ABSTRACT
Objective To investigate the method and clinical outcome of partial nail carried by great toe fibular flap for repairing the defect of fingertip soft tissue and nail bed.Methods From June,2016 to October,2017,12 cases suffered the defect of fingertip soft tissue and nail bed.The injury fingers included 5 index fingers,6 mindle fingers and 1 ring finger.All cases were complicated with nail bed defect of different degrees.The nail matrix was intact.The area of fingertip defect ranged from 1.0 cm×1.0 cm to 1.5 cm×2.5 cm.The area of nail bed defect ranged from 0.2 cm×0.8 cm to 0.5 cm×1.5 cm.Great toe fibular flap combine with partial nail was harvested.Donor site was directly sutured or skin grafting according to the size.The regular preoperative followed-up was performed.Results All flaps survived with donor sites healing good.The average followed-up time was 7 (ranging from 2 to 10) months,and cosmetically acceptable results were achieved for all patients.The mean static 2-PD in the flaps was 7.5 (range,6.0 to 8.0) mm.No obvious deformity of the great toe nail.Conclusion Findings proved that using partial nail carried by great toe fibular flap is a beneficial microsurgical alternative for reconstructing defect of fingertip soft tissue and nail bed.
ABSTRACT
Objective To investigate the design of the postoperatively marker system based on the perforator flap and its clinical application.Methods According to the basic anatomy and blood supply characteristics of perforator flap,the observation points were marked on the flap surface and recipient area postoperatively,and judge flap blood flow changes with hand-held Doppler(HHD) and clock-face measurement based on perforators.From November,2015 to November,2017,prospectively conducted a control study evaluating the incidence of vascular crisis,accuracy rate,reoperation rate and survival rate of flaps between simple traditional flap monitoring group (n=100) and traditional flap monitoring combine with postoperatively marker system monitoring group (n=100).Results Vascular crisis was mostly concentrated with in 48 h postoperative in traditional flap monitoring group and combined group.There was no significant difference in the incidence,positive rate and negative rate of vascular crisis in the two groups (P＞0.05).The reoperation rate in the traditional flap monitoring group (87.5％) was higher than the combined group (27.8％)(P＜0.01).The survival rate of flap of combined group (99％) was higher than the traditional falp monitoring group (90％) (P＜0.05).Conclusion The postoperatively marker system of perforator flap can effectively guide the medical staff to observe the blood supply of the flap,detect and judge the vascular crisis in time,and It is simple and easy to do without increasing the patient's trauma and medical expenses as well as no additional equipments.
ABSTRACT
Objective To explore the clinical effect of combination of vascularized fibular head epiphysis and peroneal neurovascular reverse flap repair defects of bone and skin in lateral malleolus in children.Methods Eight children with defects of bone and skin in lateral malleolus were recruited from May,2009 to September,2014.The age of children was ranging from 4 to 12 years old.Four children were injured by wheel twist,2 children were injured by traffic accident,1 was injured by machinery,and 1 was crashed with heavy object.The size of soft-tissue defect was ranging from 3 cm × 5 cm to 7 cm × 9 cm.The flap and bone healing along with ankle joint function scoring were evaluated.Patients were reviewed every 4 to 6 weeks during one year after their surgery,and they were reviewed every 6 months one year later.Results Secondary repair were conducted in all children.The curative effect got well after follow up for 6 months to 2 years(mean,12 months).The flap and fibular head epiphysis were well developed.The ossification of fibular head epiphysis did not found.According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle function evaluation criteria,the results were excellent in 5 cases,good in 2 cases and poor in 1 at 10 months after operation.The shape and function of ankle joint were good,with one exception.The average motion degree of ankle joint was (68±5.12)°.Conclusion Combination of vascularized fibular head epiphysis and peroneal neurovascular reverse flap repair defects of bone and skin in lateral malleolus in children is effective.