[Application of free flaps in combined transplantation].

OBJECTIVE: To investigate the application of free flaps in combined transplantation and its clinical outcome. METHODS: From January 1991 to December 2003, 56 cases of combined transplantation involving cutaneous or myocutaneous flaps were performed to repair extremely large soft tissue defects, large-sized skin and segmental bone defects and to simultaneously reconstruct the missing thumb and repair the associated skin defects in the first web space. Of the 56 patients, 37 were males, 19 were females. Their ages ranged from 5 to 41, 27.6 in average. The transplants included latissimus dorsi myocutaneous flap, scapular flap, lateral femoral flap, big toe skin-nail flap, and fibula. To establish blood circulation in the transplants, the common vascular pedicle was anastomosed directly to the vessels in the recipient site in 35 cases but to the selected vessels in the healthy limb in 21 through a cross-bridge procedure. Results With failure in 2 cases of combined transplantation of latissimus dorsi myocutaneous flap and vascularized fibula, all the transplants survived well. In the 32 cases of long bone defects with successful repair, the transplanted fibula united with host bones 14.5 weeks after operation on the average. A mean follow-up of 28 (10-128) months revealed that function in all cases was recovered, while one patient, who underwent a successful combined transplantation of latissimus dorsi myocutaneous flap and vascularized fibula, required amputation of the involved leg 3 years after repair because of the repeated ulcers in the toes. CONCLUSION: The application of free flaps in combined transplantation can lead to an effective repair of complicated tissue defects of the limb and to a successful reconstruction of the associated missing thumb.

Treatment of femoral head necrosis with free vascularized fibula grafting: a preliminary report.

Since October 2000, 56 hips in 48 patients with avascular necrosis of the femoral head were treated with free vascularized fibular transplants. The average follow-up was about 16 months. The Harris hip scores of all stages were improved during follow-up. Most femoral heads showed improvement (39 hips, 69.6%) or were at least unchanged (14 hips, 25.0%) on X-rays. The results show that a free vascularized fibular graft would be a valuable procedure for femoral head necrosis. By this method, we can avoid or delay progress of the disease, and improve the function of the hip and quality of life.

[Surgical technique of modified free vascularized fibular grafting for treatment of osteonecrosis of the femoral head].

OBJECTIVE: To evaluate the surgical technique, clinical results, and the complications of modified free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. METHODS: From October 2000 to August 2004, 124 patients (139 hips) with osteonecrosis of the femoral head were treated with modified free vascularized fibular grafting. There were 83 males(93 hips) and 41 females (46 hips), with a mean age of 36.4 years (16-57). The disease was caused by trauma in 49 cases(54 hips), use of steroids in 29 cases (32 hips), consumption of alcohol in 19 cases (21 hips) and idiopathic condition in 27 cases (32 hips). Of 139 hips, 50 were classified as stage II ; 71 as stage II, 18 as stage IV according to Steinberg system; the Harris hip scores were 79.3, 69.3 and 58.4, respectively. At the operation, modified technique of the fibular osteotomy was adopted. A front-hip operative approach was designed and a modified technique of removing the necrotic bone in femoral head was applied. During operation, the duration of operation, the bleeding volume, and the length of incisions were recorded. The follow-up items included the results of X-ray examination, the Harris score of the hip, and the evaluation of the complications. RESULTS: The duration of the fibular osteotomy was 10 to 30 min (15 min on average). The duration of the total operation was 80 to 120 min (90 min on average). The length of incision at the hip was 6 to 12 cm (8 cm on average). The bleeding volume was 100 to 300 ml (200 ml on average). The average hospitalization days was 7 days. After operation, Harris hip scores in most cases were improved. According to postoperative X-ray, 62 hips (79.5%) were improved to different extents and 14 hips (17.9%) had no significant changes. Deterioration occurred in 2 hips (2.6%). CONCLUSION: The modified free vascularized fibular grafting has lots of virtues, such as less bleeding volume, more clear anatomic structure, more convenience for operation, less damage, less complications, and better results of function recovery. It is an effective method for treating osteonecrosis of the femoral head.

[Clinical study on surgical repair of acute acromioclavicular dislocation by modified Weaver-Dunn technique].

OBJECTIVE: To investigate the clinical value of modified Weaver-Dunn technique in repair of acute acromioclavicular dislocation. METHODS: From January 1993 to December 1998, 18 cases of acromioclavicular dislocation were treated by modified Weaver-Dunn technique, and other 17 cases of the same suffering were treated by tension band fixation of the acromioclavicular joints. All of the patients were followed up for 12-36 months before clinical evaluation of the function of shoulder joints, according to University of Pennsylvanian Shoulder Score System. RESULTS: In short term, the shoulder joints recovered much more rapidly in the cases repaired by modified Weaver-Dunn technique; 12, 24 and 36 months after operation, the scores of the cases repaired by modified Weaver-Dunn technique were (189.7 +/- 6.7), (193.7 +/- 3.6) and (194.7 +/- 3.4) respectively according to the Shoulder Score System, while those of the cases treated by tension band fixation were (167.3 +/- 7.8), (170.2 +/- 6.3) and (165.6 +/- 5.9) respectively. The above data indicated that there was significant difference between two groups (P < 0.05). CONCLUSION: The modified Weaver-Dunn technique was a better surgical approach than tension band fixation for repair of acute acromioclavicular dislocation.

[Treatment of osteonecrosis of femoral head with free vascularized fibula grafting].

OBJECTIVE: To evaluate the effect of the treatment of necrosis of femoral head with the free vascularized fibula grafting. METHODS: From October 2000 to February 2002, 31 hips in 26 patients with ischemic necrosis of the femoral head were treated with free vascularized fibula graft. Among these patients, 21 patients (25 hips) were followed up for 6-18 months (12 months on average). According to Steinberg stage: II period, 5 hips; III period, 8 hips; IV period, 12 hips. RESULTS: Among 25 hips, their Harris Hip Score at all satges were improved during the follow-up. The symptom of pain diminished or disappeared after operation. The patient's ability to work and live was not limited or only slightly limited during the follow-up. Radiographic evaluation showed that most femoral heads improved (18 hips) or unchanged (6 hips) and only one worsened. CONCLUSION: The free vascularized fibular grafting is a valuable method for femoral head necrosis. With this method, we can prevent or delay the process of the disease.

Application of the cross-bridge microvascular anastomosis when no recipient vessels are available for anastomosis: 85 cases.

The purpose of this article is to introduce the results of free tissue transfers using the technique of the cross-bridge microvascular anastomosis when the recipient lacks suitable vessels for anastomosis. Between May of 1982 and June of 2002, a series of 85 patients underwent this procedure. The transferred tissues were the free latissimus dorsi myocutaneous flap, the free vascularized fibula, the free fibular osteocutaneous flap, and the free iliac osteocutaneous flap, alone or in combination. The donor vessels were the anterior tibial artery and great saphenous vein, the posterior tibial artery and its venae comitantes, and the radial artery and cephalic vein. Good results were achieved. The success rate reached 95.29 percent. The authors believe this procedure can be performed in the event of serious tissue defect where the vessels are unsuitable for anastomosis.