OBJECTIVE: To evaluate the effectiveness of combined anterolateral thigh-ilioinguinal Flow-through flaps for repairing complex lower limb defects. METHODS: A clinical data of 20 patients with complex lower limb injuries admitted between January 2018 and January 2024 was retrospectively analyzed. The cohort included 14 males and 6 females with an average age of 47.3 years (range, 29-65 years). Injury mechanisms comprised heavy-object trauma (n=7), traffic accidents (n=5), machinery crush injuries (n=5), and osteomyelitis (n=3). Defects involved the left (n=7) and right (n=13) limbs, with anatomical distributions including tibiofibular injuries (n=6), isolated tibial injuries (n=6), foot and ankle injuries (n=5), and femoral-tibial injuries (n=3). The size of soft tissue defects ranged from 23 cm×8 cm to 44 cm×12 cm. Reconstruction employed combined anterolateral thigh-ilioinguinal Flow-through flaps in the size of 24 cm×10 cm to 48 cm×14 cm. The recipient sites were sutured in primary closure in 12 cases, and 8 cases had no available vascular anastomosis sites in the recipient sites, and a cross-leg flap form was used to establish a temporary blood supply, and the flaps were cut off after 3-4 weeks. The donor sites in the thigh were directly sutured. During follow-up, the survival of the flaps, appearance, texture, and related complications were observed; the Vancouver scar scale (VSS) score was used to evaluate the scar condition of the flaps, the lower extremity function scale (LEFS) score was used to evaluate the function of the affected lower limb, and the visual analogue scale (VAS) score was used to evaluate the pain condition of the affected side. RESULTS: Postoperatively, the flap complete necrosis occurred in 1 case, marginal necrosis in 1 case, superficial infections in 2 cases, and venous thrombosis in 1 case. The remaining flaps survived completely with primary wound healing at both recipient and donor sites. Limb salvage was achieved in all patients. All patients were followed up with 12-24 months (mean, 18.4 months). All flaps had satisfactory color, texture, and contour. Fractures reached clinical union in all cases. Donor site morbidity included mild contralateral hip flexion/knee extension limitation (n=1), persistent hypoesthesia (n=3), and chronic pain (n=1) at 6 months. At 12 months after operation, the LEFS, VSS, and VAS scores on the affected side were 62.7±4.6, 3.5±1.1, and 1.2±0.6, respectively, which were superior to those at 1 month after operation (38.6±2.8, 8.5±1.4, 4.7±1.1), and the differences were significant (P<0.05). CONCLUSION The anterolateral thigh-ilioinguinal Flow-through flaps for repairing complex lower limb injuries is a good method. The distal blood supply of the affected side recover well, the survival rate of the flap is high, and the function recovery of the affected limb is good.
Humans ; Male ; Middle Aged ; Female ; Adult ; Plastic Surgery Procedures/methods* ; Aged ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Surgical Flaps/blood supply* ; Lower Extremity/surgery* ; Thigh/surgery* ; Treatment Outcome ; Leg Injuries/surgery*

OBJECTIVE: To investigate the effectiveness of Flow-through bridge anterolateral thigh flap transplantation in the treatment of complex calf soft tissue defects. METHODS: The clinical data of the patients with complicated calf soft tissue defects, who were treated with Flow-through bridge anterolateral thigh flap (study group, 23 cases) or bridge anterolateral thigh flap (control group, 23 cases) between January 2008 and January 2022, were retrospectively analyzed. All complex calf soft tissue defects in the two groups were caused by trauma or osteomyelitis, and there was only one major blood vessel in the calf or no blood vessel anastomosed with the grafted skin flap. There was no significant difference between the two groups in general data such as gender, age, etiology, size of leg soft tissue defect, and time from injury to operation ( P>0.05). The lower extremity functional scale (LEFS) was used to evaluate the sufferred lower extremity function of the both groups after operation, and the peripheral blood circulation score of the healthy side was evaluated according to the Chinese Medical Association Hand Surgery Society's functional evaluation standard for replantation of amputated limbs. Weber's quantitative method was used to detect static 2-point discrimination (S2PD) to evaluate peripheral sensation of the healthy side, and the popliteal artery flow velocity, toenail capillary filling time, foot temperature, toe blood oxygen saturation of the healthy side, and the incidence of complications were compared between the two groups. RESULTS: No vascular or nerve injury occurred during operation. All flaps survived, and 1 case of partial flap necrosis occurred in both groups, which healed after free skin grafting. All patients were followed up 6 months to 8 years, with a median time of 26 months. The function of the sufferred limb of the two groups recovered satisfactorily, the blood supply of the flap was good, the texture was soft, and the appearance was fair. The incision in the donor site healed well with a linear scar, and the color of the skin graft area was similar. Only a rectangular scar could be seen in the skin donor area where have a satisfactory appearance. The blood supply of the distal limb of the healthy limb was good, and there was no obvious abnormality in color and skin temperature, and the blood supply of the limb was normal during activity. The popliteal artery flow velocity in the study group was significantly faster than that in the control group at 1 month after the pedicle was cut, and the foot temperature, toe blood oxygen saturation, S2PD, toenail capillary filling time, and peripheral blood circulation score were significantly better than those in the control group ( P<0.05). There were 8 cases of cold feet and 2 cases of numbness on the healthy side in the control group, while only 3 cases of cold feet occurred in the study group. The incidence of complications in the study group (13.04%) was significantly lower than that in the control group (43.47%) ( χ ²=3.860, P=0.049). There was no significant difference in LEFS score between the two groups at 6 months after operation ( P>0.05). CONCLUSION Flow-through bridge anterolateral thigh flap can reduce postoperative complications of healthy feet and reduce the impact of surgery on blood supply and sensation of healthy feet. It is an effective method for repairing complex calf soft tissue defects.
Humans ; Thigh/surgery* ; Plastic Surgery Procedures ; Leg/surgery* ; Cicatrix/surgery* ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Treatment Outcome ; Lower Extremity/surgery* ; Skin Transplantation/methods* ; Perforator Flap

Arthroplasty, Replacement, Knee ; Humans ; Knee Joint/surgery* ; Leg ; Lower Extremity/diagnostic imaging* ; Osteoarthritis, Knee/surgery* ; Rotation ; Tibia/surgery*

OBJECTIVE: To investigate the effect of different proximal femoral shapes on leg length discrepancy(LLD) after total hip arthroplasty(THA). METHODS: Total 131 patients with osteoarthritis or osteonecrosis received unilateral biological total hip arthroplasty from June 2013 to June 2019. All patients' age, sex, side and pelvis anteroposterior digital radiography were retraspectively analyzed. There were 69 males and 62 females, 57 cases of left hip and 74 cases of right hip. The age ranges from 25 to 89 with an average age of 62 years. There were 48 cases of osteoarthritis and 83 cases of osteonecrosis. In this study, femoral cortical index (FCI) was used as the classification of proximal femoral shape, and bilateral lower limb length differences were measured by preoperative and postoperative pelvis anteroposterior digital radiography. Grouping according to FCI:> 0.6 was Dorr A group, 0.5 to 0.6 was Dorr B group, <0.5 was the Dorr C group, and the relationship between proximal femur morphology and the leg length discrepancy after total hip arthroplasty was determined. RESULTS: The postoperative average FCI was(0.56±0.08) mm and the median LLD was 5.10 mm (IQR -1.00 to 8.80 mm). Three groups were divided according to the level of FCI, and there were no statistically significant differences in gender, age, side, diagnosis and intraoperative fracture rate distribution among three groups. FCI>0.6, the postoperative LLD was 6.30 mm (IQR 1.00 to 10.95 mm). When FCI was 0.5 to 0.6, the postoperative LLD was 5.85 mm(IQR-0.55 to 8.90 mm). FCI<0.5, the postoperative LLD was 1.95 mm(IQR -2.50 to 6.68 mm). LLD comparison of different proximal femoral shape was statistically significant ( CONCLUSION High FCI increases the risk of lower extremity prolongation after surgery on the affectedside, while low FCI reduces the risk of lower extremity prolongation after surgery on the affected side. The surgeon can assess the shape of the proximal femur of the patient preoperatively and inform the patient in advance of possible changes in leg length of both lower extremities after total hip replacement.
Arthroplasty, Replacement, Hip/adverse effects* ; Female ; Femur/surgery* ; Humans ; Leg ; Leg Length Inequality/etiology* ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVE: To compare the accuracy of three methods for measuring the length of both lower limbs in hip arthroplasty for femoral neck fracture in the elderly, and to introduce a "shoulder to shoulder" anatomical location marking method for femur. METHODS: From January 2017 to January 2019, 90 elderly patients with femoral neck fracture were treated with hip replacement, including 39 males and 51 females, aged 65 to 96(78.0±7.4) years, 56 cases of total hip and 34 cases of hemi hip. According to garden classification, there were 7 cases of typeⅡ, 63 cases of type Ⅲ and 20 cases of type Ⅳ. The patients were divided into three groups according to different measurement methods:contralateral contrast method (group A) of 19 cases, shuck test method (group B) of 28 cases, and "shoulder to shoulder" anatomical marker localization method (Group C) of 43 cases. The accuracy of the three methods was compared by measuring the length difference of lower limbs in vitro and imaging. RESULTS: All patients completed the operation successfully. After total hip arthroplasty, the length of lower limbs in group A was(12.9±8.6) mm, and that in group B was(10.3±4.4) mm. After hemiarthroplasty, the length of lower limbs in group A was (13.2±7.2) mm, group B was (8.7±3.5) mm, and group C was (6.3±2.8) mm; the measurement results of unequal length of lower limbs after total hip arthroplasty were(12.9±8.1) mm in group A, (9.6±4.0) mm in group B and (6.6±2.6) mm in group C. The results of factorial analysis of variance showed that the differences among the three groups were statistically significant ( CONCLUSION The "shoulder to shoulder" anatomic localization marking method can reduce the length of lower limbs simply, effectively and accurately in the elderly patients with femoral neck fracture hip replacement.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Female ; Femoral Neck Fractures/surgery* ; Hemiarthroplasty ; Humans ; Leg Length Inequality/surgery* ; Lower Extremity ; Male ; Treatment Outcome

A male patient weighing 2.5 kg was admitted for respiratory difficulty, and a large ventricular septal defect (VSD) was diagnosed. During care, sudden right leg swelling with a femur shaft fracture occurred. The patient's father had a history of recurrent lower extremity fractures; thus, osteogenesis imperfecta was considered. The patient's respiratory difficulty became aggravated, and VSD repair in the neonatal period was therefore performed with gentle sternal traction and great vessel manipulation under total intravenous anesthesia to prevent malignant hyperthermia. The patient was discharged without notable problems, except minor wound dehiscence. Outpatient genetic testing revealed that the patient had a COL1A1/COL1A2 mutation.
Anesthesia, Intravenous ; Fathers ; Femur ; Genetic Testing ; Heart Septal Defects, Ventricular ; Humans ; Infant, Newborn ; Leg ; Lower Extremity ; Male ; Malignant Hyperthermia ; Osteogenesis Imperfecta ; Osteogenesis ; Outpatients ; Thoracic Surgery ; Traction ; Wounds and Injuries

PURPOSE: Defects around the distal one third of the leg and ankle are difficult to manage by conservative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects. METHODS: This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and ankle, which were treated using distally based peroneus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery. RESULTS: There were 21 males and 4 females with the mean age of 39 (5-76) years. The most common cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4-50) cm. The mean operating time was 75 (60-90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patients have graft loss due to underlying hematoma and required secondary split thickness skin grafting. CONCLUSION The distally based peroneus brevis muscle flap is a safe option with reliable anatomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.
Adolescent ; Adult ; Aged ; Ankle Injuries ; surgery ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged ; Muscle, Skeletal ; Operative Time ; Retrospective Studies ; Surgical Flaps ; Tissue and Organ Harvesting ; Treatment Outcome ; Young Adult

STUDY DESIGN: Retrospective study (level of evidence=3). PURPOSE: We examine the relationship between residual symptoms after discectomy for lumbar disc herniation and peripheral nerve (PN) neuropathy. OVERVIEW OF LITERATURE: Patients may report persistent or recurrent symptoms after lumbar disc herniation surgery; others fail to respond to a variety of treatments. Some PN neuropathies elicit symptoms similar to those of lumbar spine disease. METHODS: We retrospectively analyzed data for 13 patients treated for persistent (n=2) or recurrent (n=11) low back pain (LBP) and/or leg pain after primary lumbar discectomy. RESULTS: Lumbar re-operation was required for four patients (three with recurrent lumbar disc herniation and one with lumbar canal stenosis). Superior cluneal nerve (SCN) entrapment neuropathy (EN) was noted in 12 patients; SCN block improved the symptoms for eight of these patients. In total, nine patients underwent PN surgery (SCN-EN, n=4; peroneal nerve EN, n=3; tarsal tunnel syndrome, n=1). Their symptoms improved significantly. CONCLUSIONS: Concomitant PN disease should be considered for patients with failed back surgery syndrome manifesting as persistent or recurrent LBP.
Diskectomy ; Failed Back Surgery Syndrome ; Humans ; Leg ; Low Back Pain ; Lumbosacral Region ; Nerve Compression Syndromes ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Retrospective Studies ; Spine ; Tarsal Tunnel Syndrome

Epiduroscopy is defined as a percutaneous, minimally invasive endoscopic investigation of the epidural space. Periduroscopy is currently used mainly as a diagnostic tool to directly visualize epidural adhesions in patients with failed back surgery syndrome (FBSS), and as a therapeutic action in patients with low back pain by accurately administering drugs, releasing inflammation, washing the epidural space, and mechanically releasing the scars displayed. Considering epiduroscopy a minimally invasive technique should not lead to underestimating its potential complications. The purpose of this review is to summarize and explain the mechanisms of the side effects strictly related to the technique itself, leaving aside complications considered typical for any kind of extradural procedure (e.g. adverse reactions due to the administration of drugs or bleeding) and not fitting the usual concept of epiduroscopy for which the data on its real usefulness are still lacking. The most frequent complications and side effects of epiduroscopy can be summarized as non-persistent post-procedural low back and/or leg discomfort/pain, transient neurological symptoms (headache, hearing impairment, paresthesia), dural puncture with or without post dural puncture headache (PDPH), post-procedural visual impairment with retinal hemorrhage, encephalopathy resulting in rhabdomyolysis due to a dural tear, intradural cyst, as well as neurogenic bladder and seizures. We also report for first time, to our knowledge, a case of symptomatic pneumocephalus after epiduroscopy, and try to explain the reason for this event and the precautions to avoid this complication.
Brain Diseases ; Cicatrix ; Epidural Space ; Failed Back Surgery Syndrome ; Hearing Loss ; Humans ; Inflammation ; Leg ; Low Back Pain ; Paresthesia ; Pharmaceutical Preparations ; Pneumocephalus ; Post-Dural Puncture Headache ; Punctures ; Retinal Hemorrhage ; Rhabdomyolysis ; Seizures ; Tears ; Tissue Adhesions ; Urinary Bladder, Neurogenic ; Vision Disorders

PURPOSETo express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period. Five kinds of flaps were used. Each flap was presented with detailed information regarding indication, blood supply, skin territory and technique.

METHODSAltogether 26 patients underwent lower leg reconstruction were included in this study. The reconstructive procedures applied five flaps, respectively distally based posterior tibial artery perforator flap (n = 8), distally based peroneal artery perforator flap (n = 4), distally based sural flap (n = 6), medial planter artery flap (n = 2) and cross leg flaps (n = 6).

RESULTSIn all cases, there were no signs of osteomyelitis of underlying bones or discharge from the undersurface of the flaps. Fat necrosis occurred at the distal end of posterior tibial artery perforator flap in one female patient. The two cases of medial planter artery flap showed excellent healing with closure of donor site primarily. One cross leg flap had distal necrosis.

CONCLUSIONWould at lower third of leg can be efficiently covered by posterior tibial, peroneal artery and sural flaps. Heel can be best covered by nearby tissues such as medial planter flap. In presence of vascular compromise of the affected limb or exposure of dorsum of foot, cross leg flap can be used.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Foot Injuries ; surgery ; Free Tissue Flaps ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged ; Postoperative Care ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Young Adult