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Objective: To discuss the pathological and clinical characteristics,methods of therapies and perioperative considerations of cervicothoracic spinal fractures and dislocations in patients with ankylosing spondylitis (AS)., Methods: Thirteen patients with ankylosing spondylitis and cervicothoracic spinal fractures and dislocations were treated from January 2001 to March 2009, including 11 males and 2 females,aged varied from 33 to 60 years (mean 46) in 11 males and from 36 to 59 years (mean 47.5) in 2 females respectively. The symptom duration of AS was from 12 to 27 years (means 14.5 years). The chief complains were pain around cervical part and shoulder blades, some accompanied with decrease of motor power and sensation in upper or lower limbs. Spine radiographs revealed a displaced fracture of cervicothoracic spine. Laboratory examination presented positive results of HLA-B27 test. Fusion of fracture and ASIA neurological function grade variation were observed., Result: A total of 13 patients, who underwent operation, were followed up for 12 to 43 months(means 35.6 months). There were 6 patients were treated with anterior cervical discectomy and fusion, 4 with anterior cervical corpectomy and fusion, 1 with laminectomy and fusion and 2 with combined anterior and posterior stabilisation. The bone fusion were observed after reduction of fractures and dislocations ultimately. Twelve patients acquired an improved neurological status in different degrees, and only one suffered from persistent neurological impairment loss. The complications occurred in 5 cases during perioperation., Conclusion: This study suggests that most cervicothoracic spinal fractures and dislocations in patients with AS are extremely unstable and require operations. If operative method is proper and operative process accurate, either anterior,posterior or combined approach can achieve good spinal myeloid functional recovery with low rates of operative complications occurrence, under the guidence of imaging manifestation.

Objective: To summarize clinical application experience of treatment of occluded iliofemoral veins with great saphenous vein cross-over bypasses., Methods: From September 1998 to December 2005,6 patients(5 men, 1 woman) with occluded iliofemoral veins underwent great saphenous vein cross-over bypasses. They ranged in age from 36 to 52 years (mean, 41 years old). All patients had unilateral thigh and leg edema and swelling with accompanying pain. The normal contralateral great saphenous vein was dissected and it was tunneled across the super-pubic fat pad and anastomosed to the femoral vein or the proximal portion of great saphenous vein in distal to occluded iliofemoral veins., Results: The postoperative course was uneventful. One case sustained superficial infection postoperatively at donor site and the gradual wound healed by daily wound dressings. At 1 to 3.5 years (mean 1.8 years) followed up, all patients had pain disappearance and obvious relief of the edema but some swelling., Conclusion: Great saphenous vein cross-over bypasses is effective operative method of treatment of occluded iliofemoral veins. The operation is relatively simple and safe.

Objective: To report the clinical results of scalp defect using V-Y-S rotation flap., Methods: From March 2003 to October 2005, 5 cases scalp defect (4 male, 1 female) were reconstructed with the technique. The age ranged from 26 to 52 years (mean 32 years). The scalp defect ranged from 3 cmx3.5 cm to 4 cmx5 cm. Four cases were reconstructed with bilateral flap and one case was reconstructed with unilateral flaps., Results: All patients were followed-up from 10 to 42 months (mean, 28 months). All the flaps survived completely and showed good hair growth and had satisfactory clinical results., Conclusion: Repair of scalp defect using V-Y-S rotation flap technique is simple with no need for a skin graft and can be performed quickly, there is minimal morbidity and the outcome is highly successful.

Objective: To summarize clinical application of the high tibial osteatomy (HTO) with lateral closing-wedge for the treatment of pain of unicompartmental osteoarthritis of the knee., Methods: From February 2000 to February 2004,9 patients (3 males and 6 females, ranging in age from 52 to 58 years, with an average of 56 years) with unicompartmental osteoarthritis of the knee treated by HTO with lateral closing-wedge. The proximal tibiofibular joint was exposed, the anterior part of the capsule was incised, and to remove a laterally based wedge with saw cuts and osteotomes. Stepped staples were used for the fixation of tibial osteotomies after closing the defect of osteotomy., Results: The operative course was uneventful. There were no complications after operation. The postoperative follow-up period ranged from 2 to 5.5 years (mean, 3.5 years). The results were evaluated with functional assessment criterion of the osteoarthritis of the knee, among the 9 cases, excellent was in 5 cases, good in 3 cases, fair in 1 case., Conclusion: HTO with lateral closing-wedge is an effective operative method for the treatment of pain of unicompartmental osteoarthritis of the knee, but except for older patients over 60 years.

Objective: To summarize clinical application of the sural medial gastrocnemius island muscle flap to cover wound of infection on upper region of the tibial., Methods: Nine patients (7 men, 2 women) with soft tissue defects on the upper region of the tibial underwent reconstruction with the sural medial gastrocnemius island muscle flap. The age ranged from 21 to 60 years old (mean, 34 years). The immediate coverage of the muscle flaps were performed by a meshed split-thickness skin graft. The donor site was closed directly. The donor leg was ipsilateral in all cases., Results: Only one case sustained superficial infection postoperative and the gradual wound healed by daily wound dressings. All the muscle flaps and skin graft had survived completely without major complication with satisfactory clinical results. All patients were followed-up for 13 months to 4 years (mean 21 months), the donor site was healing, there was no remarkable donor site morbidity., Conclusion: The sural medial gastrocnemius island muscle flap is nourished by the medial sural artery. The muscle flaps seem to have highly vascularize, a constant vascular anatomy and a long vascular pedicle. The muscle flap is thin and suitable for repairing soft tissue defect on the upper region of the tibial.

Objective: To summarize clinical application of one-stage toenail lengthening in free second toe transfer for reconstruction of the thumb (finger)., Methods: Nine patients (male 7, female 2) underwent thumb (finger) reconstruction with second toe transfer were treated by one-stage toenail lengthening technique. Eight were the thumb and 1 was the index finger. Patients aged from 18 to 46 years,with an average of 25 years. A rectangle skin was resected at 0.5 cm away from the eponychium, which was 0.2 cm high and as wide as the toenail. Then stripped U shape flap gently towards proximal end and sutured it. During the operation, the injury of the subcutaneous vascular network should be avoided., Results: Superficial infection at donor area happened in 1 case and was healed by changing dressings. All the reconstruction thumbs (fingers) had survived completely. 2 to 3 mm extending of toenail length was obtained and the appearance of thumb (finger) was improved. There was no growth deformation of toenail. After 7 to 24 months follow up (the average time 13 months), the appearance of the nail was good., Conclusions: One-stage toenail lengthening in free second toe transfer for reconstruction of the thumb (finger), which can obtain a satisfactory appearance of the nail and have no influence on the motion of the reconstruction thumb (finger), is a simple and an effective operative procedure.