Objective To introduce the application of the pedicled anterolateral thigh flap transferring for coverage of the oversized skin defect of the hand. Methods The pedicled anterolateral thigh flap was transferred to cover the large skin defects of the hands or the skin defects of theabdomen after the abdominal flap transferred to the hand in 5 male patients aged 16-44 years from April 2002 to August 2005. The injured sites were as follows:4 right hands and 1 left hand, including 2 hands injured by a machine and 3 hands injured by burning.The mechanically injured patients underwent an operation within 6 hours after the injury. The burned patients were reconstructed by the flap transferring 4-7 days after the burn when the decayed tissues could be clearly indentified.The areas of the hand defects were 12.19 cm×18.22 cm.The areas of the pedicled anterolateral thigh flaps were 7.12 cm×16.24 cm. The areas of the abdominal flaps were 13.20 cm×19.23 cm.The pedicles were separated 3 weeks after the repairing operation. Results All the flaps survived well and there was no vascular crisis, with the wound healing of the first intention. The skin defects of the hand were covered completely. Five patients were followed up for 6-12 months. The texture of the flaps was soft and the flaps had a good blood circulation. Of the patients, 3 underwent the finger exclusion and degreasing operation 47 months after operation. All the flaps of the hands had protective sensation, which could meet the requirement of the daily life. Conclusion The pedicled anterolateral thigh flap can provide the large coverage for the skin defects of the hands. The risk of the operation can be greatly decreased by obviation of the vessel anastomosis. It can be an optimal choice for themanagement of the oversized skin defects of the hands.
Objective To introduce the surgical procedure and indication of the reverse fascial pedicle island flap of the digital artery dorsal branches in repairing finger skin defect. Methods By use of the dorsal branches of the digital artery as the pedicel, the reverse island flap was designed. The skin defectsof the proximal interphalangeal joint and beyond in 35 cases (42 fingers) were repaired and the joint or extensor tendon was reconstructed simultaneously. Donor site was primarily closed or a skin graft was used. The flap size ranged from 1.0 cm×2.5 cm to 1.5 cm×3.5 cm.Results Thirtyfive patients were followed up 3 months to 1 year, all the flaps survived. The two-point discrimination was between 6 mm and 10 mm. The function of interphalangeal joint was satisfactory.Conclusion These flaps have the advantages of an extended skinpaddle and a versatile pivot point on the phalanx, and they allow coverage of wide and distal defects.
OBJECTIVE In order to increase the survival area of pedicled fasciocutaneous flap, a multiple pedicled blocking randomized fasciocutaneous flap was designed. METHODS From January 1991 to September 1998, this technique was used to repair 33 cases, including 27 males and 6 females and the ages ranged from 6 to 58 years. All of the patients were suffered from traffic accidents. In these cases, 22 cases had skin defects of legs and feet with bone, nerve and tendon exposed, 5 cases had osteomyelitis as well as internal fixaters exposed and the other 6 had deformity from scar. The size of the flap was 25.0 cm x 13.0 cm x 2.4 cm at its maximum and 6.0 cm x 3.5 cm x 1.5 cm at its minimum. Based on the traditional blocking flap, according to the severity of the wound and conditions of the neighboring tissues, a flap having 2 to 4 orthogonal pedicles with a width of 1.5 to 3.0 cm was designed. The medical-graded stainless steel sheet was implanted below the deep fascia, and after blocking for 3 to 6 days, the side pedicles were divided. 6 to 14 days later, one of the two remaining pedicles was divided and was transferred to repair the defect. RESULTS 31 cases were followed up for 6 months to 5 years without any trouble of the joints. The flap had a good external appearance and was high pressure-resistant. CONCLUSION The multiple pedicled blocking randomized fasciocutaneous flap increased the size of the flap and the length to width ratio. It had the following advantages: manage at will, high resistance to infection and a large survival area of flap.
OBJECTIVE To introduce a skin flap containing the middle cutaneous branch of the medial plantar artery. METHODS Microanatomic study was performed on 8 fresh cadaveric feet, the arteries were dissected and infused with methylene blue to observe their vascular distribution and the skin area supplied by the middle cutaneous branch. Furthermore, the clinical application was reported. A local pedicled flap containing the middle cutaneous branch was used to repair the soft tissue defects of the foot in 7 patients, and free cutaneous graft was used to repair the skin defects of the fingers in 6 patients. RESULTS The results showed that the medical plantar artery gave off 3 cutaneous branches to supply the medial aspect of the foot, among which the middle branch was the largest one and anastomosed with the other two branches. The skin flaps used clinically were all survived completely. CONCLUSION Medial plantar cutaneous graft had a reliable blood supply, and it’s one of the best choice in repairing small to middle sized skin defects of the foot and the fingers.
Superficial cervical artery skin flap is widely used in clinical practice. In order to inprove the outcome of the flap in clinic, eleven cases of skin defect of scalp who were treated with the flap was discussed. After operation, the donor area healed but there was no hair growth on recipient area. Among them, six cases occurred partial necrosis of skin flaps. In order to avoid these problen, the relevant solution discussed as follows: 1. Handle well the pedicle of the skin flap to prevent the interference with venous returm. 2. Adhere strictly to indications. 3. Apply skin expander to obtain "extra" skin, then carryout the tranfer of skin flap and 4. Better use the skin flap with residual hair.
To meet the special need of function and cosmetics, thin skin flap was used in repair of skin defect of hand. It was reported that 37 cases with skin defect of hand had been treated since 1992. Eight kinds of flaps were used, including sub-abdominal flap (in 8 cases), paraumbilical flap (in 8 cases), intercostal flap (in 5 cases), subclavicular flap (in 3 cases), thoracoacromial flap (in 3 cases), trigonum clavopectoral flap (in 4 cases), thenal flap (in 2 cases) and pedicled flap carrying superficial iliac circumflex artery (in 4 cases). All of defects were treated by one-stage operation. The size of the flaps used ranged from the minimum of 1.2 cm x 2.5 cm to the maximum of 10 cm x 16 cm. All the flaps were survived. The function and appearance of the hands were satisfactory. It was noted that thin skin flap had developed from conventional pedicled flap and subcorium vascular-net flap, but it was easy to perform and had a high rate of success. The principle in choosing the flap was also discussed. It was suggested that more attention should be concentrated to solve the problems encountered in the use of thin skin flap in the repair of skin defect.
From 1988 through 1990, the free arteriolized venous network skin flap from dorsum of foot for skin defect of dorsum of hand was done in 8 cases. The size of the skin flap measured 10×9cm in max. and 7×6cm in min. The operation achieved good success and the clinical results were satisfactory. The mechanism of survival of the skin flap, the indications of this procedure in the repair of skin defects of the dorsum of the hand and its advantages were discussed.
To introduce the experience and comprehend of appl ication of many kinds of skin flaps in repair of heel skin and soft tissue defect. Methods From August 1993 to April 2007, 242 cases of skin and soft tissue defect on heel were treated. There were 157 males and 85 females aged 27-76 years. There were 35 cases of unstable scar, 46 cases ofchronic ulcer, 57 cases of squamous cell carcinoma, 72 cases of mal ignant melanoma and 32 cases of injury. The defect area ranged from 2 cm × 2 cm to 8 cm × 14 cm, wound was with low-grade infection in 51 cases. The course of disease was 1 hour to 5 years. The lateral calcaneal flaps (34 cases), the dorsum pedis flaps (15 cases), the medial plantar artery island flaps (108 cases), the sural neurovascular flaps (36 cases), the saphenous neurocutaneous vascular flaps (26 cases) and free (myocutaneous) skin flaps (23 cases) were used to repair heel wounded surface according to specific location of heel wounded surface, range of skin and soft tissue defect. The size of the (myocutaneous) skin flap was 3.0 cm × 2.5 cm to 15.0 cm × 9.0 cm. The donor area was directly sutured or covered with skin grafts. Results In 242 cases, 235 cases achieved heal ing by first intention, 5 cases had partial necrosis of flaps, 2 cases had mild infection. The donor area healed by first intention. A total of 217 patients were followed up for 1 month to 60 months. The color of flaps were normal and the texture of flaps were softer than that of normal heel tissue; the flaps were wearable, the shape of flaps were satisfactory. The patients can walk after 6 months of operation, andthe gait was normal. In 118 cancer patients, no local tumor recurrence occurred, and distant metastatic lesions were observe in 22 mal ignant melanoma patients. In 32 cases of mal ignant melanoma followed up 60 months, no distant metastatic lesions were found. Conclusion In base of following the primary disease treatment, heel function reconstruction and contour structural feature remodel ing, we adopted some kind of island or free (myocutaneous) skin flap can be used to repair heel wound. The ideal effect in heel function reconstruction and contour structural feature remodel ing were obtained.
Objective To observe the clinical outcome of primary repair of the tissue defects of the Achilles tendon and skin by thigh anterolateral free flap and free iliotibial tract. Methods From January 2000 to January 2005, the thigh anterolateral free flap and the iliotibial tract were used to primarily repair the defects of the Achilles tendon and skin in 11 patients (7 males and 4 females, aged 6-45 years). The defects of the skin and Achilles tendon were found in 6 patients, and the defects of the Achilles tendonand skin accompanied by the fracture of the calcaneus were found in 5 patients.The defect of the Achilles skin was 6 cm×5cm-14 cm×8 cm in area. The defect of the Achilles tendon was 511 cm in lenth. The skin flap was 11 cm×6 cm-17 cm×11 cm in area.The iliotibial tract was 7-13 cm in length and 3-5 cm in width. The medial and lateral borders were sutured to from double layers for Achilles tendon reconstruction. The woundon the donor site could be sutured directly in 5 patients, and the others could be repaired with skin grafting. Results After operation, all the flaps survived and the wound healed by first intention. The followup of the 11 patients for 6 mouths-4 years (average, 30 months) revealed that according to Yin Qingshui’s scale, the result was excellent in 6 patients, goodin 4, and fair in 1. The excellent and good rate was 99%. The results showed a significant improvement in the “heel test” and the Thompson sign, and both were negative. No complications of ulceration on the heel and re-rupture of the Achiles tendon occurred. Conclusion The primary repair of the tissue defects of the Achilles tendon and skin by free grafting of the anterolateral femoral skin flap and the iliotibial tract is an effective surgical method.
Objective To investigate an operative method of repairing large skin defect of the forearm and the hand. Methods From July 2003 to September 2008, 11 patients with large skin defect of the forearm and the hand were repaired using bilateral groin flaps in complex with abdominal flaps, including 7 males and 4 females aged 17-55 years old (average33.5 years old). Among the 11 cases, 5 were caused by carding machine and 4 by traffic accident, and the interval between injury and operation was 90 minutes to 6 hours (average 3.5 hours); 2 cases suffered from severe cicatricial contracture deformity in the late stage of burn injury, and the interval between injury and operation was 7 months and 19 months, respectively. The size of skin defect ranged from 42 cm × 12 cm to 60 cm × 16 cm. The flaps harvested during operation was 45.0 cm × 10.5 cm - 62.0 cm × 18.0 cm in size. Pedicle division of the combined flaps was performed 4 weeks after operation. The donor site wound was repaired by direct suturing in 7 cases and by free skin grafting in 4 cases. Results All flaps survived. All incisions healed by first intention. The donor site wound all healed by first intention. Skin graft all survived. All patients were followed up for 2 months to 3 years. The flaps were soft in texture, full in contour, and normal in color. Sensory recovery of the flaps was evaluated according to the Criteria of UK Medical Research Council (1954), 4 cases were in grade S1, 6 in grade S2, and 1 in grade S3. Hand function was assessed by the Criteria of Chinese Hand Surgery Society, 7 cases were graded as excellent, 2 as good, 2 as poor, and the excellent and good rate was 81.8%. Conclusion Combined use of bilateral groin flaps and abdominal flap is an effective approach to repair large skin defect of the forearm and the hand due to its simple operative procedure and satisfying effect.