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find Keyword "足部" 20 results
  • EXCISION OF ACCESSORY NAVICULAR WITH RECONSTRUCTION OF POSTERIOR TIBIAL TENDON INSERTION ON NAVICULAR FOR TREATMENT OF FLATFOOT RELATED WITH ACCESSORY NAVICULAR

    Objective To analyze the excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular for the treatment of flatfoot related with accessory navicular and to evaluate its effectiveness. Methods Between May 2006 and June 2011, 33 patients (40 feet) with flatfoot related with accessory navicular were treated. There were 14 males (17 feet) and 19 females (23 feet) with an average age of 30.1 years (range, 16-56 years). All patients had bilateral accessory navicular; 26 had unilateral flatfoot and 7 had bilateral flatfeet. The disease duration ranged from 7 months to 9 years (median, 24 months). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-midfoot score was 47.9 ± 7.3. The X-ray films showed type II accessory navicular, the arch height loss, and heel valgus in all patients. All of them received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor. Results All patients got primary wound heal ing without any compl ication. Thirty patients (36 feet) were followed up 6-54 months with an average of 23 months. All patients achieved complete pain rel ief at 6 months after surgery and hadgood appearance of the feet. The AOFAS ankle-midfoot score was 90.4 ± 2.0 at last follow-up, showing significant difference when compared with preoperative score (t=29.73, P=0.00). X-ray films showed that no screw loosening or breakage was observed. There were significant differences in the arch height, calcaneus incl ination angle, talocalcaneal angle, and talar-first metatarsal angle between pre-operation and last follow-up (P lt; 0.01). Conclusion The excision of accessory navicular with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular, with correction of deformity, excellent effectiveness, and less complications.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • REPAIR OF TRAUMATIC METACARPOPHALANGEAL JOINT DEFECT BY METATARSOPHALANGEAL JOINT COMPOSITE TISSUE FLAP AUTOGRAFT

    Objective To investigate the surgical method and effectiveness of repairing traumatic metacarpophalangeal joint defect by the composite tissue flap autograft of the second metatarsophalangeal joint. Methods Between June 2005 and December 2009, 6 cases (6 fingers) of traumatic metacarpophalangeal joint defect were treated with the composite tissue flap autograft of second metatarsophalangeal joint (containing extensor tendon, flexor tendon, proper digital nerve, planta or dorsal flap). All patients were males, aged 18-48 years, including 3 cases of mechanical injury, 2 cases of crush injury, and 1 case of penetrating trauma. The 2nd, 3rd, and 4th metacarpophalangeal joints were involved in defects in 2 cases, repectively, and defects ranged from 1.5 cm × 1.5 cm to 3.0 cm × 2.5 cm in size. All patients had skin and soft tissue defects, and defects ranged from 4 cm × 2 cm to 5 cm × 4 cm in size; and 5 cases complicated by extensor tendon defect (2.5-5.0 cm in length), 3 cases by flexor tendon rupture, and 3 cases by common palmar digital nerve injury. The time from injury to admission was 2-6 hours. Results The composite tissue flaps and skin grafts survived in all cases. All incisions healed by first intention. All patients were followed up 1-5 years. The X-ray films showed good healing between the transplanted metatarsophalangeal joint and metacarpals and phalanges at 9-14 weeks postoperatively. The appearance, colour, and texture of the skin flap were satisfactory, and the senses of pain and touch were recovered. The palmar flexion range of transplanted metacarpophalangeal joints was 50-70°, and the dorsal extension range was 5-10° at last follow-up. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 4 cases, good in 1 case, and fair in 1 case, and the excellent and good rate of 83.3%. No dysfunction of the donor foot was observed. Conclusion The metatarsophalangeal joint composite tissue flap can provide bone, nerve, skin, muscles, and tendons, so it is an effective approach to repair the metacarpophalangeal joint defect and to recover the function of the injured joints in one operation.

    Release date:2016-08-31 05:45 Export PDF Favorites Scan
  • 带腓肠神经营养血管逆行岛状皮瓣修复足跟部皮肤软组织缺损

    目的 总结带腓肠神经营养血管逆行岛状皮瓣修复足跟部皮肤软组织缺损的手术方法及疗效。 方 法 2004 年5 月- 2007 年10 月,应用带腓肠神经营养血管逆行岛状皮瓣修复22 例足跟部皮肤软组织缺损。男14 例,女8 例;年龄17 ~ 62 岁,平均43.5 岁。机器绞伤10 例,车祸伤7 例,重物砸伤5 例。伴跟腱外露9 例,跟骨外露8 例,两者均外露5 例。软组织缺损范围为5 cm × 4 cm ~ 14 cm × 8 cm。受伤至手术时间为2 h ~ 10 个月,平均6 个月。术中切取皮瓣6 cm × 5 cm ~ 16 cm × 9 cm。4 例供区直接缝合,18 例游离植皮修复。 结果 20 例患者术后皮瓣顺利成活,切口Ⅰ期愈合;2 例切口远端皮缘坏死,经换药Ⅱ期愈合。供区植皮成活,切口均Ⅰ期愈合。22 例患者均获随访,随访时间5 ~ 12 个月。皮瓣与周围皮肤色泽相似,无臃肿,两点辨别觉6 ~ 8 mm。术后能穿鞋正常行走,皮瓣受力处无破溃。 结 论 带腓肠神经营养血管逆行岛状皮瓣是修复足跟部皮肤软组织缺损的有效方法之一。

    Release date:2016-09-01 09:05 Export PDF Favorites Scan
  • REPAIR OF WHOLE-HAND DESTRUCTIVE INJURY AND HAND DEGLOVING INJURY WITH TRANSPLANT OF PEDIS COMPOUND FREE FLAP

    Objective?To investigate the surgical method and clinical efficacy of repairing whole-hand destructive injury or hand degloving injury with the transplant of pedis compound free flap.?Methods?From February 2003 to June 2008, 21 patients with whole-hand destructive injury or hand degloving injury were treated, including 15 males and 6 females aged 18-45 years old (average 25 years old). The injury was caused by punching machine crush in 10 cases, roller crush in 7 cases, and imprinter crush in 4 cases. The time between injury and operation was 1-9 hours. Eleven cases had the skin-degloving injury of the whole hand, while the other 10 cases had the proximal palm injury combined with dorsal or palmar skin and soft tissue defect. After debridement, the size of wound was 9 cm × 7 cm - 15 cm × 10 cm in the dorsal aspect and 10 cm × 7 cm -16 cm × 10 cm in the palmar aspect. The defect was repaired by the thumbnail flap of dorsalis pedis flap and the second toenail flap of dorsalis pedis flap in 5 cases, the thumbnail flap of dorsalis pedis flap and the second toe with dorsalis pedis flap in 4 cases, and bilateral second toe with dorsalis pedis flap in 12 cases. The flap area harvested during operation ranged from 6 cm × 5 cm to 16 cm × 11 cm. Three fingers were constructed in 2 cases and two fingers in 19 cases. Distal interphalangeal joint toe amputation was conducted in the thumbnail flap donor site, metatarsophalangeal joint toe amputation was performed in the second toenail flap donor site, and full-thickness skin grafting was conducted in the abdomen.?Results?At 7 days after operation, the index finger in 1 case repaired by the second toenail flap suffered from necrosis and received amputation, 1 case suffered from partial necrosis of distal dorsalis pedis flap and recovered after dressing change, and the rest 42 tissue flaps survived. Forty-three out of 44 reconstructed fingers survived. All the wounds healed by first intention. At 2 weeks after operation, 2 cases had partial necrosis of the donor site flap and underwent secondary skin grafting after dressing change, the rest skin grafts survived, and all the wounds healed by first intention. Nineteen cases were followed up for 6-36 months (average 11 months). The flaps of palm and dorsum of hand showed no swelling, the reconstructed fingers had a satisfactory appearance and performed such functions as grabbing, grasping, and nipping. The sensory of the flaps and the reconstructed fingers recovered to S2-S4 grade. The donor site on the dorsum of the foot had no obvious scar contracture, without obvious influence on walking.?Conclusion?For the whole-hand destructive injury or hand degloving injury, the method of transplanting pedis compound free flap can repair the defect in the hand and reconstruct the function of the injured hand partially. It is an effective treatment method.

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • 足部复发恶性黑色素瘤术后创面修复

    目的 总结足部复发恶性黑色素瘤切除术后应用带血管蒂皮瓣修复创面的疗效。 方法 2005 年5 月- 2008 年6 月,收治7 例足部恶性黑色素瘤复发患者。男2 例,女5 例;年龄21 ~ 63 岁。足跟3 例,足内侧3 例,足外侧1 例。瘤体直径为2.0 ~ 4.5 cm,根据美国癌症联合会分期标准,均为Ⅰ~Ⅱ期。于外院行肿瘤局部切除手术术后3 ~ 48 个月复发。术中扩大切除黑色素瘤后,采用大小为8 cm × 4 cm ~ 14 cm × 10 cm 带足背动脉或带足底内侧动脉皮瓣修复创面。供区游离植皮修复。 结果 术后14 d 1 例带足底内侧动脉皮瓣边缘发生溃疡;供区2 例10 d 植皮部分坏死,均经相应处理后愈合;余皮瓣及植皮均成活,切口Ⅰ期愈合。患者均获随访,随访时间6 ~ 36 个月,平均26 个月。患者均无瘤生存,皮瓣均有感觉恢复,两点辨别觉15 ~ 20 mm;色泽同受区相似,耐磨,足部外形满意,足及足趾活动良好。 结论 带血管蒂皮瓣修复足部复发恶性黑色素瘤术后创面,愈合率高,血运与感觉良好,可获得较好外观和功能效果。

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • 足趾皮瓣修复前足部小面积皮肤缺损

    探讨4 种足趾皮瓣修复前足部小面积皮肤缺损的疗效,为临床治疗前足部小面积皮肤缺损伴骨、肌腱外露患者提供一种有效修复方法。 方法 2004 年4 月- 2006 年12 月,采用口止母 趾腓侧皮瓣、趾侧腹皮瓣、趾蹼皮瓣和第2 趾全趾皮瓣修复前足部小面积皮肤缺损11 例。其中男7 例,女4 例;年龄12 ~ 56 岁。伴有跖趾骨骨折骨外露者7 例,单纯趾伸肌腱外露2 例,趾伸肌腱断裂并外露2 例。皮肤缺损范围1.5 cm × 1.0 cm ~ 6.0 cm × 5.5 cm。伤后距手术时间8 h ~ 28 d。皮瓣切取范围1.8 cm × 1.2 cm ~ 6.5 cm × 6.0 cm。 结果 11 例均获随访4 ~ 17 个月,平均7.6 个月。9 例切口均Ⅰ期愈合;1 例切口延期愈合;1 例皮瓣周围植皮区部分坏死,经换药后愈合。无伤口感染、皮瓣坏死发生,患足外形好,皮瓣有满意感觉,耐磨擦耐压,无皮肤破溃发生,皮瓣不臃肿,穿鞋方便,患肢行走功能正常。 结论 足趾皮瓣切取简便、血供好、不臃肿,是修复前足部小面积皮肤缺损的有效方法之一。

    Release date:2016-09-01 09:12 Export PDF Favorites Scan
  • ANATOMICAL STUDIES AND CLINICAL APPLICATIONS OF DISTALLY-BASED INTERMEDIATE DORSAL NEUROCUTANEOUS FLAP ON THE FOOT

    Objective To provide the anatomic basis for thedesign of the intermediate dorsal neurocutaneous flap on the foot and to reportthe clinical results. Methods On 32 adult cadaver lower limb specimens perfused with red latex, the origins, diameters, courses, branches, and distributions of the intermediate dorsal cutaneous nerve of the foot and its nutrient vessels were observed. On this anatomic basis, from June 2004 to October2005, 5 flaps were developed and applied to the repair of the soft tissue defect in the feet of 4 patients. Results The intermediate dorsal cutaneous nerve of the foot was found to arise from the superficial peroneal nerve. Crossing the intermalleolar line, it was located 1.3±0.6 cm lateral to the midpoint of the line with a diameter of 2.05±0.56 mm. The nerve stem divided into branches 2.8±1.3 cm distal to the line. They distributed the dorsal skin of the second, third and fourth metatarsal and toe. On average, 5.1 perforators per specimen were identified. At least 3 nutrient vessels were always found in each. They originated from the cutaneous branches of the anterior tibial artery and the dorsalis pedis artery in the proximal end and the dorsalis metatarsal artery in the distal end. They perforated the deep fascia 4.3±0.4 cm proximal to the intermalleolar, 1.6±0.3 cm proximal to the tip of the third toe webspace and 1.5±0.3 cm proximal to the tip of the forth toe webspace, respectively. The external diameters of them were 0.82±0.13, 0.42±0.07 and 0.49±0.09 mm, respectively. The patients were followed up for 4-10 months. All theflaps survived completely. Their appearance and function were satisfactory. Conclusion The distallybased intermediate dorsal neurocutaneousflap on the foot has an abundant blood supply. This kind of flap is especially useful in repair of the soft tissue defect in the foot.

    Release date:2016-09-01 09:22 Export PDF Favorites Scan
  • CLINICAL APPLICATION OF LOWER ROTATING POINT SUPER SURAL NEUROCUTANEOUS VASCULAR FLAP

    Objective To explore the clinical effect of the lower rotating point super sural neurocutaneous vascular flap on the repair of the softtissue defects in the ankle and foot. Methods From May 2001 to February 2006, 24 patients with the soft tissue defects in the ankle and foot were treated with the lower rotating point super sural neurocutaneous vascular flaps. Among the patients, 15 had an injury in a traffic accident, 6 were wringedand rolled by a machine, 1 was frostbited in both feet, 2 were burned, 25 had an exposure of the bone and joint. The disease course varied from 3 days to 22 months; 19 patients began their treatment 3-7 days after the injury and 5 patients were treated by an elective operation. The soft tissue defects ranged in area from 22 cm × 12 cm to 28 cm × 12 cm. The flaps ranged in size from 24 cm × 14cm to 30 cm × 14 cm, with a range up to the lower region of the popliteal fossa. The rotating point of the flap could be taken in the region 1-5 cm above thelateral malleolar. The donor site was covered by an intermediate thickness skingraft. Results All the 25 flaps in 24 patients survived with asatisfactory appearance and a good function. The distal skin necrosis occurred in 1 flap, but healing occurred after debridement and intermediate thickness skin grafting. The follow-up for 3 months to 5 years revealed that the patients had a normal gait, the flaps had a good sense and a resistance to wearing, and no ulcer occurred. The two point discrimination of the flap was 5-10 mm. Conclusion The lower rotating point super sural neurocutaneous vascular flap has a good skin quality, a high survival rate, and a large donor skin area. The grafting is easy, without any sacrifice of the major blood vessel; therefore, it is a good donor flap in repairing a large soft tissue defect in the ankle and foot.

    Release date:2016-09-01 09:22 Export PDF Favorites Scan
  • 逆行胫前动脉岛状皮瓣修复足部皮肤软组织缺损

    目的 探讨应用带蒂逆行胫前动脉皮支岛状皮瓣修复足部皮肤软组织缺损的疗效。 方法 2000年7月~2005年4月,收治10例各种原因致足部皮肤软组织缺损,均存在不同程度的骨、关节与肌腱外露,软组织缺损范围6 cm×4 cm ~16 cm×10 cm。急诊修复7例;择期手术3例,其中1例足部黑色素瘤7年伴皮肤破溃5个月,行手术扩大切除。应用带蒂的胫前动脉皮支岛状皮瓣逆行移位修复,皮瓣切取范围8 cm×5 cm ~17 cm×12 cm 。 结果 术后皮瓣均成活,创口Ⅰ期愈合。随访1~21个月,皮瓣外观好,不臃肿,无感染、破溃。足部外形满意,行走正常,皮肤两点辨别觉1.0~2.5 cm。 结论 胫前动脉皮支皮瓣血管解剖恒定,易于解剖,皮瓣可切取面积大,手术方法简便,成功率高 ,适用于足部皮肤软组织缺损的修复。

    Release date:2016-09-01 09:22 Export PDF Favorites Scan
  • CLINICAL APPLICATION OF DISTAL BASE SURAL ISLAND FLAP

    OBJECTIVE: To sum up the experience of clinical application of distal base sural island flap. METHODS: From January 1997 to April 1999, the posterior island flap of leg pedicled with sural nerve and its nutrient vessels was applied to repair heel or dorsum of foot in 6 cases, chronic ulcer of heel in 2 cases, chronic osteomyelitis in 2 cases, scar contracture of bone defect accompanying fistulation in 1 case. The range of flap was 5 cm x 8 cm to 8 cm x 12 cm. RESULTS: All the flaps survived completely without vascular crisis. All the wounds healed by first intention. Followed up 3 to 12 months, no ulcer, osteomyelitis, fistulation were recurrence, and the sensation of flap was recovered slightly. CONCLUSION: The flap do not damage critical blood vessels and nerves, the donating region is hidden. The manual of operation is simple and blood supply of flap is sufficient. It can repair the defect of soft tissue on heel and dorsum with high survival rate.

    Release date:2016-09-01 10:27 Export PDF Favorites Scan
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