Repair soft-tissue defect in forefoot with reversed lateral soleus muscle flap / 中国骨伤

<p><b>OBJECTIVE</b>To summarize clinical application results of repair soft tissue defect in forefoot with a reversed lateral soleus muscle flap on peroneal artery pedicle.</p><p><b>METHODS</b>From January 2005 to January 2013, 8 patients with soft-tissue defect on forefoot were underwent reconstruction with a reversed lateral soleus muscle flap on peroneal artery pedicle. There were 6 males and 2 female, aged from 16 to 48 years with an average of 26.8 years old. The reversed lateral soleus muscle flap was transposed to the forefoot defect area, then immediate coverage of the muscle flaps were performed by a meshed split-thickness free skin graft. The donor site was closed directly. The muscle flap survey was observed after the repair of the forefoot.</p><p><b>RESULTS</b>All muscle flaps had survived completely. No clinical vascular deficiency was found on muscle flaps postoperatively. One case occurred recipient area sustained insignificant superficial infection, one patient developed distal muscle flap small skin graft necrosis, and spontaneous heal by 2 weeks' change dressing. Follow-up period was ranged form 2.5 to 5.5 years with an average of 3.5 years postoperatively. A good contour was confirmed at the recipient area. According to Cedell questionnaire, 6 patients obtained good results and 2 fair.</p><p><b>CONCLUSIONS</b>When the local skin flap or muscle flap application is limited, lateral soleus muscle flap survey is satisfactory after repair and very suitable for repair of soft tissue defect of forefoot.</p>

Treatment of the mid and distal segment humeral fractures through modified posterior approach / 中国骨伤

<p><b>OBJECTIVE</b>To summarize clinical result of the modified posterior approach for the treatment of the mid and distal segment humeral fractures.</p><p><b>METHODS</b>Between January 2006 and December 2010, 26 patients with the mid and distal segment humeral fractures were treated with the open reduction and plate fixation by the modified posterior approach including 17 males and 9 females with an average of (37.1±1.5) years old ranging from 24 to 50 years old. The time from humeral fractures to operation were from 8 hours to 6 days with an average of (3.3±0.6) d. The elbow function were assessed by Morrey-Bryan.</p><p><b>RESULTS</b>There was no procedure related complications occurred. No neurologic injury and wound infection after operation occurred. All patients were followed up from 22 to 48 months with an average of (30.1±1.6) months. The humeral fractures were confirmed healing. The clinical results of Morrey and Bryan were excellent in 19 cases (94.6±1.8), good in 7 cases (86.5±1.2).</p><p><b>CONCLUSIONS</b>The modified posterior approach avoided injury of triceps muscle and improved postoperative triceps function. The technique may be particularly useful in the treatment of the mid and distal segment humeral fractures.</p>

Application of cross-leg soleus muscle flap transplantation to treat the soft-tissue defect in contralateral leg / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the clinical application results of the repair soft tissue defect in contralateral leg with a cross-leg soleus muscle flap pedicle transplantation.</p><p><b>METHODS</b>From January 2008 to January 2013, 8 patients with soft-tissue defect in lower leg underwent reconstruction with a cross-leg soleus muscle flap pedicle transplantation (without microvascular anastomoses). There were 7 males and 1 female, aged from 20 to 49 years old with an average of 31.8 years. The operative time after injury was from 2 to 8 weeks with the mean of 46 days. The soleus muscle flap was transposed across to the contralateral leg defect area, then immediate to perform the coverage of the muscle flaps by a meshed split-thickness skin graft. The donor site was closed directly.</p><p><b>RESULTS</b>All the muscle flaps had survived completely. In one case, recipient area edge had a less exudate from drainage hole everyday, the incision spontaneously was healed after 2 week's changing dressing. Follow-up period ranged form 1.5 to 4 years with an average of 2.5 years postoperatively. The tibia and fibula fractures were healed well. A good contour was achieved at the recipient area. According to LEM standard, 2 cases got excellent results, 5 good and 1 fair.</p><p><b>CONCLUSION</b>Soleus flap pedicle transplantation is very suitable to repair the soft tissue defect of the injuried leg only one main blood vessel, and can reduce the damage of donor area.</p>

Repair of-limb soft tissue defect with free deep inferior epigastric perforator flap / 中国骨伤

<p><b>OBJECTIVE</b>To report the clinical application results of free deep inferior epigastric perforator flap in the repair of soft tissue defect.</p><p><b>METHODS</b>From January 2006 to January 2012,13 patients with soft tissue defect (7 cases in leg and 6 cases in forearm) underwent reconstruction with a free deep inferior epigastric perforator flap. There were 9 males and 4 females, aged from 21 to 45 years old with an average of 33 years. Soft tissue defect in the extremities were from 7 cm x 17 cm to 8 cm x 26 cm. The medial branch and lateral brangh flaps were 7 cases and 6 cases respectively. The donor site was closed directly.</p><p><b>RESULTS</b>One patient developed small wound dehiscence, which spontaneous healed at one month after surgery. All the flaps had survived completely. Follow-up period ranged from 1.8 to 4.0 years with the mean of 2.8 years postoperatively. Satisfactory clinical results were obtained in 12 cases. A good contour was confirmed at the recipient area.</p><p><b>CONCLUSION</b>The free deep inferior epigastric perforator flap for the extremities defects of soft tissue is a good option. This technique is safe and reliable, and can decrease the injury of donor site.</p>

Application of selective nerve root blocks in limited operation of the lumbar spine / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the clinical application result of the selective nerve root blocks in limited operation of the lumbar spine.</p><p><b>METHODS</b>From January 2008 to October 2012,68 patients with lumbar spinal canal stenosis with multiple levels were underwent the selective nerve root blocks in limited operation of the lumbar spine,including 47 males and 21 females with an average age of 56 years old ranging from 45 to 80. After never roots blocks,64 cases were positive for limited operation of the lumbar spine; the other 4 cases were negative and abort the operation.</p><p><b>RESULTS</b>The nerve roots block operation smoothly and no complications related to the nerve roots block occurred. There was no neurologic injury complication in this study. Follow-up period ranged from 16 to 45 months postoperatively (means, 32 months). The recovery effect was calculated with Macnab scores, the result was excellent in 44 cases, good in 18 cases, poor in 1.</p><p><b>CONCLUSION</b>Operative treatment for lumbar spinal canal stenosis with multiple levels is focused on the areas causing symptomate neural compression rather than prophylactic decompression at areas of nonsymptomatic disease. Application of selective nerve root blocks can accurately judge the responsible vertebral body and pain source and improve the curative effect of limited operation of the lumbar spine</p>

Micro-decompression procedure for the treatment of lumbar spinal stenosis with multilevel / 中国骨伤

<p><b>OBJECTIVE</b>To summarize the clinical application results of the micro-decompression procedure for the treatment of lumbar spinal stenosis with multilevel.</p><p><b>METHODS</b>From January 2004 to December 2008, 40 patients with lumbar spinal stenosis with multilevel were treated by micro-decompression procedure. There were 28 males and 12 females, ranging in ages from 55 to 80 years,with an average of 58 years. The course of this disease ranged from 18 months to 12 years,averaged 32 months. Forty patients with lumbar spinal stenosis with multilevel were diagnosed by CT or MRI examination. There were 20 cases with two levels stenosis (L4,5 and L5S1), 15 cases with three levels stenosis (L3,4, L4,5 and L5S1), and 5 cases with four levels stenosis (L2,3, L3,4, L4,5 and L5S1). The therapeutic effects were evaluated according MacNab standard in aspect of pain, bladder function, range of lumbar spine motion and muscle strength of lower limb.</p><p><b>RESULTS</b>All of the incisions healed without infections and complications. The mean operation time of each side was 70 minutes (ranged from 50 to 90 minutes), and mean blood loss was 150 ml (ranged from 90 to 200 ml). All the patients were followed up from 22 to 52 months with an average of 26 months. According to MacNab standard, 28 cases got an excellent result, 10 good and 2 poor.</p><p><b>CONCLUSION</b>Operative treatment for lumbar spinal stenosis with multilevel should focus on the symptom sites causing by neural compression and preventive decompression operations are not necessary for nonsymptomatic sites. The micro-decompression procedure can be easily tolerated by older patients;it can decrease the damage to the posterior stabilizing structures of the lumbar spine. It is easily to access to spinal canal and decompress the nerve roots.</p>