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Objective@#To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis.@*Methods@#From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting. Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anastomoses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds. Sizes of artery exposed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured. Postoperative follow-up was conducted to observe the postoperative effect.@*Results@#Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites.@*Conclusion@#The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.
ABSTRACT
Objective To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis. Methods From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting.Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anasto鄄moses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds.Sizes of artery ex鄄posed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured.Postoperative follow-up was conducted to observe the postoperative effect. Results Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites. Conclusion The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.
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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 To provide anatomical information and clinical application of flaps based on the proximal ulnar artery perforators.Methods Ten fresh cadavers who underwent injected with artery imaging technology and dissected with layer by layer;Eighteen patients who sought surgical treatment with proximal ulnar artery perforator flap for soft tissue defects of the finger and dorsum wrist at our hospital between October 2011 and November 2012 were included in this study.Results The diameter and superficial length of the main perforator respectively were 0.5-0.9 mm and 33.0-47.0 mm in our dissection.There were 5-9 perforators given from the ulnar artery to supply skin over the medial side of the forearm.All of the 18 flaps survived after surgeries.The flap size ranged from 3.0 cm × 2.5 cm to 10.0 cm × 5.5 cm.All of the transplanted flaps presented favourable contours and good functions at 6 to 12 months' followed-up.Conclusion Proximal ulnar arter perforator flap has favourable appearance,constant vascular pedicle,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 soft tissue defects of forearm and hand.
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Objective:In order to provide a new area of bone flap were supplied for non-unions, osseous defect of upper limbs and chondral defect of elbow joint.Methods:The origin,course,distribu- tion and anastomosis of inferior ulnal collateral artery and ulnal recurrent artery were observed on 40 adult cadaver upper limbs.Based on the results,transposition of pedicled medial lower part of humerus bone flap with vessels was designed.Results:Satisfactary results were achieved in 9 case of patients (non-unions of 3 case and osseous defect of 2 case on medial part of humerus bone;non-unions of 3 case on medial upper part of ulna and radius;chondral defect of 1 case on elbow joint.)Conclusion:This pe- riosteal flap that there are constant vessels and abundant anastomosis with inferior ulnar collateral artery form many area of bone flap were supplied with blood supply for repairing the non-unions,os- seous defect of humerus,ulna,radius and chondral defect of elbow joint.