Interlocking nailing of compound lower leg fractures]

Seventy-eight patients with lower leg fractures treated by interlocking nailing at the hospital in Schwaz were reviewed. The overall results were satisfying. There were nine misalignements, two of which underwent subsequent correction. Two infections took place, one after precipitant bone grafting at another place and another one following new trauma. Seven first and five second degree open fractures had an uneventful healing. Interlocking nailing was found to be the treatment of choice for compound fractures with open or closed soft tissue injury of first or second degree after Tscherne. Compared with a previous study about ski injuries, complex fracture patterns combined with severe closed soft tissue lesions showed an increasing incidence during the last ten years. This contrast with the decreasing number of ski injuries in general.     

Replantation of the distal part of the leg

We successfully replanted five amputated legs in five patients and followed the patients for two years or more (average, six years and three months). Although some patients found it impossible to squat and to run because of joint contractures, muscle weakness, or deformities of the foot, all patients could perform other activities without difficulty. None had important pain or any intolerance to cold, and all were satisfied with the results of the replantation.     

Free-flap transfer of the omentum to the lower leg]

The authors describe an unusual procedure for closure of a large skin defect of the lower limb exposing the tibia. Due to the severity of the vascular and cutaneous lesions, a greater omentum free flap was used with micro-anastomosis onto the contra-lateral leg: heeling was satisfactory after release of the flap.     

Replantation at the level of the wrist joint: A case report

Upper extremities amputations are devastating injuries that have a major impact on patients’ quality of life. Replantation after traumatic amputation is often performed to obtain limb recovery. Following the high survival rate of replantation of post-traumatic hand amputation, recent emphasis has now shifted to functional recovery rather than survival only. Wrist replantation remains a challenging procedure for orthopaedic and hand surgeon. We reported a case of a 25-year-old male with traumatic amputation of the right hand.     

Replantation of a leg in an adult with 6-years' follow-up

After traumatic amputation of the distal half of the leg, a replantation was carried out using microsurgical technique in a 24-year-old lumber mill worker. He returned to his job after 1 year, and 6 years after the accident he had good function and satisfactory sensibility in the sole of his foot. The case shows that even a lower limb replantation may give useful results under favourable conditions.     

Replantation of a leg in an adult with 6-years' follow-up

After traumatic amputation of the distal half of the leg, a replantation was carried out using microsurgical technique in a 24-year-old lumber mill worker. He returned to his job after 1 year, and 6 years after the accident he had good function and satisfactory sensibility in the sole of his foot. The case shows that even a lower limb replantation may give useful results under favourable conditions.     

严重小腿损伤的中晚期修复

目的 探讨严重小腿损伤中晚期修复的方法及疗效.方法 对45例严重小腿损伤后出现并发症的患者,运用负压封闭引流技术治疗创面感染,显微外科方法治疗小腿软组织及骨缺损、骨小连,骨迁移技术修复大段胫骨骨缺损,关节松解或成形术改善膝踝关节功能.结果 45例患者中有41例获12-64个月(平均38个月)随访,全部组织瓣均成活,39例骨折愈合,2例并发慢性骨髓炎发牛病理性骨折.下肢功能评价:优20例,良15例,差6例,优良率为85.4%.结论 综合运用负压封闭引流技术、显微外科方法、骨迁移技术及关节松解或成形术修复中晚期严重小腿损伤,可以恢复小腿功能,降低致残率.     

Replantation of the upper extremity severed at the level of the ulnar joint.

Two cases of upper extremity replantation at the level of the ulnar joint are presented. In both cases, the ulnar joint and adjacent anatomic functional structures were destroyed in accidents and excised during surgery. Some functional rehabilitation of the replanted extremities was obtained. In one case, the grasp function of the hand was recovered through primary use of the muscular apparatus of the upper arm. In another patient, the function of the lost ulnar joint was restored through microsurgical autotransplantation of the vascularized first metatarsophalangeal joint of the foot.     

Lateral lower leg skin flap

Use of a lower leg lateral skin flap in 7 patients since January 1982 is described. Satisfactory results were obtained in 6 of 7 patients. The blood supply of this new flap is based on the peroneal artery, which gives rise to cutaneous or musculocutaneous branches to nourish the flap. The venous blood of the flap is drained by the venae comites accompanying these cutaneous or musculocutaneous branches. In clinical practice, the beginning portion of the peroneal artery and the vein arising from the posterior tibial vein are used for vascular anastomosis. The caliber of the peroneal artery is 2.5 to 3.0 mm, and that of the peroneal vein is 3 to 4 mm. The vascular pedicle can be as long as 8 to 12 cm. In 4 of these patients, the flaps were freely transferred using a microvascular technique; in the remaining 3, a reversed transfer for treating defects over the foot was used.     

Aesthetic reconstruction of lower leg defects using a new anterolateral lower leg perforator flap.

Our objective in this study was to report on the successful clinical use of a new perforator flap obtained from the proximal quarter of the anterolateral lower leg. Eight patients had the procedure either as a result of trauma (seven patients) or to treat Marjolin's ulcer (one patient). During the procedure, a line was drawn from the anterior fibular head to the anterior lateral malleolus. Then, using Doppler, a septocutaneous perforator from the fibular head to the proximal quarter point of the line was identified. The subfascial dissection was continued to the detected perforator. Along the perforator in the anterior intermuscular (peroneal) septum, a deep dissection was performed. The perforator was then separated and the flap harvested. The septocutaneous perforator was the perforator of the superficial peroneal nerve accessory artery in three cases, the perforator of the superior lateral peroneal artery in one case, and the perforator originating directly from the anterior tibial artery in four cases. Seven of eight cases were treated successfully. The results obtained were satisfactory, both aesthetically and functionally. This flap is a valuable alternative to the various perforator flaps from the lower leg. This flap has the advantage of being very thin, which makes it suitable for reconstruction of defects in the foot, ankle, pretibial area, and knee. However, one limitation of this procedure is that the diameter of the perforator was approximately 0.6-1.2 mm.     

Indications and experiences in saving of the lower leg following injuries and tumors]

In the primary treatment of skin and soft tissue defects of the lower leg, after injuries or tumor excision, split skin grafting is the method of choice. But in respect to the late results, frequently additional plastic reconstructive measures, preferrably skin flap procedures, must be considered. Follow-up over decades and if necessary, skin transplantation, are mandatory to prevent interference of growth and function of the leg, as well as malignant degeneration of the scars.