Repair of complex soft tissue defects of lower extremities with anterolateral thigh chimeric perforator flap / 中华显微外科杂志

Objective:To investigate the application of anterolateral thigh chimeric perforator flap in repairing complex soft tissue defects in lower extremities.Methods:From January, 2015 to June, 2019, 76 cases of complex soft tissue defects in lower extremities were repaired with free anterolateral thigh chimeric perforator flap pedicled with the descending branch of lateral circumflex femoral artery, including 29 cases in shank and 47 cases in ankle, and all had various tissue necrosis, infection, deep tissue defect and orthopaedic implant exposure. The size of the wound ranged from 15 cm×8 cm to 35 cm×20 cm, in which 45 cases associated with dead cavity formation, 62 cases with combined fractures at the same site, and 38 cases with combined fractures or other system injuries in other sites. After debridement, VSD treatment, good wound granulation and infection control, the chimeric perforator flap pedicled with the descending branch of the circumflex lateral femoral artery was designed and harvested. The perforator flap was used to repair most of the wounds with deep tissue exposures, the muscle flap was used to fill the dead cavity and (or) cover the wound around the flap, and free skin was grafted of the muscle flap at the first or second stage. Scheduled follow-up was conducted after the operation.Results:All 76 flaps survived, including vascular crisis occurred in 2 cases within 72 hours after surgery and ceased after immediate surgical exploration. One case had a further surgical operation due to excessive bleeding. Partial necrosis occurred at the distal end of the flap or the skin graft area of the muscle flap in 4 cases, of which 2 cases were treated with grafted skin again and the other 2 cases completely eliminated the wound after active dressing change. Other 16 cases of post-traumatic osteomyelitis with bone defect were repaired respectively with bone grafting, bone transportation or Masquelet technique in 3 to 6 months after wound healing. Among the 76 cases, 68 cases had primary wound healing while 8 cases delayed. Seventy-one cases were followed-up from 9 to 24 months, with an average of 16 months, while 5 cases lost. The appearance and function of the affected limbs recovered satisfactorily without recurrence of infection.Conclusion:With the anterolateral thigh chimeric perforator flap transplantation, the perforators flap can be conveniently used to repair the wound, and the muscle flap can be used to fill dead cavity and(or) deep wounds with free skin graft. Only the descending branch of lateral circumflex femoral artery is required to be anastomosed. It achieves a 3-dimensional effective reconstruction of the complex wound in extremities. It is a safe and effective technique to repair and reconstruct the complex wound in lower extremities and ideal in clinical applications.

Application of free gracilis transplantation in reconstruction of traumatic limb / 中华创伤骨科杂志

Functional reconstruction of a major injured nerve or muscle group in a destructive limb caused by high energy has always been a big problem for trauma orthopedists.When no local tendon,muscle or nerve is available for transference,functional free muscle transplantation (FFMT) is an ideal functional reconstruction method for severe limb injury characterized by definite curative effect and quick recovery.Gracilis is considered to be an ideal donor site for FFMT because of its anatomic features of long tendon,good excursion,stable blood supply,long neurovascular pedicle,shaded donor site,little donor site loss and sufficient nourishment of the whole musculocutaneous flap by anastomosis of one single major pedicle.It has been widely applied in clinics.Transplantation of single free gracilis flap,double free gracilis flaps,and adductor longus-gracilis flap with single pedicle anastomosis can meet different clinical applications.The best donor motor nerve,which is critical to functional restoration of the affected limb using FFMT,is always a major concern to many scholars.This paper focuses on the advances in functioning free gracilis transplantation in reconstruction of limb motor function,applied anatomy of the gracilis and application of functional reconstruction for major nerve injury and major muscle group defects in a destructive limb,hoping to provide useful information for wider clinical application of FFMT.

Repair of soft tissue defect of foot and ankle with the supercharged peroneal artery perforator propeller flap / 中华显微外科杂志

Objective To explore the clinical technical points of the treatment of soft tissue defect of the foot and ankle with the supercharged peroneal artery perforator propeller flap,and to provide theoretical support by anatomical observation.Methods From January,2010 to February,2018,a total of 10 patients with soft tissue defect of foot and ankle were treated with supercharged peroneal artery perforator propeller flap.Cause of injury:trauma in 7 cases,wound ulcer in 1 case,and poor healing of the calcaneus incision in 2 cases.Defect site:5 cases of heel,2 cases of medial and lateral malleolus,and 3 cases of dorsum and sole.The size of flap ranged from 6.0 cm×3.0 cm to 16.0 cm×5.0 cm.All patients were followed-up at 1,3,6 months after operation,and the function recovery was judged by AOFAS Ankle Hindfood Scale at 3 months post-opertively.From November,2016 to May,2017,the anatomical basis and operative points of the supercharged peroneal artery perforator flap were summarized.Results All the 10 cases of supercharged peroneal artery perforator propeller flap survived.Two of them had local epidermal necrosis at the proximal end of the flap.After 1 to 2 weeks of dressing,they finally healed.The other 8 cases healed well.Anatomical studies showed that different planes of the supercharged peroneal artery perforator propeller flap can only reduce the compression of the double pedicles and reduce the distal necrosis rate of the flap by rotating in different rotation directions.Conclusion The supercharged peroneal artery perforator propeller flap can enhance the blood supply and venous return in the "big paddle" artery of the flap,preventing distal necrosis.

Skin stretching device combined with collagen sponge for wound repair / 中华创伤骨科杂志

Objective To evaluate the feasibility and clinical efficacy of our self-designed simple skin stretching device combined with collagen sponge for management of severe soft tissue wounds.Methods From September 2015 to October 2017,a consecutive series of 43 patients whose soft tissue wounds could not be closed primarily were enrolled for a therapy using a simple skin stretching device made of round osseous pins and wire combined with collagen sponge.They were 27 males and 16 females,with a mean age of 31.5 years (from 5 to 56 years).There were 18 fresh wounds and 25 old ones.Their skin defects ranged from 5.5 cm × 3.0 cm to 18.0 cm × 7.5 cm.After debridement and vacuum sealing drainage,2 round osseous pins with a diameter of 2.0 mm or 2.5 mm were driven through the dermis about 1 to 2 cm from both edges of the wound,in parallel with the longitudinal axis of the wound.After the parts of 2 pins exposed outside the skin were bent,they were fixed respectively with a fine wire with 2 twisted strands.The wounds were continuously stitched with eversion suture.The wires and sutures were gradually tightened to contract the wounds until the skin color changed and capillary filling reaction started.Then medical collagen sponge was used to cover the wounds.Next,the wires and sutures were tightened continuously until the wound edges were pulled together.Details of this therapy and its complications were recorded.Follow-up visits were paid until wound healing.Results Of the 43 cases,the wounds were directly closed immediately after primary stretching procedure in 8,closed after skin stretching for 4 to 12 days (average,7.5 days) in 30,and significantly reduced in 5 which were cured following skin graft.Eventually,40 cases were followed up for an average of 6.8 months (from 3 to 18 months) and 3 were lost.Aesthetic reoperation was performed in 3 patients who were inflicted with postoperative scar formation after skin graft.Linear healing of the wound edges was achieved in 37 patients without complications like skin necrosis,pathological hyperplasia scar,skin sensation deletion or wound infection,leading to fine appearance and functional recovery.Conclusion Our self-designed simple skin stretching device combined with collagen sponge provides a cost-effective and practical technique for clinical treatment of soft tissue defects,with an advantage of reducing or even avoiding secondary repair with skin graft or skin flap.

Treatment of infective long bone defect by external fixator combination of iliac bone graft with deep iliac circumflex vessels / 中华显微外科杂志

Objective To discuss the technique and clinical effect of infective long bone defect treated by external fixator combination of iliac bone graft with deep iliac circumflex vessels.Methods All 28 patients with posttraumatic infective long bone defect were treated by external fixator and iliac bone graft with deep iliac circumflex vessels from July, 2008 to June, 2014.The length of the bone defect was from 3 to 7 cm (averaged 5.1 cm), including tibia defect in 13 patients, femoral defect in 7, humeral defect in 4, and ulna and radius defect respectively in 2, and 17 patients also with soft tissue defect.After thorough debridement, the bone defect was fixed by the external fixator, and then VSD was applied for irrigation drainage.As fresh granulation tissue growth, iliac bone vascularized by deep iliac circumflex vessels, size from size 5.0 cm× 3.0 cm to 8.0 cm× 3.5 cm, was transplanted.As for composite defect of infective bone and soft tissue in 17 patients, 6 cases of them was repaired with the iliac flap combined free flap, three with the iliac flap combined local skin flap, 4 cases with the iliac flap doubled with both the deep and the shallow iliac circumflex vessels, 3 cases with the circumflex iliac artery chimeric perforators flap and 1 with random iliac osteocutaneous flap.Affected limb function was graded with Enneking's system.Results All transplanted vascularized iliac bone survived, postoperative infection controlled well, but there were 2 patients of iliac flap partial necrosis.After dressing exchange and reoperation, the wound all repaired again.Twenty-six patients followed from 8 to 50 months, with an average of 18 months while 2 patients lost postoperative.The osseous healing time of the iliac bone graft was an average of 6.5 months, 25 patients healed well but 1 case encouraged tibia fracture again.Appearance of the limb also recovered satisfactorily.Twenty-six patients had the average limb function restored in 89.7％.There was no obvious complication in the donor.Conclusion It is an effective technical method to treat infective long bone defect by external fixator combination of iliac bone graft with deep iliac circumflex vessels, which can not only fix and bridge bone defects and enhance bone healing, but also obliterate dead space and resist local infection by ensuring blood supply.But the method is suitable for the receipt site infection under control and the length of the long bone defect less than 10 cm.

Free vascularized fibular graft bridged vascular pedicle by vein transplantation for infective long bone defect recon-struction / 中华骨科杂志

Objective To explore the surgical method and curative effect of free vascularized fibular graft bridged vascu?lar pedicle by vein transplantation for infective long bone defect with or without soft tissue defect reconstruction. Methods From June 2008 to January 2014, 17 patients with infective long bone defect were treated, 11 male and 6 female, 1.5 to 55 years old and averaged 31.3 years. 8 cases in femur, 5 cases in tibia, 3 cases in humerus and 1 case in radius. Bone defect were 4 to 19 cm in length with an average of 9.4 cm. 8 cases with soft tissue defect, from 5.0 cm×3.0 cm to 17.0 cm×5.5 cm. Required adequate surgi?cal debridement, and vacuum sealing drainage (VSD) was used. Free vascularized fibular (skin) flap was designed and harvested . Artery and veins close to the health site were dissected, and bridged vascular pedicle of free vascularized fibular flap by autolo?gous vein transplantation with end to end anastomosis. The length free vascularized fibular graft was from 5 to 18 cm, with an aver?age of 9.6 cm. The free fibula flap ranged from 6.5 cm×4.0 cm to 18.0 cm×6.0 cm. Results All the 17 cases of fibular flap sur?vived, no vascular crisis happened. Post?operative wound primary healed in 11 cases, delayed 1 to 2 weeks to heal in 6 cases. Cal?lus was seen in the 6 to 8 weeks later. 15 cases were followed from 9 months to 6 years (averaged 30 months) while 2 cases were lost to follow?up. Bone defect primary healed in 13 cases, and the fibula graft unhealed in 2 cases, but healed again after a second operation. Fibula stress fracture occurred in one case at 7 months after grafting procedures and bone union was achieved 4 months after reapplying an external fixator. Infected bone defect healing time ranged from 4.2 to 9.8 months, averaged 5.9 months. Accord?ing to the Enneking score, 11 cases were excellent, good in 3 cases, one in fair. Excellent and Good rate was 93.3%. Conclusion Free vascularized fibular (skin) graft with vein bridged vascular pedicle can not only effectively repair infected bone and soft tissue defect, but also improve local blood supply and control infection, shorten the course of treatment, which is an effective treatment of infective long bone defects with or without soft tissue defects.

Repairing of limb extremity wounds with free descending genicular artery perforator flap without saphenous vein / 中华骨科杂志

Objective To explore the surgical technique and the efficacy of free descending genicular artery perforator flap without saphenous vein for tissue defect. Methods 18 cases of extremity tissue defect were involved in this study from Au?gust 2010 to April 2014, including 16 males and 2 females with an average age of 32.4 years (8 plantar or heel soft tissue defect, 10 back of hand or palm soft tissue defect). 2 old injury cases that had soft tissue defect after scar release were treated by free flaps and the other 16 were open injury with infection, among which 5 cases were combined with fractures or bone defect. Sizes of the skin and soft tissue defect were 2.0 cm × 8.0 cm to 9.0 cm × 12.0 cm. All wounds were treated by free descending genicular artery perforator flap from the contralateral limb. Medial femoral cutaneous nerve was kept in flaps as far as possible. The projection points of descending genicular artery perforator and saphenous vein were detected by Doppler, then the flaps were cut with reverse approach, and saphenous vein and saphenous nerve were preserved. Results All 18 flaps were survived and all cases were fol?lowed up for 3 to 30 months (average, 10.3 months). The flap sizes varied from 2.5 cm×9.0 cm-9.5 cm×13.0 cm. 2 cases with bone defect were healed 3 months later without infection, and the other 3 cases with fractures were healed 2-3 months after operation. The two point’s discrimination distance was 7.0-12.0 mm on the flap. The disabilities of the arm, shoulder, and hand question?naire score averaged 51, and the mean Japanese Orthopaedic Association's foot rating scale was 70.5. Most patients were satisfied with appearance of the recipient and donor sites, among which 5 cases had skin?graft on the donor sites, and the other 12 cases had small scars on the donor sites. Poor healing was detected in 1 case on the thigh which was healed 3 weeks later. There was no par?esthesia and rash on the donor sites. The mean distance between projection points of descending genicular artery perforator and sa?phenous vein was 3.7 cm. Conclusion Free descending genicular artery perforator flap without saphenous vein is an optimal therapy for the extremity tissue defect, which has the advantage of covert donor site, less invasion, less variation of perforator, and could recover the skin sense of recipient site.

Tissue defect repair and functional reconstruction of the limb with free flap by inverted-Y-shape microvascular anastomosis / 中华显微外科杂志

ObjectiveTo discuss the clinic application and surgical technique of the free flap by inverted-Y-shape microvascular anastomosis in tissue defect repair and functional reconstruction of the limb.Methods Twenty-two flaps in 18 patients were involved in the study between June 2006 and September 2010( 12 cases for soft tissue defect repair with exposure of the tendons, bones or joints, and 6 cases for functional reconstruction;five cases were around the elbows and 13 cases were around the extremity of the lower limb). Before free flap graft, twelve cases with infective tissue defect were debrided extensively and covered with vacuum sealing drainage from 1 to 2 times and each time last 5 to 7 days until the granulation tissue growing well.Designed the free anterolateral thigh flaps with the transverse and descending branches of the lateral femoral circumflex vessels or free latissimus dorsi flaps with the subscapular and circumflex scapular vessels forming a inverted-Y-shape pedicle to repair the tissue defect or to reconstruct the limb function.The recipient artery was sectioned and the arterial tree of the flap was anastomosed to the recipient vessel by two end-to-end anastomoses.This inverted-Y-shape microvascular anastomosis could supply blood for both the free flap and the extremity of the limb.Not all of the veins of the recipient limb need to be cut off.Observed the circulation of the limb extremity, and evaluated the quality of flaps'survival.ResultsComplete flap survival was achieved in 21 flaps and without vaso-occlusive crisis;while partial flap loss in 1 case, which healed after changing dressings.The mean follow-up was 16.2 (6-36) months postoperatively,appearance of the flaps and the functions of limbs were satisfactory,and no obvious complication was found in the donor site.ConclusionThe free flap by inverted-Y-shape microvascular anastomosis is a new choice for the tissue defect repair and functional reconstruction of the limb,especially for the wound around elbow or extremity of the lower limb with one major artery destroyed.

Repair of ankle soft tissue defect with anterolateral thigh perforator flap or free saphenous artery perforator flap / 中华显微外科杂志

Objective To evaluate the surgical technique and clinical significance of the therapy for ankle soft tissue defect with 2 different flee perforator flaps.Methods Twenty-five cases of ankle soft tissue defect with exposed bone of the ankle were involved in this study from August 2006 to April 2012.and the wound sizes varied from 4.0 cm × 5.5 cm to 11.0 cm × 23.0 cm.Twenty cases with acrotarsium soft tissue defect were repaired by free anterolateral thigh perforator flap,five cases with pelma soft tissue defect were repaired by free saphenous artery perforator flap.Results All Twenty-five flaps survived.At 3 to 50 months follow-up [on an average of (18.0 ± 0.8) months] postoperatively,appearance of the flaps was satisfactory,with 10 to 22 mm in 2-PD,and the sensation percentage beyond S2+ was 13/20 cases and 5/5 cases at 3 months follow-up,respectively.Conclusion The optimal therapy for the acrotarsium soft tissue defect is the free perforator anterolateral thigh flap,and free saphenous artery perforator flap should be used for pelma soft tissue defect.Avoid secondary orthopaedic surgery,pay more attention to the donor site of the flap.VSD can significantly promoting the survival rates of the free perforator flaps if the soft defects are caused by open injury.

Retrospective study of failed surgical treatment of acetabular fractures / 中华骨科杂志

Objective To analyze the possible reasons of failed surgical treatment of acetabular fractures. Methods Various methods were used for positive patient identification, including according to Matta's X-ray assessment and Merle d'Aubigne & Postel hip function score of clinical standards for classification of acetabular fracture reduction surgery were not satisfied or not carried out a reduction and fixation,the clinical evaluation of hip joint as a "bad", occurrence of femoral head subluxation or dislocation, femoral head necrosis and other serious complications. From February 2000 to February 2008, 22 patients including 14 males and 8 females with an average age of 38.6 years (range, 18-72 years) were considered as failed cases. Results 45.5% of these cases were posterior wall fractures which were not given any fixation, 27.3% of them were posterior column fractures which were not fixed, 13.6% of them whose reduction and fixation of anterior wall fractures were not satisfied, and 9.1% of them were anterior column fractures which needed fixation. One case should take open reduction and iternal fixation instead of THA. The rate of misdiagnosis and mistaken diagnosis were 90% if only X-ray evaluation was made and this rate decreased to 8.3% if computed tomography was taken. The rate of wrong selection of operative approach was 100% in 10 cases of misdiagnosis, and which was 58.3% in 12 cases of correct diagnosis. In the 5 patients with correct diagnosis and selection of operative approach, the reasons of failed surgical treatment were due to imperfect surgical skills in 3 cases, and inappropriate fixation patterns in 2 cases. Conclusion The causes of the failure of surgical treatment for acetabular fracture might include preoperative missed diagnosis and misdiagnose, inappropriate approach, and an unreasonable internal fixation with unskillful technique.

Treatment of large area soft tissue defect in children limbs by sequential vacuum-assisted closure and free flaps / 中华显微外科杂志

Objective To investigate the operative techniques and clinical significance in the treatment of large area soft tissue defect in children limbs by sequential vacuum-assisted closure and free flaps. Methods Twenty-two cases of children patients, with a range between 3 and 10 years, were treated by sequential vacum-assisted closure (VSD) and free flaps. All the patients suffered from large area soft tissue defect after severe trauma of limbs, with bone, tendon and other deep tissues exposed or partial defected. The wound area varied from 12 cm × 8 cm to 34 cm × 25 cm, and among the wound 9 cases were fresh and the other 13 were necrotizing infection. After strictly cleaned, the wound was covered with VSD according to the condition of the soft tissue defect and its underlying tissue damage. For the patients complicated with unsteady fracture, the fracture was fixed with outside-fixed frame or inside-Kirschner nails. The VSD negative pressure membrane was removed after 5 to 9 days, then the wound was repaired by free flaps grafting in 8 cases and by free flap combined with skin grafting in the other 14 cases. The survival and recovery conditions were followed up after the operation. Results After treatment by VSD, no obvious infection was seen in 22 cases of children patient with large area soft tissue defect complicated by underlying tissue exposure, and granulation tissue surrounding tendons and bone exposure area grew well. The survival rate of the free flaps was 100% whithout vascular crisis.The infection was well controlled, and no fistula tract was seen. The patients were followed up for 6-24 months and the flaps had soft texture and good appearance with satisfactory functional recovery of the affected limbs.Conclusion For pediatric patients with large area soft tissue defect complicated by underlying tissue exposure, after strict debridement, the treatment circle will be obviously shortened by the application of sequential vacuan seding dranage and microsurgical technique, and the success rate of the operation is improved. Therefore, function of the affected limbs in children will be recovered as far as possible.

New porous beta-tricalcium phosphate as a scaffold for bone tissue engineering / 中国组织工程研究

BACKGROUND: New porous β-tricalcium phosphate (TCP) was made by appropriate prescription and unique technology, with a porosity of (75±10)%, spheroidal hole>80%, micropore<20%, interlink rate between the holes of 100% and mechanical strength>2MPa.OBJECTIVE: To assess the application outcome of the new porous β-TCP as a scaffold for bone tissue engineering.DESIGN, TIME AND SETTING: The control experiment was performed at the Laboratory of Tissue Engineering of Southern Medical University, China from July 2005 to March 2006.MATERIALS: Twelve 6-month New Zealand rabbits were used to create 1.5cm large bone and periosteum defects of the left radial bone. Porous β-TCP was purchased from bio-lu, France.METHODS: Osteoblasts differentiated from rabbit bone marrow mesenchymal stem cells (BMSCs) were co-cultured with porous β-TCP. Inverted phase contrast microscope and scanning electron microscope were used to observe the growth of BMSCs. MTT assay was employed to assess cell proliferation and compatibility. Cytotoxicity was detected by analyzing the effects of different concentrations of porous β-TCP leaching liquor on cell proliferation.MAIN OUTCOME MEASURES: Cell compatibility and cytotoxicity of β-TCP were measured. The status of bone defect repair was appraised by histology, radionuclide bone scan and X-ray at 2, 6, 12 weeks after surgery.RESULTS: The new porous β-TCP had good cell adhesion and its cytotoxicity was in 0 grade. Histology, imageology and radionuclide bone scan showed the new porous β-TCP could repair large radial bone defect in rabbits. At the same time, its degradation rate was accordance with bone formation rate in vivo.CONCLUSION: The new porous β-TCP with a good compatibility is a good scaffold for bone tissue engineering, and obtains good outcomes in repairing large bone defect of rabbit radial bone.

Anterolateral thigh flap transferred with iliotibial tract for coverage of complicated forearm wounds / 中华创伤杂志

Objective To introduce the transfer of anterolateral thigh flap with iliotibial tract in repair of massive skin and soft tissue defects of the forearm and reconstruction of extension or flexion of the forearm. Methods Eight cases of complicated raw wounds of the forearm were repaired with transfer of anterolateral thigh flap with iliotibial tract. Flexor tendons of 3 cases and extensor tendons of 5 cases were repaired with iliotibial tract. The axial vessel of the flap was used to rebuild blood supply of the hand. Results All the flaps survived completely. A follow-up ranging from 3 months to 2.5 years re- vealed that the reconstructed forearms were good in appearance and soft in texture and restored protective sensation. Affected limbs could perform extension or flexion. Total range of motion (TRM) of the hands was excellent in 6 cases and poor in 2. Conclusion Anterolateral thigh flap with iliotibial tract can not only repair soft tissue defects of the forearm, but also reconstruct the main extension or flexion of the forearm simultaneously.

Influence of high molecular weight polyethylene on viability of osteoblasts and new bone formation / 生物医学工程学杂志

To investigate the influence of high molecular weight polyethylene (HMWP) on the viability of osteoblasts and new bone formation in the process of fracture healing, the osteoblasts derived from adult human bone marrow were cultured in HMWP maceration extract and normal culture medium. The viability of the osteoblasts was measured by MTT assay, and the function of the osteoblasts was detected by use of alkaline phosphatase test kit. The locked double-plating (steel plate and HMWP plate) was implanted and fixed at the artificial fracture of distal femur of dogs. Specimens were gained at 3, 6, 9 and 12 weeks postoperatively, examined with macroscopy, microscope and scanning electron microscope (SEM). The results showed that HMWP did no harm to osteoblasts. There is no significant difference in activities of proliferation and alkaline phosphatase between HMWP maceration extract and normal culture medium at each observation time of at 2,4,8, and 14 dyas (P>0. 05). Bone tissue under the implanted HMWP plate manifested no absorption; the new bones formed under the HMWP plate and gradually matured as time went on. It is demonstrated in this study that HMWP has no adverse influence on the viability of osteoblasts and new bone formation and it can be used as internal fixation implant in treating fractures.

Abdominal skin flaps for whole-finger degloving injury of multiple fingers / 中国矫形外科杂志

[Objective]To evaluate several abdominal skin flaps used for treatment of whole-finger degloving injury of multiple fingers.[Method]Since 2000, 45 patients with whole-finger degloving injury of multiple fingers except the thumb were treated with transfer of abdominal skin flaps. Among these patients,10 were treated with random abdominal tubed pattern flaps,15 with pedicle skin flaps with thoraco-umbilical perforator artery,12 with pedicle skin flaps with superficial iliaccircumflex artery,and 8 with embedding with abdominal flaps.At the second-stage operation,fingers were dissected with pedicels or with abdominal flaps before fingerweb plasty and flap plasty were carried out for many times.[Result]All the skin flaps survived. Three fingers of 3 cases had distal cutaneous necrosis after finger web plasty.Follow-up from 5 to 36 months showed the active motion of metacarpophalangeal joints averaged 60?, and interphalangeal articulations averaged 30?.Sensation recovery reached S3 in fingers with remanent palmar digital nerve, but poor in other fingers. All fingers could perform grasping. The contour of fingers was fine except for the 3 cases of necrosis.[Conclusion]Treatment of whole-finger degloving injury of multiple fingers except the thumb with suitable abdominal flaps can restore the shape and function of hand to the greatest extent and is still a practical, safe and convenient operative method.

The influence of virtual reality on the development of minimally invasive surgery in 21st century / 中华创伤骨科杂志

Virtual reality that is based on the high and new technology has witnessed great progress since the end of 20th century. It will result in promising methods to be used widely in clinic and to promote the development of minimally invasive surgery (MIS). As far as MIS is concerned, it will reshape the principles, expand the scope and improve the result of diagnose and treatment. Furthermore, it will also accelerate innovation of the instrument for MIS. The development of virtual reality, however, is still at its beginning. Not only high-level specialists but also expensive and special equipment is needed to explore virtual reality before it can be applied in MIS. As a result, virtual technology should be applied step by step, first in the most suitable indications. Meanwhile basic and applied research on virtual reality should be forcefully carried on to render it into effective and practical methods for the minimally invasive or non-invasive surgical treatment.

Surgical treatment of complicated distal femoral fractures / 中华创伤杂志

Objective To explore different techniques for treat me nt of complicated distal femoral fractures in order to obtain the best curative effects. Methods A retrospective study was done on the cli nical data of 62 patients (64 sides) with complicated distal femoral fractures a dmitted to our hospital from January 1999 to June 2002. According to AO classifi cation: 20 cases (21 sides) belonged to type A and 42 (43 sides) to type C. The supporting steel of AO femoral condyles were applied in 18 cases (19 sides), loc ked double-plating (steel plate and polyethylene plate) in 20 (21 sides) and th e retrograde intramedullary nail in 24. All cases received scientific and ration al rehabilitative treatment post-operatively. Results The 4-38 months follow up showed that 62 cases go t fracture healing with average healing period of 4.2 months (from 10 weeks to 1 6 months). According to criteria of Kolmert and Wulff, 31 sides were excellent, 28 good but 5 poor with an excellence rate of 75%. Conclusions A majority of treatment results of complicate d distal femoral fractures are satisfactory through rational and reliable intern al fixation. The supporting steel plate is suitable for all distal femoral fract ures; and the retrograde intramedullary nail is the treatment of choice for type A and type C1 fractures. As for types C2 and C3 fractures, the locked double-p lating combined with polyethylene is more effective than the supporting steel pl ate or the retrograde intramedullary nail for it has advantages of reasonable de sign, convenient operation and firm fixation.

Current microsurgery:its obstacles and development strategy / 中华创伤骨科杂志

Microsurgery has been in a plateau period after a development of 4 decades. Now it has been faced with a difficult situation in China: shrinking scope and increasingly slow development. This may be an inevitable outcome of the spiral rising pattern of development of anything in the world, as well as a combined result of fierce impact of market economy, hysteresis of medical system, ideological deviation and investment deficiency. Recently, however, application of new and high technology, new devices and materials in microsurgery, such as nanometer techniques and materials, gene and tissue engineering, and computerization, has broadened a new development space. Microsurgery in the 21st century should make more efforts in expanding its application dimension, perfecting its therapeutic methods, enhancing basic research, raising technical proficiency of its personnel and improving the welfare of its workers. It should also be nourished with new ideas, interdisciplinary cooperation before it can realize its rejuvenation in the new century.

A new technique of orthopaedics in 21st century——minimally invasive surgery / 中华创伤骨科杂志

Recent years have witnessed an extre mely rapid development in minimally invasive surgery(MIS).It is widely accepted that treatmen t of bone fractures should be shifted from biomechanical fixation to biological fixation in order to gain a minimal invasion and good function al recovery.Minimally invasive tec hniques have been widely applied in clinics,such as procedures assisted by arthr oscope in orthopedics and endoscope in spine surgery,percutaneous treatm ent of the fractures and diseases of l imbs and spines.They have also been enhanced by the computer-assisted s urgical navigation system,surgical simulation system,telepresence c onsul-tation system and robotic remote-co ntrol surgery.Application of MIS in microsurgery has been documented to be able to decrease the notorious donor site morbidity while maintaining th e quality and costs of outcomes.Adva nces in image technique and intervention al radiology have greatly improved minimally invasive methods to be used in orthopedics.MIS has also found new p ossible and potential therapeutic means in such technologies as laser,microwave,cryoablation,ultrason ofocusing,nanotechnology,gene th erapy and tissue engineering.In short,since the scope of MIS will keep on exp anding during the 21st century,it is certain that MIS will see an in-creasingly bright future and become a mainstay in orthopedics.

The recent progress of the treatment of the fractures of long tubular bones / 中华创伤骨科杂志

This article reviews the currently most widely used methods and their features of the non operative and operative treatment for the fractures of long tubular bones. It is widely accepted that each of the two methods is useful in its injury degree and in kind. It is wise to choose the non operative treatment for child fractures, adult fractures easily reduced, and the complementary therapy after surgery. External bone fixation is preferentially selected as for the open long tubular bone fracture with severe injuries to the soft tissues, early freatments of long tubular bone fracture with multiple injuries all over the body and fire arm injury. While it is widely accept that an active operative treatment should be take for the open fractures, multiple fractures, multi plane fractures, intraarticular fractures, and the fractures with vessel or nerve injury, and the biological fixation should be chosen in order not to impair circulartory supply of soft tissues. Arriving at the conclusions that future studies of the treatments for the fractures of long tubular bones will be conducted in meticulously design for therapy, minimally invasive osteosynthesis, satisfactory reduction, stably biological fixation, immediately active motion and results in a good runctional recovery for the limbs.