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Objective:To investigate the microsurgical anatomy of thoracodorsal artery perforators, and the clinical effect in repairing the soft tissue defect of hand with the thoracodorsal artery perforator flap (TAP).Methods:From October, 2014 to November, 2014, the axillary arteries in 10 thoracodorsal specimens were perfused with red latex. The number and diameter of the perforators of the thoracodorsal arteries were mearsured. From January, 2015 to February, 2019, 52 cases of soft tissue defects in hand combined with bone and extensor tendon exposure were repaired with TAP. The patients were followed-up in outpatient department to observe the clinical efficacy.Results:The number of perforators of thoracodorsal artery was 2-4 mostly, and 3 perforators was the most. The diameter of perforators was 0.22-0.68 mm, and the distance between the perforating point and the posterior axillary wall was 5.2-11.8 cm. All the operations were completed successfully, and the donor sites were closed directly. In 52 cases, 48 flaps survived, 2 had partially necrosis, and 2 had completely necrosis. The patients were followed-up for 5 to 24 months. The blood supply of the flaps was good with soft texture and good appearance.Conclusion:The TAP is an ideal flap because of its thin in thickness, concealed donor area and no obvious scar after direct suture.
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Objective:To introduce ulnar shortening oblique osteotomy combined with arthroscopy technique for ulnar impaction syndrome and to evaluate the outcomes.Methods:From August 2012 to January 2015, data of 25 cases with ulnar impaction syndrome who were treated in our hospital with oblique osteotomy of the ulna and internal fixation were retrospectively analyzed. There were 14 males and 11 females with an average age of 32.5±4.9 years old (range, 18-62 years). All 25 cases had wrist triangular fibrocartilage complex (TFCC) injuries. Intraoperative arthroscopy was conducted to investigate the pathologic changes of the articular disk of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, and tears of the lunotriquetral interosseous ligament (LTIL), debridement of the synovial membrane and the free edge of the central perforation of TFCC, to remove the cartilage from the lunate and triangular bone, and to perform oblique osteotomy of the ulna and internal fixation after repairing of TFCC ulnar tear. We evaluated the outcomes by means of comparing the postoperative values of modified Mayo and visual analogue scale (VAS).Results:There were 5 cases of IB, 5 of IIA, 7 of IIB, 4 of IIC, 4 of IID according to Palmer's classification. All 25 cases were followed-up for 24.6±1.9 months (range, 12-46 months). All patients achieved bone healing with an average of 14.0±1.9 weeks (range, 12-20 weeks). The mean value of preoperative ulnar variation was 3.8 ±1.5 mm which decreased to -1.5±0.5 mm after operation. The preoperative VAS was 7.8±0.7 which decreased to 1.3±1.5 at the latest follow-up. The modified Mayo value increased from 52.8±15.8 to 83.0±11.2. There were 19 cases with excellent wrist function, 5 good and 1 fair. The excellent-good rate was 96% (24/25). Grip strength value increased from 6.3±1.5 kg preoperative to 12.3±1.9 kg postoperative. There was no postoperative infection, delayed or nonunion of bone, but irritation of steel plate appeared in 10 patients, which disappeared after the removal of the steel plate.Conclusion:Arthroscopy combined with ulnar shortening oblique osteotomy technique for ulnar impaction syndrome can reduce wrist pain, increase hand grip strength, improve the activity of the wrist joint, and the clinical effect is positive.
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Objective@#To evaluate the outcome of free hypothenar perforator flap, with different vascular perforators, in fingerskin defects repairment.@*Methods@#From April 2014 to September 2016, 15 cases of skin defects on finger were treated with hypothenar perforator flap, based on different vascular perforators.Patients had nerves, vessels, tendons or bone exposure.Defects ranged from 1.5 cm×3.5 cm to 2.0 cm×4.5 cm in size. Fivecases were treated with hypothenar perforator flap based on a cutaneous perforator branch of the ulnar artery, 8 cases were based on acutaneous perforator branch of the ulnar digital artery, 2 cases were based on branch of the superficial volar arch.Donor site was closed directly.@*Results@#Vascular crisis occurred in 3 cases postoperatively, which were rescued by propertreatment. Other 12 transferred free flaps survived uneventfully.After averaged 13.5-month postoperative follow-up (ranging from 3 to 24 months), the appearance of transferred flaps was satisfactory. Flap texture was good with no obvious atrophy. All the fingers had good function.The sensation of flaps recovered to S3, and two-point discrimination was 8-9 mm. The donor site was healed with linear scar.@*Conclusions@#The hypothenar perforator free flap was relatively easy to practice.Constant vascular anatomy, the appearance, texture and good functional recovery after hypothenar free flap transferring, suggest this is achoice for repairing small skin defects on finger.
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Objective To study the surgical techniques and the clinical curative ettect of the reconstruction of adjacent large finger pulps with the modified sensate free proximal ulnar artery perforator flap.Methods From February,2013 to May,2016,20 fingers in 10 patients with adjacent large finger pulp defects crossing the DIP joint were reconstructed by the modified senate free proximal ulnar artery perforator flap.All the pulps of every patient were recovered by 1 flap in the first stage and the artificial syndactyly of two digits was divided in 7 weeks after the flap transfer in the second stage.In order to reconstruct the sensation of two pulps in each patient,firstly both of the proximal and distal ends of the cutaneous nerve in flaps were dissected and anastomosed with the most lateral and medial palmar digital nerves of two adjacent fingers respectively,which were divided into 2 groups.Secondly the cutaneous nerve in the middle part of flap was cut and the two ends were anastomosed with the other two palmar digital nerves in the second surgery.There were 8 fingers in 4 patients with the index and middle finger pulp defects,12 fingers in 6 patients with the middle and ring finger defects.The flap size was from 5.0 cm×3.5 cm to 5.5 cm×4.0 cm,and the perforator artery was anastomosed with the palmar digital artery in 6 cases and with the joint branch of digital artery in 4 cases.Results Nine flaps survived uneventfully except the venous congestion was found in 1 flap which was salvaged successfully by acupuncture bleeding.Also,no congestion or ischemia of all the 20 pulp flaps occurred right after releasing the artificial syndactyly.The time of followed-up was from 11 months to 32 months with the average of 17 months after the second surgery.The static two point discrimination of the 2 groups of the sensate pulp flap was (7.3 ± 1.2) mm and (8.6 ±2.4) mm respectively.There was no significant difference between groups (P ＞ 0.05).These 20 pulp flaps were also assessed by the Semmes-Weinstein monofilament test with the result of diminished light touch in 14 pulps and diminished protective touch in 6 pulps.The total active motion in all 20 fingers was (248.0±4.5) °.No patients suffered cold intolerance and local pain but 1 had hypersensitiveness in the pulp flap.Conclusion The modified sensate free proximal ulnar arte~ perforator flap is a practical alternative for the reconstruction of two large adjacent pulps with satisfactory functional and aesthetic outcomes.
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Objective To evaluate the clinical outcome of the method of repairing donor site of foot after improved toe-to-thumb reconstruction utilizing superficial circumflex iliac artery perforator (SCIAP) chimeric flap.Methods Fourteen cases of thumb defect were recruited from April,2012 to January,2016.According to Gu Yudong's classification,5 cases met the criterion of type Ⅰ,4 cases met the criterion of type Ⅱ,and 5 cases met the criterion of type Ⅲ.For type Ⅰ,the thumb was reconstructed with the great toe wrap-around flap.For type Ⅱ and Ⅲ,the thumb was reconstructed by the combined tissue with mutual artery (great toe wrap-around flap,and the bonetendon tissue of the second toe).All the donor sites of foot were repaired utilizing SCIAP chimeric flap.Results All the reconstructed thumbs survived.Among 14 free flaps of donor site,1 case suffered venous crisis and survived after exploration and rescue surgery.Dorsal skin necrosis of the second toe was found in 1 case,which was healed by local skin flap transposition.All patients were followed-up ranged from 3 to 30 months (averaged at 16 months).In spite of slightly bloated,the color and texture of all the flaps' was satisfied,and the average healing time of the bone in the donor sites was 2.5 months.All patients did not feel painful and had no adverse effect when walking and running.Three months after the operation,5 slightly bloated flaps in the donor sites under went flap plastic and achieved better appearance.On the part of iliaca,there was only one inconspicuous linear scar without any discomfort.Conclusion Repairing donor site of foot after improved toe-to-thumb reconstruction utilizing SCIAP chimeric flap was an ideal method.Using this method,the reconstructed thumb can achieve good appearance and function,all the toes of donor site were reserved,and the disability of the donor site is minimized.