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The reconstruction of the injured tissue around the knee is a complex procedure for the plastic and orthopaedic surgeon. The objective is to provide an acceptable function and aesthetic result. Successful wound management includes meticulous debridement, planning and proper execution of the surgical procedure. An 11-year-old male patient with a right patellar fracture using an anterolateral thigh flap with reverse flow to cover the skin defect. For such purposes, the reverse flow anterolateral flap is an effective, trustworthy and well-documented option. The correct obtaining and implantation of the flap reduces the morbidity of the donor site, offers options in size and design, an adequate length of the pedicle and the possible combination with the fascia lata in case it is required. The versatility of the reverse flow anterolateral flap makes it a possible therapeutic alternative in reconstructive surgery since it is aesthetic and functional for the reconstruction of tissue near the knee joint.
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Objective To investigate the effects of changing the arteriovenous pressure difference on the survival area of reverse island flap in New Zealand white rabbits models.Methods The saphenous artery and saphenous vein of New Zealand rabbits were selected to design experimental models of reverse island flap.Experi mental rabbits were randomly divided into 4 groups:group A:control group (reserved pedicle integrity of superficial veins);group B:part anastomosis of saphenous artery group (the distal saphenous artery of the flap was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group C:part anastomosis of vein group (distal superficial veins was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group D:ligated superficial veins group (pedicle superficial veins was ligated).After surgery,the flaps were measured by general observation.Blood distribution at different times of the flaps was detected by radionuclide scans.Survival area of the flap was measured to compare the survival rate of flap.Distribution of blood vessels and the state of blood cells were observed by Histological examination.Results The flap survival rate was (82.27-± 11.71)％ in group B,showing significant differences when compared with that group A (47.70-± 11.18)％,group C (47.70 ± 11.18)％ and group D (47.70 ± 11.18)％ (P ＜ 0.05).Radionuclide scans showed that the radioactive material in group B could be seen clearly,the radioactive material in groups A,C and D were a transient existence.Ten days postoperatively,histological observation showed that group B had more capillary regeneration and blood cells remain compared with other groups.Conclusion Increase the blood supply can increase the survival area of the reverse island flap,and simply promote the venous drainage can not effectively improve the survival rate of the flap.
Résumé
Objective The mechanism of delaying flap with the minimal invasive surgery was approached to understand its effects on the whole delayed survival of skin flaps thoroughly so as to provide the rationale for its clinical use.Methods 80 male or female Wistar rats were randomly subdivided into two groups:delayed by the minimal invasive surgery,and immediately transfer without delay.Flaps in each group delayed were cut at 1,2,3 and 4 weeks,respectively.The flap was designed at the lower back of rat,with the size of 5 cm × 1 cm,crossing the middle area for 2.5 cm and including stem of iliac branch from iliolumbar artery.2 weeks after second operation,the survival area,capillary density and content of lactic acid of the flaps in each group were examined,and the survival of the falps delayed by the minimal invasive surgery was compared.Results The longer delaying time,and the higher survival rate were observed in the experimental group.Delaying for 3 weeks and 4 weeks,the survival rate was (86.13 ±1.13) ％,(93.49 ± 1.15) ％,respectively,in the experimental group.While in control group,the survival rate was no more than 63％.The longer delaying time,the higher the capillary density were noted in two groups,but 3 weeks delayed group equally matched to the 4 weeks delayed group.In the experimental group,the content of lactic acid increased peaked in 1 week delayed group,then fell-down gradually,but kept steady in 3 and 4 weeks delayed group.The content of lactic acid in the control group kept steady.Conclusions The experimental model is selected as cross-area axial flap on the lower back of rats.The minimal invasive surgery plays the same role as in delaying flaps,which causes vasoconstriction,resulting in disorder of internal environment,ischemia and hypoxia,finally vasodilatation.The more ramus anastomosis,the more survival rate of the flap.
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Twin-Reversed Arterial Perfusion (TRAP sequence) is a rare complication of monochorionic twins (MC, twins sharing one placenta). TRAP sequence is known as acardius or chorioangiopagus parasiticus. It occurs in 1% of monochorionic twin pregnancies and in 1 in 35,000 pregnancies. The risk of recurrence was estimated 1:10,000. TRAP sequence is characterized by a structurally normal pump twin perfusing an anomalous twin. In TRAP syndrome, there is mortality and deformities in both twins. The acardiac/acephalic twin is a parasitic twin that fails to develop a head, arms and a heart. The parasitic twin is with or without legs, receives its blood supply from the host twin (Pump twin). In TRAP sequence, one twin is usually developmentally normal (pump twin) and the other twin has a serious condition, either missing a heart (acardiac) or a head (acephalic) or both, that prevents it from surviving on its own. The acardiac/acephalic twin receives all of its blood from the normal or “pump” twin. The abnormal fetus does not have a heart; all of its blood must come from the normal twin. And it is kept alive by the blood which is pumped from the normal twin through the placenta. The term “reversed perfusion” is used to describe this scenario because blood enters the acardiac/acephalic twin through reversed flow through its umbilical artery and exits through the umbilical vein, which is opposite to the normal blood supply of the fetus.The acardiac twin loses direct vascular connection with the placental villi and receives its entire blood supply from the pump twin [1,2,3,4]. Proper timing of the delivery is of prime importance for the survival of the normal fetus. The emphasis is placed on close sonographic monitoring from early antenatal diagnosis. The mortality of the acardiac twin is 100%, and the perinatal mortality of the pump twin is reported to be around 50%. The mortality rate of the pump twin appears to correlate with the size of the acardiac twin and primarily due to congestive heart failure. We present such a case of TRAP sequence because of its rarity. TRAP sequence, was diagnosed by ultrasound at the obstetrics and gynecology department at KAMS & RC (Kamineni) and it was closely followed up until delivery. Clinical presentation, ultrasound findings, outcome and management were reviewed in present article.
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Objective To investigate the mechanism of venous reverse-flow flap in the differentperiod after operation.Methods The rabbits wero randomly allocated into 3 groups.In group A,including saphenous artery and venae commutante.In group B,saphenous artery without venae commutante.In group C,surface seeping and saphenous artery and venae commutante.Flap appearance,intravenous pressure,vessel diameter,mierocircular and histological examination were mea8ured.Results The difference of introvenous pressure between group A.B and C was obvious.Reverse flow WaS found in group A and C group through microcirculation observation 2 hours post-operation.Venous valve lose efficacy while the vessel diameter wes at maximum just after the pressure peak.Conclusion Venous retrograde return in reverse-flow island flaps can be achieved more easily through"incompetent valves route"than through "communicating and collaterall by pass route".By pass route is a supplementary way.Surface seeping Can slighfly relieve the venous pressure but can cause infection.
Résumé
Breast reconstruction using TRAM flap after mastectomy has been widely adopted and regarded as a gold standard method. In patients with the abdominal midline scar, insufficient blood circulation to regions contralateral to the pedicle disables inclusion of them in the TRAM flap design. So modifications including Double- pedicled TRAM, Super-charged, Turbo-charged, Bipedicled free TRAM et al. have been attempted to resolve the problem of circulatory interruption by midline scar. The authors designed a new bipedicled free TRAM flap to avoid limitations like epigastric buldging, significant abdominal weakness and complexity of flap insetting. The two donor arteries(right and left deep inferior epigastric arteries) are anastomosed to the proximal and distal ends of divided internal mammary arteries using the reverse flow. Vein anastomoses were performed in the same manner through the divided venae comitantes. Two patients having infraumbilical midline scar underwent breast reconstruction using author`s new flap. Flaps survived without fat necrosis or partial flap loss in both patients and their results in aesthetic aspects were very satisfactory. Compared to previous method for breast reconstruction of patients having infraumbilical midline scar, author's new method is useful and effective in terms of the aesthetic and technical aspect.