OBJECTIVETo investigate the early clinical efficacy of induced membrane technique for reconstruction of large bone defects after debridement in adults with chronic osteomyelitis of limbs.

METHODSFrom March 2010 to March 2012,a total of 23 adult patients with chronic osteomyelitis of limbs were treated in our department. There were 15 males and 8 females, with a mean age 35.2 years old (ranged from 26 to 49 years old). Sixteen patients had open fracture history. According to the lesion site, there were 12 cases of tibia, 7 cases of femur, 3 cases of humerus, and 1 case of both radius and ulna. Among them, 19 patients had diseases in diaphysis and 4 patients in the metaphysis. The mean interval from infection to operation was 6.9 months (ranged from 4 to 13 months). All the patients were treated by using induced membrane technique. The follow-up evaluation included clinical complications, time of bone healing and limbs function. The Chinese version of SF-36 scores was used in the assessment of quality of life pre- and post-operation.

RESULTSThe average duration of follow-up was (27.6 ± 5.3) months (ranged from 18 to 43 months). Two patients had postoperative flap edge necrosis, 1 patient had superficial iliac incision infection, no obvious complications were recorded. Twenty patients obtained radiological union at a mean time of 4.6 months (ranged from 3 to 7 months). Among them, 16 patients treated with lower limbs surgery achieved full weight-bearing at about 5.2 months (ranged from 4 to 8 months) postoperatively. Four patients suffered from reinfection during follow-up, but 3 of them achieved complete bone healing after the second surgeries with induced membrane technique. At the final follow-up, there was a substantial improvement in each dimension scores and total scores of SF-36 as compared with those before surgery.

CONCLUSIONWhen treating with adult chronic osteomyelitis of limbs, the induced membrane technique can effectively reconstruct large bone defects after debridement, significantly shorten treatment cycle, provide satisfactory results with minimal complications, promote good recovery of limbs function and require relatively simple operation technique.

Adult ; Chronic Disease ; Extremities ; surgery ; Female ; Humans ; Male ; Middle Aged ; Osteomyelitis ; surgery ; Reconstructive Surgical Procedures ; methods

Drainage ; Extremities ; injuries ; surgery ; Humans ; Reconstructive Surgical Procedures ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps

INTRODUCTIONAmputation is no longer the sole contribution of the orthopaedic surgeon to the management of primary bone tumours. Improvements in the design of endoprostheses and surgical reconstructive techniques have combined with advances in chemotherapeutic regimens to result in surgical procedures for salvaging limbs with aggressive sarcomas and in limb reconstruction. This has made limb salvage a viable alternative to amputation in many cases. The aim of this study was to evaluate functional outcome and complications of patients with primary bone tumours who were treated with re-section and mega-endoprosthetic replacement.

MATERIALS AND METHODSNineteen patients with bone tumours were retrospectively reviewed. These patients had wide local re-section and mega-endoprosthetic reconstruction performed between 1999 and 2006 in a tertiary hospital. Functional evaluation was performed based on the Musculoskeletal Tumour Society (MSTS) scoring system, with numerical values from 0 to 5 points assigned for each of the following 6 categories: pain, function, emotional acceptance, use of supports, walking ability and gait. These values were added, and the functional score was presented as a percentage of the maximum possible score. Complications were also analysed.

RESULTSThe final mean functional score was 78.3% +/- 16.6%. Eight patients had complications related to surgery, including infection and subluxation of hip implant. Six patients had infection, while 2 had subluxation of hip implants. Infection was a common complication in our study. None had implant breakage, loosening or fracture. We found no statistical difference in the functional outcome between upper limb and lower limb procedures, and between hip and knee procedures. T-test also showed no evidence of gender differences in functional outcome. Kaplan-Meier survival analysis revealed the mean survival duration of megaprosthesis to be 75.6 months.

CONCLUSIONMega-endoprosthetic reconstruction in limb salvage provides good functional outcome in patients with bone tumours. The early results from patients treated with mega-endoprosthesis have been encouraging.

Bone Neoplasms ; rehabilitation ; surgery ; Extremities ; surgery ; Humans ; Postoperative Complications ; Prostheses and Implants ; Retrospective Studies

OBJECTIVETo investigate the application of tourniquet in burn patients during tangential excision on the extremities.

METHODSSeventy - nine burn patients who were arranged to receive tangential excision and skin grafting on the extremities were randomly divided into A and B groups. The patients in A group (n = 41) underwent the operation with the tourniquet applied continuously throughout the operation, while those in B group (n = 38), only with tourniquet applied during tangential excision. The amounts of blood loss and blood transfusion, the operation time and the take rate of grafted skin and the incidence of complications were investigated and recorded.

RESULTSThe amounts of blood loss and blood transfusion during operation in A group were 42% and 50% less than those in B group, respectively (P < 0.001). Moreover, the operation time on the upper and lower extremities in A group was much shorter (for 41% and 37%, respectively) than those in B group (P < 0.001). In addition, there was no difference of the take rate of skin graft and the incidence of subcutaneous hematoma between the two groups (P > 0.05).

CONCLUSIONContinuous tourniquet application during tangential excision on the extremities in burn patients was proved to be effective in reducing operational blood loss, blood transfusion and in shortening operation time.

Adult ; Blood Loss, Surgical ; prevention & control ; Blood Transfusion ; Burns ; surgery ; Extremities ; surgery ; Humans ; Skin Transplantation ; Tourniquets

OBJECTIVETo report the clinical application results of free deep inferior epigastric perforator flap in the repair of soft tissue defect.

METHODSFrom January 2006 to January 2012,13 patients with soft tissue defect (7 cases in leg and 6 cases in forearm) underwent reconstruction with a free deep inferior epigastric perforator flap. There were 9 males and 4 females, aged from 21 to 45 years old with an average of 33 years. Soft tissue defect in the extremities were from 7 cm x 17 cm to 8 cm x 26 cm. The medial branch and lateral brangh flaps were 7 cases and 6 cases respectively. The donor site was closed directly.

RESULTSOne patient developed small wound dehiscence, which spontaneous healed at one month after surgery. All the flaps had survived completely. Follow-up period ranged from 1.8 to 4.0 years with the mean of 2.8 years postoperatively. Satisfactory clinical results were obtained in 12 cases. A good contour was confirmed at the recipient area.

CONCLUSIONThe free deep inferior epigastric perforator flap for the extremities defects of soft tissue is a good option. This technique is safe and reliable, and can decrease the injury of donor site.

Adult ; Extremities ; surgery ; Female ; Humans ; Male ; Middle Aged ; Perforator Flap ; Soft Tissue Injuries ; surgery

OBJECTIVE: To review the research progress of supraclavicular vascularized lymph node transfer (VLNT). METHODS: The research literature related to supraclavicular VLNT at home and abroad in recent years was extensively reviewed, and the anatomy of supraclavicular lymph nodes, clinical applications, and complications of supraclavicular VLNT were summarized. RESULTS: The supraclavicular lymph nodes are anatomically constant, located in the posterior cervical triangle zone, and the blood supply comes mainly from the transverse cervical artery. There are individual differences in the number of supraclavicular lymph nodes, and preoperative ultrasonography is helpful to clarify the number of lymph nodes. Clinical studies have shown that supraclavicular VLNT can relieve limb swelling, reduce the incidence of infection, and improve quality of life in patients with lymphedema. And the effectiveness of supraclavicular VLNT can be improved by combined with lymphovenous anastomosis, resection procedures, and liposuction. CONCLUSION There are a large number of supraclavicular lymph nodes, with abundant blood supply. It has been proven to be effective for any period of lymphedema, and the combined treatment is more effective. The more clinical studies are needed to clarify the effectiveness of supraclavicular VLNT alone or in combination, as well as the surgical approach and timing of the combined treatment.
Humans ; Quality of Life ; Lymphedema/surgery* ; Lymph Nodes/blood supply* ; Lymphatic Vessels/surgery* ; Extremities

PURPOSE: Reconstruction of postburn scar contractures is one of difficult tasks in burn plastic surgery. A linear scar contracture is usually repaired by using skin grafts, traditional or modified Z-plasty. However, the scar itself remains even if the contracture is released. Therefore, it should be suggested to reduce scars at the time of release of scar contractures. For this purpose, we have designed the Y-V flap method. This paper is presents our clinical experiences for reconstruction of postburn linear scar contractures and scar reduction by newly designed the Y-V flap. METHODS: We had 3 cases of postburn scar contractures with depressed deformities in extremities, buttock using the newly designed the Y-V flaps. The Y-V flap is made by the V shaped flap at a right angle to the scar band and it is advanced to Y incision site of opposite edge of the scar band, and this flap can correct the linear contracted scar band with moderate scar reductiontion. RESULTS: 2 cases of the postburn scar contractures were treated using the Y-V flaps. 1 case of scar contractures of extremities was reconstructed using Y-V flap and multiple Z-plasties. After postoperative follow up, relatively satisfactory results were obtained in all cases. CONCLUSION: We have had successful reconstruction of postburn scar contractures with depressed deformities by newly designed Y-V flap. The design of Y-V flap and its reliability have been introduced. The Y-V flap can be used effectively for the correction of linear scar contractures with depressed contour deformities and scar reduction.
Burns ; Buttocks ; Cicatrix* ; Congenital Abnormalities ; Contracture* ; Extremities* ; Follow-Up Studies ; Skin ; Surgery, Plastic ; Transplants

Malignant fibrous histiocytoma (MFH) is an aggressive soft-tissue sarcoma that most commonly occurs in the skeletal muscle of the extremities or retroperitoneum of the middle and late adulthood. We present a case of a 65-year-old woman who was presented with an asymptomatic erythematous nodule with central erosion on left temporal area. She was diagnosed with MFH, and then underwent Mohs micrographic surgery and flap coverage. No sign of metastatic recurrence was noted during the 6 month follow-up period.
Aged ; Extremities ; Female ; Follow-Up Studies ; Histiocytoma, Malignant Fibrous ; Humans ; Mohs Surgery ; Muscle, Skeletal ; Recurrence ; Sarcoma

Skin neoplasms can result in large skin defects after surgical removal. Skin grafting has been used commonly to repair large defects, but it is associated with esthetic and functional problems. Herein, we report three cases with application of the keystone island flap in large skin defects of the trunk and extremities. A 53-year old male with recurred dermatofibrosarcoma protuberans on his thigh was repaired by the keystone island flap after Mohs micrographic surgery, and a 52-year old male with malignant melanoma on his back was successfully reconstructed by the keystone island flap after wide excision. Lastly, a 59-year old male diagnosed with dermatofibrosarcoma protuberans on the inguinal area was closed by the keystone island flap with commendable cosmetic outcome. Due to the ease of performance, excellent cosmetic and functional results, we recommend the keystone island flap for the reconstruction of large skin defects on the trunk and extremities.
Dermatofibrosarcoma ; Extremities ; Humans ; Male ; Melanoma ; Mohs Surgery ; Skin Neoplasms ; Skin Transplantation ; Skin* ; Thigh

OBJECTIVE: Spinal cord stimulation (SCS) is an effective means of treatment of chronic neuropathic pain from failed back surgery syndrome (FBSS). Because the success of trial stimulation is an essential part of SCS, we investigated factors associated with success of trial stimulation. METHODS: Successful trial stimulation was possible in 26 of 44 patients (63.6%) who underwent insertion of electrodes for the treatment of chronic pain from FBSS. To investigate factors associated with successful trial stimulation, patients were classified into two groups (success and failure in trial). We investigated the following factors : age, sex, predominant pain areas (axial, limb, axial combined with limbs), number of operations, duration of preoperative pain, type of electrode (cylindrical/paddle), predominant type of pain (nociceptive, neuropathic, mixed), degree of sensory loss in painful areas, presence of motor weakness, and preoperative Visual Analogue Scale. RESULTS: There were no significant differences between the two groups in terms of age, degree of pain, number of operations, and duration of pain (p>0.05). Univariate analysis revealed that the type of electrode and presence of severe sensory deficits were significantly associated with the success of trial stimulation (p<0.05). However, the remaining variable, sex, type of pain, main location of pain, degree of pain duration, degree of sensory loss, and presence of motor weakness, were not associated with the trial success of SCS for FBSS. CONCLUSION: Trial stimulation with paddle leads was more successful. If severe sensory deficits occur in the painful dermatomes in FBSS, trial stimulation were less effective.
Chronic Pain* ; Electrodes ; Extremities ; Failed Back Surgery Syndrome* ; Humans ; Neuralgia ; Spinal Cord Stimulation* ; Spinal Cord*