Objective:Medial sural artery perforator flap (MSAPF) was applied to aesthetically reconstruct wounds in foot, and clinical outcome of this surgical method was explored.Methods:A retrospective analysis was conducted on the data of 10 patients who underwent the surgery of transfer of free MSAPF in reconstruction of foot wounds in the Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from January 2020 to January 2023. The patients were 6 males and 4 females, aged 21 to 52 years, with an average of 42.5 years. The soft tissue defects of the injuries were at 2.0 cm × 4.0 cm to 3.5 cm × 6.0 cm in size, with deep tissues exposure down to the base of wound. MSAPF was used for aesthetic reconstruction of the wounds. The surgical procedures were: (1) The flap was thinned under a microscope and only the subdermal vascular network was kept. (2) Vascular pedicle of the flap was taken as long as possible and had it anastomosed with the proximal dorsal foot artery and vein through a subcutaneous tunnel. (3) Allg?wer-Donati method was applied to suture the skin of flap. (4) Donor site was directly closed in surgery. All patients were entered in the scheduled postoperative follow-up at the outpatient clinic of the surgeon who performed the surgery to evaluate the postoperative effect and observe the survival of flaps. Maryland foot function score and British Medical Research Council (BMRC) sensory function score were used to assess the recovery of flap and limb function.Results:The flaps completely survived, and all the donor and recipient sites had primary healing. All of the 10 patients were included in the postoperative follow-up which lasted 8 to 15 months, with an average of 12 months. The flaps from foot featured a pleasing appearance, with good elasticity and wear-resistant. All patients were satisfied and able to walk normally and bear weight without an occurrence of flap ulceration. At the final follow-up, the therapeutic effect was evaluated according to the Maryland scoring system and achieved the scores at 91 to 98, with 95.6 in average. Nine patients were rated as excellent and 1 as good. The sensory grading by BMRC for the flaps was as follows: the flap sensation of the sutured nerve group recovered to S 3 in 3 cases and S 4 in 2 cases, while the non sutured nerve group only recovered protective sensation, S 2 in 3 cases and S 2+ in 2 cases. Conclusion:By applying MSAPF aesthetics to treat foot wounds, a good appearance has been achieved, with good functional recovery and satisfactory therapeutic effects.

In October 2023, a patient with locally advanced breast cancer was treated in the Department of Reconstructive Microsurgery, Xuzhou Renci Hospital. Radical mastectomy for breast cancer was performed, and the huge soft tissue defect (40.0 cm×22.0 cm) was reconstructed by a pedicled transverse rectus abdominis myocutaneous flap (TRAMF) combined with a free deep inferior epigastric artery perforator flap (DIEPF) and a free anterolateral thigh perforator flap (ALTPF). The size of the lower abdominal flap was 28.0 cm×11.0 cm, and the size of ALTPF was 30.0 cm×11.0 cm. All flaps survived well with soft texture. Scores of Karnofsky Performance Status (KPS) and Visual Analogue Scale (VAS) were significantly improved at 1 month after the surgery. The patient refused chemotherapy, radiotherapy and other comprehensive treatments at the time. A local cancer recurrence in chest wall was found at 9 months after surgery, the patient was currently under chemotherapy and other comprehensive therapies.

In October 2023, a patient with locally advanced breast cancer was treated in the Department of Reconstructive Microsurgery, Xuzhou Renci Hospital. Radical mastectomy for breast cancer was performed, and the huge soft tissue defect (40.0 cm×22.0 cm) was reconstructed by a pedicled transverse rectus abdominis myocutaneous flap (TRAMF) combined with a free deep inferior epigastric artery perforator flap (DIEPF) and a free anterolateral thigh perforator flap (ALTPF). The size of the lower abdominal flap was 28.0 cm×11.0 cm, and the size of ALTPF was 30.0 cm×11.0 cm. All flaps survived well with soft texture. Scores of Karnofsky Performance Status (KPS) and Visual Analogue Scale (VAS) were significantly improved at 1 month after the surgery. The patient refused chemotherapy, radiotherapy and other comprehensive treatments at the time. A local cancer recurrence in chest wall was found at 9 months after surgery, the patient was currently under chemotherapy and other comprehensive therapies.

Objective:Medial sural artery perforator flap (MSAPF) was applied to aesthetically reconstruct wounds in foot, and clinical outcome of this surgical method was explored.Methods:A retrospective analysis was conducted on the data of 10 patients who underwent the surgery of transfer of free MSAPF in reconstruction of foot wounds in the Department of Foot and Ankle Surgery, Xuzhou Renci Hospital from January 2020 to January 2023. The patients were 6 males and 4 females, aged 21 to 52 years, with an average of 42.5 years. The soft tissue defects of the injuries were at 2.0 cm × 4.0 cm to 3.5 cm × 6.0 cm in size, with deep tissues exposure down to the base of wound. MSAPF was used for aesthetic reconstruction of the wounds. The surgical procedures were: (1) The flap was thinned under a microscope and only the subdermal vascular network was kept. (2) Vascular pedicle of the flap was taken as long as possible and had it anastomosed with the proximal dorsal foot artery and vein through a subcutaneous tunnel. (3) Allg?wer-Donati method was applied to suture the skin of flap. (4) Donor site was directly closed in surgery. All patients were entered in the scheduled postoperative follow-up at the outpatient clinic of the surgeon who performed the surgery to evaluate the postoperative effect and observe the survival of flaps. Maryland foot function score and British Medical Research Council (BMRC) sensory function score were used to assess the recovery of flap and limb function.Results:The flaps completely survived, and all the donor and recipient sites had primary healing. All of the 10 patients were included in the postoperative follow-up which lasted 8 to 15 months, with an average of 12 months. The flaps from foot featured a pleasing appearance, with good elasticity and wear-resistant. All patients were satisfied and able to walk normally and bear weight without an occurrence of flap ulceration. At the final follow-up, the therapeutic effect was evaluated according to the Maryland scoring system and achieved the scores at 91 to 98, with 95.6 in average. Nine patients were rated as excellent and 1 as good. The sensory grading by BMRC for the flaps was as follows: the flap sensation of the sutured nerve group recovered to S 3 in 3 cases and S 4 in 2 cases, while the non sutured nerve group only recovered protective sensation, S 2 in 3 cases and S 2+ in 2 cases. Conclusion:By applying MSAPF aesthetics to treat foot wounds, a good appearance has been achieved, with good functional recovery and satisfactory therapeutic effects.

OBJECTIVE To establish the HPLC fingerprint of Jianpi huayu decoction， and to determine the contents of 8 components. METHODS Thermo Hypersil Gold C18 column was used with mobile phase consisted of methanol-0.05% phosphoric acid aqueous solution （gradient elution） at the flow rate of 1.0 mL/min. The column temperature was 30 ℃， the injection volume was 5 μL. The detection wavelength of matrine was 211 nm， and the other components’ detection wavelength was 283 nm. The similarity evaluation of HPLC fingerprints for 10 batches of Jianpi huayu decoction was performed by using the Similarity Evaluation System of Chromatographic Fingerprint of Traditional Chinese Medicine （2012 edition）. The contents of chlorogenic acid， vanillic acid， p-coumaric acid， ferulic acid， hesperidin， quercetin， bergapten and matrine in the samples were determined by HPLC. RESULTS HPLC fingerprint of Jianpi huayu decoction was established. A total of 27 common peaks were identified， and 8 components were identified. The similarity between 10 batches of samples and the control map ranged from 0.942-0.999. RSDs of precision， repeatability and stability tests were less than 3% （n＝6）. The average recoveries of chlorogenic acid， vanillic acid， p-coumaric acid， ferulic acid， hesperidin， quercetin， bergapten and matrine were 99.48%， 101.32%， 101.18%， 100.79%， 101.12%， 99.19%， 99.81% and 102.46%， respectively； RSDs were 1.34%， 0.93%， 1.90%， 1.84%， 0.54%， 1.53%， 1.33% and 1.01%， respectively （n＝6）. The contents were 0.021-0.061， 0.025-0.034， 0.116-0.295， 0.006- 0.062， 0.014-0.053， 0.017-0.026， 0.014-0.027 and 14.05-24.11 mg/g， respectively. CONCLUSIONS The established fingerprint and content determination method can provide a reference for the quality control and subsequent preparation development for Jianpi huayu decoction.

Objective To observe the clinical effect of Yi'naokang Capsules combined with Donepezil Hydrochloride Tablets in treating post-stroke cognitive impairment(PSCI).Methods 110 patients who met the diagnostic criteria of PSCI in the outpatient department were included.According to the random number table method,the patients were divided into trial group and control group,with 55 cases in each group.Patients in control group were treated with routine western medicine,including the treatment of Donepezil Hydrochloride Tablets and secondary prevention of stroke such as lowering blood pressure,lowering blood lipid,lowering blood glucose and anti-platelet aggregation.The trial group was treated with Yi'naokang Capsules on the basis of the treatment in control group,and both groups were treated for 6 months.Before and after 6 months of treatment,the cognitive function of patients was evaluated by the Montreal Cognitive Assessment(MoCA)scale.The activity of daily living(ADL)scale was used to evaluate the ability of daily living,and the severity of cerebral white matter lesions was evaluated by Fazekas scale,and the adverse reactions were also observed.Results After 6 months of treatment,the total score of the MoCA,the scores of visual space and executive function,attention,delayed recall and the ADL of the two groups were all improved(P＜0.05),and the improvement degree of the trial group was better than that of the control group(P＜0.05).The Fazekas score of the trial group after treatment was no significant difference when compared with that before treatment(P＞0.05),but it increased in the control group after treatment(P＜0.05),and the effect of delaying white matter lesion in the trial group was better than that in the control group(P＜0.05).Conclusion Yi'naokang Capsules combined with Donepezil Hydrochloride Tablets are superior to Donepezil alone in the treatment of PSCI,which can safely and effectively improve the cognitive function and daily living ability of patients,as well as prolong the progress of white matter lesions.

Objective:To investigate the effect of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus.Methods:Clinical data of patients with post-traumatic lower extremity shortening and talipes equinovarus treated by the Ilizarov technique in the Department of Orthopaedics of Xuzhou Renci Hospital from January 2013 to April 2020 were retrospectively analyzed. The annular external fixator was installed on the affected limb according to the Ilizarov principle of external fixation. 3 days after the operation, the internal and lateral screw rods were adjusted at the speed of 2 mm/d to gradually correct the talipes equinovarus. 7 days after surgery, the lower leg was lengthened at a speed of 1 mm/d. After the foot was corrected, the foot external fixator was continued to be worn for 4 to 6 weeks, and then the fixator was removed and the foot was immobilized with a brace for 6 to 8 weeks. The lower leg fixator was removed after the lower extremity length was restored and the bone mineralization at the extension site was good. The length of both lower extremities, angle of talonavicular joint, angle of plantar flexion and dorsal extension of the ankle, and range of motion of ankle were compared before surgery and at the last follow-up. At the last follow-up, the affected feet were scored and rated using the International Clubfoot Study Group (ICFSG) scoring system, which was divided into four grades: excellent, good, medium, and poor. SPSS 25.0 software was used for statistical analysis, and each measurement index and ICFSG score were expressed in Mean±SD. Paired t-test was used to compare the preoperative and last follow-up data, and P<0.05 was considered statistically significant. Results:A total of 31 patients were enrolled, including 17 males and 14 females. The age was 15-18 years old, with an average of 16.5 years old. There were 16 cases on the right side and 15 cases on the left side. The lower extremity shortening was 45-75 mm, with an average of 65 mm. The fixation time of the external fixator was 4.5-6 months after surgery, with an average of 5 months, and the follow-up time was 22-28 months, with an average of 25.5 months. The length of the affected lower extremity recovered, the shape was basically satisfactory, and the plantar gait was restored. At the last follow-up, compared with the preoperative period, the anteroposterior talocalcaneal angle of the foot (23.0°±2.1° vs. 8.5°±2.6°), from lateral talocalcaneal angle the foot (27.0°±4.3° vs. 11.2°±4.4°), ankle plantar flexion angle (24.5°±6.8° vs. 51.1°±6.5°), ankle dorsiflexion angle (5.8°±3.5° vs. -46.8°±7.0°) and ankle range of motion (30.3°±8.2° vs. 4.2°±1.6°) were statistically significant ( P <0.01). ICFSG score: The points at the last follow-up (8.0 ± 4.2) were significantly lower than that before the operation (41.9 ± 5.3) ( P<0.01), of which 18 were excellent, 9 were good, and 4 were medium. Two cases had recurrent deformities in the later stage, and the results were satisfactory after the fusion of the talonavicular joint and calcaneocuboid joint and the anteposition of the posterior tibial tendon in the second stage. There were 4 cases of toe contracture deformity, which did not recur after the release of the flexor digitorum longus tendon at the toe. Anterior ankle impingement was observed in 5 cases and improved after the arthroscopic osteophyte removal. After the lower extremity extension was in place, the external fixator was replaced by the intramedullary nail for walking in 6 patients. The infection of the nail path occurred in 7 cases, which improved after replacement of fixing pins and dressing change of the nail path. Conclusion:The application of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus has the advantages of small trauma and dynamic control of deformity correction, which can achieve good result.

Objective:To investigate the effect of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus.Methods:Clinical data of patients with post-traumatic lower extremity shortening and talipes equinovarus treated by the Ilizarov technique in the Department of Orthopaedics of Xuzhou Renci Hospital from January 2013 to April 2020 were retrospectively analyzed. The annular external fixator was installed on the affected limb according to the Ilizarov principle of external fixation. 3 days after the operation, the internal and lateral screw rods were adjusted at the speed of 2 mm/d to gradually correct the talipes equinovarus. 7 days after surgery, the lower leg was lengthened at a speed of 1 mm/d. After the foot was corrected, the foot external fixator was continued to be worn for 4 to 6 weeks, and then the fixator was removed and the foot was immobilized with a brace for 6 to 8 weeks. The lower leg fixator was removed after the lower extremity length was restored and the bone mineralization at the extension site was good. The length of both lower extremities, angle of talonavicular joint, angle of plantar flexion and dorsal extension of the ankle, and range of motion of ankle were compared before surgery and at the last follow-up. At the last follow-up, the affected feet were scored and rated using the International Clubfoot Study Group (ICFSG) scoring system, which was divided into four grades: excellent, good, medium, and poor. SPSS 25.0 software was used for statistical analysis, and each measurement index and ICFSG score were expressed in Mean±SD. Paired t-test was used to compare the preoperative and last follow-up data, and P<0.05 was considered statistically significant. Results:A total of 31 patients were enrolled, including 17 males and 14 females. The age was 15-18 years old, with an average of 16.5 years old. There were 16 cases on the right side and 15 cases on the left side. The lower extremity shortening was 45-75 mm, with an average of 65 mm. The fixation time of the external fixator was 4.5-6 months after surgery, with an average of 5 months, and the follow-up time was 22-28 months, with an average of 25.5 months. The length of the affected lower extremity recovered, the shape was basically satisfactory, and the plantar gait was restored. At the last follow-up, compared with the preoperative period, the anteroposterior talocalcaneal angle of the foot (23.0°±2.1° vs. 8.5°±2.6°), from lateral talocalcaneal angle the foot (27.0°±4.3° vs. 11.2°±4.4°), ankle plantar flexion angle (24.5°±6.8° vs. 51.1°±6.5°), ankle dorsiflexion angle (5.8°±3.5° vs. -46.8°±7.0°) and ankle range of motion (30.3°±8.2° vs. 4.2°±1.6°) were statistically significant ( P <0.01). ICFSG score: The points at the last follow-up (8.0 ± 4.2) were significantly lower than that before the operation (41.9 ± 5.3) ( P<0.01), of which 18 were excellent, 9 were good, and 4 were medium. Two cases had recurrent deformities in the later stage, and the results were satisfactory after the fusion of the talonavicular joint and calcaneocuboid joint and the anteposition of the posterior tibial tendon in the second stage. There were 4 cases of toe contracture deformity, which did not recur after the release of the flexor digitorum longus tendon at the toe. Anterior ankle impingement was observed in 5 cases and improved after the arthroscopic osteophyte removal. After the lower extremity extension was in place, the external fixator was replaced by the intramedullary nail for walking in 6 patients. The infection of the nail path occurred in 7 cases, which improved after replacement of fixing pins and dressing change of the nail path. Conclusion:The application of the Ilizarov technique in the treatment of post-traumatic lower extremity shortening with talipes equinovarus has the advantages of small trauma and dynamic control of deformity correction, which can achieve good result.

Objective:To investigate the efficacy of TiRobot navigation combined with ankle arthroscopy in the reduction and internal fixation of Hawkins type Ⅱ talus neck fracture.Methods:From January 2019 to September 2020, a total of 13 patients with Hawkins type Ⅱ talus neck fracture were admitted to Department of Foot and Ankle Surgery, Xuzhou Renci Hospital. They were 8 males and 5 females, with a mean age of 35.8 years (from 22 to 61 years). All fractures were reduced and fixated using TiRobot navigation combined with ankle arthroscopy. Time for fracture reduction assisted by intraoperative arthroscopy, time for internal fixation assisted by TiRobotic navigation, fracture union time and complications were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used at the last follow-up to evaluate the functional outcomes.Results:All the operations were finished within 2 hour. The primary screw placement succeeded in all. The time for fracture reduction assisted by intraoperative arthroscopy averaged 52.8 min (from 43 to 66 min) and the time for internal fixation assisted by TiRobotic navigation 43.6 min (from 33 to 55 min). All the patients were followed up for an average 13.3 months(from 12 to 15 monhs). They obtained bony union within 3 months. One patient developed traumatic subtalar arthritis with mild pain and was treated conservatively. None of the patients had complications like incision infection or talus necrosis. The average AOFAS ankle-hindfoot score was 91.0 points (from 83 to 94 points) at the last follow-up.Conclusion:In the reduction and internal fixation of Hawkins type Ⅱ talus neck fracture, TiRobot navigation combined with ankle arthroscopy shows advantages of minimal invasion, accurate reduction and screw placement, and limited complications, leading to fine short-term functional outcomes.

Objective:To summarise the experience in use of sural neurouascular flap in repair of the soft tissue defects of foot and ankle, and explore the methods in promoting the survival and appearance of the flap.Methods:Data of 10 patients who underwent sural neurocutaneous flap surgery for repairing soft tissue defects in the foot and ankle in the Department of Foot and Ankle of Xuzhou Renci Hospital from October 2019 to June 2020 were retrospectively analysed. Among the 10 patients, 8 were males and 2 were females, and the age ranged from 18 to 54 years old, with an average age of 42.5 years old; Causes of injury: 8 patients injured by traffic accident and 2 by incision necrosis after calcaneal fracture operation. The areas of soft tissue defect were 4.0 cm×6.0 cm-16.0 cm×10.0 cm. Sural neurouascular flap was used for the defect repairs. Method of optimisation: ①The small saphenous vein in the flap was separated and retained in the limb to optimise the venous circulation. ②Freed peroneal perforator vessels that entered the pedicle, and made the point where the vessels entering the pedicle as the rotation point. The pedicle contained the sural neurovascular bundle, the main trunk of the small saphenous vein and the fascia tissue, with a width about 2.0 cm. It not only increased the blood supply of the flaps, but also a good appearance of the pedicle. ③ The torsion of the pedicle was covered by an arc-shaped flap and transferred through an open channel to prevent compression. ④The donor site was covered with relay flap. According to the location of the donor site, a proximal peroneal artery perforator flap or medial and lateral sural artery perforator flap was selected. ⑤Sural nerve was anastomosed with the peripheral sensory nerve in some cases. The survival of the flap, Maryland Foot Function Score and British Medical Research Council (BMRC) sensory function evaluation were investigated in the follow-up to evaluate the functional recovery of the flap and limb.Results:All the 10 patients received the follow-up for 6 to 12 months, with an average of 8.5 months. The donor and recipient flaps survived completely with good appearance in lower limb, good soft texture, good elasticity and wear resistance. The sensation of the flap with nerve anastomosis in 3 cases was evaluated according to BMRC, and they achieved sensation recovery up to level of S 3 or above. The patients had great satisfactions. At the last follow-up, the curative efficacy was evaluated according to the Maryland scoring system. It ranged from 85 to 98 points, with an average of 91.6 point, 8 patients in excellent and 2 in good. Conclusion:Sural neurouascular flap can achieve a sufficient blood supply, a reasonable venous circulation and a high survival rate. The donor site was covered with relay flap to obtain a good appearance, and the anastomosed sensory nerve offered a good sensation. The function of foot and ankle recovered well, and the clinical effect was satisfactory.