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Objective To provide anatomical information and clinical application of periosteal perforator bone-skin flap of proximal lateral tibia. Methods From March, 2015 to March, 2017, 15 fresh cadavers who underwent injected with imaging technology and dissected with layer by layer. The origins, branches, distribution and anastomosis of periosteal perforator vessels in the proximal lateral tibial were observed. Sixteen patients of composite tissue defect in hands and feet were repaired with the method of free transplantation of this flap from March, 2015 to March, 2017. Injured area was from 3.0 cm × 0.8 cm to 6.0 cm × 5.5 cm. Bony defect size was from 1.7 cm × 1.5 cm × 1.0 cm to 5.0 cm × 1.0 cm × 1.0 cm. The bone-skin flap size ranged respectively from 3.0 cm × 0.8 cm to 6.0 cm × 5.5 cm and 1.6 cm ×1.0 cm × 0.8 cm to 5.0 cm×1.0 cm × 1.0 cm. Postoperative followed-up was done termly. Results The diameter and superficial length of the main perforators respectively were 0.5 to 1.2 mm and from 2.5 to 4.3 cm. The followed-up time was from 6 to 24 months in 14 cases, with the results of the bone-skin flaps presented favourable contours and good functions. The healing time of bone flap was 2 to 4 months. The function of shank was normal. Conclusion The periosteal perforator of proximal lateral tibia has favourable appearance, constant vascular pedi-cle, reliable blood supply and large diameter. The free transplantation of this flap offers a satisfactory alternative for repairing the small and medium-sized area of composite tissue defects of hands and feet.
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Objective Through investigating the anatomical features of the perforator from the ulnar palmar digital artery of the little finger and the dorsal descending branch of the ulnar artery,to establish a new approach for the reconstruction of sofi tissue defect of the ulnar palm and the little finger.Methods The fifth caput metacarpale was taken as the observation points on 30 specimens of adult human upper limb perfused with red latex.Something as follows were observed under surgery magnifier:①The origin,external diameter,branches,distribution and the backbone length of the perforator of the ulnar palmar digital artery of the little finger;the distance from the fifth caput metacarpale to the perforate artery ; ② The route and distribution of the dorsal descending branch of the ulnar artery.Mimic operation was performed on another fresh specimen.Results The origin of the ulnar palmar digital artery of the little finger has two different type:93.3％ spring from the external of the arcus volaris superficialis,6.7％ formed by the combination of the third arteriae metacarpeae palmares and the branch from arcus volaris profundus.Although it has two different origins,the perforator has only one piercing point,which located at (1.3 ±0.3)cm upon the fifth caput metacarpale.The perforator,ultimately,combines with the descending branch of the ulnar artery after it pass through the slot between the muscle tendon of hypothenar superficial layer (the flexor digiti minimi brevis and the abductor digiti minimi) and the fifth metacarpale bone.External diameter of the perforator was (0.8 ± 0.4) mm and the backbone length was(2.0 ±0.6)cm.Conclusion The location of the anastomose point between the perforator,which springs from the ulnar palmar digital artery of the little finger,and the dorsal descending branch of the ulnar artery is constant.The perforator flap based on the perforator of ulnar palmar digital artery of the little finger,with sufficient blood supply,can be transferred flexiblely,and can be designed to repaire the defect of soft tissue on the ulnar palm and the little finger.
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Objective To observe the anatomy of the perforator flap of the posterolateral midforearm. Methods Lateral condyle of the humems wag taken as the observation mark on 30 specimens of adult upper limb perfused with red latex.The surgical magnifier Wag used to obse~e the origin,branches and distribution of the perforating branches of the posterolateral midforearm as well as alanagtomosis between perforating branches and peripheral vessels.Mimic operation WaS performed on the two sides of the fresh specimen.Results The perforating branches of the posterolateral midforearm originated from the radial musculoculancous branches of the posterior interosseous artery,the intermuscular branches of the radial artery and the direct periosteal branch of the radial artery had relatively stable location of piercing the deep fascia.Then,the perforating branches of the posterolateral midforearm pagsed through the deep fascia to the subcutaneous part among the spatium intermusculare of extensor digitorum and extensor carpi radialis brevis,supinator and abductor pollicis longus(within 12.5-15.8 cm below the lateral condyle of the humerus).Large number of small blood Vessels were also separated and closely aligned with the musculoculancous branches vascular,perineural and neural stem vascular chain of lateral branches of posterior antebrachial cutaneous nerve.Then,the vascular plexus was formed along the spatium intermusculare and lateral branches of posterior antebrachial cutaneous nerve longitudinal axis between extensor digitorum and extensor carpi radialis brevis. Conclusion The axial pattern flaps or cross-regional blood supply skin flap pedicled with the perforating branches of the posterolateral midforearm Can be formed to repair the soft tissue defect of tlle forearm and wrist.
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Objective To provide anatomical basis for lateral antebrachial neurocutaneous flap pedi-cled with inferior cubital artery perforator in repairing tissue defects around elbow joint. Methods Thirty embalmed upper limbs of adult cadavers perfused with red latex were used for this study, and followings were observed:①The course and distribution of lateral antebrachial cutaneous nerve; ②Anastomoses between inferior cubital artery and nutrient vessels of lateral antebrachial cutaneous nerve. Mimic operation was performed on other side of fresh specimen. Results ①The main trunk of lateral antebrachial cutaneous nerve (LACN) lined in the radial forearm and distributed in the 1/3 region of lateral forearm. ①The nutritional vessels of the flap were plurisegmental and polyphyletic. The inferior cubital artery which was relatively constant reached to skin through "V"-shaped peak formed by communicating branches of cephalic vein and deep venous system. They also gave off large number of small veins, which closely aligned with perineural branches and neural stem vascular chain of lateral antebrachial cutaneous nerve. Conclusion The lateral antebrachial neurocutaneos flap pedicled with inferior cubital artery perforator can be formed to repaire tissue defects around elbow joint.
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Objective To provide anatomical basis for the thigh medial neurocutaneous vascular flap pedicled with descending genicular artery perforators. Methods ① The course and distribution of thigh medial cutaneous nerve. ②Anastomosis between descending genicular artery perforators and thigh medial neurocutaneous vascular, were observed on 40 specimens of adult lower limb perfused with red latex. Mimic operation was performed on one side of fresh specimen. Results ①The line between the midpoint of inguinal ligament and medial femoral condyle can be considered as the projection on body surface of thigh medial cutaneous nerve. ②Perforating branches of descending genicular artery (infrapatellar branch )started from the lower edge of medial femoral condyle about 4 cm, and passed through the deep fascia in which the triangle depression surrounded by the vastus medialis muscle, adductor tendon and the medial femoral condyle to the subcutaneous. They also separated large number of small blood vessels, which closely aligned with the perineural and neural stem vascular chain of thigh medial cutaneous nerve. Then they formated vascular plexus in the upper part of thigh along the thigh medial cutaneous nerve longitudinal axis. Conclusion The thigh medial neurocutaneous vascular flap pedicled with descending genicular artery perforators can be formed to repair soft tissue defect around knee joint.
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@#Objective To provide anatomic basis for sensation restoratiou of distally based island flap pedicled with nutrient vessels of superficial peroneal nerve by use of lateral sural cutaneous nerve. Methods The origin, course and distribution rule of lateral part sensory nerve of leg were dissected and observed in 40 antisepticized adult cadaveric limbs. Results ①Lateral sural cutaneous nerve originated from common peroneal nerve 7cm above apex of fibular head, descended short distance along common peroneal nerve, then passed through pepliteal fascia to facies lateralis cruris,along the way it sent out 1-3 terminal branches, which distributed over the skin of Ⅰ , Ⅱ area in the posterior lateral leg. ②Superficial peroneal nerve originated from common peroneal nerve 1.9cm below apex of fibular head, descended forward between peroneus longus and fibula, then descended between peroneus longus and peroneus brevis, and sent out branches to the two muscles. The nerve bole (pure sensory nerve branch) descended straight between peroneus brevis and anterior cmral intermuscular septum, at the juncture between Ⅱ、Ⅲ area in facies lateralis eruris, passed through deep fascia to subcutaneous tissue, then sent out medial dorsal cutaneous nerve of foot and intermediate dorsal cutaneous nerve of foot, which distributed over the skin of dorsum of foot and Ⅲ area in facies lateralis cmris. Conclusion It may be available in sensation restoration of distally based island flap pedicled with nutrient vessels of superficial peroneal nerve through anastomosis of lateral sural cutaneous nerve bole with sensory nervous ramification of recipient site.
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BACKGROUND: The distally based skin flap pedicled with nutrient vessels of saphenous nerve has provided a method with higher achievement ratio to repair the tissue defect of ankle and foot, due to its high rotation point, lacking of distributive characteristics of distally pedicled vessels description for the specific operations, so it is still difficult in clinical application.OBJECTIVE: To investigate the distal artery perforators of medial leg, so as to suggest an anatomical theory for the reasonable design of the distally based compound flap pedicled with nutrient vessels of saphenous nerve-great saphenous vein.DESIGN: A single sample experiment.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out in the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from May to October, 2004.Thirty-four adult specimens perfused with red emulsion at lateral arteries of upper lower limbs were provided by the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: Specimens of the distal medial legs were dissected with microscope taking the most prominent point of medial malleolus as the pivot point.MAIN OUTCOME MEASURES: ① Distal artery perforators of medial leg; ② Distal nutrient vessels of saphenous nerve-great saphenous vein; ③ Blood supply correlation of nutrient vessel with neighboring muscle, bone and skin.RESULTS: ① The distal artery perforators of medial leg derived from 9 main blood supplying sources were as follows:Intermuscular perforator of posterior tibial artery, superior malleolar branches of anterior tibial artery, osteocutaneous perforators of peroneal artery or posterior tibial artery, medial malleolar branch of medial anterior malleolar artery, tarsal tunnel branch of posterior tibial artery, medial malleolar branch of medial plantar artery, medial malleolar branch of lateral plantar artery, medial malleolar branch of the superficial branch of medial plantar artery and medial maleolar branch of medial tarsal artery. ② The above-mentioned artery perforators sent out cutaneous branches, fascial branches, periosteal branches, nutrient vessels of saphenous nerve and great saphenous vein, thus formed a superior and inferior vascular net of deep fascia, vascular chain of superficial fascia and neurocutaneous superficial vein, and periosteal vascular network. Artery perforators constituted 3 distal longitudinally distributed fascial vascular plexus in medial leg (anterior, middle and posterior), including anterior longitudinally distributed fascial vascular plexus of medial anterior malleolar artery and superior malleolar branch of anterior tibial artery; middle longitudinally distributed fascial vascular plexus of osteocutaneous perforators; posterior longitudinally distributed fascial vascular plexus of malleolar canal artery perforators and intermuscular perforators of posterior tibial arteries.CONCLUSION: The blood supply of distal medial leg, which makes the anatomical basis for distally pedicled compound flaps, has the anatomical characteristics of multiple-sources, longitudinal distribution and homogeneity of nutrient vessels.Three kinds of distally pedicled skin flap supplied by nutrient vessels of saphenous nerve-great saphenous vein can be designed by taking the intermuscular perforator of posterior tibial artery, fascial perforators of medial anterior malleolar artery and artery perforators of tarsal tunnel perforators as pedicle, and the point of rotation is on the plane of medial malleolus, which are suitable for repairing the defects of distal leg, ankle and foot.
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BACKGROUND: Posterior antebrachial skin is beneficial for repairing injury of dorsum of hand; however, according to lacking operative researches on distal pedicel arterial perforators of posterior antebrachial cutaneous nerve nutrient vessel flap, it is still a confusing problem in clinic.OBJECTIVE: To investigate the features of distal antebrachial arterial perforators of dorsal forearm and provide anatomical theories for suitable designing pedicle flap and compound flap at distal flap pedicled with nutrient vessels of posterior antebrachial cutaneous nerve.DESIGN: Single sample observation.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIAL5: The experiment was carried out at the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from May to October, 2004. Thirty-three upper limbs of adult cadavers perfused with red latex through arteries were provided by Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of PLA.METHODS: Thirty-three adults upper limbs were dissected and observed with microscope with taking rhe styloid process of ulna and radius as pivot point.MAIN OUTCOME MEASURES: ① Distal antebrachial arterial perforators of dorsal forearm; ② nutrient vessels of distal posterior antebrachial cutaneous nerve; ③ their blood supply relationship with nearby muscle, bone and skin.RESULTS: ① Along extensor digitorum communis muscle, distal antebrachial arterial perforators of dorsal forearm were perforated along bilateral muscular interspace and tendon interspace to form lateral and interior inosculated vascular plexuses of fascia. The axis of lateral muscle interspace, dorsal antebrachial lateral vascular plexuses consisted of lateral branch of dorsal carpal branch of anterior interosseous artery, radial interosseous cutaneous perforators, radial interosseous cutaneous perforators of posterior interosseous artery, carpal dorsal branch of radial artery and its perforators. The axis of medial muscle interspace, dorsal antebrachial medial vascular plexuses was consisted of medial branch of dorsal carpal branch of anterior interosseous artery, ulnaris interosseous cutaneous perforators, ulnaris interosseous cutaneous perforators of posterior interosseous artery, carpal dorsal branch of ulnaris artery and its perforators. ②Above mentioned arterial perforators sent out cutaneous branches, fascia branches and posterior antebrachial cutaneous nerve nutrient vessel to form vascular chain of cutaneous nerve stem and vascular nets of deep and superficial fascia.Muscle-periosteum branches of posterior interosseous artery had some ulnar periostea whose radial interosseous cutaneous perforators were anastoimosed with periosteum vessels in the middle and inferior segments of radius; therefore,there was an anatomic basis for distal pedicele compound flap.CONCLUSION: Blood supply of distal antebrachial arterial perforators of dorsal forearm is characterized by multiple sources, obviously longitudinal distribution and homologous nutrient vessel; therefore, there are three blood-supplied distal pedicled flap or compound flap of posterior antebrachial cutaneous nerve nutrient vessel. Rotation point of distal pediclde flap can reach wrist joint, and the compound flap can be applied in repairing the injury of distal tissue of hand.
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BACKGROUND: Flap pedicled with nutritional vessels of the lateral antebrachial cutaneous nerve is beneficial for repairing injury of dorsum; however, lacks of system researches of the lateral antebrachial cutaneous nerve compound flap.OBJECTIVE: To study the anatomic theory of the distally based compound flap pedicled with nutrient vessels of the lateral antebrachial cutaneous nerve - cephalic vein.DESIGN: A single sample observation.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out at the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from January to May in 2004.A total of 30 upper limbs of adult cadavers perfused with red latex through arteries were provided by the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: The radial styloid process was taken as the mark for the microanatomical observation of the follows: ① the origins, branches, distribution and anastomosis of nutrient vessels of the inferior 1/3 segment of lateral antebrachial cutaneous nerve-cephalic vein; ② the relationship of nutrient vessels of lateral antebrachial cutaneous nerve-cephalic vein and radius periosteal vessels; ③ the superficial-deep communicating branches of cephalic vein.MAIN OUTCOME MEASURES: ① The origins, branches, distribution and anastomosis of nutrient vessels of the inferior 1/3 segment of lateral antebrachial cutaneous nerve-cephalic vein; ② The relationship of nutrient vessels of lateral antebrachial cutaneous nerve-cephalic vein and radius periosteal vessels.RESULTS: ① The origins of nutrient vessels supplying the inferior 1/3 segment of the lateral antebrachial cutaneous nerve were: 6 to 11 cutaneous branches of radial artery with an outer diameter of (0.7±0.3) mm, 2 to 6 cutaneous branches of superficial palmar branch, with an outer diameter of (0.5±0.3) mm, 1 to 2 cutaneous branches of recurrent branch nourishing the radial styloid process with an outer diameter of (0.8±0.1) mm, 1 to 2 cutaneous branches nourishing tabatiere anatomique with an outer diameter of (0.6±0.2) mm. 8.0 to 15.0 cm superior to the radial styloid process, there were 1 to 3 spatium intermuscular osteocutaneous perforators of radial artery with an outer diameter of (1.1 ±0.2) mm, and periosteal branches distributed in the denudate area of the middle-inferior radial bone with its cutaneous branches (0.8±0.2) mm in diameter. Above perforators gave rise to cutaneous branches, fascia branches,periosteal branches and nutrient vessels of nerve to superficial vein to form a vessel chain of cutaneous nerve-cephalic vein and vascular networks of deep fascia, superficial fascia and periosteum.CONCLUSION: The nutrient vessels of lateral antebrachial cutaneous nerve-cephalic vein and the nutrient vessels of muscle, bone and skin are homologous. The compound flap of lateral antebrachial cutaneous nerve-cephalic vein pedicled with the cutaneous branches of radial artery can be applied to repair the distal tissue defects of the hand by rotating the flap on the plane of wrist joint.
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BACKGROUND: Flap pedicled with nutritional vessels of the cutaneous antebrachial medialis nerve is beneficial for repairing injury of dorsum of hand; but it needs the support from systemic anatomic research on distally based compound flap.OBJECTIVE: To study the anatomic theory of the distally based compound flap pedicled with nutrient vessels of the cutaneous antebrachial medialis nerve -basilic vein.DESIGN: Single sample observation.SETTING: Research Center for Clinical Anatomy, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out at the laboratory for Research Center for Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from March to August 2003. A total of 30 upper limbs of adult cadavers perfused with red latex through arteries were provided by Research Center for Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. Each cadaver was injected with a mixture of red gelatin to show the branches, distributions and anastomosis of the lesser vessels on the stained small arteries of the finger tips.METHODS: All 30 adult upper limbs were dissected and observed under the microscope based on the pivot point of styloid process of ulna: ①The origins, branches, distribution and anastomosis of nutrient vessels of the inferior 1/3 segment of medial antebrachial cutaneous nerve-basilic vein, and whose blood supply relationship with ulnar periosteal vessels. ②The superficial and deep communicating branches of basilic vein.MAIN OUTCOME MEASURES: ①The origins, branches, distribution and anastomosis of nutrient vessels of medial antebrachial cutaneous nerve, and whose blood supply relationship with vicinal bone and skin. ② The superficial and deep communicating branches of basilic vein.RESULTS: ①The origins of nutrient vessels supplying the inferior 1/3 segment of the lateral antebrachial cutaneous nerve were 5-9 cutaneous branches of ulnar artery with an outer diameter of (0.7±0.3)mm. The ascending and descending branches of wrist superior branches sent out several cutaneous branches nourishing basilic vein, with an outer diameter of (0.6±0.3) mm. Between the position of (6.0-16.0) cm superior to ulnar malleolus, anterior interosseous artery sent out 2-3 perforating bone-skin branches, with an outer diameter of (0.7±0.2) mm; Posterior interosseous artery sent out 1-3 bone-skin perforating branches, with an outer diameter of (0.6±0.3) mm. Both of them were distributed on periosteum and skin of the corresponding area. All above-mentioned cutaneous perforators gave off cutaneous branches, fascia branches, periosteal branches and nutrient vascular branches of cutaneous nerve-superficial vein, and a vessel chain of cutaneous nerve-basilic vein and vascular networks of deep fascia, superficial fascia and periosteum formed. ②Ulnar artery had two accompanying veins, one was grossus, and the other thin. The two veins accompanied along two sides of artery, and the accompanying vein of arterial cutaneous branches infused. Superior wrist cutaneous branches of ulnar artery had two accompanying veins. One pumped into ulnar branch of ulnar vein, and the other one passed through deep fascia, then entered subcutaneous tissue, and straightly pumped into basilic vein. The injected position was (2.3±0.8) cm superior to ulnar malleolus, with an outer diameter of (2.8±0.5) mm.CONCLUSION: The nutrient vessels of medial antebrachial cutaneous nerve-basilic vein and the nutrient vessels of bone and skin are homologous. The rotation point of their distally based pedicled flap and compound flap can reach the plane of wrist joint, which can be applied to repair the distal tissue defects of the hand.
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BACKGROUND:Posterior antebrachial skin is beneficial for repairing injury of dorsum,however,the systematic anatomic characteristics of distally based compound flap pedicled with nutrient vessels need to be further studied.OBJECTIVE:To investigate the anatomic characteristics of distally based flap pedicled with nutrient vessels of the posterior antebrachial cutaneous nerve and compound flap.DESIGN:Single sample observation.SETTING:Research Center for Clinical Anatomy,Military Institute of Orthopaedics,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS:The experiment was carried out at the laboratory for Research Center for Clinical Anatomy,Military Institute of Orthopaedics,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from October to December 2004.A total of 30 upper limbs of adult cadavers perfused with red latex through arteries were provided by Research Center for Clinical Anatomy,Military Institute of Orthopaedics,Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.METHODS:All 30 adults upper limbs were dissected and observed under the microscope based on the pivot point of styloid process of ulna and radius.The following microdissection was emphasized:The origins,branches,distribution and anastomosis of nutrient vessels of the posterior antebrachial cutaneous nerve;The blood supply relationship of nutrient vessels of posterior antebrachial cutaneous nerve and vicinal bone and skin.MAIN OUTCOME MEASURES:The ordgins and branches of nutrient vessels of posterior antebrachial cutaneous nerve,and whose blood supply relationship with vicinal bone and skin.RESULTS:The origin of nutrient vessels of posterior antebrachial cutaneous nerve were as follows:Proximal part:2-6cutaneous perforators of radial collateral artery,with an outer diameter of (0.6±0.3) mm;Distal part:3-5 cutaneous perforators of dorsal carpal branch of anterior interosseous artery,with an outer diameter of (0.8±0.2) mm;Others:6-9cutaneous perforators of posterior nterosseous artery,with an outer diameter of (0.7±0.3) mm.Posterior interosseous artery sent out 6-8 muscle- periosteum branches with an outer diameter of (0.3-1.0) mm,which distribute on ulnar periosteum;Radial bone-skin perforators of posterior interosseous artery anastomosed with periosteal vessels of mid-inferior bare area of radial bone.All above mentioned cutaneous perforators gave off cutaneous branches,fascia branches,periosteal branches and nerve-nutrient vascular branches,all of which formed a vascular chain of cutaneous nervous stem and vascular networks of deep fascia,superficial fascia and periosteum.CONCLUSION:The nutrient vessels of posterior antebrachial cutaneous nerve have the same origins as the vicinal bone-skin nutrient vessels,and the rotation point of its distally based pedicled flap and compound flap can reach the plane of wrist joint,which may be helpful to design a kind of more convenient and simplified flap to repair the distal tissue defects of the hand.
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[Objective]To explore the method of rehabilitation for serious open injury below knee.[Method]A fotal of 153 cases with serious open injury below knee were treated.In which 106 cases were primary repair,47cases were second repair,treated with 7 kinds of internal fixation methods,11 kinds of flap.[Result]A fotal of 132 cases were followed up from 6 months to 5 years after operation,the average time was 17 months,the postoperative satisfaction rate was 85.7%,the flap survival rate was good 25 cases with local necrosis,4 cases with non-union,8 cases with chronic infection,3 cases with osteomyelitis.[Conclusion]The improvement of the flaps enlarge the application and reduce the complication of the flaps.The study offer a reasonable method to repair serious open injury below knee.The proficiency microsurgical scissors and reasonable application of various tissue flaps was the key to repair the injury successfully.
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BACKGROUND: Distally based flap pedicled with the distal nutritional vessels in forearm is especially suitable for reconstructing the tissue defects in the distal end of hands, while high rotation point cannot satisfy the requirements of reconstructing the distal injuries or defects in hands, and severer lesion may even be caused in the donor site.OBJECTIVE: To study the anatomic proceeding of artery perforators in distal radial margin of forearms, so as to provide anatomic basis for the design of distally based compound flap pedicled with the nutrient vessel of cephalic vein in distal radial margin of forearms.DESIGN: Single sample experiment.SETTING: Center for Clinical Anatomy of the Department of Orthopedics,Fuzhou General Hospital of Chinese PLA of Nanjing Military Area Command.MATERIALS: The experiment was conducted in the Laboratory of Center for Clinical Anatomy of Department of Orthopedics, Fuzhou General Hospital of Chinese PLA of Nanjing Military Area Command between August and December 2004. The upper extremities of 30 cadavers injected with a mixture of red gelatin into the artery (provided by the Center for Clinical Anatomy of Department of Orthopedics, Fuzhou General Hospital of Chinese PLA of Nanjing Military Area Command) were adopted.METHODS: The vascular external diameter and distance were measured with sliding caliper and ruler with radial styloid process as the marker.MAIN OUTCOME MEASURES: ① The perforator artery in distal radial margin of forearms. ② The nutrient vessels of cephalic vein. ③ The relationship of blood supply between the nutrient vessels and vicinal bone and skin as well as the lateral antebrachial cutaneous nerve. ④ The superficial and deep communicating branches of cephalic vein.RESULTS: The perforator artery in distal radial margin of forearms derived from: 6-11 cutaneous branches of radial artery with external diameter of (0.7±0.3) mm; 2-6 cutaneous branches of superficial palma with the external diameter of (0.5±0.3) mm; 1-2 recurrent cutaneous branches of the styloid process of radius with the external diameter of (0.5±0.1) mm; 1-2 cutaneous branches of snuff tobacco with the external diameter of (0.6±0.2) mm. At 8.0-15.0 cm above radius styloid process there were 1-3 intermuscular cutaneous branches of radial artery with an initial external diameter of (1.1±0.2) mm, distributing in the exposureregion and corresponding skin of middle and inferior segments in radius. The above-mentioned perforator arteries all developed into cutaneous branch, fascia branch, periosteum branch, cephalic vein and nutrient vessel branch of distal cutaneous nerve,and constituted the vascular chain, the by-pass of cephalic vein, vascular chain of cutaneous nerve stem as well as superficial, deep fascias and periosteal vascular net.CONCLUSION: The perforator artery in distal radial margin of forearms is the source of nutrient vessels in cephalic vein, while the nutrient vessels share an isogeny with the nutrient vessels derived from vicinal bone, skin and lateral antebrachial cutaneous nerve, which provide an anatomic basis for designing the distally based compound flap pedicled with the nutrient vessels of cephalic vein. The rotation point of compound flap pedicled with the recurrent branch of radius styloid process (or branch of snuff tobacco) can reach the surface of rotation joint, which can be adopted in the transposition and reconstruction of distal tissue defects in hands.
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BACKGROUND: Skin flap of nutrient vessel of antebrachial cutaneous nerve is beneficial for repairing injury of distal tissue of hand; thus, it is important for comprehending the correlation of blood supply between distal nutrient vessel of basilic vein and medial cutaneous nerve of bone, skin and forearm to design distal pedicled flap of nutrient vessel of antebrachial cutaneous nerve on clinic. OBJECTIVE: To investigate distally arterial perforating branch of ulnar margin of forearm and provide anatomical bases for designing distal pedicled flap of nutrient vessel in basilic vein of ulnar margin of forearm. DESIGN: Simple sample study. SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of PLA. MATERIALS: The experiment was carried out at the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of PLA from May to October 2004. Thirty upper limbs of adult cadavers perfused with red latex through arteries were provided by Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospitalof Nanjing Military Area Command of PLA. METHODS: Samples of lateral upper limbs of 30 adults were dissected as the pivot point of styloid process of ulna with microscope. MAIN OUTCOME MEASURES: ① Sources of distally arterial perfo- rating branch of ulnar margin of forearm; ② nutrient vessel between perfo- rating branch and basilic vein; ③ correlation of blood supply between nutrient vessel and medial cutaneous nerve of bone, skin and forearm; ④ superficial and deep communicating branch of basilic vein. RESULTS: ① Sources of distally arterial perforating branch of ulnar margin of forearm, which was derived from 5-9 cutaneous branches ulnar artery with external diameter of (0.7±0.3) mm, 1-3 upper cutaneous branches ulnar artery with the external diameter of (0.6±0.3) mm, 6.0- 16.0 mm above styloid process of ulna, 2-3 cutaneous perforating branches anterior interosseous artery and 1-3 posterior interosseous artery with external diameter of 0.4-1.2 mm, middle and inferior segment of periosteum of ulnar and skins in corresponding areas. ② Arterial perforating branches mentioned above started at cutaneous branches, fascia branches, periosteum branches, basilic vein and nutrient vessel branches of cutaneous nerve to form vascular chains of basilic vein and cutaneous nerve stem and vascular nets of deep, superficial fascia and periosteum. CONCLUSION: Nutrient vessel of basilic vein is derived from distally arterial perforating branch of ulnar margin of forearm, and this is homophylic with that of medial cutaneous nerve of bone, skin and forearm. Both of them are anatomical basis to design distal pedicled flap of nutrient vessel in basilic vein. Rotational point of distal pedicled flap can reach wrist joint. The compound flap can be applied to repair to injury of distal tissue of hand.
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BACKGROUND: The incidence rate of spondylolysis of lumbar vertebral arch in recruits is higher during the training, and it affects the normal training. OBJECTIVE: To analyze the correlation of the incidence rate of spondy lolysis of lumbar vertebral arch with training and the original lesions at waist in recruits. DESIGN: A randomized sampling survey. SETTING: Department of Orthopaedics, the 97 Hospital of Chinese PLA. PARTICIPANTS: Totally 100 male recruits aged 18.7 years averagely en rolled in 2003 were involved in the survey. METHODS: The 100 recruits were followed up for the whole course, the X-ray examination at lumbar vertebrae of right, lateral and two-slope positions were observed before training and after 100-day reinforced training. MAIN OUTCOME MEASURES: The incidence rates of spondylolysis of vertebral arch, and whether there was slippage and other aggravations in those with spondylolysis before were mainly observed. RESULTS: All the 100 recruits entered the analysis of results. ① The in cidence rate of spondylolysis of vertebral arch before and after training: Be fore training, 5 cases had spondylolysis of L5 vertebral arch, and the incidence rate was 5%. At the end of the 100-day training, 8 cases had spondylolysis of lumbar vertebral arch, and the incidence rate increased to 8%. ② The results of X-ray examination before and after training: The Xray examination showed that isthmus narrowing of left and L5 vertebral arch occurred in 2 cases and 1 case respect ively, and spondylolysis of bilateral L5 vertebral arches occurred in 5 cases, including 1 case of degree I slip page before training. At the end of the 100-day training, the degree I slip page and below occurred in 3 of the 5 cases with spondylolysis of bilateral L5 vertebral arches before, another 3 cases with original narrowing of lumbar vertebral arch all had breakage. CONCLUSION: The incidence rate of spondylolysis of vertebral arch is associated with the training intensity. It suggestes that the examination of spinal cord should be reinforced in enrolled recruits, and the items of Xray examination at lumbar vertebrae of right, lateral and two-slope positions should be added.
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BACKGROUND: There exists insufficient study with specific applicability regarding vascular distribution characteristics of sural nerve nutrient vessels of the distally based flap.OBJECTIVE: To investigate the distribution of sural nerve nutrient vessels of the distally based flap and provide an anatomical evidence for the design of operation on repair of foot injury.DESIGN: A single sample study.SETTING: Research Center of Clinical Anatomy, Fuzhou General Military Hospital of Nanjing Military Area Command of Chinese PLA, and Department of Orthopaedics, the 97 Hospital of Chinese PLA.PARTICIPANTS: Thirty-two samples of lower extremities whose blood vessels were perfused with red emulsion were provided by Research Center of Clinical Anatomy, Fuzhou General Military Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: The origin of the blood vessels of distally based flap and deep communicating branches of the lesser saphenous vein in the samples were dissected and observed.MAIN OUTCOME MEASURES: ①The nutrient vessels of sural nerve of distally basde flap.②The nutrient vessels of lesser saphenous vein of distally based flap.③The superficial and deep communicating branches of lesser saphenous vein of distally based flap.RESULTS: There were 2 to 5 nutrient vessels in the distally based flap:one originating from the perforating branch of the lateral calcaneal artery was (0. 6 ± 0.2) mm in diameter and one from the terminal perforating branch of the peroneal artery was(0.8±0. 2) mm in diameter and they were (1.0 ± 1.3) and(2. 8 ± 1.0) cm, respectively, away from the lateral malleolus. The incidence of intermuscular septum perforating branches (0 to 3) was 96. 7%, 66.7% and 20. 0%, respectively, and their diameter was (0.9 ±0. 3), (1.0 ±0. 2) and (0. 8 ±0. 4) mm and their distance to lateral malleolus was(5.3 ±2. 1), (6. 8 ±2.8) and (7.0 ±4.0) cm, respectively. There were 2 types of nutrient vessels of the lesser saphenous vein of distally based flap, the nutrient vessels of nerve-vein and the ones of vein-nerve. The superficial and deep communicating branches of the lesser saphenous vein were(1.7 ±0. 5) mm in diameter and(3.4 ±0. 9) cm away from the lateral malleolus. They ended at the peroneal veins.CONCLUSION: The perforating branches of heel lateral artery, the terminal perforating branches and intermuscular septum perforating branches of the peroneal artery have sub-branches to deep fascia, skin, nerves and parenteral nutrient vessels. These sub-branches communicate and form vascular chain of lesser saphenous vein to sural nerve and vascular network of superficial and deep fascia. The superficial and deep communicating branches end at the peroneal veins.
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Objective To explore the improving way to repair the lower one-third of leg soft tissue defect transferred the adjacent flap with non-main vessel pedicle. Methods Analyzing 42 cases.using 4 kinds flaps with nonmain vessel pedicle.If it is fine the skin around soft tissue defect of the lower one-third shank,choosing adjacent adversed sural neurotaneous vascular flap or sapheenous nerve vascular flap.If the skin damaged,chosing gastrocnemius flap.If the soft tissue defect was large,combined adversed sural neurotaneous vascular flap with gastrocnemius flap.Osteomyelitis and peroneus previs musculocutaneous flaps were choosed for small soft tissue defect. Results All case observed 6 to 12 months,37 cases were survived completely,5 cases distal part necrsis partly,among them,2 cases transferred flap repaired;1 case musculocutaneous flap transferred, 2 cases after granulation tissue grown,skin grafted. Conclusion The flap transferred adjacent non-main vessel pedicle is the best way to repaire soft tissue defect of one-third lower leg.Different flap can fit with kinds of soft tissue defect.
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Objective To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle. Methods Lay a foundation of anatomic studying from february 2003 to March 2004, using lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle in 11 cases. Cause of injuring: traffic accident 7 cases, crushing 1 case, saw injuring 1 case, skin cancer 1 case, chronic ulcer 1 case. Areas; foot heel 6 cases, shand lower section 2 cases, heel tendon 2 cases, the distant back of the foot 1 case. Using the flap axis point was 1cm-3cm above the pink of the external heel,average 2cm. The scope of the flap was 6.0cm?8.0cm-12.0cm?18.0cm. Results All sural nerve flap were lively. About all,2 cases have distant part necrosis, accompanying with subcutaneous tissue 1 case heels after change dressings, another heels after skin grating. All case can walk as usal, the flap has wear-resisting and keenly feel. Conclusion Lower rotating point nutrient vessels of sural nerve flap, donner area exiting fine, utlizing scope large, skin nice, grating easy, no hurting important blood vessle,alive rate high,it is an good donner area in repairing around heel, foot and shand lower section.
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Objective To provide anatomic basis for transposition of vascularized radial midforearm flap. Methods On 40 adult cadaveric upper limber specimens injected with red dye, the origin, course, branchs, diameters and anastomosis of intermuscular branch of radial artery and its cutaneous branch were observed. Results Originating from radial artery, intermuscular branch of radial artery descended along periosteum closely between pronator teres and supinator, the main stem was (4.8?1.0) cm in length and (1.2?0.2) mm in diameter. After its periosteal branches were sent off to distribute over middle and inferior shaft of radius, its eutaneous branch perforated from intermuscle and deep fascia and anastomosed with some other cutaneous branches in the forearm. Perforating point of the cutaneous branch was located(11.1?1.3) cm beneath laleral epicondyle of humerus, its diameter was about(0.6?0.1)mm. Conclusion Radial midforrarm flap pedicled with intermuscular branch of radial artery can be transferred to repair soft tissue defect of elbow, forearm or hand.
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Objective To provide a series of surgical approaches for treatment of bone lesions in ankle and foot. Methods Based on the anatomic investigations,vascularized cuboid bone,medial cuneiform bone,navicular bone and lateral part of calcaneum bone grafting were designed for repaired bone lesions in the area of ankle and foot,and applied to 55 clinic cases. Results Forty-eight cases among them were followed up from 1 year to 10 years,4 years and 6 month in average,the results were satisfactory. Conclusion The designed four types of vascularized tarsal bone flaps are easy and reliable for dissection because of their superficial pedicle.