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 probe the principle and the method to repair facial soft tissue defect with the prefabricated expander flap the neck with the vessles of temporalis superficialis. Methods The expandor was implanted into the surface layer of the platysma in neck. The pedicle of the expander flap contained the arteria temporalis superficialis and its ramux parietalis. After 3 months, the prefabricated island expander flaps pedicled with the arteria temporalis superficialis and its ramux parietalis could be transferred to the face. From 1998 to 2003, 6 cases of facial soft tissue defects were repaired. The maximal flap size was 12 cm×8 cm.Thepedicel length was 7.8 cm.Results After a follow-up of 3-6 months, all expander flaps survived. The excellent function and cosmetic result were achieved. Conclusion The prefabricated expander flaps of the neck pedicled with the arteria temporalis superficialis and its ramux parietalis can be transferred to the upperface to repair tissues defect. The supply of blood of the prefabricated expander flaps were safe and reliable. The survived areas of the flaps are directly proportional to the areas of temporalis superficialis fascia combining the expander flaps.
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 investigate a method of improving design of the skin flap pedicled with descending branch of lateral femoral circumflex artery, in order to increase the accuracy of preoperative Doppler location. Methods Firstly, the interspace between rectus femoris and vastus lateralis was regarded as line A, and the point of intersection between line A and the vertical line through the midpoint of the line between anterior superior iliac spine and lateral margin of patella was point A. And then the line between the midpoint of groin and point A was regarded as line B. Based on this , the perforating point of cutaneous branch could be located by Doppler along the line B. From November 2001 to October 2004, this method was used in 38 skin flaps of 37 cases, being all males and 16-48 years old. The area of the flap ranged from 7 cm×6 cm to 24 cm×16 cm. Results All the perforatingpoint of cutaneous branch were located outward the line A. The rate that the preoperative Doppler location was consistent with the utility point of formatting skin flap was 97.4%. All the cases were followed up postoperatively 1-20 months. Among the cases, 36 skin flaps of 35 cases was successful and only 2 skin flaps partially necrosed, which healed after changing dressings or skin graft.Out of 35 cases, the sensation restoration of the skin flap was S2-S3 in 6 cases owing to the anastomosis of lateral femoral cutaneous nerve and a skin nerve of the recipient site, while that of the other cases was S0-S1. Conclusion Preoperative Doppler location and improving design of lineB can be a useful instruction for the design of skin flap pedicled with descending branch of lateral femoral circumflex artery.
Objective To explore the effectiveness of changeable cross-leg style sural neurovascular flap in repairing contralateral fairly large soft tissue defects on dorsum of forefoot. Methods Between June 2006 and June 2015, 12 patients with fairly large soft tissue defect on dorsum of forefoot were treated. There were 8 males and 4 females, with an average age of 35.6 years (range, 18-57 years). Defects were caused by traffic accident injury in 4 cases, machine crush injury in 3 cases, and heavy object crush injury in 3 cases, with a median disease duration of 11 days (range, 5 hours to 28 days) in the 10 cases; the defect cause was atrophic scar in 2 cases, with disease duration of 2 years and 3 years respectively. The wound size of soft tissue ranged from 6.2 cm×4.1 cm to 11.5 cm×7.4 cm; combined injuries included tendon exposure in all cases and bone exposure in 6 cases. The changeable cross-leg style sural neurovascular flaps were used to repair defects. The width and length of flap pedicle were increased. The cross-leg position was maintained with the elastic net bandage. The size of flaps was 16 cm×7 cm to 21 cm×11 cm, with a pedicle of 8-16 cm in length and 5-6 cm in width. Results After operation, 10 flaps survived, and wound healed by first intention. Extravasated blood occurred at the flap edge in 2 cases and was cured after symptomatic treatment. No pressure sore occurred. All patients were followed up 3-24 months (mean, 7 months). The appearance and function of the affected legs were good, and the flaps had soft texture and normal color. Conclusion Changeable cross-leg style sural neurovascular flap can achieve good effectiveness in repairing fairly large soft tissue defect on dorsum of forefoot. Some drawbacks of single cross-leg style can be avoided.
From Nov. 1988 through Apr. 1994, 78 cases with laryngocarcinoma underwent laryngectomy and laryngeal reconstruction by the use of transfered cervical skin. Three to six months after operation, all patients were subjected to direct or indirect laryngoscope. It was found that the keratinized of layer of the transfered skin tended to be thining out, and that hair had grown in one case. With the followup ranging from 3 months to 5 years,the results were good. All patients following the reconstruction of larynx could phonate, swallow and breath. Postoperatively, 32 patients were alive for 3 years, 2 patients died from recurrence of laryngocarcinoma. The complications included laryngeal fistula in 6 cases and laryngostenosis in 2 cases. The cause as well as the prevention of complications were discussed. It was suggested that thetransfer of cervical flap was feasible for laryngeal reconstruction.
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.
Objective To summarize the therapeutic effectinevess of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist. Methods Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, l imitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm × 4.5 cm to 11.3 cm × 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm × 5.0 cm to 12.5 cm × 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft. Results Bl ister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P lt; 0.05). Conclusion Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.
Objective To investigate the application and effect of the crossbridge vascular anastomosis free flap transplantation for tissue defects of extremities. Methods From May 1982 to November 2005, 110 cases of tissue defects of extremities were treated with cross-bridgevascular anastomosis free tissue transplantation. Of 110 patitents, 80 were male and 30 were female with a median age of 30 years(5 to 54 years). Tissue defects were caused by traffic accidents (59 cases), machine injuries (32 cases) and mangled injuries (19 cases). The locations were the forearms in 2 cases and the legs in 108 cases. And 69 cases had simple soft tissue defects, 6 cases had simple bone defects, and 35 cases had complicated defects. The length of bone defectranged from 5 cm to 19 cm and the area of soft tissue defect ranged from 6 cm×10 cm to 15 cm×35 cm. The graft tissue included latissimus dorsi musculocutaneous flap, vastus anterolateral flap,cutaneous fibula flap, osseous fibula flap, and cutaneous iliac flap. The cross-bridge of the two lower extremities wasperformed in 106 cases, the cross-bridge of the two upper extremities in 2 cass, and the crossbridge of the upper-lower extremities in 2 cases. The compoite tissue transplantation was used if the graft tissues were two or more. The wounds of donor site was directly sutured in 67 cases, and partly sutured with skingrafting in 43 cases. Results Vascular crisis occurred in 9 cases. Vascular crisis was relieved in 5 cases and grafting tissues was survival after exploring the vessel; 4 cases failed. The graft tissue was survival in 101 cases, and the survivalrate was 96.4%. The follow-up time was 4 months to 22 years with an average of 6.3 years. Graft bone healed and mean healing time was 4 months. The flap appearance was satisfactory and extremity function was restored to normal. One case became necrosis in the edge of the flap and cured by debridement, dressing and skingrafting, the other got primary healing at 2-3 weeks after operation. Conclusion The application of the cross-bridge vascular anastomosis free tissue transplantation for tissue defects of extremities is an effective method, when extremities have no vessel anastomosed.
Objective To report the clinical result of the improvedisland skin flap with distallybased sural nerve nutrient vessels in repairing skin defect in the heel, ankle or foot. Methods From August2004 to April 2005, 15 patients with skin defect in the heel, ankle or foot at distal part were treated by the improved island skin flap with distally-based of sural nerve nutrient vessels. Of 15 flaps, 12 were simplex flaps and 3 were complex flaps. These flap area ranged from 7 cm×6 cm to 11×8 cm. The donor sites were sutured directly and covered with free flap. Results All flaps survived without flap swelling and disturbance of blood circulation. The wounds of donor and recipient sites healed by first intention. The followup period ranged from 3 to 6 months. The texture of flap was soft and the color of flap was similar to that of normal skin. The foot function was excellent. Conclusion The improved island skin flap with distally-based sural nerve nutrient vessels is an ideal skin flap for repairing skin defect in the heel, ankle or foot distal part in clinical. The operation is simple and need not to anastomose blood vessel.