Objective To investigate short-term clinical outcomes of double-modified Limberg flap transplantation in treatment of sacrococcygeal pilonidal sinus. Methods One hundred patients with sacrococcygeal pilonidal sinus from October 2010 to May 2015 in this hospital were included, and subsequently were divided into double-modified Limberg flap transplantation group (double-modified flap group,n=30), classical Limberg flap transplantation (classical flap group,n=30), and interrupted suture after resection group (interrupted suture group,n=40). The duration of operation, intraoperative bleeding, hospital stay, duration of return to work, recurrence rate, and incision complications rate were compared among these three groups. Results ① The age, gender, body mass index, and preoperative complications had no significant differences among these three groups (P>0.05). ② The intraoperative bleeding and the hospital stay had no significant differences among these three groups (P>0.05). Compared with the interrupted suture group, the durations of operation were significantly longer (P<0.05), the durations of return to work were significantly shorter (P<0.05), the recurrence rates were significantly lower (P<0.05) in the double-modified flap group and the classical flap group. The above indicators had no significant differences between the double-modified flap group and the classical flap group (P>0.05). ③ The incision hematoma and the part disruption of incision had no significant differences among these three groups (P>0.05). Compared with the interrupted suture group, the rates of incision infection and incision complete disruption were significantly lower (P<0.05) in the double-modified flap group and in the classical flap group. The incision maceration of the classical flap group was significantly higher than that of the interrupted suture group (P<0.05) or the double-modified flap group (P<0.05). No skin flap necrosis occurred in the double-modified flap group and the classical flap group. Conclusions Double-modified Limberg flap transplantation and classical Limberg flap transplantation have less complications and lower recurrence rate than interrupted suture after resection. Compare with classical Limberg flap transplantation, double-modified Limberg flap transplantation has a lower incision maceration rate. Because of limitation of sample size in this study, long-term clinical efficacy of double-modified Limberg flap transplantation needs to be confirmed by multicenter randomized controlled trials.
OBJECTIVE: To summarize the application of simple skin traction technique in repair of soft tissue defect of limb. METHODS: From 1999, 42 cases of soft tissue defect of limbs were repaired by simple skin traction technique instantly; the defect area ranged from 2.5 cm x 2.0 cm to 8.0 cm x 6.5 cm. RESULTS: The soft tissue defect less than 8.0 cm can be sutured instantly. All of the wound achieved primary healing without infection and necrosis of skin edge, the circulation and sensation of limbs were normal; healing time was 10 days to 16 days, 12.8 days on average. Thirty-two cases were followed up for 6 months; the shape and function recovered well. CONCLUSION: Simple skin traction technique is a good option to repair the soft tissue defect of limbs.
OBJECTIVE To determine the role of endogenous carbon monoxide(CO) in oxidant-mediated organ injury following limb ischemia-reperfusion (I/R) in rats. METHODS: Sixty-four SD rats were divided into 4 groups: Sham group, Sham + zinc protoporphyrin (ZnPP, an inhibitor of heme oxygenase activity), 2-hour ischemia followed by 4-hour reperfusion (I/R) group and I/R + ZnPP group. Carboxyhemoglobin (COHb) level in the artery blood, malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in the lung, heart, liver and kidney were detected. The 24-hour survival rate of rats was studied. RESULTS: Compared with the sham group, the COHb level and MDA content significantly increased, while the SOD activity and the survival rate significantly decreased in I/R group (P lt; 0.05). Compared with the I/R group, MDA content significantly increased, while the SOD activity, the 24-hour survival rate and COHb level significantly decreased in I/R + ZnPP group (P lt; 0.05, respectively). CONCLUSION: Limb I/R could lead to the oxidant-mediated multiple organ injury accompanied by the increase of CO level which play an important role in the defense against I/R-induced remote multiple organ injury in rats.
Objective To explore the cl inical outcomes of repairing l imb wound with distal based neurocutaneous flap. Methods From June 2003 to June 2009, 187 cases with wounds in the hand, foot, and distal leg were treated. There were127 males and 60 females aged 20-70 years old (average 37.5 years old). The wound was caused by traffic accident in 130 cases, crush injury in 38 cases, machinery accident in 16 cases, and explosion injury in 3 cases. Among them, the soft tissue defect was in the dorsal and palmar aspects of the hand in 35 cases, the distal leg in 50 cases, the dorsal aspect of foot in 40 cases, the region around ankle in 27 cases, the tendon area in 11 cases, the medial side of foot in 4 cases, the heel and sole of foot in 5 cases, and the forefoot area in 15 cases. The size of skin soft tissue defect was 5.0 cm × 3.0 cm-17.5 cm × 10.0 cm. Four cases suffered from nonunion of heel and 15 cases suffered from tibia defect (3-7 cm). The course of disease was 3 days-8 years. During operation, 35 cases with wound in the hand were treated with three types of lower rotation point of forearm neurocutaneous flaps with rotation points 0-3 cm above the wrist joint, 66 cases were treated with distal based saphenous nerve and saphenous vein neurovascular flaps, muscle flaps and bone flaps with rotation points 2-5 cm above the medial malleolus, and 86 cases were treated with sural and saphenous flaps, muscle flaps and bone flaps with rotation points 1-5 cm above the external malleolus. The flap was 5 cm × 3 cm-17 cm × 15 cm in size, the muscle flap was 5 cm × 3 cm × 1 cm-10 cm × 6 cm × 2 cm in size, the fibula flap was 4.0 cm × 2.5 cm-10.0 cm × 8.0 cm in size. The l igation of the superficial veins was performed below the rotation point of the flap in 163 cases, and the cutaneous nerve ending anastomosis was performed in 22 cases. The donor site was repaired byspl it thickness skin grafting from the inner side of the thigh. Results Various degree of skin flap swell ing occurred, and the swell ing extent in the patients receiving the superficial vein l igation was obvious less than that of patients with no l igation. At 4-7 days after operation, 6 cases had necrosis at the edge of flaps and 6 cases had bl ister, all of them healed after changing dress. The rest skin flaps and skin grafting in the donor site survived uneventfully, and the incision healed by first intention. All the patients were followed up for 2 months to 3 years. The appearance of the flap was satisfactory, the hand function and the foot function of walking and weight-bearing recovered. The two point discrimination of the patients 1 year after cutaneous nerve ending anastomosis was 8-12 mm. The grafted fibula in the patients with bone defect reached union 8-10 months after operation. The appearance and the movement of the donor site were normal. Conclusion The new type distal based neurocutaneous flap has such advantages as simple operative procedure, less invasion, high survival rate, and recovery of the sensory function of the hand and the foot. It is suitable to repair the tissue defect in the hand, the foot, and the distal leg.
Objective To summarize and analyze the clinical experience and theclinical outcome of treating tumorous diseases in the proximal femur by the customized hip arthroplasty. Methods Eleven patients (7 males and4 females, aged 40-69 years) with a tumorous disease in the proximal femur received a removal ofthe proximal femur and the customized hip arthroplasty from February 1994 to November 2002. Of the 11 patients, 7 had giant cell tumor in the proximal femur, 2 had chondroblastoma, 1 had osteitis deformans, and 1 had fibrous dysplasia. Six patients received the artificial total hip replacement and 5 underwent the dipolar-cup artificial femoral head prosthesis replacement. Results The follow-upfor 1-5 years in 9 patients (2 patients lost the follow-up) revealed that afteroperation one patient with hemorrhage from the incision had been given a local compression for 5 days, and finally lost the function of the quadriceps muscle and had sensory deprivation in the anterior part of the thigh. Five years later, the patient had a quadriceps muscle power of the “0” degree, a decreased sensation, the “3” degree of the hamstring and the extension and flexion muscles of the lower limb, with lameness and crutch walking. The quadriceps muscle powertest showed that 5 patients had the “3” degree of the muscle power and 2 of them had paroxysms of pain in the upper part of the thigh, especially after a long time of standing and walking, so both of them received the dipolar-cup artificial femoral head prosthesis replacement. Three patients had the “4” degree of the quadriceps muscle power, with an extension range of the hip joint of 10°27° and an average flexion degree of 74°. According to the Harris scale, 3 patientswere assessed to be good (8089), 5 moderate (70-79), but 1 bad (lt;70). No infection, recurrence or the loosening of the prosthesis was found in all the patients during the follow-up. Conclusion The customized hip arthroplasty has a goodclinical outcome in treatment of a tumorous disease in the proximal femur. However, there is a high incidence of deficiency of the quadriceps muscle power after operation, which may be relevant to the removal of the upper attachment of the quadriceps muscle. If the attachment of the quadriceps muscle, especially the internal, external and posterior septum attachment, can be fixed in the body of the prosthesis during operation, the power of the quadriceps muscle can be enhanced and the patient can have a better therapeutic effect.
OBJECTIVE To emphasize the importance of reconstruction and repair after resection of soft tissue sarcoma. METHODS From November 1990 to November 1996, in 107 cases of soft tissue sarcoma 32 cases had received various reconstructive or reparative operations. Among the 32 cases, 4 cases were primary sarcomas and 28 cases were recurrent sarcomas. In surgical grading, 3 cases were of I B, 3 cases of II A and 26 cases of II B. Radical resection was performed in 13 cases, widen local resection in 17 cases and local excision in 2 cases. After operation, 13 cases received chemotherapy and 7 cases received radiotherapy. Reconstruction of blood vessels was performed in 3 cases, reconstruction of kinetic function in 16 cases, and repair of defect was carried out in 23 cases. RESULTS Thirty patients were followed up for 4 months to 6 years and 6 months. The clinical results showed that the local control rate of sarcoma was 80%, limb-salvage rate after reconstruction of blood vessels was 100%, the excellent and good rate after reconstruction of kinetic function was 87.5%, and the survival rate of the tissue flap of transplantation and transposition was 96%. CONCLUSION It was concluded that the reconstruction and repair after resection of soft tissue sarcoma was the extension of operative treatment, and was very important in lowering the recurrence rate and improving the life quality of the sufferings.
ObjectiveTo establish a forecasting model for inpatient cases of pediatric limb fractures and predict the trend of its variation.MethodsAccording to inpatient cases of pediatric limb fractures from January 2013 to December 2018, this paper analyzed its characteristics and established the seasonal auto-regressive integrated moving average (SARIMA) model to make a short-term quantitative forecast.ResultsA total of 4 451 patients, involving 2 861 males and 1 590 females were included. The ratio of males to females was 1.8 to 1, and the average age was 5.655. There was a significant difference in age distribution between males and females (χ2=44.363, P<0.001). The inpatient cases of pediatric limb fractures were recorded monthly, with predominant peak annually, from April to June and September to October, respectively. Using the data of the training set from January 2013 to May 2018, a SARIMA model of SARIMA (0,1,1)(0,1,1)12 model (white noise test, P>0.05) was identified to make short-term forecast for the prediction set from June 2018 to November 2018, with RMSE=8.110, MAPE=9.386, and the relative error between the predicted value and the actual value ranged from 1.61% to 8.06%.ConclusionsCompared with the actual cases, the SARIMA model fits well with good short-term prediction accuracy, and it can help provide reliable data support for a scientific forecast for the inpatient cases of pediatric limb fractures.
ObjectiveTo explore the relationship between the oxygen partial pressure of mice hindlimb muscles with normal blood supply or ischemia and expression of HIF-1αprotein, and to provide a theoretical basis for the study of angiogenesis in vitro hypoxia. MethodsMice hind limb ischemia model were established, tissue oxygen tension of gastrocnemius muscle and bone marrow were measured by micro electrode at different time points of ischemia (24 hours, 1 week, 2 weeks, 3 weeks, and unoperated as control). Protein level of hypoxia inducible factor-1αand histological examination were performed on gastrocnemius muscle as well. ResultsThe oxygen tension baselines of gastrocnemius muscle and femoral bone marrow was (47.78±4.37) mm Hg and (21±3.40) mm Hg, respectively. Muscle oxygen tension decreased significantly at all time points after modeling (P < 0.05), and reached lowest level in 1 week of ischemia. The inflammatory reaction was most serious and HIF-1αprotein reached highest level at the same time point. With the extension of ischemic time, the tissue oxygen tension recovered while HIF-1αlevel was down-regulated, however, There was no statistical correlation(r=-0.86, P > 0.05). Oxygen tension in bone marrow didn't show any significant change at all time points. ConclusionsThe expression level of HIF-1αprotein in ischemic tissue can reflect the degree of ischemic limb. The concept that physiological oxygen level differs in different tissue is highlighted, and may provide basis for ex vivo hypoxic research.
Objective To study the clinical feasibility of the prosthetic composites of the intercalary allograft and the segmental allograft in reconstruction of the skeletal defect after the limb tumor resection. Methods Between August 1999 and December 2003, 28 patients with skeletal defects after the limb tumor resection were treated with the intercalary allograft or the segmental allograft megaprosthesis composite for reconstruction of skeletal defects. The bone involvements were observed in 16 patients with osteosarcoma, 4 patients with parosteal osteosarcoma, 5 patients with Ewing sarcoma, and 3 patients with soft tissuesarcoma. Preoperative biopsy was performed on all the patients, and the pathological result was confirmed after surgery. According to the Enneking system, 5 patients were grouped in ⅠB and 23 patients in ⅡB. The patients with osteosarcomaor Ewing sarcoma received the standard chemotherapy before and after operation.Eighteen and ten patients received the segmental allograft prosthetic compositereplacement and the intercalary allograft with the interlocking intramedullary nail fixation, respectively. The functional outcome was evaluated by the MSTS score. Results According to the follow-up for 5-48 months (average, 24 months), local recurrence was observed in 1 patient who underwent amputation eventually. Of the 28 patients, 3 developed nonunion of the allografthost junction accompanied by severe resorption and 2 developed deep infection. No allograft fracture was seen in the patients. Most of the patients achieved a good functional result with an average MSTS score of 23.4. ConclusionThe prosthetic composite replacement of the intercalary allograft and the segamental allograft can be used n the skeletal defect reconstruction after the limb tumor resection. The stablecontact in the allografthost junction and the b intramedullary internal fixation can help to reduce the complication rate of the allograft.
Objective To investigate the clinical effects of repairing massive bone defects in limbs by using vascularized free fibular autograft compoundingmassive bone allografts. Methods From January 2001 to December 2003, large bone defects in 19 patients (11 men and 8 women, aging from 6 to 35 years) were repaired by vascularized free fibular transplant with a monitoringflap compounding massive deep frozen bone allografts. The length of bone defects were 12 to 25 cm (16.6 cm on average), of vascularized free fibular 15 to 28 cm (18.3 cm on average), and of massive bone allografts 11 to 24 cm (16.1 cm on average). Thelocation of massive bone defects were humerus in 1 case, femur in 9 cases and tibia in 9 cases. Results After followup of 5 to 36 onths (18.2 months on average), wounds of donor and recipient sites were healed at Ⅰstage, monitoringflaps were alive, no obvious eject reaction of massive bone allografts was observed and no complications occurred in donor limbs. The radiographic evidence showed union in 15 patients 3 months and 3 patients 8 months after operation. One case of malignant synovioma of left lower femur recurred and amputation was performed 2.5 months after surgery. Internal fixation was removed in 5 patients, and complete bone unions werefound 1 year postoperatively. No massive bone allografts was absorbed or collapsed. Conclusion With strict indication, vascularized free fibular autograft compounding massive bone allografts, as an excellent method of repairing massive bone defects in limbs, can not only accelerate bone union but also activate and changer the final results of massive bone allografts from failure.