Objective To investigate the clinical efficiency of thedistally based sural island flap and myofasciocutaneous flap in reconstruction of defect and osteomyelitic cavity of the ankle and foot. Methods From June 1997 to October 2004, 21 patients with soft tissue defects and osteomyelitis in the ankle and foot were treated with the distally based sural island flap and myofasciocutaneous flap. There were 20 males and 1 female aging from 6 to 78 years. The defect was caused by soft tissue defect trauma(18 cases) and electrical injury ( 3 cases). Among 21 patients, 17 were treated with island flaps, 4 by the myofasciocutaneous flap. The size of flaps ranged from 4 cm×5cm to 16 cm×22 cm. The donorsites were closed directly in 4 cases. Results The flaps completely survived in 21 cases and healing by first intention was achieved. After a follow-up of 36 months, no complication occurred. The color and texture of the flaps were good. The appearance and the function were satisfactory. Conclusion Distally basedsural flap is a reliable flap. This flap has rich blood supply without sacrifice of major arteries. Flap elevation is easy. It is very useful in repairing large soft tissue defects of the lower leg, the ankle and the foot, especially inrepairing deep soft tissue defects and osteomyelitic cavities .
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.
【Abstract】 Objective To investigate the operative techniques and cl inical results of repairing the soft tissue defectsof forearm and hand with free peroneal perforator-based sural neurofasciocutaneous flap. Methods From May 2006 toJanuary 2007, 6 patients including 5 males and 1 female were treated. Their ages ranged from 22 years to 51 years. They were injured by motor vehicle accidents (2 cases), or crushed by machines (4 cases), with skin defect of hand in 1 case, skin defect of hand associated with tendon injuries and metacarpal fractures in 2 cases, skin defect of forearm in 2 cases, and forearm skin defects with fractures of radius and ulna in 1 case. The areas of soft tissue defect ranged from 16 cm × 7 cm to 24 cm × 10 cm. The debridement and the primary treatment to tendons or bones were performed on emergency. And free flaps were transplanted when the wound areas were stable at 4 to 7 days after the emergent treatment. During the operation, the flaps were designed along the axis of the sural nerve nutrient vessels according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascula anastomosis. Then the flaps were harvested and transferred to the reci pient sites with the peroneal vartey anastomosed to the radial (or ulnar) artery and the peroneal veins to one of the radial (or ulnar) veins and the cephal ic vein, respectively. The flap size ranged from 18 cm × 8 cm to 25 cm × 12 cm. The donor areas were closed by skin grafts. Results The 5 flaps survived after the surgery. Partial inadequate venous return and distal superficial necrosis happened in only 1 case, which also got secondary heal ing by changing dressing and anti-infective therapy. The donor sites reached primary heal ing completely. The followed-up in all the patients for 6 to 13 months revealed that the appearance and function of the flaps were all satisfactory, and no influence on ambulation of donor site was found. Conclusion Peroneal perforator-based sural neurofasciocutaneous flap has the advantages of favourable appearance, constant vascular pedicle, rel iable blood supply, large size of elevation and minor influence on the donor site. And the free transfer of this flap is an ideal procedure to repair the large soft tissue defects of forearm and hand.
Objective To investigate a best method of obtaining the sural neurofasciocutaneous flap by observing the models of different pedicles based sural neurofasciocutaneous flaps in rabbits and the effect of different pedicles on the survival of the flaps. Methods Forty adult New Zealand rabbits (male or female, weighing 2.5-3.0 kg) were randomly divided into 4 groups (10 rabbits in each). The flaps of 7 cm × 1 cm were designed at the lateral hind legs, and the pedicle was 0.5 cmin length. In group A, the flaps were elevated based on a single perforator pedicle; in group B, the flaps were elevated based on fascia pedicle; in group C, the flaps were elevated based on perforator-plus fascia pedicle; and in group D, the flaps were elevated and sutured in situ. At 7 days after operation, the flap survival rate was recorded, and the blood flow in the center of the flap was monitored by laser doppler flowmetry. The perfusion unit (PU) was measured. Results After operation, the flaps had no obvious swell ing, and the flaps had good color at the proximal end, but pale at the distal end in groups A and B. Obvious swell ing was observed with pale color at the distal flaps in group C, but swell ing decreased gradually. However, the skin color became dark gradually in group D after operation. The flap survival rates were 74.0% ± 2.7%, 60.0% ± 2.5%, 75.0% ± 3.5%, and 0 in groups A, B, C, and D respectively after 7 days of operation. The PU values were 83.39 ± 4.25, 28.96 ± 13.49, 81.85 ± 5.93, and 8.10 ± 3.36 in groups A, B, C, and D respectively. There were significant differences in flap survival rates and PU values between groups A, B, C and group D (P lt; 0.05). Significant differences were found between groups A, C and group B (P lt; 0.05), but no significant difference between group A and group C (P gt; 0.05). Conclusion The sural neurofasciocutaneous flap based on a single perforator pedicle has a rel iable blood supply and enough venous drainage, which is one of the best methods to obtain the sural neurofasciocutaneous flap.
Objective To find a better method of emergency repair of skin and soft tissue defects in the lower leg, ankle and foot. Methods The distally based superficial sural artery flap was designed on the posterior aspect of the leg. From February 2000 to December 2003, 18 patients with skin and soft tissue detects of the lower leg, ankle and foot were treated with island fasciocutaneous flap supplied by superficial sural artery by emergency. The size of the flap ranged form 4 cm× 5 cm to 11 cm×12 cm. Results The flaps survived totally in 16 cases and necrosed partially in 2 cases. After 1-2 year postoperative follow-up, the results were satisfactory except that in 2 flaps. Conclusion The island fasciocutaneous flap supplied by superficial sural artery may provide a useful method for emergency repair of soft tissue defect of the lower limbs.
ObjectiveTo introduce a modified technique of a sloped skin island design for the distally based sural nuerofasciocutaneous flap to reconstruct soft tissue defects longitudinal in distal pretibial region or transverse in the heel and ankle, and report the effectiveness of the modified technique. MethodsBetween April 2001 and January 2016, 37 patients (38 defects) with longitudinal defects in distal pretibial region or transverse defects in the heel and ankle were treated with the sural nuerofasciocutaneous flap with slope-designed skin island. These patients included 28 males and 9 females, with a median age of 37 years (range, 5-78 years). The horizontal and vertical dimensions ranged from 3 to 8 cm and 8.5 to 14.5 cm in 11 distal pretibial defects, and from 9 to 21 cm and 3.0 to 10.5 cm in 27 heel and ankle defects, respectively. The disease duration ranged from 2 days to 5 years. ResultsWhen the skin islands were routinely designed, the skin islands of 25 flaps would exceed the lateral limit (the anterior border of the fibula) laterally or medial limit (the medial border of the tibia) medially. After the skin islands were obliquely designed, the horizontal dimensions in 38 flaps decreased an average of 5.4 cm (range, 2.5 to 14.8 cm), and the vertical dimensions increased an average of 5.3 cm (range, 2 to 15 cm). The rotation angles ranged from 42° to 90°, with an average of 67°. Thirty-five flaps survived uneventfully. Margin necrosis occurred in 2 flaps, and partial necrosis in 1 (2.6%) flap. The grafted skins at donor site survived, and primary healing of incision was obtained. All patients were followed up 6 to 42 months (mean, 10 months). No infection or ulceration was noted during the follow-up period, and the appearances of the flaps were satisfactory. At last follow-up, according to Boyden et al criteria, the limb function was excellent in 30 cases, good in 6 cases, and poor in 2 cases, with the excellent and good rateof 94.7%. ConclusionWhen the distal sural nuerofasciocutaneous flap is used to reconstruct soft tissue defects longitudinal in distal pretibial region or transverse in the heel and ankle, the modified technique of sloped skin island design can decrease the horizontal dimension of the skin island, improve the flap survival rate, and extend its indications.
Objective To discuss the clinical effect of repairing soft tissue defects in cnemis,ankle and foot with calf and sural distal fasciocutaneous flaps. Methods From August 1998 to July 2004, 34 cases of soft tissue defects in cnemis, ankles and feet were repaired with calf and sural distal fasciocutaneous flaps. There were 27 males and 7 females, aging from 17 to 61 years and the disease course was 4 hours to 8 months. The locations were metainferior segment of cnemis in 18 cases, ankle and foot in 11cases, weight loading region of calcar pedis in 5 cases. There were 13 cases chronic osteomyelitis in tibia or calcaneal bone, 8 cases of raw surface was infected, 3 cases of bone exposure.The sizes of the flap ranged from 6 cm×4 cm to 15 cm×12 cm. Results Thirty-one flaps survived except 3 cases which had partial necrosis. They were followed up from 6 months to 12 months. Both the quality and the appearance of the flaps were satisfactory. The blood supply and function of cnemis, ankle and foot returned to normal. Conclusion It is a convenient, simple and reliable method to repair softtissue defects in cnemis, ankle and foot with calf and sural distal fasciocutaneous flaps,without sacrifice of major arteries and with high survival rate and beautiful outlook form of skin flaps.
Objective To investigate the operative techniques and cl inical results of the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery in repairing donor site defect of forefoot. Methods From March 2005 to October 2007, 15 patients (11 males and 4 females, aged 20-45 years with an average of 33.6 years) with finger defects resulting from either machine crush (12 cases) or car accidents (3 cases) were treated, including 12 cases of thumb defect, 2 of II-V finger defect and 1 of all fingers defect. Among them, 6 cases were reconstructed with immediate toe-to-hand free transplantation after injury, and 9 cases were reconstructed at 3-5 months after injury. The donor site soft tissue defects of forefoot were 6 cm × 4 cm-12 cm × 6 cm in size, and the superficial peroneal neruofasciocutaneousflaps ranging from 10 cm × 4 cm to 14 cm × 6 cm were adopted to repair the donor site defects after taking the escending branch of the distal perforating branch of peroneal artery as flap rotation axis. The donor sites in all cases were covered with intermediate spl it thickness skin grafts. Results All flaps survived and all wounds healed by first intention. All reconstructed fingers survived completely except one index finger, which suffered from necrosis. Over the 6-18 months follow-up period (mean 11 months), the texture and appearance of all the flaps were good, with two-point discriminations ranging from 10-13 mm, and all patients had satisfactory recovery of foot function. No obvious discomfort and neuroma were observed in the skin-graft donor sites. The feel ing of all the reconstructed fingers recovered to a certain degree, so did the grabbing function. Conclusion Due to its rel iable blood supply, no sacrifice of vascular trunks, favorable texture and thickness and simple operative procedure, the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery is effective to repair the donor site defect in forefoot caused by finger reconstruction with free toe-to-hand transplantation.
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.
ObjectiveTo investigate the effectiveness of using radial mid-forearm perforator fasciocutaneous flap to repair soft tissue defect in lower segment of the forearm and the wrist. MethodsBetween May 2007 and July 2012, 7 cases of soft tissue defect of lower segment of the forearm and the wrist were repaired with radial mid-forearm perforator fasciocutaneous flap. There were 6 males and 1 female with an average age of 38 years (range, 22-45 years). Defects were caused by crushing injury in 4 cases with the disease duration of 3-22 days (mean, 14 days), by internal fixation of ulnar comminuted fracture in 2 cases after 16 and 20 days of operation respectively, and by focal cleaning of wrist joint tuberculosis in 1 cases after 24 days of operation. The locations of defect were the lower segment of the forearm in 5 cases and the dorsal side of the wrist in 2 cases. The area of soft tissue defect ranged from 4 cm×3 cm to 9 cm×5 cm. The size of flap ranged from 6 cm×4 cm to 12 cm×6 cm. The donor site was closed with direct suturing or skin grafting. ResultsThe intraoperative blood loss was 50-90 mL (mean, 64 mL); the operation time was 60-80 minutes (mean, 72 minutes). Six flaps survived with wound heal ing by first intention; partial flap necrosis occurred in 1 case, and delayed healing was obtained after dressing change. Skin grafting at donor sites survived with healing of incision by first intention. The patients were followed up 3-14 months (mean, 9 months). No ulcer or sinus tract was observed; all flaps showed a sl ightly swollen appearance and had normal color. ConclusionRadial mid-forearm perforator fasciocutaneous flap does not need to dissect the source of blood vessels due to constantly anatomical structure. It has the advantages of easy operation, rich blood supply, high survival rate, and satisfactory cl inical effect, so it is an important supplement of the other non-main vessel pedicle flaps to repair soft tissue defect in the lower segment of the forearm and the wrist.