OBJECTIVETo investigate clinical effect of transverse tibial bone transport micro vessels regeneration technology combined with vacuum drainage in treating diabetic foot ulcer.

METHODSFrom November 2015 and December 2016, clinical data of 19 diabetic foot ulcer patients treated with transverse tibial bone transport micro vessels regeneration technology combined with vacuum drainage were retrospective analyzed, including 15 males and 4 females aged from 42 to 82 years old with an average of (64.57±7.14) years old;the courses of diabetic ranged was (14.62±6.19) years;12 cases on the left side and 7 cases on the right side;the area of ulcer ranged from 2 cm×3 cm to 8 cm×6 cm. All patients were stage D according to Texas classification, 3 cases were grade 2, 10 cases were grade 3 and 6 cases were grade 4. Ankle-brachial index and Michigan Neuropathy Screening Instrument (MNSI) were used to evaluate recovery of peripheral vessel and nerve before and after operation, the result of angiography and vascular ultrasound were also compared after operation.

RESULTSSeventeen of 19 patients were followed up from 3 to 13 months with an average of 6.9 months. Seventeen patients' surface wound were healed. Ankle-brachial index was increased from (0.51±0.20) before operation to (0.93±0.18) at 3 months after operation, and had significant difference(=13.63, =0.000);MNSI was increased from (4.06±1.36) before operation to(5.76±1.44) at 3 months after operation, and differences were statistically significant (=7.31, =0.000). Postoperative angiography and vascular ultrasound showed satisfied regeneration of micro-vessel and affected foot achieved normal movement and daily life.

CONCLUSIONSTransverse tibial bone transport micro vessels regeneration technology could reconstruct micro-vessel under lower affected limb, promote recovery of peripheral vessel and nerve, while with vacuum drainage could promote wound healing, has advantages of simple operation, obvious clinical effect, and high success rate of limb-salvage, and is one of ideal treatment for diabetic foot ulcer.

Adult ; Aged ; Aged, 80 and over ; Angiography ; Ankle Brachial Index ; Diabetic Foot ; surgery ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Regeneration ; Retrospective Studies ; Tibia ; blood supply ; Treatment Outcome ; Ultrasonography ; Vacuum

OBJECTIVETo investigate the therapeutic effect of V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus for small skin defect on children heel.

METHODSFrom Mar. 2012 to Jan. 2014, 9 children with small skin defects on heel were treated with adjacent V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus. The flaps were 8.0 cm x 4.0 cm to 9.0 cm x 4.5 cm in size and the wounds at donor sits were directly closed.

RESULTSAll flaps survived completely with primary healing. 9 cases were followed up for 6-12 months( average, 9 months). The flaps had good match with surrounding tissue in texture and color. The function of ankle was normal. All the parents were satisfied with functional and cosmetic results.

CONCLUSIONSIt is a safe and practical method for treatment of small skin defect on children heel with adjacent V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus.

Ankle ; Child ; Fibula ; Heel ; injuries ; Humans ; Perforator Flap ; blood supply ; transplantation ; Reconstructive Surgical Procedures ; Skin ; injuries ; Skin Transplantation ; Tibial Arteries ; Wound Healing

OBJECTIVETo evaluate the effect of lateral supramalleolar artery descending branch antidromic flap for the repair of soft tissue defects in the foot and ankle.

METHODSFrom May 2009 to October 2013,12 patients with soft tissue defects combined with tendon and bone exposure in the foot and ankle were treated by lateral supramalleolar artery descending branch antidromic flap for the repair of soft tissue defects in the foot and ankle, including 9 males and 3 females with an average age of 37.5 years old ranging from 19 to 58 years. Ten cases had the soft tissue defects in the dorsum of foot and 2 in the ankle. The defect area of soft tissue was from 11 cm x 9 cm to 8 cm x 5 cm.

RESULTSTwelve patients were follow-up for 3 to 12 months (averaged 7.3 months). The flaps of 9 cases were survived,the flaps edges of the other 3 cases were necrosis,and healed after dressing change. The flaps were slightly swelling without ulcer occurrence.

CONCLUSIONLateral supramalleolar artery descending branch antidromic flap can repairing the damage by one-stage operation with advantage of dissection easy,rich blood supply without sacrifice of major artery.

Adult ; Ankle ; blood supply ; surgery ; Arteries ; surgery ; Female ; Foot ; blood supply ; surgery ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Young Adult

OBJECTIVETo evaluate the therapeutic effect of dominant perforator neurocutaneous flaps for one-staged reconstruction of defects caused by high energy at lower legs, ankles and feet.

METHODSFrom July 2003 to Feb. 2011, 39 cases, with defects caused by high energy at lower legs, ankles and feet, were retrospectively studied. The defects were covered primarily by one or two perforator neurocutaneous flaps (free or pedicled) which were based on a dominant perforator arising from the posterior tibial or peroneal artery (including the lateral supramalleolar perforating artery which is also from the peroneal vessel) respectively through sural, saphenous and superficial peroneal neurocutaneous vascular axis.

RESULTS39 cases with 44 defects were treated by 32 sural neurocutaneous flaps based on the peroneal perforator (5 free and 27 pedicled), 6 saphenous neurocutaneous flaps on the posterior tibial perforator (1 free and 5 pedicled) and 6 superficial peroneal ones on the lateral supramalleolar perforating artery. The largest flap size was 22 cm x 10 cm. All flaps were survived successfully without necrosis. The average in-hospital time was 23 days ( ranged from 12-36 days).

CONCLUSIONSThe three kinds of dominant perforator neurocutaneous flaps have reliable blood supply with a relatively large size. They can be chosen and designed individually for all kinds of defects over the lower leg, ankle and foot. There are many advantages in a primary procedure, such as easier dissection, better vessel status in or around recipient areas, less secondary necrosis and lower risk of chronic infection. Moreover, the reduction of granulation and scar tissues benefit functional rehabilitation.

Adolescent ; Adult ; Ankle Injuries ; surgery ; Child ; Female ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged ; Perforator Flap ; blood supply ; innervation ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Young Adult

We measured the ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) and ABI in 97 ischemic stroke patients and 93 control subjects to investigate the relationship between baPWV, ABI and risk factors of ischemic stroke. The stroke patients were grouped according to the results of MRA and Carotid artery color Doppler ultrasound. The correlation of baPWV and ABI to the arteriosclerosis was discussed. There was a significant difference in the patients with hypertension, diabetes mellitus, baPWV and ABI between ischemic stroke patients and control subjects. baPWV was the most sensitive risk factor for ischemic stroke. ABI and diabetes mellitus were the relatively sensitive risk factors for ischemic stroke. baPWV were found to have a positive correlation with common carotid arteriosclerosis (gamma=0.215, P=0.048), while ABI had a negative correlation with intracranial arteriosclerosis (gamma=-0.237, P<0.05). BaPWV and ABI may closely relate to severity of ischemic stroke. Simple measurements of baPWV and ABI in patients could be a useful tool for evaluating the risk of ischemic stroke.
Aged ; Ankle ; blood supply ; Ankle Brachial Index ; Arteriosclerosis ; physiopathology ; Blood Flow Velocity ; Brachial Artery ; physiopathology ; Brain ; blood supply ; pathology ; Brain Ischemia ; complications ; Carotid Arteries ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Pulsatile Flow ; Pulse ; Risk Factors ; Stroke ; diagnosis ; etiology ; physiopathology

OBJECTIVETo investigate the therapeutic effect of V-Y flap pedicled with superior malleolus cutaneous branch for small skin defect at the dorsal side of foot.

METHODSFrom Aug. 2008 to Aug. 2010, 9 cases with skin defects at the dorsal side of feet were treated by V-Y flaps pedicled with superior malleolus cutaneous branch. The flap size ranged from 6.0 cm x 5.5 cm to 12.0 cm x 6.5 cm. The defects at the donor sites were closed directly.

RESULTSAll flaps survived completely. 9 cases were followed up for 6-12 months after operation. The flaps had good texture and color match. The 2-point discrimination distance at the flap was 10-14 mm. The function of ankle was normal.

CONCLUSIONSThe V-Y flap pedicled with superior malleolus cutaneous branch is ideal for the treatment of small skin defect at the dorsal side of foot.

Adolescent ; Adult ; Aged ; Ankle ; blood supply ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Young Adult

OBJECTIVE: To determine the efficacy, safety and primary follow-up results of a guidewire looping technique for the treatment of infrapopliteal arteries. MATERIALS AND METHODS: From October 2006 to May 2008, an intraluminal angioplasty of the infrapopliteal arteries was attempted in 200 consecutive patients. Altogether, 417 infrapopliteal lesions, with lengths varying from 2 cm to 32 cm, were treated as part of this study, including 305 lesions in the anterior tibial arteries, 89 in the posterior tibial arteries, and 23 in the peroneal arteries. The 'U'-shaped guidewire technique was attempted in 393 lesions from 361 limbs. The tip of a hydrophilic 0.035-inch guidewire was formed into a 'U' shape with the aid of a 4-Fr catheter and collateral branch vessel to recanalize the completely occluded long segment lesions. RESULTS: A successful angioplasty with at least one artery recanalized directly to the malleolar or dorsal foot was achieved in 322 limbs (89%). The looping technique had a success rate of 90% (352 of 393 lesions). After the procedure, the rest pain was relieved in 58 of 69 patients, while 207 of 245 limbs (85%) showed improvement for intermittent claudication. Complete wound healing was noted in 21 of 54 patients, while 20 of 54 patients showed an improvement in the wound size or depth. A total of 38 major immediate procedure-related complications were noted, including retroperitoneal hematoma, distal emboli, and vessel rupture. CONCLUSION: The results of this study suggests that the guidewire looping technique is a safe and effective method for the recanalization of the occluded lesions in infrapopliteal vessels.
Aged ; Aged, 80 and over ; Angioplasty/*methods ; Ankle Brachial Index ; Arterial Occlusive Diseases/*surgery ; Female ; Follow-Up Studies ; Foot/blood supply/surgery ; Humans ; *Magnetic Resonance Angiography ; Male ; Middle Aged ; *Popliteal Artery ; Postoperative Complications ; Treatment Outcome

As there are a number of ankle arteries and some of them can not be blocked completely under higher pressure from the external inflate cuff, we can not accurately identify the starting point of the pulse wave, so the errors of lower limb systolic blood pressure measurement take place and affect the accuracy of ankle-brachial index in diagnosing vascular disease. In this paper, we constructed delay vectors from the data we already collected from lower limb pulse wave and formed an embedding matrix; thus solving the problem of inadequate sensor dimensions. We extracted a single arterial pulse wave through the blind signal separation on the basis of embedding matrix, and we identified the lower limb systolic blood pressure corresponding to the starting point. Simulation and clinical experiments show the method can be used to separate the wave signals of ankle artery which contains information of systolic blood pressure. It improves the accuracy of lower limb systolic blood pressure measurement and hence provides accurate data for the clinical diagnosis of arterial disease.
Algorithms ; Ankle ; blood supply ; Blood Pressure ; Blood Pressure Determination ; methods ; Brachial Artery ; physiology ; Humans ; Leg ; blood supply ; Pulsatile Flow ; physiology ; Signal Processing, Computer-Assisted

According to the pulse-wave theory, the authors developed a new non-invasive instrument for measuring arterial elastic function. It collects the pulse waveforms from the arteries of four limbs as well as from the radial arteries of carpus. After signal pre-processing, it calculates the arterial elastic parameters by the pre-prepared algorithm and program. Individual parameters such as pulse wave velocity (PWV), ankle-brachial index (ABI), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)can be obtained. At the same time, a series of clinical trials were conducted with reference to PWV and ABI, which confirmed the validity, accuracy and reliability of the instrument. The instrument can be used to determine the differences between cardiovascular patients and normal persons, as well as the extent of atherosclerosis. At the same time it can reflect the situation of vascular obstruction and screen the peripheral arterial disease. Therefore, it is of some value to the epidemiological study, prevention and early detection of cardiovascular disease.
Aging ; physiology ; Ankle ; blood supply ; Arteries ; physiopathology ; Arteriosclerosis ; physiopathology ; Blood Pressure ; physiology ; Brachial Artery ; physiopathology ; Elasticity ; physiology ; Humans ; Hypertension ; physiopathology ; Pulsatile Flow ; physiology ; Pulse ; Systole

OBJECTIVETo discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle.

METHODSFrom Jan. 2005 to Jun. 2009, 10 cases with small wounds around ankle were treated with medial planta island flaps pedicled with anterior tibial artery perforator. The flap size ranged from 7.5 cm x 2.8 cm to 13.0 cm x 5.0 cm. The wounds at the donor sites were covered with skin grafts.

RESULTSAll the 10 flaps and skin grafts were survived with primary healing. The patients were followed up for 6-12 months with satisfactory cosmetic results. The 2-point discrimination was 4-6 mm when the proximal end of saphenous nerve was not injured, and it was 9-10 mm when the nerve was injured or cut off. The patients could walk with no occurrence of ulcer in flaps or donor site.

CONCLUSIONSThe medial planta island flaps pedicled with anterior tibial artery perforator can effectively repair the small wounds around ankle with reliable blood supply.

Adult ; Ankle Injuries ; surgery ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Skin Transplantation ; Surgical Flaps ; blood supply ; Tibial Arteries ; surgery ; Treatment Outcome ; Young Adult