OBJECTIVE In order to increase the survival area of pedicled fasciocutaneous flap, a multiple pedicled blocking randomized fasciocutaneous flap was designed. METHODS From January 1991 to September 1998, this technique was used to repair 33 cases, including 27 males and 6 females and the ages ranged from 6 to 58 years. All of the patients were suffered from traffic accidents. In these cases, 22 cases had skin defects of legs and feet with bone, nerve and tendon exposed, 5 cases had osteomyelitis as well as internal fixaters exposed and the other 6 had deformity from scar. The size of the flap was 25.0 cm x 13.0 cm x 2.4 cm at its maximum and 6.0 cm x 3.5 cm x 1.5 cm at its minimum. Based on the traditional blocking flap, according to the severity of the wound and conditions of the neighboring tissues, a flap having 2 to 4 orthogonal pedicles with a width of 1.5 to 3.0 cm was designed. The medical-graded stainless steel sheet was implanted below the deep fascia, and after blocking for 3 to 6 days, the side pedicles were divided. 6 to 14 days later, one of the two remaining pedicles was divided and was transferred to repair the defect. RESULTS 31 cases were followed up for 6 months to 5 years without any trouble of the joints. The flap had a good external appearance and was high pressure-resistant. CONCLUSION The multiple pedicled blocking randomized fasciocutaneous flap increased the size of the flap and the length to width ratio. It had the following advantages: manage at will, high resistance to infection and a large survival area of flap.
Objective To evaluate the effectiveness of the dermal pedicled nasolabial flap with subdermal vascular network for repairing nasolabial skin defects. Methods Between July 2008 and July 2011, 43 cases of nasolabial defects wererepaired with dermal pedicled nasolabial flap with subdermal vascular network. There were 22 males and 21 females with a median age of 36 years (range, 6-68 years). All defects were caused by excision of lesions, including pigmented nevus in 23 cases, scar in 16 cases, and inflammatory granuloma in 4 cases. The disease duration was 3 months to 35 years. Lesions were located at the tip of the nose in 11 cases, at the alae of the nose in 10 cases, at the alae and tip of the nose in 10 cases, at the alar groove of the nose in 8 cases, and at upper l ip in 4 cases. The defect size ranged from 0.7 cm × 0.5 cm to 1.2 cm × 1.0 cm. The flap size ranged from 1.0 cm × 0.7 cm to 1.5 cm × 1.2 cm. Results All flaps survived and incisions at donors and wound healed by first intention. After operation, 34 patients were followed up 6-12 months (mean, 10 months). The texture and color of the flap were similar to adjacent skin. No obvious scar was observed at donor sites. Conclusion The dermal pedicled nasolabial flap with subdermal vascular network has the advantages of flexible flap transplantation, small damage to donor site, and low incidence of bloated subcutaneous tunnel.
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.
ObjectiveTo evaluate the clinical efficacy of domestic minimally-invasive percutaneous screw system for thoracolumbar fractures without neurological damage. MethodsSixty patients suffering from unstable thoracolumbar fractures without obvious neurologic deficits treated from January 2011 to April 2012 were studied retrospectively. The patients were divided into two groups:group A (domestic minimally-invasive percutaneous screw system) and group B (imported minimally-invasive percutaneous screw system). Perioperative parameter, pre-and post-operative imaging indexes, visual analog scale (VAS) and modified MacNab evaluation standard were studied for comparison. ResultsAll the patients were followed up from 6 to 18 months with an average of (12.2±3.0) months. The Cobb's angle and anterior height of the fracture vertebral body changed significantly in each group (P<0.05). There was no significant difference in incision size, surgical time, postoperative improvement of Cobb's angle, anterior height of the fracture vertebral body and accuracy of pedicle screw placement between the two groups (P>0.05). ConclusionDomestic minimally-invasive percutaneous screw system is reliable with minimal invasion, which is comparable to imported minimally-invasive percutaneous screw system.
Objective To explore the effects of natural hirudin on the survival of dorsal random flap after early pedicle division in rats. Methods Thirty-eight adult Wistar rats, male or female, weighing 220-280 g, were selected and randomly divided into natural hirudin group (experimental group, n=19) and normal saline group (control group, n=19). The dorsal random flap of 9 cm × 3 cm in size was prepared on the back of the rats. Six symmetrical injection points were selected at 2, 4, and 8 cm from the pedicle, 0.5 mL (3 ATU) natural hirudin and equivalent normal saline were injected in experimental group and control group respectively every day to the end of the experiment. After 4 days, the pedicles were cut. The flap was observed, and the ratio of flap survival area was measured at 7 days after pedicle division. At immediately after flap preparation, at 1 day before pedicle division, and at 3 and 7 days after pedicle division, the specimens were harvested for histological staining, immunohistochemical staining, microvessel density (MVD) measurement, and detection of vascular endothelial growth factor (VEGF) mRNA expression by fluorescent quantitative RT-PCR. Results All rats of 2 groups survived to the completion of the experiment. After pedicle division, the flap necrosis area of experimental group was smaller than that of control group; at 7 days, the ratio of flap survival area in experimental group was 85.366% ± 2.872%, and was significantly higher than that in control group (75.252% ± 3.455%) (t=7.117, P=0.000). Histological staining showed that no significant difference was found in the number of capillaries between 2 groups at immediately after flap preparation; at 1 day before pedicle division and at 3 and 7 days after pedicle division, the capillary number of experimental group was significantly more than that of control group. Immunohistochemical staining showed that CD34 positive cells were observed in 2 groups; MVD of experimental group was significantly higher than that of control group at 1 day before pedicle division, and at 3 and 7 days after pedicle division (P lt; 0.05). At 7 days after pedicle division, the VEGF mRNA expression was 7.122 ± 0.503 in experimental group, and was 5.655 ± 1.174 in control group, showing significant difference (t=3.633, P=0.003). Conclusion Natural hirudin can promote the formation of new blood vessels, improve the blood supply of the flap, and increase the survival of random flap after early pedicle division by increasing VEGF expression.
In order to seek a good method to treat the severe, complex damage of the digital flexor tendon, an anatomical study based on 30 cadavers was done, and the result showed that the source of the blood supply to the palmaris longus tendon was from the radial and ulnar arteries. Three cases of severe complex digital flexor tendon injuries were satisfactory. Its main advantages were: (1) The tendon transplant had its own blood supply and had no need to the revascularization, therefore the adhesion formed between the tendon and adjacent tisues might be less;(2) Besides reparing the tendon defect, it can simultaneously solve the problem of the defect of the soft tissues and the skin.
Rectus femoris muscle of the lower abdomen was used as myocutaneous flap in the reconstruction of the breast in 4 patients, of which, in 2 cases the reconstruction was carried out immediately following the radical mastectomy for breast cancer by using trancfer of the pedicled myocutaneous flap, and in the other two cases, the vascularized free myocutaneous flap was used 2 months and 5 years after the radical mastectomy, respectively. The vascularized free myocutaneous flaps were survived, however, in the pedicled myocutaneous flap group, the fat of the flaps had liquefaction 23 weeks after operation. The latter were healed after repeated dressings. The external appearance of the 4 reconstructed breasts lookedsattisfactory. The patients wete follwed up for 10 to 18 months, 2 patients hadno ill effects, while the 2 pedicled myocutaneous flaps, in which 1 patient hadbulging of the weakened abdominal wall, and the other had lost from follow up.
Objective?To investigate the operative method and efficacy of subcutaneous pedicle scar-band rotation flap in the treatment of cervical postburn scar contracture.?Methods?Between August 2008 and May 2010, 15 patients with cervical postburn scar contracture were treated with subcutaneous pedicle scar-band rotation flaps, including 9 males and 6 females with an average age of 17.3 years (range, 7-35 years). The disease duration was 1-8 years (mean, 3 years). The locations were the left cervical region in 6 cases, the right cervical region in 8 cases, and mental cervical angle region in 1 case. According to LI Ao’s classification standard for cicartrical contracture, there were 12 cases of grade I and 3 cases of grade II. The area of scar ranged from 8 cm × 5 cm to 25 cm × 12 cm. After scar relaxation, wounds were repaired with the subcutaneous pedicle scar-band rotation flaps of 7 cm × 5 cm to 15 cm × 10 cm at size. In 3 cases of grade II, free split thickness skin grafts (7 cm × 4 cm to 12 cm × 7 cm at size) were used simultaneously.?Results?After 2 weeks of operation, 2 scar-band flaps had distal partial necrosis and healing was achieved after dressing change with formation of hypertrophic scar; the others survived with healing of incisions by first intention. After 6-12 months of follow-up, all patients possessed good cervical contours, sufficient release of scar contractures, and normal cervico-mandicular or mental cervical angles. The skin’s color and texture were satisfactory. There was no recurrence of cervical scar contracture and other complications. All patients acquired normal cervical movement at last follow-up.?Conclusion?Subcutaneous pedicle scar-band rotation flap is a simple, efficient, and versatile technique in release of cervical postburn scar contracture. It is an effective method to make use of the lateral excess scar flap to resurface defects caused by scar release.
ObjectiveTo explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy.MethodsBetween January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m2, with an average of 30.8 kg/m2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g).ResultsThe skin flap necrosis at the " T” trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15).ConclusionFor severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.
Objective To explore the safety and feasibility of using modified Glisson pedicle transection methodin the precise hepatectomy of hepatocellular carcinoma （HCC）. Methods Sixty patients with HCC， which confirmed by postoperational pathology were admitted in the study. During the surgery of experimental group （Glisson group）， the segment pedicle were transected firstly using modified Glisson pedicle transection method. Then， the liver parenchyma was split follow the hepatic vein guided by intraoperative ultrasound. During the surgery of contrast group （Prigle group），the liver parenchyma was split using ultracision harmonic scalpel under intermittent pringle clamping of hilar. Results There were no significant difference in the amount of intraoperative bleeding， blood transfusion， as well as duration of surgery， serum alanine aminotransferase， total bilirubin， and length of hospital stay between the two groups （P＞0.05）. However， the incidence of postoperative complication was lower in Glisson group （23.3% vs. 50.0%， P＜0.05）. In addition， the length of tumor margin was more favorable in Glisson group 〔（2.3±0.7） cm vs. （1.5±0.6） cm， P＜0.05〕. The recurrence rate of Glisson group was lower than that Prigle group， but was not different significantly （P＞0.05）. Conclusions The modified Glisson pedicle transection method has the same safety as traditional method in the precise hepatectomy of HCC. And it has the advantages in lower postoperative complication and more favorable tumor margin， which may reduce the recurrence rate theoretically.