OBJECTIVE To introduce the method using the gracilis myocutaneous flaps to repair of vulvar defect after radical vulvectomy. METHODS The gracilis myocutaneous flaps were applied in 4 cases with vulvar carcinoma which located vestibule of vulva and bulk, and the carcinoma was large after radical resection to repair vulvar defect simultaneously. RESULTS The incision of 3 cases was healing by first intention, and 1 case with type II diabetes mellitus was healing by second intention. After followed up 3-6 years, 1 case was recurrent in 2 years after operation, 3 cases were survival without complication. CONCLUSION Vulvar reconstruction with the use of gracilis myocutaneous flaps in radical vulvectomy could markedly decrease the rate of complication.
Objective To discuss and evalue the effects and the advantages of pectoral is major myocutaneous flap in repair of defect caused by resection of tonsillar cancer. Methods The data were retrospectively summarized from 10 patients with recurrent tonsillar cancer after radical radiotherapy from January 1998 to December 2005, including 7 cases of squamouscell carcinoma, 2 cases of undifferentiated carcinoma, and 1 case of adenoid cystic carcinoma. There were 8 males and 2 females, aged 43-68 years with an average of 58 years. All cases were classified as stages III and IV before radiotherapy according to staging standard of oropharyngeal cancer (International Union Against Cancer, 1997). The time of relapse was 6-32 months after radiotherapy. Recurrent tonsil cancer invased tongue base, soft palate, posterior wall of pharyngeal, parapharyngeal space, and palate. Tumor size was from 4 cm × 2 cm to 8 cm × 5 cm. Seven cases were accompanied by lymph node metastasis. After carcinoma were completely resected and defects were reconstructed by pectoral is major myocutaneous flap of 7 cm × 5 cm- 12 cm × 9 cm. The donor sites were sutured directly. Results After operation, pectoral is major myocutaneous flap completely survived in 9 cases. Partial necrosis of pectoral is major myocutaneous flap was found in 1 case; after treatment, the necrotic flap remained small pharyngeal defect. Incision at donor site healed by first intention in 10 cases. All patients showed satisfactory functions of respiratory, voice, and swallowing with no compl ication. Ten patients were followed up 2 years to 5 years and 8 months. The 3-year survival rate was 66.7% (6/9), and the 5-year survival rate was 20.0% (1/5). Conclusion Pectoral is major muscle flap has a high survival rate, which is safe, rel iable, easy-to-operate, and can repair larger defect. Pectoral is major myocutaneous flap is an ideal material in repair of defect caused by resection of recurrent tonsillar carcinoma after radiotherapy.
Objective To explore the results of repairing widespread traumatic soft tissue defects in the heels and adjacent regions with free latissimus dorsi muscle-skin flaps. Methods From March 1998 to May 2005, 10 cases of widespread traumatic soft tissue defects in the heels and adjacent regions were repaired with free latissimus dorsi muscleskin flaps. Of the 10 patients, 9 were male and 1 was female, whose ages ranged from 32 to 60years, and the disease course was 2 hours to 2 months. The defect was by ploughmachine injury in 5 cases, by crush injury in 2 cases, by snake injury in 2 cases, and electricity injury in 1 case. Eight cases of defects involved in the posteriorof heel and leg, the defect area ranged from 21 cm×12 cm to 35 cm×15 cm; 2 cases had widespread soft tissue defects on heel, ankle, sole and dorsal foot, and the defect area was 27 cm×14 cm and 30 cm×21 cm respectively. All cases were accompanied by the exposure of bone; 6 cases by fracture; 4 cases by openinfection of ankle joint; and 2 cases by injuries of the posterior tibial vessel and the tibial nerve. The sizes of the dissected flap ranged from 25 cm×14 cm to 33 cm×24 cm. The donor sites were covered by large mid-thickness flap. Results There were no postoperative complication of vascular crisis and infection. Ten flaps survived completely and the wounds healed by first intention. After a follow-up of 3 to 24 months, five cases received twostageplastic operation because bulky flaps bring some trouble in wearing shoes. In 5cases of reconstructed sensation, two cases recovered pain and temperature sensation. All cases recovered the abilities to stand and walk without ulcer complication. Conclusion The free latissimus dorsi muscle-skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds with muscle defects and bone exposure in the heel and adjacent regions, because it has such advantages as adequate blood supply, big dermatomic area, and excellent ability to resist infection.
OBJECTIVE: To explore a method to repair severe radiation-induced ulcer and evaluate its clinical effects. METHODS: From August 1988 to December 1998, 12 cases of severe radiation-induced ulcer were treated by muscular or musculocutaneous flap transfer, which included 1 case of pectoralis major muscular flap, 3 cases of three-lobed transverse rectus abdominis musculocutaneous flap, 2 cases of latissimus dorsi musculocutaneous flap, 1 case of tensor fascia lata musculocutaneous flap, 1 case of longitudinal rectus abdominis musculocutaneous and tensor fascia lata musculocutaneous flap, 1 case of gastrocnemius muscular flap, 1 case of gluteus major musculocutaneous flap, huge filleted musculocutaneous flap from lower limbs in 1 case and from upper limbs in 1 cases. RESULTS: All the flaps survived. Primary healing occurred in 9 cases and secondary healing in 3 cases. The extensive multiple ulcers in 2 cases were repaired with filleted limb musculocutaneous flap, and patients were saved. And in other 3 cases, the chest wall defect as the result of radionecrosis were repaired with simultaneous breast reconstruction. CONCLUSION: Muscular or musculocutaneous flaps have abundant blood supply, they are ideal tissue to fill the cavity and repair the defect, especially in repairing severe radiation-induced ulcers.
Objective To explore the clinical effect of latissimus dorsi musculocutaneous flap with a few muscle in repairing the soft tissue defect of lower limbs. Methods From June 2000 to December 2006, 8 patients with soft tissue defects of lower limbs were repaired with the latissimus dorsi musculocutaneous flaps. There were 6 males and 2 females, aged from 2569 years. The locations were heel in 3 cases, dorsum pedis in 2 cases, anticnemion in 2 cases, and the right leg (squamous carcinoma) in 1 case. The area of soft defect ranged from 10 cm×7 cm～18 cm×12 cm. The flap in size ranged from 15 cm×8 cm to 22 cm×15 cm. Results Of all the flaps,6 survived,1 had vascular necrosis 2 hours after operation and survived by skin grafts, 1 had delayed healing because of infection. The wound and donor site achieved primary healing. The followup for 3 to 12 months revealed that all the flaps had a good appearance. The function of donor site was as normal. Conclusion It is an ideal method to repair the softtissue defect of lower limbs with latissimus dorsi musculocutaneous flap.
Objective To reconstruct the maxillary defect by usingfree vascularized iliac osteomusculocutaneous flap combined with immediate zygomatic implantation for early rehabilitation of maxillary contour and masticatory function. Methods In August 2003, the patient presented with deformity ofleft middle face(Brown Ⅱ type defect) after subtotal maxillectomy. After hospitalization, a set of preoperative preparations were made, including spiral CT scanning, manufacture of nature size anatomical model and implantation protocol design. The maxillary defect was reconstructed with free vascularized iliac osteomusculocutaneous flap combined with simultaneous insertion of one Br¨nemark zygomatic implant and two general implants. Six months later the prosthesis were placed. Results The vascularized osteomusculocutaneous flap survived, the osseointegration was observed between bone and implant 6 months later. The contour of face and palate was satisfactory, the normal occluding relation was gained. The average masticatory force of operative side was 76.3% of the normal side. No tumor recurrence was noticed during the follow-up of 14 months. Conclusion It is a reliable method for functional reconstruction of maxillary defect via vascularized iliac osteomusculocutaneous flap combined with immediate zygomatic implantation.
Objective To observe an early result after the repair of the large upper thoracic wall defect by a combined use of the titaniumnet, reconstruction nickelclad, and latissimus dorsi myocutaneous flap in a patient who underwent a breast sarcomatoid caricinoma resection on the upper thoracic wall. Methods A breast sarcomatoid carcinoma in the upper thoracic wall was removed in 1 56yearold female patient in February 2006. After the tumorectomy, a large thoracic wall defect was left, which was 20cm×15cm in size. The defect was covered by the titanium net, the bilateral stumps of the clavicles were connected by the reconstruction nickelclad, and the soft tissue defect was repaired with the right latissimus dorsi myocutaneous flap(20cm×15cm). Results The patient depended on the breathing machine for 3 days after operation. When the breathing machine was discontinued, the patient developed a severe paradoxical breathing. Two weeks after operation when theblood circulation of the flap was stabilized, the paradoxical breathing disappeared with the help of the chest bandage for fixation of the chest cavity, and the blood supply of the flap was improved. The chest X-ray film showed that the titanium net and the reconstruction nickelclad were well positioned. The patient received chemotherapy 1 month after operation, The follow-up for 3 months revealed that the patient’s local condition and physical condition were good, and ROMof both the shoulders was improved, with AF 90° and ABD 90°. No recurrence ofthe tumor was found. Conclusion A large thoracic wall defect should be repaired with solid materials. The normal anatomic locations of the clavicles should be maintained with fixation by the reconstruction nickelclad for a good function of the shoulders. The latissimus dorsi myocutaneous flap can be properly enlarged.
Objective?To investigate the effects of botulinum toxin type A (BTXA) on the excessive expansion speed and blood supply of myocutaneous flap.?Methods?Seven adult Guizhou minipigs of clean grade were included, female or male and weighing 16-20 kg. The 2.4 mL BTXA solution (96 U) was injected in cutaneous muscle (24 points) of one side as experimental group (n=7), the 2.4 mL saline in the other side as control group (n=7). Two expanders (200mL) were implanted beneath the cutaneous muscle on the bilateral flank of each pig symmertrically at 3 days after injection. One week later, the expanders were filled with saline every 4 days with an intracapsular pressure of 11.97 kPa, and accumulative total amounted to 400 mL for 3 weeks in control group and 5 weeks in experimental group. Then the expanders were taken out; the myocutaneous flaps formed and were sutured in situ. The myocutaneous flaps were cut for histological examination and capillary count. The expansion speed of the myocutaneous flap were recorded. The blood supply of the myocutaneous flap were observed by infrared thermography at 1 week after implantation expanders, before removing the expanders, and at 5 days after myocutaneous flap suture in situ.?Results?All the animals survived to the end of the experiment. The total expansion time was (54.0 ± 3.1) days in experimental group and (67.0 ± 3.9) days in control group, showing significant difference (t= —8.107, P=0.000). All myocutaneous flaps survived after being sutured in situ. Infrared thermograhy revealed that the temperature of the distal myocutaneous flap in experimental group was significantly higher than that in control group at 1 week after implantation of expanders (P lt; 0.05); at 5 days after myocutaneous flap suture in situ, the temperature of the central flap in experimental group was significantly higher than that in control group (P lt; 0.05); and there was no significant difference between 2 groups at the other time points (P gt; 0.05). The histological observation showed that the blood vessel density of the dermal layer and tissue between the capsule and the muscle layer in experimental group was significantly higher than those in control group (P lt; 0.05).?Conclusion?When excessive expansion is performed, BTXA can accelerate the expansion rate and improve the blood supply of expanded myocutaneous flaps.