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Objective:Exploring the clinical efficacy of using ultra-thin lobulated anterolateral thigh perforator flap(ALTPF) with retrograde separation of perforating vessels from the superficial and deep junction layer of the superficial fascia to repair large soft tissue defects in the foot.Methods:From August 2021 to November 2022, 8 patients (5 males and 3 females) were admitted to the Second Department of Hand and Foot Surgery, the Affiliated Central Hospital of Dalian University of Technology. The patients were 28 to 52 years old in age. The soft tissue defects were located in dorsal and plantar foot. At the plantar foot, the wound involved the weight-bearing area with explosion of bone, tendon or internal fixtures. The area of soft tissue defects was 6.0 cm × 5.0 cm - 16.0 cm × 8.0 cm, and the sizes of ALTPF were 8.0 cm ×5.5 cm - 18.0 cm × 8.5 cm. Preoperative high frequency CUD combined with CTA angiography were employed to locate the 2 flap perforator vessels. By keeping the perforator vessels at center and according to the soft tissue defect area and the wound shape, an ALTPF with a proper size and shape was designed in anterolateral thigh. The perforator were separated in the boundary layer between superficial and deep fascia, where it helped to obviously thin the flap. After the flap was harvested, it was further lobulated between the 2 perforators into 2 lobes after having confirmed the effective blood supply. Finally the lobulated ALTPF was transferred to covered the defect in foot. Cautions should be taken to ensure that the flap covered the weight-bearing area of foot. All the donor sites were directly sutured. Postoperative follow-up was conducted to observe the survival of flaps and the functional recovery of the reconstructed site, also to evaluate the clinical effect. Postoperative follow-up included outpatient visits and reviews over WeChat or telephone. Recovery of the ankle motor function was evaluated according to the American Orthopedic Foot and Ankle Societ (AOFAS) ankle-hind foot score scale.Results:All 8 ALTPF survived. Over 6 to 18 months (10.8 months in average) of follow-up, the transferred flaps had good blood supply, soft in texture, with good elasticity and thin in appearance. Appearance and function of donor sites recovered well, except 1 patient who had mild scar hyperplasia. The plantar flap had good abrasion resistance. No flap damage, bleeding or granulation tissue hyperplasia occurred when walking. The mean score of AOFAS ankle-hind foot score achieved 95.6.Conclusion:The application of ultra-thin lobulated ALTPF with retrograde separation of perforating vessels from the superficial fascia at the junction layer for repairing large soft tissue defects in the foot has good clinical efficacy.
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Objective:To retrospectively analyze the treatment of 25 cases of lower necrotizing fasciitis.Methods:A total of 25 patients with lower limb necrotizing fasciitis (13 males and 12 females), with mean age 63 years old (48-75 years old) in Dalian Municipal Central Hospital from September 2016 to December 2020. After admission, the patient′s general physical condition was strictly evaluated, the relevant preoperative examination was improved, and the necrotizing fasciitis laboratory risk index (LRINEC) score was performed. In the absence of surgical contraindication, multiple debridement was performed, leaving the necrotic tissue removed for general bacterial culture and drug sensitivity test in parallel. After debridement, eight patients showed a large area of skin necrosis, and amputation was selected. The other 17 patients chose limb protection treatment after debridement, and adopted debridement and free skin grafting. After surgery, patients were encouraged to strengthen rehabilitation exercise to restore limb function to the maximum extent.Results:With followed up 0.6 to 3.0 years, with an average of 1.8 years. Methods include outpatient return visit, WeChat contact or telephone inquiry. The skin survived in 17 patients with mean healing time (27.5 ± 6.9) d. Eighteen patients were multiple bacterial infections and seven patients were single bacterial infections. All patients had no joint dysfunction caused by scar contracture, and reinfection in the skin grafting area.Conclusions:Necrotizing fasciitis requires early diagnosis and early treatment, with correct choice of treatment method is closely related to the patient′s prognosis.
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Objective To investigate the clinical effect of free bilateral anterolateral femoral perforator flap in repairing large area soft tissue defects of foot and ankle. Methods From July, 2013 to December, 2017, 30 pa-tients (19 males and 11 females) with large soft tissue defects of ankle and foot were treated , aged 21-52 years. The defects were located in the middle and distal part of the foot and ankle, the wounds were all exposed with bone, ten-don or internal fixator, and the area of skin defect was 15 cm × 22 cm-19 cm× 28 cm. All of them were repaired by free bilateral anterolateral femoral perforator flaps. The perforating branch of bilateral flap was determined by CDU or DSA before operation. According to the area of skin defect and the shape of wound, an appropriate perforating branch flap was designed in the anterolateral thigh region. One perforating branch flap was used as the proximal series flap, the proximal vessel pedicle was anastomosed with the recipient region arteriovenous flap. The other perforating branch flap was used as the distal series flap, the artery and vein were anastomosed between the two flaps. The total area of the two flaps was 17 cm × 25 cm-23 cm × 32 cm. The survival of the flap and the functional recovery of the repair site were observed and the clinical effect was evaluated. Results There was no vascular crisis after operation, and the flaps survived. Followed-up for 5-28(mean, 13.5)months showed that the flap had good blood flow, soft texture and good elasticity, among which 4 cases were slightly bloated and improved after plastic operation. After operation, 26 cases were excellent (90-100 points), 4 cases were good (75-89 points), and the average score of AOFAS was 93.8 points. Conclusion The traffic accident of anterolateral perforating branch and the attention in the process of flap cutting and series were summarized.
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BACKGROUND:Studies have shown that nerve grafts with Schwann cels can repair peripheral nerve defect and Schwann cels have an important role in nerve regeneration. OBJECTIVE: To observe the rehabilitation status of neutral function after sciatic nerve injury in rats bridged by nerve grafts with Schwann cels. METHODS: A rat model of sciatic nerve injury was established, and schwann cels were primarily cultured. Then, the rat model was repaired with polylactic-co-glycolic acid copolymer-extracelular matrix gel-Schwann cels complex. According to different concentrations of Schwann cels, there were five cel groups from 105/L to 109 RESULTS AND CONCLUSION: The nerve conduction velocities in the cel groups were al higher than that in the control group at 3, 6, 12 weeks after modeling (P < 0.01), and it was highest in the 10 and a control group. The nerve conduction velocity was detected respectively at 3, 6, 12 weeks after modeling; the e tibialis anterior muscle gravity was detected and histological observation was done at 12 weeks. 8/L (P < 0.05). At 12 weeks, hematoxylin-eosin staining of the tibialis anterior muscle showed that the number of normal muscle fibers was higher in the cel groups than the control group (P < 0.05). In the 108/L and 109 and had similar length, thickness and density. These findings indicate that polylactic-co-glycolic acid complex with 10/L groups, the morphology of tibialis anterior muscle recovered wel; the muscle fibers were in strip-like and wavy shapes, grew in the same direction, 8/L Schwann cels is better to promote sciatic nerve regeneration.