Objective To investigate the cl inical results of the flap pedicled with collateral branch of descendingrarus of lateral circumflex femoral artery with digital three-dimensional reconstruction technique for lower l imb soft tissue defects. Methods Between March 2009 and January 2010, 7 patients with lower l imb soft tissue defects were treated with free flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery. There were 6 males and 1 female with an age range from 6 to 51 years. They were injured by traffic accident (4 cases), or by object hit from height (3 cases). The locations were foot in 2 cases, ankle in 2 cases, and anterior tibia in 3 cases. The disease duration was 8 hours to 40 days (mean, 20 days). All the cases compl icated by exposure of tendons or bones. The areas of soft tissue defect ranged from 12 cm × 7 cm to 20 cm × 14 cm. Free flaps were transplanted at 4 to 16 days after symptomatic treatment. Before operation, all the flaps were designed with digital three-dimensional reconstruction technique. The size of flaps ranged from 15 cm × 9 cm to 22 cm × 16 cm The donor sites were closed directly in all cases. Results All the flaps survived. The wounds and incisions at donor sites healed by first intention. All the patients were followed up 6 to 12 months. The texture, appearance, and function of the flaps were satisfactory, and no compl ication occurred. All the flaps had protective sensation, which could meet the requirement of the daily l ife. The function of ankle was satisfactory with normal walk; the extension was 19-22° and the flexion was 30-36°. No obvious scar formed at donor sites. Conclusion The flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery has rel iable blood supply, easy operation, l ittle influence on the donor site, and high success rate with digital three-dimensional reconstruction technique. It is an excellent option for repairing lower l imb soft tissue defects.
Drug addiction has been one of the serious social problems. The peripheral phlebitis caused by drug injection is common, but the occurrence of pseudoaneurysm with infection of femoral artery from injection injury was rarely reported in China. From January 1995 to March 1996, six cases of injury of femoral artery with infection from heroine injection were admitted. The characteristics of the injury were described. The therapeutic measures and details of attention to be needed were discussed. It was concluded that this type of injury was different from the injury caused in agricultural, industrial or traffic accidents. The treatment of choice depended upon the type of injury.
The injuries of the femoral arteries were mistreated in 5 cases. The causes of the mistakes were resulted from: the initial cause of the injury was not carefully analyzed; the arterial injury was overlooked by the concomitant injuries, and the improper method of management was selected, as a result, 2 patients died from acute renal failure and the other 3 patients developed the complications of secondary thrombosis of the artery or rupture of the artery at the anastomotic site following repair. Of the 3 patients, 2 patients had recovered following reoperation and the other 1 patient had lost his limb from amputation. It should be emphasized that all of the following key points might avoid the mistakes occurred in the management of the injury of the femoral artery: (1) early diagnosis; (2) debredment of arteral end; (3) in infections wounds, insted of vein transplantation bypass technique should be done.
ObjectiveTo summarize the effects of endovascular intervention and artificial graft bypass for the occlusive superficial femoral artery disease. MethodsThe clinical data of 122 patients (136 limbs) with superficial artery occlusive disease underwent endovascular intervention or artificial graft bypass from January 2008 to April 2011 in this hospital were collected retrospectively. Age, TASCⅡgrading, condition of outflow tract, complications before and after procedures, hospital stay, primary patency rate, rate of amputation, and death rate were recorded. Results①Seventy-four limbs of 64 patients were accepted percutaneous transluminal angioplasty and stent graft (PTA/S group), 62 limbs of 58 patients were accepted femoral popliteal artery artificial graft bypass (artificial graft bypass group). Compared with the artificial graft bypass group, the age was significantly older (P < 0.05), TASCⅡA or B lesions were more (P < 0.05), TASCⅡC or D lesions were less (P < 0.05), the limbs with one or three outflow tracts were more (P < 0.05) in the PTA/S group. The limbs with two outflow tracts, and the patients combined with diabetes or hypertension or diabetes and hypertension had no significant differences between these two groups (P > 0.05).②There was no perioperative mortality in two groups. Compared with the artificial graft bypass group, the average hospital stay was sifnificantly shorter (P < 0.05), the 3-year death rate after procedure was higher (P < 0.05), the rate of postoperative incision infection was lower (P < 0.05), the primary patency rate of 36-month after operation was lower (P < 0.05) in the PTA/S group. The rate of amputation, the primary patency rates of 6-, 12-, and 24-month after operation had no significant differences between these two groups (P > 0.05). ConclusionsManagement of occlusive superficial femoral artery disease with femoral popliteal artery artificial bypass grafting exhibits a higher long term patency as compared with percutaneous stent graft. However, the hospital stay is longer than that in PTA/S group, and postoperative infection also occurres individually in artificial graft bypass group. Percutaneous transluminal angioplasty and stent graft has little trauma, faster recovery, shorter hospital stay, which is an important significance for the patients with too old or weak to accept femoral popliteal artery artificial graft bypass. But its long term patency rate needs to be improved.
ObjectiveTo investigate the feasibility of the free descending branch of lateral circumflex femoral artery perforator tissue flap (fascia flap plus skin flap) to repair large soft tissue defects of the extremities and its impact on the donor site. MethodsBetween January 2013 and February 2015, 9 cases of large tissue defects of the extremities were repaired with the free descending branch of lateral circumflex femoral artery perforator tissue flap. There were 8 males and 1 female, aged from 13 to 56 years (median, 36 years). The causes included traffic accident injury in 6 cases and crushing injury by heavy object in 3 cases. Soft tissue defect located at the lower limbs in 7 cases and at the upper limbs in 2 cases, including 2 cases of simple tendon exposure, 2 cases of simple bone exposure, and 5 cases of tendon and bone exposure. After debridement, the soft tissue defect area ranged from 13 cm×7 cm to 20 cm×18 cm. The tissue flaps ranged from 14 cm×8 cm to 23 cm×19 cm. The donor site was directly sutured, scalp graft was used to cover the fascia flap. ResultsAfter operation, partial necrosis of the skin grafting on the fascia flap occurred in 2 cases and healed after dressing change. Arterial crisis occurred in 1 case and the flap survived after anastomosis. The other tissue flaps survived and wounds healed by first intention. The skin grafting healed by first intention in 7 cases, by second intention in 2 cases. The patients were followed up 4-24 months (mean, 10 months). The appearance and function of the tissue flaps were satisfactory, only linear scar was observed at the donor site, which had less damage and no effect on walking. ConclusionFree descending branch of lateral circumflex femoral artery perforator tissue flap can repair large soft tissue defect of the extremities. The donor site can be sutured directly, which reduces damage to donor site and is accord with the principle of plastic surgery.
Objective To explore the feasibility and technical points of soft tissue defect reconstruction of the lower extremity using the distally based anterolateral thigh (dALT) flap based on perforating vessels from the lateral circumflex femoral artery (LCFA) oblique branch. Methods Between July 2010 and July 2016, 7 patients underwent defect reconstruction of the lower extremities using the dALT flap based on perforating vessels from the LCFA oblique branch. There were 4 males and 3 females with an average age of 26.7 years (range, 3-58 years). The etiologies included angiofibrolipoma in 1 case, malignant fibrous sarcoma in 1 case, soft tissue sarcoma in 1 case, and post-burn scar contracture in 4 cases. The disease duration was 13 years, 1 year, and 8 months in 3 patients with tumors respectively, and was from 6 months to 35 years in 4 patients with post-burn scar contracture. After resection of lesion tissues, the defect size ranged from 8 cm×6 cm to 24 cm×8 cm. The flap size ranged from 9 cm×7 cm to 24 cm×8 cm. The length of the pedicle ranged from 12 to 22 cm (mean, 16.6 cm). The distance from the flap pivot point to the superolateral border of the patella ranged from 9.5 to 14.0 cm (mean, 11.8 cm). The donor sites were directly closed in 6 cases and covered with the split-thickness skin graft in 1 case. Results All flaps survived after surgery without any major complications. All wounds at the donor and the recipient sites healed primarily. The patients were followed up from 5 to 54 months (mean, 30.7 months). The color, texture, and thickness of the flaps were similar to those of the surrounding skin. No tumor recurrence was observed. The range of motion of flexion and extension of the knee joint were greatly improved in the patients with post-burn scar contracture. Conclusion For patients who have the oblique branch from the LCFA descending branch which sends out perforating vessels to the skin of the anterolateral thigh region, a dALT flap could be used to reconstruct soft tissue defects of the lower extremities.
ObjectiveTo investigate the clinical anatomy and application of free profunda femoral artery pedicled chimeric myocutaneous perforator flap in the defect reconstruction after radical resection of tongue carcinoma. MethodsBetween April 2011 and January 2016, 44 cases of tongue carcinoma underwent radical resection, and tongue defects were reconstructed by free profunda femoral artery pedicled chimeric myocutaneous perforator flaps at the same stage. There were 40 males and 4 females, with a mean age of 46.3 years (range, 32-71 years). The pathologic type was squamous cell carcinoma, which involved the lingual margin in 24 cases, the ventral tongue in 17 cases, and the mouth floor in 3 cases. According to Union for International Cancer Control (UICC) TNM staging, 16 cases were rated as T4N0M0, 11 cases as T4N1M0, 9 cases as T3N1M0, and 8 cases as T3N2M0. The course of disease ranged from 1 to 22 months (mean, 8.6 months). The size of perforator flap ranged from 8.5 cm×4.0 cm to 12.0 cm×6.5 cm, and the size of muscle flap ranged from 4.0 cm×3.0 cm to 7.5 cm×5.0 cm. The adductor magnus myocutaneous flap with a pedicle of (8.3±0.5) cm was used in 11 cases, and the gracilis muscle myocutaneous flap with a pedicle of (8.1±0.8) cm was used in 33 cases. The donor sites were sutured directly. ResultsAll 44 perforator flaps survived uneventfully, and the donor site healed well. The patients were followed up for 12 to 40 months (mean, 23.8 months). The reconstructed tongue had good appearance and function in swallowing and language. No local recurrence was found. Only linear scar was left at the donor sites. ConclusionThe free profunda femoral artery pedicled chimeric myocutaneous perforator flap can be harvested in various forms, and is an ideal choice to reconstruct defect after radical resection of tongue carcinoma.
Objective To investigate the influencing factors for restenosis after femoral endarterectomy in treatment of arteriosclerosis obliterans at femoral artery . Methods A total of 103 patients with arteriosclerosis obliterans at femoral artery who underwent femoral endarterectomy from Jan. 2012 to Jan. 2017 in our hospital were retrospectively selected as subjects of this study, to compare the clinical feathers between restenosis group and patent group, and then exploring the influencing factors for restenosis after femoral endarterectomy. Results Thirty-six patients (35.0%) suffered from restenosis after femoral endarterectomy. Patients in the restenosis group had a high proportion of high smoking and diabetes mellitus, and high level of low density lipoprotein than those corresponding indexes of the patent group (P<0.05). Results of Cox proportional hazard model showed that, diabetes mellitus 〔RR=3.338, 95% CI was (1.003, 11.113), P=0.049〕 and high level of low density lipoprotein 〔RR=3.311, 95% CI was (1.166, 9.397), P=0.024〕 were independent risk factors for restenosis after femoral endarterectomy. Conclusions Monitoring of high-risk factors like controlling blood glucose strictly and strengthening statin treatment should be done to reduce the risk of restenosis after femoral endarterectomy for patients with arteriosclerosis obliterans at femoral artery.
Objective To evaluate the safety and efficacy of the femoral arterial preclosure by purse-string suture for thoracic endovascular aortic repair (TEVAR). Methods From January 2013 to September 2016, TEVAR was performed on 40 patients with Standford type B aortic dissection. There were 34 males and 6 females aged 57.9±10.4 years. According to the surgical procedure, they were divided into a purse-string group (20 patients, 16 males, 4 females, aged 58.1±10.3 years), in which the patients received femoral arterial preclosure by purse-string suture and a convention group (20 patients, 18 males, 2 females, aged 57.7±10.8 years), in which the patients underwent conventional femoral cutdown. The outcomes and complications of two groups were evaluated. Results There was no in-hospital death and no paraplegia event. There was significantly shorter operation time (70.4±24.0 min vs. 100.8±35.6 min, P=0.003) and less blood loss (39.5±29.8 ml vs. 83.5±86.5 ml, P=0.038) in the purse-string group than those in the convention group. Femoral artery stenosis was observed in 3 patients (15.0%) in the convention group and none in the purse-string group during the follow-up of 1-36 (17.2±11.5) months with no statistical difference (P=0.231). Conclusion Using the femoral arterial preclosure by purse-string suture for TEVAR can save operation time, reduce intraoperative bleeding and decrease the approach-associated complications.
ObjectiveTo discuss the effectiveness of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting in treatment of lower extremity arteriosclerosis obliterans (ASO) or combined with diabetic foot. MethodsBetween March 2014 and June 2016, 9 patients with lower extremity ASO or combined with diabetic feet were treated with femoral-femoral artery bypass grafting and transverse tibial bone transporting. All patients were male, aged from 63 to 82 years with an average of 74.2 years. The disease duration of ASO was 1.5-22.0 months (mean, 10.5 months). All cases were severe unilateral iliac arterial occlusion, including 5 cases of the left side and 4 cases of the right side. There were 7 cases with superficial femoral and/or infrapopliteal artery disease. There were 7 cases of ASO and 2 cases of ASO combined with diabetic foot (Wagner grade 4); all the ASO were grade Ⅳ according to Fontaine criteria. All patients had rest pain before operation, and the ankle brachial index was 0.24±0.12. In femoral-femoral artery bypass grafting operations, artificial blood vessels were used in 7 cases and autologous saphenous vein were used in the other 2 cases. The tibial bone transverse transporting began on the 8th day after operation by 1 mm per day and once per 6 hours; after transported for 2-3 weeks, it was moved back. The whole course of treatment was 10-14 weeks. ResultsThe incision of tibial bone transverse transporting was necrotic in 1 case, and healed after dressing change. There was no obvious complication at the orifice of the needle. The other patients had no incision complication. The granulation tissue of foot wound was growing quickly after tibial bone transverse transporting, and the wound was reduced after 2-3 weeks. All the 9 patients were followed up 12-32 months (mean, 19 months). The ankle brachial index was 0.67±0.09 at 2 months postoperatively, which was significantly higher than that before operation (t=17.510, P=0.032). All the feet ulcer wounds healed and the healing time was 6.7-9.4 weeks (mean, 7.7 weeks). During follow-up, color Doppler ultrasound or CT examination revealed grafted blood vessel patency. The external fixator was removed at 12-14 weeks after operation. One case died of sudden myocardial infarction at 14 months after operation, and there was no lymphatic leakage. The patency rate of femoral-femoral bypass was 100% at 1 year after operation. The tibial transverse bone grafting healed with tibia at 4-6 months after operation. At last follow-up, the effective rate was 100%. ConclusionFemoral-femoral artery bypass grafting combined with transverse tibial bone transporting is an effective method in the treatment of lower extremity ASO or combined with diabetic foot.