Objective To investigate the location of the artery correlated with rectus abdominis musculocutaneous flap in order to promote the reconstruction of the breast after radical mastectocy for breast cancer.Methods An anatomic study was carried out on 15 cadavers of 30 sides，which were immersed in paraformaldehyde less than six months. Whole thoraepigastrica wall was cutted, which scale was from subclavian as upper limit to inguinal ligament, the lower limit across left and right of middle axillary. Veins or arteriesof inferior epigastrica and internal thorax in hang were injected with red or blue ink to show all of vessel branches. Results The external diameters of both the superior epigastric arteries and inferior vessels were 1.87±0.28 mm and 2.25±0.32 mm respectively. The myocutaneous arteries from inferior abdomen vessels had an intensive horizontal distribution on hylum. The perforators significantly decreased but could be found to pass through anterior rectus sheath in Rand. The distances between lateral perforators and Ⅰ,Ⅱ and Ⅲ parts in external edge of anterior rectus sheath were 1.22, 1.46 and1.57 cm, respectively; and the distances between medial perforators and Ⅰ, Ⅱ, and Ⅲ parts at median line were 1.54, 1.62, 1.66 cm. Perforators were more thick and intensive near hylum than in other part. The subcostal arteries derived from inferior abdomen artery and 1.25±0.37 cm away from costal arch. Afterdividing into subcostal artery, the outer diameter of 67 percent of subcostal artery was bigger than that of inferior abdomen arteries. The branches of subcostalarteries were distributed at the 2/3 lateral rectus abdominis, forming an extenive choke anastomosis system with intercostal anterior artery and vessels supplied diaphragmatic muscle. The rectus abdominis at the level of xyphoid was supplied by a branch came from inferoir thorax artery, which diverged epigastric vessels at the same time.Conclusion During the process of makingthe inferior transverse rectus abdominis musculocutaneous flap base on superior epigastric vessels and superoir rectus abdobminis, reservation of pro-theca edge 1 cm of rectus abdominis can protect inferior abdomen artery from injury. Reservation of more than 2 cm pro-theca and rectus abdominis below costal arch at the flag will protect effectively subcostal artery from injury. No damage of subcostal arteries can influence the survival of musculocutaneous flap.
OBJECTIVE To introduce the method using the gracilis myocutaneous flaps to repair of vulvar defect after radical vulvectomy. METHODS The gracilis myocutaneous flaps were applied in 4 cases with vulvar carcinoma which located vestibule of vulva and bulk, and the carcinoma was large after radical resection to repair vulvar defect simultaneously. RESULTS The incision of 3 cases was healing by first intention, and 1 case with type II diabetes mellitus was healing by second intention. After followed up 3-6 years, 1 case was recurrent in 2 years after operation, 3 cases were survival without complication. CONCLUSION Vulvar reconstruction with the use of gracilis myocutaneous flaps in radical vulvectomy could markedly decrease the rate of complication.
From 1985 through May of 1989, a total of 6 cases of breast carcinomas underwent primary reconstruction of breast immediately following radical mastectomy by using transposition of vaseularized latissimus dorsi myocutaneous flap for reconstruction of breast. The re- sults of all these 6 cases were satisfactory. The design of the operation and the operative technique were detailed. The importance of the reconstruction of breast immediately after the radical mastectomy and the advantages of using vascularized latissimus dousi myocutanous flap for reconstruction were discussed.
Objective To introduce the experience of the cl inical appl ication of vertical trapezius myocutaneous flap in repairing soft tissue defects after head and neck tumor resection. Methods Between June 2008 and February 2010, 12 cases of soft tissue defect caused by head and neck tumor resection were repaired with vertical trapezius myocutaneous flap.There were 9 males and 3 females with an age range from 32 to 76 years (median, 54 years). Twelve cases including 2 cases of basal cell carcinoma of orbital skin, 2 cases of squamous cell carcinoma of the parotid gland, 2 cases of submandibular gland mal ignant mixed tumor, 2 cases of metastatic lymph nodes of nasopharyngea carcinoma after radiotherapy, 1 case of squamous cell carcinoma of tongue, and 3 cases of squamous cell carcinoma of occipital skin, and all were classified as TNM stages T3 or T4. The area of soft tissue defect ranged from 13 cm × 6 cm to 25 cm × 13 cm. The vertical trapezius myocutaneous flap ranged from 14 cm × 7 cm to 26 cm × 14 cm and was transfered to repair defect tissue in the homolateral wounds after tumor resection and neck dissection homochronously. The donor sites were sutured directly. Results All incisions healed primarily without infection. Eleven flaps survived except 1 flap with edge necrosis, which was cured after dressing change. Subcutaneous hematocele and effusion occurred in 2 cases on the back after tube was removed at 7 days postoperatively, and they were cured by sucted and pressured dressing. Eleven patients were followed up 1-3 years (mean, 2 years). Nine cases had no tumor recurrence and the flaps had statisfactory appearance; the abduction function of shoulder joint were normal. One case of orbit basal cell carcinoma occurred 3 months after operation and 1 case of nasopharyngeal carcinoma died of brain metastasis 12 months after operation. Conclusion It is an easy and simple therapy to repair head and neck soft tissue defect using the vertical trapezius myocutaneous flap, which can meet the needs of repairing tissue defect of head and neck.
Objective To evaluate the feasibil ity and cl inical significance of the computed tomography angiography (CTA) for the latissimus dorsi muscle (LDM) flap transplantation. Methods From September 2007 to August 2008, 3 cases of soft tissue defects in l imbs were treated with LDM flap transplantation. Three patients included 2 males and 1 female whowere 23 to 42 years old. All of soft tissue defects were caused by trauma. The locations were the forearm in 2 cases and the leg in 1 case. The area of defect was 17 cm × 8 cm-20 cm × 10 cm. All cases received CTA to observe the distribution and anastomosis of thoracodorsal artery. Subsequently, three-dimensional computer reconstruction were carried out to display the stereoscopic structure of the LDM flap and to design the LDM flap before operation. Results The anatomy characteristic of LDM flap can be displayed accurately by the three-dimensional reconstruction model. The distribution of thoracodorsal artery in 3 cases of flaps was in concordance with preoperative design completely. All the flaps were excised successfully, the area of the flap was 19 cm × 10 cm-22 cm × 12 cm. All the transferred flaps survived completely. All cases were followed up from 4 months to 12 months. The color and texture of the flaps were good. Conclusion The three-dimensional reconstructive images can provide visible, stereoscopic and dynamic anatomy for cl inical appl ication of LDM flap. The digitized three-dimensional reconstructive models of LDM flap structures can be appl ied in cl inical training and pre-operative design.
Objective To evaluate the results of the reconstruction of the soft tissue defects following the en block resection of tongue cancer using free anterolateral thigh myocutaneous flaps. Methods From November 2006 to December 2008, 109 cases underwent the reconstruction of the soft tissue defects following the en block resection of tongue cancer using free anterolateral thigh myocutaneous flaps. There were 75 males and 34 females with an age of 23-75 years (50.4 yearson average). The disease course was 1-6 months. According to 2002 International Union Control Cancer (IUCC) criterionfor TNM stage, there were 35 cases of T2N0M0, 8 cases of T2N1M0, 2 cases of T2N2M0, 31 cases of T3N0M0, 12 cases of T3N1M0, 7 cases of T3N2M0, 5 cases of T4N0M0, 4 cases of T4N1M0, 3 cases of T4N2M0, and 2 cases of T4N3M0. The range of tongue defect was 5 cm × 3 cm to 12 cm × 8 cm. The flap area ranged from 7 cm × 4 cm to 20 cm × 8 cm. Eighty-two patients with T3, T4 and positive lymph node metastasis determined by pathological examination after operation received radiotherapy. The vital ity of the flaps and the heal ing of the wounds were observed postoperatively. The shape and function of the reconstructed tongue were determined, the influences on function at donor site were evaluated and the flap tolerance to radiotherapy was investigated during the follow-up period. Results Mouth floor mandibular fistula occurred in 5 cases 5-7 days after operation, seroma formation in 1 case and wound dehiscence in another case at the donor site; the wounds healed by secondary intention after dressing. The other wounds healed primarily. All 105 flaps survived completely, 3 flaps developed partial necrosis 3-5 days after operation, the wounds healed after dressing; and 1 flap failed 3 days after operation, then it was removed and defects was repaired using pectoral is major muscle flap. Bl isters occurred in 8 flaps (all being thinning flaps) 1 day after operation. The overall complete survival of the flap was 96.3% (105/109). The patients were followed up for 0.5-2.5 years (1.2 years onaverage). Although the flaps had a l ittle atrophy, the shape of the reconstructed tongue was still satisfactory with suitable tonguemandibular groove. No depression was observed in the mandibular region. The speech as well as swallowing function were well recovered. The scar was easily hidden with no important functional impairment at the donor site. No flap necrosis occurred in all the patients who received postoperative radiotherapy. Conclusion Free anterolateral thigh myocutaneous flap transplantation is safe and rel iable, and it has the advantages of the better result at the recipient site, the less morbidity at the donor site, fewer postoperative compl ications and excellent tolerance to radiotherapy. So it is an ideal flap to repair soft tissue defects following the en block resection of tongue cancer.
Objective
To explore the value of the application of latissimus dorsi myocutaneous flap in the breast reconstruction.
Methods
The clinical data of the 36 patients with breast tumor who had undergone breast reconstruction with latissimus dorsi myocutaneous flap from January 2012 to December 2016 were collected retrospectively. The postoperative complications and cosmetic results were analyzed.
Results
Thirty-six patients with breast tumor who underwent breast reconstruction with latissmus dorsi myocutaneous flap, including 32 patients with immediate breast reconstruction and 4 patients with delayed breast reconstruction respectively. The operative time of the patients who undertwent immediate breast reconstruction was 235–490 min (mean of 325 min), the intraoperative blood loss was 200–260 mL (mean of 220 mL), and the hospitalization time was 18–33 d (mean of 23.6 d). The total operative time of patients who underwent delayed breast reconstruction was 325–550 min (mean of 355 min), the total intraoperative blood loss was 200–250 mL (mean of 220 mL), and the total hospitalization time was 27–45 d (mean of 32.5 d). The cosmetic results was excellent in 22 patients, good in 8 patients, fair in 6 patients, respectively, and fine rate was 83.3% (30/36). There was no flap loss, but donor site seroma occurred in 21 patients, partial necrosis of the surgical margin of back skin occurred in 1 patient, partial necrosis of the nipple and areola skin occurred in 2 patients. All the patients were followed-up for 3–60 months, and the mean follow-up time was 37 months. During the follow-up period, no patient occurred metastasis or recurrence. After undergoing radiotherapy, reconstructive breast volume of 2 patients significantly contracted. None of the patients had significant limb function.
Conclusion
The breast reconstruction with the latissimus dorsi myocutaneous flap is a simple, easy, and effective surgical procedure.
Objective To investigate the reconstructive methods and effectiveness of modified pedicled anterolateral thigh (ALT) myocutaneous flap for large full-thickness abdominal defect reconstruction. Methods Between January 2016 and June 2018, 5 patients of large full-thickness abdominal defects were reconstructed with modified pedicled ALT myocutaneous flaps. There were 3 males and 2 females with an average age of 43.7 years (range, 32-65 years). Histologic diagnosis included desmoid tumor in 3 cases and sarcoma in 2 cases. The size of abdominal wall defect ranged from 20 cm×12 cm to 23 cm×16 cm. Peritoneum continuity was reconstructed with mesh; lateral vastus muscular flap was used to fill the dead space and rebuild the abdominal wall strength; skin grafting was applied on the muscular flap, the rest abdominal wall soft tissue defects were repaired with pedicled ALT flap. The size of lateral vastus muscular flap ranged from 20 cm×12 cm to 23 cm×16 cm, the size of ALT flap ranged from 20 cm×8 cm to 23 cm×10 cm. The donor site was closed directly. Results All flaps and skin grafts survived totally, and incisions healed by first intention. All patients were followed up 6-36 months (mean, 14.7 months). No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying. Conclusion Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.
Transplantation of composite latissimus dorsi myocutaneous flap and vascularized fibula was performed primarily to repair the tibial defects in 12 cases and radial defects in 2 cases, both of which were associated with large-sized skin defects. The peroneal artery and vein of the fibula were anastomosed to the circumflex scapular artery and vein of the myocutaneous flap, the subscapular artery and vein, as the common vascular pedicle of the two transplants, are anastomosed to the nutrient vessels in the recipient site. Cross-bridge vascular anastomosis was used in 13 cases . All of tfe transplanted tissues survived, Follow-up revealed a good growthof the transplanted flaps, solid union between the transplanted fibulas and the host bones, and the good functional recovery of the repaired extremities. The operative indication and technique were introduced, ahd the merit of the repair ahd reliability of the cross-bridge procedure were discussed.
Objective To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect. Methods Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly. Results All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis). Conclusion The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.
