Objective To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds. Methods Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured. Results Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up. Conclusion The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.
Objective To evaluate the effect of tissue engineered skin with isogeneic cells on repairing skin defects in inbred rat model so as to provide relevant evidences for the clinical application. Methods The skins of newborn inbred F344 rats were harvested and treated with Dispase trypsin to isolate the epidermal cells. The skins of adult Sprague Dawley rats were obtained and treated with hypertonic sodium-SDS-trypsin to prepare the acellular dermal matrix. The tissue engineered skin was reconstructed by submerging culturing and air-liquid interface culturing in vitro. The full-thickness skin defects of 1.5 cm × 1.5 cm in size were prepared along the dorsal both sides of 36 adult inbred F344 rats, and 72 defects were repaired with tissue engineered skin in experimental group (n=24), with allogeneic acellular dermal matrix in negative control group (n=24), and with autologous full-thickness skin in positive control group (n=24). Finally the gross observation, the survival rate, wound contraction rate, and histological observation were used to evaluate the effect. Results The wound healed by first intension at 4 weeks postoperatively in the experimental group; the grafts connected with the adjacent tissue tightly and had normal appearance. At 4 weeks after operation, the survival rate of the graft was 0 in the negative control group; the survival rates were 62.5% (15/24) in the experimental group and 91.7% (22/24) in the positive control group, showing significant difference between 2 groups (χ2=5.779, P=0.016). The wound contraction rates of the experimental group and positive control group were significantly lower than that of the negative control group (P lt; 0.05), but no significant difference was found between the experimental group and positive control group (P gt; 0.05). Histological observation showed that slight inflammation reaction appeared at 1 week postoperatively in the experimental group; the regeneration of the blood vessel and the proliferation of the fibroblasts in dermis and the gradual maturation of epidermis were observed at 2 weeks, and new collagen deposition and collagen remodeling in the dermis of the graft were found at 4 weeks postoperatively. Conclusion The tissue engineered skin is able to repair full-thickness skin defect of rats effectively, it has similar effect to the autologous full-thickness skin in preventing the wound contraction and promoting the wound healing, which provides experimental evidences for the clinical application.
ObjectiveTo investigate the effectiveness of radial-lateral forearm free perforator flap on repairing of soft tissue defects in the finger.MethodsBetween January 2017 and May 2018, 26 cases of finger skin defects were treated with radial-lateral forearm free perforator flap based on the radial branch of the posterior interosseus artery. There were 21 males and 5 females, with an average age of 26.6 years (range, 19-56 years). The cause of injury included the cutting injury in 16 cases and crush injury in 10 cases. The interval between injury and admission was 30 minutes to 4 hours (mean, 1.5 hours). The injury located at thumb in 6 cases, index finger in 8 cases, middle finger in 6 cases, ring finger in 3 cases, and little finger in 3 cases; and at the dorsum of finger in 6 cases, the lateral side in 6 cases, and the palm in 14 cases. All wounds were accompanied with the tendon and bone exposures, and phalangeal fractures occurred in 10 cases. The size of the defects ranged from 2.0 cm×1.0 cm to 4.0 cm×2.5 cm. And the size of the flap ranged from 2.5 cm×1.5 cm to 4.5 cm×3.0 cm. All wounds at donor sites were sutured directly.ResultsAll the 26 cases were followed up 4-12 months (mean, 7 months). The 24 flaps survived uneventfully after operation, and the wounds healed by first intention. Partial necrosis occurred at the distal part in 2 flaps, and secondary healing achieved after debridement and dressing. All incisions at donor sites healed by first intention. The appearance and texture of all flaps were satisfactory. The two-point discrimination of the flaps was 5-10 mm (mean, 8 mm) at 4 months after operation. Sensory of the flaps was grade S3. Only linear scar was noted at the donor site.ConclusionThe radial-lateral forearm free perforator flap in repairing of the soft tissues in finger can shorten the disease duration, reduce the damage of the donor site, and improve the patients’ quality of life.
ObjectiveTo investigate the effectiveness of modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries in repairing large skin defect of the hand. Methods Between September 2017 and March 2021, 15 cases of large skin defect of the hand were treated. There were 11 males and 4 females with an average age of 42 years (range, 24-66 years). The injury causes included machine twist injury in 6 cases, pound injury in 5 cases, and crush injury in 4 cases. The injured parts included 6 cases of finger skin defect and 9 cases of distal skin defect of palm and dorsum of hand, all of which had tendon, joint, and bone exposure. The interval from injury to operation ranged from 2 to 6 hours (mean, 4 hours). The defect sizes after thorough debridement ranged from 3.5 cm×3.0 cm to 8.0 cm×4.5 cm. The modified dorsal metacarpal artery reverse island flap with a range of 3.8 cm×3.3 cm to 9.0 cm×5.0 cm was used to repair the defect, and the flap donor site was repaired with full-thickness skin graft. ResultsAll the flaps survived successfully after operation, and the wounds in the recipient site and the skin grafts in the donor site healed by first intention. All patients were followed up 9-24 months, with an average of 14 months. The appearance of the flap was good, and its texture and color were similar to those of the surrounding normal tissue. There was no obvious scar contracture, depression, and pigmentation in the donor site. At last follow-up, the static two-point discrimination of the flap was 8-20 mm, with an average of 13.6 mm. According to the Michigan Hand Outcome Questionnaire, 5 patients were very satisfied with the appearance of the flap, and 10 patients were satisfied. Conclusion The modified dorsal metacarpal artery reverse island flap based on two adjacent recurrent branches of dorsal metacarpal arteries has reliable blood supply, larger harvested area, simple procedure, and minimal donor site damage, which is suitable for emergency repair of large skin defect of the hand.
Objective To investigate the therapeutic effect of V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery for skin defect at the same dorsal finger. Methods Between January 2008 and February 2010, 15 cases of skin defect at the same dorsal finger were treated. There were 9 males and 6 females, aged 15-72 years (mean, 43 years). Defect was caused by saw machine in 6 cases, machines crush in 7 cases, and cutting nodule in 2 cases. The locationswere distal dorsal finger in 2 cases, middle dorsal finger in 6 cases, and proximal dorsal finger in 7 cases. All cases compl icated by exposure of tendon and bone. The size of defect ranged from 0.8 cm × 0.5 cm to 1.4 cm × 1.0 cm. The interval between injury and operation was 3-8 hours. All fingers were treated by V-Y advancement flap from the dorsal cutaneous branch of digital artery, which size was 1.2 cm × 0.8 cm-2.5 cm × 1.0 cm, and the donor site was directly sutured. Fracture reductionand Kirschner wire for internal fixation were performed in the patients with fracture; extensor tendon was repaired with 4-0 thread in the patients with tendon injury. Results All flaps survived completely. The incisions of donor and recipient sites healed by first intention. Ten cases were followed up 6 months to 2 years after operation. The flaps had good texture, color, and appearance; 2-point discrimination of the V-Y flap was 10-12 mm. X-ray examination showed that all finger fractures healedsuccessfully in 5 cases, with an average bone union time of 6 weeks (range, 5-8 weeks). According to the criteria for function assessment by total active motion, the results were excellent in 8 cases, good in 1, and fair in 1 with an excellent and good rate of 90%. Conclusion It is an ideal method to treat skin defect at the same dorsal finger with V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery.
The traditional Kutler and Atasoy V-Y advancement flaps have minimal advancement degree, did not satisfy to repair large skin defect in fingers, hence, have no wide indications. The sensory function of the fingers to be influenced because of injury of sensory nerves and sear formation. Since 1985 to 1991, the V-Y advancement flaps pedicled by bilateral digital arteries and nerves have been used for reconstruction of 33 finger tip defect and 5 digital volar skin contraction. All of these cases obtained satisfactory function and excellent appearance.In this paper, the anatomical charactistics and principles of devicerecommended, the advantages and key points to success discussed.
ObjectiveTo discuss the effectiveness of free anterolateral thigh flap pedicled with medial sural vessels for treatment of leg skin and soft tissue defects. MethodsBetween July 2008 and January 2014, 32 cases of serious skin and soft tissue defects in the leg were repaired by using free anterolateral thigh flap pedicled with medial sural artery and vein. Of them, there were 22 males and 10 females, aged 23 to 50 years (mean, 36.5 years). Defects were caused by traffic accidents injury in 9 cases, crash injury of heavy object in 15 cases, and machine twist injury in 8 cases. The left side was involved in 10 cases and the right side in 22 cases. The mean interval of injury and admission was 2.5 hours (range, 1-4 hours). The location was the upper, middle, and lower one third of the anterior tibia in 15 cases, 10 cases, and 7 cases respectively. The area of defect ranged from 10 cm×5 cm to 23 cm×9 cm. After debridement and vaccum sealing drainage treatment, the anterolateral thigh flap ranging from 12 cm×7 cm to 25 cm×11 cm pedicled with the medial sural vessels was used to repair the wound. The donor site was sutured directly or repaired with the skingrafts. ResultsAll flaps and skingrafts survived after operation, and primary healing of wound was obtained. After 6-23 months (mean, 14.5 months) follow-up, all flaps were characterized by soft texture, good color, and satisfactory appearance. The sensation of the flaps were recovered to S2~S3+ according to the Britain's Medical Research Council criteria at 6 months after operation. No obvious scar contracture was observed at donor site. ConclusionThe medial sural artery has the advantages of constant anatomical position, large diameter, rich blood flow, and a long artery pedicle, so the medial sural vessels is an ideal choice as recipient vessels for the reconstruction of leg skin and soft tissue defect.
Objective To investigate the method and clinical effect of free iliac flap grafting in repairing the tibia traumatic osteomyelitis complicated withboneskin defect. Methods From June 2001 to February 2006，28 patients with tibia traumatic osteomyelitis complicated with boneskin defect were treated with free iliac flap grafting at stageⅠ. There were 18 males and 10 females, with an average of 32.5 years(1868 years). There were traffic injury in 11 cases, bruise in 6 cases, explosive injury in 5 cases, machinery injury in 4 cases, and falling injury in 2 cases. The disease courses of patients were 1-6 months. All patients had been treated by 26 operations. The wounds located at the mid and upper tibia in 13 cases, and the inferior tibia in 15 cases. The length of free iliac was0.5-6.0 cm and the size of the flap ranged from 4.5 cm×3.5 cm to 28.0 cm×16.0 cm.The external fixation were applied in 18 cases, and steel plate were applied in 10 cases. The donor sites were sutured directly. Results All of the flaps survived completely. The wounds healed by first intention in 26 cases and by second intention in 2 cases. The donorsites healed by first intention. Twentyeight patients were followed up for 6 to 56 months(mean, 30 months).The appearances of the flaps were satisfactory and the colour was similar to recipient site. All grafted bone united 2-14 months (mean，4.6 months) after operation according to X-ray examination. In 20 patients who did not achieved union before operation, fracture healed 2 to 6 months after operation(mean, 3.2 months). Osteomyelitis recurred 12 months after operation in 2 cases and healed by nidus clearing. Conclusion Free iliac flap which used to repair tibia traumatic osteomyelitis complicated with boneskin defect, can repair the defect at stageⅠand enhance the antiinfectious ability. It isone of appropriate and effective clinical methods.
ObjectiveTo investigate the effectiveness of anterolateral femoral flap in combination with fascia lata grafting in repair of large Achilles tendon and skin defects.MethodsThe clinical data of 18 patients with large Achilles tendon and skin defects repaired with anterolateral femoral flap in combination with fascia lata grafting between January 2018 and January 2019 were retrospectively reviewed. There were 14 males and 4 females; age ranged from 32 to 57 years (mean, 42.1 years). There were 9 cases of postoperative infection of Achilles tendon rupture, 1 case of traffic accident injury, and 8 cases of combined infection of skin and Achilles tendon defects after heel trauma. The length of Achilles tendon defect was 4-8 cm, with an average of 5.6 cm; the range of the skin defect was 14 cm×3 cm to 20 cm×5 cm. Flap survival was observed, and ankle function recovery was evaluated according to McComis functional assessment criteria, and dorsal extension and plantar flexion mobility of the affected limb were measured at last follow-up and compared with those of the healthy side.ResultsEighteen cases were followed up 8-24 months, with an average of 16.7 months. All the flaps survived after operation, the flaps were soft and elastic, and the incisions healed by first intention. At last follow-up, 15 cases were excellent, 2 cases were good, and 1 case was acceptable according to McComis functional evaluation criteria, with an excellent and good rate of 94.4%. The two-point discrimination of the heel posterior region of the affected foot was 4-7 mm, with an average of 5.32 mm. The heel-raise test was negative. The dorsiflexion range of the affected side was (21.55±1.26)°, which was significantly different from that of the healthy side (25.23±1.45)° (t=8.128, P=0.000); the plantar flexion of the affected side was (44.17±1.52)°, which was not significantly different from that of the healthy side (46.13±1.31)° (t=0.444, P=0.660).ConclusionThe application of anterolateral femoral flap in combination with fascia lata grafting for the repair of large Achilles tendon and skin defects can achieve good effectiveness.
Objectives To investigate the clinical therapeutic effect of tibial boneskin flaps in the repair of infective boneskin defects of the leg. Methods Between February 2000 and March 2005, 68 cases of leg infective wounds with tibial bone and skin defects were treated: 4 cases using free grafting, 64 cases using crossleg or ipsilateral transposition grafting of tibial boneskin flaps so that the tibial support continuity of the affected leg could be reconstructed and the wound could be covered at one stage. The skin flap area ranged from 9 cm×4 cm to 25 cm×12 cm and the bone flap length ranged from 6 cm to 21 cm. Results The flaps were completely survived in 67 of the 68 cases except 1 case which was repaired by fibular boneskin flaps because of the failed blood-vessel anastomosis; the bone flaps were healed in 66 cases,except 1 case which had delayed union of the proximal end through 6month follow-up because tibial bone flap was lengthened, leading to long soft tissue stripping of the proximal end. All the 68 patients were followed up 6 months to 5 years. The leg function and contour weresatisfactory 2 years after operation. Those patients followed up more than 2 years showed normal weight loading walking without obviously abnormal gait, and can engaged in original work. Conclusion On the basis of sufficient antiinfection, the onestage reconstruction of tibial support continuity and the covering of wound by the three methods are suitable for many types of leg bone and skin defects, have a great application value and high successful rate and can retain the affected limb and create the conditions for the functional recovery.