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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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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 study the anatomy of the perforator propeller flap of superior lateral genicular artery, and to explore a surgical method and clinical application in repair of the soft tissue defect of anterolateral knee with the flap.Methods:From September 2019 to September 2021, 8 knees of 4 chilled fresh specimen of adults were studied. The perforators of the superior lateral genicular artery were observed. The length, outer diameter of the perforators, and the locations of the skin perforation were recorded. The superior lateral genicular artery perforator propeller flaps were then applied clinically to 5 patients(3 males and 2 females) with soft tissue defects of anterolateral knee. Two of the patients had combined ligament injury and(or) bone joint exposure. The age of patients ranged from 25 to 48 years old, at 33.4 years old in average. The sizes of soft tissue defects ranged from 4.0 cm×4.0 cm to 8.0 cm×5.0 cm. The sizes of perforator propeller flaps of superior lateral genicular artery were 10.0 cm×5.0 cm to 13.0 cm×6.0 cm. The superior perforating vessels of the superior lateral genicular artery were found and marked at the points of skin perforation. Preoperative contrast-enhanced ultrasound were performed to confirm the dominant perforating vessels and had the skin perforating points marked. Intraoperative CDU were further performed to confirm the points of dominant perforating vessels. Perforator propeller flaps were designed depending on the size of the anterolateral soft tissue defect, and flaps were prepared and transferred to the defect sites. Postoperative follow-ups were conducted at outpatient clinic. The survival of the flap and knee function were observed according to the Bai-ly knee scoring.Results:The anatomy showed that an average pedicle length of the superior lateral genicular artery perforator was(8.2±0.9) cm, with an average starting outer diameter at(1.1±0.2) mm. All 5 flaps survived during the follow-up that lasted for 10 to 24 months, with an average of 15.3 months. All flaps healed in 2 weeks after surgery without complications such as soft tissue infection, bone and joint infection were observed. At the last follow-up, no obvious bloated appearance of the flaps were observed. The colour and elasticity of the flaps were similar to the surrounding skin. The knee function was assessed: 4 patients were in excellent and 1 in good. The range of knee flexion and extension was from 100° to 150°. The patients were satisfied with the appearance and function of the knees.Conclusion:The size of the perforator of superior lateral genicular artery and the pedicle length are ideal. The propeller flap can be used to repair the soft tissue defect around the anterolateral knee, with satisfactory functional recovery of a knee. It is a good method to repair the soft tissue defect around anterolateral knee.
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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 estimate the preliminary result of circumflex scapular perforator propeller flap in reconstruction of axillary scar contractures.Methods:From January 2016 to June 2021, circumflex scapular perforator propeller flaps were used in 7 cases for reconstruction of soft tissue defect after axillary scar contractures. Patients were 5 males and 2 females. Age ranged from 23 to 38 years old, mean age of 27.7 years old. According to Kurtzman and Stern classification of axillary scar contractures, there were 1 case with type 1a, 1 with type 1b, 2 with type 2, and 3 with type 3. The preoperative range of motion of the shoulder joint were 40°-85°, with an average of 63.7°. All the patients were underwent scar release and circumflex scapular perforator propeller flap transfer. All flaps were transferred as the manner of perforator propeller flap. All the donor sites were closed directly. The defects after releasing ranged from 5.0 cm×7.0 cm to 11.0 cm×9.0 cm, and the flaps ranged from 16.0 cm×7.0 cm to 24.0 cm×9.0 cm. Flap survival, complications of donor site and recipient site were recorded after surgery. The range of motion of the shoulder joint, donor and recipient sites were reviewed in outpatient clinic.Results:All flaps survived uneventfully after surgery, besides 1 case complicated with distal venous congestion. The follow-up time ranged from 6 to 23 months, with an average of 12 months. The texture and contour of the flaps were good in all. At last follow-up, the range of motion of the shoulder joints were 90°-120°, with an average of 107°. Mild scar hyperplasia occurred in 2 cases.Conclusion:The circumflex scapular perforator propeller flap is an effective protocol in reconstruction of axillary scar contractures.
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Objective:To investigate the clinical effect of propeller flap pedicled with perforating branch of peroneal artery in repairing soft tissue defects of ankle and foot.Methods:From August 2018 to August 2021, 15 cases of soft tissue defect of ankle and foot were repaired with propeller flap pedicled with perforating branch of peroneal artery in the Department of Hand and Microsurgery, Baoji Third Hospital. Among them, there were 7 cases with soft tissue defect in heel, 6 cases in lateral ankle and 2 cases in front of ankle. The size of defects was 3.0 cm×3.5 cm-5.5 cm×4.0 cm, and the size of flaps was 5.0 cm×4.5 cm-12.0 cm×6.0 cm. In 7 cases, the donor sites were closed directly with the aid of small paddle. The donor sites in other cases were covered with medium thickness skin graft after the wounds were narrowed by pull-up suture. The clinical efficacy was evaluated by follow-up at outpatient clinic and via telephone or WeChat interviews. Functional recovery was evaluated according to the American Orthopedic Foot Ankle Society (AOFAS) -Marylad.Results:Among the 15 flaps, 2 had distal necrosis and healed after dressing change; One flap was swelling and had venous osculation, but relived 2 weeks later. The rest of the 12 flaps survived smoothly. At the final follow-up: the shape and texture of the flap were good, and the protective feeling was restored; The ankle also recovered the normal flexion, extension and weight-bearing. According to the AOFAS-Marylad, function recovery were excellent in 9 cases, good in 4 cases, and fair in 2 cases.Conclusion:It is simple, safe and reliable to repair the soft tissue defect of foot and ankle with propeller flap pedicled with perforating branch of peroneal artery. It does not sacrifice the main blood vessels of limb, and the blood supply of the flap is reliable. It is an ideal operation for repairing the soft tissue defects of ankle and foot.
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Objective:To investigate the preliminary clinical effect of posterior interosseous artery propeller flap in the repair of dorsal of wrist and hand wounds.Methods:From March, 2015 to December, 2019, 9 cases of dorsal of wrist and hand wounds were repaired with posterior interosseous artery propeller flap, including 6 cases of dorsal hand defect and 3 cases of dorsal wrist defect. Defect area: 6 cm × 4 cm-3 cm × 3 cm; There were 3 cases of metacarpal fracture, 1 case of phalangeal fracture and 1 case of tendon rupture. According to the size and shape of the wound, the posterior interosseous artery propeller flap was designed to transfer and repair the soft tissue defect wound. The size of the flap: 20 cm × 5 cm-12 cm × 3 cm, the size of posterior interosseous artery propeller flap was recorded and the surgical characteristics were summarized; The survival of the flap, donor and recipient complications were observed and followed-up.Results:All flaps were cut smoothly and the donor areas were sutured directly. The flap survived completely in 8 cases and partial necrosis in 1 case; One case complicated with wound infection. The follow-up ranged from 6 to 31 months, with an average of 14 months. The texture and shape of the flap were good; The last DASH score was 3-18, with an average of 9.3; There were 2 cases of mild scar hyperplasia in the donor area and 1 case of mild scar hyperplasia at the edge of the flap.Conclusion:Posterior interosseous artery propeller flap may be an effective method to repair small and medium-sized wounds of dorsal of wrist and hand.
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Objective:To compare the effect of stripped perforator pedicle on the survival of perforator flap.Methods:From January, 2015 to December, 2019, 44 patients with soft tissue defects of distal shank and ankle were repaired with perforating vessel pedicled propeller flap. According to the nudity of the perforator pedicle, the patients were divided into 2 groups: stripped group ( n=14) and non-stripped group ( n=30). The gender, age, history of smoking, history of diabetes, location of wound, size of flap, perforator artery of flap, closure method of donor site, degree of flap swelling 3 days after operation, percentage of survival area of flap 7 days after operation and postoperative complications were analysed retrospectively. Data were analyzed statistically. The difference was statistically significant when P<0.05. Results:There was no significant difference between the 2 groups in age, smoking history, diabetes history, wound location, size of flap, perforator artery and donor site closure( P<0.05). The degree of swelling of flap in the stripped group 3 days after operation [(+) 94.00%, (++) 6.00%, (+++) 0.00%, (++++) 0.00%)] was less than that in the non-stripped group [(+)47.00%, (++) 29.00%, (+++) 13.00%, (++++) 11.00%)] . The difference was statistically significant between the 2 groups( P<0.05). The percentage of flap survival area in the stripped group [(100.00±0.00) %] was higher than that in the non-stripped group [(88.23±21.29)%] , and the difference was statistically significant ( P<0.05). The incidence of postoperative complications in the stripped group(0.00%) was lower than that in the non-stripped group (39.00%). The difference heel statistically significant( P<0.05). Conclusion:The stripped pedicle of the perforating vessel can promote a better survival of the arterial perforating branch propeller flap, and the degree of postoperative swelling and complications of the flap are lower.
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Objective: To investigate the clinical application of the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap in repair of foot and ankle defects. Methods: Between October 2014 and October 2018, 18 cases with foot and ankle defects were treated. There were 12 males and 6 females with an average age of 32.8 years (range, 8-56 years). There were 11 cases of traffic accident injuries, 3 cases of falling from height injuries, and 4 cases of heavy objects injuries. The wound was at the dorsum of the foot in 9 cases, the heel in 4 cases, the lateral malleolus in 5 cases. The time from injury to flap repair was 7-34 days (mean, 19 days). The size of wound ranged from 6.0 cm×2.5 cm to 11.0 cm×6.0 cm. The foot and ankle defects were repaired with the peroneal artery terminal perforator propeller flap in size of 6 cm×3 cm-18 cm×7 cm, which donor site was repaired with the anterior tibial artery perforator propeller flap in size of 8 cm×3 cm-16 cm×6 cm. Results: One patient had a hemorrhagic swelling in the peroneal artery terminal perforator propeller flap, and survived after symptomatic treatment. All recipient and donor sites healed by first intention. Eighteen patients were followed up 6-15 months (mean, 12.5 months). At last follow-up, the shape, color, texture, and thickness of the flaps in the donor sites were similar with those in the recipient sites. There were only linear scars on the donor sites. The two-point discrimination of the peroneal artery terminal perforator propeller flap ranged from 10 to 12 mm (mean, 11 mm). According to American Orthopaedic Foot and Ankle Society (AOFAS) score criteria, the results were excellent in 15 cases and good in 3 cases, with an excellent and good rate of 100%. Conclusion: The foot and ankle defects can be repaired with the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap. The procedure is not sacrificing the main vessel and can avoid the skin grafting and obtain the good ankle function.
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Objective: To study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap. Methods: Between March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained. Results: The origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements ( P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%. Conclusion: The digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.
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Objective@#To explore the effects of free perforator propeller flap from buttock in repairing deep wound of buttock.@*Methods@#From February 2016 to May 2018, 27 patients with buttock skin and soft tissue defects caused by various reasons were admitted to the Burn and Plastic Surgery Center of the 940th Hospital of the Joint Logistic Support Force of People′s Liberation Army, including 19 males and 8 females, aged from 28 to 70 years. Among the protopathy, there were 14 cases of pressure sores, 7 cases of scar carcinoma, 2 cases of low-temperature scald, 2 cases of abscess, and 2 cases of pilonidal sinus. The wounds were located in the sacrococcygeal region in 15 cases, the ischial tuberosity in 8 cases, and the rest area of buttock in 4 cases after injury or lesion resection. The size of wounds ranged from 4.0 cm×4.0 cm to 12.0 cm×6.0 cm after debridement or extended resection. The free perforator propeller flaps from buttock with areas of 8.0 cm×4.0 cm-16.0 cm×6.0 cm were used to repair the wounds, and the donor sites were selected adjacent to the wounds where the skins were relatively loose. All flaps took buttock free perforator vessels as the axis and were transferred in propeller-type to repair the wounds. The donor sites were directly closed and sutured. The survival, complications, and follow-up of flaps were recorded.@*Results@#All the flaps survived 100% in 27 patients. Congestion formed under flaps 2-6 days post operation in 2 patients due to inadequate drainage, which were healed after dressing change and drainage for 14-18 days. The sutures of flaps in the other cases were removed in 10-14 days post operation, and the wounds were healed. Follow-up for 2-12 months showed that the shapes of flaps and the donor sites were plump, which were not much different from the healthy sides, and the flaps could bear weight.@*Conclusions@#Repairing buttock deep wound with buttock free perforator propeller flap has good effects. The donor site can be designed in the area adjacent to the wound where the skin is relatively loose and can be directly closed and sutured while repairing the wound, which can ensure plump buttock appearance.
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Introduction: Women play a pivot role in the family andsociety. Pregnancy constitutes one of the most severe states ofphysiological adaptation. This study was carried out to assessthe flow rate during pregnancy and compare with those ofnon-pregnant women.Material and methods: In this study 120 pregnant womenwithin the age group of 20 years to 40 years, from differenttrimester of pregnancy without having any cardio-respiratorydiseases were selected. Forty non-pregnant women of sameage group were taken as control.Results: The present study clearly indicates that there isgradual decrease of peak expiratory flow rate compared withthe control group, which is significantly marked from first tosecond trimester, but this decline is not very much markedfrom second to third trimester of pregnancy. This may be dueto enlarging gravid uterus, increased progesterone, whichcause relaxation of smooth muscle.Conclusion: Thus the above informations useful for reportingof PFT, better antenatal care, assessment of fitness foranaesthesia, progress of pre-existing lung diseases whichultimately confirms diagnosis and to start treatment.
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Objective To explore the clinical technical points of the treatment of soft tissue defect of the foot and ankle with the supercharged peroneal artery perforator propeller flap,and to provide theoretical support by anatomical observation.Methods From January,2010 to February,2018,a total of 10 patients with soft tissue defect of foot and ankle were treated with supercharged peroneal artery perforator propeller flap.Cause of injury:trauma in 7 cases,wound ulcer in 1 case,and poor healing of the calcaneus incision in 2 cases.Defect site:5 cases of heel,2 cases of medial and lateral malleolus,and 3 cases of dorsum and sole.The size of flap ranged from 6.0 cm×3.0 cm to 16.0 cm×5.0 cm.All patients were followed-up at 1,3,6 months after operation,and the function recovery was judged by AOFAS Ankle Hindfood Scale at 3 months post-opertively.From November,2016 to May,2017,the anatomical basis and operative points of the supercharged peroneal artery perforator flap were summarized.Results All the 10 cases of supercharged peroneal artery perforator propeller flap survived.Two of them had local epidermal necrosis at the proximal end of the flap.After 1 to 2 weeks of dressing,they finally healed.The other 8 cases healed well.Anatomical studies showed that different planes of the supercharged peroneal artery perforator propeller flap can only reduce the compression of the double pedicles and reduce the distal necrosis rate of the flap by rotating in different rotation directions.Conclusion The supercharged peroneal artery perforator propeller flap can enhance the blood supply and venous return in the "big paddle" artery of the flap,preventing distal necrosis.
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Objective To investigate the clinical efficacy of microsurgical repair of soft tissue necrosis after beak-type calcaneal fracture.Methods From January,2012 to March,2017,surgically flaps were used to repair wounds in 8 patients with soft tissue necrosis after calcaneal beak fracture.Five patients underwent sural neurovascular flap in the first stage of repair,2 patients were treated with peroneal perforator propeller flap,and 1 patient was treated with posterior tibial artery perforator propeller flap.The donor sites of 3 flaps were directly closed,and donor areas of the remaining 5 were covered with medium-thickness skin grafts without being sutured directly.The size of flap was 5.0 cm× 3.0 cm-7.0 cm × 5.0 cm.Through postoperative outpatient and WeChat follow-up.The patient's flap survival,infection,flap shape,sensation and ankle function were evaluated.Results All flaps and skin grafts survived post-operatively.All patients were followed-up for 6-12 (mean,8.4) months.All patients had good flap survival and no complications such as soft tissue and calcaneal infection.The flaps were good in texture,shape and function of ankle.At the last follow-up,according to the British Medical Research Institute (BMRI),the sensory function was divided into 6 levels.The flap sensory function recovered to S2 in 3 cases,and the remaining 5 cases was S1.According to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-hindfoot Scale (AHS),the results were excellent in 5 cases,and good in 3 cases.All patients had good clinical results and satisfaction at the last followedup.Conclusion The treatment of soft tissue necrosis after calcaneus beak fractures can be completed in one stage by using flaps,which avoided the occurrence of calcaneal osteomyelitis.It is easy to perform early rehabilitation exercise and the ankle function is well restored.
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Objective@#To explore the flap design and clinical applications of the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery in defect reconstruction.@*Methods@#Between September 2009 and December 2018, 27 patients with soft tissue defects from lower extremities were involved in this study, including 15 males and 12 females, with an average age of 34.6 years old (range, 3 to 73 years old). Before surgery, the type of the flap to be used was designed preliminarily by evaluating the location, size and shape of the lesion or defect. The perforators of the lateral circumflex femoral artery were explored using an ultrasound Doppler probe, marked on skin. The computed tomographic angiography was also used to get more information of the branches of the lateral circumflex femoral artery when possible. The propeller flaps were divided into typeⅠ, Ⅱ, Ⅲ, and Ⅳ according to the perforators that originated from the transverse, descending, oblique, and rectus femoris branches of the lateral circumflex femoral artery, respectively. The type Ⅱ flap was subdivided into type Ⅱa and type Ⅱb flaps that were based on antegrade and reverse flow from the descending branch. The defects were reconstructed using the perforator propeller flap.@*Results@#Twenty-seven patients underwent reconstruction of defects using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery including 3 type Ⅰ flap, 12 type Ⅱa, 2 type Ⅱb, 10 type Ⅲ and 3 type Ⅳ. The size, pedicle length and rotation angle of the flaps were 12 cm×6 cm to 30 cm×15 cm, 4 cm to 15 cm, and 60 to 180 degrees, respectively. Total necrosis occurred in one flap and small-sized distal necrosis in another one. Minor complications occurred in two flaps and the remaining propeller flaps survived completely. All patients were followed up from one to 25 months and mean follow-up time was 9.9 months. Tumor recurrence was noticed in one patient. All patients were satisfied with the final functional and aesthetic outcomes.@*Conclusions@#For appropriate cases, reconstruction of defects from the groin to the knee could be achieved by using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery, with advantages of easy-to-operate and minor donor-site morbidity.
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A 37-year-old woman presented with a congenital spinal meningocele for 37 years and ruptured for 6 months. She was admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences in March 2018. The diameter of the lesion was about 10 cm, with purulent secretion and malodor. The superior gluteal artery perforator propeller flap was used to reconstruct the defect after the lesion resection. Part of the wound didn’t heal and cerebrospinal fluid leaked from the wound postoperatively. The wound eventually healed after wound debridement and drainage changing. Cerebrospinal fluid retention under the flap could result in wound dehiscence and cerebrospinal fluid leakage. The author introduced the treatment process and operative method. The preliminary experience in treating cerebrospinal fluid leakage after surgical management of the spinal meningocele was also summarized.
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Objective To localise and evaluate the precise position of the shank perforators preoperatively with the CTA and hand-held color Doppler (HHD),then evaluate the clinical efficacy of the method.Methods From April,2013 to June,2017,designed 36 propeller perforator flaps in 36 patients by following methods.Firstly,the CTA test was performed to calculate the parameters of perforator vessel positioning.Secondly,a HHD was typically used to verify the location of perforators found on preoperative CTA.At last,according to the "like with like" principle,the propeller perforator flaps were accurately designed.The regular followed-up was performed.Results All patients were followed-up for 3-24 months after operation.Thirty-six propeller perforator flaps survived,and 3 cases among them showed partial epidermal necrosis and healed after skin grafting.Donor sites were closed primarily in 24 cases,and skin grafting were performed in 12 cases.The skin graft sites survived without necrosis,and the average time of cutting flaps was 45 min.Conclusion By the methods of mapping the perforator propeller flaps with CTA and HHD,the perforator vessel can be positioned more accurately and quickly.The operation time was shortened,and the clinical efficiency can be achieved with the good clinical application values.
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Objective@#To investigate the feasibility and technical tips of repairing facial defects with pre-expanded propeller flap based on the perforators of the supratrochlear artery or the supraorbital artery.@*Methods@#In the first-stage operation, a tissue expander was buried underneath the frontalis muscle. The second-stage operation was conducted using pre-expanded supratrochlear artery or the supraorbital artery based propeller flap to repair facial defect.@*Results@#From July 2010 to July 2016, this method was used in 8 patients. 5 flaps were based on the supratrochlear artery, and 3 flaps based on the supraorbital artery. Expander size was ranged from 150 ml to 300 ml. The size of propeller flaps was from 10 cm × 6 cm to 15 cm × 13 cm. All the flaps survived without any major complications. Follow-up period ranged from 3 to 36 months. Eyebrow replacement, flap thinning and scar revision were performed in 6 cases. All patients were satisfied with the final aesthetic result.@*Conclusions@#The pre-expanded propeller flap based on the supratrochlear artery or the supraorbital artery is an alternative option to repair the facial defect in appropriate cases.
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Objective: To explore the effectiveness of propeller facial artery perforator flap to repair the defect after resection of skin malignant tumor at upper lip.
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Objective: To investigate the effectiveness of internal mammary artery perforator (IMAP) propeller flap repair combined with radiotherapy for chest keloid in female patients. Methods: Between January 2015 and December 2016, 15 female patients with chest keloids were treated, aged 28-75 years (mean, 45.2 years). The keloid disease duration was 1-28 years (median, 6 years). The causes of disease included secondary keloid caused by folliculitis in 7 cases, cardiac surgery in 4 cases, skin abrasion in 2 cases, mosquito bite in 1 case, and unknown etiology in 1 case. The size of keloid ranged from 5 cm×3 cm to 17 cm×6 cm. The IMAP propeller flaps were used to repair the defects after chest keloid excision. The size of flaps ranged from 7 cm×5 cm to 14 cm×8 cm. The donor sits were sutured directly. The routine radiotherapy was performed after operation. Results: All IMAP propeller flaps survived well, and the donor site healed by first intention. All 15 patients were followed up 12-24 months (mean, 16 months). No telangiectasia or incision dehiscence occurred. No radiation-related carcinogenesis occurred during follow-up. The patients were satisfied with the breast shape and symmetry after operation. The symptoms of pain and itching were relieved at keloid area in 13 cases (86.7%), with no obvious recurrence of keloid at the donor site and the primary site. Only 2 cases (13.3%) recurred and were treated with continuously conservative treatment. Conclusion: IMAP propeller flap is an ideal reconstruction method for repairing the wounds after chest keloid excision in female patients, which can preserve the good breast shape. The IMAP propeller flap repair combined with early postoperative radiotherapy can effectively reduce the recurrence rate, and the effectiveness is satisfactory.