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.     

游离股前外侧穿支皮瓣或隐动脉穿支皮瓣修复足踝部软组织缺损

目的 探讨利用游离股前外侧穿支皮瓣或隐动脉穿支皮瓣修复足踝部软组织缺损的效果及手术技术.方法 2006年8月至2012年4月,对足踝部软组织缺损患者25例,创面范围4.0cm×5.5 cm～11.0 cm×23.0 cm.其中,足背软组织缺损采用游离股前外侧穿支皮瓣修复20例,足底软组织缺损采用游离隐动脉穿支皮瓣修复5例.结果 术后25例皮瓣全部成活.术后随访3～ 50个月,平均(18.0±0.8)个月.皮瓣修复后外形大部满意,皮瓣末梢二点辨别觉为10～22 mm,股前外和隐动脉穿支皮瓣组术后3个月随访,恢复S2+以上感觉分别为13/20和5/5例.结论 股前外穿支皮瓣修复足背软组织缺损较合适,隐动脉穿支用于修复足底软组织缺损.避免受区二次手术整形,重视皮瓣供区处理.负压封闭引流技术对开放性损伤导致创面的皮瓣成活有明显促进作用.     

Anterolateral thigh flap salvage following failed deep inferior epigastric artery perforator breast reconstruction

The deep inferior epigastric artery perforator flap is an option for women desiring autologous tissue breast reconstruction. If this reconstruction fails, other autologous tissue flaps, including the gluteal artery perforator and latissimus dorsi flaps, may be used for salvage. The anterolateral thigh (ALT) flap offers adequate tissue volume for breast reconstruction, acceptable fat quality and a long vascular pedicle. Other advantages include obviating the need for intraoperative position changes and harvesting tissue outside of the radiation field. Two cases involving ALT flaps used in the setting of deep inferior epigastric artery perforator failure are presented with favourable results. A review of the anatomy of the ALT flap is included.     

Reconstruction of foot and ankle defects with a superthin innervated anterolateral thigh perforator flap

Background: An anterolateral thigh (ALT) perforator flap can be thinned to an extent to which it is vascularised only by the subdermal plexus. This study presents an innervated flap thinning technique and its application for dorsal foot and ankle resurfacing.

Methods: A superthin innervated ALT perforator flap was used to repair the dorsal foot and ankle of 12 patients. The perforators were classified according to their variations in the adipose layer, and the corresponding microdissection technique was then applied. The branch of the lateral femoral cutaneous nerve and its accompanying vessels were adopted to construct a sensory flap.

Results: The flap thickness before defatting, which was measured immediately after flap elevation, ranged from 25–45?mm. The average flap thickness after defatting was 4.55?mm (range =?3–6?mm). A total of 11 flaps completely survived, and one flap presented superficial necrosis within a small area (2?cm ×2?cm) in the distal part of the flap. No further flap revision or defatting procedures were required for these patients during an average follow-up period of 16.5 months (range =?10–24 months). In the transferred flap, protective sensibility existed in all cases, and the static two-point discrimination was 13–16?mm.

Conclusions: The superthin innervated ALT perforator flap may be considered as an ideal strategy for foot and ankle reconstruction.     

320排螺旋CT血管造影和三维重建在阴股沟穿支皮瓣临床设计中的应用

目的：以320排螺旋CT血管造影和三维重建为基础,尝试在临床为阴股沟穿支皮瓣血管蒂的术前设计提供体表定位方法.方法：对18名需运用阴股沟穿支皮瓣行会阴部再造的实验组患者,术前进行320排螺旋CT血管造影和三维重建,并通过影像学资料为阴股沟穿支皮瓣血管蒂提供体表定位,从而进一步指导手术.同时设置对照组,包括20名运用阴股沟穿支皮瓣行会阴部再造患者,未使用CT血管造影技术.结果：两组共38名患者皮瓣完全存活,实验组手术时间较对照组明显缩短（P＜0.0001）,术后并发症实验组明显减少（P＜0.05）.皮瓣外观形态满意,生理功能接近正常.结论：320排螺旋CT血管造影及三维重建为阴股沟穿支皮瓣血管蒂的术前体表定位提供了一种可靠、有效的方法.     

上臂内侧扩张皮瓣修复颈部瘢痕挛缩

目的 探讨上臂内侧扩张皮瓣的血供及用于治疗颈部不同程度的瘢痕挛缩的方法.方法 对10例患者分期手术:Ⅰ期手术时将扩张器置入上臂内侧深筋膜浅层;Ⅱ期手术时,利用尺侧上副动脉或尺侧返动脉供血、贵要静脉属支及腋静脉属支回流的上臂内侧扩张皮瓣带蒂转移修复松解颈部瘢痕挛缩后的创面;Ⅲ期时将扩张皮瓣断蒂,扩张皮瓣最大面积25 cm×15 cm.结果 移植皮瓣全部成活,皮瓣色泽及性状接近颈部正常组织,外形良好,上臂内侧供瓣区遗留较小的继发畸形.结论 将扩张器置于上臂内侧皮肤深筋膜浅层形成的扩张皮瓣用于治疗颈部瘢痕挛缩,是一个可行的方法,但分期治疗需要较长时间,在转移期间上肢与头部问的强迫体位固定的痛苦是其不足.     

双侧游离股后内侧穿支皮瓣再造一侧乳房

目的探讨双侧游离股后内侧穿支皮瓣再造一侧乳房的可行性。方法回顾性分析2018年10月至2019年6月湖南省肿瘤医院肿瘤整形外科收治的6例女性早期乳腺癌患者的临床资料。患者年龄31~47岁。肿瘤均为单侧,左侧3例,右侧3例;浸润性导管癌3例,浸润性小叶癌3例。对6例乳腺癌患者行一期或二期双侧游离股后内侧穿支皮瓣移植再造乳房。一期再造3例,乳腺肿块直径2.5~4.0 cm;二期再造3例。术后对皮瓣和供区的情况进行随访观察。结果6例患者手术过程顺利,切取皮瓣长(24.4±0.5)cm、宽(8.3±0.5)cm、厚(3.4±0.5)cm,血管蒂长度为(8.9±0.4)cm,动脉管径为(1.5±0.4)mm,静脉管径为(1.9±0.3)mm。皮瓣平均质量为235 g(165~345 g)。1例皮瓣供区术后1周出现淋巴漏,经持续负压吸引于2周后自行愈合。6例获5~8个月随访,平均5.5个月,所有皮瓣均成活,再造乳房外形可,弹性好,无皮瓣挛缩变形,供区仅遗留线性瘢痕,无下肢功能影响。6例效果均较满意,未发现乳腺癌复发。结论应用双侧游离股后内侧皮瓣移植再造一侧乳房效果较好,方法可行,可作为特殊情况下乳房再造的备选手术方案。     

First web-space reconstruction by the anterolateral thigh flap

Four patients with severe contracture of the first web space were treated with an anterolateral thigh perforator flap. The flap size ranged from 10 to 13 cm in length and from 7 to 8 cm in width. The donor site was closed directly and thinning of the flap was performed in all cases. All flaps survived and there were no re-explorations. Web space opening was maintained over the follow-up period. There was an average postoperative increase of the angle of the first web space of 61 degrees. The thinned anterolateral thigh flap provides a pliable vascularized tissue for resurfacing the skin after release of severe contracture of the first web space and represents a reliable alternative to other flaps.     

Combined use of medial thigh skin flaps and gracilis musculocutaneous flaps for the reconstruction of scrotum

Summary A case of combined use of bilateral medial thigh skin flaps and gracilis musculocutaneous flaps for the reconstruction of a scrotal defect resulting from Fournier's gangrene is presented. The procedure provided a sac-like scrotum, and the donor sites were successfully reconstructed using bilateral gracilis musculocutaneous V-Y advancement flaps.     

薄型游离旋股外侧动脉穿支皮瓣修复手足部瘢痕挛缩畸形北大核心CSCD

目的探讨薄型游离旋股外侧动脉穿支皮瓣修复手、足部瘢痕挛缩畸形的疗效。方法 2017年1月—2020年10月,收治15例手、足部瘢痕挛缩畸形患者。男9例,女6例;年龄6~42岁,中位年龄23岁。瘢痕挛缩时间1~21年,中位时间13年。瘢痕挛缩畸形位于手部11例、足部4例;导致不同程度手、足部关节功能障碍。术中瘢痕挛缩松解后遗留创面范围为6 cm×4 cm~9 cm×8 cm;合并血管、神经或者肌腱外露12例,肌腱缺损4例。经浅筋膜浅层切取薄型游离旋股外侧动脉穿支皮瓣修复,皮瓣切取范围为6.0 cm×5.0 cm~10.0 cm×8.5 cm;取阔筋膜条重建肌腱。皮瓣供区减张缝合。结果术后1例皮瓣出现静脉血管危象,经对症处理后皮瓣成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。皮瓣供区切口均Ⅰ期愈合。患者均获随访,随访时间6~12个月,平均9个月。皮瓣外形、质地良好。患手功能明显改善,末次随访时按照中华医学会手外科学会上肢部分功能评定试用标准,获优7例、良4例。患足足趾关节畸形及功能均明显改善。供区无肌疝、感觉麻木等并发症发生。结论经浅筋膜浅层切取的薄型游离旋股外侧动脉穿支皮瓣修复手、足部瘢痕挛缩畸形松解后创面,可获得良好外观及功能,而且供区并发症少。     

穿支游离皮瓣修复头颈肿瘤术后缺损

目的 探索更为理想的穿支游离皮瓣修复技术，运用于头颈肿瘤术后缺损。方法 2003年12月-2005年5月用于头颈部手术缺损修复的穿支游离皮瓣共14例（股前外侧皮瓣8例，腹壁下深动脉穿支皮瓣6例）。其中10例为复发后挽救手术，12例曾行放疗（平均63．5Gy）。头颈部肿瘤手术缺损部位分别为舌体3例，颊黏膜3例，口咽壁3例，舌根2例，颅底、头皮以及中面部各1例。受区供吻合动脉主要是甲状腺上动脉和面动脉；静脉为颈内静脉。结果 13例穿支游离皮瓣成功（93％），有1例穿支皮瓣因吻合侧的颈内静脉血栓形成导致皮瓣坏死。受区未发现其它明显并发症。供区均直接缝合关闭并一期愈合，未发现腹壁疝和运动受限等手术并发症。结论 穿支游离皮瓣保留了供区的肌肉、筋膜和神经，将供区的并发症降到最低限度，是头颈部缺损修复新的可靠技术。     

股前内侧穿支皮瓣游离移植修复手部创面

目的 探讨应用股前内侧穿支皮瓣游离移植修复手部创面的临床疗效.方法 2008年6月至2011年6月,应用股前内侧穿支皮瓣游离移植修复手部创面共15例,其中手掌侧创面5例,尺侧创面4例,虎口区创面1例,手背创面5例;缺损面积:6 cm×4cm～13cm×9 cm;其中11例与受区桡动脉、头静脉吻合,4例与尺动脉、贵要静脉吻合.供区直接缝合9例,部分植皮6例.结果 本组15例皮瓣全部存活,未出现血管危象.随访3～ 12个月,临床效果满意.结论 应用股前内侧穿支皮瓣游离移植修复手部(正)面,临床效果满意,值得推广应用.     

逆行股前外侧皮瓣治疗膝周韧带样纤维瘤6例

2008年7月～2010年12月,笔者应用逆行股前外侧皮支皮瓣修复膝周韧带样纤维瘤病切除后创面6例,效果满意。1材料与方法1.1病例资料本组6例,男3例,女3例,39～67岁。肿瘤位于膝上外侧部5例,肿瘤扩大切除后皮肤缺损面积为7     

Popliteal fossa reconstruction with a medial sural artery perforator free flap using the medial sural vessel as the recipient

Background: Reconstruction of the popliteal fossa using a free flap is challenging. Therefore, to facilitate easier free flap reconstruction of the popliteal fossa, we use a medial sural artery perforator (MSAP) free flap with a medial sural vessel as the recipient vessel, as it provides several advantages based on many reports.

Methods: This report describes the authors’ experience and outcomes with this technique. Between October 2010 and January 2015, 10 patients with medium-sized defects in their popliteal fossa underwent MSAP free flap reconstruction using the medial sural vessel as the recipient vessel. The flap size and thickness were evaluated, as well as the pedicle length, for each case.

Results: The skin flap sizes ranged from 60–112?cm². The average flap thickness was 6?mm (range?=?4–8?mm), and the average pedicle length was 7.5?cm (range?=?6–9?cm). Full flap survival was observed in nine cases, and flap tip necrosis was observed in one case during a mean follow-up of 15 months (range?=?3–36 months). MSAP free flap reconstruction was performed for moderate-sized defects in the popliteal fossa, using the medial sural vessel as the recipient vessel.

Conclusion: The obvious advantages of this technique included simple vascular anastomosis (minimal size discrepancy), no intraoperative position changes, and good aesthetic outcomes (replacing like with like).     

Flow-through anterolateral thigh flap for reconstruction in electrical burns of the severely damaged upper extremity

Background

Many surgeons have to face the challenge of the sophisticated management of catastrophic high-voltage injuries to upper extremities. These patients present with both vast soft tissue defects and varied segmental main artery defects with compromised circulation of the distal limb. This study is a first attempt to analyze the outcome of the flow-through anterolateral thigh flap for reconstruction in acute electrical burns of the severely traumatized upper extremity.

Method and patient

From March 2001 to February 2012, five men were enrolled in the study. All in this series suffered from high voltage current (higher than 1000 V) electrical burn and had the presence of wide segmental soft tissue defects, exposure of underlying vital structures and segmental artery injury with compromised circulation. Flow-through anterolateral thigh flaps were used for limb salvage.

Result

Follow up for all patients was present from 6 months to 7 years. The mean age was 37.8 years old. The mean timing of free flap transfer was 5.8 days after injury. The mean flap sizes were 31.6 cm × 16.5 cm. The mean artery defect was 14.2 cm in length. Venous thrombosis occurred 1 day post-operatively in one patient. No donor site morbidity was noted. In the postoperative period, no infection, no hematoma, nor deaths were noted. Successful limb salvage rate was 80% in this series.

Conclusion

In electrical injuries of the severely damaged upper extremity, flow through anterolateral thigh flaps provide for reconstruction of both the vessels and soft tissue simultaneously. Although the risk of flap failure is higher than with other etiologies of burn, the data shows that the above reconstruction technique is useful for upper extremity salvage.     

股外侧穿支皮瓣的临床应用研究

目的 探讨股外侧穿支皮瓣修复四肢软组织缺损的可行性与临床疗效. 方法 通过解剖红色乳胶灌注的6例成人下肢标本,观测大腿中下段外侧区皮肤穿支数目、分布、蒂长、外径、走行与类别.结合 解剖研究结果设计13例皮瓣修复四肢不同形状创面,皮瓣面积3.0 cm×3.0 cm～19.0 cm×8.0 cm.其中带蒂转移l例,游离移植12例,2例采用穿支皮瓣组合移植. 结果 13例皮瓣全部顺利成活.术后随访3～6个月,皮瓣外形不臃肿,质地柔软,有弹性,色泽良好,未发生冻伤与溃疡.供区无一例出现肌肉粘连或瘢痕挛缩畸形导致的关节活动障碍.直接缝合的病例仅留线性瘢痕,植皮修复者植皮区域饱满无凹陷. 结论 股外侧穿支皮瓣薄而柔软、外形较美观、解剖分离相对简单、手术创伤小等优点,游离移植适合四肢中小型皮肤缺损创面修复,带蒂转移适宜修复膝、腘部位创面,组合移植适宜修复四肢大面积创面.