Objective:To investigate the effect of Masquelet technique combined with platelet-rich plasma (PRP) on repair of massive tibial defects.Methods:A prospective randomized controlled single blind trial was conducted in the 21 patients who had been admitted to Department of Repair and Reconstruction Surgery, Foshan Hospital of Chinese Medicine for massive tibial defects from June 2016 to June 2018.The length of bone defects ranged from 6.0 to 22.5 cm (mean, 10.8 cm)in length.They were 14 males and 7 females, aged from 29 to 60 years(mean, 42.1 years).The patients were divided into 2 groups by an en-crypting envelope with a random digital table.In the experimental group of 11 cases, the bone defects were repaired with Masquelet technique combined with PRP; in the control group of 10 cases, the bone defects were reconstructed with only Masquelet technique.The 2 groups were compared in terms of operation time, hospital stay, wound healing, weight-bearing time, bony union time, clinical union time, complications and John-er-Wruhs scores at the second stage.Results:The 2 groups were comparable due to insignificant differ-ences between them in the preoperative general data ( P>0.05).All patients were followed up for 12 to 24 months (mean, 14.9 months).There were no significant differences in operation time, hospital stay, wound healing, weight-bearing time, Johner-Wruhs scores or rate of complications at the second stage between the 2 groups ( P>0.05).The bony union time (4.5 months ± 1.2 months) and clinical union time (4.1 months ± 0.9 months) in the experimental group were significantly shorter than those (5.7 months ± 1.5 months and 5.4 months ± 1.1 months) in the control group ( P<0.05).No such postoperative complications as infection, loosening of internal fixator, bone resorption or nonunion were found in the experimental group.One case of wound infection occurred in the control group but responded to dressing change. Conclusion:Masquelet technique combined with PRP is a safe and effective reparative treatment for massive tibial defects and can speed up bone healing.

Objective:Microvascular clip plays important role in microsurgery. Therefore, the development of microvascular clips and research in clamp-related vascular injuries becomes a major topic. Based on clamp-related microvascular injuries, the study investigated in 4 aspects: injury assessment, vascular characteristics and blood vessel injury, vessel repair, and development of microvascular clamp. A prospects of the current researches is also given.

Objective:To explore the method and clinical efficacy of Flow-through latissimus dorsi musculocutaneous flap to repair children’s limb wounds.Methods:From January, 2017 to September, 2019, the Flow-through latissimus dorsi myocutaneous flap was used to repair the limb wounds in 9 children, which were 3 cases of upper extremity wounds and 6 cases of lower extremity wounds. The patients were 5-12 years old, with an average age of 9.4 years. The wound debridement was performed in the first stage, and the wound was covered with VSD. The second operation was performed 5-8 days later. Flow-through free latissimus dorsi muscle flap was used to repair the wound, and 6 patients combined with skin grafting. During the operation, both ends of the recipient area artery were trimmed into a downward slant. The proximal end of the recipient area blood vessel was coincided with the subscapular artery, the distal end was coincided with the circumflex scapular artery, and the thoracodorsal vein and the recipient area vein were coincided. One patient had 2 thoracodorsal veins, and 8 patients had 1 thoracodorsal vein. After the operation, the patients were given anti-infection, anticoagulation and antispasmodic treatment. And regular follow-up.Results:In this group, 8 flaps survived completely, and 1 had partial epidermal necrosis, which healed under the scab. Skin grafting survives well. Nine patients were followed-up for 3 to 28 months, 7 of which were followed-up in the outpatient clinic, and 2 by WeChat. CDU showed smooth blood flow in all patients 1 month after operation, in addition of 3 after 1 year. The flap had good blood flow and soft texture. Flap plastic surgery was performed in 3 cases.Conclusion:Using Flow-through latissimus dorsi musculocutaneous flap to repair the wounds of the children’s limbs, the flap survived well after the operation, and the blood circulation of the main vessel in the affected area was smooth, which had no obvious effect on the blood supply to the distal limb of the affected area.