Objective: To investigate the effectiveness of Masquelet technique combined with flap transplantation in treatment of infectious bone and soft tissue defects of the lower leg. Methods: Between January 2013 and January 2017, 35 cases of infectious bone and soft tissue defects of lower leg were treated with Masquelet technique combined with flap transplantation. There were 21 males and 14 females, with an average of 31.5 years (mean, 25-55 years). All patients were tibial fractures caused by trauma and the infections occurred after debridement or internal fixation. The time from injury to admission was 1 to 6 months, with an average of 3.2 months. Defect located at the proximal leg in 11 cases, the middle leg in 11 cases, and the distal leg in 13 cases. The length of tibia defect after debridement ranged from 5.6 to 11.2 cm, with an average of 7.1 cm. The size of soft tissue defect ranged from 14.2 cm×6.9 cm to 17.3 cm×8.7 cm. Bacterial culture of purulent secretion of wound was positive in 18 cases. After debridement, the bone cement was used to fill the bone defect and the flap transplantation was used to repair the wound. The bone cement was taken out at 8 to 12 weeks after the one-stage operation, and the bone defect was repaired with autogenous iliac bone or combined with artificial bone. Results: Three cases had necrosis at the distal edge of the flap after one-stage operation, and survived after dressing change. The other flaps survived successfully, and the wounds healed by first intention. All incisions healed by first intention after two-stage operation. All patients were followed up 24-32 months, with an average of 27 months. The color of the flap was similar to that of the surrounding normal tissue, and its texture was good. X-ray reexamination showed that all bone defects healed after 6-8 months, with an average of 6.7 months. At 9 months after two-stage operation, according to the revised Edwards tibial fracture evaluation standard, 19 cases were excellent, 14 cases were good, and 2 cases were poor, the excellent and good rate was 94.3%. The American Orthopedic Ankle Association (AOFAS) score was 60-98, with an average of 81.3. And 21 cases were excellent, 11 were good, and 3 were fair, with an excellent and good rate of 91.4%. Conclusion: Masquelet technique combined with flap transplantation is an effective treatment for infectious bone and soft tissue defects of lower leg.

Objective:To discuss the clinical curative effect of the minimally invasive percutaneous suture technique of eight times for repairing closed injury extensor tendon zone I of finger.Methods:From February 2017 to January 2020, 12 patients (male 8, female 4) with mallet finger deformity were retrospectively studied, with an average age of 35 years (range, 18-50 years). And all the affected fingers were acute closed rupture of extensor tendon in zone I of single finger, 5 cases of the left finger and 7 cases of the right finger. There were 1 case of the thumb finger, 2 cases of the index finger, 3 cases of the middle finger, 4 cases of the ring finger and 2 cases of the little finger. 12 patients with fresh sputum mallet fingers were with 3-0 thread monofilament suture on extensor tendon zone I of finger in the minimally invasive percutaneous suture technique of eight times, and the distal end of the tendon was fixed to the base of the distal phalanx through the bone hole. Removal of the Kirschner wire 6-8 weeks, the brace was used to fix the affected finger in the dorsal extension. The flexion and extension of the affected finger was gradually strengthened. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up. The active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total action movement (TAM) of the finger were recorded. Finger function was evaluated according to TAM of the American Association of Hand Surgeons.Results:All operations were successfully completed, the operation time of the patients ranged from 18 to 25 min, with an average of 20.1±0.2 min. There was only a small amount of bleeding in the surgery. All 12 cases were followed up and the follow-up periods ranged from 6 to 14 months, with an average of 10.2±1.1 months. Mallet finger deformities were all corrected postoperatively; there were no knot exposure, skin necrosis and other complications. According to the Crawford standard, 9 cases were excellent, 2 cases were good, and 1 case was fair. The excellent and good rate was 91.7% (11/12). The mean active flexion of distal interphalangeal joints on the wounded finger and healthy finger were 82.11°±2.02° and 84.09°±2.01°, the mean active extension of distal interphalangeal joints on the wounded finger and healthy finger were -2.04°±3.01° and 0.02°±1.02°, there were significant differences between them ( t=2.447, 3.246; P=0.019, 0.004). The degrees of active joint activity of wounded finger were: 91.02°±4.01° of the metacar-pophalangeal joint, 94.04°±2.11° of the proximal interphalangeal joint, 83.01°±2.02° of the distal interphalangeal joint, and 265.05°±13.04° of total active activity; the degrees of active joint activity of healthy finger were: 93.01°±3.21° of the metacar-pophalangeal joint, 94.03°±3.07° of the proximal interphalangeal joint, 85.02°±2.01° of the distal interphalangeal joint, and 269.02°±12.10° of total active activity. The TAMs of the healthy side were 269.02°±12.10°, and the TAMs of the affected side were 265.05°±13.04°, there was no significant difference between them ( P>0.05). According to TAM system assessment criteria: excellent in 9 patients, good in 3 patients, and the excellent and good rate was 100% (12/12). Conclusion:The minimally invasive percutaneous suture technique of eight times can well repair closed injury extensor tendon zone I of finger, can have satisfactory treatment outcome in mallet finger with a simple procedure and good outcome. It is a simple, safe, effective method with minimal invasion.