The canine saphaneous skin flap was used as a model in this experiment. The cutaneous autograft would give long-term survival, whereas the allograft without pretreatment would only survive 10. 2±1.9 days from its transplantation. If the pretreatment consisted of the use of immunosuppressive agent as PHA or infusion of dexamesone, the survival days of the allografts could be prolonged to 15.1±2.5 and 13.7±2.8, respectively(Plt;0.01). The histological examination gave the evidence that drug perfusion delayed the rejection.
ObjectiveTo investigate the surgical methods and effectiveness to use the iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect. MethodsBetween January 2013 and January 2016, iliac flap combined with anterolateral thigh flap was used to repair the first metatarsal bone and large skin defect in 9 patients. There were 5 males and 4 females, with a median age of 15 years (range, 10 to 60 years). The causes included traffic accident injury in 6 cases and crush injury of machine in 3 cases. The average time from injury to operation was 3 hours to 14 days (mean, 7 days). The size of skin soft tissue defect ranged from 10 cm×6 cm to 20 cm×10 cm. The size of first metatarsal bone defect ranged from 2 cm×1 cm to 5 cm×1 cm. The size of iliac flap was 3.0 cm×1.5 cm to 6.0 cm×1.5 cm, and the size of anterolateral thigh flap was 10 cm×6 cm to 20 cm×10 cm. The donor site was directly sutured or repaired by free skin graft. ResultsAfter operation, the composite flaps survived with primary healing of wound; the skin grafts at donor site survived and the incision healed by first intention. All patients were followed up 6 months to 2 years (mean, 1.6 years). X-ray examination showed that the bone healing time was 3.5-5.0 months (mean, 4 months). The flap had soft texture, good color and appearance. All patients could normally walk. According to the American Orthopaedic Foot and Ankle Society (AOFAS) standard, the foot function was excellent in 6 cases and good in 3 cases, and the excellent and good rate was 100% at last follow-up. ConclusionThe iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect is a practical way with good shape at one stage.
Objective To study the method and effect of transferring the pedicled second metatarsal base for repairing bone defect of lateral malleolus. Methods Thirty lower limb specimens were anatomized to observe the morphology, structure and blood supply of the second metatarsal bone . Then transferring of thepedicled second metatarsal base was designed and used in 6 patients clinically.All cases were male, aged from 24 to 48 years old, and the area of bone defect was 3-4 cm. Results Followed up for 3-11 months, all patients healed primarily both in donor and recipient sites. There were excellent results in 4 cases and good results in 2 cases . The morphology and function of the malleoli were satisfactory. Conclusion Transferring of the pedicled second metatarsal base for repairing bone defect of lateral malleolus is an effective and reliable operative method.
OBJECTIVE To summarize and analyze the main point on the reconstruction of traumatic tissue defects of limbs with vascularized skin and multi-tissue flaps. METHODS: Sixty-seven cases of traumatic tissue defects of limbs were reconstructed with 14 kinds of skin or multi-tissue flaps. The operative methods included local transposition, cross-transposition with vessel pedicles and vessel anastomosed free transplantation. RESULTS: Forty cases with vessel anastomosed free transplantation and 26 cases with local or cross-transposition of vessel pedicled flaps were survived. In the followed up cases, 53 cases were satisfied with the outward appearance of the skin flaps. All the cases with bone flap or skin-bone flap resulted in union. And the cases with motor nerve anastomosed myocutaneous flap transplantation had recovered to 2-3 grade muscle contraction ability. CONCLUSION: It is important that the appropriate flaps and operative methods should be chosen according to the size, location, depth and structure of the tissue defects. To raise the success rate and to gain better operation effect, the correct manipulation in operation and the rational postoperative treatment are necessary.
Twenty cases (25 eyes) of severe ptosis were treated with the levator aponeurosis-Muller’s muscle complex combined frontalis suspension. From 6 months to 3 years followingup the results were satisfactory.The surgical procedure was described. The surgical principles, advantages and disadvantages were discussed.
Objective To investigate the treatment method of ischemic necrosis of the femoral head by the transplantation of pedicled bone flap with deep iliac circumflex vessel in adult and to assess its curative effect. Methods From February 1996 to September 2003, 46 adult patients with ischemic necrosis of thefemoral head (58 coxas) were treated by transplantation of pedicled bone flap with deep iliac circumflex vessel. The locations were the left side in 34 coxas and the right side in 24 coxas（stage Ⅱ in 16 coxas, stage Ⅲ in 39 coxas and stage Ⅳ in 3 coxas）.Results Thirty-seven patients (40 coxas) were followed up 6 months to 10 years after operation. According to the assess of FanQishen,the result was excellent in 19 cases (21 coxas), good in 11 cases (12 coxas), fair in 5 cases (5 coxas) and poor in 2 cases (2 coxas). The postoperative excellent and good rate was 81%. Conclusion Operative treatment of ischemic necrosis of the femoral head in adult by transplantation of bone flap pedicled with deep iliac circumflex vessel has the characteristics of restoration of blood supply ofthe femoral head, decompression of marrow cavity, elimination of necrotic bone and support of the femoral head. It is an effective and advanced method for treatment of ischemic necrosis of the femoral head in adult.
In order to study the feasibiliy of the insular skin flap of the nasolabial groove with the retrograde superior labial artery, 8 adult cadavers were dissected and the relation between the superior labial artery and the skin of nasolabial groove was observed. The result revealed that superior labial artery was one of the branches of the facial artery and could be found in every cadaver. The diameter of the artery was 0.8 +/- 0.1 mm and the length was about 90 mm. The left and right facial arteries were connected with each other in the mid-line in the formation of the arcuate artery. The arcuate artery lay within the submucous tissue beyond the vermilion border about 6 mm. The concomitant veins were constant. If the facial artery being sectioned was beyond its initial site of superior labial artery, the skin of nasolabial groove on the same side could receive blood supply from contralateral supperior labial artery. The conclusion was that the insular skin flap of the nasolabial groove with the retrograde superior labial artery could be used in patients, because it had support from anatomical research.
OBJECTIVE: To provide anatomical bases for dorso-ulnar aspect of mid-hand reverse flap. METHODS: After red latex was infused into the arteries of 40 sides of adult cadava upper limbs, the origin, course, branches, distribution and distal anastomosis on the dorsal carpal branch of ulnar arteries were observed. And the mid-hand flap transfer was used to repair two cases of soft tissue defect (ranged 4.5-5.0 cm x 2.0-3.5 cm on ring and little fingers). RESULTS: The dorsal carpal branch begins with ulnar artery (3.9 +/- 1.2) cm above the pisiform with diameter of (1.3 +/- 0.2) mm, and branches off into ascending and descending branches. The descending one is the continuing of dorsal branch, it crosses the ulnar edge of the fifth metecarpal bone and anastomizes with the digital artery of little finger or hypothenar branch of deep palmar (accounted for 70%). While the other ascending branch with the former two branches formed anastomosis accounts for 30%. The two cases got healed in one-stage. The function of fingers recovered after 3-4 month follow-up. CONCLUSION: The reverse flap of dorso-ulnar aspect of mid-hand is available to repair the soft tissue defect on dorsum of hand with neighbor finger.
Superficial cervical artery skin flap is widely used in clinical practice. In order to inprove the outcome of the flap in clinic, eleven cases of skin defect of scalp who were treated with the flap was discussed. After operation, the donor area healed but there was no hair growth on recipient area. Among them, six cases occurred partial necrosis of skin flaps. In order to avoid these problen, the relevant solution discussed as follows: 1. Handle well the pedicle of the skin flap to prevent the interference with venous returm. 2. Adhere strictly to indications. 3. Apply skin expander to obtain "extra" skin, then carryout the tranfer of skin flap and 4. Better use the skin flap with residual hair.
Since October 1984, we have designed a method of conversed transplant of radial styloid bone flap with fascial pedicle in the treatment of 22 patients with non-united waist fractures of carpal scaphoid. The results from follow-up of 2-7 years were satisfactory.This article introduced the design of the bone flap, the operative procedure and the advantages of the bone flap.