Objective To review the methods and progress on repairing hand injury with dorsal neurocutaneous vascular flap. Methods Recent l iterature on repairing hand injury with dorsal neurocutaneous vascular flap was reviewed and analyzed. Results Island fascial flap was designed on the radial or ulnar side of the dorsum of the hand based on the anatomical study of the dorsum of the hand, and the choice of pedicle depended upon the position of wound. Conclusion Repairing hand injury with dorsal neurocutaneous vascular flap is easy to perform and in l ine with the principle of repairing wounds in proximity. It is one of the effective methods of repairing wounds of the hand.
Objective To explore the clinical value of repairing extensive gluteal-sacral defects with the posterior femoral cutaneous neurovascular island flap. Methods From July 2002 to May 2005, the posterior femoral cutaneous neurovascular flap was applied to repairing extensive gluteal-sacral defects in 6 patients (3 males, 3 females; aged 31-59 years). Threepatients had a skin defect in the gluteal-sacral region caused by squamous cell carcinoma, 1 patient had the defect in the same region caused by malignant fibrohistiocytoma, and 2 patients had the defect caused by bedsores of grade Ⅲ. The area of defects ranged from 15 cm×8 cm to 16 cm×10 cm.The flaps rangedin area from 15 cm×8 cm to 18 cm×10 cm. Results In all the 6 patients had their flaps survived well and the wounds gainedthe primary healing. The follow-up for 2.5-12 months revealed that, flaps were satisfactory in their appearance, texture, and sensory functions. Conclusion The repair of extensive gluteal-sacral defects with the posterior femoral cutaneous neurovascular island flap has advantages of the unchangedanatomic structures, reliable blood supply, easy dissection for extensive defects, good sensory recovery, and sacrificing no major vessels; therefore, this kind of repair is an optimal approach to repairing extensive glutealsacral defects.
Objective To investigate the management of the soft tissue defect after the Achilles tendon repair. Methods From April 1996 to April 2006, 24 patients(17 males, 7 females; aged 16-59 years), who suffered from postoperative Achilles tendon exposure caused by local soft-tissue necrosis after the Achilles tendon repair, were treated and evaluated. Of the 24patients, 8 had an original open injury (machinecrush injury in 2 patients, heavy-object press injury in 3, motorcycle wheel crush injury in 3) and 16 patients had a closed injury (sports injury). In their treatment, the transferof the sural neurovascular flap was performed on 8 patients and the transfer ofthe saphenous neurovascular flap was performed on 3 patients. The secondary Achilles tendon repair was performed on 13 patients before the neurovascular flap transfer was performed. The time between the injury and the operation was 9-76 days, and the time between the Achilles tendon expousure and the operation was 3-65 days. Results All the flaps survived and the Achilles tendon exposure was well covered by the flaps of good texture. Eighteen patients followed up for 6 months to 24 months had no flap complication, and the two point discrimination of the flaps was 12-20 mm. The AOFASAnkleHindfoot Scale assessment revealed that 8 patients had an excellent result, 6 had a good result, 3 had a fair result, and just 1 had a poor result, with theexcellent and good results accounting for 77.8%. Sixteen patients (89%) were able toperform a tip-toe stance on their operative sides, and only 3 of them complained a loss of plantarflexion strength. However, 2 patients still could not perform the tip-toe stance. Conclusion The Achilles tendon repair, ifnot well performed, can result in the local soft-tissue necrosis and the subsequent Achilles tendon exposure. If those complications occur, the neurovascular flap transfer should be performed as soon as possible; if necessary, the secondary Achilles tendon repair should be performed, too.
Objective To provide the anatomic basis for thedesign of the intermediate dorsal neurocutaneous flap on the foot and to reportthe clinical results. Methods On 32 adult cadaver lower limb specimens perfused with red latex, the origins, diameters, courses, branches, and distributions of the intermediate dorsal cutaneous nerve of the foot and its nutrient vessels were observed. On this anatomic basis, from June 2004 to October2005, 5 flaps were developed and applied to the repair of the soft tissue defect in the feet of 4 patients. Results The intermediate dorsal cutaneous nerve of the foot was found to arise from the superficial peroneal nerve. Crossing the intermalleolar line, it was located 1.3±0.6 cm lateral to the midpoint of the line with a diameter of 2.05±0.56 mm. The nerve stem divided into branches 2.8±1.3 cm distal to the line. They distributed the dorsal skin of the second, third and fourth metatarsal and toe. On average, 5.1 perforators per specimen were identified. At least 3 nutrient vessels were always found in each. They originated from the cutaneous branches of the anterior tibial artery and the dorsalis pedis artery in the proximal end and the dorsalis metatarsal artery in the distal end. They perforated the deep fascia 4.3±0.4 cm proximal to the intermalleolar, 1.6±0.3 cm proximal to the tip of the third toe webspace and 1.5±0.3 cm proximal to the tip of the forth toe webspace, respectively. The external diameters of them were 0.82±0.13, 0.42±0.07 and 0.49±0.09 mm, respectively. The patients were followed up for 4-10 months. All theflaps survived completely. Their appearance and function were satisfactory. Conclusion The distallybased intermediate dorsal neurocutaneousflap on the foot has an abundant blood supply. This kind of flap is especially useful in repair of the soft tissue defect in the foot.
Objective To investigate the surgical methods and cl inical results of reconstructing soft tissue defects in distal dorsal is pedis with distally based medial dorsal neurocutaneous flap on foot. Methods From January 2004 to July 2007, 11 cases of soft tissue defects in distal dorsal is pedis were treated with the distally based medial dorsal neurocutaneousflap on foot, including 8 males and 3 females aged 18-55 years. Nine cases were caused by crash and 2 cases were caused by traffic accident. There were 4 cases of tendon exposure and skin defects in the distal dorsal is pedis, 6 cases of bone exposure and skin defects in and adjacent to the first metatarsal head and 1 case of bone exposure and skin defects in the distal dorsal is pedis due to the third and fourth toe damage. The area of defects ranged from 3 cm × 3 cm to 7 cm × 5 cm. Distally based medial dorsal neurocutaneous flaps on foot were incised to repair the soft tissue defects and the size of the flaps ranged from 4 cm × 4 cm to 8 cm × 6 cm. Thickness skin graft was appl ied to repair donor site. Results All the flaps survived and all wounds healed by first intention. Skin graft in donor site survived completely in 10 cases and survived partly in 1 cases (heal ing was achieved after the flap above lateral malleolus was used to repair). All cases were followed up for 6 months-1 year. The color, texture and thickness of the flaps were similar to those of recipient site. All patients returned to their normal weight-bearing walking. No skin ulceration in flaps and donor site was observed. Conclusion The operative technique of the distally based medial dorsal neurocutaneous flap on foot is simple, convenient and safe. The distally based flap is effective in repairing soft tissue defects of middle and small sized skin and soft tissue defects in distal dorsal is pedis.
Objective To investigate the operative techniques and cl inical results of the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery in repairing donor site defect of forefoot. Methods From March 2005 to October 2007, 15 patients (11 males and 4 females, aged 20-45 years with an average of 33.6 years) with finger defects resulting from either machine crush (12 cases) or car accidents (3 cases) were treated, including 12 cases of thumb defect, 2 of II-V finger defect and 1 of all fingers defect. Among them, 6 cases were reconstructed with immediate toe-to-hand free transplantation after injury, and 9 cases were reconstructed at 3-5 months after injury. The donor site soft tissue defects of forefoot were 6 cm × 4 cm-12 cm × 6 cm in size, and the superficial peroneal neruofasciocutaneousflaps ranging from 10 cm × 4 cm to 14 cm × 6 cm were adopted to repair the donor site defects after taking the escending branch of the distal perforating branch of peroneal artery as flap rotation axis. The donor sites in all cases were covered with intermediate spl it thickness skin grafts. Results All flaps survived and all wounds healed by first intention. All reconstructed fingers survived completely except one index finger, which suffered from necrosis. Over the 6-18 months follow-up period (mean 11 months), the texture and appearance of all the flaps were good, with two-point discriminations ranging from 10-13 mm, and all patients had satisfactory recovery of foot function. No obvious discomfort and neuroma were observed in the skin-graft donor sites. The feel ing of all the reconstructed fingers recovered to a certain degree, so did the grabbing function. Conclusion Due to its rel iable blood supply, no sacrifice of vascular trunks, favorable texture and thickness and simple operative procedure, the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery is effective to repair the donor site defect in forefoot caused by finger reconstruction with free toe-to-hand transplantation.