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Objective@#To explore the clinical effect of free latissimus dorsi myocutaneous flap in the repair of head composite tissue defect.@*Methods@#From July 2015 to April 2018, 7 patients with head composite tissue defect, which included 5 males and 2 females, aged from 10 to 52 years old were admitted in the First People′s Hospital of Yulin. The wounds were caused by various reasons 5 cases of head squamous cell carcinoma, 1 case of electric injury and 1 case of trauma. For tumor patients combined with neurosurgery to remove the lesion tissue, the latissimus dorsi myocutaneous flap were cut and transplanted to cover the wound immediately after the thorough expansion of trauma patients, and the donor area were closed directly or byskin grafts.@*Results@#The latissimus dorsi musculocutaneous flaps were cut with areas from 16 cm×6 cm to 28 cm×20 cm, 6 cases of thoracic and dorsal vessels anastomos is with the superficial temporal vessels, and 1 case of thoracic and dorsal vessels anastomosis with occipital vessels. The blood supply of myocutaneous flaps were good in 6 cases, and venous crisis occurred in 1 case on the second day after the operation. Postoperative follow-up was conducted for 3 months to 1 year. No tumor recurrence was observed in the tumor patients, and the wound surfaces were locally smooth.@*Conclusions@#The latissimus dorsi musculocutaneous flap is a good method for repairing the defect of the head composite tissue defect with big size and good blood supply.
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Objective@#The purpose of this study is to review the single institutional experience in oncoplastic treatment of locally advanced breast cancer (LABC).@*Methods@#This is a retrospective analysis of 246 female patients who underwent breast and chest wall reconstruction after LABC ablation in the department from August 2007 to December 2015. The mean age of the patients is 43.7 years old, range from 34 to 70 years old. The soft tissue defect size ranged from 12 cm×6 cm to 32 cm×28 cm, different flaps were chosen for reconstruction, flap size ranged from 13 cm×6 cm to 33 cm×29 cm. Simple rib defects or sternum defects occurred in 65 cases, using mesh repair and flap reconstruction; simple soft tissue defects were noted in 112 cases, pedicled flap or free flap was used; in 69 cases complicated composite chest wall defects involving multiple layers (soft tissue, ribs/sternum, and intrathoracic organs) were repaired with methylmethacrylate/polypropylene mesh sandwich prostheses. The breast and chest wall soft tissue defects were repaired with pedicled or free flap.@*Results@#In 3 cases with pedicled rectus abdominis flap partial necrosis was noted, local flap was used after further debridement in 2 cases, in the third case with extensive defect left, free anterolateral thigh flap was transferred for reconstruction. In 2 cases with free deep inferior epigastric artery perforator flap, postoperative venous congestion occurred. The re-exploration procedure was carried out, edema was removed and the flap survived thoroughly. In 2 cases with free deep inferior epigastric artery perforator flap postoperative course margin dehiscence and chest wall basement partial necrosis was noted, free anterolateral thigh flap was transferred for reconstruction after thoroughly debridement, the wounds healed smoothly. All other wounds healed uneventfully, all flaps survived totally. The hospital stay time ranged from 12 days to 42 days, all patients received further therapy. The mean follow-up was 28.8±0.4 months, with a range from 9 to 96 months. 26 cases were lost for follow up, in the rest 220 cases, local tumor recurrence was noted in 52 cases, distant metastasis was noted in 42 cases, all other patients recovered well, the function and appearance of flaps were satisfactory, the life quality of patients improved notably.@*Conclusions@#Oncoplastic techniques are suitable and safe for LABC reconstruction, helpful for oncological local control, can improve patients life quality.
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In July 2016, we used free superficial palmar branch of radial artery flap to repair one case of complete dissection of the thumb with skin defect, and achieved good result .
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Objective@#To explore the application of free profunda femoral artery pedicled gracilis chimeric myocutaneous flap in the reconstruction of defect after radical resection of buccal mucoca squamous cell carcinoma.@*Method@#From January 2014 to May 2016, 12 cases with buccal mucoca squamous cell carcinoma underwent radical resection, leaving buccal mucoca defect which was reconstructed by free profunda femoral artery pedicled gracilis chimeric myocutaneous flap at the same stage. The buccal mucoca defect was reconstructed with skin paddle, the mouth floor cavity was filled with muscular flap.@*Result@#The Length of free profunda femoral artery pedicled gracilis chimeric myocutaneous flap was (9.0±0.3) cm, the width of flap was (4.5±0.3) cm, the thickness of flap was (1.8±0.4) cm.The length of pedicle was (7.4±0.6) cm.All 12 chimeric perforator flaps survived uneventfully, the defects at the donor sites were closed directly in all cases. All patients were followed up for 10-28 months (14.8 on average) with satisfied esthetic and functional results in flap reconstruction. The swallowing and speech function was satisfactory. No local recurrence happened. Only linear scar was left in the donor sites, the function of thighs was not affected.@*Conclusions@#The free profunda femoral artery pedicled gracilis chimeric myocutaneous flap is an ideal choice for reconstruction of the defect after radical resection of buccal mucoca squamous cell carcinoma.
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Objective To review our single institutional 10-year experience in complex chest wall reconstruction and identify a working algorithm based on our retrospective analysis.Methods A retrospective analysis of 87 patients who underwent chest wallreconstruction in our department from January 2005 to December 2015.Fifty female patients and 37 male patients who underwent the above procedure were reviewed retrospectively.The median age of the patients is 52.3 years (24-75years).Histologic diagnosis including squamous-cell carcinoma (n =10),soft tissue sarcoma(n =22),chondrosarcomas(n =13) and metastasis from breast cancer(n =42).Type of skeletal defect including partial ribs/sternum defects in 19 cases,soft tissue defects alone in 33 cases,complicated composite chest wall defects involving multiple layers(soft tissue,ribs/sternum,and intrathoracic organs) in 35 cases.Sole methylmethacrylate/polypropylene mesh was used for small sized rib defects in 26cases.Methylmethacrylate/polypropylene mesh sandwich prostheses was used in 28 cases with extensive skeletal reconstruction after partial sternectomy and rib resection.The chest wall defects were repaired with pedicled internal mammary artery perforator flap(3 cases),pedicled deep superior epigastric artery perforator flap(4 cases),pedicled pectoralis major flap(8 cases),free anterolateral thigh perforator flap(9 cases),free deep inferior epigastric artery perforator flap(17 cases),pedicled lateral thoracic flap(5 cases),pedicled latissimus dorsi flap(17 cases),pedicled rectus abdominis flap(15 cases),free deep inferior epigastric artery perforator flap combined with pedicled rectus abdominis flap (4 cases),pedicled bipaddled latissimus dorsi flap(5 cases).11 cases with extensive full-thickness defects of the chest wall,the skeletal reconstruction was achieved with prosthetic sandwich and then covered with the omental flap,further free flaps were harvested for skin and soft tissue repairing.Results 1 case with pedicled rectus abdominis flap partial necrosis was noted,free anterolateral thigh flap was used for repairmen after further revision.1 case with edicled bipaddled latissimus dorsi flap,necrosis of the distal 1/4 part of one paddle was noted,healed with dressing therapy,no secondary skin grafting was required.Postoperative venous congestion occurred in 2 cases with deep inferior epigastric artery flap transplantation,in which both skin flaps exhibited venous crisis within 24 h after surgery.The reexploration procedures were successful in both cases and the flaps survived totally.All other flaps survived.The mean follow-up was 31 months,ranged from 9 to 72 months.No tumour extirpation was noted,functional and appearance results were satisfied.Conclusion According to the size and location of chest wall defect,different pedicled and free flaps should be chosen to achieve optimal outcome.Free flaps are efficient for large complex chest defects reconstruction.
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Objective To discuss the effect of two different warming methods on the circulation of free flaps during operation and seek for an optimal warming method which is benificial for the circulation of free flaps, and thus provide clinical evidences for intraoperative care. Methods A total of 96 patients undergoing free flap transplantation were divided into routine warming group and diversification warming group randomly (n=48 each). In routine warming group, temperature in the operating room was set at routine temperature and flaps were douched by routine heated saline. In diversification warming group, the temperature in the operation room, fluids used for washing wounds and flaps were warmed, fluids for intravenous application were pre-warmed by a fluid warmer, in addition, the operation table where patients were lying on was covered with warmer blanket. The influence of two different warming methods on the circulation of free flaps was observed. Results The scores of flap elasticity and capillary refill time in routine warming group were 2.02 ± 0.79 and 2.04 ± 0.81, respectively, vs. 2.50 ± 0.61 and 2.48 ± 0.6 in diversification warming group, showing diversification warming group was statistically better than routine warming group (Z=1.949, 3.872, P<0.05). In addition, the flap survival rate in routine warming group was 81.2%(39/48) vs. 95.8%(46/48) in diversification warming group, showing significantly better results in diversification warming group (χ2=4.02, P < 0.05). Conclusions The diversification warm keeping method can effectively promote the circulation and survival of flaps, improve clinical prognosis, accelerate postoperative rehabilitation, therefore is worthy of being recommanded its clinical application.
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PURPOSE: Gracilis muscle free flap transplantation is chosen in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity. We set a study to search for gracilis free flaps to know whether symptoms were cured or recurred in patients that have passed over 10 years from flap transplantation. MATERIALS AND METHODS: From August 1995 through September 2010, we have performed 28 cases of gracilis muscle free flap in the lower extremities. Ever since no case visited to demand any discomfort, breakdown or recurrence in the flap site on outpatient basis. We made a telephone call to patients or relatives documented in the medical record and only 2 cases visited outpatient department and 9 cases postponed the visit who satisfied with the final result but 17 cases had wrong telephone numbers. Causes, area of lower extremity, recipient vessels in the lower extremity, condition of the donor thigh and overall satisfaction of the flap transplantation in activities of daily living were investigated and written down in the medical record. RESULTS: 11 cases were reviewed after average postoperative 13.7 years. Gracilis muscle flaps were not break down at the recipient site in all cases. The wound of donor thigh wound healed good and overall activities of daily living was satisfied in all cases. CONCLUSION: Gracilis muscle flaps which had performed and followed up average 13.7 years revealed confident in the medium sized soft tissue defect and bone exposure from trauma and chronic osteomyelitis in the lower extremity.