From 1984 to 1993, 49 cases with varioussoft tissue defects around the knee were treated with pedicled calf myocutaneous flap, lateral sural cutaneous artery island skin flap, saphenous neurovascularskin flap and fasciocutaneous flap. The postoperation results were sucessful in 47 cases, and failure 2 cases, in one case with flap infection and theother with scar formation surrounding the knee. Both the failure cases were cured with split skin graft. The patient were followed up for an average of three and a halfyears, the knee function was almost completely regained, and the blood supply of the flaps, the elasticity and colour of the flaps were similiar to that of the normal skin, without being cumbersome. The sensation of the saphenous neurovascular flaps and the lateral suralcutaneous artery island flaps was preserved, except partial numbness was presented at the distal part of the flaps. Operative indications and selection of cases were discussed.
Eight cases of tissue defect inthe faciomaxillo-neck region weretreated by application of the vascu-larized paraseapular free flap Themain causes of the tissue defects werepostresection of tumor in the faceor neck and cicatrical contractureafter burn. The method of flapdesign was discussed. It was stress-ed that the incision of the flap onthe outer margin should be 2 cmbeyond the lateral border of thescapula, thus the damage to thesuperficial branch of the circumfl-ex seapular artery could be avoided.
Objective To introduce an effective method to repair failed hypospadias. Methods From October 1998 to October 2002, 8 cases of failed penoscrotal junction hypospadias were repaired by repeated use of scrotal septum vesicular pedicle island flap to reconstruct urethra. The patientsranged in ages from 4 to 8 years. Results All flaps in 8 patients survived, the reconstructed urethra was big and smooth. After a follow up of 6-12 months, the satisfactory appearance and normal urinary stream were obtained. No complications were found. Conclusion This method is an effective operative procedure to repair failed hypospadias and is a simple and convenient operation.
Objective To investigate the clinical significance of the distally-based sural musculocutaneous flap for the treatment of chronic calcaneal osteomyelitis. Methods From January 2002 to October 2005, 7 patients (4 males, 3 females; age range, 15-68 years ) were treated with the distallybased sural musculocutaneous flap, who had chronic calcanealosteomyelitis after calcaneal fracture. After the radical debridement for all the nonviable and poorly vascularized tissues, all the chronic calcaneal osteomyelitis patients, who had suffered from open calcaneal fracture or closed calcaneal fracture, were treated with the open reduction, the internal fixation, and thebone graft. The ulcer lasted for 3-12 months before diagnosis of osteomyelitis. The musculocutaneous flaps ranged in size from 8 cm×4 cm to 12 cm×7 cmand the muscle flaps ranged from 4 cm×3 cm to 6 cm×5 cm. The donor defects were closed primarily in 5 patients and were resurfaced with the splitthicknessskin graft in 2 patients. Results All the musculocutaneous flaps survived completely and all the wounds healed smoothly. All the patients followed up for 2-6 months had no recurrence of osteomyelitis or return to their preoperative ambulatory status.Conclusion It is feasible to use the distallybased sural musculocutaneous flap for treatment of chronic calcaneal osteomyelitis.
In order to preserve the major vessels of the extremities in the repair and reconstruction of wounds of the extremities, the distally based fascial pedicled island flap was applied clinically. Its axis and rotatary point were designed along orientation of the major arteries, and the blood supply was from the abundant vascular networks in the deep fascia. Twenty-two cases with exposure of tendon and bone including 10 upper limbs and 12 lower limbs were treated. The flap area of forearm ranged from 7 cm x 8 cm to 12 cm x 9 cm and the ratio of the length to width of the pedicle was 1: 1-2. The flap area of the calf ranged from 10 cm x 6 cm to 16.5 cm x 12 cm and the ratio of the length to width of the pedicle was 2:1. The rotatary angle was 130 degrees-170 degrees. After operation, 18 flaps were survived completely, 2 cases had partial necrosis on the margin, 2 failures received cross-leg flap in the second operation. The patients were followed up with an average of 13.5 months (ranged from 3 months to 2 years). The conclusions were as follows: 1. the blood supply of this type of flap was reliable and the major arteries of the extremities needed not to be sacrificed; 2. the preparation of the flap was easy and the survival rate was satisfactory; 3. the shortcomings of this flap were unsightly incision scar and the limited size of flap and; 4. during the operation, the compression of the pedicle must be avoided.
This experiment was to study the blood supply of diffcrent types of skin flaps and the revascularization of the host region. The types of skin flaps used in this cxpcriment were the axial pattern flap and the random pattern flap on the back of rabbite. Forty New Zealand rabbits were divided into 5 groups at random. In gathering the data For assessment, besides the local changes such as color, swelling of the flaps, the area of survival of flaps after division of the pedicles, the tests used to observe the postoperative changes included the isotope (99mTc) clearance test, intravenous orescein test, tissue transparent method by perfusion of the flap vessels with Chengdu ink and histologie study. The following conclusions cule be drawn: The complete revaseularization of random pattern flap occurred at 10 days after operation and that of xaial pattern flap was 14 days, the random pattern flaps had a quicker rate of revascularization. It was suggested that the flap ischemia was a factor which enhanced revascularization.
Objective To investigate a method of improving design of the skin flap pedicled with descending branch of lateral femoral circumflex artery, in order to increase the accuracy of preoperative Doppler location. Methods Firstly, the interspace between rectus femoris and vastus lateralis was regarded as line A, and the point of intersection between line A and the vertical line through the midpoint of the line between anterior superior iliac spine and lateral margin of patella was point A. And then the line between the midpoint of groin and point A was regarded as line B. Based on this , the perforating point of cutaneous branch could be located by Doppler along the line B. From November 2001 to October 2004, this method was used in 38 skin flaps of 37 cases, being all males and 16-48 years old. The area of the flap ranged from 7 cm×6 cm to 24 cm×16 cm. Results All the perforatingpoint of cutaneous branch were located outward the line A. The rate that the preoperative Doppler location was consistent with the utility point of formatting skin flap was 97.4%. All the cases were followed up postoperatively 1-20 months. Among the cases, 36 skin flaps of 35 cases was successful and only 2 skin flaps partially necrosed, which healed after changing dressings or skin graft.Out of 35 cases, the sensation restoration of the skin flap was S2-S3 in 6 cases owing to the anastomosis of lateral femoral cutaneous nerve and a skin nerve of the recipient site, while that of the other cases was S0-S1. Conclusion Preoperative Doppler location and improving design of lineB can be a useful instruction for the design of skin flap pedicled with descending branch of lateral femoral circumflex artery.
Objective To find a better method of emergency repair of skin and soft tissue defects in the lower leg, ankle and foot. Methods The distally based superficial sural artery flap was designed on the posterior aspect of the leg. From February 2000 to December 2003, 18 patients with skin and soft tissue detects of the lower leg, ankle and foot were treated with island fasciocutaneous flap supplied by superficial sural artery by emergency. The size of the flap ranged form 4 cm× 5 cm to 11 cm×12 cm. Results The flaps survived totally in 16 cases and necrosed partially in 2 cases. After 1-2 year postoperative follow-up, the results were satisfactory except that in 2 flaps. Conclusion The island fasciocutaneous flap supplied by superficial sural artery may provide a useful method for emergency repair of soft tissue defect of the lower limbs.
Objective To investigate the effectiveness of free latissimus dorsi myocutaneous flap transplantation combined with external fixation in the treatment of bone and soft tissue defects around the knee joint. Methods A retrospective analysis was conducted on the clinical data of 13 patients with high-energy trauma-induced bone and soft tissue defects around the knee joint admitted between January 2016 and July 2023. Among them, 11 were male and 2 were female, the age ranged from 23 to 61 years, with an average of 35.7 years. The causes of injury included 10 cases of traffic accident, 2 cases of machine entanglement injury, and 1 case of heavy object crush injury. According to the Gustilo-Anderson classification, 11 cases were type Ⅲ B and 2 cases were type Ⅲ C. Post-injury, 2 cases had wound infection and 2 cases had popliteal artery injury. The time from injury to flap repair was 40-49 days, with an average of 27.5 days. The wound size was 18 cm×13 cm to 32 cm×20 cm, all accompanied by distal femoral bone defects and quadriceps muscle defects. After primary debridement, vacuum sealing drainage combined with external fixation was used for treatment. In the second stage, free latissimus dorsi myocutaneous flaps were transplanted to repair soft tissue defects, with the flap size ranging from 20 cm×15 cm to 34 cm×22 cm. The donor sites of 9 flaps were directly sutured, and 4 cases with large tension were repaired with a keystone flap based on the posterior intercostal artery perforator. At 6-15 months postoperatively, with an average of 10.5 months, 11 patients underwent knee arthrodesis surgery; 2 patients with large bone defects at the distal femur and proximal tibia underwent multi-segment bone transport reconstruction of the bone defect. At last follow-up, the recovery of the flap and the donor site was recorded, and the function of the shoulder joint was evaluated by the American Shoulder and Elbow Surgeons (ASES) score, and the function of the affected knee joint was evaluated by the Knee Society Score (KSS). ResultsAll the flaps survived after operation, the wounds and donor site incisions healed by first intention. All 13 patients were followed up 15-55 months, with an average of 21.6 months. Four patients who underwent the restoration of the donor site with the thoracodorsal keystone perforator flap had obvious scar hyperplasia around the wound, but no contracture or symmetrical breasts on both sides. At last follow-up, the appearance and texture of the flaps were good; the bony fusion of the knee joint was good, and the range of motion and function recovered well; the shoulder joint function on the flap-harvested side was not significantly affected, and the range of motion was satisfactory. The ASES shoulder joint score of the latissimus dorsi muscle-harvested side was 85-95, with an average of 89.5. The knee joint function KSS score was 75-90, with an average of 81.2. ConclusionFree latissimus dorsi myocutaneous flap transplantation combined with external fixation for the treatment of bone and soft tissue defects around the knee joint caused by high-energy trauma can repair bone and soft tissue defects and reconstruct the stability of the knee joint, effectively preserve the integrity of the limb and soft tissues, and improve the patient’s ability of self-care.
Objective To provide the anatomic basis for thedesign of the intermediate dorsal neurocutaneous flap on the foot and to reportthe clinical results. Methods On 32 adult cadaver lower limb specimens perfused with red latex, the origins, diameters, courses, branches, and distributions of the intermediate dorsal cutaneous nerve of the foot and its nutrient vessels were observed. On this anatomic basis, from June 2004 to October2005, 5 flaps were developed and applied to the repair of the soft tissue defect in the feet of 4 patients. Results The intermediate dorsal cutaneous nerve of the foot was found to arise from the superficial peroneal nerve. Crossing the intermalleolar line, it was located 1.3±0.6 cm lateral to the midpoint of the line with a diameter of 2.05±0.56 mm. The nerve stem divided into branches 2.8±1.3 cm distal to the line. They distributed the dorsal skin of the second, third and fourth metatarsal and toe. On average, 5.1 perforators per specimen were identified. At least 3 nutrient vessels were always found in each. They originated from the cutaneous branches of the anterior tibial artery and the dorsalis pedis artery in the proximal end and the dorsalis metatarsal artery in the distal end. They perforated the deep fascia 4.3±0.4 cm proximal to the intermalleolar, 1.6±0.3 cm proximal to the tip of the third toe webspace and 1.5±0.3 cm proximal to the tip of the forth toe webspace, respectively. The external diameters of them were 0.82±0.13, 0.42±0.07 and 0.49±0.09 mm, respectively. The patients were followed up for 4-10 months. All theflaps survived completely. Their appearance and function were satisfactory. Conclusion The distallybased intermediate dorsal neurocutaneousflap on the foot has an abundant blood supply. This kind of flap is especially useful in repair of the soft tissue defect in the foot.