Three-dimensional reconstruction technique in gastrocnemius flap surgery: initial clinical application / 南方医科大学学报

<p><b>OBJECTIVE</b>To discuss the experience with three-dimensional reconstruction technique in initial clinical application in gastrocnemius muscle flap surgery.</p><p><b>METHOD</b>From 2007 to 2008, 7 patients received gastrocnemius muscle flap surgeries to repair the wounds. Preoperative CT angiography or magnetic resonance imaging (MRI) was performed after injection of the contrast media for individualized three-dimensional gastrocnemius muscle flap reconstruction using Amira4.1 software. According to the size of the defect in the wound, individualized three-dimensional gastrocnemius muscle flap was designed and harvested from the posterior leg.</p><p><b>RESULTS</b>Individualized three-dimensional reconstruction of the gastrocnemius flap was performed in 7 cases, and the reconstructed flaps clearly displayed the blood vessels, skin and the adjacent three-dimensional structures. In 6 cases the main perforating branched and trunk of the blood vessels in the designed flap were consistent with the surgical findings; in 1 case, the perforating branches failed to be clearly displayed in the designed flap, and surgical examination identified perforating branches with an average diameter of 0.5 mm (minimally 0.3 mm). The flaps survived in all the 7 cases.</p><p><b>CONCLUSIONS</b>Three-dimensional reconstruction of the gastrocnemius flap based on the lower limb CT angiography or MRI allows three-dimensional observation of the anatomy of the flap and accurate marking of the extent of the flap to be harvested, therefore avoiding intraoperative injuries to the blood vessels to better survival of the flaps.</p>

Application of skin flaps with supra-carpal cutaneous branch of the ulnar artery and dorsal carpal branch of the anterior interosseous artery in reconstruction of complicated amputaled palm / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of carpal branch of ulnar artery skin flap and dorsal carpal branch of anterior interosseous artery skin flap in replantation of complicated severed hand.</p><p><b>METHODS</b>From August 1999 to October 2005, 18 patients with complicated severed hands were treated in our department. According to the skin defect of severed hand, the palm of the hand was restored with upper carpal branch of ulnar artery skin flap (2-4 cm x 3-6 cm), followed by restoration of the back of the hand with dorsal carpal branch of anterior interosseous artery skin flap (4-6 cm x 5-8 cm) and replantation of the hand was performed simultaneously.</p><p><b>RESULTS</b>All the replanted hands and the skip flaps survived after the surgery with satisfactory shape and function. The surgery achieved an over 70% recovery of the hand function in all cases.</p><p><b>CONCLUSIONS</b>For complicated severed hands, upper carpal branch of the ulnar artery skin flap and dorsal carpal branch of the anterior interosseous artery skin flap are effective to repair the skin defect, and this procedure provides a good option for reconstructing shape and function of the severed hands.</p>

A biomechanical study of sacroiliac dislocation treated with euthyphoria reduction and percutaneous canulated screw fixation / 中华创伤骨科杂志

Objective To study the anatomy basis and biomechanical stability of euthyphoria reduction and percutaneous cannulated screw fixation for sacroiliac dislocation,and to evaluate the primary clinical efficacy of this method.Methods The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were measured on 12 adult cadavers (24 sides) fixed and preserved by formalin.Models of sacroiliac dislocation were made on six pelvic specimens of fresh cadavers.A comparison of stability was made on the six models between the fixation studied here and the traditional fixations by posterior percutaneous sacroiliac screws and by anterior sacroiliac joint plates.At the same time,17 patients with type C Tile fracture were treated with our method.The clinical efficacy was analyzed for the 17 patients.Results The distances from the anterior branches of the nerve roots at L4,and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were 20.24?1.20mm,23.80?1.43mm,and 16.26?2.07 mm respectively. There was no statistically significant difference in stability between our method and the traditional fixation by posterior percutaneous sacroiliac screws,though ours seemed better.Follow-ups for the 17 cases averaged 2.2 years,re- vealing fine functional recovery in all according to Matta scoring.Conclusions Euthyphoria reduction and per- cutaneous cannulated screw fixation can lead to sufficient biomechanical stability for the sacroiliac joint and effec- tively avoid nervous injuries.In addition,our method is simple and clinically effective,It is recommendable for small and middle-sized hospitals.