OBJECTIVE: To evaluate the clinical efficacy of fasciocutaneous flap in the repair of the III degree burn wound in the facio-cervical region. METHODS: From January 1997 to October 2001, 11 cases of III degree burn wounds in the facio-cervical region were repaired with the cervical-thoracic fasciocutaneous flap ranging from 18 cm x 8 cm to 13 cm x 5 cm. Donor sites were covered with "Z" plasty or skin grafting. RESULTS: Except for partial necrosis of distal end of the flap in 1 case, the flaps in the other 10 cases all survived and presented satisfactory appearance and function during the following up. CONCLUSION: The fasciocutaneous flap in the cervical-thoracic region may provide a large area of flap, and can be easily transferred. It’s an ideal flap for the repair of skin defect in the facio-cervical region, especially for the repair of the wounds with infection or exposure of vessel, nerve and tendon.
Objective To improve the success rate of the reverse fascio-cutaneous flap in repairing the infected wound, to observe the effect of surgical delay on the anti-infection abil ity of the reverse fascio-cutaneous flap by establ ishing an oryctolagus cuniculus model of reverse fascio-cutaneous flap based on sural nerve on the lateral side of left later l imb. Methods Sixteen 5-month-old Japanese white rabbits weighing 2.0-2.5 kg (mean, 2.3 kg) were randomly divided into experimental group (n=8) and control group (n=8). The reverse fascio-cutaneous flap of 4 cm × 2 cm was designed, based on 1 cm above the lateral malleolar as pedicle in sural nerve region in the lateral left later l imb. In the experimental group, thefull-thickness of the flap distal end half was harvested according to the design; and after 10 days delay, the full-thickness flap was obtained according to the design, and 0.5 mL staphylococcus aureus solution was implanted at a density of 3.8 × 106 /mL in 2 groups. The general observation was performed postoperatively; the venous blood of the marginal ear vein was collected to observe white blood cell (WBC) count before implantation of staphylococcus aureus solution and after 1, 3, 5, 7, 10, and 14 days of implantation. The flap survival rate and the colony counting of necrosis flap tissue were calculated after 10 days of implantation; the blood vessel cal iber and the peak value of peroneal artery blood flow of flap proximal end were measured after 14 days of implantation. Results All animals survived to the end of the experiment, and all incisions healed primarily. Inflammatory reaction with different degrees was observed after implantation in 2 groups, and it was obvious at 3-5 days. Inflammatory reaction in the experimental group was sl ighter than that in the control group. Except for no significant difference before implantation and after 14 days of implantation between 2 groups (P gt; 0.05), there were significant differences in WBC count at other time points between 2 groups (P lt; 0.05). The flap survival rate of the experimental group (93.20% ± 4.62%) was significant higher than that of the control group (72.65% ± 7.80%) after 10 days of implantation (P lt; 0.05). The colony counting of necrosis flap tissue in the experimental group [(20.63 ± 5.76) × 103 colony/g] was significantly lower than that in the control group [(32.38 ± 6.14) × 103 colony/g] after 10 days of implantation (P lt; 0.05). The blood vessel cal iber of the experimental group and the control group were (1.03 ± 0.10) mm and (0.75 ± 0.09) mm, respectively, and the peak value of peroneal artery blood flow in the experimental group and the control group were (20.73 ± 2.46) cm/s and (13.83 ± 1.51) cm/s, respectively, after 14 days of implantation; showing significant differences between 2 groups (P lt; 0.05). Conclusion Surgical delay has the abil ity of enhancing survival and anti-infection of the rabbit reverse fascio-cutaneous flap.
OBJECTIVE: To provide an anatomical basis for the clinical applications of the medial fascinocutaneous flap of calf and to verify its clinical value. METHODS: In 20 lower limb specimens of adult human cadavers, the number, course, size, position and distribution of septocutaneous branches of the posterior tibial vessels are marked by means of red latex and black ink irrigations through femur artery and septocutaneous branches of the posterior tibial artery respectively. RESULTS: The posterior tibial artery gives off several septocutaneous branches at the upper, middle and lower one-third of the leg respectively. Each septocutaneous artery has one or sometimes two concomitant veins. Based on this result, anterograde or reverse pedicled fasciocutaneous flap can be performed for the purpose of repairing soft tissue defects of leg and foot. The flap was clinically applied to treat leg and foot soft tissue defects in 12 cases with satisfactory results. CONCLUSION: The flap is easy to dissect, the posterior tibial artery can be preserved with high successful rate. Therefore, it offers an useful alternative in the repairing and reconstruction of nonextensive soft tissue defects in the leg and foot.
The ultra length and width random calf fasciocutaneous flaps whose blood supply came from the calf fasciocutaneous vascular network were transposed in 9 cases for the treatment of severe trauma of leg. All of the flaps survived except one having necrosis of the distal fourth. The length and width of the flap to the width of the pedicle were 6.1∶1 and 2.7∶1 respectively. Properly extended the area and decreased of blood perfusion of the flan would reduce the burden of the venous backflow to the flap relatively. The abundant vascular networks of the calf fasciocutaneous flap was a very important factor that this type of flap would possibly survive.
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.
Considering the abundant vascular anastomotic networks in the deep fascia of the posterior calf, three kinds of distally based facial flap containing deep fascial vascular network were applied clinically. They were: 1. posterolateral distally based island fascial flap which could be used to repair the skin defect of heel, dorsum of foot and lateral-distal part of leg; 2. posteromedial distally based island fascial flap which could be used to repair the skin defect of heel, medial malleolus and medial-distal part of leg and 3. posterolateral malleolar distally based fascial flap which could be used to repair the skin defect of heel and lateral malleolus. Eighteen cases with soft tissue defects around the distal calf were treated, the area of skin defect ranged from 4 cm x 3 cm to 13 cm x 6 cm. All the flaps were survived completely after operation with an average of follow-up for 15 months (ranged from 6 months to 2 years). So the advantages of these flaps were as follows: the blood supply was reliable, preparation of the flap was easy and the major arteries of the calf needed not be sacrificed; the flap had a long and rotatable pedicle so that they would basically satisfy the need to repair skin defect of lower leg, dorsum of foot, heel and malleolus and the resistance of the flap to pressure and wear was better. However, the injury to the superficial sural nerve was the shortcoming.
Objective To evaluate clinical significance of reversed sural neurovascular fasciocutaneous flap for reconstruction of softtissue defects in ankle and foot. Methods From July 1994 to December 2002, 52 cases of soft-tissuedefects in the ankle and foot were reconstructed by use of reversed sural neurovascular fascio-cutaneous flap, including 47 cases of traumatic defects, 3 cases of chronic ulcer and 2 cases of tumors. The flap area ranged from 4 cm×6 cm to 10 cm×21 cm. Results The flaps survived in 48 cases; the distal part necrosed and secondary free-skin graft were further conducted in 4 cases. All soft-tissue defects were repaired and their accompanied bone and tendon exposurehealed. Forty-six cases were followed-up for 5 months to 48 months, the color and texture of the flaps were excellent and 2point discrimination was 11-17 mm(14 mm on average).The functions of ankle joints were good.Conclusion The reversedsural neurovascular fascio-cutaneous flap is convenient in design and dissection. Its use can retained and replace vascular anostomosed flaps to certain degrees.
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.