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Applied anatomical and clinical application of reconstruction of the medial malleolus with bone-severed vascularized fibular head epiphysis

Xuetao LIU ; Chengjin ZHANG ; Chengqi WANG ; Lianjun QU ; Xuesheng LIU ; Guangjun LIU ; Yong LIU

Chinese Journal of Microsurgery.2009;32(3):217-220. doi:10.3760/cma.j.issn.1001-2036.2009.03.017

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.

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Effect of modified trabeculectomy on the treatment of glaucoma secondary in uveitis

Xing LIU ; Hui XIAO ; Jingjing HUANG ; Yimin ZHONG ; Xiaobei CHEN ; Dan CAO

Chinese Journal of Microsurgery.2009;32(3):202-204. doi:10.3760/cma.j.issn.1001-2036.2009.03.012

Objective To investigate the effect of trabeculectomy combined with segmental iridectomy, mitomycin C (MMC) and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, differ-ent concentration of MMC (0.25-0.33 mg/ml) was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridec-tomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoper-ation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was (12.01±3.56) months. The postoperative visual acuity improved in 14 eyes, didn't change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pres-sure (15.20± 4.64) mmHg was significantly lower than the preoperative intraocular pressure (38.37±12.93) mmHg (t = 8.255, P = 0.000). The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculeetomy combined with MMC, viscoelastic agents usage, separation of anterior and poste-rior syneehia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.

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Clinical appfications of the anterolateral skin flap in the lower leg and the reversed superficial peronealneurocutaneous island flap

Chinese Journal of Microsurgery.2009;32(3):187-189. doi:10.3760/cma.j.issn.1001-2036.2009.03.006

Objective To investigate the anatomy and clinical effect of the anterolateral skin flap in the lower leg and the reversed superficial pereneal neuracutaneous island flap. Methods Seven cases of hand skin defect were treated with anterolateral skin flap in the lower leg with vascular anastomosis. 7 cases of ankle soft tissue loss were repaired with reversed superficial peroneal neurocutaneous island flap. 4 cases of the tissue defects in the middle and proximal parts of the leg and 13 cases of the tissue defects in the middle and distal parts of the leg were repaired with sequential superficial peroneal artery island flap and combined flap of super-ficial peroneal artery island flap and superficial peroneal neurocutaneous island flap respectively. Results Seven cases of the anterolateral skin flap in the lower leg with vascular anastomosis, 4 cases of the sequential superficial peroneal artery island flap and 13 cases of the combined flap of superficial peroneal artery island flap and superficial peroneal neurocutaneous island flap were survived.Becanse of vein drainage disturbance which led to partial necrosis of flap, one case of the reversed superficial peroneal neurocutaneous island flap was de-layed healing with epluehage and skin grafting. Conclusion The anterolateral skin flap in the lower leg and the reversed superficial peroneal neurocutaneous island flap compensate each other anatomically. The operation based on the anatomy enlarges the size of the flap and extends the scope of reconstruction.

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Microtechnique of bilayer amniotic membrane transplantation for treatment of Mooren's ulcer

Xuan XIAO ; Jing ZHAO ; Dianqiang WANG ; Lixin XIE

Chinese Journal of Microsurgery.2009;32(3):205-206. doi:10.3760/cma.j.issn.1001-2036.2009.03.013

Objective To investigate the mierotechnique of bilayer amniotic membrane transplantation for treatment of Mooren's ulcer and evaluate the efficacy. Methods Six patients (6 eyes) with Mooren's ulcer were recruited for this study. After medical treatment or lameilar keratoplasty failed to arrest progress of corneal ulcer, bilayer amniotic membrane transplantation was performed for the treatment. We investigated the integrity of corneal epithelium, the healing of corneal ulcer, the improvement of stromal edema, the atrophy of neovessels, the transformation of amniotic membrane and the occurrence of relapse. Results All patients were followed up for 24-34 months (mean 30 months). In all cases, superficial anmiotic membrane dissolved or shed on postoperative day 7-11, disconnecting now. Corneal ulcer healed within 7-15 days postoperatively. In 5 eyes, corneal stromal edema faded away within 2-3 weeks. Corneal neovessels regressed within 2-3 months. The deeper grafts were adhered into the ulcer and fused with the cornea 3 months after the operation. Corneal transparence or macula was achieved within 5-8 months. No recurrence of Moorcn's ulcer was oc-curred in 4 patients during the follow-up period, while 2 eyes relapsed for the exposure of sutures and not re-moving the stitches timely, which had been treated with lamellar keratoplasty and no recurrence again during the follow-up period. Conclusion Bilayer amniotic membrane transplantation has advantages for Mooren's ulcer treatment. Mastering the microsurgical techniques and removing the stitches timely are the key to the success of surgery. It also provides good conditions for the further conduct of keratoplasty.

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Microsurgical treatment of intraspinal extramedullary benign tumors

Yanchao MA ; Zhengyi SUN ; Xu WANG ; Ping DONG ; Haiyu ZHOU ; Shuanke WANG

Chinese Journal of Microsurgery.2009;32(3):196-198. doi:10.3760/cma.j.issn.1001-2036.2009.03.010

Objective To explore the clinical efficacy of using the disposable whole laminectomy, laminoplasty and microsurgical tumor removal to treat intraspinal extramedullary benign tumors. Methods Sixty-four patients, 71 cases adult intraspinal extramedullary benign tumors were removed by the disposable whole laminectomy, laminoplasty and microsurgical tumor removal operation, all postoperative patients were followed up to observe the clinical efficacy. Results Patients with small tumors and large tumors all had a faster recovery of neurological function than preoperative, recent and long-term efficacy were all better than preoperative, and long-term efficacy was superior to short-term efficacy; Patients with giant tumors had a slow-er recovery of neurological function than preoperative, short-term efficacy was not better than preoperative, but the long-term efficacy was superior to preoperative. Conclusion The disposable whole laminectomy, laminoplasty and microsurgical tumor removal is an excellent method of treating intraspinal extramedullary be-nign tumors.

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The anatomical study of contralateral C7 transfer through the vertebral body route

Yufa WANG ; Bin WANG ; Fu LI ; Zhe ZHU ; Youqiong LI ; Lue SU ; Shuangwei ZOU

Chinese Journal of Microsurgery.2009;32(2):133-135. doi:10.3760/cma.j.issn.1001-2036.2009.02.017

Objective To find the optimal route of eontralateral C7 nerve transfer for brachial plexus avulsion injuries through autopsy. Methods The bilateral brachial plexus were exposed on 30 sides of 15 cadaverie specimens of adult. The C7 nerve root was sectioned at the junction site of trunk and division, and then dissected proximally to the foramina. The max length of anterior and posterior division of C7 was measured. The distance between the roof of C7 and the upper trunk and the lower trunk at the affected side through vertebral body route, prespinal route and a subcutaneous tunnel on the anterior surface of the neck was measured. Results The max length of anterior and posterior division of C7 was (7.67±1.06) cm and (7.79±1.36) cm respectively. The distance between the roof of C7 and the upper trunk at the affected side through vertebral body route, prespinal route and a subcutaneous tunnel on the anterior surface of the neck was (6.97±0.56) cm and (10.04±0.94) cm and (16.56±1.24) cm respectively, there were statistical significance among them (P < 0.01). The distance between the roof of C7 and the lower trunk at the affected side through vertebral body route and prespinal route and a subcutaneous tunnel on the anterior surface of the neck was (6.82±0.92) cm、(9.91±0. 83) cm and (17.64±0.97) cm, with a significant difference (P<0.01). Conclusion The best way of contralateral C7 nerve transfer for the treatment of brachial plexus injury was through the vertebral body route from the point of anatomy.

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Microsurgical treatment of communicative skull base chordoma

Wei WEI ; Bing LIU ; Genglin SUN

Chinese Journal of Microsurgery.2009;32(2):98-100. doi:10.3760/cma.j.issn.1001-2036.2009.02.005

Objective To investigate the appropriate surgical approaches and microsurgical resection of communicative skull base chordoma. Methods Twenty two cases of communicative skull base chordomas were microsurgically treated from 1995 to 2005 and followed up. The tumors were removed with extended anterior skull base approach in eight cases, with modified Weber-Ferguson (transmaxillary) approach in eight cases, and with transmandibular approach in six cases. Some cases were resected with combined approaches including pterional approach in 3 eases, subtemporal-zygomatie approach in 1 case, and suboccipital-retromastoid approach in 2 cases. Results Total, subtotal and partial removal of the tumors were achieved in 10 cases, 7 and 5 cases respectively. No patients died and had severe nervous system dysfunction after surgery. However, one had CSF rhinorrhea, one with infection, three with cranial never dysfunction. Twenty patients were followed-up with average 3.4 years, 12 returned to normal or partial works, 5 took care by oneself, 1 needed help, 2 died from tumor recurrence. Conclusion The treatment of communicative skull base chordoma is a challenge to neurosurgeon. The key point is the total removal of the tumor with the microsurgical technique and the appropriate approach depend on the location of the tumor. Moreover, skull base reconstruction is also important to avoid the cerebrospinal fluid leak and infection.

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Treatment of the donor site after wrap around flap from toe

Baoshan WANG ; Xiaoju ZHENG ; Xinhong WANG ; Shulin GAO

Chinese Journal of Microsurgery.2009;32(1):26-28. doi:10.3760/cma.j.issn.1001-2036.2009.01.010

Objective To investigate the methods to cover the donor site of wrap around flap from toe. Methods In 34 cases, 8 thumbs reconstructed with wrap around flap from great toe, 8 thumbs and 14 fingers reconstructed with half nail flap from fibular side of second toe, and 4 fingers reconstructed with dorsal nail flap from second toe. The donor site were covered with pedicle flap (first metatarsal dorsal flap, second toe digital flap, neighbor flap from dorsal of second toe, and lateral tarsus flap) or free flap (medical plantar flap, fibular artery flap, and lateral tarsus flap). Results Twelve cases were followed up after 2 months, normal gait were found, 6 cases were followed up after 4 months, (4 cases for first metatarsal dorsal flap, one for fibular artery flap and one for internal volar flap). 2 cases recovered defend sensibility and showed a bit dark, the cases which reconstructed with medical plantar flap and second toe digital flap had nearly normal sensibility. The outward appearance of the donor site were chubbiness, flexible, and no complaint were found. Conclusion Covered the donor site of wrap around flap from toe with these flaps can avoid complications like pain and ulcerate, and have a satisfactory appearance.

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Repair and reconstruction of cripple hand and defected digital bone

Jianli WANG ; Zhaodong WANG ; Yongqing GUO ; Wuzhou WANG ; Huashan YANG ; Xingiong QU ; Chengqi WANG

Chinese Journal of Microsurgery.2009;32(1):23-25. doi:10.3760/cma.j.issn.1001-2036.2009.01.009

Objective To explore and solve the problem of insufficiency and malformation due to cripple hand and defect of digital bone resulted of innate and injured. Evaluation to the methods of bone autografting combinated with flaps to reconstruct the deficient hand and digits. Methods Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps were used to reconstruct the defected bone in palm or fingers. Combined with tendon absence in such cases should be repaired or restituted by tendon autografting in one stage or by stages. Results Total 16 cases were treated by the methods metioned above. Except 1 of 16 was failure resulted in severe infection, the others were reconstructed successfully. 13 of 16 were followed up 8 months to 2 years, the evalution of the group from motion,sensation and appearance shew that the fine rate of motion was 53.8 percent, the rate of appearance and sensation were both 69 percent. Conclusion Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps are available to reconstruct the defected bone in palm or fingers, and can reduce disability effectively while obtain a satisfactory outlook and proper functions by those methods.

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Bilateral decompression in lumbar degenrative stenosis associated with unilateral approach under minimally invasive microendoscopy(METRx)

Yue ZHOU ; Jian WANG ; Changqin LI ; Tongwei CHU ; Zhengfeng ZHANG ; Yong PAN ; Wenjie ZHENG

Chinese Journal of Microsurgery.2009;32(1):19-22. doi:10.3760/cma.j.issn.1001-2036.2009.01.008

Object To discuss the surgical techniques and the clinical outcomes of the bilateral microendoscopic decompression surgery for lumbar spinal canal and lateral recess stenosis through unilateral approach. Methods 18-ram-diameter microendoscopic tubular retractor was placed with fluoroscopic gnidance, bilateral microendoscopic decompression surgery for lumbar spinal stenosis through unilateral approach were managed by adjusting the angle of tubular retractor. During the procedure, supra-interspinal ligament and contralateral bony lamina were well preserved. Results In the group of single-level microendoscopicdecompression, the mean operation time was 94 min and the mean blood loss was 65 ml. In the group of twolevel microendoscopic decompression, the mean operation time was 135 rain and the mean blood loss was 90 ml. The mean bed rest time was 6.5 days. After operation, the average back pain VAS score decreased from 6.5 to 3.1, the average leg pain VAS score decreased from 7.2 to 2.2, the average Oswestry Disability Index (ODI) decreased from 46.8 to 24.6, which had shown significant statistical difference before and after surgery (P ＜ 0.05). According to Nakai criteria, the excellent and good rate was 84%. Conclusion Bilateral microendoscopic decompression of lumbar canal through unilateral approach under METRx system offers a save, effective and minimal invasive option for lumbar spinal stenosis.

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