Six diiTerent types of tissue flaps supplied by different tributaries of the subscapular artery were used as free graft or transfer, they were latissimus dorsi myocutaneous flap in 9 cases, latissimus dorsi muscle flap in 1 case, lateral thoracic skin flap in 5 cases, and others. The results were: 22 successful, 3 failures. According to the conditions of the recipient, the appropriate tributary of the subcapular artery should be selected for the blood supply of the flap, however, it was also important to select the best artery of the ecipient for anastomosis.
Objective To study the surgical treatment of tracheal and main bronchial tumors. Methods We retrospectively analyzed the clinical data of 30 patients with tracheal and main bronchial tumors treated in Shengjing Hospital of China Medical University from January 2000 to December 2015. There were 12 males and 18 females with the age ranging from 22 to 80 years. Results Ten patients were treated with enucleation, 12 patients tracheal tumor resection and end-to-end anastomosis, 1 patient window resection, 1 patient wedge resection, 5 patients tumor resection and tracheal reconstruction by using pulmonary tissue flap with alloy stent and 1 patient left pneumonectomy. One patient died of sudden massive hemoptysis 26 d after operation. Intraoperative complications were found in 2 patients. Others had a good recovery after operation. Patients were followed up for 11 months to 14 years. Eight patients were followed up less than 5 years postoperatively, one patient died of sudden massive hemoptysis 14 months after operation, while others survived; 21 patients were followed up more than 5 years and 5 patients were lost to follow-up. Conclusion Surgical resection is recommended for tracheal and main bronchial tumors. Patients with small benign tumor may choose local tracheal resection; tracheal segmental resection and end-to-end anastomosis is the most common surgical treatment. Patients with more than half of the whole length of tracheal defects or in the risk of anastomotic ischemic necrosis may be suggested to receive tracheal reconstruction.
Thirty-one cases of below pairt nasal defect were re-paired by various auricular compound tissue flap. All of thepatients have good appearance after operations,The operativetechniques and the application range of various auricularcompound tissue flaps were introduced.
Various tissue flaps were used in the repair of 255 cases of the wounds from severe deep burns and cicatricial deformities. The types of flaps used included: 6 kinds of myocutaneous flaps in 54 cases, 10 kinds of axial cutaneous flaps in 50cases, 7 kinds of fasciocutaneous flaps in 44 cases, pedicled subcutaneous tissues flaps in 12 cases, pedicled thin skin flaps in 54 cases, subdermal vascular networks cutaneous flaps in 38 cases, and free skin flaps with arter ialization of vein flap, retrograd island cutaneous flap with great or small saphaneous vein, in each. The survival rate from the transplantation was 99.2 per cent, and the rate of primary healing was 94.5 per cent. According to the time interval between the injury and operation and the conditions of the wounds, the patients were divided into acute, infected and selective cases, and the rate of primary healing was 93.0 per cent, 91.6 per cent and 97.9 per cent, respectively. The selection of the types of flap to be used and the attentions to be taken dueing operation were discussed.
Objective To evaluate the advantages and disadvantages of vascularized free peroneal composite flaps for reconstruction of oral and maxillofacial defects. Methods From November 1999 to December 2002, 28 cases of oral maxillofacial defects were reconstructed with vascularized free peroneal composite flaps, with fibulacutaneous flap in 21 cases and with fibulamyocutaneous flap in 7 cases. Three cases received insertion of dental implants into the fibula flap. The flap size was 3.0 cm×5.5 cm to 8.0 cm ×12.0 cm; the fibula length was 5.5 cm to 16.0 cm. Results Of the 28 flaps reconstructed, 24 survived,3 necrosed partially and 1 necrosed completely. All the 5 implants survived andachieved good bone integration in 3 cases. Twenty-six cases were followed up 1-36 months with an average of 18.5 months, the facial appearance and the vocal function were satisfactory in 23 cases. Conclusion Vascularized peroneal flap has many advantages and is one of the optimal flaps for reconstruction of oral maxillofacial defects.
OBJECTIVE: To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel. METHODS: Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm x 5.0 cm to 4.5 cm x 11.0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm x 8 cm to 12 cm x 25 cm. RESULTS: All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X-ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma. CONCLUSION: The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.
Objective?To investigate the surgical method and clinical efficacy of repairing whole-hand destructive injury or hand degloving injury with the transplant of pedis compound free flap.?Methods?From February 2003 to June 2008, 21 patients with whole-hand destructive injury or hand degloving injury were treated, including 15 males and 6 females aged 18-45 years old (average 25 years old). The injury was caused by punching machine crush in 10 cases, roller crush in 7 cases, and imprinter crush in 4 cases. The time between injury and operation was 1-9 hours. Eleven cases had the skin-degloving injury of the whole hand, while the other 10 cases had the proximal palm injury combined with dorsal or palmar skin and soft tissue defect. After debridement, the size of wound was 9 cm × 7 cm - 15 cm × 10 cm in the dorsal aspect and 10 cm × 7 cm -16 cm × 10 cm in the palmar aspect. The defect was repaired by the thumbnail flap of dorsalis pedis flap and the second toenail flap of dorsalis pedis flap in 5 cases, the thumbnail flap of dorsalis pedis flap and the second toe with dorsalis pedis flap in 4 cases, and bilateral second toe with dorsalis pedis flap in 12 cases. The flap area harvested during operation ranged from 6 cm × 5 cm to 16 cm × 11 cm. Three fingers were constructed in 2 cases and two fingers in 19 cases. Distal interphalangeal joint toe amputation was conducted in the thumbnail flap donor site, metatarsophalangeal joint toe amputation was performed in the second toenail flap donor site, and full-thickness skin grafting was conducted in the abdomen.?Results?At 7 days after operation, the index finger in 1 case repaired by the second toenail flap suffered from necrosis and received amputation, 1 case suffered from partial necrosis of distal dorsalis pedis flap and recovered after dressing change, and the rest 42 tissue flaps survived. Forty-three out of 44 reconstructed fingers survived. All the wounds healed by first intention. At 2 weeks after operation, 2 cases had partial necrosis of the donor site flap and underwent secondary skin grafting after dressing change, the rest skin grafts survived, and all the wounds healed by first intention. Nineteen cases were followed up for 6-36 months (average 11 months). The flaps of palm and dorsum of hand showed no swelling, the reconstructed fingers had a satisfactory appearance and performed such functions as grabbing, grasping, and nipping. The sensory of the flaps and the reconstructed fingers recovered to S2-S4 grade. The donor site on the dorsum of the foot had no obvious scar contracture, without obvious influence on walking.?Conclusion?For the whole-hand destructive injury or hand degloving injury, the method of transplanting pedis compound free flap can repair the defect in the hand and reconstruct the function of the injured hand partially. It is an effective treatment method.