Search

PERFORATORBASED FLAP FOR REPAIR OF GLUTEAL-SACRAL DEFECTS

Objective To investigate the operative technique and clinical effect of perforator-based flap for repair of glutealsacral skin defects. Methods A new perforator-based flap derived from the gluteal, parasacral and the lumbar arteries was used to repair skin defects ofglutealsacral region caused by trauma or pressure sore. The flap areas ranged from 6 cm×5 cm to 19 cm×11 cm, the diametre of perforating vessel ranged from 1.3 to 2.1 mm,the length of free perforating vessel pedicle ranged from 2.5 to 4.5 cm.Results All the flaps survived andthe wound gained primary healing. All the patients were followed up for 6 to 24months. The colour and texture of the flaps were excellent, the configuration was satifactory and there was no ulcer recurrence. Conclusion This new type of flap is characterized by delicate design, easy dissection, reliable blood supply, nosacrifice of the underlying muscle and no requirement skin graft for donor site closure. It is an optimalmethod in repairing soft tissue defects of the gluteal-sacral region. 

Reconstruction finger web with dorsal two wing-shaped advancement flap for the treatment of congenital syndactyly

ObjectiveTo discuss the effectiveness of using dorsal two wing-shaped advancement flap to reconstruct finger web for treatment of congenital syndactyly.MethodsBetween August 2014 and August 2017, 30 cases of congenital syndactyly were treated, including 18 males and 12 females with an average age of 2.5 years (range, 1.5-5 years). Eight cases were of bilateral hands syndactyly and 22 cases of single hand syndactyly. There were 39 webs of syndactyly (including 1 case of syndactyly of middle finger, ring finger, and little finger). Among them, 11 webs were complete and 28 webs were incomplete. At the dorsum, a flap with V-shaped tip and two wing-shaped pedicle was designed and was just sewed up with an anchor-shaped incision at the palm. Distal end of fingers were separated by serrated flap and were sutured after removal of fatty tissue. In 11 cases with tight skin connection, the defect area at lateral and distal end of fingers was repaired by small pieces of full-thickness skin graft.ResultsAll the flaps survived completely after operation, and no flap necrosis occurred. The skin grafts on the distal side of the finger survived and the wound healed by first intension. All 30 cases were followed up 6-12 months, with an average of 9 months. Postoperative flexion and extension function of fingers were good, and the web depth and width were normal. At last follow-up, according to the Swanson et al. standard, 20 fingers were graded as excellent, 8 as good, and 2 as fair, with an excellent and good rate of 93.3%.ConclusionThe effectiveness of using dorsal two wing-shaped advancement flap to reconstruction finger web for treatment of congenital syndactyly is satisfactory.

Flow-through 前臂静脉皮瓣结合静脉移位在拇指旋转撕脱离断伤再植中的应用

目的总结应用 flow-through 前臂静脉皮瓣结合掌骨头间静脉移位修复伴有断端背侧皮肤及静脉组织缺损的拇指旋转撕脱离断伤的疗效。方法2013 年 4 月—2018 年 3 月，收治 15 例伴有断端背侧皮肤及静脉组织缺损的拇指旋转撕脱离断伤患者。男 12 例，女 3 例；年龄 18～54 岁，平均 34 岁。均为完全离断，拇指掌指关节离断 7 例，近节指骨离断 5 例，指间关节离断 3 例。均伴有断指背侧皮肤及静脉组织缺损，断指背侧皮肤缺损范围为 2.0 cm×1.5 cm～2.5 cm×2.0 cm。受伤至手术时间 0.5～3 h，平均 1.5 h。应用 flow-through 前臂静脉皮瓣结合第 2、3 掌骨头间静脉移位逆行桥接修复再植；应用手背“＞”形单切口同时转移示指固有伸肌腱、桡神经感觉支修复肌腱和神经。结果15 例再植指及皮瓣全部成活；3 例皮瓣术后肿胀瘀血，有张力性水疱，结痂换药后成活。全部患者均获随访，随访时间 4～18 个月，平均 8.7 个月。再植指及皮瓣血运良好，拇指外形饱满，两点辨别觉达 5.3～6.5 mm；再植指对掌对指功能好，全部患者均在骨折愈合后恢复工作。末次随访时根据中华医学会手外科学会上肢部分功能评定试用标准评定再植指功能：优 9 例，良 5 例，可 1 例。结论对于伴有近端软组织及静脉缺损的拇指旋转撕脱离断伤，应用 flow-through 前臂静脉皮瓣结合掌骨头间静脉移位的方法进行再植，可取得较好疗效。

皮瓣肌皮瓣修复四肢皮肤软组织缺损

COMBINED TREATMENT OF REFRACTORY DECUBITUS ULCERS

Objective To summarize the clinical experience in the treatment of refractory decubitus ulcers.Methods From May 1998to March 2005, 22 patients with decubitus ulcers(29 decubitus ulcers) were admitted, whose age was 3692 years. The lesion size was 4 cm×2 cm to 18 cm×15 cm. The locations of decubitus ulcers were the sacrococcygeal region(18 cases), the tuber ischiadicum region (6 cases) and the trochanter major region(5 cases).Enteral nutrientwas given orally and the wound was treated with Wuhuangyihao 8-15 days. Three diabetic patients were injected with insulin. According to patient’s age, ulcer position, ulcer extent and ulcer degree, the flap type was determined. Three wounds were repaired by local flaps, the flap size was 6 cm×4 cm-12 cm×10 cm; 10 by fasciocutaneous flaps, 10 cm×7 cm-20 cm×17 cm; 9 by gluteus maximusmyocutaneous flaps, 13 cm×11 cm-17 cm×14 cm; and 6 by longhead of biceps femoris flaps,11 cm×6 cm-14 cm×7 cm. One was sutured directly. After operation, the patients were placed on airflow suspended bed 7-14 days.Results General nutritional status was improved, hemoglobin was greaterthan 100 g/L, albumen was greater than 30 g/L. Necrosis tissue was removed, granulation tissue turned into fresh, secretion reduced and no redness and swelling occurred in wound. All flaps survived and the wounds healed by first intention. After a followup of 6 months to 5 years, no patient had a recurrence, the color and texture of the flaps were good, the appearance was satisfactory.Conclusion Applying the technique of combined treatment can accelerate the healing of refractory decubitus ulcers and improves the success of operation. 

拇指软组织缺损的修复

目的 探讨不同类型拇指软组织缺损的修复方法。方法 2003年1月～2005年1月，对23例外伤性拇指软组织缺损患者采用单纯或联合食指背侧岛状皮瓣、拇指桡侧指动脉逆行岛状皮瓣、指动脉侧方岛状皮瓣、趾腹皮瓣及足母甲皮瓣移植术治疗。 结果 术后皮瓣全部成活，均获随访6～24个月。皮瓣血运、外观、质地均良好，拇指活动、对掌功能及皮肤感觉均恢复良好。 结论 不同皮瓣对于拇指软组织缺损修复有其适应证。手术时皮瓣选取适宜、设计合理，可以最小的创伤获得最佳的拇指修复效果。

TISSUE FLAP TRANSFERRING FOR WOUND REPAIR OF THE CLAVICLE

Objective To investigate the result of tissue flap transferring for wound repair of the clavicle. Methods From 1994 to 2000, 3 patients( 1 withclavicle osteosynthesis, 1 with chronic clavicle osteomyelitis, and 1 with radioactive ulcer in clavicular region accompanied by chronic osteomyelitis of clavicle) were reconstructed with turnover adipofascial flap, myocutaneous flap of pectoris, and myocutaneous flap of latissimus dorsal respectively. The outcome was observed. The operation principles of tissue flaps transferring for wound repair of the clavicle were summarized. Results Follow-ups were done for 2 months to 7 years. All tissue flaps survived well and the wounds in clavicular region were healed well. There was no recurrence of chronic clavicle osteomyelitis. Conclusion Turnover adipofascial flap, myocutaneous flap of pectoris and latissimus dorsal are often used for wound repair of theclavicle. Most of the wounds of the clavicle can be repaired by turnover adipofascial flap. Myocutaneous flap of pectoris and latissimus dorsal are more suitablefor wound repair with chronic clavicle osteomyelitis. In the case of radioactive ulcer of the clavicular region, myocutaneous flap of latissimus dorsal transposition is a better alternative for wound repair.

股前外侧皮支皮瓣急诊修复手部皮肤软组织缺损

NEW PROGRESS OF PERFORATOR FLAP REPAIR

Objective To introduce the new progress of perforator flaps as an new reconstruction technique. Methods The literature both at home and abroad was reviewed, and the research findings of different perforator flaps were summarized. Results The advantage of perforator flaps versus musculocutaneous flaps was the reduced morbidity of the donor site with preservation of the nerves, muscles and deep fascia. The postoperative complications at donor sites reduced. Conclusion Perforator flap was the new and reliable technique forreconstructionof tissue defect and may be one of the primary choices in the future.

拇指末节软组织缺损的修复

目的 总结拇指末节软组织缺损的修复方法及临床效果。 方法 2002 年1 月－ 2008 年1 月，收治37 例拇指末节软组织缺损。男24 例，女13 例；年龄17 ～ 52 岁，平均27.4 岁。电锯伤5 例，冲压伤24 例，撕脱伤8 例。其中末节指尖组织缺损6 例，指腹12 例，指背9 例，指侧方5 例，脱套伤5 例。缺损范围1.5 cm × 1.0 cm ～ 6.0 cm ×3.0 cm。受伤至入院时间1 h ～ 7 d，平均36 h。根据拇指末节软组织缺损情况，采用第1 掌骨背侧逆行筋膜皮瓣8 例，拇指尺背侧逆行岛状皮瓣9 例，示指背侧岛状皮瓣13 例，中指动脉侧方岛状皮瓣2 例， 甲瓣3 例，第1 掌骨背侧逆行筋膜皮瓣联合示指背侧岛状皮瓣2 例。皮瓣切取范围1.5 cm × 1.0 cm ～ 6.0 cm × 3.0 cm。供区植皮修复。 结果 术后1 例甲瓣修复者拇指伤口感染，1 例示指背侧岛状皮瓣血供不良，1 例第1 掌骨背侧逆行筋膜皮瓣远端表皮坏死，均经对症处理后愈合。其余皮瓣及供区植皮均顺利成活，切口Ⅰ期愈合。患者术后均获随访，随访时间6 ～ 24 个月，平均15 个月。皮瓣血运、质地、弹性良好。指间关节活动范围15 ～ 70°，平均56°；掌指关节活动范围正常。根据1954 年英国医学研究会感觉功能恢复评定标准：感觉功能恢复为S1 ～ S3+。两点辨别觉为5 ～ 12 mm。 结论 对拇指末节软组织缺损选择适当的皮瓣进行修复，可获得满意的临床效果。