Accurate tissue flap reconstruction method based on the quadratic surface developability for head and neck soft tissue defects / 生物医学工程学杂志

Soft tissue defects resulting from head and neck tumor resection seriously impact the physical appearance and psychological well-being of patients. The complex curvature of the human head and neck poses a formidable challenge for maxillofacial surgeons to achieve precise aesthetic and functional restoration after surgery. To this end, a normal head and neck volunteer was selected as the subject of investigation. Employing Gaussian curvature analysis, combined with mechanical constraints and principal curvature analysis methods of soft tissue clinical treatment, a precise developable/non-developable area partition map of the head and neck surface was obtained, and a non-developable surface was constructed. Subsequently, a digital design method was proposed for the repair of head and neck soft tissue defects, and an in vitro simulated surgery experiment was conducted. Clinical verification was performed on a patient with tonsil tumor, and the results demonstrated that digital technology-designed flaps improved the accuracy and aesthetic outcome of head and neck soft tissue defect repair surgery. This study validates the feasibility of digital precision repair technology for soft tissue defects after head and neck tumor resection, which effectively assists surgeons in achieving precise flap transplantation reconstruction and improves patients' postoperative satisfaction.

Variations in Innervation Pattern to Dorsum of Foot by Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve with Surgical and Clinical Correlations: A Cadaveric Dissection Based Study

The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site.

Clinical application of the mixed reality technique to assist the location and anatomy of perforator vessels of the anterolateral femoral flap / 口腔疾病防治

Objective@#To explore the clinical application value of mixed reality technology in locating perforator vessels and assisting perforator vessel dissection to harvest anterolateral thigh flaps.@*Methods@#Six patients who needed anterolateral thigh flap repair after resection of oral and maxillofacial tumors were recruited from the Department of Oral and Maxillofacial Surgery of Nanchong Central Hospital from January 2020 to January 2021. Before surgery, the CT angiography data of the lower limbs of the patients carrying the calibration points were imported into the data workstation to perform 3D reconstruction of the perforator vessels and surrounding tissues of the thigh, and the reconstruction results were imported into Microsoft HoloLens 2 glasses. During the operation, calibration was performed at the calibration point of the operative area so that the preoperative reconstruction results were superimposed on the operative area through Microsoft HoloLens 2 glasses. The clinical application value of mixed reality technology assisted perforator vessel location and anatomy of anterolateral femoral perforator flap was discussed from six aspects: whether the perforator vessel was reconstructed preoperatively, intraoperative calibration time, whether the actual position of the perforating vessels passing through the fascia lata fulcrum deviated from the preoperative reconstruction result within 1 cm, time required to harvest the flap, and whether the actual route of the perforator vessel was consistent with the reconstruction result, and whether the postoperative flap survived.@*Results @# The position and course of perforating vessels were successfully reconstructed in 6 cases before the operation. The actual course of perforating vessels during the operation was consistent with the reconstruction results. The deviation between the actual position of the perforating points and the preoperative reconstruction results was within 1 cm, which met the requirements of the actual asisting of the anterolateral thigh flap. The average time of flap harvest was (70.50 ± 7.20) min. The average calibration time was (13.33 ± 5.50) min. All flaps survived.@* Conclusions @# Mixed reality technology projects the reconstruction results of anterolateral femoral perforator vessels directly into the operative area, which provides a new method for asisting localization and anatomy of anterolateral femoral flap perforator vessels and reduces the possibility of injury to perforator vessels.

Repair of soft tissue defect around ankle with lateral tarsal artery island flap / 中华显微外科杂志

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.

Clinical application of a thoracodorsal artery chimeric perforator flap to repair extremity soft tissue defects complicated with a deep dead cavity / 中华创伤骨科杂志

Objective:To explore the curative effects of thoracodorsal artery chimeric perforator flap used to repair extremity soft tissue defects complicated with a deep dead cavity.Methods:From July 2014 to July 2019, 17 patients with extremity soft tissue defects complicated with a deep dead cavity were repaired by a thoracodorsal artery chimeric perforator flap at Department of Orthopaedics, Xiangya Hospital. They were 10 males and 7 females, aged from 2 to 39 years (mean, 20.2 years). There were 7 cases of traffic accident trauma, 5 ones of chronic osteomyelitis, 2 ones of crushing injury and 3 ones of radical resection of tumor. The defects were located at the lower extremity in 15 cases and at the upper extremity in 2. The wound sizes ranged from 5 cm × 3 cm to 24 cm × 9 cm. All the wounds were complicated somewhat with a dead cavity or exposure of deep tissues after debridement. The muscular component of thoracodorsal artery chimeric perforator flap was used to fill the dead cavity while the skin component to cover the superficial wounds. The flap donor sites were closed directly. The flap survival and donor site recovery were followed up regularly after operation. The curative effects were assessed according to the comprehensive evaluation criteria of hand surgery for flaps.Results:Necrosis of the distal flap occurred in only one case which responded to dressing change; the flaps survived uneventfully in the other 16 cases. The recipient and donor sites of flaps healed primarily in all patients. Venous crisis developed in one case which survived uneventfully after vascular crisis exploration. The 17 patients were followed up for 6 to 24 months (mean, 15.8 months). In all patients the flap presented with good color, texture and elasticity but without obvious swelling. At the last follow-up, the curative effects by the comprehensive evaluation criteria of hand surgery for flaps were excellent in 10 cases, good in 6 and fair in one. Only linear scar remained at the flap donor site and abduction of the shoulder was not affected.Conclusion:The thoracodorsal artery chimeric perforator flap is an ideal means for repair of extremity soft tissue defects complicated with a deep dead cavity because it can repair the deep dead cavity and body surface wounds at the same time only after anastomosis of a bundle of vascular pedicles.

A clinical study on reconstruction of small and medium sized defects of tendo Achilles and heel regions with fascio cutaneous flaps

Background: Soft tissue defects of tendo Achillis and heel regions are difficult to reconstruct because of less vascularity and limited mobility of the skin. Most of these defects result from trauma, infection and excision of malignancy. Well vascularized tissues with sensation are needed to cover these defects as these regions are more prone for repeated friction and weight bearing. Aim was to study the versatility and applications of various flaps in the reconstruction of soft tissue defects of tendo Achillis and heel regionsMethods: This retrospective study was conducted in the Department of Plastic and Reconstructive Surgery, Thanjavur Medical College, Tamil Nadu, India from 2015-2019. About 22 patients with soft tissue defects of tendo Achillis and heel regions were studied. The aetiology of the defect, size of the defect and the outcome of treatment with various flaps were evaluated.Results: Of the 22 patients 20 patients were males and 2 patients were females. The age group ranged from 12 years to 68 years. Most of the defects were due to road traffic accidents. The soft tissue defects were classified into small, medium and large sized defects based on the area of the defects. Reverse sural artery flap extended lateral calcaneal artery flap, posterior tibial artery perforator flap and lateral supra malleolar flap were the various flaps used to cover these defects.Conclusions: Fascio cutaneous flaps play a major role in the reconstruction of tendo Achillis exposed defects and heel defects. Long term follow-up with physiotherapy is essential to achieve excellent function of tendo Achillis.

Extended reverse sural artery pedicle flap: a versatile and reproducible option for coverage of ankle and foot defects

Background: Coverage of soft tissue defects around distal third of the leg, particularly ankle and foot is a common situation faced by a plastic and reconstructive surgeon. Options available for such defects are limited due to scarcity of additional soft tissue that can be used without exposing tendons or bone. Associated conditions such as major vascular compromise, comorbidities and lack of facilities or expertise make free tissue transfer less preferred. Distally based sural artery flap has been a frequently used flap in such conditions, easy to perform and has reproducible results. We extended the reach of the flap and reproduced the results.Methods: We performed extended reverse sural artery pedicled flaps in 19 patients who presented to us between 2015 to 2017 with soft tissue defects around ankle and foot. Patients included 15 post RTA, 2 diabetic foot, 1 post resection defect and 1 post burn contracture release defect. Size of the defect ranged between 8x6cm to 14x10cm. Average follow up period was ranging from 8 months to 2.5 years.Results: All the flaps healed well without any obvious complications except one patient in whom marginal necrosis (2 cm margin of distal most flap) was observed and was secondarily treated with skin grafting.Conclusions: We observed that extended reverse sural pedicle flap is a rapid, reliable option for coverage of soft tissue defects around ankle and heel, sparing major vessel compromise and lengthy surgical procedure during free tissue transfer. This flap should be the first option for the patients with trauma and defects over weight bearing foot in whom peroneal axis vessels are preserved.

One-stage repair of soft tissue defects in open leg fracture / 中华创伤骨科杂志

Objective@#To evaluate one-stage repair of leg open fracture with soft tissue defect by fixation plus skin flap.@*Methods@#From January 2011 to January 2018, 34 patients with leg open fracture plus soft tissue defect were treated at Department of Orthopedics, The Second Affiliated Hospital to Harbin Medical University. They were 31 males and 3 females, aged from 13 to 54 years(average, 35 years). According to the Gustilo classification, the defects were type ⅢA in 31 cases and type ⅢB in 3 cases. The wound size ranged from 6 cm×3 cm to 25 cm×10 cm. All patients were treated with emergency fracture fixation and flap repair by one stage after thorough debridement. Internal bone plating was performed in 32 patients and external fixation at a single arm in 2 patients. All defects were repaired with a free anterolateral thigh flap. Flap survival, vascular crisis and bone infection were followed up postoperatively.@*Results@#All the free flaps survived in the 34 cases with no vascular crisis. These patients were followed up for 6 months to 3 years (average, 10 years). The flaps healed well, with good appearance and soft texture. No bone infection occurred at the defective sites. After postoperative rehabilitation, the knee extension ranged from 160° to 180°, knee flexion from 90° to 110°, ankle dorsal extension from 90° to 110°, and ankle plantar flexion from 100° to 120°.@*Conclusion@#Soft tissue defects in leg open fracture can be effectively treated by flap repair after thorough debridement at the same time of fracture fixation, because the primary wound healing can avoid infection and lead to fine survival of the flap.

Free fibular composite tissue flap with peroneus longus and brevis for complicated extremity trauma / 中华创伤骨科杂志

Objective@#To report our clinical application of free fibular composite tissue flap with peroneus longus and brevis in the treatment of complicated extremity trauma.@*Methods@#From August 2014 to September 2017, 5 patients with complicated extremity trauma were treated using a free fibular composite tissue flap with peroneus longus and brevis at Department of Orthopaedics, The Sixth People's Hospital of Shanghai. They were 4 men and one woman, aged from 23 to 52 years (average, 35.1 years). All of them had tendon defects; one had a radius defect, one an ulnar defect and three a tibial defect. The length of bone defects ranged from 8 cm to 18 cm; the size of soft tissue defects ranged from 10 cm × 5 cm to 18 cm ×8 cm. A fibular composite tissue flap was designed according to the soft tissue condition and defect area to repair and fixate the bone defect after thorough debridement and cover the wound before functional reconstruction. Postoperatively, survival of the flap and functional recovery of the corresponding tendon at the recipient site, healing time of the tibia, and wound healing, ankle motion and complications at the donor site were all observed.@*Results@#The 5 patients were followed up for 18 to 38 months (average, 25.2 months). All flaps survived without any vascular crisis or infection. The union time for the fibular graft ranged from 4 to 16 months (average, 8.4 months). In the 3 patients with a tibial defect, the maximum angle of dorsal extension ranged from 0° to 10° and no foot drop was observed. Thumb and digital flexion was reconstructed in the patients with a forearm bone defect only to achieve opposition of index finger and thumb but we failed to make them have a fist. At the 5 flap donor sites, the wound was sutured by the second stage after vacuum suction and healed well; obvious scar formed in one of them. No obvious foot varus was observed at the donor site. The patients were satisfactory with their ankle joint motion. No refracture of the fibular graft occurred during follow-up.@*Conclusion@#A free fibular composite tissue flap with peroneus longus and brevis is a good choice for complicated extremity trauma.

One-stage repair of soft tissue defects in open leg fracture / 中华创伤骨科杂志

Objective To evaluate one-stage repair of leg open fracture with soft tissue defect by fixation plus skin flap.Methods From January 2011 to January 2018,34 patients with leg open fracture plus soft tissue defect were treated at Department of Orthopedics,The Second Affiliated Hospital to Harbin Medical University.They were 31 males and 3 females,aged from 13 to 54 years(average,35 years).According to the Gustilo classification,the defects were type ⅢA in 31 cases and type Ⅲ B in 3 cases.The wound size ranged from 6 cm × 3 cm to 25 cm × 10 cm.All patients were treated with emergency fracture fixation and flap repair by one stage after thorough debridement.Internal bone plating was performed in 32 patients and external fixation at a single arm in 2 patients.All defects were repaired with a free anterolateral thigh flap.Flap survival,vascular crisis and bone infection were followed up postoperatively.Results All the free flaps survived in the 34 cases with no vascular crisis.These patients were followed up for 6 months to 3 years (average,10 years).The flaps healed well,with good appearance and soft texture.No bone infection occurred at the defective sites.After postoperative rehabilitation,the knee extension ranged from 160° to 180°,knee flexion from 90° to 110°,ankle dorsal extension from 90° to 110°,and ankle plantar flexion from 100° to 120°.Conclusion Soft tissue defects in leg open fracture can be effectively treated by flap repair after thorough debridement at the same time of fracture fixation,because the primary wound healing can avoid infection and lead to fine survival of the flap.

Free fibular composite tissue flap with peroneus longus and brevis for complicated extremity trauma / 中华创伤骨科杂志

Objective To report our clinical application of free fibular composite tissue flap with peroneus longus and brevis in the treatment of complicated extremity trauma.Methods From August 2014 to September 2017,5 patients with complicated extremity trauma were treated using a free fibular composite tissue flap with peroneus longus and brevis at Department of Orthopaedics,The Sixth People's Hospital of Shanghai.They were 4 men and one woman,aged from 23 to 52 years (average,35.1 years).All of them had tendon defects;one had a radius defect,one an ulnar defect and three a tibial defect.The length of bone defects ranged from 8 cm to 18 cm;the size of soft tissue defects ranged from 10 cm × 5 cm to 18 cm × 8 cm.A fibular composite tissue flap was designed according to the soft tissue condition and defect area to repair and fixate the bone defect after thorough debridement and cover the wound before functional reconstruction.Postoperatively,survival of the flap and functional recovery of the corresponding tendon at the recipient site,healing time of the tibia,and wound healing,ankle motion and complications at the donor site were all observed.Results The 5 patients were followed up for 18 to 38 months (average,25.2 months).All flaps survived without any vascular crisis or infection.The union time for the fibular graft ranged from 4 to 16 months (average,8.4 months).In the 3 patients with a tibial defect,the maximum angle of dorsal extension ranged from 0° to 10° and no foot drop was observed.Thumb and digital flexion was reconstructed in the patients with a forearm bone defect only to achieve opposition of index finger and thumb but we failed to make them have a fist.At the 5 flap donor sites,the wound was sutured by the second stage after vacuum suction and healed well;obvious scar formed in one of them.No obvious foot varus was observed at the donor site.The patients were satisfactory with their ankle joint motion.No refracture of the fibular graft occurred during follow-up.Conclusion A free fibular composite tissue flap with peroneus longus and brevis is a good choice for complicated extremity trauma.

Clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area / 中华烧伤杂志

Objective@#To explore the clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area.@*Methods@#Eleven patients (7 males and 4 females, aged from 18 to 73 years) with soft tissue defects of finger web area in distal dorsal side were admitted to Xinhua Hospital (Chongming) of Shanghai Jiao Tong University School of Medicine from October 2010 to September 2018. The sizes of skin and soft tissue defects ranged from 2.5 cm×1.5 cm to 6.0 cm×2.5 cm. According to the origin, course, branches, and distribution of the dorsal perforator of deep palmar arch, and the anatomical characteristics with vascular network of dorsal carpal and dorsal metacarpal, dorsal perforator fascia pedicle flaps of the deep palmar arch from the back of the injured hands were designed and transferred to repair the wounds of finger web area in distal dorsal side. The sizes of the flaps of patients ranged from 3.5 cm×2.0 cm to 6.5 cm×3.0 cm. The donor sites were sutured directly or covered with free forearm full-thickness skin graft. The clinical effects and swelling degree of flaps in early and late stages were evaluated during the follow-up of 3 to 36 months post surgery.@*Results@#All the flaps survived in 11 patients, the incisions in donor and recipient sites were healed. During the follow-up of 3 to 36 months post surgery, the survival of flaps was good, and the appearance, color, and elasticity were close to normal skin, with two-point discrimination distance of 7 to 10 mm and sensory function recovery of grade S3. The wounds in donor site had small scar without infection. The efficacy was evaluated as satisfactory in 8 patients, general in 3 patients, and dissatisfactory in no patient. Flap swelling rating in early stage was 1st degree in 7 patients, 2nd degree in 2 patients, and 3rd degree in 2 patients. Flap swelling rating in late stage was 1st degree in 8 patients, 2nd degree in 2 patients, and 3rd degree in 1 patient. The extension and flexion of the metacarpal and interphalangeal joints were basically normal and the patients were satisfied with the outcomes.@*Conclusions@#Based on the dorsal perforator of deep palmar arch, dorsal perforator fascia pedicle flap of the deep palmar arch is reliable to transfer to repair skin and soft tissue defects of finger web area in distal dorsal side, which is worthy of promotion in clinic.

Early diagnosis of pulmonary embolism in patients with skin and soft tissue defects after trauma / 中华烧伤杂志

Objective@#To investigate the early diagnosis method of pulmonary embolism in patients with skin and soft tissue defects after trauma.@*Methods@#From January 2011 to July 2014, 5 patients with skin and soft tissue defects and pulmonary embolism after trauma were admitted to Department of Plastic Surgery and Burns of the Affiliated Drum Tower Hospital of Nanjing University Medical School, including 4 males and 1 female, aged 26-68 years. The medical records of the 5 patients were retrospectively analyzed. Hierarchical screening of patients with suspected pulmonary embolism was performed after admission for 4-45 days. Computed tomography pulmonary angiography (CTPA) was performed immediately in 2 patients who had hemodynamic disorder and were able to tolerate CTPA, and pulmonary embolism was confirmed. Clinical risk assessment was conducted for the other 3 patients who had no obvious hemodynamic disorder and only had clinical manifestations of pulmonary embolism such as chest tightness and dyspnea. Among the 3 patients, two of them were assessed as high risk possibility by clinical risk assessment and diagnosed with pulmonary embolism by CTPA immediately. The other one patient′s clinical risk assessment was moderate risk possibility, but D-dimer was positive, and the patient was diagnosed with pulmonary embolism by CTPA immediately. Wound exudation of all patients was collected within 1 week after admission for microbial culture, and wound debridement and skin grafting were performed according to the wound condition. The color Doppler ultrasonography of blood vessel on lower extremity was performed to determine deep venous thrombosis of lower extremity after appearance of symptoms of pulmonary embolism. The patient was immediately given urokinase or recombinant tissue plasminogen activator by intravenous infusion for thrombolysis after definite diagnosis of pulmonary embolism. The activated partial thromboplastin time (APTT) was monitored after treatment, and standardized anticoagulation began when APTT was equal to or lower than 70 seconds. The treatment results of patients, D-dimer measurement value, bed time before definite diagnosis of pulmonary embolism, number of patients underwent wound debridement during hospitalization, definite diagnosis time of pulmonary embolism after wound debridement, and number of patients with deep venous thrombosis of lower extremity and wound infection were recorded.@*Results@#Wounds with skin and soft tissue defects of all patients were completely healed, all skin grafts survived well, pulmonary embolism recovered well after timely treatment, and the trunk and branches of involved pulmonary artery recovered blood supply. The course of disease ranged from 1 month to 3 months. The measurement value of D-dimer was 2.4-31.7 mg/L, and the measurement values of D-dimer of 4 patients were equal to or higher than 5.0 mg/L. The bed time before definite diagnosis of pulmonary embolism was 4-46 days, with an average of 23.2 days. Four patients underwent wound debridement during hospitalization. The definite diagnosis time of pulmonary embolism after the wound debridement was 14-40 days, with an average of 20.5 days. Four patients were diagnosed with deep venous thrombosis of lower extremity. All patients had wound infection, and the bacteria causing wound infection included Pseudomonas aeruginosa of 2 cases, Staphylococcus aureus of 2 cases, and Enterococcus faecalis of 1 case.@*Conclusions@#In the diagnosis process of pulmonary embolism in patients with skin and soft tissue defects after trauma, D-dimer positive, long-term bed rest, experiencing operation during hospitalization, and with deep vein thrombosis and wound infection can be regarded as the key points for diagnosis. When a patient has clinical symptoms of pulmonary embolism and the above conditions, the clinician should promptly perform hierarchical screening, select the corresponding examination to confirm pulmonary embolism, and immediately perform thrombolysis for the patient with pulmonary embolism according to the patient′s tolerance, thereby improving patient survival rate.

Improvement of thoracic umbilical flap repair the extremity giant soft-tissue defects / 中华整形外科杂志

Objective@#To investigate the clinical outcome of modified thoracic umbilical flap, spanning chest and abdomen, in repairing large soft-tissue defect of limbs.@*Methods@#From April 2012 to March 2017, 7 patients with large soft-tissue defects of limbs were admitted in the Department of Traumatic Osteopathic, Yidu Central Hospital of Weifang. The patients include 5 males and 2 females, aged from 29 to 51 years, with the mean age of 43 years. Four patients had upper limb soft-tissue defect and 3 patients were lower limb. All limbs large soft-tissue defects were treated by ultra-long thoracic umbilical flaps, spanning chest and abdomen. Epigastric artery and intercostal arteries or lateral thoracic artery were included in the flap to provide double blood supply with only one vascular anastomosis.@*Results@#All 7 flaps(30 cm×9 cm-45 cm×13 cm) survived. The followed-up period was 3 months to 1 years. There was no necrosis or infection in tendon and bone observed. The texture of flaps in 5 patients were similar to surrounding skin, or slightly thickened by 2-3 mm. One patient had slightly bloated flap due to obesity, but had no effect on limb function. All patients were satisfied with the outcome.@*Conclusions@#Modified thoracic umbilical flap is an reasonable design for the repairment of large soft-tissue defect of limbs, and easily to carry out.

Clinical analysis of free perforator flap for repairing soft tissue defects of the dorsum of foot / 中华整形外科杂志

Objective@#This study aims to analyze the outcome of free perforator flap for repairing soft tissue defects on the dorsum of foot.@*Methods@#Thirty-six patients with soft tissue defects on the dorsum of foot were treated at a single institution from March 2015 to September 2017. They were 20 males and 16 females, aged from 21 to 59 years old, with the mean age of 39.4 years. The causes of injury include crush injury (n=19), traffic injury (n=15), and electric injury (n=2). The injury site involves left foot (n=19) and right foot (n=17). The defect area of soft tissue was from 4.4 cm ×6.6 cm to 7.1 cm×16.2 cm in size. The vacuum sealing drainage dressing (VSD) was performed for all patients at the first stage of operation. The fracture and dislocated bone were fixed using Kirschner needle and plate screw. The ruptured tendon was repaired at the same time. The flap transplantation was performed at the second stage of operation. Twelve patients were treated with free anterolateral thigh perforator flap, 15 patients were treated with free sural artery perforator flap, and 9 were free peroneal perforator flap. The skin flap was from 4.9 cm× 7.2 cm to 7.9 cm × 17.8 cm in size.@*Results@#All 36 flaps survived. The wounds of both donor and recipient area primarily healed, without infection or skin necrosis. The venous crisis occurred in 1 patient of anterolateral thigh flap and 1 patient of free medial sural flap within 24 hours after surgery. Both flaps survived after stitches removed and blood cleaned. All patients were followed up for 6—22 months, with an mean follow-up period of 9.8 months. Except for the swollen anterolateral thigh perforator flap in 2 patients, the other patients were satisfied with the shape of flap and in wearing shoes. The sensation of flap was good, and the two-point discrimination was 11—16 mm. There was no obvious dysfunction occurred in the donor site.@*Conclusions@#The free anterolateral thigh perforator flap, free sural artery perforator flap and free peroneal perforator flap are suitable for repairing soft tissue defects on the dorsum of the foot. A reasonable surgical plan can help to obtain satisfactory clinical outcome.

Precision repairing of compound tissue defect at limbs by 3-Dimentional contrast printing and fibular head compound tissue flap transplantation / 中华显微外科杂志

Objective To explore the clinical application and effect of fibular head compound soft tissue flap transplantation on precision repairing of compound tissue defect at limb joints assisted by 3-Dimensional contrast printing technology.Methods From March,2014 to September,2017,9 patients with bone and soft tissue defect at limb joints were selected.In which,2 were distal radius bone defect with joint capsule and ligament defect,2 were lower segment tibia bone and soft tissue defect,2 were femur under section of the bone and soft tissue defect,2 were medial malleolus bone and ligament defect,and 1 was external ankle ligament and bone defect.Using 3-Dimensional printing to conduct bilateral mirror-image contrast prior to the operation,morphology of bone defect at limb joints was acquired.Based on the texture printed out,corresponding fibular head compound blocks with blood vessels were removed from the donor site and transplanted to the recipient site before anastomosing the blood vessels and restoring the blood flow.The regular post-operative followed-up was performed.Results The 9 transplanted tissue blocks survived.The donor sites and the recipient sites were healed.The followed-up for restoration of limb function was from 9 to 35 (average,17.5) months.The ankle function was assessed according Kofoed scale,resulted in 2 excellent and 1 good;The wrist function was assessed according Mayo scale,resulted in 1 excellent and 1 good.The medial malleolus bone defect and criteria bone defect were healed at 6 months.The patients were satisfied with the efficacy.Conclusion The application of 3-Dimensional contrast printing of fibular head compound tissue flap transplantation in repairing compound tissue defects at limb joints can reduce damage to the donor site,realizing precise repairing on limb tissue defect,and make good function restoration.

Clinical application of deep inferior epigastric perforator flap in repair of soft tissue defects of the calf / 中华显微外科杂志

Objective To investigate the clinical efficacy of deep inferior epigastric perforator (DIEP) flap in the repair of soft tissue defects of the calf.Methods From January,2015 to January,2017,the DIEP flap was used to repair the soft tissue defect of calf in 11 patients,which were 7 males and 4 females,aged 23-62 years,with an average age of 42 years.Among them,there were 5 cases of anterior tibial soft tissue defect and 6 cases of posterior tibial soft tissue defect.The size of soft tissue defects ranged from 9.0 cm×5.0 cm to 32.0 cm×12.0 cm.The wounds were heavily polluted and debridement exploration combined VSD surgery in emergency.After 7 to 14 days,free deep inferior epigastric perforator flap was used to repaire.The flap was cut in the range of 10.0 cm×6.0 cm-34.0 cm×13.0 cm.Nine cases of abdominal donor sutured direct,and a small part of 2 cases to take thigh thick skin graft repair.Results All the flaps survived.In only 1 patient,the distal part of the flap was necrotic and healed after appropriate treatment.Eleven patients were followed-up for 3-18 months (average of 10 months).The shape of the flap was similar to that of the affected area.The texture was soft and not bloated.Conclusion The DIEP flap can provide reliable blood supply,large cutting area and flexible design.It can be used to repair soft tissue defect of calf and obtain satisfactory clinical results.

Colgajo fasciocutáneo sural para la cobertura del tercio distal de pierna y pie / Fasciocutaneous sural flap for soft tissue coverage in the third distal leg, ankle and foot

Introducción: Los traumatismos de alta energía en miembros inferiores se asocian, con frecuencia, a defectos de partes blandas y su reconstrucción puede presentarse como una tarea desafiante. En el extremo distal de la pierna y el pie, los colgajos de perforantes representan la mejor opción de cobertura. El motivo de este trabajo es comunicar el resultado del tratamiento de lesiones de partes blandas de pierna distal, tobillo y talón utilizando exclusivamente el colgajo de perforantes fasciocutáneo sural. Materiales y Métodos: Entre marzo de 2008 y febrero de 2016, en nuestro Hospital, se realizaron 37 colgajos fasciocutáneos surales en 35 pacientes. El criterio de inclusión fue todo paciente con defecto tegumentario en el tercio distal de tibia y talón con exposición ósea, tendinosa o defecto de la almohadilla plantar. La edad promedio fue de 49.6 años y el seguimiento promedio, de 18 meses. Resultados: Se logró la cobertura completa de defecto de tejidos blandos en 29 casos. Se detectaron tres colgajos con necrosis parcial y cinco con necrosis completa; cuatro de estos pacientes tenían antecedentes de enfermedad vascular. El tamaño del defecto fue de 9,6 x 6,7 cm (15 x 9). Conclusiones: Aunque esta serie no es extensa, los resultados coinciden con los publicados. Creemos que este colgajo es una alternativa viable para lesiones distales de pierna y pie, con una baja tasa de complicaciones y de morbilidad en el miembro afectado, y con resultados satisfactorios. Nivel de Evidencia: IV

Introduction: High energy injuries in lower limbs are frequently associated with soft tissue defect and soft tissue reconstruction can be a challenge. Perforator flaps are the best option to cover soft tissue defects in the lower leg, ankle and foot. The objective of this paper is to report the results after the use of a distally-based reverse fasciocutaneous sural flap in the reconstruction of soft tissue loss around the distal leg, ankle and foot. Methods: A total of 37 fasciocutaneous pedicled reverse sural flaps were performed in 35 patients between March 2008 and February 2016, in our Hospital. The inclusion criterium was a soft tissue defect of the lower third of the leg, ankle and heel in which bone, tendons and sole are exposed. Average age: 49.6 years and average follow-up: 18 months. Results: Complete soft tissue defect coverage was achieved in 29 cases. Three flaps with partial necrosis and five with complete necrosis were observed; four of these patients had history of vascular disease. Defect size averaged 9.6 x 6.7 cm (15 x 9). Conclusions: Although this series is not extensive, results are consistent with those reported in the literature. We consider that this flap is a valid alternative for lesions involving the distal leg, ankle and foot, with a low rate of complications and morbidity, and satisfactory results. Level of Evidence: IV

Transplantation of flow-through anterolateral thigh flap combined with fibular flap for reconstruction of composite tissue defects at leg / 中华整形外科杂志

Methods@#To explore the transplantation of flow-through anterolateral thigh flap combined with fibular flap for reconstruction of composite tissue defect at leg.@*Method@#12 cases with leg composite tissue defects were reconstructed by flow-through anterolateral thigh flaps combined with fibular flaps. The skin defects ranged from 6 cm×12 cm to 12 cm×20 cm. The bone defects were 4-10 cm in length.The size of flow-through anterolateral thigh flaps was 14 cm×8 cm to 23 cm×13 cm and the fibular osteocutaneous flaps were 6 cm×4 cm to 12 cm×6 cm. The fibular bone was harvested as 7 cm to 13 cm in length.@*Results@#All the flaps survived in 12 cases. Bony reunion was achieved in all the cases. Vascular crisis happened in 2 cases 1 day after operation. Margin necrosis occurred in distal end of one flap, which healed after dressing. All the flaps had soft texture with satisfactory cosmetic and functional result . There was no complication in donor sites.@*Conclusions@#Flow-through anterolateral thigh flap combined with fibular flap can reconstruct soft tissue defect and bone defect simultaneously. It is the ideal method for leg composite tissue defects.

Application of individualized anterolateral thigh flap (ALTF) designed by computed tomography angiography (CTA) for tongue reconstruction after resection of tongue carcinoma / 实用口腔医学杂志

Objective:To evaluate the clinical applicability of CT angiography (CTA) for locating the perforator vessels of anterolateral thigh flap(ALTF) and the effects of individualized ALTF designed by CTA for the reconstruction of the soft tissue defects of tongue after the resection of tongue carcinoma.Methods:21 patients with tongue squamous cell carcinoma underwent CTA for locating the perforator vessels of ALTFs and for the design of individualized ALTFs before operation.The patients underwent soft tissue defect reconstruction with individualized ALTFs after tumor removal.Results:All the operations came off as preoperative designed,the intraoperative findings of the blood vessel alignment were consistent with the preoperative CTA results.The size of flaps was 6.0 cm × 5.0 cm-11.0 cm× 8.5 cm.20 ALTFs survived,2 ALTFs appeared vascular crisis,1 remained survival and the other was necrotic after surgical exploration.During 6 ～ 60 momhs of follow-up,the survival condition of flaps and the wound healing condition were both satisfactory.1 patient died because of distant metastasis 18 months after operation.20 patients reminded free of carcinoma and satisfied with the reconstructive effects of chewing,swallowing and linguistic function.Conclusion:CTA can accurately locate perforator vessels for the design of individualized AFLT.AFLT designed by CTA is an ideal choice for the reconstruction of postoperative soft tissue defects after resection tongue carcinoma.