To introduce a new technique for vascular pedicle elongation in the anterolateral thigh island flap transplantation and evaluate the outcome of this technique in the clinical application. Methods From January 2003 to January 2006, 6 patients (5 males, 1 female; age, 1849 years) were admitted for surgical operation because of the soft tissue defect around the knee joint. The soft tissue defect after the injury was found in 3 patients, the defect after the removal of the softtissue tumor in 1, and the defect after the prosthetic replacement in the knee joint in 2. The soft tissue defects ranged in size of 8 cm×4 cm to 15 cm ×6 cm. When the anterolateral island flap of the thigh underwent the reverse transplantation, the ascending branch of the lateral circumflex femoral artery was used as a nutrient vessel for the flap, and the descending branch of the lateral circumflex femoralartery was separated to the distal part. The main trunk of the lateral circumflex femoral artery was ligated at the point that was proximal to the furcation ofthe ascending and decending branches so that the vessel pedicle of the flap could be lengthened and then the defect was repaired.The flaps ranged in size of 10cm×6 cm to 18 cm×8 cm Results All the flaps were successfullytransferred in the 6 patients. The lengthened pedicle ranged in length from 8 to 12 cm, with an average of 10 cm. There was no vascular crisis after operation. All the transferred flaps survived, with a color and texture similar to those in the recipient site. The postoperative followup for 6-18 months revealed that the motion range of the knees was satisfactory. Conclusion The vascular pedicle elongation technique can enlarge the application scope of the anterolateral thigh island flap and the survival rate of the flap is not influenced by any factor.
Objective To investigate the surgical characteristics and preliminary effectiveness of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors. Methods Twenty-two patients received Orthofix unilateral external fixator treatment for bone defect after tumor excision or complications after limb salvage surgery between June 2011 and March 2016. There were 11 males and 11 females with a median age of 23.5 years (range, 4-57 years). The bone defect or limb length discrepancy after tumor resection was at proximal femur in 6 cases, distal femur in 8 cases, diaphysis of femur in 3 cases, proximal tibia in 2 cases, and diaphysis of tibia in 3 cases. The external fixation was used for temporary fixation after reconstruction of bone defect in 10 cases [the length of bone defect was 6-19 cm (mean, 12.3 cm); using vascularized fibular graft in 2 cases, allograft bone and free fibular graft in 2 cases, allograft bone and autogenous bone graft in 5 cases, allograft bone reconstruction in 1 case]; bone distraction lengthening for limb length discrepancy in 5 cases [the length of shortening was 6.5-8.5 cm (mean, 7.5 cm)]; temporary fixation after open biopsy in 3 cases; bone transportation over locking plate in 1 case (the length of bone defect was 7.5 cm); fixation for preoperatively pathology fracture in 1 case; and joint distraction for dislocation after tumor ablation in 2 cases. Results All the patients were followed up 12-72 months (mean, 36 months). In 10 patients with bone defect reconstruction, the wearing external fixator time was 3-8 months (mean, 4.8 months); all got bone union with the healing time of 3-16 months (mean, 6.4 months); the Musculoskeletal Tumor Society 93 (MSTS 93) score was 73.3-93.3 (mean, 87.2); and no complication occurred during wearing external fixator. In 5 patients with bone distraction lengthening for limb length discrepancy, the wearing external fixator time was 7-15 months; 2 patients had axial deviation during distraction and2 had greenstick fracture after apparatus removal; pin site infection was observed in 2 cases with grade 1 and 1 case with grade 2 according to Checketts-Otterburn classification system; the MSTS 93 score was 80.0-96.7 (mean, 89.2). The remaining patients had no complications, the knee and ankle joint movement was normal. Conclusion Orthofix unilateral external fixator can be used in fixation for complex bone defect after tumor resection and to correct limb length discrepancy after limb salvage surgery.
Objective To evaluate the clinical effect of end-to-end neurorrhaphy following rapid expansion of the nerve in repairing facial nerve defect. Methods From August 2000 to February 2005, 9 patients suffering from facial nerve defect were treated by the surgical method. The defect was caused by traffic injury(4 cases) , by cutting injury (2 cases) and falling wound(1 case). Seven cases showed prominent facial paralysis. The other 2 cases were invaded by parotid carcinoma, without remarkable paralysis. One case had unibranch defect, and the other 8 cases had multibranch defect. The nerve gap ranged from 1.5cm to 3.0 cm. After both the proximal and the distal segment had been dissected,the nerve was elongated by the expander designed and manufactured. The expansionwas done at a speed of 2.0 cm/30 min, and it lasted until the end-to-end neurorrhaphy can be done easily. The treatment result was evaluated according to Baker’s classification and HouseBrackmann’s grading system. Results Nine patients were followed up 618 months. In 5 cases achieving good result, both dynamic look and static look of face were symmetric, the EMG peak value of mimetic muscle was 82%95% of normal side. In 3 cases achieving fair result, thedynamic look and static look of face were basically symmetric, and the EMG peak value of mimetic muscle was 60%90% of normal side. In 1 case achieving poor result, the function of mimetic muscle was improved slightly, and the EMG peak value of mimetic muscle was 55% of normal side. Conclusion The satisfactory resultcan be obtained by endtoend neurorrhaphy following rapid expansion of the nerve in condition that nerve defect is less than 3.0 cm.
Objective To discuss the elbow skin fold extension line in Kirschner wire internal fixation of extended supracondylar humeral fractures in children. Methods The clinical data of 58 children with extended supracondylar fractures of the humerus who met the selection criteria between August 2021 and July 2024 were retrospectively analyzed. In 28 cases, needle placement of medial epicondyle of humerus was performed with the assistance of the elbow skin fold extension line (study group), and 30 cases were assisted by routine touch of the medial epicondyle of the humerus (control group). There was no significant difference in baseline data such as gender, age, side, cause of injury, Gartland type, Kirschner wire configuration, and time from injury to operation between the two groups (P>0.05). The closed reduction rate, total operation time, time of medial humeral condyle pin placement, fluoroscopy times during medial pin placement, rate of one-time determination of medial entry point, ulnar nerve injury incidence, and fracture healing time were recorded and compared between the two groups. At the same time, the closed reduction rate of patients with the time from injury to operation ≤24 hours and >24 hours was compared. The elbow function was evaluated by Mayo elbow function score. Results The closed reduction rate of the study group was significantly higher than that of the control group (P<0.05). Among all patients, the closed reduction rate of patients with the time from injury to operation ≤24 hours [73.3% (22/30)] was significantly higher than that of patients >24 hours [42.9% (12/28)] (χ2=5.545, P=0.019). The total operation time, medial needle placement time, and fluoroscopy times in the study group were significantly less than those in the control group, and the one-time determination rate of medial needle entry point in the study group was significantly higher than that in the control group (P<0.05). There were 4 cases of ulnar nerve injury in the control group, and no ulnar nerve injury in the study group, but there was no significant difference in the incidence of ulnar nerve injury between the two groups (P>0.05). All patients were followed up 6-12 months (mean, 8 months). There was no bone nonunion in both groups, and the fracture healing time of the study group was significantly shorter than that of the control group (P<0.05). Volkmann ischemic contracture, heterotopic ossification, myositis ossificans, and premature epiphyseal closure were not observed after operation. No complications such as loosening or fracture of Kirschner wire occurred. At last follow-up, the Mayo elbow joint function score was used to evaluate function, and there was no significant difference between the two groups (P>0.05). Conclusion In the treatment of extended supracondylar fractures of the humerus in children, the elbow skin fold extension line can help to quickly locate the medial epicondyle of the humerus, quickly insert Kirschner wire, and reduce the operation time and trauma.
Ten, fifteen and twenty millimeter nerve defects were produced on both trunks of sciatic nerve in 18 rabbits. The stumps of the nerve were enclosed by a silicon tube in the right hind limb (slilcon group) and the left limbs were free (free group). The proximal and distal nerve stumps in both groups were elongated by using a selfdesigned nerve stretching device, and the nerve were gradually stretched by 1mm, 2mm and 3mm per day respectively. when the expected lengths were achieved, the defects of the nerve were managed by endtoend coaptation. The samples were analysed by electrophysiological examination, and light and electron microscopes. Results were as follows: (1) The nerve defect could be repaired by gradual elongation in rabbits; (2) The results of silicon group were superior to the free group; (3) The structure and microcirculation of the nerve would be damaged if the stretching speed exceeded the limit of 2mm per day. But the eventual results following repair by elongation could not reached the normal level.
Objective To explore the effectiveness of limb shortening/re-lengthening technique combined with in situ tissue regeneration technique in limb salvage for patients with complex lower limb fractures and soft tissue defects. Methods Between January 2021 and December 2024, 12 patients with complex lower limb fractures and soft tissue defects caused by trauma were admitted. There were 10 males and 2 females; the age ranged from 18 to 46 years, with an average of 36 years. Among them, 1 case of open comminuted tibiofibular fracture caused bone necrosis and soft tissue infection; 4 cases of open tibiofibular fractures developed bone and soft tissue infections after being fixed with a combined external fixator, resulting in defects; 7 cases of closed tibial fractures that underwent internal fixation developed soft tissue infections, leading to bone and soft tissue necrosis. The time from injury to the formation of bone and soft tissue defects was 2-9 weeks, with an average of 6 weeks. The length of bone defects was 5.0-10.2 cm, with an average of 6.8 cm; the area of soft tissue defects was 32-54 cm2, with an average of 43.9 cm2. After admission, all patients underwent thorough debridement. The limb shortening treatment was performed after the wound had filled with fresh granulation tissue, and an Ilizarov ring-shaped external fixator was placed or replaced. The limb was shortened at a rate of 1 mm/day to reduce bone defects. At the same time, the soft tissue defects were repaired using the in situ tissue regeneration technique. After the wound healed, osteotomy was performed, and limb lengthening was carried out at a rate of 1 mm/day. The lower limb full-length X-ray films were taken, and the lengthening was stopped when the lower limb alignment was restored. The healing condition of the wound was observed and the healing time was recorded. Results One patient died due to a traffic accident during limb lengthening. The remaining 11 patients completed limb shortening and re-lengthening treatment and were followed up 18-36 months, with an average of 20 months. All 11 patients successfully preserved their limbs. The wound healing time was 4-12 weeks, with an average of 8 weeks; the limb shortening time was 4-8 weeks, with an average of 6 weeks; and the limb lengthening time was 4-12 weeks, with an average of 8 weeks. One patient experienced delayed bone mineralization during bone lengthening, and one had pin tract infection. Both were treated symptomatically. The lower limb mechanical axis of all 11 patients was restored, and they were able to walk independently. ConclusionThe application of limb shortening/re-lengthening technique combined with in situ tissue regeneration technique in the treatment of large bone and soft tissue defects not only effectively avoids the occurrence of nonunion at the apposition ends and increases the stability of the lower limb, but also significantly shortens the wound healing time, avoids the risk of soft tissue infection and increases the limb salvage rate. It can be used as a treatment technique for patients with complex lower limb fractures combined with soft tissue defects.
Objective To evaluate the effect of the modified extended iliofemoral approach on treatingcomplex acetabular fractures. Methods Thirty-six cases of complex acetabular fractures were treated by the open reposition and internal fixation by a modified extended iliofemoral approach. Results Thirty-sixcases were followed up for 7-46 months, with an average of 23.8 months. According to the Matta standard, anatomical reposition was performed in 24 cases, perfect reposition in 8 cases, and unsatisfactory reposition in 4 cases. By the modified d’Aubignepostel score, among the 36 cases, 22 had an excellent result, 9 had a good result, and 5 had a poor result. Conclusion Themodified extended iliofemoral approach facilitates the operative exposure of the anterior and posterior walls and both columns of the acetabulum in the surgically-treated acetabular fractures by the open reposition and internal fixation.Because of the reconstruction, the functions of the abductor muscle mass managed by the lagscrew-fixed osteotomies of the iliac crest, and greater trochanter, the patients can achieve a rapid rehabilitation of the joint.
Post operational recovery from cardiac surgery can be affected by many factors, including preoperative, intraoperative, and postoperative factors. Prolonged mechanical ventilation (PMV) , one of the major complications, has been widely accepted as a measure to evaluate the performance and outcomes of cardiac surgeries. Great progress has been made in the studies of risk factors contributing to PMV following cardiac surgeries in recent years. However, no clear and effective measures and approaches are available yet to prevent PMV. In this review, the authors try to summarize the risk factors that are associated with PMV throughout the perioperative period of cardiac surgery, as well as possible interventions when applicable.
Objective To investigate the relationship between the tibia callus diameter ratio(CDR) and prognosis during tibial distraction and the occurrenceof late deformity or fracture. Methods We measured tibiallengthening callus diameter and added up the cases of angular deformity and fracture in 68 casesfrom January 1996 to December 2001, to calculated callus diameter ratios and compare the relationship between the tibia callus diameter during tibial distraction and the occurrence of late callus angular deformity or fracture. Results In 23 cases of CDRlt;80%, 13 cases had new bone fracture, 21 cases had angular deformity gt;5 degree. In 6 cases of 81%lt;CDRlt;85%, there were 4 cases of angular deformity gt;5 degree. In the other 39 cases of CDRgt;85%, there were no fracture and angular deformity. Conclusion When the CDR was gt;85%, there wereno angular deformity and fracture, but when the CDR was lt;80%, the complications of fracture and angular deformity occur. CDR is a better alarming index for preventing the complications occurring in tibial lengthening.