Background Traditional research methods have limited the application of anterior tibial artery perforator flap due to incomplete knowledge of the perforator. This study aimed to investigate the feasibility of three-dimensional digitalized virtual planning of free anterior tibial artery perforator flap for repairing soft tissue defects in extremities. Methods A total of 11 patients with soft tissue defects in extremities were included. The patient underwent computed tomography angiography (CTA) of bilateral lower limbs, and then the three-dimensional models of bones, arteries, and skin were constructed. Septocutaneous perforators with appropriate length and diameter were selected to design anterior tibial artery perforator flaps in software, and the virtual flaps were superimposed onto the patient's donor site in a translucent state. During the operation, the flaps were dissected and anastomosed to the proximal blood vessel of the defects as designed. Results Three-dimensional modeling showed clear anatomical relationships between bones, arteries, and skin. The origin, course, location, diameter, and length of the perforator obtained during the operation were consistent with those observed preoperatively. Eleven anterior tibial artery perforator flaps were successfully dissected and transplanted. Postoperative venous crisis occurred in one flap, partial epidermis necrosis occurred in another flap, while the remaining flaps completely survived. One flap was treated with debulking operation. The remaining flaps maintained aesthetic appearance, which did not affect the function of the affected limbs. Conclusions Three-dimensional digitalized technology can provide comprehensive information on anterior tibial artery perforators, thus assisting in planning and dissecting patient-specific flaps for repairing soft tissue defects in extremities.

目的 探讨术前计算机断层扫描血管造影(CTA)精准定位胫后动脉穿支皮瓣在手部创面中的应用价值.方法 回顾性分析2017年3月—2019年6月中国人民解放军联勤保障部队第九二〇医院骨科收治的8例手部软组织缺损患者临床资料,男性6例,女性2例;年龄20～55岁,平均35.6岁.致伤原因:机器绞伤4例,切割伤3例,电击伤1例.依据术前CTA观测胫后动脉穿支数量及穿出点位置,设计并切取游离胫后动脉穿支皮瓣修复手部创面,测量皮瓣切取面积,观察皮瓣移植术后成活情况,记录供区创面闭合方式,观察手功能恢复效果.结果 下肢CTA可观察到胫后动脉穿支平均数量为:左侧3.3支,右侧3.9支,每个穿支以距内踝距离精确定位.依据CTA观测结果设计胫后动脉穿支皮瓣,皮瓣均顺利切取,皮瓣切取面积:2cm×4cm～6cm×10cm,小腿供区6例直接缝合,2例植皮.术后皮瓣均存活,无血管危象、皮瓣坏死发生,供区创面均顺利愈合,手功能恢复良好.结论 术前CTA精准定位能准确观察并测量胫后动脉穿支血管走形、位置,为皮瓣设计提供了影像学依据.游离胫后动脉穿支皮瓣不牺牲主干血管,厚度适中,是修复手部创面理想的选择之一.

目的 观察股方肌骨瓣结合髂骨或股骨大转子植骨治疗股骨颈骨不连的疗效.方法 2006年8月至2016年3月,收治股骨颈骨折骨不连患者33例,男23例,女10例,年龄19～48岁,平均31.5岁,均为GardenⅣ型.术后采用Harris髋关节评分标准进行髋关节评分:总分100分,90～100分为优,80～90分为良,70～80分为可,70分以下为差.结果 33例患者术后获2～12年随访,平均(38.65±25.90)个月,患者全部临床愈合,愈合时间为4～ 16个月,平均愈合时间为(6.53±2.71)个月.术后无内固定松动失败,1例患者术后伤口感染,给伤口清创,放置万古霉素骨水泥棒后感染愈合.31例患者双下肢等长,无髋内外翻畸形;2例患者出现股骨颈短缩,髋内翻畸形.无股骨头坏死发生,末次随访,Harris髋关节评分标准评分65～95分,平均(88.54±7.46)分:优26例,良3例,可2例,差2例,优良率为89.9％.结论 股方肌骨瓣结合髂骨或股骨大转子植骨治疗股骨颈骨不连是一种操作简单、疗效确切的治疗方法.

Objective To investigate the effect and characteristics of anterolateral thigh flap in repair of extremity wound in children.Methods A retrospective case series study was conducted to analyze the clinical data of 69 patients with limb soft tissue defects admitted to Kunming General Hospital of PLA from January 2008 to December 2016.There were 57 boys and 12 girls,aged 2-15 years (mean,6.7 years).There were 56 cases of lower extremity wounds and 13 cases of upper limb wounds.The wound areas ranged from 3 cm ×4 cm to 14 cm × 15 cm,with an average of 52.4 cm2.All wounds were repaired with the anterolateral thigh flap.The type of flap,number of perforators,type of perforation,closure of donor site,healing of the flap,complications,and reoperation were recorded.Results Seventy anterolateral thigh flaps were harvested in 69 children,including 42 musculocutaneous flaps and 28 perforator flaps.Intraoperative visualization identified 76 perforators,including 14 septocutaneous and 62 musculocutaneous perforators.The donor site was closed primarily in 52 cases,and a split-thickness skin graft was required in 18 cases.After operation,vascular crisis occurred in four cases.After exploration,one flap survived,and partial necrosis was found in three flaps.Except for one flap with total necrosis because of infection,the rest of the flaps survived.Other postoperative complications included flap edge necrosis in six cases,local infection in six,and wound dehiscence in three.The follow-up ranged from 6 to 33 months,averaged 14.9 months.Hypertrophic scar occurred at donor site in 27 children.The number of reoperation was 46,including 23 debulking procedures,seven skin grafts,four debridements,and 12 others.Conclusions The anterolateral thigh flap is a safe,reliable option for reconstruction of soft tissue defects in extremities of children.The anterolateral thigh musculocutaneous flap is used commonly in children.However,hypertrophic scar at donor site occurs more often after flap surgery,with high rate of reoperations.

In this study, Graphene Nanoplates/Al7075 (GNPs/Al7075) composites were prepared by powder metallurgy and hot extrusion. And the microstructure and mechanical behavior of GNPs/Al7075 composites prepared by ball-milling and hot extrusion were investigated. Compared with the unreinforced Al7075 matrix, these composites possess significantly improved stiffness and tensile strength.

Objective To explore how to overcome the difficulties during two paddle anterolateral thigh flap harvest. Methods From January, 2009 to December, 2015, the harvest of two paddle anterolateral thigh flap was encountered difficulties during surgery in 8 cases, which were 7 males and 1 female. The age was ranged from 16 to 48 years old, with averaged of 32.8. Six patients presented with one defect, and 2 patients presented with two defects. The skin defects ranged from 60-247 cm2. The number of the flap perforator, vascular source, flap pattern and out-comes was recorded. All patiants were followed-up at regular intervals. Results All of 8 flaps were converted suc-cessfully during surgery. Only 1 perforator was found in 4 cases. The flap was converted to sigle perforator flap. The dornor site was covered by skin graft. Two perforators from different origins were found in 2 cases, and the flap was converted to sequential chimeric flap. Two perforators from descending branch and transverse branch respectively were found in 1 case, and the flap was converted to combined anterolateral thigh and tensor fascia lata flap. Only 1 perfora-tor was found in 1 case, which the distal defect was small sized, the flap was converted to deepithelialized two paddle flap. The flap ranged from 78-288 cm2. Venous compromise was happened in 1 case, and the flap survived after reex-ploration surgery. Local infection was found in 2 cases, and cured with wound dressing. Other flaps were survived un-eventfully. At donor site, 1 case wound dehiscence and 1 case local infection, both of which underwent debridement and healed. All patiants were followed-up for 7-21(mean, 11.5)months. The flaps had satisfactory appearance and soft texture. Conclusion When it is difficult to harvest two paddle anterolateral thigh flap during surgery, the flap need to be converted rationally based on the characteristics of the defect, the number of the flap perforator, and the vascular origins.

Objective To investigate the clinical application value of antibiotic cement combined with pro-peller flap in the repair of diabetic foot and ankle wounds .Methods From Sep.2013 to Dec.2015,9 diabetic pa-tients with foot and ankle wounds who were treated by vancomycin cement or tobramycin cement combined with pero -neal artery perforator or posterior tibial artery propeller flap were reviewed retrospectively .There were 6 males and 3 females,with an average age of 53.1 years (range,45 to 63 years).The causes included traffic accident injury in 5 cases,heavy crush injury in 2 cases,machine injury in 1 case and falling injury in 1 case.Among all the cases,the wound secretion bacterial culture was positive in 7 cases,and the defect area ranged from 4.5 cm ×4.0 cm to 8.0 cm ×6.5cm.Before operation,the blood sugar was controlled within 7mmol/L when limosis,and within 11mmol/L at two hours after meal .A sufficient amount of sensitive antibiotics was used to prevent infection .After peripheral e-dema dissipating ,hand-held Doppler ultrasound was used to locate the perforators and complete propeller flap de -sign.Through debridement during the operation , preoperative design guided the flap harvest and flap rotation re-paired the wound .In the serious infection areas under the flap ,1-2 vancomycin cement bars were placed ,and pulled out after 2-3 weeks.The size of flaps varied from 13.0 cm ×5.0 cm to 23.0cm ×9.0cm.The donor sites in 4 ca-ses were directly sutured ,and the donor sites of 5 cases were repaired by skin graft .Results During the operation , the flaps were successfully harvested and the wounds were repaired .All flaps survived smoothly ,among which 2 cases had distal flap necrosis but healed after changing dressing .The donor sites were healed by first intention .All cases were followed up from 6 months to 21 months (mean,11.1 months).All flaps had good shape.Conclusion Antibi-otic cement combined with propeller flap is an effective way in the repair of diabetic foot and ankle wounds .

Objective:To investigate the feasibility and application value of digital technology in establishing the micro-vessels model of cross-boundary perforator flap in rat.Methods:Twenty 8-week-old female Sprague Dawley rats, weighing 280-300 g, were used to established micro-vessels model. The cross-boundary perforator flaps of 10 cm×3 cm in size were prepared at the dorsum of 20 rats; then the flaps were sutured in situ. Ten rats were randomly picked up at 3 and 7 days after operation in order to observe the necrosis of flap and measure the percentage of flap necrosis area; the lead-oxide gelatin solution was used for vessels perfusion; flaps were harvested and three-dimensional reconstruction of micro-vessel was performed after micro-CT scanning. Vascular volume and total length were measured via Matlable 7.0 software.Results:The percentage of flap necrosis area at 3 days after operation was 19.08%±3.64%, which was significantly lower than that at 7 days (39.76%±3.76%; t=10.361, P=0.029). Three-dimensional reconstruction via the micro-CT clearly showed the morphological alteration of micro-vessel of the flap. At 3 days after operation, the vascular volume of the flap was (1 240.23±89.71) mm 3 and the total length was (245.94±29.38) mm. At 7 days after operation, the vascular volume of the flap was (1 036.96±88.97) mm 3 and the total length was (143.20±30.28) mm. There were significant differences in the vascular volume and the total length between different time points ( t=5.088, P=0.000; t=7.701, P=0.000).Conclusion:The digital technology can be applied to visually observe and objectively evaluate the morphological alteration of the micro-vessels of the flap, and provide technical support for the study of vascular model of flap.

Objective To evaluate the nerve growth factor (NGF) effect on survival of dorsal cross-boundary perforator flap of SD rats. Methods 60 adult SD rats were divided into the experimental group and the control group equally,in the dorsum of which a cross-boundary perforator flap with an area of about 3 cm×10 cm was harvested. The experimental group was injected subcutaneously with NGF solution (10 nmol· ml-1 · kg-1);the control group was injected with 0.1 mol/L PBS solution (1ml/kg). 3 and 7 days after surgery, VEGF and CD34 of the local tissues of flap were tested via Blot Western;Angiography was performed by the micro-CT to detect Three-dimensional morphological alteration of microvasculature using factorial design analysis of vascular volume and total length. At day 7, survival area of the flap was measured before the observation of expression of KDR and TrkA in vasculature by immunohistochemical stain. Results Day 3, there was no statistically significant differences in the expression of VEGF between two groups (P=0.088);the expression of CD34 in the experimental group was higher than that in the control group (P=0.004); Day 7, there were higher expression of VEGF and CD34 in the experimental group (P<0.05);Morphological analysis showed that there is an interaction between NGF and time in the increase of vascular volume (F=33.304, P<0.05) and the total length of vessels (F=8.493, P=0.01); Compared with the control group, the flap survival area of the experimental group was significantly higher (P<0.05). The expression of KDR in experimental group was markedly superior to the control group. Conclusion NGF can promote the survival of thecross-boundary perforator flap in SD rat.

ObjectiveTo investigate the effectiveness of the digital technology in repairing tiny hand wounds with superficial lateral sural artery perforator flap.MethodsBetween August 2013 and October 2016, 10 cases of tiny hand wounds were treated with the superficial lateral sural artery perforator flap. There were 6 males and 4 females, aged 19 to 47 years (mean, 31.2 years). The causes included crushing injury by machine in 6 cases, traffic accident injury in 3 cases, and electric burning injury in 1 case. The location of the soft tissue defect was the first web in 2 cases, the thumb pulp in 3 cases, the index finger pulp in 1 case, the dorsal palms in 3 cases, and the dorsum of finger in 1 case. The time from injury to hospitalization was 4 hours to 10 days (mean, 3.5 days). The size of wound was from 4 cm×3 cm to 8 cm×7 cm. All defects were associated with exposure of tendon and bone. CT angiography (CTA) from aortaventralis to bilateral anterior and posterior tibial arteries was performed before operation, and the appropriate donor site as well as perforator was selected. Then the CTA data were imported into the Mimics15.0 software to reconstruct the three dimensional structure of the perforator artery, bone, and skin; according to flap size, the flap design and harvesting process were simulated. The flap was obtained on the basis of preoperative design during operation. The size of flaps varied from 5 cm×4 cm to 10 cm×8 cm. The donor site was sutured directly in 9 cases and repaired with skin grafting in 1 case.ResultsSuperficial medial sural artery peforator was cut in 3 patients whose superficial lateral sural artery was too narrow, and the flaps were obtained to repair defects smoothly in the others. Venous crisis occurred in 1 flap, which survived after exploration of the vessel, thrombus extraction, and thrombolysis; the other flaps survived successfully. All wounds and incisions healed by first intention. All cases were followed up 3-18 months (mean, 10 months). The flaps had good shape. At last follow-up, the results were excellent in 6 cases, good in 3 cases, and fair in 1 case according to total active motion (TAM).ConclusionThe preoperative individualized design of the superficial lateral artery perforator flap can realize through CTA digital technology and Mimics15.0 software; it can reduce the operation risk and is one of better ways to repair the tiny hand wounds.

Objective Retrospectively investigate the application of anterolateral thigh flow-through flap in reconstruction of the extremities,to estimate its role and characteriscts.Methods From March,2010 to January,2016,anterolateral thigh flow-through flap was performed for reconstruction of the extremities in 87 patients (56 males,and 31 females).Patient ages ranged from 13 to 68 years,average of 34.4 years.Of all cases,there were 37 legs,21 ankles or foots,1 arm,19 forearms,and 9 hands.The role and result of anterolateral thigh flow-through flap was analyzed retrospectively.Results The result showed that when anterolateral thigh flow-through flap was transferred,which simutaneously played various roles as follows:①rebuilding main vascular defect,to revascularise the distal limb.② preserving recipient vessels,to prevent flow impaired.③rebulding recepient vessel defect.④ protecting vascular anastomosis and preserving recipient flow simultaneously.⑤avoiding the dilemma of end-to-side anastomosis when recipient vessels is deep.⑥ balancing blood flow,the blood supply of the flap was more stable.⑦ linking another tissue in a series fashion,to achieve complex reconstruction.Vascular compromise occurred in 3 cases after surgery,total necrosis occurred in 1 case and partial necrosis in 1 case after reexploration.One case presented deep infection and secondary with renal failure,and received amputation.Local infection presented in 3 cases,wound dehiscence in 2 cases.All the other flaps survivled uneventfully,and its texture and color was normal.In donor site,local infection occurred in 1 case,wound dehiscence in 2 cases.Conclusion Anterolateral thigh flow-through flap has function of many sided reconstruction,which is able to play a vital role in reconstruction of the extremities.

[目的]探讨万古霉素骨水泥联合螺旋桨皮瓣在修复感染性跟骨外露创面及预防跟骨骨髓炎中的临床应用价值。[方法]2012年1月~2015年3月,应用万古霉素骨水泥联合胫后动脉穿支或腓动脉穿支螺旋桨皮瓣修复感染并跟骨骨折骨外露创面13例。其中10例伤口分泌物细菌培养为阳性,创面缺损范围5.0 cm×3.5 cm~8.5cm×7.0 cm。术前用手持普勒超声进行穿支点定位并完成螺旋桨皮瓣设计。术中对创面进行彻底清创,清除游离及坏死的骨质;按术前设计切取皮瓣,皮瓣旋转修复创面;在皮瓣下方跟骨缺损或感染严重的区域放置万古霉素骨水泥条1~2根,术后1个月拔出。皮瓣切取范围14.5 cm×4.0 cm~27.0 cm×7.5 cm,8例供区直接缝合,5例供区植皮修复。其中3例因跟骨缺损较多,术后二期行取髂骨植骨术。[结果]术中顺利完成皮瓣切取及创面修复,术后皮瓣均顺利成活,创面及供区切口Ⅰ期愈合。患者均获随访,随访时间12~23个月,平均17个月。随访中均未发现创面处感染复发及窦道形成,X线片未见骨髓炎病灶形成。所有皮瓣外形良好。末次随访时根据美国足踝外科协会（AOFAS）评分评价足部功能,足部功能总优良率为76.9%。[结论]万古霉素骨水泥联合螺旋桨皮瓣是修复感染性跟骨外露创面及防治跟骨骨髓炎的有效方法。

Objective To investigate the clinical efficacy of superficial lateral sural artery perforator flap for hand reconstruction.Methods From March,2012 to April,2015,15 superficial lateral sural artery perforator flaps were planned for hand reconstruction.Of all cases,11 cases were male,4 cases were female,age ranged from 21 to 51 years old,with average age of 38.2 years.The skin defects ranged from 1.5 cm × 3.5 cm to 5.0 cm × 6.5 cm.Superficial lateral sural artery perforator flap were harvested uneventfully in 12 cases,the flaps were converted to superficial medial sural artery perforator flap in 3 cases.The flap size ranged from 1.8 cm × 3.8 cm to 5.5 cm × 6.5 cm.All reconstructive surgeries were performed secondarily.Results All of 15 flaps survived well,all donor sites were closed directly.During a mean follow-up of 9 months,the flaps were thin and pliable,none of the patients needed secondary flap thinning.The appearance of donor site was satisfactory,no patients complained about functional restrictions.Conclusion The superficial lateral sural artery perforator flap is feasible for reconstruction of middle-sized defects of the hand.

OBJECTIVE:To investigate the effectiveness of digital technology in repairing wounds of the hand and foot with anterolateral thigh flap.METHODS:Between September 2013 and September 2014, 16 cases of wounds of the hand and foot were treated with the anterolateral thigh flap. There were 10 males and 6 females, with an average age of 31 years (range, 20-52 years). The causes included traffic accident injury in 8 cases, crushing injury by machine in 6 cases, burning injury in 1 case, and animal biting injury in 1 case. The locations of soft tissue defect were the dorsum of the foot in 5 cases, the ankle in 4 cases, the planta pedis in 1 case, and the hand and forearm in 6 cases. The time was 2 hours to 45 days from injury to hospitalization (mean, 14.3 days). All defects were associated with exposure of bone and tendon. The size of wound was from 9.0 cmx4.0 cm to 29.0 cmx8.5 cm. CT angiography (CTA) was performed before operation, and the appropriate perforator as well as the donor site was selected. Then the Mimics l5.0 software was used to reconstruct the data of CTA so as to locate the main perforators, design the three-dimensional models of the anterolateral thigh flap, and simulate operation. The flap was obtained according to preoperative plan during operation. The size of flaps varied from 11 cm x 5 cm to 31 cm x 10 cm. The donor sites were sutured directly in 14 cases and were repaired by free skin graft in 2 cases.RESULTS:The lateral femoral circumflex artery identified by Mimics l5.0 software before operation, as well as the starting position of its descending branch, the blood vessel diameter at start site, vascular distribution, the maximum cutting length of the vascular pedicle were consistent with the actual observation during operation. All flaps were harvested and were used to repair defect smoothly. Vascular crisis occurred in 1 flap after operation, and the other flaps survived successfully. The wounds and the incisions obtained healing by first intention, and grafted skin survived completely. All cases were followed up 6-17 months (mean, 9 months). Fifteen flaps had good shape; but a second- stage operation was performed to make the flap thinner in 1 case. At last follow-up, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case according to total active motion (TAM) in 6 cases of hand and forearm injury; the results were excellent in 5 cases, good in 3 cases, and fair in 2 cases according to American Orthopaedic Foot and Ankle Society (AOFAS) in 10 cases of foot injury. The total excellent and good rate was 81.25%.CONCLUSION:The preoperative individualization design of the flap can be realized through CTA digital technology and Mimics 15.0 software; it can reduce the operation risk.

Objective To study the surgical treatment effects of Pilon fractures .Methods 14 patients with Pilon fractures were admitted in our department from May ,2008 to April,2008 surgery treatment and all of them belonged to type Ⅲ by Rtiedi-Allgower classification standard .The surface of tibial astragaloid joint was reestablished openly through anterolateral ankle approach and exposing tibial articular surface through post-lateral peroneal approach .Results The operation treatment of effect was satisfactory , including 11 cases with wound healing in stage Ⅰ and 3 ones in stage Ⅱ.All cases obtained synostosis and no postoperative osteomyelitis occurred .Conclusions This method can completely expose the surface of tibial astragaloid joint and is conducive to the fracture reduction and fixation ,which has a good therapeutic effect on Pilon fracture .

<正>2007年3月～2011年1月,笔者应用多轴钉棒系统固定治疗11例创伤性下颈椎骨折脱位患者,临床效果满意,报道如下。1材料与方法1.1病例资料本组11例,男9例,女2例,年龄38～61岁。爆裂骨折4例,单侧脱位3例,双侧脱位2例,压缩