ObjectiveTo investigate the effectiveness of using a sensory prefabricated flap to repair the heel avulsion injury. MethodsBetween August 2012 and August 2013, 6 cases of heel avulsion injury were treated. There were 4 males and 2 females, aged 16-54 years (mean, 29 years). The causes were crush injury in 4 cases and wheel twist injury in 2 cases. The injury to admission time was 2-6 hours (mean, 4 hours). The size of skin avulsion ranged from 5 cm×3 cm to 15 cm×8 cm. Avulsion skin had no replanted condition. At one stage operation, the avulsed heel skin soft tissue was made the full thickness skin graft which was fostered on the anterolateral thigh with lateral circumflex femoral artery perforator, and the lateral femoral cutaneous nerve was put beneath the skin to prefabricate the prefabricated flap; at two stage operation, the prefabricated skin flap pedicled with lateral circumflex femoral artery was used to repair the wound, and the lateral femoral nerve was anastomosed with the calcaneal nerve to reconstruct the feeling. ResultsSix prefabricated flaps all survived, and re-plantation flaps survived after operation. The wounds healed by first intention at donor site and recipient site. The patients were followed up 1-2 years (mean, 1.5 years). The flaps had satisfactory appearance and soft texture. At 1 year after operation, the sensation of the flaps was S3, with two-point discrimination of 22-27 mm (mean, 24.3 mm). According to ZHANG Ming's evaluation standards, the results were excellent in 5 cases, and good in 1 case. The patients could walk normally or with weight-bearing; only linear scar formed at the donor site. ConclusionFor patients with heel soft tissue avulsion injury without replantation qualification, a sensory prefabricated flap by the avulsed heel skin soft tissue can transplanted to repair the heel defect. Satisfactory effectiveness can be obtained in heel appearance and function recovery.
ObjectiveTo discuss the effectiveness of improved interosseous dorsal artery reversed island flap to repair dorsal skin and soft tissue defect of the hand. MethodsBetween March 2009 and September 2012, 29 cases of dorsal skin and soft tissue defects were treated with improved interosseous dorsal artery reversed island flap. Of 29 cases, there were 17 males and 12 females, aged 23-71 years (mean, 47 years); and the left hand was involved in 12 cases and the right hand in 17 cases. There were 11 cases of avulsion injury, 9 cases of crushing injury, 5 cases of strangulation injury, and 2 cases of traffic accident injury; the interval of injury and admission was 1-7 hours (mean, 4 hours). Two patients had scar contracture. The locations of soft tissue defects were dorsal hands in 21 cases, first webs in 5 cases, and dorsal thumb in 3 cases. The size of soft tissue defects ranged from 4 cm×3 cm to 10 cm×8 cm. One-stage repair was performed in 11 cases, and two-stage repair in 18 cases. The size of flaps ranged from 5.5 cm×4.5 cm to 12.0 cm×10.0 cm. The donor sites were sutured directly or repaired by skin grafting. ResultsAll flaps survived, and wounds healed in first stage. And the grafted skins at donor sites all survived, and incisions all healed in first stage. Twenty-six patients were followed up 3 months-3 years (mean, 19.5 months). Bulky flap was observed in 3 cases, and defatted operation was performed after 6 months; the other flaps had good appearance and texture, and wrist function was normal. According to total angle of motion (TAM) systematic evaluation, the results were excellent in 17 cases, good in 6 cases, and fair in 3 cases at 3 months after operation. ConclusionImproved interosseous dorsal artery reversed island flap has the advantages of easy-to-obtain, simple operation, and high survival rate of flaps, so it is an effective method to repair dorsal skin and soft tissue defect of the hand.
ObjectiveTo investigate the treatment outcome of applying venous Flow-through flap in the replantation of severed finger with circularity soft tissue defect and vascular defect. MethodsBetween January 2010 and December 2012,11 cases (11 fingers) of severed finger with circularity soft tissue defect and vascular defect underwent replantation with venous Flow-through flaps.There were 8 males and 3 females,aged 18-42 years (mean,24.6 years).The cause of injury was squeeze injury in 6 cases,crush injury in 3 cases,and strangulation in 2 cases.Combined injuries included nerve defect in 3 cases (1.0,2.0,and 3.5 cm in length),and tendon defect in 2 cases (2.0 and 6.5 cm in length); cyclic skin and soft tissue defect was 3.0-4.5 cm in width,was 1/2-1 finger circumference in length,and was 2.0 cm×1.0 cm to 7.0 cm×4.5 cm in size.Six cases had complete circular defect (both finger artery and vein defects),and 5 cases had incomplete circular defect (only finger artery defect),and vascular defect was 1.0-4.5 cm in length.The time from injury to operation was 1.5-4.5 hours. ResultsVenous crisis occurred in 1 case at 2 days after operation,was cured after vein graft; flap edge necrosis was observed in 2 cases and was cured after dressing change and skin grafting respectively; flap edema and blister occurred in 2 cases and relieved spontaneously.The other 6 flaps and replanted fingers survived completely,with primary healing of incision.Ten cases were followed up 12-18 months (mean,15.5 months).Only a linear scar was seen at the donor sites,with no functional limitation.The flaps had similar color and texture to adjacent skin.The two-point discrimination was 6.5-13.0 mm (mean,8.6 mm).According to replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association,the results were excellent in 6 cases,good in 3 cases,and poor in 1 case at last follow-up,and the excellent and good rate was 90%. ConclusionVenous Flow-through flap can repair both vascular defect and soft tissue defect,so it has good outcome in increasing the survival rate of replanted finger for severed finger replantation with circularity soft tissue defect and vascular defect.
ObjectiveTo explore the effectiveness of the free bilobed medial sural artery perforator (BMSAP) flap to repair penetrating wound of the foot. MethodsBetween April 2012 and October 2014, 7 cases of foot penetrating wounds were treated with the BMSAP flap. There were 5 males and 2 females, aged from 21 to 43 years (mean, 31.5 years). The causes of injury included the crush injury (4 cases), blunt puncture (2 cases), and firearm injury (1 case). The wound was located at the left foot in 4 cases and at the right foot in 3 cases. There were longitudinal penetrating injury in 5 cases and transverse penetrating injury in 2 cases. The size of wound ranged from 4 cm×3 cm to 9 cm×7 cm. The interval between injury and admission was 0.5-5.5 hours (mean, 3.2 hours). The free BMSAP flap of 5 cm×4 cm-10 cm×8 cm in size was used to repair the wounds on both sides and to reconstruct the sensation. The donor site was sutured or repaired with skin graft. ResultsAfter operation, 1 case had distal flap necrosis, the flap survived after dressing change; 1 case had wound infection, and delayed healing was obtained after drainage; and the flap survived completely, and primary healing was obtained in the other 5 cases. The skin grafts survived and healing of incision by first intention was observed at donor sites. The patients were followed up from 7 to 24 months (mean, 12.5 months). The flap had soft texture and similar color to normal skin. According to the British Medical Research Council (BMRC) sensory function assessment system, 1 case was rated as S2, 4 cases as S3, and 2 cases as S3+. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 86-97 (mean, 93.6); the results were excellent in 6 cases and good in 1 case. ConclusionThe free BMSAP flap is very suitable to repair penetrating wound of the foot. The flap has the advantages of repairing the two wounds at the same time and reconstructing skin sensation as well.
ObjectiveTo investigate the effectiveness of the island flaps based on the superficial palmar branch of the radial artery (SPBRA) to repair the thumb wound. MethodsBetween February 2012 and November 2013, 8 cases of thumb defects and bilateral artery defect were treated. There were 5 males and 3 females with an average age of 30.5 years (range, 19-51 years). The injury was caused by crush (4 cases), avulsion (3 cases), and twist (1 case). The injury located at the metacarpophalangeal joints in 3 cases, at the proximal palmar side in 2 cases, and at the interphalangeal joints in 3 cases. The defect size ranged from 3.5 cm×1.5 cm to 6.5 cm×2.0 cm. The digital artery defect was 2.5-8.5 cm (mean, 5.3 cm). The disease duration was 2.0-4.5 hours (mean, 3.2 hours). The reversed island flaps based on the SPBRA were designed, which size was 4.0 cm×2.0 cm to 7.5 cm×3.0 cm. The donor sites were closed directly. ResultsThe operation was successfully completed in 7 patients except 1 patient having vascular variation. All flaps survived completely. Wound and incision at the donor site healed by first intention. All patients were followed up 6-18 months (mean, 13 months). The flaps had similar color and texture to adjacent skin. Linear scar was seen at the donor site in 1 patient, with no functional limitation. According to the functional assessment criteria of upper limb by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 6 cases, good in 1 case, and fair in 1 case, with an excellent and good rate of 87.5%. ConclusionThe reversed island flap based on the SPBRA is an ideal flap for the thumb reconstruction because the advantages of reliable blood supply, easy dissection, less injury at donor site, and good repair results.