From jan.1984 through dec.1991,65 cases of hand skin defects were primarily repaired by podicled groin flap. Four of the 65 cases had skin defects on both sides of the palms and dorsal aspot of the hands which were treated by the Y-shaped hypogastric groin flap .Five easec had thumb loss in which the lxdicled groin tubed flap was used to reconstruct the thumb.The time of division of the pedicles ranged from 14 to 28 days(averaged 16 days).All flape survived after division of the podicl...
In order to correct the dysfunction of head and neck with scar contracture, since 1980, sixty-two cases were undertaken the operation by using local skin flap to repair the soft tissue defect after scar resection. The skin flaps included pedicled delto-thoracic skin flap in 26 cases, cervico-thoracic skin flaps in 25 cases, cervico-shoulder flaps in 6 cases, pedicled vascularized extralong delto-thoracic skin flap in 4 cases and free parascapular flap in 1 case. Sixty cases had total survival of the flaps and 2 flaps had partial necrosis. After 1 to 10 years follow-up, the appearance and function of neck were excellent. It was suggested that grafting local skin flap was a good method to treat cicatricial deformity of neck especially using the skin flap with pedicle and vascular bundle.
In this study, 8 pigs, weight ranged from 25 to 30kg, were used. Island skin flaps with the deep circumflex iliac artery were designed as pedicle on both buttocks. In the distal half of the island skin flap, which had been made on the right buttock, a subdermal vascular network island skin flap was made by preserving the subdermal vascular network. Blood supply between the two types of skin flap was compared by skin temperature, laser Doppler, fluorescent stain, histological examination, ink perfusion microangiography and transparent specimen technique. The observation showed thatthe blood supply of the subdermal vascular network island skin flap was decreased prominently in comparison with that of the conventional island skin flap. The subdermal vascular network skin flap was actually a combination of axial pattern skin flap with randomized skin flap.
ObjectiveTo study the effects of the new small molecular oxygen free radical scavenger Tempol on the survival and vasculogenesis of the long random pattern skin flap (LRPSF) and its mechanism. MethodsEighty-four male Sprague Dawley rats were randomly divided into control and Tempol groups (42 rats in each group). LRPSF of 9 cm×3 cm in size were prepared on the backs of rats in two groups based on the Mcfarlane flap. Rats were administered with Tempol (100 mg/kg) in the Tempol group and with normal saline in the control group by intraperitoneal injection at 15 minutes before operation and at 1-7 day after operation. The rat and the skin flap survival conditions were observed after operation; the survival rate of skin flap was measured, and the vascular structure, vascular volume, and total length of blood vessels were analyzed with Micro-CT three-dimensional imaging after 7 days; HE staining was used to observe the structure of the skin flaps and inflammation, immumohistochemical staining to observe vascular endothelial growth factor (VEGF) expression; water-soluble tetrazolium-1 method was used to measure the content of superoxide dismutase (SOD) and malondialdehyde (MDA), and ELISA to detect the expressions of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) after 1, 3, and 7 days. ResultsAll of rats survived after operation, without hemorrhage, edema, and infection. With the extension of time, necrosis occurred in the distal part of the skin flaps in 2 groups, but the necrosis degree of the Tempol group was lower than that of control group; meanwhile, the blood vessel distribution and continuity were better than those of control group. The skin flaps survival rate, vascular volume, and total length of blood vessels of Tempol group were significantly higher than those of control group after 7 days (P<0.05). The clearer skin flaps structure, lighter inflammation reaction and inflammation cell infiltration, and higher VEGF staining intensity were observed in the Tempol group than the control group after 7 days. There was no significant difference in SOD, MDA, and TNF-α, and IL-6 contents between the 2 groups at immediate after operation. SOD significantly increased, but MDA, TNF-α, and IL-6 contents significantly decreased in the Tempol group when compared with control group after 1, 3, and 7 days (P<0.05). ConclusionTempol can significantly promote the LRPSF survival rates, its mechanism is closely related to the promotion of vasculogenesis and reduction of oxidative stress and inflammation.
OBJECTIVE To investigate the clinical result in repair of soft tissue defect with combined skin flap vascularized by pedicle on the one end and vascular anastomosis on the other end. METHODS From October 1990 to August 1995, 5 cases with soft tissue defect at the extremities and 1 cases with sacral bed sore were repaired by the combined skin flaps transfer, ranged from 15 cm x 30 cm to 16 cm x 70 cm in defect, among them, 5 cases with myocutaneous flap and 1 case with skin flap, and the size of the combined skin flaps was 15 cm x 40 cm to 12 cm x 80 cm. RESULTS All the flaps were survived with satisfactory effect. Followed up 3 to 6 years, there was no obvious complication. CONCLUSION Transfer of combined skin flaps vascularized by pedicle and vascular anastomosis is suitable to repair the soft tissue defect, especially in large area defect.
The digital defects which severely interfered with the hand functions must be reconstructed. The primary repair by vascularized skin flap with the dorsal branch of proper palmar digital nerve could be done. The vascularized flap was rich in blood circulation, perfect sensibility and a good contour, as well as preserving donor digital sensation. However, it was simple, safe, and with higher success. From 1989 to 1991, 10 cases of digital defects were treated, all of the patients gained very good results. The indication and technique of thismethod wasdiscussed in detail.
In order to investigate the mechanism of blood supply to the delayed separated skin flap and the time and criteria for its transfer, 5 smallsized Banna pigs were selected to produce 14 skin flaps. In the experimental group the skin flap on one side was made from the middle of the back having an extrathin steel sheet intervened between the flap and the soft tissue of the back whereas the flap on the opposite side without a steel sheet intervened was served as the selfcontrol. The skin flaps were examined 3,7,10 and 20 days after the operation and 3,7 and 10 days after transfer, respectively, by (1) gross observation; (2) ultrasonic Doppler; (3) superficial skin temperature measurement and; (4) histomorphological examination. In the experimentalgroup the survival rate of the flap was 100 percent whereas in the control group all of the flaps had necrosis from 30 to 50 percent after the flap being transfered. In the experimental group, the echo sound from the arterial blood flow from ultrasonic Doppler was heard at the pedicle 7 days after the operation, and as time elapsed, the echo sound spread distally, whereas in the controls no echo sound could be heard over the skin flap. There was significant difference statistically between the experimental and control groups in the temperature of the flaps while the flaps were being transferred (P lt; 0.01). The external diameters of the blood vessels in the central area of the skin flap were larger in the experimental group, 0.8 to l.2mm in comparison to 0.4mm.
Objective To summarize the operation opportunity and recovery effect of pedicle skin flap of subdermal vascular plexus on repairing theraw surface of hand injury. Methods From January 1999 to June 2004, the thoracic or abdominal pedicle skin flap of subdermal vascular plexus was used to repair the raw surface of hand with defect of skin and soft tissue in 22 patients with hand injury. 17 cases were males, 5 cases were females, the ages ranged from 9 to 42. Thecauses of hand injuryincluding avulsed wound in 12 cases, mangled injury in 2 cases, hot crush injury in 5 cases, electric burn in 3 cases; 13 cases needed emergency operation, 9 cases needed operation in 3 to 7 days. The thoracic or lower abdominal flap was selected depending on the raw surface of hand injury. Subcutaneous fat was trimmed and retained the thickness of 2 to 4 mm. The skin flap was designed into 2 to 3 leaves to form several pedicle skin flap of subdermal vascular plexus, which were used to repair defect of skin and soft tissue of several fingers. The defect site of skin and soft tissue of hand were put into flap.Results A little of skin flap in distal end became necrosis in 1 case after operation, but recovered fully after changing dressing to the raw surface. The rest of the flaps all survived. Followup was conducted 3 months to 2 years.The pedicle skin flap was living,the skin of the recipient site was smooth and integrated, color and luster was satisfactory and texture was soft.The disrupted pedicle skin flap needed no trimming. The hand function was significantly recovered. Conclusion To repair the defect of skin andsoft tissue in the hand injury by using thoracic or lower abdominal pedicle skin flap of subdermal vascular plexus has the forte of shorter course of treatment and better functional recovery and good outlook. It is one of the ideals for repairing the hand injury with defect of skin and soft tissue.
The clinical experiences in the appieation of umbilical-thoracic skin flap in the coverage of the defect of the forearm in 9 cases were reported. The flap was supplied by the branches of inferior epigastric artery.The biggest flap was 8.5×28cm,the smallest one was 7× 16cm.All flaps surviVed.The results were satisfactory. The advantages of the flap were:(1)potients felt comfortable when the upper extremity was immobilized at the side of the they;(2)the size of skin taken from the do...
Objective To investigate the feasibility of reconstruction of the contracted eye socket by an application of the expanded forehead island skin flap with the supratrochlear and supraorbital arteries. Methods From June 2002 to June 2005, 6 patients with the eye socket defects were treated with an expanded forehead island skin flap with the supratrochlear and supraorbital arteries.There were 4 males and 2 females, aged 16-42 years. The defects were caused bytumors in 2 patients, by trauma in 3, and by chemical burns in 1; the defects were in the left eyes of 4 patients and in the right eyes of the remaining 2 patients, with the illness course of 1 year to 4 years.All the patients first underwent the skin and soft tissue expanding operation on the donor forehead skin area; 1 month later, the transplant of the expanded forehead island skin flap with the supratrochlear and supraorbital arteries was performed to reconstruct the eye sockets. The flaps ranged in size from 8 cm×5 cm to 10 cm×6 cm.The appearance and functional recovery of the reconstructed eye sockets were observed after operation. Results The follow-up of all the patients for 1-3 years revealed that the skin flaps survived, with no visible contracture, and the fine sensory function was still present. The artificial eyes could be steadily placed in the reconstructed eye sockets. The donor areas were healed with no visible hyperplastic scars. Conclusion Reconstruction of the eye socket with an expanded forehead island skin flap with the supratrochlear and supraorbital arteries is a feasible, effective and simply method, and the patient can have a concealed incision, a satisfactory appearance, and a fine sensory function.