To provide anatomical evidences for the blood supply compound flap based on fibular head to rebuild internal malleolus. Methods The morphology of vessels and bones in donor site and in recipient site was observed. The materials for the study were l isted as follows: ① Forty desiccative adult tibias (20 left and 20 right respectively) were used to measure the basilar width, middle thickness, anterior length, posterior length and introversion angle of internal malleolus; ② Forty desiccative adult fibulas (20 left and 20 right respectively) were used to measure the middle width and thickness, as well as the extraversion angle of articular surface of fibular head; ③ Thirty adult lower l imb specimens which perfused with red rubber were used to observe the blood supply relationships between the anterior tibial recurrent vessels and fibular head, and internal anterior malleolar vessels inside recipient site. Results The internal malleolus had a basilar width of (2.6 ± 0.2) cm, a middle thickness of (1.3 ± 0.2) cm, an anterior length of (1.4 ± 1.9) cm and a posterior length of (0.6 ± 0.1) cm. Its articular facet was half-moon. Its introversion angle was (11.89 ± 3.60)°. The fibular head had a middle thickness of (1.8 ± 0.6) cm, a middle width of (2.7 ± 0.4) cm. Its articular facet was toroid, superficial and cavate in shape, and exposed inwardsly and upwardsly, and had a extraversion angel of (39.2 ± 1.3)°. The anterior tibial recurrent artery directly began from anterior tibial artery, accounting for 93.3%. Its initiation point was (4.5 ± 0.7) cm inferior to apex of fibular head. Its main trunk ran through the deep surface of anterior tibial muscle, and ran forwards, outwards and upwards with sticking to the lateral surface of proximal tibia. Its main trunk had a length of (0.5 ±0.2) cm and a outer diameter of (2.0 ± 0.4) mm. Its accompanying veins, which had outer diameters of (2.1 ± 0.5) mm and (2.6 ± 0.4) mm, entry into anterior tibial vein. It constantly gave 1-2 fibular head branches which had a outer diameter of (1.7 ± 1.3) mm at (1.0 ± 0.4) cm from the initiation point. The internal anterior malleolar artery which began from anterior tibial artery or dorsal pedal artery had a outer diameter of (1.6 ± 0.4) mm. Its accompanying veins had outer diameters of (1.3 ± 0.5) mm and (1.1 ± 0.4) mm. Conclusion The blood supply compound flap based on fibular head had a possibil ity to rebuild internal malleolus. Its articular facet was characterized as the important anatomical basis to rebuild internal malleolus.
Objective To study diagnosis, treatment and rebuilding of scrotum gangrene. Methods From January 1992 to September 2004, 15 patients with scrotum gangrene were treated and their clinical data were analysed.Their ages ranged from 23 to80 years. The results of bacterial culture were positive for wound sample in 14 cases and for blood in 1 case. All the patients underwent surgical treatment including incision,aggressive debridement,drainage,irrigation and antibiotic therapy. Two patients accepted hyperbaric oxygen therapy. All the patients received scrotum rebuilding by transfer of skin flap, skin grafting and suturation and orchectomy was given in 2 elder patients. Results All the patients received healing by first intention after 21 to 34 days.There was no death. Aftera follow-up of 1 to 3 years, the appearance of scotum was satisfactory and no orchiatrophy occurred. Thirteen patients with testicles had normal sexual function. Conclusion After a definite diagnosis,early aggressive debridement,broad-spectrum antibiotics and sufficient local drainage should be used. If available,hyperbaric oxygen therapy may be used to promote healing of tissue wound. Scrotum should be rebuilt based on different conditions.
Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
Objective To explore the clinical effect of different types of free tissue transplantation on repairing tissue defects and reconstructing functions. Methods From November 2001 to September 2004, 14 types of freetissue transplantation and 78 free tissue flaps were applied to repairing tissue defects and reconstructing functions in extremities and maxillofacial region in 69 cases. Of the 69 cases, there were 53 males and 16 females (their ages ranged from 18 to 56, 31 on average). Five cases were repaired because of skin defects in foot, 22 cases were repaired because of skin defects in leg, 36 cases were repaired as the result of skin defects in hand or forearm and finger reconstruction, 3 cases were restored by virtue of ulna or radius defects, and 3 cases were repaired in maxillofacial region. There were 55 cases of open wound, in which 16 cases were infectious wound, 6 cases were osteomyelitis or pyogenic arthritis. There were 14 cases of noninfectious wound. The area of these tissue flaps ranged from 2.0 cm×1.5 cm to 43.0 cm×12.0 cm. The length of bone transplantation ranged from 10 cm to 15 cm. Results Arterial crisis occurred in 2 cases, venous crisis occurred in 2 cases.Seventysix flaps survived completely and 2 flaps survived partially which werelater healed. Fiftytwo cases were healed at stageⅠ, 13 cases were healed at stageⅡ(healing time ranged from 20 to 30 days), purulent infection occurred to 4cases(healing time ranged from 3 to 11 months). Bone healing time ranged from 6 to 8 weeks in finger reconstruction. Bone healing time ranged from 4 to 6 months in fibula transplantation. The function reconstruction and appearance were satisfying. The functions of all regions, where free tissues were supplied, were not disturbed. Conclusion Tissue transplantation and composite tissue transplantation are effective in repairing tissue defects and reconstructing functions.
Objective To observe the effectiveness of traumatic dislocation of the knee joint combined with multi ple ligament injuries treated by stages. Methods Between June 2005 and November 2008, 13 cases of traumatic dislocation of the knee joint combined with multi ple ligament injuries were treated by stages, including 9 males and 4 females with an average age of 30.7 years (range, 18-54 years). The dislocations were left knee in 3 cases and right knee in 10 cases. The causes of injury were sports injury in 8 cases, traffic accident injury in 2 cases, fall ing from height injury in 2 cases, and sprain injury in 1 case. The average time from injury to hospitalization was 9 hours (range, 6 hours to 2 days ). Anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL) were involved in 8 cases; ACL, PCL, and lateral collateral ligament (LCL) in 3 cases; and ACL, PCL, MCL, and LCL in 2 cases. The valgus stress testing results of 10 knees were ++ to +++; the varus stress testing results of 5 knees were ++ to +++; all knees showed positive in the anterior or the posterior drawer test and ++ to +++ in Lachman test. The nerve, vessel, MCL, LCL, PCL, meniscus were repaired in the first operation. The functional exercise of knee joint was done after fixation for 3-4 weeks. During the second operation, the ACL was reconstrcted under arthroscopy after the range of motion (ROM) of knee joint was good with anterior instabil ity of knee within 4-6 months. Results All wounds healed by first intention after two operations; no compl ications of infection and compartment syndrome occurred. All cases were followed up 12-60 months with an average of 36 months. Joint effusion of knee occurred in 2 cases at 4 weeks after the first operation and was cured after removal of fluid. At 3 months after the second operation, the results of valgus stress testing and Lachman test were ++ in 1 case, respectively; the results of valgus stress testing, varus stress testing, and Lachman test were + in 1 case, respectively; and others showed negative results. After 12 months of the second operation, the mean flexion of the knee was 123.4° (range, 100-135°), and the mean extension of the knee was 2.3° (range, 0-4°). According to Lysholm evaluation system, 9patients got excellent results, 2 good, and 2 fair; the excellent and good rate was 84.6%. Conclusion It is an effective method in the treatment of traumatic dislocation of the knee joint combined with multi ple ligament injuries by stages.
OBJECTIVE: To investigate the method and clinical effect of temporal fascia flap, free forearm flap, free iliac bone transfer and immediate implant on reconstruction of maxillary defect. METHODS: From February 1999 to July 2002, 8 cases of maxillary defects due to excision of cancer were repaired immediately with temporal fascia flap, free forearm flap, free iliac bone transfer and implant. Out of 8 patients, there were 6 males and 2 females, aged 32-49 years, with a disease course of 3 months to 2 years. RESULTS: Free iliac bone and forearm flap survived in all 8 cases. Osseo-integration could be seen and the implants could be used for denture repair and chew function. After 6-12 months, X-ray examination showed iliac bone healing; facial shape and functional restoration were satisfactory. CONCLUSION: Temporal fascia flap, free forearm flap, free iliac bone transfer and immediate implant is an ideal method to repair maxillary defect immediately and reconstruct its function.
Objective To evaluate the results of chest wallreconstruction (CWR) in patients who underwent chest wall tumor resection accompanying huge chest wall defect. Methods From Jan. 1998 to Mar. 2003, 31 patients underwent CWR. Among them, 20 were male and 11 female. The age ranged from 8 to 72 years.The indications for resection were primary chest wall tumor in 21 patients, lung cancer with invasion of chest wall 6, recurrence of breast cancer 2, radiationnecrosis 1 and skin cancer 1. The number of rib resected was 2~7 ribs (3.6 in average). The defect was 20~220 cm2 (97.1 cm2 in average). Concomitant resectionwas done in 13 patients, including lobectomy or wedge resection of lung 10, partial resection of diaphragm 2, and partial sternectomy 1. Seven patients underwent soft tissue reconstruction alone(latissimus dorsi+greater omentum, latissimusdorsi myocutaneous flap, latissimus dorsi muscle flap), 5 patients bony reconstruction alone(Prolen web), and simultaneous BR and STR were performed in 19 patients(latissimus dorsi, pectorails major, latissimus dorsi+fascia lata, and Prolene web). Results Three patients (9.7%) developed postoperative complications. Postoperative survival period was 6~57 months with a median of 22 months. Conclusion A favorable clinical outcome can be achieved by CWR for the patients with hugechest wall defects that result from resection of chest wall tumors.
Objective To investigate the treatment and effectiveness of inferior polar comminuted fractures of patella and patellar tendon injury. Methods Between January 2003 and December 2008, 5 patients with inferior polar comminuted fractures of patella and patellar tendon injury were treated with Nitinol Patellar Concentrator and fascia lata allograft. There were 3 males and 2 females with a mean age of 33.7 years (range, 20-48 years). The interval of injury and operation was 1-5 days. Fracture degree: 3 cases had 3 fractures of patella, 2 cases had 4 fractures; patellar tendon injury degree: 3cases had horizontal rupture of middle l igament, 1 case had obl ique rupture of tibial tubercle, and 1 case had longitudinal partial rupture. Results Heal ing of incision by first intention was achieved in all patients, and no compl ication of infection or deep venous thrombosis occurred. The X-ray films at 2 days after surgery showed that patella recovered to normal height, which meaned ratio of patella height to patellar tendon length recovered to 1 : 1. Five cases were followed up 18 months on average (range, 10-22 months). At 3-12 weeks after surgery, the knee function of the injury side almost reached that of the normal side in 4 patients, and the knee range of motion was about 100° in 1 patient. The fracture heal ing time was 3-5 months. At 12-15 months after surgery, patella holder was taken out and no lost of reduction or refracture occurred. During follow-up, there was no fracture displacement, loosening and breakage of implant, or rerupture of patellar tendon. According to ZHANG Chuncai’ s criterion for knee joint function, the results were excellent in 3 cases, good in 1 cases, and fair in 1 case with an excellent and good rate of 80%. According to XU Shaoting’s criterion for knee joint function, the results were excellent in 2 cases, good in 2 cases, and fair in 1 case with an excellent and good rate of 80%. Conclusion Nitinol Patellar Concentrator and fascia lata allograft is a new method to treat inferior polar comminuted fractures of patella and patellar tendon injury, and it can ensure the knee joint stabil ity in early motion after surgery.
Objective To investigate the feasibility of bacterial cellulose patch to repair and reconstruct rabbit tracheal defect, so as to lay the foundation for the development of bacterial cellulose artificial trachea. Methods Thirty adult rabbits (weighing, 2.5-3.5 kg) were selected to establish full-thickness defect of the cervical trachea (1.0 cm×0.6 cm in size) which involved the anterior and side walls and 2-3 rings. Defect was repaired with sheet bacterial cellulose (1.2 cm in diameter and 6 layers) in experimental group (n=15), and with autologous cervical fascia in control group (n=15). The general condition of the animals was observed after operation; after 4, 8, and 12 weeks, the samples were obtained for measuring the tracheal stenosis degree, counting new microvessels, and observing lumen reconstruction situation by scanning electron microscope. Results Three rabbits died of infection, tracheal stenosis, or asphyxia caused by airway secretions retention in 2 groups respectively, and the other rabbits survived to the end of experiment. Gross observation showed that reconstruction materials gradually adhered to adjacent tissue and were enwrapped by connective tissue, small blood vessels like nutrient vessel were seen in 2 groups; no significant difference was found in the tracheal lumen stenosis degree between 2 groups (P > 0.05). Histological observation showed that the continuous growth of mucosal epithelial cells was observed near patch and anastomosis site with time, and cell morphology gradually turned mature in experimental group; while mucosal epithelial cells arranged loosely in control group. At each time point, new capillaries of experimental group were significantly more than those of control group (P < 0.05). Scanning electron microscope observation showed the continuous epithelioid cells were observed at anastomosis site with time, and gradually grew into the middle of the patch in experimental group; while less and discontinuous epithelioid cells were observed in control group. Conclusion Bacterial cellulose patch is feasible to reconstruct cervical tracheal defect in rabbits, and the new mucosa is formed early and completely, so it is expected to be used as artificial trachea material.
Objective To study the surgical resection and reconstruction methods of mal ignant melanoma on the heel. Methods Between July 2007 and June 2009, 15 cases of mal ignant melanoma on the heel were treated. There were 9 males and 6 females, aged from 32 to 71 years with a mean age of 47.2 years. Of them, 13 patients were initially treated, and 2 patients received repair after local excision. Tumor thickness was from 0.6 mm to 7.2 mm, and the size of the lesion was from 1.3 cm × 0.5 cm to 5.0 cm × 3.5 cm. According to the American Joint Committee on Cancer (AJCC) stage system, there were 1 case of IA, 2 cases of IB, 3 cases of IIA, 5 cases of IIB, 1 case of IIC, and 3 cases of III. Wide excision was performed in all cases. Defects were repaired by medial pedal skin flap (5 cases), lateral pedal skin flap (2 cases), and retrograde skin flap suppl ied by sural nutrition blood vessels (8 cases), and the flap size ranged from 7 cm × 5 cm to 12 cm × 8 cm. Inguinal lymph node dissection was performed in 3 patients. Wounds of donor site were repaired by skin graft. Results One case had marginal necrosis of lateral pedal skin flap and 2 cases had local necrosis of medial pedal skin flap on the skin graft; the other flaps and skin grafts survived and incisions healed by first intention. All patients were followed up from 12 to 36 months (mean, 21 months). Considering the recovery of the function and sense, the best result was acquired in the lateral pedal skin flap, followed by the medial pedal skin flap, and the poor result in the retrograde skin flap suppl ied by sural nutrition blood vessel. No patient had local recurrence at follow-up. Five patients had inguinal lymph node metastasis, and 1 patient died of lung metastasis. Conclusion Wide resection can provide satisfactory local control for mal ignant melanoma on the heel. Local flap can cover the wound safely, but the retrograde skin flap suppl ied by sural nutrition blood vessel has poor sensory recovery.