Objective To investigate the clinical efficiency of thedistally based sural island flap and myofasciocutaneous flap in reconstruction of defect and osteomyelitic cavity of the ankle and foot. Methods From June 1997 to October 2004, 21 patients with soft tissue defects and osteomyelitis in the ankle and foot were treated with the distally based sural island flap and myofasciocutaneous flap. There were 20 males and 1 female aging from 6 to 78 years. The defect was caused by soft tissue defect trauma(18 cases) and electrical injury ( 3 cases). Among 21 patients, 17 were treated with island flaps, 4 by the myofasciocutaneous flap. The size of flaps ranged from 4 cm×5cm to 16 cm×22 cm. The donorsites were closed directly in 4 cases. Results The flaps completely survived in 21 cases and healing by first intention was achieved. After a follow-up of 36 months, no complication occurred. The color and texture of the flaps were good. The appearance and the function were satisfactory. Conclusion Distally basedsural flap is a reliable flap. This flap has rich blood supply without sacrifice of major arteries. Flap elevation is easy. It is very useful in repairing large soft tissue defects of the lower leg, the ankle and the foot, especially inrepairing deep soft tissue defects and osteomyelitic cavities .
【Abstract】 Objective To investigate the method and effectiveness of repairing sacrococcygeal pressure sores with modified upper gluteal rhomboid fasciocutaneous flap. Methods Between January 2004 and March 2011, 43 patients with sacrococcygeal pressure sores were treated. There were 25 males and 18 females with an average age of 63 years (range, 38-95 years). The disease duration was 3 months to 2 years and 6 months (mean, 8.5 months). The size of pressure sores ranged from 6 cm × 5 cm to 18 cm × 13 cm. According to the extent and lesion degree of pressure scores, 23 pressure sores were rated as degree III and 20 pressure sores as degree IV. The modified upper gluteal rhomboid flap was designed, one-side upper gluteal fasciocutaneous flaps were transplanted to repair sacrococcygeal pressure sores in 19 cases and two-side flaps in 24 cases. The size of one side flap ranged from 6.5 cm × 4.5 cm to 18.0 cm × 11.5 cm. Results Fluid under flap occurred in 1 case and edge necrosis of the flaps in 3 cases at 7 days after operation, which were cured after drainage and dressing change; the other flaps survived, and incisions healed by first intention. All patients were followed up 6 months to 3 years with an average of 11 months. Two patients relapsed at 5 months and 8 months, respectively; the other patients had no recurrence. The color of the flaps was normal, and the appearance and elasticity of the flaps were good. Conclusion The modified upper gluteal rhomboid fasciocutaneous flap has the advantages of simple design and operation, less injury, and reliable effect in repairing sacrococcygeal pressure sores.
Objective To investigate the operative procedures and cl inical outcomes of the modified superficial peroneal neuro-fasciocutaneous flap in repairing soft tissue defect of forefoot. Methods From May 2006 to May 2009, 5 male patients (aged 40-63 years) with soft tissue defect of forefoot were treated with the modified superficial peroneal eurofasciocutaneous flap. Tendons and bones were exposed in all cases. Defect was caused by object crash (4 cases) and traffic accident (1 case). The sizes of soft tissue defects of forefoot were 4 cm × 2 cm-8 cm × 4 cm. Rotating point of the modified superficial peroneal neuro-fasciocutaneous flap pedicled with the peripheral vessels network of ankle joint was at the level of tibiotalar joint. The flaps ranging from 5 cm × 4 cm to 10 cm × 6 cm were adopted to repair soft tissue defects of forefoot. The donor sites were either sutured directly or covered with intermediate spl it thickness skin grafts. Results All flaps survived and all wounds healed by first intention. Skin graft at donor site survived completely in all cases. All patients were followed up 6-18 months (mean 11 months). The appearance, texture, and function of the flap were satisfactory. There was a protective sensibil ity in all flaps without abrasion or ulceration, and the two-point discrimination of the flaps was 10-13 mm. The walking pattern was normal. No obvious discomfort was observed at the skin-graft donor sites. Conclusion With rel iable blood supply, no sacrifice of vascular trunks, favorable texture, and thickness, the modified superficial peroneal neuro-fasciocutaneous flap pedicled with the peripheral vessels network of ankle joint is useful to repair skin soft tissue defect of the forefoot.
Objective To find a better method of emergency repair of skin and soft tissue defects in the lower leg, ankle and foot. Methods The distally based superficial sural artery flap was designed on the posterior aspect of the leg. From February 2000 to December 2003, 18 patients with skin and soft tissue detects of the lower leg, ankle and foot were treated with island fasciocutaneous flap supplied by superficial sural artery by emergency. The size of the flap ranged form 4 cm× 5 cm to 11 cm×12 cm. Results The flaps survived totally in 16 cases and necrosed partially in 2 cases. After 1-2 year postoperative follow-up, the results were satisfactory except that in 2 flaps. Conclusion The island fasciocutaneous flap supplied by superficial sural artery may provide a useful method for emergency repair of soft tissue defect of the lower limbs.
ObjectiveTo investigate the operative method of repairing soft tissue defect of the thumb with modified radial dorsal fasciocutaneous flap and its effectiveness.MethodsBetween June 2015 and December 2016, 15 patients with volar or dorsal defects of the thumb were treated with modified radial dorsal fasciocutaneous flaps which distal pedicles were cut off. Of 15 cases, 11 were male and 4 were female, aged 35-70 years (mean, 46 years). The causes of injury included crush injury in 12 cases and avulsion injury in 3 cases. Because all patients had volar or dorsal defects of the thumb which were accompanied by tendon or bone exposure, they had no condition or desire to replant. There were 12 cases of volar defect of thumb and 3 cases of dorsal defect. The area of defects ranged from 2.0 cm×1.2 cm to 3.0 cm×2.5 cm. The time between injury and operation was 16 hours to 2 days (mean, 30.4 hours). The radial dorsal fascio-cutaneous flaps of 2.3 cm×1.5 cm to 3.3 cm×2.8 cm in size were adopted to repair defects. The donor sites were directly sutured.ResultsAll flaps survived, and no severe swelling or tension blister occurred. The donor sites and wounds healed by first intention. All patients were followed up 3-12 months (mean, 6 months). The color and texture of the grafted flaps were similar to those of normal skin, with no bloated appearance. According to total active motion standard at last follow-up, the finger function was excellent in 8 cases and good in 7 cases.ConclusionModified radial dorsal fasciocutaneous flap of the thumb is a reliable flap with easy dissection and less trauma in repair of soft tissue defects of the thumbs, and satisfactory clinical outcome can be obtained.
ObjectiveTo introduce a modified technique of a sloped skin island design for the distally based sural nuerofasciocutaneous flap to reconstruct soft tissue defects longitudinal in distal pretibial region or transverse in the heel and ankle, and report the effectiveness of the modified technique. MethodsBetween April 2001 and January 2016, 37 patients (38 defects) with longitudinal defects in distal pretibial region or transverse defects in the heel and ankle were treated with the sural nuerofasciocutaneous flap with slope-designed skin island. These patients included 28 males and 9 females, with a median age of 37 years (range, 5-78 years). The horizontal and vertical dimensions ranged from 3 to 8 cm and 8.5 to 14.5 cm in 11 distal pretibial defects, and from 9 to 21 cm and 3.0 to 10.5 cm in 27 heel and ankle defects, respectively. The disease duration ranged from 2 days to 5 years. ResultsWhen the skin islands were routinely designed, the skin islands of 25 flaps would exceed the lateral limit (the anterior border of the fibula) laterally or medial limit (the medial border of the tibia) medially. After the skin islands were obliquely designed, the horizontal dimensions in 38 flaps decreased an average of 5.4 cm (range, 2.5 to 14.8 cm), and the vertical dimensions increased an average of 5.3 cm (range, 2 to 15 cm). The rotation angles ranged from 42° to 90°, with an average of 67°. Thirty-five flaps survived uneventfully. Margin necrosis occurred in 2 flaps, and partial necrosis in 1 (2.6%) flap. The grafted skins at donor site survived, and primary healing of incision was obtained. All patients were followed up 6 to 42 months (mean, 10 months). No infection or ulceration was noted during the follow-up period, and the appearances of the flaps were satisfactory. At last follow-up, according to Boyden et al criteria, the limb function was excellent in 30 cases, good in 6 cases, and poor in 2 cases, with the excellent and good rateof 94.7%. ConclusionWhen the distal sural nuerofasciocutaneous flap is used to reconstruct soft tissue defects longitudinal in distal pretibial region or transverse in the heel and ankle, the modified technique of sloped skin island design can decrease the horizontal dimension of the skin island, improve the flap survival rate, and extend its indications.
Objective To discuss the clinical effect of repairing soft tissue defects in cnemis,ankle and foot with calf and sural distal fasciocutaneous flaps. Methods From August 1998 to July 2004, 34 cases of soft tissue defects in cnemis, ankles and feet were repaired with calf and sural distal fasciocutaneous flaps. There were 27 males and 7 females, aging from 17 to 61 years and the disease course was 4 hours to 8 months. The locations were metainferior segment of cnemis in 18 cases, ankle and foot in 11cases, weight loading region of calcar pedis in 5 cases. There were 13 cases chronic osteomyelitis in tibia or calcaneal bone, 8 cases of raw surface was infected, 3 cases of bone exposure.The sizes of the flap ranged from 6 cm×4 cm to 15 cm×12 cm. Results Thirty-one flaps survived except 3 cases which had partial necrosis. They were followed up from 6 months to 12 months. Both the quality and the appearance of the flaps were satisfactory. The blood supply and function of cnemis, ankle and foot returned to normal. Conclusion It is a convenient, simple and reliable method to repair softtissue defects in cnemis, ankle and foot with calf and sural distal fasciocutaneous flaps,without sacrifice of major arteries and with high survival rate and beautiful outlook form of skin flaps.
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 summarize the cl inical experience of repairing soft tissue defect in dorsal pedis with reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flap, and to explore surgery matters needingattention and measures to prevent flap necrosis. Methods Between August 2000 and April 2009, 31 patients with soft tissue defects in dorsal pedis were treated with reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flaps. There were 23 males and 8 females with a median age of 34 years (range, 3-65 years). Defects were caused by traffic accident in 20 cases, by machine in 2 cases, and by crush in 2 cases. The time from injury to admission was 1-32 days (mean, 15 days). And 6 cases had chronic ulcer or unstable scar excision with disease duration of 6 months to 10 years, and 1 case had squamous carcinoma with disease duration of 5 months. The wounds were located in medial dorsal pedis in 12 cases and lateral dorsal pedis in 19 cases; including 14 wounds near the middle metatarsal and 17 wounds beyond the middle metatarsal (up to the metatarsophalangeal joint in 10 cases). All cases accompanied with bone or tendon exposure. Five cases accompanied with long extensor muscle digits tendon rupture and defect, 1 case accompanied with talus fracture, 1 case accompanied with talus fracture and third metatarsal fracture. The size of the wounds ranged from 6.0 cm × 4.5 cm to 17.0 cm × 10.0 cm. The size of the flaps ranged from 8.0 cm × 5.5 cm to 20.0 cm × 12.0 cm. The donor sites were resurfaced by skin graft. Results Seventeen flaps survived uneventfully, wounds healed by first intention. Distal epidermal or superficial necrosis occurred in 6 flaps at 5-12 daysafter operation, wounds healed by dressing change or skin graft. Distal partial necrosis occurred in 8 flaps (7 in medial dorsal pedis and 1 in lateral dorsal pedis) at 7-14 days after operation, wounds healed by skin graft in 3 cases, by secondary suture in 3 cases, by local flap rotation in 1 case, and by cross leg flap in 1 case. All skin grafts at donor sites survived uneventfully, wounds healed by first intention. Twenty-nine patients were followed up 6-29 months (mean, 19 months). The appearance was sl ightly overstaffed, but wearing shoe function and gait were normal. The texture and color of the flaps in all cases were good. There was no pigmentation and suppuration relapse. There was neither ankle plantar flexion deformity nor hammer toe deformity in 5 cases accompanied with long extensor muscle digits tendon rupture and defect. All fractures healed at 3 months after operation in 2 cases. Conclusion The reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flaps are suitable to repair most soft tissue defects in lateral dorsal pedis. When the flaps are used to repair soft tissue defects in medial dorsal pedis, avoiding tension in flaps and fascia pedicles should be noted so as to improve flap survival.
Objective To explore the effectiveness of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defect and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture. Methods Between October 2009 and June 2011, 10 cases of Achilles tendon and soft tissue defects were treated. There were 7 males and 3 females, aged from 5 to 60 years (median, 40 years). Injury was caused by spoke in 5 cases, by heavy pound in 3 cases, and by traffic accident in 2 cases. The time between injury and admission was 2-24 hours (mean, 8 hours). The size of wound ranged from 11 cm × 7 cm to 18 cm × 10 cm; the length of Achilles tendon defect was 4-10 cm (mean, 7 cm). Three cases complicated by calcaneal tuberosity defect. After admission, emergency debridement and vacuum sealing drainage were performed for 5-7 days, anterolateral thigh fasciocutaneous flap transplantation of 11 cm × 7 cm to 20 cm × 12 cm was used to repair skin and soft tissue defects, and improved method of ilio-tibial bundle suture was used to reconstruct Achilles tendon. The flap donor site was closed directly or repaired with skin grafting to repair. Results All flaps and the graft skin at donor site survived, healing of wounds by first intention was obtained. All patients were followed up 6-18 months (mean, 10 months). The flap was soft and flexible; the flap had slight encumbrance in 3 cases, and the others had good appearance. At last follow-up, two-point discrimination was 2-4 cm (mean, 3 cm). The patients were able to walk normally. The range of motion (ROM) of affected side was (24.40 ± 2.17)° extension and (44.00 ± 1.94)° flexion, showing no significant difference when compared with ROM of normal side [(25.90 ± 2.33)° and (45.60 ± 1.84)° ] (t=1.591, P=0.129; t=1.735, P=0.100). According to Arner-Lindhoim assessment method for ankle joint function, all the patients obtained excellent results. Conclusion A combination of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defects and simultaneous Achilles tendon reconstruction with modified methods of ilio-tibial bundle suture is beneficial to function recovery of the ankle joint because early function exercises can be done.