OBJECTIVE: To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel. METHODS: Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm x 5.0 cm to 4.5 cm x 11.0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm x 8 cm to 12 cm x 25 cm. RESULTS: All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X-ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma. CONCLUSION: The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.
This paper reported the use of superficial temporal vessels pedicled postauricular island flap for the reconstruction of eye socket. Six cases were treated by this method since 1988 with universal satisfactory results. The disign of the flap was diseribed. The operative procedure was detailed, and the advantages of the flap were evaluated: 1. The donor defect was hidden behind the ear; 2. The flap has a relatively long pedicle, hence easy for distant transfer, and 3. the blood supply was highly reliable.
Objective To assess the curative effect of the subtalararthrodesis on the serious subtalar joint with the posterior tibial tendon dysfunction.Methods From October 2000 to February 2006, 31 patients (18 males, 13 females; age 23-62 years, averaged 36.4years) with serious subtalar joint osteoarthrisis and stage Ⅱ posterior tibial tendon dysfunction were treated by the subtalar arthrodesis. The tibial tendon dysfunction involved 15 right and 16 left lower extremities, which were caused by retrograde osteoarthritis in 14 patients,sequel of an injury in 8 patients, infection in 7 patients, and anatomic structural abnormity in 2 patients. The treatment course averaged 9.5 months (range, 6-30 months). Before the subtalar arthrodesis, the injured tendons were repaired, and then the bone grafting was performed in the tarsus sinus. All of the patients were assessed before and after operation according to the Hindfoot scores system (American Orthopedics Foot and Ankle Society, AOFAS). Results Among the patients, 28 were followed up on an average of 23.6 months (range, 8-61 months). The AOFAS scores ranged from 45.30±1.08 before operation to 79.60±2.14 afteroperation. The pain indexes ranged from 15.40±2.23 before operation to 38.50±2.61 after operation. The functional indexes of the foot and ankle joint ranged from averaged 21.60±3.01 before operation to averaged 37.40±2.83 after operation. The statistical analysis of the t-test on all the above data showed that there was a significant difference between beforeoperation and after operation (P＜0.01). The angles between the longitudinal line of the talar and the calcaneal bone were 43.70±1.06° before operation and 29.40±0.98° after operation, and the deviation angles between the calcanealline and the talus were 48.20±0.85° before operation and 39.40±1.02° after operation. There was a significant difference between before operation and after operation (P＜0.01). Conclusion The subtalar arthrodesis combined with the bone grafting in the tarsus sinus and the repair of the injured tendons can effectivelycorrect the deformity of the deformity of the metapodium, relieve the pain, retin the adjacent joint motion ability, and this method can be recommended for the adult patient who suffers from serious subtalar osteoarthritis and stage Ⅱ osterior tibial tendon dysfunction.
Objective To review the recent anatomy and biomechanical research progress of knee posteromedial corner, to analyze deficient aspect, and to predict future research directions. Methods Domestic and international l iterature about the anatomy and function of knee posteromedial corner in recent years was reviewed extensively, at the same time, the biomechanics of corresponding structure was summarized and analyzed. Results The anatomical structures ofknee posteromedial corner included the static stabil ity structures and the dynamic stabil ity structures. The dynamic stabil ity structures were more important, including posterior root of medial meniscus, posterior obl ique l igament, semimembranosus extensions, meniscotibial l igament and obl ique popl iteal l igament. The posterior obl ique l igament was most important structure to contribute to stabil ization of valgus, anterior internal rotation of knee and posterior movement of tibia. Conclusion Anatomical reconstruction of knee posteromedial corner especially the posterior obl ique l igament is the key to the reconstruction of knee posteromedial function stabil ity.
Ten cases of neurotmesis of posterior interosseous nerve of the forearm were treated with mierosurgical technique from Aug, 1988 to Oct. 1990, of which, 4 cases by autogenous nerve graft and 6 cases by direct neurosuture. Eight cases have been followed-up from 4 months to 1 year after operation concerning with satisfactory results. Some questions the diagnosis, the points for attention in operation, and the relation of the results and the time when the operation done were discussed. The comparison of the results and the recovery time between the autogenous-nerve graft and direct neurosuture was made.
Objective To introduce the procedure of thoracic outlet tumors removal through posterior thoracotomy and its efficacy. Methods Ten patients with thoracic outlet tumors underwent surgical treatment via posterior approach from June 2004 to June 2007. Five patients suffered from neurogenic tumors, 4 patients apical lung carcinomas, and 1 patient apicoposterior lung tumor. The skin incision was started superiorly lateral to the transverse process of 6th cervical vertebrae, carried downward a way between the medial border of the scapula and the posterior midline and was extended in a gentle arc below the inferior angle of the scapula to the posterior axillary line. The chest was entered and the tumor is removed through resecting the rib(2nd or 3rd rib) located at the lower edge of the tumor after the scapula had been pushed forward. Results There was no death in this group. Tumors in 9 patients were resected completely. Thoracotomy only was done in another patients as a result of tumor invading neighboring major organs. Shoulder and back pain in 3 of 4 patients was remitted postoperatively. Two patients with “dumbell” neurogenic tumors improved strength of lower limbs. Pain and abdominal wall reflex resumed in one patient and muscle strength of lower limbs increased to 4th grade from 2nd grade in another one. Two patients required thoracentesis because of complicating with pleural effusion. The mean followup period was 18 months (range 336). Seven of 10 patients still lead a normal life. Conclusion Posterior thoracotomy can provide an excellent approach to remove the thoracic outlet tumors safely and completely.
Tissues defect of the sole of the foot requires a high quality of repair, because the sole bears the body weight most. Once there is loss of soft tissues and skin from the sole, the os calsis and the plantar fascia will be exposed. The use of vascularized tissue flaps to cover the beare area of the sole has been generally recognized. From May, 1985 through May, 1994, 26 cases of extensive tissue defects of the soles were treated. During the primary debridement, the wounds were repaired primarily by using retrograde island skin flap from the medial side of the leg with the posterior tibial artery. From the follwup, the results weresatisfactory. The advantages were: the skin flap had rich blood supply, large skin flap was avallable, the thickness of the flap was appropriate, and the elasticity or the weight bearing was good. Besides, the location of the artery was constant, and the operative technique was easy to handle and could be done in onestage with high survival rate of the skin flap.
ObjectiveTo compare the effectiveness of posterior malleolus fractures treated by plate and screw internal fixation through posterolateral approach.MethodsThe clinical data of 95 patients with posterior malleolus fractures who were admitted between January 2016 and December 2019 and met the selection criteria were retrospectively analysed. They were divided into plate group (44 cases, treated with posterolateral plate internal fixation) and screw group (51 cases, treated with posterolateral screw internal fixation) according to different treatment methods. There was no significant difference in general data between the two groups of patients such as age, gender, cause of injury, side of injury, ankle fracture or injury classification, time from injury to operation, and percentage of posterior ankle fracture area to the distal tibia articular surface (P>0.05). The operation time, hospital stay, fracture healing time, and surgical complications were compared between the two groups. Imaging examinations (X-ray film, CT scan and reconstruction) were used to assess the reduction quality of ankle fracture, articular congruity, and re-displacement in ankle fracture. At last follow-up, the pain visual analogue scale (VAS) score was used to evaluate the patients’ pain, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate ankle joint function.ResultsPatients in both groups were followed up 6-30 months, with an average of 18.2 months. The operation time of the plate group was significantly longer than that of the screw group (U=−2.040, P=0.041); there was no significant difference in hospital stay between the two groups (U=−1.068, P=0.285). Incision swelling occurred in 2 cases in the plate group, sural nerve injury in 3 cases, and traumatic arthritis in 2 cases during follow-up. In the screw group, there were 1, 2, and 2 cases, respectively. The incidence of complications in the two groups (15.9% vs. 9.8%) was not significantly different (P=0.372). All patients who underwent tibiofibular screw fixation underwent the removal of the tibiofibular screw before taking full weight bearing at 12 weeks after operation, and there was no screw fracture and retention. During the follow-up, there was no infection, re-displacement of fracture, delayed bone union or nonunion, and there was no significant difference in fracture healing time between the two groups (t=0.345, P=0.731). There was no significant difference between the two groups of reduction quality of ankle fracture and articular congruity evaluation results (P>0.05). At last follow-up, there was no significant difference in VAS score, AOFAS ankle-hindfoot score and evaluation grade between the two groups (P>0.05).ConclusionBoth the plate and screw internal fixation through posterolateral approach can achieve satisfied effectiveness in the treatment of posterior ankle fractures with maintenance of fracture reduction, and recovery of ankle joint function. The screw internal fixation has the advantages of minimal invasion and shorter operation time.
ObjectiveTo investigate the effectiveness of wide fascial and doubly vascularized pedicle posterior cnemis flap in repair of the soft tissue defect of forefoot.MethodsBetween March 2011 and March 2017, 18 cases with severe soft tissue defects of forefeet were repaired with the wide fascial and doubly vascularized pedicle posterior cnemis flaps. There were 13 males and 5 females with an average age of 33 years (range, 11-49 years). Of 18 cases, the defects were caused by trauma in 16 cases with an average disease duration of 15 hours (range, 3-72 hours), by infection after correction of spastic clubfoot in 1 case, and by infection after open fracture fixation in 1 case. The defects were on the planta of forefoot in 11 cases and on the dorsum of forefoot in 7 cases. The size of soft tissue defects ranged from 6 cm×4 cm to 15 cm×9 cm. All defects combined with the bone, joint, and tendon exposures and 4 defects combined with fractures. The size of flaps ranged from 8 cm×5 cm to 17 cm×10 cm. All wounds of donor sites were repaired by skin grafting.ResultsThe operation time was 100-190 minutes (mean, 140 minutes). Seventeen flaps survived and wounds healed by first intention. One flap had partial necrosis and cured after dressing change. Seventeen cases were followed up 5-24 months (mean, 16 months). Both the color and texture of the flaps were satisfactory. But the pedicles of flaps were swollen. The functions of foot and ankle returned to normal.ConclusionThe wide fascial and doubly vascularized pedicle posterior cnemis flap has reliable blood supply and sufficient venous reflux to ensure its survive, which can be used to repair severe soft tissue defect of forefoot.
Objective To compare the short-term effectiveness between dynamic neutralization system (Dynesys) and posterior lumbar interbody fusion (PLIF) in the treatment of lumbar degenerative disease. Methods The clinical data were retrospectively analyzed, from 14 patients undergoing Dynesys and 18 patients undergoing PLIF to treat lumbar degenerative disease between February 2009 and March 2011. No significant difference in gender, age, duration of disease, and lesion segments was found between 2 groups (P gt; 0.05). The visual analogue scale (VAS) score, Oswestry disability index (ODI), and radiographic results were compared between 2 groups at preoperation and last follow-up. Results Thirty-one cases were followed up 12-21 months (mean, 17 months). No internal fixation loosening, broken screws, and broken rods was found during follow-up. The mean interbody fusion time was 15 months (range, 13-19 months) in PLIF group. The VAS score and ODI were significantly improved in 2 groups at last follow-up when compared with the preoperative ones (P lt; 0.05); but there was no signficant difference between 2 groups (P gt; 0.05). Imaging assessment: the range of motion (ROM) of operated segment in PLIF group was (0.1 ± 0.4)° at last follow-up, showing significant difference when compared with preoperative ROM (7.8 ± 0.6)° (t=28.500, P=0.004); the ROM in Dynesys group (5.0 ± 1.5)° decreased, but showing no significant difference when compared with preoperative ROM (7.5 ± 0.8)° (t=0.480, P=0.113); and significant difference was found between 2 groups (t=5.260, P=0.008) at last follow-up. The ROM of adjacent segment in Dynesys group at last follow-up (7.2 ± 0.7)° decreased when compared with preoperative ROM (7.3 ± 1.8)°, but showing no significant difference (t=0.510, P=0.108); however, ROM of adjacent segment in PLIF group (8.7 ± 0.4)° increased significantly when compared with preoperative ROM (7.0 ± 1.6)°, showing signifcant difference (t=3.440, P=0.042); and there was significant difference between 2 groups (t= — 2.100, P=0.047) at last follow-up. Conclusion Dynesys and PLIF have equivalent short-term effectivness in the treatment of lumbar degenerative disease. However, the Dynesys could retain ROM of operated segment without increased ROM of the adjacent segment, which will promote the disc recovery of operated segment and prevent degeneration of adjacent segment.