游离同侧前臂穿支皮瓣修复指端缺损

目的：分析探讨游离同侧前臂穿支皮瓣修复指端缺损的临床经验。方法自2011年6月至2014年6月,本科采用游离同侧前臂穿支皮瓣修复17例(18指)患者指端缺损,采用中华医学会手外科学会上肢部分功能评分试用标准等评定疗效。结果其中14个皮瓣顺利成活。2个骨间背侧穿支皮瓣、1个尺动脉穿支皮瓣、1个桡动脉穿支皮瓣在术后24 h内出现静脉危象。视循环危象具体情况分别采用拆除皮瓣部分缝线,皮瓣小切口放血,皮瓣按摩等方法处理,未行手术血管探查。2个皮瓣存活、1个部分坏死、1个全部坏死,全部坏死病例改用邻指皮瓣修复。患者均获得3.0~12.0个月随访,平均随访5.8个月。皮瓣色泽红润、质地柔软、外观自然、不臃肿,与周围皮肤接近。指端饱满,外形良好。两点辨别觉8~12 mm,无严重触痛。患指各关节活动基本正常,无关节坚硬。患者对指端感觉及伤指外形均较为满意,能适应正常的工作与生活。按中华医学会手外科学会上肢部分功能评定试用标准评定：优12指,良4指,可2指,优良率88.9%。结论游离同侧前臂穿支皮瓣移植修复指端缺损,皮瓣供区、受区位于同一上肢、同一术野。患者仅需在一侧臂丛神经阻滞麻醉下即可接受手术,可在止血带控制下进行无血、无创操作。手术操作简单、麻醉方便,成功率高。手术不破坏手背及手指组织,不损伤主干血管,损伤小。但是,手术需要较高显微外科技术,有一定的皮瓣坏死率,手术风险较高。     

Osteomyocutaneous peroneal artery perforator flap for reconstruction of composite maxillary defects

BACKGROUND: Composite maxillary defects often involve the maxilla, nasal mucosa, palate, and maxillary sinus. We presented the surgical techniques and outcome of the osteomyocutaneous peroneal artery perforator (PAP) flap for reconstruction of composite maxillary defects. METHODS: Six patients underwent an osteomyocutaneous PAP flap reconstruction of composite maxillary defects. The average age was 52 years. The defects were Cordeiro type II in three patients and type IV midfacial defects in another three patients. RESULTS: No total or partial flap failures occurred. At a mean 12-month follow-up, five patients had a normal speech and were able to eat a regular diet. One patient tolerated a soft diet and had intelligible speech. One patient had ectropion develop. Excellent cosmesis was found in five patients. CONCLUSIONS: The osteomyocutaneous PAP flap represents a further refinement of the fibula flap and increases its versatility, with multiple skin paddles, bone segments, and soleus muscle independently isolated. It is a comparable reconstruction option for composite maxillary defects.     

指动脉逆行岛状皮瓣修复63例69指指端缺损

目的分析、探讨指动脉逆行岛状皮瓣修复指端缺损的临床效果。方法1990～1999年应用指动脉逆行岛状皮瓣治疗63例69指指端缺损。结果除1例皮瓣坏死外,其余均存活。术后经1～28个月随访,外形满意,效果良好。结论指动脉逆行岛状瓣是一种修复指端缺损的可行方法。     

重建感觉的指动脉终末背侧支逆行岛状皮瓣修复指端缺损的近期疗效

目的探讨应用重建感觉的指动脉终末背侧支逆行岛状皮瓣修复指端缺损的方法及疗效。方法 2008年12月-2010年3月,收治32例40指外伤致指端缺损患者。男20例23指,女12例17指;年龄20～62岁,平均42岁。受伤至入院时间1～8h。拇指2例,示指6例,示、中指3例,中指7例,中、环指3例,环指8例,环、小指2例,小指1例。创面范围为1.2cm×1.0cm～2.2cm×1.8cm。术中取以指动脉终末背侧支为蒂,带神经分支的中节指背岛状皮瓣逆行移位修复创面,将神经分支和指固有神经残端吻合。皮瓣切取范围为1.5cm×1.0cm～2.5cm×2.0cm。供区游离植皮修复。结果术后6例9指皮瓣出现水疱,2例2指皮瓣出现部分坏死,均经对症处理后愈合。其余患者皮瓣及植皮均顺利成活,创面Ⅰ期愈合。术后30例38指获随访6个月。手指外形满意,质地柔软,可完成握拳动作。术后6个月,皮瓣浅感觉及深痛觉均恢复;24指两点辨别觉为4～6mm,13指为7～10mm,1指无两点辨别觉;皮瓣感觉按照中华医学会手外科学会上肢部分功能评定试用标准,获S31指,S3+13指,S424指。结论重建感觉的指动脉终末背侧支逆行岛状皮瓣切取简便、血供可靠,同时吻合神经分支可恢复皮瓣感觉,是修复指端缺损的有效方法之一。     

Pedicled medial sural perforator flap for the reconstruction of knee defects

Soft tissue defects exposing the patellar tendon or bone are common in patients who have experienced trauma or implant infection. The purpose of this article is to present our experience of six patients who underwent reconstruction of soft tissue defects of the knee using a pedicled medial sural perforator flap. Between November 2013 and November 2015, six patients who presented with a soft tissue defect overlying the knee were admitted to our hospital. After adequate debridement or wide excision of the tumour, these patients underwent pedicled medial sural perforator flap placement to resurface the complex soft tissue defects and to provide a gliding surface for the exposed patellar tendon. The patients' age, comorbidity, aetiology, defect size and location, flap size, perforator numbers and lengths, outcome and follow‐up period were reviewed. The six medial sural perforator flaps survived completely, and the wounds healed satisfactorily over a mean follow‐up of 21·5 months (range, 6–51 months). Donor sites were closed primarily or covered with a split‐thickness skin graft. The medial sural perforator flap is a reliable flap for coverage of defects overlying the knee. The thin and pliable flap, long pedicle length and less donor site mobility benefit patients. Thus, the medial sural perforator flap may be a valuable alternative for defect reconstructions overlying the knee, which produces satisfactory results both functionally and cosmetically.     

Medial sural artery perforator flap for tongue and floor of mouth reconstruction

BACKGROUND: The radial forearm flap is frequently considered the first choice for tongue reconstruction, but the disadvantages of donor site morbidity are well known. The search for another thin skin flap as an alternative has led to the application of the medial sural artery perforator flap. METHODS: We used 12 medial sural artery perforator flaps to reconstruct tongue and floor of mouth following cancer ablation. We paid attention to the major perforator (vein >or= 1 mm) as the vascular relay. RESULTS: Most flaps were raised with a single perforator. The size of the skin paddle varied from 9 cm x 5 cm to 14 cm x 12 cm. The mean thickness of the flap was 5.2 mm. We reexplored 1 patient for venous insufficiency and could not salvage the flap. CONCLUSIONS: The thin medial sural artery perforator flap permits high accuracy of tongue restoration and reduces the morbidity at the donor site.     

Repair of complex digital soft-tissue defects using a free composite ulnar artery perforator flap from the volar wrist

Digital skin defects resulting from trauma are often associated with dysfunction of the digital nerve and the extensor and flexor tendons in the affected fingers. The repair of these complex tissue defects requires a graft containing multiple tissues that can be used to reconstruct the tendons and nerves and restore the skin. Such procedures can cause multiple injuries and significant damage to the donor site. The current study used a novel technique to repair complex dorsal and palmar digital soft-tissue defects. First, multiple tissues were cut and collected from the donor site. Then, part of the flexor carpi ulnaris tendon was transplanted to repair the tendon defect, and a medial antebrachial cutaneous nerve graft was used to repair the digital nerve defect. Finally, a skin flap was used to cover the skin defect. This paper reports on 31 cases of complex soft-tissue digital defects, with defect areas of 2–18 cm². One patient presented with a postoperative arterial crisis in the flap. All other patients recovered without experiencing a vascular crisis, flap necrosis, or wound infection. The postoperative flaps were similar in texture to the original digital skin. The sensation and the extension/flexion functions in the affected fingers recovered well. The effect on grip strength, wrist flexion, and forearm sensation was minor and the postoperative total active motion scores of the affected digits were good or excellent in 96.77% of the cases. The flap sensation recovery rate was also excellent in 83.87% of the cases. The present technique facilitates the repair of multiple dorsal and palmar digital soft-tissue, tendon and nerve defects, reduces the damage to the donor site, and significantly improves the success of surgical repair.     

Internal mammary artery perforator flap for reconstruction of the chest wall

Abstract

We used internal mammary artery perforator (IMAP) flaps from the opposite side for reconstruction of small-to-medium-sized defects in the chest wall. The IMAP flaps were used in two patients who had unhealed, localised ulcers of the chest wall with exposure of the ribs after radical mastectomy. The lesion was excised widely, and the flap, based on a perforator vessel in the second or third intercostal space of the opposite chest wall, was raised. The flap was rotated from 90° to 180° along the vascular axis to the chest wall defect. The donor site was closed primarily. Both flaps showed stable postoperative circulation and survived completely. Defects of the chest wall could be covered with healthy, well-vascularised tissue on one perforator without deep infection. The IMAP flap is a reliable and less invasive option to be considered for medial, localised, reconstruction of the chest wall.     

Internal mammary artery perforator (IMAP) flap for tracheostoma reconstruction

BACKGROUND: Tracheostoma reconstruction requires a thin flap to avoid occlusion. Although the deltopectoral flap has been used as a rotational flap for decades, clinical use of a true internal mammary artery perforator island flap has not been reported. METHODS: In two cases, tracheostoma and anterior neck reconstruction were performed by use of an internal mammary artery perforator flap as a pedicled island flap. One flap was based on the perforator vessels in the second intercostal space and, the other, on the third. Donor sites were closed primarily in both patients. RESULTS: The internal mammary artery perforator flaps were well perfused in both cases. Both flaps healed uneventfully, with reliable reconstruction of the tracheal stoma and coverage of the anterior neck, although overall prognoses were poor. CONCLUSION: The internal mammary artery perforator flap is a relatively thin and reliable flap for tracheostoma and lower neck reconstruction.     

侧方指动脉穿支皮瓣在手指远端缺损修复中的临床应用

目的 探讨应用手指侧方指动脉穿支皮瓣修复指端缺损的临床疗效. 方法 2008年10月至2010年8月期间,应用手指侧方指动脉穿支皮瓣修复9例共12指指端部分缺损患者,其中拇指5指,示指2指,中指3指,环指2指.切取皮瓣面积为2.7 cm × 1.4 cm ～ 3.1 cm×1.8 cm,供区游离植皮修复. 结果 11例皮瓣血运良好,伤口一期愈合,1例术后出现皮瓣远端部分青紫,经局部换药3周后愈合.患者均获随访,随访3～6个月,皮瓣外形饱满,颜色质地接近正常.10例皮瓣术后3个月内两点辨别觉恢复至4～5 mm. 结论 应用手指侧方指动脉穿支皮瓣修复指端缺损,避免了主干血管损伤,皮瓣外观、感觉恢复良好,疗效满意.     

The sural artery perforator flap for coverage of defects of the knee and tibia

We reconstructed four knee and lower leg defects using the sural artery perforator flap between 2000 and 2003, and describe them here. The sural artery perforator flap can save the gastrocnemius muscle, its motor nerve, deep fascia, lesser saphenous vein, and sural nerve with no functional loss. Intramuscular dissection of the perforator achieves increased length of the pedicle compared with a conventional gastrocnemius myocutaneous flap. The flap is thin, and either the medial or lateral sural artery may be used. The flap is suitable in selected cases for regional reconstruction around the knee and upper half of the lower leg as a pedicled flap.     

环指指动脉皮瓣与拇指桡侧逆行筋膜皮瓣瓦合修复拇指缺损

【】 目的 探讨环指指动脉顺行岛状皮瓣与拇指桡侧逆行岛状筋膜皮瓣瓦合修复拇指缺损的临床应用效果。方法 我院自2010 年4月以来对10例I类拇指缺损采用环指指动脉顺行岛状皮瓣与拇指桡侧逆行岛状筋膜皮瓣瓦合修复结合自体髂骨移植,治疗后观察皮瓣及骨愈合、皮瓣感觉功能及术后相关并发症发生情况。结果 经过12个月随访,10例拇指缺损修复良好,皮瓣及移植骨愈合良好,按中华医学会手外科学会拇、手指再造功能评定试用标准[1],优8例,良2例,无术后相关并发症发生。结论 环指指动脉顺行岛状皮瓣与拇指桡侧逆行岛状筋膜皮瓣瓦合结合自体髂骨移植修复I类拇指缺损的临床效果满意。     

Extended locoregional use of intercostal artery perforator propeller flaps

Besides conventional flaps, intercostal artery perforator flaps have been reported to cover trunk defects. In this report the use of anterior intercostal artery perforator (AICAP) flap, lateral intercostal artery perforator (LICAP) flap and dorsal intercostal artery perforator (DICAP) flap for thoracic, abdominal, cervical, lumbar and sacral defects with larger dimensions and extended indications beyond the reported literature were reevaluated. Thirty‐nine patients underwent surgery between August 2012 and August 2014. The age of the patients ranged between 16 and 79 with a mean of 49 years. The distribution of defects were as follows; 12 thoracic, 8 parascapular, 3 cervical, 8 abdominal, 4 sacral and 4 lumbar. AICAP, LICAP and DICAP flaps were used for reconstruction. Fifty‐two ICAP flaps were performed on 39 patients. Flap dimensions ranged between 6 × 9 cm and 14 × 35 cm. Twenty‐six patients had single flap coverage and 13 patients had double flap coverage. Forty‐six flaps have been transferred as propeller flaps and 6 flaps have been transferred as perforator plus flap. Forty flaps (75%) went through transient venous congestion. In one DICAP flap, 30% of flap was lost. No infection, hematoma or seroma were observed in any patient. Follow‐up period ranged between 3 and 32 months with a mean of 9 months. The ICAP flaps provide reliable and versatile options in reconstructive surgery and can be used for challenging defects in trunk.     

Incisional lumbar hernia after the use of a lumbar artery perforator flap for breast reconstruction

Abstract

Autologous breast reconstruction with a perforator flap has become increasingly popular. The free lumbar artery perforator (LAP) flap has been described as a good alternative for autologous breast reconstruction. The LAP flap is a perforator flap based on a single pedicle. This flap is easy to harvest, with minimal donor-site morbidity. We present a case of a lumbar incisional hernia after LAP flap breast reconstruction in a 53-year-old patient. The patient had been treated with a bilateral mastectomy for cancer. Secondary breast reconstruction was performed with a bilateral DIEP flap. Reoperation was necessary because of a failed DIEP flap at the left side. Reconstruction was performed with a free LAP flap. The patient was referred for a right lumbar incisional hernia at the donor-site of the LAP flap. Open repair was performed with a retroperitoneal mesh. The thoracolumbar fascia was closed in with a running suture. Lumbar artery perforator is a perforator flap based on a single pedicle. Although it does not sacrifice any muscle and seems to be associated with minimal donor-site morbidity, we present the first report of a lumbar incisional hernia repair after LAP flap breast reconstruction treated using an open retroperitoneal mesh repair.     

The use of innervated radial artery superficial palmar branch perforator free flap for complex digital injuries reconstruction

Loco-regional flaps have been widely used for the reconstruction of digital injuries without requiring microvascular anastomosis, however, they result in scarring and compromised functional outcomes. This study demonstrates our experience utilizing the innervated radial artery superficial palmar branch (RASPB) perforator free flap for complex digital injury reconstruction. From May 2007 to March 2014, the innervated RASPB perforator free flap was used to reconstruct 79 distal complex hand and digital soft tissue defects of which 14 were used to re-vascularise the distal digit in a flow-through fashion. All free flaps were innervated by the palmar cutaneous branch of the median nerve. All 79 free flaps survived and all 14 digits re-vascularized successfully. One flow-through free flap developed distal skin necrosis which healed uneventfully without further procedure. The average follow-up was 21.5 months. Measurement of two-point discrimination ranged from 7 to 13?mm. All patients were satisfied with the aesthetic results. The innervated RASPB perforator free flap is a feasible and effective option for the reconstruction of complex digital defects and the flow-through concept, when utilized in cases with compromised vascularity, provides reliable re-vascularization. Level III, therapeutic study.