Objective To investigate a best method of obtaining the sural neurofasciocutaneous flap by observing the models of different pedicles based sural neurofasciocutaneous flaps in rabbits and the effect of different pedicles on the survival of the flaps. Methods Forty adult New Zealand rabbits (male or female, weighing 2.5-3.0 kg) were randomly divided into 4 groups (10 rabbits in each). The flaps of 7 cm × 1 cm were designed at the lateral hind legs, and the pedicle was 0.5 cmin length. In group A, the flaps were elevated based on a single perforator pedicle; in group B, the flaps were elevated based on fascia pedicle; in group C, the flaps were elevated based on perforator-plus fascia pedicle; and in group D, the flaps were elevated and sutured in situ. At 7 days after operation, the flap survival rate was recorded, and the blood flow in the center of the flap was monitored by laser doppler flowmetry. The perfusion unit (PU) was measured. Results After operation, the flaps had no obvious swell ing, and the flaps had good color at the proximal end, but pale at the distal end in groups A and B. Obvious swell ing was observed with pale color at the distal flaps in group C, but swell ing decreased gradually. However, the skin color became dark gradually in group D after operation. The flap survival rates were 74.0% ± 2.7%, 60.0% ± 2.5%, 75.0% ± 3.5%, and 0 in groups A, B, C, and D respectively after 7 days of operation. The PU values were 83.39 ± 4.25, 28.96 ± 13.49, 81.85 ± 5.93, and 8.10 ± 3.36 in groups A, B, C, and D respectively. There were significant differences in flap survival rates and PU values between groups A, B, C and group D (P lt; 0.05). Significant differences were found between groups A, C and group B (P lt; 0.05), but no significant difference between group A and group C (P gt; 0.05). Conclusion The sural neurofasciocutaneous flap based on a single perforator pedicle has a rel iable blood supply and enough venous drainage, which is one of the best methods to obtain the sural neurofasciocutaneous flap.
Objective To provide the anatomical basis for posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator. Methods A total of 30 embalmed lower limbs of adult cadavers perfused with red latex were dissected and measured to observe the course and distribution of posterior femoral cutaneous nerve (PFCN), and the anastomoses between direct popliteal artery perforator and nutrient vessels of PFCN. Mimic operation was performed on 1 side of fresh specimen. Results PFCN started from the midpoint of the inferior gluteus maximus edge, and went down along the middle line of posterior thigh region, and the final trunk of PFCN accompanied with small saphenous vein down to the middle line of lower leg. The diameters of PFCN was (3.0 ± 0.6) mm at the inferior gluteus maximus edge, and was (2.0 ± 0.7) mm at the superior fossa poplitea. The nutrient vessels of PFCN were multi-segmental and polyphyletic. The direct popliteal artery perforator which started from popliteal artery directly was constant pierced into deep fascia about 7-11 cm above the knee joint, and its original diameter was (0.8 ± 0.2) mm. The direct popliteal artery perforator had 1-2 accompanying veins, and this perforator artery was the main nutrient vessel of the inferior segment of PFCN. The direct popliteal artery perforator gave off 5-8 small vessels which anastomosed with the 1st-3rd perforator of deep femoral artery, the obturator artery perforator, and the lateral femoral circumflex artery perforators. Then these nutrient vessels formed vascular plexus along PFCN in the middle line of posterior region of thigh. Mimic operation showed that the posterior femoral neurocutaneous vascular flap pedicled with direct poplitea artery perforator could be formed successfully. Conclusion The posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator has constant blood supply and can be easily formed to repair defects around knee joint.
Objective To review the methods and progress on repairing hand injury with dorsal neurocutaneous vascular flap. Methods Recent l iterature on repairing hand injury with dorsal neurocutaneous vascular flap was reviewed and analyzed. Results Island fascial flap was designed on the radial or ulnar side of the dorsum of the hand based on the anatomical study of the dorsum of the hand, and the choice of pedicle depended upon the position of wound. Conclusion Repairing hand injury with dorsal neurocutaneous vascular flap is easy to perform and in l ine with the principle of repairing wounds in proximity. It is one of the effective methods of repairing wounds of the hand.
Objective?To investigate the surgical methods and clinical results of repairing soft tissue defects in the thumb with distally-based dorsal thumb neurocutaneous vascular flap.?Methods?From January 2006 to October 2007, 23 patients with soft tissue defect in the thumb were treated, including 20 males and 3 females aged 19-46 years old (average 27.5 years old). The defect was caused by crush injury in 1 case, electric planer accident in 6 cases, incised injury in 8 cases, and avulsion injury in 8 cases. The defect was located on the palmar aspect of the thumb distal phalanx in 3 cases, the dorsal-radial aspect of the thumb distal phalanx in 3 cases, and ulnar or dorsal aspect in 17 cases. The defect size ranged from 3.3 cm × 1.2 cm to 4.2 cm × 1.2 cm. Among them, 18 cases were complicated with distal 1/2 nail bed defect or injury. The time between injury and hospital admission was 1- 72 hours (average 22 hours). During operation, the defect was repaired with distally-based dorsal-radial neurovenocutaneous vascular flap of the thumb in 3 cases and distally-based dorsal-ulnar neurovenocutaneous vascular flap of the thumb in 20 cases. The size of those flaps was 4.0 cm × 1.6 cm-5.0 cm × 3.0 cm. The donor site underwent direct suture or split thickness skin graft repair.?Results?At 10 days after operation, 3 cases suffered from the epidermal necrosis in the distal part of the flap, 2 of them experienced the exfoliation of dark scab 14 days later and the flap survived, and the flap of the rest one survived after dressing change. The other flaps and the skin graft at the donor site all survived uneventfully. The wounds healed by first intention. All the patients were followed up for 10-16 months (average 12.6 months). The flaps were soft in texture and full in appearance. The two-point discrimination value 6 months after operation was 8-10 mm. At 12 months after operation, the growth of the residual fingernail was evident in 18 cases, including 4 cases of curved or hook fingernail. Active flexion and extension of the thumb were normal. The abduction of the first web space reached or surpassed 80 percent of the normal side in 20 cases and was below 80 percent of the normal side in 3 cases. The clinical outcomes were satisfactory in 11 cases, approximately satisfactory in 8 cases, and unsatisfactory in 4 cases according to self-designed evaluation system.?Conclusion?The operative method of repairing the soft tissue defects in the thumb with the distally-based dorsal thumb neurocutaneous vascular flap is simple, stable in anatomy, in line with the principle of proximity, and suitable for repairing thumb tip defect 3 cm in size. It can bring a good postoperative appearance of the thumb and little influence on the hand function.
Objective To investigate the surgical methods and cl inical results of reconstructing soft tissue defects in distal dorsal is pedis with distally based medial dorsal neurocutaneous flap on foot. Methods From January 2004 to July 2007, 11 cases of soft tissue defects in distal dorsal is pedis were treated with the distally based medial dorsal neurocutaneousflap on foot, including 8 males and 3 females aged 18-55 years. Nine cases were caused by crash and 2 cases were caused by traffic accident. There were 4 cases of tendon exposure and skin defects in the distal dorsal is pedis, 6 cases of bone exposure and skin defects in and adjacent to the first metatarsal head and 1 case of bone exposure and skin defects in the distal dorsal is pedis due to the third and fourth toe damage. The area of defects ranged from 3 cm × 3 cm to 7 cm × 5 cm. Distally based medial dorsal neurocutaneous flaps on foot were incised to repair the soft tissue defects and the size of the flaps ranged from 4 cm × 4 cm to 8 cm × 6 cm. Thickness skin graft was appl ied to repair donor site. Results All the flaps survived and all wounds healed by first intention. Skin graft in donor site survived completely in 10 cases and survived partly in 1 cases (heal ing was achieved after the flap above lateral malleolus was used to repair). All cases were followed up for 6 months-1 year. The color, texture and thickness of the flaps were similar to those of recipient site. All patients returned to their normal weight-bearing walking. No skin ulceration in flaps and donor site was observed. Conclusion The operative technique of the distally based medial dorsal neurocutaneous flap on foot is simple, convenient and safe. The distally based flap is effective in repairing soft tissue defects of middle and small sized skin and soft tissue defects in distal dorsal is pedis.
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.
Objective To investigate the management of the soft tissue defect after the Achilles tendon repair. Methods From April 1996 to April 2006, 24 patients(17 males, 7 females; aged 16-59 years), who suffered from postoperative Achilles tendon exposure caused by local soft-tissue necrosis after the Achilles tendon repair, were treated and evaluated. Of the 24patients, 8 had an original open injury (machinecrush injury in 2 patients, heavy-object press injury in 3, motorcycle wheel crush injury in 3) and 16 patients had a closed injury (sports injury). In their treatment, the transferof the sural neurovascular flap was performed on 8 patients and the transfer ofthe saphenous neurovascular flap was performed on 3 patients. The secondary Achilles tendon repair was performed on 13 patients before the neurovascular flap transfer was performed. The time between the injury and the operation was 9-76 days, and the time between the Achilles tendon expousure and the operation was 3-65 days. Results All the flaps survived and the Achilles tendon exposure was well covered by the flaps of good texture. Eighteen patients followed up for 6 months to 24 months had no flap complication, and the two point discrimination of the flaps was 12-20 mm. The AOFASAnkleHindfoot Scale assessment revealed that 8 patients had an excellent result, 6 had a good result, 3 had a fair result, and just 1 had a poor result, with theexcellent and good results accounting for 77.8%. Sixteen patients (89%) were able toperform a tip-toe stance on their operative sides, and only 3 of them complained a loss of plantarflexion strength. However, 2 patients still could not perform the tip-toe stance. Conclusion The Achilles tendon repair, ifnot well performed, can result in the local soft-tissue necrosis and the subsequent Achilles tendon exposure. If those complications occur, the neurovascular flap transfer should be performed as soon as possible; if necessary, the secondary Achilles tendon repair should be performed, too.