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Application of perforator flaps to repair chronic osteomyelitis with soft tissue defect in the distal lower extremity

Zhaohui PAN ; Jianli WANG ; Pingping JIANG ; Shan XUE ; Xuesheng LIU

Chinese Journal of Microsurgery.2010;33(5):353-356. doi:10.3760/cma.j.issn.1001-2036.2010.05.001

Objective To evaluate free or pedicled perforator flaps for repairing chronic osteemylitis with soft-tissue defect in the distal lower extremity. Methods From May of 2006 to October of 2007, 28 consecutive patients of chronic osteomylitis with soft-tissue defect in the distal lower extremity underwent surgical debridement and reconstruction with free or pedicled perforator flaps. There were 13 free flaps. The free anterolateral thigh flaps were used in 2 cases to repair the soft defects in the front of leg, 3 cases in the front of the malleolus, 2 cases in the dorsum of foot, 2 cases in the heel. The free lateral crural flaps nourished by perone al artery were used in 4 cases to repair the soft defects in the dorsum of foot. There were 15 pedicled flaps. Posterior tibial artery perforator flaps were used in 4 cases to repair the soft defects in the front of leg, and 2 cases in the medial malleolus. Lateral retromalleolar perforator flaps nourished by peroneal artery were used in 6 cases to repair the soft-defects in the heel, 1 case in the lateral malleolus and 1 case in the dorsum of foot, the first dorsal metatarsal artery perforator flap was used to repair the proximal dorsum of hallux. The wound was closed with irrigation-suction in 7 cases and with vancomycin-impregnated gelatin in 8 cases. Results All 27 flaps were successfully survived except insuffcient vein refluence in 1 posterior tibial artery perforator flap, which resulted in a superficial necrosis and healed spontaneously. The follow-up period from 6 months to 2 years revealed that recurrence developed in two diffuse type patients and both were treated once and twice with success, respectively. The others healed without any signs of recurrences. No debulking procedure was necessary in any case. Secondary bone graft was performed in 3 cases. All patients were ambulatory and fully weight-bearing with normal clinical parameters at the time of last review. According to the evaluating criteria for the treatment of foot disease, the mean score was 84.5. Conclusion Free or pedicled perforator flap has been shown to be well vascularised, and it is feasible for the treatment of chronic osteomyelitis with soft-tissue defect in the distal lower extremity.

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The comprehension of preservation for petrosal vein in 147 operative cases with acoustic neuroma

Jian XI ; Xianrui YUAN ; Hongwei LIU ; Xiping DING ; Xingjun JIANG ; Qing LIU ; Zefeng PENG

Chinese Journal of Microsurgery.2010;33(5):375-377. doi:10.3760/cma.j.issn.1001-2036.2010.05.007

Objective To discuss the preservation and clinical significance of petrosal vein in microsurgical operation of acoustic neuroma. Methods 147 patients with acoustic neuroma were operated, with internal decompression of the tumor firstly then dissected the tumor with surrounding structures, the petrosal vein were protected well in 143 cases and failed to protect in 4 cases. Results No hemorrhagic infarction in cerebellar was observed in 143 cases with intact petrosal vein. One case occurred with extensive cerebellar edema, which has gait disturbance after 18 months follow-up. The other three cases occurred with vein infarction and hemorrhagic edema after petrosal vein damage. One was dead and the other two were recovered well after decompression of posterior cranial fossa. One has no significant neurological deficit after 33 months follow-up, while the other has difficulty in line walking after 12 months follow-up. Conclusion Petrosal vein should be well protected in the operation of acoustic neuroma, the decompression of posterior cranial fossa should be considered if petrosal vein failed to protect.

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Clinical application of the extended reverse anterolateral leg flap

Laijin LU ; Xu GONG ; Zhaopeng XUAN ; Bin LIU ; Jiaao YU ; Lei CHEN ; Jianli CUI ; Xiguang SUN ; Lu LU

Chinese Journal of Microsurgery.2009;32(5):360-362. doi:10.3760/cma.j.issn.1001-2036.2009.05.004

Objective To introduce the clinical application of the extended anterolateral leg flap,which is based on the superficial peroneal artery and lateral supramalleolar artery. Methods Through anatomic study on the blood supplies of the skin over the anterolateral portion of the leg.The combined superficial peroneal artery and lateral supramalleolar artery could extend the size of the traditional anterolateral leg flap.In addition,the point of pivot of the extended anterolateral leg flap could locate at the level of the lateral malleolus,which decreases the distance between the flap and recipient site.Clinically,we have used the extended anterolateral leg flaps in 60 patients to cover skin defect over the feet.The flap ranged from 16 cm×10 cm(pedicle length 8.0 cm)to 26 cm×7 cm(pedicle length 6.0 cm). Results In the series, the flap survived in 53 patients(88.3%)unevently,and partial necrosis occurred in 7 patients(11.7%).Conclusion Based on the combined superficial peroneal artery and lateral supramalleolar artery,the size of the traditional anterolateral leg flap could be inceased,which enlarges its value on the coverage of skin defects over the feet.

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Clinical application of distally based lesser saphenous-sural nerve adipofascial flap

Chenglin YANG ; Zhenggang BI ; Chunjiang FU ; Yang CAO

Chinese Journal of Microsurgery.2009;32(5):363-365. doi:10.3760/cma.j.issn.1001-2036.2009.05.005

Objective To explore the clinical application of lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft taken from the groin area for reconstruction of the distal one third of anterior tibia,.around the ankle. Methods A distally based lesser saphenous.sural nerve adipofag.cial flap accompanied with a full-thickness skin graft which was taken from the groin area was studied and used to treat 12 patients with soft tissue defects in the distal one third of anterior tibia,3 cases with soft tissue defects and tibia osteomyelitis,2 cases with soft tissue defects and tibia osteomyelitis.The size of the soft tissue defects ranged from 3 cm×5 cm to 9 cm×13 cm,and the biggest donor flap was 13 cm×18 cm.The donor sites at the posterior aspect of the leg and at the groin area were closed primarily. Results All 17 patients were followed up for 6-12 months(average 9 months).All 17 flaps had good perfusion and survived completely,which successfully treated all 17 patients with soft tissue defects or with both soft tissue defects and osteomyelitis.The donor and recipient sites of adipofascial flaps and the groin area healed primarily,and satisfactory appearance and function were achieved.Conclusion Distally based lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft which was taken from the groin area can reconstruct the distal one third of anterior tibia,around the ankle,and even treat osetomyelitis successfully,in the same time,which can preserve the function and appearance of the involved limb to the utmost.

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Effecacy analysis on finger reconstruction by transplantation of two second toes

Geng LUO ; Xianhui GUO ; Hong JIANG ; Yanshan LI ; Guosheng WANG ; Ni YAN ; Ming SHENG

Chinese Journal of Microsurgery.2010;33(4):287-289. doi:10.3760/cma.j.issn.1001-2036.2010.04.010

Objective To study the clinical application of finger reconstruction by transplantation of two second toes and evaluate the postoperative appearance and function regarding the reconstructed hand and donor feet. Methods Defect of fingers were treated by transplantation and reconstruction with a total of 74 cases,including two second toes transplantation for both thumbs in 2 cases,thumb with index finger in 10 cas es, index finger with middle finger in 8 cases and middle finger with ring finger in 17 cases. Results Sevetythree fingers survived except 1 failed. During the follow up examination made from 3 to 36 months, the reconstructed fingers could move, write and dress with ease, pinch forcefully, show good recovery of manual work and the sensation of pain and warmth. Two-point discrimination found to be between 5 to 10 mm. Both donor feet have symmetrical appearance with normal gait and satisfactory motion. Also, no pain was complained.Conclusion Transplantation of two second toes from both feet is a good method to reconstruct defect of multiple fingers, and has little effect on the appearance and motion of feet.

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HGF depress the production of α-SMA and extracellular matrix induced by TGF-β1 in fibroblasts of the flexor tendon sheath

Dapeng JIANG ; Zhaozhu LI ; Yubo ZHANG ; Fuyou HAN ; Shengyang GUAN ; Zhitao JIANG

Chinese Journal of Microsurgery.2010;33(4):297-300. doi:10.3760/cma.j.issn.1001-2036.2010.04.013

Objective To examine the effectiveness of HGF in blocking TGF-β1 induced α-SMA and extracellular matrix production in fibroblasts of the flexor tendon sheath. Methods Seven adult male New Zealand white rabbits (3.75-4.00 kg) were used for this study. Both of their front feet were sterilised and the middle digit flexor digitorum profundus tendon equivalents were identified and isolated. These specimens were used to establish primary cell cultures. Sheath fibroblasts were obtained from rabbit flexor tendons. After the cells reached confluence, cells were detached with trypsin/ethylenediamine tetra-acetic acid. All experiments were performed using the cells at the third passage. At 70% confluence the medium was supplemented with 5 ng/ml of TGF-β1 along with increasing doses of HGF (10-40 ng/ml). After 72 hours incubation, the productions of α-SMA were assayed by Western-Blot. The productions of collagen Ⅰ and fibronectin in supernatants culture were examined using ELISA. Results Evaluation of protein expression revealed that TGF-β1 markedly induced α-SMA expression in cultured rabbit flexor tendon sheath fibroblasts. TGF-β1 treated fibroblasts expressed 1.8-fold more protein compared to non-treated fibroblasts (P ＜ 0.05). However, simultaneous incubation of HGF significantly abrogated TGF-β1 induced α-SMA expression in a dose-dependent manner (P＜ 0.05). Treatment with TGF-β1 significantly stimulated collagen Ⅰ and fibronectin production in flexor tendon sheath fibroblasts (P ＜ 0.01). Remarkably, the addition of HGF reduced productions of all components induced by TGF-β1 in a dose-dependent manner (P ＜ 0.05). Conclusion HGF antagonizes TGF-β1 induced α-SMA, collagen Ⅰ, and fibronectin production in flexor tendon sheath fibroblasts. The findings provide a cellular and molecular basis for HGF's acting as a therapeutic agent for adhesions in flexor tendons.

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Clinical efficacy of micro-tympanoplastic operation with osteo retention on treating cholesteatomatous otitismedis

Feng YU ; Huicheng GONG ; Haoliang ZHANG ; Guojie TAN ; Yuzhang HUANG

Chinese Journal of Microsurgery.2010;33(4):290-292. doi:10.3760/cma.j.issn.1001-2036.2010.04.011

Objective To discuss with micro-tympanoplastic operation with osteo retention on treating cholesteatomatous otitismedis. Methods Choose 33 cases cholesteatomatous otitis medis patients who toke the tympanoplastic with osteo retention operation,then analyze the postulate and method of the operation, curative effect and complication after operation. Results Follow up with those patients by 12-72 months, and when 3-4 months after operation we endoscopiced the ears, could see that 43 cases of patients ear mastoid process and tympanic sinus were covered with epithelium, those mastoid cavity were well epithelial metaplasia;and the middle ear was separate from mastoid cavity; 39 cases patient of transplant eardrums are heal up (39/43, 90.7%). 2 cases have perforation of the tympanic membrane toke place after 4 months and 6 months with the operation, and it will heal up by anti-inflammatory drug and laser burning, 1 case had tympanic sinus hyperplasia with granulation tissue, and also had grassery juice; after taken anti-inflammatory drug and change bandage for 15 weeks, the symptom disappear. 1 case had grassery juice of operation cavity, after taking anti-inflammatory drug and physiotherapy, the symptom disappear in 24 weeks. After operation the pure tone audiometry shows that air conduction raise (16.8±6.8) dB HL, hearing raise up to:79.1%(34/43). Conclusion Base on right indication of operation choose, taken combined therapy of ambi-operation period, focus of infection are thoroughly cleaning up. Tympanoplastic with osteo retention are treating well with patients of cholesteatomatous otitismedis.

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Sural neuro musculocutaneous flap transplantation plus catheter irrigation for chronic lateral-malleolus Ostoemyelitis

Jie LIU ; Shuanke WANG ; Shifang GUO ; Huiping TAI

Chinese Journal of Microsurgery.2010;33(4):281-283. doi:10.3760/cma.j.issn.1001-2036.2010.04.008

Objective To describe the method and clinical result of super sural neuromusculocutaneous flap grafting plus catheter irrigation in the treatment for chronic lateral malleolus osteomyelitis. Methods From March 2000 to March 2008, 17 cases, male 14, femal 3, 21 to 75 years old (average 43-year-old),were underwent reversed saphenous musculocutaneous island flap after wide excision of lateralmalleolus lesion. The cause of lateral-malleolus lesions was trauma. The smallest flap was 5 cm× 6 cm and the largest was 7 cm × 11 cm. Catheter irrigation was used in all cases. Results Follow-up ranged from 12 to 96 months, average 49 months. After operation, the wounds were irrigated with sensitive antibiotics 1 to 2.5 months(average 49 days), and all flaps were survived. Except 2 cases, the other 15 were healed in 1 month.The 2 cases were not healed at first stage. According to the lab result,we changed the antibiotic, and in 2.5 months, we took off the catheter. Conclusion To deal with the chronic traumatic lateral-malleolus osteomyelitis, super sural neuromusculocutaneous flap grafting plus catheter irrigation is approprite and effective.

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Microsurgical repairment of finger-tip defection

Baoshan WANG ; Xiaoju ZHENG

Chinese Journal of Microsurgery.2009;32(5):372-373. doi:10.3760/cma.J.issn.1001-2036.2009.05.008

Objective To investigate the methods to repair the defection of finger tip.Methods During Feb.2004 to July 2008,in 98 cases,23 fingers were reconstructed with 2nd toe transfer which was reformed with digital flap or trilobed flap from 2nd toe,33 fingers were coverd with wrap around flap or half wrap around flap from great toe,or combined wrap around flap from great with pulp flap from 2nd toe,28fingers were repaired with fabular flap from great toe combined with tibial flap from 2nd flap,and 27 fingers were repaired with nail flap or enlarged nail flap from great toe. Results Vessel articulo took place in 5 cases,and all cases recovered with wonderful outward appearance Conclusion Microsurgical technic is an ideal method to repair the finger-tip defection.

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Microsurgical treatment of craniopharyngioma by modified pterional approach

Minhong LI ; Jun XIANG ; Yugang JIANG ; Qian ZHOU

Chinese Journal of Microsurgery.2010;33(3):206-209. doi:10.3760/cma.j.issn.1001-2036.2010.03.014

Objective To study the clinical effect of microsurgical treatment of craniopharyngioma by modified pterional approach.Methods Forty-one patients were carried out a retrospective case study with craniopharyngioma who underwent microsurgieal treatment via modified pterional approach at our department.Preoperative preparation mainly included hormone replacement therapy and prevention of epilepsy.The modified pterional approach was adopted.The patients' clinical indications were monitored postoperatively such as consciousness, blood pressure, in and out quantity of water, urine specific gravity, electrolytes, CT and MRI, and prompt prevention and treatment of the complications including diabetes insipidus and disorder of electrolytes were carried out after the surgery.Meanwhile, measures were taken to prevent postoperative epilepsy and low level of hormone.Results Thrrty-three patients had total craniopharyngioma resection, 5 had subtotal craniopharyngioma resection and 3 had partial craniopharyngioma resection, and all of them survived from the surgery.2 to 19 months postoperative follow-up showed that 32 patients could normally live,study and work, while 9 patients had to be assisted for normal lives.There was a recurrence of the tumor in 3 patients out of 8 patients that had subtotal and partial craniopharyngioma resection within 12 months postoperatively.Conclusion Adopting modified pterional approach plus efficient and effective perioperative management can reduce the damage rate of hypothalamus and improve the total resection rate of the craniopharyngioma, and achieve good results of the treatment.

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