Repair of foot degloving injury by ALTF combined with MPF / 中华显微外科杂志

Objective:To investigate the clinical effect of free anterolateral thigh flap(ALTF) combined with medial plantar flap(MPF) transfer in repairing forefoot and mid-foot degloving injury.Methods:From May, 2016 to November, 2019, 6 patients with forefoot and mid-foot degloving injuries underwent reconstructions using free ALTF combined with MPF. The study included 4 males and 2 females patients with an average of 43 (range, 35-55) years. The size of soft tissue defects was 15 cm×12 cm-19 cm×14 cm. The dimension of the MPF was 8 cm×5 cm-10 cm× 6 cm, and that of ALTF was 16 cm×7 cm-20 cm×8 cm. The ALTF was used to cover the dorsal and lateral foot, the flap artery was anastomosed to the dorsalis pedis artery. The MPF was used to repair the weight-bearing area of the forefoot, the flap artery was anastomosed to the medial plantar artery in recipient site. All patients entered follow-up by outpatient clinic or Wechat for 9-18(mean, 14) months, and the appearance of flap and limb function were recorded.Results:The MPF and ALTF survived uneventfully in all 6 patients, and the wound in donor and recipient areas healed in one stage. At the last follow-up, the flaps had satisfactory contour, the texture of the flaps was soft, the protective sensation was recovered, and the appearance and function of the foot recovered satisfactorily. The Maryland score of reconstructed foot function was considered excellent (90-100) in 4 cases and good (75-89) in 2 cases. The average Maryland score was 91.2.Conclusion:ALTF combined with MPF generated good effect and satisfactory function in repairing forefoot and mid-foot degloving injury.

Peroneal artery perforator flap with anterior tibial artery perforator in repair of the wound of dorsum of forefoot and midfoot / 中华显微外科杂志

Objective:To investigate the clinical effectiveness of peroneal artery perforator flap with anterior tibial artery perforator in repair of the soft tissue defect of dorsum of forefoot and midfoot.Methods:From February, 2015 to July, 2019, peroneal artery perforator flaps with anterior tibial artery perforator were used to repair dorsal foot soft tissue defect in 42 patients. There were 25 males and 17 females, with an averge age of 62(44-73) years. The size of soft tissue defect ranged from 7 cm×4 cm to 18 cm×5 cm. The recipient sites on forefoot and midfoot were repaired by peroneal artery perforator flaps with anterior tibial artery from the anterolateral aspect of shank. The donor sites were resurfaced with full-thickness skin graft. All patients were followed-up at the outpatient clinic or through WeChat for 3-12 months. The appearance of the flaps and limb recovery were recorded.Results:All flaps survived successfully. The donor sites and recipient sites were well healed. At the last follow-up, the texture and aesthetic of flaps were good, and the appearance and function of the foot were satisfactory.Conclusion:The peroneal artery perforator flaps with anterior tibial artery double blood supply and can be designed to repair large and distanced soft tissue defect of forefoot and midfoot.

Arthroscopic posterior approach for reconstruction of posterior cruciate ligament / 中华创伤杂志

Objective To evaluate the clinical results of arthroscopic reconstruction of posterior cruciate ligament (PCL) via posteromedial,posterolateral and posterior trans-septal portals with the preservation of intact meniscofemoral ligaments and remnant PCL fibers.Methods Nine patients with PCL injuries were treated with autogenous hamstring tendons arthroscopically through routine arthroscopic portal,posteromedial portal,posterolateral portal and posterior trans-septal portal with preservation of intact meniscofemoral ligaments and remnant PCL fibers.Tibial tunnel of 1-1.5 cm was made below the lateral articular surface of PCL tibial attachment via arthroscopic posterolateral approach.Femoral tunnel of 1 cm was made posterior to the articular cartilage of the medial femoral condyle through anterolateral approach.Autogenous tendon graft was positioned in the knee joint through the navigation of tibial and femoral double-folded silk loops that traversed the bone tunnels and was fixed with bioabsorbable interface screws at both ends.Knee function was evaluated with Lysholm scale six months postoperatively.Results All patients were followed up for average 8.6 months (range,7-14 months).None of the patients had knee extension limitation six months postoperatively,but there were two patients with 10°-15° flexion limitation and one withⅠ degree positive result in posterior drawer test.Lysholm knee score was increased from preoperative (47.6 ± 14.9)points to (92.9 ±4.6) points at six months postoperatively (P ＜0.01).Conclusion PCL reconstruction via posteromedial,posterolateral and posterior trans-septal portals can obtain clear vision (with no blind area),safe operation,accurate positioning of tibial attachment and affirmative short term treatment results.

Artificial liver support system combined with allotransplantation for the treatment of serious hepatitis in 5 cases / 中国组织工程研究

BACKGROUND: The maximal problem of patient with serious hepatitis and surgical doctor is whether they can get donator and rational therapy timely. Looking for the suitable preoperative therapy method to enhance the success rate of operation and improve patient's prognosis is the focus of this domain.OBJECTIVE: To investigate the therapeutic effect of artificial liver support system (ALSS) combining with allotransplantation of the liver on patients with serious hepatitis.DESIGN: Retrospective case analysis. SETTING: Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University.PARTICIPANTS: Five male patients with serious hepatitis who underwent allograft liver transplantation were selected from Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University form June 2004 to May 2005. Their age ranged from 25 to 48 years. Inclusion criteria: The diagnosis was in accordance with phase standard established at the National Infectious Disease and Parasitology Academic Meeting in September 2000; all patients had signs of routine liver transplantation; their patients fiercely requested the operation.METHODS: Plasma exchange (PE) combined with continuous veno-venous hemofiltration (CVVH) technique was used in this study. Donor who supplied lives was from 20-38-year patients. All of them and their family agreed to donate their organ and signed the donate file before operation. All of 5 patients were used classical no-by-pass orthotopic liver transplantation (OLT). MAIN OUTCOME MEASURES: They were follow-up visited for 21-32 months for rechecking liver and kidney function,RESULTS: All of 5 patients' operation was succeeded. One continued coma postoperative and his serum creatinine and urea nitrogen raised up progressively and complicated by pulmonary infection 1 week after operation and died 2 weeks after operation although given medical treatment hemodialysis positively. The rest recovered well. All of them discharged one month after operation smoothly.CONCLUSION: Allotransplantation of the liver is an utilizable method to treat serious hepatitis. ALSS can be used as an effective method of supportive treatment preoperatively.