Objective To evaluate clinical significance of reversed sural neurovascular fasciocutaneous flap for reconstruction of softtissue defects in ankle and foot. Methods From July 1994 to December 2002, 52 cases of soft-tissuedefects in the ankle and foot were reconstructed by use of reversed sural neurovascular fascio-cutaneous flap, including 47 cases of traumatic defects, 3 cases of chronic ulcer and 2 cases of tumors. The flap area ranged from 4 cm×6 cm to 10 cm×21 cm. Results The flaps survived in 48 cases; the distal part necrosed and secondary free-skin graft were further conducted in 4 cases. All soft-tissue defects were repaired and their accompanied bone and tendon exposurehealed. Forty-six cases were followed-up for 5 months to 48 months, the color and texture of the flaps were excellent and 2point discrimination was 11-17 mm(14 mm on average).The functions of ankle joints were good.Conclusion The reversedsural neurovascular fascio-cutaneous flap is convenient in design and dissection. Its use can retained and replace vascular anostomosed flaps to certain degrees.
OBJECTIVE To investigate the repairing method of soft tissue defect of heel, pedicled island myocutaneous flap of flexor digitorum brevis was designed. METHODS From 1984 to 1997, 26 cases with soft tissue defect of heel were adopted in the clinical trial. Among them, the were 18 males, 8 females and the age ranged from 15 to 60 years old. The area of wound ranged from 2.5 cm x 1.5 cm to 8.0 cm x 6.0 cm. RESULTS After operation, all of the flaps survived. They were followed up for 9 to 72 months. All of the flaps had primary healing except in one there was infection of peripheral of the flap. The contour of heel was satisfactory the sensation of flap was good and the weight-bearing function was also successful. CONCLUSION It was concluded that the myocutaneous flap of flexor digitorum brevis could be used to repair the soft tissue defect of heel because of its nearby position, hidden location, good recovery of skin sensation and weight-bearing function, Besides, the procedure of this operation was simple and the anti-inflammatory potential of the flap was high. However, Because of the limited donor area, the pre-operative design was important.
Objective To establish a new operative method to repair defects of palm and proximal fingers with double vascular pedicle flaps. Methods From August 1992 to June 2000, 20 cases of soft tissue defects of palm and fingers were repaired with double vascular pedicle flaps. Twenty patients included 9 males and 11 females, aged 17-35 years. The causes were crush,avulsion, and so on. The interval between injury and operation was 3-11 hours.The wound area ranged from 8 cm×12 cm to 10 cm×20 cm. We devised the two side flaps on pectoral-umbilical place with well-known blood vessel to cover flexion and extension regions of palm and the multi-lobes skin flap to cover defect of fingers simultaneously. Results Out of 20 patients, 19 were followed up 8-12 months with an average of 9.8 months. All the flaps survived completely. The skin colour and the contour of the palm and digits were good. Conclusion The double vascular pedicle flap is one of the best choices torepair soft tissue defect of the palm and proximal fingers; the procedure is simple and the operation is extended easily.
Objective To study the method and effect of free rectusabdominis muscle flaps with intermediate split thickness skin graft in repairing defects on legs and ankles.Methods From May 1998 to December 2002, 11 cases of defects on legs(2 cases) and on ankles( 9 cases) were repaired by use of unilateral free rectus abdominis flap with skin graft. The soft tissue defects were accompanied by osteomyelitis or the exposure of bone or tendon.The disease course was 1 month to 10 years. The defect size ranged 3 cm×4 cm to 8 cm×14 cm. The area ofrectus abdominis muscle flaps was 4 cm×6 cm to 8 cm×15 cm. Results All patients were followed up 6 months to 4 years after operation. All rectusabdominis flaps survived with good appearances and functions.The primary healing was achieved in 8 cases, intermediate split thickness skin graft necrosed in 3 cases and the wound healed after skin re-graft.Conclusion Free rectus abdominis flap is a proper option for repair of the soft tissue defects or irregular woundson legs and ankles. It has the advantages of abundant blood supply, b anti-infection ability, good compliance and satisfied appearance.
Objective To investigate the appl ication and cl inical result of flap in the repair of wounds with Achilles tendon exposure. Methods Between May 2006 and May 2010, 21 patients with Achilles tendon skin defects were treated with microsurgical reconstruction. There were 15 males and 6 females, aged 7-63 years with a median of 34 years. The defect causesincluded sport injury in 4 cases, wheel twist injury in 7 cases, crush injury in 5 cases, chronic ulcer in 3 cases, and Achilles tendon lengthening in 2 cases. The areas of wounds with Achilles tendon exposure ranged from 2 cm × 2 cm to 10 cm × 8 cm. After debridement, wounds were repaired with the medial malleolus fasciocutaneous flap (5 cases), sural neurocutaneous vascular flap (8 cases), foot lateral flap (2 cases), foot medial flap (2 cases), and peroneal artery perforator flap (4 cases). The size of the flaps ranged from 3 cm × 3 cm to 12 cm × 10 cm. The donor sites were either sutured directly or covered with intermediate spl it thickness skin grafts. The Achilles tendon rupture was sutured directly (2 cases) or reconstructed by the way of Abraham (2 cases). Results All flaps survived and wounds healed by first intention except 2 flaps with edge necrosis. Twenty-one patients were followed up 6-18 months (mean, 12 months). The flaps had good appearance and texture without abrasion or ulceration. The walking pattern was normal, and the two point discrimination was 10-20 mm with an average of 14 mm. The Ameritan Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale assessment revealed that 10 patients had an excellent result, 7 had a good result, 3 had a fair result, and 1 had a poor result with an excellent and good rate of 81.0%. Fourteen cases could l ift the heels with power; 5 cases could l ift the heels without power sl ightly; and 2 cases could not l ift the heels. Conclusion The wounds with Achilles tendon exposure should be repaired as soon as possible by appropriate flap according to the condition of wound.
目的 评价不同皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损的效果，探讨小腿及足踝部皮肤软组织缺损的理想修复方法。 方法 2002年6月－2010年1月，应用15种皮瓣、肌皮瓣修复128例（138处）小腿及足踝部皮肤软组织缺损。其中小腿中上段21处，小腿中下段45处，内外踝及足跟部43处，足背及前足29处。主要应用最多的皮瓣有腓肠神经营养血管皮瓣、腓肠肌内外侧头肌皮瓣、腓浅神经营养血管皮瓣和足底内侧皮瓣。修复软组织缺损范围5 cm×4 cm～23 cm×14 cm。 结果 术后135处创面Ⅰ期愈合，皮瓣完全成活；2处皮瓣部分坏死，经二次手术植皮修复；1例游离股前外侧皮瓣修复小腿中下段软组织缺损，皮瓣完全坏死，后改取对侧腓肠神经营养血管交腿皮瓣修复成活。腓肠神经营养血管皮瓣应用例数最多，成活率高，吻合血管的游离皮瓣坏死率较高。术后患者均获随访1～10年，平均23个月，皮瓣均成活良好, 无溃疡、渗液等。 结论 正确认识并选择皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损可提高皮瓣成活率，恢复肢体良好功能，腓肠神经营养血管皮瓣是一种修复小腿及足踝部软组织缺损的理想皮瓣。