[Repairing the bone and skin defect of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery]

Objective: To evaluate the clinical outcome of repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery. Methods: Twelve patients of toe defect after reconstruction were repaired from March, 2015 to June, 2017 utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery in the Department of Hand and Foot Microsurgery of Xin'an Hospital, Dongguan City.Of which, there were 7 cases of great toe defect with fibular side of phalanx ungual and skin, 5 cases of second toe defect with proximal interphalangeal joints and the partial bone accompanied the great toe defect.Double bone flaps of one pedicles were used to repair first and second phalanx defect in 5 cases.The skin injured area: 5.5 cm×2.5 cm to 6.5 cm×10.0 cm. Bone defect size of great and second toe were 1.5 cm×1.0 cm×0.8 cm to 1.7 cm×1.0 cm×1.0 cm and 2.5 cm×1.0 cm×1.0 cm to 4.0 cm×1.0 cm×1.0 cm, respectively.The flap size ranged from 6.0 cm×3.0 cm to 6.5 cm×12.0 cm, and the bone flap size ranged from 1.5 cm×1.0 cm×0.8cm to 1.7 cm×1.0 cm×1.0 cm(great toe) and 2.0 cm×1.0 cm×1.0 cm to 3.5 cm×1.0 cm×1.0 cm(second toe). The wound of donor site of the leg was directly combined or local skin transfer sutured with 8 cases, skin-grafting in 4 cases. Results: All the bone-skin flaps survived.After 6-27 months of follow-up, the great toe flaps were found with normal color, good texture and moderate thickness, the two-point discrimination was 7-10 mm. The donor site of the leg showed little influence with normal function.No pain and discomfort in the foot were recorded, and the patients walked well.The healing time of bone flap was from 1.5 to 4 months, with an average of 2.5 months.Using the Maryland Foot Score, 5 cases of 7 feet got excellent and 2 cases of 2 feet got good result in the great toe group (7 cases of 9 feet), the good rate was 100%.Three cases got excellent and two cases got good result in the combined reconstruction group (5 cases), the good rate was 100%. Conclusion: Repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery can also repair bone and skin defect of the great and the second toe, keep the great and the second toe, and restore the appearance and function of the first and the second toe at utmost.

Intermittent on/off prostaglandin E2 and risedronate are equally anabolic as daily PGE2 alone treatment in cortical bone of ovariectomized rats

In this study, we evaluated the rat cortical bone changes after a two-cycle, 60-day each (ON/OFF/ON/OFF) treatment with either prostaglandin E2 (OVX/c-PGE2) alone or in combination with risedronate (OVX/c-PGE2+Ris), in comparison with daily treatment with PGE2 for 240 days (OVX/PGE2-240d) in ovariectomized (OVX) rats. At the end of the study, we found that: (1) the overall effectiveness of the treatment on bone mass in the tibial shaft indicates the following ranking: OVX/PGE2-240d = OVX/c-PGE2+Ris > OVX/c-PGE2 > OVX/c-Ris > or = OVX = aging; (2) the same bone mass and architecture were produced in the OVX/PGE2-240d and the OVX/c-PGE2+Ris groups, but the histomorphometric profiles differed in that the former exhibited a higher bone turnover and index of resorption; (3) OVX/c-PGE2+Ris treatment prevented endocortical bone loss and minimized trabecular bone loss during the OFF periods; and (4) the OVX/c-PGE2 alone treatment resulted in the accumulation of less total bone than OVX/PGE2-240d and OVX/c-PGE2+Ris because it could not maintain most of the new subendocortical and marrow trabecular bone generated earlier. In summary, both continuous daily PGE2 and two cycles ON/OFF combined PGE2 and Ris treatments result in more bone mass than two cycles ON/OFF PGE2 alone and Ris alone in estrogen-deficient rats. This study showed that the anabolic effects of PGE2 can be induced and maintained either by continuous administration or by cyclical PGE2+Ris.

Risedronate plus prostaglandin E2 is superior to prostaglandin E2 alone in maintaining the added bone after withdrawal in a non-growing bone site in ovariectomized rats

Effects of risedronate and prostaglandin E2 (PGE2) alone or in combination on the distal tibia, a non-growing bone site with closed epiphysis at 3 months of age, were studied in ovariectomized (ovx) rats. Six-month-old Sprague-Dawley female rats were either ovx or sham-ovx. Rats were treated immediately after operation either with risedronate (5 micrograms/kg/2x/wk), PGE2 (6 mg/kg/d), or risedronate+PGE2 for 60 days (on-groups) and followed by 60 days without treatment (off-groups). Trabecular area, width and numbers were determined in metaphyseal cancellous bone of the distal tibia. No significant bone loss or structural changes were observed in the distal tibial metaphysis after 120 days of ovx. Risedronate alone did not produce any effect on bone mass during the treatment and the withdrawal periods. PGE2 alone increased the trabecular bone mass associated with thickened trabeculae and increased trabecular numbers. However, some of the newly formed bone was lost at the end of 60 days withdrawal. Combination of risedronate and PGE2 treatment added the same amount of bone mass as PGE2 alone, and the added new bone was maintained during the 60 days withdrawal. These results indicate that treatment with risedronate and PGE2 can preserve the anabolic effect of PGE2 on bone mass for at least 60 days after treatment.

Neural activity in the midbrain correlated with hindlimb extension initiated by locomotor stimulation of the hypothalamus of the anesthetized rat

Midbrain neuronal activity that correlated with the initiation of locomotion produced by hypothalamic stimulation was studied. Locomotion was elicited by electrical stimulation in the perifornical hypothalamus of 59 rats anesthetized with Nembutal. The first hindlimb extension indexed stepping onset. Single and multiple neurons were recorded ipsilateral to the stimulation site at 2230 sites in the anterior and posterior midbrain. To classify responses, activity patterns averaged around stimulation onset and around the extension onset were examined. Responses with specific correlations to extension onset were Type I; responses not specifically related to the extension onset were Type II. In the anterior midbrain, 6% of sites were Type I and 8% were Type II. The larger Type I responses were frequent in the anterior tegmentum near the central gray. The relative frequency of Type I patterns in the posterior ventrolateral tegmentum was similar. Other regions showed relatively more Type II responses; they included the ventral tegmental area, and the regions near the superior cerebellar peduncle and the posterior central gray. Regional population profiles showed that during the initiation of locomotion, neurons in the posterior peribrachial region responded early and neurons in the anterior dorsal and the posterior ventrolateral tegmentum responded later. The initiation-related activity of Type I neurons in the anterior and posterior midbrain tegmentum suggest that they warrant further study for a role in locomotor initiation.