Objective To investigate the surgical characteristics and preliminary effectiveness of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors. Methods Twenty-two patients received Orthofix unilateral external fixator treatment for bone defect after tumor excision or complications after limb salvage surgery between June 2011 and March 2016. There were 11 males and 11 females with a median age of 23.5 years (range, 4-57 years). The bone defect or limb length discrepancy after tumor resection was at proximal femur in 6 cases, distal femur in 8 cases, diaphysis of femur in 3 cases, proximal tibia in 2 cases, and diaphysis of tibia in 3 cases. The external fixation was used for temporary fixation after reconstruction of bone defect in 10 cases [the length of bone defect was 6-19 cm (mean, 12.3 cm); using vascularized fibular graft in 2 cases, allograft bone and free fibular graft in 2 cases, allograft bone and autogenous bone graft in 5 cases, allograft bone reconstruction in 1 case]; bone distraction lengthening for limb length discrepancy in 5 cases [the length of shortening was 6.5-8.5 cm (mean, 7.5 cm)]; temporary fixation after open biopsy in 3 cases; bone transportation over locking plate in 1 case (the length of bone defect was 7.5 cm); fixation for preoperatively pathology fracture in 1 case; and joint distraction for dislocation after tumor ablation in 2 cases. Results All the patients were followed up 12-72 months (mean, 36 months). In 10 patients with bone defect reconstruction, the wearing external fixator time was 3-8 months (mean, 4.8 months); all got bone union with the healing time of 3-16 months (mean, 6.4 months); the Musculoskeletal Tumor Society 93 (MSTS 93) score was 73.3-93.3 (mean, 87.2); and no complication occurred during wearing external fixator. In 5 patients with bone distraction lengthening for limb length discrepancy, the wearing external fixator time was 7-15 months; 2 patients had axial deviation during distraction and2 had greenstick fracture after apparatus removal; pin site infection was observed in 2 cases with grade 1 and 1 case with grade 2 according to Checketts-Otterburn classification system; the MSTS 93 score was 80.0-96.7 (mean, 89.2). The remaining patients had no complications, the knee and ankle joint movement was normal. Conclusion Orthofix unilateral external fixator can be used in fixation for complex bone defect after tumor resection and to correct limb length discrepancy after limb salvage surgery.
ObjectiveTo explore the effectiveness of iliac myocutaneous flap pedicled with deep circumflex iliac artery (DCIA) on the repair of lower limb composite defect wounds with cavity. MethodsA retrospective analysis of 7 patients with lower limb composite defect wounds treated between March 2017 and September 2020 was conducted, including 4 males and 3 females, aged 24-58 years, with a median age of 37 years. The causes of injury were machine twisting injury in 2 cases, fall from height injury in 2 cases, and traffic accident injury in 3 cases. According to Gustilo-Anderson classification, there were 1 case of type Ⅲa, 4 cases of type Ⅲb, and 2 cases of type Ⅲc (combined with anterior tibial artery rupture); according to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 2 cases of type 42-C3, 2 cases of type 43-A2, and 3 cases of type 43-B1. The time from injury to admission ranged from 2 to 10 hours, with an average of 6 hours. Tibial bone defect and surrounding soft tissue defect with deep cavity were left after primary emergency debridement. In the second stage, according to the characteristics of the wound, the three-dimensional repair of the composite defect was designed with DCIA embedded iliac myocutaneous flap. The size of the iliac flap was 2.0 cm×2.0 cm×2.0 cm to 7.0 cm×3.0 cm×2.5 cm, and the size of the flap was 12.0 cm×8.0 cm to 21.0 cm×13.0 cm. The internal oblique muscle flap was harvested in size of 3.0 cm×2.0 cm×2.0 cm to 5.5 cm×4.0 cm×4.0 cm. The donor site was primarily closed. ResultsAll the flaps survived after operation, except for 1 case of partial necrosis of the flap edge, which healed after secondary skin grafting, and the donor and recipient wounds healed by first intention. All patients were followed up 16-24 months, with an average of 18 months. The broken end of the bone defect healed well, and the healing time was 8-10 months, with an average of 7.3 months. At last follow-up, the shape of the flap was satisfactory, the texture was soft, and there was no abnormal hair growth, pigmentation, and so on. Only linear scar was left in the donor site, and no complication such as abdominal hernia occurred. According to Paley fracture healing scoring system, bone healing was rated as excellent in 5 cases and good in 2 cases. The limb function was satisfactory, and full weight bearing was achieved at 12-16 months after operation. According to the lower extremity functional scale (LEFS), 6 cases were excellent and 1 case was good. Conclusion The iliac myocutaneous flap pedicled with DCIA is flexible in design and highly free in tissue composition, which can repair the composite defect wound of lower limbs with deep cavity in a three-dimensional way, and repair the limb shape and reconstruct weight-bearing function to the greatest extent.
Objective To evaluate the application value of infrared thermography in breast reconstruction, cosmetic surgery, and limb reconstruction. Methods A retrospective analysis of clinical data from 67 patients undergoing breast reconstruction and cosmetic procedures and 30 patients undergoing limb reconstruction between February 2022 and June 2025. The patients undergoing breast reconstruction and cosmetic surgery were all female, aged 25-60 years with a median age of 48 years. Procedures included breast reconstructions in 48 cases, breast reductions in 8, nipple reconstructions in 5, revision breast reconstructions in 2, revision nipple reconstruction in 1, and labia minora reductions in 3. Among the patients undergoing limb reconstruction, 18 were males and 12 were females, aged 29-62 years with a mean age of 43 years. Procedures included skin flap transplants for wound repair in 10 cases, fracture internal fixation in 17, and limb lengthening reconstructions in 3. An infrared thermography device was applied intraoperatively and within 48 hours postoperatively to monitor flap and distal limb temperature and vascular perfusion. Results Intra- and post-operative infrared thermography assessment indicated 2 positive cases (2.1%, 2/97), comprising 1 false positive. Among the 95 negative cases (97.9%, 95/97), 1 false negative was recorded. After operation, 1 case of immediate breast reconstruction exhibited localized vascular compromise at the edge of the local flap, though infrared detection showed no abnormally low skin temperature. The wound healed with delayed healing following dressing changes. One case of latissimus dorsi myocutaneous flap exhibited persistent infrared hypothermia during transfer. However, the flap demonstrated active dermal hemorrhage and a positive pinch test. Continuous monitoring revealed a subsequent rise in flap temperature, confirming adequate perfusion. The flap survived, with primary wound closure achieved. The postoperative infrared thermal imaging monitoring of the surgical site indicated adequate blood supply with no local ischemic necrosis in other patients. All patients were followed up. The patients undergoing breast reconstruction were followed up 1-30 months, with a median follow-up time of 15 months. The reconstructed breasts and nipples demonstrated good survival. The patients undergoing labia minora reduction were followed 3, 8, and 13 months, respectively. The surgical sites exhibited favorable appearance and blood supply. The patients undergoing limb reconstruction were followed 1-12 months (mean, 7 months). Transplanted flaps showed good survival, and patients with fractures or limb lengthening achieved favorable limb recovery. Conclusion Infrared thermography offers a convenient, non-invasive, and objective supplementary indicator for breast and limb reconstruction. This technology can be used intra- and post-operatively to assess blood supply, thereby aiding surgical decision-making and reducing the risk of postoperative complications. However, attention should be paid to the potential for false positives and false negatives.