ObjectiveTo investigate the therapeutic effect of modified side-to-end lymphaticovenular anastomosis in the treatment of post-mastectomy upper limb lymphedema. MethodsBetween May 2010 and May 2011, 11 female patients with post-mastectomy upper limb lymphedema underwent a modified side-to-end lymphaticovenular anastomosis. The average age was 49.5 years (range, 38-55 years). Lymphedema occurred at 7-30 months (mean, 18.3 months) after resection of breast cancer, with an average disease duration of 25.5 months (range, 10-38 months). The left upper limb was involved in 5 cases and the right upper limb in 6 cases. In accordance with difference value between health and affected sides criteria, 5 cases were rated as moderate, and 6 cases as severe. ResultsModified side-to-end lymphaticovenular anastomosis was successfully completed in all patients. Primary healing of incision was obtained in the other patients except 1 case of delayed healing. All patients were followed up for an average of 38.4 months (range, 36-40 months). Limb pain and swelling were relieved; no episodic attack or recurrence was observed. The circumference of affected upper arm was significantly decreased from preoperative (33.9±3.7) cm to postoperative (31.0±3.5) cm at 6 months and (30.9±3.5) cm at 36 months (P<0.05), but no significant difference was found between at 3 and 6 months (P>0.05); the circumference of affected forearm was significantly decreased from preoperative (30.1±3.6) cm to postoperative (27.8±3.4) cm at 6 months and (27.7±3.3) cm at 36 months (P<0.05), but no significant difference was shown between at 6 and 36 months (P>0.05). According to Campisi evaluation standard to assess efficacy, the results were excellent in 3 cases, good in 6 cases, and improved in 2 cases. ConclusionUsing modified side-to-end lymphaticovenular anastomosis may be effective in the treatment of upper limb lymphedema after mastectomy.
ObjectiveTo discuss the effectiveness of free anterolateral thigh flap pedicled with medial sural vessels for treatment of leg skin and soft tissue defects. MethodsBetween July 2008 and January 2014, 32 cases of serious skin and soft tissue defects in the leg were repaired by using free anterolateral thigh flap pedicled with medial sural artery and vein. Of them, there were 22 males and 10 females, aged 23 to 50 years (mean, 36.5 years). Defects were caused by traffic accidents injury in 9 cases, crash injury of heavy object in 15 cases, and machine twist injury in 8 cases. The left side was involved in 10 cases and the right side in 22 cases. The mean interval of injury and admission was 2.5 hours (range, 1-4 hours). The location was the upper, middle, and lower one third of the anterior tibia in 15 cases, 10 cases, and 7 cases respectively. The area of defect ranged from 10 cm×5 cm to 23 cm×9 cm. After debridement and vaccum sealing drainage treatment, the anterolateral thigh flap ranging from 12 cm×7 cm to 25 cm×11 cm pedicled with the medial sural vessels was used to repair the wound. The donor site was sutured directly or repaired with the skingrafts. ResultsAll flaps and skingrafts survived after operation, and primary healing of wound was obtained. After 6-23 months (mean, 14.5 months) follow-up, all flaps were characterized by soft texture, good color, and satisfactory appearance. The sensation of the flaps were recovered to S2~S3+ according to the Britain's Medical Research Council criteria at 6 months after operation. No obvious scar contracture was observed at donor site. ConclusionThe medial sural artery has the advantages of constant anatomical position, large diameter, rich blood flow, and a long artery pedicle, so the medial sural vessels is an ideal choice as recipient vessels for the reconstruction of leg skin and soft tissue defect.
ObjectiveTo investigate the effectiveness of dorsalis pedis flap series-parallel big toe nail composite tissue flap in the repairment of hand skin of degloving injury with tumb defect. MethodsBetween March 2009 and June 2013, 8 cases of hand degloving injury with thumb defect caused by machine twisting were treated. There were 7 males and 1 female with the mean age of 36 years (range, 26-48 years). Injury located at the left hand in 3 cases and at the right hand in 5 cases. The time from injury to hospitalization was 1.5-4.0 hours (mean, 2.5 hours). The defect area was 8 cm×6 cm to 15 cm×11 cm. The thumb defect was rated as degree I in 5 cases and as degree II in 3 cases. The contralateral dorsal skin flap (9 cm×7 cm to 10 cm×8 cm) combined with ipsilateral big toe nail composite tissue flap (2.5 cm×1.8 cm to 3.0 cm×2.0 cm) was used, including 3 parallel anastomosis flaps and 5 series anastomosis flaps. The donor site of the dorsal flap was repaired with thick skin grafts, the stumps wound was covered with tongue flap at the shank side of big toe. ResultsVascular crisis occurred in 1 big toe nail composite tissue flap, margin necrosis occurred in 2 dorsalis pedis flap;the other flaps survived, and primary healing of wound was obtained. The grafted skin at dorsal donor site all survived, skin of hallux toe stump had no necrosis. Eight cases were followed up 4-20 months (mean, 15.5 months). All flaps had soft texture and satisfactory appearance;the cutaneous sensory recovery time was 4-7 months (mean, 5 months). At 4 months after operation, the two-point discrimination of the thumb pulp was 8-10 mm (mean, 9 mm), and the two-point discrimination of dorsal skin flap was 7-9 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the results were excellent in 4 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. ConclusionDorsalis pedis flap series-parallel big toe nail composite tissue flap is an ideal way to repair hand skin defect, and reconstructs the thumb, which has many advantages, including simple surgical procedure, no limitation to recipient site, soft texture, satisfactory appearance and function of reconstructing thumb, and small donor foot loss.