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Objective:To investigate the clinical therapy of one-stage internal and external fixation combined with early perforator fiap for treatment of ankle fracture dislocation with soft tissue defects of Gustilo types Ⅲ.Methods:A retrospective study was conducted of the 20 patients with ankle fracture dislocation of Gustilo type Ⅲ who had been treated from May 2014 to July 2017 at Deparment of Traumatic Orthopaedics, the Second Hospital of Tangshan. There were 14 males and 6 famales among the patients, aged from 18 to 58 years (average, 40 years). There were 5 cases of Gustilo type ⅢA, 12 cases of type ⅢB, and 3 cases of type ⅢC; AO classification of ankle fractures: 4 cases of type A, 7 cases of type B, and 9 cases of type C; The wound size ranged from 4 cm×3 cm to 20 cm×9 cm. All patients were treated by primary internal and external fixation plus secondary transfer with a perforator flap. The times from injury to initial surgery ranged from 1 to 8 h (average, 5.5 h), the period from injury to secondary flap transfer ranged from 7 to 21days (average, 12 days). Among them, 11 cases of posterior tibial artery perforator flap, 5 cases of fibular artery perforator flap, 1 case of anterior ankle flap, and 3 cases of posterior tibial artery perforator flap combined with fibular artery perforator flap.Results:All 20 cases of limb preservation were successful, and there were no amputees. 9 patients showed superficial infection, no deep infection and osteomyelitis occurred. All 19 cases of flap survived, 1 case of distal part of posterior tibial artery perforator flap was necrosis, and the skin graft was cured later. All patients were followed up for 6 to 18 months (average, 12 months). The flap healed well. There was no sinus tract and bone exposure. The sensory recovery was S1 in 2 fiaps, S2 in 12 flaps, S3 in 6 flaps. The fracture healing time vanged from 4 to 10 months (average, 6.5 months), no bone disunion in patients. According to the American foot ankle surgery scoring system, the efficacy was assessed: 4 excellent cases, 11 good cases, 3 fair cases, 2 poor cases, yielding an excellent to good rate of 75%.Conclusions:One-stage internal and external fixation combined with early perforator fiap transfer is an effective strategy for treatment of ankle fracture dislocation with soft tissue defects of Gustilo types Ⅲ, due to its advantages of shortened treatment period, possibility for early rehabilitation, decreased complications and satisfactory functional recovery.
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Objective To investigate the value of one-stage lymphatics-venous anastomosis in radical mastectomy of breast cancer to prevent post-mastectomy upper limb lymphedema.Methods Ninety patients requiring radical mastectomy of breast cancer in Tangshan Tumor Hospital Affiliated to North China University of Science and Technology from March 2010 to May 2013 were collected as the objects.They were divided into the control group (45 cases) and the treatment group (45 cases) using block randomized grouping (concealment of allocation).Both groups underwent radical mastectomy of breast cancer, and the treatment group was treated with one-stage lymphatics-venous anastomosis on the basis of radical mastectomy.The operation times, amount of bleeding, hospitalization times, postoperative complications and the numbers of axillary lymph node dissection of the patients in the two groups were compared, and the postoperative upper limb lymphedema incidence rates of the patients in the two groups were compared.Results The operative times of the patients in the treatment group and the control group were (152.82 ± 18.76) min and (78.92 ± 10.33) min respectively, and amount of bleeding were (416.64 ± 94.65) ml and (250.84 ± 63.17) ml, with statistical significances (t =-20.39, P =0.00;t =-4.48, P =0.00).The average hospitalization times of the patients in the treatment group and the control group were (14.91 ± 5.44) d and (13.45 ± 2.36) d respectively, the numbers of axillary lymph node dissection were 14.63 ± 3.37 and 14.37 ± 3.18, the numbers of postoperative complications occurred were 9 cases (20.00％) and 5 cases (11.11％), with no statistical significances (t =-0.47, P =0.64;t =0.75, P =0.46;x2 =1.35, P =0.38).Compared with the control group, the treatment group has lower incidence of upper extremity lymphedema (13.95％ vs.40.91％) and lower swelling degree, with statistical significance (x2 =8.48, P =0.03).Conclusion One-stage lymphatics-venous anastomosis in radical masteetomy of breast cancer can effectively transfer lymph diversion to the venous circulation and reduce the incidence of limb lymphedema, which has significant preventive effect.
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Objective To compare the complication and cost-effectiveness of the deep inferior epigastric perforator(DIEP) flap and transverse rectus abdominis myocutaneous(TRAM) flap.Methods From January 2000 to December 2014,all patients who underwent DIEP flap and TRAM flap in the People's Hospital of Tangshan and the Affiliated Hospital of North China University of Science and Technology, were selected.Eleven patients underwent immediate breast reconstruction with TRAM flaps and 19 patients with DIEP flaps.The treatment cost,length of hospitalization, and complication in the two year after surgery for each group were compared.Results For the major complications,there were 5 cases appeared fat necrosis in TRAM group, and 1 case in DIEP group,the differences was statistically significant(P=0.016).One case appeared flap loss in TRAM group,and DIEP group was zero,both of the two group had no abdominal wall hernia, there was no significant difference (P ＞ 0.05).For the minor complications, there were 4 cases appeared postoperative hematoma in TRAM group, and 1 case in DIEP group, the difference was statistically significant(P =0.047).Two cases appeared wound dehiscence in TRAM group,and DIEP group was 1 case, 1 case happened infection in TRAM group,there was no statistically significant difference(P＞0.05).The treatment costs were (14 133.12±1 546.88)yuan for the TRAM group and (16 838.94± 3 006.05)yuan the DIEP group, the difference was statistically significant (P =0.010).The hospital stay was (17.28± 2.08)days for the pedicled TRAM group and (18.39±2.87) days for the DIEP group,the different was not statistically significant(P＞0.05).Conclusion The DIEP flap has a better clinical outcomes,but more expensive.