ObjectiveTo explore the effectiveness of one-stage metacarpal osteotomy, thumb opponensplasty and polygonal flap reconstruction in the treatment of congenital spade hand deformity. MethodsEight cases of congenital spade hand were treated between January 2013 and March 2017. There were 5 males and 3 females, with an average age of 17.5 months (range, 13-35 months). The clinical manifestations of all the children were congenital spade hand and the affected hand was shorter than the healthy side. The contralateral hand was normal and there was no chest, skull, or facial deformity. The operation was performed with metacarpal osteotomy and thumb opponensplasty, and through the dorsal metacarpal rectangular flap to reconstruct the first web and through rotation of polygonal skin flap to reconstruct thumb web and lateral fold of thumb index nail. The dorsal ulnar and proximal radial segment of thumb were repaired by skin grafting. A vernier caliper was used to measure the first web space and the thumb function was evaluated by modified Tada score. ResultsThe reconstruction of palmar function and the formation of first web were completed in one stage in 8 children. Skin grafting on the dorsal ulnar side of thumb and radial side of index finger survived after operation. All the children were followed up 13-29 months, with an average of 16.1 months. There was no infection, skin flap necrosis, lateral deviation of thumb, scar contracture, or other complications. At last follow-up, there was no significant difference in skin color between the healthy side and the first web of the affected hand. The opening distance of first web space was 3.5-5.0 cm, with an average of 4.2 cm. According to the modified Tada scoring system, the results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. The thumb could grasp and pinch actively, and the palm opposition function was good. ConclusionOne-stage thumb opponensplasty combined with polygonal flap for reconstruction of congenital spade hand deformity can improve hand function very well. The reasonable designing of skin flap can effectively cover important areas, and the operation is safe and reliable.
Objective To investigate the operative technique and clinical effect of perforator-based flap for repair of glutealsacral skin defects. Methods A new perforator-based flap derived from the gluteal, parasacral and the lumbar arteries was used to repair skin defects ofglutealsacral region caused by trauma or pressure sore. The flap areas ranged from 6 cm×5 cm to 19 cm×11 cm, the diametre of perforating vessel ranged from 1.3 to 2.1 mm,the length of free perforating vessel pedicle ranged from 2.5 to 4.5 cm.Results All the flaps survived andthe wound gained primary healing. All the patients were followed up for 6 to 24months. The colour and texture of the flaps were excellent, the configuration was satifactory and there was no ulcer recurrence. Conclusion This new type of flap is characterized by delicate design, easy dissection, reliable blood supply, nosacrifice of the underlying muscle and no requirement skin graft for donor site closure. It is an optimalmethod in repairing soft tissue defects of the gluteal-sacral region.
Objective To introduce the new progress of perforator flaps as an new reconstruction technique. Methods The literature both at home and abroad was reviewed, and the research findings of different perforator flaps were summarized. Results The advantage of perforator flaps versus musculocutaneous flaps was the reduced morbidity of the donor site with preservation of the nerves, muscles and deep fascia. The postoperative complications at donor sites reduced. Conclusion Perforator flap was the new and reliable technique forreconstructionof tissue defect and may be one of the primary choices in the future.
Objective To investigate the surgical resection and reparation of heel with malignant melanoma. Methods Eight patients with malignant melanoma were treated from May 2001 to December 2003. The patients included 5 males and 3 females, and their ages ranged from 28 to 56 years. All lesions were located in theheel and were proved by pathological examination. According to Breslow classification, there were 2 cases of Grade Ⅰ, 5 cases of Grade Ⅱ, and 1 case of GradeⅢ. Local extensive resection was performed in all cases. Lateral pedal skin flap, plantar medial artery island skin flap, and retrograde skin flap supplied bysural nutrition blood vessel were respectively applied in the reparation according to the size of heel soft tissue defect. The treatment with interferon was delivered before and after the operation. Results The surgical reparation was successful in all 8 cases. The postoperative follow-up was conducted from 18 monthsto 4 years. All patients remained alive and no tumor recurrence was observed. Considering the recovery of the function and sense, the best result was acquired with plantar medial artery island skin flap and lateral pedal skin flap, good with retrograde skin flap supplied by sural nutrition blood vessel. Conclusion Local extensive resection is essential for the heel with malignant melanoma. Reparative reconstruction should be made on negative operative margin. Satisfactory clinical outcome is achieved by using lateral pedal skin flap, plantar medial artery island skin flap, and retrograde skin flap supplied by sural nutrition blood vessel.
OBJECTIVE To provide the anatomical basis for the free paraumbilical flap with sensory nerve. METHODS The morphology, branch and distribution of the inferior epigastric artery and inferior intercostal nerve were dissected and measured in 20 adult cadaver specimens. RESULTS The diameter of inferior epigastric artery at the original point was (2.3 +/- 0.3) mm, and that of its accompanying vein was (3.6 +/- 0.4) mm. The anterial branch of inferior intercostal nerves transversed through their corresponding intercostal spaces of axilla anterior line and ran out of the superficial fascia at the midclavicular line. The lateral anterior branch of the eighth to tenth intercostal nerves ran out of superficial fascia in the range of 0-7 cm above umbilicus and innervated the paraumbilical flap. CONCLUSION It is possible to design sensory paraumbilical flap with the lateral anterior branch of the eighth to tenth intercostal nerve.
【Abstract】 Objective To study the repair and functional reconstruction of oropharyngeal defects after resection of advanced-stage tonsillar cancer, and to select the donor site of appropriate flap. Methods Between October 2000 and February 2010, 13 patients with advanced-stage tonsillar cancer were treated, including 5 cases of high differentiation squamous cell carcinomas and 8 cases of medium differentiation squamous cell carcinomas. There were 11 males and 2 females, with an average age of 53.6 years (range, 39-67 years). According to Union for International Cancer Control (UICC) 1997 standards of oropharyngeal cancer, 1 case was classified as T1N1M0, 2 as T2N1M0, 2 as T2N2M0, 3 as T3N1M0, 2 as T3N2M0, 2 as T4N1M0, and 1 as T4N2M0. The disease duration was 1-8 months with an average of 4.3 months. The tumor invaded lateral wall of nasopharyngeal in 1 case, lateral wall of hypopharynx in 3 cases, epiglottis in 1 case, soft palate in 4 cases, and tongue root in 3 cases. The tumor infiltrating range was from 2 cm × 2 cm to 12 cm × 6 cm. All the 13 cases underwent integrated methods of surgery and postoperative radiotherapy. After resection of tumor by combined neck-mandible-oral cavity approach, pectoralis major myocutaneous flaps were transplanted in 5 cases, forearm free skin flaps in 5 cases, and anterolateral thigh free skin flaps in 3 cases. Results The postoperative pathological results showed 10 cases of cervical lymph node metastasis; 2 cases had local recurrence and 3 cases had cervical lymph node metastasis after postoperative radiotherapy. Neck infection occurred at 5 days after operation in 1 case undergoing transplantation of pectoralis major myocutaneous flap, and vascular crisis occurred at 12 hours after operation in 1 case undergoing transplantation of forearm free skin flap, which were cured after correspondent treatments. The other flaps survived with incision healing by first intention. Second suture was carried out in 1 case undergoing anterolateral thigh free skin flap transplantation because of wound disruption at the donor site. All the patients were followed up 1 to 6 years, with an average of 3.6 years. In 5 cases undergoing pectoralis major myocutaneous flap transplantation, swallowing obstruction and stomatolalia occurred. In 8 cases undergoing free skin flaps transplantation, the appearances of the flaps and the functions of swallowing or speaking were satisfactory, with no dysfunction at the donor site. All the patients returned to normal occlusion, facial appearance and function were normal. According to the direct calculation method, the three-year survival rate was 60.0% (6/10), and five-year survival rate was 37.5% (3/8). Conclusion For the patients with advanced-stage tonsillar cancer, forearm free skin flaps, or anterolateral thigh free skin flaps is the first choice for repairing defect. However, it is better to choose pectoralis major myocutaneous flaps in patients who need large flap and fail to radiotherapy.
Objective To discuss the advantages and disadvantages of flaps in therepairment of soft tissue defects in upper extremity. Methods Based on the 2 609 cases of flaps in 2 512 patients from 1995 to 2004,the advantages and disadvantages of different sort of flaps, outcomes of treatment and indications of different soft of flaps were analyzed retrospectively. In the series, 2 089 pieces of the traditional flaps of different sorts were applied in 1 992 patients, 474 piecesof the axial flaps of different sorts were applied in 474 patients, different sorts of free flaps were used in 46 patients. Results Follow-ups were done for 1 month to 9 years (2.7 months in average). 2 531 flaps survived (97.01%); complete necrosis occurred in 10 flaps(0.38%); partial necrosis occurred in 68 flaps(2.61%). Of the 2 089 traditional flaps, 46 had partial necrosis(2.2%); 687 needed flap revisions(32.9%). Of the 474 axial flaps, 28 had complete or partial necrosis(5.9%); 82 needed revisions(17.3%). Of the 46 free flaps, 4 had complete or partial necrosis(8.7%) and nearly all the anterolateral flpas of thighs needed revisions.Conclusion Traditional flaps had the advantages of easy manipulation and the highest survival rate, however, also had the disadvantages of poor texture and many timesof operations. The flap with a pedicle had the advantage of good texture, consistent artery, free-range arc, however, the venous congestion was its disadvantage, which impaired the survival of the reverse flap. Free flap had the advantage ofgood texture and abandant donor site, but complicate manipulation was its shortage. Axial Flap with a pedicle is the optional choicefor repairing soft tissue defects in upper extremity.