Objective To determine the outcome of the combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg.Methods Sixteen patients were identified from a retrospective review from July,2008 to July,2013,who suffered the large soft tissue defects and bone lose in the lower leg and underwent single-stage soft tissue and osseous reconstruction using the flap technique and Ilizarov method.There were 12 males and 4 females aged from 22 to 62 years old (average 42.6 years old).The size of soft tissue defect ranged from 8 cm×9 cm to 30 cm×20 cm.The length of the bone discrepancy ranged from 2 to 14 cm.According to the local condition of the lower leg and the size of the composite tissue defects,10 patients received the free flap covering,6 patients repaired by the saphenous neurocutaneous perforator flap (3 cases) and sural nerve neurocutaneous flap (3 cases).Daily monitoring the skin temperature postoperative.Distraction was commenced on postoperative day 10 to 14 at the rate of 1 mm/day and continued in 4 equal increments.Results The follow-up time ranged from 18 to 36 months.Sixteen flaps survived completed,only 1 flap was observed the venous congestion in postoperative day 2.The duration of ilizarov application ranged from 3.5 to 18.0 months.All patients achieved final union.All patients were satisfied with the outcome of the surgery.Conclusion The combined use of neurocutaneous flap and Ilizarov technique for reconstruction of large composite soft tissue defect in the lower leg.Significantly reduce patient treatment time,improving traction osteogenesis of long bones and the ability of resistance to infection.

[Objective]To evaluate the curative effect,indication and care for cage,the patients with lumbar vertebrae instability were treated by 1umbar interbody ecstatic fusion cage.[Method]There were 42 patients,male 31 and female 11,aged 3 5~78 years(averaged 46 years) and suffered with spondylolisthesis of isthmus non-union in 26 cases and degenerative spondylolisthsis in 1 6 cases,including spondylolisthsis of L3、4 5 cases,of L4、5 23 cases and of L5S1 14 cases.According to Meyerding classification,there were grade-I spondylolisthsis 29 cases and grade-Ⅱ 13 cases.All patients were treated with decompression of lumbar canal,resection of vertebral disc,insertion of ecstatic fusion cage.The curative effect was observed and evaluated.[Result]Patients were followed up for 6 months to 6 years,the results were good rate of JOA scores 95%,the recovery rate of inter-spinal height,reduction and bone fusion rate were up to 98%.[Conclusion]For lumbar spondylolisthesis of grade Ⅰ～Ⅱ,the ecstatic fusion cage has good effect on recovery of inter-spinal height,improvement of bone fusion rate,maintaining lumbar stability,relieving clinical symptom.It is a good curative method for lumbar vertebrae instability.

[Objective]To evaluate the cytocompatibility of chitosan-alginate scaffolds through in vitro cytoxicity experiment,cell-material co-culture experiment and in vivo implantation test.[Method]Chitosan-alginate scaffolds with longitudinal,paralleled multi-channels were produced via freeze-drying. Bone marrow derived stromal cells (BMSCs) were cultivated with the leach liquor. The cytotoxicity of scaffold was analyzed using MTT assay after 1,3 and 5 days of culture.Scanning electron microscopy was conducted after 3,5 and 7 days of BMSCs culture on the chitosan-alginate scaffold in vitro. Immunofluorescence detection was performed after implanting BMSCs and chitosan-alginate scaffolds in vitro in acute hemi-transaction spinal cord injury.[Result]The cytotoxicity of chitosan-alginate scaffold was in grade 0-1. Scanning electron microscopic observation indicated that the cells adhered to and grew on the surface of scaffold,arranging in a directional manner after 3 days of co-culture. NF200 and NSE fluorescence detection proved that a great many BMSCs were survival in the scaffold after 6 weeks,and that some transplanted cells differentiated into neuron-like cells.[Conclusion]Chitosan-alginate scaffold has a satisfactory cytocompatibility and may be an ideal tissue engineering scaffold material.

Objective To analyze the radiographical and histological features of implanted composites of decalcified bone matrix(DBM) impregnated with calcium phosphate cement(CPC) and recombinant human bone morphogenetic protein-2(rhBMP-2) in bone defect,and evaluate its biodegradation properties.Methods By prefabricating the rabbit DBM,the CPC/DBM/rhBMP-2 composites were prepared in a DBM/CPC ratio of 2∶8 and the rhBMP-2 content of about 1.2mg/cm3.Twenty-four rabbits were divided into groups A and B(12 each).Animals in group A were implanted with the composites in the bone defects at femoral condyle and femoral muscle,and the rabbits in group B CPC was implunted in the same place.Animals were sacrificed at 6,12 and 24 weeks after operation(4 each),and the implants were examined radiographically and histologically.Results It was shown by radiography that,in group A,the margin of implants in femoral condyle defects became irregular 6 weeks after operation;the appearance of the implants appeared hazy and shrunken in size 12 weeks after operation;and most of the implant was absorbed and the medullary cavity became partly rediotransparent 24 weeks after operation.The density of the implants in muscles beoame less dense gradually during 6 to 24 weeks after operation.While in group B,the appearance and density of the implants in femoral condyle defects and muscles were not obviously changed during 6-24 weeks after operation.Histological observation showed that,in group A,the interface between the implants in the bone defects was filled with newly formed bone grown into the composites 6 weeks after operation.New bone formed inside the composites 12 weeks after operation,and the bone defect was repaired,and most of the implants were replaced by new bones,with a little portion of it remained 24 weeks after operation.Fibrous tissue was seen to grow into the composites in muscles during 6-12 weeks after operation,and only a little of the composites remained 24 weeks after operation.In group B,no fibrous tissues or new bones grew into composites implanted in femoral condyle defects or muscles 6-12 weeks after operation,and the bone defects was still filled with materials of CPC,and no new bone or fibrous tissue was found inside CPC 24 weeks after operation.Conclusion Compare with CPC,the DBM with an optimal formula is are easy biodegradable and can be replaced by autologous bone.

Objective To discuss the donor site complications and the treatments of the anterolateral thiIgh flap transfer. Methods From July 1988 to July 2007,427 patients treated by anterolateral thish flap surgery were followed up.The donor sites were treated by several methods,including direct closure(49 cases),skin graft transfer(258 cases),anterolateral fascial flap transfer(27 cases),musculocutaneous flap and skin sraft transfer(65 cases), superficial epigastric artery flap transfer(28cases).The area of these flaps ranged from 30 cm×10 cm to 18 cm×7 cm.and the average follow-up was 21 months(ranged from 8 months to 54 months). All the data was analyzed by SPSS for Windows,Version 11.0.1. Results Short-term complications(within 4 weeks)and long-term complications (over 6months)were observed.The former included skin necrosis(5.4%),wound infection(4.0%),and necrosis of rectus femoris(0.5%); and the latter included chronic ulcer(4.9%), aerious scar(6.6%), serious discomfortable(5.9%),and quadriceps femoris disfunction(3.7%).The statistical results showed that there was a close correlation between the donor site morbidity and the surgical methods. Conclusion The complications of the donor site cannot be ignored.Protect the soft-tissue of the donor site carefully,design all appropriate operation plan.Careful preoperative examination and local flap transplantation can effectively decrease the rate of complications.

10.3969/j.issn.2095-4344.2013.25.008

Objective To study the anatomy of superficial palmar digital veins in fingertip,and explore the clinical application of superficial palmar digital veins as venous drainage in fingertip replantation.Methods One hundred fingers were studied with three methods: microanatomy,sectional anatomy,and X-ray.According to microanatomical observation,thirteen fingers in 10 cases with fingertip amputations and dorsal veins defect were replanted by anastomosis of palmar digital veins to reconstruct the venous drainage of the amputated digits. Results ( 1 ) 1 to 3 tiny superficial palmar digital veins can be found at the level of the onychorrhiza.The average diameters of the superficial palmar digital veins were 0.2-0.5 mm.(2)In clinical practice,13 replanted fingers were survived.After 3-18 months following-up,the appearance and function were satisfactory. Conclusion The distribution of the palmar digital veins was in some pattern.Anastomosis of the superficial palmar digital veins can not only improve the success rate of the fingertip replantation,but also avoid the complications of the other venous drainage methods.

Objective To evaluate the clinical effect of the reversed saphenous fasciocutaneous island flap combined with the VSD therapy in plate exposure of the distal tibia.Methods From January 2008 to July 2010,seven patients with hardware exposure following internal fixation of the distal tibia fracture were treated by VSD therapy and reversed saphenous fasciocutaneous island flap reconstruction.The VSD therapy was performed from 7 to 26 days after hardware exposure,and the flap transfer was performed 7 to 14 days after the VSD therapy.The size of the soft-tissue defect ranged from 4 cm × 2 cm to 13 cm × 4 cm.The mean follow-up was 10.6 months after the fracture (range,8-14 months).Results The average times of the VSD therapy was 1.3.After VSD was removed,the exposed hardware was covered by healthy granulation tissue in all cases.All flaps were successfully transplanted,and the size of flap ranged from 6 cm × 3 cm to 15 cm × 6 cm.Six of 7 flaps survived completely without further procedures.The necrosis of the distal margin of the flap occurred in 1 patient.A solid bony union was confirmed by the X-ray in all patients after 4-6 months postoperatively.No skin defects or fistulae were observed.Conclusion The combination of the reversed saphenous fasciocutaneous island flap and VSD therapy could save the exposed hardware and cover the soft tissue defects in the distal tibia.

BACKGROUND:Studies have shown that the vacuum sealing drainage technology can effectively promote the wound healing, and it has a wide prospect of clinical application, but there are few reports addressing the
treatment of diabetic foot.
OBJECTIVE:To discuss the clinical effect of vacuum sealing drainage technology in the treatment of diabetic foot wounds.
METHODS: Sixty diabetic foot patients were randomly divided into two groups: traditional treatment group,
regulating blood sugar level, dressing and traditional debridement; vacuum sealing drainage group, conventional treatment combined with the vacuum sealing drainage technology. The clinical efficacy of two treatments for
diabetic foot was evaluated.
RESULTS AND CONCLUSION: Compared with the traditional treatment group, the vacuum sealing drainage
showed better outcomes in switching frequency, stable blood sugar control, preparation time, wound healing time and cure rate (P < 0.05). It indicates that the vacuum sealing drainage technology in the treatment of diabetic foot ulcers can resolute wound inflammation, stimulate the growth of granulation, create a favorable surgical condition for secondary skin grafting or flap coverage, significantly shorten the treatment time, and exhibit better curative effects than the traditional treatment.

Objective To report the anatomical study and clinical application of the free peroneal perforator-based sural neurofasciocutaneous flap. Methods Latex injection studies were performed on 10 adult cadaveric lower limbs. The presence, prevalence, and location of the peronel perforators that were suitable for vascular anastomosis were documented. From April 2007 to January 2010, 6 patients with large soft tissue defects in the upper limb underwent the reconstructive procedures with the free peroneal perforatorbased sural neurofasciocutaneous flap transfers. 4 patients were men and 2 were women, with the age ranging from 19 to 60 years. The causes of the injury included 4 motor vehicle accidents, and 2 massive machinery trauma. The area of the flap ranged from 16 cm × 8 cm to 30 cm × 10 cm, and the length of the perforator pedicle was 4 cm to 6 cm. Results A mean of 5.3 perforating vessels of the peroneal artery was noted in the specimen. The peroneal perforator that located at the junction of the middle and lower thirds of the fibula was found suitable for microsurgery, with the external diameter and the length being (1.21 ± 0.13)mm and (4.6 ± 0.8)cm respectively. All the 6 flaps survived completely without necrosis. No severe venous congestion was observed. All the patients were satisfied with the aesthetic outcome postoperatively at 3 to 12 months'follow-up. There were no major donor site complications. Conclusion The free sural neurofasciocutaneous flap based on a single peroneal perforator is an excellent tool for reconstruction of extensive soft tissue defects in the upper limb.