Objective To investigate the operative method and effectiveness of repairing defects at medial malleolus in children with vascularized fibular head composite flap. Methods Between November 2008 and January 2011, 8 children with bone and soft tissue defects at the medial malleolus were treated. There were 5 boys and 3 girls, aged 2-9 years (mean, 4.6 years). Injuries were caused by machine twisting in 2 cases and by wheel twisting in 6 cases. Soft tissue defect area ranged from 3.5 cm × 3.0 cm to 7.0 cm × 4.5 cm; defect was total in all medial malleolus. The disease duration from injury to admission was 2-8 hours (mean, 4.5 hours). Defects were repaired with vascularized fibular head composite flap carrying the skin around the head of the fibula in 5 cases, and with vascularized fibular head composite flap and skin flap above the medial malleolus in 3 cases having too large defect (gt; 5 cm × 4 cm). The donor sites were repaired with direct suture in 2 cases and with skin graft in 6 cases. Results All 8 fibular head composite flaps and 3 skin flaps above the medial malleolus survived completely. Wounds healed by first intention; the skin grafts at donor sites survived in the other cases except 1 case having local necrosis, with healing of incision by first intention. The patients were followed up 10 months to 3 years (mean, 22 months). The color and elasticity of the flaps were good. All the children had equal leg length. Of 8 cases, 6 had no joint valgus; 2 cases had progressive ankle varus after 1 year of operation. The ankle flexion and extension function returned to normal in 5 cases, and was slightly limited in 3 cases; horizontal side, forward and backward movements had no difference compared with normal side. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle function evaluation criteria, the results were excellent in 5 cases, and good in 3 cases at 10 months after operation. X-ray film showed that the ankle hole gap development of both sides was similar; no premature closure of the epiphysis or bone bridge formation of the medial malleolus was observed in 6 cases, and bone bridge formed in 2 cases after 1 year of operation. Conclusion The satisfactory short-term effectiveness can be obtained in repairing children medial malleolus and soft tissue defects by vascularized fibular head composite flap, and the reconstructed medial malleolus can develop with the growth of children. Long-term effectiveness still need more follow-up study.
Objective To observe the effectiveness of wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor. Methods Between March 2000 and March 2009, 31 cases of distal radius giant cell tumor were treated with extended resection and vascularized fibular head graft for repairing defects of the distal radius, and reconstructing wrist joint. There were 14 males and 17 females with an average age of 37.2 years (range, 15-42 years). The disease duration ranged from 1 month to 2 years and 3 months with an average of 8 months. The size oftumor was 6.5 cm 3.5 cm-8.0 cm 4.5 cm. The range of motion (ROM) of wrist joint was as follows: extension 5-15° (mean, 10.7°), flexion 9-21° (mean, 14.2 ), radial incl ination 0-10 (mean, 8.6 ), and ulnar incl ination 0-15° (mean, 7.9°). The ROM of forearm was as follows: pronation 15-50 (mean, 28.7 ) and supination 10-25° (mean, 16.5°). The histopathological examination revealed that there were 5 cases of stage I, 17 of stage II, and 9 of stage III. Results All patients achieved primary heal ing of incision and were followed up 1-9 years with an average of 4.5 years. The X-ray films showed that bone heal ing time was 12-16 weeks with an average of 13 weeks. No tumors recurrence was observed. The ROM of wrist joint was as follows at 1 year after operation: extension 20-50 (mean, 29.0 ), flexion 30-50° (mean, 35.0°), radial incl ination 10-20° (mean, 16.5°), and ulnar incl ination 20-25 (mean, 23.5 ). The ROM of forearm was as follows: pronation 40-90° (mean, 68.3°) and supination 30-80 (mean, 59.6 ). There were significant differences in the ROM between before operation and after operation (P lt; 0.05). According to the Krimmer et al wrist score, the results were excellent in 17 cases, good in 12, and fair in 2. Conclusion Wrist joint reconstruction with vascularized fibular head graft can restore function of wrist joint. The operation is proved to be safe and effective in treating distal radius giant cell tumor.
Transplantation of composite latissimus dorsi myocutaneous flap and vascularized fibula was performed primarily to repair the tibial defects in 12 cases and radial defects in 2 cases, both of which were associated with large-sized skin defects. The peroneal artery and vein of the fibula were anastomosed to the circumflex scapular artery and vein of the myocutaneous flap, the subscapular artery and vein, as the common vascular pedicle of the two transplants, are anastomosed to the nutrient vessels in the recipient site. Cross-bridge vascular anastomosis was used in 13 cases . All of tfe transplanted tissues survived, Follow-up revealed a good growthof the transplanted flaps, solid union between the transplanted fibulas and the host bones, and the good functional recovery of the repaired extremities. The operative indication and technique were introduced, ahd the merit of the repair ahd reliability of the cross-bridge procedure were discussed.
ObjectiveTo investigate the clinical outcomes of resection of mandibular benign tumors and primary reconstruction with autogenous bone graft via an intraoral approach. MethodsFifteen patients with mandibular benign tumors were treated between January 2009 and September 2012. There were 7 males and 8 females, aged from 18 to 45 years (mean, 30 years). The pathological diagnosis identified 11 cases of ameloblastoma, 3 cases of odontogenic keratocyst, and 1 case of odontogenic myxoma. According to the Urken's CRBS (Condyle, Ramus, Body, Symphysis) classification criteria based on the location of the mandibular defect, there were 3 cases of body type (B type), 3 cases of ramus type (R type), and 9 cases of body and ramus type (BR type). The surgeries were performed via an intraoral approach, except 1 patient with the lesion at the level of sigmoid notch via an auxiliary preauricular incision. To fix the bone grafts to the dissected mandibular defects, reconstructive titanium plates were used, either indirectly according to the computer aided design/computer aided manufacturing mandibular models before surgery (9 patients) or directly according to the exposed mandibles during surgery (6 patients). The patients received benign mandibular tumor resection and primary autogenous bone graft reconstruction with free iliac bones (11 cases) or vascularized fibular flaps (4 cases). The mandibular inferior alveolar nerves were preserved in 6 cases. ResultsPrimary healing of incision was obtained in 14 patients, while secondary healing in 1 patient suffering from bone graft infection. All the patients were followed up 1-4 years (mean, 2.5 years). At last follow-up, no patients showed facial nerve damage; occlusion of remaining teeth was similar to preoperative conditions; the chewing function was satisfactory; mouth opening was 30-35 mm (mean, 33 mm); and swallowing and speaking functions were normal. Only slight extraoral scars caused by the auxiliary incision and the transbuccal appliances were observed, and all the patients were satisfied with the facial appearance. Lower lip numbness was relived in patients with preserved inferior alveolar nerves. There was no tumor recurrence during follow-up period. ConclusionThe intraoral approach is a feasible and proper approach for resection of benign mandibular tumors and primary reconstruction with autogenous bone grafts, with the advantages of inconspicuous facial scars, minimum damage to the facial nerve, and expectable aesthetic appearance.