[Treatment of tibial traumatic osteomyelitis with vacuum sealing drainage combined with open bone graft].

OBJECTIVE: To explore the effectiveness of vacuum sealing drainage (VSD) combined with open bone graft for tibial traumatic osteomyelitis. METHODS: Between June 2007 and December 2012, 23 cases of tibial traumatic osteomyelitis were treated, including 15 males and 8 females with an average age of 32.5 years (range, 22-48 years). The time from injury to admission was 7-18 months (mean, 8.6 months). There was local bone scarring in 15 cases, the size ranged from 8 cm x 4 cm to 15 cm x 8 cm. The CT multi-planar reconstruction was carried out preoperatively. Eleven cases had segmental bone sclerosis with a length of 1.5 to 3.8 cm (mean, 2.6 cm); 12 cases had partial bone sclerosis with a range of 1/3 to 2/3 of the bone diameter. On the basis of complete debridement, infection was controlled by VSD; bone defect was repaired by VSD combined with open bone graft. After there was fresh granulation tissue, the wound was repaired by free skin graft or local skin flap transfer. RESULTS: Nail infection occurred in 2 cases, which was cured after the use of antibiotics. The wound healed at the first stage after repairing. All cases were followed up 10-18 months (mean, 13.5 months). In 11 cases of segmental bone sclerosis, the infection control time was 7-14 days (mean, 8.8 days); the bone healing time was 32-40 weeks (mean, 34.4 weeks); and the frequency of VSD was 3-6 times (mean, 4.5 times). In 12 cases of partial bone sclerosis, the infection control time was 7-12 days (mean, 8.3 days); the bone healing time was 24-31 weeks (mean, 27.3 weeks); and the frequency of VSD was 3-5 times (mean, 3.6 times). Infection recurred in 1 case, and the patient gave up the therapy. No infection recurrence was observed in the other patients. CONCLUSION: The VSD combined with open bone graft is an effective method for the treatment of tibial traumatic osteomyelitis.

Ten-digit replantation with seven years follow-up: A case report.

In this report, we present a case of successful replantation of 10-digit complete amputation and results of postoperative rehabilitation in 7 years follow-up. The rehabilitation program included psychotherapy, physical therapy, sensory re-education, and measurements. At the 7 years postoperatively, the static two-point discriminations of replanted digits ranged from 4 to 11 mm. Grasping powers ranged from 69 to 81 lb, and pinching powers ranged from 13 to 19 lb. The patient returned to the previous employment. Our experience has demonstrated that systemic postoperative rehabilitation and measurements could achieve satisfactory recovery of the sensory and motor functions of multiple-digit replantation.

One-stage reconstruction of complicated thumb injury with combination of microsurgical transplantations.

Complicated thumb loss of the hand still remains a great challenge to hand and microsurgeons. In this article, we report our technique and outcomes in 10 cases using one-stage microsurgical procedures. In each case, three tissue transplants in combination with a sequential vascular anastomoses was performed, i.e. the second toe for the thumb, the extensor digitorum brevis for thenar opponent muscle, and the anterolateral thigh flap for the first web space, and adjacent soft tissue defects. All the transplants survived eventually. After an average of 6 years follow-up, the results were very inspiring. Combined tissue transfer can hasten patient recovery and improve functional outcomes. However, this method needs meticulous technique and great experience in microsurgery.