Objective To investigate the effect of transplantation of the cutaneous iliac flap on repairing bone and soft tissue defect of metatarsal. Methods From October 1999 to December 2003, the cutaneous iliac flap was designed for the repair of bone and soft tissue defect of metatarsal in 4 male patients, whose ages ranged from 26 to 47, with skin graft for the coverage of the iliac flap. The duration of injury ranged from 1 to 5 months. The length of the defect ranged from 4 to 7 cm and the defect area ranged from 5 cm×3 cm to 9 cm×5 cm. Results One week after transplantation, complete survival of iliac flap was observed in 3 cases and partial survival in 1 case (but later proved survived). Callus was seen 1 month after transplantation and Kwires were removed 4months after transplantation. Patients were followed up for 5 to 24 months. There were no ulcers. The ability of walking and bearing was satisfying as well asthe function and shape. Conclusion With satisfying restoration of function and shape, transplantation of the cutaneous iliac flap with skin graft is an alternative to treat bone and soft tissue defect of metatarsal with one stage surgery.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
Six cases of maxillary tumors after being resccted radically, a primary repair of the maxillary defects were carried out by grafting of the pedicled buccal fat pad as the oral linning combined with bone graft. The cases were followed from 8 to 14 months. The function of the maxillary sinuses was normal and the facial contour was restored symmetrical. The applied anatomy and the method of operation were introduced in details. The advantages of the method were discussed.
Seven cases with bone tumor in upper limb were reported. Five cases were treated by using free vascularized fibular graft, 2 cases by using fusion between humorus and clavicle. A follow-up study of six patients showed that the graft bone was united within 3 months in 5 cases, in 6 months in one case. Partial function of upper limb in 6 patients have been restored.
Objective To investigate the long-term clinical results of treatment of adult unicameral bone cyst with cancellous allograft. Methods From 1993 to 1998, 15 patients with unicameral bone cyst were treated by allograft with lyophilized cancellous bone. Among 15 patients, there were 5 males and 10 females, aging 19-41 years with an average of 27 years. The average follow-up time was 7.5 years (6-11 years). The X-ray films were taken and the CT scanning were carried out. Results The X-ray films showed that the allograft particles became vague 2-3 months after operation, that the allograft particles fused and began to form new bone and the bone density increased 5 months after operation, and that new bone formation completed after 7 months of operation. At the end of follow-up, remodelling in new bone occurred. Reoccurrence was not found in all patients. The symptom of pain disappeared or relieved obviously. Conclusion Allograft of lyophilized cancellous bone is an effective treatment for adult unicameral bone cysts.
Objective To investigate the way to reconstruct bone scaffold afterremoval of giant benign bone tumor in extremities of children. Methods From June 1995 to October 2000, 6 cases of benign bone tumor were treated, aged 614 years. Of 6 cases, there were 4 cases of fibrous hyperplasia of bone, 1 case of aneurysmal bone cyst and 1 case of bone cyst; these tumors were located in humerus (2 cases), in radius (1 case), in femur (2 cases) and in tibia(1 case), respectively. All patients were given excision of subperiosteal affected bone fragment, autograft of subperiosteal free fibula(4-14 cm in length) and continuous suture of in situ periosteum; only in 2 cases, humerus was fixed with single Kirschner wire and external fixation of plaster. Results After followed up 18-78 months, all patients achieved bony union without tumor relapse. Fibula defect was repaired , and the function of ankle joint returned normal. ConclusionAutograft of subperiosteal free fibula is an optimal method to reconstruct bone scaffold after excision of giant benign bone tumor in extremities of children.
Objective To investigate the effect of microsurgical repair of refractory bone defects and nonunion in distal humers. Methods Twelve cases of bone defects and nonunion indistal humerus wererepaired with free vascularised fibular graft and fixed with the anatomical bone plate. Of the 12 cases, 8 had pseudarthrosis, and 4 had bone defects 3-5 cm. Fibular graft ranged from 5-15 cm, 8.5 cm in average. Results After a follow-up of 3-18 months, 8.5 months in average, all cases of free vascularised fibular graft healed within 38 months. The fibular graft thickenedas time passed. Normal recessive osseous elbow joint, improvement in the inflection and extension of elbow joint, and normal revolving of antebrachium were attained. The short of limbs were corrected. Satisfactory functions of supporting and fine operation were attained. Conclusion With the support of anatomical bone plate, the fibular graft can help the recovery of joint functionand repair bone defects and nonunion as to avoid joint replacement with prosthesis.
OBJECTIVE To study the function of the composite of bone matrix gelatin(BMG) and plaster in the repairing process of bone defects. METHODS Sixteen New Zealand rabbits which were defected in corpus radii were made as implant zone of bone. Sixteen sides of radii were implanted with the composite of BMG and plaster as experimental group. Others were implanted with BMG(8 sides) and bone stored in alcohol(8 sides) as control groups. The repairing process in bone defects were observed by X-ray and histological examination. RESULTS There was an obvious osteogenesis in experimental group. The defects of radii were almost healed at 12th week after operation. There were osteogenesis in both control groups, but the repairing process was slower than that of the experimental group. CONCLUSION The composite of BMG and plaster is a good material for bone transplantation.
Objective To explore an effective way fortreating severe complicated distal femoral fractures. Methods Twenty-six patients with complicated distal femoral fracture who all belonged to 33C3.3type according to AO/ASIF lassification, were treated with a lateral condylar buttress plate or self-desinged aliform anatomical plate, and operated on with allogeneic bone grafting. Results All cases were followed up for an average of 14 months (ranging 5-25 months). Twenty-four wounds were primary healing postoperatively, 2 wounds were infected and healed after dressing change. Twenty-four had bone healing after 411 months, 2 needed to operate again because of earlier weight-bearing resulting in fixation failure. According to shelbourne and Brueckmann score, the excellent and good rate was 88.46%. Conclusion The internal fixation forcomplicated distal femoral fracture by self-designed aliform anatomical plate and lateral condylar buttress plate with a great deal of allograft bone is an effective surgical method. As it has long oval holes and the holes are consecutive ,the aliform anatomical plate is more suitable for severe complicated fractures. At the same time, autogenous-ilium transplantation can be substituted by the allograft bone.