Thoracoumbilical flap combined with random abdominal flap in repair of large-area soft tissue defects of calf in children / 中华显微外科杂志

Objective:To investigate the clinical effect of thoracoumbilical flap combined with random abdominal flap in repair of large-area soft tissue defects of calf in children.Methods:The clinical data of 16 children with large-area soft tissue defects of calf treated with thoracoumbilical flap combined with abdominal random flap from January 2004 to December 2007 in PLA Trauma Orthopaedic Research Institute, 80th Group Military Hospital of the PLA were retrospectively analysed. There were 7 boys and 9 girls aged 8 to 14(11.3 in average) years old. Six cases were crushed by heavy objects, 6 crushed by wheels, 3 by thermal press and 1 by machine strangulation. After thorough debridement, the wound area ranged from 16.0 cm×9.0 cm to 38.0 cm×15.0 cm. Four cases were treated after 3-10 hours of injury by emergency surgery. Twelve cases received surgeries 0-11 days after hospital admission and wound being stabilised. Doppler ultrasound was used to locate the perforating vessels according to the location, size and shape of the wound. Thoracoumbilical flap combined with abdominal random flap were designed and harvested to repair the wound. The sizes of flaps were 18.0 cm×11.0 cm-40.0 cm×16.0 cm. All patients entered follow-up at the outpatient clinic or through WeChat interviews. The appearance, texture of the flap and limb recovery were checked and recorded.Results:After surgery, all of 16 flaps survived, of which 12 flaps had phase-one healing, 3 flaps had small area of necrosis at the edge, which healed after repeated dressing changes and 1 flap developed vascular comproise, and survived after surgical exploration. The donor sites healed in phase-one. All 16 children had 6 months to16 years of follow-up, with an average of 20.7 months. The colour of the flaps was normal with soft texture. The motor function of calf was satisfactory. According to Punor functional evaluation criteria, 12 cases were in excellent and 4 in good.Conclusion:The thoracoumbilical flap combined with abdominal random flap features a reasonable design, strong blood supply and repair of a large area. It is a reliable method for repairing large area soft tissue defects in the calf of children.

Colgajo toracoabdominal para la cobertura de lesión traumática de mano / Thoracoabdominal flap for hand traumatic injury coverage

Es de gran importancia conocer las técnicas apropiadas para la restauración de las unidades funcionales de la mano a consecuencia de lesiones traumáticas, resguardando en lo posible su configuración y funcionalidad, puesto que desempeña múltiples tareas en distintos ámbitos de la vida. A continuación, se expone el caso de un paciente con lesión traumática por aplastamiento en mano derecha, cuyo tratamiento de consideración fue el colgajo toracoabdominal que fue llevado a cabo en tres tiempos, el paciente evolucionó de forma favorable sin complicaciones de infección, dehiscencia o necrosis del colgajo. A pesar de la introducción microquirúrgia para la reconstrucción de estas lesiones, los colgajos pediculados continúan siendo factibles con resultados óptimos en situaciones en las que la microcirugía no puede ser considerada. Si bien existen múltiples técnicas para la corrección de los defectos en mano, la habilidad y creatividad del cirujano siguiendo los principios básicos de la reconstrucción serán concluyentes para un resultado óptimo.

It is very important to know the appropriate techniques for the restoration of hand injuries, protecting as much as possible their configuration and functionality, since it performs multiple tasks in different areas of life. Hence, we present the case of a patient with traumatic injury due to crushing in the right hand, which treatment was considered the thoracoabdominal flap that was carried out in three times, the patient evolved favorably without complications of infection, dehiscence or necrosis of the flap. Despite the introduction of microsurgery for the reconstruction of these lesions, pedicle flaps continue to be feasible with optiomal results in situations in which microsurgery cannot be considered. Although there are multiple techniques for the correction of defects in hand, the skill and creativity of the surgeon following the basic principles of reconstruction will be conclusive for an optimal result.

Selection of surgical methods for postburn scar contracture deformity in children′s hands / 中华整形外科杂志

Objective@#To explore the surgical methods for children with contracture deformity on hands after burn.@*Methods@#From January 2014 to January 2018, 33 pediatric patients, a total of 42 hands with scar contracture deformities were reviewed. There were 24 males and 9 females, aged from 11 months to 6 years and 7 months. Among them, 20 hands were volar metacarpophalangeal joint contractures, 9 were volar interphalangeal joint contractures, 7 were dorsal metacarpophalangeal joint contractures (3 claw-shaped hands), 3 were hand back contractures, and 3 were palm contractures. Of the 42 hands, 36 hands were repaired with full-thickness skin grafts or split-thickness skin grafts, after the removal of contracted scar, and 6 hands were repaired with abdominal skin flaps, due to the tendon or bone exposure after the scar removal.@*Results@#Skin grafts on 31 hands were all survived after 2 weeks. However, the survival area of 3 skin grafts was about 90%, and 2 skin grafts survived about 80%. All of them healed well after dressing changing. The 6 hands repaired with abdominal skin flap healed well too. After 1-2.5 years of follow-up, finger scar contracture occurred in 4 hands with skin grafting, and they were performed scar excision and sheet skin grafting. Three hands were treated with Z-plasty, due to web space contracture. The function of other hands were normal, without contracture or deformity. The skin color and texture were similar to the surrounding skin, with limited pigmented. Scars on the edge of skin grafts was not obvious. Patients and their families were satisfied.@*Conclusions@#The sheet skin graft is the main method for postburn scar contracture in children′s hands. The abdominal skin flap should be considered, if tendon or bone is exposed, especially for large wound or multiple sites.

Application of dual-pedicle abdominal flap for unilateral breast reconstruction / 中国修复重建外科杂志

Objective: To explore the effectiveness of dual-pedicle abdominal flap for unilateral breast reconstruction. Methods: Between March 2014 and March 2018, a clinical data of 19 female patients underwent dual-pedicle abdominal flap reconstruction because of unilateral mastectomy defect was reviewed retrospectively. The median age was 45 years (range, 32-51 years), including 3 immediate breast reconstruction and 16 delayed breast reconstruction, and left side in 7 cases and right side in 12 cases. Unilateral breast reconstruction were performed for 8 patients with unilateral pedicle transverse rectus abdominis musculocutaneous (TRAM) flap and contralateral free TRAM flap, for 3 patients with pedicle TRAM flap and contralateral deep inferior epigastric perforator (DIEP) flap, for 7 patients with bilateral DIEP flaps, for 1 patient with free muscle-sparing TRAM flap and contralateral DIEP flap. The size of abdominal flap ranged from 24 cm×7 cm to 43 cm×13 cm. The donor sites were closed directly. Results: Vascular crisis ocuurred in 1 flap and relieved after surgical exploration. The other flaps survived. Poor wound healing in abdominal incision occurred in 1 patient and was successfully treated with debridement. The other donor sites healed without any other complication. The patients were followed up with a median period of 12 months (range, 4-42 months). Four patients received reparative operation of their reconstructive breast, and 2 patients received mamopexy of the contralateral breast due to mastoptosis. The abdominal BREAST-Q score was 84.1±11.7, chest score was 86.5±8.9, and breast score was 67.6±16.4 at last follow-up. Conclusion: The dual-pedicle abdominal flap for unilateral breast reconstruction provides adequate soft tissue volume and good blood supply. It is a reliable and effective breast reconstructive method for patients who need large tissue volume to make symmetric with the contralateral breast, or slim patients with few tissue in the donor site, or patients with scars in the donor site, especially vertical abdominal scars.

Research progress and application of breast reconstruction with free abdominal flap / 中国癌症杂志

Breast cancer is the most common malignant tumor in women. Surgical treatment is one of the important treatment methods. Breast reconstruction following mastectomy can improve patients' quality of life with acceptable oncological safety. Autologous tissue breast reconstruction has become an important way owing to its spe-cific advantages. The ideal tissue for autologous breast reconstruction is free abdominal flap. This review presented the clinical application, timing of operation and complications of breast reconstruction with free abdominal flap.

Reconstrução de mama com retalho excedente de abdominoplastia reversa / Breast reconstruction with excess reverse abdominoplasty flap

Introdução: A mastectomia é um procedimento muito traumático para a mulher. A reconstrução mamaria é parte fundamental do tratamento para melhorar o bem estar psicossocial e a qualidade de vida destas pacientes. Muitas técnicas foram descritas e evoluíram até chegar à atual diversidade de procedimentos modernos associados ou não as próteses mamárias. Esta diversidade de técnicas possibilita a seleção adequada para cada caso, oferecendo melhores resultados. O objetivo deste trabalho é apresentar uma alternativa cirúrgica de reconstrução mamária com retalho de abdome superior associado à prótese mamária. Método: paciente de 59 anos com mastectomia radical direita e três cirurgias prévias de reconstrução mamária com prótese de silicone, sem sucesso. Foi utilizada abdominoplastia reversa com aproveitamento do retalho excedente direito para cobertura de prótese no mesmo tempo cirúrgico. Simetrização da mama contralateral foi obtida dois anos depois, através de mastopexia com troca de prótese. Resultado: Foi obtido o resultado planejado para reconstrução do volume mamário. Discretos sinais inflamatórios no pós-operatório imediato, principalmente no polo superior, tratado com corticoterapia por duas semanas, com regressão completa dos sinais e sintomas. Aspirado seroma (20 ml) com seringa no dia 15º pós cirúrgico, sem recidiva. Não ocorreram complicações como epiteliólise ou necrose do retalho. Conclusão: A reconstrução mamária com retalho abdominal resultante de abdominoplastia reversa pode ser uma opção em casos especiais, oferecendo resultado satisfatório.

Introduction: Mastectomy is a highly traumatic procedure for many women, and mammary reconstruction is a fundamental part of the treatment. Reconstruction has been shown to improve the psychosocial wellbeing and quality of life of these patients, and several techniques and advancements thereof have been described in order to reach the current diversity of modern procedures, whether associated with breast implants or not. This diversity in techniques enables an appropriate selection for each individual case, thus attaining better results. The objective of this report was to present an alternative breast reconstruction method using an upper abdominal flap along with breast implants. Method: A 59-year-old woman had undergone right radical mastectomy and three previous breast reconstruction operations with silicone prostheses, without success. We first performed reverse abdominoplasty with exploitation of an excess right flap used as prosthesis coverage. Two years later, we performed contralateral breast symmetrization using mastopexy with a change of prosthesis. Result: The planned breast volume reconstruction was achieved. Discrete inflammatory signals were observed in the immediate postoperative period, mainly in the upper pole, and treated with corticosteroid therapy for two weeks; this resulted in complete regression of all signs and symptoms. Seroma was aspirated (20 ml) with a syringe on the 15th postoperative day, with no recurrence. No complications, such as epitheliolysis or flap necrosis, occurred. Conclusion: Breast reconstruction with an abdominal flap from reverse abdominoplasty may be an option in a subset of cases, and offers satisfactory results.

Incisão em abordagem única por meio de técnica de retalho deltopeitoral para reconstrução de traqueostomia em paciente submetido à radioterapia após laringectomia / One stage "slit" deltopectoral flap technique for end tracheostomy reconstruction in irradiated postlaryngectomy patient

Reconstruir lesão do estoma traqueal em pacientes submetidos a laringectómica total é um desafio, especialmente, quando a pele do perístoma está lesionada devido à radioterapia. A reconstrução é complexa e geralmente requer mais de uma abordagem. Apresenta-se técnica simples utilizada com sucesso em paciente de 80 anos com deiscência de lesão do estoma traqueal e retração da traqueia.

Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challenging especially when the peristomal skin is unhealthy due to radi therapy. The reconstruction is complex and usually requires more than one stage. We present a simple techniqued successfully used in an 80-year-old patient with dehisced tracheal stoma wound and retraction of trachea.

Repair of skin and soft tissue defects in upper limbs with low abdominal superficial artery flap / 中华显微外科杂志

ObjectiveTo investigate the clinical effects of applying low abdominal superficial artery flap to repair skin and soft tissues defects in upper limbs.MethodsTotal 42 cases with soft tissues defects were recruited in this study.Seven cases were repaired using skin flaps with circumfiexa ilium superficial artery.Five cases were repaired using osteocutaneous flaps based on circumfiexa ilium superficial artery.Eleven cases were repaired using flaps with superficial epigastric artery.Seven cases were repaired using flaps with circumfiexa ilium superficial artery,lateral branches of superficial epigastric artery and musculocutaneous perforators of the fourth lumbar artery.Six cases were repaired using flaps with origin of circumfiexa ilium superficial artery,medial and lateral branch of superficial epigastric artery,and the deep and cutaneous branch of circumfiexa ilium superficial artery.ResultsAfter surgery,forty-two flaps all survived.Flaps areas were between 5 cm × 6 cm-9 cm × 30 cm.Followed up 6-24 months,the appearance,texture,color and function of flaps were recovered well and did not need to trim again.ConclusionLow abnominal superficial artery flap could be used to repair skin and soft tissues,also its texture is so thin and areas can be direct sutures,which,is an ideal method to forearm repairment.

Case Report of Breast Reconstruction with SIEA Flap

PURPOSE: Breast reconstruction with abdominal flap has many advantages. However, it might cause abdominal complications such as bulging or hernia. SIEA (Superficial inferior epigastric artery) flap is the most advanced form of abdominal flap which has no adverse effect on abdominal fascia. We report 2 cases of breast reconstruction with SIEA flap with reference review. METHODS: From Jun 2006 to Jan 2009, 110 patients underwent breast reconstruction with free abdominal flap. We tried to find the SIEA in every cases and adopted SIEP flap if the diameter was larger than 1mm and it had visible pulsation. 2 patients underwent breast reconstruction with SIEA flap. After design of abdominal flap SIEA was investigated with portable Doppler. SIEA was usually found 4-5 cm lateral to the midline. Flap was elevated with SIEA and SIEV to their maximal length at hiatus. RESULTS: There were no complications, such as infection, hematoma, and necrosis of flap. In both cases, flaps survived completely with excellent vascularity and breast reconstruction was successful. In one case, there was skin necrosis of mastectomy flap, and it was healed by conservative management. CONCLUSION: With the SIEA flap, donor site morbidity can be minimized along with reduction of operation time. If there is reliable SIEA, SIEA flap would be the preferred skills. However, the limitation of the SIEA flap is difficulty in identifying the SIEA. The reason for less availability of the flap in Korea might include high prevalence of the Caesarian section scar and relatively higher level of the lower margin of the flap.

Determination of microvessel density of abdominal flap / 上海第二医科大学学报

Objective To determine the difference of microvessel density(MVD) in each layer and region of abdominal flap. MethodsFlaps were obtained from 60 patients with abdominal operations,10 in each of the regions from I to VI.The vascular endothelial cells were marked with CD34 by immunohistochemistry,and the MVD in each region and layer of the abdominal flaps was determined.Results The vascular net of abdominal flap was divided into five layers: papillary layer of corium,papillary underlayer of corium,papillary deep layer of corium,superficial fascia and deep fascia.The mean MVD of the five layers were 17.80?1.68,9.12?1.84,27.91?2.44,37.18?6.55 and 46.91?7.02,respectively,with significant differences among them(P0.05).Conclusion Anatomic factors may be responsible for the survival of large abdominal flaps.Either of the direct and retrograde motion is feasible in the transplantation.