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.
ObjectiveTo investigate the relationship between pulmonary ventilation function (obstructive and restrictive ventilation dysfunction) and atherosclerosis, and explore the correlation between brachial-ankle pulse wave velocity (ba-PWV, an effective index for evaluating atherosclerosis) and pulmonary ventilation function.MethodsFrom January to August 2018, a total of 6403 healthy subjects who reported no major chronic diseases such as stroke, myocardial infarction, cor pulmonale or malignant tumor were selected. Past history such as smoking history, hypertension, diabetes, blood biochemistry, and blood hypersensitive C reactive protein (hs-CRP), hemodynamic indexes such as systolic pressure, diastolic pressure and ba-PWV, body measurement indexes such as height, weight, waist circumference and pulmonary ventilation function were collected. The relationship between ba-PWV and pulmonary ventilation function were evaluated.ResultsA total of 2433 subjects were included, including 916 males and 1517 females. Ba-PWV showed significant positive correlations with age, smoking index, waist circumference, systolic blood pressure, diastolic blood pressure, triglyceride, cholesterol, low density lipoprotein, hs-CRP, glycosylated hemoglobin, and significant negative correlations with height, percentage of forced vital capacity (FVC) in the predicted value (FVC%pred), forced expiratory volume in one second (FEV1), percentage of FEV1 in the predicted value (FEV1%pred), FEV1/FVC ratio and percentage of maximun midexpiratory flow (MMEF) in the predicted value (MMEF%pred). The ba-PWV was not correlated with weight, body mass index, FVC, MMEF, γ-glutamyl transpeptidase, high density lipoprotein, creatinine or uric acid. In multiple regression analysis using factors other than ba-PWV and respiratory function as adjustment variables, both FVC%pred and FEV1%pred showed significant negative relationships with ba-PWV (P<0.05).ConclusionsThe results indicate that FEV1/FVC, an indicator of airflow limitation, is not a predictor of ba-PWV. However, since ba-PWV showed significant negative relationship with FVC%pred and FEV1%pred, clinically assessment of arterial stiffness might be considered in individuals with impaired pulmonary ventilation.
ObjectiveTo explore the clinical efficacy of fascial manipulation (FM) treatment in patients with chronic ankle instability (CAI).MethodsThe clinical data of CAI patients who received rehabilitation treatment in the Department of Rehabilitation Medicine of the Second Hospital of Jilin University from October 2018 to December 2020 were retrospectively collected. According to different treatment methods, patients were divided into balance training (BT) group and FM group. The BT group received BT for 4 weeks, while the FM group received BT for 4 weeks after FM treatment. Propensity score matching (PSM) was used for 1∶1 matching to compare the effects of different treatment options on the dysfunction of CAI patients. Foot and Ankle Ability Measure (FAAM) [including FAAM-activity of daily living (FAAM-ADL), activity of daily living (ADL) self-scoring, FAAM-sports (FAAM-S), and sports self-scoring], center of pressure (COP), foot lift test (FLT) were used to evaluate the changes in balance function and symptoms pre-treatment and post-treatment.ResultsA total of 52 patients were included, including 24 cases in FM group and 28 cases in BT group. Finally, after PSM method, 34 patients were included, 17 cases in each group. Before intervention, there was no significant difference in FAAM, COP and FLT between the two groups (P>0.05). After the intervention, FAAM-ADL, ADL self score, COP and FLT in the FM group were better than those in the BT group (P<0.05); there was no significant difference between FAAM-S and exercise self score (P>0.05). Before and after the intervention, FAAM, COP and FLT were improved in both groups (P<0.05). The improvement of FAAM ADL, ADL self-score and the decrease of COP in FM group were higher than that of the BT group (P<0.05). Comparison of FAAM-S, exercise self score and FLT before and after intervention, there was no significant difference between the two groups (P>0.05).ConclusionBT can improve the function of patients with CAI, and the combination of FM is more effective in improving the ability of daily living and static balance.
Objective To explore perioperative management and postoperative effectiveness of hemophilia induced lesions of the foot and ankle. Methods Between June 1998 and February 2012, 10 cases (12 feet) of hemophilia induced lesions of the foot and ankle were treated with surgery, including 9 cases (11 feet) of hemophilia A and 1 case (1 foot) of hemophilia B. Single foot was involved in 8 cases and both feet in 2 cases, including 3 left feet and 9 right feet. All were males, aged from 13-41 years (mean, 22.6 years). Disease duration was 5-84 months (mean, 32.2 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.2 ± 21.1. Short Form 36 Health Survey Scale (SF-36) score was 45.4 ± 20.0. All patients were given clotting factors (2 000-3 500 U) for pre-experiment and clotting factors substitution therapy was performed perioperatively. Four cases (4 feet) underwent arthrodesis, and 7 cases (8 feet) underwent Achilles tendon lengthening/tendon transposition (1 patient underwent tendon lengthening on the left foot and arthrodesis on the right foot). Results The operation time was 65-265 minutes (mean, 141.1 minutes); 1 case had 400 mL blood loss and 200 mL autogenous blood transfusion, the other cases had less than 50 mL blood loss and no blood transfusion. Wounds healed by first intention in all patients, no postoperative infection, deep vein thrombosis, or other complications occurred. All cases were followed up 6 months to 14 years and 3 months (median, 22 months). The X-ray films at last follow-up showed the patients undergoing arthrodesis obtained complete joint fusion. AOFAS scores at postoperative 6 months and last follow-up were 78.8 ± 14.7 and 75.8 ± 14.5, respectively; SF-36 scores were 76.6 ± 13.1 and 75.5 ± 13.2, respectively; and significant differences were found when compared with preoperative scores (P lt; 0.05), but no significant difference between postoperative 6 months and last follow-up (P gt; 0.05). Conclusion For patients with hemophilia induced lesions of the foot and ankle, surgical treatment could relieve foot and ankle pain and improve the function. Clotting factors pre-experiment at preoperation and substitution therapy at perioperation can reduce the risk of severe postoperative hemorrhage.
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 summarize the clinical application value and progress of Ilizarov technique in the treatment of foot and ankle trauma. MethodsThe related literature of Ilizarov technique in the treatment of foot and ankle trauma was extensively reviewed, and the fundamental principles of Ilizarov technique and its clinical application in the treatment of complex foot and ankle trauma such as Pilon fractures, lateral malleolus defects, calcaneal fractures, and talus fractures were reviewed, and its efficacy and complications were analyzed. ResultsThe Ilizarov technique demonstrates significant advantages in treating open fractures, bone defects, and cases with poor soft tissue conditions, achieving high rates of bone defect repair, effective infection control, and improved functional scores. However, complications such as pin tract infections remain notable. Conclusion The Ilizarov technique is an effective approach for managing complex foot and ankle trauma, particularly in high-risk cases. Its dynamic fixation mechanism combines mechanical stability with biological repair. Future advancements should focus on integrating three-dimensional printing and smart sensor technologies to enhance precision.
By analyzing the physiological structure and motion characteristics of human ankle joint, a four degree of freedom generalized spherical parallel mechanism is proposed to meet the needs of ankle rehabilitation. Using the spiral theory to analyze the motion characteristics of the mechanism and based on the method of describing the position with spherical coordinates and the posture with Euler Angle, the inverse solution of the closed vector equation of mechanism position is established. The workspace of mechanism is analyzed according to the constraint conditions of inverse solution. The workspace of the moving spherical center of the mechanism is used to match the movement space of the tibiotalar joint, and the workspace of the dynamic platform is used to match the movement space of subtalar joint. Genetic algorithm is used to optimize the key scale parameters of the mechanism. The results show that the workspace of the generalized spherical parallel mechanism can satisfy the actual movement space of human ankle joint rehabilitation. The results of this paper can provide theoretical basis and experimental reference for the design of ankle joint rehabilitation robot with high matching degree.
ObjectiveTo investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach.MethodsBetween January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness.ResultsThe operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved (t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved (t=?27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up.ConclusionIt is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.
Objective To explore the clinical effect of the lower rotating point super sural neurocutaneous vascular flap on the repair of the softtissue defects in the ankle and foot. Methods From May 2001 to February 2006, 24 patients with the soft tissue defects in the ankle and foot were treated with the lower rotating point super sural neurocutaneous vascular flaps. Among the patients, 15 had an injury in a traffic accident, 6 were wringedand rolled by a machine, 1 was frostbited in both feet, 2 were burned, 25 had an exposure of the bone and joint. The disease course varied from 3 days to 22 months; 19 patients began their treatment 3-7 days after the injury and 5 patients were treated by an elective operation. The soft tissue defects ranged in area from 22 cm × 12 cm to 28 cm × 12 cm. The flaps ranged in size from 24 cm × 14cm to 30 cm × 14 cm, with a range up to the lower region of the popliteal fossa. The rotating point of the flap could be taken in the region 1-5 cm above thelateral malleolar. The donor site was covered by an intermediate thickness skingraft. Results All the 25 flaps in 24 patients survived with asatisfactory appearance and a good function. The distal skin necrosis occurred in 1 flap, but healing occurred after debridement and intermediate thickness skin grafting. The follow-up for 3 months to 5 years revealed that the patients had a normal gait, the flaps had a good sense and a resistance to wearing, and no ulcer occurred. The two point discrimination of the flap was 5-10 mm. Conclusion The lower rotating point super sural neurocutaneous vascular flap has a good skin quality, a high survival rate, and a large donor skin area. The grafting is easy, without any sacrifice of the major blood vessel; therefore, it is a good donor flap in repairing a large soft tissue defect in the ankle and foot.
【Abstract】 Objective To explore the cause of the perioprative period compl ication of scandinavian total anklereplacement(STAR) and to summarize the experience in the treatment and prevention. Methods From March 1999 toNovember 2006, 35 patients were given total ankle replacement(TAR) with STAR system. There were 19 males and 16 femaleswith an average age of 50.5 years (27 to 68 years), including 12 cases of posttraumatic arthritis, 8 cases of osteoarthritis and 15cases of rheumatoid arthritis. All patients had pain of ankle joint, swell ing and l imitation of joint motion. The disease coursewas 9-64 months. The curative effect was estimated by Kofoed total ankle scoring system. The mean preoperative ankle scorewas 29(6-48); the mean pain score was 18.3(0-35); the mean function score was 11.7(6-18); and the mean activity score was9.2(3-12). The type of all compl ications were record, and its cause, prevetion and treatment were analyszed. Results Thirtythreepatients achieved heal ing by first intention, 2 achieved delayed union because of infection. Twenty-eight patients werefollowed up 3-80 months (mean 43.5 months). Medial malleolus fracture occurred in 2 cases, unstable ankle joint introversion in2 cases, l imitation of ankle dorsiextension in 1 case and 1 case had hypoesthesia at intermediate dorsal skin of foot and 3rd-5thmetatarsal skin without obvious dysfunction; all were treated with symptomatic medication. The postoperative mean ankle scorewas 85.5 (58-95); the mean pain score was 48.3(35-50); the mean function score was 20.7(18-30); the mean activity score was17.2(16-20). There were statistically significant differences when compared with preoperative score(P lt; 0.01). The cl inical resultswere excellent in 16 patients, good in 9 patients and fair in 3 patients. The X-ray films showed no loosening and subsidence ofprosthesis. Conclusion Although STAR can retain the functions of the operated joint, it has its special compl ications. It isimportant to obey operation principle with proficient operative technique, to strictly control surgical indication and to intensifyperioperative period treatment so as to decrease the compl ications.