ObjectiveTo investigate the effectiveness of soft tissue balance technique by flexor pollicis longus (FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children. Methods A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months (range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion (ROM) of passive flexion and extension of the interphalangeal joint (IP) and metacarpophalangeal joint (MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb. Results All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months (mean, 21.7 months). At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation (P<0.05); the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation (P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side. ConclusionThe soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the Wassel Ⅳ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.
OBJECTIVE: To evaluate the application of skin and soft tissue expansion in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound. METHODS: From 1988, 83 cases of application of skin and soft tissue expansion were reported. In those patients with deformity due to severe burn of large area and with whole nasal defect, soft tissue expander was used under the forehead skin graft and venter frontalis, followed by reconstruction of nose with the expanded vascularized skin flap and carved cartilago costalis as nasal frame. In patients of severe deep electrical burned scalp and skull with fresh wound, skin and soft tissue expansion were used to repair the wound simultaneously with scalp burn alopecia, anesthetics and antibiotics injected into the extracapsular space of the expander in case of pain and infection. RESULTS: All of the cases were successfully treated with little pain and minimized infection. CONCLUSION: Skin and soft tissue expansion in a safe and reliable measure in the treatment of deformity due to extensive severe burn injury and repair of severe deep electrical burned scalp and skull with fresh wound.
Objective To explore the effectiveness of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in repairing complex calf soft tissue defects. Methods The clinical data of 11 patients with complex calf soft tissue defects between April 2018 and October 2021 were retrospectively analyzed, including 9 males and 2 females, aged 11-60 years, with a median age of 39 years. There were 8 cases of calf soft tissue defect caused by traffic accident, and 3 cases of calf skin infection caused by chronic osteomyelitis. The skin and soft tissue defects ranged from 10 cm×8 cm to 35 cm×10 cm after thorough debridement and accompanied with bone and tendon exposure. There was only one main vessel in calf of 9 cases and no blood vessel that could be anastomosed with the flap vessel could be found in the recipient site of 2 cases. The anterolateral thigh skin flap (the flap size ranged from 12 cm×10 cm to 37 cm×12 cm) was taken to repair the soft tissue defect. The donor site of the flap was treated with direct suture (8 cases) or partial suture followed by skin grafting (3 cases), and the vascular bridge was wrapped with medium-thickness skin graft. Results The flaps of 11 patients survived completely without necrosis, infection, and vascular crisis. The blood supply of the vascular bridge was unobstructed and the pulse was good. The color of the medium-thickness skin graft were ruddy. All 11 patients were followed up 2-40 months, with an average of 19.4 months. The flaps healed well with the surrounding tissues without obvious exudation and color difference. The flaps had normal color and temperature, good blood supply, and soft texture. The shape of the flap and calf contour were satisfactory and the function of the limb recovered well. The donor area of thigh flap healed by first intention without obvious scar formation. The donor area of skin healed well with a longitudinal oblong scar only and the appearance was satisfactory. ConclusionThe anterolateral thigh bridge flap transplantation with free skin wrapping vascular bridge is an effective method for the treatment of complex calf soft tissue defects.
ObjectiveTo investigate the clinical application of the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap in repair of foot and ankle defects.MethodsBetween October 2014 and October 2018, 18 cases with foot and ankle defects were treated. There were 12 males and 6 females with an average age of 32.8 years (range, 8-56 years). There were 11 cases of traffic accident injuries, 3 cases of falling from height injuries, and 4 cases of heavy objects injuries. The wound was at the dorsum of the foot in 9 cases, the heel in 4 cases, the lateral malleolus in 5 cases. The time from injury to flap repair was 7-34 days (mean, 19 days). The size of wound ranged from 6.0 cm×2.5 cm to 11.0 cm×6.0 cm. The foot and ankle defects were repaired with the peroneal artery terminal perforator propeller flap in size of 6 cm×3 cm-18 cm×7 cm, which donor site was repaired with the anterior tibial artery perforator propeller flap in size of 8 cm×3 cm-16 cm×6 cm.ResultsOne patient had a hemorrhagic swelling in the peroneal artery terminal perforator propeller flap, and survived after symptomatic treatment. All recipient and donor sites healed by first intention. Eighteen patients were followed up 6-15 months (mean, 12.5 months). At last follow-up, the shape, color, texture, and thickness of the flaps in the donor sites were similar with those in the recipient sites. There were only linear scars on the donor sites. The two-point discrimination of the peroneal artery terminal perforator propeller flap ranged from 10 to 12 mm (mean, 11 mm). According to American Orthopaedic Foot and Ankle Society (AOFAS) score criteria, the results were excellent in 15 cases and good in 3 cases, with an excellent and good rate of 100%.ConclusionThe foot and ankle defects can be repaired with the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap. The procedure is not sacrificing the main vessel and can avoid the skin grafting and obtain the good ankle function.
ObjectiveTo summarize the nursing experience of vacuum-assisted closure (VAC) technology for deficiency of skin and soft tissue in "4·20" earthquake damage. MethodsWe used VAC to treat 20 patients suffering from deficiency of skin and soft tissue who were injured in "4·20" earthquake (35 wounds) from April 21st to 28th, 2013; and we observed closely the results of nursing for pain and psychological care. ResultsA total of 35 wounds were all cleaned after 5 to 7 days; 20 wounds were healed after VAC treatment; 15 wounds recovered well by covering autogenous split-thickness skin; 20 patients had stable emotion and all left the hospital with the recovery. ConclusionVAC for deficiency of skin and soft tissue caused by "4·20" earthquake damage may obviously decrease the time of wound healing, relieve the pain caused by changing fresh dressing, and reduce the length of stay in the hospital.
Objective To investigate the effectiveness of Flow-through bridge anterolateral thigh flap transplantation in the treatment of complex calf soft tissue defects. Methods The clinical data of the patients with complicated calf soft tissue defects, who were treated with Flow-through bridge anterolateral thigh flap (study group, 23 cases) or bridge anterolateral thigh flap (control group, 23 cases) between January 2008 and January 2022, were retrospectively analyzed. All complex calf soft tissue defects in the two groups were caused by trauma or osteomyelitis, and there was only one major blood vessel in the calf or no blood vessel anastomosed with the grafted skin flap. There was no significant difference between the two groups in general data such as gender, age, etiology, size of leg soft tissue defect, and time from injury to operation (P>0.05). The lower extremity functional scale (LEFS) was used to evaluate the sufferred lower extremity function of the both groups after operation, and the peripheral blood circulation score of the healthy side was evaluated according to the Chinese Medical Association Hand Surgery Society’s functional evaluation standard for replantation of amputated limbs. Weber’s quantitative method was used to detect static 2-point discrimination (S2PD) to evaluate peripheral sensation of the healthy side, and the popliteal artery flow velocity, toenail capillary filling time, foot temperature, toe blood oxygen saturation of the healthy side, and the incidence of complications were compared between the two groups. Results No vascular or nerve injury occurred during operation. All flaps survived, and 1 case of partial flap necrosis occurred in both groups, which healed after free skin grafting. All patients were followed up 6 months to 8 years, with a median time of 26 months. The function of the sufferred limb of the two groups recovered satisfactorily, the blood supply of the flap was good, the texture was soft, and the appearance was fair. The incision in the donor site healed well with a linear scar, and the color of the skin graft area was similar. Only a rectangular scar could be seen in the skin donor area where have a satisfactory appearance. The blood supply of the distal limb of the healthy limb was good, and there was no obvious abnormality in color and skin temperature, and the blood supply of the limb was normal during activity. The popliteal artery flow velocity in the study group was significantly faster than that in the control group at 1 month after the pedicle was cut, and the foot temperature, toe blood oxygen saturation, S2PD, toenail capillary filling time, and peripheral blood circulation score were significantly better than those in the control group (P<0.05). There were 8 cases of cold feet and 2 cases of numbness on the healthy side in the control group, while only 3 cases of cold feet occurred in the study group. The incidence of complications in the study group (13.04%) was significantly lower than that in the control group (43.47%) (χ2=3.860, P=0.049). There was no significant difference in LEFS score between the two groups at 6 months after operation (P>0.05). ConclusionFlow-through bridge anterolateral thigh flap can reduce postoperative complications of healthy feet and reduce the impact of surgery on blood supply and sensation of healthy feet. It is an effective method for repairing complex calf soft tissue defects.
Objective To explore the method and effectiveness of index finger proximal dorsal island flap supplied by the nutrient vessels of superficial branch of radial nerve for treatment of thumb skin and soft tissue defect. Methods Between August 2019 and December 2024, 12 patients with thumb skin and soft tissue defects caused by trauma accompanied by variation of the first dorsal metacarpal artery were treated. There were 8 males and 4 females, aged 19-55 years, with an average age of 32 years. The wound area ranged from 2.2 cm×2.0 cm to 5.5 cm×3.5 cm. The time from injury to operation ranged from 1.5 to 6.0 hours, with an average of 4.5 hours. After thorough debridement, the wound was repaired with a index finger proximal dorsal island flap supplied by the nutrient vessels of the superficial branch of the radial nerve. The flap area ranged from 2.4 cm×2.2 cm to 6.0 cm×4.0 cm. The donor site was repaired with free skin grafting. Regular follow-up was conducted postoperatively to observe the appearance, texture, sensory recovery of the flap, and the condition of the donor site. Results The operation time ranged from 30 to 72 minutes, with an average of 47 minutes; intraoperative blood loss ranged from 30 to 70 mL, with an average of 46 mL. After operation, partial necrosis occurred at the skin edge of the radial incision on the dorsum of the hand in 1 case, which healed after dressing changes; all other flaps survived uneventfully, with primary wound healing. The skin grafts at the donor sites all survived. All 12 patients were followed up 5-36 months, with an average of 14 months. The appearance and texture of the flaps were good. At last follow-up, the two-point discrimination of the flaps ranged from 4 to 9 mm, with an average of 5.2 mm. According to the functional evaluation criteria for upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were excellent in 11 cases and good in 1 case. No scar contracture, pain, or joint movement limitation was observed at the donor sites. Conclusion For patients with skin and soft tissue defects of the thumb accompanied by variation of the first dorsal metacarpal artery, the index finger proximal dorsal island flap supplied by the nutrient vessels of the superficial branch of the radial nerve can be selected. This method has advantages such as shorter operation time, less intraoperative bleeding, and good postoperative appearance and sensation of the flap.
Abstract An animal experiment had been conducted for the purpose to find out the possibility of application of instantaneous sustained limited expansion (ISLE). A total of 54 skin defects in 9 pigs were obtained and were divided into two groups. One group of the pigs were subjected to instantaneous sustained limited expansion, the others, as the control group, just received the tension suture. At the same time the blood supply of the skin was measured by laser doppler flowmeter (LDF). It was showed that microcirculatory perfusion of the ISLE group was considerably better than that of the control. Inaddition, the correlation between the blood flow of the skin and the expanding pressure, as well as the pathologic changes of the skin were discussed.
Small intestinal submucosa (SIS) is a natural decellularized extracellular matrix material. Due to its excellent biocompatibility, unique biomechanical properties and biological activity, it has been widely used as a scaffold in regenerative medicine. This article reviews the recent progress in the characterization and medical application of SIS respectively. The specific biological properties of the SIS, as well as its interaction with cells, are highlighted. Some of the SIS products and clinical cases are also reviewed and discussed.
Objective To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury. Methods Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years (range, 19-37 years). The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days (mean, 6.5 days). The bone defect length was 8-18 cm (mean,14 cm); the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation. Results Eleven flaps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months (mean, 6.5 months). All bone defects were repaired with bone healing time of 12-22 months (mean, 17 months). All patients were followed up 8-24 months (mean, 15 months). No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good. Conclusion Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity.