SEQUENTIAL THERAPY OF VACUUM SEALING DRAINAGE AND PEDICLED FLAP TRANSPLANTATION FOR CHILDREN WITH MOTORCYCLE SPOKE HEEL INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DONGFu , ZHUJinrong , LIYunfeng ,  LUChun

Department of Orthopaedics, Beihai People's Hospital, Beihai Guangxi, 536000, P. R. China;

Corresponding?author：

LUChun, Email: luchun305629718@sina.com

Keywords：

Spoke heel injury; Thermal damage; Vacuum sealing drainage; Pedicled flap transplantation; Children

DOI：

10.7507/1002-1892.20150100

Video：

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Objective To investigate the clinical characteristics of motorcycle spoke heel injury and the effectiveness of sequential therapy of vacuum sealing drainage (VSD) and pedicled flap transplantation for treating motorcycle spoke heel injury in children. Methods Between January 2010 and January 2014, 15 children (aged from 3 to 8 years, 5.7 years on average) with motorcycle spoke heel injury received sequential therapy of VSD and pedicled flap transplantation. The interval from injury to admission was 3-7 days, with an average of 4.9 days. The locations were the heel in 8 cases, the heel and lateral malleolus in 2 cases, and the medial malleolus and medial heel in 4 cases, and the medial and lateral malleolus and heel in 1 case. The patients had different degrees of defects of the skin, tendon, and bone. The skin defect size ranged from 3 cm×3 cm to 13 cm×6 cm. VSD was applied for twice in 13 cases and three times in 2 cases. Reversed flow sural flap was applied in 8 cases, lateral supramalleolar flap in 2 cases, medial supramalleolar perforator-based flaps in 4 cases, and posterior tibial artery flap in 1 case. Eight pedicled flaps with neuroanastomosis were selected according to the wound characteristics. The flap size ranged from 4 cm×4 cm to 14 cm×7 cm. Results Of 15 cases, 13 flaps survived well except that two had partial skin necrosis at the distal site. Primary healing was obtained, and skin graft at donor site survived. The patients were followed up 9-21 months (mean, 13 months). Mild and moderate bulky flaps were observed in 9 cases and 6 cases respectively. Of 15 cases, 13 could walk with weight loading, and 2 had slight limping. Superficial sensation recovered to S3 in 8 patients undergoing neuroanastomosis, and recovered to S2 in 7 patients not undergoing neuroanastomosis at 6 months after operation. According to AOFAS evaluation system for Ankle-Hindfoot, the results were excellent in 13 cases and good in 2 cases, with an excellent and good rate of 100% at 8 months after operation. Conclusion The main characteristic of motorcycle spoke heel injury lies in a combination of high energy damage and thermal damage. Sequential therapy of VSD and pedicled flap transplantation can be regarded as a reliable option to obtain good outcome of wound healing and satisfactory functional recovery for the management of motorcycle spoke heel injury.

Citation： DONGFu, ZHUJinrong, LIYunfeng, LUChun. SEQUENTIAL THERAPY OF VACUUM SEALING DRAINAGE AND PEDICLED FLAP TRANSPLANTATION FOR CHILDREN WITH MOTORCYCLE SPOKE HEEL INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 462-466. doi: 10.7507/1002-1892.20150100 Copy

1.	嚴立, 胡銳, 丁凡, 等. 負壓封閉引流技術聯合游離皮瓣移植治療合并骨折的小腿及足踝部熱壓傷. 中華創傷骨科雜志, 2013, 15(4):312-315.
2.	楊錦, 楊曉東, 付尚俊, 等. 股前外側穿支皮瓣修復手背熱壓傷13例. 中華燒傷雜志, 2013, 29(5):436-437.
3.	Suri MP, Naik NR, Raibagkar SC, et al. Heel flap injuries in spoke wheel accidents. Injury, 2007, 38(5):619-624.
4.	朱躍良, 徐永清, 李軍, 等. 兒童足后跟輪輻傷的臨床治療. 中國修復重建外科雜志, 2009, 23(10):1180-1182.
5.	張林祥, 譯. 對燒傷病理生理學解釋的進展——以燒傷休克的病理生理學為中心. 中國燒傷創瘍雜志, 1992, 4(4):59-62.
6.	巨積輝, 鄒國平, 金光哲, 等. 多種游離皮瓣修復手背側熱壓傷27例. 中華燒傷雜志, 2012, 28(4):312-313.
7.	蔡曉燕, 馮裕董, 林聯鐸, 等. 前臂橈動脈穿支筋膜蒂皮瓣在手部、腕部熱壓傷修復中的應用. 中華外科雜志, 2012, 50(5):473-474.
8.	王加利, 趙春霞, 陳仲華. 吻合神經的游離髂骨皮瓣修復足跟部復合組織缺損.中華顯微外科雜志, 2014, 37(1):35-38.
9.	Li RG, Yu B, Wang G, et al. Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities. Injury, 2012, 43(6):822-828.
10.	李林東, 蔣純志, 邱維勝, 等. 應用VSD技術和股前外側皮瓣修復小腿軟組織缺損. 實用骨科雜志, 2013, 19(1):81-82.
11.	錢曉玲, 周學芹, 尹曉莉, 等. 封閉負壓引流干預慢性創面神經生長因子和微血管的變化. 中國組織工程研究, 2014, 18(11):1647-1652.
12.	魏永輝, 劉云寧, 馬鵬濤, 等. 封閉負壓引流在小腿足創傷中的應用. 臨床骨科雜志, 2014, 17(4):425-426.
13.	陳忠江, 雷晉, 段鵬, 等. 序貫模式治療脛腓骨骨折合并內固定物外露難愈性創面12例. 中華燒傷雜志, 2013, 29(4):391-392.
14.	章斌, 郭錦明, 劉俊, 等. 脛后動脈內踝上皮支皮瓣修復小腿遠端及足踝部皮膚軟組織缺損. 中國骨與關節損傷雜志, 2013, 28(4):383-384.
15.	陳浩, 高峻青, 何斌, 等. 脛后動脈穿支隱神經營養血管雙供血皮瓣修復小腿和足踝大面積軟組織缺損. 中華顯微外科雜志, 2013, 36(3):225-228.
16.	Jakubietz RG, Schmidt K, Holzapfel BM, et al. Soft tissue reconstruction of the distal lower extremity using the 180-degree perforator-based propeller flap. Oper Orthop Traumatol, 2012, 24(1):43-49.
17.	張連雙, 任志勇, 史迅. 吻合感覺神經穿支皮瓣移植修復足跟部軟組織缺損.中國矯形外科雜志, 2013, 21(16):1681-1683.
18.	谷增泉, 孫雪生, 呂伯實, 等. 吻合皮神經腓腸筋膜皮瓣修復前足皮膚缺損.中國矯形外科雜志, 2005, 13(10):736-737.

1. 嚴立, 胡銳, 丁凡, 等. 負壓封閉引流技術聯合游離皮瓣移植治療合并骨折的小腿及足踝部熱壓傷. 中華創傷骨科雜志, 2013, 15(4):312-315.
2. 楊錦, 楊曉東, 付尚俊, 等. 股前外側穿支皮瓣修復手背熱壓傷13例. 中華燒傷雜志, 2013, 29(5):436-437.
3. Suri MP, Naik NR, Raibagkar SC, et al. Heel flap injuries in spoke wheel accidents. Injury, 2007, 38(5):619-624.
4. 朱躍良, 徐永清, 李軍, 等. 兒童足后跟輪輻傷的臨床治療. 中國修復重建外科雜志, 2009, 23(10):1180-1182.
5. 張林祥, 譯. 對燒傷病理生理學解釋的進展——以燒傷休克的病理生理學為中心. 中國燒傷創瘍雜志, 1992, 4(4):59-62.
6. 巨積輝, 鄒國平, 金光哲, 等. 多種游離皮瓣修復手背側熱壓傷27例. 中華燒傷雜志, 2012, 28(4):312-313.
7. 蔡曉燕, 馮裕董, 林聯鐸, 等. 前臂橈動脈穿支筋膜蒂皮瓣在手部、腕部熱壓傷修復中的應用. 中華外科雜志, 2012, 50(5):473-474.
8. 王加利, 趙春霞, 陳仲華. 吻合神經的游離髂骨皮瓣修復足跟部復合組織缺損.中華顯微外科雜志, 2014, 37(1):35-38.
9. Li RG, Yu B, Wang G, et al. Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities. Injury, 2012, 43(6):822-828.
10. 李林東, 蔣純志, 邱維勝, 等. 應用VSD技術和股前外側皮瓣修復小腿軟組織缺損. 實用骨科雜志, 2013, 19(1):81-82.
11. 錢曉玲, 周學芹, 尹曉莉, 等. 封閉負壓引流干預慢性創面神經生長因子和微血管的變化. 中國組織工程研究, 2014, 18(11):1647-1652.
12. 魏永輝, 劉云寧, 馬鵬濤, 等. 封閉負壓引流在小腿足創傷中的應用. 臨床骨科雜志, 2014, 17(4):425-426.
13. 陳忠江, 雷晉, 段鵬, 等. 序貫模式治療脛腓骨骨折合并內固定物外露難愈性創面12例. 中華燒傷雜志, 2013, 29(4):391-392.
14. 章斌, 郭錦明, 劉俊, 等. 脛后動脈內踝上皮支皮瓣修復小腿遠端及足踝部皮膚軟組織缺損. 中國骨與關節損傷雜志, 2013, 28(4):383-384.
15. 陳浩, 高峻青, 何斌, 等. 脛后動脈穿支隱神經營養血管雙供血皮瓣修復小腿和足踝大面積軟組織缺損. 中華顯微外科雜志, 2013, 36(3):225-228.
16. Jakubietz RG, Schmidt K, Holzapfel BM, et al. Soft tissue reconstruction of the distal lower extremity using the 180-degree perforator-based propeller flap. Oper Orthop Traumatol, 2012, 24(1):43-49.
17. 張連雙, 任志勇, 史迅. 吻合感覺神經穿支皮瓣移植修復足跟部軟組織缺損.中國矯形外科雜志, 2013, 21(16):1681-1683.
18. 谷增泉, 孫雪生, 呂伯實, 等. 吻合皮神經腓腸筋膜皮瓣修復前足皮膚缺損.中國矯形外科雜志, 2005, 13(10):736-737.

Chinese Journal of Reparative and Reconstructive Surgery

SEQUENTIAL THERAPY OF VACUUM SEALING DRAINAGE AND PEDICLED FLAP TRANSPLANTATION FOR CHILDREN WITH MOTORCYCLE SPOKE HEEL INJURY

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