Objective To investigate the effect of staging treatment for diabetic leg ulcer by vacuum sealing drainage surgery (VSD) combined with perforator flap.Methods From Aug.2013 to Aug.2015,21 patients (in glycemic stability) with diabetic leg ulcer received the sustained VSD suction after a thorough debridement at the first phase and used perforator flap to repair the wound at second phase.Results After a thorough debridement and the sustained VSD suction,all the wounds were repaired with perforator flaps at the second phase.Postoperative flaps of 19 cases survived completely.Postoperative flaps of 2 cases appeared 1/4-1/5 area necrosis of distal flap and healed well after clear debridement.All patients were followed up in glycemic stability and all the flaps survived well without complications such as osteomyelitis and soft tissue infection.Conclusion Based on glycemic stability,VSD combined perforator flap in treatment of diabetic leg ulcers can control the infection and wound closure,which is worthy of clinical application and promotion.

Objective To investigate the clinical efficiency of applying tibial artery perforator flap to treat anterior medial incision poor healing one-stage after Pilon fracture.Methods From June,2012 to August,2015,13 cases of anterior medial incision poor healing after Pilon fracture,with tendon or plate exposure in patients and without acute infection,treated by tibial artery perforator flap to repair wound one-stage after thorough debridement.Results All the wounds were repaired by tibial artery perforator flap after a thorough debridement.There was flap necrosis in distal 1/3 part of flap in 1 case,which gained healing after debridement and skingrafting.The remaining 12 cases of flaps survived well.All patients were followed up for 5-14 months (mean 9.8 months),the flaps or skin grafts survived well,without tissue infection,osteomyelitis and other complication,and the functional recovery of the ankle was basically normal.Conclusion It is a simple and effective method by using posterior tibial artery perforator flap to treat anterior medial incision poor healing one-stage with non-acute infection after Pilon fracture on the basis of thorough debridement,worthy of clinical application and promotion.

Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.

Objective To analyze the reason of post-operative infection of tibial plateau fracture, the therapeutic effect of using pedicle musculocutaneous flaps of proximal leg was researched and summarized. Methods There were 52 patients of tibial plateau fracture after internal fixation complicated by disunion of infected wound and soft tissue defects, traumatic osteomyelitis from January 2005 to May 2009. After pre-operative physical examination, laboratory examination, X-ray, CT scan and bacterial culture of the secretion,the operation, such as debridement, dead bone moving, medullary cavity cleaning, transferring to the external fixation when the internal fixation lost efficacy and bacterial culture of granulation tissue of different levels. The cavity was filled with RBK combined with vancomycin or tobramycin. If the cavity was rather large, autografts from the iliac bone were combined. The tissue defects were covered with pedicle musculocutaneous flaps of proximal leg, and the wound had effective drainage. The antibiotic was used for 3-4 weeks, and the X-rays were given at fixed period until the fracture was cured. Results The soft tissue defects of all 52 patients were repaired well. They were followed from 1 year to 5 years, and the time of bone union ranged from 4 months to 1 year. Two patients of osteomyelitis had a relapse after 3,4 months, then they were cured by the second operation. Three patients had unhealed fracture after 6 months, then they were cured by bone grafting again after 4-6 months. Conclusion Patients of tibial plateau fracture after internal fixation complicated by disunion of infected wound and soft tissue defects, traumatic osteomyelitis should be cured by comprehensive treatments, one of the crucial treatment for success is using pedicle musculocutaneous flaps of proximal leg to fill in lacuna, close wound, improve the local blood supply and promote bone union.

Objective: To summarize and explore the clinical effect and application of L-shaped flap pedicled with peroneal artery perforator in the treatment of unhealed lateral L-shaped incision after calcaneal fractures. Methods: From October 2013 to March 2015, 17 patients with unhealed L-shaped incision after calcaneal fractures were treated with one-stage thorough debridement, artificial bone filling with antibiotics-laden calcium sulphate and L-shaped flap pedicled with peroneal artery. Flap areas ranged from 8 cm × 2 cm to 11 cm × 3 cm. Donor sites are primarily sutured. Results: All 17 patients were followed up for 6 to 18 months with an average of 11.5 months. All patients with infection were cured effectively, demonstrating well survived flaps with normal elasticity and pigmentation, no scar contracture, satisfactory appearance and normal ankle joint motility. Conclusions L-shaped flap pedicled with peroneal artery perforator was an effective method in the treatment of unhealed lateral L-shaped incision after calcaneal fractures. It was suitable for coverage of the unhealed wound and worthy of being popularized.

Objective:To investigate the clinical efficiency of gastrocnemius muscle flap combined with antibiotics loaded calcium sulfate in the treatment of postoperative infection and plate exposure of tibial plateau fracture in elderly patients.Methods:From January, 2015 to May, 2019, 21 elderly patients with postoperative infection and plate exposure of tibial plateau fracture were treated, including 14 males and 7 females with an average age of 72.6 years, ranging from 61 to 82 years. The average course of disease was 22.7 days, ranging from 6 to 91 days. The site of wound infection was at medial in 8 cases, lateral in 9 cases and bilateral in 4 cases. The size of wound ranged from 2.0 cm×3.5 cm to 5.0 cm×12.0 cm. All wounds were implanted with antibiotics loaded calcium sulfate and repaired by gastrocnemius muscle flap combined with skin graft after debridement. Muscle flap survival, wound healing, inflammatory index, fracture healing and knee joint function were recorded. The curative effect was evaluated by McKee infection treatment criteria and the knee joint function was evaluated by HSS scoring criteria.Results:All 21 muscle flaps survived. In 1 case, skin graft necrosis occurred in a small area, and the wound healed well after dressing change. One case had exudation which was clear and the bacterial culturing was negative, and the wound healed after 2 weeks of dressing change. The other incisions were healed in stage I, and the healing rate was 90%. All patients were followed-up for an average of 28.7(16-39) months. The redness and swelling occurred in 1 case without exudation after 2 months which disappeared after anti-infection treatment and didn't recur again. The infection recurred in 1 case after 5 months, and it which was controlled after debridement and plate removal. According to McKee criteria, 19 cases were cured, 1 improved and 1 recurred with an effective rate of 95.2%. The fracture healing time was from 3 to 7 months, with an average of 4.6 months. According to HSS scoring criteria, the knee joint function was excellent in 12 cases, good in 7 cases and moderate in 2 cases.Conclusion:After thorough debridement, gastrocnemius muscle flap combined with antibiotic loaded calcium sulfate can effectively control the infection, repair the wound, promote fracture union and restore limb function in the treatment of postoperative infection and plate exposure of tibial plateau fracture in elderly patients.

Objective To explore the curative efficacy of treating tibial transport gap fracture after bone transport by external fixation with locking compression plate(LCP) and autologous iliac grafting.Methods From February 2015 to January 2016,9 patients who had sustained tibial transport gap fracture after bone transport were treated by LCP external fixation and autologous iliac grafting.They were 7 men and 2 women,aged from 26 to 56 years (average,40.2 years).One of them received bone transport because of limb shortness after replantation and others did because of traumatic osteomyelitis.The distances of tibial transport averaged 9.2 cm (from 7 to 12 cm);the time for external fixation averaged 20.1 months (from 13 to 25 months);the time from removal of external fixator to gap fracture averaged 1.8 weeks (from 1 to 3 weeks).Two patients were complicated with docking site fracture.The durations from gap fracture to operation averaged 4.1 days (from 3 to 5 days).Five patients sustained angular deformity of various severities which could not be corrected by surgery.The curative efficacy was evaluated according to conventional criteria for fracture healing.Results The 9 patients were followed up for 11 to 15 months (average,13.1 months).The time for LCP external fixation averaged 9.0 months (from 8 to 10 months);the time for fracture union averaged 4.6 months (from 4 to 5 months).The 5 patients with angular deformity obtained fracture malunion which did not obviously affect their limb appearance.One case suffered extensive cellulitis at the leg which responded to intravenous administration of antibiotics.No pin track infection happened.The knee and ankle functions after removal of LCP external fixation were not significantly different from those after removal of external fixator following bone transport.Wounds at the iliac donor site and bone graft area all healed well.Conclusions LCP external fixation is an effective treatment for tibial transport gap fracture after bone transport,due to its stable fixation,limited injury to soft tissues,positive curative efficacy and miniature size as well.However,it requires sophisticated operative skills and demanding postoperative care.

Chronic osteomyelitis is a serious clinical problem with repeated courses and high disability rate, which seriously affects the physical and mental health of patients. Through continuous learning and summary in the process of using traditional therapies, the innovative improvements and changes had made in the treatment of osteomyelitis: Radical debridement of lesions was performed by applying the basic principles of modern bone tumor surgery. The application of microsurgical technique to transfer composite tissue flap can provide guarantee for tissue defect repair and wound closure without tension. Combined with bone grafting, local antibiotics and bone fixation, an one-stage operation has significantly improve the therapeutic effect of chronic complex osteomyelitis.

Objective To prepare biomimetic bone material by reconstructing type Ⅰ collagen combined with polyaspartic acid. Methods By acid hydrolysis,rat tail type Ⅰ collagen was decomposed into collagen fibers,which were then placed in the calcium phosphate mineralization solution. Under the cross-linking of glutaraldehyde,the collagen fibers were reconstructed and assembled into collagen fibers,and the calcium phosphate crystals were wrapped in the inner side of the collagen fibers for biomineralizationin. After poly aspartate acid was added,calcium hydroxyapatite calcium precursor was added into the collagen fibers to simulate thebiomimetic biomineralizationin the human body. After mineralization for 3-9 days,the bone mineralization process was observed by transmission electron microscopy and electron diffraction. Results Transmission electron microscopy and electron diffraction displayed that,after 3 days of mineralization,calcium hydroxyapatite precursor was wrapped in the collagen fiber gap,and the collagen fiber was partially mineralized. After 9 days of mineralization,calcium hydroxyapatite precursor completely infiltrated into the collagen fiber,and the amorphous calcium phosphate was transformed into hydroxyapatite calcium crystal. Thus,the simulation of bone mineralization was completed,and collagen type Ⅰ collagen/hydroxyapatite calcium biomimetic bone material was formed. Conclusion Reconstruction of type Ⅰ collagen combined with polyaspartic acid can prepare biomimetic bone material that has close chemical composition and molecular structure to the human bone tissue.