In recent years, flap surgery has been well-developed, and many theories and techniques of flap surgery have been updating. The purpose of manuscript which is based on the flap-related literature is to summarize recent developments of basic and clinic researches, indicate the future of the flap surgery, and show the consensus and guidelines of flap surgery made by Chinese experts.
ObjectiveTo explore the effectiveness and safety of a new temporary intravascular shunt (TIVS) device for limb injury in dogs.MethodsEighteen adult beagle dogs, male or female, weighing (20±2) kg, were taken for experiment. A semi-amputated limb model was made by circular amputating the knee joint of one hindlimb, which retained only skin, femoral artery, femoral vein, femoral nerve, and femur. Then the femoral artery was clamped for 2 hours in all animals, resulting in the ischemic environment of the distal limbs. The animals were randomly divided into 3 groups (n=6). In group A, the bypass was started by using a new TIVS device and replenishing saline through the infusion port; In group B, after intravenous injection of heparin sodium solution, the bypass was started by using a new TIVS device and replenishing 3% heparin sodium solution through the infusion port; In group C, the bypass was started by using the self-made bypass tube. The bypass was end after 12 hours. The general vital signs (body temperature, heart rate, blood pressure) before and after bypass were measured, and the time required for the insertion of the bypass tube, the patency during the bypass, shedding, and thrombosis were recorded. Routine blood test and blood coagulation indicators [white blood cell (WBC), red blood cell (RBC), platelet (PLT), hemoglobin (HGB), activated partial thromboplastin time (APTT), fibrinogen (Fib)] and biochemical indicators [lactic dehydrogenase (LDH) and creatine kinase (CK)] were recorded before bypass and after 3, 6, 9, and 12 hours of bypass, respectively. The gastrocnemius muscles on the surgical side before and after bypass were harvested and the muscle necrosis, the wet-to-dry weight ratio, and the content of malondialdehyde (MDA) and myeloperoxidase (MPO) were measured. In addition, the gastrocnemius muscle and femoral artery were observed after bypass by HE staining.ResultsThere was no significant difference in body temperature, heart rate, and blood pressure between groups before and after bypass (P>0.05). Compared with groups A and B, the time required for the insertion of the bypass tube in group C was significantly longer (P<0.05), and the number of thrombus in the bypass tube, the blockage time significantly increased (P<0.05). Shedding and sliding of bypass tube occurred in 3 cases of group C, but no shedding or sliding of bypass tube occurred in groups A and B; there was no significant difference in the incidence of shedding between groups (P=1.000). There was no significant difference (P>0.05) in routine blood test, blood coagulation indicators, LDH, CK, MPO, MDA, and wet-to-dry weight ratio between groups before bypass. After bypass, the routine blood test and blood coagulation indicators of the 3 groups did not change significantly, and the differences between groups was not significant (P>0.05); LDH and CK gradually increased (P<0.05), and group C significantly higher than groups A and B at 12 hours (P<0.05). After bypass, thrombosis was seen in the bypass tube, the distal gastrocnemius muscle necrosis occurred in group C, and the femoral artery injury was slightly heavier than that in groups A and B.ConclusionThe new TIVS device is safe and effective and has the advantages of convenient implantation, lower thrombosis rate, and less limb ischemia-reperfusion injury.
Objective To overview the effect of bacterial biofilms (BBF) on the formation of chronic osteomyel itis and the treatment measure. Methods The original articles in recent years about the relationship between BBF and chronic osteomyel itis were reviewed. Results The diagnosis and treatment of chronic osteomyel itis was very difficult, besides hyperplasia oflocal scar, poor blood supply, drug-resistant, forming of BBF also was an important reason. BBF formed on the surface of necrosis soft tissue and dead bone. Due to the protection of BBF, the bacterium were far more resistant to antimicrobial agents, which caused the recurrence of chronic osteomyel itis. The forming of BBF included three processes which were adhesion, development and maturity. As the major pathogens of chronic osteomyel itis, staphylococcus had its own characteristic. Designing therapeutic programmes according to these characteristics had become the trend of anti-infection treatment of BBF. Conclusion Although there are lots of studies on anti-biofilm due to the key factors during the forming of BBF, the most effective way of anti-biofilm is still debridement.
ObjectiveTo summarize the current researches and progress on experimental animal models of avascular necrosis of the femoral head. MethodsDomestic and international literature concerning experimental animal models of avascular necrosis of the femoral head was reviewed and analyzed. ResultsThe methods to prepare the experimental animal models of avascular necrosis of the femoral head can be mainly concluded as traumatic methods (including surgical, physical, and chemical insult), and non-traumatic methods (including steroid, lipopolysaccharide, steroid combined with lipopolysaccharide, steroid combined with horse serum, etc). Each method has both merits and demerits, yet no ideal methods have been developed. ConclusionThere are many methods to prepare the experimental animal models of avascular necrosis of the femoral head, but proper model should be selected based on the aim of research. The establishment of ideal experimental animal models needs further research in future.
Objective To summarize the research progress of the artificial wrist joint prosthesis. Methods Domestic and abroad literature concerning artificial wrist joint prosthesis was reviewed and analyzed thoroughly. Results Artificial wrist joint prosthesis has been developed to the 4th generation. The artificial wrist joint arthroplasty has advantages of pain relief and functional improvement and can achieve ideal short-term effectiveness. But there are some problems, such as loosening, subsidence, fracture, and dislocation of prosthesis. The long-term effectiveness of the 3rd and 4th generation prosthesis still need to be followed up. Conclusion The biomechanics of wrist joint is extremely complicated, which results in less application and slow development of artificial wrist joint prosthesis. Early-term effectiveness of artificial wrist joint arthroplasty is basically satisfactory, but there are still some long-term complications. So the artificial wrist joint prosthesis remains to be developed.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
Objective To investigate the basic mechanism of venous flow in reverseflow island flap. Methods Recent relevant literature on the mechanism of venous reverse flow in reverseflow island flap wereextensively reviewed. Results The mechanism of venous reverse flow was a multifactorial phenomenon. “Communicating and collateral by pass route” and “incompetent valve route” were two theories. Conclusion The two routes of venous reverse flow in reverse-flow island flap coexistand complement each other.
Objective To investigate the long-term effectiveness of Ni-Ti memory alloy tripod fixator in the treatment of Kienböck disease. Methods The clinical data of 22 patients with Kienböck disease who were treated with Ni-Ti memory alloy tripod fixator between January 2011 and September 2013 and followed up more than 10 years was retrospectively analyzed. There were 14 males and 8 females with an average age of 45 years (range, 20-64 years). The Lichtman staging was stage Ⅲb. According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, there were 6 cases of type B1, 2 cases of type B2, 10 cases of type B3, and 4 cases of type C2. The disease duration ranged from 18 to 50 months, with an average of 30.7 months. The operation time, intraoperative blood loss, and complications were recorded. Wrist height ratio and scapholunate angle were measured by wrist anteroposterior and lateral X-ray films before and after operation. The grip strength of bilateral hands was measured by Jamar dynamometer. The wrist pain was evaluated by visual analogue scale (VAS) score, and the wrist function was evaluated by Mayo score, and the radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion of wrist were measured. Results The operation time was 45-60 minutes, with an average of 52.21 minutes; the intraoperative blood loss was 50-60 mL, with an average of 58.63 mL. No nerve or blood vessel injury occurred during operation. All patients were followed up 10-13 years (mean, 11.3 years). X-ray films at 3 months after operation showed that the density of lunate bone was lower than that before operation. Satisfactory fusion of the scapho-trapezio-trapezoeid joint was achieved at 3-6 months after operation (mean, 4.5 months), and the wrist height ratio and the scapholunate angle after fusion significantly improved when compared with those before operation (P<0.05). Wrist pain relieved, scaphoid rotation and dislocation improved, and no radiocarpal joint degeneration was found during follow-up, and no internal fixator loosening, breakage, or lunate bone necrosis occurred. At last follow-up, the wrist radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion, VAS score, and grip strength of the affected side significantly improved when compared with those before operation (P<0.05); the grip strength of the affected side recovered to 99.00%±1.25% of the healthy side. Mayo score ranged from 72 to 93, with an average of 85; 14 cases were rated as excellent, 5 good, and 3 satisfactory, the excellent and good rate was 86.4%. ConclusionIn the treatment of stage Ⅲb Kienböck’s disease, the scapho-trapezio-trapezoeid joint usion using Ni-Ti memory alloy tripod fixator can effectively reduce pain, improve hand function, and prevent further deterioration, and achieve good long-term effectiveness.
Objective To investigate the safety and efficacy of a new biodegradable magnesium internal fixation screw for vascularized iliac bone flap grafting in treatment of osteonecrosis of the femoral head (ONFH). Methods Patients with ONFH admitted between July 2020 and February 2021 were selected as the research objects, and 20 patients (20 hips) met the selection criteria and were included in the study. The patients were divided into two groups (n=10) by central random method. The iliac bone flap was fixed with a new biodegradable magnesium internal fixation screw in the trial group, and the iliac bone flap was wedged directly in the control group. There was no significant difference (P>0.05) in gender, age, and side, type, Association Research Circulation Osseous (ARCO) stage, and disease duration of ONFH between the two groups. The operation time and intraoperative blood loss of the two groups were recorded. Laboratory tests were performed at each time point before and after operation, including white blood cell (WBC), electrolytes (K, Ca, P, Mg), blood urea nitrogen (BUN), serum creatinine (Scr), glomerular filtration rate (eGFR), lymphocyte ratio (CD4/CD8), immunoglobulin G (IgG), IgM, alanine transaminase (ALT), aspartate aminotransferase (AST). After operation, Harris score was used to evaluate the hip joint function. CT of the hip joint and X-ray films in anteroposterior and frog positions of the pelvis were used to review the iliac bone flap position, fusion, and screw biodegradation in the trial group. Results The vital signs of the two groups were stable, the incisions healed by first intention, and no adverse events occurred after operation. One patient in the control group refused to return to the hospital for follow-up at 3 months after operation, and 1 patient in the trial group refused to return to the hospital for follow-up at 1 year after operation. The rest of the patients completed the follow-up at 2 weeks, 3 months, 6 months, and 1 year after operation. Laboratory tests showed that there was no significant difference in WBC, electrolytes (K, Ca, P, Mg), BUN, Scr, eGFR, CD4/CD8, IgG, IgM, ALT, and AST between the two groups at each time point before and after operation (P>0.05). The operation time and intraoperative blood loss of the trial group were significantly less than those of the control group (P<0.05). The Harris scores of the two groups at 1 year significantly increased when compared with the values before operation and at 6 months after operation (P<0.05). There was no significant difference in Harris score between the two groups at each time point (P>0.05). Postoperative CT of hip joint and X-ray films of pelvis showed that the iliac bone flap reached osseous fusion with the fenestration of the head and neck junction of femoral head in the two groups at 1 year after operation, and no loosening or shedding of iliac bone flap was observed during follow-up. In the trial group, there were signs of dissolution and absorption of the new biodegradable magnesium internal fixation screws after operation, and the diameter of the screws gradually decreased (P<0.05); no screw breakage or detachment occurred during follow-up. Conclusion In the treatment of ONFH with vascularized iliac bone flap grafting, the new biodegradable magnesium internal fixation screws can fix the iliac bone flap firmly. Compared with the traditional iliac bone flap wedging directly, it has a shorter operation time, less intraoperative blood loss, and can obtain similar joint function.