Force CT microvascular anatomical imaging technology and its clinical application / 中华显微外科杂志

Objective:To explore the scanning and image reconstruction parameters, post-processing technology and effect of clinical application of Force CT microvascular anatomy imaging technology.Methods:From April 2019 to June 2021, 50 cases of free tissue flap transfer were reviewed in Department of Hand and Foot Surgery of Provincial Hospital Affiliated to Shandong First Medical University, including 34 males and 16 females in 3-67 (mean, 37) years old. In which, 33 cases were free flap, 10 were free composite tissue flap and 7 were digit reconstruction. CTA image score and clinical application evaluation were performed respectively. Follow-up was conducted by outpatient visit, telephone call and WeChat.Results:The qualified rate of Force CT microvascular anatomy imaging in 73 parts of 50 patients and the coincidence rate with clinical practice were 100%. All tissue flaps and reconstructed digits survived completely. No vascular compromise and other complicatiors occurred. The postoperative follow-up was 3 to 15 months, with an average of 11 months, and the flap healed well. Of the 7 reconstructed digits, 6 were satisfactory in appearance and 1 was reconstructed with flap plasty because of digit bloat.Conclusion:Force CT microvascular anatomical imaging technology can accurately display and reconstruct microvessels, and has guiding significance for the design and transfer of free tissue flap, which has a good promotion value.

Donor site repair of great toe-nail flap in finger reconstruction surgery / 中华显微外科杂志

ObjectiveTo explore methods of donor repair of the great toe-nail flap in finger reconstruction surgery.MethodsFrom December 1998 to December 2010, various kinds of flaps were used in 511 donor sites to repair the great toe-nail flaps,including:32 dorsal pedal artery flaps;twenty-four first dorsal metatarsal artery flaps;twenty-one second dorsal metatarsal artery flaps;forteen anterior malleolar flaps;seventeen medial tarsal artery flaps;seventy-nine lateral tarsal artery flaps;one hundred and six plantar metatarsal flaps,seventy-nine flaps from second toe;fifteen flaps from mid/lower leg and 124 freed flaps.ResultsAfter postoperative 6 months to 11 years of follow-up, repaired donor sites of great toe-flaps all survived successfully,with ideal outlook and function.ConclusionThere are many kinds of methods for donor site repair of the great toe-nail flap,and each kind of method has its own advantages and disadvantages. Among these flaps, plantar pedal artery flap and free groin flap are amony the best ones.

Full reconstruction of Ⅰ to Ⅲ-degree finger defect / 中华显微外科杂志

ObjectiveTo introduce the new method of full reconstruction for Ⅰ to Ⅲ-degree finger defect.MethodsFor reconstruction of Ⅰ to Ⅱ-degree finger defect, the surgery procedure was as follows:Harvest part of nail,skin and dorsal part of distal phalanx from hallux to form a composite flap,and then the flap was transplanted to the finger stump to reconstruct the defect part of the finger.The design of the composite flap was according to the recipient part. For reconstruction of Ⅲ-degree finger defect, the skin included in the flap could be designed according to the recipient part, but the bone can only be harvested from the fibulodoral part of the hallux and far from the insertion of the extensor hallucis longus tendon, which means the length was limited.If the bone length was not enough,one bone mass with appropriate size and shape was harvested from the iliac bone and connected with the bone of the composite flap. Some cases of Ⅲ-degree finger defect were reconstructed by harvesting interphalangeal joints from the second toes to reconstruct distal interphalangeal joints(DIP). The bone defect was reconstituted by bone mass from the iliac bone to conserve the contour of the second toe.The hallux wound was covered by a local flap or free flap transplantation.ResultsOne hundred and eighteen cases (126 fingers) of Ⅰ-degree defect, one hundred and eighty-seven cases (201 fingers) of Ⅱ-degree defect and 90 cases (111 fingers) of Ⅲ-degree finger defect were applied full reconstruction. All the reconstructed fingers survived completely and the configurations were similar to real fingers. Followed up our work on 150 fingers from a number of patients, between 1 and 11 years after the original surgery.Total ranges of motion of the reconstructed fingers got to over 180°.The reconstructed DIP joints had the range of motion of 15°-40°. The donor halluxes and toes were conserved with the normal length,relatively primary appearance and full function. ConclusionFull reconstruction for Ⅰ to Ⅲ-degree finger defect has great advantages in that the reconstructed finger has very realistic configuration as well as ideal function and the donor hallux is conserve well.

Full reconstruction of Ⅳ to Ⅵ-degree finger defect / 中华显微外科杂志

ObjectiveTo introduce the clinical application of full reconstruction for 72 cases of Ⅳ to Ⅵ-degree finger defect.MethodsFrom December 1998 to December 2010, sixty-three cases (85 fingets) of Ⅳ-degree finger defect, thirty-three cases (49 fingers) of Ⅴ-degree finger defect and 17 cases (23fingers) with Ⅵ-degree finger defect were applied full reconstruction. The procedures of full reconstruction of Ⅳ to Ⅴ-degree finger defect were as follows:Harvest part of nail, skin which includes some skin harvested from dorsal and palmar metatarsal to ensure the length of the reconstructed finger,and dorsal part of distal phalanx from hallux to form a composite flap, which constitute the contour of a finger, and harvesting interphaalangeal joint from the second toes to reconstruct the proximal interphalangeal (PIP) joint. Bone transplantation from the iliac bone to the distal (for Ⅳ-degree and light Ⅴ-degree defect) or both proximal and distal (for severe Ⅴ-degree defect) stump of the reconstructed PIP joint was needed to get to an appropriate length.On the basis of the treatment of Ⅴ-degree defect, reconstruction of Ⅵ-degree finger defect was to harvest one more joint: the metatarsophalangeal joint of the second toe, and connect it with the proximal iliac bone rod.ResultsAbout half of the cases were conserved of 4 toes, and the donor wound of halluxes were covered with the composite flaps (composed of nail, skin) harvested from the second toes which had been sacrificed.The other cases were conserved of all the 5 toes,and the donor wound of halluxes were covered by free flap transplantation.The second toes were reconstituted by bone transplantation from the iliac bones.All of the 157 fingers survived completely, and 75 fingers underwent second-stage plastic surgeries. Sixty-seven fingers underwent second-stage tenolysis surgeries.Follow-ups 7 months to 11 years after surgery, and all the reconstructed fingers had realistic configurations, and the two-point discrimination of the finger pulps ranges from 5 mm to 12 mm. Dorsal extension of the PIP joints were -10°～10°, flexion of the PIP joints range from 55° to 85°,and the average was 76°. ConclusionThe full reconstruction is an ideal alteration for Ⅳ to Ⅵ-degree finger defect reconstruction for the realistic configuration and ideal function of the reconstructed fingers.The one disadvantage of the full reconstruction is that the surgery is much more complex.

Finger reconstruction: combined flap constituted of bilateral hallux nails, skins and bones / 中华显微外科杂志

Objective To report our usage of a combined flap which is constituted of bilateral hallux nails, skins, bones to reconstruct a finger, and to introduce the method and outcome of this way. Methods Combine two halves of halluxes harvested from both feet to reform a fabricated finger and then transplant it to the finger stump to reconstruct the defect part of the finger. Plantar flaps or some other flaps near the donor sites were transposed to cover them. From June 2003 to June 2009, a total of 20 fingers (20 cases) which had defect degrees range from I to Ⅲunderwent reconstruction surgeries in this way. Results All the 20 fingers transplanted survived completely. Follow-ups 1 to 5 years after each surgery: all the fabricated fingers had very realistic configurations. The MP joints of the reconstructed thrumbs got to the normal range of motion, and the other reconstructed fingers' total ROM were 203 degree on average. All the reconstructed fingers had the sensation function above S3,and their two-point discriminations ranged from 6mm to 10mm. Both halluxes of each case were conserved major parts of nails and had nice, symmetric appearances. All the flaps for the donor halluxes survived completely, and none of the cases showed pains, ulcers or abrasions of their feet. All the cases showed normal gaits during follow-ups. Conclusion The combined flap by bilateral hallux nails, skins, bones is an ideal alteration for finger defect reconstruction for the important advantages of realistic configuration as well as minor destructions to donor sites.

Clinical application of split dorsal pedal flap to repair round-like cutaneous deficiency / 中华显微外科杂志

@#Objective To research the clinical application of split dorsal pedal flap for the repair of round-like soft tissue defect. Methods Design a long-strip dorsal pedal flap with slightly larger area than cutaneous deficiency,cut off the flap to the layer of superficial fascia along the suitable line degined in the middle of flap,and then rotate and reshape the split flap to resemble recipient area,and cover the wound surface based on pedical flap or free grafting;Meanwhile,donor area in dorsum of foot can be sutured directly.Results All the 5 cases of flap were survived,including one case which was free grafted and the others which were rotated locally, as well,donor area in dorsum of foot was satisfied because the cutting edge could be sutured directly. Conclusion It is a laudable modus operandi on account of beautiful outlook of both recipient and donor area.