Pedicled abdominal flap using deep inferior epigastric artery perforators for forearm reconstruction: A case report

BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.

Scoring system for poor limb perfusion after limb fracture in children

BACKGROUND Assessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome,which is an emergency condition.AIM To establish a simple and efficient grading scale of limb perfusion in children undergoing surgery for limb fracture.METHODS This retrospective study included pediatric patients with a limb fracture and postoperative plaster fixation who were admitted at The Department of Pediatric Orthopedics of Xinhua Hospital between February 2017 and August 2017.The outcome was poor limb perfusion,which is defined as the postoperative use of mannitol.The children were divided into two groups:The normal perfusion group and the poor perfusion group.Key risk factors have been selected by univariable analyses to establish the Grading Scale for Vascular Status.RESULTS A total of 161 patients were included in the study:85 in the normal perfusion group and 76 in the poor perfusion group.There were no significant differences in age,sex,body mass index,ethnicity,cause of fracture,fixation,or site of fracture between the two groups.After surgery,the skin temperature(P=0.048)and skin color(P<0.001)of the affected limb were significantly different between the two groups.The relative risk and 95%confidence interval for skin temperature of the affected limb,skin color,and range of motion of the affected limb are 2.18(1.84-2.59),2.89(2.28-3.66),and 2.16(1.83-2.56),respectively.The grading scale was established based on those three factors(score range:0-3 points).Forty-one patients(32.5%)with score 0 had poor limb perfusion;all patients with scores 1(n=32)and 2(n=3)had poor limb perfusion(both 100%).CONCLUSION In children undergoing surgery for limb fracture,a higher Grading Scale for Vascular Status score is associated with a higher occurrence of poor limb perfusion.A prospective study is required for validation.

Diagnosis,treatment and complications of radial head and neck fractures in the pediatric patient

Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.