Objective:To investigate the efficacy of an anterolateral femoral chimeric perforator flap combined with vancomycin-loaded calcium sulfate in the treatment of chronic infection after internal fixation of calf fracture with soft tissue defects.Methods:Retrospectively analyzed were the data of 16 patients with chronic infection combined with extensive soft tissue defects after internal fixation of calf fracture who had been admitted to Department of Orthopedics, Shenzhen Hospital Affiliated to Peking University from September 2008 to November 2020. There were 11 males and 5 females, aged from 16 to 62 years (average, 37 years). Infection sites: the upper tibia in 4 cases, the middle and lower tibia in 10 cases, and the middle fibula in 2 cases. According to the Cierny-Mader classification, all patients were anatomical type III and by the host classification, there were 14 cases of type B and 2 cases of type C type. The areas of soft tissue defects ranged from 6 cm × 4 cm to 23 cm × 14 cm. All patients were treated by transplantation of an anterolateral thigh chimeric perforator flap combined with vancomycin-loaded calcium sulfate therapy. At the last follow-up, the curative efficacy was evaluated according to the Paley fracture union scoring.Results:All patients were followed up for 8 to 24 months (mean, 16 months). Complete flap survival was achieved in 15 flaps and partial survival in one. According to the Paley fracture union scoring at the last follow-up, the curative efficacy was evaluated as excellent in 15 cases and as good in one. Both the grafted artificial bone and the tibia and fibula achieved bone union after 6 to 12 months (mean, 8.9 months). Infection with chronic sinus tract pus recurred in one case at post-operative one year. After re-debridement, the infection was controlled and the wound healed. The plate internal fixation was replaced by the unilateral or annular external fixator in 14 patients and retained in 2 patients. The lengths of the bone defects averaged 2.4 cm and the time for the external fixation 10.5 months (from 8 to 14 months).Conclusion:In the treatment of chronic infection after internal fixation of calf fracture with extensive soft tissue defects, the efficacy of an anterolateral femoral chimeric perforator flap combined with vancomycin-loaded calcium sulfate is satisfactory, because the flap can fully cover the bone and soft tissue defects while the vancomycin-loaded calcium sulfate can effectively control the infection.

Objective To investigate the application effect of interscalene brachial catheter plus functional exercise af-ter tendon adhesion lysis. Methods A total of 40 patients with 68 fingers who hospitalized due to postoperative tendon adhesions of flexor tendon injury repair and the need of tendon adhesion lysis from January 2012 to December 2013 were chosen, and were randomly divided into group A and group B. Group A received scalene brachial plexus catheter analgesia, and group B received the conventional therapy. Knuckle total active activity and pain degree of the two groups were compared. Results There were significant differences in comparing knuckles TAM of group A before ad-ministration, group A after administration and group B after operation for 1 d to 1 week, and TAM good rate of group A after administration increased significantly. There were significant differences in comparing NRS scores of group A be-fore administration, group A after administration and group B, and pain of patients in group A after administration sig-nificantly improved(P<0.05). Conclusion Application of brachial plexus catheter analgesia can significantly reduce the pain of functional exercise, promote recovery of hand function in patients and reduce the incidence of tendon re-adhe-sions.