Free peroneal perforator-based sural neurofasciocutaneous flaps for reconstruction of hand and forearm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap.</p><p><b>METHODS</b>Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm x 7 cm to 24 cm x 10 cm in size in hand and forearm after injured by motor vehicle accidents (2 cases) or crushed by machine (8 cases). Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve 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 vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial (or ulnar) artery and the peroneal veins to one of the radial (or ulnar) veins and the cephalic vein respectively. The flap sizes ranged from 18 cm x 8 cm to 25 cm x 12 cm. The donor areas were closed by skin grafts.</p><p><b>RESULTS</b>All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months' follow-up.</p><p><b>CONCLUSIONS</b>Peroneal perforator-based sural neurofasciocutaneous flap has favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation, and minimal influence on the donor site. The free transplantation of this flap offers a satisfactory alternative for repairing the large soft tissue defects of forearm and hand.</p>

Study on antithrombogenicity and surface heparinization of small intestinal submucosa / 中华创伤骨科杂志

Objective To study surface heparinization of small intestinal submucosa(SIS)and an- tithrombegenicity of beparinized SIS films with plasma initiation technique for the engineering vascular scaffolds. Methods The SIS films were grafted with heparin by hypothermia plasma initiation technique.The blood com- patibility of the modified SIS films was assessed by observing blood coagulation time in vitro and the long term pa- tency of hepafinized SIS vascular scaffolds directly under the circulation of blood.Results The hypothermia plasma initiation method could attach heparin onto the SIS surface,The water contact angle of SIS films modified with heparin was decreased while the surface free energy and hydrophilicity increased.The prothrombin time(PT),ac- tivated partial thromboplastin time(APTT)and thrombin clotting Time(TT)of the SIS films modified with heparin were prolonged obviously.Small caliber engineering vascular scaffold made of heparinized SIS films kept the patency for six weeks.Conclusion Heparin can be attached to SIS films by hypothermia plasma initiation technique.The modified surfaces provide good and persistent antithrombogenicity,and possess potent blood compatibility,