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Objective:To investigate the clinical effect of free anterior tibial artery proximal periosteal perforator bone-skin flap for repairing phased thumb defect.Methods:Eight patients of phased defect of thumb were repaired from March, 2013 to January, 2019 utilizing proximal tibial artery periosteal perforator bone and skin flap. Of which, 2 cases suffered defects at interphalangeal joint of thumb, 3 in proximal phalanx, and 3 at thenar muscle and metacarpale. There were 4 cases with tendon defect, 6 cases with other finger injuries.The areas of soft tissue defect was 4.5 cm×2.5 cm to 7.2 cm×4.0 cm, and the length of metacarpale bone defect was 1.2 to 2.5 cm. The flap size ranged from 5.0 cm×3.0 cm to 7.5 cm×4.5 cm, and the bone flap size was 1.2 cm×1.0 cm×0.8 cm to 2.5 cm×1.0 cm×1.0 cm. Six cases received direct suture or local skin metastasis in anterior tibial region and 2 cases with skin grafting. All patients were followed-up by clinic visits, telephone or WeChat reviews, and home visits.Results:All the flaps survived after surgery. A 6 to 24 months followed-up showed that the flaps were normal in colour with good texture and moderate thickness. TPD of the flaps ranged from 7 to 10 mm. The donor site of the shank had good appearance and were in normal function, and the walking were not affected. Healing time of transplanted bone flaps ranged from 2.0 to 4.0 months, with an average of 2.6 months. According to the Evaluation Criteria of Upper Limb Function of the Hand Surgery Society of Chinese Medical Association, the results were excellent in 7 thumbs and good in 1 thumb. According to Michigan Hand Function Evaluation Criteria, 8 thumbs scored 81.3 to 91.8 points, with an average of 83.6 points.Conclusion:The reconstruction of phased defect of thumb with proximal tibial artery periosteal perforator bone-skin flap can restore the appearance and function of thumb to the greatest extent, and the affect to donor site is minimum. It is an effective surgical method for repairing phased defect of thumb.
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Objective To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis. Methods From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting.Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anasto鄄moses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds.Sizes of artery ex鄄posed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured.Postoperative follow-up was conducted to observe the postoperative effect. Results Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites. Conclusion The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.
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Objective@#To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis.@*Methods@#From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting. Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anastomoses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds. Sizes of artery exposed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured. Postoperative follow-up was conducted to observe the postoperative effect.@*Results@#Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites.@*Conclusion@#The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.
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Objective To evaluate the clinical efficacy of ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery,the anterior fourth lumbar artery or the posterior intercostal artery.Methods Between April,2005 to August,2015,6 patients diagnosed as large skin defects in the upper extremity were treated with ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery,the anterior fourth lumbar artery or the posterior intercostal artery.The proximal flap blood supply was offered by the superficial circumflex iliac artery,and the distal flap blood supply was provided by the anterior fourth lumbar artery or the posterior intercostal artery.The maximal size of the flap was measured as 35.0 cm×15.0 cm,and the minimal size was 25.0 cm×9.0 cm.The donor sites of the flap were directly sutured.All cases were implemented by postoperative followup visit in hospital for observation of appearance,texture,functions and donor site of flaps.Results Postoperatively,all flaps survived.The follow-up time endured for 6 to 24 months.The flap thickness was appropriate with normal shape and soft texture.Protective sensation and perspiration function of the flap were restored.Linear scars alone were observed in the donor sites of the flap.Conclusion Ilioinguinal conjoined perforator flap transplantation pedicled with the superficial circumflex iliac artery,the anterior fourth lumbar artery or the posterior intercostal artery can extend the excision scope of the flap and provides sufficient blood supply for the flap.The flap texture is soft and can be directly sutured.This technique is an ideal option for repairing of large soft tissue defects of the upper extremity.
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Objective To explore the efficacy of transplantation of a U-shaped ilioinguinal flap in the re pair of skin and soft tissue defects of the extremity.An axial flap based on the superficial iliac circumflex artery and trimmed to a subdermal vascular network flap was used for the procedures.Methods Seven patients with skin and soft tissue defects treated between June,2009 and May,2014 were studied.The patients were 22-45 years of age (mean,32 years),and included 5 males and 2 females.Four patients had punch-press injuries,1 patient had a hot-crush injury,and the remaining 2 patients were injured in the accidents.The wound sizes were 14.0 cm × 10.0 cm to 6.0 cm × 5.0 cm,with a varying extent of exposed tendons and bones.Repairs were performed using free ilioinguinal flaps,which were 15.0 cm × 11.0 cm to 7.0 cm × 5.0 cm in size.The axial flap was trimmed to a U-shaped subdermal vascular network flap and transplanted to the recipient site with anastomosis of blood vessels.Results All transplanted flaps survived.Four patients were followed for 1-6 months,with a mean duration of follow-up of 4 months.The trimmed flaps showed gradual reddening immediately after surgery,and the capillaries were recovered with a flat surface.Re-examination 3 months after surgery showed that the flaps were thin and flexible and met the aesthetic demand.No obvious pigmentation occurred,and the donor site was sutured directly,leaving only linear scars.Conclusion Repair of skin and soft tissue defects of the extremity using a U-shaped trimmed ilioinguinal flap has the advantages of a hidden donor site,small scar,and conformity to aesthetic requirements.The trimmed flaps are preferred over untrimmed flaps in terms of color and texture.The former flap is thinner,meets the aesthetic demand,and achieves a better efficacy.
