Thoracoumbilical flap combined with random abdominal flap in repair of large-area soft tissue defects of calf in children / 中华显微外科杂志

ABSTRACT

Objective:To investigate the clinical effect of thoracoumbilical flap combined with random abdominal flap in repair of large-area soft tissue defects of calf in children.Methods:The clinical data of 16 children with large-area soft tissue defects of calf treated with thoracoumbilical flap combined with abdominal random flap from January 2004 to December 2007 in PLA Trauma Orthopaedic Research Institute, 80th Group Military Hospital of the PLA were retrospectively analysed. There were 7 boys and 9 girls aged 8 to 14(11.3 in average) years old. Six cases were crushed by heavy objects, 6 crushed by wheels, 3 by thermal press and 1 by machine strangulation. After thorough debridement, the wound area ranged from 16.0 cm×9.0 cm to 38.0 cm×15.0 cm. Four cases were treated after 3-10 hours of injury by emergency surgery. Twelve cases received surgeries 0-11 days after hospital admission and wound being stabilised. Doppler ultrasound was used to locate the perforating vessels according to the location, size and shape of the wound. Thoracoumbilical flap combined with abdominal random flap were designed and harvested to repair the wound. The sizes of flaps were 18.0 cm×11.0 cm-40.0 cm×16.0 cm. All patients entered follow-up at the outpatient clinic or through WeChat interviews. The appearance, texture of the flap and limb recovery were checked and recorded.Results:After surgery, all of 16 flaps survived, of which 12 flaps had phase-one healing, 3 flaps had small area of necrosis at the edge, which healed after repeated dressing changes and 1 flap developed vascular comproise, and survived after surgical exploration. The donor sites healed in phase-one. All 16 children had 6 months to16 years of follow-up, with an average of 20.7 months. The colour of the flaps was normal with soft texture. The motor function of calf was satisfactory. According to Punor functional evaluation criteria, 12 cases were in excellent and 4 in good.Conclusion:The thoracoumbilical flap combined with abdominal random flap features a reasonable design, strong blood supply and repair of a large area. It is a reliable method for repairing large area soft tissue defects in the calf of children.