[Repairing the bone and skin defect of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery].

Objective: To evaluate the clinical outcome of repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery. Methods: Twelve patients of toe defect after reconstruction were repaired from March, 2015 to June, 2017 utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery in the Department of Hand and Foot Microsurgery of Xin'an Hospital, Dongguan City.Of which, there were 7 cases of great toe defect with fibular side of phalanx ungual and skin, 5 cases of second toe defect with proximal interphalangeal joints and the partial bone accompanied the great toe defect.Double bone flaps of one pedicles were used to repair first and second phalanx defect in 5 cases.The skin injured area: 5.5 cm×2.5 cm to 6.5 cm×10.0 cm. Bone defect size of great and second toe were 1.5 cm×1.0 cm×0.8 cm to 1.7 cm×1.0 cm×1.0 cm and 2.5 cm×1.0 cm×1.0 cm to 4.0 cm×1.0 cm×1.0 cm, respectively.The flap size ranged from 6.0 cm×3.0 cm to 6.5 cm×12.0 cm, and the bone flap size ranged from 1.5 cm×1.0 cm×0.8cm to 1.7 cm×1.0 cm×1.0 cm(great toe) and 2.0 cm×1.0 cm×1.0 cm to 3.5 cm×1.0 cm×1.0 cm(second toe). The wound of donor site of the leg was directly combined or local skin transfer sutured with 8 cases, skin-grafting in 4 cases. Results: All the bone-skin flaps survived.After 6-27 months of follow-up, the great toe flaps were found with normal color, good texture and moderate thickness, the two-point discrimination was 7-10 mm. The donor site of the leg showed little influence with normal function.No pain and discomfort in the foot were recorded, and the patients walked well.The healing time of bone flap was from 1.5 to 4 months, with an average of 2.5 months.Using the Maryland Foot Score, 5 cases of 7 feet got excellent and 2 cases of 2 feet got good result in the great toe group (7 cases of 9 feet), the good rate was 100%.Three cases got excellent and two cases got good result in the combined reconstruction group (5 cases), the good rate was 100%. Conclusion: Repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery can also repair bone and skin defect of the great and the second toe, keep the great and the second toe, and restore the appearance and function of the first and the second toe at utmost.

[The anatomic study and clinical application of the bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle].

OBJECTIVE: To explore the anatomic feature and clinical application of the bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. METHODS: The anatomic features and distribution of upper muscular branches of lateral femoral muscle were observed in the lower extremities of 40 adult cadavers. From February 1989 to February 1999, 7 cases with bone defect or nonunion of upper part of femur were treated with transfer of bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle. RESULTS: The upper muscular branches of lateral femoral muscle originated from the transversal branch of lateral circumflex femoral artery. The musculoperiosteal branch and periosteal branch were originated at 16.8 +/- 3.0 cm below the greater trochanter. The diameter and length of musculoperiosteal branch were 1.4 to 1.7 mm and 2.7 to 5.6 cm, those of the periosteal branch were 0.4 to 0.6 mm and 1.2 to 1.5 cm respectively. Bone union achieved in 10 to 18 weeks after operation in all 7 cases after 18 to 42 months follow-up. The motion of hip joint reached 180 degrees in 4 cases, 120 degrees in 2 cases and 65 degrees in 1 case. The donor area recovered well. CONCLUSION: The bone (periosteum) flap pedicled with upper muscular branches of lateral femoral muscle is an effective alternative for repairing the bone defect or nonunion of the upper or middle part of femur.

[Repair of medial collateral ligament defect of knee joint with transposition of great adductor muscular tendon pedicled vessels].

OBJECTIVE: To study the effect of transposition of great adductor muscular tendon pedicled vessels in repairing the medial collateral ligament defect of knee joint. METHODS: From September 1991 to September 1999, on the basis study of applied anatomy, 30 patients with the medial collateral ligament defect were repaired with great adductor muscular tendon transposition pedicled vessels. Among them, there were 28 males and 2 females, aged 26 years in average. RESULTS: Followed up for 17 to 60 months, 93.3% patients reached excellent or good grades. No case fell into the poor grade. CONCLUSION: Because the great adductor muscular tendon is adjacent to the knee joint and similar to the knee ligament, it is appropriate to repair knee ligament. Transposition of the great adductor muscular tendon pedicled vessels is effective in the reconstruction of the medial collateral ligament defect of knee joint.

[Treatment of nonunion of scaphoid bone by transfer of radial periosteal bone flap pedicled with recurrent branch of radial artery].

OBJECTIVE: To introduce the operation method of treatment of nonunion of scaphoid bone by transfer of pedicled radial periosteal bone flap. METHODS: From Match 1986, 26 cases with old nonunion of scaphoid bone were treated by transfer of radial periosteal bone flap pedicled with recurrent branch of radial artery, the size of bone flap was 1.0 cm x 0.4 cm x 0.5 cm. RESULTS: All patients with old nonunion of scaphoid bone were healed by first intention, bone union was occurred after 2 to 3 months of operation, and wrist joint almost recovered normal function. CONCLUSION: It is an effective operation method to treat nonunion of scaphoid bone.