Objective:To investigate the clinical efficacy of integrated steel plate system combined with Kirschner wire internal fixation in the treatment of Lisfranc injury.Methods:Data of 30 cases with Lisfranc injury who were admitted from January 2010 to December 2018, including 22 males and 8 females were retrospectively analyzed. The age ranged from 22 to 58 years, with an average age of 44.5 years. All of them were closed injuries, including 8 cases involving metatarsal tarsal base fracture, and 2 cases with compression fracture of dice. Classification of Lisfranc joint injury: 6 cases of injury of the inner column alone, 10 cases of injury of the inner column and the middle column, 4 cases of injury of the middle column and the outer column, 10 cases of injury of the three columns. Cause of injury: traffic injury in 12 cases, machine injury in 10 cases, fall injury in 8 cases. The time from injury to operation was 2-7 d, with an average of 5 d. After the improvement of soft tissue conditions, all patients were treated with open reduction and internal fixation using integrated plate system combined with Kirschner wire, followed up by regular post-operative imaging examination, and the therapeutic effect was evaluated by the American Association of Foot and Ankle Surgery (AOFAS) midfoot score.Results:Thirty patients were followed up for 12-30 months (mean 24 months), during which no soft tissue complications such as wound infection and skin necrosis were observed. Average postoperative healing was observed at 12 weeks (10-16 weeks) for them who combined with fracture. At the latest follow-up, the AOFAS midfoot score was 65-95 points (mean 85 points). The midfoot function scores of the 30 patients were: excellent in 15 cases, good in 10, fair in 3, poor in 2. The excellent and good rate was 83.3% (25/30). One patient showed low toxicity and red skin 8 months after the operation. The integrated steel plate system was removed and the skin healed smoothly after the operation. One year after surgery, 10 patients requested removal of the internal fixation. None of the patients had the complication of plate, screw and Kirschner wire fracture. Two patients with three-column injury developed traumatic arthritis and walking pain 12 and 18 months after surgery, respectively, and then underwent metatarsal tarsal joint fusion. The postoperative pain disappeared.Conclusion:The integrated steel plate system combined with Kirschner wire internal fixation for the treatment of Lisfranc injury is simple, can avoid joint redislocation and articular cartilage reinjury, is a safe and effective method for the treatment of Lisfranc injury.

BACKGROUND: Current numerous studies have confirmed that silver nanoparticles have been extensively applied due to their good anti-bacterial performances. OBJECTIVE: To summarize the overseas and domestic research and development of anti-bacterial silver coating based on the anti-bacterial mechanism and bio-safety of silver nanoparticles as wel as progression of anti-bacterial silver coating. METHODS: The first author retrieved the databases of Web of Science, PubMed and CNKI for relative articles published from January 1976 to January 2015. The keywords were “silver nanoparticles, titanium al oy, implant, antibacterial properties, biosecurity, coating” in English and Chinese, respectively. RESULTS AND CONCLUSION: Because of their smal dimension and quantum effects, as wel as great specific surface area, silver nanoparticles can be in close contact with pathogenic microorganisms to exert biological effects. Additional y, silver nanoparticles exhibit the excellent resistance to bacteria, fungi, viruses and cancer cel s. However, most of their mechanisms of biological effects remain unclear, and there are unresolved problems about the slow-release time of silver nanoparticles in vivo and how to control the slow-release silver ions. Besides, there are fewer long-term animal experiments. Therefore, a large number of laboratory and clinical studies are needed to ensure that silver nanoparticles cannot cause adverse reactions during long-term administration and how to reduce their toxicity.

Objective To explore the clinical outcomes of free latissimus dorsi lobulated musculocutaneous flap for repairing the soft tissue defects of the shank.Methods From January 2011 to December 12,free latissimus dorsi lobulated musculocutaneous flap was transferred to repair soft tissue defects of the shank in 22 cases.There were 16 males and 6 females retrospectivelyanalyzed,with an average age of 37.5±2.5 years.The wounds all had tendon,bone and/or internal fixation exposed.The size of the defect area was 18 cm×10 cm to 28 cm×15 cm.At first,the site of perforator vessels was determined by Doppler as the center,then the lobulated flaps were designedaccording to the wound shape and size.During the operation,the thoracic and dorsal nerves and part of latissimus dorsi muscle were preserved,and the myocutaneous flap was formed into lobulated myocutaneous flap.Finally,the pedicle was dissociated to the appropriate lengthwhen only the vascular pedicle was connected with the flap.After the combination of the two lobulated myocutaneous flaps,the skin flap was trimmed,and the subcutaneous fat was removed in a step-like way from the peripheral to the point of perforation of vascular cutaneous branches.Only the dermis was retained around the integral skin flap,and the blood supply of the skin flap was observed at the same time to prevent the injury of perforating vessels.The transplantation of musculocutaneous flap was performed to repair the leg wound.All donor sites were sutured directly.The flap survival was observed according to the comprehensive evaluation standard of hand surgery.Results All the 22 flaps survived,and the size of lobulated musculocutaneous flap was 20 cm× 12 cm to 30 cm× 16 cm.No vascular crisis happened,and all skin grafts survived in donor sites.22 cases were follow-up for 6 to 24 months.The flaps were supple and elastic with nearly normal color.There was no bulkiness.Sensory function recovered well and two-point discrimination (2-PD) was about 3.5-5.0 cm.The function and appearance of the foot and ankle was good.According to the operative hand surgery function evaluation of flap,the results were excellent in 13 cases,good in 8 cases,fair in 1 case,with excellent and good rate of 95.45％ (21/22).1.0 cm×0.5 cm of the distal of flap was necrosis in 1 case and healed by dress changing.Conclusion The free latissimus dorsi lobulated musculocutaneous flap is an improvement of the traditional latissimus dorsi flap.The survival rate of musculocutaneous flap is high and the clinical effect of repairing soft tissue defect of lower leg is satisfactory.

Objective:To explore the repair of fingertip defects with transplantation of different types of free perforator flaps pedicled with the superficial palmar branch of radial artery (SPBRA).Methods:A retrospective analysis was carried out of the clinical data of 46 fingers from 38 cases [28 males and 10 females, aged 17-54 years with a mean age at (38.5±15.5) years] with tissue defects of fingertips that were repaired with free perforator flaps based on SPBRA, between January, 2013 and December, 2018. The soft tissue defects were 1.5 cm ×3.5 cm to 2.5 cm×5.5 cm. Among them, 8 cases were repaired with bilateral free SPBRA perforator flaps. Thirteen flaps carried long palmar tendon. Thirty flaps carried radial nerve and the other 16 flaps without. The size of flaps was 1.6 cm×4.0 cm- 2.8 cm×6.0 cm. Donor sites were all closed directly. Monthly postoperative follow-up was conducted. All the evalua- tion indexes of flap were measured and recorded. Instructed patients to do wrist and finger joint exercises.Results:All 46 flaps survived. No vascular crisis happened and all skin grafts survived in donor sites. There was 0.5 cm×0.3 cm of distal flap necrosis in 1 case and healed by dress changing. Thirty-eight cases had followed-up for 6 to 24 months. The flaps were soft and elastic, and colours were near to normal. There was no bulkiness. Sensory function re- covered well and TPD was 5.0-8.5 mm. The function and appearance of the finger were good. According to the Oper- ative Hand Surgery Function Evaluation of Flap after 6 months, the result was excellent in 42 cases, good in 3 cases, fair in 1 case, with 97.83% of excellent and good rate.Conclusion:Using different types of free tissue perforator flap based on SPBRA can repair fingertip defect, and reconstruct the defect of digital artery, nerve or tendon in one stage. The operation was simple and easy to do, and can achieved good results with high survival rates and good function recovery.