ObjectiveTo investigate the application of expanded anterolateral thigh myocutaneous flap in the repair of huge chest wall defect. Methods Between August 2018 and December 2020, 12 patients, including 4 males and 8 females, were treated with expanded anterolateral thigh myocutaneous flap to repair huge complex defects after thoracic wall tumor surgery. The age ranged from 28 to 72 years, with an average of 54.9 years. There were 4 cases of phyllodes cell sarcoma, 2 cases of soft tissue sarcoma, 1 case of metastatic chest wall tumor of lung cancer, and 5 cases of breast cancer recurrence. All cases underwent 2-7 tumor resection operations, of which 3 cases had previously received lower abdominal flap transplantation and total flap failure occurred, the other 9 cases were thin and were not suitable to use the abdomen as the flap donor site. After thorough debridement, the area of secondary chest wall defect was 300-600 cm2; the length of the flap was (24.7±0.7) cm, the width of the skin island was (10.6±0.7) cm, the length of the lateral femoral muscular flap was (26.8±0.5) cm, the width was (15.3±0.6) cm, and the length of the vascular pedicle was (7.9±0.6) cm. Results The myocutaneous flaps and the skin grafts on the muscular flaps were all survived in 11 patients, and the wounds in the donor and recipient sites healed by first intention. One male patient had a dehiscence of the chest wall incision, which was further repaired by omentum combined with skin graft. The appearance of the reconstructed chest wall in 12 patients was good, the texture was satisfactory, and there was no skin flap contracture and deformation. Only linear scar was left in the donor site of the flap, and slight hyperplastic scar was left in the skin harvesting site, which had no significant effect on the function of the thigh. All patients were followed up 9-15 months, with an average of 12.6 months. No tumor recurrence was found. ConclusionThe expanded anterolateral thigh myocutaneous flap surgery is easy to operate, the effective repair area is significantly increased, and multiple flap transplantation is avoided. It can be used as a rescue means for the repair of huge chest wall defects.
Objective To investigate the cl inical results of the flap pedicled with collateral branch of descendingrarus of lateral circumflex femoral artery with digital three-dimensional reconstruction technique for lower l imb soft tissue defects. Methods Between March 2009 and January 2010, 7 patients with lower l imb soft tissue defects were treated with free flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery. There were 6 males and 1 female with an age range from 6 to 51 years. They were injured by traffic accident (4 cases), or by object hit from height (3 cases). The locations were foot in 2 cases, ankle in 2 cases, and anterior tibia in 3 cases. The disease duration was 8 hours to 40 days (mean, 20 days). All the cases compl icated by exposure of tendons or bones. The areas of soft tissue defect ranged from 12 cm × 7 cm to 20 cm × 14 cm. Free flaps were transplanted at 4 to 16 days after symptomatic treatment. Before operation, all the flaps were designed with digital three-dimensional reconstruction technique. The size of flaps ranged from 15 cm × 9 cm to 22 cm × 16 cm The donor sites were closed directly in all cases. Results All the flaps survived. The wounds and incisions at donor sites healed by first intention. All the patients were followed up 6 to 12 months. The texture, appearance, and function of the flaps were satisfactory, and no compl ication occurred. All the flaps had protective sensation, which could meet the requirement of the daily l ife. The function of ankle was satisfactory with normal walk; the extension was 19-22° and the flexion was 30-36°. No obvious scar formed at donor sites. Conclusion The flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery has rel iable blood supply, easy operation, l ittle influence on the donor site, and high success rate with digital three-dimensional reconstruction technique. It is an excellent option for repairing lower l imb soft tissue defects.
Objective To investigate the vascular anatomy and the clinical application of type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery on skin soft tissue defect at the limbs. Methods Vascular anatomy of anterolateral thigh flap was performed on a 43-year-old male cadaver perfused with red latex, and the travel and perforating distribution of the oblique branches of lateral circumflex femoral artery were observed. A retrospective case series study was used to analyze the clinical data of 12 patients with skin soft tissue defects of the extremities admitted between January 2018 and September 2019, including 9 males and 3 females; aged from 18 to 65 years, with a median age of 32 years. The injury site included 7 cases of foot and ankle, 3 cases of calf, and 2 cases of hand. The wound size was ranged from 9 cm×7 cm to 28 cm×10 cm. The time from injury to operation was 1-2 weeks, with an average of 10 days. All patients were repaired with type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery, including 3 cases of single-leaf flap, 6 cases of double-leaf flaps, and 3 cases of tri-leaf flaps. The flap ranged from 15 cm×5 cm to 28 cm×10 cm. The donor site was directly sutured or repaired with local flap. The flap survival and complications were observed after operation. ResultsThe results of vascular anatomy showed that the lateral femoral circumflex artery sent out transverse branches, oblique branches, and descending branches. The oblique branches sent out multiple muscle perforating branches along the way, the perforating branches passed through the anterolateral femoral muscle, and the blood supply scope was the skin of the anterolateral femoral region. The clinical results showed that all flaps survived completely and the incisions healed by first intension. There was no complication such as vascular crisis. All 12 patients were followed up 3-12 months, with an average of 7 months. The appearance and texture of the flap were good. At last follow-up, according to the British Medical Research Council (BMRC) Society for neurological trauma standard, the sensory of the flap reached S2 in 9 cases and S3 in 3 cases. Linear scar remained in the donor area, without pain, pruritus, tactile allergy, and other discomfort. The patients and their families were satisfied. Conclusion Type Ⅲ perforator flap based on the oblique branch of lateral circumflex femoral artery is a reliable method for repairing the soft tissue defect of the limbs, with reliable blood supply, large cutting area, various types of perforator flaps.
Drug addiction has been one of the serious social problems. The peripheral phlebitis caused by drug injection is common, but the occurrence of pseudoaneurysm with infection of femoral artery from injection injury was rarely reported in China. From January 1995 to March 1996, six cases of injury of femoral artery with infection from heroine injection were admitted. The characteristics of the injury were described. The therapeutic measures and details of attention to be needed were discussed. It was concluded that this type of injury was different from the injury caused in agricultural, industrial or traffic accidents. The treatment of choice depended upon the type of injury.
ObjectiveTo investigate the clinical anatomy and application of free profunda femoral artery pedicled chimeric myocutaneous perforator flap in the defect reconstruction after radical resection of tongue carcinoma. MethodsBetween April 2011 and January 2016, 44 cases of tongue carcinoma underwent radical resection, and tongue defects were reconstructed by free profunda femoral artery pedicled chimeric myocutaneous perforator flaps at the same stage. There were 40 males and 4 females, with a mean age of 46.3 years (range, 32-71 years). The pathologic type was squamous cell carcinoma, which involved the lingual margin in 24 cases, the ventral tongue in 17 cases, and the mouth floor in 3 cases. According to Union for International Cancer Control (UICC) TNM staging, 16 cases were rated as T4N0M0, 11 cases as T4N1M0, 9 cases as T3N1M0, and 8 cases as T3N2M0. The course of disease ranged from 1 to 22 months (mean, 8.6 months). The size of perforator flap ranged from 8.5 cm×4.0 cm to 12.0 cm×6.5 cm, and the size of muscle flap ranged from 4.0 cm×3.0 cm to 7.5 cm×5.0 cm. The adductor magnus myocutaneous flap with a pedicle of (8.3±0.5) cm was used in 11 cases, and the gracilis muscle myocutaneous flap with a pedicle of (8.1±0.8) cm was used in 33 cases. The donor sites were sutured directly. ResultsAll 44 perforator flaps survived uneventfully, and the donor site healed well. The patients were followed up for 12 to 40 months (mean, 23.8 months). The reconstructed tongue had good appearance and function in swallowing and language. No local recurrence was found. Only linear scar was left at the donor sites. ConclusionThe free profunda femoral artery pedicled chimeric myocutaneous perforator flap can be harvested in various forms, and is an ideal choice to reconstruct defect after radical resection of tongue carcinoma.
Objective To investigate the influencing factors for restenosis after femoral endarterectomy in treatment of arteriosclerosis obliterans at femoral artery . Methods A total of 103 patients with arteriosclerosis obliterans at femoral artery who underwent femoral endarterectomy from Jan. 2012 to Jan. 2017 in our hospital were retrospectively selected as subjects of this study, to compare the clinical feathers between restenosis group and patent group, and then exploring the influencing factors for restenosis after femoral endarterectomy. Results Thirty-six patients (35.0%) suffered from restenosis after femoral endarterectomy. Patients in the restenosis group had a high proportion of high smoking and diabetes mellitus, and high level of low density lipoprotein than those corresponding indexes of the patent group (P<0.05). Results of Cox proportional hazard model showed that, diabetes mellitus 〔RR=3.338, 95% CI was (1.003, 11.113), P=0.049〕 and high level of low density lipoprotein 〔RR=3.311, 95% CI was (1.166, 9.397), P=0.024〕 were independent risk factors for restenosis after femoral endarterectomy. Conclusions Monitoring of high-risk factors like controlling blood glucose strictly and strengthening statin treatment should be done to reduce the risk of restenosis after femoral endarterectomy for patients with arteriosclerosis obliterans at femoral artery.
ObjectiveTo evaluate the efficacy and safety of transcatheter closure of patent ductus arteriosus (PDA) with transthoracic echocardiography (TTE).MethodsFrom February 2016 to November 2018, 98 patients of pure PDA were selected, including 43 patients of funnel type and 55 patients of tube type. There were 38 males and 60 females at age of 2-48 (9.8±10.4) years. All patients underwent TTE-guided retrograde closure of the PDA through the femoral artery to establish a femoral-abdominal aorta-thoracic aorta-ductus arteriosus-aorta-right ventricle trajectory.Under the guidance of TTE, a suitable closure umbrella was placed through the femoral artery. One month, 3 months, 6 months, 12 months after the surgery, the patients received out-patient clinical follow-up.ResultsNinety eight patients were successfully occluded by TTE. The occluder was replaced many times in an adult PDA patient, but finally it was successfully plugged. The operation time was 33.2±5.8 min. The lumbar diameter was 12±6 mm. And the postoperative murmur disappeared. Ultrasound showed no shunt between the aorta and the pulmonary artery, and the postoperative hospital stay was 3-4 days. No shunt signal was found in 1, 3, 6, 12 months follow-up. Left atrial anteroposterior diameter (25.8±6.1 mm vs. 30.6±8.4 mm) and left ventricular end diastolic diameter (38.5±9.1 mm vs. 45.2±11.5 mm) were significantly smaller (P < 0.05).ConclusionTTE-guided transcatheter closure of PDA via femoral artery is a safe and effective method to avoid the damage of X-ray and contrast medium. The prospect of clinical application is good.
ObjectiveTo investigate the clinical efficacy and application value of percutaneous interventional treatment for structural heart diseases under guidance of ultrasound.MethodsThe clinical data of 1 010 patients with structural heart diseases treated by transcutaneous ultrasound-guided occlusion in our hospital from December 2, 2015 to December 31, 2019 were retrospectively reviewed, including 360 males and 650 females, aged 1-50 years. There were 692 patients of atrial septal defect (603 with central type, 9 combined with arterial catheter, 80 with ethmoid type), 116 patent foramen ovale, 25 ventricular septal defects (3 combined with atrial septal defect), 132 patent ductus arteriosus, 32 pulmonary valve stenosis (3 combined with atrial defect), 1 main pulmonary artery window, and 3 aneurysm rupture of aortic sinus. All patients were diagnosed by transthoracic echocardiography (TTE) before operation. Treatment was accomplished intraoperatively through TTE or transesophageal echocardiography (TEE) via the femoral artery or femoral vein. After operation, echocardiography, electrocardiogram and chest radiograph were reexamined.ResultsSatisfactory results were obtained in 1 005 patients, and 1 patient failed to seal the ventricular defect and was repaired under direct vision, occluder detachment occurred in 5 patients after operation (3 patients of atrial septal defects underwent thoracotomy for Amplatzer device and were repaired, 1 patient of atrial septal defects was closed after removing Amplatzer device, 1 patient of patent ductus arteriosus underwent thoracotomy for Amplatzer device and was sutured), mild pulmonary valve regurgitation occurred after balloon dilation in 2 patients with pulmonary stenosis, a small amount of residual shunt was found in 2 patients with ventricular defect, which disappeared after 3 months of follow-up, and 1 patient of right bundle branch block occurred and disappeared after 1 week. After follow-up of 1-24 months, 3 patients of ethmoidal atrial septal defect were reexamined with mild shunt. The occluder was in good position and the pressure difference of pulmonary valve was significantly reduced. There was no complication such as hemolysis, arrhythmia, embolism or rupture of chordae tendinae.ConclusionPercutaneous transfemoral artery and vein guided by TTE or TEE is safe and effective, with little trauma, no radiation or contrast agent damage, and has significant clinical efficacy and application values.
Objective To explore the characteristics and clinical application of the anterolateral thigh flap pedicled with the oblique branch in the intramuscular of lateral circumflex femoral artery. Methods The clinical data of 25 patients with skin and soft tissue defects of extremities admitted between December 2020 and April 2021 were retrospectively analyzed, including 16 males and 9 females, aged 14-75 years, with the median age of 43 years. The defect site included 13 cases of hand, 2 cases of forearm, 2 cases of calf, and 8 cases of foot and ankle. The wound area ranged from 6 cm×4 cm to 35 cm×22 cm. Twenty-four patients with trauma were admitted to hospital immediately after injury, and 1 patient with diabetic foot infection was transferred to the hospital after ineffective treatment in other hospital. Flap surgery was performed from 0 to 56 days (median, 22 days) after admission. A total of 26 thigh flaps were harvested in 25 patients, with unilateral flaps in size of 7 cm×5 cm to 40 cm×10 cm. The type, caliber, and location of the perforating branch were recorded during the operation, and the anatomical characteristics of the oblique branch of the intramuscular trunk were mainly observed. The flap harvesting time was recorded; the flap survival and wound healing time were observed; at last follow-up, XIAO Feipeng et al. flap comprehensive efficacy evaluation table was used to evaluate the effectiveness of flap repair from three aspects of donor site, recipient site, and subjective satisfaction of doctors and patients. Results After the oblique branch in intramuscular of lateral circumflex femoral artery was sent out, it ran 2-3 cm obliquely laterally and inferiorly in the intermuscular septum and then entered the vastus lateralis muscle, and sent out perforating branches to nourish the skin. A total of 61 perforating branches were marked in 26 thighs of 25 patients before operation, and 70 perforating branches were found during operation, including 9 transverse branches, 29 descending branches, and 32 oblique branches, all of the oblique branches were musculocutaneous perforators. All 25 patients were followed up 6-10 months, with an average of 8 months. The time of unilateral thigh flap harvesting ranged from 13 to 90 minutes, with an average of 48 minutes. One patient with diabetes developed disturbance of blood supply and complete necrosis of the flap at 1 month after operation, and then the flap was repaired with skin graft; 1 case developed arterial crisis after operation, which survived after timely exploration; and the rest of the flaps survived smoothly. The wound healing time of the recipient site ranged from 10 to 44 days, with an average of 19 days, and the donor site of the thigh healed by first intention. At last follow-up, the color and texture of the flap was good and the sensation recovered to S1-S2. Only linear scar was left in the donor site, no scar contracture, pain, and other discomfort occurred, and no other serious complications occurred. Evaluated by flap comprehensive efficacy evaluation table, the score was 74-93, with an average of 88, of which 10 cases were excellent, 13 cases were good, and 2 cases were fair, with an excellent and good rate of 92%. Conclusion The intramuscular trunk oblique branch is not uncommon, and its trunk course and perforators distribution are regular. To improve the understanding of this type of oblique branch and adopt appropriate methods during operation can improve the success rate of skin flap extraction.
ObjectiveTo explore the ultrasonic morphological indexes influencing the effectiveness of ultrasound-guided thrombin injection (UGTI) in the treatment of iatrogenic femoral artey pseudoaneury (IFAP).MethodsThe patients with IFAP treated by UGTI in the West China Hospital of Sichuan University from 2015 to 2017 were collected according to the inclusion criteria. The demographic data, comorbidities, clinical symptoms, ultrasonic morphological parameters, thrombin dosage, and postoperative complications were analyzed. The risk factors of technical success of UGTI were analyzed by logistic regression analysis. The technical success was defined as absence of flow within the FAP immediately after UGTI. ResultsA total of 53 patients who met the criteria of inclusion were included in this study. The technical and treatment success rates of UGTI were 84.9% (45/53) and 96.2% (51/53), respectively. No deep venous thrombosis, arterial thromboembolism, infection, bleeding, allergy, and other complications or death occurred in all patients. There were no statistical differences in the age, clinical symptoms, comorbidities (except hypertension, P=0.040), ultrasonic morphological parameters (except femoral artery diameter, P<0.001), and thrombin dosage between the patients with technical success and failure (P>0.05). Multivariate logistic regression analysis showed that the smaller femoral artery diameter was the risk factor of the technical failure [OR=0.350, 95%CI (0.165, 0.743), P=0.006]. Further adjustment of thebaseline data of patients (excluding patients with hypertension), the logistic regression analysis still found that smaller femoral artery diameter was the risk factor of the technical failure [OR=0.419, 95%CI (0.205, 0.860), P=0.018].ConclusionsUGTI in treatment of IFAP is minimally invasive and has a higher technical success rate. Smaller femoral artery diameter might affect technical success rate of UGTI.