RESUMO
Objective to study the factors of delaying survival of the ankle and foot which were linked with leg only by skin, fascia and tibia after all the infected and inactivated muscles and intermuscular vessels had been removed, and to study the effect of artery blood supply reconstruction to avoid the necrosis and ischemia contracture of the foot. Methods The leg was linked with ankle and foot by the tibia which was covered only by skin and fascia after all the muscles, interosseous membrance, intermuscular vessels and fibula had been removed. And then the artery blood supply for the injured limb was reconstructed by stages. Results The sense of haphalgesia, with normal temperature and color, recovered in the injured limb 7 months after operation, no contracture and deformity happened in the food muscles and joint, and the patient may smooth stand and walk with a stick freely. Conclusion The necrosis and ischemia contracture of foot was delayed by reticular collateral circulation among skin, deep and superficial fascia and tibia of the injured limb, although the blood supply was very little after all the muscles and intermuscular vessels had been removed because of infection and necrosis. Finally the injured limb was reserved successfully by artery blood supply reconstruction. The clinical effect was satisfactory.
RESUMO
Objective To study the characteristics of toe-to-thumb transplantation in a group of infants who completely lacked the thumb.The mean age was 24.6 months,and the youngest was 10 months old,The operative technique and rehabilitation were studied.Methods In two infants with Ⅲ-Ⅳ? defects of the thumb together with multiple injuries of fingers,the wounds were debrided and toe-to-thumb transplantation was done later.In case 3 Ⅲ? defect of the thumb together with palm injury,one-stage toe-to-thumb transplantation and the palm injury was covered with an abdominal flap were done at the same time.Considering the characteristic physiological structure of a dorsalis pedis and the first metatarsal arteries.In the infant,minimally invasive operation under 10? microscope was employed.A series of early functional exercises was given for the reconstructed thumbs.Results The reconstructed thumbs completely survived,hand function was recovered 3-6 months after the operation.With follow-up for longer than 2 years in 2 cases,it was noted that the reconstructed thumb grew consistent with the wounded hand.The appearance and function thumb were satisfactory.Conclusion Toe to thumb transference was successful in infancy,with the combined technique of minimally invasive and plastic surgery.Reconstruction of the thumbs can be completed in two stages on immediately after injury.The appearance and function can be restored.[