Objective To introduce a new design of the scapular flap.Methods The lateral descending cutaneous branch of the circumflex scapular artery was investigated in 10 cadavers with radiography. Based on the results, we usedthe scapular flap(from 8 cm×25 cm to 11 cm×35 cm) pedical on the lateral descending cutaneous branch of the circumflex scapular artery to reconstruct defects offaciocervical region after burning in 7 patients, with direct suture the donatearea,or skin grafting.Results Sever flaps survived completely, satisfactoryresults were obtained except 2 patients’ flap to need to be thinned during the following up.Conclusion This flap can be designed to extend to the inframamary fold, the donor-site scar of the flap is well hidden. The design of the flap broadens the application of the scapular flap.
efect of the eyebrow is a common facialdefect. It was resulted from a variety of causes,but the most common was burn. The operationby using free postauricular scalp graft to repairthe defect of eyebrow was intreduced. The var-ious metheds of eyebrow reconstruction werecompared. The treatment of 79 patients with thedefect of eyebrow was summarized. It was notedthat it had the following advantages , such as theoperation being simple and easy, a naturallooking, appropriate density and r...
Twenty cases with skin defect of forearm and hand were treated by free skin graft with subcutaneous fat from 0.5 to 0.7 cm in thickness. The maximal area of free skin graft is 27×10cm, and the smallest one is 1.5×2cm. All of skin flaps survived except one having partial necrosis. Follow up shown round external figure, clasticity, and no change of skin color. It preserved the function of sweat gland and the cutaneous sensation began to recover 4 months postoperation.
Since 1979, nine children had been treated by free fibular graft in our hospital. Five of them were males, and 4 were females, with a mean age of eight years. The average length of the skeletal defects was 7 cm. The average length of the fibula that was removed for reconstruction was 12.3 cm. The blood circulation of the donor bone was re-established by direct anastomosis of one peroneal artery and vein of the transfer with the appropriate artery and vein of the host region. Nine patients had been followed from 1 year to 9 years,avereged 5.5 years. S even grafts which were substituted in the tibia defects took the same shape and caliber as that of the normal tibia with canalization of the marrow cavity . From the roentgenographic examination of the side where the fibular graft was removed, there was definite caudal migration of the upper fibular in 5 cases,averged 5.2mm,while in 7 cases there was cephalic migration of the distal fibular segments,averaged 4.3mm. The breadth of ankle mortise where increased in 7 cases,The tibio-talus angle was averaged 7 degrees,in 3 cases. In 3 of the 9 cases during follow-up,alaterl wedging of the distal tibia epiphysis with lateral tilting of the talus invarably associated with instability of the ankle was evident. We believed that the elevation of the lateral malleolus and latral wedging of the distal tibia epiphysis were responsible for instability of the ankle.
OBJECTIVE: To sum up transplantation of free scapular flap to repairing injury of faciocervical region, 103 cases in past 16 years were reviewed. METHODS: The scapular flap contained the ascending, descending, and transverse branches of the circumflex scapular artery. The range of the flap was as following: across the scapular spine to the acromion in upper edge, to the level of anterior iliac spine in lower edge, to the bilateral middle axillary line in both sides. RESULTS: The clinical result was good. Fifty eight cases were followed up for 3 months to 10 years, the function of the faciocervical region was recovered with satisfied contour. In part of the patients, a second-stage operation was performed to make the flap thinner. CONCLUSION: The maximal range of the flap can be 45 cm x 16 cm. For its sufficient blood supply, it should be of no influence on survival of the flap if the window is open in suitable site. Because of its large range of donating region and sufficient blood supply, it is fit for children.
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.
Objective To study the quantitative changes of ubiquitin l igase MAFbx mRNA and protein expression, muscle atrophy and muscle function following free muscle transplantation and to explore relationshi ps among them. Methods Thirty-six female SD rats, SPF grade, weighing (250 ± 25) g, were used. One hind l imb of the rat was randomly selected as experimental side to receive in situ free gracil is muscle transplantation, and the counterlateral hind l imb underwent no operation serving as control side. General condition of the rats was observed after operation. Muscle contractivecapacity and muscle wet weight maintenance rate of the experimental and the control side were detected 1, 2, 4, 10, 15, and 30 weeks after operation, and 6 rats were killed at each time point. Meanwhile, HE staining was performed to observe muscle fibre cross-sectional area, real-time quantitative PCR was appl ied to detect relative expression of MAFbx/Atrogin-1 mRNA, and Western blot test was used to observe MAFbx protein expression. Results All rats survived till the end of the experiment, all incisions healed well, and no dysfunction occurred in the experimental sides. The value of muscle contractive capacity, muscle wet weight maintenance rate, muscle’s maximal force of single contraction, and muscle’s maximal force of tetanic contraction in the experimental sides dramatically decreased in the first 4 weeks after operation and increased gradually over 4 to 30 weeks. The MAFbx mRNA expression of the experimental sides peaked and was seven times greater than the control sides 2 weeks after operation, then the value gradually decreased over 15 to 30 weeks after operation and was 1.1 to 1.5 times greater than the control sides, and significant difference was evident between the experimental sides and the control sides at each time point (P lt; 0.05). Significant difference was evident between the experimental sides and the control sides in terms of MAFbx protein expression of the muscle 1 to 15 weeks after operation according to the Western blot result (P lt; 0.05), and no significant difference was noted at 30 weeks (P gt; 0.05). The correlation coefficient between muscle wet weight maintenance rate and muscle’s maximal force of single contraction maintenance rate was 0.95, between muscle wet weight maintenance rate and muscle’s maximal force of tetanic contraction maintenance rate was 0.75, between muscle fibre cross-sectional area recovery rate and muscle’s maximal force of single contraction maintenance rate was 0.93, and between muscle fibre cross-sectional area recovery rate and muscle’s maximal force of tetanic contraction maintenance rate was 0.68 (P lt; 0.05). The correlation coefficient between MAFbx mRNA expression and the parameter of muscle wet weight maintenance rate, muscle fibre cross-sectional area recovery rate, muscle’s maximal force of single contraction maintenance rate, and muscle’s maximal force of tetanic contraction maintenance rate was — 0.62 (P lt; 0.05), — 0.45 (P gt; 0.05), — 0.72 (P lt; 0.05) and — 0.78 (P lt; 0.05), respectively; the correlation coefficient between MAFbx protein relative expression and the parameter of muscle wet weight maintenance rate, muscle fibre cross-sectional area recovery rate, muscle’s maximal force of single contraction maintenance rate, and muscle’s maximal force of tetanic contraction maintenance rate was — 0.95 (P lt; 0.05), — 0.82 (P lt; 0.05), — 0.89 (P lt; 0.05), and — 0.54 (P gt; 0.05), respectively. Conclusion Decrease of muscle function after transplantation correlates closely with muscle atrophy. The high expression of MAFbx mRNA and protein, especially their persistent increases from 4 to 15 weeks after nerve reinnervation, is a junction between the muscle atrophy and thedecrease of muscle function.
In order to understand the influence of the free tendon graft and the tendon transfer on their blood supply, histological and biochemical changes during healing following repair of the damaged tendon after the alteration of the nourishing environment, an experiment was carried on 36 New Zealand white rabbits. In the front paws of the rabbits, the free tendon graft was sutured in the tendon defect of flexor of the fourth toe and the flexor tendon of the third toe was transferred to the second toe to reconstr...
Objective To study the anatomical basis of micro transverse flap pedicled with the superfical palmar branch of radial artery from the palmar wrist for using this free flap to repair soft tissue defect of the finger. Methods Thirty-eight fresh upper limb specimens (22 males and 16 females; aged 26-72 years with an average of 36 years; at left and right sides in 19 limbs respectively) were dissected and observed under operating microscope. Two specimens were made into casting mould of artery with bones, and 2 specimens were injected with red emulsion in radial artery. Thirty-four specimens were injected with 1% gentian violet solution in the superfical palmar branch of the radial artery. A transverse oval flap in the palmar wrist was designed, the axis of the flap was the distal palmar crease. The origin, distribution, and anastomosis of the superfical palmar branch of the radial artery were observed. Results The superficial palmar branch of the radial artery was constantly existed, it usually arises from the main trunk of the radial artery, 1.09-3.60 cm to proximal styloid process of radius. There were about 2-5 branches between the origin and the tubercle of scaphoid bone. The origin diameter was 1.00-3.00 mm, and the distal diameter at the styloid process of radius was 1.00-2.90 mm. The venous return of flap passed through 2 routes, and the innervations of the flap mainly from the palmar cutaneous branch of the median nerve. The area of the flap was 4 cm × 2 cm-6 cm × 2 cm. Conclusion The origin and courses of the superficial palmar branch of the radial artery is constant, and its diameter is similar to that of the digital artery. A transverse oval flap pedicled with the superfical palmar branch of radial artery in the palmar wrist can be designed to repair defects of the finger.