Reconstruction of Soft Tissue Defects in the Hand with a Free Anterolateral Thigh Deep Fascia Flap

ObjectiveTo report our experience in the reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From November 2016 to January 2020, six patients (four men and two women) with soft tissue defects in the hand were included in this study. The average age of the patients was 33.7 ± 12.7 years (range, 20 to 50 years). All patients underwent reconstructions with free anterolateral thigh deep fascia flaps. Relevant clinical characteristics were recorded prior to surgery. The size and thickness of the deep fascia flap and the thickness of the skin were measured intraoperatively. The survival of the flaps and skin grafts and the occurrence of infection were recorded after the operation. At follow‐up, donor site complications and postoperative effects were evaluated according to the outcome satisfaction scale. The pain in the injured hand was assessed using the visual analog scale.ResultsThe average body mass index (BMI) was 26.6 ± 1.7 kg/m² (range, 23.9 to 28.7 kg/m²). The defect sizes ranged from 5 cm × 5 cm to 13 cm × 8 cm (average, 53.1 ± 27.9 cm²). The six anterolateral thigh deep fascia flaps ranged from 7 cm × 6 cm to 14 cm × 9 cm in size (average, 71.8 ± 29.1 cm²). The thicknesses of skin ranged from 25 mm to 40 mm (average, 32.5 ± 4.8 mm), and the thicknesses of the deep fascia flaps ranged from 2 mm to 3 mm (average, 2.5 ± 0.5 mm). After the operation, the blood supply of the deep fascia flap was normal in all cases. The second‐stage skin grafts of most patients survived completely. The skin graft in one case was partially necrotic and healed after a dressing change. No infection occurred. At follow‐up (average, 16.3 ± 6.9 months), there was only a linear scar and no loss of sensation at the donor site of each patient. According to the outcome satisfaction scale, the outcome satisfaction score ranged from 6 to 8 (average, 7.2 ± 0.9), all of which were satisfactory. Apart from one patient who reported mild pain, all the other patients reported no pain. Three typical cases are presented in this article.ConclusionsThe free anterolateral thigh deep fascia flap, which is suitable for reconstruction of soft tissue defects in the hand, can provide very good outcomes both functionally and aesthetically.     

大鼠皮瓣血液循环的磁共振波谱学初步研究

观察皮瓣的能量代谢。方法：利用磁共振波谱技术分别对大鼠皮瓣在正常灌注、动脉阻流、静脉阻流、失活等条件下ＡＴＰ、ＰＣｒ、Ｐｉ峰形的变化进行分析。结果正常时,Ｐｉ低于ＡＴＰ的γ及α峰。     

The distally based subcutaneous tarsometatarsal flap

Injuries to the distal part of the foot, or even the toes, can still provide reconstructive problems. It is not always wise to amputate the damaged, distal part of the foot. Some surgeons have stated that reconstruction of the distal foot is not necessary, but it is our opinion that it has a similar priority to reconstruction of the hand. While large defects are mostly reconstructed by free flaps, minor defects should also be considered for reconstruction. As in a previous paper, Small toe muscles for defect coverage [12], we are presenting a new way to reconstruct damaged tissue distal to the tarsometatarsal region.Correspondence to: G. Wechselberger     

Transanaler rektaler Verschiebelappen (rectal advancement flap) versus mukosaflap mit internusnaht im management komplizierter fisteln des anorektums Eine prospektive klinische und manometrische studie

A prospective study was carried out on 55 patients with complicated anal fistulas (41 transsphincteric, 5 suprasphincteric and 9 rectovaginal) to evaluate the value of two sphincter-conserving techniques with primary occlusion of the internal ostium and endorectal advancement flap (group A, n=34) or mucosal flap (group B, n=21). Ten of the patients had Crohn's disease. Both techniques consist in one-stage fistulectomy without drainage of the intersphincteric space. The inflamed proctodeal and granulation tissue was carefully cleared. The site of the former primary orifice of the fistula was adapted by means of two or three peranally performed single stitches. The peranally applied suture included the layers of the internal anal sphincter muscle only. A mobilized flap of rectal wall (group A) and rectal mucosa and submucosa (group B) about 4 cm × 3 cm in size was stitched below the muscular sphincter. The perianal part of the wound was left to heal by second intention. Postoperatively there were 16 cases of suture leakage (23.5% in group A, and 38% in group B), and 19 patients (26% or 47% in both groups) had to have revision surgery because of recurrent fistula or sutur leakage; 2 patients (3.6%) developed incontinence with intermittent fecal soiling. Complete incontinence was not observed in any patient. No significant difference in clinical and functional results was determined between the two groups.

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Transanaler rektaler Verschiebelappen (rectal advancement flap) versus mukosaflap mit internusnaht im management komplizierter fisteln des anorektums Eine prospektive klinische und manometrische studie

Zusammenfassung Bei 55 Patienten mit komplizierten Analfisteln (41 transsphinktere, 5 suprasphinktere, 9 rektovaginale Fisteln) wurde eine prospektive Studie zur Bewertung von 2 sphinktererhaltenden Techniken mit primärem Verschlu des inneren Fistelostiums and anschlieender Deckung durch einen endorektalen Verschiebelappen (Gruppe A, n=34) oder Mukosalappen (Gruppe B, n=21) durchgeführt. Zehn Patienten hatten M. Crohn. Beide Techniken bestehen aus einer einzeitigen Fistulektomie ohne Drainage des Intersphinkterraumes. Das entzündlich veränderte Procdodealdrüsen- und Granulationsgewebe wurde vorsichtig mit dem scharfen Löffel entfernt. Der Ort der früeren Primäröffnung der Fistel wurde mit zwei bzw. drei peranal angelegten Einzelknopfnähten verschlossen. Die peranal gelegte Naht umfate die Schichten des M. spincter ani internus. Ein mobilisierter Rektumwandlappen (Gruppe A) oder ein Mukosa-Submukosalappen (Gruppe B), in einer Gröe von ca. 4×3 cm wurde versetzt und über den muskulären Verschlu gedeckt. Der perianale Teil der Wunde heilte sekundär. Postoperativ trat bei 16 Fällen eitle Nahtinsuffizienz auf (23,5% in Gruppe A, 38% in Gruppe B). Neunzehn Patienten (26% gegenüber 47% in beiden Gruppen) erforderten eine erneute Operation aufgrund von wiederkehrenden Fisteln oder Nahtinsuffizienzen. Zwei Patienten (3,6%) entwickelten eine Inkontinenz in Hinblick auf intermittierendes Stuhlschmieren. Eine völlige Störung der Kontinenz wurde in keinem Fall beobachtet. Ein signifikanter Unterschied zwischen beiden Gruppen war weder in klinischen noch in den funktionellen Ergebnissen zu ermitteln.

     

胫后侧逆行岛状筋膜蒂皮瓣修复踝周围软组织缺损

总结１９９３年５月－１９９８年８月,应用胫后侧二种逆行岛状筋膜蒂皮瓣多向转位修复踝部周围皮肤缺损的临床效果。利用胫后动脉肌间隙的穿动脉,腓动脉肌间隙支,腓动脉外踝支与腓肠浅动脉广泛吻合,设计胫后侧两种筋膜蒂皮瓣。     

两种LASIK微型角膜刀的临床应用探讨

目的　比较ＫＮ－ ５０００ 型微型角膜刀与Ｍｏｒｉａ 微型角膜刀在ＬＡＳＩＫ 术中制作角膜瓣时的优缺点。方法　选用连续病例５６ 例１０３ 眼,随机分ＫＮ 组和Ｍｏｒｉａ 组,ＫＮ 组２８ 例５３眼,术前近视度数平均为－ ９－２１±７－４１Ｄ,散光≤－５－００Ｄ,Ｍｏｒｉａ 组２８ 人５０ 眼,术前近视度数平均为－１０－４７±３－７３Ｄ,散光≤－２－５０Ｄ,术中分别用ＫＮ－５０００ 微型角膜刀和Ｍｏｒｉａ 微型角膜刀制作角膜瓣。结果　两组病例角膜瓣边缘整齐。基质面：ＫＮ组全部术眼光滑、规则,Ｍｏｒｉａ 组部分术眼有“搓衣板”现象。瓣异常：ＫＮ组游离瓣２ 眼,Ｍｏｒｉａ 组不全瓣５ 眼。ＫＮ组角膜瓣质量优于Ｍｏｒｉａ 组,瓣异常率低于Ｍｏｒｉａ 组。结论　ＫＮ－ ５０００ 微型角膜刀在ＬＡＳＩＫ术中制瓣时性能及安全性、稳定性优于Ｍｏｒｉａ 组微型角膜刀。ＫＮ－ ５０００ 微型角膜刀还具有良好的易学性和进行ＬＡＳＩＫ角膜板层移植的功能。     

Aesthetic considerations in facial reconstructive surgery: The V-Y flap revisited

The subcutaneous pedicled V-Y advancement flap (also known as the kite flap of Dufourmentel) has been described by many authors. Its versatility in reconstructive surgery is well known, both in facial reconstructive surgery as well as surgery of the trunk and extremities. Its advantages in achieving aesthetic reconstruction in specific facial regions have been less well emphasized in the literature. The flap can be designed within natural facial creases and heals inconspicuously because of its widely based subcutaneous or muscle pedicle which incorporates venous and lymphatic drainage over most of its length. The undesirable biscuiting or flap edema frequently observed with other conventional transposition flaps is avoided. We have found the V-Y flap particularly useful in reconstructing the lower eyelid/medial canthus, supra-alar, and nasolabial regions. Our experience with over 40 such flaps is described, and technical considerations in designing and elevating the flap are discussed.     

Respecting the aesthetic units in the surgery of palpebral malignancy

Summary The authors, based on their own experience in this field suggest their own therapeutical view which can be described as follows: a much more frequent use of plastic procedures using sliding flaps from the cheek, associated usually with chondromucosal free grafts from the septum, will give not only much better aesthetic results but also a better guarantee against neoplastic recurrence due to the possibility of being able to carry out a much larger ablation.     

带蒂骨膜瓣修补外伤性脑脊液鼻漏

目的：探讨一种有效的外伤性脑脊液鼻漏修补方法。方法：分析本科收治的6例经颅修补的脑脊液鼻漏，采用带蒂骨膜瓣翻转缝合及EC胶严密封闭漏口。结果：无手术死亡，术后脑脊液漏均停止。通过4个月-2年随访，仅有1例术后3个月轻微复发，保守治疗自愈。结论：该方法取材方便，抗感染能力强，一次手术成功率高。尤其适应于额窦后壁、筛窦顶部骨折或缺损所致的脑脊液鼻漏。