A new method of transfer of the nasolabial skin flap, the myocutaneous flap with pediculated guadratus labii superioris muscle was introduced. It was applied in 9 cases mid-face defects with satisfactory results. The applied anatomy and the its operative technique were briefly discussed.
OBJECTIVE To investigate the repairing method of soft tissue defect of heel, pedicled island myocutaneous flap of flexor digitorum brevis was designed. METHODS From 1984 to 1997, 26 cases with soft tissue defect of heel were adopted in the clinical trial. Among them, the were 18 males, 8 females and the age ranged from 15 to 60 years old. The area of wound ranged from 2.5 cm x 1.5 cm to 8.0 cm x 6.0 cm. RESULTS After operation, all of the flaps survived. They were followed up for 9 to 72 months. All of the flaps had primary healing except in one there was infection of peripheral of the flap. The contour of heel was satisfactory the sensation of flap was good and the weight-bearing function was also successful. CONCLUSION It was concluded that the myocutaneous flap of flexor digitorum brevis could be used to repair the soft tissue defect of heel because of its nearby position, hidden location, good recovery of skin sensation and weight-bearing function, Besides, the procedure of this operation was simple and the anti-inflammatory potential of the flap was high. However, Because of the limited donor area, the pre-operative design was important.
Semitendinosus muscle composite flap was used to repair the neighbouring tissue defects. This is a admissible operation method. Accordingly, this article introduced our studies on semitendinosus muscle: 1. The length of the muscle renter was evaluated by regression equation. 2. Morphological characteristics the muscle, the source and distribution of the vessels were observed. The length of the pedicle of the vessel and external caliber were measured. 3. According to the clinic requrement, the muscle was divided at certain position and was turned upwards or downwards with the vascular pedicle to carry out the repair the defects of the gluteal, sacral, perineal or leg region, and so forth. This study provided the morphoiogical data of semitendinosus muscle composite flap for surgical application.
Oral carcinoma；Platysma myocutaneous flap；Defect repair
OBJECTIVE: To investigate the location of transverse rectus abdominis musculocutaneous (TRAM) flap perforators on abdomen skin and the peak systolic flow velocities of the perforators. METHODS: A series of 94 consecutive patient’s TRAM flap perforators were detected by color-flow duplex Doppler scanning peroperatively. Perforator locations were tabulated on the abdomen skin according to their vertical position relative to the umbilicus and their lateral location relative to the abdominal midline. RESULTS: The perforators on both left and right side of TRAM flap were quite not symmetry. The peri-umbilical region contained 81.1% of the perforators. All perforators were detected with peak systolic flow velocities ranging from 5 to 81 cm/s. CONCLUSION: The preoperative color-flow Doppler localization of TRAM flap perforators improves the surgeon’s ability to design the flap in order to capture the dominant vessels, and select single- or double-pedicle and free TRAM flaps based on each patient’s individual characteristics.
Objective To explore the effect of facial artery musculo-mucosal (FAMM) flap to reconstruct tongue and floor of mouth defects. Methods Between January 2011 and January 2016, 24 cases of tongue and floor of mouth defects were repaired with FAMM flap after tumor resection. There were 16 males and 8 females, aged from 38 to 70 years with an average of 55 years. The disease duration was from 1 week to 6 months with an average of 4 months. The defect located at the floor of mouth in 4 cases, at the tongue in 15 cases, and both tongue and floor of mouth in 5 cases. There were 2 cases of carcinoma at the floor of mouth, 2 cases of adenoid cystic carcinoma at the floor of mouth, 14 cases of carcinoma at the tongue, 1 case of adenoid cystic carcinoma at the tongue, and 5 cases of carcinoma at the tongue and floor of mouth. The size of defect ranged from 4 cm×3 cm to 8 cm×7 cm. Three ipsilateral and 21 contralateral FAMM flaps were harvested (5 cases were repaired with FAMM flap and submental muscle island flap due to the large defect area). The size of FAMM flap ranged from 5 cm×4 cm to 5 cm×5 cm, the size of submental muscle island flap ranged from 4 cm×3 cm to 5 cm×4 cm. Results All flaps survived after operation, without local necrosis. Wound dehiscence at donor site occurred in 5 cases, and healed after cleaning; primary healing was obtained in the other 19 cases. All the patients were followed up 8 months to 5 years with an average of 2 years and 4 months. No obvious facial deformity or fistula of the floor of mouth occurred after operation. Injury of the submandibular branch of the facial nerve was observed in 16 patients, who returned to normal at 3 months. All 24 patients had limitation of mouth opening after operation, which disappeared after 12 months. The functions of speech, chewing, and swallowing were normal. Conclusion FAMM flap has many advantages of simple operation, good repair, high flap survival rate, and less injury at donor site for repairing tongue and floor of mouth defects.
In order to observe the morphological feature and blood supply of the pedicled trapezius myocutaneous flap, dissection was carried out on 114 sides of 54 cadavers. It was demostrated that trapezius muscle had multiple sources for its blood supply, including (1) dorsal scapular artery; (2)transvers cervical artery; (3) occipital artery and (4)spinal perforating artery. The dorsal scapular artery may originate from the same stem with the transvers cervical artery (68.4%), or originate seperatly (31.6%). Thirteen patients had radical resection for malignant tumour of head and neck, and were combined with pedicled trapezius myocutaneous flap, in which 6 with upper trapezius myocutaneous flap and 7 with lower trapezius myocutaneous flap. The results were fairly good. the advantages and disadvantages of the lower and upper trapezius myocutaneous flaps as well as the pectorlis major myocutaneous flap were discussed.
Rectus femoris muscle of the lower abdomen was used as myocutaneous flap in the reconstruction of the breast in 4 patients, of which, in 2 cases the reconstruction was carried out immediately following the radical mastectomy for breast cancer by using trancfer of the pedicled myocutaneous flap, and in the other two cases, the vascularized free myocutaneous flap was used 2 months and 5 years after the radical mastectomy, respectively. The vascularized free myocutaneous flaps were survived, however, in the pedicled myocutaneous flap group, the fat of the flaps had liquefaction 23 weeks after operation. The latter were healed after repeated dressings. The external appearance of the 4 reconstructed breasts lookedsattisfactory. The patients wete follwed up for 10 to 18 months, 2 patients hadno ill effects, while the 2 pedicled myocutaneous flaps, in which 1 patient hadbulging of the weakened abdominal wall, and the other had lost from follow up.
Objective To investigate the clinical significance of the distally-based sural musculocutaneous flap for the treatment of chronic calcaneal osteomyelitis. Methods From January 2002 to October 2005, 7 patients (4 males, 3 females; age range, 15-68 years ) were treated with the distallybased sural musculocutaneous flap, who had chronic calcanealosteomyelitis after calcaneal fracture. After the radical debridement for all the nonviable and poorly vascularized tissues, all the chronic calcaneal osteomyelitis patients, who had suffered from open calcaneal fracture or closed calcaneal fracture, were treated with the open reduction, the internal fixation, and thebone graft. The ulcer lasted for 3-12 months before diagnosis of osteomyelitis. The musculocutaneous flaps ranged in size from 8 cm×4 cm to 12 cm×7 cmand the muscle flaps ranged from 4 cm×3 cm to 6 cm×5 cm. The donor defects were closed primarily in 5 patients and were resurfaced with the splitthicknessskin graft in 2 patients. Results All the musculocutaneous flaps survived completely and all the wounds healed smoothly. All the patients followed up for 2-6 months had no recurrence of osteomyelitis or return to their preoperative ambulatory status.Conclusion It is feasible to use the distallybased sural musculocutaneous flap for treatment of chronic calcaneal osteomyelitis.
Objective To investigate the application of free flaps in combinedtransplantation and its clinical outcome. Methods From January 1991 to December 2003, 56 cases of combined transplantation involving cutaneous or myocutaneous flaps were performed to repair extremely large soft tissue defects, large-sized skin and segmental bone defects and to simultaneously reconstruct the missing thumb andrepair the associated skin defects in the first web space.Of the 56 patients, 37 were males, 19 were females. Their ages ranged from 5 to 41, 27.6 in average.The transplants included latissimus dorsi myocutaneous flap, scapular flap, lateral femoral flap, big toe skin-nail flap, and fibula. To establish blood circulation in the transplants, the common vascular pedicle was anastomosed directly to the vessels in the recipient site in 35 cases but to the selected vessels in the healthy limb in 21through a cross-bridge procedure. Results With failure in 2 cases of combined transplantation of latissimus dorsi myocutaneous flap and vascularized fibula, all the transplants survived well. In the 32 cases of long bone defects with successful repair, the transplanted fibulas united with host bones 14.5 weeks after operation on the average. A mean follow-up of 28 (10-128) months revealed thatfunction in all cases was recovered, while one patient, who underwent a successful combined transplantation of latissimus dorsi myocutaneous flap and vascularized fibula, required amputation of the involved leg 3 years after repair because of the repeated ulcers in the toes. Conclusion The application of free flaps incombined transplantation can lead to an effective repair of complicated tissue defects of the limb and to a successful reconstruction of the associated missing thumb.