Objective To study the repair and function reconstruction of complex soft tissue defect of posterior of hand and forearm. Methods From May 2001 to November 2003, 8 cases of soft tissue defect of posterior of hand and forearm were repaired with thoracico abdominal flaps with hilum for primary stage. The tendon transplantation and allogeneic tendon function reconstruction of hand were performed for secondary stage. The range of the flap was 9 cm×15 cm to 12cm×38 cm. Allogeneic tendon amounted to 6.Results All the flaps survived. The flap countour was good. The results of allogeneic tendon transplantation were satisfactory and the function of hand was good. Conclusion Repairing complex soft tissue defect of posterior of hand and forearm and reconstructing hand function by use of thoracico abdominal flaps with hilum and transplantation of allogeneic tendon have the satisfactory clinical results.
OBJECTIVE: Soft tissue defect of heel is not uncommon. Transplantation of free cutaneous flap and transfer of axial cutaneous flap have been used in treating such defect successfully, but both of them are somewhat complicated. Local plantar rotatory flap might show great importance in this field. METHODS: Since March 1993 to March 1998, 9 cases with soft tissue defect of heel were repaired by local plantar rotation flaps. The size of defect ranged from 2 cm x 4 cm to 6 cm x 8 cm, and it was designed superficial to plantar fascia. The flap was medially based, and nutrilized by proximal plantar subcutaneous plexus of blood supply as well as lateral and medial plantar nerve. RESULTS: Followed up 4 months to 2 years, all the flaps were survived. Sensation of the flap was preserved in 7 patients, who had normal sensation of the donated area preoperatively. The transferred flap was endurable to body bearing. CONCLUSIONS: The flap is easily prepared with reliable blood supply and sensation of the flap preserved. The method is worthy to be recommended for widely use because of its advantages over other methods.
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 explore a safe, highlyefficient and rapid approach to the repair of the sacrum soft tissue defect and/or partial exposure of the bone.Methods From February 2003 to April 2006, 6 patients (4 males, 2 femals; aged 28-67 years) with the sacrum soft tissue defect were surgically treated by the multiisland flap with shallow branches of the gluteus upper artery. The soft tissue defects ranged in area from 15 cm×12 cm to 25 cm×20 cm,averaged 20 cm×16 cm.The obtained flaps ranged in area from 18 cm×15 cm to 30 cm×25 cm. Of the patients, 5 had a sacral ulcer (Grade Ⅲ in 3 patients, Grade Ⅳ in 2) and 1 had a tumor, with their illness course from 3weeks to 20 years. Results All the flaps survived completely in the 6 patients, in whom 5 had an incision healing of the first intention, and the remaining 1had a healing of the second intention 32 days after the treatment for the minorischemia and necrosis at the edges of the flap.The follow-up for 2-38 months (average, 19.3 months) revealed that all the flaps grew well with no recurrence of the sacralulcer. Conclusion The surgical treatment with the multi-island flap with shallow branches of the gluteus upper artery is a safe, highly-efficient and rapid approach to repair of the sacrum soft tissue defect and/or partial exposure of the bone. This kind of treatment has advantages of simpler procedures, better blood circulation of the flap, fewer complications, and higher success rates.
Objective To discuss different applications ofanterolateral thigh flap in repairing large skinsoft tissue defects. Methods From January 1997 to July 2004, 27 pitients with large-complex tissue defects were treated using anterolateral thigh flap. The tissue defect was located at face in 9 cases,at cervix in 4 cases, at lower limbs in 6 cases, at vulvae in 4 cases,at hip in 1 case, at groin in 1 case and at breast tissue in 2 cases. The defect area was from 9 cm×8 cm to 20 cm×15 cm and the flap was harvested from 10 cm×8 cm to 33 cm×15 cm. Results Flaps survived in 26 cases after operation, and patients were satisfied with local function and appearance; flap necrosis occurred only in1 case，and the defect was covered with free skin graft after dress exchanges. Twenty-three cases were followed up from 3 months to 2 years. The appearance and the sense of recipient site were similar to the adjacent tissue. No obvious malformation of the donor site was observed. No local recurrence was found in the 6 cases of malignancy during the follow-up from 6 months to 15 months. Conclusion Anterolateral thigh skin flap can provide enough tissue to repair large skinsoft tissue defect,and can be used in different ways. So anterolateral femoral skin flap is an ideal flap in repairing large skinsoft tissue defect.
Objective To investigate the cl inical results of treating leg open fracture with soft tissue defect by pedicle flap transfer in combination with external fixator. Methods From May 2004 to June 2007, 12 cases of leg open fracture with soft tissue defect, 9 males and 3 females aged 18-75 years, were treated. Among them, 8 cases were caused by traffic accidents, 2 crush, 1 fall ing and 1 mechanical accident. According to the Gustilo Classification, there were 2 cases of type II, 5 of type IIIA and 5 of type IIIB. There were 2 cases of upper-tibia fracture, 3 of middle-tibia and 7 of middle-lower. The sizes of soft tissue defect ranged from 5 cm × 3 cm to 22 cm × 10 cm.The sizes of exposed bone ranged from 3 cm × 2 cm to 6 cm × 3 cm. The course of the disease was 1-12 hours. Fracture fixation was reached by external fixators or external fixators and l imited internal fixation with Kirschner wire. The wounds with exposed tendons and bones were repaired by ipsilateral local rotation flap, sural neurocutaneous flap and saphenous nerve flap. The size of selected flap ranged from 5 cm × 4 cm to 18 cm × 12 cm. Granulation wounds were repaired by skin grafting or direct suture. Results All patients were followed up for 6 months to 2 years. All patients survived, among whom 2 with the wound edge infection and 1 with the distal necrosis were cured by changing the dressing, 8 with pin hole infection were treated by taking out the external fixator, 1 with nonunion received facture heal ing after bone graft in comminuted fracture of lower tibia, 2 suffered delayed union in middle-lower tibia fracture. The ROM of ankle in 3 cases was mildly poor with surpass-joint fixation, with plantar extension of 0-10° and plantar flexion of 10-30°, while the others had plantar extension of 10-20° and plantar flexion of 30-50°. Conclusion The method of pedicle flap transfer combined with external fixator is safe and effective for the leg open fracture with soft tissue defect.
Objective To probe the principle and the method to repair facial soft tissue defect with the prefabricated expander flap the neck with the vessles of temporalis superficialis. Methods The expandor was implanted into the surface layer of the platysma in neck. The pedicle of the expander flap contained the arteria temporalis superficialis and its ramux parietalis. After 3 months, the prefabricated island expander flaps pedicled with the arteria temporalis superficialis and its ramux parietalis could be transferred to the face. From 1998 to 2003, 6 cases of facial soft tissue defects were repaired. The maximal flap size was 12 cm×8 cm.Thepedicel length was 7.8 cm.Results After a follow-up of 3-6 months, all expander flaps survived. The excellent function and cosmetic result were achieved. Conclusion The prefabricated expander flaps of the neck pedicled with the arteria temporalis superficialis and its ramux parietalis can be transferred to the upperface to repair tissues defect. The supply of blood of the prefabricated expander flaps were safe and reliable. The survived areas of the flaps are directly proportional to the areas of temporalis superficialis fascia combining the expander flaps.
ObjectiveTo compare the effectiveness using bone transport and bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects. MethodsBetween January 2004 and May 2012,31 patients with tibial bone and soft tissue defects were managed by Ilizarov technique,the clinical data were retrospectively analyzed.Bone transport was used in 18 cases (group A),and bone shortening-lengthening in 13 cases (group B).There was no significant difference in age,gender,type of fracture,defect location,size of bone and soft defects,and time from injury to operation between 2 groups (P>0.05).Postoperative complications were observed;Paley's criterion was used to assess the bone healing and function recovery of the limb. ResultsAll the flaps survived and healing of wounds by second intention was obtained in all cases of group A;healing of wounds by first intention was obtained in 1 case,delayed healing in 3 cases,and healing by second intention in 9 cases in group B.All patients were followed up 1.5-4.5 years (mean,2.4 years).Pin loosening or pin tract infection occurred in 15 cases of group A and in 10 cases of group B,and limb length discrepancy in 1 case of group B;there was no significant difference in the rate of complication (χ2=0.003,P=0.955).In the distracted zone,all fractures healed naturally with excellent scale.The healing time was (251±39) days in group A,and was (239±45) days in group B,showing no significant difference (t=0.800,P=0.430);the healing index was (4.26±0.19) d/mm in group A,and was (4.13±0.19) d/mm in group B,showing no significant difference (t=1.775,P=0.086).In the bone defect zone,natural healing was obtained in 12 cases and healing after second operation or bone grafting in 6 cases,with healing time of (341±55) days (excellent in 17 cases and good in 1 case) in group A;natural healing was obtained in 11 cases and healing after second operation or bone grafting in 2 cases,with the healing time of (295±62) days (excellent in 12 cases and good in 1 case) in group B;and there was significant difference in the healing time (t=2.195,P=0.036),but no significant difference in the healing scale (Z=-1.693,P=0.091).At last follow-up,the function recovery was excellent in 7 cases,good in 6 cases,and fair in 5 cases in group A,and was excellent in 3 cases,good in 6 cases,and fair in 4 cases in group B,showing no significant difference (Z=-0.660,P=0.509). ConclusionUsing bone transport or bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects,the overall outcomes are similar,but the healing of bone defect zone is faster when using bone shortening-lengthening.
Objective To study the method and effect of free rectusabdominis muscle flaps with intermediate split thickness skin graft in repairing defects on legs and ankles.Methods From May 1998 to December 2002, 11 cases of defects on legs(2 cases) and on ankles( 9 cases) were repaired by use of unilateral free rectus abdominis flap with skin graft. The soft tissue defects were accompanied by osteomyelitis or the exposure of bone or tendon.The disease course was 1 month to 10 years. The defect size ranged 3 cm×4 cm to 8 cm×14 cm. The area ofrectus abdominis muscle flaps was 4 cm×6 cm to 8 cm×15 cm. Results All patients were followed up 6 months to 4 years after operation. All rectusabdominis flaps survived with good appearances and functions.The primary healing was achieved in 8 cases, intermediate split thickness skin graft necrosed in 3 cases and the wound healed after skin re-graft.Conclusion Free rectus abdominis flap is a proper option for repair of the soft tissue defects or irregular woundson legs and ankles. It has the advantages of abundant blood supply, b anti-infection ability, good compliance and satisfied appearance.
To summarize the results of the free transplantation of anti-valve-inflow and pro-valveoutflow arterial ized venous flap in repairing soft tissue defect of fingers in emergency treatment. Methods From October 2002 to March 2007, 7 cases of soft tissue defects of fingers were repaired with arterial ized venous flaps. There were 6 males and 1 female, aged 17-46 years. Defect was caused by crush injury in 6 cases and by stab injury in 1 case. The interval between injuryand operation was 2-7 hours and the size of defects ranged from 3.0 cm × 2.0 cm to 6.0 cm × 3.5 cm. All defects were repaired by arterial ized free venous flap from the ipsilateral forearm, in which the proximal ends of veins were anastomosed to artery and vein of the finger. The donor site was directly sutured. Results Six cases of arterial ized venous flap survived completely and 1 case had partial superficial necrosis and healed with conservative management. The donor site healed by first intention. Postoperative follow-up ranged from 3 months to 4 years, the texture and the thickness of the flaps were satisfactory, only one presented partial pigment deposits because of superficial necrosis. No sclerosis, contracture and l imited range of motion occurred in all flaps. According to the evaluation criteria for upper l imb function issued by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 3 cases and good in 4 cases. Conclusion It is an ideal method to repair soft tissue defect of fingers by using anti-valve-inflow and pro-valve-outflow arterial ized venous flap.