Objective To investigate the clinical feasibility of different types of the saphenous neuro-veno-fascial cutaneous flaps. Methods From June 1996 to October 2002, 18 cases of skin defects in the knee and the lower part of the limb were treated with proximally(4 cases) or distally(11 cases) based pedicles of saphenous neuro-venofascial cutaneous flap or crossleg flap (3 cases)according to the site of defects . The sizes of the flaps ranged from 4 cm×5 cm to 9 cm×20 cm. Results The flaps survived completely in 17 cases, distal 1/5 of the flap necrosed partially in 1 case because of vein drainage disturbance. The colour and texture of flaps were excellent, the appearance and function were satisfactory after a follow up of 6-24 months.Conclusion The saphenous neuro-veno-fascial cutaneous flap is an idea flap in repairing skin defects of the knee, the leg, the ankle and the foot because it is easy to be designed and dissected and it has reliable blood supply and preserved main artery. The relationship between the septal perforating branches of the tibial posteriorartery and survival size of flap need to be investigated further.
OBJECTIVE: To evaluate clinical result of reconstructed thumb and finger with a free hallux nail flap(HNF) and frozen-phalanx-joint-tendon-sheath composite tissue allograft in 270 cases. METHODS: The patients were followed up with reexamination in the ambulant clinic, communication, X-ray photography, lab-examination, isotope 99mTc MDP and reoperation. The data were analyzed by statistics or proved by clinical observation, which were followed up for five years in average (ranging from five months to sixteen years). RESULTS: Enveloping the allogeneic finger composite tissue with self-HNF and pieces of phalanx of great toe, it could reconstruct a thumb or finger with good contour and nutrition. The excellent rate of opposition function of the reconstructed thumbs was 71.91%. The sense of the fingers recovered after 3 months to 8 months of operation. Two-point discrimination was 3 mm to 15 mm. The junction between implanted allo-phalanges and auto-phalanges could be hastened by implanted with vascularized autogenous phalanx pieces in the HNF. The isotope 99mTc MDP was used to take X-ray photography in 24 cases for four months to 9 years and seven months, which showed that the blood vessels grew into the allo-phalanges. However, the Charcot’s arthropathy of allogeneic joints and bony absorption still could be seen in some cases. That might be concerned with chronic abrasion of joint or chronic rejection of host to graft. CONCLUSION: The operation is fit for repairing the defect of thumb or finger in any degree. The implanted vascularized self-phalanx pieces can promote bone union, but it can not prevent the allogeneic joints from arthropathy or bone absorption
OBJECTIVE: To investigate the therapeutic effect of flap transplantation in repairing soft tissue defects of children. METHODS: From January 1997 to May 2002, 75 cases of different soft tissue defects (52 males and 23 females, with the age of 3-14 years) were repaired by axial and non-axial flaps transfer, and axial flaps transplantation by microvascular anastomosis. The flaps area ranged from 3 cm x 5 cm to 15 cm x 42 cm. Emergency operation was performed in 26 cases and secondary operation in 49 cases (infective wound such as osteomyelitis and plate extra-exposed of fracture). The defect regions included the forearm, back of the hand, thumb, index finger, leg and foot. The types of flap graft and application range included 39 cases of axial flaps transfer or transplantation (27 cases of along- or contra-transfer of transplantation and 12 cases of microvascular anastomosis). The non-axial flaps transfer were designed along- or contra-transfer near the wound area in 36 cases. The ratio of length to width was 2.5:1-3.5:1 in 27 cases, and larger than 3.5:1 in 9 cases. Adequate anesthesia method should be chosen according to the characteristics of children, non-traumatic operating during surgery and postoperative supervision and nursing of flaps should also be paid enough attention. RESULTS: After operation, blood circulation crisis occurred in 2 cases (1 case of artery failure and 1 case of vein failure). The flaps survived in 37 cases and partially survived in 1 case and necrosed in 1 case. The survival rate was 96.2%. The postoperative follow-up period was 3 to 60 months, the blood supply, elasticity and texture of flaps were good. The effect of repair was satisfactory. CONCLUSION: Different types of transplantation of blood-supply of flaps may repair the different types of soft tissue defects in children. Free flap transplantation is safe and beneficial in children, different defects of soft tissue were repaired by axial and non-axial flaps transfer, axial flaps transplantation by microvascular anastomosis. Non-traumatic operating and postoperative supervision and nursing of flaps should also be paid enough attention.
Objective To evaluate the effectiveness of soft tissue reconstruction after resection of musculoskeletal tumor and to discuss the strategy of soft tissue reconstruction. Methods Between June 2003 and December 2010, 90 patients with musculoskeletal tumor underwent tumor resection and soft tissue reconstruction. There were 59 males and 31 females with a median age of 37.2 years (range, 9-85 years), including 52 bone tumors and 38 soft tissue tumors. One stage reconstruction of soft tissue was performed after tumor resection in 75 cases; reconstruction of soft tissue was performed after debridement in 7 cases of wound dehiscence; and two stage reconstruction of soft tissue was performed after debridement and vacuum sealing drainage placement in 8 cases of infected wounds. The gastrocnemiums flap was used in 40 cases, the latissimus dorsi myocutaneous flap in 6 cases, rectus abdominis myocutaneous flap in 4 cases, gluteus maximus musculocutaneous flap in 1 case, pectoralis major muscle flap in 1 case, cross-abdominal flap in 1 case, local transfer flap in 27 cases, pedicled flaps in 5 cases, and skin grafts in 5 cases. The size of the flap ranged from 6.5 cm × 4.5 cm to 21.0 cm × 9.0 cm. Results Eighty-seven flaps survived, and incisions healed by first intention in 81 cases. In 6 cases of healing by second intention, 2 had partial flap necrosis, which was cured by dressing change; 3 had delayed healing; 1 had mild infection, which was cured after conservative treatment. Wound of donor site healed primarily, and the grafted skin survived. Seventy-three patients were followed up 10-102 months (mean, 36.1 months). Local tumor recurrence was observed in 6 patients, who received second resection at 2-27 months (mean, 8.2 months) after operation. Thirteen patients dead of primary disease at 6-34 months (mean, 19.2 months) after operation. Conclusion The defects caused by resection of musculoskeletal tumor require soft tissue reconstructions. Optimal reconstruction can enhance wound closure, decrease incidence of wound complication, preserve limb function.
Objective To investigate the appl ication and cl inical result of flap in the repair of wounds with Achilles tendon exposure. Methods Between May 2006 and May 2010, 21 patients with Achilles tendon skin defects were treated with microsurgical reconstruction. There were 15 males and 6 females, aged 7-63 years with a median of 34 years. The defect causesincluded sport injury in 4 cases, wheel twist injury in 7 cases, crush injury in 5 cases, chronic ulcer in 3 cases, and Achilles tendon lengthening in 2 cases. The areas of wounds with Achilles tendon exposure ranged from 2 cm × 2 cm to 10 cm × 8 cm. After debridement, wounds were repaired with the medial malleolus fasciocutaneous flap (5 cases), sural neurocutaneous vascular flap (8 cases), foot lateral flap (2 cases), foot medial flap (2 cases), and peroneal artery perforator flap (4 cases). The size of the flaps ranged from 3 cm × 3 cm to 12 cm × 10 cm. The donor sites were either sutured directly or covered with intermediate spl it thickness skin grafts. The Achilles tendon rupture was sutured directly (2 cases) or reconstructed by the way of Abraham (2 cases). Results All flaps survived and wounds healed by first intention except 2 flaps with edge necrosis. Twenty-one patients were followed up 6-18 months (mean, 12 months). The flaps had good appearance and texture without abrasion or ulceration. The walking pattern was normal, and the two point discrimination was 10-20 mm with an average of 14 mm. The Ameritan Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale assessment revealed that 10 patients had an excellent result, 7 had a good result, 3 had a fair result, and 1 had a poor result with an excellent and good rate of 81.0%. Fourteen cases could l ift the heels with power; 5 cases could l ift the heels without power sl ightly; and 2 cases could not l ift the heels. Conclusion The wounds with Achilles tendon exposure should be repaired as soon as possible by appropriate flap according to the condition of wound.
Objective To investigate the surgical methods and effects of perineal Paget’s disease. Methods From January 1998 to September 2004, 20 perineal Paget’s disease cases were treated with several surgical methods. All the patients were male. Their ages ranged from 47 to 80 years. The courses of diseases ranged from 1 year to 9 years (4.7 years on average). Among them, 14 cases involved scrotums purely, 5 cases involved scrotums and penises, 1 cases involved scrotum, penis and hypogastric zone. Fifteen cases were diagnosed as having Paget’s disease through pathological exam. No metastasis was found before operation. ResultsThe wounds healed by first intention in 19 cases, the free skin graft necrosed partially in 1 case and healed by second intention after dress changing. All the patients were followed up 2 to 5 years, the contours of scrotums and penises were good. Two cases had tumor recurrence and received surgery again. Recurvation occurred in 2 cases during penis erecting，and was corrected by regional flap transplantation Conclusion The lesions like eczema in perineal reigon should be suspected as Paget’s disease, and should be biopsied earlier. Complete removal by surgery is the only effective treatment. Perineal Padget’s disease should be diagnosed and treated earlier. If the raw surfaces could not be repaired completely, flap transplantation and free skin graft should be used .The patients should be followed up closely.
Objective To provide the anatomic basis for defect repair of the knee, leg, foot and ankle with great saphenous venosaphenous neurocutaneous vascular island flaps. Methods The origin, diameter, branches, distribution and anatomoses of the saphenous artery and saphenous neurocutaneous vascular were observed on 20 sides of adult leg specimens and 4 fresh cadaver voluntary legs. Another4 fresh cadaver voluntary legs were radiogeaphed with a soft X-ray system afterthe intravenous injection of Vermilion and cross-sections under profound fascial, otherhand, micro-anatomic examination was also performed in these 4 fresh cadaver legs. The soft tissue defects in lower extremity,upper extremity, heel or Hucou in handwere repaired with the proximal or distal pedicle flaps or free flaps in 18 patients(12 males and 6 females,aging from 7 to 3 years). The defect was caused by trauma, tumour, ulcer and scar.The locations were Hucou (1 case), upper leg(3 cases), lower extremity and heal (14 cases). Of then, 7 cases were complicatedby bone exposure, 3 cases by tendon exposure and 1 case by steel expouse. the defect size were 4 cm×4 cm to 7 cm×13 cm. The flap sizes were 4 cm×6 cm to 8 cm×15 cm, which pedicle length was 8-11 cm with 2.-4.0 cm fascia and 12 cm skin at width. Results Genus descending genicular artery began from 9.33±0.81 cm away from upper the condylus medialis, it branched saphenous artery accompanying saphenous nerve descendent. And saphenous artery reached the surface of the skin 7.21±0.82 cm away from lower the condylus medialis,and anastomosed with the branches of tibialis posterior artery, like “Y” or “T” pattern. The chain linking system of arteries were found accompanying along the great saphenous vein as saphenous nerve, and then a axis blood vessel was formed. The small artery of only 00-0.10 mm in diameter, distributed around the great saphenousvein within 58 mm and arranged parallelly along the vein like water wave in soft X-ray film. All proximal flaps,distal pedicle flaps and free flaps survived well. The appearance, sensation and function were satisfactory in 14 patientsafter a follow-up of 6-12 months. Conclusion The great saphenous vein as well as saphenous neurocutaneous has a chain linking system vascular net. A flap with the vascular net can be transplanted by free, by reversed pedicle, or by direct pedicle to repair the wound of upper leg and foot. A superficial vein-superficial neurocutaneous vascular flap with abundance blood supply and without sacrificing a main artery is a favouriate method in repair of soft tissue defects in foot and lower extremity.
Objective?To introduce a new method of flap design and to investigate the feasibility of the clinical application.?Methods?Between April 2006 and November 2009, 89 patients with skin and soft tissue defects were treated. There were 47 males and 42 females with an average age of 36 years (range, 16-67 years). The injuries were caused by machine crush (38 cases), electric saw (16 cases), electricity (8 cases), traffic accident (18 cases), rolling machine (3 cases), and crash of heavy object (6 cases). The locations were forearm in 4 cases, palm in 23 cases, finger in 41 cases, lower leg in 7 cases, and dorsum of foot in 14 cases. All the cases complicated by exposure of tendons or bones. The time from injury to hospitalization was 30 minutes to 5 days (mean, 3 hours). The areas of skin and soft tissue defect ranged from 2.0 cm × 1.5 cm to 26.0 cm × 18.0cm. The wounds were repaired with the pedicle flaps in 72 cases and the free flaps in 17 cases. All the flaps were designed with eight-point-location method. A trapezoid was made in the raw surface and the four vertexes of the trapezoid were on the edge of the raw surface. The exterior points of the heights of arciforms were made on the edge of the raw surface too. The eight points were the labelling points. The top width, the bottom width, the height of the trapezoid, and the heights of the arciforms could be measured. The above numerus were expanded 5%-10%. The expanded numerus were the corresponding numerus of the skin flap. The size of flaps ranged from 2.2 cm × 1.7 cm to 28.5 cm × 19.5cm. The donor sites were closed directly in 17 cases, and repaired with skin grafts in 72 cases.?Results?All the flaps were successfully dissected according to flap design. When the flaps were transplanted to the wounds, tension of the flaps was appropriate. All the flaps and skin grafts survived. The wounds and incisions at donor sites healed by first intention. Eighty-nine patients were followed up 6 to 26 months (mean, 20 months). The texture, appearance, flexibility, and function of the flaps were satisfactory, and no complication occurred. The sensory restoration of the pedicle flaps were graded as S3-S4.?Conclusion?It is an ideal and simple method to design flap using eight-point-location method. The flaps are precise in the figure and area.
Objective To summarize the clinical effects of the repairing methods for deep wounds of the foot and ankle. Methods From March 2002 to June 2006, 49 patients with skin and deep tissue defects of the foot and ankle underwent the repairing treatment. Of them, 36 were males and 13 were females, aged 16 to 67 years( 39 years on average). The causes of injuries included mangled injury in 24 cases, high fall injury in 9 cases, cut injury in 7 cases, malignant soft tissue tumor in 5 cases, decubital ulcer in 2 cases, and electric burn in 2 cases. Of the 49 cases, 19 were in left side and 30 in right side. The defect size of skin ranged from 3 cm×2 cm to 20 cm×15 cm and deep tissue injuries were accompanied by defects of tendon and ligament in 24 cases, by damage of joint in 12 cases, and by bone defect in 9 cases, and 35 of them had infections, and 2 of them had diabetes of stage 2. The time between the injury and surgery ranged from 4 hours to 1 year.The wounds were repaired separately by local flap(3 cm×3 cm to 6 cm×4 cm) in 15 cases, local island flap(8 cm×5 cm to 12 cm×7 cm) in 25 cases, free flap(15 cm×11 cm to 24 cm×17 cm) in 4 cases, and cross leg flap(5 cm×4 cm to 8 cm×6 cm) in 5 cases. In 24 cases of defects of tendon and ligament, 15 underwent the reconstruction in one-stage operations,9 in two-satge operation.In 9 cases accompanied by bone defect, twostage bone grafting (12-64 g) was given after wound healed. Results All of the 49 flaps survived. Fortysix healed by the first intention and 3 with distal edge necrosis healed after skin grafting. Two patients with sinus formation healed after 68 months of dressing change. All the cases were followed up 6 months to 3 years, and all the flaps were well developed, the functions of the foot and ankle were satisfactory. Conclusion It can get an excellent result of appearance and function recovery repairing deep wounds of the foot and ankle with proper flaps in earlier time.
Objective To introduce the current situation and prospect of the tissue-autografting, such as the flaps, muscle flaps, and bone(periosteum) flaps, andits application in reparative and reconstructive surgery. Methods Based on our own experiences and combined with the review of the literature at home and abroad, the latest development of the tissue autografting was analyzed. Results The femoral anterolateral flap, latissimus dorsi muscle flap, upper arm lateral flap, scap flap, temporal fascial flap and perforator flap are the frequently used in clinic. Of all the perforator flap had such advantages as better repair of the recipient sites and less damage of the donor site. Beacause of more advantages of the free myocutaneous flap transplantation, it substituted thefree muscle transplantation. The atissimus dorsi muscle myocutaneous flap was the most frequently used in the transplant of the vessels, with preserved function of the thoracodorsal nerve or with repair of the defected tissues by the bridge. The most common donor sites of the bone were ribs，iliac bone，fibula andscapula, so the severe bone defects or the bone nonunion, femoral head ischemic necrosis, and the bone graft from the tumor removal could be managed with the bones from those sites. Conclusion The autografting in repairing the tissue defect has become one of the most important surgical techniques in reparative and reconstructive surgery.