Objective This study is to compare flap-viability-related complications, coverage reach, recon-struction outcomes and donor-mobidities between distally-based peroneal artery perforator-plus fasciocutaneous (DPAPF)flap and distally-based posterior tibial artery perforator-plus fasciocutaneous(DPTAPF)flap for recon-struction of soft-tissue defects over the distal lower leg, ankle and foot, and thus provide evidence for selection of the flaps. Methods Between April, 2002 and February, 2012, 216 and 59 patients underwent the reconstructions with DPAPF flaps(peroneal group)and DPTAPF flaps(posterior tibial group)respectively. We subdivided the distal lower leg, ankle and foot into 12 subregions. In all the patients, flap-viability-related complications and its potential risk factors(including age,sex,etiology,location of top edge,location of pivot point,length and width of both the skin is-land and adipofascial pedicle, length-width ratio, and total length), coverage reach(the subregion in which the most distal part of the reconstructed defect lies),duration of flap elevation and hospital stay were compared between the two groups. In patients with at least 3 months postoperative follow-up, comparative study of reconstruction outcomes, pa-tient's satisfaction with flap appearance and donor-site morbidities were performed between the groups. Results Partial necrosis rate in the peroneal of the posterior tibial group were 12.0 percent versus 20.3 percent,respectively(P> 0.05). Marginal necrosis and overall complication (including partial and marginal necrosis)rates in the peroneal group(1.9 percent and 13.9 percent, respectively)were significantly lower than those in the posterior tibial group (8.5 percent and 28.8 percent,respectively)(P<0.05).Incidence of partial necrosis of the flaps for the defects over subregions 7 to 10 in the peroneal group(7 of 41)was significantly lower than that in the posterior tibial group(2 of 2).There was no difference in reconstruction outcomes and patient's satisfaction with flap appearance in both groups(P >0.05).Incidences of hypertrophic scar,itching and pigmentation at the donor site were significantly lower in the peroneal group(P<0.05). Conclusion DPAPF flap is superior to DPTAPF flap in reliability,safe coverage reach and less donor-site morbidities.The former is recommended as the first choice when local pedicle flaps are considered to recon-struct soft-tissue defects over the distal lower leg,ankle and foot.

Objective:To explore the clinical effect of Bobath manipulation combined with traditional Chinese medicine fumigation and intradermal acupuncture on shoulder hand syndrome(SHS) after stroke.Methods:From April 2017 to August 2019, 80 patients with SHS after stroke admitted to the People's Hospital of Deqing County were selected, and they were divided into control group and observation group according to the random digital table method, with 40 cases in each group.The control group was treated by Bobath therapy, and the observation group was treated by Bobath therapy combined with acupuncture(intradermal acupuncture) and traditional Chinese medicine fumigation.After 8 weeks of treatment, the ROM scale, FMA scale, BI scale and VAS scores were used to evaluate the improvement in the mobility of the shoulder and wrist joints, motor function of the upper limbs, quality of life and pain, and the clinical efficacy of the two groups was compared.Results:Compared with before treatment, the ROM scale score of all dimensions of shoulder and wrist mobility, FMA scale score and BI scale score of all patients after treatment increased significantly, and the VAS score decreased significantly, the differences were statistically significant(all P<0.05). Compared with the control group after treatment, the improvement of the indicators mentioned above of the observation group were better[shoulder joint flexion ROM score: (154.83±25.63)points vs.(133.82±22.03)points; shoulder joint abduction ROM score: (152.36±25.68)points vs.(133.35±19.96 )points; shoulder joint external rotation ROM score: (75.87±14.69)points vs.(60.82±16.57 )points; wrist joint palm flexion ROM score: (73.94±14.37)points vs.(57.37±9.47)points; wrist joint back extension ROM score: (60.83±7.61)points vs.(42.27±6.37 )points; FMA scale score: (45.74±6.82)points vs.(34.19±4.07)points; BI scale score: (70.36±12.09)points vs.(58.70±12.53)points; VAS score: (1.05±0.49)points vs.(3.37±1.14)points, t=3.703, 3.715, 3.257, 5.576, 7.964, 3.037, 8.746, 3.153, all P<0.05]. The total effective rate of the observation group was significantly higher than that of the control group[97.5%(39/40) vs.62.5%(25/40), χ 2=15.313, P<0.05)]. Conclusion:The combination of Bobath therapy with traditional Chinese medicine fumigation and intradermal acupuncture can improve the pain degree, joint mobility disorder, upper limb motor function and quality of life of SHS patients, the efficacy is better than single Bobath therapy.The clinical effect is accurate, and it is worthy of further promotion and application.