BACKGROUND:The most advanced and representative diagnosis techniques for perforating branch of blood vessels include digital subtraction angiography, CT, MRI and other imaging techniques. These methods can visualize blood vessels clearly and have a high precision, but there are some trauma and less popular.
OBJECTIVE:To apply high-frequency ultrasound for detection of thoracic dorsal artery and perforating branch, and provide a reference for preoperative design of thoracic dorsal artery perforating flap.
METHODFifteen patients candidate for thoracic dorsal artery perforating flap were included in this study. Before surgery, we used high-frequency ultrasound to detect the perforating branch, including vascular contorts, diameter, the location of the perforators and surface markers. The thick, superficial, paral el perforating branch was selected as the main blood vessels, to design and cur the skin flap.
RESULTS AND CONCLUSION:In the involved 15 cases, thoracic dorsal artery were derived from the subscapular artery, thoracic dorsal artery and its main branches, as wel as more than 1 mm main perforating branch in 13 cases were clearly visible. It was consistent with intraoperative measurement results. The perforating branch less than 1 mm only showed strip-like blood flow signal or no blood flow and spectrum signal, and there was an unclear boundary to surrounding tissue. One case appeared distortion and variation of blood vessels before surgery, thus changed to other surgery. Two cases had no perforating branch by preoperative detection, which was then confirmed by intraoperative anatomy. High-frequency ultrasound has a significant effect on preoperative position of perforating branch, and the combination with computer tomography angiography and magnetic resonance angiography can support a more comprehensive and reliable reference.

Objective To investigate the brachial plexus injury patients regional and national characteristics,epidemiological characteristics.Methods Reference to foreign brachial plexus injury epidemiology survey methodology,retrospective analysis of five representative hospitalsthe trauma center in Urumqi,Xinjiang during January 2010 and May 2013 were treated 166 cases of patients with brachial plexus injury medical records.Results The incidence rate of brachial plexus injury was 1.17％ in this 5 trauma center.From 20 to 49 age group accounted for 69.87％,the ratio of male to female was 4.53:1.Workers and farmers accounted for 51.8％,Uygur,Han accounted for respectively 62.04％,24.69％.Kashi,Aksu,Urumqi accounted for respectively 22.89％,12.04％,8.43％.Motor vehicle accidents,high-altitude fall injury and injuries caused by birth trauma accounted for respectively 33.73％,31.92％ and 9.67％.Injury type:root,trunk,bundle/bundle branch injury cases accounted for respectively 28.91％,27.10％,40.36％.Conclusion Brachial plexus injury occurs mainly in young men with low income,motor vehicle accidents,and high-altitude fall injury are dangerous injury factors,different nationalities,different areas occurs constitutes obvious difference,neonatal birth trauma caused by brachial plexus injury constitute relatively high.

BACKGROUND:Vacuum sealing drainage is currently considered as a safe and effective for fasciotomy wounds in the treatment of compartment syndrome. But the wounds after treatment are often not self-closed, which needs skin grafts that can cause secondary injury. Studies have shown that shoelaces technology is useful for leg fasciotomy wounds in the surgical treatment of lower leg compartment syndrome, but so far there are few domestic reports. OBJECTIVE:To compare the vacuum sealing drainage and shoelace technique for treatment of leg fasciotomy wounds. METHODS:A total of 36 patients, with 46 leg fasciotomy wounds, were randomized into vacuum sealing drainage and shoelace technique groups, 23 wounds in each group. In the vacuum sealing drainage group, patients were subjected to vacuum sealing drainage after fasciotomy based on fracture reduction and external fixation;in the shoelace technique group, the fasciotomy wounds were covered with polyethylene/ethanol hydrated seaweed salt foam fol owed by shoelace technique. After 1 month, wound size, wound closure time, infection, further intervention and daily treatment cost were compared between the two groups. RESULTS AND CONCLUSION: Wound closure time was significantly higher in the vacuum sealing drainage group compared to the shoelace technique group (P < 0.05). Eight wounds in the vacuum sealing drainage group required skin grafts; while, no skin graft was necessary in the shoelace technique group. In the shoelace technique group, the vessel loops had to be replaced in five wounds. There was no wound infection, increased compartment pressure and skin flap necrosis postoperatively in both two groups. Both vacuum sealing drainage and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. Vacuum sealing drainage requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required.

Objective: To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C₇) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation. Methods: A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C₇ transfer from September, 2004 to December, 2014. Among them, contralateral C₇ were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases. The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery. Results: All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C₇ transferred to the median nerve group, 10 cases had muscle strength recovered≥M₃, and 26 cases had sensory recovered≥S₃; In the group of C₇ transferred to the radial nerve, 6 cases had muscle strength recovered≥M₃, and 9 cases had sensory recovered ≥S₃; In the group of C₇ transferred to the musculocutaneous nerve, 12 cases had muscle strength recovered≥M₃, and 17 cases had sensory recovered≥S₃. In the group of C₇ simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M₃, 5 cases had elbow flexion recovered≥M₃, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S₃, respectively. Conclusion Contralateral C₇ transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.

Objective To study the clinical efficacy of two-stage bone transport combined with induced membrane technique in the treatment of post-traumatic tibial osteomyelitis.Methods A retrospective study was conducted of the 14 patients with post-traumatic tibial osteomyelitis who had been treated by two-stage bone transport combined with induced membrane technique from February 2009 to August 2015.They were 12 males and 2 females,aged from 26 to 59 years (average,40.4 years).By the Cierny & Mader classification,they all belonged to type Ⅳ.Their disease course ranged from 6 to 30 months,averaging 15.3 months.The number of their previous operations ranged from 2 to 6 times,averaging 3.3 times.In the first stage of operation,tibial extended external fixation was installed according to preoperative design,followed by early debridement and extensive removal of osteomyelitis lesion.The length of bone defect after resection of osteomyelitis lesion was from 4 to 18 cm (average,8.5 cm).10％ vancomycin-contained polymethyl methacrylate (PMMA) bone cement was molded and placed in the bone defects.In the second stage of operation,the PMMA-induced membrane was opened to remove the PMMA bone cement,the bone marrow was drilled through and the induced membrane was then sutured up.Tibial osteotomy was conducted at an appropriate part.The average interval between the first and second stages was from 4 to 7 weeks (average,4.8 weeks).The clinical efficacy was evaluated according to the Paley criteria at final follow-ups.Complications were recorded.Results All the patients were followed up for 15 to 50 months (17.5 months).No relapse of osteomyelitis occurred.The total treatment time ranged from 11 to 19 months,with an average of 14.7 months.The total time for external fixation was from 10 to 18 months,averaging 13.2 months.The external fixator indexes ranged from 31 to 75 day/cm,with an average of 48.5 day/cm.According to Paley criteria at final follow-ups,the clinical efficacy was excellent in 11 and good in 3 cases.Pin tract infection occurred in 9 patients,mal-alignment after removal of external fixation in 6,and malunion or nonunion at the docking site in 5.Conclusions Two-stage bone transport combined with induced membrane technique can cure thoroughly post-traumatic tibial osteomyelitis.Its operation procedures are simple but effective.

Objective:To investigate the clinical effect of vascularised free fibula transfer in the treatment of infectious bone defects after the surgery of proximal and distal femoral fractures.Methods:The clinical data of 27 patients with femoral bone defects treated by vascularised free fibulae grafting with fibular artery and vein as pedicle from December 2010 to December 2022 were retrospectively analysed in the Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University. There were 21 males and 6 females, at 17-72 years old, with a mean age of 41.7 years old. Twenty-one patients had bone defect of right femurs and 6 of left femurs. The length of bone defect ranged from 5.0 cm to 9.0 cm, with an average of 6.6 cm. The length of transferred fibulae ranged from 5.0 cm to 14.0 cm, with an average of 6.8 cm. Donor sites were carefully sutured layer by layer, and standardised antibiotic therapy was given before and after surgery. X-ray reviews of the affected limbs were taken at 1, 3, 6, 12, 18 and 24 months after surgery to observe the healing of the transferred fibulae and femurs to evaluate the time for full weight-bearing and removal of external frames. Before discharge, the patients were instructed to carry out pin tract care for prevention of infection. The psychological status of the patients was monitored at outpatient clinic or telephone interviews, and the functional recovery of the affected limbs was assessed using the Enneking lower limb function scoring system.Results:All of 27 patients were included in the postoperative follow-up from 19 months to 34 months, with a mean time of 26.1 months. The transferred fibulae survived with bone union. The bone healing time was from 5.1 months to 8.8 months, with an average of 7.1 months. Twenty-five patients had primary healing of the recipient site wound, and 2 patients had a sinus formed at the orifice of drainage with secretion, and the results of bacterial culture were negative. The sinuses healed after cleaning and dressing change at outpatient clinic. No stress fracture was observed from the transferred fibulae in all patients, as well as no recurrence of infection at recipient sites. The Enneking lower limb function score at the final follow-up ranged from 22 points to 27 points, with an average of 23.7 points.Conclusion:Anastomosis of vascularised free fibula in bone transfer is a feasible method to reconstruct the infected bone defects after proximal and distal femoral fractures. It provides reliable fixation and satisfactory bone healing for bone defects and facilitates the healing of transferred fibula and the recovery of lower limb function.

To investigate the role of the bionic multi-channel nerve conduit by reducing mis-match of regenerated nerve fibers in the rabbit sciatic nerve defect. Methods The experiment was conducted from July, 2017 to February, 2019. A total of 55 New Zealand white rabbits were randomly divided into two groups (First group, n=30 and Second group, n=25).There were 5 subgroups (n=6) in the first group, which were autograft and cus-tom-anatomic nerve conduits (CANC) with different channel (1-CANC, 2-CANC, 3-CANC, 4-CANC) that implanted to repair the rabbit sciatic nerve defect (10 mm). The electrophysiological, triceps muscle wet weight recovery rate, histological study and ankle index analysis were used to evaluate the treatment of each group at 12 and 24 weeks postoperatively. There were 5 subgroups (n=5) in the second group. The simultaneous retrograde tracing method was applied to compare with the number of mismatched nerve fibers at 24 weeks postoperatively. All data were recorded and analyzed by One-way ANOVA method, the Turkey’s method was used to compare the differences between each subgroup. The difference was considered to be statistically significant if P＜0.05. Results The autograft group showed the best recovery in the electrophysiology, histology study and ankle index at 12 and 24 weeks postoperatively (P＜0.05).Histology results showed that the same number of myelinated nerve fibers in all CANC group (P＞0.05), but di-ameters of nerve fiber and myelin thickness were higher in 2-CANC and 3-CANC [(10.67±0.56) μm,(10.65±0.53) μm, respectively] compared with 1-CANC and 4-CANC groups [(8.43±0.63) μm, (9.03±0.55) μm, respectively].The differ-ences were similar in electrophysiological, wet weight recovery rate of triceps muscle, histological study and ankle index analysis.Simultaneous retrograde tracing showed that the autograft group had highest total number of labeled profiles, but no significant difference of the total number of labeled profile was showed among the CANC groups. However, the 1-CANC group[(7.1±2.4) %] showed highest percentage of the FB-NY-neurons than other CANC groups[(2.7±1.9)% in 2-CANC, (2.5±2.3) % in 3-CANC, and (2.2±1.2)% in 4-CANC](P＜0.05). Conclusion The autograft group showed the best results among all groups.Compared with the 1-CANC group, the 2-CANC and 3-CANC group obtained more mature regenerated nerve fibers and with a fewer mismatch rate.Moreover, that did not affect the number of regenerated fibers.

Objective:To investigate the clinical effect of two types of free gracilis musculocutaneous flap in transverse or vertical for reconstruction of the complex wound in calf.Methods:A retrospective series case study was conducted to analyse the clinical data of 22 patients who were treated in the Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University for complex single wounds in calf from August 2019 to January 2023. The patients were 12 males and 10 females and aged 26-58 years old, with 46.7 years old in average. There were 12 wounds on the left calf and 10 on the right. Nine of the wounds were of car accident, 8 of iatrogenic complications, 3 of bone infection and 2 of tumour resection. The wounds sized at 10.0 cm× 5.0 cm - 15.0 cm×7.0 cm. Sixteen transverse gracilis myocutaneous flaps and 6 vertical gracilis myocutaneous flaps were designed and harvested to reconstruct complex wounds in calf. The flaps were 12.0 cm×6.0 cm - 22.0 cm×9.0 cm in size. Time for the gracilis myocutaneous flap harvesting and the time for whole surgery were recorded. The time for flap harvest was 40-60 minutes and the time for the whole surgery was 3- 5 hours. Flap donor sites were directly sutured. All patients were included in the regular postoperative follow-up at outpatient clinic or through telephone and WeChat interviews and the flap survival, long-term flap appearance, healing of donor and recipient sites and limb functions were observed.Results:All 22 flaps survived after surgery. One flap had a blue edge with blood oozing. Urgent surgical exploration revealed that embolization occurred at the anastomotic site between the great saphenous vein at the proximal end of the flap and the great saphenous vein at the recipient site. After removal of the thrombus, the veins were re-anastomosed and flap survived. All the donor sites healed in stage one and functioned well. All patients entered postoperative follow-up for 5-25 months, 14.42 months in average. The flaps were in satisfactory appearance with good texture. All recipient sites healed without complication. The infected wounds were controlled. Function of the limbs was evaluated according to the Punor functional assessment criteria with excellent for 15 patients, good for 5 and fair for 2.Conclusion:Application of free transverse and vertical layout of gracilis musculocutaneous flap is an effective method to reconstruct a complex wound in calf. The anastomosis of the great saphenous vein at the proximal end of the gracilis muscle flap with great saphenous vein or small saphenous vein at the recipient site can reduce the occurrence of venous occlusion.