Objective To investigate the method and the short term cl inical effectiveness of in situ suture repair procedure of knee dislocation with multi ple-l igament injury at acute stage. Methods From February 2006 to November 2007, 9 patients suffering from single knee closed dislocation with multi ple-ligament injury underwent open in situ suture repairprocedure with non-absorbable thread and managements of other combined injuries simultaneously. Nine patients included 6 males and 3 females, aged 34-52 years old. The injured knees were left side in 4 cases and right side in 5 cases. Injuries were caused by traffic accident in 8 cases and heavy-weight crushing in 1 case. EMRI and arthroscopic examination showed that all patients suffered from the avulsion injuries of anterior cruciate l igament and posterior cruciate l igament. The time from injury to operation was 4 to 7 days with an average of 5.1 days. Results No bacterial arthritis occurred after operation. Subcutaneous liquated fat occurred and cured after symptomatic treatment in 2 cases, other incisions healed by first intension. All patients were followed up 12 months. At 12 months postoperatively, 2 patients’ flexion range of the suffering knees lost 10° when to compared with normal knees, and the range of motion was from 0 to 125°. The Lysholm knee scores were 83-92 (average 86.3), the results were excellent in 3 cases and good in 6 cases. The posterior drawer test and anterior drawer test were one-degree positive in 3 cases respectively; the Lachman tests were one-degree positive in 5 cases, lateral stress tests were negative in all cases. Conclusion In situ suture repair procedure of knee dislocation with multi ple-ligament injury at acute stage has the advantages such as rel iable fixation, simultaneous management of other combined injuries and satisfactory short term effect.
OBJECTIVE: To investigate the clinical application of subdermal vascular network skin flap pre-fabricated by ultrasonic liposuction in reconstruction of digital avulsion. METHODS: Forty-seven injured fingers of 23 cases were treated from June 1997 to February 2000. Conventional abdominal skin flap was elevated, according to the size of digital avulsion, and subcutaneous fat was removed with scissors. Ultrasonic liposuction technology was adopted, in order to minimize the injury of subdermal vascular vessels, to remove the fat particles close to the vascular network. Finally, the pre-fabricated skin flap was used to repair the digital avulsion. The vascular pedicle was severed in 5 to 7 days after operation. The range of skin flap was 4 cm x 3 cm to 8 cm x 7 cm, and the ratio of length and width was (2 to 3) to 1. RESULTS: All the skin flaps were survived. Twenty-one patients were available for postoperative follow-up for 6 to 24 months. The motion of interphalangeal joint achieved functional recovery, and the sensation of pain, temperature and taction recovered well. CONCLUSION: Ultrasonic liposuction does not obviously injure the subdermal vascular network skin flap, it is a simple and safe method for treatment of digital avulsion.
OBJECTIVE To explore the effect of intravascular low level He-Ne laser irradiation on skin flap survival after orthotopic transplantation in avulsion injury. METHODS Fifty eight cases suffered avulsion injury were treated by debridement and orthotopic transplantation of avulsed flap within 6 hours, 31 of them were received intravascular low level He-Ne laser irradiation and routine treatment, and 27 of them were received routine treatment as control group. RESULTS The survival area and quality of avulsed flap in the experimental group were superior to that of control group after 15 days of operation, and the hemorheological items were markedly changed at 5 days after operation. CONCLUSION The better flap survival after orthotopic transplantation in avulsion injury can be improved by intravascular low level He-Ne laser irradiation through changed superoxide dismutase activity and hemorheological items in optimal irradiation intensity.
OBJECTIVE In the determination of the viability of skin following incomplete avulsion, subjective criteria such as color, skin temperature, pressure reaction and the stab bleeding would often give a high rate of failure. In order to resolve this problem, a retrospective study was carried out. METHODS In 27 patients, there were 18 males and 9 females, the age ranged from 7 to 41 years old. In operation, the blood supply of the skin was determined by above subjective criteria carefully. RESULTS After operation, 5 cases had total survival, 7 cases had peripheral or small area necrosis and 15 cases resulted in large area of necrosis. CONCLUSION: The conclusion was that if the incompletely avulsed skin showed sign of being compressed and squeezed, or the incompletely avulsed skin had uncertain or unstable circulatory status, even though the circulatory status being good, active attitude should be given to debridement in complete removal of the avulsed skin in order to improve the successful rate. For the other 2 cases with degloving injuries of large area of the limbs, the avulsed skin was made into a subdermal vascular network skin flap and several axial incisions were made to save the blood circulation of flap. The result was satisfactory and the vital tissues were preserved and used to the greatest extent.
Objective To evaluate the surgical procedure and short-term effectiveness of one-stage repair and reconstruction of knee dislocation with multiple ligament injuries (KDMLI). Methods Between September 2010 and April 2014, 9 cases (9 knees) of KDMLI were treated. There were 7 males and 2 females with an average age of 42 years (range, 27-57 years). Injury was caused by traffic accident in 3 cases, heavy-weight crushing in 3 cases, sports sprain in 2 cases, and falling from height in 1 case. The average time from injury to operation was 11 days (range, 3-19 days). The results of posterior drawer test and Lachman test were positive in all patients. The results of varus stress testing were three-degree positive in 4 cases, and the results of valgus stress testing were three-degree positive in 6 cases. The Lysholm score of knee was 27.2±6.3; the International Knee Documentation Committee (IKDC) score was 29.7±6.5; and the range of motion (ROM) was (52.6±12.8)°. All patients suffered from posterior cruciate ligament (PCL) injury and femoral avulsion injury of anterior cruciate ligament (ACL). Combined injuries included medial collateral ligament (MCL) injury in 4 cases (medial meniscus injury in 1 case), lateral collateral ligament (LCL) injury in 2 cases, and MCL and LCL injuries in 2 cases (medial meniscus and lateral meniscus injuries in 1 case). Autologous harmstring tendon was used to reconstruct PCL under arthroscopy combined with limited open in situ suture for repair of femoral avulsion injury of ACL, and repair of MCL, LCL, and other injury in one-stage operation. Results All incisions healed by first intention. Joint effusion of knee occurred in 1 case and was cured after removal of fluid combined with pressure bandage. All patients were followed up 12-36 months with an average of 22 months. At last follow-up, the result of posterior drawer test was negative in all patients. The results of Lachman test were one-degree positive in 2 cases; the result of varus stress testing was one-degree positive in 1 case; the results of valgus stress testing were one-degree positive in 2 cases; and flexion dysfunction of the knee was observed in 1 case. The Lysholm score of knee was 87.3±6.6; the IKDC score was 88.9±6.8; and the ROM was (121.7±12.3)°, all showing significant differences when compared with preoperative ones (t=44.246, P=0.000; t=37.903, P=0.000; t=19.894, P=0.000). Conclusion For KDMLI, one-stage repair and reconstruction using autologous harmstring tendon to reconst ruct PCL under arthroscopy combined with limited open in situ suture repair of femoral avulsion injury of ACL, and repair MCL, LCL, and other injury has such advantages as minimal invasiveness, reliable fixation, less complications, and fast recovery, which can significantly improve the stability, ROM, and function of knee and obtain good short-term effectiveness.