Objective To provide the anatomic basis of flap which was anatomized to the ankle by Anatomy study of vascular net around ankle joint.Methods 32 lower limbs were infiltrated into red emulsion;4 perfusions of lower limbs,artery;2 cases of radiography;1 lower limb was infiltrated into black ink.Application anatomy was observed the origin,track-way,branches and configuration in ankle and foot.Results The blood provision in ankle includes three parts;All the patients recovered well after treatment by careful flap-design.Conclusion The vascular net around anatomy of the ankle can provide help for the design,the choice and the operation of ankle's,tissue flap,and the function's,recovery after surgery.

Objective To observe the clinical outcomes of the superior gluteal neurocutaneous flap for sacrococcygeal pressure sores. Methods Twelve cases with sacrococcygeal pressure sores were covered by the superior gluteal neurocutaneous flap from May 2005 to Nov. 2009. The sore size ranged from 15 cm ×30 cm to 5 cm × 8 cm, while the flap size ranged from 17 cm × 32 cm to 10 cm× 12 cm. Results All 12 flaps survived totally with the pressure sores healed. The longest follow-up time was four years, the short follow-up time was half a year, the average time was 2.5 years. The superior gluteal neurocutaneous flap was good blood circulation, pressure sores not recur. Conclusion The superior gluteal neurocutaneous flap is a good treatment for sacrococcygeal pressure sores for its reliable blood supply and simple harvesting.

Objective To discuss experiences in reconstruction of severe tibial shaft fractures by using different flaps and external fixations.Methods The study involved 190 patients with type GustiloⅢB Ⅲ C (160 patients) and GustiloⅢC (30 patients) tibial shaft fractures treated from 1990 to 2007.There were 169 males and 21 females,at average age of 42.5 years.The injury causes included traffic accidents in 132 patients,machine accidents in 32 and stone smashing in 26.The management procedure consisted of administration of antibiotics,serial debridement and different flap grafting (including free thoracoumbilical flaps in 20 patients,sural neurocutaneous vascular flaps in 108,saphenous neurocutane ous vascular flaps in 12,superficial peroneal neurocutaneous flap in two,fasciocutaneous flaps in 26 and gastrocnemius muscular flaps in 22) and different external fixators (half-ring fixators in 84 patients,unilateral axial dynamic fixators in 12,AO fixators in 10,Weifang fixators in 42 and hybrid fixators in 40).The average follow-up was 7.3 years.Results All flaps survived.Of all,186 patients obtained fracture healing,with mean fracture healing time varying in different patients treated with different external fixators:7.5 months for 84 patients treated with half-ring fixators,11.2 months for eight with unilateral axial dynamic fixators,8.5 months for 12 with AO fixators ,8.1 months for 42 with Weifang fixators and 7.8 months for 40 with assembly fixators.Except for half-ring fixation,the other fixators needed necessary bone graft.Four patients treated with unilateral axial dynamic fixators resulted in nonunion due to osteo myelitis.The latest follow up showed that the function of the ankle and knee was normal,with no pain.Conclusion Combination of half-ring external fixators with various flaps provides good method for treatment of Gustilo ⅢB and ⅢC tibial shaft fractures.

Objective To explore the application of bridging-combined internal fixation for extremity fractures.Methods From May 2010 to August 2017,56 patients were treated by bridging-combined internal fixation for 58 different extremity fractures at Department of Orthopaedics,Military Orthopaedic Trauma Institute,Kunming General Hospital of PLA.They were 34 males and 22 females,aged from 16 to 83 years (average,48 years).There were 48 comminuted and 16 open fractures.The interval from injury to surgery ranged from one to 34 days (average,8 days).Early functional rehabilitation was encouraged for the patients.The therapeutic outcomes were evaluated in terms of fracture union time,postoperative infection,and postoperative functional recovery.Results Fifty-two of the patients were followed up for 12 to 28 months (average,16 months).The fractures united after 3 to 6 months (average,3.5 months).Comprehensive evaluation of the therapeutic outcomes resulted in 36 excellent,12 good,and 4 fair cases,yielding an excellent to good rate of 92.3％.Follow-ups revealed no postoperative infection,bone nonunion,loosening or breakage of the implants.Conclusion The bridging-combined internal fixation may lead to fine therapeutic outcomes for traumatic extremity fractures,because this system is flexible and easy to apply,and leads to fine reduction and limited postoperative complications.

Objective To investigate the therapeutic effects and complications of one-or two-site tibial osteotomy and distraction osteogenesis for treatment of massive infectious compound defects of the tibia.Methods A retrospective analysis was conducted of the 41 cases of massive infectious compound defects of the tibia which had been treated from May 2009 to May 2016 at The Traumatic Orthopedic Research Institute of PLA,Kunming General Hospital.They were 37 males and 4 females,aged from 2 to 58 years,with an average age of 33.4 years.The defects were located at the proximal tibia in 11 cases,at the middle tibia in 25 and at the lower tibia in 5.The defects of the anterior tibial soft tissue ranged from 7 cm × 8 cm to 24 cm × 12 cm in area;the tibial defects ranged from 6.5 cm to 18.2 cm (average,11.4 cm) in length.Metaphysis osteotomy of the tibia was performed at one site in 11 cases and at two sites in 30 cases.Bone and soft tissue healing and complications were observed.Results The postoperative follow-up periods ranged from one to 8 years,with an average of 32 months.Infections were all cured with no relapse of osteomyelitis,and all the bone defects and soft tissue wounds healed.Delayed healing at the docking site was observed in 4 patients but healing was eventually achieved after bone graft.Wound infection and poor osteogenesis appeared at the bone lengthening area in 3 patients which responded to placement of vancomycin bone cement rods for 2 months and "accordion" technique.Tibial line deviation was detected in 4 patients but disappeared after symptomatic treatment.Conclusions For a tibial defect from 6 to 8 cm combined with soft tissue defects,one-site tibial osteotomy and distraction osteogenesis can lead to fine healing;for a tibial defect from 8 to 20 cm combined with soft tissue defects,two-site tibial osteotomy and distraction osteogenesis can lead to fine therapeutic effects,due to reduced time for bone and soft tissue healing.

Objective:To explore the treatment of pressure sores in different parts of the buttocks.Methods:From May, 2005 to March, 2020, 170 (157 patients) pressure sores in different parts of buttocks were treated. Eighty-two pressure sores located at sacrococcyx, 52 at ischial tuberosity, 24 at greater trochanter (without hip joint exposure) and 12 at femoral greater trochanter with exposure of the hip joint. Flaps were used to repair the pressure sores. ①Seventy-one sacrococcygeal pressure sores were repaired by the gluteal epithelial neurovascular flap; ②10 (10 patients) sacrococcygeal and 42 (36 patients) sciatic tubercle pressure sores were repaired by the posterior femoral neurovascular flap; ③24(24 patients) femoral trochanter pressure sores and 1(1 patient) sacrococcygeal pressure sore were repaired by the tensor fascia lata myocutaneous flap; ④2 (2 patients) sciatic tubercle pressure sores were repaired by the gracilis myocutaneous flap; ⑤12 (10 patients) femoral trochanter pressure sores were with hip joint exposure treated with hip joint amputation; ⑥8 (8 patients) pressure sores at ischial tuberosity were treated with VSD. The pressure sores were measured at 5.0 cm×8.0 cm-15.0 cm×30.0 cm, and the flaps were sized 10.0 cm×12.0 cm-17.0 cm×32.0 cm. The follow-up was conducted in 2 methods: visit of outpatient clinic by patients and WeChat distanced interview by medical staff.Results:The gluteal epithelial neurovascular flaps, tensor fasciae lata flaps, gracilis myocutaneous flaps and posterior femoral neurovascular flaps all survived; 4 of 10 posterior femoral neurovascular flaps had partial necrosis and healed after dressing change. A total of 139 patients were treated by flap repair, of which 136 pressure sores healed, except 1 sacrococcygeal pressure sore and 1 femoral greater trochanter pressure sore did not heal because the patient was in old age, long-term hypoproteinaemia and anaemia, and 1 ischial tubercle pressure sore failed to heal due to osteomyelitis osteomyelitis. Ten pressure sores at femoral greater trochanter decubitus with hip joint exposure treated by hip joint amputation and 8 pressure sores at ischial tubercle decubitus treated by simple insertion of VSD were all healed. The follow-up period was 0.5-15.0 years, 7.5 years in average. The results of follow-up showed that pressure sores healed without recurrence in 154 patients, but failed to heal in 3 patients.Conclusion:The gluteal epithelial neurotrophic vascular flap has reliable blood supply and is simple to harvest, and it is a good flap to repair sacrococcygeal pressure sores. The tensor fascia lata myocutaneous flap has reliable blood supply and is simple to harvest, hence it is a good flap to repair greater trochanteric pressure sores. Transposition of the posterior femoral cutaneous nerve nutrient vessel flap or the V-Y advancement flap is simple and effective in repair of the sciatic tuberosity pressure sores. However, it is not recommended to apply the transposition of posterior femoral cutaneous nerve nutrient vessel flap in repair of the sacrococcygobtaineal pressure sore, because it would cause a necrosis at the distal part of the flap. When a greater trochanteric pressure sore coexists with an expose of hip joint, the hip joint can be dissected. For the pressure sore at ischial tuberosity, and if there is a small wound with a large internal cavity, it can be treated with simple insertion of VSD.