 2009 to May 2021, a total of 24 patients (24 digits) with degloving injury of distal thumbs were treated in the Department of Hand and Microsurgery of Baoji Third Hospital. The flap was selected according to the patient's wishes and occupation. Of the 24 patients, 13 were repaired by free hallux toe nail flap transfer (group of hallux toe nail flap), and 11 were repaired by combining the proper palmar digital artery island flap of middle (ulnar side) and ring (radial side) fingers with the same volar common digital artery vascular pedicle (group of tile combined flap). Follow-up was performed at the 1st, 3rd, 6th,12th and 18th months after surgery respectively through outpatient clinic and telephone or WeChat interviews. The follow-ups focused on the appearance, colour, texture and two-point discrimination (TPD) of the flap, as well as thumb flexion, extension, opposition and grasping functions. Functional recovery evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the 24 flaps survived and all were included in the follow-up. The follow-up lasted 12-60 and 6-18 months, with an average of (18.5±0.5) months and (6.8±0.3) months in group of hallux toe nail flap and group of tile combined flap, respectively. Appearance of thumb body and function at the last follow-up showed: in the group of hallux toe nail flap, the nails, thumbtips and fine sensations were restored, with the TPD at 5-8 mm. The thumb flexion, extension, opposition and grasping functions were good. Apart from without nails and fingerprint, the flaps in the group of tile combined flap had good appearance and texture, and the protective feeling was restored with the TPD at 6-11 mm. The affected thumbs also recovered the basic functions of flexion, extension, opposition and grasping. According to the Trial Standard of Upper Limb Function Evaluation of the Chinese Medical Association Hand Surgery Society, 7 cases were excellent, 5 cases were good, and 1 case was poor in the group of hallux toe nail flap. In the group of tile combined flap, 3 cases were in excellent, 5 in good, and 3 in poor. Appearance of flaps (such as nails and thumbtip fingerprint), fine sensory recovery, and the accuracy and stability of the grasping function, the group of hallux toe nail flap was significantly better than that of the group of tile combined flap. There was no functional impact on the donor site.Conclusion:Both types of flap are classic surgical procedures for repair of distal thumb degloving injury. In order to meet the individual requirement and to improve the efficacy of the treatment, such as for those who have high expectation for digit restoration, especially those who are young with aesthetical or professional requirement, free hallux toe nail flap repair is used to restore the perfect shape and function. And for those who are reluctant to sacrifice their toes or for the middle-aged and elderly people who do not have high expectation for the shape of thumb, a tile combined flap repair is used to restore thumb function.
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Objective To discuss the effect and application value of applying the master teacher responsibility system in neurology teaching. Methods 100 five-year medical students were randomly di-vided into the experimental group and the control group with computer. Master teacher and teaching team were set in the experimental group to use a variety of teaching methods for course-teaching. At the same time, the traditional teaching method was used in the control group. After the course, theory test was arranged for the two groups blindly. Statistic tool SPSS 13.0 of t test was used to evaluate the teaching effect of these two groups. And capability-oriented questionnaire survey for experimental group was conducted to survey students' subjective assessment of their own learning. Results The experimental group students' average score of the theory examination was (73.87±7.12), while control group students' average score was (73.18± 9.94), and the difference was not statistically significant (t=0.265, P=0.792). Besides, there was no signifi- cant difference in the scores of male and female students in the experimental group either (t=0.068, P=0.947). Teaching satisfaction survey results showed that 100% (16/16) of the experimental group students believed that their ability of autonomous learning, problem analysis and team cooperation was improved significantly. Conclusion Setting up master teacher responsibility system is beneficial to strengthening teacher team and cultivating students' autonomous learning ability, and it also ensures the fairness of the exam. But it still need to be improved in the quality of teachers, quantity of students, process supervision and so on to ensure the teaching effect.
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Setting up the chief teacher to be fully responsible for the medical course teaching is an explorative idea.It is necessary for the construction of medical teachers,integration of medicine courses and capacity building of young teachers.A qualified chief teacher should be a professional teacher with enough academic prestige and some management experience.Chief teachers will play important roles in the overall course teaching process,including organizing the teaching team,developing the objectives,plans,guidelines of the course and supervising the execution teaching program.The author also propose that the chief teacher responsibility system should be put into the medical course teaching practice which will improve the course teaching quality and make contributions to training excellent medical personnel.
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Objective To investigate the method and effectiveness of the digital artery series and parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger Methods Between September 2008 and July 2012,the finger artery series retrograde island flaps tiled in the repair of finger degloving injury in 13 cases,repair of adjacent finger tip degloving injury in 11 cases; 8 cases of degloved injuries of the fingertip were tiled with the digital artery parallel island flap from ulnaris middle finger and radialis ring finger of arteria digitalis communis pedicled which were from the same palm side.The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm-7.2 cm ×5.5 cm,gutted flap minimum ranged from 1.1 cm × 1.0cm-1.5 cm × 1.3cm,and the maximum ranged from 3.0 cm × 2.2 cm-5.5 cm × 4.5 cm.The donor sites were repaired with the intermediate split thickness free skin grafts and performed with pressure dressing.Results The group of 32 cases,in 1 case the flap vasospasm occurred in operation of free process,the symptoms disappeared after local application of papaverine and hot compress ; 1 case of flap occurred disturbance of blood circulation after operation because of tight suturing for pedicle,the symptoms relieved after removing the stitches at intervals; 2 cases blisters appeared after operation,disappeared after a week.All skin flaps were survived,incision and skin graft donor sites healed by first intention.Twenty patients were followed-up from 6 to 12 months after operation.All flaps presented the satisfactory appearance and texture,recovered protective feeling.At last follow-up,the two-point discrimination was 7 to 10mm,and the flexion and extension function of wounded fingers recovered to normal.According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association,there were excellent in 19 cases,good in 10 cases,and moderate in 3 cases.No significant loss to the donor shape and function.Conclusion The surgery by adopted the digital artery series or parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger,not only has the advantages of simpleness,safety and reliability,but also can satisfy the patients who aren't willing to accept or because of physical reasons can't accept the treatment of abdominal skin tube or nail flap from hallux toe,which performs in both high-end and low level hospitals,and deserves of general application.