Objective
To explore the effectiveness of modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis in treatment of soft tissue defects in the middle and lower segments of the leg.
Methods
Between March 2011 and June 2015, 15 cases with skin and soft tissue defects in the middle and lower segments of the legs were treated. There were 9 males and 6 females, aged 22-48 years (mean, 32.6 years). Of whom, 8 patients caused by traffic accidents, 5 by machine twist, and 2 by crash injury of heavy object. The mean interval from injury to admission was 82.6 hours (range, 2 hours to 1 week). The area of defect ranged from 13 cm×9 cm to 23 cm×16 cm. After primary debridement and vaccum sealing drainage treatment, the defects were repaired with modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis. The size of flap ranged from 15 cm×10 cm to 25 cm×15 cm. The donor sites were sutured directly or repaired with the skin grafts. The pedicle division was done at 4 weeks after operation.
Results
After operation, venous crisis occurred in 1 case and distal skin necrosis in 2 cases which was healed by dressing change. The other tissue flaps survived successfully and wounds healed by first intention. All skin grafts at donor site survived after operation, and primary healing of wound was obtained. All patients were followed up 6-24 months (mean, 13 months). All flaps were characterized by soft texture, satisfactory appearance, and restoring the protective sensation. Moreover, the two-point discrimination ranged from 15 to 28 mm (mean, 19.5 mm) at 6 months after operation. The function of both lower extremities were normal without obvious contracture of scar at donor site.
Conclusion
Modified free anterolateral thigh perforator flap, with little damage in donor site, a reliable blood supply by making a cross-bridge microvascular anastomosis with pretibial or posterior tibial blood vessel on normal leg, is a reliable alternative method for repairing soft tissue defects with the main vessels of serious injury in the middle and lower segments of the leg.
ObjectiveTo investigate the effectiveness of Masquelet technique combined with flap transplantation in treatment of infectious bone and soft tissue defects of the lower leg.MethodsBetween January 2013 and January 2017, 35 cases of infectious bone and soft tissue defects of lower leg were treated with Masquelet technique combined with flap transplantation. There were 21 males and 14 females, with an average of 31.5 years (mean, 25-55 years). All patients were tibial fractures caused by trauma and the infections occurred after debridement or internal fixation. The time from injury to admission was 1 to 6 months, with an average of 3.2 months. Defect located at the proximal leg in 11 cases, the middle leg in 11 cases, and the distal leg in 13 cases. The length of tibia defect after debridement ranged from 5.6 to 11.2 cm, with an average of 7.1 cm. The size of soft tissue defect ranged from 14.2 cm×6.9 cm to 17.3 cm×8.7 cm. Bacterial culture of purulent secretion of wound was positive in 18 cases. After debridement, the bone cement was used to fill the bone defect and the flap transplantation was used to repair the wound. The bone cement was taken out at 8 to 12 weeks after the one-stage operation, and the bone defect was repaired with autogenous iliac bone or combined with artificial bone.ResultsThree cases had necrosis at the distal edge of the flap after one-stage operation, and survived after dressing change. The other flaps survived successfully, and the wounds healed by first intention. All incisions healed by first intention after two-stage operation. All patients were followed up 24-32 months, with an average of 27 months. The color of the flap was similar to that of the surrounding normal tissue, and its texture was good. X-ray reexamination showed that all bone defects healed after 6-8 months, with an average of 6.7 months. At 9 months after two-stage operation, according to the revised Edwards tibial fracture evaluation standard, 19 cases were excellent, 14 cases were good, and 2 cases were poor, the excellent and good rate was 94.3%. The American Orthopedic Ankle Association (AOFAS) score was 60-98, with an average of 81.3. And 21 cases were excellent, 11 were good, and 3 were fair, with an excellent and good rate of 91.4%.ConclusionMasquelet technique combined with flap transplantation is an effective treatment for infectious bone and soft tissue defects of lower leg.
ObjectiveTo explore the surgical technique and effectiveness of limited bone and soft tissue surgery combined with Ilizarov technique in the treatment of adolescents severe cerebral palsy with flattened valgus foot and lower leg external rotation deformity. MethodsA retrospective analysis was conducted on 12 patients with severe cerebral palsy with flattened valgus foot and external rotation deformity of the lower leg, totaling 16 feet, admitted between January 2022 and January 2025. There were 5 males with 7 feet and 7 females with 9 feet, the age ranged from 12 to 18 years, with an average of 15 years. There were 10 cases on the left foot, 6 cases on the right foot, and 4 cases on both feet. The preoperative external rotation angle of the lower leg ranged from 20° to 35°, with an average of 26°. The preoperative visual analogue scale (VAS) score was 4.9±0.9, the American Orthopaedic Foot & Ankle Society (AOFAS) score was 68.7±12.0, the calcaneal tilt angle was (12.69±1.78)°, and the hindfoot angle was (18.69±3.55)°. Patients with bilateral lower leg deformities underwent surgery in two phases, with an interval of 3-6 months between surgeries. Select soft tissue surgery (Achilles tendon elongation, release or transposition of joint capsule and ligaments) and bone surgery (joint fusion, calcaneal osteotomy, medial wedge osteotomy, etc.) combined with tibiofibular internal rotation osteotomy and Ilizarov external fixation were selected according to the patient’s condition. At 1 week after operation, the external fixators of the lower leg and ankle were slowly adjusted, and the deformities that were not completely solved in the three-dimensional correction operation were corrected. Postoperative pain relief and functional recovery were evaluated by VAS and AOFAS scores, and the improvement of foot deformity was evaluated by calcaneal tilt angle and hindfoot angle on radiographic data, and the postoperative effctiveness was evaluated according to the International Clubfoot Study Group (ICFSG). Results At 2 weeks after operation, the foot deformity of the patient was basically adjusted. All patients were followed up 6-36 months, with an average of 18 months. The incisions healed by first intention without nerve injury, infection, or other complications. At last follow-up, the patients recovered satisfactorily, the osteotomy sites healed, and the external rotation of the lower leg was corrected. The VAS score was 1.2±0.1 and AOFAS score was 86.7±6.8, which were significantly different from those before operation (P<0.05). The calcaneal tilt angle was (18.38±1.15)° and the hindfoot angle was (10.06±2.93)°, which were significantly different from those before operation (P<0.05). According to the ICFSG scoring standard, 13 feet were excellent and 3 feet were good, and the excellent and good rate was 100%. ConclusionThe combination of bone and soft tissue limited surgery and Ilizarov technique is a safe, minimally invasive, and effective method for treating severe cerebral palsy in adolescents with flattened valgus foot and external rotation deformity of the lower leg. It conforms to biological principles and follows the concept of natural bone reconstruction.
