Aesthetic Reconstruction of Scrotum after Founiers Gangrene using Laterally based Medial Thigh Fasciocutaneous Flap

Introduction : Fournier抯 Gangrene is a rapidly progressive necrotising faciitis affecting the genital region, perineum, perianal region and the abdominal wall. It can have an adverse effect on the functional and psychological aspects of the patient. Many flaps are available for the defect coverage. Aim : The aim of this prospective study was to analyse the effectiveness of laterally based medial thigh flap for scrotal reconstruction. This is a fasciocutaneous flap just below the Scrotum which covers moderate to large sized scrotal defects successfully. Methods and Materials : This study was done at a teaching hospital in South India on patients with major scrotal defects secondary to Fournier抯 Gangrene. Ten patients with major scrotal defects secondary to Fournier抯 gangrene were subjected to reconstruction of scrotum by medial thigh fasciocutaneous flap. Results and Conclusions : All ten flaps survived and provided a durable and aesthetic cover for exposed testes. Only one flap had necrosis of distal 2cm, which was successfully managed by secondary suturing. The donor areas were primarily covered with placement of a small graft near the base of the flap, which healed well with an inconspicuous scar. In conclusion, the laterally based medial thigh fasciocutaneous flap provides excellent closure for extensive scrotal skin loss. It is a robust flap, easy to mobilise, rarely undergoes necrosis, provides a sensate cover with excellent aesthetic results. The technique is simple, less time consuming and can be easily incorporated by plastic Surgeons and General Surgeons

Tratamiento quirúrgico de las úlceras por radionecrosis con colgajos músculo y fasciocutáneos / Surgical treatment of radionecrosis ulcers with myocutaneous and fasciocutaneous flaps

Resumen Introducción: La Ulcera con radionecrosis debe ser resecada ampliamente y reparada con colgajos miocutáneos y fasciocutáneos. Objetivo: Presentar el tratamiento quirúrgico de las úlceras por radionecrosis mediante colgajos Miocutáneos y Fasciocutáneos pediculados y microquirúrgicos. Materiales y Método: La casuística es de 31 pacientes portadores de úlceras por radionecrosis resueltas con colgajos miocutáneos y fasciocutáneos. Ellos han sido pediculados y microquirúrgicos. Las edades fluctuaron entre 30 y 75 años operados entre el 2000 y el 2019. Resultados: Se realizaron 19 colgajos musculares o miocutáneos y 12 fasciocutáneos en diferentes zonas del organismo. Los colgajos correspondieron a: temporal, latissimus dorsi de pedículo central y en reversa, latissimus dorsi microquirúrgicos, recto abdominal, escapular microquirúrgico, para escapular, gracilis, gastrocnemius, rectus femoris, cubital microquirúrgico, fasciocutaneos: cone flap y de rotación local. Las complicaciones fueron dehiscencia de herida operatoria suturada y celulitis tratada con antibióticos. No hubo necrosis completa de los colgajos. El seguimiento fue de 3 a 6 meses. Discusión: En esta serie hemos utilizados los colgajos músculo cutáneos de preferencia, los fasciocutáneos los hemos reservados para aquellos casos en los que por razones anatómicas, de localización de las úlceras, era más adecuado usar estos últimos, como en las lesiones planas o poco profundas. Generalmente los colgajos fueron pediculados y en determinados casos, cuando el tejido vecino de reparación no estaba disponible, realizamos colgajos con microcirugía. Conclusión: El tratamiento de las úlceras por radionecrosis es efectivo cuando se realiza desbridamiento exhaustivo con cobertura inmediata con colgajos musculares o músculocutáneos y fasciocutáneos. Fueron colgajos pediculados y microquirúrgicos.

Introduction: The radionecrosis ulcer have to be widely resected and repaired trough flaps with good blood supply who contibute with oxigen, nutrients and antibiotics. Thinking on this the more suitable flaps are the myocutaneous ones and in special conditions the fasciocutaneous. Aim: The objetive of this paper is to show the surgical treatment of radionecrosis ulcers with myocutaneous and fasciocutaneous flaps. Materials and Method: Casuistic is 31 patients with radionecrosis ulcers treated with, mainly, myocutaneous flaps and in special areas with fasciocutaneous ones. The majority were pedicle flaps and in less number microsurgical flaps. The age of patients were betwee30 and 75 years old. Results: 19 muscle or myocutaneous flaps and 12 fasciocutaneous flaps were made. Flaps were latissimus dorsi, temporal, escapular, para escapular, rectus abdominis, rectus femoris, gracilis, gatrocnemius, cone flap and local fasciocutaneous flaps. Complications were sutured operative wound dehiscence and cellulitis treated with antibiotics. There were no complete necrosis of any flap. Discusion: In this serie we used muscle or myocutaneous flaps because they give good blood supply, oxigen, nutrients and arrival of antibiotic with filling of the deep ulcers. When the ulcers were shallow we use fasciocutaneous flaps. The majority of our flaps were pedicles and microsurgical flaps were used when there was no near avialable tissue. Conclusion: The treatment have to be wide debridement of the ulcer. The surgical treatment is with myocutaneous and fasciocutaneous flaps sometimes pediculates and in others conditions microsurgicals.

Bilateral Pudendal Thigh Fasciocutaneous Flap Vaginoplasty in Mayer Rokitansky Kuster Hauser Sydnrome: A Step-by-Step Approach

@#<p>The surgical management in a case of vaginal agenesis is technically challenging and requires a strong demand for expertise. The objective of this report was to record the hospital's first experience in vaginal reconstruction using Bilateral Pudendal Thigh Fasciocutaneous Flap. Presented here is a case of 23-year old, female who consulted for primary amenorrhea who plans of getting married soon. Physical examination revealed normal secondary sexual characteristics with absent vagina. Imaging revealed an absent uterus with normal ovaries and distal vagina that ends in a blind pouch. Patient underwent vaginal reconstruction with no post-operative complications. Follow-up revealed incision site infection but eventually resolved with oral and topical antibiotics. Four weeks post-operatively, good wound healing was noted, vagina was 6 centimeters in length, admits two fingers on internal examination. Overall, the authors' first neovaginoplasty using Bilateral Pudendal Thigh Fasciocutaneous Flap was a technically safe procedure with good cosmetic outcome.</p>

Lateral genicular artery flap for reconstruction of defects around the knee: a series of 5 cases

The lateral genicular artery flap is a fasciocutaneous flap used for knee reconstruction with low donor site morbidity. It is raised from the lower lateral thigh and is based upon the cutaneous termination of superior lateral genicular artery. This flap showed constant anatomy and is reliable for coverage of defects at superior and lateral portions of the knee and the proximal part of the lower leg. The study period was from January 2016 to June 2017 where we operated on 5 patients, 3 for post-traumatic and 2 were post burn contracture excision. The flap was used as a pedicled fasciocutanous and was based on the superior lateral genicular artery. Five cases underwent lateral genicular artery flap of which 4 were males and 1 was a female. Mean defect size was 12 cm×10 cm. All the donor sites were closed with a split skin graft. One patient had distal necrosis which was managed conservatively. The lateral genicular artery flap is a thin, versatile, reliable and easy to harvest flap for reconstructing defects around the knee, with good cosmetic and functional outcome.

Supraclavicular artery flaps for head and neck reconstruction: a prospective study

Reconstruction of defects of the head and neck remains a challenge to the reconstructive surgeon. This is due to the complex anatomy of the region as well as the age and comorbidities of the patients, which prevent the use of free tissue transfer as the primary tool of reconstruction. The supraclavicular artery (SCA) island flap is a well vascularised tissue and provides a thin and pliable skin for cutaneous and mucosal defects of the head and neck region. Here, we had done this flap for eight patients with no major complications and hence, we concur that it is a safe, reliable and versatile reconstructive option for these defects. The study period was from January 2015 to June 2016 where we operated on 8 patients, 5 for post burn contracture neck and 3 for post oncologic resection. The flap was used as a pedicled fascio-cutaneous and was based on the transverse supraclavicular artery. Eight cases underwent supraclavicular artery flap of which 5 were males and 3 females. Mean defect size was 15×10 cm. All the donor sites were closed with a split skin graft. One patient had distal necrosis which was managed with debridement and secondary suturing. The supraclavicular artery flap is a thin, versatile, reliable and easy to harvest flap for reconstructing head and neck defects, with good cosmetic and functional outcome.

Large Meningomyelocele Defects Reconstruction Using Double Opposing Fasciocutaneous Flaps

When a part of neural tube fails to develop or close properly, it manifests as spina bifida. Spina bifida defects range from the mild form (spina bifida occulta) to severe form (meningomyelocele). Meningomyelocele is to be closed surgically as early as possible to prevent infection and other complications. Many methods are available for treatment of meningomyelocele defects ranging from skin graft to flap cover. Meningomyelocele defects when small in size can be closed primarily. Large meningomyelocele defects poses technical challenge to reconstructive surgeon. Many flap cover techniques were described to cover the large meningomyelocele defects. We wanted to evaluate bilateral opposing fasciocutaneous flaps method for closure of large defects without tension.METHODSTo cover large meningomyelocele defects, fasciocutaneous flaps give good and stable cover, and prevents wear and tear, and infections. We have used double opposing fasciocutaneous flaps method for reconstruction of large meningomyelocele defects. The advantages of this technique are its simplicity and it being a single stage procedure. 20 children with meningomyelocele defects of various sizes were operated with this method and followed for 6 months for wound dehiscence and CSF leak.RESULTSClosure of large meningomyelocele defects is made possible with simple and easy technique. Ease of planning and execution even for the inexperienced are the most noticeable features. All children were well post operatively. Two patients in whom flaps were taken with acute angles suffered tip necrosis. All flaps gave stable cover to the defect without dehiscence at the suture line. The entire reconstructive process consumed less time and was without major complications.CONCLUSIONSNeural tube malformation congenitally causes spina bifida defects. Spina bifida cases may range from simple to severe defects. Treatment of meningomyelocele spans from primary closure to flap cover closure. Closure of large meningomyelocele defect by bilateral fasciocutaneous flaps is a good method to adopt. This method is simple, less time consuming, technically non-demanding and easily reproducible.

Pelvic limb reconstruction failed by propeller flap resolved with microsurgery

Reconstruction of lower limb defects is a constant challenge for surgeons, the etiology of the defect can be very variable from diabetic ulcers, traffic accidents, fall from height, oncological resections and many others. Free flaps have always been an important option because it has great results in complex reconstructions in lower limbs, it is a microvascular technique, so it has a higher level of complexity. This technique is usually reserved for extensive perilesional wide defects. On the other hand, the propeller flap, which is considered less invasive and easier as it does not involve microvascular surgery. An 18-year-old patient who had a fracture of the right tibial pylon due to a 7-meter drop, who after orthopedic treatment had a defect with exposure of ostesynthesis material of 3 cm in circumference in the medial malleolus. This defect was first managed with a propeller flap complicated with necrosis at 48 hours which was treated with sub atmospheric pressure system for 5 days and later with an ultra-thin anterolateral flap of the pelvic limb. Complete pedicled propeller flap failure is very rare but, because necrosis develops distally, even partial necrosis can expose bone, tendons, or other tissue. Some surgeons consider that propeller flap placement is risky in this location, especially the distal third of the lower leg a prefer to use free flaps. Whenever any pelvic member reconstruction plan fails in the distal third, the best and safest is the use of microsurgery even with the failure of a previous micro vascular flap.

Clinical efficacy of dorsal digital nerve fasciocutaneous pedicle flap with superficial vein anastomosis in repair of the type III and type IV of fingertip defects / 中华显微外科杂志

Objective@#To analysis the clinical efficacy of dorsal digital nerves fasciocutaneous pedicle flap (DDNFPF) with superficial vein anastomosis in the treatment of the type III and type IV of fingertip defect, and the relationship between the incidence of vein crisis and superficial vein anastomosis.@*Methods@#A total of 85 patients with 92 fingers, treated by DDNFPF from February, 2017 to December, 2018, were retrospectively analyzed. The superficial veins of 30 patients with 32 fingers were anastomosed, and 55 patients with 60 fingers were not. The difference of the superior rate and the incidence of venous crisis between superficial vein anastomosis and non-superficial vein anastomosis was compared by Chi-square test. The difference was considered as statistically significant when P<0.05. The regular postoperative followed-up was performed.@*Results@#The average followed-up time was (7.0±2.9) months. The incidence of venous crisis in anastomosis group (1/32) was lower than that in non-anastomosis group (13/60). The difference was statistically significant (χ2=4.217, P<0.05) . There was no significant difference in the superior rate between the 2 groups after operation (96.8% and 90.0% respectively, χ2=0.596, P>0.05) . The repaired fingertips of the 2 groups were in good appearance, wear-resistant, stable holders and two-point discrimination was 5 to 8 mm.@*Conclusion@#DDNFPF for the type III and IV type of fingertip defect is safe and effective. A anastomosis of superficial veins in recipient area can significantly reduce the incidence of venous crisis.

Clinical efficacy of dorsal digital nerve fasciocutaneous pedicle flap with superficial vein anastomosis in repair of the type III and type IV of fingertip defects / 中华显微外科杂志

Objective To analysis the clinical efficacy of dorsal digital nerves fasciocutaneous pedicle flap (DDNFPF) with superficial vein anastomosis in the treatment of the type III and type IV of fingertip defect, and the re鄄lationship between the incidence of vein crisis and superficial vein anastomosis. Methods A total of 85 patients with 92 fingers, treated by DDNFPF from February, 2017 to December, 2018, were retrospectively analyzed.The superficial veins of 30 patients with 32 fingers were anastomosed, and 55 patients with 60 fingers were not. The difference of the superior rate and the incidence of venous crisis between superficial vein anastomosis and non-superficial vein anasto鄄mosis was compared by Chi-square test. The difference was considered as statistically significant when P＜0.05. The regular postoperative followed-up was performed. Results The average followed-up time was (7.0±2.9) months. The incidence of venous crisis in anastomosis group (1/32) was lower than that in non-anastomosis group (13/60). The dif鄄ference was statistically significant ( χ2=4.217, P＜0.05). There was no significant difference in the superior rate be鄄tween the 2 groups after operation(96.8% and 90.0% respectively, χ2=0.596, P＞0.05). The repaired fingertips of the 2 groups were in good appearance, wear-resistant, stable holders and two-point discrimination was 5 to 8 mm. Con鄄clusion DDNFPF for the type III and IV type of fingertip defect is safe and effective. A anastomosis of superficial veins in recipient area can significantly reduce the incidence of venous crisis.

Application of extended clavicular epithelial flap in postoperative defect repair in elderly patients with oral cancer / 口腔疾病防治

Objective @#To explore the clinical application of an extended clavicular epithelial flap with a transverse cervical arterial blood supply in the repair of postoperative soft tissue defects in elderly patients with oral cancer.@*Methods@#From January 2015 to June 2018, 24 elderly patients with oral cancer were admitted to the Department of Oral and Maxillofacial Surgery, Hainan Provincial People′s Hospital, including 15 males and 9 females, aged 65-82 years, with an average age of 71.8 years. The supraclavicular epithelial flap was used to repair the soft tissue defect after radical resection of the oral cancer. The flap was at least 4 cm × 6 cm, and the maximum size was 7 cm × 9 cm. All patients completed a University of Washington Quality of Life (UW-QOL) survey 6 months after surgery, and a subjective satisfaction survey was conducted.@*Results @#The prolonged clavicular epithelial flap survival rate was 91.6% (22/24). The patients had good speech and swallowing function, hidden scars and no obvious sequelae. The average UW-QOL score 6 months after the operation was 76.5 ± 6.4. The follow-up satisfaction rate was 87.5% (21/24).@*Conclusion@#An extended clavicular epithelial flap with a transverse cervical arterial supply is reliable, of moderate thickness, is simple to implement, causes little trauma at the donor site, and yields a relatively concealed donor site. It is suitable for the simultaneous repair of soft tissue defects in elderly patients with oral cancer.

Anatomic feature of the adjacent perforator fasciocutaneous flap of plantar and its clinical application / 中华显微外科杂志

Objective To study the anatomic basis and its clinical effects of the adjacent perforator fasciocutaneous flap in planta.Methods From October,2010 to December,2017,the work was on two fronts:① The blood supply of the flap was studied by the dissection of 5 adult lower limbs which were perfused with red emulsion.Under the magnifying glass,the source of blood supply to the pedicle perforator fasciocutaneous flap near the foot was observed,and the caliber of perforating vessels was measured by vernier caliper.② Methods based on the anatomic study,the adjacent perforator fasciocutaneous flap was designed to repair plantar defect.Eleven cases with defects in planta were treated with the flap including 5 malignant melanoma,5 refractory wound and 1 pigmented nevus.The size of defects ranged from 1.5 cm×2.0 cm to 4.0 cm ×5.0 cm with the size of the flaps ranging from 7.0 cm×3.0 cm to 13.0 cm×7.0 cm.Results Anatomical studies showed that the supply vessels of the fasciocutaneous flap near the perforator of the plantar space were plantar medial arteries.The external diameter was greater than or equal to the 0.5 mm perforating number of about 7,the average outer diameter was (0.85±0.19) mm.The medial plantar artery emits multiple branches along the running direction and forms anastomotic branches in the arch of the foot to ensure the blood supply of the flap.Eleven cases of perforator fasciocutaneous flaps survived,including 1 case of distal necrosis of small area and healed after change dressings.The follow-up results during 6-24 months showed that all patients were walking normally,with full texture and no localized dull pain.Conclusion On the basis of the extent of diseases,projected the adjacent perforator fasciocutaneous flap,the wear resistance and abrasive resistance are improved resulted from flaps with similar skin texture of defects.The donor site can be closed directly without skin graft.It is an simple and reliable method to repair medium and small-sized plantar defects.

Comparision between distally-based peroneal artery perforator-plus and posterior tibial artery perforator-plus fasciocutaneous flap for reconstruction of the distal lower leg,ankle and foot / 中华显微外科杂志

Objective This study is to compare flap-viability-related complications, coverage reach, recon-struction outcomes and donor-mobidities between distally-based peroneal artery perforator-plus fasciocutaneous (DPAPF)flap and distally-based posterior tibial artery perforator-plus fasciocutaneous(DPTAPF)flap for recon-struction of soft-tissue defects over the distal lower leg, ankle and foot, and thus provide evidence for selection of the flaps. Methods Between April, 2002 and February, 2012, 216 and 59 patients underwent the reconstructions with DPAPF flaps(peroneal group)and DPTAPF flaps(posterior tibial group)respectively. We subdivided the distal lower leg, ankle and foot into 12 subregions. In all the patients, flap-viability-related complications and its potential risk factors(including age,sex,etiology,location of top edge,location of pivot point,length and width of both the skin is-land and adipofascial pedicle, length-width ratio, and total length), coverage reach(the subregion in which the most distal part of the reconstructed defect lies),duration of flap elevation and hospital stay were compared between the two groups. In patients with at least 3 months postoperative follow-up, comparative study of reconstruction outcomes, pa-tient's satisfaction with flap appearance and donor-site morbidities were performed between the groups. Results Partial necrosis rate in the peroneal of the posterior tibial group were 12.0 percent versus 20.3 percent,respectively(P> 0.05). Marginal necrosis and overall complication (including partial and marginal necrosis)rates in the peroneal group(1.9 percent and 13.9 percent, respectively)were significantly lower than those in the posterior tibial group (8.5 percent and 28.8 percent,respectively)(P<0.05).Incidence of partial necrosis of the flaps for the defects over subregions 7 to 10 in the peroneal group(7 of 41)was significantly lower than that in the posterior tibial group(2 of 2).There was no difference in reconstruction outcomes and patient's satisfaction with flap appearance in both groups(P >0.05).Incidences of hypertrophic scar,itching and pigmentation at the donor site were significantly lower in the peroneal group(P<0.05). Conclusion DPAPF flap is superior to DPTAPF flap in reliability,safe coverage reach and less donor-site morbidities.The former is recommended as the first choice when local pedicle flaps are considered to recon-struct soft-tissue defects over the distal lower leg,ankle and foot.

Clinical effects of adjacent fasciocutaneous flaps in repairing small wounds with bone or steel plate exposure in anterior tibia / 中华烧伤杂志

Objective@#To explore the clinical effects of adjacent fasciocutaneous flaps in repairing small wounds with bone or steel plate exposure in anterior tibia.@*Methods@#Twelve patients with small wounds of bone or steel plate exposure in anterior tibia covering area of 2 cm×2 cm to 5 cm×3 cm were admitted to our unit from January 2014 to December 2016. A circular or elliptical adjacent fasciocutaneous flap was designed on the normal skin located at the inside or outside of the wound according to the size of wound after thorough debridement. The pedicle of the flap was located at the proximal end and transferred through the subcutaneous tunnel to cover the wound. The sizes of flaps were 3 cm×3 cm to 6 cm×4 cm. Flaps were fixed with interrupted sutures and drainage rubber sheets were placed under the flaps. The drainage rubber sheets were removed within 24 to 48 hours. The donor area was repaired by medium-thickness skin graft collected from homolateral outer thigh.@*Results@#All the flaps of 9 patients survived. Two patients had necrosis at the distal end of the flaps and were cured by changing dressing. One patient had tension blisters on the flap and was cured by removing blisters and improving microcirculation. All patients were followed up for 3 months, and the flaps were good in blood supply, appearance, and color, with hypaesthesia.@*Conclusions@#Repair of small wounds with bone or steel plate exposure in anterior tibia by adjacent fasciocutaneous flap is simple in surgical procedure and does not damage the well-known blood vessels, and the appearance, texture, and thickness of flaps are close to the skin of anterior tibia region. It is a good choice for repairing this kind of wounds and worth promoting in clinic.

Colgajo fasciocutáneo por pérdida del pulpejo. Presentación de un caso / Fasciocutaneous flap by soft flesh losses. Case Presentation

Introducción: Las pérdidas de sustancia de los pulpejos constituyen uno de los motivos de consulta más frecuentes en las salas de urgencias de traumatología. El pulpejo es el área del dedo con mayor densidad de terminaciones sensoriales, que constituyen el primer eslabón de conexión entre nuestro sistema nervioso central y el medio externo en cuanto a la sensación táctil se refiere. Objetivo: Evidenciar las ventajas del uso del colgajo fasciocutáneo pectoral presentando un caso con lesión del pulpejo del pulgar. Presentación del caso: Un paciente con pérdida traumática del pulpejo del pulgar, a quien se le realiza un colgajo fasciocutáneo pectoral, revisando las particularidades morfofisiológicas del sitio operatorio y el proceder. Conclusiones: Los conocimientos de Morfofisiología Humana tienen importancia y aplicación en diferentes procederes médico-quirúrgicos(AU)

Introduction: Soft flesh losses is one of the most frequent consult's reasons in traumatology's emergency wards. Soft flesh is the at;the finger with higher density of sensorial endings, which constitute the first link between our central nervous system and the external environment in terms of tactile sensation. Objective: to remark the advantage of the use of Pectoral fasciocutaneous flap through a Case Presentation. Case presentation: patient suffering a soft flesh traumatic loss of the tactile pad of the thumb, reviewing the morphophysiological specificities of surgery area and procedure. Conclusions: it is concluded that Human Morphophysiological knowledge are important in several medical-surgical procedures(AU)

Free peroneal perforator cutaneoadipofascial flap containing neurovascular axis for coverage of dorsal forefoot defects / 中华整形外科杂志

Objective@#To report operative techniques and clinical results of free sural cutaneoadipofascial flap containing the neurovascular axis based on a dominant peroneal perforating artery (DPPA, with a caliber≥0.8 mm) and its concomitant veins for reconstruction of dorsal forefoot soft tissue defects.@*Methods@#The flap was applied in 32 cases with middle to large soft tissue defects in the dorsal forefoot from Aug. 2009 to Dec. 2014. DPPAs arising from the posterolateral intermuscular septum was located and assessed preoperatively with color Doppler flow image and computed tomography angiography. According to the location, size, and shape of the defects, one of these DPPAs was chosen for flap planning. The flap was harvested from the posterolateral aspect of the leg. The neighboring neurovascular axis (one or more of that of the sural nerve, the medial cutaneous nerve, the lateral cutaneous nerve of calf and the sural communicating nerve) was included to ensure vascular supply. According to skin laxity of the donor site, the width of the full harvesting part which should be able to cover the region of the recipient site where pressure and friction force were prominent while wearing shores was decided; the rest was harvested as an adipofascial flap (without skin) to get enough size. After transfer to recipient site, the flap was revascularized by anastomosing the perforating artery and its venae comitantes with appropriate recipient vessels, and reinnervated (antegrade or retrograded methods). Skin grafting was performed on the adipofascial surface of the flap primarily or secondarily. The defects in donor site of the leg was closed directly.@*Results@#All flaps (ranged from 7.5 cm×5.0 cm to 23.0 cm×13.0 cm) were transplanted successfully, and no vascular or donor site problems occurred. All primary skin grafts (19 cases) was partially lost, but only 2 of them need a second grafting. Adipose necrosis occurred in 4 of 13 cases receiving secondary grafting but only needed wound care before surgery. Following up for 11-26 months showed both satisfactory functional and cosmetic results without problems of shoe wearing. Flap sensibility restored at least to the degree of S3.@*Conclusions@#The cutaneoadipofascial flap combines the advantages of perforator, neurocutaneous axis, free and adipofascial flaps leaving only suture scar in the donor leg, and is a satisfactory method for free-style and acute coverage of dorsal forefoot defects.

Rotation and advancement of the radial-based fasciocutaneous flap for primary closure of the radial forearm flap donor defect / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aims to investigate the feasibility and clinical application value of a new method for primary donor-site closure of radial forearm flaps with the use of rotation and advancement of radial-based fasciocutaneous flaps.</p><p><b>METHODS</b>The forearm donor-site defects of 36 patients were primarily closed by rotation and advancement of radial-based fasciocutaneous flaps after radial flap harvest from November 2014 to May 2015. Patients included 28 males and 8 females aged 28 to 67 years (53.6 years old on average). Flap size ranged from 3.0 cm×5.0 cm to 4.0 cm×6.0 cm. Wound healing, scar hyperplasia, and forearm appearance were recorded and evaluated. Wrist flexion angle, dorsal extension angle, ulnar deviation angle, and radial deviation angle were measured three and six months after the operation. Wrist joint loss index was calculated and compared with the preoperative index to evaluate wrist function recovery. The results were subjected to comparative t-
test to perform statistical analysis with SPSS 19.0 statistical software package.</p><p><b>RESULTS</b>Forearm donor sites were successfully closed without skin grafting in all patients. Skin ischemia caused by excessive tension was observed at the incision edge in five cases, thereby leading to skin exfoliation and pigment loss without affecting wound healing. All patients were followed up at six and twelve months, and presented a satisfactory appearance. No scar hyperplasia was observed. No significant difference was observed in radial deviation, ulnar deviation, palmar flexion, dorsiflexion, radial deflection angle, or wrist joint loss index (P>0.05) after the operation.</p><p><b>CONCLUSIONS</b>Application of rotation and advancement of radial-based fasciocutaneous flaps can directly close small-to-medium radial forearm flap donor defects. Satisfactory postoperative appearance can be achieved with no loss in wrist joint function. The novel method prove worthy of promotion and application in clinical work.</p>

Repair of children fingertip defect with dorsal nerve fasciocutaneous flap / 局解手术学杂志

Objective To investigate the clinical curative effect of dorsal nerve fasciocutaneous flap in the treatment of children fingertip defect.Methods A total of 20 children (26 fingers)with fingertip defect were chosen as the research objects,and all of them were given the dorsal nerve fasciocutaneous flap surgery within the same finger.The sensory recovery,color,shape and function of the fingers were ob-served.Results All the 26 fingers were survived,and the survival rate was 100%.There were 8 cases of ambient blood circulation crisis 1 to 2 days after the surgery which were eliminated with corresponding treatment.Postoperative follow-up results showed that the sensory re-covery of the skin flap was S2 ~S3 6 months after surgery,and the two-point discrimination (2-PD)was 8 ~14 mm;the sensory recovery of the skin flap was S3 ~S3 +(19 fingers of S3 and 7 fingers of S3 +)12 months after surgery,and the two-point discrimination (2-PD)was 6 ~10 mm;the sensory recovery of the skin flap was S3 +~S4 (20 fingers of S3 +and 6 fingers of S4)12 months after surgery,and the two-point discrimination (2-PD)was 5 ~8 mm.Up to then,the finger shape and color of patients was similar with normal finger,the skin graft donor site was smooth without scar contracture,the finger joint function recovered well,and the distal interphalangeal joint function were normal.Conclusion Treatment of dorsal nerve fasciocutaneous flap repair for children fingertip defect has good clinical effect and it is wor-thy of clinical application.

Repair of fingertip soft tissue defect with the dorsal branches island flaps of the proper palmar digital arteries: a report of 35 cases / 中华显微外科杂志

Objective To discuss the treatment method and effect of the application of the dorsal branches island flaps of the digital arteries in clinic.Methods During January,2010 to February,2015,a total of 20 cases of palmar soft tissue defect of the 2nd-5th distal segments of single fingers were incorporated and repaired by the dorsal branches island flaps of the digital arteries in the base of the distal phalanx.The size of the selected flaps was 3.5 cm × 2.5 cm-2.0 cm × 2.0 cm.In addition,palmar soft tissue defect (n =15) of the 2nd-5th middle and distal segments of single fingers were repaired by the dorsal branches island flaps of the digital arteries at the 1/3 site of the proximal digital arteries,and the selected flaps size was 4.5 cm × 2.5 cm-3.0 cm × 2.0 cm.Full-thickness skin graft urethroplasty was used in the donor sites.Flap shape,texture,sensory recovery and texture of the skin region,function recovery of the wounded fingers were followed up at 1,3,and 6 months after operation.Results Thirty-five patients were followed up from 6 to 13 months (average of 7 months).All flaps survived completely in the incorporated 35 cases postoperatively.Flaps had satisfactory appearance,fine texture,and soft texture in the skin transplantation area.The postoperative improvement of sensory function was between S2 and S3,and the two-point discrimination was 10-15 mm.Assessment of the upper limb function using the standard issued by the Hand Surgery Society of Chinese Medical Association graded 23 cases as excellent,10 cases as good,and 2 cases as fair.Conclusion The dorsal branches island flaps of the digital arteries are characterized by easy dissection,reliable blood supply,and no major blood vessels needed to be sacrificed,which is an effective procedure for finger soft issue defect repairing.

Clinical application of finger soft tissue defect coverage with dosal proximal digit fatty fasciocutaneous flap / 中华显微外科杂志

Objective To discuss the coverage of finger soft tissue defect with dorsal proximal digit fasciocutaneous flap on the middle and distal digit.Methods From May,2013 to December,2014,8 cases with soft tissue defects at 8 fingers were treated with dorsal proximal digit fasciocutaneous flap.The flap sizes ranged from 2.5 cm × 2.0 cm to 3.5 cm × 3.0 cm.The donor site were closed straightly.Results Eight flaps of 8 fingers survived.All the wounds at the donor sites healed well.Eight fingers in 8 cases were followed up for 6-12 months.The color,texture and contour of the flaps were satisfied.The two-point discrimination distances were 8-10 mm.Conclusion The skin defect in the middle and distal digit can be satisfied covered with dorsal proximal digit fasciocutaneous flap.This flap is a simple,reliable and safe management for digit defect and can be performed in the primary hospital.To ensure the surviving of the flap,ensure the surviving of the flap,the awareness of the anatomy of the flap should be known well.The limits of its reconstruction of sensation and coverage size exit in its application.

Staged Operation Using Fasciocutaneous Transposition Flap on Reconstruction of Exposed Patella Region in 4th Degree Burn: Case Report

PURPOSE: Soft tissue injuries of the patellar region are difficult problems because of insufficient arterial blood supply and lack of muscle. There have been many methods for reconstructing the soft tissue injuries of the patellar area such as primary closure, skin graft, muscle flap and free tissue transfer. However, each method has some limitations in their application. We used fasciocutaneous transposition flap according to limitations of patient's condition. METHODS: A 67-year-old-man was hospitalized by contact burn with TBSA 15% involving scalp, back, buttock, both legs. We found 20x30 cm2 sized eschar on right knee. We debrided necrotizing patella bone and found insufficient blood supply. In addition, general weakness, low weight (170 cm/42 kg), old age, DM made us to plan 2 staged operation. At first, coverage using medial fascio-cutaneous transposition flap. After 7 days, there were 1/4 necrosis by congestion. we used Vancomycin for systemic antibiotic treatments and betadine irrigation. 2 weeks after, We debrided necrotizing patella bone and coverage using lateral fascio-cutaneous transposition flap. RESULTS: There were no post-operative complications such as infection, hematoma, seroma or flap necrosis. And there was no contracture or contour deformity. CONCLUSION: Due to limitations of patient's condition, we used fasciocutaneous transposition flap instead of musculocutaneous flap or free flap. We gained satisfactory result by using fasciocutaneous flap in patella exposed wound reconstruction.