带膝上外侧动脉蒂逆行股前外侧岛状皮瓣和肌皮瓣临床应用

目的：报道带膝上外侧动脉蒂逆行股前外侧皮瓣修复膝关节周围组织缺损的结果。方法：应用股前外侧皮瓣和肌皮瓣逆行转移修复膝关节周围缺损，该皮瓣以膝上外侧动脉为蒂，通过膝上外则动脉与旋股外侧动脉降支之间的吻合支营养股前外侧皮瓣，血供丰富。皮瓣大小１２～１５ｃｍ×３～７ｃｍ，供区均原位缝合，结果：修复膝关节周围缺损４例，小腿淋巴水肿桥接淋巴通道１例，皮瓣均成活。术后外形及功能恢复良好。结论：作者认为该皮瓣是膝关节周围组织缺损修复较为理想的方法。     

蒂部潜移法增加V-Y筋膜皮瓣的推进距离

目的:为修复上肢中小创面提供一种V-Y推进皮瓣。方法:在邻近创面的健康皮肤,依纵行的筋膜皮下血管丛方向设计V-Y筋膜皮瓣,通过对蒂部在深筋膜下间隙及皮下疏松组织中不同层次的潜行分离,既增加了皮瓣的推进距离,又不影响皮瓣的血供基础。结果:临床修复上肢创面6例,皮瓣面积为3cm×4cm~5cm×8cm,推进距离2.5cm~5.0cm,均完全成活。结论:皮瓣蒂部潜移法能安全有效地增加V-Y筋膜皮瓣的推进距离,是修复中小面积创面的较好方法。     

皮神经营养血管组织瓣的临床应用原则与命名

目的 探讨皮神经营养血管组织瓣的临床应用原则，并提出新的命名方法。方法 总结皮神经营养血管组织瓣的解剖研究和临床经验。结果 皮神经多与皮静脉伴行，在其周围均存在丰富的链式吻合血管丛，显著增加了这类组织瓣的血供。临床以远端(31例)或近端(3例)为蒂，在前臂(26例)和小腿(8例)切取带皮神经和皮静脉营养血管的岛状筋膜皮瓣(20例)和筋膜皮下组织瓣(14例)共34例，长宽比例2．7～5．1：1，平均3．5：1，完全成活。结论 带皮神经营养血管的组织瓣是传统筋膜皮瓣和筋膜皮下组织瓣的特殊范例，临床应用应遵循一定的原则。     

小腿前外侧的皮瓣及筋膜瓣的临床应用

目的介绍小腿前外侧的皮瓣筋膜瓣的应用解剖、手术方式、方法及临床应用。方法在14侧成人下肢标本及1条断腿上,观察了腓浅血管的起始部位、行程及皮支的分布情况,设计了小腿前外侧组织瓣的4种术式。1988年以来,临床应用26例。结果术后皮瓣筋膜瓣全部成活,切口Ⅰ期愈合23例,Ⅱ期愈合3例,20例随访4个月到5年,情况稳定良好,无复发。结论手术操作简单、安全可靠,对供区影响小,是修复小腿及对侧踝及跟部后方创面及治疗胫骨慢性骨髓炎的一种可供选用的方法。     

Distally based perforator sural flaps for foot and ankle reconstruction

Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.     

The medial femoral trochlea flap with a monitor skin island—Report of two cases

In this report, we present two cases of the bony reconstruction with the medial trochlea (MFT) flap including a skin island that was used to monitor the perfusion of flap in the postoperative period. Between March 2013 and April 2015, we performed surgery on two patients who suffered from scaphoid and talus non‐union after trauma and initial treatment by osteosynthesis. A skin island (1 cm × 1 cm and 3 cm × 1 cm, respectively) was included with the osseous flap (1.6 cm × 1 cm × 1 cm and 2 cm × 3 cm × 2 cm, respectively) to assess the perfusion of the flap. The design of the skin island was based on either the saphenous artery perforator or a cutaneous perforator of the descending genicular artery. Both flaps remained viable throughout the postoperative period, and there were no donor site complications. After a follow‐up of 36 and 11 months, bony union was observed in both patients with a high degree of satisfaction. Thus, a MFT flap with a skin island could be a tool to assess the perfusion of the flap in the early postoperative period. © 2016 Wiley Periodicals, Inc. Microsurgery 37:431–435, 2017.     

Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes

Study aims

To report the surgical anatomy of the perforator arteries at the lower leg, analyse clinical outcomes in previous studies, and forward methodological recommendations for future studies of post-traumatic perforator flap reconstructions.

Methods

A study sample of 640 human patients drawn from 24 clinical reports was included for review. The sample comprised of four subsets: sural flap reconstructions (n = 257), saphenous flaps (n = 122), supramalleolar flaps (n = 92), and propeller flaps (n = 169).

Results

Statistical analysis of samples from anatomical studies documents significant differences in the perforator distribution from the tibial and peroneal artery; peroneal perforator arteries are randomly organised whereas tibial artery perforators are clustered at three definite levels. The failure rates in clinical studies ranged from 0% to 6%, being lowest for supramalleolar flap reconstructions and highest for saphenous flaps; however, differences between the four subsets were not statistically significant at the 95% confidence level. Due to methodological flaws, outcome comparisons in the actual study sample should be interpreted cautiously; in most clinical studies both risk variables and outcome indicators are poorly defined. The outcome of Dynamic Infrared Thermography imaging of post-transposition changes of flap perfusion is reported.

Summary

Fasciocutaneous perforator flaps seem to have high survival rates and represent a feasible approach to post-traumatic reconstructions, especially in low-resource settings. A template for data gathering is recommended for higher accuracy in future comparative studies, and for scientific analysis of success and risk factors. New imaging techniques indicate a promising potential of micro-circular angiogenesis during the first two weeks after flap transpose.     

Experience with the forearm septofascial flap

Summary Fascia has a well vascularized surface, and when it is covered with a split skin graft, it provides the thinnest possible flap. The authors present their own experience with the use of the forearm septofascial flap in 23 patients. A free septofascial flap was used in 15 patients and an island flap in 8 patients. Seven days later, only 25% of the patients had complete take of the split skin graft, while in 60% of the cases, there was only partial take of the graft. The results at 6 months, regarding appearance of the flap and donor site, were good. In 2 patients, a composite osteofascial flap was used for reconstruction of the mandible. In those patients, the viability of the bone was assessed with scintigraphy. There were no significant complications with the donor site. The forearm septofascial flap proved to be a good and reliable method of reconstruction in those parts of the body where thin cover was required. Constant anatomy and minimal postoperative complications are great advantages of the forearm septofascial flap when compared with other fascial flaps.     

The versatile rhomboid (Limberg) flap

The rhomboid (Limberg) flap can be used to close defects almost anywhere on the body. It is versatile in that a random pattern flap can be raised from any one or all corners of the rhomboid. The defect is filled with tissue of the same thickness and colour, and with good vascularity. The present paper demonstrates the versatility of the rhomboid flap.     

Cornerstones in reconstructive plastic surgery: Argentinian development of muscular,myocutaneous, and fasciocutaneous flaps

This article pays tribute to two Argentinian surgeons whose work has been published in their local journals but is unknown internationally. Goldtraj's pioneering work on the treatment of vascular ulcers of the leg using a muscular flap, presented in 1954, and Spadafora's work on the treatment of tissue defects with myocutaneous and fasciocutaneous flaps, presented in 1964, are discussed. Both papers deserve a place among the pioneering contributions on the subject of muscular as well as myocutaneous and fasciocutaneous flaps.     

Distally-based superficial sural flap: Advantages of the adipofascial over the fasciocutaneous flap

Abstract

The distally-based superficial sural flap has proved to be an easy and reliable method of reconstruction in soft tissue cover of the distal third part of the leg. There are two ways to prepare this flap: as a fasciocutaneous flap, which includes the fascia with the subcutaneous tissue including the skin; or as an adipofascial flap, which is made up of both the fascia and the subcutaneous adipose tissue. In the latter case, the flap is covered with a partial thickness skin graft either immediately after or at a later stage. The aim of this study was to assess the advantages and disadvantages of the two flaps. The adipofascial flap seems to be better, as it is associated with less donor site morbidity, improved quality of reconstruction, and fewer complications.     

小腿外侧腓动脉皮支皮瓣的解剖与临床应用

目的研究以腓动脉皮支血管为蒂的小腿外侧皮瓣吻合血管游离移植的解剖学与临床应用。方法解剖20具40侧成人尸体小腿,测量小腿外侧腓动脉皮支的有关数据。多普勒血管仪测定30侧成人活体小腿外侧腓动脉皮支血管穿出点。临床行21例小腿外侧腓动脉皮支皮瓣吻合血管的游离移植手术。结果40侧小腿共观察到皮支140支,每侧1~7支不等,平均3.5支,其中一侧只有1支高位皮支。皮支的穿出点大多(76%)在腓骨头最凸点下方7~21 cm范围。每侧最粗的皮支动脉外径平均为(1.8±0.4)mm(1.4~2.9 mm),两条伴行静脉外径平均(3.0±0.5)mm和(2.4±0.4)mm。30侧活体小腿共测到小腿外侧皮支血管穿出点145个,平均每侧4.8个。临床切取皮瓣大小5.0 cm×3.5 cm~28 cm×11 cm,21块皮瓣均成活。结论小腿外侧皮瓣由不同数目的腓动脉皮支供养,其主皮支能满足显微外科吻合血管的要求。以皮支血管为蒂的小腿外侧游离皮瓣移植,比以腓血管为蒂创伤小、操作简单、血运重建符合生理。     

Recycling a flap: Making a perforator flap from a previous gluteal fasciocutaneous flap

Abstract

We report a case of raising a previous gluteal fasciocutaneous flap again as a perforator-based flap to cover a recurrent defect. This case illustrates that conventional flap tissue with a preserved perforator can be recycled as a perforator flap, and that this method can be an efficient surgical option for recurrent defects.     

穿支皮瓣修复的新进展

目的了解皮瓣修复的新进展之一,即穿支皮瓣修复技术。方法广泛查阅近年来国内外有关各种穿支皮瓣的文献,并对其研究成果进行回顾与综合分析。结果穿支皮瓣是对传统肌皮瓣的技术改良,其优点是保留了供区的肌肉、筋膜和神经,从而将供区并发症发生率降到最低,已在临床广泛应用。结论穿支皮瓣是新的修复组织缺损的可靠技术,有可能成为缺损修复的首选皮瓣。     

Soft tissue reconstruction of theupper extremity

Soft tissue coverage of the upper extremity requires careful analysis of each defect by the surgeon to establish an appropriate plan for reconstruction. Each anatomic area of the upper extremity has unique reconstructive requirements. Also, patient characteristics including age, compliance, and medical history play a role in the management of upper extremity wounds. The surgeon must incorporate all of these elements to select a suitable reconstructive option that will maximize function and aesthetics as well as minimize morbidity.     

The faciocervicopectoral flap for non-oncological cases of cheek reconstruction

IntroductionMajor facial defect has been a challenging case for plastic surgeons in terms of wound healing and covering technique for a long time.MethodsEight faciocervicopectoral (FCP) flaps were performed for reconstruction of major cheek defects due to handmade explosive and gun injuries. They were evaluated perioperatively and postoperatively with regard to operative time and operative blood loss as well as the function and cosmetic appearance.ResultsThe technique showed marvellous cosmetic results but encountered minor postoperative flap complications.ConclusionsThe FCP flap is one of the best solutions for coverage of a simple or complex cheek defect. Application of the FCP flap is easy and rapid.