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腓肠肌筋膜蒂皮瓣移位修复胫前皮肤缺损

MPROVEMENT OF SURGICAL TECHNIQUES IN FASCIOCUTANEOUS FLAP OF LIMBS

To summarize the effectiveness of the improv ed surgical techniques in fasciocutaneous flaps of the limbs. MethodsFrom February 1999 to December 2005, 58 patients (39 males, 19 females, aged 1068 years) underwent repairs of the skin defects with improved fasciaocu taneous flaps of the limbs. Twentyone patients had the skin defects in front of the tibial bone in the middle and lower parts, 12 patients had the skin defect s in the heels, 16 patients had the skin defects in the ankles, 3 patients had t he skin defects around the knees, 1 patient had a wide sacrococcygeal bedsore, and 5 patients had the skin defects in the wrists and hands. The wounds ranged in size from 5 cm×3 cm to 18 cm× 12 cm. According to the wound lo cations, the following flaps were selected: 4 cutaneous antebrachii medialis nerve and basilic vein fasciocutaneous flaps, 1 cutaneous antebrachii lateralis nerve and cephalic vein fasciocutaneous flap, 3 saphenous nerve and great saphenousvein fasciocutaneous flaps, 1 cutaneous nerve of thigh posterior fasciocutaneous flap, 32 reverse sural nerve and saphenous vein fasciocutaneous flaps, and 17 reverse saphenous nerve and great saphenous vein fasciocutaneous flaps. The dissected flaps ranged in size from 6 cm× 4 cm to 18 cm× 13 cm. The donor wounds underwent straight sutures in 39 patients, and the skin grafting (6 cm×3 cm to 13 cm× 6 cm) was performed on 19 patients after the donor wounds were closed. Results The wounds healed by first intention, and the flaps survived completely in 54 patients. The flaps developed partial necrosis in 4 patients. The followup for 120 months (average, 8 months) revealed that the flaps had a satisfactory appearance with a soft texture and the function was also satisfactory. Conclusion A fasciocutaneous flap of the limbs is an ideal flap for repairing defects in the skins and soft tissues of the limbs. The survival rate of the flap can be further improved by an improvement of the surgical techniques.

EMERGENCY REPAIR OF SKIN AND SOFT TISSUE DEFECTS OF LOWER LIMBS WITH ISLAND FASCIOCUTANEOUS FLAP SUPPLIED BY SUPERFICIAL SURAL 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. 

RECONSTRUCTION OF URETHRA PARTIAL DEFECT WITH SCROTAL FLAP

Objective To introduce the application of the scrotal flap on reconstructing partial urethra defect. Methods From March 1998 to August 2004, 31 patients with urethra defect were treated with scrotal flap. Their ages ranged from6 to 34 years. Thirty-one patients included 8 cases of congenital deformity of urethra and 23 cases of complication of urethral fistula, urethral stenosis and phallus bend after hypospadias repair. The flap widths were 1. 2. cm in child and 2.3. cm in adult. The flap lengthwas 1. -2.0 times as much as the width. Nine cases were classified as penile type, 10 cases as penoscrotal type, 7 cases as scrotal type(3 children in association withcleft scrotum) and -cases as perrineal type because of pseudohermaphroditism.Urethroplasty was given by scrotal fascia vascular net flap to reconstruct urethra defect. Results All the flaps survived, and the incision healed well. Twenty four cases achieved healing by first intention and 7 cases by second intention. And fistula occurred and healed after 2 weeks in 1 case. 27 cases were followed up 14 years, 2 cases had slight chordee, the others were satisfactivly. Conclusion Urethroplasty with scrotal fascia vascular net flap is an ideal method for the partial defect urethra.

指神经血管筋膜蒂逆行岛状皮瓣的临床应用

The Clinical Outcome of Anatomical Reconstruction of the Patellar Tendon Using a Y-shaped Flap Folded Back from the Vastus Lateralis Fascia

目的　评价股外侧肌远端筋膜瓣折叠修复重建陈旧性髌韧带断裂的安全性及临床疗效。 方法　对2008年6月－2010年10月收治的10 例陈旧性髌韧带断裂患者，采用股外侧肌远端筋膜瓣折叠联合减张钢丝张力带固定方法重建髌韧带。术后1、2、3、6及12个月随访，采用美国膝关节协会评分对膝关节功能进行评分，包括膝关节疼痛、行走能力和上下楼梯能力、活动度等，同时行超声检查对膝关节髌韧带的连续性进行评估。 结果　10例患者中9 例获得随访，平均随访12个月（6～15个月）。末次随访时平均膝关节疼痛评分、功能评分、膝关节活动范围均较术前明显改善。超声检查显示所有患者肌腱完全愈合，连续性完好，不需要进一步外科手术干预。所有随访患者均未发生手术相关并发症。 结论　采用股外侧肌远端筋膜瓣折叠重建陈旧性髌韧带断裂是一种有效、可靠的方法，能够恢复良好的膝关节功能。

REPAIR OF SOFT TISSUE DEFECT AFTER BURN AT WRIST SY REVERSED FASCIOCUTANEOUS FLAP

Ten cases of soft tissue defect at palm orwrist were repaired by reversed fasciocutaneousflap from the forearm. All were. survived excepttwo cases having necrosis of the distal portion ofthe graft. The blood supply of the skin of the fore-arm was comming from the perforation fasciocuta-neous and musculocutaneous giving rise from theulna , radial and interosseous arteries. Therefore ,when the flap was designed,it was best to have thefascial pedicle over the arterial trunks in order toinclude more perforating arteries in the flap . It was indicated that venous supply might also played an important role in flap nutrition.

筋膜皮瓣修复四肢关节部位烧伤创面

CLINICAL STUDY ON CORRECTION OF HEMIFACIAL ATROPHY WITH FREE ANTEROLATERAL THIGHADIPOFASCIAL FLAP

Objective To investigate the effect of free anterolateral thigh adipofascial flap in correcting the hemifacial atrophy. Methods From January 1997 to May 2006, 35 patients suffering from hemifacial atrophy were corrected with microvascular anastomotic free anterolateral thigh adipofascial flap and other additional measures according to the symptoms of the deformities. There were 11 males and 24 females, aging 1547 years. The locations were left in 12cases and right in 23 cases. The course of disease was 4 to 28 years. Their hemifacial deformities were fairly severity. Their cheeks were depressed obviously. The X-ray films and threedimensinal CT showed the 28 patients’ skeletons were dysplasia. The size of adipofascial flap ranged from 8 cm×7 cm to 20 cm×11 cm. Donor sites weresutured directly. Results Recipient site wound of all patients healed by first intention. All adipofascial flaps survived. The donor sites healed well and no adiponecrosis occurred. Thirty-five cases were followed up for 6 months to 8 years. The faces of all patients were symmetry, and the satisfactory results were obtained. There were no donor site dysfunction. Conclusion The anterolateral thigh adipofascial flapprovides adequate tissue, easytosurvive, no important artery sacrificed and the donor scar ismore easily hidden. Combining with other auxiliary methods, it can be successfully used to correct the deformity of hemifacial atrophy.

指背逆行筋膜岛状皮瓣修复多指指端缺损

目的 探讨一期修复多指指端缺损的方法。方法 2000年5月～2006年2月,采用指背逆行筋膜岛状皮瓣移位修复多指指端缺损14例35个皮瓣。其中男11例，女3例；年龄15～48岁。损伤原因：挤压伤3例，撕脱伤5例，切割伤6例。指端缺损：2～5指1例4指，2～4指或3～5指5例15指，2个手指8例16指。缺损范围1.5 cm×1.5 cm～3.0 cm×2.0 cm。皮瓣切取范围1.6 cm×1.6 cm～3.2 cm×2.2 cm。结果 14例均随访6个月～4年，〖JP1〗手指外观满意。吻合指背神经皮瓣患者1～2个月感觉恢复，无痛觉过敏，两点辨别觉8～10 mm；未吻合指背神经皮瓣者4～5个月感觉逐步恢复，两点辨别觉9～12 mm，触痛觉及放电感减弱或消失。手功能按TAM法评定，优22指，良11指，可2指，优良率943％。结论 该术式操作简便、疗程短、疗效满意，是治疗多指指端同时缺损的一种可行的手术方法。