Objective To compare the long-term results andpossible complications of a modified temporalis muscle transfer(TMT) with the Johnson’s procedure in correction of paralytic lagophthalmos.Methods FromSeptember 1997 to March 2000, paralytic lagophthalmos due to leprosy in 92 patients were corrected with TMT. The 89 cases (127 to eyes including 51 unilateral and 38 bilateral) followed up 3 years after operation were analyzed. There were 69 males and 20 females with ages ranging from 18 to 65 years (52 years on average). The duration of lagophthalmos was 1-22 years with an average of 8.2 years.And 36 eyes were complicated with lower eyelid ectropion. Sixtyfive eyes were corrected with Johnson’s procedure(Johnson’s TMT group), 62 with the modified TMT procedure (modified TMT group). The modifications were as follows: ① omitting the fascial strip in the lower eyelid to avoid postoperative ectropion. ② fixing the fascial strip of the upper eyelid to the middle or inner margin of the tarsal palate depending on the degree of the lagophthalmos to avoid possible ptosis of the upper eyelid. Results In Johnson’s TMT group, the mean lid gap on light closure was reduced to 3.1 mm postoperatively from 7.7 mm preoperatively; and the mean lid gap on tight closure was reduced to 0.5 mm postoperatively from 6.1 mm preoperatively. The symptoms of redness (73.7%) and tearing(63.7%) disappeared or were improved postoperatively. However, ectropion and ptosis occurred in 24 eyes and 9 eyes respectively. The overall excellent and goodrate was 58.5%. In the modified TMT group, the mean lid gap on light closure was reduced to 3.3 mm postoperatively from 7.5 mm preoperatively; and the mean lidgap on tight closure was reduced to 0.6 mm postoperatively from 6.3 mm preoperatively. The symptoms of redness (90.9%) and tearing (71.0%) disappeared or wereimproved postoperatively, and no ectropion or ptosis was found except one ectropion. The overall excellent and good rate was 87.1%, which was significantly higher than that of Johnson’s group(Plt;0.01). Conclusion The modified TMT is an efficiency and simple procedure with very few complications, and thus is bly recommended for use when TMT is an indication.
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 repairing result for the massive bony defects of upper and middle tibia and lower femur. METHODS: Since 1974, four types of pedicled-fibula transposition were performed to repair the massive bone defect of tibia and femur in 25 cases, which included; 9 cases with benign tumor of upper part of tibia were performed muscle-pedicled fibula transposition and knee fusion after tumor resection; 9 cases with extensive benign tumor or tumoroid lesion of tibia shaft were performed muscle-pedicled fibula transposition and tibia-fibula fusion after tumor resection; 2 cases with extensive benign tumor or tumoroid lesion of middle and lower parts of tibia were performed vascular pedicled fibula transposition and tibia-fibula fusion; 5 cases with benign tumor of distal femur were performed vascular pedicled fibula reversal transposition and knee fusion. RESULTS: After 3 months to 11 years follow-up, 23 cases showed bone healing at 6 months postoperatively. The other 2 cases showed bone healing at 12 months postoperatively. All cases had satisfactory functional rehabilitation. CONCLUSION: Pedicled-fibula transposition is a choice method for repairing massive defects of tibia and femur.
From March 1991 to October 1993, 6 the latissimus dorsi M. was transferred to reconstruct the flexor of the elbow following the injury of brachial plexus in 12 cases (8 males and 4 females). The average age was 31-year-old (6to 45-year-old). The patients were followed up for six months to two years. All of musculocutaneous flaps were survived. The contour of the upper arm was satisfactory. In 8 cases, the muscle strength was more than grade 4 and the active motion of the elbow was 135 degrees in flexion and 10 degrees in extension. The elbow could lift the load of l0kg. In 2 cases, the muscle strength was grade 4 and the active movement was 25 degrees in flexion and 25 degrees in extension. On 90 degrees flexion, the elbow could lift the load of 3kg. In 2 cases, the muscle strength was grade 3 and the active movement of elbow was 100 degrees in flexion 25 degrees in extension. Following the irreversible injury of the brachial plexus, the atrophy of the muscles was obvious. After the transfer of musculocutaneous flap, the circumference of the arm was increased while the tenseness of the skin was decreased. This faciliated the movement of the transferred muscle, improved the appearance of the upper limb and was convenient to observe the blood supply of the flap. When the brachial plexus was injuried at the root level, the latissimus dorsi M. was atrophied, after transfer of the nerve to the muscle, the function of the muscle recovered, then the tranferred muscle could be transferred to reconstruct the flexor of the elbow.
OBJECTIVE In order to inquire the methods of thumb reconstruction by transferring the index finger with incomplete conditions of nerve or blood vessels. METHODS From April 1987 to October 1997, 6 cases were treated by 3 kinds of operative methods according to the damage type of thumb and complications injures of the rest of hand: 1. transferring the index finger with pedicle without proximal phalanx, 2. transferring the index finger with palmar nerve and blood vessels, and dorsal skin pedicle, 3. transferring the index finger with compound pedicle. RESULTS All 6 cases of thumb reconstruction were successful. Followed up 6 months to 2 years, the pinching and gribing functions in 6 cases were completely recovered, and the sensation were partly recovered. CONCLUSION The operative method of thumb reconstruction had following advantages: Simple operation, high survival rate and certain function recovery. It can enlarge the indications of thumb reconstruction.
【Abstract】 Objective To investigate the relationships between residual displacement of weight-bearing and non weight-bearing zones (gap displacement and step displacement) and hip function by analyzing the CT images after reconstruction of acetabular fractures. Methods The CT measures and clinical outcome were retrospectively analyzed from 48 patients with displaced acetabular fracture between June 2004 and June 2009. All patients were treated by open reduction and internal fixation, and were followed up 24 to 72 months (mean, 36 months); all fractures healed after operation. The residual displacement involved the weight-bearing zone in 30 cases (weight-bearing group), and involved the non weight-bearing zone in 18 cases (non weight-bearing group). The clinical outcomes were evaluated by Merle d’Aubigné-Postel criteria, and the reduction of articular surface by CT images, including the maximums of two indexes (gap displacement and step displacement). All the data were analyzed in accordance with the Spearman rank correlation coefficient analysis. Results There was b negative correlation between the hip function and the residual displacement values in weight-bearing group (rs= — 0.722, P=0.001). But there was no correlation between the hip function and the residual displacement values in non weight-bearing group (rs=0.481, P=0.059). The results of clinical follow-up were similar to the correlation analysis results. In weight-bearing group, the hip function had b negative correlation with step displacement (rs= — 0.825, P=0.002), but it had no correlation with gap displacement (rs=0.577, P=0.134). Conclusion In patients with acetabular fracture, the hip function has correlation not only with the extent of the residual displacement but also with the location of the residual displacement, so the residual displacement of weight-bearing zone is a key factor to affect the hip function. In patients with residual displacement in weight-bearing zone, the bigger the step displacement is, the worse the hip function is.
Objective To estimate clinical effect ofspin iliac deep vascular pedicled periosteum flap in repairing traumatic femoral neck of theca inside fracture in young and middleaged. Methods From April 1993 to September 2001, 12 cases of traumatic femoral neck fracture were given diaplastic operation with fixation of 3 centre hollow pressed bolt and were conducted under os traction bed and "C" arm X-ray machine. Spin iliac deep vascular pedicled periosteum flap wasstripped off, and transferred to the front of femoral neck fundus，then transplanted to the narrow inside of fracture through outer open door of articular capsule.Results All patients were followed up for 17 years. All fracture healedwithout femoral head necrosis, but mild arthritis appeared in 7 cases.Conclusion Vascular pedicled periosteum flap transfer of young and middle-aged femoral neck fracture, by decompression of femoral neck and reconstruction of blood circulation, can promote the fracture healing and decrease the wound and blood circulation destroy.