Since 1982. nineteen cases of defect of mouth floorhave been treated by free skin flap and myocutaneous flapgrafts. All of cases were sucecssful with good appearence andfunctions. The repairing method of defect of mouth floorwere disscused and verious free skin flaps graft in repairingdefect of mouth floor were evaluated.
ObjectiveTo investigate the effectiveness of medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery in the repair of palm soft tissue defect. MethodsBetween September 2013 and December 2015, 9 cases of palm soft tissue defects were repaired with medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery. There were 7 males and 2 females with a mean age of 33 years (range, 21-52 years). The causes included traffic accident injury in 4 cases, crushing injury by heavy object in 3 cases, and electrical injury in 2 cases. The time between injury and admission was 3 hours to 2 days (mean, 9 hours). Five cases had pure soft tissue; combined injuries included tendon exposure in 2 cases, median nerve defect in 1 case, and exposure of tendon and nerve in 1 case. After debridement, the soft tissue defect area ranged from 6 cm×4 cm to 11 cm×6 cm. The flap size ranged from 7.0 cm×4.5 cm to 13.0 cm×7.0 cm. The vascular pedicle length was from 6 to 10 cm (mean, 7.5 cm). The donor sites were covered with ilioinguinal full thickness skin graft. ResultsNine flaps survived, primary healing of wound was obtained. Partial necrosis occurred at the donor site in 1 case, and the other skin graft successfully survived. All patients were followed up 6-20 months (mean, 10 months). All flaps had soft texture and satisfactory appearance; the cutaneous sensory recovery time was 4-7 months after operation (mean, 5 months). At last follow-up, sensation recovered to grade S4 in 4 cases, to grade S3+ in 3 cases, and to grade S3 in 2 cases; two-point discrimination was 7-10 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the hand function was excellent in 5 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. ConclusionThe medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery can repair soft tissue defect of the palm, and it has many advantages of soft texture, satisfactory function, and small injury at donor site.
ObjectiveTo investigate the effectiveness of abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle.MethodsBetween June 2016 and June 2019, 15 patients with large skin and soft tissue defects of foot and ankle were admitted, including 10 males and 5 females with an average age of 30 years (range, 10-60 years). The causes of injury included 6 cases of traffic accident, 3 cases of machine strangulation, 3 cases of heavy object injury, 2 cases of fall, and 1 case of electric shock. The time from injury to admission was 3 hours to 10 days, with an average of 2 days. The wound located at dorsal foot in 5 cases, ankle in 6 cases, dorsal foot and ankle in 3 cases, and dorsal foot and sole in 1 case. All wounds were contaminated to varying degrees and accompanied by tendon and bone exposure, including 5 cases of extensive necrosis of the dorsal skin with infection. The area of defects ranged from 18 cm×6 cm to 25 cm×8 cm. There were 9 cases of foot and ankle fractures and dislocations, and 2 cases of foot and ankle bone defects. The wound was repaired with abdominal free flap carrying bilateral superficial circumflex iliac arteries. The area of the flaps ranged from 20 cm×8 cm to 27 cm×10 cm; the skin flaps were thinned under the microscope to make the thickness of 0.5-1.0 cm, with an average of 0.7 cm. All incisions at the donor site were sutured directly.ResultsDuring the operation, 1 case was replaced with an abdominal free flap carrying the superficial abdominal artery because the superficial iliac circumflex artery was thin and the superficial abdominal artery was thicker. The skin flaps of 15 cases survived smoothly, and the wounds healed by first intention; the donor incisions all healed by first intention. All patients were followed up 8-36 months, with an average of 15 months. The flap shape was satisfactory, with good texture and mild pigmentation of the flap edge, without obvious bloating, effect on shoe wear, or secondary surgical thinning of the flap. The linear scar left in the donor site and had no effect on hip joint movement. All fractures healed well, and the healing time ranged from 3 to 8 months, with an average of 6 months.ConclusionThe abdominal free flap carrying bilateral superficial iliac circumflex arteries has concealed donor site, with little damage, and can be sutured in one stage. The blood vessel is anatomically constant, with less variation, and reliable blood supply. It is one of the ideal flaps for repairing large skin and soft tissue defects of foot and ankle.
The forearm radial or ulnar vascularized cuteneuous ( or myocutaneous ) flaps were used to repair and reconstruct 17 cases of lip defects since 1981. All of the flaps were survived and their functions and contours were satisfactory, from 15 patients followed from 1-6 years. The methods of repairing lip defects and those complicated with defects of nasal vestibulum, alae nasi, nasal columella or alveolar process were also discussed. It was concluded that the forearm radial or ulnar cuteneuous (or myocutaneous) flap was suitable to repair of lipdefects.
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.
【摘要】 目的 〖JP2〗探讨护理干预对前臂游离皮瓣移植修复口腔癌围手术期软组织缺损患者的经验。 方法 2005年6月—2009年6月，对收治的63例口腔癌术后软组织缺损应用前臂桡侧游离皮瓣修复患者的围手术期护理方法进行回顾性分析，并做好术前心理护理及相关准备，术后严密观察皮瓣移植情况，以便及时发现血管危象，同时做好口腔、呼吸道、体位及皮瓣供受区护理。 结果 通过精心护理，密切观察移植皮瓣，及早发现、及时处理血管危象，从而确保63例患者皮瓣移植一次性成活率达95.24%，疗效满意。 结论 科学合理的围手术期护理是前臂游离皮瓣移植修复口腔癌术后软组织缺损成功的重要保证。【Abstract】 Objective To investigate the perioperative nursing experiences of the transplanted forearm free flaps for reconstruction of soft tissue defects after oral cancer operation. Methods We retrospectively analyzed the clinical data of perioperative nursing care for 63 patients with soft tissue defects after oral cancer reconstructed with radial forearm free flaps. Psychological care and related preparation work was well carried out before operation. After operation, we closely monitored the outcome of transplantation of skin flaps to detect vascular crisis as early as possible, and at the same time, intensive care for oral cavity, respiratory tract, flap position and the affected areas was done. Results By intensive care, closely monitoring the transplanted flaps, and early discovery and management of the vascular crisis, we achieved a satisfying one-time transplantation survival rate of 95.24% for the 63 patients. Conclusion Scientific and proper perioperative care is an important factor in the successful reconstruction of soft tissue defects with free forearm flaps after oral cancer operation.