Application And Comparative Study Of Different Limb Salvage Methods In The Treatment Of Lower Limb Composite Tissue Defect

Objective:With the development of industrialization and transportation,the proportion of patients with severe limb injuries is increasing.According to statistics: in 2011,there were about 4 million patients with severe physical trauma in our country.Its treatment is very tricky.Some patients face unavoidable amputation treatment when limb salvage treatment is difficult.The application of the residual limb flap can reduce the amputation plane of the patient,preserve the knee joint,improve the function of the patient after wearing the prosthesis,and is also a kind of limb salvage treatment.With the development of microsurgical techniques and the wide application of Ilizarov technology,the indications for limb salvage treatment have been broadened.The method of pulling the osteogenesis with the free or partial flap combined with the external fixation stent can reconstruct the composite defect of the patient and save the function of the lower limb.Clinical comparison and long-term follow-up of limb salvage treatment methods for lower limb complex tissue defects.This article describes in detail the application of the foot residual limb flap in the treatment of knee protection and a variety of limb salvage treatment methods.Through retrospective study and follow-up study,the long-term effects of different lower limb composite tissue defect treatment methods are compared.Methods:1.Through a retrospective study,data on the history of patients treatedwith knee-retained limb flaps for knee-protection were collected.The knee joint function and flap sensation recovery were further collected by follow-up study.To evaluate the application of the foot flap of the foot in the treatment of knee injury in patients with severe lower limb injuries.2.Data of patients with complex tissue defects after severe trauma of lower extremities were collected by case system.According to the treatment method,they were divided into group A: composite tissue valve group;group B: skin flap combined with bone migration group;group C:shortening extension/soft tissue and bone Co-migration group.At the same time,the patient's gender,age,MESS score,foot sensation,wound size,number of operations,complications and long-term follow-up treatment,including pain(VAS score)and life ability(SIP score)were collected.Compare the long-term effects of different treatments.3.Through retrospective study,compare the long-term effects of knee-protection and limb salvage treatment from the aspects of weight-bearing time,number of operations,total cost of treatment,DMRC function score,and patient satisfaction score.Results:1.From July 2013 to January 2016,a total of 11 patients with severe lower extremity trauma were treated with a free calcaneus osteocutaneous fillet flapfor retaining the knee joint.The patients ranged in age from 16 to59 years with an average age of 34.4 years.A total of 2 patients had complications,which were partial flap necrosis caused by venous return disorder.They were healed after wound dressing.Nine patients recovered their sensation during follow-up.All patients walked normally after wearing knee prosthesis.2.A total of 55 patients with severe trauma of the lower extremity treated in the Department of Orthopaedics,Shanghai Sixth People's Hospital from January 2006 to January 2016 were enrolled.A total of 55 patients were enrolled,including 21 patients in group A and 28 patients ingroup B.6 patients in group C.The complication rates were 28.6%,25%,and 50%,respectively.The average treatment time per cm of bone defect was: 36 days,29 days,31 days.At 2 years of long-term follow-up,the mean visual pain scores(VAS scores)were 2.67,2.78,and 2.67,respectively.The average disease impact life score(SIP score)of each group was 10.5,11.7,and 11.5,respectively.3.By comparing 11 patients with knee-assisted knee-protection and 55 patients with limb salvage treatment,the following results were obtained:the average time from the initial surgery to the weight-bearing in the knee-protection group was 6.4 months,and the average number of operations was 1.7.The total hospitalization cost was 28,000 yuan.The average distance between the two points was 46.0mm,the average DMRC was 5.6 points,and the average patient satisfaction was 3.6 points.The average weight-bearing time of the limbs was 11.8 months,and the average number of operations was 2.8 times.The total hospitalization cost was 42,000 yuan,the average distance between the two points was 47.1mm,the DMRC score was 6.6 points,and the patient satisfaction score was 3.9 points.Conclusion:The free calcaneus osteocutaneous fillet flaphas the advantages of good wear resistance,stable blood supply,sensory reconstruction,and small damage to the donor site.It is the preferred procedure for knee protection and even hip protection when the indication is allowed.In the treatment of complex tissue defects with severe trauma of the lower extremities,the local/free flap combined with bone migration technique has the shortest treatment period and relatively few complications.The shortening technique is suitable for use in situations where the shortening does not affect the blood supply and sensation of the distal end of the patient's limb.The co-transport technique of soft tissue and bone is suitable for patients with small wound defects and requires good medical compliance.Theknee-protection treatment cycle is short,the cost is small in the short term,and the function recovery is better.Limb salvage treatment has a long treatment period and poor functional recovery,but the patient satisfaction is higher.