Clinical applications of free temporoparietal flaps in hand reconstruction

Vascularized temporoparietal fascia can be used to cover deficits up to 14.0 X 12.0 cm in the hand or fingers. The tissue is thin, pliable, and has a smooth gliding surface advantageous to tendon function. Through scalp incisions, with meticulous yet straightforward dissection, this fascia can be isolated as a vascular island based on the superficial temporal artery system. Vessels are large and the anatomy is constant. Technique and clinical applications are discussed in detail.     

Arterialized venous toenail flaps for treating nail loss in the fingers

Ten arterialized venous toenail flaps with two venous pedicles, one of which was anastomosed to a digital artery and the other to a dorsal vein of the finger, were used in nine patients to reconstruct nail loss due to trauma. Four flaps were taken from the lateral part of the big toe and six flaps from the second toe. Four toenail flaps with pulp and three flaps with the distal half of distal phalanx were used. Nine flaps survived completely and one had partial necrosis. All showed excellent aesthetic and functional results except for one case with minimal deformity in growth of the nail. The mean operating time was 2 hours.     

游离双叶骨间后动脉皮瓣修复两个手指软组织缺损

目的 探讨游离双叶骨间后动脉皮瓣修复两个手指软组织缺损的临床应用效果. 方法 根据相邻两指创面相隔距离的远近,利用骨间后动脉不同区域的皮支组合,设计以骨间背动脉为主干的一蒂双叶皮瓣,修复10例20指皮肤软组织缺损,其中创面分布于拇、示指1例,示、中指2例,中、环指4例,环、小指3例.手指创面面积最小2.5 cm×2.0 cm,最大9.5 cm×3.0 cm,皮瓣面积最小3.0 cm×2.5cm,最大10.0 cm×3.5 cm.结果 10例19指皮瓣术后顺利存活,1指皮瓣尖端少许坏死,换药后愈合.术后随访6 ～ 22个月,平均13.8个月,皮瓣颜色、质地好,8例外形美观,2例较臃肿,8指皮瓣吻合皮神经,两点辨别觉恢复到10 ～ 15 mm,平均12.8 mm.前臂供区的运动功能均无影响. 结论 游离双叶骨间后动脉皮瓣修复两个手指软组织缺损,可以获得良好的外观与功能,供区损伤小,是一种较好办法.     

静脉皮瓣的临床应用研究

临床应用静脉皮瓣6例共7块修复四肢组织缺损,完全成活6块,1块表皮及部分真皮坏死,最大成活皮瓣的面积为5cm×15cm。提出临床应用静脉皮瓣的原则及应注意的事项,     

静脉皮瓣的临床应用研究

临床应用静脉皮瓣６例共７块修复四肢组织缺损，完全成活６块，１块表皮及部分真皮坏死，最大成活皮瓣的面积为５ｃｍ×１５ｃｍ。提出临床应用静脉皮瓣的原则及应注意的事项。     

Clinical applications of paraumbilical perforator flaps in multiple angiosomes for the reconstruction of the upper limbs

Background:Repair of extensive deep wounds in the forelimb remains challenging for surgeons. The objective of this study was to evaluate the surgical technique ...     

岛状皮瓣、肌皮瓣的临床应用

目的总结1985年以来,临床52例应用15种岛状皮瓣、肌皮瓣,修复四肢创伤软组织缺损、瘢痕挛缩畸形、先天性畸形鼻再造以及巨大直肠阴道瘘的修补经验。方法以非主干动脉的岛状皮瓣为主共47例(90.38％),其中逆行岛状皮瓣24例,占46.15％。结果 52例中除1例胸大肌岛状肌皮瓣远端有很小面积坏死外,余均全部成活。40例术后随访8个月～11年,功能及形态恢复满意。结论岛状皮瓣、肌皮瓣具有血运丰富、抗菌能力强,移位方便、操作简单,不受设备条件的限制等优点。     

Pedicled and "flow-through" venous flaps: clinical applications

Recently, the pedicled venous flap and "flow-through" venous flap have been the focus of increasing attention for skin defects of the fingers and hands. For successful venous flap use, the following approaches have been suggested: (1) a pedicled venous flap with preservation of the draining veins alone; (2) a "flow-through" flap with preservation of a flow-through vein in the flap; and (3) an arterialized "flow-through" venous flap which ensures arterial blood flow into the flap. Based on findings that venous blood is helpful in flap survival, the authors made use of the first two flap types, the pedicled venous flap and the "flow-through" venous flap and attempted to establish and clarify reasonable conditions for flap survival. Venous pressure of the finger and elbow was measured and venographies of the finger and hand were also carried out. The following conditions are regarded as essential in successful venous flap procedures: (a) use of a venous flap with a rich venous network; (b) preservation of many "flow-through" veins; (c) harvesting a pedicled venous flap where the veins have afferent (reversed) venous pressure; and (d) anastomosing veins of the "flow-through" flap with recipient veins where high efferent venous pressure exists and differential pressure is observed. Clinical cases are presented and the authors attempt to explain flap failure from previously unknown causes. Conditions for flap harvesting are also discussed.     

Recovery of sensitivity in the hand after reconstruction with arterialised venous flaps.

Loss of soft tissues of the fingers were repaired in 22 patients using 25 arterialised venous flaps harvested from the thenar, hypothenar, or forearm regions. Twenty-one of the flaps survived completely, 16 of which were raised from the thenar or hypothenar region, and the other five from the forearm region. We studied the sensory recovery and skin characteristics of the flaps harvested from the three regions. Good sensory recovery was obtained for the thenar or hypothenar venous flaps, which were characterised by durable skin and suitable texture for replacement of defects in the finger pulp. On the other hand, no moving two-point discrimination was recorded during the follow-up period in the group given forearm venous flaps. These flaps showed instability during pinching and grasping. However, larger flaps and longer veins can be harvested from the forearm region. This type of flap is therefore considered useful for covering dorsal defects of the finger or large and multiple skin defects.     

岛状皮瓣、肌皮瓣的临床应用

目的总结１９８５年以来，临床５２例应用１５种岛状皮瓣、肌皮瓣，修复四肢创伤软组织缺损、瘢痕挛缩畸形、先天性畸形鼻再造以及巨大直肠阴道瘘的修补经验。方法以非主干动脉的岛状皮瓣为主共４７例（９０．３８％），其中逆行岛状皮瓣２４例，占４６．１５％。结果５２例中除１例胸大肌岛状肌皮瓣远端有很小面积坏死外，余均全部成活。４０例术后随访８个月～１１年，功能及形态恢复满意。结论岛状皮瓣、肌皮瓣具有血运丰富、抗菌能力强，移位方便、操作简单，不受设备条件的限制等优点。     

岛状皮瓣,肌皮瓣的临床应用

总结１９８５年以来，临床５２例临床应用１５种岛状皮瓣，肌皮瓣，修复四肢创伤软组织损，痕挛缩畸形，先天性形鼻 及巨大直肠阴道瘘的修补经验。方法以非主干动脉的岛状皮瓣为主共４７例，其中逆行岛状皮瓣２４例，占４６．１５％。结论岛状皮瓣，肌皮瓣具有血运丰富，抗菌能力强，移位方面，操作简单，不受设备条件的限制等优点。     

Management of flaps with compromised venous outflow in head and neck microsurgical reconstruction

Microvascular tissue transfer has become an indispensable procedure for head and neck reconstruction. Although remarkable progress has been made technically, anastomosed vessel occlusion is still a serious complication. Even with technically skilled microsurgeons, anastomosed vessel occlusion occurs because the technique is not the sole prophylaxis against thrombosis in microsurgery. Therefore, to minimize the possibility of an unfavorable result in microsurgery, microsurgeons must be familiar with management options for a vascular compromised flap. Most investigators have agreed that venous obstruction occurs more often than arterial obstruction. Here, we reviewed the published literature on the salvage of venous compromised flaps from the viewpoints of surgical correction, including reanastomosis and catheter thrombectomy, and nonsurgical procedures, such as a medicinal leech, hyperbaric oxygen, and thrombolytic therapy.