Objective To investigate the clinical application and effect of repair infectious bone defect in femur with free vascularized fibular graft.Methods From April,2008 to April,2013,9 patients that had infectious bone defect in femur underwent repaired with free vascularized fibular graft.The bacterier cultivation of sinus tract excretion in preoperation and focal zone in operation had proved the infection.The length of bone defect were7.5 cm on average.The bone defect was repaired with free vascularized fibular graft on one stage in 6 cases and two stages in 3 cases after the cure of infection.Six patients underwent folded and 3 patients underwent single vascularised fibula graft transfer.The skin island flaps were used as a postoperative predictor of vascularized fibula graft viability in 6 cases.The transfer fibulars were fixed with plate in 6 cases,external fixor in 3 cases.Time to union was recorded through evaluation of plain radiographs.The Enneking score system was applied to evaluate the lower extremity function.Results The vascularized fibular survived and bony fusion was achieved in all patients.All cases were followed up 24.5 months(12-39 months).The average length of the transfer fibula was 14.5 ± 3.2 cm.The average time for bone union at allograft-host junction was 5.5 ± 1.2 months.Of the 9 cases,the mean scores was 24 (their scores ranged from 20 to 27) at final follow-up.The functions of supplied regions were not found malfunctional,no recurrence of infection occurred.There were no stress fracture in inlay fibula.Conclusion Free vascularized fibular graft will benefit to control the infection in femur,have high bone union rate,and is an optimal choice.

Objective: To investigate the effect of potassium channel opener nicorandil on myocardial ischemia-reperfusion injury (MIRI) in isolated rat's heart. Methods: Langendorff system was established for isolated heart reperfusion. A total of 44 rats were randomly divided into 4 groups: Normal control group, Ischemia-reperfusion (I-R) group, Adenosine/I-R (A/I-R) group, the I-R heart was treated by adenosine 100 μmo/L and Nicorandil/I-R (N/I-R) group, the I-R heart was treated by nicorandil 200 μmo/L.n=11 in each group. Left ventricular developed pressure (LVDP), the maximal rise/fall rate of left ventricular pressure (±dp/dtmax), reperfusion arrhythmia (RA) and myocardial infarction (MI) size were recorded; the expressions of left ventricular tissue acetaldehyde dehydrogenase 2 (ALDH2), Bcl-2 and Bax were examined and compared among different groups. Results:①Compared with I-R and A/I-R groups, N/I-R group had increased LVDP at 30 min and 45 min reperfusion, allP<0.05.②Compared with N/I-R and A/I-R groups, I-R group showed reduced ±dp/dtmax at 30 min and 45 min reperfusion, allP<0.05; while ±dp/dtmax in N/I-R group was higher than A/I-R group at 30 min and 45 min reperfusion, all P<0.05.③Compared with I-R group, both N/I-R and A/I-R groups presented reduced RA score, allP<0.01, RA score was similar between N/I-R group and A/I-R group,P=0.771.④compared with I-R group, both N/I-R and A/I-R groups had the smaller MI size,P<0.01 and N/I-R group showed the smaller MI size,P<0.05.⑤Compared with Normal control group, I-R group had decreased mitochondrial ALDH2 expression and increased Bcl-2, Bax expression; ALDH2 level was elevated in N/I-R group had reduced in A/I-R group; Bcl-2 and Bax levels were increased in both N/I-R and A/I-R groups. Compared with I-R group, both N/I-R and A/I-R groups had increased ratio of Bcl-2/Bax,P<0.05; the anti-apoptosis effect was similar between N/I-R group and A/I-R group,P>0.05. Conclusion: Nicorandil may reduce MIRI and protect myocardium in isolated rat's heart, the overall effect is better than adenosine. Nicorandil can up-regulate the expressions of mitochondrial ALDH2, Bcl-2 and down-regulate the expression of Bax.

Objective: To explore the clinical application and effect of free fibula composite tissue flap trans-plantation to repair bone and soft tissue defect after open fracture of proximal tibial. Methods: From June, 2012 to June, 2018, free fibula composite tissue flap transplantations were applied to repair bone and soft tissue defect after open fracture of proximal tibial in 11 cases. Of the 11 cases, there were 10 males and 1 female(their ages ranged from 32 to 56, 36 on average); Six cases were caused by traffic accident, and 5 by crash. There were 3 fresh wounds and 8 chronic and infective wounds. Free fibular flaps were used in 7 cases, and free fibular flexor hallucis myocutaneous flaps were used in 4 cases. The fibular length with transplantation was 7-18 cm. The area of flaps or muscle flaps was ranged from 4 cm×8 cm to 8 cm×20 cm. Bone fracture healing was observed at 3, 6 and 12 months after operation. The function of injured extremity was evaluated in 1 year after surgical operation. Results: All were successfully repaired, and composite tissue flaps survived. Of which, 10 wounds healed by first intention, and 1 wound healed by secondary intention, with the healing time of 12-18 days. All 11 cases were followed-up. The mean followed-up time was 18 months. The bone healing time ranged from 6 to 9 months (7 months on average). The Enneking Score System was applied to evaluate the leg function. Of the 11 cases, the mean scores was 25 (ranged from 22 to 27). The donor sites were not found malfunctional. Conclusion Transplantation of free fibula composite tissue flap can reduce the treatment time with good mechanical strength. It is an ideal method to repair bone and soft tissue defect after open fracture of proximal tibial.

OBJECTIVETo analyze the long-term effect of primary combined tissue transplantation on hand reconstruction.

METHODSThe data of 8 kinds of combined tissue transplantations employed to reconstruct the severely injured hands of 26 patients over the past 2 to 11 years were studied retrospectively. Among them, combined tissue transplantation taking the anterior-lateral femoral flap as the main tissue unit was applied in 21 cases and taking the second toe as the main tissue unit was applied in 5 cases. Blood vessel anastomosis was performed in parallel in 16 cases, series in 6 cases and both in 4 cases.

RESULTSAmong the 60 free tissue units employed on 26 patients, 58 survived completely and the other 2 survived after dressing change because of postoperative partial necrosis. The patients were followed up for 2-11 years postoperatively, with an average of 3.5 years. According to the standard for function of reconstructed hands by Chinese Medical Association, excellent results were obtained in 10 cases, good in 12 cases, fair in 3 cases and bad in 1 case.

CONCLUSIONSPrimary combined tissue transplantation, which may preserve the tissue vitality of injured hands to the maximum and thus facilitate function restoration of the hands, is a promising method in reconstructing severely-injured hands.

Adolescent ; Adult ; Child ; Female ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Surgical Flaps ; Treatment Outcome

Objective To explore the clinical effects of sequential flap of thigh perforator for closure of the anterolateral thigh free flap donor site.Methods From March,2014 to May,2015,8 consecutive patients underwent elective anterolateral thigh free flap reconstruction for limb soft tissue defect.To design a sequential flap of thigh perforator to achieve primary closure of the anterolateral thigh free flap donor site.The area of anterolateral thigh free flap ranged from 9.0 cm×6.0 cm to 20.0 cm×1 1.0 cm,respectively.The area of thigh perforator flap ranged from 7.0 cm×3.0 cm to 12.0 cm×7.0 cm.Results All flaps healed uneventfully.Distal skin flap necrosis appeared in 1 flap which was healed after local transposition flap.All the patients were followed up for 1 to 6 months,with mean time of 4 months.The color,texture and appearance of flaps were satisfactory.Conclusion Sequential flap of thigh perforator,with reliable blood supply and constant position,represents an ideal model to close the anterolateral thigh free flap donor site of small defect.

This is a report of a complex defects in the right upper extremity treated in the Department of Hand and Microsurgery, 521 Hospital of Norinco Group, in October 2016. The patient received multi-transfers of flaps for one-stage reconstruction, including a double-paddled ALTPF and a compound flap of the great toe and the second toe. Vascular compromises occurred in flaps on the 2nd day after surgery. All the flaps were rescued and survived completely after surgical exploration. Followed-up at 3 year after surgery showed that the appearance and function of the affected limb recovered well. The flexion and extension of elbow and wrist were normal. The pinch function of the reconstructed thumb and index finger recovered well.

Objective To explore the clinical application and effect of induced membrane technique com-bined with anteriolateral thigh(ALT)flap transfer for repair of complex tissue defect of the lower extremity. Methods From June,2011 to June,2014,induced membrane technique combined with ALT flap transfer were applied to repair complex tissue defect of the lower extremity in 12 cases. Of the 12 cases, there were 11 males and one female(their ages ranged from 18 to 45 years, 35 years on average). One caused by road accident,4 cases were caused by crush injury, 7 cases were caused by squeeze injury. First stage, the soft tissue defect were repaired by ALT flap transfer, the bone defect were filled with antibiotic cement after debridement and fixed with external or internal fixation. The area of the ALT flap ranged from 9.0 cm×15.0 cm to 15.0 cm×20.0 cm. The length of bone defect ranged from 3.0 cm to 14.0 cm,one of them was muscucaneous flap. Second stage,bone defect were filled with cancellous bone following cement removal in 6 to 12 weeks,8 weeks on average. Results All cases were successfully repaired. Twelve cases were followed up. A mean follow-up was 20 months. All flaps survived,11 cases were healed in first stage. One case were healed in second stage,healing time ranged from 12 to 18 days; bone healing time ranged from 6 to 9 months, 7 months on average. The functions of supplied regions were not found malfunctional. Conclusion Induced membrane technique combined with anteriolateral thigh flap transfer reduce patient treatment time,improve the ability of resis-tance to infection of bone transfer,is an optimal method to repair the complex tissue defect of the lower extremity.

Objective To explore the clinical application and effect of Flow-through anterolateral thigh flap transfer combined with bone transport technique for repairing the segamental mutilating injury in lower extremity.Methods From June,2010 to June,2016,Flow-through anterolateral thigh flap transfer combined with Ilizarov technique were applied to repair the segamental mutilating injury in lower extremity in 10 cases.Of the 10 cases,there were 8 males and 2 females (their ages ranged from 26 to 55,36 on average).Four caused by road accident,4 caused by crush injury,2 cases caused by squeeze injury.First stage,Flow-through anterolateral thigh flap transfer were applied to revascularize the lower limb and repair the soft tissue defect in emergency.Second stage,bone transfort with external fixator were applied to repair bone defect in second stage.The area of the flap ranged from 12.0 cm×15.5 cm to 20.0 cm×25.0 cm.The repair of bone defect ranged from 4.0 cm to 10.0 cm.Time interval between two stages ranged from 2 to 4 months,3 months on average.Followed-up method was regular outpatientcare after discharge.The main contents include:the presence of red swollen with pus,the condition of infection in the pin,if the fixed pin was loosening,and adjust the speed of bone transport according to the mineralization of new bone.Results All cases were successfully repaired in 10 cases.Ten cases were followed-up with a mean followed-up time of 42 months.All flaps survived,in with 6 cases were healed in first stage,4 case were healed in second stage (healing time ranged from 14 to 30 days),and bone transfort time ranged from 6 to 16 months.The docking site union occurred in 6 cases and were healed by use of bone debridement,bone graft and compression.Deformity in foot and ankle occurred during the bone transport in 2 cases and were cured by draft therapy with adding ring fixator.The functions of donor sites were not found malfunctional.Conclusion Flow-through anterolateral thigh flap transfer combined with bone transport have high success rate of limb salvage,good quality of os teogenesis,and satisfactory function recovery.It is an optimal method to repair the segamental mutilating injury of the lower extremity.

Objective:To explore the clinical effect of cosmetic reconstruction for partial defect of distal segment of digits.Methods:Form January 2018 to January 2021, the Department of Hand Surgery of Institute for Hygiene of Ordnance Industry(The 521 Hospital of Weapon Industry) admitted 129 patients with partial defect of distal segment of thumb or fingers with phalange or tendon exposure. The patients were 111 males and 18 females with an average age of 34(17-59) years old. The sizes of nailbed defect were 0.4 cm×1.1 cm-1.8 cm×2.0 cm, the length of phalange defect was 0.4-1.8 cm, and the sizes of the soft tissue defect were 1.6 cm×1.8 cm-3.2 cm×4.8 cm. Great toe tissue flaps were used to reconstruct the partial defect of distal segment of thumb or fingers after debridement. Wounds of fibular flap of great toe in 77 cases were directly sutured in 17 patients. The donor sites in rest 60 great toes were narrowed first and then repaired with skin grafts in 10 cases, with artificial dermis in 28 cases and with transverse V-Y advancement flaps of ipsilateral great toes for 22 cases. Forty-nine of 52 donor site wounds for hallux toenail flap were repaired with artificial dermis and 3 with free peroneal artery perforator flaps. The method was outpatient follow-up. Postoperative follow-up lasted until July 2022. The check-items for follow-up included: occurrence of necrosis, appearance, shape and texture of the flap, appearance of the reconstructed nails, TPD of the reconstructed digit pulps, tolerance to cold on the scars of flaps, flexion and extension of the reconstructed digits. The healing time of phalanges of the reconstructed digits was evaluated by X-rays. The appearance, sensation, the tolerance to cold of great toe and the movement of donor foot were also assessed.Results:Postoperative follow-up lasted for 18 to 24 months, with an average of 21 months. A total of 128 flaps survived. Necrosis occurred in 1 fibular hallux flap, the necrosis was cured with a reverse digital proper artery island flap. Thereafter, all flaps healed well. The appearance, shape, texture and nails of reconstructed digits were close to the contralateral digits. The reconstructed thumb and finger were evaluated according to Zook, 127 cases were excellent and 2 cases were good.TPD of the pulps of the reconstructed digits was 4-10 mm. The mean score of the Vancouver scar scale(VSS) was 0.6 for scars of the reconstructed digits. The mean score of the Visual analog scale(VAS) was 0.3 for the tolerance to cold. Flexion and extension function recovered well in all the reconstructed digits. According to the Evaluation Criteria of Upper limb Function Hand Surgery Society of Chinese Medical Association, the function of hand was excellent in 127 cases and 1 in each of good and fair. X-rays of all digits showed the phalange healing of the reconstructed digits, with an average healing time of 2 months after surgery, without phalange resorption, infection, nonunion nor stress fracture. There was no difference between the length of the donor great toe and the contralateral toe, except the donor site of the great toe nail root. There was no significant visual difference between the appearance of the donor great toe and the contralateral toe. TPD of the pulps of donor great toe was 4-8 mm. The mean score of the VSS was 1.4 for scars in the donor great toe. The mean score of the VAS was 0.7 for the tolerance to cold of the donor great toe. There was no stress fracture at donor site, and the functions of donor foot were not affected when walking, running, jumping and tiptoeing in all patients.Conclusion:It is an ideal method for reconstructing a partial defect of distal segment of digit by great toe flap. It can not only reconstruct the partial defect of distal segment of the digit, but also results in a good appearance and satisfactory functions of the reconstructed digit. Damage to the donor site is minimum. The length of the donor great toe is unchanged, and it has little impact on sensation and appearance of the donor great toe. Meanwhile, there is no adverse effect on walking, running and jumping with the donor foot.

Objective:To investigate the clinical effect of gracilis musculocutaneous flap in repair of perineal soft defect with open pelvic fracture.Methods:From June 2009 to June 2019, 11 cases of open pelvic fracture associated with perineal injury were treated in the Department of Trauma and Orthopaedic of 521 Hospital of Norinco Group. There were 4 males and 7 females aged 16-56 (33 in average) years old. Cause of injuries: 6 cases by traffic accident, 4 by falling from height, and 1 by crushing. All the patients had open pelvic fractures. According to Tile classification, 1 case was rated as type A, 7 as type B and 3 as type C. All the patients were accompanied with perineal injury and soft tissue defect. The wound sizes ranged from 5 cm×5 cm to 8 cm×12 cm. The defects were repaired with gracilis musculocutaneous flap. The size of gracilis myocutaneous flaps was 6 cm×5 cm to 9 cm×13 cm. All donor areas of the flap were sutured directly. After surgery, 11 patients treated with strengthened nutritional support, keep supine position to avoid abduction, and appropriately raise the lower limbs. Follow-ups were conducted regularly after surgery.Results:All patients entered 6 to 30 (22 in average) months of follow-up. All of 11 myocutaneous flaps survived, besides 1 had a few necrosis at the distal surface of the myocutaneous flap, and healed after change of dressing. All the incisions at donor site had stage I healing. The colour, texture and flexibility of the gracilis myocutaneous flap were good. There was a scar at the donor sites without causing obvious dysfunction. Over the follow-up period, there was no failure of flap in either the recipient and donor sites. The patients were satisfied with the appearance and function.Conclusion:Gracilis musculocutaneous flap is one of the ideal methods in repair of perineal soft tissue defect with open pelvic fracture.