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Objective@#Based on 3D printing technology, explore the precision of a perforator vessel location guide plate for fibular musculocutaneous flaps before the transplantation of fibular osteocutaneous flaps and evaluate its application effects.@*Methods@#This study was reviewed and approved by the ethics committee, and informed consent was obtained from the patients. From May 2019 to October 2022, 14 patients with jaw defects who needed to undergo fibular perforator flap transplantation at the First Affiliated Hospital of Xinjiang Medical University were selected. For the seven patients in the guide plate group, CTA was combined with Mimics software to reconstruct both lower limbs, and the perforator vessel positioning guide for locating perforator vessels was designed; the two ends of the guide plate were designed as fixed ends, with the upper end fixed to the knee joint and the lower end fixed to the ankle joint, and the guide plate was fabricated by a 3D printer. For the seven patients in the control group, a conventional handheld Doppler probe was used for perforator vessel location. The average operation time, bleeding volume, recovery time, deviation of perforator vessel location, postoperative flap-related complications, postoperative donor site shape satisfaction, and lower extremity functional scale (LEFS) score were recorded. SPSS 25.0 software was used for statistical analysis.@*Results@#The average operation time, bleeding volume, recovery time, deviation of perforator vessel location and postoperative donor site shape satisfaction were significantly better in the guide plate group than in the control group (P<0.05); moreover, the differences in postoperative flap-related complications and LEFS scores were not statistically significant (P>0.05).@*Conclusion@#Based on 3D printing technology, fibular musculocutaneous flap perforator vessels can be more accurately located using a guide plate and the knee and ankle as fixed points, and this method can effectively stabilize the guide position, prevent soft tissue offset, and improve positioning accuracy and thus deserves to be generalized.
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Objective:To figure out the structure and relevant data measurements of zygomatic ligament by cadaver anatomy and review of previous studies.Methods:From July 2018 to January 2020, the zygomatic areas of 20 Chinese frozen fresh cadaver hemifaces were dissected in the Department of Anatomy, Health Science Center of Hangzhou Normal University. Then the structures of zygomatic ligaments were shown. The characters of the ligament and the relationship with adjacent tissue were described and measured. And 16 previous studies were reviewed to get a comprehensive description about the characters of zygomatic ligaments.Results:Zygomatic ligaments were even and dense fibrous tissue structures distributed vertically between the skin and the subcutaneous tissue. Under the SMAS plane, the ligaments divided into two bundles. The origin of major bundle located beyond the origin of the zygomatic major muscle on the periosteum, and the origin of minor bundle located between the origin of the zygomatic minor and major muscle.Conclusions:The anatomy of the zygomatic ligament has a regular pattern, and its anatomical data has certain directive significance for clinical application.
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The ameloblastoma is a rare odontogenic tumor of the oral cavity. It is slow growing, locally invasive benign tumor affecting mandible more than maxilla mostly in age group 30-60 years. It grows in bone and soft tissue causing facial disfigurement. Treatment is surgical taking wide margins. This case report describes the treatment of a 30-year-old female having right side jaw swelling since two years, fine needle aspiration cytology was suggestive of ameloblastoma. Right hemi mandibulectomy was done by head and neck surgery team and reconstruction was done by plastic surgery team using free fibula flap. The free fibula osteocutaneous flap is the most versatile and reliable option for microsurgical reconstruction of large mandibular defects.
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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.
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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.
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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.
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Objective:To evaluate the clinical outcomes of 2 kinds of osteocutaneous flap in the treatment of mandibular osteoradione-crosis.Methods:35 cases with mandibular osteoradionecrosis were treated by partial mandibulectomy and bone graft according to de-fect size and patients'requirements.The defects in 7 patients were reconstructed with iliac osteocutaneous flap and 28 with fibular os-teocutaneous flap.All flaps and wounds were monitored regularly.Results:One flap with venin crisis was observed in the patients treated with iliac osteocutaneous flap,its skin island was failed but the bone graft was survived.In the fibular osteocutaneous flap group,3 flaps with vein crisis were observed.2 of them were failed and 1 was rescued after second surgery.The most common compli-cations were infection,delayed wound healing and scar.The appearance and function were all satisfied and limitation of mouth opening was improved after surgery.Conclusion:Both of fibular osteocutaneous flap and iliac osteocutaneous flap can be applied in the defect reconstruction of patients with mandibular osteoradionecrosis.Fibular osteocutaneous flap is a good choice for huge mandibular defect and iliac osteocutaneous flap seems more esthetical.
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PURPOSE: Fibular osteocutaneous free flap is the procedure of choice for mandibular reconstruction. However, the anatomic consistency and the reliability of the skin paddle have been considered to be questionable and the utilization of the fibular osteocutaneous free flap can be challenging for the inexperienced surgeon. Preoperative computed tomography (CT) angiography can support revolutionary help with the operator design of the fibular osteocutaneous flap. The purpose of this article is to share the valuable experience of support with preoperative CT angiography. METHODS: Three consecutive patients, who needed mandibular reconstruction, were treated with fibular osteocutaneous free flap. Each of the patients had undergone lower extremity CT angiography before the surgery. The CT angiographies were scrupulously investigated to calculate the locations and the tracts of the peroneal artery perforators. We compared the findings of the CT angiography with those of the real operation. RESULTS: The information about the perforators was sufficiently matched with the findings of the operation. With the use of preoperative CT angiography, we were able to achieve confident performance during operation, shortening of operation time, and fine outcomes with a no flap failure. CONCLUSION: The CT angiography of lower extremity can provide reliable information of the perforators of the fibular osteocutaneous free flap.
Sujets)
Humains , Angiographie , Artères , Lambeaux tissulaires libres , Tête , Membre inférieur , Reconstruction mandibulaire , Cou , PeauRésumé
PURPOSE: Fibular osteocutaneous free flap is the procedure of choice for mandibular reconstruction. However, the anatomic consistency and the reliability of the skin paddle have been considered to be questionable and the utilization of the fibular osteocutaneous free flap can be challenging for the inexperienced surgeon. Preoperative computed tomography (CT) angiography can support revolutionary help with the operator design of the fibular osteocutaneous flap. The purpose of this article is to share the valuable experience of support with preoperative CT angiography. METHODS: Three consecutive patients, who needed mandibular reconstruction, were treated with fibular osteocutaneous free flap. Each of the patients had undergone lower extremity CT angiography before the surgery. The CT angiographies were scrupulously investigated to calculate the locations and the tracts of the peroneal artery perforators. We compared the findings of the CT angiography with those of the real operation. RESULTS: The information about the perforators was sufficiently matched with the findings of the operation. With the use of preoperative CT angiography, we were able to achieve confident performance during operation, shortening of operation time, and fine outcomes with a no flap failure. CONCLUSION: The CT angiography of lower extremity can provide reliable information of the perforators of the fibular osteocutaneous free flap.
Sujets)
Humains , Angiographie , Artères , Lambeaux tissulaires libres , Tête , Membre inférieur , Reconstruction mandibulaire , Cou , PeauRésumé
PURPOSE: To report the outcome of a reversed osteocutaneous radial forearm flap for a thumb reconstruction. MATERIALS AND METHODS: Five patients who underwent a reversed osteocutaneous radial forearm island flap for a thumb reconstruction between 2001 and 2005 were reviewed retrospectively. They were all males with a mean age at the time of surgery of 45 years. The types of thumb defects, size of the flap, length of the radius harvested, time to union, the range of motion of the thumb, grip and pinch strengths, and complications were analyzed. RESULTS: The mean size of the transferred radial forearm flap was 58.4 cm2. The mean length of the harvested radius was 4.4 cm. All flaps survived completely. The mean interval required to obtain bone union was 2.8 months. The mean ROM of the thumb was 47degrees. The postoperative mean grip strength was 94 lbs and the mean pinch power was 14.6 lbs. Mean moving two-point discrimination on the flap was 13 mm. There were no complications. All 5 patients were satisfied with the reconstructed new thumb. CONCLUSION: A reversed osteocutaneous radial forearm island flap is a useful procedure for reconstructing of a combined defect of the thumb.
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Humains , Mâle , , Avant-bras , Fractures ouvertes , Main , Force de la main , Force de la pince pouce-index , Radius , Amplitude articulaire , Études rétrospectives , PouceRésumé
A 27 year old patient with ameloblastoma of the mandible underwent anterior mandibulectomy and reconstruction with left fibula osteocutaneous flap. The bone was shaped at the lower limb before cutting the pedicle. Vascularised free fibula flap provides a good alternative to other bone grafts in mandible reconstruction as it is relatively easy to perform, carries a low complication rate, and mandibular shaping with intact pedicle cuts down on ischaemic as well as total operative time.
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Adulte , Humains , Mâle , Processus alvéolaire , Carcinome épidermoïde , Fibula , Lambeaux tissulaires libres , Tête , Mâchoire , Mandibule , Reconstruction mandibulaire , Lambeau musculo-cutané , Cou , Ostéoradionécrose , Ostéotomie , Oxygène , Radiothérapie , Donneurs de tissusRésumé
Objective:To summarize the experience of reconstruction of mandibular defects with vascularized fibular osteocutaneous flap.Methods:Segmental mandibular resection and immediate reconstruction with vascularized fibular osteocutaneous flap were performed in 8 patients with tumor.The fibula flaps were cut into 2-4 segments and bent to the contour of the mandibles,and they were fixed precisely by the titanium plate.The skin flaps were used for reconstruction of soft tissue defects or as observation windows of the blood circulation.Results:In all 8 patients,transplanted vascularized fibular osteocutaneous flaps survived well,and restoration of mandibular contour and function was satisfactory. Conclusion:The fibular osteocutaneous flap can be cut into segments and shaped according to location and contour of mandibular defect.Vascularized fibular osteocutaneous flap may be an ideal selection for the reconstruction of mandibular defect.
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Exenteraion in early infancy by a tumor and radiotherapy caused the contracted eye socket and Orbital hypoplasia. This result is because of the abscence of the conjunctival fornix and in severe contraction of orbital fat and developmental bone abnormalities. The authors corrected a contracted eye socket and orbital hypoplasia simultaneously, secondary to previous surgery and radiotherapy. A one-stage surgical reconstruction was undertaken using a radial osteocutaneous flap, which were transfered for eye socket reconstruction and orbital hypoplasia. Adipofascia and fragment of radius inserted as an hypoplastic orbit rim susbtitute to enlarge the orbital region. We report that we have experienced a case of eye socket reconstruction with a radial forearm osteocutaneous free flap.
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Avant-bras , Lambeaux tissulaires libres , Orbite , Radiothérapie , RadiusRésumé
Only several stages of conventional operation have been able to treat the open fracture of the limb with extensive bone and soft tissue loss. So we, authors, reviewed 25 cases of vascularized osteocutaneous fibulat transfer which were performed to the extensive bone defect of the limb and associated soft tissue injury(from May 13, 1982 to September 30, 1988). In 25 cases, one case was a chronic osteomyelitis combined pseudocarcinomatous epithelial hyperplasia of surrounding soft tissue, the other(24 cases) were the open comminuted fractures with the extensive bone and soft tissue loss of the limbs. The average size of the skin flap was 12.33 × 5.83cm, the average length of vascularized fibula was 16.5cm in length. The complications were fractures of grafted fibula, partial necrosis of both ends of the skin flap and uncontrolled infection of proximal end of grafted fibula. During postoperative period, the patency of the anastomoses were monitored by observing the color of the skin of buoy skin flap. The average amounts hypertrophied fibula at 12 months after operation were 20.6cm. And the following remarkable result were obtained. 1. With the uncontrolled bone infection, the vascularized osteocutaneous fibular transfer was able to be performed. 2. During the follow up period, the grafted fibula had been hypertrophied. 3. In roentgenogram, as compared with conventional bone graft, grafted bone was not resorbed and early united. 4. In adult, free fibula can be obtained and grafted as 23cm as long and the skin flap with fibula can be obtained and grafted as 21 × 7cm as large in or experience. 5. In the vascularized osteocutaneous fibula transfer, the patency of anastomoses was monitored indirectly by confirming skin flap. 6. The fractured fibula was united early by cast immobilization, and it was hypertrophied at the fracture site. 7. The vascularized osteocutaneous fibula transfer is also useful in application of the other long bones.
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Adulte , Humains , Membres , Fibula , Études de suivi , Fractures comminutives , Fractures ouvertes , Hyperplasie , Immobilisation , Microchirurgie , Nécrose , Ostéomyélite , Période postopératoire , Peau , TransplantsRésumé
Thumb reconstruction with a free neurovasculsr wrap around flap from the great toe by microsurgery had been first reported by O'Brien, Macleod and Morrison in 1980. We have performed one case of thumb reconstruction with psrtial first metstarsus for loss of thumb except pulp and one digital vessel by microsurgery. The results were summerized as followings ; 1. This one stage procedure has the unique advantage to reconstruct a thumb almost identical to the origin. 2. This technique allows preservstion of the toe and the secondary defect results in no significant morbidity.
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Lambeaux tissulaires libres , Microchirurgie , Pouce , OrteilsRésumé
Recently, there were many cases which was associated with bone defect in the limb and skin defect. We had performed vascularized osteocutaneous fibular transfer with microsurgical technique and experienced early bone union and simutsneous external wound healing. So we, authers, reviewed 12 cases of vascularized osteocutaneous fibular transfer which were performed to the extensive bone defect of the tibia and associated soft tissue injury. And the following remarkable results were obtained. 1. With the uncontrolled bone infection, the vascularized osteocutaneous fibular transfer was able to be performed and there was no non-union. 2. During the follow up period, the grafted fibula had been hypertrophied. 3. In the cases which the fibula were grafted to the defect after the segmental and partial excision of the tibia, in general, the partial weight bearing was able to be started from 3 months to 5 months after the operation, In the cases with segmental and complete excision of the tibia, the partial weight bearing was able to be started from 5 months to 7 month after the operation. 4. In adult, free fibula can be obtained and grafted as 20cm as long and the fibula was a good donor for extensive long bone defect as a compact bone; the skin flap with fibula can be obtained and grafted as 17 × 9cm as large in our experience. 5. In the vascularized osteocutaneous fibula transfer, the skin flap could be confirmed wheather the vascular anastomosis is patent or not as a monitor.
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Adulte , Humains , Étude clinique , Membres , Fibula , Études de suivi , Microchirurgie , Peau , Traumatismes des tissus mous , Tibia , Donneurs de tissus , Transplants , Mise en charge , Cicatrisation de plaieRésumé
70 cases free fiap were performed from March 1978 to July 1985. The donor fiap were dorsalis pedis flap in 34 cases, groin flap in 8 cases, osteocutaeous flap in 3 cases, gracilis flap in 17 cases, and latissimus dorsi flap in 8 cases respectively. The success rate was 90% in total including partial success. The causes of failure were 2 cases infection necrosis, and 1 case kinking of drain vessel. The gracilis and latissimus dorsi myocutaneous flap were very satisfactory method for the reconstruction of the upper extremity flexion power, especially in the case of Volkmann's ischemic contracture. The neurovascular dorsalis pedis flap was regarded as excellent method for the heel pad reconstruction, and tactile sensation reconstruction of the hand.
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Humains , Lambeaux tissulaires libres , Aine , Main , Talon , Contracture ischémique , Méthodes , Microchirurgie , Lambeau musculo-cutané , Nécrose , Sensation , Muscles superficiels du dos , Donneurs de tissus , Membre supérieurRésumé
A microvascular osteocutaneous free flap is totally detached from its origin and reattached at a distant site, in one stage, by the use of microvascular anastomosis to maintain its viability. The advantages of microvascular osteocutaneous free flap trsnsfer are more rapid healing, greater resistance to infection, less risk of absorption than conventional bone grafts, and shortened hospitalization. Two cases of microvascular osteocutaaeous free flap transfer were performed at the department of Orthopaedic surgery of Hanyang University Hospital, and satisfactory results were obtained.