Objective To investigate the effectiveness of groin flap combined with medial plantar artery perforator flap (MPAP) for degree Ⅲ-Ⅳ defects of multiple fingers. Methods Between January 2018 and June 2019, 12 patients with degree Ⅲ-Ⅳ defects of multiple fingers caused by crushing were admitted. There were 9 males and 3 females with a median age of 29 years (range, 16-42 years). The mean interval between the injury and admission was 3 hours (range, 1-9 hours). The injured fingers of 7 cases were index and middle fingers, 4 cases were middle and ring fingers, and 1 case was index, middle, and ring fingers. All fingers were taken thorough debridement and covered by the vacuum sealing drainage device during the emergency operation. The mean interval between the debridement and flap repairing was 18 hours (range, 12-36 hours). During the first-stage operation, the iliac bone graft was used to reconstruct bone frame, and the proximal interphalangeal (PIP) joint from the foot was transferred as the digital PIP joint, then the thin groin flap and MPAP were tailored to cover the dorsal and palmar defects, respectively. The size of the groin flap was 7.0 cm×4.5 cm-14.0 cm×9.0 cm, and the size of the MPAP was 8.0 cm×4.5 cm-14.0 cm×6.5 cm. The abdominal donor site was directly sutured, and the foot was repaired with full-thickness skin grafting. The flaps were separated into the finger shape at the second-stage. Results All the flaps survived, and the wounds healed by first intention; the incisions in the donor site healed by first intention, and the skin grafts survived completely. All patients were followed up 12-18 months (mean, 16 months). At last follow-up, the injured finger was similar to the contralateral one in terms of texture, appearance, and color. The mean two-point discrimination was 8 mm (range, 6-10 mm), and the sensate level recovered to the S3-S4. According to the Michigan Hand Outcomes Questionnaire (MHQ), the reconstructed hand function was excellent in 8 cases and good in 4 cases. There was no complication in the donor sites. Conclusion The degree Ⅲ-Ⅳ defects of multiple fingers were repaired by the groin flap and MPAP, and the reconstructed fingers can perform good texture and motion with being sensate, with less sacrifice on the foot.
OBJECTIVE: To provide a new reconstructive method to treat refractory ulcers on the sole of the forefoot. METHODS: The reversed medial plantar flap with the medial plantar pedal artery and vein as pedicle was used to treat the refractory ulcers on the sole of the forefoot in 5 cases. The size of the flap was 3.5-5.0 cm x 4.0-5.5 cm. The deformities were corrected at the same time and the flaps were protected after operation. RESULTS: All flaps survived without complications. There was no recurrence after 6-month following-up. The patients could walk. CONCLUSION: The distal ends of medial plantar pedal artery and vein have plenty anastomoses with dorsal pedal artery and deep plantar arch. The reversed medial plantar flap has reliable blood supply by these anastomoses. The reversed medial plantar flap should be a choice in treating refractory ulcers on the sole of the forefoot.
Turning gait is very common in daily lives. However, study of turning is still limited. For researching the differences of the walking characteristics between straight gait and turning gait and between different turning strategies, and for analyzing the endopathic factor, this study selected 10 healthy young men to perform straight walking and 90° turning using two turning strategies (outside leg turning and inside leg turning). The Vicon capture system and plantar pressure capture system were used to measure gait parameters and plantar pressure parameters at the same time. The study showed that stride velocity reduced while stride time and proportion of stance time increased when turning was compared to straight walking. Inside leg turning strategy needed stronger muscle controlling and could promote turning, while outside leg turning strategy was more stable. This results will offer data for projecting gait of biped robot and provide reference value for walking rehabilitation training design and development of walking assistive equipments, etc.
Objective To investigate the operative procedure and the short-term therapeutic effects of medial plantar venous flaps for estoration of soft-tissue defects on the volar aspect of fingers. Methods From May 2007 to July 2009, 13 cases (15 fingers) of volar soft tissue defects were treated with medial plantar venous flaps, including 7 males (9 fingers) and 6 females(6 fingers) with an average age of 30 years (range, 17-55 years). Soft tissue defects were caused by electric saws in 4 cases (5 fingers), by crush injury in 6 cases (6 fingers), and by burned scar removal in 3 cases (4 fingers). The size of soft tissue defects ranged from 1.0 cm × 0.9 cm to 5.8 cm × 3.3 cm, included 5 thumbs, 3 index fingers, 3 l ittle fingers, 2 ring fingers, and 2 middle fingers. The emergency surgical treatment was performed in 10 traumatic cases after 2 to 12 hours (4 hours on average); and the elective surgical treatment was performed in the other 3 cases of scar after burn. The 15 medial plantar venous flaps, with size of 1.0 cm × 1.0 cm to 6.0 cm × 3.5 cm, were harvested to restore defects. Of them, 12 venous flaps had 1 superficial vein and the other 3 had 2 veins; and the veins of 13 venous flaps bridged a single digital artery and the veins of the other 2 flaps bridged both arteries. The donor sites were sutured directly or were covered with skin graft. Results All 15 venous flaps survived completely, and the donor and reci pient sites healed by first intention. Eleven cases (11 fingers) were followed up for 2 to 12 months. The texture and color of the flaps were similar to those of adjacent normal skin with a satisfactory appearance. The two-point discrimination was 6-9 mm. According to criterion for joint junction of total active range of motion/total active range of flexion, the results were excellent in 10 cases and good in 1 case; the excellent and good rate was 100%. Conclusion The medial plantar venous flap has advantages of easy-to-operate, rich blood supply and high survival rate. So it is an ideal and rel iable choice for volar soft tissue defects of fingers.
【摘要】 目的 探討應用足底內側動脈穿支蒂皮瓣修復足跟皮膚缺損的臨床應用。 方法 1998年9月-2009年3月，應用此皮瓣修復足跟皮膚軟組織缺損42例。術前對創面作充分準備，術中以術前彩色多普勒超聲探測的足底內側血管及穿支走向為軸心，根據需要設計皮瓣，沿皮瓣兩側向中間顯露，在踇展肌與趾短屈肌之間解剖出足底內側血管主干，顯露動脈穿支及伴行神經。將血管向近端分離獲得足夠長度后，掀起皮瓣，切取完成并將皮瓣行明道轉移修復創面。 結果 除2例術后4 d出現皮瓣遠端部分壞死，經換藥后愈合，其余40例皮瓣均全部成活。 結論 足底內側動脈穿支蒂皮瓣是修復足跟軟組織缺損的一種理想皮瓣。【Abstract】 Objective To study the clinical application of perforator artery flap of medial plantar in repairing skin defect of the heelstick. Methods From September 1998 to March 2009, skin defects of the heelstick of 42 patients were repaired with the perforator artery flap of medial plantar. Adequate preparations were given on the wound before operation. Based on the results of color Doppler ultrasound of the medial plantar vascellum before or during the operation, the flap was designed according to the size of the defect and transferred to repair the defect. Results All the flaps survived completely except two flaps were partial lynecrotic in the distal, which healed after change of dressing. Conclusion Perforating artery flap of medial plantar is an ideal way to repair skin defect of the heelstick.
Objective To investigate the effectiveness of the wrap-around great toe flap combined with medial plantar artery perforator flap (MPAP) for repairing the completely degloved fingers. Methods Between February 2018 and December 2019, 12 patients with the completely degloved fingers caused by machine strangulation were admitted. There were 9 males and 3 females with a median age of 32 years (range, 18-42 years). The injured finger was index finger in 7 cases, middle finger in 3 cases, and ring finger in 2 cases. The skin was avulsed from the metacarpophalangeal joint level, with the intact tendon and joint. The interval between injury and admission was 1-8 hours (mean, 5 hours). All fingers were taken debridement during the emergency operation. The size of the skin defect ranged from 8.0 cm×5.0 cm to 12.0 cm×7.5 cm. After flap thinning, the wrap-around great toe flap (8.0 m×2.0 cm-12.0 cm×3.5 cm) and MPAP (8.0 cm×4.0 cm-12.0 cm×5.5 cm) were used to repair the degloved finger. The donor sites were repaired with the full-thickness skin graft or the flap. Results All flaps and skin grafts survived completely without significant complications and the wounds at recipient and donor sites healed by first intention. All patients were followed up 12-16 months (mean, 14 months). The texture, appearance, and color of the affected fingers were close to those of normal fingers, and the nails grew normally. At last follow-up, the mean two-point discrimination of the flap was 9 mm (range, 8-10 mm), and the sensation of the injured finger recovered to S3-S4. And 10 cases were rated as excellent and 2 cases as good according to the Michigan Hand Outcomes Questionnaire (MHQ). There was no complication such as pain from walking or skin ulceration at the donor site. The American Orthopaedic Foot and Ankle Society (AOFAS) score was excellent in 9 cases and good in 3 cases. Conclusion Treating for the completely degloved fingers, the wrap-around great toe flap combined with MPAP can obtain good effectiveness in the respect of the sensation, function, and appearance.
