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RECONSTRUCTION OF LEG AND ANKLE DEFECTS BY USING FREE RECTUS ABDOMINIS MUSCLE FLAPS WITH INTERMEDIATE SPLIT THICKNESS SKIN GRAFT

Objective To study the method and effect of free rectusabdominis muscle flaps with intermediate split thickness skin graft in repairing defects on legs and ankles.Methods From May 1998 to December 2002, 11 cases of defects on legs(2 cases) and on ankles( 9 cases) were repaired by use of unilateral free rectus abdominis flap with skin graft. The soft tissue defects were accompanied by osteomyelitis or the exposure of bone or tendon.The disease course was 1 month to 10 years. The defect size ranged 3 cm×4 cm to 8 cm×14 cm. The area ofrectus abdominis muscle flaps was 4 cm×6 cm to 8 cm×15 cm. Results All patients were followed up 6 months to 4 years after operation. All rectusabdominis flaps survived with good appearances and functions.The primary healing was achieved in 8 cases, intermediate split thickness skin graft necrosed in 3 cases and the wound healed after skin re-graft.Conclusion Free rectus abdominis flap is a proper option for repair of the soft tissue defects or irregular woundson legs and ankles. It has the advantages of abundant blood supply, b anti-infection ability, good compliance and satisfied appearance.

內踝上皮支皮瓣修復足踝部皮膚軟組織缺損

Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children

Objective To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. Methods The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed. There were 18 boys and 10 girls with an average age of 7.3 years (range, 6-14 years). There were 8 cases of traffic accident injury and 20 cases of chronic infection wound. The disease duration was 2-4 months, with an average of 2.8 months. After thorough debridement, the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm. Repairing was performed after 7-28 days of the infection in control. According to the location, size, and shape of the wound, the perforating vessels were located by ultrasonic Doppler, and the perforator propeller flap (area ranged from 6 cm×5 cm to 11 cm×6 cm) was designed and harvested to repair the wound. Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases. The donor site was sutured directly (22 cases) or repaired with skin graft (6 cases). Results Twenty-six flaps survived, of which 20 cases were in primary healing, and 6 cases had epidermal necrosis at the end of small paddle, which healed after dressing change. Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation. Primary wound healing was achieved in donor site. All 28 children were followed up 6-24 months (mean, 10.5 months). The texture, shape, and motor function of the lower limb was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Association (AOFAS) score was 89.8±8.0, which was significantly different from the preoperative score (79.6±10.4) (t=?11.205, P<0.001); 20 cases were excellent, 6 cases were good, and 2 cases were poor, and the excellent and good rate was 92.8%. ConclusionThe perforator propeller flap of lower limb in children has its own characteristics. It is a reliable method to repair the foot and ankle defect in children.

腓腸神經營養血管蒂逆行島狀皮瓣修復足踝部深度燒傷

足踝部皮膚軟組織缺損的修復

【摘 要】 目的 總結足踝部皮膚軟組織缺損修復方法及療效。 方法 2005 年8 月－ 2008 年8 月，收治46 例足踝部皮膚軟組織缺損患者。男40 例，女6 例；年齡12 ～ 68 歲，平均35 歲。交通事故傷31 例，機器碾壓傷6 例，醫源性損傷2 例，電擊傷1 例，糖尿病足潰瘍6 例。缺損范圍4 cm × 2 cm ～ 27 cm × 16 cm。病程4 h ～ 2 年。采用股前外側游離皮瓣12 例，腓腸神經營養血管皮瓣25 例，脛后動脈逆行皮瓣1 例，隱神經皮瓣2 例，腓動脈終末穿支皮瓣2 例，交腿皮瓣1 例，足底內側皮瓣2 例，跖背皮瓣1 例，皮瓣切取范圍4 cm × 3 cm ～ 28 cm × 18 cm；供區直接縫合或中厚皮片游離移植修復。 結果 術后46 例患者均獲隨訪，隨訪時間6 個月～ 3 年，平均11 個月。術后10 d 2 例腓腸神經營養血管皮瓣發生遠端部分壞死；其余皮瓣均成活，創面Ⅰ期愈合。供區植皮均成活，無明顯攣縮；切口Ⅰ期愈合。術后6 個月，1 例采用腓腸神經營養血管皮瓣修復的足底創面發生小面積潰瘍，經對癥處理后愈合；其余患者皮瓣質地、色澤正常。患者可負重行走，步態正常。 結論 合理采用局部帶蒂皮瓣或游離皮瓣修復足踝部皮膚缺損，可明顯縮短病程，達到保肢保足目 的。

Treatment of foot and ankle deformities combined with knee and lower limb deformities using QIN Sihe’s surgical strategy

Objective To summarize the clinical characteristics of foot and ankle deformities combined with knee and lower limb deformities and evaluate the advantages, clinical outcomes, and considerations of QIN Sihe’s surgical strategy for treating such complex deformities. Methods Between January 2022 and December 2024, 32 patients with foot and ankle deformities combined with knee and lower limb deformities were enrolled. The cohort included 23 males and 9 females, aged 10-67 years (mean, 41.1 years). The main etiologies included post-polio sequelae (20 cases) and congenital limb deformities (3 cases). Deformities were categorized as follows: equinovarus foot (12 cases), equinus foot (2 cases), equinovalgus foot (3 cases), equinus foot with swan-neck deformity (2 cases), calcaneus foot (5 cases), foot valgus (2 cases), knee flexion deformity (14 cases), genu recurvatum (4 cases), genu varum (3 cases), genu valgum (3 cases), lower limb shortening (3 cases), and lower limb external rotation (6 cases). QIN Sihe’s surgical strategies included osteotomies, tendon releases, and tendon transfers for deformity correction, followed by external fixation for residual deformity adjustment and stabilization. Outcomes were assessed using QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction. Results All patients were followed up 8-32 months (mean, 16.5 months). Complications included pin tract infection (1 case, 1 site), ankle pain (2 cases), delayed healing at the proximal tibial osteotomy site (1 case), and anterior talar dislocation (1 case). At last follow-up, insufficient correction of foot deformity was observed in 1 case; both knee and lower limb deformities were corrected, with only mild recurrence of knee flexion deformity in 1 case. The foot/ankle and knee joint function improved. Based on QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction, outcomes were rated as excellent in 30 cases and good in 2 cases, with an excellent-good rate of 100%. Conclusion Foot and ankle deformities combined with knee and lower limb deformities are complex, QIN Sihe’s surgical strategy can achieve satisfactory clinical outcomes for simultaneous correction.

逆行隱神經皮瓣交腿移位修復難治足踝部創面

目的 總結采用逆行隱神經皮瓣交腿移位修復難治足踝部創面的方法及療效。 方法 2005 年9 月－2010 年11 月，采用逆行隱神經皮瓣交腿移位修復9 例難治足踝部創面。男8 例，女1 例；年齡17 ～ 47 歲，平均34.5 歲。交通事故傷5 例，重物壓砸傷3 例；傷后至入院時間為2 h ～ 6 個月。脈管炎1 例，病程18 個月。缺損部位：踝部4 例，足跟部3 例，前足2 例。缺損范圍為6 cm × 5 cm ～ 17 cm × 11 cm。術中皮瓣切取范圍為8 cm × 6 cm ～ 16 cm × 10 cm，術后3 ～ 5 周行皮瓣斷蒂。供區游離植皮修復。 結果 1 例感染創面術后4 d 發生局限感染，經換藥處理后愈合，皮瓣成活；其余交腿皮瓣及供區植皮均順利成活，創面Ⅰ期愈合。患者均獲隨訪，隨訪時間6 ～ 34 個月，平均16 個月。皮瓣質地優良，無潰瘍發生。術后22 個月皮瓣兩點辨別覺為8 ～ 10 mm，均恢復保護性感覺。足踝均能負重行走，踝關節活動范圍：背伸8 ～ 20°，跖屈10 ～ 35°。供區術后足背內側感覺支配區麻木感范圍隨時間延長縮小。 結論 逆行隱神經皮瓣切取簡便，厚薄適度，不損傷知名血管，術后可恢復皮瓣感覺，有效防止皮瓣再破潰，是修復足踝部創面的較好方法之 一。

腓腸神經營養血管皮瓣修復足踝部軟組織缺損

總結腓腸神經營養血管皮瓣修復足、踝部軟組織缺損的臨床效果。 方法 2003 年3 月－2006 年7 月，應用腓腸神經營養血管皮瓣修復足、踝部軟組織缺損18 例，其中男10 例，女8 例；年齡6 ～ 52 歲。皮帶、車鏈絞傷15 例，砸傷3 例。合并踝關節、跗骨、跖骨骨折脫位5 例，跟踺缺損2 例，感染5 例。軟組織缺損8 cm ×6 cm ～ 17 cm× 8 cm。行急診手術8 例；擇期手術10 例。同時行關節和骨折內固定5 例，置管持續沖洗2 例，跟腱修復2 例。 結果 18 例皮瓣均成活。15 例傷口Ⅰ期愈合；1 例皮瓣邊緣表層壞死，經換藥、植皮后愈合；2 例傷口感染，換藥后愈合。患者獲隨訪8 個月～ 3 年，皮瓣外形、色澤、質地良好，踝關節功能滿意。背屈18 ～ 20°，跖屈30 ～ 35°。 結 論 腓腸神經營養血管皮瓣血運良好，操作簡便、安全，可有效修復足、踝部軟組織缺損。

聯體股前外側穿支皮瓣修復足踝部大面積軟組織缺損

目的總結應用聯體股前外側穿支皮瓣修復足踝部大面積軟組織缺損的方法與療效。方法2020年1月—2022年1月，應用聯體股前外側穿支皮瓣修復足踝部大面積軟組織缺損10例。男7例，女3例；年齡18～60歲，平均34歲。創面位于足部5例，踝關節及足部5例；均伴有骨、肌腱外露。皮膚缺損范圍為25 cm×7 cm～33 cm×13 cm。受傷至手術時間3～31 d，平均8 d。皮瓣切取范圍為26 cm×8 cm～34 cm×13 cm；蒂長7～16 cm，平均9.5 cm。通過與旋股外側動脈降支遠端或分支行內增壓6例，與受區血管分支吻合行外增壓4例。供區直接縫合8例，植皮修復2例。 結果術后9例皮瓣完全成活，1例出現皮瓣近端部分淺層壞死，經換藥后愈合；供區創面均Ⅰ期愈合，植皮均成活。10例患者均獲隨訪，隨訪時間3～24個月，平均11個月。皮瓣顏色、質地良好，負重區無壓瘡。2例皮瓣局部稍臃腫，予以二期削薄；余8例皮瓣外形良好。所有患者均恢復正常行走功能。術后3個月足踝部美國矯形足踝協會（AOFAS）評分達優6例、良3例、可1例，優良率90%。 結論聯體股前外側穿支皮瓣可切取較大面積和長度，且供區損傷小，是修復足踝部大面積軟組織缺損的理想方法之一。

Application of Taylor spatial frame for treating post-burn foot and ankle deformities in adults

Objective To investigate the safety and effectiveness of using the Taylor spatial frame (TSF) based on the Ilizarov tension-stress principle for treatment of post-burn foot and ankle deformities in adults. Methods A clinical data of 6 patients with post-burn foot and ankle deformities treated between April 2019 and November 2023 was retrospectively analyzed. There was 1 male and 5 females with an average age of 28.7 years (range, 20-49 years). There were 3 cases of simple ankle equinus, 2 cases of ankle equinus, midfoot rocker-bottom foot, and forefoot pronation, and 1 case of calcaneus foot and forefoot pronation. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 45.3±18.2, 12-Item Short-Form Health Survey (SF-12)-Physical Component Summary (PCS) score was 34.3±7.3 and Mental Component Summary (MCS) score was 50.4±8.8. Imaging examination showed tibial-calcaneal angle of (79.8±31.5)°, calcaneus-first metatarsal angle of (154.5±45.3)°, talus-first metatarsal angle of (–19.3±35.0)°. Except for 1 case with severe deformity that could not be measured, the remaining 5 cases had talus-second metatarsal angle of (40.6±16.4)°. The deformities were fixed with TSF after soft tissue release and osteotomy. Then, the residual deformities were gradually corrected according to software-calculated prescriptions. TSF was removed after maximum deformity correction and osteotomy healing. External fixation time, brace wearing time after removing the TSF, and pin tract infection occurrence were recorded. Infection severity was evaluated based on Checketts-Otterburns grading. Joint function was evaluated using AOFAS score and SF-12 PCS and MCS scores. Patient satisfaction was assessed using Likert score. Imaging follow-up measured relevant indicators to evaluate the degree of deformity correction. Deformity recurrence was observed during follow-up. Results The external fixation time was 103-268 days (mean, 193.5 days). The mild pin tract infections occurred during external fixation in all patients, which healed after pin tract care and oral antibiotics. No serious complication such as osteomyelitis, fractures, neurovascular injury, or skin necrosis occurred. After external fixation removal, 3 cases did not wear braces, while the remaining 3 cases wore braces continuously for 6 weeks, 8 weeks, and 3 years, respectively. All patients were followed up 13.9-70.0 months, with an average of 41.7 months. During follow-up, none of the 6 patients had recurrence of foot deformity. At 1 year after operation, the AOFAS score was 70.0±18.1, SF-12-PCS and MCS scores were 48.9±4.5 and 58.8±6.4, respectively, all showing significant improvement compared to preoperative values (P<0.05). Imaging follow-up showed that all osteotomies healed, and all distraction cases achieved bony union at 6 months after stopping stretching. At 1 year after operation, tibial-calcaneal angle was (117.5±12.8)° and talus-first metatarsal angle was (–3.3±19.3)°, both showing significant improvement compared to preoperative values (P<0.05). Calcaneus-first metatarsal angle was (132.0±14.4)°, which also improved compared to preoperative values but without significant difference (P>0.05). Except for 1 case with severe deformity that could not be measured, the remaining 5 cases had talus-second metatarsal angle of (18.0±6.4)°. And there was no significant difference (P>0.05) between pre-and post-operative data of 4 patients with complete data. At 1 year after operation, 1 patient was satisfied with effectiveness and 5 patients were very satisfied. Conclusion The TSF, by applying the Ilizarov tension-stress principle for gradual distraction and multi-planar adjustment, combined with soft tissue release and osteotomy, can effectively correct foot and ankle deformities after burns, especially equinus deformity with contracture of the posterior soft tissues of the lower leg. There are still limitations in treating cases with tight, adherent scars on the dorsum of the foot that require long-distance distraction. If necessary, a multidisciplinary approach combined with microsurgical techniques can be utilized.