Objective To study and discuss the problems involved in as well as the significance a nd methods of restoration and reconstr uction of forefoot defects.Methods Various procedures were adopted ac-cording to the wound variety and severity.For just absense of mefatarsal bones,only soft tissue was restored.For defects of metatarsals or metatarso phalangeal joints(usually associated with soft tissue defects)homochronous reconstruction and restoration was conducted by using vascularized bon e incorporation with free flap transplan-tation.Results Total 47cases wih forefoot defects were recpaired by using procedures me ntioned above from1994to 2000.All of this group regain ed their walking and weight-bearing functions as well as a good appearance.Conclusions Classification of forefoot injurie s according to their severity and loc ation is helpful in treatment,precise description and further stu dy of the injuries.Vascular bone incorporating with vascular flaps proved to be an ideal method of repairing compound defects.

Objective To study and solve the reconstruction of the defects of first metatarsal and the forefoot. Methods Using microsurgical technique,adopt transplantation of vascularized iliac bone incorporating with free flap to restore the defects of first and second metatarsal as well as forefoot. Results The injuried foot was restored its weight-bearing and walking functions and obtained a satisfactory contour. Conclusion The vascular iliac bone was an ideal donor site for reconstruction of absense of metatarsal,and vascular bone incorporating free flap were proved superiorly in treatment of forefoot defects.

Objective To explore reconstructive methods for defects uf bone and soft tissue in traumatic injury uf medial malleolus.Methods A vascular iliac bone with a piece of faacial strip is used together with a local island flap or a free flap to reconstruct the defects of bone,triangular ligament and skin in medial malleolus al one or two stages.Results Follow-ups of 11 to 24 months proved that the stability and walking and weight loading functions uf ankle joint of the patients were restored satisfactorily and their normal varus range without abnormal articular motion was restored.Slight varus occurred during walking in one case,and pain appeared after fatigue in two cases.The X-grams showed no obvious absorption or areosis in the free iliac bone implanted.Conclusion In repair of defects of medial malleolus,combined transplantation of iliac bone and flap is rceommendable because it can keep the essential integrity of malleolus and achieve good Stability and functional recovery of ankle joint.

OBJECTIVETo investigate the clinical effect of lateral superior genicular composite tissue flap for tissue defect.

METHODSThe axis line of flap is the lateral thigh vertical midline. The cutaneous branch is inserted 4 cm near the femoral lateral epicondylus. The anterior border is the elongation line along patellar lateral border. The posterior margin is the hinder margin of femoral biceps. The lower border is the horizontal line along the upper line of patella. The composite flaps were used in 18 cases with soft tissue defects in extremities, 11 cases with clacaneus tenden defects and 16 cases with bony nonunion. Results From Mar. 2002 to Sept. 2013, 45 cases were treated with the composite tissue flaps. The flaps size ranged from 6 cm x 3 cm to 17cm x 9 cm. All the flaps survived completely. Blood supply crisis happened in 2 cases, which was released by reanastomosis. The patients were followed up for 1 - 2. 5 years with satisfactory aesthetic and functional results. All the bone defect and nonunion were healed. Good healing was also achieved in donor sites. 8 months after operation, knee joint function is evaluated as good by hospital special surgery knee score (HSS).

CONCLUSIONLateral superior genicular compostie tissue flap can be used to reconstruct soft tissue defect, bone defect and tenden calcaneus defect in one stage.

Anatomic Landmarks ; anatomy & histology ; Follow-Up Studies ; Graft Survival ; Humans ; Knee ; anatomy & histology ; Muscle, Skeletal ; anatomy & histology ; Soft Tissue Injuries ; pathology ; surgery ; Surgical Flaps ; transplantation ; Thigh ; Time Factors ; Wound Healing

Objective To study and discuss the methods for repairation and reconstruction of foot defects in order to reduce the deformity and insufficiency of foot and to restorat its functional and cosmetic aspects. Mehtods Soft tissue recovery was enough for digital absence, dorsal, submalleolus and calcaneous defect; Delects in plantar should be repaired with pre flap; Abstence of metatarsats head should be reconstructed by using vascularized bone incorporation with free flap transplantation. Results Total 247 cases with bone and soft tissue defects of foot were recpaired by using managements mentioned above aehived satisfactory clinical result. All patiants were assed according to AOFAS of USA fool malleolus scores, excellent 84 cases; good 107; fair 42; poor 14. Conclusion Being flat in shape and abundant blood supply, the iliac bone is a valuable supply bone lor foot defects espesial for muti-matatarsal and ealeaneus. Absence of malleous should be reconstructed by free iliac bone or free febular head with fascial strip. Vascular bone incorporating with vascular flaps provided an ideal method of reconstruction foot conpound defeets.

Objectives To approach the method and clinical effect on tendo calcaneus and complex tissue defect with microsurgery repair.Methods Retrospective summary the methods of 356 cases with tendo calcaneus and complex tissueserious defect,which repaired by different microsurgery from June 1994 to March 201 1.Two type were divided on account of different degree of serious tendo calcaneus and complex tissue defect.Type A:the length of tendo calcaneus defect was less than 3 cm,and cutaneous deficiency is less than 3 cm × 20 cm.Direct suture (166 cases) or Abraham retrograde V-Y method (72 cases)was used to repair endo calcaneus defec,anfregional flap metastasis was used to repair cutaneous deficiency.Two hundred and thirtyeight cases were used by those methods,including of lateral heel flap repair(23 cases),medial plantar island flap(58 cases),instep island flap(40 cases),above medial malleolus flap(48 cases),above ateral malleolus flap (24 cases),sural nerve nutrient vessel flap (29 cases) gastrocnemius muscle flap (16 cases).Type B:the length of tendo calcaneus defect was more than 3 cm,and cutaneous deficiency was more than 3 cm × 20 cm.Direct suture could not repair tendo calcaneus,the complex tissue flap free grafting was used to primary repair tendo calcaneus and complex tissue defect.One hundred and erghteen cases were used by those methods,including of tensor fasciae latae flap free grafting (52 cases),lateral above knee complex tissue flap free grafting (26 cases),latissimus dorsi muscle fascia flap free grafting (24 cases),rectus abdominis muscle front sheath flap free grafting (16 cases).Three hundred and fifty-six cases were repaired by these methods,including 238 cases of regional flap transfer 118 cases of tissue flap free grafting.Results In 238 cases of regional flap transfer,two hundred and twenty-six cases were successful,and 12 cases were partly success,which were wound healing by change dressings.In 118 cases of tissue flap free grafting,one hundred and nine cases were successful,and blood vesse articulo were happened to 8 casess,which were success by operations research,and 1 case was failure which had to use another tissue flap.Follow-up visit was dane from 1.0 year to 4.5 years after operation (average 3.2 years).Functional assessment according to the Thermann ralted the results as excellent in 240 csaes,good in 86 cases,common in 22 cases and worse in 8 cases.The fineness rate was 91.6％.Conclusion Microsurgical repair is a good method to tendo calcaneus and complex tissue defect,different method and strategy selected actively by tissue defect degree of tendo calcaneus and complex tissue can achieve satisfactory functional rehabilitation purpose.

OBJECTIVETo investigate the therapeutic effect of primary reconstruction of skin avulsion injury with bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.

METHODSFrom June 2005 to Aug. 2011, 4 cases with skin avulsion injury on both feet were treated. The bilateral anterolateral thigh flaps, including with anterolateral thigh cutaneous nerves, were transferred to cover the feet plantar. The thorax umbilicus flap or latissimus dorsi flap were used to cover the feet dorsum.

RESULTSAll the skin avulsion injury were reconstructed primarily. All the flaps survived completely with good cosmetic and functional results. The patients were followed up for 6 months to 2 years with good sensory recovery (two point discrimination: 14-18 mm).

CONCLUSIONThe skin avulsion injury on both feet can be primarily reconstructed by bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.

Adolescent ; Follow-Up Studies ; Foot Injuries ; surgery ; Humans ; Lacerations ; surgery ; Myocutaneous Flap ; transplantation ; Reconstructive Surgical Procedures ; Skin ; injuries ; innervation ; Surgical Flaps ; innervation ; transplantation ; Thigh ; innervation