ObjectiveTo investigate the surgical methods and effectiveness to use the iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect.
MethodsBetween January 2013 and January 2016, iliac flap combined with anterolateral thigh flap was used to repair the first metatarsal bone and large skin defect in 9 patients. There were 5 males and 4 females, with a median age of 15 years (range, 10 to 60 years). The causes included traffic accident injury in 6 cases and crush injury of machine in 3 cases. The average time from injury to operation was 3 hours to 14 days (mean, 7 days). The size of skin soft tissue defect ranged from 10 cm×6 cm to 20 cm×10 cm. The size of first metatarsal bone defect ranged from 2 cm×1 cm to 5 cm×1 cm. The size of iliac flap was 3.0 cm×1.5 cm to 6.0 cm×1.5 cm, and the size of anterolateral thigh flap was 10 cm×6 cm to 20 cm×10 cm. The donor site was directly sutured or repaired by free skin graft.
ResultsAfter operation, the composite flaps survived with primary healing of wound; the skin grafts at donor site survived and the incision healed by first intention. All patients were followed up 6 months to 2 years (mean, 1.6 years). X-ray examination showed that the bone healing time was 3.5-5.0 months (mean, 4 months). The flap had soft texture, good color and appearance. All patients could normally walk. According to the American Orthopaedic Foot and Ankle Society (AOFAS) standard, the foot function was excellent in 6 cases and good in 3 cases, and the excellent and good rate was 100% at last follow-up.
ConclusionThe iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect is a practical way with good shape at one stage.
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.
【Abstract】 Objective To investigate and evaluate the effectiveness of covering amputated raw surface with freetissue transplantation from damaged limbs. Methods Between August 2010 and June 2011, 5 cases of severe injury of lower extremities were treated, including 4 males and 1 female with an age range of 3 years and 8 months to 43 years. Of them, 3 cases suffered from traffic accident injury and 2 had machine injury. The disease duration was 2-9 hours. Among the 5 cases, 1 suffered from half pelvis destruction and traumatic amputation of hip joint, 1 from comminuted open fracture of proximal femur, and another 3 from thigh destruction with survival soft tissue of legs. All cases were treated with emergency operation of amputation. The raw surface of the residual stumps was 20 cm × 10 cm to 20 cm × 20 cm in size. Two lateral anterior thigh flaps and 3 posterior tibial artery flaps were harvested from the damaged limbs. The flap size ranged from 15 cm × 10 cm to 25 cm × 20 cm. The wounds were repaired with free tissue transplantation. Results Five transplanted tissue flaps were survival. Skin necrosis occurred in the wound edge at 7-10 days postoperatively and was cured after excision of necrotic tissue, dressing change or vacuumed drainage for 1-2 months. All wounds healed and the patients were followed up 1-3 months. No sinus tract or ulceration was observed. The appearance of stumps was satisfactory. Conclusion The effectiveness of repairing amputated raw surface with free tissue transplantation from amputated limbs is satisfactory. It is an effective procedure to repair the raw surface of amputated stumps.
Objective To investigate the method and effectiveness of repairing fingertip defects with reverse island flappedicled with terminal dorsal branch of digital artery with sense reconstruction. Methods Between December 2008 and March2010, 32 patients (40 fingers) with fingertip defects were treated. There were 20 males (23 fingers) and 12 females (17 fingers), aged from 20 to 62 years (mean, 42 years). The time between injury and admission was from 1 to 8 hours. The injured fingers included thumb (2 cases), index finger (6 cases), index finger and middle finger (3 cases), middle finger (7 cases), middle finger and ring finger (3 cases),ring finger (8 cases), ring finger and little finger (2 cases), and little finger (1 case). The defect area ranged from 1.2 cm × 1.0 cm to 2.2 cm ×1.8 cm, and the flap area ranged from 1.5 cm × 1.0 cm to 2.5 cm × 2.0 cm. The fingertip defects were repaired by the reverse island flaps pedicled with terminal dorsal branch of digital artery and branch of digital nerve, and the branch of digital nerve was anastomosed withstump of proper digital nerve. The donor sites were repaired with free skin grafts. Results Bl isters occurred in 6 cases (9 fingers) andpartial necrosis of the flaps in 2 cases (2 fingers), which were cured after symptomatic treatment. The other flaps and skin grafts survived and the wounds healed by first intention. Thirty cases (38 fingers) were followed up 6 months postoperatively. The shape, contour of the reconstructed fingertip, and motivation of the fingers were satisfactory. The superficial sensation and deep pain sensation recovered after 6 months of operation. The two-point discrimination was 4-6 mm in 24 fingers, 7-10 mm in 13 fingers, and none in 1 finger. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, S3 was achieved in 1 finger, S3+ in 13 fingers, and S4 in 24 fingers. Conclusion It is simple and safe to harvest the reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction; at the same time, the blood supply of the flap is rel iable and its sense can be reconstructed. It is one of effective methods for repairing fingertip defects.
Objective
To investigate the clinical application of micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist to repair skin defect of finger.
Methods
Twenty-six cases (26 fingers) with skin defect of finger were repaired with micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist between December 2011 and February 2013. There were 20 males and 6 females with the average age of 31.5 years (range, 20-56 years). The causes of injury included cutting injury in 20 cases and crushing injury in 6 cases. The time from injury to admission was 1-5 hours with an average of 2 hours. Injured fingers included thumb in 6 cases, index finger in 6 cases, middle finger in 6 cases, ring finger in 4 cases, and little finger in 4 cases; the locations were the dorsal side of the finger in 6 cases, lateral side in 6 cases, and the volar of the finger tip in 14 cases; there were 4 cases on the proximal phalangeal skin, 8 cases on the middle phalangeal skin, and 14 cases on the distal phalangeal skin. The defect area ranged from 2.0 cm × 1.5 cm to 4.0 cm × 2.0 cm, and the flap area ranged from 2.5 cm × 2.0 cm to 4.5 cm × 2.5 cm. All the donor sites were directly sutured.
Results
The flaps of 25 cases survived well after operation, and wound healed by first intention； 1 case had partial necrosis and the wound had a scar healing by changing dressing. All cases were followed up 6-12 months (mean, 10 months). The color and appearance of the flaps were satisfactory with tender texture. The two-point discrimination of the flap was 5-8 mm (mean, 6.8 mm). The donor sites healed primarily without scar contracture and limitation of wrist flexion or extension.
Conclusion
The micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist is a good option to repair skin defect of finger. It has the advantages of hidden donor site, the same operative field, great comparability of flap and finger skin, and it can be used as a vascularized tendon or nerve graft.
Objective
To explore the effectiveness of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defect and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture.
Methods
Between October 2009 and June 2011, 10 cases of Achilles tendon and soft tissue defects were treated. There were 7 males and 3 females, aged from 5 to 60 years (median, 40 years). Injury was caused by spoke in 5 cases, by heavy pound in 3 cases, and by traffic accident in 2 cases. The time between injury and admission was 2-24 hours (mean, 8 hours). The size of wound ranged from 11 cm × 7 cm to 18 cm × 10 cm; the length of Achilles tendon defect was 4-10 cm (mean, 7 cm). Three cases complicated by calcaneal tuberosity defect. After admission, emergency debridement and vacuum sealing drainage were performed for 5-7 days, anterolateral thigh fasciocutaneous flap transplantation of 11 cm × 7 cm to 20 cm × 12 cm was used to repair skin and soft tissue defects, and improved method of ilio-tibial bundle suture was used to reconstruct Achilles tendon. The flap donor site was closed directly or repaired with skin grafting to repair.
Results
All flaps and the graft skin at donor site survived, healing of wounds by first intention was obtained. All patients were followed up 6-18 months (mean, 10 months). The flap was soft and flexible; the flap had slight encumbrance in 3 cases, and the others had good appearance. At last follow-up, two-point discrimination was 2-4 cm (mean, 3 cm). The patients were able to walk normally. The range of motion (ROM) of affected side was (24.40 ± 2.17)° extension and (44.00 ± 1.94)° flexion, showing no significant difference when compared with ROM of normal side [(25.90 ± 2.33)° and (45.60 ± 1.84)° ] (t=1.591, P=0.129; t=1.735, P=0.100). According to Arner-Lindhoim assessment method for ankle joint function, all the patients obtained excellent results.
Conclusion
A combination of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defects and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture is beneficial to function recovery of the ankle joint because early function exercises can be done.
ObjectiveTo investigate the effectiveness of different free flaps in the repair of large defects after resection of scalp malignant tumors.
MethodBetween March 2012 and January 2015, 18 patients with large defect after resection of scalp malignant tumors were treated with different free flaps. There were 13 males and 5 females with an average age of 49 years (range, 18-72 years). There were 17 cases of squamous carcinoma and 1 case of dermato-fibril sarcoma protuberans. The defect size ranged from 15 cm×12 cm to 22 cm×17 cm after resection of tumors. Defects were repaired with anterolateral thigh flap in 5 cases, latissimus dorsi myocutaneous flap in 6 cases, thoracodorsal artery perforator flap in 3 cases, and latissimusdorsi muscle flap plus intermediate split thickness skin graft in 4 cases. The flap size was 17 cm×14 cm to 24 cm×19 cm. The donor sites of the skin flap were covered with skin graft, while the donor sites of the muscle flap were directly sutured.
ResultsOf 14 skin flaps, the other 13 flaps survived except 1 flap necrosis; all muscle flaps survived. The patients were followed up 5-33 months (mean, 20 months). Three patients died because of intracranial metastasis at 5, 7, and 13 months after operation, respectively. Two patients had local recurrence and underwent secondary operation. The results of both appearance and function were satisfactory; secondary operation of thinning the flaps was performed in 4 cases of bulky flaps. The flaps had good wear resistance, without ulceration during follow-up. No obvious impairment was observed after harvesting latissimus dorsi myocutaneous flap.
ConclusionsLarge scalp defects after malignant tumor resection can be effectively repaired by proper application of different free flaps.
Objective To investigate the method and effectiveness of V-U-shaped flaps in repairing soft tissue defect of the fingertip. Methods Between January 2006 and February 2011, 47 patients (55 fingers) with soft tissue defect of fingertip were treated by using the V-U-shaped flaps. There were 25 males and 22 females, aged 18 to 35 years (mean, 26 years). The injury was caused by cuts in 21 cases and avulsion in 26 cases. The time between injury and admission was 1 to 6hours with an average of 2.6 hours. The injured fingers included thumb (18 fingers), index finger (10 fingers), middle finger (10 fingers), ring finger (9 fingers), and l ittle finger (8 fingers). Forty-one fingers had skin avulsion of the distal interphalangeal joint with phalanx exposure, and 14 fingers had distal dactylopodite defect and second phalanx exposure. The size of wound ranged from 1.1 cm × 1.0 cm to 1.9 cm × 1.7 cm. The time between injury and first-stage operation was 2 to 7 hours with an average of 5 hours. In the first-stage operation, the pedicled flap was used to repair the defect of dactylopodite. Then at 3 weeks after the first-stage operation, one U-shaped flap and two V-shaped flaps were prepared to cover defect of the fingertips in the second-stage operation. Results At 2 days after the second-stage operation, congestion and bl isters occurred in 5 fingers, and were improved after symptomatic treatment. The other flaps survived, and wounds healed by first intention. Incisions at the donor site healed primarily. After the second-stage operation, 42 cases (50 fingers) were followed up 6 to 12 months (mean, 8.9 months). The appearance, texture, and color of the flaps were similar to normal skin. Injured fingers had tactile, pain, and thalposis, and the two point discrimination was 5-8 mm. At last follow-up, according to the functional assessment standards by the Chinese Medical Association Society of Hand Surgery of the upper l imbs, the results were excellent in 46 fingers and good in 4 fingers. Conclusion V-U-shaped flaps can be considered as an ideal method to repair soft tissue defect of the fingertip because of good appearance and function recovery.
Objective To compare the cl inical effectiveness of the medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap in repairing defect caused by resection of cutaneous mal ignant melanoma (CMM) in the heel region. Methods The cl inical data were retrospectively analysed from 24 patients with defect who had CMM in the heel region and were treated by radical excision and flap repairing between March 2007 and March 2010. Defects were repaired with the reverse sural neurocutaneous flaps of 8 cm × 7 cm-14 cm × 12 cm at size in 12 patients (groupA), with the medial plantar flaps of 6 cm × 5 cm-8 cm × 7 cm at size in 7 patients (group B), and with the retrograde posterior tibial vascular flaps of 9 cm × 7 cm-15 cm × 13 cm at size in 5 patients (group C). There was no significant difference in gender, age, duration of illness, cl inical stage, and size of CMM among 3 groups (Pgt; 0.05). The donor site was sutured directly or by free skin graft. Results No significant difference was found in the operation time and the intraoperative blood loss among 3 groups (P gt; 0.05). All skin flaps or grafts survived and wounds healed by first intention. The patients were followed up 1-3 years. The flaps had normal texture and color with no ulcer in 3 groups. At 1 year after operation, the sensory recovery rates of the flaps were 0, 100%, and 20% in groups A, B, and C, respectively, showing significant difference among 3 groups (P=0.001). The patients had normal appearance of heel and pain-free walking [10 (83%) in group A, 6 (86%) in group B, and 4 (80%) in group C] of heel region, showing no significant difference among 3 groups (χ2=40.000, P=0.135). Heel pain existed in weightbearing walking of 3 groups, and there were significant differences in visule analogue scale (VAS) score (Plt; 0.05). There was no significant difference in range of motion of ankle joint among 3 groups (P gt; 0.05). Except 1 patiant of relapse in group A at 1 month after operation, no relapse was observed in the other patients during follow-up. Conclusion The medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap can achieve the good cl inical effectiveness in treating heel defect caused by the resection of CMM. And the medial plantar flap is the first choice in small skin defect of heel area.
ObjectiveTo observe the effectiveness of the forearm free arterialized venous flap in repairing soft tissue defect of the hand.
MethodsBetween December 2008 and January 2013, 49 cases of soft tissue defects of the hand were treated. There were 39 males and 10 females, aged 16-52 years (mean, 34 years). Defect was caused by crush injury in 34 cases, cutting injury in 7 cases, avulsion injury in 5 cases, and hot crush injury in 3 cases. The locations were index finger in 21 cases, middle finger in 14 cases, ring finger in 10 cases, little finger in 1 case, and the first web space and the dorsal palm in 3 cases. The duration of injury and admission was 2-10 hours (mean, 4.5 hours). The size of defects ranged from 2.5 cm×1.5 cm to 6.0 cm×4.5 cm. Of them, 46 cases had fracture of metacarpal or finger bone and/or injury of tendon and nerve. Emergency operation was performed in 43 cases and selective operation in 6 cases. All defects were repaired by free arterialized venous flap from the ipsilateral forearm, in which the proximal ends of veins were anastomosed to artery and vein of the finger. The flap size ranged from 3.5 cm×2.5 cm to 7.5 cm×5.3 cm. The donor site was directly sutured.
ResultsSeven flaps survived which was similar to physiological free flap. Mild or medium swelling and blister were observed in 39 flaps and heavy swelling and partial necrosis occurred in 3 flaps after operation. The patients were followed up 6 months-2 years (mean, 13.5 months). The flaps had soft texture, slightly bulky appearance, and deeper color than normal skin. At last follow-up, the two-point discrimination was 16-22 mm (mean, 20 mm). According to the standard for functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 21 cases, good in 21 cases, fair in 3 cases, and poor in 4 cases.
ConclusionIt is an ideal method to repair soft tissue defect of the hand to use forearm free arterialized venous flap. It has the advantages of massive area, no major blood vessel needed to be sacrificed, safe and easy operation, and satisfactory appearance.
