OBJECTIVE: Soft tissue defect of heel is not uncommon. Transplantation of free cutaneous flap and transfer of axial cutaneous flap have been used in treating such defect successfully, but both of them are somewhat complicated. Local plantar rotatory flap might show great importance in this field. METHODS: Since March 1993 to March 1998, 9 cases with soft tissue defect of heel were repaired by local plantar rotation flaps. The size of defect ranged from 2 cm x 4 cm to 6 cm x 8 cm, and it was designed superficial to plantar fascia. The flap was medially based, and nutrilized by proximal plantar subcutaneous plexus of blood supply as well as lateral and medial plantar nerve. RESULTS: Followed up 4 months to 2 years, all the flaps were survived. Sensation of the flap was preserved in 7 patients, who had normal sensation of the donated area preoperatively. The transferred flap was endurable to body bearing. CONCLUSIONS: The flap is easily prepared with reliable blood supply and sensation of the flap preserved. The method is worthy to be recommended for widely use because of its advantages over other methods.
Objective To explore the cl inical outcomes of repairing l imb wound with distal based neurocutaneous flap. Methods From June 2003 to June 2009, 187 cases with wounds in the hand, foot, and distal leg were treated. There were127 males and 60 females aged 20-70 years old (average 37.5 years old). The wound was caused by traffic accident in 130 cases, crush injury in 38 cases, machinery accident in 16 cases, and explosion injury in 3 cases. Among them, the soft tissue defect was in the dorsal and palmar aspects of the hand in 35 cases, the distal leg in 50 cases, the dorsal aspect of foot in 40 cases, the region around ankle in 27 cases, the tendon area in 11 cases, the medial side of foot in 4 cases, the heel and sole of foot in 5 cases, and the forefoot area in 15 cases. The size of skin soft tissue defect was 5.0 cm × 3.0 cm-17.5 cm × 10.0 cm. Four cases suffered from nonunion of heel and 15 cases suffered from tibia defect (3-7 cm). The course of disease was 3 days-8 years. During operation, 35 cases with wound in the hand were treated with three types of lower rotation point of forearm neurocutaneous flaps with rotation points 0-3 cm above the wrist joint, 66 cases were treated with distal based saphenous nerve and saphenous vein neurovascular flaps, muscle flaps and bone flaps with rotation points 2-5 cm above the medial malleolus, and 86 cases were treated with sural and saphenous flaps, muscle flaps and bone flaps with rotation points 1-5 cm above the external malleolus. The flap was 5 cm × 3 cm-17 cm × 15 cm in size, the muscle flap was 5 cm × 3 cm × 1 cm-10 cm × 6 cm × 2 cm in size, the fibula flap was 4.0 cm × 2.5 cm-10.0 cm × 8.0 cm in size. The l igation of the superficial veins was performed below the rotation point of the flap in 163 cases, and the cutaneous nerve ending anastomosis was performed in 22 cases. The donor site was repaired byspl it thickness skin grafting from the inner side of the thigh. Results Various degree of skin flap swell ing occurred, and the swell ing extent in the patients receiving the superficial vein l igation was obvious less than that of patients with no l igation. At 4-7 days after operation, 6 cases had necrosis at the edge of flaps and 6 cases had bl ister, all of them healed after changing dress. The rest skin flaps and skin grafting in the donor site survived uneventfully, and the incision healed by first intention. All the patients were followed up for 2 months to 3 years. The appearance of the flap was satisfactory, the hand function and the foot function of walking and weight-bearing recovered. The two point discrimination of the patients 1 year after cutaneous nerve ending anastomosis was 8-12 mm. The grafted fibula in the patients with bone defect reached union 8-10 months after operation. The appearance and the movement of the donor site were normal. Conclusion The new type distal based neurocutaneous flap has such advantages as simple operative procedure, less invasion, high survival rate, and recovery of the sensory function of the hand and the foot. It is suitable to repair the tissue defect in the hand, the foot, and the distal leg.
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.
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.
ObjectiveTo investigate the effectiveness of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle. Methods Between January 2017 and December 2020, 16 cases (17 feet) of soft tissue defects of foot and ankle were repaired with free transverse gracilis myocutaneous flaps. There were 10 males and 6 females, with an average age of 38 years (range, 23-60 years). There were 9 cases of left foot, 6 cases of right foot, and 1 case of bilateral feet. The causes of soft tissue defect were traffic accident injury in 3 cases, heavy object smash injury in 4 cases, machine injury in 3 cases, infection in 4 cases, electrical burn in 1 case, and synovial sarcoma after operation in 1 case. The wounds located at the distal plantar in 2 cases (2 feet), the heel and ankle in 6 cases (6 feet), the dorsum of the foot in 7 cases (8 feet), and the first metatarsophalangeal joint to the medial malleolus in 1 case (1 foot). The size of wounds ranged from 6 cm×5 cm to 18 cm×7 cm. The size of flap ranged from 11 cm×6 cm to 21 cm×9 cm. The donor site was sutured directly. Results After operation, 1 case (1 foot) of flap vascular crisis, 1 case (1 foot) of partial necrosis of the flap, and 1 case of partial dehiscence of the incision at donor site occurred, all of which healed after symptomatic treatment. The other flaps survived, and the incisions at donor and recipient sites healed by first intention. All patients were followed up 12-36 months (mean, 24 months). Except for 1 case (1 foot) of swollen flap, which underwent two-stage trimming, the other flaps had good shape and texture. All the flaps had a protective feeling. At last follow-up, Kofoed scores of foot and ankle function ranged from 73 to 98 (mean, 89.7); 13 cases were excellent, 2 cases were good, and 1 case was poor, with an excellent and good rate of 93.8%. Linear scar was formed at the donor site without adverse effect on lower limb function. ConclusionThe free transverse gracilis myocutaneous flap is an effective flap for repairing large soft tissue defects of foot and ankle due to its advantages of large excisable area, less variation of vascular anatomy, and concealment of donor site.
A study was carried out to observe the application of microsurgical technique in the repair defects of soft tissue and infected wounds of extremities. Eighty-three patients with soft tissue defects and infected wounds of extremities were treated by either transferring of vascularized cutaneous flap or transplantation of myocutaneous flap with vascular anastomosis. The result showed that eighty-three patients had gained success after a follow-up of 6 months to 4 years. It was concluded that soft tissue defects and infected wounds of extremities should be repaired as early as possible. Selecting the donor flap near the recipient site was of first choice. The method used for repair should be simple and easily applicable rather these very complicated one. The success depended on the correct treatment of local conditions, resonable design of donor flap and close monitoring after operation.
OBJECTIVE: To sum up the application experience of the sural nerve island flap pedicled with the collateral vessels. METHODS: From 1997, the retrograde-flow sural nerve island flaps pedicled with collateral vessels were performed to repair the soft tissues defects of the shank in 3 cases, ankle in 3 cases and foot in 8 cases. RESULTS: Twelve flaps were survived, one flap was partially necrosed and one flap was necrosed. Among them, 10 wounds healed by first intention, 3 cases were healed after changing dressing and the one necrosed flap was repaired by free flap transplantation. Nine cases were followed up for 3 to 21 months and had fine appearance and function. The flap texture was similar to normal skin, the sensation of flap partially recovered after 6 months. CONCLUSION: The flap has more reliable blood supply and great rotation arc, it is easy to resect with little injury. It is excellent for repairing the soft tissues defect in the anterior leg, ankle and proximal half of foot. It is more significant while the main blood vessels are damaged.
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 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.
In order to solve the difficult problems of repair and reconstruction for severe deep burns with compound tissue defects of upper limb, 26 cases were treated with transplantation of compound tissue flap, vascularized by anastomosis of blood vessel or by vascular pedicle. Several kinds of reparative and reconstructive procedure could be performed simultaneously. Not only the tissue defect was repaired, but also the upper limb function was reconstructed in one stage operation. Owing to the presence of abundant vascular supply from the vascularized compound tissue and primarily closing the wounds, the anti-infection potency was high, then it was suitable for such conditions as fresh severe deep burn with infection and compound tissue defects. As a result, this technique provided the best chance to save upper limb from amputation. The duration required for treatment could be markedly shortened. All the cases successed. The long-term functional recovery was satisfactory. This method provided the possibility to solve effectively the difficult problem dealing with the severe deep burns with compound tissue defects of upper limb.