Treatment of skin and soft tissue defect in the hallex with flaps / 中华整形外科杂志

<p><b>OBJECTIVE</b>To summarize the therapeutic effect of 5 kinds of flaps for the treatment of skin and soft tissue defect in the hallex.</p><p><b>METHODS</b>From Jan. 2008 to Jun. 2013, 24 cases with skin and soft tissue defects in the hallex were treated with 5 kinds of reversed flaps, including medial foot dorsal neurocutaneous flaps, medial foot neurocutaneous flaps, lateral tarsal flaps, anterior malleous flaps, medial cross leg and saphenous nerve flaps. The defects size ranged from 3 cm x 2 cm to 5 cm x 3 cm, with the flap size from 3. 5 cm x 2. 5 cm to 5. 5 cm x 4. 0 cm.</p><p><b>RESULTS</b>Partial superficial necroisis happened at the distal end of one foot dorsal medial neurocutaneous flap. One third flap necrosis occurred in 1 foot medial neurocutaneous flap due to too tight suture at flap pedicle and resulted thrombosis. All the other 23 flaps survived completely. 15 cases were followed up for 3-36 months with normal walking function and satisfactory appearance. Among the 8 cases with nerve anastomosis, 4 cases were followed up with 2-point discrimination distance of 8-11 mm. the flaps without nerve anastomosis also had protective sense due to nerve ingrowth.</p><p><b>CONCLUSIONS</b>Skin and soft tissue defects in the hallex can be treated with different appropriate flaps. The hallex length can be reserved with satisfactory function and appearance.</p>

[Diagnosis and treatment of vascular injury in limbs].

OBJECTIVE: To report the diagnosis methods and clinical treatment effects of blood vessel trunk damage in limbs. METHODS: From January 2001 to June 2006, 72 patients with vascular injury in limbs were treated. There were 50 males and 22 females, aged from 5-60 years (median 39 years) and including 44 cases of open injury and 28 cases of closed injury. The locations were subclavian artery in 1, femoral artery in 23, popliteal artery in 20, radia artery and ulna artery in 12, brachial artery in 11, axillary artery in 3 and anterior and posterior tibia artery in 2. The disease course was 30 minutes to 27 days. Injured arteries were repaired by suturing directly in 3 cases, by end-end anastomosis in 39 cases and by saphenous transplantation in 30 cases. The length of transplant veins was 3 cm to 8 cm. RESULTS: In 72 cases, 67 survived and 5 were given amputation. Forty-eight cases were followed up 6 months to 5 years. The blood flow rate and the diameter of blood vessel on the affected limbs were not different from that of normal limbs by colorful Doppler blood flow monitor. Forty cases recovered satisfactory limb function. Eight cases had different degrees of dysfunction, of them, four cases received functional reconstructive operation, and the function and appearance were improved. CONCLUSION: To investigate the mechanism and situation of injury, to examine patients carefully and analyze comprehensively are the key points of making earlier diagnosis for branch blood vessel damage; microsurgical repair of the injured blood vessel is the assurance of the blood flow rate. For the blood vessel above elbow and knee injured and lacked blood supply more than 4 hours and fascia syndrome, earlier opening the fascia cavity is the effective methods to recover the function of the limbs and to avoid disability.