Abstract The narrow pedicled intercostal cutaneous perforater (np-ICP) thin flaps were successfully used for reconstruction of hand deformity from scar contraction. This flap was designed with a narrow pedicle (3～5cm in width) which included ICPs of 4th～9th intercostal spaces, and with awide distal part (the maximum is 15cm×15cm) which covered the lower chest and upper abdomen. The thickness of flap was cut until the subdermal vascular networkwas observed. The pedicle was divided between the 7th～14th days after operation. Sixteen flaps in 15 cases were transferred for covering of the skin defects at the dorsum of the hand. The perforators which were included in the narrow pediclewere mostly from the 7th intercostal spaces in 9 flaps. Fifteen of the 16 flapswere survived almost completely, except in one case there was necrosis of the distal portion of the flap. It seemed that this flap was more useful than the conventional methods, not only functionally but also aesthetically. Moreover, the operative techinque was more simple and safer than the island or free intercostalflap due to without the necessity to dissect the main trunk of the intercostalneurovascular bundle. Gentle pressure on the thinning portion of the flap for a short time after operation was important.
OBJECTIVE: To report repair and reconstruction of massively damaged wound under unusual condition. METHODS: One hundred and forty-seven patients with deep tissue defects were admitted from January 1993 to December 2000, among them, 96 cases suffered from electrical injury, 18 cases with hot press injury, 18 cases with deep burns as a result of CO poisoning or epileptic seizure, 6 cases caused by chemical producing necrosis and wound infection, 3 cases with radiation injuries, 2 cases with chemical burn, 2 cases with explosive injury, 2 cases with frostbite. One hundred and seventy five wounds in 147 patients were repaired by transfer of local flap, forearm conversal island skin flap, pectoralis major myocutaneous flap, delto-pectoral skin flap, latissimus dorsi skin flap, gastroecnemius myocutaneous flap, anterior and posterior tibial artery island skin flap, and so on. The wound defect ranged from 1 cm x 1 cm to 20 cm x 28 cm, and the flaps were 1.5 cm x 2.0 cm to 22 cm x 30 cm. The necrotic tendon was replaced with acellular allogenic tendon simultaneously in 7 cases. RESULTS: One hundred and sixty-nine flaps were survival with first intention, while necrosis of the tip of flap occurred in 6 cases. The transplantation of acellular allogenic tendon in all cases were survival. The function and configuration in 28 cases were satisfactory after 4 months to 8 years follow-up. CONCLUSION: Various types of flaps are choosen according to the position, defect range and degree of wound, which is an ideal method to restore the function and to improve patients’ living condition.
Superficial cervical artery skin flap is widely used in clinical practice. In order to inprove the outcome of the flap in clinic, eleven cases of skin defect of scalp who were treated with the flap was discussed. After operation, the donor area healed but there was no hair growth on recipient area. Among them, six cases occurred partial necrosis of skin flaps. In order to avoid these problen, the relevant solution discussed as follows: 1. Handle well the pedicle of the skin flap to prevent the interference with venous returm. 2. Adhere strictly to indications. 3. Apply skin expander to obtain "extra" skin, then carryout the tranfer of skin flap and 4. Better use the skin flap with residual hair.
OBJECTIVE: To evaluate the application of skin and soft tissue expansion in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound. METHODS: From 1988, 83 cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe burn of large area and with whole nasal defect, soft tissue expander was used under the forehead skin graft and venter frontalis, followed by reconstruction of nose with the expanded vascularized skin flap and carved cartilago costalis as nasal frame. In patients of severe deep electrical burned scalp and skull with fresh wound, skin and soft tissue expansion were used to repair the wound simultaneously with scalp burn alopecia, anesthetics and antibiotics injected into the extracapsular space of the expander in case of pain and infection. RESULTS: All of the cases were successfully treated with little pain and minimized infection. CONCLUSION: Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.
In order to study the effect of vascular endothelial cell growth factor (VEGF) on the survival of skin flap 30 SD rats were used. A randomized flap measuring 7.5 cm x 3.0 cm was created on the back of each SD rat. The treatment group (n = 10) received VEGF 40 ng/flap by subcutaneous injection with microinjector during and 24 hours after operation. The control groups received heparin 16 U/flap (n = 10) or normal saline 800 microliters/flap (n = 10). After operation, on the 3rd and 11th day, the survival rate of the skin flaps and the dermovascular density of each flap were investigated by histological and histo-morphometrical examination. The results showed that there was no significant difference in the survival rate between the treatment group and the controls on the 3rd day after operation, while on the 11th day, there was a significant difference between them, and the survival rate was much higher in the treatment group. Besides, dermovascular density was much more increased in the treatment group than that in the controls, especially in the distal 1/3 of the flap (P lt; 0.02). The conclusion was that VEGF could .
The applied anatomy and clinical application were described in this paper. The blood supply of this flap was based on the second dorsal metacarpal artery. It gave some advantages of as easy of application, safe and reliable. Since November 1990, we had successfully used six such flaps in covering the soft tissue defects of the hand.
Objective To observe the protective role of the ectogenesis zinc on the cells in rat flap with ischemia reperfusion injury and study the mechanisms. Methods A right low abdominal island flap was created in Wistar rats. Fortyeight rats were randomly divded into 3 groups (n=16):the control group, the ischemia reperfusion group and adding zinc ischemia reperfusion group.The content of malondialdehyde(MDA) and the activity of myeloperoxidase(MPO) were measured by thiobarbituric acid methods and colorimetry. The location of expression of MT was observed,and the image analysis was performed. The quantity of MT was represented by the integratial optical density. The ultrastructure changes of skin flap with ischemia reperfusion injury and the flap viability were observed. Results In the ischemia reperfusion injury flaps, the content of MDA and MPO show no statistically significant difference among the control group,IR group and the adding-zinc-IR group (P＞0.05). Compared with the control group at 1 h and 24 h of reperfusion, the level of MDA increased 62.2% and 136.4%(P＜0.01) in the IR group, which increased 11.3% and 33.2%(P＜0.01) in the adding-zinc-IR group. The activity of MPO increased 238.4% and 503.4%(P＜0.01)in the IR group when compared with the control group, and increased 17.9%and 24.1%(P＜0.05) when compared with the adding-zinc-IR group. In the ischemia reperfusion injury falps, the content of MT in the control group and the IR group is too minimal to measure. While the content ofMT in the adding-zinc-IR group is 45.30±7.60. At 1 h and 24 h of reperfusiion, the content of MT in the adding-zinc-IR group increased 41.5% and 44.9% (P＜0.01) compared with the IR group, and increased 119.9% and 234.6% (P＜0.01) compared with the control group. The flap viability is 100% in the control group, 19.65%±4.38% in the IR group, and 24.99%±5.12% in the adding-zinc-IR group, which increased 27.2% (P＜0.05) compared with IR group. Conclusion Many kinds of cells in skin flap with ischemiareperfusion injury can be protected by ectogenesis zinc and the flap viability increases significantly.
Objective To present a method for quantifying the anastomosis between two vessels based on angiograpy and provide a theoretical basis for vascular study in skin flap. Methods Ten bilateral skin flaps of 20 cm×20 cmbased on deep iliac circumflex vessels were elevated fromthe abdominal wall including musculus rectus abdominis and deep superior epigastric vessels in 5 minipigs which were 100-115 cm in length and 25-35 kg in weight. One side was inserted an expander under the panniculus carnosus and was expanded regularly with 30-40 ml isotonic Na chloride injection (expanded group) and the other was unexpanded group which were without any treatment. A X-ray image of the flap vessles was obtained after a gelatinlead oxide mixture was carotid arterially injected and 24 hours of cryopreservation of the body. Three parallel lines with equal interval perpendicular to long axis of the two vessels were designed at the communication area. Vessel anastomosis quantifying was determined by counting the number of marks derived from the intersections of the lines and the vessels and statistical analysis was carried out. Results The mark of intersectionin expanded group (81.20±10.33) was more than that in unexpanded group (22.40±5.41), showing significant difference(Plt;0.01). Conclusion The method for quantifying vessel anastomosis in skin flap is simple, reliable, and easytoperform. The principles of this procedure may also be applied to other experimental and clinical studies.
The comparative study of local application of magnetic piece dressings of different intensities (Gs) on the effect of survival of 48 skin flaps (2×5cm in size) and the healing of the incisional wornds was reported. Twelve Japanese long ear white rabbits were used for this study. It was noted that the magnetic field intensity of 200or 400 Gs showed remarkable increase of the area of survival of the skin flaps and enhancement of the healing of the incisional wounds.
Four cases of defects of soft palate followingcomplete resection of soft palate because ofmalignant tumors had been successfullyreconstructed in which 3 patients wereperformed reconstructed with forehead flap andone patient with free forearm flap . All the flapewere survived. The appearance of the soft palateand function of swallowing were recoveredsatisfactorily from reconstruction. The operativetechnique of the reeonstruction of soft palate wasintroduced,and the points of attention ...