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小腿内侧神经血管蒂皮瓣修复足部软组织缺损

陈旧性跖跗关节脱位的足弓重建

目的 总结陈旧性跖跗关节脱位足弓重建的治疗方法及效果。 方法 2004 年9 月－ 2008 年1 月，收治陈旧性跖跗关节骨折脱位26 例。男19 例，女7 例；年龄18 ～ 56 岁，平均38.4 岁。交通伤8 例，重物砸伤10 例，高处坠落伤8 例。根据Myerson 分类法的X 线分型：A 型6 例，B 型5 例，C 型2 例，D 型6 例，E 型3 例，F 型4 例。受伤至手术时间4 周～ 9 个月，平均9 周。采取切开复位、内固定术9 例，足弓重建跖跗关节原位融合术 17 例。 结果 术后切口均Ⅰ期愈合。26 例均获随访，随访时间12 ～ 48 个月，平均22 个月。4 例术后5 个月发生足部转移性疼痛，应用足弓垫治疗，2 例1 年后疼痛缓解，2 例扩大关节融合后疼痛缓解。按Maryland 足部评分标准测定：优 5 例，良17 例，可4 例；优良率84.6%。关节融合全部愈合。 结论 伤后4 ～ 6 周的陈旧性跖跗关节脱位可行切开复位内固定术，疗效满意；6 周以上陈旧性跖跗关节脱位，宜行足弓重建跖跗关节原位融合术。

足跟部软组织缺损的修复

两种蒂的小腿后筋膜皮瓣的临床应用

摘要:目的: 探讨修复膝、小腿前、足踝部骨外露创面的简单有效的方法。 方法 :2002年1月至2007年12月,应用两种皮瓣,以腓肠神经营养血管为蒂的小腿后逆行筋膜皮瓣和以腘动脉发出的皮动脉为蒂的小腿后侧顺行皮瓣,前者用以修复足踝、小腿中下部创面19例,后者用来修复膝及小腿中上部创面10例。 结果 : 28例皮瓣全部成活,1例逆行皮瓣远端部分坏死,部分胫骨外露行腓肠肌肌皮瓣修复。所有病例均经3个月以上随诊,皮瓣成活良好,外形较满意。合并开放骨折者10例,8例半年以上随访,7例骨痂生长良好,1例无骨痂生长。 结论 :小腿后区是修复膝、胫前、踝、足部软组织缺损的良好供区,两种设计间有很好的互补性,应用得当可满足绝大多数该部位创面的修复。

HEEL REPLANTATION AND RECONSTRUCTION

Three cases of the defects of theskin and soft tissuess of the heel orsole complicated with defect of thecalcaneus bone from trauma weretreated. Primary replantation andreconstruction surgery was applied.The author believed that the recon-struction of the defect of the heelshould include the repair of the heelstructures and the sensation of the sole.

RECONSTRUCTION OF LEG AND ANKLE DEFECTS BY USING FREE RECTUS ABDOMINIS MUSCLE FLAPS WITH INTERMEDIATE SPLIT THICKNESS SKIN GRAFT

Objective To study the method and effect of free rectusabdominis muscle flaps with intermediate split thickness skin graft in repairing defects on legs and ankles.Methods From May 1998 to December 2002, 11 cases of defects on legs(2 cases) and on ankles( 9 cases) were repaired by use of unilateral free rectus abdominis flap with skin graft. The soft tissue defects were accompanied by osteomyelitis or the exposure of bone or tendon.The disease course was 1 month to 10 years. The defect size ranged 3 cm×4 cm to 8 cm×14 cm. The area ofrectus abdominis muscle flaps was 4 cm×6 cm to 8 cm×15 cm. Results All patients were followed up 6 months to 4 years after operation. All rectusabdominis flaps survived with good appearances and functions.The primary healing was achieved in 8 cases, intermediate split thickness skin graft necrosed in 3 cases and the wound healed after skin re-graft.Conclusion Free rectus abdominis flap is a proper option for repair of the soft tissue defects or irregular woundson legs and ankles. It has the advantages of abundant blood supply, b anti-infection ability, good compliance and satisfied appearance.

treatment of the wound on donor site after great toe-nail flap grafting

OBJECTIVE: To investigate the method of improving the vitality of skin graft on donor site of the great toe-nail skin flap. METHODS: From June 1982 to April 1998, 252 cases of the great toe-nail flaps with piece of phalangeal bone and 18 cases of the simple great toe-nail flap were repaired with thin skin graft and packed under proper pressure. The stitches were removed two weeks later in common situation. It should be postponed on split thickness or partial survival skin flap avoiding early mobilization. RESULTS: Sixty-six cases of skin graft were necrotic after operation. Among them, 38 cases needed second skin grafting and 28 cases were healed after changing dressing. The survival rate of skin grafting was obviously higher on phalangeal marrow surface than on periosteum of the naked phalange. Contracture of the skin graft after operation made the retained skin flap expanding from medial side to lateral side and covered the whole plantar surface of the great toe. CONCLUSION: The survival rate of the skin graft on donor foot is improved after adopting the improved measures on taking the flap from great toe and paying attention to skin graft planting and packing. Free flap grafting is advocated for repairing of the wound on donor area of the great toe nail flap.

REPAIR OF CALCANEUS AND SKIN DEFECTS WITH ALLOGRAFT AND SURAL NEUROVASCULAR FLAP

Objective To investigate the clinical results of allograft and sural neurovascular flap in repairing calcaneus and skin defects.Methods From February 1996 to December 2002, allograft and sural neurovascular flap were used to repair calcaneusand skin defects in 6 cases. The causes included road accident in 3 cases, strangulation in 2 cases and crashing object in 1 case. The defect locations were at theback of the calcaneus( 1/3, 1/2 and 2/3 of calcaneus in 3 cases, 2 cases and 1case respectively). The flap area ranged from 6 cm×7 cm to 12 cm×17 cm. Results The flaps survived completely in 4 cases; the distal flaps necrosed partly in 2 cases and the wound healed by dressing. The postoperative X-ray films showed that the repaired bone and joint had normal position and the arcus plantaris recovered. After a follow upof 6 months to 3 years all the patients were achieved bone union in allograft and had no complications of absorption, infection and repulsion. The weightbearing and walking functions were restored and the injured foot obtained a satisfactory contour. After 36 months of operation, the sensory recovery of foot occurred. Conclusion The used-allograft iseasy to be obtained and arcus plantaris is easy to recover. The reversesural neurovascular- flap in repairing calcaneus and skin defects has the following advantages: the maintenance of blood supply for injured foot, the less dangerous operation, the simple procedure, the recovery of walking function, and the good appearance and sensation.

FREE MEDIAL SURAL ARTERY PERFORATOR FLAP FOR REPAIRING ANTERIOR DORSAL FOOT WOUND

ObjectiveTo investigate the effectiveness of the free medial sural artery perforator flap for repairing anterior dorsal foot wound. MethodsBetween January 2010 and April 2015, 16 patients with skin and soft tissue defects of the anterior foot dorsal side were treated. There were 12 males and 4 females with the average age of 35 years (mean, 16-58 years). The disease causes included burn in 5 cases, traffic accident injury in 8 cases, and crush injury in 3 cases. The time from injury to admission was 2-30 hours (mean, 6.5 hours). The wound area ranged from 4 cm×3 cm to 10 cm×7 cm; combined injury included defects of lateral collateral ligament and joint capsule in 3 cases, and bone exposure in 12 cases, and all had exposure of tendon. Wounds were repaired with the medial sural artery perforator flap in 13 cases, and with medial sural artery perforator composite tissue flap carrying of medial head of gastrocnemius muscle flap in 3 cases. The size of flaps ranged from 5 cm×4 cm to 11 cm×8 cm. The donor site was sutured directly or was repaired with skin grafting. ResultsAll flaps survived well and wounds healed with stage I; skin grafts at donor site survived and the incision healed with stage I. All patients were followed up 6-36 months (mean, 11 months). The appearance of skin flap was satisfactory, without overstaffed; the joint of reconstructed ligament was stable, without secondary deformity. There was no obvious depression at the donor site, and no effect on the function. ConclusionThe medial sural artery perforator flap has the advantages of relatively constant perforator anatomy, reliable blood supply, and carries the gastrocnemius muscle flap for repair of compound tissue defect. It is one of better ways to repair the anterior dorsal foot wound.

MICROSURGICAL RESTORATION OF FOOT TISSUE DEFECTS

From 1984 to 1994, 236 different types of traumatic defects of foot were repaired by microsurgical tissue grafting. They included simple cutaneous flap in 187 and composite flap in 49. Among the 236 different tissue flaps, vascularized flap was used in 97 and pedicled flap in 139. The 4 fore-foot and 6 heel defects were repaired by composite skeleted cutaneous grafts with scapula and vascularized febula respectively. After the follow-up from 1 to 10 years, all the grafted tissues were survived and healed well. The functions were satisfactory, and 186 patients had resumed their original works. The key to good function following repair was to maintaion the integrity of foot structures and the sensation of the sole and heel.