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.
Since November 1974 to December 1993, 110 cases with malignant tumors of the extremities were treated by en bloc resection and limb salvage procedure in our hopsital. There were 57 males and 53 females. Their ages ranged from 14 to 70 years. The diagnosis of all patients were confirmed by pathology. Among them, 68 cases were malignant bone tumor, 42 cases were malignant tumor of soft tissue. If the soft tissue was involved by the malignant tumors, the tumor was resected radically and myocutaneous or skin flap was transferred to covered the defect. Among the 42 cases, 5 were free vascularized and 37 were pediculated flaps. The maximal size of the flap was 15×25 cm and the minimal was 6×8 cm. For the malignant bone tumors, en bloc resection was performed and the bone defect was reconstructed with autogenous free vascularized fibular graft, autograft of massive bone with fusion or allograft of cryogenic massive bone. If the joint was involved, limited excision with replacement of prosthesis was recommended. When both soft tissue and bone were involved, segmental resection of tumor was indicated in 17 cases. The patients were followed up for 2 to 9 years, the results of 53 cases were still alive with a survival rate of 48.2%. We emphasized that the local extensive resection should be performed with a safety margin of 3 to 5 cm beyond the tumor. A djuvant chemotheapy and radiotherapy had definite value in the treatment of some malignant tumors, so that preoperative or postoperative chemotherapy or radiotherapy was necessary. Sometimes radical resection of regional lymph rodes was necessary. The indications and causes of recurrence were discussed.
ObjectiveTo evaluate the effects of nerve growth factor (NGF) on angiogenesis and skeletal muscle fiber remodeling in ischemic hindlimbs, and study the relationship of NGF and vascular endothelial growth factor (VEGF) to angiogenesis. MethodsEighteen mice were randomly allocated to normal control group (n=6), blank control group (n=6), and NGF gene transfection group (n=6). The left hindlimb ischemia model was established by ligating the femoral artery. NGF plasmid (125μg) was injected into the mouse ischemic gastrocnemius in the NGF gene transfection group. The same volume of normal saline (200μL) was injected into the mouse ischemic gastrocnemius in the blank control group. The gastrocnemius of left hindlimb was harvested under the condition of peritoneal cavity anesthesia on the 21th day after operation, and then the mice were sacrificed. The gastrocnemius of three groups were tested by hematoxylin-eosin staining, proliferating cell nuclear antigen (PCNA) and CD34 were determined by immunohistochemistry staining. Skeletal muscle fiber type was tested by myosin ATPase staining. NGF and VEGF protein expression were detected by enzyme linked immunosorbent assay. ResultsOn the 21th day after surgery, compared with the blank control group, the skeletal muscle atrophy degree was weaker, the functional assessment score was significantly lower (P < 0.05), the endothelial cell proliferation index, capillary density, the typeⅠskeletal muscle fiber proportion, NGF and VEGF expression were significantly higher (P < 0.05) in the NGF gene transfection group. ConclusionsNGF gene transfection could promote NGF and VEGF expression and angiogenesis in ischemic hindlimbs, and induce typeⅠskeletal muscle fibers formation in ischemic hindlimbs. The molecular regulation mechanism still needs to be further studied.
Objective To evaluate the effectiveness of soft tissue reconstruction after resection of musculoskeletal tumor and to discuss the strategy of soft tissue reconstruction. Methods Between June 2003 and December 2010, 90 patients with musculoskeletal tumor underwent tumor resection and soft tissue reconstruction. There were 59 males and 31 females with a median age of 37.2 years (range, 9-85 years), including 52 bone tumors and 38 soft tissue tumors. One stage reconstruction of soft tissue was performed after tumor resection in 75 cases; reconstruction of soft tissue was performed after debridement in 7 cases of wound dehiscence; and two stage reconstruction of soft tissue was performed after debridement and vacuum sealing drainage placement in 8 cases of infected wounds. The gastrocnemiums flap was used in 40 cases, the latissimus dorsi myocutaneous flap in 6 cases, rectus abdominis myocutaneous flap in 4 cases, gluteus maximus musculocutaneous flap in 1 case, pectoralis major muscle flap in 1 case, cross-abdominal flap in 1 case, local transfer flap in 27 cases, pedicled flaps in 5 cases, and skin grafts in 5 cases. The size of the flap ranged from 6.5 cm × 4.5 cm to 21.0 cm × 9.0 cm. Results Eighty-seven flaps survived, and incisions healed by first intention in 81 cases. In 6 cases of healing by second intention, 2 had partial flap necrosis, which was cured by dressing change; 3 had delayed healing; 1 had mild infection, which was cured after conservative treatment. Wound of donor site healed primarily, and the grafted skin survived. Seventy-three patients were followed up 10-102 months (mean, 36.1 months). Local tumor recurrence was observed in 6 patients, who received second resection at 2-27 months (mean, 8.2 months) after operation. Thirteen patients dead of primary disease at 6-34 months (mean, 19.2 months) after operation. Conclusion The defects caused by resection of musculoskeletal tumor require soft tissue reconstructions. Optimal reconstruction can enhance wound closure, decrease incidence of wound complication, preserve limb function.
Objective To investigate the effectiveness and technical points of shortened replantation combined with limb lengthening in the treatment of severe amputation of middle and distal lower leg. Methods Twelve cases of severe amputation of middle and distal lower leg were treated with shortened replantation at the 1st stage and limb lengthening at the 2nd stage between April 2009 and May 2016. There were 9 males and 3 females with an average age of 28 years (range, 16-32 years). The injury causes included traffic accident injury in 4 cases, heavy pound injury in 6 cases, and machine crush injury in 2 cases. The interval from injuries to treatment ranged from 30 minuts to 6 hours (mean, 3 hours and 12 minutes). All of 12 cases, 6 cases were completely amputated in the right middle and distal lower leg, 4 were not completely amputated in the left middle and distal lower leg, and 2 were ankle amputations. The limbs were 4.0-12.5 cm shorter than the contralateral sides, with an average of 7.3 cm. Limb lengthening was performed at 1.5-8.0 months after replantation and the time of extension was 1.7-5.3 months (mean, 3.1 months). Results All 12 patients recovered the same lengths of both lower extremities after shortened replantation and limb lengthening. The lengthened segments gained good bone mineralization, bony union was achieved at lengthened segments and broken end of fracture at 7-16 months (mean, 11.3 months). All patients were followed up 6 months to 5 years (mean, 2 years and 5 months). The range of motion of the knee joint were 0-5° (mean, 3°) in hyperextension and 110-140° (mean, 120°) in flexion. Except for 2 cases of ankle arthrodesis, plantar flexion angles were 15-45° (mean, 26°) and dorsiflexion angles were 10-25° (mean, 15°) in the other cases. The plantar sensation was restored to the S3+ level in 4 cases, S3 level in 6 cases, and S2 level in 2 cases. At last follow-up, the affected limb function were excellent in 7 cases, good in 3 cases, fair in 2 cases according to Kofoed functional evaluation criteria. Conclusion It expanded indications for replantation of lower limb amputation, reduced the operation difficulty and trauma with shortened replantation combined with limb lengthening in the treatment of severe amputation of middle and distal lower leg.
ObjectiveTo make a better understanding of potassium channel-complex autoimmune antibodies associated limbic encephalitis, we studied in details with patients of this autoimmune disease accompanying without tumors. MethodsDiagnosis of 3 patients were confirmed by antibody detection in serum or CSF. All the clinical data, including history, CSF data, cranial MRI, EEG, pelvic ultrasound and treatment strategy, were carefully gathered. Two to eleven months follow-up were carried out. Results3 female adult patients showed common initial manifestation of seizures, and changes of consciousness, mental disorder and cognitive impairment. Hyponatremia was found in one LGI1-Ab+ patient. Cranial MRI showed unilateral or bilateral signal changes with limbic system. Changes of CSF and EEG were nonspecific. All 3 patients became recovery in different levels after two to eleven months. ConclusionsPotassium channel-complex antibodies associated encephalitis may be a common type of limbic encephalitis in adults without tumors. Seizures may be the first sign of the disease. Hyponatremia is one of characteristics of LGI1-Ab+ patient. Patients may have a fairly good short outcome.
ObjectiveTo investigate the reasons and managements of implant-related complications after hinge knee replacement for tumors around the knee. MethodsA retrospective analysis was made on the clinical data of 96 patients undergoing hinge knee replacement between January 2000 and December 2012. There were 64 males and 32 females with the mean age of 31.0 years (range, 15-72 years). The most common tumor type was osteosarcoma (72 cases), and the second was giant cell tumor (15 cases). The tumor located at the distal femurs in 52 cases and at the proximal tibias in 44 cases. Fifteen hinge and 81 rotating hinge prostheses were used. The recurrence, metastasis, and survival were recorded. The implant-related complications were observed. ResultsThe median follow-up time was 43.5 months (range, 10-156 months). Complications were observed in 21 patients (25 implant-related complications);13 complications located at the femur and 12 complications at the tibia. The complications included aseptic loosening (8 cases), deep infection (7 cases), prosthetic breakage (4 cases), peri-prosthetic fracture (2 cases), and dislocation (4 cases). Most deep infection occurred within 12 months after operation (6/7), and most aseptic loosening after 40 months of operation (6/8). The rate of limb salvage was 90.6% (87/96) and the amputation rate was 9.4% (9/96). The overall survival rate of the prosthesis was 76.7% (5-year) and 47.2% (10-year). The 5-year survival rate was 82.9% for femoral prosthesis and 71.0% for tibial prosthesis, showing no significant difference (P=0.954). ConclusionHinge knee prosthesis still has a high rate of complications. Deep infection is main reason to decrease short-term prosthetic survival rate, and aseptic loosening shortens the long-short prosthetic survival time.
Objective To investigate the effect of the semi-joint prosthesis replacement in treating malignant tumors around the children’s knees. Methods Five children (aged 8-12 years) with malignant tumors around the proximal end ofthe tibia underwent the semi-joint prostheses replacement from March 2000 to June 2005. All the children had been diagnosed with osteosarcoma, which was graded as ⅡB by the Enneking staging system. The pathologic changes involved the upper segment of the tibia 9-11 cm in length. Before operation all the patients underwent puncture biopsy and standard chemotherapy. The lesion extent was determined by X-ray, CT and MRI, and then the size of the prosthesis was determined. The length of the prosthesis was 1-2 cm longer than that of the excised bone. After operation the patients were given neoadjuvant chemotherapy for 2 courses and they could walk with the help of a special brace 4 weeks postoperatively. Results All the 5 patients had a successful semi-joint prosthesis replacement exceptone patient who had a skin flap necrosis, and the wound healed after a flap grafting. The remaining patients had their wounds healed by first intention. The12-36 months’ follow-up revealed that all the patients had no metastasis or recurrence of the tumor and they were living and well except one patient who died oflung metastasis 8 months after operation. Conclusion The semi-joint prosthesis replacement in the limb salvage surgery for maligant tumors around the children’s knees has advantages of avoiding a damage to the normal osteoepiphysis, stabilizing the knee joint, and facilitating elongation of the limb in future. Italso creates the condition for total knee replacement in adults.
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.