Objective To investigate the effectiveness of nickel-titanium shape memory staples in treating multiple metatarsal fractures. MethodsThe clinical data of 27 patients with multiple metatarsal fractures who were treated between January 2022 and June 2023 and met the selection criteria were retrospectively analysed. The cohort consisted of 16 males and 11 females, aged 33-65 years (mean, 47.44 years). The causes of injury included heavy object impact in 11 cases, traffic accidents in 9 cases, and crush in 7 cases. Simultaneous fractures of 2, 3, 4, and 5 bones occurred in 6, 6, 4, and 8 cases, respectively, with tarsometatarsal joint injury in 3 cases. Fixation was performed using staples for 16, 22, and 9 fractures in the metatarsal neck, shaft, and the base, respectively, and 5 tarsometatarsal joint injuries. Preoperative soft tissue injuries were identified in 8 cases and classified according to the Tscherne-Oestern closed soft tissue injury classification as type Ⅰ in 5 cases and type Ⅱ in 3 cases. One case of type Ⅱexhibited preoperative skin necrosis. The patients were treated with fixation using nickel-titanium shape memory staples. Complications and fracture healing were documented. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used to evaluate the function, and the visual analogue scale (VAS) score was used to evaluate the pain. Results The 27 patients were followed up 9-19 months (mean, 12.4 months). Postoperative X-ray films revealed no loss of fracture reduction, and all fractures achieved bony union. No internal fixator loosening, breakage, or other mechanical failures was observed. The mean fracture healing time was 3.13 months (range, 3-4 months). Postoperatively, 4 cases (2 of Tscherne-Oestern type Ⅰ, 2 of type Ⅱ) developed superficial skin necrosis, which resolved with dressing changes. No infection was observed in the remaining patients, and all wounds healed. At last follow-up, the AOFAS forefoot score ranged from 70 to 95, with an average of 86.6, of which 19 cases were excellent, 6 cases were good, and 2 cases were fair, with an excellent and good rate of 92.6%; the VAS score ranged from 0 to 3, with an average of 0.9, of which 24 cases were excellent, and 3 cases were good, with an excellent and good rate of 100%. Conclusion The use of nickel-titanium shape memory staples in the treatment of multiple metatarsal fractures can effectively protect local skin and soft tissues and minimize secondary damage associated with internal fixator insertion. It is a viable surgical option for management of multiple metatarsal fractures.
ObjectiveTo explore the epidemiological characteristics and analyze the related diagnosis and treatment information of wound outpatient cases in a tertiay hospital in Leshan City.MethodsThe data of cases admitted to the wound clinic in a tertiary hospital of Leshan City between January 1st, 2017 and December 31st, 2019 were retrospectively collected. The SPSS software was used for statistical analyses in terms of basic patient information, wound type and dressing use, number of visits and expenses.ResultsA total of 10 880 cases were enrolled. The average age of the patients treated was (45.23±13.45) years old. Patients from the Central District, where the hospital was located in, accounted for the highest proportion (38.63%). The proportion of acute skin and soft tissue injuries was higher than that of chronic skin and soft tissue injuries (62.51% vs. 37.49%). According to the proportions from high to low, the top three chronic skin and soft tissue injuries were postoperative refractory wounds (19.63%), skin and soft tissue infections (3.90%), and stoma complications (3.04%), respectively. A total of 22 937 functional wound dressings were used, of which non-woven outer dressings accounted for 47.52%. Patients with acute skin and soft tissue injuries had a higher healing rate compared with those with chronic skin and soft tissue injuries (96.65% vs. 43.03%, P<0.05). The type of skin and soft tissue injuries with the most visits was cancerous wound [the median (lower quartile, upper quartile) was 68 (35, 121) visits], and the one with the least visits was acute skin and soft tissue injuries [the median (lower quartile, upper quartile) was 2 (1, 7) visits].ConclusionsAs the distance between residence and hospital grows, the number of patients decreases, suggesting that the specialized nursing assistance has achieved initial results in remote areas, but the task of assistance in surrounding areas is still heavy. The type of skin and soft tissue injuries is changing under the concept of enhanced recovery after surgery, and wound care plays an important role in the recovery of patients after surgery. The concept of wet healing and new dressings to promote wound healing are widely used, but still need to be further popularized among patients and medical staff. For chronic wounds that are more expensive to treat, it is necessary to formulate comprehensive treatment plans such as wound treatment, psychological support, and systemic nutrition to promote healing.
Objective To summarize the cl inical effect of anterolateral thigh pedicle or free perforator flap in repairing soft tissue defect in the extremities. Methods From March 2000 to January 2009, 32 cases of soft tissue defect were treated with pedicle or free anterolateral thigh perforator flap. There were 30 males and 2 females with an median age of28 years (4-53 years). Soft tissue defects included left radial side in 3 cases, the left lateral elbow in 1 case, knee in 5 cases, calf in 14 cases, dorsal is pedis in 5 cases, and planta pedis in 4 cases. The defect area ranged from 9 cm × 6 cm to 15 cm × 13 cm. Nine cases compl icated by bone defect and 1 case by radial nerve defect. The time from injury to hospital ization was 1 hourto 4 months (mean 5 days). Defects in 27 cases were repaired by anterolateral thigh perforator flap, simultaneously combined with transplantation with the second toe in 1 case, with sural nerve using arterial ized small saphenous vein in 1 case, nd with fibular or il ium in 4 cases. Defects in other 5 cases were repaired with flaps pedicled with superior lateral genicular artery. Neuroanastomosis was performed in 14 cases of the flaps. The size of the flaps ranged from 10 cm × 8 cm to 16 cm × 15 cm. Skin defects at donor site were repaired with spl it thickness skin graft or sutured directly. Results All patients were followed up from 8 months to 9 years with an average of 18 months. The flaps survived well and the wounds healed by first intention in 29 cases, 3 flaps necrosed and cured after symptomatic management. Skin graft at donor site survived completely in 9 cases. The color and texture and thickness of the flaps were similar to those of recipient site. After 6 months, the sensation of the flaps recovered to grade S3-4 in 14 patients whose cutaneous nerve were anastomosed, partial recovery was observed in other patients. In 4 patients receiving transplantation of fibular or il ium, the bony heal ing was achieved within 4 to 6 months. No obvious dysfunction was found at the donor site. Conclusion The pedicle anterolateral thigh perforator flap is long and thick with constant location. Anastomosis or transferring is easy to perform. It can provide big area and feel ing recovery by nerve anastomosis. It is an effective method to repair soft tissue defect of the extremities.
Objective To investigate the surgical methods and cl inical results of reconstructing soft tissue defects in distal dorsal is pedis with distally based medial dorsal neurocutaneous flap on foot. Methods From January 2004 to July 2007, 11 cases of soft tissue defects in distal dorsal is pedis were treated with the distally based medial dorsal neurocutaneousflap on foot, including 8 males and 3 females aged 18-55 years. Nine cases were caused by crash and 2 cases were caused by traffic accident. There were 4 cases of tendon exposure and skin defects in the distal dorsal is pedis, 6 cases of bone exposure and skin defects in and adjacent to the first metatarsal head and 1 case of bone exposure and skin defects in the distal dorsal is pedis due to the third and fourth toe damage. The area of defects ranged from 3 cm × 3 cm to 7 cm × 5 cm. Distally based medial dorsal neurocutaneous flaps on foot were incised to repair the soft tissue defects and the size of the flaps ranged from 4 cm × 4 cm to 8 cm × 6 cm. Thickness skin graft was appl ied to repair donor site. Results All the flaps survived and all wounds healed by first intention. Skin graft in donor site survived completely in 10 cases and survived partly in 1 cases (heal ing was achieved after the flap above lateral malleolus was used to repair). All cases were followed up for 6 months-1 year. The color, texture and thickness of the flaps were similar to those of recipient site. All patients returned to their normal weight-bearing walking. No skin ulceration in flaps and donor site was observed. Conclusion The operative technique of the distally based medial dorsal neurocutaneous flap on foot is simple, convenient and safe. The distally based flap is effective in repairing soft tissue defects of middle and small sized skin and soft tissue defects in distal dorsal is pedis.
ObjectiveTo investigate the feasibility of the free descending branch of lateral circumflex femoral artery perforator tissue flap (fascia flap plus skin flap) to repair large soft tissue defects of the extremities and its impact on the donor site. MethodsBetween January 2013 and February 2015, 9 cases of large tissue defects of the extremities were repaired with the free descending branch of lateral circumflex femoral artery perforator tissue flap. There were 8 males and 1 female, aged from 13 to 56 years (median, 36 years). The causes included traffic accident injury in 6 cases and crushing injury by heavy object in 3 cases. Soft tissue defect located at the lower limbs in 7 cases and at the upper limbs in 2 cases, including 2 cases of simple tendon exposure, 2 cases of simple bone exposure, and 5 cases of tendon and bone exposure. After debridement, the soft tissue defect area ranged from 13 cm×7 cm to 20 cm×18 cm. The tissue flaps ranged from 14 cm×8 cm to 23 cm×19 cm. The donor site was directly sutured, scalp graft was used to cover the fascia flap. ResultsAfter operation, partial necrosis of the skin grafting on the fascia flap occurred in 2 cases and healed after dressing change. Arterial crisis occurred in 1 case and the flap survived after anastomosis. The other tissue flaps survived and wounds healed by first intention. The skin grafting healed by first intention in 7 cases, by second intention in 2 cases. The patients were followed up 4-24 months (mean, 10 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking. ConclusionFree descending branch of lateral circumflex femoral artery perforator tissue flap can repair large soft tissue defect of the extremities. The donor site can be sutured directly, which reduces damage to donor site and is accord with the principle of plastic surgery.
Objective To evaluate short-term effectiveness of staged management for complex tibial plateau fracture with severe soft tissue injury. Methods A clinical data of 12 patients with complex tibial plateau fractures and severe soft tissue injuries between July 2017 and March 2021 and met the selection criteria was retrospectively analyzed. There were 7 males and 5 females with an average age of 43.1 years (range, 33-58 years). All patients were traffic accident injuries and admitted to hospital within 24 hours after injury. The tibial plateau fractures were closed fractures. According to the Schatzker classification standard, the fractures were rated as type Ⅳ in 3 cases, type Ⅴ in 4 cases, and type Ⅵ in 5 cases. According to the Tscherne classification standard, the soft tissue injuries were rated as grade Ⅱ in 4 cases and grade Ⅲ in 8 cases. The treatment of all patients was divided into 3 stages. In the first stage, emergency trans-articular fracture fixation with external fixator was performed; in the second stage, the fracture reduction and internal fixation were performed and bone cement was implanted to fill the bone defect; in the third stage, the bone cement was removed and the bone graft was performed to repair defect. All patients performed joint function exercise after operation as early as possible. Results There was no neurological symptom after all staged managements, the incisions healed by first intention, and no complications such as incision infection or necrosis occurred. All patients were followed up 6-32 months (mean, 16.9 months). The fractures were all anatomical reduction confirmed by the X-ray films after operation. During follow-up, there was no obvious loss of reduction, loosening and rupture of internal fixator, or collapse of the articular surface. All fractures healed after 14-20 weeks (mean, 17.6 weeks). The posterior slope angle of the tibial plateau was (9.7±2.3)° and the varus angle was (3.9±1.9)° immediately after bone grafting, and were (8.5±2.9)° and (4.3±1.9)° respectively at 6 months after operation. There was no significant difference between the two time points (t=0.658, P=0.514; t=−1.167, P=0.103). At last follow-up, the Hospital for Special Surgery (HSS) score was 85-96 (mean, 91.2), and the range of motion of knee was 110°-135° (mean, 120.9°). Conclusion The staged management for complex tibial plateau fracture with severe soft tissue injury can obtain good short-term effectiveness, but the long-term effectiveness needs to be further followed up.