Objective To investigate the effect of transplantation of the cutaneous iliac flap on repairing bone and soft tissue defect of metatarsal. Methods From October 1999 to December 2003, the cutaneous iliac flap was designed for the repair of bone and soft tissue defect of metatarsal in 4 male patients, whose ages ranged from 26 to 47, with skin graft for the coverage of the iliac flap. The duration of injury ranged from 1 to 5 months. The length of the defect ranged from 4 to 7 cm and the defect area ranged from 5 cm×3 cm to 9 cm×5 cm. Results One week after transplantation, complete survival of iliac flap was observed in 3 cases and partial survival in 1 case (but later proved survived). Callus was seen 1 month after transplantation and Kwires were removed 4months after transplantation. Patients were followed up for 5 to 24 months. There were no ulcers. The ability of walking and bearing was satisfying as well asthe function and shape. Conclusion With satisfying restoration of function and shape, transplantation of the cutaneous iliac flap with skin graft is an alternative to treat bone and soft tissue defect of metatarsal with one stage surgery.
hirty-eight cases of severed levatorpalpebrae superoris muscle caused by traumawere reported- The methods how to find thesevered ends of the levator palpebrae superorismuscles and how to do the operation weresuggested. Of the 38 cases after operation, 28(73. 68 %) cases obtained symmetrical lidfissures of both eyes, 7 (18. 42%) cases had alid fissure of 1mm wider than the normal one , 3(9. 68%) cascs had 2mm a lid fissure 2mmwider. and none of them had a lid fissure 2mmwider in compariso...
Objective To explore the method of the distal perforator-based gluteus maximus muscle V-Y flap to treat the sacral ulcer and to simplify the operative procedures.Methods From March 2002 to March 2005, 11 cases of sacral ulcer were repaired by distal perforatorbased gluteus maximus muscle flaps. The area of sacral ulcer ranged from 13 cm×11 cm to 18 cm×14 cm. Of 11 cases, 7 were female and 4 were male,whose age ranged from 21 to 69 years, and the disease course was 8 months to 3 years.A triangular flap was designed to create a V-Y advancement flap.The length of the base was made almost equal to the diameter of the defect.The apex of the tringle was located near the great trochanter. The medial part of the flap was elevated as a fasciocutaneous flap by dissecting the layer between the fascia and the muscle.The distal part ofthe flap was elevated by dissecting the layer between the gluteus maximus muscle and the fascia of the deeper muscle group.The flap was advanced to the defect. Results All the flaps survived. After a follow-up of 5 months to 3 years, the bilateral buttocks were symmetry and whose appearance was satisfactory. Except for 1 case dying of other disease, no recurrence of ulcer was observed.All the flaps survived. Conclusion The distal perforatorbased fasciocutaneous V-Y flap for treatment of sacral ulcers is a simple and reliable technique, which has several advantages over the conventional V-Y flap technique,such as excelent excursion,viable coverage with the fasciocutaneous component, high flap reliability, preservation of the contralateral buttock, and preservation of the gluteus maximus muscle function.
Objective To investigate the advance in the management of skeletal trauma of the extremities. Methods The literature at home and abroad was reviewed, and the research findings withclinical experience in the therapeutic methods for fracture of the extremities were summarized.Results The concept on fracture management was renewed, the minimally invasive surgery (MIS) was developed and popularized, the implantation was improved, the navigation technique with computerassisted surgery was applied, and the tissue engineering was developed. The fracture mana gement was changed from the anatomical reduction with absolutely rigid fixation to the biological osteosynthesis with protection of the fracture environment. The minimally invasive surgical techniques included the minimally invasive plate osteosynthesis, intramedullary nailing, external fixation, arthroscopic surgery,and computer-assisted surgery. In concordance with the MIS principles, the newimplants, such as the locking compression plate, and the less invasive stabilization system were well designed and put into clinical practice so as to provide effective therapeutic results in treating osteoporotic fractures and complicated articular and/or metaphyseal fractures. In treatment of the delayed union or nonunion offractures, more effective techniques were employed, including the application of bone substitutes, which are degradable and have properties of bone conduction and induction. In the repair of segmental defects of the long tubular bone, the bonetransport and the vascularized bone grafts could work well. The investigation of the bone engineering revealed its great potentiality.Conclusion Fracture of the extremities is a common problem and its management should emphasize the recovery of the extremity function of the patient in addition to emphasis on the replacement and fixation of the biological structures. The combination of bone engineering and microsurgery represents the development tendency inthis field.
Objective?To investigate the procedure and the effectiveness of modified Sublay-Keyhole technique for repair in situ of parastomal hernia.?Methods?Between October 2007 and March 2010, 11 patients with parastomal hernia underwent modified Sublay-Keyhole technique for repair in situ. There were 5 males and 6 females with an average age of 63 years (range, 55-72 years). The average body mass index was 28.2 (range, 23.5-32.5). All stomas in patients were permanent, including 6 end colostomies caused by abdominal perineal resection for rectal cancer, 2 end ileostomies secondary to total colon resection for ulcerative colitis, and 3 end ileostomies following ileal conduit for bladder resection. One patient underwent previous prothetic repair with polypropylene mesh. The average time from last operation to admission was 2.5 years (range, 1-4.5 years). According to classification criteria of George Eliot hospital, 3 cases were classified as grade 2b, 2 as grade 3a, 5 as grade 3b, and 1 as grade 4. The average longest diameter of hernia ring was 9.5 cm (range, 6-12cm).?Results Reconstructions of abdominal wall in all patients were performed successfully through modified Sublay-Keyhole technique. The average size of hernia ring was 75.5 cm2 (range, 30-112cm2), and the average size of polypropylene mesh was 280.5 cm2 (range, 175-360 cm2). The average operative time was 165 minutes (range, 120-195 minutes) and the average postoperative hospitalization days were 11 days (range, 9-14 days). All patients achieved healing of incision by first intention with no abdominal wall infection. Seroma and hematoma occurred in 2 patients and 1 patient, respectively, and were cured by needle aspiration and pressure bandaging. All patients were followed up 26.3 months on average (range, 10-39 months). One case suffered from parastomal hernia recurrence at 11 months postoperatively because of suture loosening and too wide aperture in mesh; and re-sutures in both mesh aperture and myofascial dehiscence were given and no recurrence was observed during additional follow-up of 15 months. No parastomal hernia recurrence or incisional hernia occurred in the other 10 patients.Conclusion?Modified Sublay-Keyhole technique is an effective procedure for reconstruction of abdominal wall in patients with parastomal hernia for low recurrence incidence and less complications. But the long-term effectiveness needs further follow-up
Objective To report the experience of repairingperineal and adjacent defects with thoracoum biblical island flaps. Methods From January 1988 toOctober 2003, 7 cases of perineal and adjacent soft tissue defects with thoracoum biblical island flaps, aged 17-52 years. Of 7 cases, there were 2 cases of severe scar contracture due to burn on perineal, 1 case of malignancy on perineal,4 cases of vast soft tissue defects of trauma on the parts of groin and higher two-third thigh. The area of flaps was 9 cm×27 cm-12 cm×30 cm, the longest pedicel of blood vessel was 16 cm. The donor sites of flaps less than 10 cm couldbe sutured directly, the ones more than 10 cm could be repaired with skin grafting. Results All the flaps primarily survived. There was no ischemia and necrosis atthe distal part of flaps. Four patients were followed up 6 months to 6 years. The color, texture and appearance of the flaps were good. The functions of walk and squat were satisfactory.Conclusion The thoracoum bilical island flap can repair perineal and adjacent soft tissue defects, moreover the donor is shady and the effect is ideal.
ObjectiveTo investigate the risk factors of skin necrosis around incision after total knee arthroplasty (TKA),and explore the measures of prevention and treatment. MethodsBetween June 2007 and June 2013,7 patients with skin necrosis around incision after TKA were treated.There were 5 males and 2 females with an average age of 69 years (range,59-78 years),including osteoarthritis in 4 cases,traumatic arthritis in 2 cases,and rheumatoid arthritis in 1 case.Two cases complicated by diabetes,and 2 cases by hypertension; 1 case received long-term hormone therapy; and 2 cases had a history of smoking.Scar was seen near knee joint in 2 cases.The skin necrosis ranged from 10 cm×2 cm to 13 cm×8 cm.The time from TKA to debridement was 7-15 days (mean,12 days).After thorough debridement,the saphenous artery skin flap,medial head of gastrocnemius muscle flap,lateral head of gastrocnemius muscle flap were used in 4 cases,2 cases,and 1 case respectively; reconstruction of patellar ligament was performed in 2 cases.Donor sites were repaired by split-thickness skin graft. ResultsAll the flaps and myocutaneous flaps survived well,and all wounds healed by first intention.At donor site,the grafted skins survived and wounds healed by first intention.No early complication occurred.All cases were followed up 6-12 months (mean,7.8 months).The flaps and myocutaneous flaps had good texture and appearance; no prosthetic loosening and displacement happened,no secondary infection was observed after operation.The knee range of motion was 45-110° (mean,85°) at 6 months after operation.According to the Knee Society Score (KSS),the results were excellent in 3 cases,good in 2 cases,general in 1 case,and poor in 1 case at 6 months after operation. ConclusionEarly discovery,thoroughly debridement,and timely repair with axial pattern flap or myocutaneous flap are the key factors to treat skin necrosis around incision after TKA and save the artificial prosthesis.
From January, 1994 through March, 1995, 20 cases of CSF rhinorrhea happened during operation. The ages ranged from 20 to 76 years old. The types of tumors were: communicating craniofacial malignant tumors in 3 and pituitary adenoma in 17.The CSF fistulas were all repaired with autogeneous free muscle flaps, fat grains and gel foam, "threeinone" method. The defects of sphenoid and ethmoid bones and the dura mater ranged from 1.5 to 3.5cm and the filling materials used were 2 to 3 grams of fat grains and a muscle flap of 24cm in length, 1.82.5cm in width and 0.50.8cm in thickness. The survival rate from the implantation was 100 per cent, with satisfactory results. The patients were followed up for 1 to 14 months without any ill effect and recurrence of CSF rhinorrhea. The selection of the implanted material and its preparation were discussed. The main points in the surgical technique were introduced, and the mechanism of the implanted tissue was discussed preliminarily.
OBJECTIVE: To provide a new reconstructive method to treat refractory ulcers on the sole of the forefoot. METHODS: The reversed medial plantar flap with the medial plantar pedal artery and vein as pedicle was used to treat the refractory ulcers on the sole of the forefoot in 5 cases. The size of the flap was 3.5-5.0 cm x 4.0-5.5 cm. The deformities were corrected at the same time and the flaps were protected after operation. RESULTS: All flaps survived without complications. There was no recurrence after 6-month following-up. The patients could walk. CONCLUSION: The distal ends of medial plantar pedal artery and vein have plenty anastomoses with dorsal pedal artery and deep plantar arch. The reversed medial plantar flap has reliable blood supply by these anastomoses. The reversed medial plantar flap should be a choice in treating refractory ulcers on the sole of the forefoot.
The pectoralis major muscle or myocutaneous flap is characterized by its easy dissection and free rotation, as well as abundance of blood supply and tissue mass of the flap, so that it was often used in repairing the wound over the mandibulo-cervico-thoracic area. From 1989 to 1996, 11 cases with long-standing wound of this area were difficult to repair with the traditional method, but were treated with transposition of this type of myocutaneous flap. The myocutaneous flap was applied in 8 case and muscle flap in 3 case. The flap area ranged from 12 cm x 8 cm to 26 cm x 18 cm. All the flaps survived, and excellent results were achieved. The technique and design of the operation were reported in details. It was concluded that the process was easy to perform, and the flap had abundant blood supply and high resistance to infection.