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Objective@#To report the method and clinical effect of reconstruction of proximal thumb plane with iliac bone, combined with the same pedicled toenail and dorsum pedis flaps.@*Methods@#From June 2010 to May 2017, 7 patients with various degrees of proximal thumb defect were treated in the Hand Surgery Department of Ruihua Affiliated Hospital of Soochow University. Among them, there were 3 males and 4 females, aged from 18 to 50 years, with an average age of 29 years. There were 5 cases of proximal thumb defect and 2 cases of distal thumb defect. The thumb reconstruction contained 3 steps: iliac bone graft was used to repair bone defect, toenail skin flap to repair dorsal thumb wound, and dorsum pedis flap to cover volar wound. Full thickness skin graft was used to repair donor site.@*Results@#All the reconstructed fingers survived. The area of toenail skin flap was 3.0 cm×2.5 cm to 5.0 cm×3.0 cm in size. The area of dorsum pedis skin flap was 3.0 cm×3.0 cm to 6.0 cm×3.5 cm in size. The length of iliac bone graft was 2.5-5.0 cm. The follow-up time was 5-28 months, with an average of 10 months. All reconstructed finger pulp was full. The nails grew well. The appearance of fingers was satisfied, and the skin sensation of finger belly was restored to S2 to S3+ . Dorsum finger′s protective sensation of all cases were recovered, and the functions of finger joint were close to normal. The donor area on foot healed well. The scar was not obvious. The walking function was completely normal.@*Conclusions@#It is a good method to reconstruct proximal thumb with iliac bone combined with the same pedicled toenail and dorsum pedis flaps without sacrificing toes.
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Objective@#To investigate the anterior branch of subcostal artery perforator flap for defects at the lower abdomen or distal sites.@*Methods@#Ten patients were treated, including 6 males and 4 females, aged 25 to 62 years, mean (38.2 ± 6.5) years old. The anterior branch of subcostal artery perforator flap was designed in 10 cases, of which 1 case was free flap carrying the accompanying nerve. 9 cases had defects at abdomen and 1 case at the foot. The flaps size was 4 cm×8 cm-7 cm ×15 cm.@*Results@#All the 10 flaps survived completely with no vascular crisis. The abdominal shape was good with only linear scar. The free flap was used for plantar wound with nerve anastomosis of accompanying nerve with the medial plantar nerve. During the follow-up period of 6 months, the flap sensory recovery area reached more than 60% with two-point discrimination as 20-25 mm.@*Conclusions@#The anterior branch of subcostal artery perforator flap has a stable vascular pedicle with reliable vascular network and sensory nerve.
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Objective@#To investigate the application of free medial plantar flap for reconstruction of plantar defects, so as to restore cosmetic and functional sole.@*Methods@#19 Patients(16 males and 3 females) with soft tissue defects at the plantar feet, aged from 6 to 53 years old, were treated in our department, including 5 forefoot defects and 14 heel defects. Free medial plantar flaps at the contraside were used to repair the defects. The size of the flap ranged from 4 cm×5 cm to 6.5 cm×12 cm.@*Results@#All the flaps and skin grafts survived without complications. Nine patients underwent follow-up for 3 to 12 months, the contour and walking function were satisfactory with no ulcers.@*Conclusions@#Free medial plantar flap for reconstruction of plantar defect provides a long-term favorable functional and aesthetic outcome, indicating its' feasibility and efficiency for weight-bearing plantar foot reconstruction.
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Objective@#To investigate the application of free anteromedial thigh (AMT) perforator flap in the reconstruction of tongue defect after radical resection of tongue carcinoma.@*Methods@#From September 2010 to January 2015, 57 cases with tongue carcinoma underwent radical resection, leaving tongue and mouth floor defects which were reconstructed by AMT perforator flaps at the same stage.These 57 eases included tongue carcinoma at lingual margin (n=36), at ventral tongue (n=15) and at mouth floor (n=6).@*Results@#The size of AMT perforator flap ranged from 5.5 cm×4.0 cm to 7.5 cm×5.5 cm, the thickness of flap ranged from 1.0-1.7 cm.The length of pedicle from descending branch of lateral circumferential femoral artery is (8.2±0.6) cm, found in 28 cases.The length of pedicle from profunda femoral artery is (8.5±0.4) cm, found in 17 cases.The length of pedicle from femoral artery is (8.1±0.7) cm, found in 12 cases.All 57 perforator flaps survived uneventfully, the defects at donor site were closed directly in all cases. All patients were followed up for 12-24 months with satisfactory esthetic and functional results in reconstructed tongue. No local recurrence happened. Only linear scar left in the donor sites, the function of thighs were not affected.@*Conclusions@#The free AMT perforator flap is an ideal choice for reconstruction of the tongue and mouth floor defect after radical resection of tongue carcinoma.
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Objective@#To explore the value of different designed anterolateral thigh flaps(ALT) in the reconstruction of buccal defect after radical resection of buccal cancer.@*Methods@#From March 2009 to May 2016, 142 cases were diagnosed as buccal cancer in the Department of Oral and Maxillofacial Surgery of Nanjing University. All patient underwent radical resection, followed by reconstruction with different anterolateral thigh flaps. The clinical date were retrospectively analyzed.@*Results@#Among 142 cases, the muscuiocutaneous ALT flaps were used in 60 cases, the fasciocutaneous ALT flaps in 60, and the thin ALT flaps in 22. The size of the flaps ranged from 4 cm×5 cm to 14 cm×10 cm. Operative exploration during the perioperative period were performed in 4 patients, including 2 flaps with thrombotic events and 2 flaps with venous thrombosis. Among them, 2 flaps survived completely and 2 flaps were failure. The mean follow-up period was 37 months(range: 3 to 85 months).@*Conclusions@#The different designed anterolateral thigh flap for the buccal defects resulting from tumour excision is an ideal choice for reconstruction of buccal defects.
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Objective To explore the method of self-care management education for patients who have received the eyelid reconstruction surgery by transplanting with free flap-skin. Methods There were 11 cases (15 eyes) who achieved self-care management and continued nursing, including the preoperative, postoperative nursing care of the donor-skin area, eye nursing, diet guidance, medication guidance, safety protection and its like. Results None of the cases revealed infection and all the grafts showed good biological activity among the 11 cases (15 eyes). Conclusions After self-care management education and continued nursing, the averaged hospitalization days of the patients are shortened; the cost is reduced, and the successful rate of the eyelid′s construction by free skin-flap transplantation is enhanced. Self-care management education and continued nursing care played an important role in promoting the healing and improving the successful rate of eyelid′s skin-flap transplantation.
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Objective To analyze the outcome of the flow-through anterolateral thigh flap for reconstruction in the Gustilo type Ⅲ C traumatized extremities.Methods From June 2008 to June 2011,sixteen flow-through anterolateral thigh flaps were used for limb salvage.All in this series suffered from Gustilo type Ⅲ C open fractures in upper (4 cases) or lower extremities (12 cases).All patients had the presence of wide segmental soft tissue defects and segmental artery defects with compromised circulation.Four patients received primary operations and 12 patients received debridement combined with vacuum sealing drainage and secondary operations.Results All patients were followed up from 12 months to 40 months (average of 22 months).The mean age was 37.5 years old (from 18 to 62 years).The mean timing of free flap transfer was 6.7 days after injury (from 5 hours to 16 days).The mean artery defect was 12 cm in length (from 6 to 16 cm).All the flaps survived completely with a soft tissue texture.After operation,infection occurred in one patient,venous thrombosis occurred 1 day post-operatively in one patient,local flap necrosis occurred in two patients.No donor site morbidity was noted.In the last follow-up,according to Johner-Wruhs and Berton scores,the overall excellent/good rate for lower and upper extremities were 83.3％ and 75.0％ respectively.Conclusion Flow-through anterolateral thigh flaps provide for reconstruction of both the vessels and soft tissue simultaneously.Because of avoiding sacrificing one of the major vessels,it particularly indicates for only one major artery survival in the extremity.The clinical results show that the above reconstruction technique is useful for upper and lower extremities salvage.
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Objective: To summarize the experience of repairing or al and maxillofacial defects with radial forearm free flap. Methods: The clinical records of 110 cases received oral and maxillofacial reconstruction with radial forearm free flap were analyzed.Results: Forearm free flap healed well in 10 5 out of the 110 cases.with the overall success rate of 96.4%.Failure was in 4 c ases of cancer.One patient died from cerebral infarction 19 days after operation .Post operation infection did not result in the necrosis of the flaps because o f corresponding treatment in 5 cases.Conclusion: The radia l forearm free flap characterized by the anatomical consistency,easy fold, ideal thickness, flexibility and long pedicle, is feasible in the reconstruction of soft tissue defects in oral and maxillofacial region.
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Since the use of the rectus abdominis myocutaneous flap was first reported by Mathes and Bostwick in 1977, its clinical utility both as an pedicled flap and a free flap has broadened reconstructive surgery. But there is a risk of postoperative abdominal hernia formation and bulkiness due to the volume of the rectus muscle and subcutaneous fatty tissue, it is pointed out as a disadvantage in the recipient site where a thin flap is required. To overcome these problems, Koshima (1989), and Itoth (1993) described the modification of this flap which contained little or no muscle or fascia. In our department , we performed deep inferior epigastric artery free skin flap in soft tissue reconstruction in three patients: we dissected one or two muscle perforator from the rectus muscle, removed the deep fatty layer, so we could elevate a thin flap. The results were good, so we are willing to describe the operative technique and its usefulness.