Twenty cases with skin defect of forearm and hand were treated by free skin graft with subcutaneous fat from 0.5 to 0.7 cm in thickness. The maximal area of free skin graft is 27×10cm, and the smallest one is 1.5×2cm. All of skin flaps survived except one having partial necrosis. Follow up shown round external figure, clasticity, and no change of skin color. It preserved the function of sweat gland and the cutaneous sensation began to recover 4 months postoperation.
Eight cases of tissue defect inthe faciomaxillo-neck region weretreated by application of the vascu-larized paraseapular free flap Themain causes of the tissue defects werepostresection of tumor in the faceor neck and cicatrical contractureafter burn. The method of flapdesign was discussed. It was stress-ed that the incision of the flap onthe outer margin should be 2 cmbeyond the lateral border of thescapula, thus the damage to thesuperficial branch of the circumfl-ex seapular artery could be avoided.
efect of the eyebrow is a common facialdefect. It was resulted from a variety of causes,but the most common was burn. The operationby using free postauricular scalp graft to repairthe defect of eyebrow was intreduced. The var-ious metheds of eyebrow reconstruction werecompared. The treatment of 79 patients with thedefect of eyebrow was summarized. It was notedthat it had the following advantages , such as theoperation being simple and easy, a naturallooking, appropriate density and r...
Abstract In order to find a new method to repair large bone defect, the free periosteum autograft was investigated in experiment, and then the method was used clinically. In the experiment, a 6mm×18mm×5mm bone defect was made at upper end of both tibiae of 42 rabbites. The periosteum of each rabbit was cut into 1mm cubes, and implanted randomly into the tbial bone defect on one side and the other side was used as control. After 2, 4, 8 weeks, the bone defects of each group were examined for bone formation by roentgenography, radionuclide and histology. The results showed that the defects treated by free periosteum autografts healed twice as fast as the controls (its natural healing). The reason probably was that the periosteum provided with many osteogenic cells. On thebasis of these results, 21 cases of bone defects (the largest was 10.5cm×4cm×4cm, the smallest was 2cm×2cm×2cm) including 17 cases of benign bone tumor and4 cases of chronic osteomyelitis, were treated by free periosteum autografts. The defects were all healed, and the function of the joints was restored.
Objective To evaluate the effect of the treatment of necrosis of femoral head with the free vascularized fibula grafting. Methods From October 2000 to February 2002, 31 hips in 26 patients with ischemic necrosis of the femoral head were treated with free vascularized fibula graft. Among these patients, 21 patients (25 hips) were followed up for 6-18 months(12 months on average). According to Steinberg stage:Ⅱ period, 5 hips;Ⅲ period,8 hips; Ⅳ period, 12 hips.Results Among 25hips, their Harris Hip Score at all satges were improved during the follow-up. The symptom of pain diminished or disappeared after operation. The patient’s ability to work and live was notlimited or only slightly limited during the follow-up. Radiographic evaluation showed that most femoral heads improved (18 hips) or unchanged (6 hips) and only oneworsened.Conclusion The free vascularized fibular grafting is a valuable method for femoral head necrosis. With this method, we can prevent or delay the process of the disease.
Objective To introduce a method to repair soft tissue defect in different regions and different areas of hand in one procedure. Methods From May 2002 to May 2005, anterolateral femoral flap or lobulated anterolateral femoralflap(forming irregular anterolateral femoral flap) was designed into different shapes to repair multiple soft tissue defect in different regions in hand, whichwas used clinically in 27 cases. Among 27 cases, there were 16 males and 11 females; the locations were left hand in 9 , right hand in 16 and left foot in 2; including 5 penetrating injury, 9 hotpressing injury, 2 soft tissue defection of instep and planta by milled injury, 6 gearing injury and 5 carding machine injury. All the cases complicated by exposure of tendons, bones or joints. Defect was repaired with H-shape flaps in 5 cases of penetrating palm injuries; with Y-shape or K-shape flaps in 11 cases of dorsals or combined with fingers of hand with skin defect; with shape flaps in 3 cases of dorsals combined with sides of palms or the first web of hands with skin defect and in 2 cases of skin defects of dorsals combinedwith palms of feet;with h-shape flaps in 6 cases of skin defects of dorsal or palms combined with disconnected skin defect of fingers. The sizes of main flaps ranged from 6.5 cm×4.8 cm to 17.0 cm×12.0 cm, the sizes of lobulate flaps ranged from 3.5 cm×2.8 cm to 7.5 cm×4.5 cm. Results Allflaps survived without vascular crisis after operation. Except the fascia flapall recipient sites healed by first intention. The follow-up period ranged from 3 months to 1 year, all cases had satisfactory appearance, the texture of flaps was soft. Except 2 cases of penetrating injury, 3 cases of hotpressing injuryand1 case of carding machine injury whose function was not satisfactory, theremaining cases achieved the function of snap and pinch. More than 1 year after operation, the sense of pain and touch recovered. There was no functional impairment at the donor sites although scar hyperplasia was formed in some cases.Conclusion The application of irregular anterolateral femoralflap is an optimal choice for complex skin defect of hand.
Rectus femoris muscle of the lower abdomen was used as myocutaneous flap in the reconstruction of the breast in 4 patients, of which, in 2 cases the reconstruction was carried out immediately following the radical mastectomy for breast cancer by using trancfer of the pedicled myocutaneous flap, and in the other two cases, the vascularized free myocutaneous flap was used 2 months and 5 years after the radical mastectomy, respectively. The vascularized free myocutaneous flaps were survived, however, in the pedicled myocutaneous flap group, the fat of the flaps had liquefaction 23 weeks after operation. The latter were healed after repeated dressings. The external appearance of the 4 reconstructed breasts lookedsattisfactory. The patients wete follwed up for 10 to 18 months, 2 patients hadno ill effects, while the 2 pedicled myocutaneous flaps, in which 1 patient hadbulging of the weakened abdominal wall, and the other had lost from follow up.
In order to understand the influence of the free tendon graft and the tendon transfer on their blood supply, histological and biochemical changes during healing following repair of the damaged tendon after the alteration of the nourishing environment, an experiment was carried on 36 New Zealand white rabbits. In the front paws of the rabbits, the free tendon graft was sutured in the tendon defect of flexor of the fourth toe and the flexor tendon of the third toe was transferred to the second toe to reconstr...
Objective To explore the results of repairing widespread traumatic soft tissue defects in the heels and adjacent regions with free latissimus dorsi muscle-skin flaps. Methods From March 1998 to May 2005, 10 cases of widespread traumatic soft tissue defects in the heels and adjacent regions were repaired with free latissimus dorsi muscleskin flaps. Of the 10 patients, 9 were male and 1 was female, whose ages ranged from 32 to 60years, and the disease course was 2 hours to 2 months. The defect was by ploughmachine injury in 5 cases, by crush injury in 2 cases, by snake injury in 2 cases, and electricity injury in 1 case. Eight cases of defects involved in the posteriorof heel and leg, the defect area ranged from 21 cm×12 cm to 35 cm×15 cm; 2 cases had widespread soft tissue defects on heel, ankle, sole and dorsal foot, and the defect area was 27 cm×14 cm and 30 cm×21 cm respectively. All cases were accompanied by the exposure of bone; 6 cases by fracture; 4 cases by openinfection of ankle joint; and 2 cases by injuries of the posterior tibial vessel and the tibial nerve. The sizes of the dissected flap ranged from 25 cm×14 cm to 33 cm×24 cm. The donor sites were covered by large mid-thickness flap. Results There were no postoperative complication of vascular crisis and infection. Ten flaps survived completely and the wounds healed by first intention. After a follow-up of 3 to 24 months, five cases received twostageplastic operation because bulky flaps bring some trouble in wearing shoes. In 5cases of reconstructed sensation, two cases recovered pain and temperature sensation. All cases recovered the abilities to stand and walk without ulcer complication. Conclusion The free latissimus dorsi muscle-skin flap is an ideal flap for repairing widespread traumatic soft tissue defects and infectious wounds with muscle defects and bone exposure in the heel and adjacent regions, because it has such advantages as adequate blood supply, big dermatomic area, and excellent ability to resist infection.
The main arterial blood supply to the retroauricular region came from the posterior auricular artery. At the level of mastoid, the caliber of the artery was measured at 1mm in diameter, The posterior auricular vein drained into the external jugular vein. Vascularized retroauricular skin flap was used to repair 2 cases of partial nose defects with success and the outer appearance of the nose was quite satisfactory. The applied anatomy and the surgical procedure were detailed.