ObjectiveTo explore the effectiveness of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection.MethodsBetween September 2010 and December 2017, 18 patients with abdominal wall tumors were collected. There were 11 males and 7 females, with an average age of 45.2 years (range, 29-68 years). Histologic diagnosis included desmoid tumor in 8 cases, sarcomas in 6 cases, malignant teratoma in 2 cases, and colon adenocarcinoma in 2 cases. All abdominal wall defects were full-thickness defects. Peritoneum continuity was reconstructed with mesh; the lateral vastus muscular flaps were used to fill the dead space and rebuild the abdominal wall strength; the abdominal wall soft tissue defects were repaired with pedicled anterolateral thigh flaps. The size of abdominal wall defects ranged from 15 cm×6 cm to 25 cm×22 cm; the size of lateral vastus muscular flap ranged from 10 cm×8 cm to 22 cm×10 cm; the size of anterolateral thigh flap ranged from 14.0 cm×8.0 cm to 21.0 cm×8.5 cm. The bilateral pedicled anterolateral thigh myocutaneous flaps were harvested to repair the extensive abdominal wall defects in 2 cases. All donor sites were sutured directly.ResultsAll wounds healed smoothly and all flaps survived totally. All donor sites healed smoothly. The mean follow-up time was 22.5 months (range, 11-56 months). No tumor recurrence occurred, the abdominal function and appearance were satisfactory, no abdominal hernia was noted. Only linear scar left at the donor sites.ConclusionPedicled anterolateral thigh myocutaneous flap combined with mesh is fit for large full-thickness abdominal defect reconstruction.
ObjectiveTo investigate the effectiveness of combined tissue transplantation for repair of serially damaged injuries on radial side of hand and function reconstruction. MethodsBetween May 2013 and May 2017, 34 cases of serially damaged injuries on radial side of hand were treated. There were 29 males and 5 females; aged 17-54 years, with an average of 32.1 years. There were 23 cases of crushing injuries, 5 cases of bruising injuries, 4 cases of machine strangulation injuries, and 2 cases of explosion injuries. The time from injury to admission was 40 minutes to 3 days, with an average of 10 hours. According to the self-determined serially damaged injuries classification standard, there were 1 case of typeⅠa, 2 cases of typeⅠb, 10 cases of typeⅡa, 5 cases of type Ⅱb, 3 cases of type Ⅱc, 1 case of type Ⅱd, 7 cases of type Ⅲa, 3 cases of type Ⅲb, 1 case of type Ⅲc, and 1 case of type Ⅲd. According to the classification results, the discarded finger, nail flap, the second toe, anterolateral thigh flap, ilium flap, fibula flap, and other tissue flaps were selected to repair hand wounds and reconstruct thumb, metacarpal bones, and fingers. ResultsAfter operation, 2 cases of flaps developed vascular crisis and survived after symptomatic treatment; the other transplanted tissue survived smoothly. All cases were followed up 1 to 7 years, with an average of 2.4 years. The average fracture healing time was 7.4 weeks (range, 5.3-9.0 weeks). At last follow-up, the reconstructed fingers and the grafted flaps recovered good sensory function, with a two-point discrimination of 5 to 11 mm (mean, 9 mm). According to the evaluation standard of the upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the reconstructed thumb was rated as excellent in 24 thumbs, good in 8 thumbs, and fair in 2 thumbs; the reconstructed finger was rated as excellent in 18 fingers, good in 2 fingers, and fair in 1 finger. ConclusionFor the serially damaged injuries on radial side of hand, according to its classification, different tissues are selected for combined transplantation repair and functional reconstruction, which can restore hand function to the greatest extent and improve the quality of life of patients.
Objective To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds. Methods Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured. Results Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up. Conclusion The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.
Objective
To explore the effectiveness of modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis in treatment of soft tissue defects in the middle and lower segments of the leg.
Methods
Between March 2011 and June 2015, 15 cases with skin and soft tissue defects in the middle and lower segments of the legs were treated. There were 9 males and 6 females, aged 22-48 years (mean, 32.6 years). Of whom, 8 patients caused by traffic accidents, 5 by machine twist, and 2 by crash injury of heavy object. The mean interval from injury to admission was 82.6 hours (range, 2 hours to 1 week). The area of defect ranged from 13 cm×9 cm to 23 cm×16 cm. After primary debridement and vaccum sealing drainage treatment, the defects were repaired with modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis. The size of flap ranged from 15 cm×10 cm to 25 cm×15 cm. The donor sites were sutured directly or repaired with the skin grafts. The pedicle division was done at 4 weeks after operation.
Results
After operation, venous crisis occurred in 1 case and distal skin necrosis in 2 cases which was healed by dressing change. The other tissue flaps survived successfully and wounds healed by first intention. All skin grafts at donor site survived after operation, and primary healing of wound was obtained. All patients were followed up 6-24 months (mean, 13 months). All flaps were characterized by soft texture, satisfactory appearance, and restoring the protective sensation. Moreover, the two-point discrimination ranged from 15 to 28 mm (mean, 19.5 mm) at 6 months after operation. The function of both lower extremities were normal without obvious contracture of scar at donor site.
Conclusion
Modified free anterolateral thigh perforator flap, with little damage in donor site, a reliable blood supply by making a cross-bridge microvascular anastomosis with pretibial or posterior tibial blood vessel on normal leg, is a reliable alternative method for repairing soft tissue defects with the main vessels of serious injury in the middle and lower segments of the leg.
ObjectiveTo explore the effectiveness of free lobed perforator flaps in repairing of complex wounds of limbs. Methods Between January 2018 and January 2021, 10 patients with complex wounds of limbs were admitted. There were 7 males and 3 females, aged from 32 to 64 years, with an average age of 45 years. There were 4 cases of traffic accident injuries, 3 cases of machine strangulation injuries, 1 case of machine crush injury, and 2 cases of heavy object crush injuries. There were 5 cases of upper limb wounds and 5 cases of lower limb wounds. The size of wounds ranged from 11 cm×10 cm to 25 cm×18 cm. The wounds were repaired with tri-lobed flaps of the descending branch of the lateral femoral circumflex artery in 7 cases, four-lobed flaps in 2 cases, and with tri-lobed flaps of the descending branch of the lateral femoral circumflex artery combined with oblique branch in 1 case. The size of flaps ranged from 12.0 cm×10.5 cm to 28.0 cm×12.0 cm. The donor sites were sutured directly in 9 cases and repaired with superficial iliac circumflex artery perforator flap in 1 case. ResultsSinus formed at the edge of the flap in 1 patient, which healed after dressing change and drainage; other flaps survived well, and the wounds healed by first intention. The skin flap at donor site survived, and the incisions healed by first intention. All patients were followed up 6-24 months (mean, 11 months). All flaps had good appearance and function, and linear scars were left at the donor site without obvious complications. ConclusionFree lobed perforator flap is an alternative method to repair complex wounds of limbs with high safety, good effectiveness, and less complications.
ObjectiveTo investigate effectiveness of anteromedial thigh perforator flap in repair of soft tissue defects of lower limbs.MethodsBetween January 2015 and October 2018, 7 patients with soft tissue defects of the lower limbs were repaired with the anteromedial thigh perforator flaps. The patients were males, aged 8-30 years (median, 23 years). There were 5 cases of traffic accident injuries (the time from injury to admission was 1-4 hours, with an average of 1.5 hours), 1 case of scar formation after traffic accident, and 1 case of scar deformity after burn. The defect located in calf in 5 cases, foot in 1 case, and thigh in 1 case. The area of soft tissue defects ranged from 12 cm×4 cm to 21 cm×7 cm; and the area of flaps ranged from 14 cm×5 cm to 24 cm×8 cm. The donor sites were sutured directly.ResultsThe flaps survived completely after operation in 6 cases, and the wounds healed by the first intention; the partial necrosis of flap occurred and healed after skin graft repair in 1 case. One incision partially ruptured in the donor site and healed after dressing change; the other incisions healed by the first intetion. All patients were followed up 6 months to 2 years with an average of 9 months. Except 1 case complained of edema of the flap, the other patients had good shape, good color, and no swelling.ConclusionFor patients with soft tissue defects of lower limbs that cannot be repaired with anterolateral thigh perforator flap, the anteromedial thigh perforator flap can be used for good results.
Objective To investigate the therapeutic effect of medial sural artery perforator flap in the repair of small and medium size skin and soft tissue defects in the ipsilateral lower extremities. Methods The clinical data of patients with small and medium area skin and soft tissue defects of lower limbs admitted to Restorative and Reconstructive Department, NO.1 Orthopedics Hospital of Chengdu between September 2021 and January 2023 was retrospectively analyzed. Basic information of patients was collected. The anatomical characteristics, application methods, and clinical results of the flap were recorded after operation, and the comprehensive efficacy evaluation table of the flap was used to evaluate the clinical efficacy at the last follow-up. Results A total of 13 patients were included. There were 12 males and 1 female. A total of 19 perforating branches of medial sural artery were found in the 13 cases, with an average of 1.46 perforating branches. The incision range of the flap was 5.5 cm×3.5 cm?13.5 cm×5.0 cm. Anterograde pedicle metastasis occurred in 3 cases and free transplantation occurred in 10 cases; mosaic flaps were used in 5 cases, lobed flaps in 1 case, and conventional perforator flaps in the remaining 7 cases. All the flaps survived successfully. All the 13 patients were followed up for 4-15 months, with an average of (10.38±3.64) months. The comprehensive score of flap efficacy was 77-92 points, with an average of (86.76±4.45) points. Among them, 5 cases were excellent, 8 cases were good, and the excellent and good rate was 100%. Conclusion The multifunctional features and flexible use of medial sural artery perforator flap increase the repair strategy of small and medium-sized wounds of the ipsilateral lower limbs, and can obtain better aesthetic repair results.
Objective To explore the feasibility and technical points of soft tissue defect reconstruction of the lower extremity using the distally based anterolateral thigh (dALT) flap based on perforating vessels from the lateral circumflex femoral artery (LCFA) oblique branch. Methods Between July 2010 and July 2016, 7 patients underwent defect reconstruction of the lower extremities using the dALT flap based on perforating vessels from the LCFA oblique branch. There were 4 males and 3 females with an average age of 26.7 years (range, 3-58 years). The etiologies included angiofibrolipoma in 1 case, malignant fibrous sarcoma in 1 case, soft tissue sarcoma in 1 case, and post-burn scar contracture in 4 cases. The disease duration was 13 years, 1 year, and 8 months in 3 patients with tumors respectively, and was from 6 months to 35 years in 4 patients with post-burn scar contracture. After resection of lesion tissues, the defect size ranged from 8 cm×6 cm to 24 cm×8 cm. The flap size ranged from 9 cm×7 cm to 24 cm×8 cm. The length of the pedicle ranged from 12 to 22 cm (mean, 16.6 cm). The distance from the flap pivot point to the superolateral border of the patella ranged from 9.5 to 14.0 cm (mean, 11.8 cm). The donor sites were directly closed in 6 cases and covered with the split-thickness skin graft in 1 case. Results All flaps survived after surgery without any major complications. All wounds at the donor and the recipient sites healed primarily. The patients were followed up from 5 to 54 months (mean, 30.7 months). The color, texture, and thickness of the flaps were similar to those of the surrounding skin. No tumor recurrence was observed. The range of motion of flexion and extension of the knee joint were greatly improved in the patients with post-burn scar contracture. Conclusion For patients who have the oblique branch from the LCFA descending branch which sends out perforating vessels to the skin of the anterolateral thigh region, a dALT flap could be used to reconstruct soft tissue defects of the lower extremities.
Objective To investigate the clinical application and effectiveness of the composite tissue flaps pedicled with perforating branch of posterior tibial artery for repairing distal leg defects. Methods Between September 2014 and August 2017, 12 patients with skin and bone defects of distal leg were repaired with the composite tissue flaps pedicled with perforating branch of posterior tibial artery. There were 8 males and 4 females with an average age of 41.3 years (range, 25-66 years). The causes of injury included traffic accident injury in 7 cases, heavy crushing injury in 2 cases, tibial osteomyelitis with soft tissue ulcer and necrosis in 2 cases, and bone and soft tissue defect after resection of bone tumor in 1 case. Eight patients underwent primary repair, and 4 patients underwent second-stage repair. The size ranged from 6 cm×4 cm to 10 cm×7 cm in skin flap, from 4.0 cm×2.5 cm to 8.0 cm×6.0 cm in muscle flap, and from 4 cm×2 cm×2 cm to 5 cm×4 cm×4 cm in tibial bone flap. Tibial defects of the donor region were repaired by autologous iliac bone grafting, and the wounds were sutured directly in 7 cases and repaired by autologous skin grafting in 5 cases. Results All composite tissue flaps survived and both the recipient and the donor wounds healed primarily. All patients were followed up 6-12 months, with an average of 10.8 months. The appearance, color, texture of the composite tissue flaps and ankle function were satisfactory. X-ray films showed that the bone flap at the tibia defect and the ilium graft at the donor site both healed well at 6 months after operation. Conclusion The composite tissue flaps pedicled with perforating branch of posterior tibial artery has abundant blood, and it is a good donor region for repairing the distal leg defects combined with circumscribed bone defect.
ObjectiveTo investigate the effectiveness of free-style perforator flap in repairing the soft tissue defect of knee.MethodsBetween December 2011 and October 2017, 13 patients with the soft tissue defects of knees were repaired with the free-style perforator flaps. There were 9 males and 4 females, with an average age of 40 years (range, 14-65 years). The injuries were caused by traffic accident in 7 cases, crushing in 4 cases, and falling from height in 2 cases. The soft tissue defects in 9 cases formed after 2 weeks-2 months (mean, 1 month) of lower extremity fractures fixation. The other 4 cases were urgently admitted to the hospital after injury, and the time from injury to admission was 0.5-18.0 hours (mean, 8 hours). The size of soft tissue defect ranged from 3 cm×2 cm to 12 cm×8 cm after debridement. Nine propeller flaps, 6 rotating flaps, and 2 V-Y advanced flaps were used; and 9 cases were repaired by single flap and 4 cases were repaired by combined flaps. The size of flap ranged from 7.5 cm×2.5 cm to 20.0 cm×6.0 cm. The donor sites were sutured directly.ResultsThe flaps survived smoothly and incisions healed by first intention in 12 cases. The congestion occurred in 1 case, which obtained delayed healing after symptomatic treatment. All incisions at donor sites healed by first intention. All patients were followed up 3-24 months with an average of 6 months. The shape and motions of knee were satisfactory.ConclusionThe free-style perforator flap can maximize the utilization of the donor area around the knee wound, with reliable blood supply, small trauma, and easy operation. It is an ideal flap for the soft tissue defect of knee.
