Clinical effect of free fibular flap without vein of great toe in repairing soft tissue defect of finger pulp / 中华显微外科杂志

Objective:To investigate the clinical effect of free fibular flap of great toe without vein in repairing soft tissue defect of finger pulp.Methods:From June 2020 to January 2021, 8 cases of finger pulp soft tissue defect were repaired with free flap of fibular side of great toe without vein, including 6 males and 2 females, with an average age of 32(18-42) years old. The defect area of finger pulp was 1.0 cm×0.5 cm-1.8 cm×0.8 cm. The proper digital artery and digital nerve of the affected finger were anastomosed. All flaps did not carry reflux veins. The donor site of the toe was directly sutured. Postoperative routine anti infection, anti spasm and anticoagulant treatment was performed. Postoperative outpatient regular follow-up.Results:All flaps survived without vascular crisis, and the donor and recipient sites healed in the first stage. All patients were followed-up for an average of 6.4(4-12) months. At the last follow-up, the TPD was 6-8 mm, the hand function was evaluated according to the Trial Standard of Upper Limb Function Evaluation of Hand Surgery Society of Chinese Medical Association. Seven cases were excellent and 1 case was good.Conclusion:The free fibular flap of the great toe can be used to repair the small wound of finger pulp without carrying the draining vein, the flap can still survive. And it can provide a certain reference for the failure of anatomic separation of the draining vein.

Reconstruction of multiple metatarsus and soft tissue defects with fibular flap and fibular artery chimeric: A case report / 中华显微外科杂志

In May 2019, a patient who suffered with multiple foot metatarsus injury with soft tissues defect was treated in the Hand and Foot Microsurgery of Xi'an Fengcheng Hospital, by using chimeric peroneal artery for phase-1 reconstruction of metatarsus with folded fibular flap, foot cross arch and soft tissue defects. After 2 years, the arch of foot as intact without collapse. There was no arthritic lesions. The height, arc and width of metatarsus were very close to the healthy side. The flap and plantar were smooth without abrasion and ulceration. The patient could walk, run and stand with single-foot stand, and able to carry out heavy physical work continuously.

Application of fibular flap with partial continuous periosteum and cortex in hip preservation surgery for femoral head necrosis / 中华显微外科杂志

Objective:To investigate the short-term clinical effect of using fibular flap with preserving the continuity of fibula in hip preservation surgery for femoral head necrosis.Methods:From September, 2017 to November, 2020, 13 cases of femoral head necrosis were repaired with fibular flap. The fibular flaps were cut with an improved method for preserving the continuity of the fibular cortex, and the donor sites were sutured directly. The fibuls were inserted into the femoral heads with single or double segment folding support. Autogenous iliac crest combined with platelet-rich plasma(PRP) was used for impaction of bone grafting in femoral head, and the fibular flaps were anastomosed with 1 artery and 2 veins. All follow-up data were obtained, including bone union by X-ray and CT as well as the functional recovery of the hip joint and donor site. Statistical analysis was performed. P<0.05 was considered statistically significant. Results:The followed-up time ranged from 6 to 23 months. The fibular bones were significantly thicker and the incisions healed well at the donor sites. There was neither abnormal sensation in toes, dorsal foot, and lateral of the leg, nor significant influence on foot function. The hip joint activities were normal. The outcome was proved to be remarkable according to the Harris score(from 58.9±10.6 points before surgery to 81.7±10.6 points after surgery), the difference was statistically significant ( P<0.05) . Conclusion:The method of the improved fibular flap in hip preservation surgery is beneficial to the repair and reconstruction of the necrotic femoral head since the donor area is less traumatic, and a satisfactory clinical effect can be obtained.

Comparison of the effect of perforator flap of proper palmar digital artery and hallex fibular flap in repair of soft tissue defect of fingers / 中华显微外科杂志

Objective:To compare the clinical effect of perforator flap of proper palmar digital and hallex fibular flap in repair of soft tissue defect of fingers.Methods:A total of 52 patients with finger soft tissue injury were reviewed from January, 2017 to January, 2019. Twenty-seven patients were repaired by perforator flap of proper palmar digital artery, and 25 by hallex fibular flaps. Both groups of patients had only soft tissue defects without phalangeal fracture. Postoperative follow-up were conducted by phone, WeChat and visit of outpatient clinic. The recovery of finger sensory function was evaluated according to the Trial Standard for Replantation Evaluation of Severed Digit by the Hand Surgery Society of Chinese Medical Association. The flaps were evaluated according to the shape, patient satisfaction and finger function and classified in excellent, good, fair and poor. Data of the 2 groups of patients were collected and statistically analysed by SPSS 22.0. P<0.05 was statistically significant. Results:Both groups entered follow-up for 12-16 months. All flaps in both groups survived. There was statistically significant difference of TPD between the 2 groups[TPD were 4-7(5.3±1.2) mm and 6-10(8.4±1.7)mm, respectively]( t=7.642, P=0.000). According to the Evaluation Criteria of the Hand Surgery Society of the Chinese Medical Association. In the group repaired by perforator flap of proper palmar digital artery, 17 fingers were excellent, 6 good, and 4 fair, with a 85.1% of excellent and good rate. In the group repaired by hallex fibular flap, 8 fingers were excellent, 5 good, 9 fair, and 3 poor, with a 52.0% of excellent and good rate. The difference between 2 groups was statistically significant ( t=6.710, P=0.009). There was a 3.7% incidence of complications in the group repaired by perforator flap of proper palmar digital artery, and 25.9% in the group repaired by hallex fibular flap. The difference between the 2 groups was statistically significant( t=4.167, P=0.032), and there was a higher incidence of complications in the group repaired by hallex fibular flap. Conclusion:The perforator flap of proper palmar digital artery and the hallex fibular flap are good choices in the repair of finger soft tissue defect. However, the postoperative complication of the hallux fibular flap is relatively high. Therefore, it is necessary to make a decision in the choice of flap according to the actual situation in clinical work.

Postoperative position change of fibular bone after reconstruction of maxillary defect using free fibular flap / 北京大学学报(医学版)

OBJECTIVE@#To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change.@*METHODS@#Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress.@*RESULTS@#A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.

Use of partial nail carried by great toe fibular flap for repairing the defect of fingertip soft tissue and nail bed: 12 cases report / 中华显微外科杂志

Objective To investigate the method and clinical outcome of partial nail carried by great toe fibular flap for repairing the defect of fingertip soft tissue and nail bed.Methods From June,2016 to October,2017,12 cases suffered the defect of fingertip soft tissue and nail bed.The injury fingers included 5 index fingers,6 mindle fingers and 1 ring finger.All cases were complicated with nail bed defect of different degrees.The nail matrix was intact.The area of fingertip defect ranged from 1.0 cm×1.0 cm to 1.5 cm×2.5 cm.The area of nail bed defect ranged from 0.2 cm×0.8 cm to 0.5 cm×1.5 cm.Great toe fibular flap combine with partial nail was harvested.Donor site was directly sutured or skin grafting according to the size.The regular preoperative followed-up was performed.Results All flaps survived with donor sites healing good.The average followed-up time was 7 (ranging from 2 to 10) months,and cosmetically acceptable results were achieved for all patients.The mean static 2-PD in the flaps was 7.5 (range,6.0 to 8.0) mm.No obvious deformity of the great toe nail.Conclusion Findings proved that using partial nail carried by great toe fibular flap is a beneficial microsurgical alternative for reconstructing defect of fingertip soft tissue and nail bed.

Free cutaneous fibular flap combined with antibiotic-loaded artificial bone graft for the treatment of an-tibrachial osteomyelitis of Cierny-Mader type IV / 中华显微外科杂志

To investigate the effect and application value of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of antibrachial chronic osteomyelitis of Cierny-Mader type IV. Methods From August, 2013 to May, 2017, 12 cases of ulna or (and) radius chronic osteomyelitis of Cierny-Mader type IV were treated by transplantation of the free cutaneous fibu-lar flap combined with antibiotic-loaded calcium sulfate artificial bone graft. There were 7 males and 5 females, with an average age of 36.3 (21-47) years.Pure ulnar osteomyelitis in 7 cases, radius osteomyelitis in 4 cases, and both ul-nar and radius osteomyelitis in 1 case. The average range of osteomyelitis lesions was 6.3 (3.0-9.0) cm. The area of soft tissue defect (including bone scar) ranged from 8.0 cm×2.0 cm to 15.0 cm×5.0 cm. The area of the flap was 10.0 cm×3.5cm-17.0 cm×7.0 cm.The average length of the fibular flap was 8.8 (5.0-12.0) cm.Locking plate internal fixa-tion was used in 9 cases, external fixator in 2 cases, and plate combined with external fixator in 1 case. Vancomycin/gentamicin, an effective component of calcium sulfate artificial bone, averaged 0.64 g/102.7 kU (0.4 g/64 kU-1.0 g/160 kU).Routine postoperative treatment.And monthly outpatient review in the first half year after operation, and outpatient review every 3 months after half a year.One year after operation, comprehensive evaluation of elbow, forearm and wrist function with Mayo Elbow Function Index, Anderson Forearm Double Fracture Evaluation System and Cooney Wrist Function Score. Results Vascular crisis occurred in 1 case after operation, prompt surgical exploration, and ultimately all flaps survived completely.The donor sites healed well in all cases.The lower extremity functions of donor sites had no change compared with that before operation.Followed-up of an average of 22.7 months, there were 2 cases who had sen-sory disturbance in the ulnar nerve innervation area and returned to normal 3 months after operation. The fibular flaps healed satisfactorily with an average healing time of 4.7 (3-6) months.No calcium sulphate artificial bone granules were seen on X-ray at 3 months after operation.One year after operation, bone healing, forearm appearance and wrist function recovered well, but elbow and forearm motor function recovered unsatisfactorily. Conclusion On the basis of master-ing the applied anatomy and vascular anastomosis techniques of microsurgery, this method of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of an-tibrachial chronic osteomyelitis of Cierny-Mader type IV has achieved satisfactory results.The recipient area is beautiful. The bone healing is reliable.And it has little influence on the recipient area and the donor area.It is worthy of clinical application.

Application of digital 3D printing technology in repairing mandibular defects with a fibular flap / 口腔疾病防治

Objective@#To explore the application value of digital 3D printing technology for repairing mandibular defects with fibular flaps and to provide a basis for accurate repair mandibular defects.@*Methods@#Nine cases of mandibular defects were selected, and spiral CT and CTA of the lower limbs were performed before the operation. The osteotomy guide plate and plastic guide plate were created using computer software, and the titanium plate was rebuilt according to the printed mandibular model. During the operation, an osteotomy guide plate was used for mandibular resection; a fibula bone plastic guide plate was used to reconstruct the fibular flap and reconstruct the mandibular defects.@*Results@#The entire fibula flap survived, and the occlusal relationship was good. There was no complications in the donor site. The patients were satisfied with the appearance of the repair. All patients were followed up for 3 to 6 months, at which point the bone was basically healed.@*Conclusion@#Using a digital 3D printing technique to repair mandible defects with a fibular flap can shorten the operation time, reduce the risks of operation, and better restore the maxillofacial shape and the function of the jaw, which is consistent with the concept of appropriate medical treatment. Additionally, this process provides a better method for the treatment of mandibular defects.

Application of virtual surgical planning in the surgical treatment of osteoradionecrosis of mandible / 口腔疾病防治

Objective @#To analyze the value of virtual surgical planning in the surgical treatment of osteoradionecrosis of the mandible and to provide a reference for clinical practice.@*.Methods @#From September 2017 to June 2018, 13 patients with mandibular osteoradionecrosis were evaluated preoperatively using the 3D virtual surgery software CMF Proplan 2.0. The surgical guide was designed and 3D printed. Bone resection, fibula shaping and bone graft localization were completed during the operation. In some cases, implants were implanted at the same time, and denture restoration was completed 3 to 6 months after surgery. Patients’ general information, perioperative data, and efficacy evaluation were analyzed.@*Results@#All patients underwent surgery successfully. The survival rate of the free fibula musculocutaneous flap was 100% (13/13), and one patient had complications (partial necrosis at the edge of the flap). The follow-up period was 7 to 15 months, and the median time was 10 months. All patients achieved a healing effect. The number of cases with an increase in mouth opening ≥ 1 cm, 0.5 cm ≤ mouth opening increase < 1 cm, and mouth opening increase < 0.5 cm were 5, 6, and 2, respectively. An imaging examination showed that 12 patients had good bone healing, and 1 patient did not completely heal 7 months after operation. The denture restoration was 92.3% (12/13), of which 3 cases were implanted and repaired at the same time. The average chewing efficiency was 56.11% ± 7.12% (42.03%-67.83%).@*Conclusion@#Virtual surgical planning is an effective method for the surgical treatment of mandibular osteoradionecrosis, which can reduce the risk of surgery and more effectively perform mandibular shape and function repair.

A “Reverse” approach for the reconstruction of mandibular defect using fibular flap approach for the reconstruction of mandibular defect using fibular flap / 上海交通大学学报（医学版）

Objective: To design osteotomy templates for the construction of mandibular defect by using fibular flap in a reverse engineering technique approach. Methods: Five patients with mandibular defect were enrolled and their treatments were designed in a three-dimensional (3D) virtual planning software package. The 3D printing model with shaped reconstruction plate and titanium-screws were under CT scanning and the image was reconstructed and registered back to the original mandible and fibula in a surface-best-fit method. Then the osteotomy template with screw holes of shaped reconstruction plate was designed and fabricated. The reconstruction of mandible with multiple fibular segments was guided by the osteotomy template. Results: All the five patients were discharged successfully with satisfied outcome. The deviation between virtual plan and actual results were calculated: max deviation (3.53±2.33) mm and the angle deviation 3.31˚±1.48˚. Conclusion: The accuracy of the osteotomy template is satisfied and can be applied to the clinical use.

Study on the reliability of NIRS to monitor fibular flaps on Rhesus monkeys / 中华显微外科杂志

Objective To confirm the sensitivity and validity of near-infrared spectroscopy (NIRS) technology to detect the dynamic changes of blood volume and regional tissue oxygen saturation (rSO2).Methods Six fibular flaps on Rhesus monkeys were raised simulating a clinical operation.Third generation of NIRS oxygen saturation oximeter (TSAH-100) was employed on Rhesus monkeys' fibular flaps when its dominant artery and vein were blocked respectively or simultaneously,and then their relative changes of blood volume and oxygen saturation were observed and recorded in June,2008 to October,2008.Results The statistic results showed that concentration of deoxygenated hemoglobin (cHb),concentration of oxyhe moglobin (cHbO2) and rSO2 had rapid,apparent and distinct changes respectively in the case of arterial occlusion,venous occlusion and total occlusion.The initial values of cHb and cHbO2 of 3 models were 0 μmol/L.Meanwhile,the initial values of rSO2 in artery embolism,vein embolism and arteriovenous embolism were 51.6％,54.3％ and 56.8％,respectively.The maximum variations of cHb,cHbO2 and rSO2 in 3 models indicated significant difference compared with initial values (P＜0.05),the values of rSO2 after 6 s,18 s and 8 s in 3 models had significant difference compared with initial values respectively(P＜0.05).Conclusion The TSAH-100 based on NIRS technology is an extraordinarily sensitive and reliable method to monitor the changes of oxygen saturation and blood perfusion in local tissue for buried flap within a depth of 2.0 cm.

Rhabdomyolysis after the free fibular flap operation for mandibular reconstruction: a case report / 대한악안면성형재건외과학회지

BACKGROUND: Free fibular flap is one of the most useful methods in the hard tissue reconstruction of the maxilla-mandible. Free fibular flap presents some advantages in which the reconstruction of both soft and hard tissues can be done at the same time. It also provides a safe and successful bone graft for the reconstruction, along with a low rate of complications. Despite these advantages and the rarity of a postoperative complication, particularly in oral and maxillofacial surgery procedures, a prolonged operation might exhibit some complications related with rhabdomyolysis. We experienced the rare event of rhabdomyolysis after oral cancer surgery. CASE PRESENTATION: In this article, we report the case of a patient who developed rhabdomyolysis after undergoing free fibular flap surgery. CONCLUSIONS: Despite the advantages of the free fibular flap operation, clinicians must be aware of the risk of complications because there are multiple factors that could result in rhabdomyolysis, such as duration of operation, position of the subject, and pre-existing conditions of diabetes and hypertension. Once the diagnosis of rhabdomyolysis is confirmed, a prompt treatment plan should be made and applied as soon as possible. This will increase the chance of a full recovery for the patient who is exhibiting symptoms of rhabdomyolysis.

Reabilitação dentária e reconstrução mandibular com retalho microvascularizado de fíbula / Dental rehabilitation and mandibular reconstruction with microvascularized fibular flap

Introdução: O tratamento do ameloblastoma mandibular, um tumor odontogênico benigno, é controverso para suas variantes patológicas (uni ou multicístico). Curetagem e amplas ressecções ósseas ocasionam defeitos ósseos que comprometem estética e função do paciente. Relato de caso: Paciente 48 anos, gênero masculino, submetido à ressecção segmentar de mandíbula devido a ameloblastoma multicístico em região de sínfise e para sínfise foi reabilitado funcional e esteticamente com implantes dentários após reconstrução mandibular com enxerto ósseo microvascularizado de fíbula. Conclusão: O retalho microvascularizado de fíbula foi eficaz na reconstrução mandibular após ressecção de ameloblastoma e, quando associado a implantes dentários, permitiu reabilitação estomatognática e melhora estética significativas... (AU)

Introduction: Treatment of mandibular ameloblastoma, a benign odontogenic tumor, is controversial for its pathological variants (single or multicystic). Curettage and bone resections lead to large bone defects that compromise the aesthetics and function of the patient. Case report: Patient 48 years, male, underwent segmental resection of the jaw due to multicystic ameloblastoma in symphysis region. It was functionally and aesthetically restored with dental implants after mandibular reconstruction with micro- vascularized fibular bone graft. Conclusion:The microvascularized fibular flap was effective in mandibular reconstruction after amelobastoma resection and, when associated with dental implants, allowed stomathognatic rehabilitation and significant aesthetic improvement... (AU)

Application of vascularized fibular flap combined with vacuum sealing drainage in the repair of long tibia defect / 临床外科杂志

Objective To analyze the effects of vascularized fibular flap combined with vacuum sealing drainage (VSD) in the repair of tibia defect.Methods Clinical data of 24 patients with chronic osteomyelitis of the tibia who accepted the operation of vascularized fibular flap combined with VSD were collected in the study.In the first operation, the lesions were completely debrided and the dead bone was removed, then the vascularized fibular was replaced from the other limb to repair the tibia defect.Later, vacuum-assisted closure was applied to cover the wound.Results All patients enrolled in the study were followed up for 13 to 50 months, with an average of 32.3 months.The sinus of 22 cases healed in 4 weeks and the healing rate was 91.7%.The other two patients received additional debridement for the sinus and they also healed soon after that.All flaps survived and the survival rate was 100%.The X-ray showed that the transplanted fibula was healed in all cases, with a healing rate of 100%.The healing time ranged from 4 to 7 months, with an average of 4.9 months.Based on the Enneking scoring system, the patients achieved an average score of 26 points out of 30 points, and the recovery rate of limb function was evaluated as 86.7%.Conclusion For patients with chronic osteomyelitis of the tibia, vascularized fibular flap combined with VSD can not only effectively repair bone defect, but also restore the continuity of limbs.The application of VSD can effectively control infection, shorten treatment course, and restore limb function.

The clinical experience of treat long bone defect with vascularized fibular graft / 中华显微外科杂志

Objective To summarize the clinical experience of treating long bone defect with vascularized fibular graft.Methods From January,2008 to January,2015,31 cases of long bone defect were treated with vascularized fibula composite or not composite tissue flap graft.The length of transplanted fibula was 9-20 cm,and the flap area was 5 cm×3 cm to 21 cm×14 cm.All patients were followed up regularly.Limb function was assessed 12 months after surgery.Results Thirty-one cases of vascularized fibular flap survived after surgery.Thirty patients were followed up for 1.5 to 6 years (average,2.5 years).One patient was lost to follow-up.The bone defects of patients followed up were healed.There was one case fracture occurred for trauma,was treated with plaster cast for 6 months and healed.The transplanted fibular thickened for 1.3 to 2.5 years(average,1.6 years).Conclusion Vascularized fibular graft can reconstruct long bone defect for single use and shorten the duration of treatment with a good limb function.For cases combined soft tissue defect,vascularized fibula composite tissue flap can be applied to repair at the meantime.

The curative-effect observation for fibular flap synchronous repairing limbs composite tissue defects / 中华显微外科杂志

Objective To explore the curative effect of fibular flap with limbs composite soft-tissue.Methods From February,2013 to February,2016,13 cases with body severe trauma patients were treated,which including 5 cases of upper limbs and 8 cases of lower limbs,and all existed bone defect,soft tissue defect and trunk vessel defect.Three cases with limbs distal non blood supply were emergency treated with debridment and flow-through fibular flap transplantation renovation,peroneal artery repairing defective blood vesscls to rcstorc limbs distal blood supply,fibular flap repairing bone defect,skin flap repairing soft tissue defect.The limb blood supply for other 10 cases were in good condition,but one case with main artery defect did the second phase of fibular flap transplantation and repaired defective blood vessels,bone and skin soft tissue synchronously according to wound condition.According to the postoperative observation for flap survival and appearance,X-ray films to observe fracture healing after 6 weeks,three months and 6 months of operation as well as evaluating limb function recovery,then analyzed the results.Results Flaps survived successfully for 11 cases,and flaps for the other 2 cases were partial necrosis.One Case was edge flap necrosis,heal scabby after dressing,and the other case was necrosis for 1/3 of the area,but the deep fascia survival,and the skin graft healing after dressing.One case with forearm rolling was in vascular crisis after operation,but tbe crisis was relieved after detection,and fingers blood supply was recovered.All the patients were followed up for 6 to 36 months(mean,14 months).All flaps were survived,fractures healed well and limbs distal blood supply was good.Bone healing time was 8 to 24 weeks,and patients with lower limbs injury could bear load after 3 to 8 months.Lower limbs restored walking function.Upper limbs and hands restored rotation function.Transplant flapshad good elasticity and satisfactory appearance.Conclusion Using fibular flap to repair defective blood vessels,bone and soft tissue synchronously,not only can rescue the limbs on the verge of amputation,but also can repair defective composite tissue and get a good prognosis.It is an effective method for open injuries severely treatment in clinic.

Perioperative nursing for patients undergoing mandibular defect repair by forearm flap composite fibula flap / 现代临床护理

Objective To summarize the perioperational nursing strategies for patients undergoing mandibular defect repair by forearm flap composite fibula flap.Methods From January 2009 to December 2012,9 patients with mandibular defect and soft tissue defects after resection of malignant tumors received fibula flap and forearm flap.Before operation,the patient received psychological education and the preparation of donor flap and receptor area together with oral preparation was performed.After operation,the vital signs and blood circulation in the flap were observed.Results The fibula and forearm flaps in 8 patients survived.The fibula flap in one patient survived while the forearm flap developed with vascular crisis.The success rate for the transplanted flap was 89.9%. Conclusion The perioperative nursing strategies are key to increase survival rate of flaps and the success rate of operation.

Application of the free double-skin paddle string-type composite fibular flap in the reconstruction of the combined defects of ulna and radium / 中华显微外科杂志

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.

Transplantation of the cutaneous fibular flap combined with anterolateral thigh flap for the repair of complex tissue defect of the leg / 中华显微外科杂志

@#Objective To explore the clinical application and effect of the transplantation of the cutaneous fibular flap combined with anterolateral thigh flap for the repair of complex tissue defect of the leg. Methods The cutaneous fibular flap combined with anterolateral thigh flap in series connection or parallel connection transfer were applied to repair complex tissue defect of the leg in 36 cases. 10 cases were fresh non-infectious wound 26 cases were delayed infectious wound. The area of wound ranged from 25 cm × 18 cm to 45 cm × 13 cm (36 cm × 16 cm on average). The area of anterolateral thigh flap ranged from 12 cm × 13 cm to 32 cm × 18 cm. The area of the cutaneous fibular flap ranged from 2.0 cm × 1.5 cm to 18.0 cm × 16.0 era. The length of fibular transplantation ranged from 10 cm to 24 cm. 30 cases were combined in parallel connection transfer, 6 cases were combined in series connection transfer, 5 cases were repaired in emergency, 5 cases were repaired in subemergency, 26 cases were repaired in delay. Results All cases were successfully repaired in 36 cases.35 cases were followed up. A mean follow-up was 29 months. Arterial crisis occurred in 1 case, venous crisis occurred in 2 cases 34 flaps survived completely and 2 cutaneous fibular flap survived partially in parallel connection which were later healed by skin transplantation.32 cases were healed in first stage, 4 cases were healed in second stage, (healing time ranged from 12 to 18 days), Bone healing time ranged from 3 to 6 months in fibula transplantation. The Enneking score system was applied to evaluate the leg function. Of the 35 cases, the mean scores was 26 (their scores ranged from 23 to 28).The functions of all supplied regions were not found malfunctional. Conclusion Transplantation of the cutaneous fibular flap combined with anterolateral thigh flap is an optimal method to repair the complex tissue defect of the leg.

Trasplante de peroné para reconstrucción mandibular en pacientes sometidos a mandibulectomía por tumores óseos y de la cavidad buca: experiencia de 10 años / Fibular free-flap for mandibular reconstruction in patients undergoing mandibulectomy for oral cavity and bone tumors: 10-year experience

Antecedentes: La reconstrucción con colgajo osteomiocutáneo de peroné es el procedimiento de elección en la reconstrucción mandibular. Objetivo: Evaluar los resultados obtenidos en 10 años de experiencia con esta técnica. Material y métodos: Se analizaron los registros de los pacientes sometidos a mandibulectomía y reconstruidos primaria o secundariamente con peroné microvascularizado, entre 1995 y 2005. Variables analizadas: tiempo quirúrgico, tipo de microanastomosis vascular, sangrado, tabaquismo, comorbilidad, historia de radioterapia o quimioterapia, momento de reconstrucción y tipo de colgajo. Resultados: 60 pacientes, 62 colgajos, en 27 mujeres y 33 hombres, 30 con neoplasia maligna y 30 con tumor benigno; media de edad 43 años. La comorbilidad más frecuente fue diabetes. En 49 se llevó a cabo reconstrucción primaria y en 11, secundaria; en 38 el colgajo fue óseo y en 22 osteocutáneo. En 52 (87%) el transplante fue exitoso y en ocho hubo pérdida total (87% de éxito). Las complicaciones más frecuentes fueron exposición de osteosíntesis, pseudoartrosis y absceso cervical. Cuatro pacientes fueron reexplorados; en todos se preservó el colgajo. No hubo relación entre las variables estudiadas y el éxito. El resultado funcional fue adecuado en 90% relacionado con el momento de la reconstrucción. Conclusiones: El colgajo libre de peroné es una opción segura en la reconstrucción mandibular. Realizado en forma primaria ofrece los mejores resultados funcionales.

BACKGROUND: Fibular-free-flap is currently considered the optimum choice in mandible reconstruction. OBJECTIVE: Assess our results using this technique after 10 years-experience. MATERIAL AND METHODS: Patients underwent mandibulectomy and primary or secondary reconstruction with fibular-free-flap between 1995 and 2005. Variables analyzed included: surgical time, time of micro-vascular anastomosis, bleeding, tobacco history, comorbidity, chemo-radiotherapy background, flap type and primary or secondary reconstruction. RESULTS: We included, 60 patients and performed 62 flaps. We included 27 women and 33 men; mean age was 43 years, 30 had malignant tumors and 30 benign. Diabetes was the most frequent co-morbid pathology. In 49 subjects reconstruction was primary and secondary in 11; in 38 the flap was osseous and in 22 osteocutaneous. In 52 patients (87%) the flap was successful and 8 showed total loss. The most frequent complications were osteosynthesis material exposure, pseudoarthrosis and cervical abscess. Four patients were subjected to re-exploration but the flap was preserved in all. No acssociation was found among any of the variables studied and flap viability. The functional result was considered adequate in 90% of cases and was associated with time of reconstruction. CONCLUSION: Fibular-free-flap is a safe alternative in mandible reconstruction. Primary reconstruction offers better functional results.