OBJECTIVE: To investigate the effectiveness of free latissimus dorsi myocutaneous flap transplantation combined with external fixation in the treatment of bone and soft tissue defects around the knee joint. METHODS: A retrospective analysis was conducted on the clinical data of 13 patients with high-energy trauma-induced bone and soft tissue defects around the knee joint admitted between January 2016 and July 2023. Among them, 11 were male and 2 were female, the age ranged from 23 to 61 years, with an average of 35.7 years. The causes of injury included 10 cases of traffic accident, 2 cases of machine entanglement injury, and 1 case of heavy object crush injury. According to the Gustilo-Anderson classification, 11 cases were type Ⅲ B and 2 cases were type Ⅲ C. Post-injury, 2 cases had wound infection and 2 cases had popliteal artery injury. The time from injury to flap repair was 40-49 days, with an average of 27.5 days. The wound size was 18 cm×13 cm to 32 cm×20 cm, all accompanied by distal femoral bone defects and quadriceps muscle defects. After primary debridement, vacuum sealing drainage combined with external fixation was used for treatment. In the second stage, free latissimus dorsi myocutaneous flaps were transplanted to repair soft tissue defects, with the flap size ranging from 20 cm×15 cm to 34 cm×22 cm. The donor sites of 9 flaps were directly sutured, and 4 cases with large tension were repaired with a keystone flap based on the posterior intercostal artery perforator. At 6-15 months postoperatively, with an average of 10.5 months, 11 patients underwent knee arthrodesis surgery; 2 patients with large bone defects at the distal femur and proximal tibia underwent multi-segment bone transport reconstruction of the bone defect. At last follow-up, the recovery of the flap and the donor site was recorded, and the function of the shoulder joint was evaluated by the American Shoulder and Elbow Surgeons (ASES) score, and the function of the affected knee joint was evaluated by the Knee Society Score (KSS). RESULTS: All the flaps survived after operation, the wounds and donor site incisions healed by first intention. All 13 patients were followed up 15-55 months, with an average of 21.6 months. Four patients who underwent the restoration of the donor site with the thoracodorsal keystone perforator flap had obvious scar hyperplasia around the wound, but no contracture or symmetrical breasts on both sides. At last follow-up, the appearance and texture of the flaps were good; the bony fusion of the knee joint was good, and the range of motion and function recovered well; the shoulder joint function on the flap-harvested side was not significantly affected, and the range of motion was satisfactory. The ASES shoulder joint score of the latissimus dorsi muscle-harvested side was 85-95, with an average of 89.5. The knee joint function KSS score was 75-90, with an average of 81.2. CONCLUSION Free latissimus dorsi myocutaneous flap transplantation combined with external fixation for the treatment of bone and soft tissue defects around the knee joint caused by high-energy trauma can repair bone and soft tissue defects and reconstruct the stability of the knee joint, effectively preserve the integrity of the limb and soft tissues, and improve the patient's ability of self-care.
Humans ; Male ; Female ; Adult ; Middle Aged ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Plastic Surgery Procedures/methods* ; Superficial Back Muscles/transplantation* ; External Fixators ; Myocutaneous Flap/transplantation* ; Knee Joint/surgery* ; Young Adult ; Treatment Outcome ; Knee Injuries/surgery* ; Free Tissue Flaps/transplantation*

Objective:To investigate the clinical effect on sural neurovascular flap of small saphenous vein super drainage in reconstruction of soft tissue defects in foot and ankle.Methods:A retrospective case study was conducted to analyse the data of 22 patients who had transfer of sural neurovascular flaps of small saphenous vein with super drainage for reconstruction of soft tissue defects in foot and ankle in the Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University from June 2018 to September 2023. The patients were 19 males and 3 females aged from 16 to 70 years, with an average age of 39.0 years. Seven patients had the injury caused by compression cut, 2 of car accident, 4 of falling from height, 8 of infective wound and 1 of burning scar. The flaps were 7.0 cm × 5.0 cm - 15.0 cm × 9.0 cm in size. High frequency CDU was employed before surgery to detect the velocity of blood flow of the super drainage small saphenous vein. The patients who received transfer of sural neurovascular flap of small saphenous vein super drainage were entered in scheduled follow-up at outpatient clinic or via telephone interviews after surgery to observe the flap appearance, healing of donor and recipient sites, and the function of the affected limb. High frequency CDU was used to detect the velocity of blood flow of the small saphenous vein super drainage in follow-up.Results:All patients were included in the postoperative follow-up for 8-36 months, with an average of 20.15 months. Twenty-one flaps survived completely. One flap had partial necrosis at the edge. High frequency CDU detected an average velocity of blood flow at 2.80 cm/s in the small saphenous vein super drainage. The flaps had good colour and texture without swelling, and the wound in the recipient site healed well. The function of the affected limb was evaluated according to the functional assessment criteria of American Orthopaedic Foot and Ankle Society (AOFAS), with 21 patients in excellent and 1 in good. All patients had gained normal ankle function.Conclusion:The sural neurovascular flap with a super perfused small saphenous vein can establish effective venous reflux, reduce the risk of distal necrosis of the flap, and is an effective method for reconstruction of soft tissue defects around foot and the ankle.

Objective:To preliminarily explore and compare the efficacy of free fibular flap transfer with vascular anastomosis and Ilizarov bone transport in treatment of infected bone defects after internal fixation of humeral fractures.Methods:A retrospective analysis was conducted on 29 patients who were treated by transfer of free fibular flap and Ilizarov bone transport for infected nonunion of humeral fractures after internal fixation in the Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University between January 2017 and January 2023. Twelve patients with humeral defects at 4.0 - 6.0 cm in length (5.1 cm in average) were treated with free fibular flap transfer (flap transfer group) and 17 patients with humeral defect at 6.0-10.0 cm in length (7.3 cm in average) were treated by Ilizarov bone transport (bone transport group). All patients were included in the scheduled postoperative follow-up through a combination of outpatient visits and WeChat and telephone interviews. Follow-up included observation of humeral X-ray and shoulder-elbow function. Data were analysed using SPSS 27.0. Homogeneity tests were conducted on the basic data of the 2 groups, such as age, gender, length of bone defect, bone healing time and follow-up period. P<0.05 was considered statistically significant for the difference. Results:All 29 patients had completed the postoperative follow-up that lasted 8-89 months with 41.3 months in average. The lengths of bone defects were 5.2 cm±0.5 cm and 7.0 cm±1.2 cm, the bone healing time was 6.4 months±1.8 months and 14.2 months±4.6 months, and the follow-up time was 17.6 months±6.8 months and 34.4 months ±18.2 months in flap transfer group and bone transport group, respectively. Constant-Murley shoulder score was recorded of 86.0 ± 8.6 and 82.4±10.0 respectively for flap transfer group and bone transport group. Enneking Lower Extremity Functional Score in the flap transfer group was 25.0 ± 3.4, while that for bone transport group was not evaluated due to the absence of lower extremity surgery. There were statistically significant differences in bone defects, bone healing time, and follow-up time between the 2 groups ( P<0.01). There was no statistically significant differences in Constant-Murley shoulder score between the 2 groups ( P>0.05). However, in the flap transfer group, 1 patient developed a haematoma at fibular donor site after surgery, and the haematoma was removed in a secondary surgery, after which the surgical site healed smoothly. The external fixator had gone loose in 1 patient and resulted in a fracture of the transferred fibula. After the external fixator was re-fixed, the fracture healed at 8 months after surgery, and the external fixator was removed at 10 months after surgery. In the bone transport group, 3 patients had poor bone healing at fracture ends. Two patients had axial shifting of bones, the external fixator was adjusted during the bone transport process to correct the bone shifting. One patient suffered an incomplete radial nerve injury, and the radial nerve exploration and release surgery was performed. For that patient, an improvement of muscle strength was seen at 3 months and the wrist and digital extensions regained at 7 months after the radial nerve release surgery. The rest of humeri healed smoothly. Conclusion:In treatment of an infected humeral defect, it was found that a bone transport might be a better option for a larger humeral defect, while the free fibular flap transfer would be more suitable for a smaller humeral defect.

Objective:To investigate the clinical effect on sural neurovascular flap of small saphenous vein super drainage in reconstruction of soft tissue defects in foot and ankle.Methods:A retrospective case study was conducted to analyse the data of 22 patients who had transfer of sural neurovascular flaps of small saphenous vein with super drainage for reconstruction of soft tissue defects in foot and ankle in the Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University from June 2018 to September 2023. The patients were 19 males and 3 females aged from 16 to 70 years, with an average age of 39.0 years. Seven patients had the injury caused by compression cut, 2 of car accident, 4 of falling from height, 8 of infective wound and 1 of burning scar. The flaps were 7.0 cm × 5.0 cm - 15.0 cm × 9.0 cm in size. High frequency CDU was employed before surgery to detect the velocity of blood flow of the super drainage small saphenous vein. The patients who received transfer of sural neurovascular flap of small saphenous vein super drainage were entered in scheduled follow-up at outpatient clinic or via telephone interviews after surgery to observe the flap appearance, healing of donor and recipient sites, and the function of the affected limb. High frequency CDU was used to detect the velocity of blood flow of the small saphenous vein super drainage in follow-up.Results:All patients were included in the postoperative follow-up for 8-36 months, with an average of 20.15 months. Twenty-one flaps survived completely. One flap had partial necrosis at the edge. High frequency CDU detected an average velocity of blood flow at 2.80 cm/s in the small saphenous vein super drainage. The flaps had good colour and texture without swelling, and the wound in the recipient site healed well. The function of the affected limb was evaluated according to the functional assessment criteria of American Orthopaedic Foot and Ankle Society (AOFAS), with 21 patients in excellent and 1 in good. All patients had gained normal ankle function.Conclusion:The sural neurovascular flap with a super perfused small saphenous vein can establish effective venous reflux, reduce the risk of distal necrosis of the flap, and is an effective method for reconstruction of soft tissue defects around foot and the ankle.

Objective:To preliminarily explore and compare the efficacy of free fibular flap transfer with vascular anastomosis and Ilizarov bone transport in treatment of infected bone defects after internal fixation of humeral fractures.Methods:A retrospective analysis was conducted on 29 patients who were treated by transfer of free fibular flap and Ilizarov bone transport for infected nonunion of humeral fractures after internal fixation in the Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University between January 2017 and January 2023. Twelve patients with humeral defects at 4.0 - 6.0 cm in length (5.1 cm in average) were treated with free fibular flap transfer (flap transfer group) and 17 patients with humeral defect at 6.0-10.0 cm in length (7.3 cm in average) were treated by Ilizarov bone transport (bone transport group). All patients were included in the scheduled postoperative follow-up through a combination of outpatient visits and WeChat and telephone interviews. Follow-up included observation of humeral X-ray and shoulder-elbow function. Data were analysed using SPSS 27.0. Homogeneity tests were conducted on the basic data of the 2 groups, such as age, gender, length of bone defect, bone healing time and follow-up period. P<0.05 was considered statistically significant for the difference. Results:All 29 patients had completed the postoperative follow-up that lasted 8-89 months with 41.3 months in average. The lengths of bone defects were 5.2 cm±0.5 cm and 7.0 cm±1.2 cm, the bone healing time was 6.4 months±1.8 months and 14.2 months±4.6 months, and the follow-up time was 17.6 months±6.8 months and 34.4 months ±18.2 months in flap transfer group and bone transport group, respectively. Constant-Murley shoulder score was recorded of 86.0 ± 8.6 and 82.4±10.0 respectively for flap transfer group and bone transport group. Enneking Lower Extremity Functional Score in the flap transfer group was 25.0 ± 3.4, while that for bone transport group was not evaluated due to the absence of lower extremity surgery. There were statistically significant differences in bone defects, bone healing time, and follow-up time between the 2 groups ( P<0.01). There was no statistically significant differences in Constant-Murley shoulder score between the 2 groups ( P>0.05). However, in the flap transfer group, 1 patient developed a haematoma at fibular donor site after surgery, and the haematoma was removed in a secondary surgery, after which the surgical site healed smoothly. The external fixator had gone loose in 1 patient and resulted in a fracture of the transferred fibula. After the external fixator was re-fixed, the fracture healed at 8 months after surgery, and the external fixator was removed at 10 months after surgery. In the bone transport group, 3 patients had poor bone healing at fracture ends. Two patients had axial shifting of bones, the external fixator was adjusted during the bone transport process to correct the bone shifting. One patient suffered an incomplete radial nerve injury, and the radial nerve exploration and release surgery was performed. For that patient, an improvement of muscle strength was seen at 3 months and the wrist and digital extensions regained at 7 months after the radial nerve release surgery. The rest of humeri healed smoothly. Conclusion:In treatment of an infected humeral defect, it was found that a bone transport might be a better option for a larger humeral defect, while the free fibular flap transfer would be more suitable for a smaller humeral defect.

Objective:To investigate the clinical effect of two types of free gracilis musculocutaneous flap in transverse or vertical for reconstruction of the complex wound in calf.Methods:A retrospective series case study was conducted to analyse the clinical data of 22 patients who were treated in the Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University for complex single wounds in calf from August 2019 to January 2023. The patients were 12 males and 10 females and aged 26-58 years old, with 46.7 years old in average. There were 12 wounds on the left calf and 10 on the right. Nine of the wounds were of car accident, 8 of iatrogenic complications, 3 of bone infection and 2 of tumour resection. The wounds sized at 10.0 cm× 5.0 cm - 15.0 cm×7.0 cm. Sixteen transverse gracilis myocutaneous flaps and 6 vertical gracilis myocutaneous flaps were designed and harvested to reconstruct complex wounds in calf. The flaps were 12.0 cm×6.0 cm - 22.0 cm×9.0 cm in size. Time for the gracilis myocutaneous flap harvesting and the time for whole surgery were recorded. The time for flap harvest was 40-60 minutes and the time for the whole surgery was 3- 5 hours. Flap donor sites were directly sutured. All patients were included in the regular postoperative follow-up at outpatient clinic or through telephone and WeChat interviews and the flap survival, long-term flap appearance, healing of donor and recipient sites and limb functions were observed.Results:All 22 flaps survived after surgery. One flap had a blue edge with blood oozing. Urgent surgical exploration revealed that embolization occurred at the anastomotic site between the great saphenous vein at the proximal end of the flap and the great saphenous vein at the recipient site. After removal of the thrombus, the veins were re-anastomosed and flap survived. All the donor sites healed in stage one and functioned well. All patients entered postoperative follow-up for 5-25 months, 14.42 months in average. The flaps were in satisfactory appearance with good texture. All recipient sites healed without complication. The infected wounds were controlled. Function of the limbs was evaluated according to the Punor functional assessment criteria with excellent for 15 patients, good for 5 and fair for 2.Conclusion:Application of free transverse and vertical layout of gracilis musculocutaneous flap is an effective method to reconstruct a complex wound in calf. The anastomosis of the great saphenous vein at the proximal end of the gracilis muscle flap with great saphenous vein or small saphenous vein at the recipient site can reduce the occurrence of venous occlusion.

Objective:To investigate the clinical effect of vascularised free fibula transfer in the treatment of infectious bone defects after the surgery of proximal and distal femoral fractures.Methods:The clinical data of 27 patients with femoral bone defects treated by vascularised free fibulae grafting with fibular artery and vein as pedicle from December 2010 to December 2022 were retrospectively analysed in the Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University. There were 21 males and 6 females, at 17-72 years old, with a mean age of 41.7 years old. Twenty-one patients had bone defect of right femurs and 6 of left femurs. The length of bone defect ranged from 5.0 cm to 9.0 cm, with an average of 6.6 cm. The length of transferred fibulae ranged from 5.0 cm to 14.0 cm, with an average of 6.8 cm. Donor sites were carefully sutured layer by layer, and standardised antibiotic therapy was given before and after surgery. X-ray reviews of the affected limbs were taken at 1, 3, 6, 12, 18 and 24 months after surgery to observe the healing of the transferred fibulae and femurs to evaluate the time for full weight-bearing and removal of external frames. Before discharge, the patients were instructed to carry out pin tract care for prevention of infection. The psychological status of the patients was monitored at outpatient clinic or telephone interviews, and the functional recovery of the affected limbs was assessed using the Enneking lower limb function scoring system.Results:All of 27 patients were included in the postoperative follow-up from 19 months to 34 months, with a mean time of 26.1 months. The transferred fibulae survived with bone union. The bone healing time was from 5.1 months to 8.8 months, with an average of 7.1 months. Twenty-five patients had primary healing of the recipient site wound, and 2 patients had a sinus formed at the orifice of drainage with secretion, and the results of bacterial culture were negative. The sinuses healed after cleaning and dressing change at outpatient clinic. No stress fracture was observed from the transferred fibulae in all patients, as well as no recurrence of infection at recipient sites. The Enneking lower limb function score at the final follow-up ranged from 22 points to 27 points, with an average of 23.7 points.Conclusion:Anastomosis of vascularised free fibula in bone transfer is a feasible method to reconstruct the infected bone defects after proximal and distal femoral fractures. It provides reliable fixation and satisfactory bone healing for bone defects and facilitates the healing of transferred fibula and the recovery of lower limb function.

OBJECTIVE:To compare the efficacy and safety of terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures through a Meta-analysis. METHODS:By searching PubMed,Cochrane Library,EMbase,CNKI,WanFang and VIP databases,18 randomized controlled studies on terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures were included according to inclusion and exclusion criteria.Endnote X9 software was used to manage the literature and Revman 5.3 software was used to perform a Meta-analysis on the extracted data.The incidences of vertebral fracture,non-vertebral fracture and adverse reaction in postmenopausal osteoporosis patients treated with terlipatide and bisphosphate were analyzed. RESULTS:A total of 18 randomized controlled studies were included,of which 10 were of medium and high quality and 8 were of low quality.Meta-analysis results showed that the fracture incidence in the teriparatide group[risk ratio(RR)=0.56,95%confidence interval(CI):0.48-0.66,P＜0.000 01]was lower than that in the bisphosphonate group,and teriparatide was superior to alendronate in preventing fractures in postmenopausal women with osteoporosis(RR=0.50,95%CI:0.35-0.69,P＜0.000 1)and other bisphosphonates(RR=0.58,95%CI:0.49-0.70,P＜0.000 01).During the follow-up over 18 months,teriparatide was superior to bisphosphonates in preventing fractures in postmenopausal women with osteoporosis(RR=0.56,95%CI:0.48-0.69,P＜0.000 01).In addition,we found that teriparatide was superior to bisphosphonates in preventing vertebral fractures(RR=0.48,95%CI:0.37-0.62,P＜0.000 01)and non-vertebral fractures(RR=0.63,95%CI:0.51-0.78,P＜0.000 1)in postmenopausal women with osteoporosis.Teriparatide was superior to bisphosphonates in increasing lumbar bone density[odds ratio=4.16,95%CI:2.96-5.36,P＜0.000 1)and femoral neck bone density(odds ratio=1.02,95%CI:0.04-2.01,P=0.04).There was no significant difference in adverse reactions between teriparatide and bisphosphonates(RR=0.95,95%CI:0.85,1.06,P=0.37). CONCLUSION:Teriparatide is superior to bisphosphonates in preventing vertebral and non-vertebral fractures in postmenopausal women with osteoporosis,but the safety and adverse drug reactions of teriparatide and bisphosphonates are basically similar.Teriparatide is superior to bisphosphonate in preventing fracture and improving lumbar and femoral neck bone density regardless of short-term(＜18 months)or long-term(≥18 months)use.

BACKGROUND:Studies have exhibited that symmetrical distribution and effective dose of bone cement can reduce postoperative vertebral refractures and help improve outcomes,but obtaining better distribution and dose of bone cement during percutaneous vertebroplasty remains an issue for surgeons. OBJECTIVE:To investigate the risk factors of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture,and to analyze the correlation between these factors and recurrent fractures of the operative vertebral body and adjacent vertebral bodies after percutaneous vertebroplasty. METHODS:111 patients who underwent unilateral approach percutaneous vertebroplasty in Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2021 were screened and divided into fracture group(n=17)and non-fracture group(n=94)according to whether refracture was observed during follow-up.The following variables were reviewed in both groups:Gender,age,body mass index,operation time,menopause age,bone cement distribution index,bone density T value,bone cement dose,location of bone cement distribution,percutaneous vertebroplasty stage,past history,adverse reactions and disc cement leakage of patients.These variables were analyzed by univariate analysis.The statistically significant factors were replaced by a binary Logistic regression model to analyze the correlation with vertebral refracture after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis demonstrated that after percutaneous vertebroplasty,vertebral refracture was associated with disc cement leakage(P=0.000),cement dose(P=0.049),and cement distribution location(P=0.017).(2)Binary Logistic regression revealed that bone cement leakage(P=0.000),cement dose(P=0.031),and location of cement distribution(P=0.015)were risk factors for recurrent fracture of the operative vertebral body and adjacent vertebral body after percutaneous vertebroplasty.Compared with cement distribution types I,II,and III,the risk of recurrent fracture in the operative and adjacent vertebrae was higher in cement distribution types IV and V(OR=36.340,P=0.016;OR=27.755,P=0.017).(3)It is concluded that recurrent fractures of the surgically operated vertebral body and adjacent vertebral bodies are caused by the interaction of multiple risk factors.Bone cement distribution and bone cement leakage were independent risk factors.Recurrent fractures of the operative vertebra and adjacent vertebrae are more likely when the cement is distributed in type IV and type V.Surgeons should fully assess these risk factors before surgery and develop targeted prevention and treatment strategies to help reduce the risk of future refractures.

BACKGROUND:Studies have shown that good bone cement distribution during percutaneous vertebroplasty reduces postoperative secondary vertebral fractures and helps improve prognosis.However,how to get a good distribution of bone cement is a problem for spine surgeons. OBJECTIVE:To analyze the correlation of bone cement distribution with surgical and adjacent vertebral refractures after percutaneous vertebroplasty. METHODS:A total of 193 patients with thoracolumbar compression fracture(≤2 fractured vertebrae)admitted to Xinjiang Uygur Autonomous Region Orthopedic Hospital from January 2018 to December 2022 were selected.They underwent percutaneous vertebroplasty via unilateral approach and were followed up after surgery.They were divided into fracture group(n=30)and non-fracture group(n=163)based on whether the surgical and adjacent vertebral fractures were observed during the follow-up period(more than 6 months).The basic data of the two groups were analyzed by univariate analysis.Statistically significant factors were replaced with binary logistic regression model to explore the correlation with recompression fracture of surgical and adjacent vertebrae after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis showed that there was no significant difference between the two groups in gender,body mass index,menopause age of female patients,bone cement dose,previous history,smoking history,drinking history,operation segment,operation time,and hospital stay(P>0.05).There were significant differences in age,bone mineral density T value,bone cement leakage,and bone cement distribution between the two groups(P<0.05).(2)Binary logistic regression analysis showed that age(95%CI:1.016-1.167,P=0.016),bone cement leakage(95%CI:0.080-0.582,P=0.002),bone mineral density T value(95%CI:1.214-22.602,P=0.026),and bone cement distribution(P=0.007)were risk factors for recurrent fractures after percutaneous vertebroplasty and adjacent vertebroplasty.Patients with type I bone cement distribution(which did not touch the upper and lower endplates of the vertebral body)had a higher risk of recurrent fractures of surgical and adjacent vertebrae after percutaneous vertebroplasty.(3)The results of this study show that refracture of surgical and adjacent vertebrae is caused by the interaction of various risk factors.Age,bone cement leakage,T value of bone mineral density and bone cement distribution are independent risk factors for surgical and adjacent vertebral refracture.Refracture of surgical and adjacent vertebrae can easily occur when bone cement is distributed type I.