The application of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation / 中华显微外科杂志

Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation.Methods From January,2013 to October,2017,29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair.Fifteen cases treated with multiple end-to-side anastomosis on flap arteries,and 2-3 arteries were anastomosed,with the average of 2.13.Nine cases were treated with venous multiple end-to-side anastomosis,and 2-4 veins were anastomosed,with the average of 3.11.Five cases treated with arterial and venous multiple end-to-side anastomosis,and 4-6 vessels were anastomosed,with the average of 5.20.Distribution of wounds:10 cases with hands and wrists wounded,15 cases with forearms and elbow joints wounded,and 4 cases with lower legs and feet wounded.The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm,and the flap area was 6 cm× 15 cm-12 cm×29 cm.Postoperative followed-up was performed every 3-6 months to review flap survival.Results All flaps of 29 cases survived.Venous congestion occurred in 2 flaps within 48 h after the operation,among which,1 was overcomed after released the dressing and sutures,and the other underwent surgical exploration.The venous end-to-side anastomotic stomas were unobstructed,and hematoma was formed.After the hematoma compression was removed,circulation was recovered and the flap survived.With followed-up for 6 months to 2.5 years,both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder.Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable.

Repairing massive soft tissue defects of shank and foot with combined flaps with the help of 3D-CTA technique / 中华显微外科杂志

To explore the clinical value of repairing massive soft tissue defects of shank and foot with diverse combined flaps with the help of 3D-CTA technique. Methods From March, 2011 to May, 2018, 7 pa-tients with massive soft tissue defects (defect area:21 cm×14 cm-53 cm×16 cm) of shank and foot were treated with combined flaps, including free anterolateral thigh flaps(ALTP) combined with local transferred sural neurocuta-neous vascular flaps in 2 cases, free ALTP combined with local transferred supracondylar flap in 2 cases, free thora-co-umbilical flaps plus local transferred gastrocnemius muscular flaps in 1 case, and free ALTP plus free thoraco-um-bilical flap in 1 case.Free ALTP and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibial vessel from the healthy limb to form vascular pedicles in 1 case. All cases received 3D-CTA to observe the distribution and anastomosis of perforator vessel. Regular followed-up was made post-opera-tively. Results All patients had been followed-up for 6-18 months. Outpatient service combined with telephone follow-up was adopted. All flaps survived, and flap shape, colour and lustre, elasticity got good recover. At the last follow-up, thermann scale function assessment: 4 cases were excellent, 2 were good, and 1 was fair. Conclusion It is a feasible and effective method to repair massive soft tissue defects of shank and foot using differently combined flaps. Although the surgery can be risky, the method can effectively reduce the rate of limb disability, restore the limb func-tion and shorten the course of treatment.Preoperative 3D-CTA can get the vessel anatomical structure and diameter at donor and recipient sites, which will guide the operation program design and implementation so as to shorten the oper-ation time and improve the accuracy rate of vascular anastomosis.

Clinical research of 3D-CTA in anterolateral thigh perforator flap for reconstruction of extremities / 中华整形外科杂志

Objective@#To investigate the effects of three-dimensional digital technology (3D-CTA) in repairing wounds of the limb with anterolateral thigh perforator flap.@*Methods@#From April 2014 to June 2017, 12 patients with extensive skin and soft tissue defects on extremities were selected from the Yidu Central Hospital of Weifang. Twelve patients were performed anterior femoral perforator flaps. There were 9 males and 3 females, aged from 23 to 52 years old, with the mean age of 32 years. The defects were 8 cm×3 cm to 25 cm×9 cm in size, and all of them were accompanied by bone and/or muscle exposure. Preoperative CT scan of the donor site of the free flap used to achieve the three-dimensional images of arterial blood area, in order to determine the origin, direction, classification, length, diameter and the position of pedicle perforator of the anterolateral thigh perforator flap by 3D-CTA.According to the preoperative condition of lateral circumflex femoral artery, the perforator flaps of anterolateral femoral artery on the contralateral or ipsilateral side were designed to repair the wound.@*Results@#Twelve anterolateral thigh perforator flaps have been transferred using above methods. All the flaps survived well and the donor site was directly closed.All patients were followed up for 1-6 months (mean 3 months). The appearance of flaps was satisfactory. The diameter and location of the perforator artery were measured using pre-operative digital angiography, as well as the actual value of perforator artery. Preoperative digital examination was consistent with the type of perforator found during the operation, with an accuracy of 100%.@*Conclusions@#For the soft tissue reconstruction by anterolateral thigh perforator flaps, preoperative digitization technology can identify the diameter, the type and origin of vessels, optimize the operation plan, reduce the difficulty of flap design, and reduce the risk of operation.

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.

Bilateral big toe wrap-around flap for reconstruction of the defects of the finger / 中华显微外科杂志

Objective To investigate the therapeutic effect of bilateral combined flap transfer in reconstruction and repairation of thumb and finger defects.Methods A partial fibular side wrap-around flap was harvested from both big toes.The flaps were tailored and designed based on measurements taken from the finger of the intact side.These two flaps were combined to reconstruct the defects of the finger.From March,2008 to December,2015,a total of 9 fingers (9 cases) which had defect degrees range from Ⅰ ° to Ⅲ° underwent reconstruction surgeries in this way.Appearance,sensation and function of the thumb and foot flap were followed-up.Simultaneously how to improve the outcoming and success rate were explored and investigated.Results All 9 thumbs and fingers in 9 cases with these procedures were survived.No vascular crisis happened.All patients were followed up from 3 to 24 months.The reconstructed thumbs and fingers were all with abundant blood supply,having similar shape to the normal thumbs and fingers,good pain and temperature sensation,with two-point discrimination of 4-8 mm.All patients were satisfied with the thumb and finger shape,regained life and work ability as before.The donor sites had no obvious discomfort,and walking and weight-bearing function remained normal.Judged by the tentative evalution standard of function of upper limb,which was made by Chinese Medical Association for Surgery of the Hand.The results were excellent in 6,good in 2,fair in 1.Conclusion There is less damage on foot and most hand function recovery using bilateral combined flap transplantation to repair multiple fingers defect.