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To study the therapeutic effect of adjacent pedicle fascia flap filling and arthrodesis in the regional management of sinus tract in diabetic foot.From February 2007 to August 2010, 6 patients suffering diabetic foot with sinus tract were included. There were 4 male and 2 female patients, aged 47 to 68 (averaging 58.3 +/- 6.7). One case had the entrance of sinus tract in the heel, and its base located deep in the calcaneus. Three cases had the sinus tract in the vola or dorsum of the foot, in which 1 with a perforating tract connecting the vola and the dorsum. Another 2 cases were in the toes, both located around joints. Under the effective treatments of anti-infection, anti-coagulation and control of blood sugar, blood pressure as well as blood lipid level, the patients were subjected to surgical treatments of sinus tract, the sinuses in the heel, sole and dorsum of the feet were filled up with facial flap, and those in the toes were eliminated using arthrodesis.All the 6 patients received rational debridement. Four patients were treated with adjacent fascia flap filling, the other two were treated with arthrodesis. The sinus tracts healed 14-20 d after surgery in all patients. One patient developed skin necrosis at the edge of the incision in the dorsum of the foot and another whose sinus located in the toe suffered inflammation and exudation. Both patients recovered after dressing replacement, antiseptic therapy and blood sugar regulation for a period of time.Appropriately designed pedicle fascia flap can provide satisfactory healing for sinus in the heel, vola and dorsum, and arthrodesis is a safe and effective way for that in the toes. Rational debridement is the key prerequisite for healing of sinus tract in diabetic foot.

To explore the surgical managements of open wounds from 5·12 Wenchuan Earthquake.In this report, fifty one patients with open wounds were treated after transported into West China Hospital from May 12 to 26 in 2008 after 5·12 Wenchuan Earthquake. Among 51 cases, open wounds were due to open fractures (n = 8), fasciotomy (n = 6), exposed bone (n = 8) and defects of skin and soft tissue (n = 29). All cases had wound infections. Sixty operations were performed, including muscle and myocutaneous flap (n = 4), skin grafting (n = 30), NPWT (negative pressure wound therapy) (n = 2) and debridement (n = 24).Four cases of muscle and myocutaneous flaps survived with an excellent blood circulation. And 30 cases of skin grafting had a survival rate of over 90%, 2 cases of NPWT and 24 cases of debridement required further treatment.With adequate surgical managements, open wound healing from an earthquake may be accelerated and the functions maximally preserved.

To investigate the medium-term curative effects of locking proximal humerus plate for the treatment of comminuted fractures of proximal humerus, and provide evidences for the clinical practice.From August 2005 and April 2008, 23 patients with comminuted fractures of proximal humerus were treated with locking plates, including 12 males and 11 females, aged 27 to 76 years old (averaged 51.5 years old). There were 18 cases of traffic accident injuries, 4 cases of falls injuries, and 1 case injured after heavy pressure. According to Neer classification, 11 cases were three-part fractures, and 12 cases were four-part fractures. Outcomes were assessed with radiography and the Constant-Murley (C-M) shoulder evaluation.All the patients got primary healing of incisions. Twenty-three patients were followed up, and the duration ranged from 17 to 49 months, with an average of 35.25 months. Twenty patients had fracture healing during 4 to 7 months after operation. There was no significant differences among 3, 6 and 12 months after operation in C-M scoring. The average C-M score was (79.85 +/- 17.23) points (38 to 100 points) at the 12th month after operation, 8 cases got an excellent result, 8 good, 5 fair, and 2 poor. In the LPHP plus bone graft group 6 cases got an excellent result, 4 good, 3 fair, and 1 poor; in LPHP fixation group 2 excellent, 4 good, 2 fair,and 1 poor.The medium-term curative effect of the locking proximal humerus plate in the treatment of proximal humeral fractures is significant. For the comminuted fractures of proximal humerus combined with osteoporosis and bone defects, bone graft should be performed routinely.

To evaluate the patients with bone injury in Wenchuan earthquake.From May 12th to June 15th 2008 the data of 1410 patients with bone injury in Wenchuan earthquake were analyzed to evaluate clinical intervention and remedy-managing experience.The 1410 patients average age was from 4 to 103 years old. And 744 cases (52.7%) suffered from blunt injuries, 379 cases (26.9%) from buried injuries, 287 cases (20.4%) from falling injuries; And 1317 cases were with fracture, 93 with limbs soft tissue injuries; 261 patients combined with other parts of injuries including 45 cases with paralysis; 66 cases were with crush syndrome, 25 with gas gangrene, 76 with acute kidney failure, 26 with multiple organ failure. And 912 operations were performed including 402 fracture fixation, 224 debridement, 152 debridement and suture, 85 amputation, 29 implant skin, 8 fixation of joint dislocation, 5 surgical flaps transplantation, 4 nerve and tendon suture, 2 arthroscopes, 1 joint replacement. Among the 66 crush syndrome patients, 49 accepted continuous renal replacement therapy, in which 9 cases were bleeding from named arteries and 20 blood vessels were getting embolism. Among the 1410 cases, 1 died from multiple organ failure.Among the patients with bone injury in Wenchuan earthquake, the elderly patients are more than the youth; The injuries are always combined with other complications; Opened injuries are polluted severely; It is difficult to deal with the crush syndrome; Paraplegia cases are less, but the amputees are more.