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Objective:To investigate the removal of ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery and its application in wound repair.Methods:From January, 2019 to March, 2021, 32 cases of limb wounds were repaired with ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery, including 25 males and 7 females. The age ranged from 21 to 63 years, with an average of 34 years. Injury mechanism: there were 12 cases of traffic accident injury, 8 cases of machine injury, 6 cases of heavy object crushing injury and 6 cases of chronic infectious wound. The area of soft tissue defect was 8.2 cm × 6.3 cm-18.6 cm × 11.2 cm. There were 25 cases of direct suture and 7 cases of free skin grafting. All patients who needed flap repair underwent CTA and high-frequency CDU before operation to judge the approximate direction of the lateral branch of the descending branch of the lateral femoral circumflex artery and the position of the perforating branch. All patients were followed-up regularly for 3 - 13 months, with an average of 11 months.Results:All patients who underwent free flap surgery had no vascular crisis and the flap survived smoothly. At the last follow-up, the appearance of the flap was beautiful without bloating and there were no complications in the donor area.Conclusion:Compared with the traditional ALTPF, the perforator flap of the lateral branch of the descending branch of the anterolateral femoral artery is relatively simple, which can replace the traditional ALTPF to a certain extent, and is worthy of popularization and application in clinic.
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Objective:To investigate the short-term clinical effect of using fibular flap with preserving the continuity of fibula in hip preservation surgery for femoral head necrosis.Methods:From September, 2017 to November, 2020, 13 cases of femoral head necrosis were repaired with fibular flap. The fibular flaps were cut with an improved method for preserving the continuity of the fibular cortex, and the donor sites were sutured directly. The fibuls were inserted into the femoral heads with single or double segment folding support. Autogenous iliac crest combined with platelet-rich plasma(PRP) was used for impaction of bone grafting in femoral head, and the fibular flaps were anastomosed with 1 artery and 2 veins. All follow-up data were obtained, including bone union by X-ray and CT as well as the functional recovery of the hip joint and donor site. Statistical analysis was performed. P<0.05 was considered statistically significant. Results:The followed-up time ranged from 6 to 23 months. The fibular bones were significantly thicker and the incisions healed well at the donor sites. There was neither abnormal sensation in toes, dorsal foot, and lateral of the leg, nor significant influence on foot function. The hip joint activities were normal. The outcome was proved to be remarkable according to the Harris score(from 58.9±10.6 points before surgery to 81.7±10.6 points after surgery), the difference was statistically significant ( P<0.05) . Conclusion:The method of the improved fibular flap in hip preservation surgery is beneficial to the repair and reconstruction of the necrotic femoral head since the donor area is less traumatic, and a satisfactory clinical effect can be obtained.
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Objective:To explore the application of the superficial iliac perforator flap (SCIP) based on the concept of "Donor site under swimming wear" in the repair of wounds of extremities.Methods:From June, 2018 to March, 2019, a total of 20 patients with traumatic soft tissue defects of the extremities were treated. All defects were repaired with free SCIP, including 16 males and 4 females. Location of defects: 10 in the hand, 4 in the forearm, 4 in the shank, and 2 in the foot. Wound areas were 7.3 cm×5.6 cm-16.3 cm×7.7 cm. Patients received routine CTA and high-frequency CDU examinations before surgery to assist in identifying the location of the perforating vessels and the running of the superficial and deep branches of the superficial iliac circumflex artery (SCIA). Combined intraoperative light transmission experiments were used to determine the dominant branch. The superficial branch of SCIA was used as the dominant branch in 18 cases, and the flap was cut in the superficial layer of Scarpa's fascia. The deep branch of SCIA was used as the dominant branch in 2 cases and the flap was cut in the superficial layer of the deep fascia. The donor site was directly sutured. Regular postoperative follow-ups were conducted without lost.Results:All flaps had no vascular crisis after surgery and survived successfully. All patients were followed-up regularly for 8 to 16 months, with an average of 12 months. At the last followed-up, the appearance and texture of the flaps in the recipient area were good, and roughly similar to the healthy tissues around the affected limb. The function of the affected limb recovered well. There was only a linear scar in the donor area.Conclusion:The SCIP based on the concept of "Donor site under swimming wear" is soft in texture, moderate in thickness, and concealed in the supply area. The patient can directly hide the scars of the donor areas after wearing the swimming trunks, which meets the concept of minimizing the damage to the donor area. It deserves to be promoted.
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To report a 4-year-old boy with severed right index finger amputations in 2 segments. There were severe contusion on the 2 amputated sections of finger. According to the prevention and control requirement for the novel coronavirus disease(COVID-19), the patient was firstly checked to exclude the COVID-19. Then the replantation surgery was successfully carried out under the strict protective measures. The replanted index finger survived well at 2 weeks after surgery.
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Objective To investigate a method of repairing complex tissue defects one stage in one finger or several fingers for more fine recipient site repairing and less donor area traum. Methods From August 2007 to August 2010,eight cases of 20 fingers were reconstructed according to the state of complex tissue defects in a hand,second toes (right or left side) were split into two or three parts as complex tissue flaps that may including joints,tendons,skin,nail beds,et al.These flaps then were translated to hand to repair complex tissue defects by anastomosing vessels.Results Twenty fingers in 8 cases were successfully reconstructed.Follow-up ranged from 3 months to 36 months,external appearance were fine.According to the Trial Evaluation Standard of Reconstructed Finger Function of Handsurgery Society of China,sixteen fingers were excellent,three fingers were good,one finger was fine.And there was no effect on foot.Conclusion Spliting single second toe is a good method for repairing more complex tissue defects in a hand.
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Objective To investigate a more pedect method for a nice outward appearance of a reconstructed thumb.Methods A free one-stage plasty second toe transfer for thumb reconstruction by interchanging the whole skin-nail flap from the great toe with another one from the second toe.Results There were 12 cases in this group,following-up 6-9 months in 8 cases,7 cases was excellent and 1 cases was good.The reconstructed thumb got a nice looking and more normal function while no blight to the great toe occurred.Conclusion It is an effective new procedure in ameliorating outward appearance of the reconstructed thumb by transferring the free moulded second toe.