[Clinical application of tibial composite saphenous nervetissue flap for the treatment of traumatic bone-skin defect of leg].

OBJECTIVE: To investigate the effect of tibial composite saphenous nerve tissue flap in repairing traumatic bone-skin defect of leg. METHODS: From February 2009 to May 2015, 23 patients with focile skin defect caused by trauma were treated, including 18 males and 5 females, aged from 8 to 59 years old with an average age of 35.6 years old. Length of tibia bone cortex defect ranged from 4 to 12 cm, width ranged from 2 to 2.5cm, skin defect ranged from 8 cm× 3 cm to 18 cm× 11 cm, all the wound surfaces had purulent exudation. Cross shift and ipsilateral shift methods of tibial composite saphenous nerve tissue flap were used to reconstruct continuity of the injured limb tibial brace and repair wound surface. Cutting flap ranged from 9 cm× 4 cm to 20 cm × 12 cm, bone flap length was 6 to 15 cm, width was 1.5 to 2.5 cm. Fracture healing time and recovery of limb function were observed. RESULTS: At 3 to 5 months after operation, bone flap and area of affected area were healed with an average of 4.7 months. Twenty-three cases were followed up for 6 months to 5 years with an average of 30.3 months. Thirteen patients were able to walk without abnormal gait and could be engaged into original work. According to Enneking evaluation systems, 13 patients obtained excellent results, 8 moderate and 2 poor. CONCLUSIONS: With tibial composite saphenous nerve tissue flap transplantation at stage one to repair tibia and skin defects according to specific condition of affected limbs has a high rate of success and creates less damage to region of limb injury, which is an ideal method to repair skin defect of focile.

[Clinical study of safflower injection in treating and preventing the vascular crisis after free flap transplantation].

OBJECTIVE: To observe the clinical efficacy of Safflower Injection (Al) in treating and preventing the vascular crisis after free flap transplantation. METHODS: Sixty patients undergoing free flap transplantation were randomly assigned to the treatment group and control group according to the visiting sequence, thirty in each. Free flap transplantation was performed on all patients, and medication was given 0. 5 h before flap vascular anastomosis, 1-7 days after surgery. Twenty mL Al was intravenously dripped to patients in the treatment group after adding in 250 mL 5% glucose injection, while Dextran-40 was intravenously dripped to patients in the control group. The medication was conducted once per day. The hemorheology and four indices of blood coagulation [prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB)] were compared between the two groups before operation (TO), during operation (T1), 24 h after operation (T2), three days after operation (T3), and seven days after operation (T4). Meanwhile, flaps were observed and adverse reaction recorded. The clinical efficacy and safety were compared. RESULTS: Better result was obtained in the treatment group when compared their clinical efficacy (86. 67% vs 60. 00%, P<0.05). The whole blood high and low viscosity, plasma viscosity, red blood cell (RBC) volume, RBC aggregation index all decreased, and RBC deformed index increased in the two groups at T4, showing statistical difference when compared with those at T3 (P<0.05, P<0.01). There was no statistical significance in the four indices of blood coagulation when compared with any time point in the same group (P>0.05). There was no statistical significance in hemorheology and the four indices of blood coagulation between the two groups at the same time point (P>0.05). The adverse reaction rate in the treatment group was lower than that in the control group, showing statistical difference (13.33% vs 30.00%, P<0.05). CONCLUSIONS: AI could effectively prevent and treat the vascular crisis after free flap transplantation. It had less adverse reaction and good safety. It was better than Dextran-40. It was a safe and effective drug to prevent the vascular crisis.