ABSTRACT
Objective:To investigate the clinical effect of free deep femoral artery third perforating flap repaired soft tissue loss after Pilon fracture surgery in I stage.Methods:Fifteen patients were treated from April, 2013 to January, 2020. Miller AO classification: 8 cases 43-C1, 4 cases 43-C2 and 3 cases 43-C3. All cases were accompanied with severe soft tissue contusion and skin necrosis. After fracture reduction, soft tissue defects, internal fixation exposure and tendon exposure around the wound. Free deep femoral artery third perforating flap (3.5 cm ×15.5 cm to 5.5 cm×12.5 cm) for the repair of soft tissue defects around ankle in the I stage, the blood vessels of the flap were end-to-side anastomosed with vessels of the posterior tibial or anterior tibial. Regular follow-up after surgery.Results:One case of venous crisis occurred, other 14 cases survived, were followed-up from 5 to 18 months, the ankle joint function was good, did not affect the foot shoes, with excellent color and texture, the flap restored protective sensation, and leaving only linear scar, no muscle adhesion.Conclusion:Free deep femoral artery third perforating flap repaired soft tissue loss of surgical incision after fracture operated than significantly reduce the postoperative fracture infection and protect the blood supply around the fracture. It is an effective method of repair.
ABSTRACT
Objective To present the therapeutic effect of the free bilobed posterior interosseous flap for soft tissue reconstruction of two fingers.Methods According to the distance between the defects of two adjacent fingers,combining the cutaneous branches of different regin,the free bilobed flaps pedicded with posterior interosseous artery were applied for soft tissue reconstruction of 20 fingers in 10 patients.The defects of digits was on thumb and index( 1 case),index and middle(2 cases),middle and ring(4 cases),ring and little (3 cases).The size of defect was ranged from 2.5 cm × 2.0 cm to 9.5 cm × 3.0 cm.The size of single flap was from 3.0 cm × 2.5 cm to 10.0 cm × 3.5 cm.Results The flaps on 19 fingers were completely survived and the flap on 1 finger had the pointed end necrosis which healed by dressing changing.After 6 to 22 months (the average was 13.8 months ) followed-up visit,all flaps were with excellent colour and texture.The flaps in 8 cases were thin and the flap in 2 case was a little thick.Eight single flaps in which the cutaneous nerve was sutured recovered 2-PD of 10 to 15 mm (the average was 12.8 mm).There was no affection in motor function on donor site of all cases.Conclusion The free bilobed posterior interosseous flap is the valuable option for two fingers soft tissue reconstruction and it can achieve the cosmetically and fuctionaly acceptable result with low morbidity on donor site.
ABSTRACT
Objective To investigate the effect of repairing soft tissue defects in the middle and distal phalanx with the reverse dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery. Methods Twenty-five fingers with soft tissue defects in the middle and distal phalanx were repaired by the reverse dorsal metacarpal and digital fasciocutaneous flaps based on the dorsal cutaneous branches of the proper digital artery from June 2007 to June 2009. Their pivot points were located at the midpoint or distal segment of proximal phalanx. Results Among 25 flaps, 24 survived completely, but cuticular layer in the distal part of one flap was partially necrotic. Twenty flaps were followed up from 12 to 18 months after operation. All flaps were characterized by rich blood supply, cold-resistance, suitable thickness, soft texture and good colour, except that 6 flaps required a secondary operation because of their fat and clumsy pedicel. There was no adhesion of extensor tendon and contraction of interdigital web in the donor sites. Two-point discriminations of anastomosing cutaneous nerve ranged from 6 mm to 10 mm in 5 of the 20 flaps, and 8 mm to 14 mm in the other 15 flaps. Conclusion The dorsal metacarpal and digital fasciocutaneous flap based on the dorsal cutaneous branches of the proper digital artery is an ideal option for repairing soft tissue defects of middle and distal phalanx because of its advantages of easy and secure dissection, reliable blood supply, longer arch of rotation, being closer to the raw surface of finger, less injury to the donor site, good appearance, avoidance of sacrificing major arteries ,and high probability of reconstructing flap sensation by anastomosing cutaneous nerve.