Method for microsurgical repairing of tendo calcaneus and complex tissue defect / 中华显微外科杂志

Objectives To approach the method and clinical effect on tendo calcaneus and complex tissue defect with microsurgery repair.Methods Retrospective summary the methods of 356 cases with tendo calcaneus and complex tissueserious defect,which repaired by different microsurgery from June 1994 to March 201 1.Two type were divided on account of different degree of serious tendo calcaneus and complex tissue defect.Type A:the length of tendo calcaneus defect was less than 3 cm,and cutaneous deficiency is less than 3 cm × 20 cm.Direct suture (166 cases) or Abraham retrograde V-Y method (72 cases)was used to repair endo calcaneus defec,anfregional flap metastasis was used to repair cutaneous deficiency.Two hundred and thirtyeight cases were used by those methods,including of lateral heel flap repair(23 cases),medial plantar island flap(58 cases),instep island flap(40 cases),above medial malleolus flap(48 cases),above ateral malleolus flap (24 cases),sural nerve nutrient vessel flap (29 cases) gastrocnemius muscle flap (16 cases).Type B:the length of tendo calcaneus defect was more than 3 cm,and cutaneous deficiency was more than 3 cm × 20 cm.Direct suture could not repair tendo calcaneus,the complex tissue flap free grafting was used to primary repair tendo calcaneus and complex tissue defect.One hundred and erghteen cases were used by those methods,including of tensor fasciae latae flap free grafting (52 cases),lateral above knee complex tissue flap free grafting (26 cases),latissimus dorsi muscle fascia flap free grafting (24 cases),rectus abdominis muscle front sheath flap free grafting (16 cases).Three hundred and fifty-six cases were repaired by these methods,including 238 cases of regional flap transfer 118 cases of tissue flap free grafting.Results In 238 cases of regional flap transfer,two hundred and twenty-six cases were successful,and 12 cases were partly success,which were wound healing by change dressings.In 118 cases of tissue flap free grafting,one hundred and nine cases were successful,and blood vesse articulo were happened to 8 casess,which were success by operations research,and 1 case was failure which had to use another tissue flap.Follow-up visit was dane from 1.0 year to 4.5 years after operation (average 3.2 years).Functional assessment according to the Thermann ralted the results as excellent in 240 csaes,good in 86 cases,common in 22 cases and worse in 8 cases.The fineness rate was 91.6％.Conclusion Microsurgical repair is a good method to tendo calcaneus and complex tissue defect,different method and strategy selected actively by tissue defect degree of tendo calcaneus and complex tissue can achieve satisfactory functional rehabilitation purpose.

The pedicle modification of grafting in free flap which use medial-lower-leg-flap with a healthy limb cross-leg bridging thoracic umbilical flap / 中华显微外科杂志

Objective To investigate the methods and effects of the pedicle modification in free flap which use medial-lower-leg-flap with a healthy limb cross-leg bridging thoracic umbilical flap.Methods From June 2006 to June 2010,twenty-eight cases with a large area of soft tissue defects caused by severe trauma were included in this study.We used The flap was used to repair the wound,the pedicle of the flap was improved which was designed by medial lower leg flap with a healthy limb cross-leg bridging thoracic umbilical flap:thoracic umbilical flap carrying the cross midline side flap.Medial lower leg flap in tongue cutting out and carrying on the medial malleolus perforator.In the processing of bridge-pedicled,we rolled the proximal porting of cross-leg flap,used medial malleolus perforator flap as a posterior wall and used thoracic umbilical flap carrying the cross midline lateral flap as anterior wall.Two portions formed a combined percutaneous tube.The two tile formmed a combined percutaneous tube.Fixing method for operation adopted external fixator which two legs were paralleling.Observation of postoperative flap survival situation,shape,color,elastic,scar contracture,and dysfunction.Results Twenty-eight cases of postoperative all flaps survived.Vascular crisis was appeared in 2 cases after 8 hours.Upon examination that was low blood pressure,low hematocrit.In treatment of transfusion and infusion,crisis mitigated.In 1 case after 12 hours with pain occurred arterial crisis,which was reliefed with analgesia.There were no vascular crisis in other 26 cases.Followed up for 2-20 months,flap had good blood supply,color and good elasticity.The appearance was not bloated and sensory recoverred partly.There was no apparent stiffness in double knee,ankle joint.Conclusion Medial lower leg flap with a healthy limb cross-leg bridging thoracic free flap transplantation for repairing serious soft tissue defects of the leg is clinically proven good means.Based on the improvement of pedicle,it can reduce the risk and complications.At the same time,it can improve the postoperative nursing care effects.It is worthy of popularization and application.

The free soleus muscle perforator flap:an anatomic and clinical study / 中华显微外科杂志

ObjectiveTo study the anatomy of the soleus muscle perforator flap and its clinical application.MethodsIn 6 cadavers specimen with 12 lower limbs,the cutaneous branches and soleus muscle perforator artery were dissected and their measurements were recorded.Fourteen patients with skin and soft tissue defects from July 2002 to October 2010 were repaired by the soleus muscle perforator flap.Of the 14 patients,eight for dorsal and anterior defects of foot,two for anterior defects of malleolus,two for hand defects,two for elbow defects.The size of the flaps was 5 cm × 6 cm - 12 cm × 20 cm.Flap success rates and postoperative course were evaluated. ResultsThe soleus musclocutaneous perforators mostly appeared within 5 - 24 cm length below the head of fibula.The diameter of the artery cutaneous perforator was( 1.08 ±0.22)mm,vena concomitants was (1.20 ± 0.32)mm.All flaps were survived completely and the wounds got primary closure in 14 cases.The flaps were not overstaffed,and their shape,texture and color were similar to normal.All of the 14 cases were evaluated as satisfactory after 6 months to 12 months follow-up. ConclusionThe free soleus muscle perforator flap is an ideal flap for repairing skin and soft tissue defects with the merit of simple procedure,minimal trauma and more physiological circulation established.

Repair and reconstruction of cripple hand and defected digital bone / 中华显微外科杂志

Objective To explore and solve the problem of insufficiency and malformation due to cripple hand and defect of digital bone resulted of innate and injured. Evaluation to the methods of bone autografting combinated with flaps to reconstruct the deficient hand and digits. Methods Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps were used to reconstruct the defected bone in palm or fingers. Combined with tendon absence in such cases should be repaired or restituted by tendon autografting in one stage or by stages. Results Total 16 cases were treated by the methods metioned above. Except 1 of 16 was failure resulted in severe infection, the others were reconstructed successfully. 13 of 16 were followed up 8 months to 2 years, the evalution of the group from motion,sensation and appearance shew that the fine rate of motion was 53.8 percent, the rate of appearance and sensation were both 69 percent. Conclusion Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps are available to reconstruct the defected bone in palm or fingers, and can reduce disability effectively while obtain a satisfactory outlook and proper functions by those methods.

Applied anatomical and clinical application of reconstruction of the medial malleolus with bone-severed vascularized fibular head epiphysis / 中华显微外科杂志

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.

Experimental study on the long-term conversion of fresh and cryopreserved osteochondral allografts after transplantation / 中国矫形外科杂志

[Objective]To compare long-term conversion between fresh and cryopreserved osteochondral allografts in order to further provide theoretical foundation for treatment of articular cartilage defect using osteochondral allografts. [Methods]Articular cartilage defect models of 5 mm in diameter and depth were established for 32 New Zealand rabbit’s knees and treated by fresh and cryopreserved osteochondral allografts. Allografts were harvested and assessed by observing and analysing proteoglycan content,chondrocyte viability and ultrastructure of articular cartilage using Alcianblue staining and BCECF-AM /PI fluorescent staining,respectively,at 12 and 18 months postoperatively.[Results]Proteoglycan content and percentage of viable chondrocytes of osteochondral allografts were obviously decreased.Results of fresh osteochondral allografts were significantly better than those of cryopreserved osteochondral allografts at different time points. Ultrastructure of chondrocytes demonstrated degenerative changes.[Conclusion]In treatment of artificial articular cartilage defect ,serious degenerative changes were found for both fresh and cryopreserved osteochondral allografts at a long period,suggesting that fresh,especially cryopreserved osteochondral allografts are not feasible to treat articular cartilage defect.

Clinical application of distally reversed sural neurofasciocutaneous flap with muscle / 中国矫形外科杂志

[Objective]To introduce the effect of reversed sural neurofasciocutaneous flap with muscle repairing the soft tissue defect of foot and ankle.[Method]Reversed sural neurofasciocutaneous flap with muscle was applied for repairing the soft tissue defect simultaneous open fracture of tibia lower section 6 cases,the soft tissue defect simultaneous chronic osteomyelitis of tibia lower section 5 case,the soft tissue defect of sole of foot simultaneous calcaneus epicarp 3 case, the soft tissue defect of sole of foot simultaneous calcaneus osteomyelitis or dead space 2 case. The scope of the flap was 18 c m?13 cm～11 c m?7 c m and that of the gastrocnemius flap was 4 cm?3 cm～9 c m?6 cm,the thickness was 1～3 cm,the skin flap was bigger than the muscle flap.[Result]Muscle side of the muscle flap was errhysising actively and the skin flap was good circulation duing operation, the muscle flaps were used clinically in 16 patiens all survived completely after operation. All cases were followed up from 5 to 17 months ,incision of open fracture healed primarily, osteomyelitis without reoccurring, the muscle flaps were satisfactory in appearance,feel recovered and walk well.[Conclusion]Reversed sural neurofasciocutaneous flap with muscle has sufficient blood supply and high survival rate,so it is an effective and feasible method in repairing the soft tissue defect of foot, ankle and tibia lower section in special cases.

Biomechanical comparison of single-versus double-femoral tunnel the anterior cruciate ligament reconstruction technique / 中国矫形外科杂志

0.05).[Conclusion]The technique of double-tunnel with double-bundle of TE for reconstruction of anterior cruciate ligament(ACL) can improve the knee stability at the different flexion degree(0?～90?) and is more efficiently than the technique of single-tunnel with single-bundle.

Application of tissue engineered nerve in repair of peripheral nerve defects / 中华创伤骨科杂志

Regeneration of injured peripheral nerve is one of the recent research focuses. Many inspiring achievements have been made in such fields as choice of seeding cell source and proliferation in vitro. It is hopeful that nerve regeneration may be enhanced by combining the new techniques with microsurgery. In this paper, design and fabrication principles, key technologies, various applications, and new directions in the field of tissue engineered nerve are introduced. Much of this paper is devoted to the discussion of tissue engineered nerve in repair of peripheral nerve injury.

Reconstruction of medial malleolus by iliac bone with fascial flap: a preliminary report / 中华创伤骨科杂志

Objective To explore reconstructive methods for defects uf bone and soft tissue in traumatic injury uf medial malleolus.Methods A vascular iliac bone with a piece of faacial strip is used together with a local island flap or a free flap to reconstruct the defects of bone,triangular ligament and skin in medial malleolus al one or two stages.Results Follow-ups of 11 to 24 months proved that the stability and walking and weight loading functions uf ankle joint of the patients were restored satisfactorily and their normal varus range without abnormal articular motion was restored.Slight varus occurred during walking in one case,and pain appeared after fatigue in two cases.The X-grams showed no obvious absorption or areosis in the free iliac bone implanted.Conclusion In repair of defects of medial malleolus,combined transplantation of iliac bone and flap is rceommendable because it can keep the essential integrity of malleolus and achieve good Stability and functional recovery of ankle joint.

Advances concerning angiogens and angiogenesis therapy applied in reconstructive surgery / 中华创伤骨科杂志

Angiogenesis plays an important role in the process of the repair and regrowth of tissues. So far, many growth factors have been shown to have the angiogenic properties. Angiogenesis therapy using exogenous angiogens or the DNA coding for these growth factors has aroused extensive interest. The advances concerning angiogens and angiogenesis therapy applied in reconstructive surgery are reviewed in this paper.

Problems in reconstruction of compound defects of the forefoot / 中华创伤骨科杂志

Objective To study and discuss the problems involved in as well as the significance a nd methods of restoration and reconstr uction of forefoot defects.Methods Various procedures were adopted ac-cording to the wound variety and severity.For just absense of mefatarsal bones,only soft tissue was restored.For defects of metatarsals or metatarso phalangeal joints(usually associated with soft tissue defects)homochronous reconstruction and restoration was conducted by using vascularized bon e incorporation with free flap transplan-tation.Results Total 47cases wih forefoot defects were recpaired by using procedures me ntioned above from1994to 2000.All of this group regain ed their walking and weight-bearing functions as well as a good appearance.Conclusions Classification of forefoot injurie s according to their severity and loc ation is helpful in treatment,precise description and further stu dy of the injuries.Vascular bone incorporating with vascular flaps proved to be an ideal method of repairing compound defects.

Repairation of defects of bones of foot and soft tissue by using composed tissue transfer / 中华显微外科杂志

Objective To study and discuss the methods for repairation and reconstruction of foot defects in order to reduce the deformity and insufficiency of foot and to restorat its functional and cosmetic aspects. Mehtods Soft tissue recovery was enough for digital absence, dorsal, submalleolus and calcaneous defect; Delects in plantar should be repaired with pre flap; Abstence of metatarsats head should be reconstructed by using vascularized bone incorporation with free flap transplantation. Results Total 247 cases with bone and soft tissue defects of foot were recpaired by using managements mentioned above aehived satisfactory clinical result. All patiants were assed according to AOFAS of USA fool malleolus scores, excellent 84 cases; good 107; fair 42; poor 14. Conclusion Being flat in shape and abundant blood supply, the iliac bone is a valuable supply bone lor foot defects espesial for muti-matatarsal and ealeaneus. Absence of malleous should be reconstructed by free iliac bone or free febular head with fascial strip. Vascular bone incorporating with vascular flaps provided an ideal method of reconstruction foot conpound defeets.

The experience in emergent repair and restoration of the composite tissue defects after the severe trauma of the lower limbs / 中华显微外科杂志

Objective To explore the available methods in repairing and restoring the composite tissue defects after trauma of the lower extremities Methods One hundred and sixty four cases were studied in this article,each has a large area of skin defect and soft tissue defect,or combined with other tissue defects such as bone,muscle tendon,blood vessel,while blood supply to the foot of the injuried limb in all the cases was deficiency of bloodless which we called"sever trauma of the lower limb" According to the varied tissue defects and its injuried degree,five operating procedures were designed and introduced Result None of the limbs was severed,a 5～10 year follow up found a good result in 96 3% in all the cases Conclusion The five surgical means mentioned above were satisfied in repairing and restoring varied tissue defects following severe trauma of the lower limbs,and the injuried limbs may be saved

Vascular iliac bone incorporating free flap transfer for reconstruction of defects of metatarsal and forefoot / 中华显微外科杂志

Objective To study and solve the reconstruction of the defects of first metatarsal and the forefoot. Methods Using microsurgical technique,adopt transplantation of vascularized iliac bone incorporating with free flap to restore the defects of first and second metatarsal as well as forefoot. Results The injuried foot was restored its weight-bearing and walking functions and obtained a satisfactory contour. Conclusion The vascular iliac bone was an ideal donor site for reconstruction of absense of metatarsal,and vascular bone incorporating free flap were proved superiorly in treatment of forefoot defects.

Changes of matrix metalloproteinase-13 in articular cartilage of rat hindlimb after ischemia/reperfusion / 第三军医大学学报

Objective To investigate the role of matrix metalloproteinase-13 (MMP-13) in articular cartilage injury by observing the MMP-13 changes in articular cartilage in rat hindlimb after ischemia/reperfusion (IR). Methods Wistar rat model of left hindlimb IR was used. Fifty-six rats were randomly divided into sham operation group, 8-hour ischemia group, and groups that were reperfused for 3, 7, 14, 30 and 60 d after 8-hour ischemia. Articular cartilages of tibial plateau were taken to study MMP-13 and type Ⅱ collagen (COL Ⅱ) by immunohistochemical method (SP). The pathological changes of articular cartilages also were observed. Results Cartilage matrix was compact in sham operation group and 8-hour ischemia group. Articular facet became rough, cartilage matrix became looser, and chondrocytes were in disorder gradually after reperfusion, especially on day 30 and 60. MMP-13 of cartilages increased significantly in reperfusion groups (P

EXPERIMENTAL OBSERVATIONS ON BURYING NERVE ENDINGS INTO MUSCLES FOR THE RECOVERY OF THEIR MOTOR FUNCTIONS / 解放军医学杂志

From May 1981 to September 1983. experimental study of the effect of buried nerve endings into muscles on the recovery of its motor functions was carried out in our hospital with 40 robust rabbits of both-sexes divided into two groups. In group A. left common peroneal nerve was cut off at the relatively deep site of myoneural junction and divided into three bundles, which were separately buried into long extensor muscle of digits, anterior tibial muscle and long peroneal muscle. For group B. a piece of 1.2cm cut from left common peroneal nerve and another piece of 1.4cm cut from right common per-oneal nerve were freely transplanted to the left-side muscles in the same way as in group A. Experimental results showed that the motor function of the muscles transplanted with nerve ending started to recover in two months after operation, and that the muscle power reached more than the 4th grading and electric irritation could induce muscle contraction at the 6th month after operation. Electromyogra-phic examination showed mixed disturbing potential. The new motor end-plates could be found on his-tological examination. In one clinical case follow-up for 6 months was made post-operatively and the recovering muscle power was fairly satisfactory.

FILLING VEIN WITH TWO NEURAL SEGMENTS TO BRIDGE NERVE DEFECT:AN EXPERIMENTAL AND CLINICAL STUDY / 解放军医学杂志

Twenty-one rabbits were randomly divided into three groups: experimental group-filling vein with two neural segments being 0.3cm long to bridge 4cm defect of common peroneal nerve, control group-bridging vein directly to the 4cm defect of common peroneal nerve, auto-nerve-grafting group-cutting off a segment (4cm long) from common peroneal nerve and grafting it inversely.After 25 weeks, morphological, electrophysiological and histological examinations were undertaken, which revealed that the experimental group was most similar to the auto-nerve-grafting group in recovery of motion of the limbs, action potential of muscle, nerve conductive velocity, and regenerating density of nerve fibers and axons. It was a failure in control group. Satisfactory results were also achieved in 2 patients with defect of ulnar nerve treated by filling vein with two neural segments. It suggests that our method is feasible.

CLINICAL USE OF FREE AUTOTRANSPLANTATION OF PERICHONDRIUM IN THE REPAIR OF THE ARTICULAR SURFACES / 解放军医学杂志

From March 1982 through December 1083, free transplantation of the perichondrium was used to repair the cartilagenous surface of interphalangeal joints in 5 cases of traumatic comminuted fracture. Of these 5 cases, the injury involved proximal interphalangeal joint of index fingers in 2 cases, proximal interphalangeal joint of the middle finger in 2, and carpometacarpal joint of the thumb in 1. The perichondrium was harvested from the 8th or 9th costal synchondrosis.X-ray film showed growth of new smooth cartilage surface, and the movement of the joints ranging from 10 to 30 degrees was observed 3 months after operation. Points to be observed in operation are: (1) About 0.5 cm of the recipient site of the phalange should be bitten away to expose the cancellous bone, thus a surface with better blood supply was created to receive the perichondrial transplant; (2) The recipient surface was reshaped into an articular surface so that no dead space was left between the recipient surface and the graft: (3) The transplanted perichondrium should be anchored onto the bone under certain amount of tension to insure close contact with the bony surface; (4) Immobilization should be enforced for 3 weeks post-operatively.

REPLANTATION OF DISTAL SEGMENT OF THE SEVERED FINGERS IN CHILDREN / 解放军医学杂志

From Nov 1980 to Dec 1983, severed distal segments of fingers were successfully replanted by the aid of surgical microscope in 8 children. The age ranged from 31 months to 12 years. 6 fingers were completely amputated and 2 were incompletely amputated. The level of amputation was situated from distal 1/3 of middle phalanx to the distal inlerphalangeal joints. 46 fresh specimens of fingers were dissected under microscope, and regional anatomy of blood vessels and nerves of distal segment of finger were carefully studied and their calibers measured, providing a useful knowledge for replantation. It was emphasized that meticulous and accurate anastomosis of tiny arteries, and veins with diameters ranging from 0.2 to 0.3mm was the key to success o replantation. Indications for digital replantation, careful debridement under operation microscope, and postoperative management were discussed.