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Objective To explore the clinical outcome of free super?thin anterolateral femoral perforator lobulated skin flap with nerve for repairing the tissue defect of the foot and ankle. Methods Free super?thin anterolateral femoral perforator lob?ulated skin flap with nerve was transferred to repair soft tissue defects of the foot and ankle in 32 cases. There were 20 males and 12 females with an average age of 35.5 years (range, 21-50 years). The wounds located in dorsal and plantar ankle skin with ten?don, bone and/or internal fixation exposed. The defect area was from 12 cm×10 cm to 20 cm×15 cm. At first the site of perforator vessels were determined by Doppler, according to the wound shape and size, the flaps were designed and harvested with the site as center;the femoral lateral cutaneous nerve was carried and most tensor fascia was reserved. During flap harvesting trimming of the flap was carried out, the flap was freed and only connected with its vascular pedicle. A step?wise defatting was done from the pe?riphery of the flap towards the vascular pedicle with 1.0 to 2.0 cm tissue around the perforator preserved. Flap circulation was care?fully observed to prevent damage to the perforators. The vascular pedicle was disconnected and formed a split leaf skin flap, and then the flap was transferred to the foot and ankle to cover the defect. Results All the 32 flaps were survived. No vascular crisis happened and all skin grafts were survived in donor sites. Necrosis of 1.5 cm×1.0 cm of the distal flap occurred in 1 case five days after surgery and it was healed by dress changing. All the 32 cases were followed?up for 6 to 24 months (average, 13 months). The flaps were supple and elastic with near normal color. There was no bulkiness. Sensory function was recovered well and two point discrimination (2?PD) was about 3.0-5.0 mm. The function and appearance of the foot and ankle were good. According to the Chi?nese Medical Association of hand surgery upper limb function evaluation of upper limb, the results were excellent in 22 cases, good in 9, fair in 1, with 97%(31/32) overall excellent and good rate. Conclusion The free super?thin anterolateral femoral perfo?rator lobulated skin flap with nerve is an improvement of the traditional anterolateral thigh flap. The survived flaps are ideal in terms of covering foot and ankle defects and restore function.
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Objective To explore the incidence rate and the risk factors of deep vein thrombosis (DVT) in patients with traumatic fractures so as to provide references for prevention of DVT.Methods All of 534 Patients with fresh four extremities or pelvic fracture between January 2010 and December 2013 were involved in this study.The incidence of DVT under 5 risk factors including general state, injury type, fracture condition, operation and laboratory examination were analyzed.Each patient underwent three Doppler ultrasound exams in actions as the epidemiology diagnostic criterion for DVT.Results The total incidence rate of DVT in 534 patients was 11.99％.The univariate analysis showed that male patients with age≥60 years, BMI≥25 kg/m2, history of smoking, lack of exercises, history of diabetes, hypertension and coronary artery disease had higher incidence rate of DVT.In different injury types, the fall injury caused the highest incidence rate of DVT (45.71％).There were different DVT rates for different fracture sites, with the highest incidence rate of DVT for femur shaft fracture (20.69％).The incidence rate of DVT was 50.00％ for fractures of more than three parts, 15.29％ for fractures of two parts and only 3.98％ for sole part.The incidence rate of DVT for comminuted fractures was higher than others.The operation duration, massive transfusion during operation and general anesthesia were related with the increase of incidence of DVT.Positive ACA and enhancement of D-dimer, Fib and CRP were related with the increase of incidence of DVT.Conclusion The incidence of DVT in patients with traumatic fractures approaches a considerable level.It has relationships with age≥60 years, BMI≥25 kg/m2, history of smoking, fall injury, fracture of femoral shaft and hip, more than three parts of fractures, comminuted fractures, operation duration≥2 hours, largely blood transfused, massive transfusion during operation, general anesthesia, positive ACA, enhancement of D-dimer, Fib and CRP.The surgeons should recognize the importance to prevent DVT and PE in the traumatic patients.
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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.