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Objective:To explore the efficacy of digital and 3D printing technologies on design of superficial iliac circumflex artery flap for coverage the donor site of anterolateral thigh flap(ALTF).Methods:Clinical data of 8 patients were studied retrospectively for treatment of soft tissue defects of hand in the Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, from April 2017 to October 2021. The patients were 6 males and 2 females, aged from 29 to 59 years(mean, 45.8 years). Cause of injury: 3 patients were crushed, 2 by hot pressing, and 3 by machine strangulation. Site of injury included: 5 cases were dorsal hand defects and 3 cases were palm defects. All the wounds were contaminated to varying degrees with soft tissue defects. The areas of soft tissue defect ranged from 11 cm×10 cm to 22 cm×14 cm. Four patients had combined injuries of open fracture of metacarpals and phalanges and 3 with tendon defects. All wounds were repaired by free ALTF transplantation. And the donor sites in the thigh were repaired by superficial iliac circumflex artery flaps. The secondary wounds caused by flap harvesting on abdominal wall were closed directly. The targeted perforator vessels were detected preoperatively by CTA combined with CDU. 3D printed models of the affected hand were obtained before operation for individualised repairs according to the shape and area of the wounds. After the operation, all patients entered scheduled follow-ups at the outpatient clinic and via internet by observing the flap shape and testing the recovery of sensory and movement of adjacent joint.Results:The shapes and sizes of the wounds and the flaps were found basically in accordance with those in the preoperative simulative designs. All flaps in 8 patients survived and the wounds healed completely. All patients entered follow-ups for 8 to 24(average, 17.5) months. The donor thighs presented good appearance and colour, pliability without bloating. The range of motion of the hips and knees was not affected. Only linear scars remained in the abdominal donor sites, with natural colour and appearance.Conclusion:Digital and 3D printing technologies in preoperative design of flaps can help to locate the perforator vessels intraoperatively and guide the individualised design of the flaps with improved operation efficiency and satisfactory appearance of the flaps.
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Objective:To analyse the effect of the exposed bone cement technique combined with pectoralis major muscle flap in the treatment of chronic sternal osteomyelitis after coronary artery bypass surgery(CABS), and to summarise the clinical experience of staged surgery and comprehensive treatment.Methods:A retrospective analysis were carried out on 5 patients who had chronic sternal osteomyelitis and treated with exposed bone cement after the CABS from October 2017 to October 2020. Five patients(4 males and 1 female) met the inclusion criteria with a mean age of 65(range from 54 to 72) years old. Duration of all the chronic sternal osteomyelitis was 3 weeks to 3 months at admission. During the perioperative period, the general condition of the patients was controlled and systemic nutritional support was given. At the first stage, all patients underwent complete debridement. Then all the wounds were treated with exposed bone cement and covered by vacuum sealing drainage(VSD) to control the infection. At the second stage, bone cement was removed, and the dead cavity was packed with pectoralis major advancement muscle flap. Close attention was paid to the tension of wound, the patency of drainage catheter and the drainage after surgery. The wound healing, scar hyperplasia and complications were observed during the follow-up.Results:The suture tension was moderate, the drainage catheter was unobstructed, and a little liquid was drawn without turbid. All patients were clinically cured and entered follow-up for 6 to 15 months. During the follow-up, there was neigher recurrence of osteomyelitis nor sinus tract formation. No significant complication occurred at the last follow-up. The quality of life of the patients was significantly improved and all the patients were satisfactory to the treatment.Conclusion:Exposed bone cement technique combined with pectoralis major muscle flap is an effective method in the treatment of chronic sternal osteomyelitis after CABS. It has a good short-term treatment efficacy and is worthy for further clinical trials.
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Objective:To investigate the effect and indications of pedicled myocutaneous flap and modified Masquelet technique in the repair of diabetic soft tissue and tibial bone defects.Methods:From January, 2017 to October, 2019, data of surgical treatment of 20 patients with diabetic soft tissue and tibial bone defects were retrospectively studied. The detects were repaired by the pedicled myocutaneous flap combined with modified Masquelet technique. There were 13 males and 7 females aged 40 to 65(average 51) years old. Preoperative ultrasound and CTA had confirmed that there was no occlusion in anterior and posterior tibial arteries. After debridement, the bone defect was 4-9 cm in length and the soft tissue defect was 3 cm×6 cm to 7 cm×10 cm. The initial antibiotic loaded bone cement filling of the bone and soft tissue defects was carried out. Then at 7-10 days later, had the bone cement placed earlier removed the remaining spaces of bone defect were again filled by antibiotic loaded bone cement. Meanwhile, the pedicled myocutaneous flap was transferred to repair the wound. The second stage of Masquelet technique was performed later, with an interval of 8-12(mean 9) weeks. The healing of wound and bone defect, and the complications were recorded. At 12 months after the surgery, the healing and appearance of the flap were evaluated by the standard proposed by Zhang Hao, and the functional recovery of the adjacent joint was evaluated by Johner-Wruhs standard. The treatment was considered successful when the symptoms were disappeared and no recurrence occurred.Results:All patients entered 13 to 28 months of follow-up, 20 months in average. The healing time for bone defect was 6-11 (average 9.0) months. All myocutaneous flaps survived with 18 flaps healed in the stage one and 2 delayed healing. Nine flaps appeared almost normal and 11 shown bloating. Seventeen flaps were found with partial sensation and 3 without sensation at all. The temperature of 7 flaps was found normal and 13 were slightly lower. Fourteen donor site scars were mild and 6 were obvious. The overall curative effect was satisfactory. Two patients had recurred infection. The rates of excellent and good functional recovery, infection control and success of treatment were at 90%(18/20) for each.Conclusion:Pedicled myocutaneous flap combined with modified Masquelet technique can repair diabetic soft tissue and tibial bone defects. It has a good therapeutic effect for short and medium terms.
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Objective@#To summarize 7 adjacent V-Y advanced perforator flaps for defects at donor sites leaving by six commonly-used flaps.@*Methods@#From May 2007 to Jan. 2014, 66 cases with hands and feet skin defects, tendon and bone exposure were treated with reverse island flap(15 cases), thumb dorsal artery island flaps (9 cases), dorsal metacarpal artery island flaps (9 cases), abdominal pedicle flaps (9 cases), free anterolateral thigh flaps (15 cases), sural nerve retrograde island flaps (9 cases). The defects at donor sites were covered by adjacent V-Y advanced perforator flaps, including dorsal metacarpal perforator flap, snuffbox perforator flap, dorsal carpal perforator flap, deep iliac circumflex artery musculocutaneous perforating branches flap, outer knee perforator flap, medial thigh perforator flap, proximal posterior tibial artery.@*Results@#All the six common flaps survived with average healing period of 15 days. Only one adjacent V-Y advanced outer knee perforator flap underwent partial necrosis at the proximal flap end which healed after dressing. All the other V-Y advanced flaps survived. The patients were followed up for 5-24 months (8 on average) with satisfactory flap texture and color both at reconstructed area and donor sites. The adjacent joints had normal movement function.@*Conclusions@#Adjacent V-Y advanced perforator flap is an important method for closure of defects at donor sites. It has the advantages of no sacrifice of main artery, satisfactory result and easy performance.
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Objective To research the clinical outcomes of repairing donor site of abdomen flap by V-Y flap pedicled with deep circumflex iliac artery perforator musculocutaneous.Methods Nine cases with skin defects of hand were treated with lower abdomen flap from December, 2011 to March, 2013, abdominal donor sites could not be directly sutured, and pedicled with deep circumflex iliac artery perforator musculocutaneous.The flap was 8 cm × 16 cm-12 cm × 24 cm in size.Results The average healing time of the V-Y flap pedicled with deep circumflex iliac artery perforator musculocutaneous was 17 days.The patients were followed-up for 3 months to 18 months, averaged of 9 months.The appearance and the texture of the flaps were good.Abdominal wound healing was flat, with no significant depression and navel no significant skew.Patients were satisfied with function and appearance.Conclusion This procedure is easy and effective.The treatment result is satisfactory.It is improvement for repairing donor site of tradition abdomen flap.
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<p><b>OBJECTIVE</b>To investigate the clinical application of V-Y flap pedicled with the lateral superior genicular perforator for donor site defect after harvesting anterolateral thigh flap.</p><p><b>METHODS</b>From June 2011 to June 2012, 9 cases with defects at hands and feet were treated with anterolateral thigh flaps. The defects left at the donor sites were consequently reconstructed with V-Y flap pedicled with the lateral superior genicular perforator. The defects left by V-Y flap were closed directly.</p><p><b>RESULTS</b>All the 9 anterolateral thigh flap survived completely. 5 flaps underwent thinning surgery 6-8 months after operation. The flaps had a good appearance, texture, color and elasticity. The 8 perforator flaps survived completely with partial necrosis in 1 flap at the proximal end. The average healing time was 17 days. There was no obvious depression at donor sites with normal function.</p><p><b>CONCLUSIONS</b>The method is easily performed with optional therapeutic effect. It is a modified improvement for the anterolateral thigh flap.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Plastic Surgery Procedures , Methods , Skin Transplantation , Methods , Surgical Flaps , Thigh , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the therapeutic effect of V-Y advanced flap pedicled with posterior perforator from medial malleolus for small skin defect at achilles tendon region.</p><p><b>METHODS</b>From Mar. 2011 to Sep. 2012, 7 cases with small skin defect at achilles tendon region were treated by V-Y advanced flap pedicled with posterior perforator from medial malleolus. The flaps was 6.0 cm x 3.0 cm-9.0 cm x 4.5 cm in size. The defects at the donor sites were closed directly.</p><p><b>RESULTS</b>All flaps survived completely. 7 cases were followed up for 6-8 months after operation. The flaps had good texture and color match. The function of ankle was normal. All patients were satisfied with postoperative function and shape.</p><p><b>CONCLUSION</b>It is an ideal reconstruction method for skin defect at achilles tendon region with V-Y advanced flap pedicled with posterior perforator from medial malleolus. It is easily performed with low risk and short recovery time.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Achilles Tendon , Wounds and Injuries , Surgical Flaps , Treatment OutcomeABSTRACT
Objective To investigate the clinical efficiency of repairing ankle and calf wounds by antegrade or retrograde perforating flap of posterior tibial artery. Methods 13 cases with skin defects of ankle and calf wounds were reviewd. The defects were repaired using antegrade or retrograde perforating flap of posterior tibial artery from January 2011 to February 2013, 8 males and 5 females; aged 19 to 65 years old. Wounds were located in the ankle and calf, area which the tibial artery support contu-sioned slightly;defects were associated with exposed bone or tendon, exposed blood vessels. Of the 13 cases, 5 cases have multiple ankle fracture with blood circulation disorders, internal and external fracture fixation were performed emergency with blood ves-sels and nerves exposed, at the same time emergency line wound repair by posterior tibial artery perforating flap. The other 8 cases have no blood vessels and nerves exposure, and accepted vacuum sealing drainage emergency external fixation and flap surgery. Seven cases accepted V-Y antegrade perforating flap of posterior tibial artery, 6 cases using retrograde tibial artery perforator flap. Whose defects were ranged from 1.5 cm×2.0 cm to 9.0 cm×5.0 cm. Antegrade or retrograde perforating flap of posterior tibial ar-tery with 1.5 cm×3.0 cm to 14.0 cm×7.0 cm was used to repair ankle or lower leg medial defect. Antegrade flap donor site sutured directly, but retrograde flap donor site take full thickness skin graft repair from abdomen. Results Circulations of the all 13 cases were stable, with wound healing well after 2 weeks. The patients were followed up for 6 months to 24 months, average of 13 months. All flap graft survived, pedicle no bloated andcat eardeformity. Flaps were soft, no bloated appearance;color was con-sistent with normal skin. Fracture line in the 5 patients was disappeared. Bone healing time was 3.0 to 4.0 months. At the direct su-ture skin donor sites, postoperative scar was small;skin graft donor sites had no obvious scar. Postoperative ankle dorsiflexion 10° to 25°, plantar flexion 15° to 45°. Patients were extremely satisfied with the results of repair. Conclusion Using antegrade or ret-rograde posterior tibial artery perforator flap without sacrificing the main vessel, it is a simple and effective method to repair the medial malleolus and calf wounds.
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Objective To evaluate the clinical effects of free fibula and flap grafts on the repair of all the first metatarsal bone at one stage.Methods There were 9 cases with the first metatarsal bone defect from Janurary 2003 to December 2009 that treated with free vascularized fibular bone and free vascularized flap at one stage.In which 6 cases reconstructed at the primary stage and 3 cases reconstructed at the second stage.Seven cases reconstructed by free vascularized fibular combined with ALTPF,two cases reconstructed by free vascularized fibular combined with TAPF.The free vascularized fibular and flap restored the first metatarsal bone and the soft tissue defects respectively.Vascular anastomosis was the artery of flap anastomosis with anterior tibial artery and the vein of the flap anastomosis with great saphenous vein,the peroneal artery and accompany vein anastomosis with artery and vein of the flap.Results The grafted tissues survived smoothly in 8 cases,vein crisis happened in I case and the ALTPF necrosis after blood vessels expedition.So the TAPF was changed to cover the soft defect and survived smoothly.Followiy-up were done from 6 to 36 months in 9 cases.There were no ulcer on flaps and no fracture again,the fibulas had been bone healing.Evaluated by Maryland standards,six cases were excellent,two cases were fine,one case was good.Conclusion The fibula combined flap grafts provide a relatively better alternative to repair the first metatarsal bone compound tissue defects at one stage.In addition,the procedure decreased frequency of operations and short the course of treatment.Sensory function reconstruction of fibula flaps should be given full attention.As fine function of the reconstructed foot,it is a effective method for reconstruction the burdened area of the foot.
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Objective To introduce the surgical method of reverse radial side of dorsal artery the fascial pedicle island bone flap for the treatment of thumb composite tissue defects,and to evaluate its short term clinical outcome.Methods From May 2010 to March 2012,9 cases with composite tissue defects at thumb were treated with reverse radial side of dorsal artery the fascial pedicle island bone flap,including 5 males and 4 female with an average age of 38 years (range,13-68).All injuries were caused by planer.The time of injury to operation was 3-8 hours,all patients showed in both thumb root plane beyond volar or dorsal,skin and soft tissue defect accompanied by distal phalanx defect.Skin and soft tissue of thumb defect size was 1.0 cm ×1.8 cm to 2.0 cm × 2.2 cm.Preoperative hands anteroposterior and lateral X-ray were routine taken.Imaging findings were associated with the thumb base beyond the distal phalanx fractures,bone defect length was 0.4-0.7 cm.We cut thumb radial side of the dorsal artery fascia flap during surgery operation according to the thumb side wound defect case.The size of the bone flap was 0.2 cm× 0.6 cm to 0.4 cm × 0.8 cm,properly inserting intramedullary distal phalanx fixed base,9-0 line will flap inside the dorsal nerve and a nerve suture flap reconstruction feeling.Results All bone flaps were survived completely,no case occur venous disorders,flap blood circulation was stable,donor skin graft was survival in stage Ⅰ.This group of patients incision were healing 2 weeks after surgery.All the patients were followed up as scheduled,and the follow-up time was 6-12 months.All flaps survived,and the colors,texture,contour of the flaps were good.The two-points discrimination distance was 7.0-10.0 mm on the flap,Thumb distal phalanx healing time was 1.0-1.5 months.Bone absorption was not observed in graft.The thumb function was assessed as excellent in 7 fingers,good in 2 fingers,no complication occurred in donor site.Conclusion The main artery and nerve will not be sacrifice,when the bone flap is used.There are blood into the backbone of the first metacarpal nearly 1/3 of the bone to reconstruct thumb bone defect,the operative procedures is available and easy to be performed,which is a new method for the treatment of thumb composite tissue defects.
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@#Objective To evaluate the treatment effect of hand reconstruction with bilateral multiple toe transplantation. Methods There are four schedules as follow applied in 102 cases: (1) bilateral second toes to thumb and index finger transplantation in 86 cases; (2) wrap-around flap to thumb and second toe on opposite side to index or middle finger transplantation in 11 cases; (3) wrap-around flap to thumb and bilateral second toes to index and middle fingers transplantation in 8 cases; (4) bilateral wrap-around flap to bilateral thumb and second toe to index finger transplantation in 1 case. Results All reconstructed finger survived in 102 cases except for partial wrap-around flap necrosis in one case and second toe in two cases. Sixty-two patients got more than one-year following up. Two points discrimination in reconstructed finger was between 8 to 14 mm in all cases. The reconstructed finger grew synchronously with toe among children. Thumb opposition function recovered in all cases except for one case. Donor site: no limp or hallux eversion observed in all cases. Conclusion There is less damage on foot and most hand function recovery using bilateral multiple toe transplantation to repair hand or multiple fingers defect.