ObjectiveTo explore the dyeing conditions of reticular fiber staining of liver puncture tissue stained by BenchMark automatic special staining instrument, evaluate the staining effect, and share the using experience.MethodsA total of 30 cases of liver puncture specimens from April to May 2019 in West China Hospital of Sichuan University were selected. They were fixed with 4% neutral formaldehyde fix solution, treated with automatic dehydrator, embedded in paraffin, stained with adhesive slides, and baked in 65℃ oven for 30 min. Each specimen was sliced in duplicate, with a thickness of 5 μm. One was reticular fiber stained with BenchMark automatic special staining instrument under the dyeing condition according to the using experience of the laboratory, and the other was reticular fiber stained by manual Foot staining method according to the standard operating procedure of the laboratory. The staining effect under microscope was observed by a chief pathologist with extensive slide-reading experience.ResultsThe success rate of instrumental method was 100.0% (30/30), and that of the manual method was 76.7% (23/30). The difference in success rate between the two methods was statistically significant (χ2=5.143, P=0.023).ConclusionThe reticular fiber staining effect of BenchMark automatic special staining instrument is stable and reliable, and the success rate is higher than that of manual Foot staining.
Objective To report the clinical result of the improvedisland skin flap with distallybased sural nerve nutrient vessels in repairing skin defect in the heel, ankle or foot. Methods From August2004 to April 2005, 15 patients with skin defect in the heel, ankle or foot at distal part were treated by the improved island skin flap with distally-based of sural nerve nutrient vessels. Of 15 flaps, 12 were simplex flaps and 3 were complex flaps. These flap area ranged from 7 cm×6 cm to 11×8 cm. The donor sites were sutured directly and covered with free flap. Results All flaps survived without flap swelling and disturbance of blood circulation. The wounds of donor and recipient sites healed by first intention. The followup period ranged from 3 to 6 months. The texture of flap was soft and the color of flap was similar to that of normal skin. The foot function was excellent. Conclusion The improved island skin flap with distally-based sural nerve nutrient vessels is an ideal skin flap for repairing skin defect in the heel, ankle or foot distal part in clinical. The operation is simple and need not to anastomose blood vessel.
From 1984 to 1994, 236 different types of traumatic defects of foot were repaired by microsurgical tissue grafting. They included simple cutaneous flap in 187 and composite flap in 49. Among the 236 different tissue flaps, vascularized flap was used in 97 and pedicled flap in 139. The 4 fore-foot and 6 heel defects were repaired by composite skeleted cutaneous grafts with scapula and vascularized febula respectively. After the follow-up from 1 to 10 years, all the grafted tissues were survived and healed well. The functions were satisfactory, and 186 patients had resumed their original works. The key to good function following repair was to maintaion the integrity of foot structures and the sensation of the sole and heel.
ObjectiveTo investigate the effectiveness of abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle.MethodsBetween June 2016 and June 2019, 15 patients with large skin and soft tissue defects of foot and ankle were admitted, including 10 males and 5 females with an average age of 30 years (range, 10-60 years). The causes of injury included 6 cases of traffic accident, 3 cases of machine strangulation, 3 cases of heavy object injury, 2 cases of fall, and 1 case of electric shock. The time from injury to admission was 3 hours to 10 days, with an average of 2 days. The wound located at dorsal foot in 5 cases, ankle in 6 cases, dorsal foot and ankle in 3 cases, and dorsal foot and sole in 1 case. All wounds were contaminated to varying degrees and accompanied by tendon and bone exposure, including 5 cases of extensive necrosis of the dorsal skin with infection. The area of defects ranged from 18 cm×6 cm to 25 cm×8 cm. There were 9 cases of foot and ankle fractures and dislocations, and 2 cases of foot and ankle bone defects. The wound was repaired with abdominal free flap carrying bilateral superficial circumflex iliac arteries. The area of the flaps ranged from 20 cm×8 cm to 27 cm×10 cm; the skin flaps were thinned under the microscope to make the thickness of 0.5-1.0 cm, with an average of 0.7 cm. All incisions at the donor site were sutured directly.ResultsDuring the operation, 1 case was replaced with an abdominal free flap carrying the superficial abdominal artery because the superficial iliac circumflex artery was thin and the superficial abdominal artery was thicker. The skin flaps of 15 cases survived smoothly, and the wounds healed by first intention; the donor incisions all healed by first intention. All patients were followed up 8-36 months, with an average of 15 months. The flap shape was satisfactory, with good texture and mild pigmentation of the flap edge, without obvious bloating, effect on shoe wear, or secondary surgical thinning of the flap. The linear scar left in the donor site and had no effect on hip joint movement. All fractures healed well, and the healing time ranged from 3 to 8 months, with an average of 6 months.ConclusionThe abdominal free flap carrying bilateral superficial iliac circumflex arteries has concealed donor site, with little damage, and can be sutured in one stage. The blood vessel is anatomically constant, with less variation, and reliable blood supply. It is one of the ideal flaps for repairing large skin and soft tissue defects of foot and ankle.
Objective To systematically evaluate the orthotic effect of functional electrical stimulation (FES) on the improvement of walking in stroke patients with foot drop. Methods The randomized controlled trials (RCTs) that investigated the orthotic effect of FES on walking in stroke patients with foot drop were electronically searched in the databases such as PubMed, Web of Science, The Cochrane Library (Issue 1, 2013), EMbase, CBM, CNKI, VIP and WanFang Data from January 2000 to January 2013, and the relevant references of included papers were also manually searched. Two reviewers independently screened the trials according to the inclusion and exclusion criteria, extracted the data, and assessed the methodology quality. The meta-analyses were performed using RevMan 5.1 software. Results A total of 8 RCTs involving 255 patients were included. The results of meta-analyses on 4 RCTs showed that, compared with the conventional rehabilitation intervention, the functional electrical stimulation could significantly improve the walking speed, with significant difference (MD=0.09, 95%CI 0.00 to 0.18, P=0.04). The other indicators were only descriptively analyzed due to the incomplete data. Conclusions Functional electrical stimulation is effective in improving walking speed, but it is uncertain of other therapeutic indicators. So it should be further proved by conducting more high quality, large sample and multi-center RCTs.
Objective To explore the influencing factors of flexible flatfoot in preschool children and the therapeutic effects of orthopedic insoles intervention. Methods Convenient sampling method was used to select 1-to-6-year-old children who visited the Prosthetics and Orthotics, Department of Rehabilitation Medicine at the First Affiliated Hospital of Sun Yat-sen University between April 2019 and December 2023. According to the follow-up visits of children wearing orthopedic insoles after 1 year, the follow-up group was divided into the experimental group, and those who did not follow up were matched with the experimental group based on general information to form the control group. The degree of flatfoot of both feet, hallux valgus angle, heel valgus angle, knee valgus angle, navicular drop height, tibial torsion angle, foot posture index, and joint flexibility of children at the initial visit and follow-up were evaluated. Ordered multinomial logistic regression analysis was used to assess the factors influencing the degree of flatfoot of children’s feet. Results A total of 976 children were included at the initial visit, all wearing orthopedic insoles. Among them, there were 805 cases in the control group and 171 cases in the experimental group. There were no statistically significant differences in gender, age, height, or weight between the two groups (P>0.05). A comparison of the experimental group before and after wearing orthopedic insoles for 1 year showed that the degree of flatfoot of both feet, heel valgus angle, knee valgus angle, foot posture index, and joint flexibility were lower at the follow-up visit than those at the initial visit (P<0.05); the remaining parameters showed no statistically significant differences (P>0.05). At the follow-up visit of the experimental group, both heel valgus angle, knee valgus angle, and foot posture index were lower than those in the control group (P<0.05); the other parameters showed no statistically significant differences (P>0.05). Age and tibial torsion angle were negatively correlated with the degree of flatfoot (P<0.001), while hallux valgus angle, heel valgus angle, knee valgus angle, navicular drop height, foot posture index, and body mass index were positively correlated with the degree of flatfoot (P<0.05). There was a difference in the degree of flatfoot between male and female children (χ2=99.76, P<0.001). The results of the logistic regression analysis showed that navicular drop height, male gender, foot posture index, body mass index, heel valgus angle, and age were influencing factors of the degree of flatfoot (P<0.05). Conclusions The flexible flatfoot in preschool children is influenced by factors such as navicular drop height, gender, foot posture index, body mass index, heel valgus angle, and age, and it will be somewhat alleviated as they grow. Wearing orthopedic insoles can correct related biomechanical abnormalities of heel valgus and knee valgus to some extent, but it cannot significantly reduce the degree of flatfoot.
Objective To investigate the effect of first to third metatarsus defect and the effect of reconstruction with ilium on foot function. Methods The first to third metatarsus defect was simulated in a 3D foot model and rebuilt by ilium. The maximal displacement and stress calculated by the method of finite elements were used as the index of estimation. Five cases treated from Mar. 1996 to Jan. 2003 with metatarsus defect rebuilding by free vascular iliac bone incorporating free flapwere evaluated. Results Foot function was affected largely by the defect of the first to third metatarsus. Compared with the normal foot, the maximal displacement was increased by 2.15 times and the maximal stress was increased by 2.12 times in 100% defected foot, and in 50%-defected foot maximal displacement and stress were increased by 1.65 times and 2.05 times respectively. Follow-up had been conducted for 1 to 2 years. All bones and flaps of the 5 cases survived (2 excellent, 2 good, and 1 passable) by function evaluation. Conclusion The first to third metatarsus defect should be repaired, and the method of transplanting iliac bone added by flap is effective.
OBJECTIVE In order to increase the survival area of pedicled fasciocutaneous flap, a multiple pedicled blocking randomized fasciocutaneous flap was designed. METHODS From January 1991 to September 1998, this technique was used to repair 33 cases, including 27 males and 6 females and the ages ranged from 6 to 58 years. All of the patients were suffered from traffic accidents. In these cases, 22 cases had skin defects of legs and feet with bone, nerve and tendon exposed, 5 cases had osteomyelitis as well as internal fixaters exposed and the other 6 had deformity from scar. The size of the flap was 25.0 cm x 13.0 cm x 2.4 cm at its maximum and 6.0 cm x 3.5 cm x 1.5 cm at its minimum. Based on the traditional blocking flap, according to the severity of the wound and conditions of the neighboring tissues, a flap having 2 to 4 orthogonal pedicles with a width of 1.5 to 3.0 cm was designed. The medical-graded stainless steel sheet was implanted below the deep fascia, and after blocking for 3 to 6 days, the side pedicles were divided. 6 to 14 days later, one of the two remaining pedicles was divided and was transferred to repair the defect. RESULTS 31 cases were followed up for 6 months to 5 years without any trouble of the joints. The flap had a good external appearance and was high pressure-resistant. CONCLUSION The multiple pedicled blocking randomized fasciocutaneous flap increased the size of the flap and the length to width ratio. It had the following advantages: manage at will, high resistance to infection and a large survival area of flap.
ObjectiveTo explore the application value of digital subtraction angiography (DSA) in repairing foot and ankle wounds with posterior tibial arterial perforator flaps. MethodsBetween January 2010 and May 2014, 12 cases of foot and ankle wounds were repaired using posterior tibial arterial perforator flaps. There were 7 males and 5 females with an average age of 36 years (range, 22-54 years). The causes were machine injury in 2 cases, falling injury in 3 cases, and traffic accident injury in 7 cases. The disease duration ranged from 7 to 45 days (mean, 16 days). The size of wound ranged from 6 cm×4 cm to 10 cm×5 cm. Preoperative DSA was performed to observe the orientation and distribution of the posterior tibial arterial perforator and the relationship between perforator vessels. Correspondently, the flaps were designed and harvested. The size of flap ranged from 7 cm×5 cm to 11 cm×6 cm. The donor sites were repaired with skin grafts. ResultsPosterior tibial arterial perforator vessels send out ascending branches and descending branches while going down in the superficial layer. All branches were connected to form vertical chain-form anastamosis, and its orientation was consistent with limb vertical axis. According to DSA results, the flaps were designed and harvested easily. All flaps survived after operation. Meanwhile, wounds healed by first intention. All skin grafts at donor site survived. All patients were followed up 6 months. The flaps had good appearance, color, and texture. No ulcer was found. Affected feet had normal walking function. ConclusionThe size, distribution, and chain-form anastamosis condition of the posterior tibial arterial perforator vessels can be accurately observed by DSA, which provides imaging evidence for harvesting posterior tibial arterial perforator flaps and improves the success rate for repairing foot and ankle wounds.
ObjectiveTo investigate the clinical application of the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap in repair of foot and ankle defects.MethodsBetween October 2014 and October 2018, 18 cases with foot and ankle defects were treated. There were 12 males and 6 females with an average age of 32.8 years (range, 8-56 years). There were 11 cases of traffic accident injuries, 3 cases of falling from height injuries, and 4 cases of heavy objects injuries. The wound was at the dorsum of the foot in 9 cases, the heel in 4 cases, the lateral malleolus in 5 cases. The time from injury to flap repair was 7-34 days (mean, 19 days). The size of wound ranged from 6.0 cm×2.5 cm to 11.0 cm×6.0 cm. The foot and ankle defects were repaired with the peroneal artery terminal perforator propeller flap in size of 6 cm×3 cm-18 cm×7 cm, which donor site was repaired with the anterior tibial artery perforator propeller flap in size of 8 cm×3 cm-16 cm×6 cm.ResultsOne patient had a hemorrhagic swelling in the peroneal artery terminal perforator propeller flap, and survived after symptomatic treatment. All recipient and donor sites healed by first intention. Eighteen patients were followed up 6-15 months (mean, 12.5 months). At last follow-up, the shape, color, texture, and thickness of the flaps in the donor sites were similar with those in the recipient sites. There were only linear scars on the donor sites. The two-point discrimination of the peroneal artery terminal perforator propeller flap ranged from 10 to 12 mm (mean, 11 mm). According to American Orthopaedic Foot and Ankle Society (AOFAS) score criteria, the results were excellent in 15 cases and good in 3 cases, with an excellent and good rate of 100%.ConclusionThe foot and ankle defects can be repaired with the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap. The procedure is not sacrificing the main vessel and can avoid the skin grafting and obtain the good ankle function.