Objective To study the blood supply of the distally pediceled composite vascular net flap of forearm and its clinical effect. Methods From February 2000 to December 2003, the distally pediceled composite vascular net flap of forearm was used to repair a series of 26 skin defects with bone or tendon exposure on the hand and wrist.Of 26 patients, there were 17 males and 9 females at ages of 18 to 56 years; 16 received emergency operation and 10 received selective operation. The flap sizes ranged for 10 cm ×5 cm to 18 cm×7 cm. Results Allof the flaps survived. At followup of 3 to 8 months, there was no flap loss, even partial and the outcome was satisfactory in all patients.Twopoint discrimination was 6 to 10 mm. Conclusion Plexus around the cutaneous nerves and the superficial vein are connected with the superficial subdermal plexus and the deep facial plexus by perforators from the underling main arteries, forming a threedimensional vascular network and in a sort of longitudinal axiality, which is the anatomic base of blood supply for the flaps. Blood supply to the flap is provided by the perforators arising from the deeply situated radial or ulnar arteries in the distal pedical. The advantage of this flap is its constant and reliable blood supply without sacrifice of the main artery. The elevation of the flapis simple and rapid, and the flap has a higher survival rate.
OBJECTIVE: To reduce amputation rate of severe electrical burn of wrist and to promote partial recovery of the injuried hand. METHODS: From 1987 to 1999, 44 cases, with 55 limbs of severe electrical burn were classified into 4 types, according to criteria of Dr Shen Zuyao, and were all treated by primary adequate decompression, timely debridement, reconstruction of blood circulation in cases complicated with blood vessel injury, and skin flap grafting from chest, abdomen or inguinal area, followed by treatment of anti-coaggluation and anti-infection. Once the wound healed, auto- or allo-transplantation or transferring of tendons were performed to repair tendon defect, and auto-nerve or fetal nerve transplantation performed for nerve defect. RESULTS: After the primary treatment of the 55 burned limbs, all limbs of type IV were amputated, and most of other 3 types survived. The function, including sensation and movement, of survived hands partially recovered. CONCLUSION: Primary reconstruction of blood circulation, cover of wound with skin flap, and timely repair of sensation and motor function are very crucial approach to reduce amputation rate and to promote the survived hand function of severe electrical burns of wrists.