Analysis of the Therapeutic Effect of Artificial Leather Embedding Combined with Fascial Sleeve Flap Transplantation on Chronic Wounds of Lower Limbs with Bone and Plate Exposure

Background: After severe trauma of lower limbs, bone、tendon or plate graft exposure is common.The traditional repair method is to use a variety of skin flap transplantation to cover the exposed part, but the wound often can not heal after operation, or the wound is cracked, ulcer, sinus, bone and steel plate are exposed again after wound healing.The reason for this result is that when the flap is covered, the space around the bone plate is not well closed, forming a dead cavity, blood and exudate accumulation, hematoma formation or infection, and finally the wound ruptures again. In addition, due to the swelling and contracture of the flap after operation, the suture tension between the flap and the receiving area becomes larger, the skin becomes thinner and broken, and then the wound is formed. In order to solve the above problems, we carried out the study of artificial true skin embedding combined with fascial sleeve flap transplantation in the treatment of chronic bone plate exposed wounds of lower limbs.Methods: In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 9 cases and the lateral superior malleolar artery perforator flap in 2 case. Results: The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions: Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs.

Application of Artificial Dermal Graft Combined with Fascia Sleeve Flap in the Treatment of Chronic Bone and Steel Plate Exposed Wounds of Lower Extremities

Background:Bone tendon or graft exposure such as steel plate is common after severe trauma of lower extremity.The traditional repair method is to use a variety of skin flaps to cover the exposure, but the wound can not heal after operation, or the wound dehiscence, ulcer, sinus, etc. occur again after short healing, and the bone plate is exposed again.The reason for this result is that the space around the bone plate is not well closed when the flap is covered，dead space is formed, blood and exudate accumulate, hematoma forms or infection occurs, and finally the wound breaks.Also due to swelling and contracture after flap operation,the tension of the suture between the flap and the receiving area is too large and becomes thin and cracked, forming an exposed state.In order to solve the above problems, we have carried out the research on "Application of artificial gradient combined with fascia sleep flap in the treatment of chronic bone and steel plate exposed woods of lower extremes".Methods:In this paper, 11 cases of chronic wounds with bone exposure and skin necrosis after steel plate implantation were selected. First stage is the wound bed preparation including primary wound expansion,removal of necrotic tissue and incision of sinus wall, removal of deep necrotic bone and fibrotic scarred skin on the outer wall of steel plate to normal tissue on the outer edge of the wound, removal of precipitated peptone and purulent fur in the hole, periphery and bone space of the steel plate, and removal of tendon tissue with basal necrosis and disintegration of the wound. After vacuum sealing drainage (VSD) 1~2 weeks, the peritraumatic basal granulation tissue grew well and there was no necrotic tissue in the wound. In the second stage, the exposed bone was covered with artificial dermis, the steel plate hole or the periphery and the basal space were filled, and the exposed steel plate was completely embedded, and then the fascia sleeve flap was transplanted to cover the wound. The sural neurovascular flap was performed in 6 cases and the lateral superior malleolar artery perforator flap in 1 case. Results:The flap survived well in all 11 cases. During the follow-up of 6 months to the removal of the plate, there was no case of rupture, exposure and sinus formation.Conclusions:Artificial dermal covering combined with fascial sleeve flap transplantation can effectively avoid wound dehiscence or sinus formation caused by foreign body retention, infection and flap contracture,It has good effect in repairing chronic wounds with bone plate exposure after severe trauma of lower limbs,.

The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique

Background The aim of this research is to present our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method.Methods Between 2008 and 2016, soft tissue coverage with pedicled neurotrophic flap followed by distraction osteogenesis using Ilizarov external fixator was performed in 25 patients for reconstruction of segmental bone defects of lower extremity complicated by massive loss of soft tissue. There were 16 men and 9 women: their mean age was 39 years (23 to 57) at the time of surgery. The soft tissue defect after radical debridement ranged from 5 × 9 cm2 to 11 × 14 cm2, and the average size of segmental defect was 5.02 (2.5 to 7.5) cm.Results The distally based sural neurovascular flap was performed in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.74 (4.5 to 9.5) cm. The function was judged to be excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in 7 patients. Complications observed in the process of the treatment included pain, pin tract infections (PTI), ankle midfoot joints stiffness, and nonunion of docking sites. All the cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection.Conclusions The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis should be considered to be an effective alternative approach in the salvage treatment of the massively traumatized and chronically infected lower extremity.

The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique

Background The aim of this research is to present our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method.Methods Between 2008 and 2016, soft tissue coverage with pedicled neurotrophic flap followed by distraction osteogenesis using Ilizarov external fixator was performed in 25 patients for reconstruction of segmental bone defects of lower extremity complicated by massive loss of soft tissue. There were 16 men and 9 women: their mean age was 39 years (23 to 57) at the time of surgery. The soft tissue defect after radical debridement ranged from 5 × 9 cm2 to 11 × 14 cm2, and the average size of segmental defect was 5.02 (2.5 to 7.5) cm.Results The distally based sural neurovascular flap was performed in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.74 (4.5 to 9.5) cm. The function was judged to be excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in 7 patients. Complications observed in the process of the treatment included pain, pin tract infections (PTI), ankle midfoot joints stiffness, and nonunion of docking sites. All the cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection.Conclusions The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis should be considered to be an effective alternative approach in the salvage treatment of the massively traumatized and chronically infected lower extremity.Trial registration: This article has been retrospectively registered.

The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique.

Background The aim of this research is to present our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method. Methods Between 2008 and 2016, soft tissue coverage with pedicled neurotrophic flap followed by distraction osteogenesis using Ilizarov external fixator was performed in 25 patients for reconstruction of segmental bone defects of lower extremity complicated by massive loss of soft tissue. There were 16 men and 9 women: their mean age was 39 years (23 to 57)at the time of surgery. The soft tissue defect after radical debridement ranged from 5 × 9 cm2 to 11 × 14 cm2, and the average size of segmental defect was 5.02 (2.5 to 7.5) cm. Results The distally based sural neurovascular flap was performed in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.74 (4.5 to 9.5) cm. The function was judged to be excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in 7 patients. Complications observed in the process of the treatment included pain, pin tract infections (PTI), ankle midfoot joints stiffness, and nonunion of docking sites. All the cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection. Conclusions The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis should be considered to be an effective alternative approach in the salvage treatment of the massively traumatized and chronically infected lower extremity.

A modern series of subdiaphragmatic craniopharyngiomas

OBJECTIVEThe endoscopic endonasal approach has been proposed as a primary surgical strategy for select craniopharyngiomas. However, those tumors that arise from the sella have not been classified with the other craniopharyngioma subtypes in terms of surgical nuances, intraoperative findings, and postoperative outcomes. The authors describe their experience with a select subtype of craniopharyngioma arising within the sella subjacent to the diaphragma sellae and refer to these tumors as type 0.METHODSAfter obtaining IRB approval, three institutions retrospectively reviewed their data collected from 2005 to 2017. Patients eligible for inclusion in the study were those who had tumors that originated from the sella inferior to the diaphragma sellae. Demographic, clinical, radiological, surgical, and follow-up data were examined and analyzed.RESULTSTwenty-eight patients (average age 19.3 years, range 3–60 years) were included in this study. Sixteen patients (57%) were younger than 18 years of age. All patients had characteristic imaging features of an expanded sella. Seventy-five percent of the patients presented with some form of visual field deficit (89% had radiographic optic apparatus compression) and 39% with hypopituitarism. The average maximal tumor diameter in the axial, coronal, or sagittal plane was 3.1 cm. Gross-total resection was achieved in 82% of the patients. Twenty-one percent of patients experienced an iatrogenic complication, and there were only two cases (7%) of postoperative cerebrospinal fluid (CSF) leakage. Only two patients (7%) required the use of a nasoseptal flap as part of their original reconstruction. Pathology was uniformly the adamantinomatous subtype. Postoperative objective visual outcomes were improved in 71% of the patients with visual symptoms or visual field deficits on presentation and stable in 24%. Mean follow-up was 45.1 months (range 3–120 months) with an 18% recurrence rate at a mean of 44.4 months (range 10–84 months). One patient was lost to follow-up. Thirty-six percent of patients received postoperative radiation to treat recurrence or residual tumor. Endocrine data are also presented.CONCLUSIONSCraniopharyngiomas that originate within the sella below the diaphragma sellae are a select subtype characterized by 1) an enlarged sella, 2) an intact diaphragma sellae at surgery, and 3) an adamantinomatous pathology. These tumors can be treated transnasally without the absolute need for neurovascular flap reconstruction, as there is a low risk of CSF leakage.