Reconstruction of Large Area of Deep Wound in the Foot and Ankle with Chimeric Anterolateral Thigh Perforator Flap.

Objective: To evaluate the clinical application and surgical efficacy of the chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap for the reconstruction of the large area of deep wound in foot and ankle.

Methods: Clinical data of 32 cases who underwent chimeric anterolateral thigh perforator flap to repair the large area of deep wound of the foot and ankle from January 2015 to December 2018 were retrospectively analyzed. The sizes of the defects ranged from 18 cm × 10 cm to 35 cm × 20 cm, with exposed tendon and bone and/or partial defects and necrosis, contaminations, accompanied by different degrees of infection.

Free flap transplantation combined with Ilizarov bone transport for the treatment of severe composite tibial and soft tissue defects.

Objective: To evaluate the clinical efficacy of free flap transplantation combined with Ilizarov bone transport in the treatment of severe composite tibial and soft tissue defects.

Methods: We retrospectively analyzed the clinical data of 40 patients with severe composite tibial and soft tissue defects who underwent free flap transplantation combined with Ilizarov bone transport. The clinical efficacy was evaluated according to the following criteria: success rate of wound repair by free flap transplantation, incidence or recurrence rate of deep infection, healing rate of bone defects and external fixation index, incidence of complications, and functional score of affected extremities.

A neglected problem in the utilization of free anterolateral thigh flap toward reconstructing complicated wounds of extremities: the obliteration of deep dead space.

Background: Deep dead space may be thought as an independent risk factor of the poor infection control after flap reconstruction in complex limb wounds. But it can be easily neglected. The conventional skin flap and musculocutaneous flap are difficult to obliterate the deep dead space in irregular shape effectively.

Treatment options for infected bone defects in the lower extremities: free vascularized fibular graft or Ilizarov bone transport?

Objective: The objective was to explore the relative indications of free vascularized fibular graft (FVFG) and Ilizarov bone transport (IBT) in the treatment of infected bone defects of lower extremities via comparative analysis on the clinical characteristics and efficacies.

Methods: The clinical data of 66 cases with post-traumatic infected bone defects of the lower extremities who underwent FVFG (n = 23) or IBT (n = 43) from July 2014 to June 2018 were retrieved and retrospectively analyzed. Clinical characteristics, operation time, and intraoperative blood loss were statistically compared between two groups.

A solution to the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur: Bridging with vein transplantation.

Purpose: The present study aimed to evaluate the feasibility and clinical efficacy of bridging vein transplantation to deal with the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur.

Methods: Twelve patients (aged 15-58 years) with infected bone defects of the femur (between 6.0 and 18.

Free flap transplantation combined with skin grafting and vacuum sealing drainage for repair of circumferential or sub-circumferential soft-tissue wounds of the lower leg.

Background: This study is aimed at evaluating the operation techniques and clinical significance of free flap transplantation combined with skin grafting and vacuum sealing drainage (VSD) in repairing severe traumatic extensive circumferential or semi-circumferential soft-tissue defects of the lower leg.

Material And Methods: Thirty patients with severe lower leg injuries were treated by free flap transplantation combined with skin grafting and VSD from January 2008 to June 2011. The size of the wounds ranged from 23×8 cm to 44×28 cm and all affected more 70% of the low leg circumferential area.

Reconstruction of shoulder abduction by multiple nerve fascicle transfer through posterior approach.

Purpose: To evaluate the feasibility and clinical efficacy of multiple nerve fascicle transfer through posterior approach for reconstruction of shoulder abduction in patients with C5 or upper brachial plexus injury.

Methods: 11 patients (aged between 17 and 56 years) with dysfunction of shoulder abduction post C5 or upper brachial plexus injury were recruited in this study. Among them, four out of 11 patients also had dysfunction of elbow flexion simultaneously.

[Treatment of large circular soft tissue defect in lower extremities with a combination of bridge flaps and free skin graft covered by vacuum sealing drainage].

Objective: To explore the surgical technique and clinical value of treatment for posttraumatic large circular soft tissue defect in the lower extremities using a combination of posterior tibial vascular bridge flap in the unaffected leg and skin graft covered by vacuum sealing drainage (VSD).

Methods: From January 2008 to June 2010, 11 cases with posttraumatic large circular soft tissue defects with deep tissue exposed or partial necrosis in the lower extremities were treated by bridge flaps and combined with free skin graft covered by VSD. There are 7 males and 4 females, with an average age of 32.

Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities.

Purpose: The aim of the study is to evaluate the surgical technique and clinical significance of the sequential therapy of vacuum sealing drainage (VSD) and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities.

Methods: Twenty-two children (aged from 3 to 10 years) received sequential therapy of VSD and free-flap transplantation. All cases suffered from extensive area soft-tissue defects and exposure or partial defects of bones, tendons and other deep tissues.

[Three-dimensional reconstruction technique in gastrocnemius flap surgery: initial clinical application].

Objective: To discuss the experience with three-dimensional reconstruction technique in initial clinical application in gastrocnemius muscle flap surgery.

Method: From 2007 to 2008, 7 patients received gastrocnemius muscle flap surgeries to repair the wounds. Preoperative CT angiography or magnetic resonance imaging (MRI) was performed after injection of the contrast media for individualized three-dimensional gastrocnemius muscle flap reconstruction using Amira4.

Replantation of articular composite tissue masses severed from extremities.

The techniques and outcomes of in situ replantation are discussed for managing 5 cases of articular composite tissue masses severed from an extremity (digit). All 5 cases treated with in situ replantation survived. Rehabilitation was performed after surgery.

Reconstruction of phalangeal articulations of the hand with vascularised phalangeal articulations of foot.

Since arthroplasty, prosthetic replacement and non-vascularised articulation autografting do not normally produce very satisfactory results for ankylosis of metacarpophalangeal and interphalangeal joints, the authors performed reconstruction of phalangeal articulations of the hand using vascularised phalangeal articulations of the foot in 11 patients with ankylosis of the metacarpophalangeal and interphalangeal joints of hand due by trauma. Procedures included reconstruction of 9 hand metacarpophalangeal joints with vascularised grafting of pedal metatarsophalangeal joints in six patients, reconstruction of the hand metacarpophalangeal joints with grafting of vascularised proximal interphalangeal joints of foot in two patients and reconstruction of the hand proximal interphalangeal joints with grafting of vascularised proximal interphalangeal joints of foot in three patients. Early functional exercise was encouraged in all cases post-operatively.

[Green fluorescent protein as a tracer of bone marrow stromal cells in bone tissue engineering in rhesus].

Objective: To observe the role of green fluorescent protein (GFP) in tracing rhesus bone marrow stromal cells (rBMSCs) during tissue-engineered bone formation in vivo.

Methods: Ad5.CMV-GFP was amplified by infecting QBI-293A cells, and the bone marrow was harvested from the ilium of adult male rhesus to obtain rBMSCs, which were cultured and passaged in vitro.

[Study of osteoblasts transfected with gfp in vitro and traced in vivo].

Objective: To observe the osteoblasts transfected with green fluorescent protein (GFP)by adenovirus vector expressed in vitro and traced it in vivo in order to research the feasibility of GFP as a tracer of seeding cells for tissue engineering.

Methods: CFP were transfected into the osteoblasts which derived from adult human bone marrow stromal cell (hBMSc) by adenovirus vector after being packed in 293A cells. The nontransfected hBMSc was used as the control group.

[Fabrication of laryngeal cartilage by means of tissue engineering technique].

Objective: To explore the method of fabricating tissue engineered laryngeal cartilage.

Methods: The rib and articular cartilage of infant New Zealand white rabbits were harvested in sterile condition. The chondrocytes were separated by collagenase digestion and cultured in vitro for 3 passage.

[Fingertip replantation after amputation: report of 32 fingers].

Objective: To describe the surgical techniques and our experiences in fingertip replantation after amputation.

Methods: On the basis of examination of the anatomic features and the degree of fingertip vascular injury, 32 amputated fingertips in 26 cases were replanted, and flexible revascularization procedures of both artery and vein anastomoses, artery-only anastomosis, arterialized vein and arteriovenous anastomosis were adopted. All the replanted fingertips were trained with comprehensive rehabilitation program.

[Induced differentiation of adult human bone marrow derived mesenchymal stem cells in vitro toward osteoblasts].

Objective: To investigate the feasibility of inducing in vitro mesenchymal stem cells (MSCs) derived from adult human bone marrow differentiate into osteoblasts and potential applicability of the MSCs as the seed cells in tissue engineering.

Methods: Adult human bone marrow was collected from the healthy adult volunteers to obtain the MSCs, which, after in vitro culture in DMEM supplemented with 10% fetal bovine serum and incubation under standard condition, were induced to differentiate into osteoblasts in DMEM containing dexamethasone (1x10(-8) mol/L), beta-sodium glycerophosphate (10 mmol/L) and ascorbic acid (50 mg L). Proliferation and differentiation of the MSCs were observed continually under inverted phase-contrast microscope and transmission electron microscope.

[The method of accelerating osteanagenesis and revascularization of tissue engineered bone in big animal in vivo].

Objective: To study whether tissue engineered bone can repair the large segment bone defect of large animal or not. To observe what character the fascia flap played during the osteanagenesis and revascularization process of tissue engineered bone.

Methods: 9 Chinese goats were made 2 cm left tibia diaphyseal defect.

[An experimental study of treatment of comminuted distal femur fracture with locked double- plating].

Objective: To explore new techniques for the treatment of comminuted distal femoral fractures to promote functional restoration and reduce the complications of the fracture.

Methods: Sixteen adult canines were selected for this study, and the experimental and control hindlimb for each canine were randomly determined. Distal comminuted fracture (AO/ASIF Type C2) was induced in both sides of the canine's femurs, and one side was fixed with the double plates (steel plate and polyethylene plate), whereas the other with a single steel plate.

[Biocompatibility of adult human osteoblasts with coral-derived hydroxyapatite in vitro].

Objective: To study the biocompatibility of the osteoblasts from adult human bone marrow with coral-derived hydroxyapatite (CHA) in in vitro culture.

Methods: Bone marrow was obtained from healthy adult subjects and cultured in Dulbecco's modified Eagle's medium (DMEM) containing 10 % fetal bovine serum. The subsequent cell passaging was conducted in conditioned medium containing dexamethasone, beta-sodium glycerophosphate and ascorbic acid, with the osteoblasts in culture then divided into CHA group (in which the cells were cultured with CHA) and osteoblasts group (without CHA).

[Biomechanical study of double-plate fixation for comminuted fractures of the distal femur].

Objective: To explore the new treatment approach for comminuted fractures of the distal femur.

Methods: Supra- and intercondylar comminuted fractures were induced in the femurs of 20 fresh adult cadavers, 10 of which received fixation with lateral steel plates and medial polyethylenes plates while the rest with single plate in the lateral only. Biomechanical tests of bending, torsion and compression were performed.