ObjectiveTo explore the effectiveness and method of Ilizarov technology for the treatment of infected forearm nonunion.
MethodsBetween January 2004 and March 2014, 19 patients with infected forearm nonunion were treated, including 12 males and 7 females with a mean age of 37.4 years (range, 18-62 years). The injury causes included traffic accident in 11 patients, falling from height in 4 patients, and machine twist injury in 4 patients. The patients had received surgical treatment for 1-5 times (mean, 2.7 times). Bone defects located at the radius in 10 cases, at the ulna in 7 cases, and at the radius and ulna in 2 cases. The mean time of chronic infection was 8.3 months (range, 4-16 months). The mean length of the bone defects after debridement was 3.54 cm (range, 2.2-7.5 cm). Under the guidance of C-arm fluoroscope, the Orthofix unilateral external fixator was used to fix. Distraction was performed at 7-10 days after operation, and X-ray film was taken regularly to detect the osteogenesis.
ResultsThe mean external fixation time was 6.5 months (range, 3-12 months), and the mean external fixation index was 1.72 months/cm (range, 1.14-2.15 months/cm). All patients were followed up for 35.4 months on average (range, 24-55 months). The bone union time was 3-11 months (mean, 6 months); and no recurrence of infection was observed. At last follow-up, the mean wrist range of motion (ROM) were 52.78° (range, 42-55°) in flexion and 46.53° (range, 40-60°) in extension; the mean elbow ROM were 139.23° (range, 130-150°) in flexion and 3.57° (range, 0-20°) in extension; and the mean forearm ROM were 76.68° (range, 68-90°) in pronation and 81.75° (range, 72-90°) in supination.
ConclusionIlizarov technology for infected forearm nonunion can acquire satisfactory clinical results. Radical debridement is the key to control bone infection.
Objective To report the clinical characteristics and treatment analysis of 3 cases of congenital ulnar collateral flexor contracture of the forearm and take a reference for clinic. Methods A total of 3 patients with congenital ulnar collateral flexor contracture of the forearm were admitted between February 2019 and August 2021. Two patients were male and 1 was female, and their ages were 16, 20, and 16 years, respectively. The disease durations were 8, 20, and 15 years, respectively. They all presented with flexion deformity of the proximal and distal interphalangeal joints of the middle, ring, and little fingers in the neutral or extended wrist position, and the deformity worsened in the extended wrist position. The total action motion (TAM) scores of 3 patients were 1 and the gradings were poor. The Carroll’s hand function evaluation scores were 48, 55, and 57, and the grip strength indexes were 72.8, 78.4, and 30.5. Preoperative CT of case 2 showed a bony protrusion of the flexor digitorum profundus tendon at the proximal end of the ulna; and MRI of case 3 showed that the ulnar flexor digitorum profundus presented as a uniform cord. After diagnosis, all patients were treated with operation to release the denatured tendon, and functional exercise was started early after operation. Results The incisions of 3 patients healed by first intention. Three patients were followed up for 12, 35, and 12 months, respectively. The hand function and the movement range of the joints significantly improved, but the grip strength did not significantly improve. At last follow-up, TAM scores were 3, 4, and 4, respectively, among which 2 cases were excellent and 1 case was good. Carroll’s hand function evaluation scores were 95, 90, and 94, and the grip strength indexes were 73.5, 81.3, and 34.2, respectively. ConclusionCongenital ulnar collateral flexor contracture is a rare clinical disease that should be distinguished from ischemic muscle contracture. The location of the contracture should be identified and appropriate surgical timing should be selected for surgical release. Active postoperative rehabilitation and functional exercise can achieve good hand function.
Objective To study the repair and function reconstruction of complex soft tissue defect of posterior of hand and forearm. Methods From May 2001 to November 2003, 8 cases of soft tissue defect of posterior of hand and forearm were repaired with thoracico abdominal flaps with hilum for primary stage. The tendon transplantation and allogeneic tendon function reconstruction of hand were performed for secondary stage. The range of the flap was 9 cm×15 cm to 12cm×38 cm. Allogeneic tendon amounted to 6.Results All the flaps survived. The flap countour was good. The results of allogeneic tendon transplantation were satisfactory and the function of hand was good. Conclusion Repairing complex soft tissue defect of posterior of hand and forearm and reconstructing hand function by use of thoracico abdominal flaps with hilum and transplantation of allogeneic tendon have the satisfactory clinical results.
【摘要】 目的 〖JP2〗探討護理干預對前臂游離皮瓣移植修復口腔癌圍手術期軟組織缺損患者的經驗。 方法 2005年6月—2009年6月，對收治的63例口腔癌術后軟組織缺損應用前臂橈側游離皮瓣修復患者的圍手術期護理方法進行回顧性分析，并做好術前心理護理及相關準備，術后嚴密觀察皮瓣移植情況，以便及時發現血管危象，同時做好口腔、呼吸道、體位及皮瓣供受區護理。 結果 通過精心護理，密切觀察移植皮瓣，及早發現、及時處理血管危象，從而確保63例患者皮瓣移植一次性成活率達95.24%，療效滿意。 結論 科學合理的圍手術期護理是前臂游離皮瓣移植修復口腔癌術后軟組織缺損成功的重要保證。【Abstract】 Objective To investigate the perioperative nursing experiences of the transplanted forearm free flaps for reconstruction of soft tissue defects after oral cancer operation. Methods We retrospectively analyzed the clinical data of perioperative nursing care for 63 patients with soft tissue defects after oral cancer reconstructed with radial forearm free flaps. Psychological care and related preparation work was well carried out before operation. After operation, we closely monitored the outcome of transplantation of skin flaps to detect vascular crisis as early as possible, and at the same time, intensive care for oral cavity, respiratory tract, flap position and the affected areas was done. Results By intensive care, closely monitoring the transplanted flaps, and early discovery and management of the vascular crisis, we achieved a satisfying one-time transplantation survival rate of 95.24% for the 63 patients. Conclusion Scientific and proper perioperative care is an important factor in the successful reconstruction of soft tissue defects with free forearm flaps after oral cancer operation.
Objective To summarize the current research progress of finger flexion deformity caused by forearm flexor muscle lesions, providing a reference for clinical diagnosis and treatment. Methods The domestic and international literature about finger flexion deformity caused by forearm flexor muscle lesions was extensively reviewed and a summary analysis from the etiology and pathogenesis, diagnosis and differential diagnosis, and treatment methods was conducted. Results The three types of forearm flexor pathology leading to finger flexion deformity include Volkmann’s contracture, pseudo-Volkmann’s contracture, and congenital flexor muscle lesions with different pathogenesis. The diagnosis is mainly based on the patient's medical history, clinical features, and imaging examinations, with attention paid to differential diagnosis. Currently, conservative treatment for such deformities is not very effective, and surgical treatment is mainly adopted. According to the causes and severity, options such as resection of the contracture band, resection of contracture band, release of compressed muscle (tendon), and flexor origin muscle sliding surgery, could be performed to correct hand deformities and restore hand function, and thus resulting in favorable outcomes. Conclusion Volkmann’s contracture, pseudo-Volkmann’s contracture, and congenital flexor muscle lesions causing finger flexion deformity have different causes and pathogenesis, which can be distinguished by carefully inquiring about the medical history, the clinical characteristics of the three, and imaging examinations, thereby selecting appropriate treatment methods.
