Clinical application of distally-based the perforator saphenous neuro-veno-fasciocutaneous flap / 中华显微外科杂志

Objective To explore distally-based the interal ankle perforator saphenou neuro-veno-fasciocutaneous flap has been universally adopted for the repairment of the foot and the ankle soft-tissue defects.Methods Lay a foundation of anatomic studying,using the interal ankle perforator saphenous neuro-venofasciocutaneous flap 10 cases, the flap axis point was 1-3 cm above the pink of the interal ankle, average 2 cm. The scope of the flap were 4.0 cm× 3.0 cm-8.0 cm× 6.0 cm. Results All the perforator saphenous neuro-veno-fasciocutaneous flap were lively. About all, 2 cases had the small distant part necrosis, 1 case accompanying with subcutaneous tissue heels after change dressings, another heels after skin grating. All case can walk as usual, the flap had wear-resisting and keenly feel. Conclusion Distally-based the interal ankle perforator saphenous neuro-veno-fasciocutaneous flap, near ankle, donner area exiting fine, utlizing scope large, skin nice, grating easy, no hurting important blood vessle, alive rate high, it is an good donner area in repairing the foot and the ankle soft-tissue defects.

Case-control study on cannulated screw fixation and percutaneous autogenous bone marrow grafting for the treatment of femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical results of two methods for the treatment of femoral neck fracture, which are cannulated screw fixation combined with percutaneous autogenous bone marrow grafting, and simple cannulated screw fixation. To investigate the curative effects of cannulated screw fixation combined with percutaneous autogenous bone marrow garfting to promote fracture healing and reducing femoral neck necrosis.</p><p><b>METHODS</b>The clinical data of 60 cases, which were enrolled from December 2000 to December 2008 consecutively in our hospital, were analyzed retrospectively. Thirty patients with femoral neck fractures were treated with cannulated screw fixation and percutaneous autogenous bone marrow grafting. There were 20 males and 10 females, ranging in ages from 18 to 89 years,with an average of (52.3 +/- 0.2) years. There were 13 patients with traffic accident, 3 patients with falling injuries and 14 patients with tumble. Based on the Garden classification for femoral neck fractures, 1 patient was type I, 6 patients were type II, 12 patients were type III and 11 patients were type IV. Among 30 patients in the control group, 16 patients were male and 14 patients were female, ranging in age from 18 to 91 years, with an average of (51.9 +/- 0.1) years. Twelve patients injured with traffic accident, 1 patient with falling injuries and 17 patients with tumble. Based on the Garden classification for femoral neck fractures, 5 patients were type I, 2 patients were type II,15 patients were type III, and 8 patients were type IV. Patients in the control group were treated with cannulated screw fixation only. All the patients were followed up for 2 years after operation. The fracture healing and complications were evaluated and compared between the two groups.</p><p><b>RESULTS</b>The average healing time was (7.1 +/- 1.2) months in the observing group and (8.0 +/- 1.4) months in the control group. The healing of femoral neck fracture occurred in 29 cases in observing group while in 24 cases in the control group contrast to femoral head necrosis occurred in 1 case in the observing group while in 6 cases in the control group. According to Harris scoring system, the good and excellent rate of the two groups had statistical difference (P < 0.05).</p><p><b>CONCLUSION</b>Cannulated screw fixation and percutaneous autogenous bone marrow grafting is a more efficient method for accelerating healing of femoral neck fractures and reducing femoral head necrosis.</p>

A controlled clinical trial on the therapy of injured shoulder arthrochalasis by shoulder-elbow elastic band immobilization with functional exercise / 中国骨伤

<p><b>OBJECTIVE</b>To observe the therapeutic effects of shoulder-elbow elastic immobilization and functional exercise for injured shoulder arthrochalasis, and compare it with forearm-suspending immobilization and functional exercise therapy.</p><p><b>METHODS</b>The patients with injured shoulder arthrochalasis were randomly divided into treatment group (38 cases) and control group (37 cases). Treatment group underwent the therapy of shoulder-elbow elastic band immobilization and functional exercise; control group was managed by forearm-suspending band immobilization and functional exercise therapy.</p><p><b>RESULTS</b>In treatment group, 29 (76.3%) cases recovered, 7 (18.4%) improved and 2 (5.3%) failed; in control group, 15 (40.5%) cases recovered, 15 (40.5%) cases improved and 7 (19.0%) failed. The differences between two groups were statistically significant (P<0.01). The AHI (acromio-humeral interval) ranged from 8 to 19 mm (11.9+/-5.1) in treatment group and 8 to 27 mm (14.2+/-5.4) in control group, and the difference was also statistically distinct (t=2.7525, P<0.01).</p><p><b>CONCLUSION</b>The treatment with shoulder-elbow elastic band immobilization and exercise therapy for injured shoulder arthrochalasis is a safe and effective method. Immobilization with shoulder-elbow elastic band is better than forearm-suspending band for injured shoulder arthrochalasis.</p>

Fasciocutaneous flap pedicle with the perforating branches of posterior tibial artery in repairing leg soft tissue defect / 中国组织工程研究

Sixteen patients underwent fasciocutaneous flap pedicle with the perforating branches of posterior tibial artery to repair the skin defects of the middle and lower leg in Department of Orthopaedics,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from February 2003 to February 2007.Based on anatomy,the flap axis ray was designed as the connection of internal condyle of tibia and the middle point between inner malleolus and achilles tendon,rotating along the axis ray adjacent to wound with pedicle having perforating branches of posterior tibial artery.Under guidance of Doppler flowmeter,all skin including flap,pedicle,and surface of perforating branches must be fine.The upper leg skin defect was repaired using anterograde flap,and the middle-lower leg skin defect was repaired using retrograde flap,including lower leg defect in 9 cases,middle leg defect in 3 cases and upper leg defect in 4 cases.The skin defects ranged from 2.0 cm?1.5 cm to 12.5 cm?7.5 cm,and the largest size of flap was about 15.0 cm?10 cm,and the smallest size of flap was about 4.0 cm?2.5 cm.The repairing effect was observed.All flaps survived.Two cases developed distal necrosis of skin,but granulation was found in subcutaneous tissue,of which 1 case healed after changing dressings,and the other recovered after skin grating.All subjects were followed up for over 6 months.All cases could walk naturally but felt pain.Fasciocutaneous flap pedicle with the perforating branches of posterior tibial artery can repair the skin defects of leg soft tissue.The donor site is posterior leg.The pedicel is kept well after injury,and the flap is easy to design.In addition,the blood supply is reliable,and survival rate is high.It is a good surgery to repair leg soft tissue defect.

The flap combining peroneus iongus muscle with nutrient vessels of nerve repairing the chronic achilles tendon rupture with the skin defect / 中华显微外科杂志

Objective To explore the treatment methods and clinical result with the flap combining peroneus longus muscle supplying with the nutrient vessels of sural nerve to repaire the chronic achilles tendon rupture with skin defect.Methods After anatomic investigating,Analyzing 6 cases.Excising peroneus lon- gus muscle combining with the foot external flap,supplying with the pediele of the nutrient vessels of sural nerve to repaire the chronic achilles tendon rupture with skin defect,among them,the size of flap was about 6.0 cm?5.5 cm～16.5 cm?11.0 cm,the defect length of achilles tendon 2.0～7.5 cm.Results All ca- ses observed 4 to 16 months,all eases skin and achilles tendon were survived completely,the flap skin appear- ence was good,none ulcer.1 cases part necrosis,1 eases rerupture,Both healed after changed dressings.Ac- cording to Arner-Lindholm criteria to test the efficacy the result were excellent in 3 patients,good in 2,poor in 1.Conclusion It is an ideal way using the flap combining peroneus logus muscle with the nutrient vessels of sural nerve repairing the chronic achilles tendon rupture with skin defect.The advantage is operting conven- iently,transferred adjaeently,repairing the skin and tendon defect simultaneously,healing fastly and anti-bac- teria strongly,biomeehanies property and function is similar to the heel,it can fit the heel and skin for repai- ring.