Objective:To evaluated the options in selection of surgical procedures for treatment of the patients suffering from diabetic feet with chronic refractory wounds.Methods:From January 2020 to June 2021, 23 patients with diabetic feet complicated with refractory wounds were treated in Department of Hand Surgery, Shunde Heping Surgical Hospital. The patients were 15 males and 8 females, aged 51-86 years old and with an average age of 65 years old. All the patients had Type-II diabetes for over 5 - 22 years. Average blood glucose of the patients was found at 15.6 mmol/L on admission. Free anterolateral thigh perforator flaps (ALTPF) were used for reconstruction of the wound of diabetic feet in 19 patients, 2 patients received vascular bypass surgery and 2 had amputations. Regular outpatient follow-up were conduct on all patients after surgery.Results:Follow-up time lasted for 8 to 30 months, 12 months in average. At the last follow-up, the donor and recipient sites healed well in the 19 patients who received flap reconstruction, without an infection, necrosis and wound recurrence. Pains were significantly relieved after the surgery in the 2 patients who received vascular bypass surgery, and wounds all healed well after symptomatic treatment and dressing change without recurrence of wounds at the last follow-up. Average Maryland score of foot function was 84 for the patients who had limb salvage, and 2 patients were in excellent and 19 in good at the last follow-up. The 2 patients who had amputation successfully survived through the perioperative period, and the wounds healed well at the last follow-up.Conclusion:The treatment is complicated in the patient suffering from diabetic foot with chronic refractory wounds due to factors such as advanced age, co-existing and complicated underlying diseases together with the complex wounds. Most patients can achieve good prognosis in wound treatment of free flap transfer or vascular bypass surgery. However, a limb salvage is recommended with caution for the patients who have severe infections and dry gangrene.

Objective:To investigate the removal of ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery and its application in wound repair.Methods:From January, 2019 to March, 2021, 32 cases of limb wounds were repaired with ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery, including 25 males and 7 females. The age ranged from 21 to 63 years, with an average of 34 years. Injury mechanism: there were 12 cases of traffic accident injury, 8 cases of machine injury, 6 cases of heavy object crushing injury and 6 cases of chronic infectious wound. The area of soft tissue defect was 8.2 cm × 6.3 cm-18.6 cm × 11.2 cm. There were 25 cases of direct suture and 7 cases of free skin grafting. All patients who needed flap repair underwent CTA and high-frequency CDU before operation to judge the approximate direction of the lateral branch of the descending branch of the lateral femoral circumflex artery and the position of the perforating branch. All patients were followed-up regularly for 3 - 13 months, with an average of 11 months.Results:All patients who underwent free flap surgery had no vascular crisis and the flap survived smoothly. At the last follow-up, the appearance of the flap was beautiful without bloating and there were no complications in the donor area.Conclusion:Compared with the traditional ALTPF, the perforator flap of the lateral branch of the descending branch of the anterolateral femoral artery is relatively simple, which can replace the traditional ALTPF to a certain extent, and is worthy of popularization and application in clinic.

目的 探讨应用游离股前外侧穿支嵌合阔筋膜瓣显微修复前臂背侧复合组织缺损并重建患肢背伸功能的方法和疗效.方法 回顾性分析2013年3月—2017年10月顺德和平外科医院收治前臂背侧中上段复合组织缺损患者5例,男性4例,女性1例;年龄18～54岁,平均30.8岁.机器绞伤3例,道路交通伤2例.软组织缺损面积15cm×8cm～24cm×12cm,均伴伸肌群部分缺失.手术切取对侧股前外侧皮瓣,将皮瓣下的阔筋膜全部携带依据伤情将阔筋膜编织成束,调整好张力之后重建伸腕、伸指功能,皮瓣切取范围较缺损面积放大10％(16cm×10cm～25cm×14cm,阔筋膜切取为皮瓣同等大小),供区游离植皮修复.结果 患者术后均皮瓣存活顺利,无血管危象及感染发生,其中1例患者供区游离植皮发生部分坏死,经换药愈合良好.术后随访12～48个月,平均22.4个月.末次随访患者皮瓣外形无臃肿,受区具有保护性感觉,伸腕及伸指功能恢复良好.结论 携带阔筋膜的股前外侧动脉穿支皮瓣修复前臂背侧复合组织缺损,一次手术既能修复创面又能对患肢背伸功能进行重建,可以获得比较理想的外观及功能,值得在此类损伤患者中推广应用.

Objective:To explore the application of the superficial iliac perforator flap (SCIP) based on the concept of "Donor site under swimming wear" in the repair of wounds of extremities.Methods:From June, 2018 to March, 2019, a total of 20 patients with traumatic soft tissue defects of the extremities were treated. All defects were repaired with free SCIP, including 16 males and 4 females. Location of defects: 10 in the hand, 4 in the forearm, 4 in the shank, and 2 in the foot. Wound areas were 7.3 cm×5.6 cm-16.3 cm×7.7 cm. Patients received routine CTA and high-frequency CDU examinations before surgery to assist in identifying the location of the perforating vessels and the running of the superficial and deep branches of the superficial iliac circumflex artery (SCIA). Combined intraoperative light transmission experiments were used to determine the dominant branch. The superficial branch of SCIA was used as the dominant branch in 18 cases, and the flap was cut in the superficial layer of Scarpa's fascia. The deep branch of SCIA was used as the dominant branch in 2 cases and the flap was cut in the superficial layer of the deep fascia. The donor site was directly sutured. Regular postoperative follow-ups were conducted without lost.Results:All flaps had no vascular crisis after surgery and survived successfully. All patients were followed-up regularly for 8 to 16 months, with an average of 12 months. At the last followed-up, the appearance and texture of the flaps in the recipient area were good, and roughly similar to the healthy tissues around the affected limb. The function of the affected limb recovered well. There was only a linear scar in the donor area.Conclusion:The SCIP based on the concept of "Donor site under swimming wear" is soft in texture, moderate in thickness, and concealed in the supply area. The patient can directly hide the scars of the donor areas after wearing the swimming trunks, which meets the concept of minimizing the damage to the donor area. It deserves to be promoted.

目的 规避或降低手显微外科患者术后血管危象发生及危害,提高再植、再造手指或移植组织皮瓣等的成活率.方法 将我院手显微外科2015年7月—2016年6月纳入的419例患者为对照组,将2016年7月—2017年6月纳入的427例患者为观察组进行研究,对照组进行常规的术后护理;观察组通过建立手显微外科患者术后血管危象预警控制体系,具体包括建立血管危象监控网络、应用医护一体化风险控制筛选和风险预警工具,挂红、黄两色警示标识、制定血运观察护理量表、血管危象危评估表、血管危象危机值报告量表、血管危象应急处理流程、制度和建立护理安全路径等等,实施血管危象风险预控;运用SPSS 22.0分析2组患者的血管危象发生率.结果 观察组临床护士在预防手显微外科患者术后血管危象发生的防控措施达标率、再植和再造手指或移植组织皮瓣等的成活率较对照组明显提高(P<0.05),术后血管动脉危象、静脉危象发生率为明显降低(P<0.05).结论 手显微外科患者术后应用血管危象预警控制体系能够提高护士的防控能力,规避或降低手显微外科患者术后血管危象发生及危害,提高了再植、再造手指或移植组织皮瓣等的成活率.