【Abstract】 Objective To research the method and effectiveness of V-Y advancement of skin flap pedicled with the upper limb lateral branch in the treatment of small skin defect in the dorsal elbow. Methods Between March 2008 and August 2010, 6 cases of skin defect in the dorsal elbow were treated by V-Y advancement of skin flap pedicled with the upper limb lateral branch, including 4 males and 2 females with a mean age of 53 years (range, 16-76 years). Defects were caused by crushing in 3 cases, by punching in 2 cases, and the disease duration was 4 hours 30 minutes to 7 days (mean, 29.5 hours); and by chronic infection in 1 case, and the disease duration was 12 months. The defect size ranged from 4.0 cm × 2.5 cm to 9.5 cm × 3.5 cm, all complicating by bone or tendon exposure. The flap size ranged from 6.0 cm × 4.0 cm to 12.5 cm × 9.5 cm; the donor sites were sutured directly. Results All flaps survived completely, wounds and incisions at donor sites healed by first intention. Six cases were followed up 6-12 months after operation. The flaps had good texture and color. Two-point discrimination of the skin flap was 12-16 mm. The function of limb was normal, and elbow flexion and extension activity averaged 105° (range, 95-125°). Conclusion It is ideal to treat small skin defect in the dorsal elbow with V-Y advancement of skin flap pedicled with the upper limb lateral branch because of easier operation and less injury at donor site.
Objective To investigate the therapeutic effect of V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery for skin defect at the same dorsal finger. Methods Between January 2008 and February 2010, 15 cases of skin defect at the same dorsal finger were treated. There were 9 males and 6 females, aged 15-72 years (mean, 43 years). Defect was caused by saw machine in 6 cases, machines crush in 7 cases, and cutting nodule in 2 cases. The locationswere distal dorsal finger in 2 cases, middle dorsal finger in 6 cases, and proximal dorsal finger in 7 cases. All cases compl icated by exposure of tendon and bone. The size of defect ranged from 0.8 cm × 0.5 cm to 1.4 cm × 1.0 cm. The interval between injury and operation was 3-8 hours. All fingers were treated by V-Y advancement flap from the dorsal cutaneous branch of digital artery, which size was 1.2 cm × 0.8 cm-2.5 cm × 1.0 cm, and the donor site was directly sutured. Fracture reductionand Kirschner wire for internal fixation were performed in the patients with fracture; extensor tendon was repaired with 4-0 thread in the patients with tendon injury. Results All flaps survived completely. The incisions of donor and recipient sites healed by first intention. Ten cases were followed up 6 months to 2 years after operation. The flaps had good texture, color, and appearance; 2-point discrimination of the V-Y flap was 10-12 mm. X-ray examination showed that all finger fractures healedsuccessfully in 5 cases, with an average bone union time of 6 weeks (range, 5-8 weeks). According to the criteria for function assessment by total active motion, the results were excellent in 8 cases, good in 1, and fair in 1 with an excellent and good rate of 90%. Conclusion It is an ideal method to treat skin defect at the same dorsal finger with V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery.
The traditional Kutler and Atasoy V-Y advancement flaps have minimal advancement degree, did not satisfy to repair large skin defect in fingers, hence, have no wide indications. The sensory function of the fingers to be influenced because of injury of sensory nerves and sear formation. Since 1985 to 1991, the V-Y advancement flaps pedicled by bilateral digital arteries and nerves have been used for reconstruction of 33 finger tip defect and 5 digital volar skin contraction. All of these cases obtained satisfactory function and excellent appearance.In this paper, the anatomical charactistics and principles of devicerecommended, the advantages and key points to success discussed.
ObjectiveTo explore the feasibility and effectiveness of V-Y advanced sense-remained posterior tibial artery perforator flap in repairing wound around the ankle. MethodsBetween March 2012 and January 2015, 11 patients with wounds around the ankle were treated by V-Y advanced sense-remained posterior tibial artery perforator flap. There were 6 males and 5 females with a median age of 37 years (range, 21-56 years). The causes were traffic accident injury in 3 cases, thermal injury in 2 cases, burn in 2 cases, iatrogenic wounds in 2 cases, and local contusion in 2 cases. The disease duration ranged from 1 to 3 weeks (mean, 2 weeks). Injury was located at the medial malleolus in 4 cases, at the lateral malleolus in 3 cases, and at the heel in 4 cases. All had exposure of bone, tendon, or plate. The defect area ranged from 4 cm×2 cm to 5 cm×3 cm; the area of the flap ranged from 11 cm×4 cm to 15 cm×6 cm. ResultsNecrosis of distal flap occurred in 1 case after operation; re-operation to amputate the posterior tibial artery was given and the wound was repaired by proximal skin graft. Light necrosis of distal end was observed in 2 cases, and wound healed at 3 weeks after dressing. And other flaps successfully survived, and primary healing of wounds were obtained. The patients were followed up 6-24 months (mean, 11 months). The flaps were good in color, texture, and appearance. The ankle joint had normal activity. At last follow-up, 10 cases restored fine sense, and 1 case restored protective feeling with posterior tibial artery advanced flap after amputation. ConclusionV-Y advanced sense-remained posterior tibial artery perforator flap has the advantages of reliable blood supply, simple operation, good appearance, and sensory recovery. Therefore, it is an ideal method to repair wound around the ankle.
ObjectiveTo investigate effectiveness of advanced skin flap and V-shaped ventral incision along the root of penile shaft for concealed penis in children. MethodsBetween July 2007 and January 2015, 121 boys with concealed penis were treated with advanced skin flap and V-shaped ventral incision along the root of penile shaft. The age varied from 18 months to 13 years (mean, 7.2 years). Repair was based on a vertical incision in median raphe, complete degloving of penis and tacking its base to the dermis of the skin. Advanced skin flap and a V-shaped ventral incision along the root of penile shaft were used to cover the penile shaft. ResultsThe operation time ranged from 60 to 100 minutes (mean, 75 minutes). Disruption of wound occurred in 1 case, and was cured after dressing change; and primary healing of incision was obtained in the others. The follow-up period ranged from 3 months to 7 years (median, 24 months). All patients achieved good to excellent cosmetic results with a low incidence of complications. The results were satisfactory in exposure of penis and prepuce appearance. No obvious scar was observed. The penis had similar appearance to that after prepuce circumcision. ConclusionA combination of advanced skin flap and V-shaped ventral incision along the root of penile shaft is a simple, safe, and effective procedure for concealed penis with a similar appearance result to the prepuce circumcision.