Preventing delayed union after distal shortening oblique osteotomy of metatarsals in the rheumatoid forefoot

Objectives: The aim of this study is to evaluate the surgical methods to prevent delayed union after the distal shortening oblique osteotomy of the lesser metatarsals in the rheumatoid forefoot.

Methods: This retrospective observational study included 107 patients. The patients were classified into the following four groups, each of which represented the addition of a surgical technique to reduce postoperative delayed union: 1st group: original surgical method; 2nd group: a normal saline was dripped on the oscillating saw; 3rd group: the incised periosteum was sutured; 4th group: the osteotomy sites were ligated. The frequencies of delayed union were assessed.

Results: Delayed union occurred in 21 of the 127 metatarsals (16.5%) in the 1st group, 13 of the 99 metatarsals (13.1%) in the 2nd group, 5 of the 94 metatarsals (5.3%) in the 3rd group, and 6 of the 136 metatarsals (4.4%) in the 4th group. The frequency of delayed union decreased significantly with improved surgical procedures (p?=?0.0003).

Conclusions: A combination of techniques that included dripping normal saline on the oscillating saw, ligating the osteotomy sites, and suturing the periosteum at the osteotomy sites decreased the frequency of delayed union after the distal shortening oblique osteotomy of the metatarsals in rheumatoid arthritis patients.     

低旋转点外踝上皮瓣修复前足创面的临床应用

目的探讨低旋转点外踝上皮瓣在修复前足皮肤软组织缺损中的应用。方法2007年3月－2010年5月收治前足皮肤软组织缺损39例,均为外伤性前足软组织缺损,合并骨与关节损伤13例。伤后常规清创,确定胫前动脉、胫后动脉是否完好,设计皮瓣并应用低旋转点外踝上皮瓣修复缺损。结果所有皮瓣成活,1例术后2d皮瓣远端出现静脉危象,拆除旋转点处皮肤缝线后皮瓣恢复正常,4例皮瓣远端皮肤部分浅表性坏死,经换药处理后二期愈合。本组随访6个月～2年,皮瓣外观、质地优良,无色素沉着、瘢痕挛缩等情况,9例足背外侧皮肤感觉减退,考虑为术中损伤腓浅神经所致。结论低旋转点外踝上皮瓣切取较简单,成活率高,是修复前足皮肤缺损的一种理想术式。     

Reconstruction of distal forefoot burn defect with retrograde medial plantar flap

Burn reconstruction of forefoot remains as a difficult challenge, because the local flap alternatives are limited. We evaluated the efficiency of distally based medial plantar fasciocutaneous island flap in the coverage of forefoot defects resulting from release of toe contracture and burn debridement. Four patients with toe contractures and two patients with third degree burn in forefoot were treated between June 2004 and February 2006. The mean follow-up period was 10.4 months. The flaps were elevated as with a fasciocutaneous base on the distal medial plantar artery. The dimensions of the flaps ranged from 4cmx3cm to 5cmx4cm. The skin over the pedicle was included as a part of flap in three cases. Concomitant vein of the pedicle was anastomosed with the first plantar digital vein in four cases. In the early postoperative period, one flap used to cover third degree burn due to high-voltage electric injury was lost completely. We concluded that this flap was an appropriate alternative reconstructive option for the forefoot defect. Including skin and subcutaneous tissue over the pedicle to flap protects the pedicle against kinking and compression. Venous supercharging of the flap improves venous drainage.     

足内侧皮神经营养血管远端蒂皮瓣修复前足软组织缺损

目的　评价应用足内侧皮神经营养血管远端蒂皮瓣修复前足软组织缺损的效果。 方法　自2012 年 1月至 2016 年9月,共从住院病人组织缺损患者中选择10例前足软组织缺损患者应用足内侧皮神经营养血管远端蒂皮瓣进行修复。 结果　9例患者的皮瓣均顺利成活。1例患者有皮瓣远端皮缘坏死现象,经切痂换药后创面愈合。术后患者均获随访,随访时间 6～12 个月,平均 9.5个月。皮瓣外形不臃肿,色泽、质地优良,耐磨无破溃。 结论　采用足内侧皮神经营养血管远端蒂皮瓣修复前足软组织缺损,具有手术切取方便,其术后皮瓣质地柔软,外形美观,供区损伤小等特点,是修复前足软组织缺损的理想方法。