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Objective To explore the value of a set of combined vascular anastomosed flap.Methods The 36 cases were injured,the site of injury in knee and leg or ankle and foot,upper limb.Skin defect with bone and joint,tendon exposure.Selection of anastomosis of blood vessel with large flap,wherein the subscapular vascular anastomosis scapular-lateral thoracic flap in 7 cases,the maximum was 70 cm × 10 cm; anastomosis of subscapular artery lateral thoracic-latissimus dorsi muscle flap in 9 cases,the maximum was 42 cm× 24 cm.Anastomosis of subscapular artery of the scapular-back the latissimus dorsi muscle flap in 2 cases; anastomotic lateral circumflex femoral vessels with lateral femoral cutaneous nerve thigh anterior medial-tensor fascia latae flap in 8 cases; anastomosis of anterior tibial artery and the superficial peroneal nerve in the anterior ankle-dorsal foot flap in 5 cases; anastomosis of dorsal vessels and superficial peroneal nerve of the extensor digitorum brevis muscle-dorsal foot joint flap in 5 cases.Results Following up 8 months to 25 years,twenty-three cases were 19 years.All flaps survived and all the wounds were covered,infection were cured,the skin have aesthesia,fracture healing.Five cases were performed muscle tendon and arthrosis solution for creating conditions for the functional recovery of limb.Conclusion Anastomosis of blood vessel anastomosis combined flap can replace multiple vascular flaps combination,saving,convenient,high success rate,widen the indications.
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Objective To investigate the technique of design and cutting method of the thoraco- um-bilicus flap.Methods (1) Made the skin flap include not only the vascularity skin of this side,but also the opposite side,to repair overlength and overbreadth wound surface.(2) Improvement of skin flap cutting steps:first to find the blood vessel under the lower abdominal wall,then to cut the skin flap,if not find to have another donor area.(3)Technology of making thin skin flap:when cutting open the skin,made the surgical blade inclined to the flap,beveling to 2/3 of the skin flap length and in hypogastrium cutting to all over the flap with the fat keep stay in the abdomen so to make the skin flap thiner.Results There was 1 case necrosis because of infection in all 54 cases be repaired.The achievement ratio was 98.1％.Follow up with 1-5 years,skin flaps appearance was good,joint extend- bend was gratification.Soft tissue infection was cured.Conclusion Modified technology of thoraco-umbilicus flap is reasonable design and easily to cut,and the achievement ratio is higher.
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[Objective] To approach the methods of emergency microsurgery repair and one stage functional restoration in tretment of severe tissue defect of the hand.[Method]Fifteen cases of large skin compounded defects of thumb,'hukou',back of hand and palm were repaired with second toes along with anterior malleolus flap,and extend flap of dorsum of foot.Two hundreds and fifty-two cases of compounded defects of 'hukou',back of hand palm and forearm were repaired with second toes or big nail skin flap along with flap transplantation and thumb reconstruction.Thoracoumbilical flap was used in other 372 cases with bone and muscle defect or the big skin defect of the forearm.The lateral thoracic flap and scapular flap was used in repair of 18 cases of the avulsion of the hand.The lateal thoracic flap covered the raw surface of the back hand,the scapular flap covered the raw surface of the palm,so as to completely wrap up the hand or the hand complic forearm.[Result]Seven cases were found vessel crisis in the free skin flap and tissue flap,they all survived after surgical exploration and reanastomosis of blood vessel.One stage healing was gained in 619 cases,two stage healing was gained in 38 cases.All cases were followed up for 1~15 years.According to the criteria of upper limb of C.M.A hand surgery institute,there were excerllent in 340 cases,good in 228 cases,fair in 65 cases,bad in 24 cases,with the satisfactory rate of 86.5%.[Conclusion]It is an effective method of emergency microsurgery repair and one stage functional restoration in tretment of severe tissue defect of the hand.
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Objective To investigate the usage of cutaneous-muscular flap in the treatment of leg long segmental osteonecrosis.MethodOsteonecrosis models of tibia was made in 48 rabbits and divided randomly into control goup of tibia necrotic bone covered with free skin graft and experimental group with cutaneous-gastrocnemius flap. All of them were examined with ECT, radiograph, osteocalcin measurement and histological observation in 2, 4, 8, 12 weeks postoperatively. Treatment of tibia long segmental necrosis with covering of cutaneous-gastrocnemius flap in 436 patiens were reviewed.ResultAbsorptive radioactivity in arterio-phase and delay-phase of ECT in experimental group were higher than those in control group(P
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Objective To explore the available methods in repairing and restoring the composite tissue defects after trauma of the lower extremities Methods One hundred and sixty four cases were studied in this article,each has a large area of skin defect and soft tissue defect,or combined with other tissue defects such as bone,muscle tendon,blood vessel,while blood supply to the foot of the injuried limb in all the cases was deficiency of bloodless which we called"sever trauma of the lower limb" According to the varied tissue defects and its injuried degree,five operating procedures were designed and introduced Result None of the limbs was severed,a 5～10 year follow up found a good result in 96 3% in all the cases Conclusion The five surgical means mentioned above were satisfied in repairing and restoring varied tissue defects following severe trauma of the lower limbs,and the injuried limbs may be saved
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Objective To investigate the applied value of combined flap that was anastomosed a set of blood vessels. Methods This team includs 26 cases, all cases were injured in traffic accident. The wound parts were knee, calf or ankle. All skin defaults was combined with osseous exposure, chronic inflammation and the wound area was huge. So all cases were terminal repair. After drastically debriding,the wound was repaired through transplanting combined flap that was anastomosed a set of blood vessels. The 6 types flaps were selected. It demonstrates signs of adequate circulation. Its longest was 70 cm, its largest was 42 cm x 42 cm. Results All flaps were alive, the wounds were closed up, the fractures were healed up, the feet or calves were reserved. All above was condition for function reservation. Conclusion THe applying of combined flap that anastomosed a set of blood vessels could substitutes the built-up flaps that was anastomosed a group of blood vessels. The procedure have spent smaller time, and have higher successful ratio. So it would be prone to applying and popularizing in clinical.
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Objective To investigate the effective method of the treatment of the infective, complex defect of skin and bone in crus. Methods On the basis of through anti-infection, the infective surface of wound with bone and skin complex defect was completely debrided. The infective and necrotic skin and bone were moved away, and the wound surface was covered with flaps having abundant circulation. The anti-infection therapy was continued after operation. When the infection healed and the normal skin covered the wound, the bone defect was renovated at the second stage. Result The transplanted flaps all survived and the skin covering the wound remained normal. After the follow-up of four to five years, all the transplanted bones healed completely. No limbs were amputured because of wound infection or the complex defect of bone and skin. Conclusion After the infective surface of wound was completely debrided, the skin defect was renovated with flaps having abundant circulation. On the basis of infection being totally cured, the lone-piece-bone defect was renovated. This method can maintain the limbs and creat conditon for the functional recovery.
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Objective To study the effect of operation on transplanted fibula healing,which repaired long and thick and burnden bone defects by two fibula compound transplanation under periosteum with vascular loop. Methods Seventy-two healthy rabbits were divided randomly into three groups.Group A is the mono-fibular transplanation group;group B,the double fibular transplanation extra-periosteum and group C,the double fibular transplanation under-periosteum.Each group consisted of 24 rabbits.Animal models of 10mm tibial defects were established and three operation patterns were performed.the serum were obtained to determine the level of ALP and BGP bone and mineral density and biomechanic index at 2,4,8,12,16 weeks.4 rabbits of each group were examined roentgenographically and histologically.the condition of the bone healing and contour were observed.The different effects of each operation were compared with such observation index. Results The X-ray showed that the area of the external callus were larger in C groups than that in A,B and eht bone trabecula were in order,the fibula showed significant bone hypertrophy.the serum ALP,BGP and mineral density level were higher in C group than that in A,B.the difference has statistical significance (P
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From October 1985 to April 1989, free flaps using post tibial vessel of the healthy leg as a bridgework were applied to 7 cases of extensive traumatic wounds, including damage of main vessels, exposure of bone and large soft tissue defect, of the lower limbs. Success was obtained in all cases. The operative method, indication, selection of the skin donor area and the key factor of operative success were introduced and discussed in the article.
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Composite transplants of the superficial branch of the radial nerve with radial artery and vein and sural nerve with small saphenous vein or peroneal artery and vein were used in 10 patients with large loss of nerve trunks. The recipients included median nerve in 7 patients, and ulnar nerve in 3. Average loss of nerve trunks was 12.5cm. After the operation, the patients were followed-up for 8 months to 5 years. Regeneration of nerve fibers was estimated to be 1.4mm every day. Functional recovery was satisfactory.
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Objective To study the feasibility of repairing long bone defects with transplantation of vascular pedicled fibala with periosteum. Methods 72 healthy rabbits were divided randomly into three groups. Group A consisted of transplanation of single fibula, group Bwith transplantation of two fibulae without periosteum, and group C with transplanation of two fibulae with periosteum, to repair of a tibial defect of 10mm in length. Seram levels of ALP and BGP were determined, bone and mineral density were assessed by X-ray, and biomechanic index was assayed 2, 4, 8, 12, 16 weeks after the transplantation. At the same time the condition of the bone healing and contour were observed. The 34 patients, operative procedure same as in of group C was performed. Results X-ray showed that the area of external callus was larger in C group compared with groups A,B, and the bone trabeculae appeared orderly. The transplanted fibula showed significant bone hypertrophy. Serum ALP and BGP and mineral density level were higher in group C than those in groups A, B. The difference showed statistical significance (P
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Twenty-one rabbits were randomly divided into three groups: experimental group-filling vein with two neural segments being 0.3cm long to bridge 4cm defect of common peroneal nerve, control group-bridging vein directly to the 4cm defect of common peroneal nerve, auto-nerve-grafting group-cutting off a segment (4cm long) from common peroneal nerve and grafting it inversely.After 25 weeks, morphological, electrophysiological and histological examinations were undertaken, which revealed that the experimental group was most similar to the auto-nerve-grafting group in recovery of motion of the limbs, action potential of muscle, nerve conductive velocity, and regenerating density of nerve fibers and axons. It was a failure in control group. Satisfactory results were also achieved in 2 patients with defect of ulnar nerve treated by filling vein with two neural segments. It suggests that our method is feasible.
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From March 1982 through December 1083, free transplantation of the perichondrium was used to repair the cartilagenous surface of interphalangeal joints in 5 cases of traumatic comminuted fracture. Of these 5 cases, the injury involved proximal interphalangeal joint of index fingers in 2 cases, proximal interphalangeal joint of the middle finger in 2, and carpometacarpal joint of the thumb in 1. The perichondrium was harvested from the 8th or 9th costal synchondrosis.X-ray film showed growth of new smooth cartilage surface, and the movement of the joints ranging from 10 to 30 degrees was observed 3 months after operation. Points to be observed in operation are: (1) About 0.5 cm of the recipient site of the phalange should be bitten away to expose the cancellous bone, thus a surface with better blood supply was created to receive the perichondrial transplant; (2) The recipient surface was reshaped into an articular surface so that no dead space was left between the recipient surface and the graft: (3) The transplanted perichondrium should be anchored onto the bone under certain amount of tension to insure close contact with the bony surface; (4) Immobilization should be enforced for 3 weeks post-operatively.
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From Nov 1980 to Dec 1983, severed distal segments of fingers were successfully replanted by the aid of surgical microscope in 8 children. The age ranged from 31 months to 12 years. 6 fingers were completely amputated and 2 were incompletely amputated. The level of amputation was situated from distal 1/3 of middle phalanx to the distal inlerphalangeal joints. 46 fresh specimens of fingers were dissected under microscope, and regional anatomy of blood vessels and nerves of distal segment of finger were carefully studied and their calibers measured, providing a useful knowledge for replantation. It was emphasized that meticulous and accurate anastomosis of tiny arteries, and veins with diameters ranging from 0.2 to 0.3mm was the key to success o replantation. Indications for digital replantation, careful debridement under operation microscope, and postoperative management were discussed.