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Objective:To compare the clinical effectiveness of propeller flap and vascular chain flap based on dorsal cutaneous branch of proper palmar digital artery for repair of wounds of fingertip or finger-pulp.Methods:From April 2018 to May 2021, a total of 55 patients (55 fingers) with wounds of fingertip or finger-pulp in the 2nd-5th fingers were treated in emergency surgery in the Department of Hand Surgery, the Second Hospital of Tangshan. The patients were randomly divided into 2 groups by the method of drawing lots. The wounds of 29 patients (29 fingers) were repaired by propeller flaps based on dorsal cutaneous branch of proper palmar digital artery (propeller group) and that of 26 patients(26 fingers) were treated by vascular chain flaps based on dorsal cutaneous branch of proper palmar digital artery(vascular chain group). Survival of the flaps and the skin grafts at donor sites were observed between the 2 groups. The operation and follow-up time in both groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone reviews and WeChat video-clips. At final follow-up, the static TPD of the flaps, patient satisfaction with the appearance of flaps and donor sites and the Range of motion(ROM) of the injured fingers were recorded. The measurement and count data of both groups were compared by independent sample t-test, χ2 tests or Fisher's exact test, respectively. P<0.05 was considered a statistically significant. Results:All the flaps and skin grafts survived primarily in both groups. The operation time in propeller group was 57.55 minutes±4.35 minutes. It was less than what in the vascular chain group (61.12 minutes±4.58 minutes) and with statistically significant difference( P<0.05). The follow-up period was 14.55 months±2.89 months in propeller group and 15.15 months±3.78 months in the vascular chain group. There was no significant difference between the 2 groups( P>0.05). At final follow-up, the static TPD and patient satisfaction with the appearance of flaps in propeller group were 6.55 mm±1.24 mm and 4.59±0.50, which were better than 7.46 mm±1.27 mm and 4.31±0.47 in the vascular chain group with a statistically significant difference( P<0.05). The patient satisfaction with the appearance of donor sites and ROM of the injured digital joints in propeller group were 4.45±0.57 and 190.86°±8.56°, while what in the vascular chain group were 4.35±0.56 and 185.96°±10.58°. There was no significant difference between the 2 groups( P>0.05). Conclusion:The propeller flap and vascular chain flap are both based on dorsal cutaneous branch of proper palmar digital artery and are both suitable for repair of wounds of fingertip or finger-pulp. Compared with the vascular chain flap, the propeller flap has the advantages in shorter operation time, better flap sensation and appearance.
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Objective:To explore indications for replantation of proximal proper digital artery and establishing extrinsic arterial perfusion pressure in the treatment of special type of severed digits with avulsion over 12.0 hours of warm ischemia, and to analyse the factors that affected the survival rate of the replanted digits.Methods:From September 2014 to January 2022, 8 patients with severed digits and prolonged warm ischemia were treated by transposition of adjacent digital artery together with the technique of extrinsic arterial perfusion pressure in the Department of Wrist and Hand Surgery, the Orthopaedic Hospital in Sichuan Province. During the operation, the defected proximal proper digital artery was reconstructed and repaired with vein graft, one side of the digital artery was repaired with an inverted "Y" vein graft, and one side of "Y" vein was bridged and anastomosed to repair the original digital artery. On the other side, the adjacent proximal proper digital arteries were transpositioned and anastomosed to gain an extrinsic arterial perfusion pressure, which increased the distal haemodynamic and reconstituted the blood supply. Of the 8 patients (9 severed digits) : 1 had severed index and middle fingers, 2 had severed index fingers, 4 had severed thumbs and 1 had severed little finger. All the patients were males, aged 16-63 years old, at 37.6 years old in average. Warm ischemia time of the severed digits were 12.3-20.6 hours, with 17.4 hours in average. The survival rate of replanted digits was observed after surgery. Postoperative follow-ups were conducted through telephone or WeChat reviews.Results:Follow-up time was 6-26 months, at 8.3 months in average. Retrospective analysis was performed. Vascular compromises occurred in 3 patients 4 digits (arterial insufficiency in 1 digit, venous congestion in 3 digits), skin necrosis occurred in 1 patient (1 digit) and digit necrosis in 1 patient (1 digit). Overall, 8 of the 9 replanted digits survived. According to the Replantation Function Evaluation Standard of Hand Surgery Association of Chinese Medical Association, the digit function after replantation was evaluated at excellent in 6 digits, good in 1 digit and poor in 1 digit.Conclusion:For a severed digit with an ischemia time over 12.0 hours, the survival rate can be improved by transposition of an adjacent digital artery to provided extrinsic arterial perfusion pressure.
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Oral and maxillofacial-head and neck soft tissue defects affect the appearance of patients, as well as pronunciation, swallowing and other functions. Introduction of the propeller flap in 1991 has improved reconstruction procedures for oral and maxillofacial-head and neck soft tissue defects. A propeller flap has several advantages over traditional local flaps. It improves mobility, colour and texture matching for maxillofacial defect, surgical procedure, and individual satisfaction. Therefore, it can be used as a complement to the traditional flap by providing surgeons with more options. This paper reviews the classification, surgical procedures, and recent clinical applicatiosn and indications of the propeller flap.
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Objective:To investigate the effect of free thenar perforator flap on repair of finger pulp defect.Methods:From September 2019 to November 2021, 79 cases of finger injuries complicated with defects in the pulp of fingers received free thenar perforator flap transfer surgery for reconstruction of finger pulps in the Department of Hand and Foot Surgery, Taizhou Hospital, Zhejiang Province. The patients were 51 males and 28 females, aged from 17 to 52(37.5±5.2) years old. There were 34 finger-pulp defects of index fingers, 15 of middle fingers, 26 of ring fingers and 4 of little fingers. All patients were treated with free thenar perforator flaps sized 2.0 cm×2.5 cm-3.0 cm×3.5 cm. All thenar perforator flaps were pedicled with the perforator artery and subcutaneous superficial vein in the thenar region, and the vessels were anastomosed with the proper palmar digital artery and dorsal digital vein, respectively. At the same time, subcutaneous nerve and proper palmar digital nerve were sutured to reconstruct the sensation of flaps. During the operation, the dominant perforating branch of thenar was found being originated from the superficial palmar branch of radial artery in 27 cases, from the superficial palmar arch in 21 cases, from the perforating branch of metacarpophalangeal proper artery of thumb in 11 cases, from the radial artery in 10 cases and from the main artery of thumb in 10 cases. The origins of nerves within the flaps were found from the superficial branch of radial nerve(24 cases), the terminal branch of lateral cutaneous nerve of forearm(22 cases) and the palmar branch of median nerve(33 cases). The operation time was (96.7±10.7) minutes. The donor site for the flap was closed directly without skin grafting. Most of the follow-up were conducted through the visit of outpatient clinic and the patients from other regions were reviewed via telephone or WeChat.Results:All perforator flaps survived completely and the flap donor sites healed smoothly. Follow-up lasted for (20.5±3.8) months. The reconstructed finger pulp was not bulky and the texture was satisfactory. TPD of the flaps was (5.6±0.9) mm. Only a linear scar left in the flap donor sites without significant affect on thenar function.Conclusion:The vascular anatomy of thenar perforator flap is constant, which helps to regain sensations of the flap. The texture and thickness of the flap are similar to those of the finger. It is ideal for reconstruction of defect of finger pulp.
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Objective:To discuss the pedicled perforator flap around ankle in complicated replantation of severed traumatic midfoot.Methods:From May 2017 to December 2020, a total of 4 patients with severed midfoot combined with severely traumatic soft tissue defects were treated in the Department of Micro-orthopaedics, The Second Affiliated Hospital of Luohe Medical Collage. The patients were all males and aged from 22 to 53 (mean, 44) years old. Two patients had left foot injured and 2 in right foot. Causes of injuries: One patient was injured by strangulation of a corn harvester belt, and 3 were crushed by a heavy steel bar. Three patients had the severed sites at the level of intertarsal joint and 1 at the base of metatarsus. The time from injury to admission was 2.0-5.0(mean, 3.5) hours. The severed feet were replanted by anterograde method. Pedicled perforator flaps around ankle were used to repair the soft tissue defects of feet in emergency surgery or post first-stage surgery. The sizes of the flaps were 7.5 cm×8.0 cm-9.0 cm×19.0 cm. Scheduled follow-ups were arranged at outpatient clinic or by online reviews. Appearance, texture, colour, blood supply and sensory-motor function of the replanted feet and flaps were observed. The function of the foot and ankle was evaluated according to the American Orthopaedic Foot Ankle Association (AOFAS).Results:All 4 patients engaged follow-ups lasted for 13-36(mean, 19.5) months. Three replantations survived after surgery. In the other case, a chronic necrosis of the broken foot was caused by skin necrosis, wound infection, and vascular embolism. And then the necrotic forefoot was released, and the wound was later repaired with a flap based medial supramalleolar branches. A total of 5 flaps in 4 patients survived. All flaps were in good appearance with good texture and colour. All flaps healed primarily, and all skin grafts survived. All of the 4 patients could walked without assistance. Sensation restored to S 3. The patient with a failed replantation had left with a mild claudication. According to AOFAS, 2 patients were in excellent, 1 in good and 1 in fair at the last follow-up. Conclusion:Replantation of severed midfoot with an early application of pedicled perforator flap around ankle for reconstruction of severely traumatic defect is an effective and feasible treatment strategy.
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Objective:To summarise the clinical efficacy of free deep inferior epigastric artery perforator flap (DIEPF) in repairing large wounds in upper limb.Methods:From June 2016 to March 2022, free DIEPF repair surgery were performed for 9 cases with large defects in elbow, forearm and wrist in the Department of Hand Surgery, Xuzhou Renci Hospital. The patients were 3 males and 6 females at 36-65(average 50) years old. The sizes of defect ranged from 6.0 cm×7.0 cm to 25.0 cm×33.0 cm. Seven defects combined with radius-ulnar fracture, 4 with wrist fracture, 4 with metacarpal fracture and 1 with humerus fracture. All defects had various degrees of injuries of tendon, blood vessel and nerve. A total of 10 flaps were harvested, and the size of flaps were 7.0 cm×8.0 cm-12.0 cm×35.0 cm. Vessels in 7 flaps of 6 patients were anastomosed with unilateral vascular pedicles and 3 with bilateral vascular pedicles. End-to-end arterial anastomosis was performed on 1 flap, and the other 9 flaps of 8 patients had end-to-side arterial anastomoses. End-to-end vein anastomoses were performed on all flaps. Umbilical reconstruction was performed at the abdominal donor site for 3 patients, and all donor site wounds were closed in stage I surgery. Scheduled outpatient and WeChat follow-up were made after surgery.Results:Nine flaps in 8 patients survived successfully. Partial skin necrosis occurred in 1 flap and repaired by skin grafting. Follow-up lasted for 6 to 60 months(12 months in average). At the last follow-up, the colour of the flaps was found being similar to the surrounding skin with mildly bloated and soft in texture. Sensation of the flaps recovered to S 2 in 5 patients, and not detected in 4 cases. Conclusion:The free DIEPF has a relatively constant perforator and the flap can be used for repairing a large area of defect. The donor site wound can be closed in Ⅰ stage surgery. Free DIEPF is suitable for repair of large upper limb wounds.
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Objective:To observe the surgical method and clinical efficacy of applying calf tissue flap combined with artificial bone of antibiotics loaded calcium sulphate in treatment of tibia osteomyelitis.Methods:From July 2018 to January 2021, calf tissue flaps combined with artificial bone of antibiotics loaded calcium sulphate (or mixed with iliac bone) were applied to treat 16 cases with tibia osteomyelitis in the Department of Hand and Microsurgery of Baoji Third Hospital. There were 10 males and 6 females, aged 15 to 64 years old, with a mean age of 41 years old. For the 5 cases with acute osteomyelitis caused by wound infection, local dressing changes and drainage or VSD wound management were applied after debridement, together with primary systemic anti-infection treatment. After the acute infection period had been under control and stabilised, the wounds were then thoroughly exposed and cavities were filled and covered with the surgical reconstruction procedure with antibiotics-loaded artificial bone of calcium sulphate in combination with calf tissue flaps. For the 11 cases with chronic and hypotoxicity osteomyelitis, calf tissue flaps combined with antibiotics-blended artificial bone of calcium sulphate were applied to fill the cavity and cover the wound in phase I surgical reconstruction after thorough debridement. For the 7 cases with large bone defects or larger cavities after debridement, a mixed bone grafts of antibiotics-loaded artificial bone of calcium sulphate and autologous iliac bone were employed, with muscle flaps or myocutaneous flaps for an embedding repair. Sizes of the tissue flaps were 2.0 cm×3.5 cm to 12.0 cm×23.0 cm. Clinical outcomes were evaluated through follow-ups at outpatient clinic. The therapeutic effect was evaluated by the method described by McKee et al.Results:Except for 1 case of distal necrosis of tissue flap and survived after dressing change, the other tissue flap survived successfully. Postoperative follow-ups lasted for 12 to 40(mean 18) months. All the osteomyelitis were successfully cured, except 1 that had recurrence of osteomyelitis 1 year later, and treated with antibiotics-loaded artificial bone of calcium sulphate combined with autologous iliac bone implants after thorough debridement, and then healed well. The shape and texture of flaps were good. Protective sensations were restored to vary levels after 6 months. The calf regained weight-bearing and walking functions at 1 year after surgery. According to McKee et al., the therapeutic effect was evaluated: 11 cases were cured, 4 cases were improved, and 1 case relapsed, with an effective rate of 93.8%.Conclusion:Application of calf tissue flap combined with antibiotics-loaded artificial bone of calcium sulphate in the treatment of tibia osteomyelitis has a high cure rate and remarkable efficacy. It can significantly reduce the number of surgeries and shorten the course of disease.
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Objective:To evaluate the efficacy of pedicled latissimus dorsi flaps in reconstruction of large soft tissue defects around elbow.Methods:From January 2012 to January 2022, 12 patients with large soft tissue defects around elbow received reconstructive surgery with pedicled latissimus dorsi flaps in Department of Microreconstructive Surgery, The First Affliliated Hospital of Xinjiang Medical University. Partial latissimus dorsi flaps were employed to reconstruct The soft tissue defects around the posterolateral side of elbow in 6 patients. Functional reconstruction of anteromedial soft tissue defect around elbow with functional latissimus dorsi myocutaneous flap combined with biceps muscle dynamic reconstruction was performed on other 6 patients. All patients were males and aged 18 to 57 years old, at 31.4 years old in average. Causes of injury: machine strangulation in 5 patients, traffic accident in 4 patients, machine crush in 2 patients, and fall from height in 1 patient. Injured sites: 5 patients had injury on right elbow and 7 on the left. The size of soft tissue defect ranged from 18.0 cm×10.0 cm to 51.0 cm×13.0 cm. The size of the flaps were at 30.0 cm×7.0 cm-55.0 cm×14.0 cm. The wounds at donor site were directly sutured. Follow-up included postoperative reviews via telephone, WeChat and visit to outpatient clinic. Mayo elbow performance scores(MEPS) at the last follow-up were recorded.Results:All 12 flaps survived, and all donor and recipient sites healed at stage I. The follow-ups lasted for 3 months to 2 years for all patients, with 18 months in average. Three months after operation, 1 patient underwent additional surgery for flap reduction due to a bloated flap and poor appearance. Six patients who received dynamic reconstruction myocutaneous flaps achieved grade IV in elbow flexion. Six patients with lateral elbow repaired with partial latissimus dorsi myocutaneous flap showed that the appearance of the flap was not bulky and had no effect on the flexion and extension function of the elbow joint. All flaps survived well at the last follow-up, with soft texture and colour close to the surrounding normal skin. All donor sites healed well, leaving only linear scars. Motion of all elbows was good. The MEPS at the final follow-up was(90.6±6.4), with 10 patients in excellent and 2 in good.Conclusion:According to the location of elbow joint soft tissue defect, different types of latissimus dorsi myocutaneous flaps are used for reconstruction, which can achieve good clinical results.
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In 1963, the successful replantation of severed limbs in China was firstly reported in the world, and it opened a new era of microsurgery. In the past 60 years, Chinese microsurgery scholars had created numerous world firsts. Microsurgery is an advantage and characteristic clinical subject in China. We should continue to innovate and correctly position the clinical application of microsurgery technology, constantly expand the business space, serve the grass-roots level, educate new people, develop technologies and techniques, improve skills, strengthen communication.
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Objective:To investigate the clinical effect of using free bilateral anterolateral thigh flaps(ALTF) in series to repair large area soft tissue defects of forearm.Methods:The clinical data of 11 patients with large soft tissue defects of forearm admitted in the Department of Plastic(Repair and Reconstruction) Surgery, Lishui Hospital of Zhejiang University from March 2014 to December 2021 were retrospectively analyzed, including 8 males and 3 females. Aged 36 to 68 years old, with an average of 48 years old. VSD treatment was performed after debridement, and until fresh removed 3 to 5 days after the operation. Until the wound was fresh. The wound was repaired with free bilateral ALTF in series until fresh. The size of the forearm wound was 18 cm×15 cm-28 cm×13 cm. The cut area of a single flap was 10 cm×8 cm-20 cm×13 cm. The series of bilateral flaps: One of the flaps was used as the proximal flap, and its vascular pedicle was anastomosed with the arteries and veins of the recipient area. The other flap was used as the distal flap, and the arteries and veins between the 2 ALTFs on both sides were anastomosed. The vascular pedicle beyond the distal flap was ligated or anastomosed to the distal end of the ulnar artery or the distal end of the radial artery. The flap and the surrounding skin of the recipient area were sutured immediately. The donor sites of the flap was closed directly. Periodic and regular outpatient follow-up was performed after operation and the clinical efficacy was analyzed.Results:All the flaps successfully survived after the surgery. The postoperative follow-up lasted for 6-18 months, 12 months in average. The flaps survived well with good soft texture, without swelling, the capillary reaction time was normal, without surface ulceration, in rosy colour and restored protective sensations. The hand function of the affected limb recovered well. The wound at donor sites healed well without complications. At the last follow-up, the hand function of the affected limb was evaluated by the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the result was 7 in excellent and 4 in good. The patients were satisfied with the flap and the therapeutic effect.Conclusion:The free bilateral ALTF in series can be used to repair a wound surface with large area, and the donor site can be closed at the same time. It is an effective method to repair large soft tissue defect of forearm.
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Objective:To retrospectively analyse the clinical effect of sensation reconstructed free medial plantar artery perforator flap in repair of digit-tip defects.Methods:From March 2017 to February 2021, 11 cases with digit-tip defect were repaired by medial plantar artery perforator flap in the Department of Hand Surgery of Xuzhou Renci Hospital. The cutaneous sensory nerves were separated when the flap was harvested, and then the sensory nerves were sutured to the palmar nerves of the digits to reconstruct the sensation of the flap. All wounds had exposure of phalangeal bones, the size of the digit-tip defects was 1.2 cm×1.0 cm-2.5 cm×2.2 cm, the size of the flaps was 1.6 cm×1.5 cm-3.0 cm×2.7 cm. Ten donor sites were directly sutured and 1 was repaired by skin grafting. All patients were included in the postoperative follow-up through outpatient clinic and WeChat reviews to collect relevant information, including texture, sweating, stability, sensation, degree of bloating, blood circulation, usage of the flaps and skin and scars at the donor sites.Results:All flaps survived besides 1 case had venous occlusion occurred 12 hours after the operation, and the venous occlusion was relieved by releasing the dressing and removing some of sutures, and the flap survived smoothly. The wounds in the donor sites healed well. The postoperative follow-up period lasted for 6-18 months, with an average of 10.7 months. The flaps were soft, wear-resistant, and stable. The skin texture was restored with a small amount or normal sweating. One flap had mild bloated, and another flap showed a slightly poor colour of the flap together with a lower temperature. The sensory recovery of the flaps was good, reaching S 3+ or above. The TPD had achieved 6.0-8.5 mm, with an average of 7.1 mm. One patient had concerns in using the affected digit and 3 cases were in protective use of the affected digits. There was no wear and ulcer in the foot donor sites. According to Wang Shuhuan's assessment of flap function and Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the patients in this group were scored excellent in 8 cases and good in 3 cases. Conclusion:The application of free medial plantar artery perforator flap in repair of digit-tip wounds can achieve good repairs. The donor site is hidden without effect on walking. It is one of the ideal donor sites for repairing digit-tip wounds.
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Objective:To investigate the clinical effect of superthin anterolateral thigh flap(ALTF) with retrograde dissection of perforator in the interface plane between the superficial and deep layer of superficial fascia for reconstruction of soft tissue defect in the foot.Methods:The study involved 24 Side of 23 patients with foot soft tissue defects in Department of Foot and Ankle Surgery in Wuxi Ninth People’s Hospital from August 2019 to July 2021. There were 15 males and 8 females with an average of 42(range, 22-59) years old, including 9 in left foot, 13 in right foot, and 1 in both feet. The size of soft tissue defects was 4 cm×4 cm-11 cm×17 cm. The dimension of the superthin ALTF was 4 cm×5 cm-12 cm×18 cm. CTA and high-frequency CDU were used to locate the perforator in the superficial fascia plane. The perforator was exposed and dissected retrograde in the adiposal layer. The superthin ALTF was harvested to repair the foot wound. The donor site was sutured directly. All patients enter follow-up reviews at outpatient clinic or by WeChat. The appearance of flaps were recorded.Results:The superthin ALTF survived in all patients. Two cases had partial epidermal necrosis at the distal part of the flap. The thickness of the flap averaged approximately 4(range 3-6) mm. During 8-16(mean 12) months of follow-up, all superthin ALTF were soft in texture without ulceration. Two flaps required secondary defatting procedures, others showed satisfactory appearance without bulky deformity. Only linear scars left in donor areas.Conclusion:The technique of harvesting superthin ALTF with retrograde dissection of perforator in the superficial fascia plane for repairing foot wounds is reliable and is able to achieve satisfactory functional and esthetic outcome.
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Objective:To investigate the effect of V-Y advancement flap in the treatment of foot spoke injury in children.Methods:Clinical data of 8 patients, including 6 males and 2 females aged 2.5-5.0 (mean, 3.5) years old with foot spoke injury admitted to the Third Ward of Department of Orthopaedic Surgery, Xingtai General Hospital of North China Medical and Health Group from June 2019 to October 2021, were analysed retrospectively. Soft tissue defect around achilles tendon was 2.0 cm×3.0 cm-2.5 cm×4.0 cm. The size of the flap was 2.5 cm×3.5 cm-3.0 cm×4.5 cm. All patients underwent emergency debridement followed by V-Y advancement flap repair, and direct suture of the skin and tissues at donor site. The blood supply, survival and healing of flap of donor site were observed after operation. The shape of the heel and the functional recovery of the affected limb were examined on regular basis at the outpatient clinic.Results:All 8 flaps survived and the wounds had primary healing. The patients entered the follow-up for 6-12 months, with an average of 8 months. The texture and colour of the flap recipient site were good. The shape of the flap pedicle, the donor site and recipient site were satisfactory. The shoes wearing of the affected foot were not affected after surgery. The ankle function was good. The average extension was 25.8°(20°-30°), plantar flexion 32.5°(25°-40°), and the foot sensation and motion were close to normal. The average foot function score on American Association on Foot and Ankle Surgery(AOFAS) was 91.7±6.4. Five cases were excellent and 3 were good.Conclusion:The V-Y advancement flap demonstrates an ideal alternative method for treatment of small area of soft tissue defect around Achilles tendon, due to the simple operation, satisfactory shape of flap after repair, and favorable limb function.
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Objective:To explore the method and effect in repairing the defect of fingertip with lateral V-Y advancement flap with one side palmar proper digital artery.Methods:From October 2014 to May 2019, Department of the Hand and Foot Surgery, the Third People's Hospital of Jining(Yanzhou District People's Hospital of Jining City) treated 34 digits of 27 cases with a defect area of 0.5 cm×0.5 cm-1.5 cm×2.0 cm. A lateral V-Y advancement flap with one side palmar proper artery was used to repair the fingertip defect, and the flap size was 1.7 cm×1.0 cm-4.5 cm×1.5 cm. Twenty cases entered long-time follow-up after operation, with 7 cases lost in follow-up, 16 cases were reviewed at outpatient and 4 by WeChat.Results:All the flaps of 34 digits of 27 cases survived. The color of the flaps were close to or completely normal to the surrounding tissue, the texture was soft and the appearance was good. The TPD of the flap was 2.0-6.0 mm. The follow-up time ranged from 22 to 77 months, with an average of 31.45 months. The flexion and extension function of the digits were good with total range of motion(ROM) of the thumb was > 90 °; total active motion (TAM) of the fingers was 260 °-200 °. The fingers of 1 case had hook nail or hook finger deformity. According to the Evaluation Trial Standard of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, 18 cases were excellent and 2 cases were good.Conclusion:The lateral V-Y advancement flap with one side palmar proper digital artery is easy to operate. The blood supply of the flap is reliable, with good sensation. The flexion and extension of the digits are good, and the appearance and texture of the flap are good.
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Objective:To investigate the surgical method and therapeutic effect on repairing soft tissue defects around ankle with lateral tarsal artery island flap.Methods:From July 2013 to December 2020, the lateral tarsal artery island flap were used to repair the soft tissue defects around ankle in 12 patients in Hand Surgery Department, Jiangnan Hospital Affiliated to Binjiang College. Of which, 6 patients had soft tissue defects complicated with bone or tendon exposure after injury and 6 had skin necrosis with internal fixation after fracture. The area of soft tissue defects was 6.0 cm×4.0 cm-9.0 cm×5.0 cm, and the size of the flaps was 7.0 cm×5.0 cm-10.0 cm×6.0 cm. After the flap was freed, the vascular pedicle was separated up to the origin of dorsalis pedis artery. As the pedicel was not long enough in 1 patient, the dorsal pedis artery was ligated and transected at the origin of the lateral tarsal artery. Full thickness skin graft was used to repair the donor sites. The patients were treated with anti-infection and anticoagulant therapies. The postoperative follow-ups were conducted by outpatient clinic visit, telephone or WeChat interviews or home visit to observe the recoveries in texture, appearance, sensation, donor site and function of ankle.Results:All the flaps and skin grafts survived. The wound healed well without occurrence of ulcer. The follow-up ranged 6-108 months (mean 17 months). Appearance of the flaps was good. It was not bloated and the sensation was restored to S 2-S 3. Conclusion:It is a good method to apply the lateral tarsal artery island flap in repair of the soft tissue defects around ankle. It features a hidden donor site, simple operation and the high level of safety. The texture and appearance of the flap are close to those of the recipient site.
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Objective:To investigate the clinical effect of Ilizarov technique of tibial bone transverse transport combined with flap transfer in the treatment of severe diabetic foot.Methods:From April 2016 to March 2020, 7 patients with severe diabetic foot were treated by Ilizarov technique of tibial bone transverse transport combined with flap transfer in the Department of Hand and Foot Surgery of Foshan Nanhai Public Health Hospital. Diabetes Wagner classification: 2 cases were in Grade 3, in which, 1 case was ulcer in right heel and deep plantar with abscess and infection, and 1 case was ulcer in left great toe and phalanx infection; Other 5 cases were in Grade 4, of them, 2 cases were gangrene in proximal and distal of left great toe, 1 case were gangrene and infection in proximal, middle and distal segment of right 2nd toe, 1 case were gangrene and infection in proximal, middle and distal segment of left 4th toe, and 1 case were gangrene in distal segment of left 4th toe. Wound area was 2.0 cm×2.0 cm-6.0 cm×12.0 cm. Sural neurouascular flaps were used in 1 case, dorsal plantar artery flaps in 4 cases and medial plantar artery flaps in 2 cases. Size of flap was 2.0 cm×2.0 cm-6.0 cm×12.0 cm. Follow-up was conducted regularly by outpatient clinic, telephone and WeChat interviews. Content of the follow-up included foot wound healing, skin temperature of dorsal foot, lower limb paralysis, puncture exudation of external fixation stent, and blood supply of calf skin. Foot function was assessed according to the American Orthopedic Foot and Ankle Association (AOFAS) score.Results:All 7 patients entered the follow-up for 6-28 months, with an average of 8.2 months. All the foot ulcers healed. The pain of affected limbs eased off in 5 patients, and 2 patients had significant pain relief in affected limbs. Foot paralysis significantly alleviated in 7 patients, with calf skin temperature increased (1.81±0.56) ℃, and no recurrence of foot ulcers. According to AOFAS score, 3 cases were excellent, 3 cases were good and 1 case was fair.Conclusion:Ilizarov technique of tibial bone transverse transposition combined with flap transfer in the treatment of severe diabetic foot has a good clinical effect and it could be an option in the treatment of diabetic foot.
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Objective:To explore the clinical value of modified infrared thermal imaging assisted design of peroneal artery perforator propeller flap.Methods:From March 2019 to May 2021, tourniquet-reperfusion augmented thermal imaging method (TRATIM) was used to locate the perforating vessels in 14 patients for surgery or peroneal artery perforator propeller flap. The sensitivity, positive predictive value and detection time were calculated and compared with the perforating vessels located by color Doppler ultrasound(CDU), P<0.05 is statistially significant. Results:After operation, 13 flaps survived completely, but 1 flap with distal surface necrosis and healed after dressing change. Only one linear scar was left in 12 cases, and 2 cases healed well by skin grafts. Followed-up for 6-13 months, and showed that the colour and texture of the flaps were similar to the surrounding skin, without obvious swelling. The sensitivity of TRATIM and CDU in location of peral perforator vessels were 88.0% and 92.0%, respectively, and the positive predictive value was 93.6% and 95.8%, with no statistical difference between TRATIM and CDU( P>0.05). The time of positioning perforator was (3.71±0.80) min for TRATIM and(16.21±4.97) min for CDU, There was significant difference between TRATIM and CDU( P<0.01). Conclusion:With TRATIM, a surgeon can locate the peroneal perforator vessels simply, quickly and accurately, and help in design more accurate peroneal artery perforator propeller flap.
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Objective:To investigate the application and surgical effect of lobed anterolateral femoral chimeric perforator flap in repairing the complex soft tissue defects of limbs.Methods:Clinical materials of 52 cases with complex soft tissue defects of limbs were retrospectively reviewed from October 2013 to October 2020. Thirty-two males and 20 females were reviewed, and the age of them ranged from 6 to 65(mean 39) years old. The injuries include 17 cases of traffic accidents, 15 machine crush injuries, 12 engineering accidents, and 8 extensive resection of malignant tumors. The size of soft tissue defects ranged from 26.0 cm×10.0 cm to 35.0 cm×15.0 cm. Lobed anterolateral thigh chimeric perforator flaps or lobed Flow-through chimeric perforator flaps were designed according to the soft tissue defects and blood circulation of the distal extremities. Start from 8-month post-operation, upper limb function was assessed according to the Upper Limb Function Assessment Standard of Hand Surgery Branch of Chinese Medical Association and Disability of arm shoulder and hand(DASH) score scale, and Fugl-Meyer score system was used to evaluate the lower limb function. Long-term follow-up was conducted through WeChat video call and outpatient clinic evaluation.Results:All flaps survived. One patient with crush injury got delayed wound healing due to deep hemaetoma after surgery, and the rest were healed at the first stage. All the cases entered followed-up, ranged from 6 to 20(mean 8) months. The appearance of the flaps was satisfactory, and the color of the flaps has no significant difference compared with the recipient area. No recurrence of tumor was reported during the follow-up period. According to the Upper Limb Function Assessment Standard of Hand Surgery Branch of Chinese Medical Association, there were 21 excellent cases and 8 good cases, and the total excellent and good rate was 100%. The DASH score of upper limbs ranges from 11.5 to 45.1(mean 25.4±13.7), and the Fugl-Meyer score of lower limbs range from 18.6 to 31.8(mean 26.2±11.2) at the last follow-up.Conclusion:The complex soft tissue defect of limbs is a common complication caused by high-energy trauma, which is difficult to repair. The lobed anterolateral thigh chimeric perforator flap through a Decompose-Combine and arrange method for reconstruction, which is flexible in flap design. A variety of tissue flaps can be obtained by anastomosing only one group of blood vessels. It is an ideal choice for repairment of complex soft tissue defects of limbs.
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Objective:To explore the advantages and value for clinical application of clavicle segment osteotomy approach with pectoralis major muscle pedicle in surgical resection of posterior brachial plexus tumour.Methods:From April 2010 to December 2020, 6 patients with brachial plexus tumour behind the clavicle were treated. Two patients had the tumour on the left brachial plexus and 4 on the right. Two patients had the tumours located in the upper trunk of brachial plexus, 2 in the middle trunk, 1 in the medial plexus and 1 in the posterior bundle. The neurological function evaluation were grade II in 3 cases and grade III in 1 case preoperatively. The tumours sized from 3.0 cm× 3.0 cm×2.0 cm to 11.0 cm×8.0 cm×6.0 cm. The clavicular segment osteotomy approach with the pedicle of the pectoralis major was applied in order to expose the surgical field and remove the nerve tumour. All patients underwent regular postoperative outpatient clinic follow-up to record the sensation of the affected limb and the recovery of muscle strength, tumour recurrence and fracture healing.Results:In the operation, it was found that there was still a little glial-like tissue in the nerve sheath after complete dissection of the tumours in 2 patients. Postoperative pathological examination reported that there were 4 schwannoma, 1 malignant peripheral schwannoma and 1 neurolipoma. The postoperative follow-up lasted for 6 to 34 months, with an average of 12.8 months. All patients showed no symptoms of brachial plexus injury or tumour recurrence. The clinical symptoms were relieved or disappeared. The neurological function evaluation reached grade III in 5 patients and grade IV in 1 case. At the same time, the internal fixation of the clavicle was satisfactory and achieved bone union in all cases. Fracture healing time was 2.5 to 4.5 months, with an average of 3.2 months. The internal fixation was removed from 3 patients after operation in 1 year. No obvious limb movement disorder and periarthritis of shoulder and other complications occurred.Conclusion:The transclavicular osteotomy approach with the pedicle of the pectoralis major can fully expose the anatomical alignment of the brachial plexus and the relationship adjacent and between the tumour and the surrounding tissues in the surgery for a brachial plexus tumour behind the clavicle, which is helpful for a complete tumour resection. It is a feasible method to treat brachial plexus tumour behind the clavicle by finding residual tumour-like tissue, reducing the risk of surgery and tumour recurrence, and providing excellent blood supply to the osteotomy segment of the clavicle to promote fracture healing.
ABSTRACT
Objective:To explore the surgical technique and therapeutic effect of flap wrapping repair of soft tissue defect after digit degloving injury with free arm medial perforator flap.Methods:From October 2009 to December 2020, 15 patients with soft tissue defect after digit degloving injury were repaired with free arm medial perforator flaps. The patients were 9 males and 6 females aged 22 to 50 years old, with an average of 32 years old. Injury mechanism: 13 cases of machine strangulation and 2 cases of machine crushing. Plane of sleeve avulsion injury: at the distal metacarpophalangeal joint of thumb in 2 cases, at the middle and distal segment of single finger of 2nd to 5th fingers in 4 cases, and at distal metacarpophalangeal joint of 2nd to 5th fingers in 9 cases. Seven cases were in left hand and 8 in right hand. Emergency surgery was performed in 2 cases and scheduled surgery in 13 cases. The flap was designed in a shape of a long strip, and the size of the flap was 5.0 cm×2.5 cm-14.0 cm×3.5 cm. During the operation, the artery of the flap pedicle was anastomosed with the palmar digital proper artery or common digital artery of the recipient digit, the subcutaneous vein or the companion vein of the artery was anastomosed with the dorsal or palmar digital subcutaneous vein, and the medial brachial cutaneous nerve carried in the flap was anastomosed with the stump of palmar digital proper nerve. All the donor sites were directly sutured. After the surgery, follow-up visits were conducted regularly at outpatient clinic, or via telephone and WeChat review or by home visit. The flap appearance, sensation and function recovery of digital joints were observed together with the patient satisfaction. Results:All flaps survived successfully after surgery. Six patients with degloving defect of the whole digit had encountered poor wound healing caused by distal phalangeal necrosis. The second stage stump trimming was performed to keep the digit to the distal end of the middle segment. Two cases of thumb and 2 cases of middle finger suffered further burning and worn tears at 7-9 months after surgery and self-healed. The follow-up period was 6-28 (average 16) months. The flap was soft without bloating. The sensation recovered to S 2-S 3. The shape of fingers was good, and no secondary flap surgery was necessary. The overall movement of interphalangeal joints was poor. According to the evaluation standard of Michigan hand function questionnaire, 15 patients achieved very satisfactory with the overall appearance and function of hands. The linear scars at donor site were hidden without complications such as tenderness and contraction. Conclusion:The free medial perforator flap of the arm is easy to design and thin, hence does not affect the shape of a digit. So, it is ideal for the repair of soft tissue defect after digit degloving injury.