OBJECTIVE: To investigate the management strategies of external fixation combined with microsurgical techniques for repairing complex foot and ankle wounds in children. METHODS: The clinical data of 9 children with complex foot and ankle wounds who met the selection criteria between June 2017 and December 2021 was retrospectively analyzed. There were 6 boys and 3 girls, aged 3-13 years, with an average of 7.4 years. The causes of injury included crush injury in 5 cases and traffic accident injury in 4 cases. The wound size ranged from 6 cm×5 cm to 25 cm×18 cm. The time from injury to surgery ranged from 3 to 8 hours, with an average of 5 hours. All cases underwent staged surgical treatment. Among the 3 cases requiring deformity correction, 2 cases initially underwent free anterolateral thigh flap transplantation for wound coverage and limb salvage, followed by circular external fixation combined with osteotomy to address postoperative limb deformity, while 1 case received osteotomy for tibial fracture realignment prior to local pedicled flap reconstruction. All the 6 cases with non-deformity correction underwent initial external fixation followed by secondary flap reconstruction for wound management. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the foot and ankle function of children. RESULTS: All children successfully achieved limb salvage postoperatively. Among the 6 non-deformity correction cases, all flaps survived with satisfactory wound healing and no infection was observed; fractures healed within 2.5-4.5 months, after which external fixators were removed for functional rehabilitation with favorable recovery. One case treated with circular external fixation combined with osteotomy achieved bone union at 4 months postoperatively, followed by fixator removal. One case undergoing osteotomy for tibial fracture realignment showed bone healing at 2.5 months post-correction, with subsequent fixator removal. One patient receiving bone lengthening developed infection at 1 week postoperatively, which was managed with multiple debridements, ultimately achieving bone union at 16 months postoperatively and followed by fixator removal. At last follow-up, all patients demonstrated satisfactory ankle-hindfoot functional recovery, with AOFAS ankle-hindfoot scores ranging from 80 to 90 (mean, 84.2). CONCLUSION The combination of external fixation and microsurgical techniques demonstrates significant advantages in reconstructing complex foot and ankle wounds in children. The synergistic interaction provides both mechanical stability and biological repair, enabling early functional rehabilitation while reducing infection risks.
Humans ; Child ; Male ; Female ; Adolescent ; Child, Preschool ; Foot Injuries/surgery* ; Ankle Injuries/surgery* ; Retrospective Studies ; External Fixators ; Microsurgery/methods* ; Plastic Surgery Procedures/methods* ; Surgical Flaps ; Fracture Fixation/methods* ; Osteotomy/methods* ; Treatment Outcome

Objective To investigate the clinical features,therapeutic methods and therapeutic effects of sinonasal hemangiopericytoma.Methods Clinical data of 6 patients with sinonasal hemangiopericytoma,diagnosed by pathology and immmunohistochemistry between January 1990 and December 2012 were analyzed retrospectively.There were 4 males and 2 females,with a median age of 58 years.Clinical manifestation included epistaxis and nasal obstruction.These patients were operated on by nasal endoscopic surgery or endoscope-assisted surgery,of which 2 cases of tumor located in the nasal cavity underwent nasal endoscopic surgery and 4 cases of tumor located in the nasal cavity and sinuses underwent endoscope-assisted surgery.Results All the patients were followed up for a period of 6 months to 7 years after operation.Two cases recurred and 4 cases didn't recurre.One case recurred 6 months after operation and underwent second operation,with no recurrence by further one year follow-up.Another case recurred 17 months after operation and underwent second operation,with recurrence by further 9 months follow-up.This patient lived with tumor over two years.Conclusions Hemangiopericytomas are rarely found in the sinonasal cavity.Nasal endoscopic or endoscope-assisted surgery provides satisfactory effect.

OBJECTIVE: To study whether cancer stem cells promotes resistance of laryngeal squamous cancer to irradiation mediated by hypoxia. METHOD: Hep-2 cells were respectively cultured in hypoxia and normoxia environment, and the express of HIF-la was detected by western blot. Then they were radiated with different doses of gamma-rays. After that we detected growth inhibition ratio with MTT assay, cell circle and ratio of CD133+ cells with Flow cytometry at different times. RESULT: MTT assay showed that inhibition ratio of the hypoxia group was lower than that of the normoxia group after different doses of gamma-rays at each time point, and the difference was significant 24 h after 10 Gy irradiation (P < 0.05). The results of Flow cytometry demonstrated that cells of the two groups were arrested at G1 phase, and cells ratio in G1 phase of the hypoxia group was higher than that of he normoxia group after 10 Gy irradiation. The ratio of CD133-positive cells was higher in the hypoxia group than in the normoxia group after radiation, and difference was significant 24 h after 10 Gy irradiation (P < 0.05). In each group, the ratio of CD133-positive cells became higher after radiation than that before radiation (P < 0. 05). CONCLUSION We can conclude that cancer stem cells play an important role in radioresistance mediated by hypoxia.
Carcinoma, Squamous Cell ; radiotherapy ; Cell Hypoxia ; Cell Line, Tumor ; Gamma Rays ; Humans ; Laryngeal Neoplasms ; radiotherapy ; Neoplastic Stem Cells ; cytology ; Radiation Tolerance

Objective To compare the effect of pericardial devascularization with that of the modified Sugiura procedure in management of portal hypertension. Methods From 1990 to 2008, 236patients with portal hypertension underwent operations including pericardial devascularization in 147and modified Sugiura in 89 in our hospital. Results There were 12 perioperative deaths (8.2 % ), and 2 rebleedings (2 % ) in the pericardial devascularization group, and 7 perioperative deaths (7.9 % ) and 2 rebleedings(3.4 % ) in the modified Sugiura group. The follow-up rate was 91.9 % in the pericardial devascularization group and 87.8% in the modified Sugiura group respectively, in a period from 6 months to 19 years. The 1-, 3-and 5-year rebleeding rates were 5.7%,15.2% and 25.5% in the pericardial devascularization group and 6.9%, 16.3%, 29.5 % in the modified Sugiura group, respectively. The 1-, 3- and 5-year survival rates were 87.8% ,79.1% and 69.7% in the pericardial devascularization group and 95.8 %,85.0%, 76.9 % in the modified Sugiura group, respectively. Conclusion Modified Sugiura procedure and pericardial devascularization have differences in perioperative mortality as well as rebleeding and survival rates.

e advantages as those of digital artery flap, but also has proper digital artery and nerve being untouched.

Objective To investigate clinical effects of cutaneous branch flaps of the low medial leg for the repair of soft tissue defects on the foot and ankle.Methods A flap with pedical of cutaneous branches of the low medial leg was used for the repair of 7 cases of skin and soft tissue defects on the feet and ankle from March 2003 to October 2005.The cutaneous branches of the posterior tibial artery were identified along the medial border of the tibia and between the soleus muscle and the flexor digitorum longus muscle.The flap was mobilized according to the site and length of the cutaneous branches,and was transferred to soft tissue defects for skin grafting. Results The operating time was 3~5 hours(mean,4.2 hours).The flaps survived completely in all the 7 cases.Follow-up checkups were carried out for 5~18 months(mean,10 months).The appearance and functions of the foot were satisfactory and met the requirements for daily activities.Conclusions The procedure can effectively repair soft tissue defects on the foot and ankle and does not sacrifice the major arteries.This flap is easy to be prepared.