Objective To explore the effect of transferring adjacent non-main vessel pedicle flap on repairing the heel skin defect. Methods From February 2000 to April 2004, 4 kinds of flaps with non-main vessel pedicle were used to repair 30 cases of heel skin defect. Of the 30 patients, 19 were male and 11 were female, whose ages ranged from 8 to 65. Among them, 19 cases were crush injury, 5 cases were press injury, 3 cases were electric saw injury, 2 cases were osteomyelitis, and 1 case was squamous cell carcinoma. Fourteen cases were with defect area ranged from 6.0 cm×5.5 cm to 16.5 cm×11.0 cm. All the 14 cases were repaired with distant pedicled sural vascular flap of nutrient vessels and saphenous vascular flap of nutrient vessels.The sizes of the dissected flap ranged from 6.0 cm×5.0 cm to 18.0 cm×12.0 cm. And the other 16 cases with defect area ranged from 2.5 cm×2.0 cm to 5.5 cm×4.5 cm were repaired with foot lateral flap and foot base medial flap.The sizes of the dissected flap ranged from 4.0 cm×3.0 cm to 8.0 cm×7.0 cm. Results All cases were followed up for 6 to 12 months. The flaps all survived with satisfactory appearance and no ulceration. Callus appeared in 2 cases.The sense of pain and touch was partly or completely restored. The two-point discrimination sense recovered to 1.0-3.2 cm. Conclusion As it is easilyaccessible, highly flexible and causes little damage to blood circulation, transferring adjacent non-main vessel pedicle flap is effective in repairing foot heel skin defect.
ObjectiveTo investigate the effectiveness of anterolateral femoral flap in combination with fascia lata grafting in repair of large Achilles tendon and skin defects.MethodsThe clinical data of 18 patients with large Achilles tendon and skin defects repaired with anterolateral femoral flap in combination with fascia lata grafting between January 2018 and January 2019 were retrospectively reviewed. There were 14 males and 4 females; age ranged from 32 to 57 years (mean, 42.1 years). There were 9 cases of postoperative infection of Achilles tendon rupture, 1 case of traffic accident injury, and 8 cases of combined infection of skin and Achilles tendon defects after heel trauma. The length of Achilles tendon defect was 4-8 cm, with an average of 5.6 cm; the range of the skin defect was 14 cm×3 cm to 20 cm×5 cm. Flap survival was observed, and ankle function recovery was evaluated according to McComis functional assessment criteria, and dorsal extension and plantar flexion mobility of the affected limb were measured at last follow-up and compared with those of the healthy side.ResultsEighteen cases were followed up 8-24 months, with an average of 16.7 months. All the flaps survived after operation, the flaps were soft and elastic, and the incisions healed by first intention. At last follow-up, 15 cases were excellent, 2 cases were good, and 1 case was acceptable according to McComis functional evaluation criteria, with an excellent and good rate of 94.4%. The two-point discrimination of the heel posterior region of the affected foot was 4-7 mm, with an average of 5.32 mm. The heel-raise test was negative. The dorsiflexion range of the affected side was (21.55±1.26)°, which was significantly different from that of the healthy side (25.23±1.45)° (t=8.128, P=0.000); the plantar flexion of the affected side was (44.17±1.52)°, which was not significantly different from that of the healthy side (46.13±1.31)° (t=0.444, P=0.660).ConclusionThe application of anterolateral femoral flap in combination with fascia lata grafting for the repair of large Achilles tendon and skin defects can achieve good effectiveness.
The traditional Kutler and Atasoy V-Y advancement flaps have minimal advancement degree, did not satisfy to repair large skin defect in fingers, hence, have no wide indications. The sensory function of the fingers to be influenced because of injury of sensory nerves and sear formation. Since 1985 to 1991, the V-Y advancement flaps pedicled by bilateral digital arteries and nerves have been used for reconstruction of 33 finger tip defect and 5 digital volar skin contraction. All of these cases obtained satisfactory function and excellent appearance.In this paper, the anatomical charactistics and principles of devicerecommended, the advantages and key points to success discussed.
ObjectiveTo investigate the effectiveness of modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries in repairing large skin defect of the hand. Methods Between September 2017 and March 2021, 15 cases of large skin defect of the hand were treated. There were 11 males and 4 females with an average age of 42 years (range, 24-66 years). The injury causes included machine twist injury in 6 cases, pound injury in 5 cases, and crush injury in 4 cases. The injured parts included 6 cases of finger skin defect and 9 cases of distal skin defect of palm and dorsum of hand, all of which had tendon, joint, and bone exposure. The interval from injury to operation ranged from 2 to 6 hours (mean, 4 hours). The defect sizes after thorough debridement ranged from 3.5 cm×3.0 cm to 8.0 cm×4.5 cm. The modified dorsal metacarpal artery reverse island flap with a range of 3.8 cm×3.3 cm to 9.0 cm×5.0 cm was used to repair the defect, and the flap donor site was repaired with full-thickness skin graft. ResultsAll the flaps survived successfully after operation, and the wounds in the recipient site and the skin grafts in the donor site healed by first intention. All patients were followed up 9-24 months, with an average of 14 months. The appearance of the flap was good, and its texture and color were similar to those of the surrounding normal tissue. There was no obvious scar contracture, depression, and pigmentation in the donor site. At last follow-up, the static two-point discrimination of the flap was 8-20 mm, with an average of 13.6 mm. According to the Michigan Hand Outcome Questionnaire, 5 patients were very satisfied with the appearance of the flap, and 10 patients were satisfied. Conclusion The modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries has reliable blood supply, larger harvested area, simple procedure, and minimal donor site damage, which is suitable for emergency repair of large skin defect of the hand.
Objective To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds. Methods Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured. Results Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up. Conclusion The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.
Objective To investigate the therapeutic effect of V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery for skin defect at the same dorsal finger. Methods Between January 2008 and February 2010, 15 cases of skin defect at the same dorsal finger were treated. There were 9 males and 6 females, aged 15-72 years (mean, 43 years). Defect was caused by saw machine in 6 cases, machines crush in 7 cases, and cutting nodule in 2 cases. The locationswere distal dorsal finger in 2 cases, middle dorsal finger in 6 cases, and proximal dorsal finger in 7 cases. All cases compl icated by exposure of tendon and bone. The size of defect ranged from 0.8 cm × 0.5 cm to 1.4 cm × 1.0 cm. The interval between injury and operation was 3-8 hours. All fingers were treated by V-Y advancement flap from the dorsal cutaneous branch of digital artery, which size was 1.2 cm × 0.8 cm-2.5 cm × 1.0 cm, and the donor site was directly sutured. Fracture reductionand Kirschner wire for internal fixation were performed in the patients with fracture; extensor tendon was repaired with 4-0 thread in the patients with tendon injury. Results All flaps survived completely. The incisions of donor and recipient sites healed by first intention. Ten cases were followed up 6 months to 2 years after operation. The flaps had good texture, color, and appearance; 2-point discrimination of the V-Y flap was 10-12 mm. X-ray examination showed that all finger fractures healedsuccessfully in 5 cases, with an average bone union time of 6 weeks (range, 5-8 weeks). According to the criteria for function assessment by total active motion, the results were excellent in 8 cases, good in 1, and fair in 1 with an excellent and good rate of 90%. Conclusion It is an ideal method to treat skin defect at the same dorsal finger with V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery.
ObjectiveTo investigate the effectiveness of radial-lateral forearm free perforator flap on repairing of soft tissue defects in the finger.MethodsBetween January 2017 and May 2018, 26 cases of finger skin defects were treated with radial-lateral forearm free perforator flap based on the radial branch of the posterior interosseus artery. There were 21 males and 5 females, with an average age of 26.6 years (range, 19-56 years). The cause of injury included the cutting injury in 16 cases and crush injury in 10 cases. The interval between injury and admission was 30 minutes to 4 hours (mean, 1.5 hours). The injury located at thumb in 6 cases, index finger in 8 cases, middle finger in 6 cases, ring finger in 3 cases, and little finger in 3 cases; and at the dorsum of finger in 6 cases, the lateral side in 6 cases, and the palm in 14 cases. All wounds were accompanied with the tendon and bone exposures, and phalangeal fractures occurred in 10 cases. The size of the defects ranged from 2.0 cm×1.0 cm to 4.0 cm×2.5 cm. And the size of the flap ranged from 2.5 cm×1.5 cm to 4.5 cm×3.0 cm. All wounds at donor sites were sutured directly.ResultsAll the 26 cases were followed up 4-12 months (mean, 7 months). The 24 flaps survived uneventfully after operation, and the wounds healed by first intention. Partial necrosis occurred at the distal part in 2 flaps, and secondary healing achieved after debridement and dressing. All incisions at donor sites healed by first intention. The appearance and texture of all flaps were satisfactory. The two-point discrimination of the flaps was 5-10 mm (mean, 8 mm) at 4 months after operation. Sensory of the flaps was grade S3. Only linear scar was noted at the donor site.ConclusionThe radial-lateral forearm free perforator flap in repairing of the soft tissues in finger can shorten the disease duration, reduce the damage of the donor site, and improve the patients’ quality of life.
ObjectiveTo explore the effectiveness of modified rhomboid flap for repairing facial skin and soft tissue defect.MethodsBetween January 2016 and May 2018, 23 patients with facial skin and soft defect were repaired by the modified rhomboid flap. There were 10 males and 13 females with the median age of 27 years (range, 11-72 years). The primary tumor included pigmented nevus in 18 cases, basal cell carcinoma in 4 cases, and squamous cell carcinoma in 1 case. The defect location was nose in 8 cases, cheek in 4 cases, malar in 6 cases, forehead in 2 cases, and upper lip in 3 cases. The defect ranged from 0.8 cm×0.8 cm to 3.9 cm×3.9 cm. According to the location and size of facial tumors, the resection area of square lesions was designed. According to the mobility of surrounding tissues and the direction of dermatoglyphic lines, the rhomboid flaps with an angle of 45–60° was designed to repair the defect by tension-free rotation.ResultsAll the flaps survived and the incision healed by first intension. All patients were followed up 3-15 months (mean, 7.3 months). During follow-up, no tumor reoccurred; the color and texture of the flaps were similar with surrounding tissue. There was no obvious scar hyperplasia, nor traction of adjacent normal tissues, and patients were satisfied with the appearance.ConclusionThe application of modified rhomboid flaps in repairing facial skin and soft tissue defects caused by resection of round facial tumor has the advantages of flexible design, simple manipulation, and less trauma.
Objective To investigate the method and clinical effect of free iliac flap grafting in repairing the tibia traumatic osteomyelitis complicated withboneskin defect. Methods From June 2001 to February 2006，28 patients with tibia traumatic osteomyelitis complicated with boneskin defect were treated with free iliac flap grafting at stageⅠ. There were 18 males and 10 females, with an average of 32.5 years(1868 years). There were traffic injury in 11 cases, bruise in 6 cases, explosive injury in 5 cases, machinery injury in 4 cases, and falling injury in 2 cases. The disease courses of patients were 1-6 months. All patients had been treated by 26 operations. The wounds located at the mid and upper tibia in 13 cases, and the inferior tibia in 15 cases. The length of free iliac was0.5-6.0 cm and the size of the flap ranged from 4.5 cm×3.5 cm to 28.0 cm×16.0 cm.The external fixation were applied in 18 cases, and steel plate were applied in 10 cases. The donor sites were sutured directly. Results All of the flaps survived completely. The wounds healed by first intention in 26 cases and by second intention in 2 cases. The donorsites healed by first intention. Twentyeight patients were followed up for 6 to 56 months(mean, 30 months).The appearances of the flaps were satisfactory and the colour was similar to recipient site. All grafted bone united 2-14 months (mean，4.6 months) after operation according to X-ray examination. In 20 patients who did not achieved union before operation, fracture healed 2 to 6 months after operation(mean, 3.2 months). Osteomyelitis recurred 12 months after operation in 2 cases and healed by nidus clearing. Conclusion Free iliac flap which used to repair tibia traumatic osteomyelitis complicated with boneskin defect, can repair the defect at stageⅠand enhance the antiinfectious ability. It isone of appropriate and effective clinical methods.
Objective To investigate the feasibility of human amniotic membrane-living skin equivalent (AM-LSE) in repairing the skin defect. Methods A 5-year-old boy with giant nevus at neck, shoulder, and back was admitted in July 2016. Normal skin tissue of the patient was harvested and keratinocytes and dermal fibroblasts were separated and expanded in vitro. Human AM was donated from a normal delivery and de-epithelialized for constructing an LSE as a matrix. Keratinocytes were seeded on the epithelial side of the AM which was previously seeded with fibroblasts on the stromal side and then the complex was lifted for air-liquid surface cultivation for 10 days and observed under naked eyes and sampled for histological study. The nevus was excised to deep fascia and the skin defect in size of 20 cm×15 cm was covered with artificial skin of collagen sponge for 2 weeks to enhance granulation tissue formation, and then the AM-LSE grafts of stamp size were grafted on. The dressing was changed until the wound healed. Results After 10 days of air-liquid surface cultivation, the AM-LSE developed a multilayered and differentiated epidermis with the fibroblasts-populated amnion as the dermal matrix. The LSE stamps survived and expanded to cover the whole wound. The grafted area showed normal skin color and soft contexture at 6 months after operation, and histological study showed well developed epidermis with compactly aligned basal cells, stratified and well differentiated squamous, granular layers and stratum corneum and well vascularized dermal compartment without inflammatory cells infiltration. Conclusion The cultivated AM-LSE with autologous cells can repair skin defect and survive for a long term without rejection.