Abstract： Objective To summarize the application experience of Gore-Tex patch in clinical chest wall reconstruction. Methods A retrospective analysis was performed in 33 patients who underwent chest wall reconstruction using Gore-Tex patch from January 2001 to December 2010 in Shanghai Changhai Hospital, Second Military Medical University. There were 19 men and 14 women, ranging in age from 20 to 73 years with a median age of 45.7 years. The surgical strategies included choosing different incisions according to tumor location and size, and preserving normal chest wall soft tissue as much as possible during surgery. Gore-Tex patch was used to reconstruct the huge chest wall defect, and covered by transferred muscle flaps. Results All the 33 patients underwent surgical reconstruction successfully and there was no perioperative death. Complete tumor resection was performed in all the patients, including 25 patients with malignant tumor and 8 patients with benign tumor. The diameter of the resected tumors ranged from 8 to 20 cm. All the patients were followed up from 5 to 60 months, except that 3 patients （9.09%） were lost during follow-up. There was no rejection response, abnormal breathing and foreign body sensation during follow-up. The infection incidence was 3%（1/33）. Conclusion Gore-Tex patch is a safe and effective material for chest wall reconstruction due to its excellent biocompatibility. Appropriate selection of muscle flap for covering Gore-Tex patch can reduce postoperative complications.
Objective To investigate the clinical value of computed tomographic angiography (CTA) and three-dimensional reconstruction technique in repairing scalp avulsion wound with large skull exposure by the free latissimus dorsi flap transplantation. Methods Between October 2007 and June 2012, 9 female patients with serious scalp avulsion and large skull exposure were treated, aged 23-54 years (mean, 38 years). The injury causes included machine twist injury in 6 cases, traffic accident injury in 2 cases, and falling from height injury in 1 case. Before admission, 3 patients had scalp necrosis after scalp in situ replantation, and 6 patients underwent debridement and dressing. The time from injury to admission was 8 hours to 7 days (mean, 1 day). The avulsed scalp area ranged from 75% to 90% of the scalp area (mean, 81%); the exposed skull area ranged from 55% to 70% of the scalp area (mean, 63%). Two patients had unilateral auricle avulse. CTA was used to observe the superficial temporal artery and vein, facial artery, external jugular vein, dorsal thoracic artery and vein, and measure the blood vessel diameter before operation. According to the CTA results, the latissimus dorsal skin flaps were desinged to repair wounds in 7 cases, the latissimus dorsal muscle flaps combined with skin graft were used to repair wounds in 2 cases. According to preoperative design, operation was successfully completed in 7 cases; great saphenous vein was used as vascular graft in 2 cases having poor images of superficial temporal vessels. The size of latissimus dorsal skin flaps ranged from 20 cm × 14 cm to 25 cm × 20 cm; the donor site was repaired with skin graft. The size of latissimus dorsal muscle flaps were 23 cm × 16 cm and 16 cm × 10 cm; the donor site was directly sutured. Results The blood vessel diameter measured during operation was close to the value measured before operation. The operation time was 6-8 hours (mean, 6.5 hours). The latissimus dorsal muscle (skin) flap and skin graft survived, with primary healing of wound or incision at donor site. The patients were followed up 3 months-2 years (mean, 6 months). The flap had soft texture and skin had no ulceration. Conclusion The free latissimus dorsi flaps can repair scalp avulsion with large skull exposure. Preoperative CTA can get the vessel anatomical structure and diameter at donor and recipient sites, which will guide the operation program design and implementation so as to shorten the operation time and improve the accuracy rate of vascular anastomosis.
Objective To review the research progress of the skin flap, fascial flap, muscle flap, and myocutaneous flap for repairing soft tissue defects around the knee so as to provide information for clinical application. Methods Domestic and abroad literature concerning the methods of soft tissue repair around the knee in recent years was reviewed extensively and analyzed. Results Fascial flaps meet the requirements of thin, pliable, and tough skin in the soft tissue repair around the knee. Myocutaneous flaps and muscle flaps have more abundant blood supply and anti-infection function. Free skin flaps are the only option when defects are extensive and local flaps are unavailable. Conclusion Suitable flaps should be chosen for soft tissue repair around the knee according to defect position, depth, and extent. Fascial flaps may be selected as the first flaps for defects repair because of excellent aesthetic results and less injury at the donor site.
Objective To introduce the experience of the cl inical appl ication of vertical trapezius myocutaneous flap in repairing soft tissue defects after head and neck tumor resection. Methods Between June 2008 and February 2010, 12 cases of soft tissue defect caused by head and neck tumor resection were repaired with vertical trapezius myocutaneous flap.There were 9 males and 3 females with an age range from 32 to 76 years (median, 54 years). Twelve cases including 2 cases of basal cell carcinoma of orbital skin, 2 cases of squamous cell carcinoma of the parotid gland, 2 cases of submandibular gland mal ignant mixed tumor, 2 cases of metastatic lymph nodes of nasopharyngea carcinoma after radiotherapy, 1 case of squamous cell carcinoma of tongue, and 3 cases of squamous cell carcinoma of occipital skin, and all were classified as TNM stages T3 or T4. The area of soft tissue defect ranged from 13 cm × 6 cm to 25 cm × 13 cm. The vertical trapezius myocutaneous flap ranged from 14 cm × 7 cm to 26 cm × 14 cm and was transfered to repair defect tissue in the homolateral wounds after tumor resection and neck dissection homochronously. The donor sites were sutured directly. Results All incisions healed primarily without infection. Eleven flaps survived except 1 flap with edge necrosis, which was cured after dressing change. Subcutaneous hematocele and effusion occurred in 2 cases on the back after tube was removed at 7 days postoperatively, and they were cured by sucted and pressured dressing. Eleven patients were followed up 1-3 years (mean, 2 years). Nine cases had no tumor recurrence and the flaps had statisfactory appearance; the abduction function of shoulder joint were normal. One case of orbit basal cell carcinoma occurred 3 months after operation and 1 case of nasopharyngeal carcinoma died of brain metastasis 12 months after operation. Conclusion It is an easy and simple therapy to repair head and neck soft tissue defect using the vertical trapezius myocutaneous flap, which can meet the needs of repairing tissue defect of head and neck.