ObjectiveTo investigate the effectiveness of modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering in the treatment of diabetic foot (DF). MethodsThe clinical data of 22 DF patients treated with modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering between October 2019 and December 2021 were retrospectively analyzed. There were 13 males and 9 females with an average age of 61.3 years (range, 41-74 years). The duration of diabetes mellitus was 8-30 years, with an average of 12.5 years, and the duration of DF was 10-42 days, with an average of 28.2 days. There were 2 cases of grade 3 and 20 cases of grade 4 according to Wagner classification. CT angiography was performed on both lower extremities of the patients, and the blood vessels of the affected extremities were narrowed to varying degrees and the blood supply was poor. The preoperative skin temperature of affected foot was (28.27±0.91)°C, the ankle brachial index (ABI) was 0.42±0.11, and the visual analogue scale (VAS) score was 7.7±0.6. Preoperative size of DF ulcer ranged from 2.5 cm×2.0 cm to 3.5 cm×3.0 cm. The skin temperature of affected foot, ABI, VAS score, and skin wound healing of the affected foot were recorded and compared between before operation and at 3 months after operation. ResultsAll patients were followed up 3-18 months, with an average of 10.5 months. The infection of 1 patient with Wagner grade 4 did not improve significantly after operation, and there was a trend of further deterioration, and the amputation of the left leg was finally performed at 22 days after operation.The remaining 21 patients recovered well after operation, the external fixator was removed at 1 month after operation, the wound healed at 3 months after operation, and there was no recurrence of ulcer in situ or other sites during follow-up. At 3 months after operation, the skin temperature of affected foot was (31.76±0.34)°C, the ABI was 0.94±0.08, and the VAS score was 2.1±0.3, which significantly improved when compared with those before operation (t=25.060, P<0.001; t=32.412, P<0.001; t=–51.746, P<0.001). ConclusionModified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering for DF patients can effectively improve the blood supply of the affected limb, promote wound healing, and improve effectiveness.
Objective To investigate the effectiveness of the free fibular skin flap of the great toe in repairing finger flexion deformity due to scar contracture. Methods The clinical data of 12 patients with finger flexion deformity due to scar contracture treated with scar release and free fibular skin flap of the great toe between March 2022 and December 2024 was retrospectively analyzed. All patients had flexion deformity caused by scar contracture of finger joints after healing of skin defect scar. The duration of scar contracture ranged from 3 months to 2 years, with an average of 7 months. The active range of motion of the finger joint was 0°-10°, with an average of 8°. The range of skin flap was 2.0 cm×1.3 cm to 3.5 cm×2.5 cm. Results All 12 patients were followed up 6-12 months, with an average of 10.5 months. At last follow-up, the flexion deformity of the affected finger was completely corrected, and the active range of motion of the finger joint was restored to close to the healthy side (the distal finger joint was 30°-40°, with an average of 35°; the proximal finger joint was 80°-90°, with an average of 85°). The shape of the flap was plump, the texture was good, and the static two-point discrimination was 6-8 mm, with an average of 6.8 mm. According to the evaluation standard of upper limb function of Chinese Medical Association Hand Surgery Society, 9 cases were excellent, 3 cases were good, and the excellent and good rate was 100%. All wounds at donor sites healed by first intention, with no pain, ulcer or ulceration in toes, normal walking in shoes, and no influence on gait. Conclusion Free fibular skin flap of the great toe is an effective method to repair the finger flexion deformity due to scar contracture, which providing good cosmetic, motor, and sensory outcomes with low donor-site morbidity.