ObjectiveTo explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.MethodsBetween January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.ResultsIn antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups (χ2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant (P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).ConclusionThe modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.
Objective To investigate the reconstructive methods and effectiveness of modified pedicled anterolateral thigh (ALT) myocutaneous flap for large full-thickness abdominal defect reconstruction. Methods Between January 2016 and June 2018, 5 patients of large full-thickness abdominal defects were reconstructed with modified pedicled ALT myocutaneous flaps. There were 3 males and 2 females with an average age of 43.7 years (range, 32-65 years). Histologic diagnosis included desmoid tumor in 3 cases and sarcoma in 2 cases. The size of abdominal wall defect ranged from 20 cm×12 cm to 23 cm×16 cm. Peritoneum continuity was reconstructed with mesh; lateral vastus muscular flap was used to fill the dead space and rebuild the abdominal wall strength; skin grafting was applied on the muscular flap, the rest abdominal wall soft tissue defects were repaired with pedicled ALT flap. The size of lateral vastus muscular flap ranged from 20 cm×12 cm to 23 cm×16 cm, the size of ALT flap ranged from 20 cm×8 cm to 23 cm×10 cm. The donor site was closed directly. Results All flaps and skin grafts survived totally, and incisions healed by first intention. All patients were followed up 6-36 months (mean, 14.7 months). No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying. Conclusion Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.
Form April 1991 to August 1994, ten cases of extensive soft tissue injury of the extremities with bone and tendons exposed were treated by emergency transfer of latissimus dorsi myocutaneous flaps. The types of the myocutaneous flap were as follows: with vascular pedicle in 1 case, free latissimus dorsi myocutaneous flap in 8 cases,and transfer of combined bilateral latissimus dorsi myocutaneous flaps in 1 case. There were 8 males and 2 females with the ages ranging from 7 to 44 years (an average of 24.4 years). The operations were all performed within 6 hours after trauma except in 1 case, due to its delayed arrival to our hospital, the operation was carried out 14 days after trauma. The results were as follows: total survival of the flap in 6 cases, necrosis of the distal portion of the skin of the flap in 3 cases and necrosis of a greater portion of the skin in one case who had been subjected the transfer of combined bilateral latissimus dorsi myocutaneous flap. but the deep muscle layerwas intact. However, the result was encouraging. The operative technique and the advantages of emergency coverage of the wound were discussed.
Objective To introduce the experience of the cl inical appl ication of vertical trapezius myocutaneous flap in repairing soft tissue defects after head and neck tumor resection. Methods Between June 2008 and February 2010, 12 cases of soft tissue defect caused by head and neck tumor resection were repaired with vertical trapezius myocutaneous flap.There were 9 males and 3 females with an age range from 32 to 76 years (median, 54 years). Twelve cases including 2 cases of basal cell carcinoma of orbital skin, 2 cases of squamous cell carcinoma of the parotid gland, 2 cases of submandibular gland mal ignant mixed tumor, 2 cases of metastatic lymph nodes of nasopharyngea carcinoma after radiotherapy, 1 case of squamous cell carcinoma of tongue, and 3 cases of squamous cell carcinoma of occipital skin, and all were classified as TNM stages T3 or T4. The area of soft tissue defect ranged from 13 cm × 6 cm to 25 cm × 13 cm. The vertical trapezius myocutaneous flap ranged from 14 cm × 7 cm to 26 cm × 14 cm and was transfered to repair defect tissue in the homolateral wounds after tumor resection and neck dissection homochronously. The donor sites were sutured directly. Results All incisions healed primarily without infection. Eleven flaps survived except 1 flap with edge necrosis, which was cured after dressing change. Subcutaneous hematocele and effusion occurred in 2 cases on the back after tube was removed at 7 days postoperatively, and they were cured by sucted and pressured dressing. Eleven patients were followed up 1-3 years (mean, 2 years). Nine cases had no tumor recurrence and the flaps had statisfactory appearance; the abduction function of shoulder joint were normal. One case of orbit basal cell carcinoma occurred 3 months after operation and 1 case of nasopharyngeal carcinoma died of brain metastasis 12 months after operation. Conclusion It is an easy and simple therapy to repair head and neck soft tissue defect using the vertical trapezius myocutaneous flap, which can meet the needs of repairing tissue defect of head and neck.
ObjectiveTo investigate the feasibility and effectiveness of the latissimus dorsi myocutaneous flap in repair of large complex tissue defects of limb and the relaying posterior intercostal artery perforator flap in repair of donor defect after latissimus dorsi myocutaneous flap transfer.MethodsBetween January 2016 and May 2017, 9 patients with large complex tissue defects were treated. There were 8 males and 1 female with a median age of 33 years (range, 21-56 years). The injury caused by traffic accident in 8 cases, and the time from post-traumatic admission to flap repair was 1-3 weeks (mean, 13 days). The defect in 1 case was caused by the resection of medial vastus muscle fibrosarcoma. There were 5 cases of upper arm defects and 4 cases of thigh defects. The size of wounds ranged from 20 cm×12 cm to 36 cm×27 cm. There were biceps brachii defect in 2 cases, triceps brachii defect in 3 cases, biceps femoris defect in 2 cases, quadriceps femoris defect in 2 cases, humerus fracture in 2 cases, brachial artery injury in 2 cases, and arteria femoralis split defect combined with nervus peroneus communis and tibia nerve split defect in 1 case. The latissimus dorsi myocutaneous flaps were used to repair the wounds and reconstruct the muscle function. The size of the skin flaps ranged from 22 cm×13 cm to 39 cm×28 cm; the size of the muscle flaps ranged from 12 cm×3 cm to 18 cm×5 cm. The wounds were repaired with pedicle flaps and free flaps in upper limbs and lower limbs, respectively. The donor sites were repaired with posterior intercostal artery perforator flaps. The size of flaps ranged from 10 cm×5 cm to 17 cm×8 cm. The second donor sites were sutured directly.ResultsAll the flaps survived smoothly and the wounds and donor sites healed by first intention. All patients were followed up 10-19 months (mean, 13 months). At last follow-up, the flaps had good appearances and textures. The muscle strength recovered to grade 4 in 5 cases and to grade 3 in 4 cases. After latissimus dorsi myocutaneous flap transfer, the range of motion of shoulder joint was 40-90°, with an average of 70°. The two-point discrimination of latissimus dorsi myocutaneous flap was 9-15 mm (mean, 12.5 mm), and that of posterior intercostal artery perforator flap was 8-10 mm (mean, 9.2 mm). There were only residual linear scars at the second donor sites.ConclusionThe latissimus dorsi myocutaneous flap combined with posterior intercostal artery perforator flap for the large complex tissue defects and donor site can not only improve the appearance of donor and recipient sites, but also reconstruct muscle function, and reduce the incidence of donor complications.
From 1985 through May of 1989, a total of 6 cases of breast carcinomas underwent primary reconstruction of breast immediately following radical mastectomy by using transposition of vaseularized latissimus dorsi myocutaneous flap for reconstruction of breast. The re- sults of all these 6 cases were satisfactory. The design of the operation and the operative technique were detailed. The importance of the reconstruction of breast immediately after the radical mastectomy and the advantages of using vascularized latissimus dousi myocutanous flap for reconstruction were discussed.
Objective To evaluate the feasibil ity and cl inical significance of the computed tomography angiography (CTA) for the latissimus dorsi muscle (LDM) flap transplantation. Methods From September 2007 to August 2008, 3 cases of soft tissue defects in l imbs were treated with LDM flap transplantation. Three patients included 2 males and 1 female whowere 23 to 42 years old. All of soft tissue defects were caused by trauma. The locations were the forearm in 2 cases and the leg in 1 case. The area of defect was 17 cm × 8 cm-20 cm × 10 cm. All cases received CTA to observe the distribution and anastomosis of thoracodorsal artery. Subsequently, three-dimensional computer reconstruction were carried out to display the stereoscopic structure of the LDM flap and to design the LDM flap before operation. Results The anatomy characteristic of LDM flap can be displayed accurately by the three-dimensional reconstruction model. The distribution of thoracodorsal artery in 3 cases of flaps was in concordance with preoperative design completely. All the flaps were excised successfully, the area of the flap was 19 cm × 10 cm-22 cm × 12 cm. All the transferred flaps survived completely. All cases were followed up from 4 months to 12 months. The color and texture of the flaps were good. Conclusion The three-dimensional reconstructive images can provide visible, stereoscopic and dynamic anatomy for cl inical appl ication of LDM flap. The digitized three-dimensional reconstructive models of LDM flap structures can be appl ied in cl inical training and pre-operative design.
OBJECTIVE: To investigate the effectiveness of polypropylene path (Prolene) in hernia prevention following harvesting of rectus abdominis is myocutaneous flap. METHODS: From November 1999 to October 2000, Prolene patches were applied in 26 cases to repair the anterior rectus sheath following harvesting free rectus abdominis myocutaneous flap. Data concerning each case included size of rectus flap, defect of rectus sheath, size of patch used, wound healing and complications. RESULTS: Prolene patch showed good biocompatibility with abdominal tissue. No foreign-body rejection occurred after operation. Seroma developed in 1 case, and was drained bedside without complication. All prolene patches healed well in the body during follow-up. Hernia formation and abdominal bulge were not observed. CONCLUSION: Prolene patch is a satisfactory material for repair of the anterior rectus sheath after harvesting free rectus abdominis myocutaneous flap.
ObjectiveTo explore the effectiveness of iliac myocutaneous flap pedicled with deep circumflex iliac artery (DCIA) on the repair of lower limb composite defect wounds with cavity. MethodsA retrospective analysis of 7 patients with lower limb composite defect wounds treated between March 2017 and September 2020 was conducted, including 4 males and 3 females, aged 24-58 years, with a median age of 37 years. The causes of injury were machine twisting injury in 2 cases, fall from height injury in 2 cases, and traffic accident injury in 3 cases. According to Gustilo-Anderson classification, there were 1 case of type Ⅲa, 4 cases of type Ⅲb, and 2 cases of type Ⅲc (combined with anterior tibial artery rupture); according to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 2 cases of type 42-C3, 2 cases of type 43-A2, and 3 cases of type 43-B1. The time from injury to admission ranged from 2 to 10 hours, with an average of 6 hours. Tibial bone defect and surrounding soft tissue defect with deep cavity were left after primary emergency debridement. In the second stage, according to the characteristics of the wound, the three-dimensional repair of the composite defect was designed with DCIA embedded iliac myocutaneous flap. The size of the iliac flap was 2.0 cm×2.0 cm×2.0 cm to 7.0 cm×3.0 cm×2.5 cm, and the size of the flap was 12.0 cm×8.0 cm to 21.0 cm×13.0 cm. The internal oblique muscle flap was harvested in size of 3.0 cm×2.0 cm×2.0 cm to 5.5 cm×4.0 cm×4.0 cm. The donor site was primarily closed. ResultsAll the flaps survived after operation, except for 1 case of partial necrosis of the flap edge, which healed after secondary skin grafting, and the donor and recipient wounds healed by first intention. All patients were followed up 16-24 months, with an average of 18 months. The broken end of the bone defect healed well, and the healing time was 8-10 months, with an average of 7.3 months. At last follow-up, the shape of the flap was satisfactory, the texture was soft, and there was no abnormal hair growth, pigmentation, and so on. Only linear scar was left in the donor site, and no complication such as abdominal hernia occurred. According to Paley fracture healing scoring system, bone healing was rated as excellent in 5 cases and good in 2 cases. The limb function was satisfactory, and full weight bearing was achieved at 12-16 months after operation. According to the lower extremity functional scale (LEFS), 6 cases were excellent and 1 case was good. Conclusion The iliac myocutaneous flap pedicled with DCIA is flexible in design and highly free in tissue composition, which can repair the composite defect wound of lower limbs with deep cavity in a three-dimensional way, and repair the limb shape and reconstruct weight-bearing function to the greatest extent.
Objective To investigate the location of the artery correlated with rectus abdominis musculocutaneous flap in order to promote the reconstruction of the breast after radical mastectocy for breast cancer.Methods An anatomic study was carried out on 15 cadavers of 30 sides，which were immersed in paraformaldehyde less than six months. Whole thoraepigastrica wall was cutted, which scale was from subclavian as upper limit to inguinal ligament, the lower limit across left and right of middle axillary. Veins or arteriesof inferior epigastrica and internal thorax in hang were injected with red or blue ink to show all of vessel branches. Results The external diameters of both the superior epigastric arteries and inferior vessels were 1.87±0.28 mm and 2.25±0.32 mm respectively. The myocutaneous arteries from inferior abdomen vessels had an intensive horizontal distribution on hylum. The perforators significantly decreased but could be found to pass through anterior rectus sheath in Rand. The distances between lateral perforators and Ⅰ,Ⅱ and Ⅲ parts in external edge of anterior rectus sheath were 1.22, 1.46 and1.57 cm, respectively; and the distances between medial perforators and Ⅰ, Ⅱ, and Ⅲ parts at median line were 1.54, 1.62, 1.66 cm. Perforators were more thick and intensive near hylum than in other part. The subcostal arteries derived from inferior abdomen artery and 1.25±0.37 cm away from costal arch. Afterdividing into subcostal artery, the outer diameter of 67 percent of subcostal artery was bigger than that of inferior abdomen arteries. The branches of subcostalarteries were distributed at the 2/3 lateral rectus abdominis, forming an extenive choke anastomosis system with intercostal anterior artery and vessels supplied diaphragmatic muscle. The rectus abdominis at the level of xyphoid was supplied by a branch came from inferoir thorax artery, which diverged epigastric vessels at the same time.Conclusion During the process of makingthe inferior transverse rectus abdominis musculocutaneous flap base on superior epigastric vessels and superoir rectus abdobminis, reservation of pro-theca edge 1 cm of rectus abdominis can protect inferior abdomen artery from injury. Reservation of more than 2 cm pro-theca and rectus abdominis below costal arch at the flag will protect effectively subcostal artery from injury. No damage of subcostal arteries can influence the survival of musculocutaneous flap.