带神经血管蒂足底内侧皮瓣修复足跟皮肤软组织缺损

目的探讨带神经血管带足底内侧皮瓣修复足跟皮肤软组织缺损的疗效。方法1995年7月～2005年9月采用带神经血管蒂足底内侧皮瓣修复足跟部皮肤软组织缺损28例,其中外伤21例,跟骨骨髓炎6例,冻伤1例。缺损面积为3cm×3cm～7cm×6cm。结果所有患者随访3～15个月,平均12个月,皮瓣全部成活,外观满意,行走功能良好,皮瓣成活后有感觉存在,未见磨损溃疡发生。结论足底非负重区组织修复足底负重区皮肤软组织缺损不仅功能良好、外形美观,而且感觉良好,是修复足跟部皮肤软组织缺损的理想方法。     

足骨及软组织创伤缺损的组合组织修复

目的 研究解决足部创伤及疾病造成的足骨及软组织缺损的修复重建方法，减少和减轻足残疾和功能不良率，最大限度的恢复足功能和外型。方法 对足背、前足、足跟、踝下等部位单纯软组织缺损，采用局部转移或旋转皮支皮瓣、筋膜皮瓣、游离皮瓣、全厚皮片植皮等方法修复；足底负重区采用预制皮瓣方法解决；前足、足跟及其它跗骨复合组织缺损采用带血管髂骨加皮瓣组织移植重建；内、外踝缺损应予以重建。结果 247例经上述方法处理，临床疗效满意。按美国AOFAS踝-足评分标准：优84例，良107例，可42例，差14例。结论 髂骨为一扁平状骨，血运丰富，用于重建再造跖骨缺损尤其是多跖骨缺损、跟骨缺损时，接地稳定且触地面积大，便于负重、固定及承压。内、外踝可取带筋膜的髂骨和腓骨头重建骨及韧带缺损，组合带血管骨与皮瓣修复缺损，可将移植骨及皮瓣各自先充分对位满意后再行组合，较理想地恢复足的解剖和生理功能。     

足骨及软组织损伤缺损的组合组织修复临床研究

目的 研究解决足部创伤及疾病造成的足骨及软组织缺损的修复重建方法，减少和减轻足残疾和功能不良率，最大限度的恢复足功能和外型。方法 对于足背、前足、足跟、踝下等部位单纯软组织缺损，可采用局部转移或旋转皮支皮瓣、筋膜皮瓣，游离皮瓣，游离全厚植皮等方法修复；足底负重区采用预制皮瓣方法解决；前足、足跟及其它跗骨复合组织缺损采用带血管髂骨加皮瓣组合移植重建；内外踝缺损应予以重建。结果 247例患者经1．5～5年随访，按美国AOFAS踝一足评分标准：优84例，良107例，可42例，差14例。结论 髂骨用于重建再造跖骨缺损尤其是多跖骨缺损、跟骨缺损，稳定且触地面积大、承压小；内外踝可取带筋膜的髂骨和腓骨头重建骨及韧带缺损；组合带血管骨与皮瓣修复缺损，可恢复足的解剖和生理功能。     

足跟部软组织缺损修复25例

目的 比较足跟部软组织缺损各类修复方法的优缺点。方法 通过6个月-7年随访，分析和比较8种类型的皮瓣：足底内侧岛状瓣7例、小腿前外侧逆行岛状皮瓣6例、外踝上逆行岛状皮瓣3例、小腿内侧逆行岛状皮瓣3例、腓肠神经营养血管皮瓣4例、带蒂足背皮瓣1例、游离股前外侧皮瓣4例、游离腓动脉皮瓣1例，共29个皮瓣修复足跟软组织缺损的效果。结果 29个皮瓣中27个皮瓣完全成活，2个部分坏死。足底内侧皮瓣的外形、质地最佳，有感觉功能，皮瓣与跟骨有良好的贴附，负重后表皮可形成较厚的角化，无冻伤、烫伤及溃疡形成，患足可以正常负重。游离股前外侧皮瓣及小腿前外侧逆行岛状皮瓣等带蒂皮瓣表皮均无明显角化，表面存在不同程度的磨损、水疱或溃疡，皮瓣与跟骨间存在不同程度的滑动，影响足跟完全负重。结论 采用足底内侧皮瓣修复效果最好，但修复面积有限,采用不同形式的小腿皮瓣修复效果无明显差别；游离股前外侧皮瓣适合修复大面积皮肤缺损。     

带神经血管岛状皮瓣在修复足跟软组织缺损中的应用

目的优选修复足跟部组织缺损的供区皮瓣,使修复后的创面在功能和形态上得到更好的恢复。方法采用8.0cm×4.0cm的圆形足底带神经血管岛状皮瓣修复足跟软组织缺损。结果本组6例患者,随访最长时间6年,术后效果满意。结论用足内侧带神经血管岛状皮瓣修复足跟软组织缺损,在形态及功能上接近于原有组织,感觉得到恢复,不易形成溃疡,效果良好。     

带神经血管岛状皮瓣在修复足跟软组织缺损中的应用

目的优选修复足跟部组织缺损的供区皮瓣,使修复后的创面在功能和形态上得到更好的恢复.方法采用8.0 cm×4.0cm的圆形足底带神经血管岛状皮瓣修复足跟软组织缺损.结果本组6例患者,随访最长时间6年,术后效果满意.结论用足内侧带神经血管岛状皮瓣修复足跟软组织缺损,在形态及功能上接近于原有组织,感觉得到恢复,不易形成溃疡,效果良好.     

带旋髂深动脉髂骨瓣与腓肠神经营养血管皮瓣修复跟骨及软组织缺损

目的探讨带旋髂深动脉髂骨瓣、腓肠神经营养血管皮瓣修复跟骨及软组织缺损的临床疗效。方法采用游离带旋髂深动脉髂骨瓣联合腓肠神经营养血管皮瓣修复6例跟骨及软组织缺损患者。结果 6例皮瓣骨瓣全部成活。3例皮瓣发生部分边缘性坏死,经换药后创面愈合;1例因跟腱修复失败,二期行踝关节融合术。患者均获得6~20个月随访。术后小腿及足部均有良好外形及部分感觉,部分患者经锻炼后恢复承重功能。结论以带旋髂深动脉髂骨瓣联合腓肠神经营养血管皮瓣修复跟骨及软组织缺损可行,临床疗效满意。     

带血管腓骨移植及游离股前外侧皮瓣再造跟骨1例并文献复习

【】 目的 探讨应用带血管腓骨移植及游离股前外侧皮瓣再造跟骨治疗中所遇到的困难及处理方法。方法 分析1例足跟部复合组织缺损病例的治疗(一期采用逆行带血管蒂腓骨移植重建修复跟骨,游离带神经股前外侧皮瓣修复足跟部皮肤缺损,吻合皮瓣皮神经与近侧腓浅神经重建足跟感觉功能)的基础上,回顾相关文献。 结果 本例皮瓣一期成活,再造足跟外形良好,术后８月移植腓骨与受区骨骼完全愈合并取除内固定,开始部分负重行走,术后1年开始完全负重行走,经随访4年皮瓣两点辨别觉达到1.5cm,负重行走皮瓣无磨破现象,能满足日常生活需要。结论 足跟部复合组织缺损通过组织移植能得到很好的修复,后期足部功能相对较为满意,但手术方法复杂,仍存在较大改进空间。     

内踝缺损再造与重建

目的：研究创伤造成的内踝部骨及软组织缺损再造及重建的方法。方法：采用(带血管)髂骨块携带筋膜条状皮瓣或吻合血管的游离皮瓣组合移植同期或分期再造内踝骨、三角韧带及皮肤组织。结果：经采用髂骨重建带后，经随访踝关节的稳定性良好，内翻角与健侧基本相同，无侧方及前后的关节异常活动，行走负重功能恢复论：内、外踝的完整性对踝关节功能有重要的影响，采用髂骨与皮瓣组合修复方法重建内踝缺损，可恢复踝关节，获得满意功能。     

足底内侧皮瓣的临床应用

目的 报道应用足底内侧皮瓣修复手足部组织缺损的治疗效果.方法 设计皮瓣的点选择为内踝前缘与足底内侧交界处,从该点至第1、2跖骨头间引一直线为皮瓣轴心线,在轴心线两侧、跖骨头后面足底非负重区切取皮瓣.临床应用带神经血管蒂或游离的足底内侧皮瓣移植修复足跟或手部皮肤缺损32例. 结果 术后随访6个月～3年,32例移植皮瓣全部成活,感觉良好,外观满意且耐磨,手足部活动功能良好. 结论 足底内侧皮瓣是足跟或手掌部小创面软组织缺损的较好修复方法.     

带血管蒂髂骨瓣移植修复下肢骨及其周围软组织缺损

目的探讨带血管蒂髂骨瓣移植在修复下肢骨及其周围软组织缺损中的作用。方法针对小腿、足解剖结构和伤后骨与软组织易缺损的特点,利用游离髂骨移植必须携带周围肌肉,设计带血管蒂的髂骨肌肉瓣,移植修复下肢骨及软组织缺损;髂骨肌肉瓣血管与受区血管吻合后于骨瓣周围肌肉表面皮片覆盖。结果手术后1周,移植皮片全部植在髂骨周围的肌肉表面,皮片成活间接证明移植骨瓣成活;皮片全部成活4例,大部分成活3例;术后1个月均可见髂骨瓣与受区断端间有少量的骨痂形成,修复足跖骨4个月后拔除克氏针,胫骨6～8个月拆除外固定架,扶拐行走2～4个月：术后随访经6～15个月(平均10个月),双下肢等长,无溃疡,行走负重良好,外形及功能满意。结论单纯髂骨游离移植修复骨及软组织缺损一次完成手术操作,解剖塑形及外观比传统术式更满意,是修复小腿及足外伤软组织和骨缺损的较好术式。     

足组织缺损的显微修复

１９８４年～１９９４年共收治各种足部组织创伤缺损２３６例，均采用显微外科技术进行组织移植修复，其中单纯皮瓣移植修复１８７例，复合皮瓣移植修复４９例。吻合血管游离移植修复９７例，带血管蒂移位修复１３９例。４例前足缺损者用带肩胛骨的复合皮瓣移植修复，６例足跟严重缺损者用带血管的腓骨复合皮瓣移植修复。经１～１０年随访，皮瓣、复合皮瓣、移植或再植的骨骨各全部成活，愈合良好，足功能基本得到恢复，可行走、负重，１８６例恢复了原工作。认为，恢复足部结构完整与重建足跟、足底的感觉是获得良好功能的关键     

Subtalar fusion with iliac bone free flap after a recalcitrant nonunion: Report of two cases

Fractures of the calcaneus are associated with secondary osteoarthritis of the subtalar joint. In a persistent nonunion, vascularized bone flaps offer superior biologic and mechanical properties as well as accelerates joint fusion and decreases morbidity. In this report, we present results of the use of vascularized iliac bone free flap for treating subtalar failed fusions in two patients. Two patients sustained calcaneal fractures due to foot trauma, which were initially or subsequently treated with subtalar arthrodesis. Case one developed septic subtalar nonunion during treatment and case two failed three attempts at subtalar arthrodeses. The iliac crest bone flap harvested measured 4 × 4 cm (case one) and 3 × 3 cm (case two). The flap was pedicled by the deep circumflex iliac artery, which was anastomosed to the anterior tibial artery at the recipient site. No flap donor or recipient site complications occurred. Fusion was confirmed on CT scan and weight bearing was initiated at 5–6 months. At latest follow up (1–2 years), no complications occurred. Our results show that subtalar nonunion treatment with a vascularized iliac bone flap may be feasible and such a reconstruction could be clinically successful. © 2015 Wiley Periodicals, Inc. Microsurgery 36:501–506, 2016.     

Vascularized iliac crest and distal radius reconstruction

The authors relate their experience concerning the vascularized iliac crest flap. In the first chapter, they detail the anatomic vascularized osteocutaneous iliac crest. Blood supply arises from the deep and superficial circonflexe iliac artery. Many anastomoses connect the two systems. In the second chapter, they detail the operative technique of free and pedicule hone iliac crest flap. Composite cutaneous bone flaps are also detailed. In the third chapter, they detail informations about treatment of distal radius bone defects with associated skeen flap if necessary.     

Crête iliaque vascularisée et reconstruction du radius distal

The authors relate their experience concerning the vascularized iliac crest flap. In the first chapter, they detail the anatomic vascularized osteocutaneous iliac crest. Blood supply arises from the deep and superficial circonflexe iliac artery. Many anastomosis connect the two systems. In the second chapter, they detail the operative technique of free and pedicule hone iliac crest flap. Composite cutaneous bone flaps are also detailed. In the third chapter, they detail informations about treatment of distal radius bone defects with associated skeen flap if necessary.     

The load-bearing function of a patellar tendon bearing cast

An experiment was performed to study the load bearing function of a patellar tendon bearing (PTB) cast and the optimal effect of walking heel position and contra-lateral heel height. Miniature load cells were placed on the patellar tendon area, front and back area of the lower leg, anterior sole (MP joint of big toe), and posterior sole of the foot. The examinee walked on a force plate with the PTB cast. Vertical load bearing at each area in the PTB cast was evaluated by multiple regression analysis of data from the force plate and the load cells. The extent of decrease of skeletal loading was thirty per cent of body weight when the walking heel was placed slightly distal to the navicular bone. The effect of the contralateral heel height was not clear.     

Revascularization of a partially necrotic talus with a vascularized bone graft from the iliac crest

Summary A 16-year-old patient had a compound dislocation of the right talus. Following primary treatment, which included a subtaler screw arthrodesis, the talus developed clinical, radiological, and isotope scan signs of necrosis [3]. In spite of a walking caliper to prevent weight bearing on the ankle, the talar articular cartilage of the ankle joint also showed signs of degeneration. The talus was revascularized with a vascularized corticocancellous iliac crest bone graft. Six months postoperatively, there were clinical, radiological, and bone scan signs of significant revascularization. The patient is free of pain and able to walk with full weight bearing on the foot.     

Relationship between foot length and the inter anterior superior iliac distance

Reduction of unstable pelvic fracture by external fixator might be over or under corrected as there is no proper estimation from the surgical landmark. Radiographic evaluation after reduction must be carried out and improper reduction is found in a certain number. To find a better guide by normal surgical landmark the study was carried out as a survey research in 600 volunteers aged from 10 to 70 years. Simple caliper and tape were used to measure the height, foot length and inter anterior superior iliac spine distance. In 376/420 male volunteers (89%), the length between right heel and tip of the fourth toe was equal to the inter anterior superior iliac spine distance. In 173/180 female volunteers (96%), the length between right heel and tip of big toe was equal to the inter anterior superior iliac spine distance. The length of the right foot can be used as a reference in reducing unstable fractured pelvis by external fixation. These data were used in the management of 36 patients with unstable fractured pelvis with external fixation for reduction and stabilization. All had good results.