OBJECTIVE: To sum up the experience of clinical application of distal base sural island flap. METHODS: From January 1997 to April 1999, the posterior island flap of leg pedicled with sural nerve and its nutrient vessels was applied to repair heel or dorsum of foot in 6 cases, chronic ulcer of heel in 2 cases, chronic osteomyelitis in 2 cases, scar contracture of bone defect accompanying fistulation in 1 case. The range of flap was 5 cm x 8 cm to 8 cm x 12 cm. RESULTS: All the flaps survived completely without vascular crisis. All the wounds healed by first intention. Followed up 3 to 12 months, no ulcer, osteomyelitis, fistulation were recurrence, and the sensation of flap was recovered slightly. CONCLUSION: The flap do not damage critical blood vessels and nerves, the donating region is hidden. The manual of operation is simple and blood supply of flap is sufficient. It can repair the defect of soft tissue on heel and dorsum with high survival rate.
Objective To observe the clinical effects of neurovascular island flap from the same finger for repairing pulp defect. Methods From November 2003 to February 2005, 32 pulp defects in 30 cases were covered with neurovascular island flap from the same finger.There were 25 males and 5 females. The age ranged from 18 to 56 years. The operation was performedafter debridement and 2-8 days antibiotics therapy. The defect area ranged from 1.5 cm×1.2 cm to 3.5 cm×2.1 cm. The flap was harvested on the dorsal part ofthe finger ularly or radially. The distal end of the flap should be more than 5mm away from the nail base to avoid nail injury. The ventral and dorsal cut should not exceed the middle line respectively. The flap size ranged from 2.0 cm×1.5 cm to4.0 cm×2.5 cm. The donor site was covered with flap of subdermal vascular plexus from the medial side of the upper arm. Results All 32 transferred flaps survived after operation. There was no vascular crisis. Twentyfive cases were followed up from 2 to 8 months. The flaps had good appearance and texture and blood circulation. Two-point discrimination was 7-10 mm. The function of finger motion was returned to normal. Conclusion Transfer of neurovascular island flap from the same finger offered a sensational skin flap for reconstruction of pulp defect. The technique was simple, andthe clinical result was satisfactory. It is an ideal method for reconstruction of thumb or finger pulp defects.
Objective To investigate the procedure and applications ofantegrade and retrograde dorsal metacarpal flaps with cutaneous branches as pedicles in repairing soft tissue defects of wrist and fingers. Methods From 1995 to 2003, we observed that the proximal and distal branches, deriving from the dorsal metacarpal artery, formed a consistent anastomosis arc subdermally. The anastomosis arc was paralleled to the dorsal metacarpal artery. Antegrade and retrograde dorsal metacarpal flaps could be designed using proximal anddistal branches as pedicles. Twenty-seven cases of soft tissue defects were treated by use of dorsal metacarpal flaps with cutaneous branches as pedicles, including 3 cases of defects on dorsum of hand with antegrade flaps, and 24 cases of defects on fingers with retrograde flaps ( index finger:12 cases; middle finger: 6 cases; ring finger: 4 cases; and little finger:2 cases). The dimensions of the antegrade flaps were 2.0 cm×4.0 cm～4.0 cm×6.0 cm, and the dimensions of theretrograde flaps were 2.5 cm×3.5 cm～3.0 cm×7.0 cm.The incision of the donor site was closed directly. Results All flaps survived. After a follow-up of 13 years, the texture and color of the flaps were good, and the shape and function of the donors were normal. Conclusion The antegrade or retrograde flap pedicled with the distal or proximal cutaneous branches of thedorsal metacarpal artery, is an optimal flap in repairing finger or wrist softtissue defects.
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.
In this study, 8 pigs, weight ranged from 25 to 30kg, were used. Island skin flaps with the deep circumflex iliac artery were designed as pedicle on both buttocks. In the distal half of the island skin flap, which had been made on the right buttock, a subdermal vascular network island skin flap was made by preserving the subdermal vascular network. Blood supply between the two types of skin flap was compared by skin temperature, laser Doppler, fluorescent stain, histological examination, ink perfusion microangiography and transparent specimen technique. The observation showed thatthe blood supply of the subdermal vascular network island skin flap was decreased prominently in comparison with that of the conventional island skin flap. The subdermal vascular network skin flap was actually a combination of axial pattern skin flap with randomized skin flap.
OBJECTIVE: To provide an ideal method for repairing the circular cicatricial contracture of thigh. METHODS: Deep inferior epigastric perforator (DIEP) island flaps was elevated based only on the deep inferior epigastric artery and vein and transferred to cover the thigh wound after scar had been resected. RESULTS: Four DIEP island flaps was applied clinically and all flaps survived. The size of the flaps ranged from (8 cm x 28 cm) to (11 cm x 32 cm). Venous return and edema had been obviously improved postoperatively. There was no abdominal weakness and hernia in the donor sites. CONCLUSION: DIEP flap not only retains the advantages of TRAM flap such as good blood supply and rich tissue volume, but also preserves the integrity of the rectus abdominis muscle. DIEP island flap is a good material for repair of the circular cicatricial contracture of the thigh.
Objective To investigate the cl inical effect and operative method of local island flap for complex thumb mutilation with soft tissue and blood vessel defect. Methods From May 2003 to March 2006, 6 cases of complex thumb mutilation with soft tissue and blood vessel defect were treated with local island flap. There were 4 males and 2 females aged 14-48 years, with an average of 23.5 years, among whom 2 cases were caused by triangular bandage twist, 3 cases by machinesavulsion and 1 case by explosion. Five cases suffered thumb mutilation of soft and blood vessel defect only, and 1 case was combined with middle and ring finger injures. The defect was located in pulp soft tissue in 4 cases and in dorsal soft tissue in 2 cases, ranging 2.0 cm × 1.2 cm-2.5 cm × 1.8 cm in size. The time from injury to operation varied from 30 minutes to 6 hours. Two cases were replanted with bridging index finger radial is digital artery island, 2 cases were repaired by ring finger radial is digital artery island and 2 cases by index finger near dorsi-flap. The flap was 2.0 cm × 1.4 cm-2.5 cm × 1.8 cm in size. Free-skin graft from forearm was conducted. Results All flaps free skin and replanted thumbs in 6 cases survived completely, following up for 6-24 months after operation. The flaps and thumb had good texture and color match, two-point discrimination was 10-12 mm on thumb pulp and 8-10 mm on flap. All replanted thumb recovered satisfied function, there were no donor site dysfunction. According to the criteria for function assessment of amputated finger issued by the Branch of Hand Surgery of Chinese Medicine Association：4 cases were regarded as excellent and 2 as good. Conclusion Local island flap is capable of repairing complex thumb mutilation with soft tissue and blood vessel defect, maximizing the recovery of thumb appearance and function.
In order to introduce a novel reversed digital artery island flap, it was used in 13 cases involving 17 digital skin defects since 1993, in which digital skin defects were covered by a reversed digital artery island flap, a comparative study was made between the flaps with or without a palmar digital vein. The results showed that the 17 island flaps were all survived, and during the early stage after operation, the incidence of venous crisis in the flaps without palmar digital vein was 87.5% (7/8) while that in the flaps with the vein was only 11.1% (1/9), so, it was concluded that the reversed digital artery island flap containing a palmar digital vein could obviously reduce the incidence of venous crisis and improve the survival of the flap.
Objective To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. Methods From March 2005 to October 2007, 6 cases of amputated thumb fingertip (6 fingers) were treated, including 4 males and 2 females and aging 23-63 years. Six patients’ (3 crush injuries, 2 cut injuries and 1 other injury) amputated level was at nail root (2 cases), mid-nail (3 cases), and the distalone third of nai bed (1 case). The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. The flaps size ranged from 1.5 cm × 1.4 cm to 2.0 cm × 1.4 cm. Results All flaps survived. Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swell ing. All skin grafting at donor site survived in one-stage. All patients were followed up for 6-8 months. The appearance of flaps were good, and the two-point discrimination was 5-6 mm. Bone graft were healed, the heal ing time was 4-5 weeks. All finger nails were smooth and flat without pain. Conclusion When there was no indication of replantation in thumb fingertip amputation, establ ishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery flap coverage for bone and nail bed graf
Objective To summarize the methods of repairingthe urethral defect in the penis of an adult and the clinical application of the island skin flaps of the scrotum septum to the reparative treatment. Methods From January 2000 to November 2005, twenty-six cases of urethral defect in penis, including 16 cases of congenital urethral defect, 6 cases of traumatic urethral defect in middle penis, and 4 cases of distal urethral defect, were repairedby the local penis fascia flaps.The island skin flaps of the scrotum septum were transferred to cover the penis wound. The pedicle contained the artery of the posterior scrotum and the artery of the anterior scrotum. The flap taken from the scrotum septum was 2.5 cm×5.5 cm in area. Results After a follow-up of 7months to 4 years, all the 26 patients had the healing of the first intention without urethral fistula, urethral narrowness or penis curvature, except 4 patients who developedinfection and leakage of urine, but the wounds healed spontaneously 2-4 weeks after operation. Conclusion The penis fascia flaps and the island skin flaps of the scrotum septum can be used to repair the urethral defect in the penis of an adult. The blood supply to the flaps is sufficient and all theflaps can survive well. A good shape and function of the penis can be obtained.