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Objective:To evaluate the clinical effect of soft tissue defects around knee joints repaired with thigh distal perforator propeller flap.Methods:Clinical data of 72 patients with defects around knee joints from January, 2009 to October, 2019 were analyzed retrospectively, including 43 males and 29 females, aged from 17 to 83 years. The sizes of soft tissue defects ranged from 4.0 cm×3.0 cm to 22.0 cm×13.0 cm. Perforator propeller flaps were designed and harvested to repair the defects according to anatomical features of the origin, course, branches, distribution and anastomosis of vascular network of the perforator vessels and location as well as the size and shape of defects. Nine patients repaired with the lateral distal perforator propeller flaps (LDF), 53 with descending genicular artery perforator propeller flaps (DGF) and 10 with direct popliteal artery perforator propeller flaps (DPF). The size of flap was 4.5 cm×3.5 cm to 24.0 cm×14.0 cm. The donor sites were sutured directly or covered with free full-thickness skin. To evaluate the effect, the skin swelling rating in early and later stage were taken. Three to 72 months of followed-up was conducted through outpatient clinic (78%), telephone (15%) and WeChat (7%).Results:The flaps totally survived in 65 patients and 7 patients underwent partial necrosis at the distal end of the flaps ( 2 cases of LDF, 4 cases of DGF, 1 case of DPF) who were treated with dressing, and the donor sites were completely healed. The appearance and shape of the repaired knee joints was good, and the color and elasticity was close to surrounding normal skin, TPD of the flaps were 7-10 mm, and the scar was small after 3 to 72 months' follow-up. The efficacy was satisfactory in 48 cases ( 4 cases of LDF, 39 cases of DGF, 5 cases of DPF), general in 24 cases ( 5 cases of LDF, 14 cases of DGF, 5 cases of DPF). Degree of flap swelling: in early stage, I° in 40 cases ( 4 cases of LDF, 31 cases of DGF, 5 cases of DPF), II° in 20 cases ( 3 cases of LDF, 14 cases of DGF, 3 cases of DPF), III° in 10 cases ( 2 cases of LDF, 7 cases of DGF, 1 case of DPF), IV° in 2 cases(1 case of DGF, 1 case of DPF); in later stage: I° in 55 cases ( 6 cases of LDF, 41 cases of DGF, 8 cases of DPF), II° in 15 cases ( 2 cases of LDF, 12 cases of DGF, 1 case of DPF), III° in 2 cases ( 1 case of LDF, 1 case of DPF). The evaluation of knee joint function: excellent in 17 cases ( 2 cases of LDF, 12 cases of DGF, 3 cases of DPF), good in 35 cases( 4 cases of LDF, 27 cases of DGF, 4 cases of DPF), general in 20 cases( 3 cases of LDF, 14 cases of DGF, 3 cases of DPF). The good rate was about 73%. The range of motion and stability of the knee joint were basically normal and there was no pain found to affect study and life. All the patients were satisfied with the effect.Conclusion:Repairing soft tissue defect around knee joint with thigh distal perforator propeller flap is reliable and clinical applicable.
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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.
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Objective@#To report the method and effect of in situ suturing technique for severe amputation of facial composite tissues.@*Methods@#We in situ sutured severely amputated composite tissues of facial region in 14 cases in emergency by vessels and nerves anastomosis from May 2004 to December 2017.@*Results@#All replanted composite tissues survived in 13 cases. Edge necrosis of auricle occurred in 1 case because of serious contusion and it was cured after dressing changed. The color and appearance of the replanted composite tissues were close to normal after 3 to 48 months′ follow-up.@*Conclusions@#In situ suturing technique in emergency is the ideal treatment for severe amputation of composite tissues of facial region.
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Objective To investigate the feasibility of urethral prefabrication with vaginal mucosa in female-to-male transsexuals and to compare the urologic complications after penile reconstruction in female-to-male transsexuals between prefabrication group and forearm group.Methods Prefabrication of the neourethra with tubed vaginal mucosal graft was performed for 22 female-to-male transsexual patients from 2007 to 2016,while radial forearm flap,known as the traditional tube-within-tube method,was used to construct the neourethra for other 31 cases.Results All of the reconstructed penises survived completely and allowed the patients to urinate while standing in the prefabrication group.Phalloplasty by using the vaginal mucosal graft for urethroplasty significantly decreased the donor scar,the duration of the second operation and the incidence rates of urologic strictures,comparing with the forearm group (P＜0.05).Conclusions It is reliable to use the prefabrication of the neourethra with tubed vaginal mucosal graft in phalloplasty female-to-male transsexual patients.