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Objective:To evaluate the viability and clinical effect of polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of large soft tissue defect around ankle.Methods:From June 2019 to October 2022, large soft tissue defects around ankle of 11 patients were reconstructed with ALTPF in the Department of Orthopaedics of the First Affiliated Hospital of Nanchang University. The causes of injury were traffic accident in 8 patients and heavy objects in 3 patients. All wounds were large defects (15.0 cm×14.0 cm-30.0 cm×20.0 cm) and combined with various degrees of infection. Intraoperatively, polyfoliate ALTPFs sized 16.0 cm×14.5 cm-23.0 cm×18.5 cm were used in reconstruction of the defects. Deep dead spaces were filled with antibiotic bone cement, and direct suture was performed to close the donor sites or by skin grafting repair. Postoperative follow-ups were scheduled at 1, 3 and 6 months, and 6 monthly thereafter at outpatient clinics and via telephone interviews. The appearance and colour of the flaps and healing of donor sites were recorded together with evaluation of the recovery of ankle motor function according to the ankle-hindfoot rating scale of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All flaps survived. No haematoma or secondary infection occurred at the recipient site after surgery. All donor sites healed primarily. One patient had venous occlusion at the distal end of the polyfoliate ALTPF. The flap survived completely at 1 week after distal venous bloodletting. Postoperative follow-ups lasted 6-24 (15.27±5.21) months. All flaps had good blood supply with satisfactory appearance, similar colour and texture to the recipient sites, and without obvious bloat nor ulceration. Only a linear scar or few skin graft scar was left at the flap donor sites in concealed locations. The mean AOFAS ankle-hindfoot score was (88.36±10.21) point. There were 6 cases of excellent, 4 cases of good, and 1 case of fair.Conclusion:A polyfoliate ALTPF is an ideal flap for reconstruction of soft tissue defects around ankle by converting the length of a flap to the width.
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Objective:To investigate the clinical efficacy in one stage reconstruction of composite defects of Achilles tendon and surrounding soft tissues with a flap transfer combined with allogeneic tendon transplantation.Methods:From July 2018 to August 2022, a total of 12 patients, including 9 males and 3 females, with a mean age of 31.5(ranged 8 to 56) years old, had surgery with flap transfer combined with transplantation of allogeneic tendon in one stage reconstruction for compound defects of Achilles tendon and soft tissue at the Department of Orthopaedics of First Affiliated Hospital of Nanchang University. The defects of Achilles tendons ranged from 4.0 to 9.0 cm, and the soft tissue defects sized from 3.0 cm × 4.0 cm to 14.0 cm × 6.0 cm. Of the 12 patients, 6 received transfers of sural neurovascular flaps, 3 with peroneal perforator flaps and 3 with free anterolateral thigh flaps(ALTF). The flaps sized from 4.0 cm × 4.5 cm to 15.0 cm×7.0 cm, and in addition, allogeneic tendon grafts were used to reconstruct the defects of Achilles tendons in all patients. All the flap donor sites were either directly sutured or covered with skin grafts. Follow-up was carried out by visits of outpatient clinic or telephone or WeChat distant interviews. The flap survival and recovery of ankle function and Achilles tendon were observed.Results:During the 3 months to 2 years of follow-up, none of the patient showed obvious immunological rejection against the transplanted allogeneic tendon. All 12 flaps survived well with the colour and texture close to the surrounding skin. No ulceration occurred in both of the donor and recipient sites. There was no re-rupture of the transplanted allogeneic tendon. At the final follow-up, ankle movement was measured at 13.4°±2.6° in dorsal extension and 33.6°±3.2° in plantar flexion. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind foot function score, a score of 88.7±5.6 was achieved with 7 patients in excellent, 4 in good and 1 was acceptable.Conclusion:In patients with a composite defect of Achilles tendon and surrrounding soft tissue, the application of a flap transfer combined with a homogeneous allograft tendon transplantation in an one stage surgery is a feasible surgical procedure. It can achieve a satisfactory outcome with less trauma and fewer complications.
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Objective@#To investigate the efficacy and the technical details of utilizing a long segment of vein graft to bridge the vascular defect when a free flap is used to repair extensive injuries in lower extremities.@*Methods@#For the reconstruction of extensive leg defect caused by serious composite injury, a local flap is unavailable or cannot fulfill the requirements. The main vessels of the leg could be damaged. It is challenging work to find an ideal recipient vessels for a free flap. The saphenous vein was harvested from the contralateral lower extremities and utilized to bridge the vascular gap between the recipient vessels and flap pedicle vessels. A latissimus dorsi myocutaneous or anterolateral thigh free flap was used to reconstruct the leg defect. The distal end of the grafted vein was anastomosed to the superficial femoral artery in an end-to-side fashion, and the proximal end to the artery of flap pedicle in an end-to-end fashion. When a vein insufficiency was present, the proximal and distal ends of the additional grafted vein were anastomosed to the recipient vein and vein of flap pedicle in an end-to-end fashion.@*Results@#From July 2010 to April 2019, 27 patients underwent reconstruction of leg using the above-mentioned method. There were 20 males and 7 females. The patients′ age ranged from 16 to 54 years with an average of 30.6 years. There were 19 latissimus dorsi myocutaneous flaps and eight anterolateral thigh flaps. The grafted saphenous vein was used to bridge the arterial gap in 21 cases and to bridge both the arterial and venous gaps in 6 cases. The length of the grafted vein for arterial and venous defects was ranged from 14 cm to 43 cm (mean, 24.8 cm) and 5 cm to 12 cm (mean, 8.6 cm), respectively. 26 flaps completely survived after surgery. Venous congestion occurred in the remaining one flap and the flap eventually lost. The patient eventually opted for amputation. All patients were followed up for 3 to 14 months with an average of 9 months. Functional and aesthetic outcomes were obtained in both the recipient and donor sites. No obvious edema of lower extremities was observed.@*Conclusions@#For patients with a severe and large soft-tissue defect of the leg, fining an ideal recipient vessels for a free flap is crucial for a successful reconstructive surgery. It is a reliable and an additional option to choose the superficial femoral artery and/ or saphenous vein as the recipient vessels by using the grafted vein to bridge the vascular gaps.
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Objective@#To explore the clinical effects of the reconstruction of extensive leg defects using the free anterolateral thigh flap with the contralateral leg vessels as the recipient vessels.@*Methods@#From January 2012 to January 2018, ten patients were treated with severe and extensive leg defects in the department of orthopedics of the First Affiliated Hospital of Nanchang University. There were 7 males and 3 females with an average age of 35, from 17 to 56. There were no main vessels for angiogenesis around the wounds in all cases. The size of defects ranged from 20 cm×13 cm to 29 cm×15 cm. The position of defects were anterior of shank in 5 cases, medial in 3 cases and medial posterior in 2 cases. The various flaps were harvested from the anterolateral thigh region of healthy leg and transferred to repair the leg defects. The healthy vessels of the contralateral leg were chosen as the recipient vessels. The musculocutaneous flap, fascia flap or perforator was removed according to the size of the defect and whether it was necessary to fill the dead space of the wound. The limbs were placed in parallel position and was fixed by external fixator. The pedicle division training was started 1 week after operation, the period of pedicle division and external fixator removing was from 21 days to 32 days. When the pedicle was divided, the vascular end of the limb and the distal end were anastomosed to re-established the continuous vessels.@*Results@#All 10 flaps survived completely after surgery. The size of flaps ranged from 23 cm×14 cm to 32 cm×16 cm. The recipient vessels that were used included the posterior tibial vessels in 5 cases and anterior tibial vessels in the remaining 5 cases. All the vessels in flap pedicle were anastomosed to the recipient vessels in an end-to-end fashion. The anastomotic sites and vascular bundles were covered by using a local flap in 2 cases, skin tension reducer in 1 cases, and free skin graft in the remaining 7 cases. Very mild infection occurred in one case and was controlled by dress changing. A small-sized necrosis of the grafted skin occurred in another patient. All patients were followed up for 6 to 18 months with an average of 12 months. The function of the lower extremities almost recovered. All patients were happy with the final functional and aesthetic outcomes.@*Conclusions@#Although there some drawbacks of the technique, such as long-term immobilization of the lower extremities, multiple staged surgeries, for strictly selected patients, the healthy vessels of the contralateral leg could be served as recipients vessels when a free myocutaneous, fasciocutaneous, or perforator flap was used to reconstruct the extensive and severe injury of the leg, particularly in the absence of usable vessels in the ipsilateral leg.
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Objective To explore the clinical effect of peroneal artery perforator flap for the treatment of serious heel spoke injuries in children.Methods From July,2014 to September,2017,13 children with severe heel and ankle injuries were treated by peroneal artery perforator flap.There were 9 males and 4 females,with an average age of 6.5 years (ranged from 3 to 11 years).The size of flaps ranged from 10.0 cm×3.0 cm to 14.5 cm×5.0 cm.The donor sites were sutured directly or covered with skin grafting.Regular follow-up was performed to observe the survival status of the flap and the functional recovery of the ankle joint.Results Twelve flaps survived completely.One flap had partial marginal necrosis in the distal portion,which was healed after dressing.Partial inadequate venous return happened in 1 case,which also recovered by the removal of part of the suture.All cases were followed-up for 3 months to 20 months.The appearance,texture,and color of the flaps were similar to the surrounding skin.No ulcer occurred.All case acquired normal gait.Conclusion The peroneal artery perforator flap is a good option for reconstruction of serious heel spoke injuries in children.The flap has consistent blood supply while leaving minimal morbidity at donor site.
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Objective To evaluate the effect of pressure load of avascular necrosis of the femoral head(ANFH) by percutaneous injection of polymethylmethacrylate(PMMA).Methods Models of ANFH were established in 20 adult white rabbits with 40 femoral heads which were induced by injection of hydrochloride(HCL) and hormone.DR was performed to observe the bony density of femoral head in all rabbits,the cystic degeneration and collapse of femoral head were detected in 21 femoral heads,then DSA was done to observe the blood supply and they were divided into three groups at random,group A in 5 was examined by pathology,group B in 8 was injected with PMMA and group C was as control.The test of pressure loading was performed in group B and C.Results Of 21 femoral heads with cystic degeneration and collaps,8 were in the HCL-induced group and 13 were in the hormone-induced group.DSA showed that the blood supply was decreased,and the arteria were decreased in diameter.After the percutaneous injection of PMMA,all of 8 rabbits in experimental group were successful.The distinction between the means of two samples was significant in loading test(P