The combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg / 中华显微外科杂志

Objective To determine the outcome of the combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg.Methods Sixteen patients were identified from a retrospective review from July,2008 to July,2013,who suffered the large soft tissue defects and bone lose in the lower leg and underwent single-stage soft tissue and osseous reconstruction using the flap technique and Ilizarov method.There were 12 males and 4 females aged from 22 to 62 years old (average 42.6 years old).The size of soft tissue defect ranged from 8 cm×9 cm to 30 cm×20 cm.The length of the bone discrepancy ranged from 2 to 14 cm.According to the local condition of the lower leg and the size of the composite tissue defects,10 patients received the free flap covering,6 patients repaired by the saphenous neurocutaneous perforator flap (3 cases) and sural nerve neurocutaneous flap (3 cases).Daily monitoring the skin temperature postoperative.Distraction was commenced on postoperative day 10 to 14 at the rate of 1 mm/day and continued in 4 equal increments.Results The follow-up time ranged from 18 to 36 months.Sixteen flaps survived completed,only 1 flap was observed the venous congestion in postoperative day 2.The duration of ilizarov application ranged from 3.5 to 18.0 months.All patients achieved final union.All patients were satisfied with the outcome of the surgery.Conclusion The combined use of neurocutaneous flap and Ilizarov technique for reconstruction of large composite soft tissue defect in the lower leg.Significantly reduce patient treatment time,improving traction osteogenesis of long bones and the ability of resistance to infection.

Clinical evaluation of modified transthecal digital block and traditional dorsal digital block techniques for hand injury of adults in emergency / 中国组织工程研究

BACKGROUND:Dorsal digital block refers to the commonly used anesthesia for adults in smal or moderate hand injury surgeries, but in recent years, modified transthecal digital block technique is gradualy respected, which is favored with a rapid and good effect and fewer complications. OBJECTIVE:To evaluate the clinical anesthetic outcomes of modified transthecal digital block and traditional dorsal digital block technique for the treatment of hand injury of adults in emergency by a prospective randomized controled study. METHODS:Totaly 60 adult patients with hand injury were enroled and divided into two groups of modified transthecal digital block and traditional dorsal digital block randomly. Blocks were performed by one single surgeon. The operation time, local anesthetic dose, onset time of anesthesia, duration of anesthesia, success rate of anesthesia, visual analogue scale scores and complications were recorded. RESULTS AND CONCLUSION:The anesthesia effects in the two groups were acceptable. There was no significant difference in the onset time of anesthesia, duration of anesthesia, success rate of anesthesia and complications between the two groups (P > 0.05). The operation time of anesthesia, local anesthetic dose, and visual analogue scale scores were significantly different between the two groups (P< 0.05). Modified transthecal digital block is more convenient and has less pain than the traditional root digital block, which is a safe and reliable anesthetic technique.

The free peroneal perforator-based sural neurofasciocutaneous flap: anatomical study and clinical application / 中华显微外科杂志

Objective To report the anatomical study and clinical application of the free peroneal perforator-based sural neurofasciocutaneous flap. Methods Latex injection studies were performed on 10 adult cadaveric lower limbs. The presence, prevalence, and location of the peronel perforators that were suitable for vascular anastomosis were documented. From April 2007 to January 2010, 6 patients with large soft tissue defects in the upper limb underwent the reconstructive procedures with the free peroneal perforatorbased sural neurofasciocutaneous flap transfers. 4 patients were men and 2 were women, with the age ranging from 19 to 60 years. The causes of the injury included 4 motor vehicle accidents, and 2 massive machinery trauma. The area of the flap ranged from 16 cm × 8 cm to 30 cm × 10 cm, and the length of the perforator pedicle was 4 cm to 6 cm. Results A mean of 5.3 perforating vessels of the peroneal artery was noted in the specimen. The peroneal perforator that located at the junction of the middle and lower thirds of the fibula was found suitable for microsurgery, with the external diameter and the length being (1.21 ± 0.13)mm and (4.6 ± 0.8)cm respectively. All the 6 flaps survived completely without necrosis. No severe venous congestion was observed. All the patients were satisfied with the aesthetic outcome postoperatively at 3 to 12 months'follow-up. There were no major donor site complications. Conclusion The free sural neurofasciocutaneous flap based on a single peroneal perforator is an excellent tool for reconstruction of extensive soft tissue defects in the upper limb.

The distally based cross-leg anterolateral thigh flap for reconstruction of soft tissue defects in middle and distal thirds of the contralateral leg / 中华显微外科杂志

@#Objective To report the technique and effect of distally based, cross-leg, anterolateral thigh flap for reconstructing the soft tissue defects in middle and distal thirds of the contralateral leg. Methods Five patients of soft tissue defects in lower legs associated with injuries to the eontralateral legs were treated with distally based, cross-leg, anterolateral thigh flaps of the contralateral limbs. Results After the pedicle division at 6 weeks postoperatively, the 5 flaps all survived. And the blood supply of flaps remained steady when followed up for 12 to 15 months. The flaps possessed favorable contours, and allowed successful secondary repair of injured bones or tendons. The donor sites healed primarily, and no influence was observed to the donor limbs. Conclusion For the soft tissue defects in middle and distal thirds of leg associated with damage to the surrounding tissues and arterial injury of the contralateral leg, cross-leg transplantation of the contralateral distally based anterolateral thigh flap is a good option of reconstruction.

Application of reversed perforator-plus sural neurofasciocutaneous flap in lower leg / 中华显微外科杂志

@#Objective To report the operative technique and clinical results of reversed perforator-plus sural neurofasciocutaneous flap in lower leg. Methods Perforator-plus sural neurofasciocutaneous flaps, which designed along the axis of the sural nerve and based on the dual-pedicle of fasciocutaneous and per-oneal perforator, were used to reconstruct soft-tissue defect in lower extremities. Results Twenfy-four flaps, ranged from 25 cm×12 cm - 8 cm ×7 cm in size, survived completely without venous congestion and distal ischemia and necrosis. The color and texture of the flaps were good. The appearance and functional re-suits were satisfactory with following up for 6 to 12 months. Conclusion The modified technique in pediclehave minimized the complication, enlarged the size of the flap and improved the survive rates. It is a goodmethod in repairing large soft-tissue defects of extremities.

Minimally invasive osteotomy and cable osteosynthesis for treatment of adolescent cubitus varus / 中华创伤骨科杂志

Objective To explore the possibility and effectiveness of minimally invasive osteotomy and cable osteosynthesis for the treatment of adolescent eubitus varus. Methods Eleven cases of adolescent cubitus varns(2 cases complicated with internal rotation of 10°)were treated with minimally invasive supracondylar wedged osteotomy to preserve the integrity of the contralateral codex and periosteum.Two screws were inserted above and below the fracture line.They were fixed with cable after the greenstick fracture and internal rotation were adjusted.Plastic bandage was applied for 1 week postoperatively before rehabilitation. Results Bone fractures healed in the 11 cases in 36.3 days averagely,without infection or nerve palsy.Before operation,the mean angles of varus,flexion and extension were 35°±5°,125°±10°and 10°±5°respectively.After a mean follow-up of 33.5 months,the mean valgus angle of the elbow was improved to 8°±2°(t=16.632,P<0.05),flexion to 130°±8°and extension to 8°±3°(P>0.05).Internal rotation deformity was also ameliorated in the 2 cases. Conclusion It is practical and effective to treat adolescent eubitus varus with minimally invasive osteotomy and cable osteosynthesis,for it can lead to stable fixation,short healing time,and does not affect the flexion and extension of the elbow joint.

Clinical experiences of the reversed superficial peroneal neurocutaneous island flap based on the descending branch of the distal perforating branch of the pcroneal artery / 中华显微外科杂志

Objective To report the operative technique and clinical experiences of the modified reversed superficial peroneal neurocutaneous island flaps for reconstruction of the ankle and foot.Methods According to the previous anatomical studies and our clinical experiences,we devised the reversed superficial peroneal neuroeutaneous island flap based on the descending branch of the distal perforator of the peronealrtery and its venae comitantes,and covered the soft defect of the ankle and foot with it.Results Twenty-one of the 23 flaps survived completely without complications,while the other two occurred marginal necrosis.The maximum surface of the flap in our series was 12 cm×13 cm.and the minimum one was 5 cm×4 cm.The length of the pedicle ranged from 5 cm to 10 cm.The texture of the flaps was good,while the cosmetic and function of them were evaluated as acceptable in all cased after 6 to 21 months follow-up.Conclusion The reversod superficial peroneal neurocutaneous island flaps is a versatile,reliable procedure useful in reconstruction of the ankle and foot.

Treatment of tibial osteomyelitis by transfer of distally based sural nerve compound flaps / 中华创伤骨科杂志

Objective To explore the possibility of treating tibial osteomyelitis with transfer of a compound flap composed of the sural nerve fasciocutaneous flap and the lateral gastroenemius muscle.Methods We observed in cadaver specimens the anatomical structure of the sural nerve fasciocutaneous flap and the lateral gastrocnemius muscle to design a compound flap. Fifteen cases of tibia] osteomyelitis were treated with sinus excision and thorough debridement before the skin defect area was covered with a sural nerve compound flap whose muscle was stuffed into the tibia] channel. Plates were replaced with unilateral fixators in 3 cases of tibial nonunion. Results We observed 5 to 6 perforating branches of blood vessels between the sural nerve fascioeutaneous flap and the lateral gastroenemius muscle, indicating that the two can be harvested simultaneously in one compound flap. The transferred compound flaps survived in 15 cases. Tibial os-teomyelitis was completely cured in 14 cases, 1 case healed after second debridement, and 3 cases of tibial nonunion healed 6 months later after a second stage iliac bone graft. No recurrence was found after a mean follow-up of 18 (10 to 26) months. Conclusion A compound flap composed of the sural nerve fascio-cutaneous flap and the lateral gastrocnemius muscle can be used to treat tibia] osteomyelitis effectively.

Treatment of adversity congenital pseudarthrosis of the tibia by anastomosis vascular fibular transplantation / 中华显微外科杂志

Objective To explore the feasibility and effects of one stage vascular free fibular transplantation or combination of bone transport two-stage technique for reconstruction of adversity congenital pseudarthrosis of the tibia. Methods Vascularised free fibular reconstruction operations for adversity congenital pseudarthrosis of tibia were performed in 16 cases, including male in 9 and female in 7,age ranged from 6 to 14 years with the mean in 8.5 years. 2 to 6 operations history were documented in all cases with the mean in 3.2 before went to our hospital, with 3 to 12 cm and mean 5.8 em short of the tibia. Mean9.2 cm (from 6.0 to 16.0 cm) vascular free fibular were harvested and transplanted to reconstruct the bone frame in 16 cases, bone transport operation were performed in 4 cases 1 year later. Results Fourteen cases were followed up for mean 4.5 years, bone union could be found by radiology examination, mean 7.8cm (from 4.0 to 11.5 cm) elongation of the low limb were obtained in 4 cases. Basic walking function was obtained in all cases. Conclusion It is an effective method to treat adversity congenital psuedarthrosis of the tibia by thoroughly resection of the focus and enough length of vascular fibular transplantation, deficiency of low limb can be ameliorated by bone transportation technique in those patients.

Repair and tissue engineered reconstruction of finger joint damage / 中国组织工程研究

BACKGROUND: The articular surface of interphalangeal joint and metacarpophalangeal joint is destroyed or defected, that would remain serious sequela in many patients and affect patient's routine work and living. Therefore, therapeutic efficacy of finger joint damage determines the functional recovery of hands. Tissue engineering provides a novel pathway for finger joint damage. OBJECTIVE: To summarize the research progress on the repair and reconstruction of finger joint damage. RETRIEVAL STRATEGY: The researcher of this article used the computer to retrieve literatures of Pubmed database with docuterms of "Interphalangeal joints fractures, Metacarpophalangeal joints fractures, Finger osteoarticular, Reconstruct", and the language was defined to English. Meanwhile China Academic Journals Full-Text Database from 2000 to 2007 was also retrieved with docuterms of "Interphalangeal joints, Metacarpophalangeal joints, Fractures, Repair and reconstruct", and the language was defined to Chinese. Totally 106 correlated articles were screened out and the data were firstly checked. Inclusion standard: ①closely correlated to the repair and reconstruction of finger joint damage; ②those published in the near future or authorized journal in the same field were preferred. Exclusion standard: repetitive investigation. LITERATURE EVALUATION: The resource of literatures was the clinic empirical studies of the repair and reconstruction of finger joint damage. Among 32 included articles, 3 of them were reviews and the others were clinic or empirical studies. DATA SYNTHESIS: The homogeneity variant bone-joint transplantation has got some successes in clinic, but how to prolong the survival time of transplanting joints would be a new research topic. Autoallergic joint transplantation is a good method to treat the defects of finger joints, but how to make handling conveniently, diminish secondary damage and search new donor site, all deserve to research. The ideal therapeutic efficacy of the finger joint damage is anatomical reset of the joint profile, that can reduce traumatic arthritis and anchylosis at the minimal level. But it is still a tough problem in the fingers joint's repairs, because of the multiple structure of bone-joint in hands and trauma factors. Open reduction and internal fixation, skeletal traction, arthroplasty, fusion of joint, prosthetic replacement of joint, articular transplantation and bone-joint tissue engineering have all obtained success, but none can fully succeed or be generally adopted. CONCLUSION: There are many treatments of the finger joint damage, but their results are not very well. With the research of homogeneity variant bone-joint transplantation, autoallergic joint transplantation and tissue engineering development, bone-joint transplantation will have a wide prospect in treatment of finger joints damage.

Anatomical characteristics of the fifth carpometacarpal joint of the hamatum / 中国组织工程研究

0.01). CONCLUSION: The 5th CMC joint of the hamatum can be considered to be a new and well joint donor site, and it can be used to repair and reconstruct the base joints of the proximal phalanx.