Twenty cases with skin defect of forearm and hand were treated by free skin graft with subcutaneous fat from 0.5 to 0.7 cm in thickness. The maximal area of free skin graft is 27×10cm, and the smallest one is 1.5×2cm. All of skin flaps survived except one having partial necrosis. Follow up shown round external figure, clasticity, and no change of skin color. It preserved the function of sweat gland and the cutaneous sensation began to recover 4 months postoperation.
Objective To explore the results of repairing widespread traumatic soft tissue defects in the heels and adjacent regions with free latissimus dorsi muscle-skin flaps. Methods From March 1998 to May 2005, 10 cases of widespread traumatic soft tissue defects in the heels and adjacent regions were repaired with free latissimus dorsi muscleskin flaps. Of the 10 patients, 9 were male and 1 was female, whose ages ranged from 32 to 60years, and the disease course was 2 hours to 2 months. The defect was by ploughmachine injury in 5 cases, by crush injury in 2 cases, by snake injury in 2 cases, and electricity injury in 1 case. Eight cases of defects involved in the posteriorof heel and leg, the defect area ranged from 21 cm×12 cm to 35 cm×15 cm; 2 cases had widespread soft tissue defects on heel, ankle, sole and dorsal foot, and the defect area was 27 cm×14 cm and 30 cm×21 cm respectively. All cases were accompanied by the exposure of bone; 6 cases by fracture; 4 cases by openinfection of ankle joint; and 2 cases by injuries of the posterior tibial vessel and the tibial nerve. The sizes of the dissected flap ranged from 25 cm×14 cm to 33 cm×24 cm. The donor sites were covered by large mid-thickness flap. Results There were no postoperative complication of vascular crisis and infection. Ten flaps survived completely and the wounds healed by first intention. After a follow-up of 3 to 24 months, five cases received twostageplastic operation because bulky flaps bring some trouble in wearing shoes. In 5cases of reconstructed sensation, two cases recovered pain and temperature sensation. All cases recovered the abilities to stand and walk without ulcer complication. Conclusion The free latissimus dorsi muscle-skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds with muscle defects and bone exposure in the heel and adjacent regions, because it has such advantages as adequate blood supply, big dermatomic area, and excellent ability to resist infection.
A comparative study was given to a group of grafted tendons on rabbits either with complete immobilization or early controlled passive mobilization of the affected parts immediately following operation. In the study, the healing mechanism, adhesion formation and breaking strength at the grafted site of the tendons were included. The results showed that early controlled passive mobilization had no influence on the survival and its healing process, but the adhesion surrounding tendons would be looser and the vessels on the surface, of the grafted tendons would be orientated longitudinally enhancing tendon gliding promoted collagen it would also promote collagen production and thus increased the rupturing strength at the grafted site.
The main arterial blood supply to the retroauricular region came from the posterior auricular artery. At the level of mastoid, the caliber of the artery was measured at 1mm in diameter, The posterior auricular vein drained into the external jugular vein. Vascularized retroauricular skin flap was used to repair 2 cases of partial nose defects with success and the outer appearance of the nose was quite satisfactory. The applied anatomy and the surgical procedure were detailed.
OBJECTIVE: To investigate the clinical effect of free vascularized thoracoumbilical flap with reversal flow in repairing the soft tissue defect in leg with tibia exposure. METHODS: Forty-four casting mould specimens of leg arteries were studied firstly. Then 25 cases with soft tissue defect and tibia exposure in the proximal-middle segment of leg were adopted in this study. Among them, 18 cases had long distance thrombosis of the anterior tibial vessels or posterior tibial vessels due to traumatic lesion. The maximal size of defect was 28 cm x 11 cm and the minimal size of defect was 11 cm x 9 cm. In operation, the thoracoumbilical flap which was based on the inferior epigastric vessels was anastomosed to the distal end of the anterior tibial vessels or posterior tibial vessels. RESULTS: Anterior tibial artery, posterior tibial artery and fibular artery had rich communication branches in foot and ankle. All the flaps survived, the color and cosmetic result of them were good. CONCLUSION: The free vascularized thoracoumbilical flap with reversed flow is practical in repairing the soft tissue defect of leg with tibia exposure. Either the anterior tibial vessels or the posterior tibial vessels is normal, and the distal end of injured blood vessels is available, this technique can be adopted.
Abstract In order to have more selective sources of skin flaps to repair soft tissue defects, the prefabricated flap combining with skin expander was tried. Implanted the dorsal thoracic artery and vein with a muscle bundle of latissimus dorsi into the lateral thoracic wall subdermally andset a skin expander subcutaneously. Injected saline into the expander to inflate the flap gradually. In a month, an axial flap with the dorsal thoracic vesselswas prepared. the flap was transferred to the defect by vascular anastomosis technique. This method was applied in two cases, one to the left ankle, another to the left side of the neck. The sizes of the two flaps were 20cm×14cmand 22cm×15cm respectively. After operation, the flaps were alive completely. The advantages included selective source of vascular pedicle, thinpliable flap with enough blood supply, and direct closure of the donor site without skin graft.
OBJECTIVE: To explore the clinical result of velopharyngeal cerclage in repairing velopharyngeal incompetence of postoperative cleft palate patients. METHODS: From 1987 to 2000, 25 cases of velopharyngeal incompetence due to postoperative cleft palate were given the velopharyngeal cerclage. The mucosa flap of palate was pushed back, the autogenous free grafts of denervated skeletal muscle were selectively used for velopharyngeal cerclage. All the patients were followed up for 2 and a half years on average. RESULTS: All the patients achieved good results with velopharyngeal competence and good articulation. The patients’ sound of voices was clear. CONCLUSION: This method can be used to repair velopharyngeal incompetence of postoperative cleft palate patients; the operation is simple and the results are satisfactory.
Eight cases of tissue defect inthe faciomaxillo-neck region weretreated by application of the vascu-larized paraseapular free flap Themain causes of the tissue defects werepostresection of tumor in the faceor neck and cicatrical contractureafter burn. The method of flapdesign was discussed. It was stress-ed that the incision of the flap onthe outer margin should be 2 cmbeyond the lateral border of thescapula, thus the damage to thesuperficial branch of the circumfl-ex seapular artery could be avoided.
In order to understand the influence of the free tendon graft and the tendon transfer on their blood supply, histological and biochemical changes during healing following repair of the damaged tendon after the alteration of the nourishing environment, an experiment was carried on 36 New Zealand white rabbits. In the front paws of the rabbits, the free tendon graft was sutured in the tendon defect of flexor of the fourth toe and the flexor tendon of the third toe was transferred to the second toe to reconstr...