OBJECTIVE: To evaluate the clinical efficacy of fasciocutaneous flap in the repair of the III degree burn wound in the facio-cervical region. METHODS: From January 1997 to October 2001, 11 cases of III degree burn wounds in the facio-cervical region were repaired with the cervical-thoracic fasciocutaneous flap ranging from 18 cm x 8 cm to 13 cm x 5 cm. Donor sites were covered with "Z" plasty or skin grafting. RESULTS: Except for partial necrosis of distal end of the flap in 1 case, the flaps in the other 10 cases all survived and presented satisfactory appearance and function during the following up. CONCLUSION: The fasciocutaneous flap in the cervical-thoracic region may provide a large area of flap, and can be easily transferred. It’s an ideal flap for the repair of skin defect in the facio-cervical region, especially for the repair of the wounds with infection or exposure of vessel, nerve and tendon.
Objective To investigate the application of arm medial fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel. Methods From February 1999 to December 2004, 18 cases of skin and soft tissue defect in axillary region, elbow and forearm were treated with arm medial fascio-cutaneous flap pedicled with cutaneous nerve and nutrient vessel. Arm medial fascio-cutaneous flap was directly transferred in 3 cases, adversely transferred in 15 cases. The flap area was 4.5 cm×8.5 cm. Results Vein circulation crisis was observed in 3 cases. Of the3 cases, 1 was necrosis and the other 2 by decompressing small vein were saved.The rest 15 cases survived.The period of follow-up was 3 to 30 months. Flap was satisfactory in appearance and function. Conclusion Arm medial fascio-cutaneous flap pedicled withcutaneous nerve and nutrient vessels can be directly or adversely transferred to repair adjacent soft tissue defect.
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.
Objective To find a better method of emergency repair of skin and soft tissue defects in the lower leg, ankle and foot. Methods The distally based superficial sural artery flap was designed on the posterior aspect of the leg. From February 2000 to December 2003, 18 patients with skin and soft tissue detects of the lower leg, ankle and foot were treated with island fasciocutaneous flap supplied by superficial sural artery by emergency. The size of the flap ranged form 4 cm× 5 cm to 11 cm×12 cm. Results The flaps survived totally in 16 cases and necrosed partially in 2 cases. After 1-2 year postoperative follow-up, the results were satisfactory except that in 2 flaps. Conclusion The island fasciocutaneous flap supplied by superficial sural artery may provide a useful method for emergency repair of soft tissue defect of the lower limbs.
Objective To discuss the clinical effect of repairing soft tissue defects in cnemis,ankle and foot with calf and sural distal fasciocutaneous flaps. Methods From August 1998 to July 2004, 34 cases of soft tissue defects in cnemis, ankles and feet were repaired with calf and sural distal fasciocutaneous flaps. There were 27 males and 7 females, aging from 17 to 61 years and the disease course was 4 hours to 8 months. The locations were metainferior segment of cnemis in 18 cases, ankle and foot in 11cases, weight loading region of calcar pedis in 5 cases. There were 13 cases chronic osteomyelitis in tibia or calcaneal bone, 8 cases of raw surface was infected, 3 cases of bone exposure.The sizes of the flap ranged from 6 cm×4 cm to 15 cm×12 cm. Results Thirty-one flaps survived except 3 cases which had partial necrosis. They were followed up from 6 months to 12 months. Both the quality and the appearance of the flaps were satisfactory. The blood supply and function of cnemis, ankle and foot returned to normal. Conclusion It is a convenient, simple and reliable method to repair softtissue defects in cnemis, ankle and foot with calf and sural distal fasciocutaneous flaps,without sacrifice of major arteries and with high survival rate and beautiful outlook form of skin flaps.
Objective To improve the success rate of the reverse fascio-cutaneous flap in repairing the infected wound, to observe the effect of surgical delay on the anti-infection abil ity of the reverse fascio-cutaneous flap by establ ishing an oryctolagus cuniculus model of reverse fascio-cutaneous flap based on sural nerve on the lateral side of left later l imb. Methods Sixteen 5-month-old Japanese white rabbits weighing 2.0-2.5 kg (mean, 2.3 kg) were randomly divided into experimental group (n=8) and control group (n=8). The reverse fascio-cutaneous flap of 4 cm × 2 cm was designed, based on 1 cm above the lateral malleolar as pedicle in sural nerve region in the lateral left later l imb. In the experimental group, thefull-thickness of the flap distal end half was harvested according to the design; and after 10 days delay, the full-thickness flap was obtained according to the design, and 0.5 mL staphylococcus aureus solution was implanted at a density of 3.8 × 106 /mL in 2 groups. The general observation was performed postoperatively; the venous blood of the marginal ear vein was collected to observe white blood cell (WBC) count before implantation of staphylococcus aureus solution and after 1, 3, 5, 7, 10, and 14 days of implantation. The flap survival rate and the colony counting of necrosis flap tissue were calculated after 10 days of implantation; the blood vessel cal iber and the peak value of peroneal artery blood flow of flap proximal end were measured after 14 days of implantation. Results All animals survived to the end of the experiment, and all incisions healed primarily. Inflammatory reaction with different degrees was observed after implantation in 2 groups, and it was obvious at 3-5 days. Inflammatory reaction in the experimental group was sl ighter than that in the control group. Except for no significant difference before implantation and after 14 days of implantation between 2 groups (P gt; 0.05), there were significant differences in WBC count at other time points between 2 groups (P lt; 0.05). The flap survival rate of the experimental group (93.20% ± 4.62%) was significant higher than that of the control group (72.65% ± 7.80%) after 10 days of implantation (P lt; 0.05). The colony counting of necrosis flap tissue in the experimental group [(20.63 ± 5.76) × 103 colony/g] was significantly lower than that in the control group [(32.38 ± 6.14) × 103 colony/g] after 10 days of implantation (P lt; 0.05). The blood vessel cal iber of the experimental group and the control group were (1.03 ± 0.10) mm and (0.75 ± 0.09) mm, respectively, and the peak value of peroneal artery blood flow in the experimental group and the control group were (20.73 ± 2.46) cm/s and (13.83 ± 1.51) cm/s, respectively, after 14 days of implantation; showing significant differences between 2 groups (P lt; 0.05). Conclusion Surgical delay has the abil ity of enhancing survival and anti-infection of the rabbit reverse fascio-cutaneous flap.