OBJECTIVE: To compare the effect of traditional fibula flap combined with allogeneic bone transplantation and composite bone flap transplantation combined with bone lengthening in staged repair of severe soft tissue and bone defect caused by lower limb burn. METHODS: Total 68 patients with severe soft tissue and bone defect caused by lower limb burn from March 2015 to January 2018 were retrospectively analyzed, and they were divided into control group (34 cases) and study group (34 cases) according to the treatment plan. All patients had different degrees of soft tissue and bone tissue defects. In the study group, 34 patients were treated with composite bone flap transplantation combined with bone lengthening. There were 22 males and 12 females; the age ranged from 32 to 46(39.18±6.01) years; the time from injury to treatment was (16.69±5.11) h;28 cases were caused by explosion injury and 6 cases were caused by firearm burn; the length of bone defect was (12.10± 2.34) cm;and 16 cases were on the left side of affected limb 18 cases were on the right side. In the control group, there were 24 males and 10 females, aged 31 to 47 (38.93 ± 5.81) years;the time from injury to treatment was(17.10±5.63) h;the causes of injury were explosive injury in 30 cases and firearm burn in 4 cases; the length of bone defect was (11.96±2.51) cm;19 cases were on the left side and 15 cases on the right side. All patients were followed up for 6 months. The FMA scores before operation and 3 and 6 months after operation, treatment satisfaction, curative effect and complications of the two groups were recorded. RESULTS: Limb function:there was no significant difference in FMA scores between the two groups before operation ( CONCLUSION the combined use of composite bone flap transplantation and bone lengthening staged repair in the treatment of severe soft tissue and bone defect caused by lower limb burn can achieve good therapeutic effect, improve limb function, and have high treatment satisfaction and certain safety.
Adult ; Bone Lengthening ; Bone and Bones ; Female ; Humans ; Lower Extremity/surgery* ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Treatment Outcome

Acute bone shortening and delayed lengthening by Ilizarov surgery have been used to treat a wide range of soft tissue injuries including open fracture, osteomyelitis of the tibia and lower leg amputation. It has advantages such as bone lengthening as well as minimizing the loss of damaged tissues via tissue expansion. Here, we report a case of 52-year-old male with satisfactory results through acute bone shortening, replantation, and gradual bone lengthening after complete amputation of the ankle with related literature reviews.
Amputation* ; Ankle ; Bone Lengthening ; Fractures, Open ; Humans ; Leg* ; Male ; Middle Aged ; Osteomyelitis ; Replantation ; Soft Tissue Injuries ; Tibia ; Tissue Expansion

PURPOSE: Although bilateral lower-limb lengthening has been performed on patients with achondroplasia, the outcomes for the tibia and femur in terms of radiographic parameters, clinical results, and complications have not been compared with each other. We proposed 1) to compare the radiological outcomes of femoral and tibial lengthening and 2) to investigate the differences of complications related to lengthening. MATERIALS AND METHODS: We retrospectively reviewed 28 patients (average age, 14 years 4 months) with achondroplasia who underwent bilateral limb lengthening between 2004 and 2012. All patients first underwent bilateral tibial lengthening, and at 9-48 months (average, 17.8 months) after this procedure, bilateral femoral lengthening was performed. We analyzed the pixel value ratio (PVR) and characteristics of the callus of the lengthened area on serial radiographs. The external fixation index (EFI) and healing index (HI) were computed to compare tibial and femoral lengthening. The complications related to lengthening were assessed. RESULTS: The average gain in length was 8.4 cm for the femur and 9.8 cm for the tibia. The PVR, EFI, and HI of the tibia were significantly better than those of the femur. Fewer complications were found during the lengthening of the tibia than during the lengthening of the femur. CONCLUSION: Tibial lengthening had a significantly lower complication rate and a higher callus formation rate than femoral lengthening. Our findings suggest that bilateral limb lengthening (tibia, followed by femur) remains a reasonable option; however, we should be more cautious when performing femoral lengthening in selected patients.
Achondroplasia/*surgery ; Adolescent ; Bone Lengthening/*methods ; Child ; Child, Preschool ; Female ; Femur/radiography/*surgery ; Humans ; Male ; Retrospective Studies ; Tibia/radiography/*surgery ; Treatment Outcome ; Young Adult

Upper limb length discrepancy is a rare occurrence. Humerus shortening may need specialized treatment to restore the functional and cosmetic status of upper limb. We report a case of humerus lengthening of 9 cm with a monorail external fixator and the result was observed during a 2-year follow-up. Humerus lengthening needs specialized focus as it is not only a cosmetic issue but also a functional demand. The monorail unilateral fixator is more functional and cosmetically acceptable, and thus becomes an effective treatment option.
Adult ; Bone Lengthening ; instrumentation ; External Fixators ; Female ; Humans ; Humerus ; physiology ; surgery ; Range of Motion, Articular ; Surgery, Plastic ; instrumentation

A 31-year-old female patient presented with a skin and soft tissue defect measuring 8x6 cm in size with exposure of the extensor hallucis longus tendon and the first metatarsal bone after metatarsal lengthening for brachymetatarsia. The defect was covered with a distally based dorsalis pedis flap based on the distal communicating branch of the dorsalis pedis artery. Secondary defect was covered by a split thickness skin graft. There was congestion of the flap tip after the operation; however, it was resolved using medical leeches and anti-coagulants. No necrosis or infection was encountered and the contour of the flap was satisfactory. There was no donor site morbidity. Reverse dorsalis pedis flap has not been commonly used due to the anatomical variation and uncertainty, which is different from the reverse radial forearm flap. However, when faced with the challenge of a moderate soft tissue defect of the distal forefoot, we believe that the reverse dorsalis pedis flap offers a good option with various advantages.
Arteries ; Bone Lengthening ; Estrogens, Conjugated (USP) ; Female ; Foot ; Forearm ; Humans ; Leeches ; Metatarsal Bones ; Necrosis ; Skin ; Surgical Flaps ; Tendons ; Tissue Donors ; Transplants ; Uncertainty

OBJECTIVETo investigate the safety and efficacy of minimally invasive achilles tendon lengthening and system rehabilitation for the treatment of contracture of achilles tendon.

METHODSFrom January 2002 to December 2010, 27 patients (31 feet) with contracture of achilles tendon were treated with minimally invasive achilles tendon lengthening and system rehabilitation. There were 11 males and 16 females with an average age of 35.5 years (ranged 3 to 65 years). Right foot was in 13 cases, left foot was in 10 cases, both feet were in 4 cases. Course of disease was from 1 to 5 years with an average of 2.3 years. The cause of contracture included postoperative complication of tibia fractures treated with intramedullary nailing in 7 feet, sequelae of lower leg compartment syndrome in 11 feet, congenital talipes equinovarus in 13 feet (both feet in 4). Before operation, all the patients walked with limping, plantar flexion anomaly was from 15 degrees to 50 degrees with an average of 35.5 degrees. The strength of quadriceps muscle of thigh was grade V in 27 feet, grade IV in 4 feet, the strength of musculus triceps surae was grade V in 24 feet, grade IV in 7 feet.

RESULTSAll the patients were followed-up for 6-24 months with an average of 11.3 months. According to standard of Arner-Lindholm to evaluate function of ankle joint, 29 feet obtained excellent results and 2 feet good. No infection, re-rupture or re-contracture was found.

CONCLUSIONMinimally invasive achilles tendon lengthening and system rehabilitation in treating contracture of achilles tendon has advantage such as simple operation, less complication, lower recurrence rate, which is favourable for thoroughly rehabilitation of patients. But, the case in which the strength of quadriceps muscle of thigh or musculus triceps surae still less than grade III after preoperative rehabilitation care should not choose the method.

Achilles Tendon ; surgery ; Adolescent ; Adult ; Aged ; Bone Lengthening ; methods ; Child ; Child, Preschool ; Contracture ; rehabilitation ; surgery ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods

When a tooth adjacent to implant has coronal damages caused by severe dental caries or fracture, the clinical crown lengthening by forced eruption makes it possible to get esthetic restoration due to the prevention of alveolar crestal bone resorption and loss of interdental papilla. A 54-years-old male patient wanted prosthetic treatment because his anterior 3 unit bridges had fallen out. A right maxillary central incisor showed mild dental caries but a right maxillary canine lost most clinical crowns. Forced eruption combined with a gingival fiberotomy of a right maxillary canine was performed for 1 month after the dental implant had been simultaneously placed with bone grafts on a right maxillary lateral incisor. About 5 months after implant placement, 2nd surgical operation was performed. The provisional restorations were adjusted to make esthetic gingival contour for 8 weeks. The porcelain fused gold restorations were fabricated and set. The patient was satisfied with the final restorations in esthetic and functional aspect.
Bone Resorption ; Crown Lengthening ; Crowns ; Dental Caries ; Dental Implants ; Dental Porcelain ; Gingiva ; Humans ; Incisor ; Male ; Orthodontic Extrusion ; Tooth ; Transplants

OBJECTIVETo investigate the effect on intramuscular connective tissue and passive range of joint motion by the stress produced in limb lengthening.

METHODSAn animal model of limb lengthening was established in the tibia of rabbits. Distraction was initiated at a rate of 1 mm/d and 2 mm/d in two steps respectively, and both proceeded until 10% and 20% of the tibia length was achieved. Muscle samples were harvested at the time when distraction ended and at the 4th week of consolidation after the distraction. Scanning electron microscope was applied to observe the morphological changes of the perimysium. The goniometer, which we made for this study, was used to measure the passive range of joint motion.

RESULTSThe collagen fibers were partitioned in bundles, crimped and interconnected closely and orderly. In the regime of 1 mm/d distraction with 10% lengthening, no apparent changes of the collagen fiber and passive range of joint motion was demonstrated. When tibia was increased to 20%, the crimped fibers showed a tendency of being straightened while the passive range of joint motion was reduced. The findings remained the same at the 4th week of consolidation. In the regime of 2 mm/d distraction with 10% lengthening, the crimped structure of the collagen fibers in the perimysium disappeared and the fibers were almost straightened. Additionally, the interconnection of the collagen fibers became loosened and interstice was presented among the fibers. At the 4th week of consolidation, the restoration to the original crimped structure was not completed. When the lengthening ratio was increased to 20%, the collagen fibers were straightened completely. This condition remained unchanged throughout all 4 weeks. The passive range of joint motion was reduced dramatically in the regime of 2 mm/d distraction.

CONCLUSIONThe ultrastructure of perimysium and the passive range of joint motion in the regime of 1mm/d lengthening shows the condition closest to the normal ones. The regime of 2 mm/d lengthening may cause an apparent change in the ultrastructure of perimysium and passive range of joint motion.

Animals ; Bone Lengthening ; Collagen ; ultrastructure ; Connective Tissue ; injuries ; physiology ; ultrastructure ; Male ; Osteogenesis, Distraction ; Rabbits ; Range of Motion, Articular ; physiology ; Regeneration ; physiology

PURPOSE: To date, there have been no studies evaluating the usefulness of allograft as a substitute for autograft in calcaneal neck lengthening osteotomy. This retrospective study examined the results of calcaneal neck lengthening osteotomy using allograft for pathologic flatfoot deformity in children and adolescents with various neuromuscular diseases. MATERIALS AND METHODS: 118 feet in 79 children treated surgically between Mar 2000 and July 2005 were reviewed. The mean age at the time of the operation was 9+3 years (range, 3-17 years) and follow-up averaged 15.4 months (range, 13-21 months) postoperatively. Talo-1st metatarsal angle, talo-calcaneal angle, calcaneal pitch were measured before and after operation and bony union was estimated. RESULTS: Bony union was noted at the latest follow-up and there were no postoperative complications such as reduction loss, infection, nonunion, delayed union or graft loss during the follow-up period in all but one foot. All radiographic indices were improved postoperatively in all cases. CONCLUSION: Our results indicate that use of allograft in calcaneal neck lengthening osteotomy is a useful option for correction of the planovalgus deformity in skeletally immature patients whose enough autobone can not be obtained.
Adolescent ; Bone Diseases/*congenital/radiography/*surgery ; *Bone Lengthening ; *Bone Transplantation ; Calcaneus/*surgery ; Child ; Child, Preschool ; Female ; Humans ; Male ; *Osteotomy ; Transplantation, Homologous

OBJECTIVETo study the two-axis parallel method in bone lengthening.

METHODSAmong 54 patients (male 28, female 26, mean age 22) who performed tibial lengthening by metaphyseal osteotomy using two-axis parallel method, 26 patients were poliomyelitis sequelae, 13 patients were inequality in limb length after trauma, 4 patients were achondroplasia, 6 patients were genetic short stature, 1 patient was maculatum disease complicated with leg length discrepancy, 4 patients were pituitary dwarfism.

RESULTSAll the patients were followed up and the duration ranged from 18 months to 45 months, with an average of 24.5 months. All patients had bone lengthened. The maximum increase of limb length was 12 cm and the minimum increase was 5 cm, averaged 6.2 cm. One patient had foot drop, 2 patients had foot drop complicated with strephexopodia, 1 patient had serious pinhole infection, and 1 patient had delayed union of the bone.

CONCLUSIONThe two-axis parallel method tibial lengthening by metaphyseal osteotomy can reduce postoperative complications and simplify the operative procedure, which is an ideal method for bone lengthening.

Adult ; Bone Lengthening ; methods ; Female ; Humans ; Male ; Middle Aged ; Osteotomy ; methods ; Tibia ; surgery