Objective To explore the results of repairing widespread traumatic soft tissue defects in the heels and adjacent regions with free latissimus dorsi muscle-skin flaps. Methods From March 1998 to May 2005, 10 cases of widespread traumatic soft tissue defects in the heels and adjacent regions were repaired with free latissimus dorsi muscleskin flaps. Of the 10 patients, 9 were male and 1 was female, whose ages ranged from 32 to 60years, and the disease course was 2 hours to 2 months. The defect was by ploughmachine injury in 5 cases, by crush injury in 2 cases, by snake injury in 2 cases, and electricity injury in 1 case. Eight cases of defects involved in the posteriorof heel and leg, the defect area ranged from 21 cm×12 cm to 35 cm×15 cm; 2 cases had widespread soft tissue defects on heel, ankle, sole and dorsal foot, and the defect area was 27 cm×14 cm and 30 cm×21 cm respectively. All cases were accompanied by the exposure of bone; 6 cases by fracture; 4 cases by openinfection of ankle joint; and 2 cases by injuries of the posterior tibial vessel and the tibial nerve. The sizes of the dissected flap ranged from 25 cm×14 cm to 33 cm×24 cm. The donor sites were covered by large mid-thickness flap. Results There were no postoperative complication of vascular crisis and infection. Ten flaps survived completely and the wounds healed by first intention. After a follow-up of 3 to 24 months, five cases received twostageplastic operation because bulky flaps bring some trouble in wearing shoes. In 5cases of reconstructed sensation, two cases recovered pain and temperature sensation. All cases recovered the abilities to stand and walk without ulcer complication. Conclusion The free latissimus dorsi muscle-skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds with muscle defects and bone exposure in the heel and adjacent regions, because it has such advantages as adequate blood supply, big dermatomic area, and excellent ability to resist infection.
Objective To explore the clinical effect of latissimus dorsi musculocutaneous flap with a few muscle in repairing the soft tissue defect of lower limbs. Methods From June 2000 to December 2006, 8 patients with soft tissue defects of lower limbs were repaired with the latissimus dorsi musculocutaneous flaps. There were 6 males and 2 females, aged from 2569 years. The locations were heel in 3 cases, dorsum pedis in 2 cases, anticnemion in 2 cases, and the right leg (squamous carcinoma) in 1 case. The area of soft defect ranged from 10 cm×7 cm～18 cm×12 cm. The flap in size ranged from 15 cm×8 cm to 22 cm×15 cm. Results Of all the flaps,6 survived,1 had vascular necrosis 2 hours after operation and survived by skin grafts, 1 had delayed healing because of infection. The wound and donor site achieved primary healing. The followup for 3 to 12 months revealed that all the flaps had a good appearance. The function of donor site was as normal. Conclusion It is an ideal method to repair the softtissue defect of lower limbs with latissimus dorsi musculocutaneous flap.
Objective To evaluate the clinical efficacy of t ransplantation of autologous peripheral blood stemcells ( PBSC) for the t reatment of lower limb arterial ischemic disease. Methods From March 2004 to February2007 , 16 patient s with severe lower limb arterial ischemic disease were t reated with autologous PBSC t ransplantation. Recombinated granulocytecolony stimulating factor ( G2CSF) was used to mobilize the proliferation of bonemarrow stem cells and then the stem cells were released into peripheral blood. Af ter 5 - 6 days , PBSC were collected by CS23000 PLUS blood2cells separator. Such concent rated stem cells fluid was int ramuscularly injected into theischemic areas of the lower limbs. Results The result s of 3 to 242month following2up after the t ransplantation ofstem cells showed that the resting pains of the affected limb were greatly relieved , and ulcers were healed. The distance and duration of intermittent limping became farther and longer. Conclusion Transplantation of autologousPBSC would be a novel and effective method for the t reatment of arterial ischemic disease. However , this method isstill at the stage of initial clinical application , so it still need to be further studied.
Objective To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury. Methods Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years (range, 19-37 years). The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days (mean, 6.5 days). The bone defect length was 8-18 cm (mean,14 cm); the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation. Results Eleven flaps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months (mean, 6.5 months). All bone defects were repaired with bone healing time of 12-22 months (mean, 17 months). All patients were followed up 8-24 months (mean, 15 months). No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good. Conclusion Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity.
Objective To analyze the methods of treating diabetic feet and to evaluate the optimal method. Methods The clinical data of 115 patients (137 legs) with diabetic feet were retrospectively analyzed. Results Seventy-one affected legs were treated with balloon dilation or stenting (11 with additional debridement of local ulcer), 12 legs were treated by femoral-popliteal arterial bypass (5 with additional debridement of local ulcer), and 31 legs were treated by debridement of local ulcer or amputation merely, and another 23 legs were treated by medical therapy. All diabetic feet treated by surgical treatment were improved obviously without death and severe complications, while 2 cases with medicine therapy died. Conclusion Because of the complexion of the diabetic foot, it should be treated individually, and the key point is to deal with the vascular lesions.
Objective To observe the clinical efficiency of the implantation of the autologous bone marrow mononuclear cells for treatment of lower limb ischemia after the bone marrow stimulation. Methods From May to December 2005, 43 ischemic limbs in 35 patients (23 males,12 females; aged 3490 years,averaged 71.3 year) were treated. Of the 35 patients, 30 had diabetic lowerlimb ischemia with 38 lower ischemic limbs, 2 had atherosclerosis obliterans with 2 ischemic lower limbs, and 3 had thromboangiitis obliterans with 3 ischemic lower limbs. Five patients with 5 ischemic limbs were in stage Ⅰ lower limb ischemia (intermittentclaudication), 15 patients with ischemic 19 limbs were in stage Ⅱ (rest pain),9 patients with 12 ischemic limbs were in stage Ⅲa(ulceration), and 6 patients with 7 ischemic lower limbs in stage Ⅲb (gangrene); 88.4% of all the ischemic lower limbs （38/43）had a pain, 79.1%（34/43） had coldness, and 69.8%（30/43）had limb numbness. The bone marrow of each patient was stimulated by an injection of the recombinant human granulocyte-macrophage colony-stimulatory factor 300 μg/d for 2-3 days. The bone marrow 130-200 ml was drawn from the iliac spine and the mononuclear cells were obtained. Each patient received implantation of the autologous bone marrow mononuclear cells by an intramuscular injection, an arterial intraluminal injection or a combined injection of the two routes.Results The pain relief was found in 94.7% of theischemic lower limbs, and pain improvement in 97.1% . Relived numbness was found in 93.3%. The distance of the claudication was increased by all the ischemic limbs. An increase in the ankle/ brachial index (ABI)was found in 47.9%. The transcutaneous oxygen pressure (TcPO2) increased in 92.3%. The ulcer heal rate was 9.1% (1/11). Markedlyreduced ulcer wound was found in 27.3% (3/11). The amputation rate was 6.3% (3/48). Arterial angiography revealed that there was a new collateral vessel formationin 91.2%. Complications were as follows: fever and mild fatigue-developed respectively in 1 patient after the bone marrow stimulation, but relieved by themselves. Acute but mild myocardial infarction was found in 1 patient with a slight precordial pain and elevation of myocardial enzymes 1 week after transplantation of the bone marrow mononuclear cells, but recovered after medical treatment. The follow-up averaged 5 months. According to the subjective criteria, the overall efficacy was90%. ABI increased in 62.5% of the patients after operation and the value of TcPO2 was higher in 90% of the patients after this kind of therapy. Arterial angiography revealed a new collateral vessel formation in 90.5% of the 21 ischemic limbs. The foot ulcer healed in 7 and obviously improved in 3. Three of the foot ulcer patients were discharged 2-3 months after the amputation was performed on the diseased toes. Conclusion Implantation of the autologous bone marrow mononuclear cells after the bone marrow stimulation of treatment of the lower limb ischemia has advantages of less marrow aspiration, more mononuclear cell content, satisfactory shortterm effect, and relatively high safety. Itis a new method of treating the lower limb ischemia besides the autologous bone marrow and peripheral blood mononuclear cell implantation. The longterm effect of this method needs a further study.
ObjectiveTo summarize diagnostic strategies of unilateral lower limb swelling. MethodThe clinical data of 357 patients hospitalized with unilateral lower limb swelling from March 2013 to October 2014 in our department were analyzed retrospectively. ResultsThree hundred and seven (86.0%) patients were admitted to hospital within 2 weeks since the symptom onset (acute swelling), the most common cause (281 cases) was lower extremity deep vein thrombosis (DVT), other causes included infection (11 cases), hematoma (7 cases), lymphatic obstruction (4 cases), iliac vein compression syndrome (2 cases), pelvic tumor compression (1 case), arteriovenous fistula (1 case). Etiology for chronic swelling contained lower extremity DVT (33 cases), arteriovenous fistula (5 cases), lymphatic obstruction (5 cases), Klippel-Trenaunay syndrome (3 cases), pelvic tumor compression (3 cases), iliac vein compression syndrome (1 case). Up to 60.5% (26/43) lower limb swelling which were not due to DVT had histories of misdiagnosis as DVT. Nine cases of lymphatic obstruction were secondary to malignant tumor itself or the sequel of treatment. Three hundred and thirty-eight (94.6%) patients were received lower limb doppler ultrasound, while 308 patients (91.9%) were diagnosed. Fifty-nine patients needed further CT venography (CTV) or CT angiography (CTA), 10 patients were received radionuclide lymphoscintigraphy to be diagnosed. ConclusionsAlthough DVT is the main cause of unilateral lower limb swelling, the lower limb swelling which is not due to DVT is frequently misdiagnosed and belatedly treated. Considering the complexity and reciprocal overlapping for the etiology of lower limbs swelling, developing a appropriate diagnosis strategy is important. Apart from history taking and physical examination, color doppler ultrasound for the lower limb is suggested to be the preferred imaging examination mean. Pelvic cavity screening for occupancy lesions and iliac vein should be evaluated synchronously if possible. For cases which can't be diagnosed by ultrasound, CTV, CTA, or radionuclide lymphoscintigraphy could be important supplement to assist the diagnosis.
Objective To investigate the efficacy of autologous bone marrow mononuclear cells transplantation in treating lower l imb thromboangiitis obl iterans (TAO). Methods From January 2005 to November 2008, 25 patients (27 l imbs) with lower l imb TAO were treated. There were 24 males (26 l imbs) and 1 female (1 l imb), aging 16-44 years (33 years on average). Fifteen left l imbs and 12 right l imbs were involved. The median duration of disease was 2 years (from 3 months to9 years). Intermittent claudication was observed in 5 cases (5 l imbs), 16 patients (17 l imbs) had symptom of rest pain, 4 patients (5 l imbs) suffered ulcer on the distal l imbs. The results of visual analogue scale (VAS), maximum walking distance (MWD), ankle/brachial index (ABI), and transcutaneous oxygen pressure (TcPO2) before operation were (7.16 ± 1.12) points, (0.098 ± 0.043) km, 0.20 ± 0.09, and (11.78 ± 3.46) mm Hg (1 mm Hg=0.133 kPa), respectively. A total of 300 mL bone-marrow blood was extracted from the il iac bone. And then the mononuclear cells were isolated from the bone-marrow blood. All patients received cell transplantation only one time. The amount of transplantation bone marrow mononuclear cells was (1.82-29.46) × 109 (mean 13.33 × 109). Results All patients were followed up for 1 years. After 4 weeks of implantation, the results of VAS, MWD, ABI, and TcPO2 were (2.39 ± 0.51) points, (0.783 ± 0.176) km, 0.28 ± 0.16, (21.33 ± 6.57) mm Hg, respectively, showing significant difference compared with preoperative results (P lt; 0.05). The VAS, MWD, ABI, and TcPO2 increased to (2.44 ± 0.67) points, (1.199 ± 0.304) km, 0.37 ± 0.09, (27.90 ± 5.23) mm Hg after 1 year of implantation, showing significant differences compared with preoperative results (P lt; 0.05). One ulcer healed well and the improvement was obtained in other 3 cases after 4 weeks of implantation (80%). Four ulcers healed well after 1 year of implantation (80%). After 1 year of implantation, angiography revealed 37.04% affected limbs had a satisfactory neovascularization. The angiographic levels were grade 0 in 5 cases, grade 1 in 12 cases, grade 2 in 4 cases, and grade 3 in 6 cases. Conclusion Autologous bone marrow mononuclear cells transplantation could be a simple, safe, effective method to treat TAO.
ObjectiveTo systematically review the dose-effect relationship between resistance exercise intervention and lower extremity muscle strength and function enhancement in the aging. MethodsEBSCO, PubMed, Web of Science, CNKI, VIP, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the effects of resistance exercise on muscle strength and function of the lower extremities in older adults from inception to July 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A network meta-analysis was then performed by using RevMan 5.4 and Stata 15.0 software. ResultsA total of 32 RCTs with a total sample size of 1 594 individuals were included. The results of network meta-analysis showed that the elements of resistance exercise prescription: intensity 50%-70% 1RM, period 8-12 weeks, frequency 3-4 times/week, duration 30-45 min, and intervals 1.1-2 min were superior to other doses. ConclusionThe optimal dose of resistance exercise for improving lower extremity muscle strength and function in older adults is moderate exercise intensity (50%-70% 1RM) for 8-12 weeks, 3-4 times per week, 30-45 min per exercise, and 1.1-2 min interval between sets.
Objective To explore the treatment experience of acute type-A aortic dissection with lower limb malperfusion. Methods From December 2012 to December 2016, 39 patients were diagnosed as acute type-A aortic dissection complicated with lower limb malperfusion and underwent operation.There were 27 males and 12 females with an average age of 51.4±12.4 years. Results Early mortality rate was 17.9%(7/39). 32 patients of postoperative survival. The follow-up rate was 93.8%(30/32), 3 months to 3 years after the operation, the results is satisfactory. The over lower limb malperfusion recovery rate of follow-up patients was 96.7%(29/30). Conclusion Positive operation for acute type-A aortic dissection with lower limb malperfusion is safe, feasible and effective.Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary.Comprehensive evaluation of patient’s status is strongly recommended for optimal surgical decision making.