ObjectiveTo explore the therapeutic effect of Masquelet technique combined with tissue flap grafting for bone defect and soft tissue defect. MethodsBetween August 2012 and April 2015, 18 cases of bone defect and soft tissue defect were treated by using Masquelet technique combined with tissue flap grafting. There were 11 males and 7 females, aged from 23 to 59 years (mean, 37.1 years). The time between injury and treatment was 15 days to 39 months (mean, 0.9 months). Defect located at the proximal tibia in 4 cases, at the middle tibia in 8 cases, at the distal tibia in 4 cases, and at the lateral heel in 2 cases. All patients were treated with debridement. After debridement, the bone defect was (5.7±1.8) cm in length, and the soft tissue defect was 5 cm×4 cm to 13 cm×11 cm in size. In one-stage operation, bone defect was repaired with the antibiotic cement and fracture was fixed by temporary external fixation. The surfaces of wound were repaired with tissue flap. After 6 to 8 weeks when wounds healed with no sign of infection, bone grafting from iliac bone and/or fibula was performed in two-stage operation. ResultsEighteen patients followed up 10-38 months (mean, 24.3 months). After one-stage operation, 6 cases had pin track infection, which was cured by strengthened disinfection and oral antibiotics. All the tissue flaps survived. Bone healing was observed on X-ray film at 15-57 weeks (mean, 25.3 weeks) after two-stage operation. The function of the knee and ankle joint recovered well. According to the American Orthopaedic Foot and Ankle Society (AOFAS) score for the ankle joint, the scores of ankle function ranged from 74 to 98, with an average of 89.7; the results were excellent in 7 cases, good in 10 cases, and fair in 1 case. ConclusionThe Masquelet technique combined with tissue flap grafting is an effective method to treat bone defect and soft tissue defect.
Objective To discuss different applications ofanterolateral thigh flap in repairing large skinsoft tissue defects. Methods From January 1997 to July 2004, 27 pitients with large-complex tissue defects were treated using anterolateral thigh flap. The tissue defect was located at face in 9 cases,at cervix in 4 cases, at lower limbs in 6 cases, at vulvae in 4 cases,at hip in 1 case, at groin in 1 case and at breast tissue in 2 cases. The defect area was from 9 cm×8 cm to 20 cm×15 cm and the flap was harvested from 10 cm×8 cm to 33 cm×15 cm. Results Flaps survived in 26 cases after operation, and patients were satisfied with local function and appearance; flap necrosis occurred only in1 case，and the defect was covered with free skin graft after dress exchanges. Twenty-three cases were followed up from 3 months to 2 years. The appearance and the sense of recipient site were similar to the adjacent tissue. No obvious malformation of the donor site was observed. No local recurrence was found in the 6 cases of malignancy during the follow-up from 6 months to 15 months. Conclusion Anterolateral thigh skin flap can provide enough tissue to repair large skinsoft tissue defect,and can be used in different ways. So anterolateral femoral skin flap is an ideal flap in repairing large skinsoft tissue defect.
Objective To discuss the effectiveness of free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers. Methods Between May 2010 and September 2015, 28 patients with dorsal soft tissue defect of fingers were treated, including 17 males and 11 females with an average age of 23.8 years (range, 15-55 years). The reasons of injuries were machine twist (15 cases), heavy pound (4 cases), the sharp cut (5 cases), and hot crush (4 cases). The time from injury to admission was 30 minutes to 12 hours (mean, 1.5 hours). The involved fingers included thumb (3 cases), index finger (8 cases), middle finger (6 cases), ring finger (6 cases), and little finger (5 cases). The area of soft tissue defects ranged from 2.0 cm×1.5 cm to 3.5 cm×2.5 cm, and the area of free toe fibular-dorsal artery flap ranged from 2.8 cm×1.7 cm to 3.8 cm×2.8 cm. The blood supply of the flaps were reconstructed by anastomosing the toe fibular-dorsal artery, vein, and nerve to the dorsal digital artery, vein, and nerve, respectively. The donor site was repaired by free skin graft. Results The operation time was 1.5-5.5 hours (mean, 2.5 hours); the blood loss during operation was 10-50 mL (mean, 30 mL). Vessel crisis occurred in 1 case, and the flap survived after symptomatic treatment. The other flaps survived and the wounds healed with stage I; the skin grafts at donor site survived and the incisions healed with stage Ⅰ. Twenty-eight cases were followed up 6-24 months (mean, 8 months). The appearance of flaps was good, and two-point discrimination was 3.5-12.0 mm (mean, 5.3 mm) at 6 months after operation. The fingers function of grab and pinch recovered. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 20 cases and good in 8 cases, with an excellent and good rate of 100% at 6 months after operation. The donor sites of toe were smooth and had no depression. The patients had normal gait. Conclusion Free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers can obtain satisfactory effectiveness in appearance and function of fingers, and has the advantages of modified repair and less injury at donor site.
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 a safe, highlyefficient and rapid approach to the repair of the sacrum soft tissue defect and/or partial exposure of the bone.Methods From February 2003 to April 2006, 6 patients (4 males, 2 femals; aged 28-67 years) with the sacrum soft tissue defect were surgically treated by the multiisland flap with shallow branches of the gluteus upper artery. The soft tissue defects ranged in area from 15 cm×12 cm to 25 cm×20 cm,averaged 20 cm×16 cm.The obtained flaps ranged in area from 18 cm×15 cm to 30 cm×25 cm. Of the patients, 5 had a sacral ulcer (Grade Ⅲ in 3 patients, Grade Ⅳ in 2) and 1 had a tumor, with their illness course from 3weeks to 20 years. Results All the flaps survived completely in the 6 patients, in whom 5 had an incision healing of the first intention, and the remaining 1had a healing of the second intention 32 days after the treatment for the minorischemia and necrosis at the edges of the flap.The follow-up for 2-38 months (average, 19.3 months) revealed that all the flaps grew well with no recurrence of the sacralulcer. Conclusion The surgical treatment with the multi-island flap with shallow branches of the gluteus upper artery is a safe, highly-efficient and rapid approach to repair of the sacrum soft tissue defect and/or partial exposure of the bone. This kind of treatment has advantages of simpler procedures, better blood circulation of the flap, fewer complications, and higher success rates.
Objective To review the research progress of the skin flap, fascial flap, muscle flap, and myocutaneous flap for repairing soft tissue defects around the knee so as to provide information for clinical application. Methods Domestic and abroad literature concerning the methods of soft tissue repair around the knee in recent years was reviewed extensively and analyzed. Results Fascial flaps meet the requirements of thin, pliable, and tough skin in the soft tissue repair around the knee. Myocutaneous flaps and muscle flaps have more abundant blood supply and anti-infection function. Free skin flaps are the only option when defects are extensive and local flaps are unavailable. Conclusion Suitable flaps should be chosen for soft tissue repair around the knee according to defect position, depth, and extent. Fascial flaps may be selected as the first flaps for defects repair because of excellent aesthetic results and less injury at the donor site.
ObjectiveTo compare the effectiveness using bone transport and bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects. MethodsBetween January 2004 and May 2012,31 patients with tibial bone and soft tissue defects were managed by Ilizarov technique,the clinical data were retrospectively analyzed.Bone transport was used in 18 cases (group A),and bone shortening-lengthening in 13 cases (group B).There was no significant difference in age,gender,type of fracture,defect location,size of bone and soft defects,and time from injury to operation between 2 groups (P>0.05).Postoperative complications were observed;Paley's criterion was used to assess the bone healing and function recovery of the limb. ResultsAll the flaps survived and healing of wounds by second intention was obtained in all cases of group A;healing of wounds by first intention was obtained in 1 case,delayed healing in 3 cases,and healing by second intention in 9 cases in group B.All patients were followed up 1.5-4.5 years (mean,2.4 years).Pin loosening or pin tract infection occurred in 15 cases of group A and in 10 cases of group B,and limb length discrepancy in 1 case of group B;there was no significant difference in the rate of complication (χ2=0.003,P=0.955).In the distracted zone,all fractures healed naturally with excellent scale.The healing time was (251±39) days in group A,and was (239±45) days in group B,showing no significant difference (t=0.800,P=0.430);the healing index was (4.26±0.19) d/mm in group A,and was (4.13±0.19) d/mm in group B,showing no significant difference (t=1.775,P=0.086).In the bone defect zone,natural healing was obtained in 12 cases and healing after second operation or bone grafting in 6 cases,with healing time of (341±55) days (excellent in 17 cases and good in 1 case) in group A;natural healing was obtained in 11 cases and healing after second operation or bone grafting in 2 cases,with the healing time of (295±62) days (excellent in 12 cases and good in 1 case) in group B;and there was significant difference in the healing time (t=2.195,P=0.036),but no significant difference in the healing scale (Z=-1.693,P=0.091).At last follow-up,the function recovery was excellent in 7 cases,good in 6 cases,and fair in 5 cases in group A,and was excellent in 3 cases,good in 6 cases,and fair in 4 cases in group B,showing no significant difference (Z=-0.660,P=0.509). ConclusionUsing bone transport or bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects,the overall outcomes are similar,but the healing of bone defect zone is faster when using bone shortening-lengthening.
ObjectiveTo investigate the clinical application of the modified Zitelli bilobed flaps in repairing soft tissue defect of lower one-third nose. MethodsBetween February 2009 and February 2014, 26 patients with soft tissue defect of lower one-third nose after resection of basal cell carcinoma underwent reconstruction using modified Zitelli bilobed flaps. There were 15 males and 11 females, aged 48-65 years (mean, 56 years). Tumor involved the skin layer in all patients. According to TNM staging, 19 cases were rated as TisN0M0 and 7 cases as T1N0M0. The disease duration was 1-5 years (mean, 3 years). The mass size ranged from 1.0 cm×0.5 cm to 1.5 cm×1.0 cm. The defect size ranged from 1.5 cm×1.0 cm to 2.0 cm×1.5 cm after resection of basal cell carcinoma. The modified ipsilateral Zitelli bilobde flaps were designed and harvested for one-stage repair of defect, and the double-leaf flap size ranged from 2.5 cm×2.0 cm to 3.0 cm×2.5 cm and 1.5 cm×1.0 cm to 2.0 cm×1.5 cm. The donor site defects were sultured directly. ResultsTwenty-six flaps survived and incision healed primarily. No postoperative complications of hematoma, infection, and necrosis of skin flap occurred. No stretching deformation of local organs, the shape of the nose and face was symmetric. Twenty-six patients were followed up 3-24 months (mean, 13 months). Nasal and facial appearance was good and had no obvious scar formation, and patients were satisfied with the appearance. There was no tumor recurrence during follow-up. ConclusionThe modified Zitelli bilobed flap to repair soft tissue defect of lower one-third nose (the defect diameter within 2.0 cm) can obtain satisfactory effectiveness in appearance.
Objective To study the method and effect of free rectusabdominis muscle flaps with intermediate split thickness skin graft in repairing defects on legs and ankles.Methods From May 1998 to December 2002, 11 cases of defects on legs(2 cases) and on ankles( 9 cases) were repaired by use of unilateral free rectus abdominis flap with skin graft. The soft tissue defects were accompanied by osteomyelitis or the exposure of bone or tendon.The disease course was 1 month to 10 years. The defect size ranged 3 cm×4 cm to 8 cm×14 cm. The area ofrectus abdominis muscle flaps was 4 cm×6 cm to 8 cm×15 cm. Results All patients were followed up 6 months to 4 years after operation. All rectusabdominis flaps survived with good appearances and functions.The primary healing was achieved in 8 cases, intermediate split thickness skin graft necrosed in 3 cases and the wound healed after skin re-graft.Conclusion Free rectus abdominis flap is a proper option for repair of the soft tissue defects or irregular woundson legs and ankles. It has the advantages of abundant blood supply, b anti-infection ability, good compliance and satisfied appearance.
Objective To study the repair and function reconstruction of complex soft tissue defect of posterior of hand and forearm. Methods From May 2001 to November 2003, 8 cases of soft tissue defect of posterior of hand and forearm were repaired with thoracico abdominal flaps with hilum for primary stage. The tendon transplantation and allogeneic tendon function reconstruction of hand were performed for secondary stage. The range of the flap was 9 cm×15 cm to 12cm×38 cm. Allogeneic tendon amounted to 6.Results All the flaps survived. The flap countour was good. The results of allogeneic tendon transplantation were satisfactory and the function of hand was good. Conclusion Repairing complex soft tissue defect of posterior of hand and forearm and reconstructing hand function by use of thoracico abdominal flaps with hilum and transplantation of allogeneic tendon have the satisfactory clinical results.