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Objective:To investigate the clinical effect of free deep femoral artery third perforating flap repaired soft tissue loss after Pilon fracture surgery in I stage.Methods:Fifteen patients were treated from April, 2013 to January, 2020. Miller AO classification: 8 cases 43-C1, 4 cases 43-C2 and 3 cases 43-C3. All cases were accompanied with severe soft tissue contusion and skin necrosis. After fracture reduction, soft tissue defects, internal fixation exposure and tendon exposure around the wound. Free deep femoral artery third perforating flap (3.5 cm ×15.5 cm to 5.5 cm×12.5 cm) for the repair of soft tissue defects around ankle in the I stage, the blood vessels of the flap were end-to-side anastomosed with vessels of the posterior tibial or anterior tibial. Regular follow-up after surgery.Results:One case of venous crisis occurred, other 14 cases survived, were followed-up from 5 to 18 months, the ankle joint function was good, did not affect the foot shoes, with excellent color and texture, the flap restored protective sensation, and leaving only linear scar, no muscle adhesion.Conclusion:Free deep femoral artery third perforating flap repaired soft tissue loss of surgical incision after fracture operated than significantly reduce the postoperative fracture infection and protect the blood supply around the fracture. It is an effective method of repair.
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Objective@#To explore the feasibility of clinical application of common day surgery in general surgery.@*Methods@#From January 2018 to December 2018, the clinical data of 40 cases of gallbladder stones(LC group), 40 cases of breast lumps(breast lumps group) and 36 cases of mixed hemorrhoids(mixed hemorrhoids group) admitted to the daytime center of the First People's Hospital of Huainan were retrospectively analyzed.The average hospitalization days and expenses were analyzed, and each group was equally divided into control group(traditional surgery) and research group(day surgery). The hospitalization time and hospitalization expenses were compared between the control group and research group.@*Results@#The hospitalization time of the research group in the LC group, breast lumps group and mixed hemorrhoids group was (21.07±6.31)h, (45.60±7.39)h, (21.07±6.31)h, respectively, which were significantly shorter than those of the control group[(106.80±25.20)h, (184.50±25.00)h, (236.00±54.14)h], the differences were statistically significant(t=15.093, 14.898, -15.645, all P<0.05). The hospitalization expenses of the research group in the LC group, breast lumps group and mixed hemorrhoids group were (2 083.01±436.04)CNY, (8 842.46±861.15)CNY, (3 186.47±464.93)CNY, respectively, which were also significantly lower than those of the control group[(3 594.82±1 059.60)CNY, (11 003.76±1 706.78)CNY, (6 419.69±817.45)CNY], the differences were statistically significant(t=5.245, 6.666, -16.082, all P<0.05).@*Conclusion@#Day surgery has obvious advantages and development space in clinical practice of common surgery in general surgery.It has incomparable effect and is superior to traditional surgery.
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Objective To explore the feasibility of clinical application of common day surgery in general surgery.Methods From January 2018 to December 2018,the clinical data of 40 cases of gallbladder stones (LC group),40 cases of breast lumps(breast lumps group) and 36 cases of mixed hemorrhoids(mixed hemorrhoids group) admitted to the daytime center of the First People's Hospital of Huainan were retrospectively analyzed.The average hospitalization days and expenses were analyzed,and each group was equally divided into control group (traditional surgery) and research group(day surgery).The hospitalization time and hospitalization expenses were compared between the control group and research group.Results The hospitalization time of the research group in the LC group,breast lumps group and mixed hemorrhoids group was (21.07 ± 6.31) h,(45.60 ± 7.39) h,(21.07 ±6.31) h,respectively,which were significantly shorter than those of the control group [(106.80 ± 25.20) h,(184.50 ± 25.00) h,(236.00 ± 54.14) h],the differences were statistically significant (t =15.093,14.898,-15.645,all P ＜ 0.05).The hospitalization expenses of the research group in the LC group,breast lumps group and mixed hemorrhoids group were (2 083.01 ± 436.04) CNY,(8 842.46 ± 861.15) CNY,(3 186.47 ± 464.93) CNY,respectively,which were also significantly lower than those of the control group [(3 594.82 ± 1 059.60) CNY,(11 003.76 ± 1 706.78) C NY,(6 419.69 ± 817.45) CNY],the differences were statistically significant (t =5.245,6.666,-16.082,all P ＜ 0.05).Conclusion Day surgery has obvious advantages and development space in clinical practice of common surgery in general surgery.It has incomparable effect and is superior to traditional surgery.
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Objective To provide anatomic evidence for the application of the lateral thigh perforator flap.Methods Dissected five fresh Chinese adult lower limbs specimens which were injected with red latex via arterial cannula.On the lateral area of middle and distal thigh,obseved the number,distribution,course,category,length of pedicle and external diameter of the flaps' perforators on specimens.Results On the lateral area of middle and distal thigh 19 perforator arteris were observed in these specimens,averagely there were (3.8 ± 1.3) cutaneous perforators in each flap.Perforators mainly origined from the third perforator artery of profunda femoris,secondly from the second,fourth perforator artery and superior lateral genicular artery.Cutaneous perforators of the third perforator artery of profunda femoris pierced the flap on (13.8 ± 1.5) cm proximal of the fibulae capitulum,while the cutaneous perforators of superior lateral genicular artery on (8.6 ± 1.3) cm proximal of the fibulae capitulum.Averagely internal diameter of cutaneous perforators was (0.7 ± 0.2) mm at the point where the perforators pierced deep fascia.The diameter of the profunda femoris was (1.9 ± 0.2) mm,and the pedicle length was (12.2 ± 0.6)cm.The diameter of superior lateral genicular artery was (1.5 ± 0.2)mm,and the pedicle length was (6.8 ± 1.1) cm.There were inosculated branch in these perforators which came from profunda femoris and superior lateral genicular artery.Conclusion The anatomic characteristic allowed this flap would likely be clinically useful in repairing soft tissue defects in extremity limbs as a free or pedicled flap,which the cutaneous perforators invariably appeared on the skin of lateral areat of middle and distal thigh ; the flap could obtain enough length of the pedicle from its origination ; the vessel has large caliber supporting a substantial cutaneous territory.
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ObjectiveTo probe the feasibility and therapeutic effect of the lateral thigh perforator flap for repairing soft tissue defects in extremity limbs.MethodsDissected six fresh Chinese adult lower limbs specimens which were injected with red latex via arterial cannula. Obseved the number, distribution,course, category of the flaps'perforators and measured their length of pedicle, external diameter on the specimens.Combinafing the results of the anatomy study,thirteen lateral thigh perforator flaps,whose size were 3.0 cm × 3.0 cm - 19.0 cm× 8.0 cm, were applyied to repair different defect, in which 1 was pedieled flap and 12 were free flaps.Two of them applied vessel anastomosis in series with anterlateral thigh perforator flap. The axis was from the fibulae capitulum to greater trochanter of femur.ResultsAll 13 flaps surived com-pletely.In 3-6 months follow-up,all flaps were with thin and good appearance,and they were characterized by soft texture and good colour.No chimatlon and ulcer appeared in any flap.There were no effect of motor function in donor site because of muscle conglutination and scar contracture. There were plainness figure in donor site where skin- grafing was used, and only linearity scar remained where sewed directly.ConclusionThe lateral thigh flap had provided with thin and pleasing appearance, soft texture and minor morbidity in donor site and correspondingly easy dissection. It was feasiblely to repair middling to little skin and soft tissue defect in extremity limbs as a free flap, and to repair skin and soft tissue defect in knee and popliteal space as a pedicel flap.It could apply vessel anastomosis in series with anterlateral thigh perforator flap for repairing large defect.
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Objective To investigate the effect of repairing soft tissue defects in the middle and distal phalanx with the reverse dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery. Methods Twenty-five fingers with soft tissue defects in the middle and distal phalanx were repaired by the reverse dorsal metacarpal and digital fasciocutaneous flaps based on the dorsal cutaneous branches of the proper digital artery from June 2007 to June 2009. Their pivot points were located at the midpoint or distal segment of proximal phalanx. Results Among 25 flaps, 24 survived completely, but cuticular layer in the distal part of one flap was partially necrotic. Twenty flaps were followed up from 12 to 18 months after operation. All flaps were characterized by rich blood supply, cold-resistance, suitable thickness, soft texture and good colour, except that 6 flaps required a secondary operation because of their fat and clumsy pedicel. There was no adhesion of extensor tendon and contraction of interdigital web in the donor sites. Two-point discriminations of anastomosing cutaneous nerve ranged from 6 mm to 10 mm in 5 of the 20 flaps, and 8 mm to 14 mm in the other 15 flaps. Conclusion The dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery is an ideal option for repairing soft tissue defects of middle and distal phalanx because of its advantages of easy and secure dissection, reliable blood supply, longer arch of rotation, being closer to the raw surface of finger, less injury to the donor site, good appearance, avoidance of sacrificing major arteries ,and high probability of reconstructing flap sensation by anastomosing cutaneous nerve.