ABSTRACT
Objective To discuss the clinical effects of the many kinds of combined skin flaps of foot which used for repairing of many places and polymorphous skin defects of hands.Methods This study included 18 patients (15 male and 3 female) with a mean age of 32.6 years (range 15-56 years) between September 2003 and January 2012.The skin defect of hand were 2-3 places and the size of the defect ranged 1.5 cm × 2.0 cm-2.5 cm × 13.0 cm.All of them with bones and tendons exposure or defect.These 18 patients with many places and polymorphous skin defects of hands were treated with combined anterosuperior malleolusdorsalls pedis flaps (6 cases),three-leaf flap of dorsum of foot (2 cases),combined the first dorsal metatarsal artery island flap and toe back flap (5 cases)and combined toe back flaps (5 cases).Meanwhile,deep peroneal nerve was used to repair defect of digital nerve or dorsal digital nerve and long extensor tendon of toes was used to repair digital flexor tendon or digital extensor tendon.Results Eighteen patients with 32 flaps survived.In the follow-up of 4 months-2 years,the fingers and skin flaps were in good shape and normal color.The sensation of the hands of the patients with nerve repaired was restored to S2-S3 and the two-point discrimination was 8-10 mm.The motor function of the hands of the patients with tendons repaired was good,which can be competent to daily life and work.Conclusion Many kinds of combined skin flaps of foot were used to repair many places and polymorphous skin defects of hands.
ABSTRACT
Objective To investigate the outcome of the free double-skin paddle string-type composite fibular flap in the reconstruction of the combined defects of ulna and radium. Methods From June 2005 to July 2009, 5 cases with combined defects of ulna and radium were reconstructed using the free double-skin paddle string-type composite fibular flap. The length of fibular segment for the reconstruction of ulnar defect ranges from 4.5 to 7.5 cm. The length of fibular segment for the reconstruction of radial defect ranges from 5.5 to 7.0 cm. The size of the flap varies from 5.0 cm × 3.0 cm to 8.0 cm × 5.5 cm. At the 12 month follow-up, the function of reconstructed forearm was evaluated based upon Enneking scoring system.Results Ten flaps in the 5 cases all survived. The time for the transplanted fibula healed on the radium and ulna was 4-6 months. The 5 patients were followed up from 14 months to 2 years. The forearm rotation functions were excellent in 2 cases, good in 2 cases and poor in 1 case. The eligible rate was 80%. The average Enneking score was 24.8, which indicated an average of 81.3% recovery of limb function. Conclusion Bone graft with blood supply can ensure the activity of osteocytes, which facilitates the fracture union.Whilst, the procedure can reconstruct multi-location and multi-tissue defects in the forearm. Therefore, the double-skin paddle string-type composite fibular flap is an ideal alternative for the reconstruction of the combined defects of ulna and radium and the skin.
ABSTRACT
Objective To investigate the clinical outcome of the feasible method of the free string type dorsalis pedis flap and anterior malleolus flap in the repairement of skin defects caused by penetrating wound of palm. Methods From May 2004 to July 2009, the free string-type dorsalis pedis flap and anterior malleolus flap were used to repair skin defects of 16 cases who sutained penetrating wounds of palm.Results All 32 flaps in the 16 cases were all survived. Follow-ups were done from 6 months to 2 years after operation. Both the appearances of the repaired palms and the functional recovery were satisfactory. The function assessment of the hand was excellent in 8 cases, good in 5 cases, fine in 2 cases and poor in 1 case.The eligible rate was 81.25%. Conclusion The anatomy of the dorsalis pedis flap and anterior malleolus flap is rare variant, which facilitate the dissection of the flaps during operation. The repairement of skin defects at two sides, both the palm and the back of hand, can be achieved via one operation. Therefore, the free string type dorsalis pedis flap and anterior malleolus flaps offer an ideal procedure to repair skin defects secondary to penetrating wound of palm.