SEQUENTIAL THERAPY OF VACUUM SEALING DRAINAGE AND PEDICLED FLAP TRANSPLANTATION FOR CHILDREN WITH MOTORCYCLE SPOKE HEEL INJURY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DONGFu , ZHUJinrong , LIYunfeng ,  LUChun

Department of Orthopaedics, Beihai People's Hospital, Beihai Guangxi, 536000, P. R. China;

Corresponding author：

LUChun, Email: luchun305629718@sina.com

Keywords：

Spoke heel injury; Thermal damage; Vacuum sealing drainage; Pedicled flap transplantation; Children

DOI：

10.7507/1002-1892.20150100

Video：

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Objective To investigate the clinical characteristics of motorcycle spoke heel injury and the effectiveness of sequential therapy of vacuum sealing drainage (VSD) and pedicled flap transplantation for treating motorcycle spoke heel injury in children. Methods Between January 2010 and January 2014, 15 children (aged from 3 to 8 years, 5.7 years on average) with motorcycle spoke heel injury received sequential therapy of VSD and pedicled flap transplantation. The interval from injury to admission was 3-7 days, with an average of 4.9 days. The locations were the heel in 8 cases, the heel and lateral malleolus in 2 cases, and the medial malleolus and medial heel in 4 cases, and the medial and lateral malleolus and heel in 1 case. The patients had different degrees of defects of the skin, tendon, and bone. The skin defect size ranged from 3 cm×3 cm to 13 cm×6 cm. VSD was applied for twice in 13 cases and three times in 2 cases. Reversed flow sural flap was applied in 8 cases, lateral supramalleolar flap in 2 cases, medial supramalleolar perforator-based flaps in 4 cases, and posterior tibial artery flap in 1 case. Eight pedicled flaps with neuroanastomosis were selected according to the wound characteristics. The flap size ranged from 4 cm×4 cm to 14 cm×7 cm. Results Of 15 cases, 13 flaps survived well except that two had partial skin necrosis at the distal site. Primary healing was obtained, and skin graft at donor site survived. The patients were followed up 9-21 months (mean, 13 months). Mild and moderate bulky flaps were observed in 9 cases and 6 cases respectively. Of 15 cases, 13 could walk with weight loading, and 2 had slight limping. Superficial sensation recovered to S3 in 8 patients undergoing neuroanastomosis, and recovered to S2 in 7 patients not undergoing neuroanastomosis at 6 months after operation. According to AOFAS evaluation system for Ankle-Hindfoot, the results were excellent in 13 cases and good in 2 cases, with an excellent and good rate of 100% at 8 months after operation. Conclusion The main characteristic of motorcycle spoke heel injury lies in a combination of high energy damage and thermal damage. Sequential therapy of VSD and pedicled flap transplantation can be regarded as a reliable option to obtain good outcome of wound healing and satisfactory functional recovery for the management of motorcycle spoke heel injury.

Citation： DONGFu, ZHUJinrong, LIYunfeng, LUChun. SEQUENTIAL THERAPY OF VACUUM SEALING DRAINAGE AND PEDICLED FLAP TRANSPLANTATION FOR CHILDREN WITH MOTORCYCLE SPOKE HEEL INJURY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 462-466. doi: 10.7507/1002-1892.20150100 Copy

1.	严立, 胡锐, 丁凡, 等. 负压封闭引流技术联合游离皮瓣移植治疗合并骨折的小腿及足踝部热压伤. 中华创伤骨科杂志, 2013, 15(4):312-315.
2.	杨锦, 杨晓东, 付尚俊, 等. 股前外侧穿支皮瓣修复手背热压伤13例. 中华烧伤杂志, 2013, 29(5):436-437.
3.	Suri MP, Naik NR, Raibagkar SC, et al. Heel flap injuries in spoke wheel accidents. Injury, 2007, 38(5):619-624.
4.	朱跃良, 徐永清, 李军, 等. 儿童足后跟轮辐伤的临床治疗. 中国修复重建外科杂志, 2009, 23(10):1180-1182.
5.	张林祥, 译. 对烧伤病理生理学解释的进展——以烧伤休克的病理生理学为中心. 中国烧伤创疡杂志, 1992, 4(4):59-62.
6.	巨积辉, 邹国平, 金光哲, 等. 多种游离皮瓣修复手背侧热压伤27例. 中华烧伤杂志, 2012, 28(4):312-313.
7.	蔡晓燕, 冯裕董, 林联铎, 等. 前臂桡动脉穿支筋膜蒂皮瓣在手部、腕部热压伤修复中的应用. 中华外科杂志, 2012, 50(5):473-474.
8.	王加利, 赵春霞, 陈仲华. 吻合神经的游离髂骨皮瓣修复足跟部复合组织缺损.中华显微外科杂志, 2014, 37(1):35-38.
9.	Li RG, Yu B, Wang G, et al. Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities. Injury, 2012, 43(6):822-828.
10.	李林东, 蒋纯志, 邱维胜, 等. 应用VSD技术和股前外侧皮瓣修复小腿软组织缺损. 实用骨科杂志, 2013, 19(1):81-82.
11.	钱晓玲, 周学芹, 尹晓莉, 等. 封闭负压引流干预慢性创面神经生长因子和微血管的变化. 中国组织工程研究, 2014, 18(11):1647-1652.
12.	魏永辉, 刘云宁, 马鹏涛, 等. 封闭负压引流在小腿足创伤中的应用. 临床骨科杂志, 2014, 17(4):425-426.
13.	陈忠江, 雷晋, 段鹏, 等. 序贯模式治疗胫腓骨骨折合并内固定物外露难愈性创面12例. 中华烧伤杂志, 2013, 29(4):391-392.
14.	章斌, 郭锦明, 刘俊, 等. 胫后动脉内踝上皮支皮瓣修复小腿远端及足踝部皮肤软组织缺损. 中国骨与关节损伤杂志, 2013, 28(4):383-384.
15.	陈浩, 高峻青, 何斌, 等. 胫后动脉穿支隐神经营养血管双供血皮瓣修复小腿和足踝大面积软组织缺损. 中华显微外科杂志, 2013, 36(3):225-228.
16.	Jakubietz RG, Schmidt K, Holzapfel BM, et al. Soft tissue reconstruction of the distal lower extremity using the 180-degree perforator-based propeller flap. Oper Orthop Traumatol, 2012, 24(1):43-49.
17.	张连双, 任志勇, 史迅. 吻合感觉神经穿支皮瓣移植修复足跟部软组织缺损.中国矫形外科杂志, 2013, 21(16):1681-1683.
18.	谷增泉, 孙雪生, 吕伯实, 等. 吻合皮神经腓肠筋膜皮瓣修复前足皮肤缺损.中国矫形外科杂志, 2005, 13(10):736-737.

1. 严立, 胡锐, 丁凡, 等. 负压封闭引流技术联合游离皮瓣移植治疗合并骨折的小腿及足踝部热压伤. 中华创伤骨科杂志, 2013, 15(4):312-315.
2. 杨锦, 杨晓东, 付尚俊, 等. 股前外侧穿支皮瓣修复手背热压伤13例. 中华烧伤杂志, 2013, 29(5):436-437.
3. Suri MP, Naik NR, Raibagkar SC, et al. Heel flap injuries in spoke wheel accidents. Injury, 2007, 38(5):619-624.
4. 朱跃良, 徐永清, 李军, 等. 儿童足后跟轮辐伤的临床治疗. 中国修复重建外科杂志, 2009, 23(10):1180-1182.
5. 张林祥, 译. 对烧伤病理生理学解释的进展——以烧伤休克的病理生理学为中心. 中国烧伤创疡杂志, 1992, 4(4):59-62.
6. 巨积辉, 邹国平, 金光哲, 等. 多种游离皮瓣修复手背侧热压伤27例. 中华烧伤杂志, 2012, 28(4):312-313.
7. 蔡晓燕, 冯裕董, 林联铎, 等. 前臂桡动脉穿支筋膜蒂皮瓣在手部、腕部热压伤修复中的应用. 中华外科杂志, 2012, 50(5):473-474.
8. 王加利, 赵春霞, 陈仲华. 吻合神经的游离髂骨皮瓣修复足跟部复合组织缺损.中华显微外科杂志, 2014, 37(1):35-38.
9. Li RG, Yu B, Wang G, et al. Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities. Injury, 2012, 43(6):822-828.
10. 李林东, 蒋纯志, 邱维胜, 等. 应用VSD技术和股前外侧皮瓣修复小腿软组织缺损. 实用骨科杂志, 2013, 19(1):81-82.
11. 钱晓玲, 周学芹, 尹晓莉, 等. 封闭负压引流干预慢性创面神经生长因子和微血管的变化. 中国组织工程研究, 2014, 18(11):1647-1652.
12. 魏永辉, 刘云宁, 马鹏涛, 等. 封闭负压引流在小腿足创伤中的应用. 临床骨科杂志, 2014, 17(4):425-426.
13. 陈忠江, 雷晋, 段鹏, 等. 序贯模式治疗胫腓骨骨折合并内固定物外露难愈性创面12例. 中华烧伤杂志, 2013, 29(4):391-392.
14. 章斌, 郭锦明, 刘俊, 等. 胫后动脉内踝上皮支皮瓣修复小腿远端及足踝部皮肤软组织缺损. 中国骨与关节损伤杂志, 2013, 28(4):383-384.
15. 陈浩, 高峻青, 何斌, 等. 胫后动脉穿支隐神经营养血管双供血皮瓣修复小腿和足踝大面积软组织缺损. 中华显微外科杂志, 2013, 36(3):225-228.
16. Jakubietz RG, Schmidt K, Holzapfel BM, et al. Soft tissue reconstruction of the distal lower extremity using the 180-degree perforator-based propeller flap. Oper Orthop Traumatol, 2012, 24(1):43-49.
17. 张连双, 任志勇, 史迅. 吻合感觉神经穿支皮瓣移植修复足跟部软组织缺损.中国矫形外科杂志, 2013, 21(16):1681-1683.
18. 谷增泉, 孙雪生, 吕伯实, 等. 吻合皮神经腓肠筋膜皮瓣修复前足皮肤缺损.中国矫形外科杂志, 2005, 13(10):736-737.

Chinese Journal of Reparative and Reconstructive Surgery

SEQUENTIAL THERAPY OF VACUUM SEALING DRAINAGE AND PEDICLED FLAP TRANSPLANTATION FOR CHILDREN WITH MOTORCYCLE SPOKE HEEL INJURY

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