Search

腰骶部菱形筋膜蒂皮瓣修复骶尾部褥疮

腓肠神经筋膜蒂岛状皮瓣修复跟骨骨折皮肤缺损合并感染

目的 总结应用腓肠神经筋膜蒂岛状皮瓣修复感染性跟骨骨折合并皮肤缺损临床应用的可靠性。 方法 1999年7月～2002年12月，应用腓肠神经筋膜蒂岛状皮瓣一期修复感染性跟骨骨折合并皮肤缺损30例，男28例，女2例。年龄18～59岁。车祸伤19例，重物砸伤6例，利物刺伤5例。皮肤缺损范围5 cm×5 cm～10 cm×10 cm，伤后至手术时间48 h～8个月。根据缺损范围设计岛状筋膜蒂皮瓣移位于跟骨处，切取皮瓣范围6 cm×6 cm～11 cm×11 cm。 结果 术后移位皮瓣均成活，创口Ⅰ期愈合，随访12～36个月，平均18个月。足部皮瓣血循好，质地良好，皮瓣两点辨别觉为10～16 mm，平均14.5 mm。皮瓣无溃疡，踝关节功能良好，行走步态良好，无疼痛，外形恢复满意。 结论 腓肠神经筋膜蒂岛状皮瓣血管供应好，质地优良耐磨，手术操作简便，不牺牲主要血管，且有较强的抗感染能力，不仅可修复足跟、踝关节周围的皮肤缺损，还能修复小腿前侧的皮肤缺损，利用双腿交叉修复对侧小腿及足跟足踝部皮肤缺损，值得推广。

足底内侧逆行筋膜蒂皮瓣的应用

为足底前部皮肤、软组织缺损提供质地优良的皮瓣。 方法 2004 年8 月—2005 年12 月, 采用足底内侧筋膜蒂逆行皮瓣修复口止母 趾撕脱离断伤4 例以及前足底外侧皮肤软组织缺损1 例。男3 例，女2 例；年龄8 ～ 40 岁。均为机器绞伤。撕脱皮肤或软组织缺损范围5 cm × 4 cm ～ 8 cm × 6 cm；病程3 ～ 6 h。皮瓣切取范围6 cm ×5 cm ～ 9 cm × 7 cm；供区取全厚皮片移植修复。 结果 术后皮瓣肿胀5 ～ 6 d 后消退，皮瓣均成活。供、受区切口Ⅰ期愈合。术后患者获随访1 ～ 2 年，皮瓣质地良好，颜色接近正常，痛温觉部分恢复；无磨损溃疡，步态正常。 结 论 足底内侧筋膜蒂逆行皮瓣是修复足底前部缺损的一种较为理想、简便方法。

指神经血管筋膜蒂逆行岛状皮瓣的临床应用

小腿后侧远端筋膜蒂皮瓣修复踝及跟部皮肤缺损

REPAIR OF SOFT TISSUE DEFECT IN FINGER WITH MODIFIED REVERSE DORSAL DIGITAL FASCIA FLAP

To investigate the operative method of repairing soft tissue defect of finger with modified reverse dorsal digital fascia flap and its cl inical effect of preventing and treating venous crisis. Methods From February 2005 to March 2007, 19 cases (22 fingers) with soft tissue defect of finger were treated, including 14 males (17 fingers) and 5 females (5 fingers) aged 2-62 years old (median 26 years old). There were 8 cases of cutting injury, 6 cases of crush injury, 4 cases of avulsion injury, and 1 case of hot crush injury, involving 3 thumbs, 7 index fingers, 6 middle fingers, 4 ring fingers and 2 l ittle fingers. The size of soft tissue defect was 1.5 cm × 0.8 cm-5.5 cm × 1.5 cm, and the time from injury to operation was 2-11 hours(average 7 hours). The axis of flaps was the l ine of transverse striation of fingers via dominant artery. The flaps were deflected dorsally, as “b” or “d”, to cover the wounds. Reverse dorsal digital fascia flaps 1.8 cm × 1.0 cm-6.0 cm × 2.0 cm in size were adopted to repair the defects. The donor site underwent skin grafting fixation. Results All flaps survived, without venous crisis and obvious swollen. The grafted skin in the donor site all survived. All patients were followed for 6-18 months (average 11 months). Postoperatively, color and texture of the grafted flaps were similar to that of normal skin, and the pulp of the fingers was normal. The two-point discrimination was 8-11 mm, and the activities of interphalangeal joint of all injured fingers were normal. Conclusion The modified reverse dorsal digital fascia flap is ideal for repairing soft tissues defects of the fingers, and can decrease the occurrence of venous crisis.

EFFECTIVENESS OF RETROGRADE ISLAND NEUROCUTANEOUS FLAP PEDICLED WITH LATERAL ANTEBRACHIAL CUTANEOUS NERVE IN TREATMENT OF HAND DEFECT

ObjectiveTo explore the effectiveness of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve in the treatment of soft tissue defect of the hand. MethodsBetween October 2011 and December 2013, 17 cases of skin and soft tissue defects of the hands were treated. There were 8 males and 9 females, aged 23-62 years (mean, 44 years). Of them, defect was caused by trauma in 13 cases, by postoperative wound after degloving injury in 2 cases, and by resection of contracture of the first web in 2 cases; 13 cases of traumas had a disease duration of 2-6 hours (mean, 3.5 hours). The defect sites located at the back of the hand in 5 cases, at the radial side of the palm in 4 cases, at the first web in 2 cases, at the palmar side of the thumb in 4 cases, and at the radial dorsal side of the thumb in 2 cases. The bone, tendons, and other deep tissue were exposed in 15 cases. The defect size varied from 3 cm×3 cm to 12 cm×8 cm. The size of the flaps ranged from 3.6 cm×3.6 cm to 13.2 cm×8.8 cm. The lateral cutaneous nerve of the forearm was anastomosed with the cutaneous nerve of the reci pient sites in 9 cases. The donor sites were repaired by free skin graft or were sutured directly. ResultsThe other flaps survived, and obtained healing by first intention except 2 flaps which had partial necrosis with healing by second intention at 1 month after dressing change. The skin graft at donor site survived, and incisions healed by first intention. All patients were followed up 5-30 months (mean, 12 months). The flaps had good color and texture. Flap sensory recovery of S2-S3+ was obtained; in 9 cases undergoing cutaneous nerve flap anastomosis, the sensation of the flaps recovered to S3-S3+ and was better than that of 8 cases that the nerves were disconnected (S2-S3). The patients achieved satisfactory recovery of hand function. Only 2 cases had extended limitation of the proximal interphalangeal joint. At last follow-up, according to the Chinese Medical Society of Hand Surgery function evaluation standards, the results were excellent in 15 cases and good in 2 cases. ConclusionRetrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve is an effective way to repair skin defects of the hand, with the advantages of rel iable blood supply and simple surgical procedure.

Repair of thumb defects with modified radial dorsal fasciocutaneous flap of thumb

ObjectiveTo investigate the operative method of repairing soft tissue defect of the thumb with modified radial dorsal fasciocutaneous flap and its effectiveness.MethodsBetween June 2015 and December 2016, 15 patients with volar or dorsal defects of the thumb were treated with modified radial dorsal fasciocutaneous flaps which distal pedicles were cut off. Of 15 cases, 11 were male and 4 were female, aged 35-70 years (mean, 46 years). The causes of injury included crush injury in 12 cases and avulsion injury in 3 cases. Because all patients had volar or dorsal defects of the thumb which were accompanied by tendon or bone exposure, they had no condition or desire to replant. There were 12 cases of volar defect of thumb and 3 cases of dorsal defect. The area of defects ranged from 2.0 cm×1.2 cm to 3.0 cm×2.5 cm. The time between injury and operation was 16 hours to 2 days (mean, 30.4 hours). The radial dorsal fascio-cutaneous flaps of 2.3 cm×1.5 cm to 3.3 cm×2.8 cm in size were adopted to repair defects. The donor sites were directly sutured.ResultsAll flaps survived, and no severe swelling or tension blister occurred. The donor sites and wounds healed by first intention. All patients were followed up 3-12 months (mean, 6 months). The color and texture of the grafted flaps were similar to those of normal skin, with no bloated appearance. According to total active motion standard at last follow-up, the finger function was excellent in 8 cases and good in 7 cases.ConclusionModified radial dorsal fasciocutaneous flap of the thumb is a reliable flap with easy dissection and less trauma in repair of soft tissue defects of the thumbs, and satisfactory clinical outcome can be obtained.

MPROVEMENT OF SURGICAL TECHNIQUES IN FASCIOCUTANEOUS FLAP OF LIMBS

To summarize the effectiveness of the improv ed surgical techniques in fasciocutaneous flaps of the limbs. MethodsFrom February 1999 to December 2005, 58 patients (39 males, 19 females, aged 1068 years) underwent repairs of the skin defects with improved fasciaocu taneous flaps of the limbs. Twentyone patients had the skin defects in front of the tibial bone in the middle and lower parts, 12 patients had the skin defect s in the heels, 16 patients had the skin defects in the ankles, 3 patients had t he skin defects around the knees, 1 patient had a wide sacrococcygeal bedsore, and 5 patients had the skin defects in the wrists and hands. The wounds ranged in size from 5 cm×3 cm to 18 cm× 12 cm. According to the wound lo cations, the following flaps were selected: 4 cutaneous antebrachii medialis nerve and basilic vein fasciocutaneous flaps, 1 cutaneous antebrachii lateralis nerve and cephalic vein fasciocutaneous flap, 3 saphenous nerve and great saphenousvein fasciocutaneous flaps, 1 cutaneous nerve of thigh posterior fasciocutaneous flap, 32 reverse sural nerve and saphenous vein fasciocutaneous flaps, and 17 reverse saphenous nerve and great saphenous vein fasciocutaneous flaps. The dissected flaps ranged in size from 6 cm× 4 cm to 18 cm× 13 cm. The donor wounds underwent straight sutures in 39 patients, and the skin grafting (6 cm×3 cm to 13 cm× 6 cm) was performed on 19 patients after the donor wounds were closed. Results The wounds healed by first intention, and the flaps survived completely in 54 patients. The flaps developed partial necrosis in 4 patients. The followup for 120 months (average, 8 months) revealed that the flaps had a satisfactory appearance with a soft texture and the function was also satisfactory. Conclusion A fasciocutaneous flap of the limbs is an ideal flap for repairing defects in the skins and soft tissues of the limbs. The survival rate of the flap can be further improved by an improvement of the surgical techniques.

REPAIR OF DEFECT ON FINGER SKIN WITH REVERSE FASCIAL PEDICLE ISLAND FLAP OF DORSAL BRANCHE OF DIGITAL ARTERY

Objective To introduce the surgical procedure and indication of the reverse fascial pedicle island flap of the digital artery dorsal branches in repairing finger skin defect. Methods By use of the dorsal branches of the digital artery as the pedicel, the reverse island flap was designed. The skin defectsof the proximal interphalangeal joint and beyond in 35 cases (42 fingers) were repaired and the joint or extensor tendon was reconstructed simultaneously. Donor site was primarily closed or a skin graft was used. The flap size ranged from 1.0 cm×2.5 cm to 1.5 cm×3.5 cm.Results Thirtyfive patients were followed up 3 months to 1 year, all the flaps survived. The two-point discrimination was between 6 mm and 10 mm. The function of interphalangeal joint was satisfactory.Conclusion These flaps have the advantages of an extended skinpaddle and a versatile pivot point on the phalanx, and they allow coverage of wide and distal defects.