ABSTRACT
Objective:To explore the effects of 3 osteotomy methods on the bone healing in Ilizarov tibial bone transport.Methods:The data of 93 patients were retrospectively reviewed who had been treated by Ilizarov single-segment tibial bone transport at Department of Hand Surgery, The Second Hospital of Tangshan from December 2003 to April 2019. Minimally invasive osteotomy was performed in 16 patients [group A: 16 males with an age of (37.1±8.3) years; 5 cases of type Ⅱ and 11 ones of type Ⅲ by Gustilo classification], subperiosteal saw osteotomy in 57 patients [group B: 47 males and 10 females with an age of (39.1±11.8) years; 17 cases of type Ⅱ and 40 ones of type Ⅲ by Gustilo classification] and extraperiosteal wire saw osteotomy in 20 patients [group C: 19 males and one female with an age of (37.7±11.2) years; 18 cases of type Ⅱ and 2 cases of type Ⅲ by Gustilo classification]. The 3 groups were compared in terms of the bone healing index and the Association for the Study and Application of the Method of Ilizarov (ASAMI) functional scores.Results:The 3 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). All the patients were followed up for 19 to 50 months (average, 27.4 months). All patients achieved bony healing, and their associated complications were cured after corresponding treatments. There were no significant differences in the bone healing index between the 3 groups [(53.09±21.88) d/cm for group A, (59.97±33.29) d/cm for group B and (46.20±14.11) d/cm for group C] ( P>0.05). There were no significant differences either in the good to excellent rate by the ASAMI functional scores between the 3 groups (87.5% for group A, 89.5% for group B and 90.0% for group C) ( P> 0.05). Conclusion:All the 3 osteotomy methods may achieve good bony union, leading to similar bone healing indexes and postoperative functional scores.
ABSTRACT
Objective@#To investigate the effect of repairing the skin and soft tissue defects of foot with the anterior tibial artery perforator flap.@*Methods@#Nine patients received the operation using the anterior tibial artery periosteal perforator flap to repair distal foot lesion with skin and soft tissue defects.There were six males and three females.All cases were the distal foot defects of skin and soft tissue with tendon and bone exposure, including traffic accident injury in 5 cases, crush injury in 3 cases, other causes of injury in 1 case. The defects ranged from 5 cm×3 cm to 9 cm×6 cm. The flaps ranged from 7 cm×5 cm—11 cm×8 cm. The donor sites were repaired with direct suture or full-thickness skin grafts.@*Results@#All the flaps were survived, without vascular crisis, congestion and blisters. 1 case had partial necrosis of flap margin, which was cured after dressing. All cases were followed up for 6 months to 34 months(mean 18 months). The appearance and function recovery of flaps were satisfactory.@*Conclusions@#It is an ideal flap donor site for repairing soft tissue defects of the distal foot with the anterior tibial artery perforator flap, which has the advantages of simple operation, less trauma, high skin flap survival rate and good appearance.
ABSTRACT
Objective To summarize the cutaneous branches of the superficial branch of radial artery distribution were dissected and to discuss the operational technique and clinical efficacy of repairing hand tissue defect by the flap based on the superficial branch of radial artery.Methods From May,2014 to February,2017,8 fresh hand specimens perfused with red latex to observe the distribution and characteristics.And 24 cases of fingers tissue defects (3 thumbs,6 index fingers,5 middle fingers,9 ring fingers,and 1 litter finger) which were repaired with the free wrist crease flap based on the cutaneous branches of superficial palmar branch of the radial artery.Combined fracture in 5 cases.Combined rupture or defect of the flexor tendon in 8 cases.Combined vascular nerve injury in 6 cases.The maximum area of the flap was 5.5 cm × 3.2 cm,and the minimum was 2.0 cm × 1.5 cm.Regular followedup was performed after operation.Results Superficial palmar branch of the radial artery came from the level of radial styloid process ulnar palmar then through ulnar of tubercle of scaphoideum and tended to the thenar muscle.It gave 1-3 branches of the direct skin perforators at distal wrist crease and the anatomical location was constant.The vascular pedicle length could achieve 2.0-3.2 cm.All flaps were survived uneventfully.Twenty-four cases were followed-up for 6-29 months (mean,18.6 months),and the appearance and functional recovered satisfactorily.Flap sensation recovered to S3+.The 2 point discrimination was 8-13 mm.There was no complication in donor area.According to the fingers total active motion (TAM) method to assess:excellent in 17 cases,good in 5 cases,fair in 2 cases.The excellent and good rate was 91.7％.Conclusion The wrist crease cutaneous branches of superficial palmar branch of the radial artery anatomical location is constant.And the flap based on the artery has a reliable blood supply.The vascular pedicle flap is long enough and the operational technique is easy and safe.The postoperative effect is satisfied.It is an ideal method for repairing finger tissue defect.
ABSTRACT
Objective To contrast and compare two surgical treatments for mucous cysts of the distal interphalangeal joint.Methods Clinical data from April 2004 to January 2016 were retrospectively analyzed.Patients who underwent tumor excision,osteophyte excision,and local flap coverage were assigned into a flap group(n=16),while patients who received osteophyte excision,cyst pedicle resection,and cystic fluid drainage were assigned into a simple osteophyte resection group(n=17).Procedure time,pain,satisfaction score,and hand function were compared between the two groups.Results Patients in the flap group were followed up for 14 to 28 months(mean=19.5 months);the simple osteophyte resection group for 15 to 26 months(mean=20.5 months).There was no recurrence in either group.The rate of excellent efficacy was 81.25 ％ (13/16)for the skin flap group and 82.35 ％ (14/17) for the simple osteophyte resection group,and the difference was not statistically significant(x2=0.007,P ＞ 0.05).Pain relief was achieved in both groups after operation,and the postoperative satisfaction score was higher than the pre-operation score.There was no statistical difference in pre operation pain and satisfaction scores (t 0.14 and 0.35,both P ＞ 0.05),no statistical difference in postoperative pain scores(t =-0.09,P ＞ 0.05),but a statistically significant difference in postoperative satisfaction scores (t =-4.15,P ＜ 0.05) between the two groups.Conclusions Two surgical treatments of mucous cysts can achieve satisfactory aesthetic and clinical outcomes.The simple osteophyte resection method is characterized by a short procedure time and a high level of postoperative satisfaction,but it requires training in microsurgery.Local flap coverage is simple and suitable for lower level hospitals where staff surgeons may lack microsurgical skills,but it may result in certain minor injuries.
ABSTRACT
Methods@#To explore the transplantation of flow-through anterolateral thigh flap combined with fibular flap for reconstruction of composite tissue defect at leg.@*Method@#12 cases with leg composite tissue defects were reconstructed by flow-through anterolateral thigh flaps combined with fibular flaps. The skin defects ranged from 6 cm×12 cm to 12 cm×20 cm. The bone defects were 4-10 cm in length.The size of flow-through anterolateral thigh flaps was 14 cm×8 cm to 23 cm×13 cm and the fibular osteocutaneous flaps were 6 cm×4 cm to 12 cm×6 cm. The fibular bone was harvested as 7 cm to 13 cm in length.@*Results@#All the flaps survived in 12 cases. Bony reunion was achieved in all the cases. Vascular crisis happened in 2 cases 1 day after operation. Margin necrosis occurred in distal end of one flap, which healed after dressing. All the flaps had soft texture with satisfactory cosmetic and functional result . There was no complication in donor sites.@*Conclusions@#Flow-through anterolateral thigh flap combined with fibular flap can reconstruct soft tissue defect and bone defect simultaneously. It is the ideal method for leg composite tissue defects.
ABSTRACT
Objective@#To investigate the clinical effect of reconstruction of bone defects of forearm using free vascularized fibular grafts(VFG).@*Methods@#22 patients with bone defects of forearm were treated with free VFG. 6 cases with upper limb bone and soft tissue defects were repaired with free vascularized osteoseptocutaneous fibula as a composite flap. The length of ulna defect ranged from 4 cm to 12 cm and radius defect from 5 cm to 14 cm. The length of harvested fibula ranged from 13 cm to 24 cm. The area of the skin flaps ranged from 12 cm×6 cm to 20 cm×11 cm.@*Results@#All graft bone achieved bone union, with the healing time from 3 to 6 months (mean, 4.5 months). The operation incision healed primarily and all flaps survived with soft texture. All patients were followed up for 12-26 months (mean, 20.5 months). The function of forearm was recovered without refracture. The movement of ankle and the sensation in the leg were normal. According to the Anderson standard at last follow-up visit, the results were excellent in 9 cases, good in 11 cases and fair in 2 cases, with an excellent and good rate of 90.9%.@*Conclusions@#Vascularized fibular grafts VFG is an effective method to repair bone defects of forearm.
ABSTRACT
Objective To discuss the effectiveness of anterolateral thigh propeller flaps for treatment of inguinal skin and soft tissue defects.Methods From June,2009 to October,2014,12 patients with inguinal skin and soft tissue defects were treated with anterolateral thigh propeller flaps pedicled with perforator of descending branch of lateral circumflex femoral artery.Of them there were 8 males and 4 females,aged from 22 to 51 years.The left side was involved in 3 cases and right side 9 cases.Defects were caused by traffic accident injury in 5 cases,crash injury of heavy object in 7 cases.There were mere skin and soft tissue in 2 cases,combined with bone fractures,nerves,vessels and muscles injury in 10 cases.The area of defects ranged from 9.0 cm×5.0 cm to 22.0 cm×9.0 cm.During operation,anterolateral thigh propeller flaps ranging from 11.0 cm×7.0 cm to 24.0 cm×1 1.0 cm were used to repair the wounds.Results All flaps and skingrafts survived after operation and the wounds obtained primary healing.After 8-24 months follow-up,all flaps were characterized by soft texture,good color,and satisfactory appearance.According to the Britain's Medical Research Council at 8 months after operation,the sensation of the flaps were recovered to S2 ～ S3+,No obvious scar contracture and chromatosis were observed at donor site.Conclusion Anterolateral thigh propeller flaps pedicled with artery descending branch of lateral circumflex femoral perforator is an ideal choice for the reconstruction for inguinal skin and soft tissue defects.
ABSTRACT
Objective To study the first metacarpal dorsal artery anatomy,and explore the flap based on the branch chain of the first metacarpal dorsal artery.To provide anatomical basis for clinical application of the flap.Methods The origin,courses and distribution of the branch chain of the first metacarpal dorsal artery from 8 fresh hand specimens perfused by red latex were explored from January,2015 to December,2016.Results There was a dorsal artery network in the dorsal side of the first metacarpal.The radial and ulnar dorsal artery of the first metacarpal originated from the radial artery and along the first metacarpal lateral margin to go down.The initial diameter of the radial dorsal artery was (0.82±0.06)mm.The initial diameter of the ulnar dorsal artery was (0.74±0.05) mm.And anastomosed with the dorsal branches of the thumb inherent arteries.The both inherent arteries of thumb give off dorsal branches count (2.62±0.34).The initial diameter of proximal dorsal branch was (0.32±0.03) mm.The initial diameter of distal dorsal branch was (0.24±0.08) mm.Conclusion The radial and ulnar dorsal vascular chain of the first metacarpal were constant.The anastomosed branches with the dorsal branches of the thumb inherent arteries were abundant.The free flap or retrograde flap based on the vsscular chain has reliable blood supply.And without destroyed the main artery of thumb.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the effect of dorsalis pedis parallel flaps in repairing perforating skin and soft tissue defects of the palms.</p><p><b>METHODS</b>Eighteen patients with perforating skin and soft tissue defects of the palms were hospitalized from July 2008 to November 2010. The area of skin defect ranged from 2.0 cm x 1.5 cm to 5.0 cm x 2.5 cm. The dorsalis pedis parallel flaps were used to repair these defects, with the area ranging from 2.0 cm x 2.0 cm to 5.5 cm x 3.0 cm. The donor sites were covered with autologous full-thickness skin from inner thigh.</p><p><b>RESULTS</b>All the 18 flaps and skin grafts of donor sites survived completely. Seventeen patients were followed up for 6 to 23 months, with mean time of 10 months, and one patient was lost to follow-up. The texture, elasticity, and appearance of all the 17 flaps were satisfactory, with no obvious pigmentation or cicatricial contracture. At the last follow-up, the distance of two-point discrimination of flaps ranged from 6 to 9 mm, with mean distance of 7.4 mm, and the sensation of flaps reached S3 in 13 patients who had nerve anastomosis.</p><p><b>CONCLUSIONS</b>The dorsalis pedis parallel flap, with reliable blood supply and flexible design, is a good choice for repairing perforating skin and soft tissue defects of the palms.</p>
Subject(s)
Humans , Male , Middle Aged , Young Adult , Contracture , Foot , General Surgery , Hand Injuries , General Surgery , Plastic Surgery Procedures , Methods , Skin , Skin Transplantation , Soft Tissue Injuries , General Surgery , Surgical Flaps , Treatment Outcome , Wound HealingABSTRACT
<p><b>OBJECTIVE</b>To investigate the hemodynamics evidence of the descending branch of lateral circumflex femoral artery in a reversed way. To explore the clinical result of using the reversed descending branch of the lateral circumflex femoral artery as the receipt artery for free flaps for reconstruction of the leg soft-tissue defect.</p><p><b>METHODS</b>From October 2005 to February 2012, 38 patients with severe leg soft-tissue defects were treated. The proximal antegrade and retrograde mean artery pressure of the descending branch of the lateral circumflex femoral artery in 16 of 38 patients were recorded during operation. All wounds had osteomyelitis, bone and tendon exposure requiring coverage reconstruction. And there was no recipient artery in the injured lower leg for free flaps in all 38 patients. Reversed descending branches of lateral femoral circumflex arteries were used as recipient arteries for free flaps (free latissimus dorsi flap, free thoracoumbilical flap, and free anterolateral thigh flap) in all patients. The flap donor site was closed directly or with the skin graft.</p><p><b>RESULTS</b>The proximal antegrade mean artery pressure of the descending branch of lateral circumflex femoral artery was(81.6 +/- 12.4) mmHg. The proximal retrograde pressure was(48.2 +/- 10.7) mmHg. The proximal retrograde mean artery pressure was 59.07 percent of the proximal antegrade pressure. The donor skin graft survived and wound healed primarily. After operation, 2 flaps had distal partial necrosis and healing was achieved after dressing change. All the other flaps survived completely without vascular problems. All the patients were followed up for 11 months to 2.5 years (mean, 1.6 years). The flap appearance was satisfactory. The texture and color of flaps in all cases were good.</p><p><b>CONCLUSIONS</b>The reverse descending branch of lateral circumflex femoral artery is a reliable recipient artery for the free flaps. It is an easy and simple technique that can be used for reconstruction of the defects in the lower leg, with the reversed descending branch of lateral circumflex femoral artery as recipient artery.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Blood Pressure , Femoral Artery , General Surgery , Free Tissue Flaps , Hemodynamics , Lower Extremity , Wounds and Injuries , Soft Tissue Injuries , General SurgeryABSTRACT
Objective To investigate the application and clinical result of treatment soft tissue defect in the lower leg after severe trauma by using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery for free flaps.Methods Twenty-three patients with soft tissue defect of the lower leg after severe trauma from February 2007 to October 2012 were retrospectively analyzed.The patients were treated with the free flaps (the latissimus dorsi flap or the anterolateral thigh flap) using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery.There were 14 males and 9 females,with an average age of 31.7 years (range,22-49 years).The causes of injury were traffic accidents in 12 cases,crushing injury in 8 cases,and machinery injury in 3 cases.The defect located at the proximal in 4 cases,the proximal and middle in 12 cases,middle and distal in 7 cases.Sizes of the tissue defect were 14 cm×5 cm to 32cm×12 cm,and the flap sizes were 15 cm×7 cm to 34 cm×13 cm.The donor defect was closed directly or resurfaced with a splitthickness skin graft taken from the thigh.Results Twenty-three flaps survived completely.Partial necrosis at the distal edge of the flap occurred in one case,and was healed by secondary intention.No patient needed urgent operative revision due to postoperative thrombosis of the vessels.All flaps completely survived,without evidence of postoperative insufficiency of the blood supply or venous congestion.The donor skin graft survived and the incision healed by first intention.The mean follow-up period was 12.4 months (range,6-21 months).The appearance,texture,color and thickness of flaps in all cases were good at the last followup.The flap achieved protective sensation with the two-point discrimination ranging between 10-25 mm.Conclusion Due to the advantages of reliable blood supply,short treatment cycle,and without postoperative forced position,the reversed descending branch of the lateral circumflex femoral artery of the injured leg can be an ideal choice as the recipient artery for free flaps in repairing the soft tissue defect in the lower leg after severe trauma.
ABSTRACT
Objective To discuss the clinical outcome of the modified super large dorsal metacarpal artery flap in reconstruction of circumferential fingertip avulsion. Methods Twenty-four patients with circumferential fingertip avulsion were treated by the modified super large dorsal metacarpal artery flap from January 2004 to August 2008. There were six index fingers, 11 middle fingers, five ring fingers and two little fingers with surface defects beyond the distal interphalangeal joint and the distal degloving length ranged from 0.8 cm to 3.1 cm. Emergency operation was performed on 22 fingers and stage Ⅱ surgery was done for distal skin necrosis of two fingers. Results Twenty-one patients with 21 fingers were followed up for 6-28 months, which showed that all flaps survived, with satisfactory appearance and function, and that the point discrimination of flap was for 6-9 mm ( average 7.6 mm). Conclusion Modified super large dorsal metacarpal artery flap is an ideal method for reconstruction of the circumferential fingertip avulsion with advantages of easiness, convenience and short treatment period.
ABSTRACT
Objective To investigate the operative procedure and the clinical result of the modified rectangle cross-finger flap based on the dorsal branches in the middle phalange to repair degloved avulsion of fingertip.Methods From January 2006 to March 2010,26 patients with the avulsions of fingertip were treated by the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange of adjacent finger.There were 21 men and 5 women,with an average age of 31.6 years(range,17-56 years).Fourteen cases were crushed by machine,8 cases were pressed and 4 cases were tied.There were 8 index fingers,9 long fingers,4 ring fingers and 5 little fingers.The length of the avulsion was 1.1-2.6 cm.The flap was harvested from the dorsal of contiguous digital of their middle and proximal segment.The both dorsal branches of the both proper palmar digital nerves were cut off and were anatomized with the nerve end of the injured digit.The area of flaps ranged from 3.6 cm×2.3 cm-6.5 cm×3.2 cm.The donors were closed by skin graft.Results The pedicels were cut when 13-23 d after operation.Twenty-five patients were followed up for 6-28 months(mean,16.3 months).All flaps survived with satisfactory appearance,sensation and function.All flaps and donors were primary healing.Two point discrimination was 6-9 mm with an average of 7.8 mm.The postoperative outcomes were evaluated by the total active movement.The results were excellent in 17fingers,good in 7,and fair in 1.The rate of excellent and good was 96%.Conclusion The treatment of degloved avulsion of fingertip with the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange is recommendable.The operative procedure of harvesting the flap is simple.There is enough blood to supply the flap and the surviving rate is high.The postoperative function of the injured hand can be recovered satisfactorily.The figure of flap is well and the sense of flap is sensitive.The technique can be operated in the last 4 fingers without thumb.
ABSTRACT
Objective To discuss the treatment and clinical efficacy of repair of soft tissue and nerve defect of thumb with island flap of first dorsal metacarpal artery based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve.Methods The skin and nerve defect in 14 thumbs were repaired by dorsal island flap of index fingers based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve.The size of skin defect ranged from 52 mm × 32 mm to 10 mm × 8 mm.The length of the nerve defect ranged from 9 mm to 22 mm.Results The average followup was 6-35 months.All 14 flaps survived with satisfactory appearance and function.The injured side of thumb pulp sensation recovered S3 + and the injured two-point discrimination ranged from 4 mm to 7 mm.No scar contracture or sensory dysfunction complication were observed in the donor sites.Conclusions The repair of soft tissue and nerve defect of thumb with dorsal island flap of index finger based on the first dorsal metacarpal artery carrying dorsal branch graft of digital proper nerve is recommendable,since it can obtain satisfactory clinical efficacy and be easily and conveniently oerformed.
ABSTRACT
Objective To study the lateral branch of thoracodorsal nerve and the deltoid branch of axillary nerve under microscope for clinical application in the reconstruction of brachial nerve injury. Methods 31 lateral branches and deltoid branches of axillary nerve on 17 cadaver specimens were studied on topography under the light microscope(? 5) to observe the length, diameter, and the number of branches. The number of fibers was counted on the HE- stained section of the nerves. Three cases were performed: In operationⅠ , the lateral branch of thoracodorsal nerve was connected with the deltoid branch of axillary nerve. In operationⅡ , on the base of the first operation, the medial branches of the thoracodorsal nerve partially the latissimus dorsi was reconstructed for recovery of the flexion function of the elbow. In operationⅢ , the latissimus dorsi was section into two parts according to the innervation of the medial and lateral branches of the thoracodorsal, and the two branches of the thoracodorsal were transplanted in a dislplaced position for the restoration of flexion function of the elbow and the fingers. Results Thoracodorsal nerves have 2 branches near dorsal aspect of the latissimus dorsi. The lateral branch is thicker with the average length of 58.2 mm avaliable for the reconstruction purpose; the diameter is in average of 1.46 mm, the number of fibers is in average of 1 519; 90.4％ of the lateral branches redivided into 2 or 3 branches. The diameter of the deltoid branch of axillary nerve is 2.31 mm in average and 61.3％ give 3 branches; 32.3％ 2 branches; the number of fibers is in average of 2 341. Clinically the reconstruction operation is successful. In operationⅠ the strength of the deltoid muscle recovered to grade 4; in operationⅡ the strength of the deltoid muscle and elbow- flexing is reached grade 4 and in operationⅢ the strength of elbow- and finger- flexion recovered to grade 4. Conclusion Reconstruction of two muscular groups of the latissimus dorsi with loss of nerve innervation is effective by the application of double branch potential of the thoracodorsal nerve.