【Abstract】 Objective To study the image of the muscular and cutaneous branches of supratrochlear artery by internal and external carotid angiography and to design the frontal flap for nasal reconstruction. Methods The muscular and cutaneous branches of supratrochlear artery of 30 adults were investigated through internal and external carotid angiography and three-dimensional reconstruction of vessels to explore the courses of branches of supratrochlear artery and their communication with supraorbital artery. According to image observation, the frontal flap was designed and used to perform nasal reconstruction in 11 cases of nasal defects, including 7 males and 4 females with an average age of 23 years (range, 15-48 years). The nasal defect ranged from 3.0 cm × 2.5 cm to 5.0 cm × 3.5 cm. Results Internal carotid angiography and three-dimensional imaging of the vessels showed that supratrochlear artery was found in 30 patients, with a diameter of (0.9 ± 0.6) mm. The superficial cutaneous branch appeared constantly with a diameter of (0.7 ± 0.3) mm. Deep muscular branch traveled among frontal muscle, with a diameter of (0.5 ± 0.5) mm and a length of (32.0 ± 6.2) mm, and it was missing in 4 patients, the branches communicated with each other and with supraorbital artery. All flaps survived with good appearance and without cartilage exposure. After 4 months to 3 years of follow-up, the postoperative aesthetic appearance and function of nasal tip, alar, and columella were satisfactory; the height and slope length of the external nose were moderate; and the reconstructed nose had good texture and normal ventilation function without constriction of naris. Conclusion Imaging studies support the fact that supratrochlear artery has constant cutaneous branch. The application of frontal flap pedicled with cutaneous branch can improve the effectiveness of nasal reconstruction.
Objective To investigate the variation of supratrochlear vein and its relationship with supratrochlear artery and to provide anatomical basis for the reduction of congestive necrosis of paramedian forehead flap in the reconstruction of nasal defect. Methods Twenty sides of 10 antiseptic head specimens were anatomized macroscopically and microscopically. Using the horizontal and anterior median l ine of supraorbital rim as X and Y axis to locate supratrochlear vein and artery, the angles between the supratrochlear artery and vein and the supraorbital rim were detected, and the distances from the supratrochlear artery and vein to the anterior median l ine on the horizontal l ine of supraorbital rim were measured. Results The distance from the supratrochlear artery and supratrochlear vein to the anterior median l ine on thehorizontal l ine of the supraorbital rim was (16.2 ± 2.1) mm and (9.7 ± 3.1) mm, respectively, indicating there was a significant difference (P lt; 0.05). The angle between the supratrochlear vein and artery and the supraorbital rim was (83.3 ± 6.4)° and (80.5 ± 4.2)°, respectively, indicating there was no significant difference (P gt; 0.05). Two asymmetric supratrochlear veins were observed around the area of anterior median l ine in every specimen, one was far from the anterior median l ine (group A) and the other was close to or even on the l ine (group B). The distance from the supratrochlear veins to the anterior median l ine on the horizontal l ine of the supraorbital rim was (11.0 ± 1.9) mm in group A and (7.9 ± 3.2) mm in group B, showing there was a significant difference between two groups (P lt; 0.05). For all the specimens, the supratrochlear vein ran laterally along the medial anterior median l ine of the supratrochlear artery (one side was just on the anterior median l ine). The distance from the supratrochlear veins to the supratrochlear arteries on the horizontal l ine of the supraorbital rim was (6.6 ± 3.2) mm, (5.5 ± 2.0) mm in group A and (7.9 ± 3.9) mm in group B, indicating the difference between two groups was significant (P lt; 0.05). Conclusion The pedicle of the paramedian forehead flap should be wide enough (1.5-2.0 cm), the lateral boundary of the pedicle should be the supratrochlear artery while the medial boundary should be the supratrochlear vein.
Objective To investigate the feasibility of reconstruction of the contracted eye socket by an application of the expanded forehead island skin flap with the supratrochlear and supraorbital arteries. Methods From June 2002 to June 2005, 6 patients with the eye socket defects were treated with an expanded forehead island skin flap with the supratrochlear and supraorbital arteries.There were 4 males and 2 females, aged 16-42 years. The defects were caused bytumors in 2 patients, by trauma in 3, and by chemical burns in 1; the defects were in the left eyes of 4 patients and in the right eyes of the remaining 2 patients, with the illness course of 1 year to 4 years.All the patients first underwent the skin and soft tissue expanding operation on the donor forehead skin area; 1 month later, the transplant of the expanded forehead island skin flap with the supratrochlear and supraorbital arteries was performed to reconstruct the eye sockets. The flaps ranged in size from 8 cm×5 cm to 10 cm×6 cm.The appearance and functional recovery of the reconstructed eye sockets were observed after operation. Results The follow-up of all the patients for 1-3 years revealed that the skin flaps survived, with no visible contracture, and the fine sensory function was still present. The artificial eyes could be steadily placed in the reconstructed eye sockets. The donor areas were healed with no visible hyperplastic scars. Conclusion Reconstruction of the eye socket with an expanded forehead island skin flap with the supratrochlear and supraorbital arteries is a feasible, effective and simply method, and the patient can have a concealed incision, a satisfactory appearance, and a fine sensory function.
目的:通过对滑车神经行经小脑幕侧方区域的应用解剖学研究,寻找小脑幕侧方区域手术时避免损伤滑车神经的临床解剖标志。方法:对15例（男10例,女5例）防腐固定无畸形、无病变的成人头颅标本用红色乳胶灌注后,10倍手术显微镜下观察滑车神经在小脑幕侧方区域的行径,及其与周围重要神经、血管结构的毗邻关系,测量滑车神经长度、宽度、厚度及其与周围标志点的距离,并对所得结果进行统计学分析。结果:滑车神经在小脑上动脉和大脑后动脉之间向前行,进入小脑幕侧方区域,在动眼神经三角的后部穿越游离缘硬膜,其长度为（6.78±1.87）mm,宽度为（1.09±0.21）mm,厚度为（0.78±0.11）mm。滑车神经进入小脑幕侧方区域的入口处位于前床突、颈内动脉床突上段起始部、动眼神经入口后方,位于后床突后外方；距离前床突（23.24±3.18）mm、颈内动脉床突上段起始部（17.57±3.26）mm、动眼神经入口（11.42±3.32）mm；距离后床突（14.21±3.25）mm。结论:行小脑幕侧方区域手术时,为避免损伤滑车神经,前床突、后床突、颈内动脉床突上段起始部和动眼神经入口可以作为寻找滑车神经入口的重要标志,同时注意区分小脑上动脉和大脑后动脉。
Objective To investigate the method and effectiveness of operative treatment of Dubberley type 3B capitulum-trochlea fractures. Methods Between January 2009 and December 2012, 8 cases of Dubberley type 3B capitulum-trochlea fractures were treated. There were 2 males and 6 females with an average age of 55 years (range, 43-65 years). The injury was caused by falling in 6 cases, electric bicycle accident in 1 case, and traffic accident in 1 case. All fractures were fresh and closed injury. No neural or vascular injury was found. The time between injury and operation was 3-15 days (mean, 5.9days). Olecranon osteotomy was performed by a posterior midline skin incision of the elbow; 3.0 mm Herbert compression screws placed from posterior to anterior, 2.4 mm L shape locking compression plate designed for distal radius or 2.7 mm anatomical locking compression plate designed for distal humerus and 1.0 mm Kirschner wires or 3.0 mm Herbert screw for the transverse and coronal plane in the subchondral of anterior articular surface were used for fixation; and the lateral and medial collateral ligaments were repaired. Results All incisions healed by first intention. The patients were followed up 12-18 months (mean, 14.5 months). The X-ray films showed that fracture healing was achieved at 12-24 weeks (mean, 15 weeks) in 7 cases. Fracture nonunion and partial bone resorption in the capitellum were observed in 1 case. No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the range of motion of injured elbow was 0-40° in extension (mean 25.0°), 100-135° in flexion (mean, 116.3°), 60-70° in pronation (mean, 61.3°), and 80-90° in supination (mean, 81.3°). The elbow function score was 64-96 (mean, 81.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 2 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 75%. The visual analogue scale (VAS) score was 0-3 (mean, 1). Conclusion For Dubberley type 3B capitulum-trochlea fractures, an early anatomic reconstruction of capitellar and trochlea, repair of the medial and lateral collateral ligament, and early active mobilization can obtain good functional results.
ObjectiveTo introduce and analyze the role of tibial tubercle internal rotation to treat recurrent patellar dislocation associated with trochlear dysplasia. MethodsBetween February 2007 and April 2011, 28 patients with recurrent patellar dislocation underwent tibial tubercle translocation through medial transfer, rotation and elevation of the tibial tuberosity and the medial patellofemoral ligament (MPFL) reconstruction. There were 4 males and 24 females with an average age of 21.8 years (range, 17-28 years). The disease duration ranged from 6 months to 8 years (mean, 4 years). The patients suffered from 3-10 times patellar dislocation. The result of apprehension test was positive; Lysholm score was (51.64±3.79); Kujala score was (56.89±3.79). According to Dejour classification, 11 cases were rated as type B, 14 cases as type C, and 3 cases as type D; the tibial tuberosity-trocholear distance (TT-TG) was (20.53±2.58) mm; and the patellar tilt angle (PTA) was (29.34±2.54)°. ResultsPrimary healing of incision was obtained in the others except 1 case of mild infection. Twenty-seven patients were followed up 41.8 months on average (range, 27-74 months). No recurrent dislocation was found, and the result of apprehension test was negative. The knee range of motion restored to normal totally. The postoperative Kujala score and Lysholm score were significantly improved to 88.97±3.06 and 88.95±2.98 (t=-42.005, P=0.000; t=-43.122, P=0.000) respectively. TT-TG and PTA restored to normal[(11.77±2.24) mm and (7.99±2.57)°], showing significant differences when compared with preoperative ones(t=13.032, P=0.000; t=29.533, P=0.000). ConclusionThe technique of tibial tubercle translocation and MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation associated with trochlear dysplasia. Especially, tibial tubercle internal rotation can improve the patella stability and knee function.
Objective To explore the mechanism, surgical method, and effectiveness of proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of the flexor digitorum tendon. Methods A retrospective analysis was conducted on the clinical data of 4 patients with proximal phalangeal bone avulsion fracture caused by A2 circular trochlea injury of flexor digitorum tendon admitted between May 2018 and September 2022. The patients were all male, the age ranged from 26 to 52 years, with an average of 33 years. The injured fingers included 1 case of middle finger and 3 cases of ring finger. The causes of injury were rock climbing of 2 cases and carrying heavy objects of 2 cases. Preoperative anteroposterior and lateral X-ray films and CT examination of the fingers showed a lateral avulsion fracture of the proximal phalanx, with a fracture block length of 15-22 mm and a width of 3-5 mm. The total active range of motion (TAM) of the injured finger before operation was (148.75±10.11)°. The grip strength of the middle and ring fingers was (15.50±2.88) kg, which was significantly lower than that of the healthy side (50.50±7.93) kg (t=−8.280, P<0.001). The time from injury to operation was 2-7 days, with an average of 3.5 days. One Kirschner wire with a diameter of 1.0 mm was used for direct fixation through the fracture block, while two Kirschner wires with a diameter of 1.0 mm were used for compression fixation against the fracture block. The fracture healing was observed, and the TAM of the injured finger and the grip strength of the middle and ring fingers were measured. The finger function was evaluated according to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society. ResultsThe incisions all healed by first intention after operation. All patients were followed up 6-28 months, with an average of 19 months. X-ray films showed that all avulsion fractures of proximal phalanx reached bony union, and the healing time ranged from 4 to 8 weeks, with an average of 4.6 weeks. At last follow-up, the grip strength of the middle and ring fingers was (50.50±7.76) kg, which significantly improved when compared with preoperative one (t=−8.440, P<0.001). The TAM of the injured finger reached (265.50±2.08)°, and there was a significant difference when compared with preoperative one (t=−21.235, P<0.001). According to the upper limb functional assessment trial standards of the Chinese Medical Association Hand Surgery Society, the finger function was all evaluated as excellent in 4 cases. ConclusionUsing Kirschner wire fixation through bone blocks and external compression fixation of bone blocks for treating proximal phalangeal bone avulsion fracture caused by A2 circular trochlear injury of the flexor digitorum tendon can achieve good effectiveness.