Objective To summarize the latest development of the oral and maxillofacial reparative and reconstructive surgery. Methods The literature at home and abroad was reviewed and the main creative concepts in this field were summarized and analyzed. Results In the terms of the oral and maxillofacial reparative and reconstructive surgery, the significant achievements were made in the following aspects: transplantation of revascularized tissues, artificial materials, plateletrich plasma, distraction osteogenesis, microsurgery on fracture, arthroplasty, dynamic repair, and computerassisted design. Conclusion Based on the previous achievements, the oral and maxillofacial reparative and reconstructive surgery will have a further development, especially in the individualized treatment.
Objective To study diagnosis, treatment and rebuilding of scrotum gangrene. Methods From January 1992 to September 2004, 15 patients with scrotum gangrene were treated and their clinical data were analysed.Their ages ranged from 23 to80 years. The results of bacterial culture were positive for wound sample in 14 cases and for blood in 1 case. All the patients underwent surgical treatment including incision,aggressive debridement,drainage,irrigation and antibiotic therapy. Two patients accepted hyperbaric oxygen therapy. All the patients received scrotum rebuilding by transfer of skin flap, skin grafting and suturation and orchectomy was given in 2 elder patients. Results All the patients received healing by first intention after 21 to 34 days.There was no death. Aftera follow-up of 1 to 3 years, the appearance of scotum was satisfactory and no orchiatrophy occurred. Thirteen patients with testicles had normal sexual function. Conclusion After a definite diagnosis,early aggressive debridement,broad-spectrum antibiotics and sufficient local drainage should be used. If available,hyperbaric oxygen therapy may be used to promote healing of tissue wound. Scrotum should be rebuilt based on different conditions.
Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
The bone tumors are common in the lower part of the femur and upper tibia. Fifty-seven cases of repairment and reconstruction of the long bone defect after tumor resection in this area have reported in this paper. The main principle for the lesion and reservation of the joint function. The most suitable surgical procedure for each cases was selected according to the area, the character, the dimension and the length of the bone tumor.
OBJECTIVE: To investigate the reparative and reconstructive method of post-traumatic lateral instability of the ankle. METHODS: From January 1992 to June 2000, 7 cases of male patients with ankle injury (aged 25-43 years) underwent Wetson-Jones modification. A bone tunnel was drilled through 2.5 cm upside the lateral malleolus tip and talus, and short peroneal tendon was cut to pass the tunnel to fix twining. RESULTS: All patients were followed up 2-10 years, 5 cases mineworkers changed to work on the ground, 2 patients returned to the original work, no traumatic arthritis occurred. According to Baird ankle joint scoring standard, the ankle function was excellent in all cases. CONCLUSION: Reformed Wetson-Jones modification can repair and reconstruct perfectly the traumatic instability of the ankle.
OBJECTIVE: To study the reparative and reconstructive methods for the large bone defect due to the excision of bone tumor. METHODS: According to the size and shape of the bone defect, we selected the proper bone and joint or manipulated bone segment of the profound hypothermia freezing allograft and gave locked intramedullary nails or steel plate and screws for stable internal fixation. RESULTS: In the 22 cases, 20 survived without tumor and 2 died. One patient treated with the allograft of semi-knee joint was found rejection. Then the wound did not heal. After the skin flap grafting was performed, the wound still did not heal, so the patient accepted amputation(4.5%). In the other 21 cases, the X-ray and 99mTc SPECT showed some callus or concentration of nuclein which implied bone union. According to Markin bone graft criterion, the excellent rate of function recovery was 81.8%. CONCLUSION: Allografting of bone and joint is a good and workable method in repairing and reconstructing the bone defect due to the excision of bone tumor. It should be further studied and be applied.
Objective To explore an improved method of surgical operation for reposition of the articular surface with Type Ⅲ Pilon fractures. Methods From January 1999 to December 2005, 20 patients (22 sides) with Type Ⅲ Pilon fractures were treated with the delayed open reduction and the internal fixation, which took the superior articular surface of the talus as a templet so as to reposition the lower articular surface of the tibia, strengthen the bone transplantation, fasten the internal fixation, and make an early functional exercise possible. Complete data were obtained from 16 of the patients with 18 sides (13 males,15 sides; 3 females, 3 sides; age, 14-48 years). The injury due to a fallingaccident was found in 12 patients (14 sides), and due to a traffic accident in 4patients (4 sides). Results The healing of the first intention was achieved in 14 sides, the delayed healing in 3 sides, and the infection in 1 side. The follow-up of all the 16 patients for 971 months (average, 22 months) including the X-ray examinations revealed that no screw for the internal fixation entering the articular cavity. According to the Teeny’s judging standards of radiology evaluating the result of the surgery for Pilon fractures, the anatomical reduction of the related articular surface was found in 77.8% of the sides (14/18) and thehealing of the first intention (stage Ⅰ) in 94.4% (17/18). According to the Mazur’s criteria, an excellent result was obtained in 5 sides, good in 7, fair in 5, and poor in 1. The excellent and good result was 66.7%. Conclusion Propermanagement of the injured soft tissues, prompt recovery of the tibial distant plateau height, and accurate reposition of the articular surface, enough transplant bone for the solid support, b internal fixation for the distant tibial anatomical structure, and early functional exercise are the key points to the successful operation.
Objectives To investigate the curative effect of skin flap and allogenic tendon in reconstructing l imbs function of complex soft-tissue defect. Methods From May 2001 to December 2007, 43 cases of complex soft-tissue defect of l imbs were repaired by pedicled skin flaps, free skin flaps, cutaneous nerve nutrient vessel skin flaps and arterial island skin flaps for primary stage, then the function of the l imbs were reconstructed with allogeneic tendon after 2-3 months of skin flapoperation. There were 31 males and 12 females, aged 5-53 years(mean 25 years). Injury was caused by machine in 28 cases, by traffic accident in 14 cases and others in 1 case. There were 27 cases in upper l imb, 16 cases in lower l imb. Twenty-six cases compl icated by bone fracture, dislocation and bone defect, the most of bone defect were cortical bone defect. The sizes of skin and parenchyma defect were 9 cm × 4 cm to 37 cm × 11 cm, the length of tendon defect was 6 to 26 cm. The sizes of skin flaps were 10 cm × 5 cm to 39 cm × 12 cm. Allogeneic tendons were used 2-6 strips(mean 4 strips). Results Forty-three cases were followed up for 5-56 months (16 months on average), all flaps survived. The donor area healed by first intention, the incision healed by first intention in second operation, and no tendon rejection occurred. The cl inical heal ing time of fracture was 3-8 months, and the cl inical heal ing time of allograft was 6-8 months. Six cases were given tenolysis for adhesion of tendon after 3-5 months of tendon transplantation. The postoperative flexion of wrist joint was 20-50°, the extension was 20-45°. Articulatio metacarpophalangea and articulatio interphalangeae could extend completely. The flexion of articulatio metacarpophalangea of thumb was 20-45°, the flexion of articulatio interphalangeae was 30-70°. The flexion of articulatio metacarpophalangea and articulatio interphalangeae of the other fingers was 60-90°. The postoperative ankle can extend to neutral position, the neutral position of ankle was 30-50°. The flexion of articulatio metatarsophalangeae and articulatio interdigital was 20-40°. Theextension of articulatio metatarsophalangeae was 30-60°. Conclusion Through designing systematically treatment plan,practicing operation by stages, preventing adhesion of tendon actively and exercising function reasonably, the functions of l imbs reconstructed by allogenic tendon and skin flap can leads to satisfactory effect.
【Abstract】 Objective To summarize the technique and effect of the therapy for severe fracture and dislocation ofankle joint by operation. Methods From March 2003 to February 2006, 76 cases were treated with primary open restorationand internal fixation for dislocated ankle joint fracture, with 47 males and 29 females, with the average age of 36.4 years (ranging from 18 years to 65 years). According to AO criterion, these fresh fractures were classified into 13 cases for type C3-1, 45 cases for type C3-2 and 18 cases for type C3-3. Based on the Gustilo-Anderson standard, 23 open fractures were classified into 17 cases for type II and 6 cases for type Ⅲ A. The operation was delayed from 1 hours to 24 hours after the injury. Results All incisions healed at the first stage except 4 cases which delayed union because of simple infection by revision with ointment. A total of 72 cases were followed up, with the average time of 18.5 months (from 12 months to 35 months). The time of bone union was from 12 weeks to 24 weeks. The screws of fixation for lower tibia-fibula joint were found to be ruptured in 2 cases when further consultation was performed in the 16th and 20th week after the operation, respectively, and were broken within 1 year after the operation. These screws were taken out 12 weeks postoperative in 28 cases, while the whole internal fixations of the rest caseswere taken out 1 year after the operation. The postoperative function of malleolus extended from 21.7º to 26.8º and flection from 38.5º to 44.7º. Assessed by the American Orthopaedic Foot and Ankle Society Cl inical Rating Scales, 23 cases were excellent, 36 good, 13 fair, and the choiceness rate reached 81.94%. Conclusion These procedures, together with reduction by twist after hospital, open and internal fixation in time, and parenchyma managed with internal fixation, are important to attain satisfactory effect for the treatment of severe fracture and dislocation of ankle joint.