Application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar.</p><p><b>METHODS</b>The proximal end of the plantar fasciocutaneous perforator flaps were at the edge of defects. The deep fascia was cut off at the both sides of flaps. The plantar fascia should be included into the flaps. Then the flaps were rotated to cover the defects, containing two or three perforators. If necessary, the original supplying vessels could be cut off to facilitate the advancement of flaps.</p><p><b>RESULTS</b>From Jan. 2010 to Oct. 2012, 7 cases with plantar defects were treated with the horn shaped perforator flaps. The defects size ranged from 1.5 cm x 2.0 cm to 4.0 cm x5. 0 cm with the size of the flaps ranging from 7 cm x 3 cm to 13 cm x 7 cm. All the flaps survived completely with primary healing both on donor and recipient sites. The flap color, texture, function and appearance were satisfactory during the follow-up period of 3-24 months.</p><p><b>CONCLUSIONS</b>The plantar horn shaped perforator flap can reconstruct the defects at plantar weight-bearing area with the similar thick skin tissue, which facilitates the functional reconstruction. No skin graft is necessary for the defect at donor site.</p>

The application of the horn shaped fasciocutaneous flap in lower leg / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the application of the horn shaped fasciocutaneous flap for the middle or small defect of low leg.</p><p><b>METHODS</b>Between April 2008 and November 2010,12 cases were covered the defects with horn flap in the leg, in which 4 cases were male, and 8 cases were female, such as squamous cell carcinoma, basal cell carcinoma, angioneoplasm, trauma and so on. Surgical repair of tissue defect size of about 3 cm x 3 cm-5 cm x 5 cm.</p><p><b>RESULTS</b>Twelve cases were treated. Vascular deficiency happened at the distal end of one flap. All the other 11 flaps survived. The appearance and functional results were satisfactory with following up for 6 to 24 months.</p><p><b>CONCLUSIONS</b>The horn shaped fasciocutaneous flap is simple, reliable, easy to perform, has a low complication rate, is cosmetically acceptable</p>

Application of modified peroneal tendofascial compound flap with partial tendon of peroneal long muscle in lower leg refractory defects with Achilles tendon rupture / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of using modified peroneal tendofascial compound flap with partial tendon of peroneal long muscle in lower leg refractory defect with Achilles tendon rupture.</p><p><b>METHODS</b>Based on the application experience of peroneal tendofascial compound flap for lower leg refractory defects, partial tendon of peroneal long muscle was included in the flap to repair the Achilles tendon rupture.</p><p><b>RESULTS</b>6 cases were treated. The maximum size of modified compound flap reached 5 cm x 5 cm. The maximal included tendon in the flap was 5 cm in length. All the flaps survived completely. Partial epidermis necrosis happened in one case between the skin graft at the donor site and the edge of the flap pedicle. The patients were followed up for 5 months to 2 years with satisfactory cosmetic and functional results.</p><p><b>CONCLUSIONS</b>The modified compound flap has reliable blood supply and can be easily transposed, leaving less morbidity at the donor site. It is very suitable for lower leg refractory defect with the Achilles tendon rupture.</p>

Application of modified reversed neurovascular flaps nourished by cutaneous nerve-superficial vein in lower extremity / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application and therapeutic effect of modified neurovascular flaps nourished by sural nerve and small saphenous venous, or saphenous nerve and great saphenous venous.</p><p><b>METHODS</b>According to the anatomy and recipient area, we made some modifications for the two neurovascular flaps. 1) The small and great saphenous venous were ligated or anastomosed with the venous in recipient area; 2) The flap was delayed for 8 - 14 days if the donor area was above the middle and upper one third of leg; 3) The sural nerve and its branch were anastomosed to the nerve in recipient site to restore the sense of flap; 4) the lower turning point could be designed just 3 cm above the point of internal and external malleolus; 5) Partial gastrocnemius or soleus muscle could be included in the flap if needed; 6) Reversed cross leg flap was considered if the adjacent flap in the affected side could not be used. Sometimes, we adopted more than one modification in one patients.</p><p><b>RESULTS</b>From Sep, 1994 to Apr, 2007, 63 cases were treated, including 51 cases of sural and 12 cases of saphenous neurovascular flaps. Partial necrosis (about 1 - 2 cm width) happened in the distal end of flaps in 2 cases which healed after dress changing. The patients were followed up for 3 months to 2 years with satisfied functional and cosmetic results.</p><p><b>CONCLUSIONS</b>These two modified flaps have reliable blood supply and survival rate. The operation is easily performed and very practical. The flaps, or combined with other methods can repair about 70% of the refractory defects in legs.</p>

Anatomic study of peroneal tendofascial flap combined with adipofascial flap for the repair of heel tissue defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the anatomy of peroneal tendofascial flap combined with adipofascial flap for the repair of heel tissue defects.</p><p><b>METHODS</b>The lower extremities of five cadavers (10 sides) were perfused with red latex, the blood supply of peroneal tendofascial flap and vicinity adipofascial flap were observed. The diameter, course, branches and location of the blood vessels were measured. Eight fresh cadavers (16 sides) were perfused with lead oxide-gelatine mixture. The covering fascia tissues of the lower extremities was obtained and photographed by X-ray. The vascular anastomosis and association of nutrient vessel of peroneal tendofascial flap and vicinity adipofascial flap were observed. Two adult lower extremities specimens (4 sides) were used to construct vessel diagrams for observation of the course, distribution and anastomosis of the vessels. Eight cases were treated successfully with theses flaps.</p><p><b>RESULTS</b>The blood supply of the combined fascial flap is multi-originated. For the area within 4 cm below and above the lateral malleolus cusp, the blood supply includes 2-5 branches from heel lateral artery with an average diameter of (0.5 +/- 0.2) mm, 1-2 branches from posterior lateral malleolus artery with an average diameter of (0.6 +/- 0.2) mm and 2-3 branches from the descending part of perforating branches of peroneal artery with an average diameter of (0.5 +/- 0.2) mm. The blood supply of area 4 cm above lateral malleolus cusp is 1-3 branches from intermuscular septum perforating branches of peroneal artery with an average diameter of (1.0 +/- 0.2) mm. These above branches are anastomosed each other and also send off many smaller branches to form vascular net around tendon. The fascial flaps and free skin grafts in eight patients were completely survived. All patients were followed up for 3-24 months, the donor and recipient sites were healed very well. The functional and cosmetic results were satisfactory.</p><p><b>CONCLUSIONS</b>Peroneal tendofascial flap combined with adipofascial flap, with proximal pedicle or reverse distal pedicle, can be used to repair the defect at the lower leg and refractory small- and medium-sized defects at the heel.</p>