Repair and reconstruction of severe leg injuries: retrospective review of eighty-five patients

Objective： To explore a good way of the reconstruction of severe tibial shaft fractures by using different flaps and external fixators. Methods： Eighty-five patients of Type ⅢC tibial shaft fractures with average age of 42.5 years were treated in our hospital from 1990 to 2005. Injuries were caused by motorcycle accidents in 66 patients, by machine accidents in 16 patients, and by stone bruise in 3 patients. The management procedures consisted of administration of antibiotics, serial debridment, bone grafting if needed, application of different flaps, such as free thoracoumbilical flaps, fasciocutaneons flaps, saphenous neurocutaneons vascular flaps, sural neurocutaneons vascular flaps and gastrocnemins muscular flaps, and different external fixations, for instance, half-ring fixators, unilateral axial dynamic fixators, AO fixators, Weifang fixators, and Hybrid flxators. The average follow up was 6.3 vears.Results： All flaps survived. Eighty-three cases had bone healed. The average bone healing time of different external fixations was 5.5 months in 47 cases with haft-ring fixators, 9.2 months in 4 cases treated with unilateral axial dynamic fixators, 8.5 months in 6 cases with AO fixators, 10.7 months in 16 cases with Weffang fixators, and 7.8 months in 10 cases with assembly fixators. Except haft-ring fixation, other fixations all needed necessary bone graft. Two cases treated with unilateral axial dynamic fixators had nonunion of bone and developed osteomyelitis. The wounds healed after the removal of the fixators and immobilization by plaster. The last follow up examination showed ankle and knee motion was normal and no pain was noted. Conclusions： The combination of haft-ring external fixators with various flaps provides good results for Type ⅢC tibial shaft fractures.

Repair of a large soft tissue defect in the leg with cross-leg bridge free transfer of a latissimus dorsi myocutaneous flap： a case report

A 48-year-old man sustained a traffic accident injury to his left leg. It was an open fracture of the left tibia and fibula accompanied by a large soft tissue de- fect （27 cmx7 cm）. Doppler examination revealed the poste- rior tibial artery was occluded due to thrombosis. Three weeks after injury, the latissimus dots myocutaneous flap was elevated with a T-shaped vascular pedicle and was in- terposed between the two vascular ends of the posterior tibial vessel of the contralateral leg. Two end to end anasto- moses were performed between the two vascular ends of the posterior tibial vessel of the contralateral leg and the latissimus dors myocutaneous flap＇s T-shaped vascularpedicle. The latissimus dorsi myocutaneous flap was used for repair of a large soft tissue defect of the left leg. The vascular pedicle was cut off after 28 days and the flap sur- vived completely. After 3-years＇ follow-up postoperatively, a good contour was confirmed at the recipient area. The right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery ofcontralateral leg was demonstrated patent by clinical and Doppler examinations.

Effect of tuina along the pathways of meridians plus rehabilitation training on lower limb swelling after surgical repair of fracture

Objective： To investigate the effect of tuina along the pathways of meridians on lower limb swelling after surgical repair of fracture. Methods： A total of 72 cases with lower limb fractures were randomly allocated into an observation group（n=36） and a control group（n=36）. On the third day when the draining tube was removed after surgery, patients in both groups started same rehabilitation training. The patients in the observation group received additional tuina therapy along the pathways of meridians, twice a day for 7 d. Then the swelling and deswelling time of patients in both groups were observed. Results： After 7 d of treatment, the swelling degree of patients in both groups were significantly alleviated（P〈0.05）; and the alleviation was more significant in the observation group than that in the control group（P〈0.05）. There was between-group statistical difference in clinical effect（P〈0.05）. The follow-up visit 6 months after treatment showed a significantly shorter deswelling time in the observation group than that in the control group（P〈0.05）. Conclusion： Tuina along the pathways of meridians plus rehabilitation training can effectively prevent or alleviate（fracture） postoperative lower limb swelling.