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Objective:To investigate the clinical effect of flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects.Methods:A retrospective case series study was conducted to analyze the clinical date of 14 patients with hand and foot wounds associated with extensor tendon defects admitted to Ruihua Affiliated Hospital of Soochow University from January 2015 to December 2019. There were 13 males and 1 female，aged 10-57 years［（39.2±13.4）years］. The wounds were all single with the area of 10 cm×4 cm to 23 cm×12 cm，including 8 wounds on the back of the hand and 6 wounds on the back of the foot. There was 1 patient accompanied with 1 tendon defect，10 with 4 tendon defects and 3 with 5 tendon defects，with the length of tendon defects ranging from 2.0 to 6.0 cm［（3.8±1.4）cm］. The dimension of flaps ranged from 12 cm×5 cm to 23 cm×13 cm，with the fascia lata from 11 cm×5 cm to 20 cm×7 cm. The deficient extensor tendons were repaired with the fascia lata and vascular pedicles were anastomosed by flow-though. A bilobed flap was harvested in 3 patients and a single flap in 11 patients. Donor sites were sutured directly. The survival of the flap and healing of the donor area were detected after operation. The extremity revascularization and shape and sensation recovery of the flap were measured at the last follow-up. The upper extremity functional evaluation standard set up by Hand Surgery Society of the Chinese Medical Association and Maryland foot functional score were used to evaluate the hand and foot function before operation and at the cast follow-up，respectively. The donor site complications and performance of tendon release or flap thinning in the second stage were recorded.Results:All patients were followed up for 8-30 months［（15.3±6.2）months］. All flaps survived successfully，with wounds and thigh donor areas healed by first intension. No significant effect of revascularization was observed on recipient sites，and acceptable cosmetic outcomes and sensation recovery of the flap were achieved at the final follow-up. For patients with dorsal wounds of the hand，the extensor function recovered in different degrees，and the flexion activities of the fingers were not limited. The total active movement was 180°-250°［（226.3±21.7）°］at the last follow-up，compared to preoperative 110°-170°［（145.6±13.2）°］（ P<0.01）. According to the upper extremity functional evaluation standard，the function was excellent in 4 patients，good in 2 and fair in 2. For patients with wounds of the foot，the flexion and extension function was good，with no obvious deformity of toes，and the Maryland foot functional score ranged from 60 to 92 points［（76.0±12.7）points］at the last follow-up，significantly improved from preoperative 18-45 points［（27.4±7.8）points］（ P<0.01），including excellent results in 2 patients，good in 3 and fair in 1. Only linear scars were left in the thigh donor area，and there was no discomfort such as scar contracture or pain. Four patients underwent skin flap thinning at 4-8 months after operation and none underwent a tenolysis. Conclusion:Repair of dorsal wounds with extensor tendon defects of the hand and foot by flow-through anterolateral thigh perforator flap with fascia lata can reduce interference to recipient sites and repair wounds and extensor tendons simultaneously，which can obtain good flexion and extension function and minor damage to the donor area.
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Objective:To investigate the clinical efficacy of external fixators combined with anterolateral thigh musculocutaneous flap for treatment of Gustilo type IIIB/C open tibiofibular fractures.Methods:A retrospective case series study was conducted to analyze clinical data of 15 patients with Gustilo type IIIB/C open tibiofibular fractures admitted to Ruihua Hospital of Soochow University from March 2016 to June 2019. There were 11 males and 4 females, with the age of (48.5±12.6)years (range, 22-67 years). All patients underwent emergency debridement in stage I, the major blood vessels, nerves and tendons were inspected and repaired, and the fracture ends were fixed by external fixator. There were different degrees of wounds necrosis, infection and bone defect after operation. After debridement in stage II, the soft tissue defects with the dimension of 10.0 cm×5.0 cm to 30.0 cm×8.0 cm were repaired with anterolateral thigh musculocutaneous flaps whose areas ranged from 10.5 cm×5.5 cm to 30.5 cm×8.5 cm. All donor areas of the musculocutaneous flaps were sutured directly in stage I. The healing of the donor areas and musculocutaneous flaps were observed within 2 weeks after operation. At the last follow-up, the shape and sensory recovery of the flap, healing of fractures and related complications were observed. The lower extremity functional scale (LEFS) was used to evaluate the injured limb function.Results:All patients were followed-up for 12-32 months [(22.0±5.8)months]. All donor areas were healed by first intention, leaving only linear scars. The musculocutaneous flaps survived completely in all patients. Partial necrosis of large area of musculocutaneous flap occurred in 2 patients, and healed after debridement and skin grafting. Another patient had vascular crisis after musculocutaneous flap operation and survived after the embolized vein repaired by contralateral great saphenous. At the last follow-up, the shape of flap recovered well, and the feeling partially recovered with the two-point discrimination of 18-26 mm. All fractures healed well, and there were no serious infection-related complications such as osteomyelitis. The LEFS score was 47-69 points [(59.0±9.5)points].Conclusion:Theexternal fixator combined with anterolateral thigh musculocutaneous flaps for treatment of Gustilo type IIIB/Copen tibiofibular fractures can better restore the appearance of soft tissue defect of the lower leg, and can effectively reduce the occurrence of severe infection-related complications.
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Degloving injury of distal thumb is common in hand surgery. Generally, the degloving tissue is severely damaged without conditions for replantation. It is often treated by methods of stump revision, local flap coverage, free second toe reconstruction, and so on. It inevitably leads to a shortening of distal phalanx, sacrifice of the whole toe and poor appearance after repair. The hallux nail flap is considered to be the best to treat this kind of injury. However, the traditional wrap-around flap excises the toe in a large range and has many complications in the donor site. In April, 2010, a case of degloving injury of the distal thumb was repaired with a combined wrap-around flap of the hallux nail flap and the tibial flap of the second toe. The patient was followed-up for 10 years in our hospital. Both of the appearance and function of the patient's thumb are well recovered.
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Objective:To investigate the feasibility and clinical efficacy of the bilobed anterolateral femoral perforator flap pidicled with the oblique branch of lateral femoral circumflex artery in repair of the wounds in extremities.Methods:A study was conducted on 36 patients with complex limb wounds from December, 2014 to May, 2020. Thirty patients had single-wound sized from 10.0 cm×10.0 cm to 23.0 cm×17.0 cm, and 6 patients had 2 adjacent and discontinuous wounds sized from 4.0 cm×5.0 cm to 11.0 cm×9.0 cm. A total of 78 perforators were identified in routine preoperative CDU examination, and 67 perforators were confirmed. According to the actual requirement of the perforator confirmed in surgery, 19 flaps were designed with completely split up into bilobed flaps and 17 bilobed fascial flaps were designed with segmented skin and deep fascia. The blood supply of flaps relies on the anastomosis of oblique branch with the recipient vessels, therefore bridged blood Flow-through anastomosis was performed in 8 flaps. All thigh donor sites were sutured directly. Regular follow-up were made after surgery.Results:In this group, 35 cases of bilobed flaps survived successfully. Venous crisis was found in 1 case of flap repairing 2 wounds after the operation and was relieved 7 days later by remove some stitches and bloodletting. The donor sites healed by first intension, and the wound healing time was 11-83 days. All patients were followed-up for 6-39 months. The flaps had good colour and texture with S 2-S 3 sensory. All the donor sites left linear scars except 1 where left with a large scar without contracture and pain. Conclusion:The repair of the wounds in extremities by bilobed anterolateral thigh perforator flaps pedicled with the oblique branch of the lateral femoral circumflex artery could obtain a more concealed donor site. It acts as a beneficial supplement when a bilobed flap cannot be harvested on the descending branch of the lateral femoral circumflex artery.
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Objective@#To explore the clinical effect of bilateral anterolateral thigh flaps in repairing complex wounds of foot and ankle.@*Methods@#From April 2014 to June 2017, 16 patients with complex foot and ankle wounds were treated in Ruihua Hospital Affiliated to Soochow University. There were 15 males and 1 female, aged from 12 to 73 years. Two of them had two wounds for each, the area of which was from 4 cm ×5 cm to 6 cm×10 cm. Fourteen cases were single-wounds, the area of which ranged from 11 cm×8 cm to 42 cm×15 cm. According to the wound surfaces, the wide wound cloth was divided into two pieces of cloth with a width less than 8 cm. The double-leaf skin flap was designed at the point of the perforating branch of the skin flap located by B-ultrasound on the iliac-patellar connecting line of the donor area. The course of the origin artery of the skin perforating branch of the skin flap was observed by DSA image. If the perforating branch of the double-leaf skin flaps was the common origin artery, the two adjacent wounds would be repaired directly. If the perforator of the double-leaf skin flaps is not the common artery, the double-leaf skin flaps were cut separately. After the pedicle division, the perforator vessels of the high perforator skin flaps were anastomosed with the distal end of the medial circumflex lateral femoral artery of the low perforator skin flaps to form a new parallel double-leaf skin flaps, which were then assembled or lobed to the recipient area. Flap donor sites were sutured directly.@*Results@#11 cases were repaired with parallel bilateral anterolateral thigh flaps with double perforators, and 5 cases were repaired with new parallel bilateral thigh flaps formed by anastomotic bridging of perforator vessels. The area of the flaps ranged from 5 cm×6 cm to 8 cm×22 cm. All the 16 flaps survived and the donor site wounds healed in one stage. Five cases underwent internal fixation removal and skin flap thinning 6 to 10 months after operation. Follow-up for 6 to 18 months showed that the skin flaps were of good color and texture, and the sensation of the flaps ranged from S1 to S3. Linear scars were left in all donor sites and lower limb movements were normal.@*Conclusions@#It is a good method to repair complex foot and ankle wounds with bilateral anterolateral thigh flaps, and it has the advantages of flexible design, less damage to donor site and good blood supply of the flap.
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Objective@#To investigate the clinical effects of extra-long lateral femoral supercharged perforator flaps in repair of ankle and foot wounds.@*Methods@#From March 2014 to October 2018, 16 patients with foot and ankle injuries were admitted to our hospital and left large area of wounds on foot and ankle after emergency treatment. There were 13 males and 3 females, with age of 27 to 60 years. The area of the wounds ranged from 14 cm×10 cm to 40 cm×17 cm. The wounds were repaired with extra-long lateral femoral supercharged perforator flaps. The widths of flaps in 8 patients were longer than 8 cm, and the bilobed flaps were designed to repair the wounds. The area of the flaps ranged from 12 cm×5 cm to 40 cm×9 cm. During the operation, 54 perforators were detected, with an average of 3.2 perforators in each flap, and 36 source arteries of perforators were detected. The blood vessel trunk of 15 patients was descending branch of the lateral femoral circumflex artery, and their supercharged mode was anastomosis of the bulky perforator of descending branch of the lateral femoral circumflex artery with the oblique branch of the lateral femoral circumflex artery and/or medial femoral circumflex artery or the descending branch of superficial illiac circumflex artery. The blood vessel trunk of 1 patient was oblique branch of the lateral femoral circumflex artery, and the supercharged mode of the patient was anastomosis of the oblique branch of the lateral femoral circumflex artery with the bulky perforator of the descending branch of the lateral femoral circumflex artery. The wounds were covered with the flaps after supercharged blood vessel anastomosis, and blood vessels in the donor sites were anastomosed with those in the recipient sites. The donor site was sutured directly. The survival of the flap after the operation and healing time of the wound, and the flap condition, the two-point discrimination distance of flap in patients who were reconstructed with sensation, the recovery of the ankle function, and the appearance of the donor site during follow-up were recorded.@*Results@#A total of 17 flaps in 16 patients were designed, including 8 bilobed flaps and 9 non-lobulated flaps. Sixteen flaps in 15 patients survived. Vascular crisis occurred in the flap of one patient, and the flap survived when the vascular crisis was relieved by the second operation. The healing time of foot and ankle wounds ranged from 12 to 90 days. All the lateral femoral donor sites healed completely. During follow-up of 8 to 48 months, flaps in 2 patients were slightly bloated and were trimmed in 6 months after the operation. The other flaps were with good appearance, soft texture, good elasticity, and no rupture or ulceration. The two-point discrimination distances of flaps ranged from 7 to 16 mm in 8 patients who were reconstructed with sensation, and the other flaps recovered protective sensation. The flexion and extension function of ankle joint recovered well, and the walking function was not affected significantly. All donor sites formed linear scar, with no deep tissue infection such as osteomyelitis.@*Conclusions@#The application of extra-long lateral femoral supercharged perforator flaps to repair the large area of wounds in foot and ankle can significantly reduce damage to donor sites and has advantages of rich blood supply and good safety, thus it has satisfactory clinical effects.
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Objective To explore the clinical effect of complete transposition of arteriovenous in free flap artery crisis. Methods From October, 2009 to April, 2017, 13 cases of extremities tissue defect were repaired with free flaps.The intractable arterial crisis appeared after transplantation.Repeated anastomosis vessels were adapted but it was not relieved. Then the complete transposition of arteriovenous was adapted in the flaps. Namely the vein of the flap was anastomosed with the arterial in the recipient site to reconstruct the blood supply, and the arterial of the flap was anastomosed with the vein in the recipient site to reconstruct recirculation.Ten cases of hand defect and 3 cases of crus defect were repaired by 5 low abdominal flaps and 8 anterolateral thigh flaps. The tissue defect area was 16 cm× 7 cm-6 cm×4 cm and the flap area was 18 cm×8 cm-7 cm×4 cm. Results Ten flaps survived completely, the other 3 flaps almost survived that scab healed in 1 case and skin grafted in 2 cases. The flap for skin color was from purple red to dark red, and finally close to normal, and skin flap edge would have different degrees of ecchymosis; the bleed-ing from the incision of the skin flap was from dark red to bright red; the swelling of the flap was obvious in the early stage and the later swelling subsided. All cases were followed-up from 6 months to 32 months with an average of 16 months.The wounds healed well.The flaps had a clear boundary and soft texture. Conclusion Complete transposi-tion of the arteriovenous system can be used as an alternative in the presence of intractable arterial crisis after free flap transplantation, to save the flap and to reduce the trauma to the patient.
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Objective@#To report the operation methods and clinical effects of repairing finger tip defect with the free tibial dorsal nerve flap of the second toe.@*Methods@#13 patients with finger tip defects were repaired by the tibial dorsal nerve flap of the second toe. The area of finger tip defect was 2.5 cm×1.5 cm-1.3 cm×1.0 cm, and the area of cutting flap was 2.7 cm×1.7 cm-1.5 cm×1.1 cm. All donor site defects on the second toe were covered with full-thickness skin graft.@*Results@#There were 13 cases in this group, and all the flaps and skin grafts were survived. Postoperative follow-up ranged from 6 to 18 months, with an average of 13 months. The appearance of the fingers was satisfied and the sensory recovery was good. Two-point discrimination of the flaps returned to 7-13 mm, with an average of 9 mm. According to the total active move(TAM)scale, results were excellent in 11 fingers, good in 1 finger, and fair in 1 finger. The donor site skin graft was well healed, the second toe pulp was full, and the two-point discrimination of the toe pulps were 6-10 mm, with an average of 8 mm.@*Conclusions@#Compared to the traditional method of repairing finger tip defect with the tibial inherent nerve flap of the second toe, our new method can reduce the damage to the donor site, and we can repair finger tip defect as well as the traditional one at the same time. So it was a better operative method to repair finger tip defect with the tibial dorsal nerve flap of the second toe.
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Objective To explore the surgical method and clinical effect of repairing the large area skin defect of forearm with the perforator flap pedicle with the inferior epigastric artery perforator and the lateral cutaneous branch of the posterior intercostal artery.Methods From January,2006 to January,2016,14 cases of forearm large area of skin defects were treated with the ovedength flap at one stage.The proximal flap to the inferior epigastric artery umbilical perforation and the flap distal to the posterior interphalangeal artery perforation were used for the blood supply of superficial flap.The length of the flap was 25-43 cm (average,36 cm).The width of the flap was 5-14 cm (average,9 cm).All patients were followed-up regularly.The content of the follow-up included three aspects:appearance,hand function and the recovery of the donor site.Results Twelve cases of postoperative flaps successfully survived.Arterial crisis was seen in 1 flap 28 hours after surgery.The re-surgical exploration was adopted after conservation treatment for 1 h without remission and the proximal anastomotic flap embolization was confirmed.The flap survived.Venous crisis was seen in 1 case.The flap survived with the help of removing the suture,smoothing drainage and bleeding for 5 d.The wounds and the donor site of the thoracic and abdominal region healed at the first stage.The follow-up time was 8-72 months,with an average of 31 months.The flaps had no obvious bloated,the skin texture was close to forearm skin and the flaps were restored protected sensation.There was no ulceration,infection and other complications.The healing of skin graft was satisfactory in 2 cases in abdominal donor site.No skin graft contracture occurred.The remaining 12 cases had linear scar in the abdomen of the donor site.The edge of the scar was soft and no obvious contracture occurred.Conclusion Super long thoracic umbilical conjoined perforator flap can repair the lager area skin defect of forearm with double blood supply.The length of flap is significantly longer with enoughblood-supply of distal part of the flap.The clinical efffect is satisfactory.
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Objective To investigate the treatment of outcomes of repairing soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects.Methods From January,2014 to June,2016,7 patients(4 males and 3 females.Patients'age ranged from 18 to 45 years,with an average of 28.5 years) with soft tissue defects on the palmar side of the proximal and middle phalanx of the fingers accompanied by proper digital artery and nerve defects were treated by first dorsal metatarsal artery Flow-through flap,application of color Doppler ultrasound was used in the detection of vascular type before operation.The flap area was from 2.0 cm×2.5 cm to 3.5 cm×5.5 cm.All the donor site of the flap were sutured directly.The patients were followed-up in 1 month,3 months,6 months,12 months,24 months after the surgery,and the results were evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association.Results All flaps survived.These cases were followed-up for 6 to 24 months,average 12 months.All the flaps got satisfactory appearance and good sense function,and 2-PD of the flap averaged 7 mm,ranging from 6 mm to 12 mm.All injured fingers got satisfactory appearance and good sense function,2-PD of the injured fingers averaged 8 mm,ranging from 6 to 15 mm.The donor site incision healed well no obvious scar hyperplasia,good function.Conclusion Application of the first dorsal metatarsal artery Flow-through flap to reconstruct soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects,can achieve good clinical effects.This method can restore the appearance,blood supply and sensation of the injured finger.
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Objective To explore the clinical outcomes of three types of multiple flaps from the foot for re-construction of two skin and soft tissue defects in hands. Methods From February, 2003 to September, 2015, 23 cases of hands with two skin and soft tissue defects were treated with 3 types of multiple flaps from the foot. Among of them, 10 cases of adjacent fingers were treated with double foliated pulp flaps from the big toe and the second toe based on a single vascular pedicle of the first dorsal metatarsal vessels; 2 cases of composite tissue defect including finger and hand were treated with double foliated pulp flaps from dorsalis pedis flap and the big toe based on a single vascular pedicle of the dorsalis pedis artery;11 cases of two composite tissue defect in hand were treated with dorsalis pedis flaps based on a single vascular pedicle of the dorsalis pedis artery. The donor site was covered with full-thick-ness skin. All patients were followed-up regularly which included three aspects:appearance, hand function and senso-ry recovery. Results Twenty-three cases of double foliated pulp flaps were survived. Postoperative follow-up time ranged from 3 to 36 months, with an average of 15 months. The postoperative follow-up revealed satisfactory shapes of the multiple flaps and recovery of functions. The sensation was recovered to S 2-S4. The grafting skin in donor site sur-vived completely excluding partial necrosis in 3 cases. The wound were treated by wound dressing, local scar hyper-plasia in donor sites. There was no apparent impairment on the foot function. Conclusion Three types of multiple flaps from the foot based on a single vascular pedicle for reconstruction of two skin and soft tissue defects in hand could achieve good clinical outcomes. The type of flaps can be adapted according to the injury.
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Objective To discuss the concrete method and clinical effects of the wound refers to multiple fingers and fingerweb.Methods Twenty-six patients were used four different flaps to repair the wound refers to multiple fingers and fingerweb.Dorsalis pedis flap in 18 cases,2 cases were distal dorsal foot flap,anterolateral thigh flap,3 cases,toe web flap,4 cases,dorsal carpal branch of ulnar artery flap,1 case in this group.Results All of 25 flaps survived,the distal part of 1 case got necrosis and use skin grafting to treat.6 cases of dorsal foot flap and 1 case of anterolateral thigh flap use the operation of spliting fingers and finger web deepen operation.Conclusion According to the specific injury of the patients' hands refers fingerweb,using the suitable flap to repair the wound,can make a satisfactory results in the appearance and function of patients' hands.
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Objective To explore the operative technique and clinical outcomes of tiled flaps from foot with bone graft for reconstruction of thumb defects.Methods From January, 2008 to December, 2013, 8 cases of thumb defects with varying degrees were treated with tiled flaps from foot and iliac bone graft.Among them, 4 cases caused by emergency trauma, the other 4 cases was old defect after trauma, including 1 case of double thumb defect that caused by electrical burn.The thumb defects was caterorized as type Ⅰ A in 1 case, type Ⅰ B in 2 cases, type Ⅱ A in 1 case, type ⅡB in 2 cases and type ⅢA in 2 cases.Five cases in which were treated with free wrap-around flap from the ipsilateral big toe and tibial lateral-flap from the opposite second toe, 3 cases using free wrap-around flap with series connection of dorsal artery.Results All 8 reconstructed thumbs were survived.The wound healed primarily.In 1 case, the unhealed wound was healing after dressing where skin grafts in the donor sites of the foot were partial necrosis.Postoperative follow-up ranged from 6 to 72 months, the appearance of the thumb was satisfying when was compared with normal thumb.Thumb nail grew well, the blood supply was good, and sensory recovery from S2 to S4.According to the criteria issued by the Hand Surgery Society of Chinese Medical Association for functional assessment of reconstucted thumb and fingers, 5 were excellent and 3 were good.The donor site skin graft had no scar contracture and no ulceration.There was no apparent impairment on the foot function.Conclusion Combined tiled flaps from foot and iliac bone graft for reconstruction of thumb is a good method, which can recover the appearance of thumb without sacrificing toes of the donor foot.
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Objective To explore the surgical methods and clinical application effects of repairing hand soft tissue defect with free vascularized flaps based on the distal perforator of ulnar artery.Methods From March, 2001 to December, 2012 in our hospital, 90 patients with hand soft tissue defects were repaired by free vascularized flaps based on the distal perforator of ulnar artery, including 74 patients cases were repaired by Phase Ⅰ emergency surgery, 16 patients cases with scar contracture were repaired by Phase Ⅱ surgery.There were 34 cases were rebuild the sensory by repaired the continuity between the dorsal branch of the ulnar nerve and dorsal digital nerve or palmar digital nerve.The free vascularized flaps that used the emerging point of perforator of the ulnar artery as center of the flap was designed, which based on the distal perforator to repairing the hand soft tissue defect.Results All 89 patients postoperative flaps were survived.Necrosis was seen in 1 flap which was repaired by skin grafting.Follow-up ranged from 3 to 36 months with an average of 12 months.The appearance of flap was not clumsy, the quality was good.The sensation was S3-S3+ in 34 cases after nerve reconstruction surgery.The active and passive activity of 16 cases with scar contracture were improved significantly.The incision in 72 cases for direct suture were healed without scar contracture, 18 cases of skin grafts were all survived without contracture.Conclusion The free vascularized flaps based on the distal perforator of ulnar artery has constant perforating point, which can carry sensory nerves and leads to little donor site damage without major vascular injury.The flap serves as a simple approach to repair hand defects, and get satisfied skin flap appearance and texture, the fingers feel and function recovered well.
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Objective To explore the new operation method and clinical effect of treating degloving injuries of the whole thumb.Methods Nine cases of the whole thumb degloving injury caused by machine were treated with free wrap-around flap from the big toe and the flap from the opposite foot.The phalanges,joints and tendons of all injured thumbs were integral relatively,except that the interphalangeal joints in 3 cases were destroyed and the flexor and extensor pollicis longus were ruptured.The size of the dorsal tissue defects varied from 4.8 cm × 2.9 cm to 6.2 cm × 3.4 cm,and the volar tissue defects ranged from 4.7 cm × 3.2 cm to 6.1 cm × 4.0 cm.The area of the wraparound flap from the big toe harvested was from 5.0 cm × 3.2 cm to 6.7 cm × 3.9 cm.The flap from the opposite foot was tibial flap with dorsalis pedis flap from the opposite second toe,and the area of the flap was from 5.0 cm × 3.5 cm to 6.6 cm × 4.5 cm.Results All 9 combined flaps survived.The wound healed primarily.Skin grafts in the donor sites of the foot also survived.Postoperative follow-up ranged from 6 to 20 months,with an everage of 9 months.The pulp of the thumb was well-stacked.Sensory recovery ranged from S3 to S3 +.Thumb nail grew well.Thumbs performed good functions as grabbing,grasping and nipping.The range of motion of the MP joints of the reconstructed thumb was normal.The motion of interphalangeal joints were acceptable in 6 cases,but worse than the normal thumb.The interphalangeal joint in 3 cases destroyed was fused.There was no obvious influence on the function of the foot.Conclusion Applying combined wrap-around flap from the big toe with the tibial flap and dorsalis pedis flap from the opposite foot in treating degloving injuries of the whole thumb is a new operation method,which could achieve good appearance and function,but have a small influence on the donor site.It is worthy being used widely in clinical.
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Objective To explore the treatment method with combined dorsal flap based on the second toe and tibial flap for repairing the finger distal degloving injury.Methods From March 2008 to September 2011,our department chose treatment with combined use of free dorsal flap based on the second toe and contralateral second toe tibial flap for repairing finger distal degloving injury.The 11 fingers in 11 cases were treated and followed up after surgery.Results The flaps in 11 cases all survived; The donor site with skin grafting successfully healed; The follow-up was 4-15 months,averaged of 6 months.There was not obvious atrophy for the toe dorsal flaps in the finger back side and toe tibial flaps in the palm side.The finger pulp was full,the nails grew well and the appearance of the fingers was good.There was satisfactory sensory function restoration for finger pulp,two cases for S4,five cases for S3,three cases for S2 and 1 case for S1.The protective sensation was restored in the finger back for all the cases; the finger function was restored to normal; the foot donor site was healing well without scarring.Walking was completely normal.Conclusion It is an ideal treatment with combined use of free dorsal flap based on the second toe and contralateral second toe tibial flap for repairing finger distal.
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ObjectiveTo report the methods and clinical efficacy of bridging severed thumbs and fingers with foot joint compound flaps.Methods Ten patients with completely amputated thumbs and fingers with extensive defects in the proximal phalanx had bridged and repaired by using composite-free flap with joints from foot. Three of 4 cases of thumb amputation were repaired by using composite flaps of the second metatarsophalangeal and proximal interphalangeal joints in foot,and the other was used composite flap of the second metatarsophalangeal joints in foot.Donor sites underwent the second metatarsals distal osteotomy associated with free skin graft. And 6 cases with absent fingers by using composite-free flaps of the proximal interphalangeal joint to repair. The donor site in foot underwent metatarsophalangeal and toe joints osteotomy.ResultsAll flaps and replanted thumbs and fingers survived. Hand wounds recovered by primary repair.Donor site in foot all healed by primary repair except for 1 case,which healed after several dressing changes.All 10 cases were followed-up from 6 to 28 months,averaged of 9 months.The metacarpophalangeal joint of 4 replanted thumbs extension between -10° and 0°,and flexion between 20° and 50°.The function of fullfield digital mammography recovered well in 3 replanted thumbs, as well as the function of thumb-middle in the other. Three of them could completely 2-5 fingers tapping,one case could complete middle finger tapping,four cases could complete radial abduction.The proximal interphalangeal joints of 6 replanted fingers extension between -10° and 0°,and flexion between 30° and 90°,averaged of 50°.Sensory recovery of 1 case reached S4,two cases reached S3+,five cases reached S3,and 2 cases of S2.All replanted bones and joints healed after transplantations(bone healing time was 6 to 16 weeks), with no occurrence of re-fracture nor nonunion. Walking function was not significantly affected. According to the evaluation criteria of replanted severed fingers by Chinese Medical Association,one was excellent,eight were good,and 1 was poor.The excellent and good rate was 90％. Conclusion Repairing amputated thumbs and fingers with foot joint compound flaps could not only maximize the recovery of replanted fingers shape,but also get some function,which to meet everyday needs of patients.
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ObjectiveTo report the clinical results of applying free second toe hemiarthrosis to repair finger hemiarthrosis injury,and discussed the countermeasures of relative problems.MethodsFrom June 2005 to January 2010, thirteen fingers of 13 patients with traumatic finger joint injury had repaired by using vascularized second toe hemiarthrosis graft.ResultsAll 13 grafted fingers survived,and all wounds were primary healing.The time of follow-up was between 1.5 and 4.5 years,average of 3.2 years.All grafted joints were healed and the remaining joints were normal in morphology and structure,except for 1 patient subluxation with dorsal slightly convex.No degenerative changes happened to the grafted joints.No pain and no joint instability phenomenon.Nonunion and re-fracture phenomenon did not appear.The average extension of joint motion was 0°.The average flexion was 80°.Healing of the foot donate areas were satisfactory,and did not affect walking function.Using TAM assessment method of the hand joint function,the excellent rate was 90％.ConclusionThe way of using free second toe hemiarthrosis to repair finger hemiarthrosis injury could achieve satisfactory clinical efficacy.To completed set-up of transplanted joint structure and function units,a delicate surgery were improved to be important factors of the surgical treatment.
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ObjectiveTo investigate the clinical effects of applying low abdominal superficial artery flap to repair skin and soft tissues defects in upper limbs.MethodsTotal 42 cases with soft tissues defects were recruited in this study.Seven cases were repaired using skin flaps with circumfiexa ilium superficial artery.Five cases were repaired using osteocutaneous flaps based on circumfiexa ilium superficial artery.Eleven cases were repaired using flaps with superficial epigastric artery.Seven cases were repaired using flaps with circumfiexa ilium superficial artery,lateral branches of superficial epigastric artery and musculocutaneous perforators of the fourth lumbar artery.Six cases were repaired using flaps with origin of circumfiexa ilium superficial artery,medial and lateral branch of superficial epigastric artery,and the deep and cutaneous branch of circumfiexa ilium superficial artery.ResultsAfter surgery,forty-two flaps all survived.Flaps areas were between 5 cm × 6 cm-9 cm × 30 cm.Followed up 6-24 months,the appearance,texture,color and function of flaps were recovered well and did not need to trim again.ConclusionLow abnominal superficial artery flap could be used to repair skin and soft tissues,also its texture is so thin and areas can be direct sutures,which,is an ideal method to forearm repairment.
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Objective To determine the surgical approaches and evaluate the clinical efficacy of skin defects of the emergency thumb, finger reconstruction.Methods Emergency in 11 cases complicated skin defect of the thumb and the hand, fingers missing injured patients by using the method of combined of toenail flap of biped dorsalis pedis flap or the second toe.The implantation of thumbnail flap of dorsalis pedis flap combined with the second toenail flap was applied on 5 cases.3 cases had received the implantation of thumbnail flap of dorsalis pedis flap combined with the second toe and 3 cases with combined repair of the second toe of biped dorsal flap.Of all the cases, reconstruction of 3 fingers in 1 case, reconstruction of 2 fingers in 10 cases,5 cases with reconstruction by means of implantation of toenail flap of same pediele splitting flap or the second toe, 6 cases with repair of toenail flap of dorsalis pedis flap or second toe.Results Except for 1 necrosis occurred in 1 finger in 1 case of 3 fingers reconstruction, the rest of tissue flaps and fingers all survived.The primary healing was achieved postoperatively.The patients were followed up for 5-24 months.The functions such as grabbing, grasping, nipping were basically restored after the repair.The appearance of hand was also restored to a certain degree.Sensory recovery S2-S4 of reconstruction finger and flap was achieved.Healing was satisfying in the donor area, no obvious cicatricial contracture was seen, while the walk function was not affected.Conclusion The application of combined implantation of toenail flap of biped dorsalis pedis flap or the second toe in the repair of overall hand skin degloving injury could restore the function and appearance of the injured hands to a certain degree.It is proved to be an effective treatment method.