Thirty-six pedicled over-thin skin flaps of acromiopectoral region in 24 cases were transfered for repair of skin defect of face and neck following cicatrectomy. The skin flap is 15-22 cm in length and 12-23 cm in width. The pediele width of skin flap is from 3.5 to 6 cm. The ratio of length to width is 8 to 1. All Of skin flap and the operative procedure were introduced and the mechanism of skin flap survival and the treatment of donor region were discussed.
In experimental study on pigs was designed to evaluate the changes of the vessel density of super thin skin flaps.By means of stratified sampling, isotropic uniform random section, the vessel density of the supor thin skin flap was obeerved under the MIAS-200 image analyzer. The results showed that the remarkable changes of vascular density were found to begin on the 5th day after operation and was first appeared in the distal port of the survived flap,then,it proceeded gradually from the distal proximally.
The application of subdermal vascular network skin flap (SVN flap) with axial-pattern of artery for skin and soft tissues defects on the extremities of 39 cases was reported. The tyes of flaps included:SVN direct cutaneous artery skin flap in 23 eases, SVN island skin flap in 13 eases, and vaseularized SVN skin flap in 3 cases, All flaps were survived except in one ease of vaseularized SVN skin flap failed. The patients were followed for 6 months to 1 year after operation, the grafted areas showed good looking, no hypertrophy of scar tissue, and normal texture. This type of flap had the advantages of axial-pattern skin flap and that of the SVN skin flap as well, and could be widely applied in the clinical fields.
Objective To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF). Methods Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m2, with an average of 23.62 kg/m2. The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured. Results A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory. Conclusion Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.
Abstract In order to investigate the pattern of the changes of blood supply of the vascular superthin skin flap during expansion, in 17 patients, under the subdermal vessel networks layer of the periauriclar area, an expander was placed, and the skin was preliminarily expanded. The changes of blood supply were found regular: When the injected fluid volume was excessive, the skin became pale or cyanotic, the skin showed congestive telangiectasis. If great care was given during the procedure, the expanded skin could pass safely through the stage of poor blood circulation. The expanded superthin skin flap were applied in auriculoplasty in 17 patients. The results included 3 failures, and 14 satisfactory.
Eighteen cases with hand injury were repaired by 20 pediclcd over-thin skin flaps with success. The area of pedicled skin flap is from 1.5×1.2 to 12×8.5cm. The pedicles of skin flap were divided at 5-7 days postoperation after clamp training of the pedicle, and the flap all survived. The operative method is introduced and the mechanism of skin flap survival is discussed.
A comperative study Of the thickness,the ratio of length to width and the division time of the pediele between the randomized defatted skin flap and the randomized conventional skin flap wasundertaken in 12 pigs,weighing 25-30 kg.Two tpe of defatted edicled skin flape were made,inwhich,one preserved a thickness of 2-3mm adipose tissue and the Other one third of the superficialfascial beneath the subeutaneous vascular network.The resuIts indicated that after division of thepedicles on the ...
The super thin skin flaps were designed on the abdominal wall of pig.The flap were divided into6 groups. The general oppoarances,such as the color,swelling,survival of the flaps,and the bloodflow measurement of the flape were used to oherve the postoperative pathophysiology changes of theblood supply of the flaps.It、was noted that:(1)the blood flow of the flape Was increasedcompensatorily as early as 3 days after oporation and reached its highest on 5th to 7th days,thers wasgradually ...
Six cases with deformity of cicatricial contracture alter burn and one vaginoplasty were treated by using of pedicled over-thin skin flap. All were survived. The maximal ratio of length and width of skin flap is 6 to 1 and the smallest ratio is 3 to 1. Three cases were primary healing and 4 cases were delay healing. The clinical sign of delay healing shown blister or ecchymosis on distal part of skin flap. According to clinical observation, the reason of skin flap survival and advantagse of this operation were discussed.
To study the blood supply and revascularization of super thin skin flaps with a presserved subcutaneous vascular retwork , we carried out a randomized self-matched experimental study in 10pigs. The free skin grafts with a preserved subcutaneous vascular network served as control. All skingrafts and flaps were divided into 6 groupe, besed on the potoperative days (1st , 3rd, 5th , 7th , 10thand 14th day). The revascularization of flape were assessed by means of intravenous fluorescein test...