Application of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose.@*METHODS@#The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm.@*RESULTS@#One patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any "cat ear" malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction.@*CONCLUSION@#The bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.

Effect of axial flap of adjacent artery perforator with vascular pedicle in repairing facial and cervical scar deformity in patients / 中华烧伤杂志

Objective@#To explore the effect of axial flap of adjacent artery perforator with vascular pedicle in repairing scar deformity of face and neck in patients.@*Methods@#From January 2010 to June 2018, 38 patients with cicatricial deformity of face and neck after deep burn were admitted to author′s unit, including 22 males and 16 females, aged 5-56 years. The time of admission was 7 months to 19 years after burn injury. The size of wounds ranged from 7.0 cm×4.0 cm to 20.0 cm×10.0 cm after scar tissue was released. Nineteen patients were treated by upper thoracic internal artery perforator flap with size ranged from 7.0 cm×5.0 cm to 18.0 cm×8.5 cm. Among them, 16 cases were preexpanded with expanders at thorax whose rated capacity ranged from 300 to 500 mL and times of water injection of 1.8 to 3.1, and 3 cases were directly used. Twelve patients were treated by transverse carotid artery perforator flap with size ranging from 7.0 cm×4.5 cm to 11.0 cm×8.5 cm, of which 8 patients were preexpanded and 4 cases were directly used. The rated capacity of expander placed at the supraclavicular region ranged from 200 to 350 mL with times of water injection from 1.5 to 2.0. Seven patients were treated by preexpanded superficial temporal frontal branch artery perforator flap with size of 5.5 cm×3.8 cm to 8.0 cm×5.0 cm. The rated capacity of expanders placed at forehead was 150 to 300 mL with times of water injection of 1.5 to 2.0. Donor sites were directly sutured or reversely repaired by pedicled skin tube plasty. After operation, operation times and treatment time were recorded. The survival condition and complications of flaps and follow-up were observed.@*Results@#The patients each received 1 to 4 operation (s) with treatment time of 5 to 11 months. All flaps survived after operation. Among them, three flaps with perforating branches of internal thoracic artery had slight blood circulation disturbance at the distal end and were healed after conservative dressing change, etc. Pigment changes were observed at the distal end of thoracic internal artery perforator flaps in two patients in the later stage and was resected and repaired in the second stage. The patients were followed up for 5 to 18 months. The appearance and function of operation area were good with high satisfaction of patient.@*Conclusions@#The axial flap of adjacent artery perforator with vascular pedicle for repairing scar deformity of face and neck used directly or preexpanded can solve the problem of lack of normal skin around scar deformity without vascular anastomosis during the operation and with better appearance and function after operation. The donor site often can be directly sutured, but many operations often need to be completed for finishing whole treatment.

Comparison of clinical features of large-artery atherosclerosis cerebral infarction and perforating artery disease type cerebral infarction / 重庆医学

Objective To study the clinical features of large-artery atherosclerosis cerebral infarction and perforating artery disease type cerebral infarction.Methods Ninety cases of large-artery atherosclerosis cerebral infarction were set as the observation group and 90 cases of perforating artery disease type cerebral infarction as the control group.The general data and clinical characteristics were performed the comparative analysis.Results The drinking and smoking rates in the observation group were 43.33 ％ and 54.44 ％ respectively,which were in turn higher than 27.78 ％ and 25.56 ％in the control group;the occurrence rates of complicating coronary heart disease and lipid metabolism abnormality in the observation group were 45.56 ％and 58.89 ％respectively,which were in turn higher than 21.11 ％ and 37.78 ％in the control group;while the occurrence rate of complicating diabetes mellitus in the control group was 65.56 ％,which was higher than 42.22％ in the observation group,the differences were statistically significant(P＜0.05).Plasma oxidized low density lipoprotein and circulating endothelial cell count in the observation group were (687 ± 169)g/L and(9.0 ±1.7) × 106/L respectively,which were significantly higher than the normal level in the control group,the level of nitric oxide in the observation group was(77.4±21.1)mol/L,which was lower than that in the control group.The differences between the two groups were statistically significant(P＜0.05).Conclusion The onset factors of large artery atherosclerosis cerebral infarction have larger relation with drinking,smoking,complicating coronary heart disease and lipid metabolism abnormality,while perforating artery disease type cerebral infarction is more related with diabetes.

Diatally-Based Medial Crural Adipofascial Flap for Coverage of Medial Foot and Ankle

PURPOSE: We report on the clinical result after coverage of a soft tissue defect on the medial foot and ankle with an adipofascial flap based on the perforator from the posterior tibia artery. MATERIALS AND METHODS: Nine patients with soft tissue defects on the medial foot and ankle area from March 2009 to May 2014 underwent the procedure. Average age was 54 years old (range, 8~82 years). There were five male patients and four female patients. The causes of the defect were trauma (4), tumor (3), and infection (2). The pivot point of transposition of this flap is the lower perforator originating from the posterior tibia artery. The fatty tissue side of this flap could be used to resurface the defect. The donor site was closed primarily with the preserved skin, and a small caliber drain tube was used. The split-thickness skin graft was grafted to the flap and the wound. If the wound was still infected, this skin graft could be performed at a later date. RESULTS: All flaps survived and normal soft tissue coverage was obtained for the medial foot and ankle of all patients after the skin graft. Normal footwear was possible for all cases because of thin coverage. There was an extension contracture on the medial ray of the foot, which was resolved by contracture release and skin graft. CONCLUSIONS: For the medial foot and ankle soft tissue defect, the medial crural adipofascial flap based on a perforator branch of the posterior tibia artery could be a good option to cover it.

Clinical application of perforating branch flap of medial vastus muscle in treatment of skin and soft tissue defects / 中华创伤杂志

Objective To explore the clinical application of perforating branch flap of medial vastus muscle. Methods Perforating branch flap (muscle branch) of medial vastus muscle was designed by using the surface projection of the medial vastus muscle artery as flap anxial line and the given point of direct cutaneous artery as flap center to repair skin and soft tissue defects of the knee in seven patients.Results All flaps survived well with primary healing in all patients, with one stage healing. After a follow-up for 1-18 months, all flaps turned out to be with good texture and satisfactory appearance and function of the flaps. Conclusion The surgery of perforating branch flap of medial vastus muscle is simple,safe and easy handling and provides a new feasible surgical procedure to repair skin and soft tissue defects of medial femur and around the knee.