ObjectiveTo explore the effectiveness of the side island flap coinciding dorsal branch of the digital nerve for repairing thumb pulp defects. MethodsBetween May 2008 and July 2012,36 cases of thumb pulp defects were treated with the side island flap coinciding dorsal branch of the digital nerve.There were 26 males and 10 females,aged 21-51 years (mean,32.4 years).The injury causes included electric saw injury in 14 cases,punch press injury in 8 cases,machine twist injury in 5 cases,door crushing injury in 5 cases,and glass cutting injury in 4 cases.The left hand was involved in 12 cases and the right hand in 24 cases.Combined injuries included tendon and bone exposure in all cases,fracture of the distal phalanx in 3 cases,and nail bed lacerations in 2 cases.The defect size ranged from 1.4 cm×1.2 cm to 2.5 cm×2.1 cm;and the flap size ranged from 1.8 cm×1.4 cm to 3.0 cm×2.5 cm. ResultsTwo flaps with distal skin flap tension blisters and skin scabbing,which were cured after dressing changes;the wound healed by first intension in the other 34 cases.The skin grafts at donor site survived,and primary healing of incision was obtained.The patients were followed up 3-15 months (mean,8 months).The appearance and function restored well.Two-point discrimination of the flap was 5.2 mm on average (range,4-8 mm) at last follow-up.The finger joint had no stiff.According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association,the sensation was S4 in 33 and S3+ in 3 cases.No ectopic feeling was observed.The extension and flexion activity of fingers at donor site was normal,the sensation reached S4 with no atrophy of the finger. ConclusionWith constant anatomy,reliable blood supply,and safe operation,the anastomoses of the finger side island flap with dorsal branch of digital nerve is a better method to repair thumb pulp defects because it also effectively overcome the ectopic feeling with traditional methods and protect feel function of the fingers at donor site.
ObjectiveTo explore the effectiveness of the dissociative saphenous arteria flap in repairing upper limbs soft tissue defect. MethodsBetween June 2012 and April 2014, 10 cases of skin and soft tissue defects at the upper limbs were treated, including 6 males and 4 females with an average age of 42 years (range, 23-58 years). The causes of injury was the machine injury in 9 cases, the interval of injury and operation was 2 hours to 32 days (mean, 5.5 days); the locations were the dorsal radial side in 3 cases and the dorsal forearm in 6 cases. Skin defect with tendon exposure was observed in 1 case after contracture of the first web space resection. The defect size varied from 5 cm×3 cm to 16 cm×9 cm. The size of the flaps ranged from 6.0 cm×3.6 cm to 19.2 cm×10.8 cm. In 7 cases, the saphenous nerve was anastomosed with the nerve of the donor (cutaneous nerve, radial nerve, or ulnar nerve); in 5 cases, tendon defect was repaired by sartorius muscle tendon bridge. The donor sites were repaired by free skin graft or suture. ResultsThe other flaps survived and obtained healing by first intention except 1 flap which had partial necrosis with healing by second intention. The skin graft at donor site survived. All patients were followed up 5-17 months (mean, 12 months). The flaps had good color and texture without contracture. At last follow-up, the sensation recovered to S1-S3+; in 7 cases undergoing nerve anastomosis, the sensation reached S3-S3+, and it was better than that not undergoing nerve anastomosis (S1-S2); in 5 cases receiving sartorius muscle tendon bridging, the hand function recovered satisfactorily except 1 case of total active movement (TAM) value >75% of contralateral TAM at last follow-up. According to the Chinese Medical Society of Hand Surgery function evaluation standards, the results were excellent in 8 cases and good in 2 cases. ConclusionThe dissociative saphenous arteria flap is an effective way to repair skin defects of the upper limbs because of reliable blood supply and simple surgical procedure.
ObjectiveTo explore the effectiveness of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve in the treatment of soft tissue defect of the hand. MethodsBetween October 2011 and December 2013, 17 cases of skin and soft tissue defects of the hands were treated. There were 8 males and 9 females, aged 23-62 years (mean, 44 years). Of them, defect was caused by trauma in 13 cases, by postoperative wound after degloving injury in 2 cases, and by resection of contracture of the first web in 2 cases; 13 cases of traumas had a disease duration of 2-6 hours (mean, 3.5 hours). The defect sites located at the back of the hand in 5 cases, at the radial side of the palm in 4 cases, at the first web in 2 cases, at the palmar side of the thumb in 4 cases, and at the radial dorsal side of the thumb in 2 cases. The bone, tendons, and other deep tissue were exposed in 15 cases. The defect size varied from 3 cm×3 cm to 12 cm×8 cm. The size of the flaps ranged from 3.6 cm×3.6 cm to 13.2 cm×8.8 cm. The lateral cutaneous nerve of the forearm was anastomosed with the cutaneous nerve of the reci pient sites in 9 cases. The donor sites were repaired by free skin graft or were sutured directly. ResultsThe other flaps survived, and obtained healing by first intention except 2 flaps which had partial necrosis with healing by second intention at 1 month after dressing change. The skin graft at donor site survived, and incisions healed by first intention. All patients were followed up 5-30 months (mean, 12 months). The flaps had good color and texture. Flap sensory recovery of S2-S3+ was obtained; in 9 cases undergoing cutaneous nerve flap anastomosis, the sensation of the flaps recovered to S3-S3+ and was better than that of 8 cases that the nerves were disconnected (S2-S3). The patients achieved satisfactory recovery of hand function. Only 2 cases had extended limitation of the proximal interphalangeal joint. At last follow-up, according to the Chinese Medical Society of Hand Surgery function evaluation standards, the results were excellent in 15 cases and good in 2 cases. ConclusionRetrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve is an effective way to repair skin defects of the hand, with the advantages of rel iable blood supply and simple surgical procedure.
ObjectiveTo provide the anatomical basis for the selection of osteotomy site in leg lengthening or tibial slip. MethodsBetween August 2010 and July 2014, 10 adult fresh amputated leg specimens were collected. The pressure perfusion of red latex was performed by the popliteal artery. The anterior tibial artery and its main branches were separated and exposed, and the periosteal branch of anterior tibial artery was adequately exposed;the posterior tibial artery and its main branches were exposed;the peroneal artery was separated and exposed. The tibial and peroneal artery and its branches were observed and measured. When measuring the proximal end, the medial tibial plateau bone margin, the most prominent part of the tibial tuberosity, and the fibular head edge were used as a reference;when measuring the distal end, distal medial condyle of tibia malleolus tip, tibial lateral malleolus lateral tip, and distal tibial articular surface were used as a reference;the vertical distance between tibia proximal and distal main arteries and bone end reference was measured to determine the optimal osteotomy position of upper and lower tibia. The osteotomy index was calculated which was used to represent the relative position of osteotomy site in the whole tibia. ResultsThe proximal tibial osteotomy site located at (78.2±19.5) mm from medial tibial plateau margin, (41.8±16.0) mm from the tibial tuberosity pole, and (66.7±16.4) mm from the fibular head edge. The distal tibial osteotomy site located at (70.8±12.1) mm above the inferior margin of tibial medial malleolus, (83.3±13.0) mm above the inferior margin of lateral malleolus tip, and (59.1±11.7) mm from distal tibial articular surface. The proximal tibial osteotomy index was 18.45-23.35 (mean, 20.46);the distal tibial osteotomy index was 14.36-23.05 (mean, 18.81). ConclusionThe metaphyseal-diaphyseal connection shold be selected in the proximal and distal tibia osteotomy, the lower one third of the tibia is not suitable for ostetomy.