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Sample records for artery perforator flap

  1. The Versatile Extended Thoracodorsal Artery Perforator Flap for Breast Reconstruction

    DEFF Research Database (Denmark)

    Jacobs, Jordan; Børsen-Koch, Mikkel; Gunnarsson, Gudjon Leifur;

    2016-01-01

    BACKGROUND: The thoracodorsal artery perforator (TAP) flap is a versatile tool that can be used to reconstruct the breast. The authors use preoperative perforator mapping using color Doppler ultrasonography and present a safe, efficient harvesting technique to demonstrate reliable use of the TAP...

  2. Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects

    Institute of Scientific and Technical Information of China (English)

    HAI Heng-lin; SHEN Chuan-an; CHAI Jia-ke; LI Hua-tao; YU Yong-ming; LI Da-wei

    2013-01-01

    Background Perforator flaps are used extensively in repairing soft tissue defects.Superior gluteal artery perforatorflaps are used for repairing sacral defects,but the tension required for direct closure of the donor area after harvesting ofrelatively large flaps carries a risk of postoperative dehiscence.This research was to investigate a modified superiorgluteal artery perforator flap for repairing sacrococcygeal soft tissue defects.Methods From June 2003 to April 2010,we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients (study group).The wound and donor areas were measured,and the flaps were designed accordingly.Wound healing was assessed over a follow-up period of 6-38 months.From January 1998 to February 2003,twelve patients with sacrococcygeal pressure sores were treated with traditional methods,VY advancement flaps or oblong flaps,as control group.Results After debridement,the soft tissue defects ranged from 12 cm × 10 cm to 26 cm × 22 cm (mean 16.3 cm x 13.5cm).Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm (mean 18.2 cm × 14cm).Four patients were treated using left-sided flaps,and two were treated using both right-and left-sided flaps.Suction drains were removed on postoperative Days 3-21 (mean 5.9) and sutures were removed on postoperative Days 12-14.Each flap included 1-2 perforators for each of the donor and recipient sites.Donor sites were closed directly.All flaps survived.In eight patients,the wounds healed after single-stage surgery.After further debridement,the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33,respectively.The rate of first intention in the study group (80%,8/10) significantly increased than that of control group ((25%,3/12),X2=4.583,P=-0.032).Follow-up examinations found that the flaps had a soft texture without ulceration.In the two patients without

  3. Thoraco dorsal artery perforator flap for trismus release in a young girl.

    Science.gov (United States)

    Deneuve, Sophie; Qassemyar, Quentin; Blancal, Jean-Philippe; Couloignier, Vincent; Sainte-Rose, Christian; Janot, François; Kolb, Frederic

    2015-11-01

    Trismus is a frequent complication occurring after treatment of tumors of the pterygomaxillary fossa. Local flaps and full-thickness skin grafts fail to release it because they usually lead to scar contracture in previously irradiated tissues. We propose to release it with a thoracodorsal artery perforator flap, which is feasible in children like other perforator flaps. It is interesting because it is thinner than the anterolateral thigh flap and its scar may be less disgraceful and easier to hide.

  4. Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects

    Directory of Open Access Journals (Sweden)

    Lei Zhu

    2014-01-01

    Full Text Available Background: Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip. Materials and Methods: Six cases (six fingers of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site. Results: Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale and the two point discrimination was 3-8 mm. Conclusion: Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.

  5. Expanded thoracoacromial artery perforator flap for reconstruction of full-perioral scar contracture.

    Science.gov (United States)

    Wang, Qianwen; Wang, Jiaqi

    2015-03-01

    Various types of anterior chest flaps can be recruited in the reconstruction of faciocervical region. Most of them were created based on the internal mammary artery and the lateral thoracic artery, and the thoracoacromial artery (TAA) is usually used in pectoralis major musculocutaneous flap. An anterior chest flap with TAA perforator (TAAP) will have no sacrifice of the pectoralis major muscle, but less reports, especially expanded pedicled one, can be reviewed. Here, we reported a case using expanded pedicled TAAP flap to reconstruct the perioral scar contracture. In this technique, expanded TAAP flap could be easily harvested without the sophisticated microsurgical technology. Acceptable esthetic and functional results were achieved.

  6. Perforator-to-perforator musculocutaneous anterolateral thigh flap for reconstruction of a lumbosacral defect using the lumbar artery perforator as recipient vessel.

    Science.gov (United States)

    Mureau, Marc A M; Hofer, Stefan O P

    2008-05-01

    Reconstruction of large-sized lumbosacral or sacral defects often is not possible using local or regional flaps, making the use of free flaps necessary. However, the difficulty of any microsurgical procedure in this region is complicated by the need to search for potential recipient vessels to revascularize the flap. In the present case, a free musculocutaneous anterolateral thigh flap to cover a large-sized and deep lumbosacral defect was used. Arterial anastomosis was performed, connecting the cutaneous anterolateral thigh (ALT) perforator to the perforator of the second lumbar artery. In this fashion, the arterial circulation through the flap was flowing reversely through the muscle. The concomitant vein of the descending branch of the lateral circumflex femoral artery was hooked up to the thoracodorsal vein using a long interposition vein graft because the perforator of the second lumbar vein was too small. Postoperative healing was uneventful. In conclusion, a successful reconstruction of a lumbar defect has shown that local perforators in the lumbar area may be accessible for easier perforator-to-perforator anastomoses and that the muscular part of the musculocutaneous ALT flap can survive on retrograde arterial perfusion from a perforator of the skin island.

  7. The distally-based island ulnar artery perforator flap for wrist defects

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    Karki Durga

    2007-01-01

    Full Text Available Background: Reconstruction of soft tissue defects around the wrist with exposed tendons, joints, nerves and bone represents a challenge to plastic surgeons, and such defects necessitate flap coverage to preserve hand functions and to protect its vital structures. We evaluated the use of a distally-based island ulnar artery perforator flap in patients with volar soft tissue defects around the wrist. Materials and Methods: Between June 2004 and June 2006, seven patients of soft tissue defects on the volar aspect of the wrist underwent distally-based island ulnar artery perforator flap. Out of seven patients, five were male and two patients were female. This flap was used in the reconstruction of the post road traffic accident defects in four patients and post electric burn defects in three patients. Flap was raised on one or two perforators and was rotated to 180°. Results: All flaps survived completely. Donor sites were closed primarily without donor site morbidity. Conclusion: The distally-based island Ulnar artery perforator flap is convenient, reliable, easy to manage and is a single-stage technique for reconstructing soft tissue defects of the volar aspect of the wrist. Early use of this flap allows preservation of vital structures, decreases morbidity and allows for early rehabilitation.

  8. Bilateral Breast Reconstruction with Extended Thoracodorsal Artery Perforator Propeller Flaps and Implants

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon L; Børsen-Koch, Mikkel; Nielsen, Henrik Toft;

    2015-01-01

    We present our experience of bilateral total breast reconstruction using a double-sided extended thoracodorsal artery perforator propeller flap in a case series of 10 patients. Reconstruction was successfully achieved in all cases with few complications. The median time for surgery was 275 minutes...... (200-330), and the average implant size used was 350 cm(3) (195-650). We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium...

  9. Immediate reconstruction using free medial circumflex femoral artery perforator flaps after breast-conserving surgery.

    Science.gov (United States)

    Izumi, Ken; Fujikawa, Masakazu; Tashima, Hiroki; Saito, Takuya; Sotsuka, Yohei; Tomita, Koichi; Hosokawa, Ko

    2013-11-01

    Recent advances in perforator flap surgical techniques have allowed for safe and reliable autologous tissue transfer with minimal donor-site morbidity. Between April 2012 and January 2013, we performed immediate breast reconstruction using free medial circumflex femoral artery perforator (MCFAP) flaps in 15 patients after breast-conserving surgery. The flaps were harvested from patients in the lithotomy position, while a second surgical team simultaneously conducted tumour resection. Of the 15 procedures performed, three flaps were dissected as true perforator flaps, while 12 flaps were dissected as muscle-sparing perforator flaps. The mean flap weight was 138.5 g (range, 77-230 g) and the mean pedicle length was 5.7 cm (range, 3.0-9.0 cm). Recipient vessels for anastomosis were serratus branches in 10 patients, internal mammary vessels in three patients and thoracodorsal vessels in two patients. The mean duration of surgery was 6.74 h (range, 5.65-9.45 h). There were no major complications requiring surgical intervention. Researchers observed partial flap necrosis, which manifested as small firm lesions in two patients, as well as local wound infection and dehiscence in one patient, which resolved spontaneously. There were no instances of donor-site seroma formation or lymphoedema in any of the patients. An objective assessment of postoperative photographs showed that cosmetic results were mostly satisfactory. Donor-site scars along the medial groin crease were inconspicuous and readily concealed by clothing. Given its reliable vascularity and minimal donor-site morbidity, the free MCFAP flap can be a good alternative for partial breast reconstruction after breast-conserving surgery.

  10. Partial breast reconstruction with mini superficial inferior epigastric artery and mini deep inferior epigastric perforator flaps.

    Science.gov (United States)

    Spiegel, Aldona J; Eldor, Liron

    2010-08-01

    In this study, partial breast reconstruction was undertaken after breast conservation therapy using mini abdominal free flaps on both an immediate and delayed basis.Patient demographics, oncologic status, reconstructive data, and complications were collected from medical records.Twelve patients (age range 39-60) were included in this study with a mean follow-up time of 5 years. Ten mini superficial inferior epigastric artery flaps and 2 mini deep inferior epigastric perforator flaps were used (7 immediate and 5 delayed reconstructions). No flap lost, 1 minor abdominal wound dehiscence, and no local or distant recurrences were noted. Good to excellent results were reported by 91% of the women.In properly selected patients with high motivation toward breast conservation, tailored abdominal mini-free flaps can safely and satisfactorily be implemented for the reconstruction of partial mastectomy defects. Patients should be comprehensively educated on the potential future implications of using the abdominal donor site for partial breast reconstruction.

  11. Assessing the suitability of medial sural artery perforator flaps in tongue reconstruction – An outcome study

    Science.gov (United States)

    Kwon, Soo-Ha; Tsai, Chia-Hsuan; Chang, Kai-Ping; Kao, Huang-Kai

    2017-01-01

    Introduction Oncological resection of the tongue can be reconstructed using a multitude of free flaps. The medial sural artery perforator (MSAP) flap has been well described in the literature in terms of its anatomy and harvest. However, functional outcome studies of post-reconstruction tongue defects using the MSAP flap have not been reported. This study represents the largest outcome study of patients with tongue reconstructions using MSAP flaps and a comprehensive review of its use. Materials and methods From December of 2010 to October of 2015, 579 patients with subtotal glossectomy and free flap reconstructions in Chang Gung Memorial Hospital were retrospectively reviewed. 27 patients were reconstructed with MSAP flap. The pre- and intra-operative factors, as well as flap-related factors were analyzed. Post-operative complications and functional outcomes were evaluated. Donor site assessment were also conducted. Results A 96.3% flap survival rate was found with an average total operating time of 6 hours and 18 minutes. 84.6% of patients had primary closure of the donor site with and the remaining either had skin grafts or delayed closure. Donor site closure can be achieved primarily with no functional deficit. Speech intelligibility remained for most patients. 100% of patients resumed normal oral feeding. Conclusion The MSAP flap is a small to medium sized flap most suited for subtotal glossectomy defects where optimal outcomes can be achieved in terms of speech clarity and restoration of oral intake. PMID:28182639

  12. Reconstruction after Anterior Chest Wall Keloid Resection Using Internal Mammary Artery Perforator Propeller Flaps

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    Ogawa, Rei; Ono, Shimpei; Akaishi, Satoshi; Dohi, Teruyuki; Iimura, Takeshi; Nakao, Junichi

    2016-01-01

    Background: It is difficult to completely resect huge anterior chest wall keloids and then close the wound directly. We report here our retrospective analysis of our case series of patients with such keloids who underwent reconstruction with internal mammary artery perforator (IMAP) pedicled propeller flaps and then received postoperative high-dose-rate superficial brachytherapy. Methods: All consecutive patients with large/severe keloids on the anterior chest wall who underwent keloid resection followed by reconstruction with IMAP-pedicled propeller flaps and then high-dose-rate superficial brachytherapy in our academic hospital were identified. All cases were followed for >18 months. Donor site position, perforator pedicle, flap size, angle of flap rotation, complications, and recurrence were documented. Results: There were nine men and one woman. The average age was 37.9 years. The average follow-up duration was 28.7 months. The largest flap was 16 × 4 cm. The dominant perforators of the internal mammary artery were located in the sixth (n = 2), seventh (n = 5), eighth (n = 1), and ninth (n = 2) intercostal spaces. Twelve months after surgery, patients reported marked relief from keloid-associated pain and itching, except in two patients who underwent partial keloid resection; their remaining keloids were still troublesome but after conservative therapies, including steroid ointments/plasters, the keloids gradually ameliorated. Eighteen months after surgery, there was no keloid recurrence or new development of keloids on the donor site. Conclusions: IMAP-pedicled propeller flaps transfer skin tension from the anterior chest wall to the abdomen. Our series suggests that this approach combined with radiation therapy can control keloid recurrence.

  13. Novel use of a supraclavicular transverse cervical artery customised perforator flap: a paediatric emergency.

    LENUS (Irish Health Repository)

    Dolan, R T

    2013-08-01

    Perforation of the piriform fossa is a rare, potentially life-threatening paediatric emergency. Prompt diagnosis and early operative intervention is key to patient survival, yet restoring aerodigestive continuity can pose a significant reconstructive challenge. A seven-month old baby girl presented to an emergency department acutely unwell with a twenty-four-hour history of haemoptysis, cough and worsening respiratory distress. A contrast swallow demonstrated extension of contrast into the retropharyngeal region necessitating immediate surgical intervention. A 3.0 cm×1.0 cm perforation within the left posterolateral piriform fossa was identified. The defect was repaired with a supraclavicular transverse cervical artery customised perforator flap. This was inset into the piriform fossa luminal defect as a life-saving procedure. Following a stormy post-operative course, the child was discharged home on day 28 of admission and admitted electively 6 weeks later for division of flap pedicle. This case highlights the novel use of this fasciocutaneous island flap to reconstruct an extensive, potentially fatal, piriform fossa defect in an acute paediatric setting. This simple flap design offers timely mobilisation, reliable blood supply, adequate tenuity and surface area, to reconstruct this extensive defect as a life-saving intervention in a profoundly septic child.

  14. Pedicled perforator flaps

    DEFF Research Database (Denmark)

    Demirtas, Yener; Ozturk, Nuray; Kelahmetoglu, Osman;

    2009-01-01

    Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap to recon......Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap...... more practical and creative to use a free-style manner during pedicled perforator flap surgery, instead of being obliged to predefined templates for this type of procedure....

  15. The thoracodorsal artery perforator flap with a vascularized scapular segment for reconstruction of a composite lower extremity defect.

    Science.gov (United States)

    Momeni, A; Krischak, S; Bannasch, H

    2006-01-01

    High-energy trauma resulting in a composite defect of the lower extremity confronts the microvascular surgeon with more difficulties than do free flap reconstruction elsewhere in the body, since the choice of distant recipient vessels is particularly difficult. Combining principles of perforator flap surgery with those of composite tissue transfer, we designed a thoracodorsal artery perforator flap with a vascularized bone segment from the scapula for reconstruction of a composite lower extremity defect in a patient following a paragliding accident. This is the first report on the application of a composite thoracodorsal artery perforator flap with vascularized scapula in lower extremity reconstruction. Among its multiple advantages, such as preservation of latissimus dorsi function, it is a good tool for one-stage reconstruction of traumatic composite lower extremity defects because its low donor site morbidity and long vascular pedicle enables anastomosis placement outside the zone of injury.

  16. CASE REPORT A Double Thoracodorsal Artery Perforator Flap Technique for the Treatment of Pectus Excavatum

    Science.gov (United States)

    Sinna, Raphaël; Perignon, David; Qassemyar, Quentin; Benhaim, Thomas; Dodreanu, Codrin N.; Berna, Pascal; Delay, Emmanuel

    2010-01-01

    Background: Pectus excavatum is a common congenital deformity involving the anterior thoracic wall. It can be treated with several surgical approaches. Material and methods: To our best of knowledge, this is the first case of pectus excavatum repair via a 2-stage double thoracodorsal artery perforator flap procedure in a 37-year-old patient. Results: We obtained a satisfactory result in which the missing volume was correctly replaced in the absence of dorsal sequelae. The patient was very satisfied despite the dorsal scars. Conclusion: This new approach broadens the surgeon's options for the correction of thoracic deformities. PMID:20458352

  17. Brachial artery perforator-based propeller flap coverage for prevention of readhesion after ulnar nerve neurolysis.

    Science.gov (United States)

    Sekiguchi, Hirotake; Motomiya, Makoto; Sakurai, Keisuke; Matsumoto, Dai; Funakoshi, Tadanao; Iwasaki, Norimasa

    2015-02-01

    It is difficult for most plastic and orthopaedic surgeons to treat nerve dysfunction related to neural adhesion because the pathophysiology and suitable treatment have not been clarified. In the current report, we describe our experience of surgical treatment for adhesive ulnar neuropathy. A 58-year-old male complained of pain radiating to the ulnar nerve-innervated area during elbow and wrist motion caused by adhesive ulnar neuropathy after complex open trauma of the elbow joint. The patient obtained a good clinical outcome by surgical neurolysis of the ulnar nerve combined with a brachial artery perforator-based propeller flap to cover the soft tissue defect after resection of the scar tissue and to prevent readhesion of the ulnar nerve. This flap may be a useful option for ulnar nerve coverage after neurolysis without microvascular anastomosis in specific cases.

  18. Immediate breast reconstruction using the free lumbar artery perforator flap and lateral thoracic vein interposition graft for recipient lateral thoracic artery anastomosis

    Directory of Open Access Journals (Sweden)

    Toshihiko Satake

    2016-01-01

    Full Text Available The lumbar artery perforator (LAP flap, which contains excess skin and fat tissue, love handles, that extends from the lower back to upper buttock, may provide an alternate tissue source for autologous breast reconstruction. However, LAP flap use during this procedure frequently requires vessel interposition grafts to correct the short flap pedicle length and mismatched recipient vessel calibre. A 46-year-old patient underwent a right nipple-sparing mastectomy using a lateral approach for ductal carcinoma in situ and immediate LAP flap breast reconstruction. The lateral thoracic vessel served as the recipient vessel, and a lateral thoracic vein interposition graft from the distal remnant was performed to adjust the arterial length and size discrepancy between the recipient lateral thoracic artery and pedicle artery. This procedure facilitates microsurgical anastomosis and medialisation of LAP flap to make a natural decollete line and create a cleavage for the reconstructed breast.

  19. A reliable method for the treatment of lower third soft tissue defects of the leg: Use of a posterior tibial artery perforator flap

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    Fikret Eren

    2015-12-01

    Full Text Available Management of lower third limb defects is a common challenge for the reconstructive surgeon due to a lack of soft tissue in that anatomic area. Traditionally, lower third of the limb defects were usually reconstructed with free flaps. The evolution of reconstructive surgery enabled thinner and pliable flaps to be harvested for the purpose of minimizing morbidity from muscle inclusion into the flap. With the introduction of perforator flaps, repairing of small and medium size defects of the distal lower third of leg and ankle region is possible with minimal donor site morbidity. Perforator flaps are based on cutaneous, small diameter vessels that arise from a main pedicle that adjacently perforates the fascia to reach the skin. In this article, we present our experience with two cases involving the repair of these defects by using posterior tibial artery perforator flaps. [Hand Microsurg 2015; 4(3.000: 67-70

  20. The Versatile Modiolus Perforator Flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo

    2016-01-01

    BACKGROUND: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our....... The color Doppler ultrasonography study detected a sizeable perforator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical finding, and flaps...

  1. Sural artery perforator flap with posterior tibial neurovascular decompression for recurrent foot ulcer in leprosy patients

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    Ismail, Hossam El-din Ali

    2017-01-01

    Full Text Available Introduction: The sensory loss and alteration of the shape of the foot make the foot liable to trauma and pressure, and subsequently cause more callus formation, blisters, and ulcers. Foot ulcers usually are liable to secondary infection as cellulitis or osteomyelitis, and may result in amputations. Foot ulcers are a major problem and a major cause of handicaps in leprosy patients. The current study is to present our clinical experience and evaluate the use of sural flap with posterior tibial neurovascular decompression (PTND in recurrent foot ulcers in leprosy patients.Patient and methods: A total number of 9 patients were suffering from chronic sequelae of leprosy as recurrent foot ulcers. All the patients were reconstructed with the reverse sural artery fasciocutaneous flap with posterior tibial neurovascular decompression from September 2012 to August 2015. Six patients were male and three were female with a mean age of 39.8 years (range, 30–50 years. All the soft tissue defects were in the weight-bearing area of the inside of the foot. The flap sizes ranged from 15/4 to 18/6 cm. Mean follow-up period was 21.2 months (range, 35–2 months.Results: All the flaps healed uneventfully. There was no major complication as total flap necrosis. Only minor complications occurred which were treated without surgical intervention except in two patients who developed superficial necrosis of the skin paddle. Surgical debridement was done one week later. The flap was completely viable after surgery, and the contour of the foot was restored. We found that an improvement of sensation occurred in those patients in whom the anesthesia started one year ago or less and no sensory recovery in patient in whom the anesthesia had lasted for more than two years.Conclusion: The reverse sural artery flap with posterior tibial neurovascular decompression provides a reliable method for recurrent foot soft tissue reconstruction in leprosy patients with encouraging

  2. Sural artery perforator flap with posterior tibial neurovascular decompression for recurrent foot ulcer in leprosy patients

    Science.gov (United States)

    Ismail, Hossam El-din Ali; El Fahar, Mohamed Hassan

    2017-01-01

    Introduction: The sensory loss and alteration of the shape of the foot make the foot liable to trauma and pressure, and subsequently cause more callus formation, blisters, and ulcers. Foot ulcers usually are liable to secondary infection as cellulitis or osteomyelitis, and may result in amputations. Foot ulcers are a major problem and a major cause of handicaps in leprosy patients. The current study is to present our clinical experience and evaluate the use of sural flap with posterior tibial neurovascular decompression (PTND) in recurrent foot ulcers in leprosy patients. Patient and methods: A total number of 9 patients were suffering from chronic sequelae of leprosy as recurrent foot ulcers. All the patients were reconstructed with the reverse sural artery fasciocutaneous flap with posterior tibial neurovascular decompression from September 2012 to August 2015. Six patients were male and three were female with a mean age of 39.8 years (range, 30–50 years). All the soft tissue defects were in the weight-bearing area of the inside of the foot. The flap sizes ranged from 15/4 to 18/6 cm. Mean follow-up period was 21.2 months (range, 35–2 months). Results: All the flaps healed uneventfully. There was no major complication as total flap necrosis. Only minor complications occurred which were treated without surgical intervention except in two patients who developed superficial necrosis of the skin paddle. Surgical debridement was done one week later. The flap was completely viable after surgery, and the contour of the foot was restored. We found that an improvement of sensation occurred in those patients in whom the anesthesia started one year ago or less and no sensory recovery in patient in whom the anesthesia had lasted for more than two years. Conclusion: The reverse sural artery flap with posterior tibial neurovascular decompression provides a reliable method for recurrent foot soft tissue reconstruction in leprosy patients with encouraging function and

  3. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: A chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty.

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    Yamamoto, Takumi; Saito, Takafumi; Ishiura, Ryohei; Iida, Takuya

    2016-09-01

    Total ankle arthroplasty (TAA) is becoming popular in patients with rheumatoid arthritis (RA)-associated ankle joint degeneration. However, ankle wound complications can occur after TAA, which sometimes requires challenging reconstruction due to anatomical complexity of the ankle. Superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been reported to be useful for various reconstructions, but no case has been reported regarding a chimeric SCIP flap for complex ankle reconstruction. We report a case of complex ankle defect successfully reconstructed with a free quadruple-component chimeric SCIP flap. A 73-year-old female patient with RA underwent TAA, and suffered from an extensive ankle soft tissue defect (13 × 5 cm) with exposure of the implanted artificial joint and the extensor tendons. A chimeric SCIP flap was raised based on the deep branch and the superficial branch of the SCIA, which included chimeric portions of the sartorius muscle, the deep fascia, the inguinal lymph node (ILN), and the skin/fat. The flap was transferred to the recipient ankle. The sartorius muscle was used to cover the artificial joint, the deep fascia to reconstruct the extensor retinaculum, the ILN to prevent postoperative lymphedema, and the adiposal tissue to put around the extensor tendons for prevention of postoperative adhesion. Postoperatively, the patient could walk by herself without persistent leg edema or bowstringing of the extensor tendons, and was satisfied with the concealable donor scar. Although further studies are required to confirm efficacy, multicomponent chimeric SCIP has a potential to be a useful option for complex defects of the ankle.

  4. Use of Thoracodorsal Artery Perforator Flaps to Enhance Outcomes in Alloplastic Breast Reconstruction

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    Jonathan Bank, MD

    2014-05-01

    Conclusions: Patients who underwent irradiation before TDAP flap did not have a higher complication rate when compared with patients who had a full LD flap following radiation. By integrating well-vascularized, nonradiated tissue of a TDAP flap in reconstruction, overall complication rate may be minimized and the results are comparable to the generally accepted method of utilizing the entire latissimus dorsi muscle.

  5. The freestyle pedicle perforator flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Jackson, Ian T; Westvik, Tormod S;

    2015-01-01

    not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. METHODS: We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle pedicled...

  6. [Osteo-cutaneous Mycobacterium marinum infection of the elbow and reconstruction with radial collateral artery perforator-based propeller flap].

    Science.gov (United States)

    Gabert, P-E; Lievain, L; Vallée, A; Joly, P; Auquit Auckbur, I

    2016-08-01

    Mycobacterium marinum is an atypical and non-tuberculosis mycobacterium that mainly leads to cutaneous infections. Infections occur through inoculation of the organism through injury to the skin in the presence of contaminated water or fish. The patient often presents with unspecific symptoms and the evolution, in the absence of adequate treatment, is characterized by an expansion of the cutaneous lesion and a spread to deep structures. Infections of tendon sheaths and joints are described, rarely osteomyelitis. Sure diagnosis is hard to obtain and is established from the medical history and microbiological examination. There are no specific therapeutic guidelines. Double or triple antibiotherapy is often effective and should be continued several months after complete resolution of clinical signs. Surgical debridement is required in cases of invasive or resistant infections. We report the case of a young immunocompetent fishmonger with a rare osteocutaneous M. marinum infection of the elbow. Treatment included large surgical excision of infected skin and bone areas and a triple antibiotics administration. Reconstruction have been ensured by a radial collateral artery perforator-based propeller flap, satisfying appropriates functional and cosmetical concerns of this anatomical region. Surgery and appropriate antibiotics treatment were effective and allowed healing of an invasive cutaneous and bone M. marinum infection.

  7. Freestyle Local Perforator Flaps for Facial Reconstruction

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    Jun Yong Lee

    2015-01-01

    Full Text Available For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosis underwent minor revision. We reviewed the literature on freestyle perforator flaps for facial defect reconstruction and focused on English articles published in the last five years. With the advance of knowledge regarding the vascular anatomy of pedicled perforator flaps in the face, we found that some perforator flaps can improve functional and aesthetic reconstruction for the facial defects. We suggest that freestyle facial perforator flaps can serve as alternative, safe, and versatile treatment modalities for covering small to moderate facial defects.

  8. Freestyle Local Perforator Flaps for Facial Reconstruction.

    Science.gov (United States)

    Lee, Jun Yong; Kim, Ji Min; Kwon, Ho; Jung, Sung-No; Shim, Hyung Sup; Kim, Sang Wha

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosis underwent minor revision. We reviewed the literature on freestyle perforator flaps for facial defect reconstruction and focused on English articles published in the last five years. With the advance of knowledge regarding the vascular anatomy of pedicled perforator flaps in the face, we found that some perforator flaps can improve functional and aesthetic reconstruction for the facial defects. We suggest that freestyle facial perforator flaps can serve as alternative, safe, and versatile treatment modalities for covering small to moderate facial defects.

  9. Traumatic Forefoot Reconstructions With Free Perforator Flaps.

    Science.gov (United States)

    Zhu, Yue-Liang; He, Xiao-Qing; Wang, Yi; Lv, Qian; Fan, Xin-Yv; Xu, Yong-Qing

    2015-01-01

    The forefoot is critical to normal walking; thus, any reconstruction of forefoot defects, including the soft tissues, must be carefully done. The free perforator flap, with its physiologic circulation, lower donor site morbidity, and minimal thickness is the most popular technique in plastic and microsurgery, and is theoretically the most suitable for such forefoot reconstruction. However, these flaps are generally recognized as more difficult and time-consuming to create than other flaps. In 41 patients with traumatic forefoot defects, we reconstructed the forefoot integument using 5 types of free perforator flaps. The overall functional and cosmetic outcomes were excellent. Three flaps required repeat exploration; one survived. The most common complications were insufficient perfusion and the need for second debulking. The key to our success was thoroughly debriding devitalized bone and soft tissue before attaching the flap. Forefoot reconstruction with a free perforator flap provides better function, better cosmesis, better weightbearing, and better gait than the other flaps we have used.

  10. Colgajos de perforantes de las arterias epigástricas inferiores profunda y superficial Deep and superficial inferior epigastric artery perforator flaps

    Directory of Open Access Journals (Sweden)

    A. R. Gagnon

    2006-12-01

    Full Text Available Con el desarrollo de los colgajos miocutáneos de recto abdominal (TRAM, el abdomen inferior ha sido reconocido como la principal área dadora de tejidos autólogos de alta calidad, especialmente útiles en reconstrucción mamaria. Más recientemente la habilidad para obtener componentes adiposocutáneos similares sin sacrificar el músculo recto ha revolucionado el campo de la Cirugía Reconstructiva. El advenimiento de los colgajos de perforantes ha permitido a los cirujanos plásticos lograr los mismos buenos resultados estéticos que con los colgajos miocutáneos tradicionales, pero con un considerable descenso en la morbilidad del área donante. Con los colgajos de perforantes de la arteria epigástrica inferior profunda (DIEP y de la arteria epigástrica inferior superficial (SIEA, los pacientes han incrementado sus opciones de reconstrucción. Este artículo revisa la anatomía quirúrgica de la pared abdominal relativa a los colgajos SIEA y DIEP. Se explican detalladamente los pasos principales para la preparación preoperatoria, la técnica quirúrgica y los cuidados postoperatorios. Se discuten las ventajas y desventajas y se presen- tan los trucos técnicos que pueden ayudar a mejorar el resultado final. Además se ilustran con ayuda de casos clínicos las indicaciones típicas y atípicas.Following the development of the transverse rectus abdominis myocutaneous (TRAM flap, the lower abdomen has been recognized as a prime source of high quality autogenous tissue, especially useful in breast reconstruction. More recently, the ability to harvest a similar adipocutaneous component without sacrifice of the rectus muscle has revolutionized the field of reconstructive surgery. The advent of perforator flaps has allowed plastic surgeons to achieve the same highly esthetic results as with the former myocutaneous flaps while significantly decreasing the donor site morbidity. With the deep inferior epigastric artery perforator (DIEP flap and

  11. Freestyle Local Perforator Flaps for Facial Reconstruction

    OpenAIRE

    Jun Yong Lee; Ji Min Kim; Ho Kwon; Sung-No Jung; Hyung Sup Shim; Sang Wha Kim

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosi...

  12. RECONSTRUCTION OF SOFT TISSUE OF HAND USING ISLAND AND PERFORATOR FLAPS

    Directory of Open Access Journals (Sweden)

    V. S. Mel'nikov

    2014-01-01

    Full Text Available Objective: to determine the capabilities and perspectives of island and perforator flaps for soft tissue reconstruction of the hand. Material and methods. Results of treatment of 41 patients with defects of the soft tissue of the hand, treated at the in the period from 2010 to 2013 and operated using the island flaps and perforator flaps (DAP flap. Results and conclusion. In all cases the authors have received positive functional and cosmetic results, which were evaluated using a questionnaire DASH, the average score was 12.3. Digital artery perforator flaps allow close defect covering tissue any surface fingers. The use of perforator flaps allows reconstructing soft tissue defect with the skin of the same anatomical region as identical morphologically lost. The second important advantage is that the DAP flap is not included in the magisterial arteries, allows its use as a recipient for subsequent microsurgical reconstructions.

  13. Reconstruction of hand contracture by reverse ulnar perforator flap

    Directory of Open Access Journals (Sweden)

    Cengiz Eser

    2016-04-01

    Full Text Available Hand burn scar contractures affect patients in aesthetic and functional aspects. After releasing these scars, the defects should be repaired. The reconstruction methods include primary suturation, Z plasty, skin grafting, local or free flaps, etc. All methods have their own advantages and disadvantages. One of the most useful flaps is the reverse ulnar perforator flap. We performed a two-staged procedure for repairing a post-burn contracture release defect in a 40-year-old male. In the first stage we applied reverse ulnar perforator flap for the hand defect, and ulnar artery and vein repair in the second stage. In conclusion, this two-staged procedure is a non-primary but useful option for hand and finger defects and prevents major vascular structure damage of the forearm. [Hand Microsurg 2016; 5(1.000: 40-43

  14. Clinical application of little finger ulnar palmar artery perforator flaps%小指尺掌侧动脉穿支皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    林涧; 郑和平; 陆骅; 张天浩; 王之江; 张豪杰

    2014-01-01

    Objective To investigate the feasibility of repairing soft-tissue defects of the fifth phalange and the back of hand with ulnar palmar artery perforator flaps from the little finger.Methods Based on anatomic dissection,the fifth phalange ulnar palmar artery perforator flaps were created and transferred to repair soft-tissue defects at the little finger and the back of hand in 15 cases.Types of injury were stamping injury in 5 cases,planer injury in 4 cases,mechanical crash injury in 3 cases,blast injury in 2 cases,and cicatrical contracture following electric burn in 1 case.Injury involved in the palmar aspect near the middle segment of fifth phalange in 4 cases,dorsal aspect near the middle segment of fifth phalange in 6 cases,ulnar mesiodistal of the back of hand in 3 cases,and distal ulnar palmar aspect of hands in 2 cases.There were 6 patients wounded in left hands and 9 patients wounded in right hands.Results All flaps survived and all wounds healed by first intention.At the follow-up of 2-18 months,the flaps resurfaced the soft-tissue defects with good color and texture match and the maintenance of contour and function of donor and recipient sites were satisfactory.Conclusion The fifth phalange ulnar palmar artery perforator flap,as it has advantages of constant perforator vessels,rich blood supply and good texture and can be operated safely and easily,is considered an ideal treatment choice in repairing softtissue defects of the fifth phalange and the back of hand.%目的 探讨应用小指尺掌侧动脉穿支皮瓣修复手背、小指皮肤缺损的可行性.方法 根据术式解剖学基础,在手背尺侧设计并切取小指尺掌侧动脉穿支皮瓣移位修复手背、小指创面15例.致伤原因:冲床冲压伤5例,电刨伤4例,机器压砸伤3例,爆炸伤2例,电烧伤后瘢痕挛缩1例.损伤部位:小指近中节掌侧皮肤缺损4例,小指近中节背侧皮肤缺损6例,手背中远段尺侧皮肤缺损3例,

  15. REPAIR OF SOFT TISSUE DEFECTS OF LOWER EXTREMITY BY USING CROSS-BRIDGE CONTRALATERAL DISTALLY BASED POSTERIOR TIBIAL ARTERY PERFORATOR FLAPS OR PERONEAL ARTERY PERFORATOR FLAPS%桥式交叉胫后动脉或腓动脉穿支皮瓣修复对侧下肢软组织缺损

    Institute of Scientific and Technical Information of China (English)

    范存义; 阮洪江; 蔡培华; 刘坤; 黎逢峰; 曾炳芳

    2011-01-01

    目的 探讨采用健侧逆行胫后动脉或腓动脉穿支皮瓣桥式交叉修复下肢软组织缺损的可行性.方法 2007年8月-2010年2月,收治15例下肢软组织缺损患者.男14例,女1例;年龄25~48岁,平均33.9岁.交通事故伤8例,机器伤4例,重物砸伤3例.1例踝部植皮后遗留22 cm×8 cm大小的瘢痕(伤后35个月);余14例软组织缺损位于踝部1例,小腿中下1/3处12例,小腿中上1/3处1例;创面范围8cm×6 cm~26 cm×15 cm;受伤至入院时间为4~28 d,平均14.8 d.采用逆行胫后动脉穿支皮瓣(9例)或腓动脉穿支皮瓣(6例)桥式交叉修复,皮瓣切取范围为10 cm×8 cm~28 cm×17cm.供区创面两端直接缝合,中部残留创面取游离皮片植皮修复.术后5~6周行皮瓣断蒂.结果 术后2例腓动脉穿支皮瓣分别出现远端轻度淤血及边缘部分坏死,经换药后均成活;其余皮瓣断蒂后均顺利成活,受区创面Ⅰ期愈合.供区切口Ⅰ期愈合,植皮均成活.15例均获随访,随访时间7~35个月,平均19.5个月.皮瓣质地、色泽与受区相近,外形较满意.末次随访时根据美国矫形足踝协会(AOFAS)踝与后足功能评分标准,评分为81~92分,平均87.3分.结论 健侧逆行胫后动脉或腓动脉穿支皮瓣桥式交叉可较好修复对侧小腿或足部大面积皮肤软组织缺损,术中无需吻合血管,血管危象发生率低,手术成功率高.%Objective To discuss the feasibility of repairing soft tissue defects of lower extremity with a distally based posterior tibial artery perforator cross-bridge flap or a distally based peroneal artery perforator cross-bridge flap. Methods Between August 2007 and February 2010, 15 patients with soft tissue defect of the legs or feet were treated. There were 14 males and 1 female with a mean age of 33.9 years (range, 25-48 years). The injury causes included traffic accident in 8 cases, crush injury by machine in 4 cases, and crush injury by heavy weights in 3 cases. There was

  16. The "Gent" consensus on perforator flap terminology: preliminary definitions.

    Science.gov (United States)

    Blondeel, Phillip N; Van Landuyt, Koen H I; Monstrey, Stan J M; Hamdi, Moustapha; Matton, Guido E; Allen, Robert J; Dupin, Charles; Feller, Axel-Mario; Koshima, Isao; Kostakoglu, Naci; Wei, Fu-Chan

    2003-10-01

    Due to its increasing popularity, more and more articles on the use of perforator flaps have been reported in the literature during the past few years. Because the area of perforator flaps is new and rapidly evolving, there are no definitions and standard rules on terminology and nomenclature, which creates confusion when surgeons try to communicate and compare surgical techniques. This article attempts to represent the opinion of a group of pioneers in the field of perforator flap surgery. This consensus was reached after a terminology consensus meeting held during the Fifth International Course on Perforator Flaps in Gent, Belgium, on September 29, 2001. It stipulates not only the definitions of perforator vessels and perforator flaps but also the correct nomenclature for different perforator flaps. The authors believe that this consensus is a foundation that will stimulate further discussion and encourage further refinements in the future.

  17. Intraoperative esophageal Doppler hemodynamic monitoring in free perforator flap surgery.

    Science.gov (United States)

    Figus, Andrea; Wade, Ryckie G; Oakey, Stephen; Ramakrishnan, Venkat V

    2013-03-01

    Goal-directed fluid therapy optimizes cardiac output and flap perfusion during anesthesia. Intraoperative esophageal Doppler (ED) monitoring has been reported as more accurate and reliable, demonstrating improved surgical outcomes compared with central venous pressure and arterial catheter monitoring. A prospective study of patients undergoing free perforator (deep inferior epigastric artery perforator/anterolateral thigh) flap surgery with intraoperative ED monitoring (51 patients) or central venous pressure monitoring (53 patients) was undertaken. Fluid input included crystalloids, colloids, or blood products. Fluid output included urine, blood, or suctioned fluid. Postoperative fluid balance was calculated as fluid input - output. Fluid input between groups was not different. Fluid output was greater in the ED group (P = 0.008). The ED group showed less fluid balance (P = 0.023), less anesthetic time (P = 0.001), less hospital stay (mean 1.9 days; P = 0.147), less monitoring and flap complications (P = 0.062). ED monitoring demonstrated no monitoring complications, provides a favorable postoperative fluid balance, and may reduce flap complications and hospital stay.

  18. The clinical experience of repairing forefoot wound with perforator flap of free peroneal artery%游离腓动脉穿支皮瓣修复前足创面的临床体会

    Institute of Scientific and Technical Information of China (English)

    梁献丹; 王雨露; 周浩; 严威; 朱玉辉

    2016-01-01

    目的:探讨游离腓动脉穿支皮瓣修复前足创面的临床效果。方法2012年5月-2014年5月,收治前足皮肤软组织缺损7例,均采用游离腓动脉穿支皮瓣修复。结果7例皮瓣全部成活,无血管危象发生。随访6~12个月,皮瓣质地优良,颜色及外形满意,踝足部功能正常。结论采用游离腓动脉穿支皮瓣修复前足创面手术简单,疗效满意。%Objective To study the clinical effect of repairing forefoot wound with perforator flap of free peroneal artery. Methods From May 2012 to May 2014, 7 patiens were treated, whose forefoot skin and soft tissue was defected and were repaired with perforator flap of free peroneal artery. Results All flap of the 7 cases survived, and no blood vessel crisis appeared. By follow-up for 6 months, flap character was better, color and appearance was satisfied, the function of ankle and foot was normal. Conclusion The operation of repairing forefoot wound with perforator flap of free peroneal artery is a simple and the curative method, which can obtain satisfactory effect.

  19. Reconstruction of soft tissue defect of the extremity with the perforator flap from inguinal region

    Institute of Scientific and Technical Information of China (English)

    HUANG Dong; WANG Hai-wen; WANG Hong-gang; WU Wei-zhi; ZHAO Cheng-yi

    2009-01-01

    Background The perforator flap has become a very useful reconstructive means of soft tissue defect of extremities.The perforator flap from the inguinal region has advantages that include the ability to cover a large area with little donor site morbidity and provision of suitable thickness for reconstruction.Methods From July 1, 2005 to June 30, 2007, 10 patients with various types of soft tissue defect underwent reconstruction with 10 perforator flaps from the inguinal region. Six flaps were applied to the upper extremities and four flaps to the lower extremities. The dimensions of the transferred flaps ranged from 7-30 cm in length and 4-10 cm in width.Results The postoperative course of all 10 flaps was uneventful and all flaps survived. Distal small partial necrosis was observed in one case due to arterial insufficiency of the distal part of the flap. All patients were satisfied with the functional and esthetic resurfacing outcome.Conclusion Use of perforator flap from the inguinal region could overcome the disadvantages of the traditional free groin flap, and represents a safe and useful tool for coverage of soft tissue defects.

  20. Direct popliteal artery perforator flap: anatomical study and clinical application%腘窝直接动脉穿支皮瓣的解剖学基础与临床应用

    Institute of Scientific and Technical Information of China (English)

    林涧; 陆骅; 郑和平; 林加福

    2014-01-01

    Objective To investigate and evaluate the clinical effect of the direct popliteal artery perforator flap.Methods Thirty embalmed lower limbs of adult cadavers which perfused with red latex were used to dissection,major observations were the origin,perforators and anastomoses regulations of the direct popliteal artery.Based on the anatomical study,direct popliteal artery perforator flaps were designed and used clinically to 7 patients who had soft tissue defects in popliteal fossa.Results The direct popliteal artery perforator was direct started from lateral wall of the superior segment of popliteal artery,and about 7-11 cm above knee joint.Then it goes up along the middle line of posterior region of thigh,and pierced from the carvity between semitendinosus and biceps femoris and gave off several branches in superficial fascia.Finally,these branches anastomoses with many perforating branches which were gave off form deep femoral artery (the 1st to 3rd perforator artery),obturator artery and lateral circumflex femoral artery.Clinically,all flaps were survived eventually,and 6 of them were healed quickly,only 1 case needed to change dressings to healed its partial necrosis for the pedicle had too much soft tissues and too swelling to block its blood supply.After 2-12 months of following-up,the colors and appearances of these flaps were excellent,and the function of knees were nearly normal.Conclusion Direct popliteal artery perforator flap has relatively constant location and sufficient blood supply to use in clinical application,it is safe and easy to use for recovering soft tissue defects in popliteal fossa.%目的 探讨与评价胭窝直接动脉穿支皮瓣的临床应用效果. 方法 在30侧动脉内灌注红色乳胶的成人下肢标本上,解剖观测腘窝直接动脉穿支的起源、分支与吻合规律;设计腘窝直接动脉穿支皮瓣,并转位修复腘窝部软组织缺损7例. 结果 胭窝直接动脉穿支于膝关节平面上7~11 cm处起

  1. Video Capture of Perforator Flap Harvesting Procedure with a Full High-definition Wearable Camera.

    Science.gov (United States)

    Miyamoto, Shimpei

    2016-06-01

    Recent advances in wearable recording technology have enabled high-quality video recording of several surgical procedures from the surgeon's perspective. However, the available wearable cameras are not optimal for recording the harvesting of perforator flaps because they are too heavy and cannot be attached to the surgical loupe. The Ecous is a small high-resolution camera that was specially developed for recording loupe magnification surgery. This study investigated the use of the Ecous for recording perforator flap harvesting procedures. The Ecous SC MiCron is a high-resolution camera that can be mounted directly on the surgical loupe. The camera is light (30 g) and measures only 28 × 32 × 60 mm. We recorded 23 perforator flap harvesting procedures with the Ecous connected to a laptop through a USB cable. The elevated flaps included 9 deep inferior epigastric artery perforator flaps, 7 thoracodorsal artery perforator flaps, 4 anterolateral thigh flaps, and 3 superficial inferior epigastric artery flaps. All procedures were recorded with no equipment failure. The Ecous recorded the technical details of the perforator dissection at a high-resolution level. The surgeon did not feel any extra stress or interference when wearing the Ecous. The Ecous is an ideal camera for recording perforator flap harvesting procedures. It fits onto the surgical loupe perfectly without creating additional stress on the surgeon. High-quality video from the surgeon's perspective makes accurate documentation of the procedures possible, thereby enhancing surgical education and allowing critical self-reflection.

  2. The perforator flap from peroneal artery: an anatomic and clinical application%小腿外侧穿支皮瓣的解剖与临床应用

    Institute of Scientific and Technical Information of China (English)

    李学渊; 胡瑞斌; 梅劲; 王晓峰; 王欣; 陈宏; 章伟文; 唐茂林

    2012-01-01

    Objective To explore the anatomic characteristics of the peroneal perforator branches and its clinical application as vascularized flap transfer. Methods Twenty fresh cadaver specimen with 40 sides lower limbs were used in this study.Lead oxide gelatin was injected to the whole body,lower extremity radiaograph, spiral CT scan was then used to construct three demention visual model. The peroneal artery and its perforators were dissected,number of peferators,distance to fibular head,diameter and the length of the vascular pedicles were measured and analyzed. From July 2005 to October 2009, forty-three cases with skin defects were performed vascularized transfer in our study,surviving rate and postoperative function were followed up for 6 months to 2 years.Results Perforators were seen most at (9.80 ± 0.93)cm,(13.40 ±0.90) cm,(17.20 ± 1.13)cm,and (21.30 ± 0.77)cm beneath the fibular head with the artery branch diarneter(1.33 ± 0.39) mm,(1.30 ± 0.46)mm,(1.17 ± 0.30)mm,and (1.22 ± 0.23)mm,respectively,while the pedicle length was (5.87 ± 0.73)cm,(5.83 ± 1.73)cm,(5.44 ± 1.09)cm,and (5.10 ± 1.93) cm respectively.In clinic,42/43 free flaps survived.Postoperative outlook were satisfied except in 7 cases,the flaps looked bulky and needed secondary revision.All the donor calves showed good apperaence and function.Conclusion There are 4 regular perferators in lateral calf, while perforators in the middle 1/3 are bigger with relatively longer vascular pedicles which are appropriate for vascularized transfer.%目的 通过解剖学研究,分析腓动脉穿支特点,评价其临床应用的可行性. 方法 通过解剖40侧新鲜小腿标本,使用明胶氧化铅灌注技术,行一次性全身动脉造影、容积螺旋CT扫描,构建三维可视化模型,重点观察小腿.解剖后统计小腿外侧穿支出现数量、穿出位置、各穿支的管径、血管蒂的长度,归纳其规律性.针对2005年7月至2009年10月的43例中等面积的手、足皮肤缺

  3. Flow-through ulnar artery proximal perforator flaps for wound coverage of palm defects%尺动脉近段血流桥接穿支皮瓣修复手掌部创面缺损

    Institute of Scientific and Technical Information of China (English)

    李涛; 陈振兵; 艾方兴; 丛晓斌; 田甲; 洪光祥

    2014-01-01

    目的 探讨尺动脉近段血流桥接穿支皮瓣修复手掌部创面缺损的临床应用.方法 本组5例均为外伤导致手掌部皮肤、软组织缺损、血管损伤合并手指血运不良.2012年2月至10月我们应用尺动脉近段血流桥接穿支皮瓣修复创面,桥接了手掌部血管.术后超声检测桥接血管通畅情况,问卷调查患者对皮瓣外形的满意度,检测皮瓣触痛觉、温度觉、两点分辨觉,检查患指的关节活动度.结果 5例皮瓣均存活良好.随访时间为12~ 18个月,皮瓣较薄、外形良好,桥接血管血流均通畅,供区伤口均Ⅰ期愈合.患者对皮瓣外形满意度高(100%),术后12个月皮瓣两点分辨觉恢复至7.3~ 12.1 mm,平均7.8mm,皮瓣感觉恢复至S3+.结论 尺动脉近段血流桥接穿支皮瓣在修复手掌部创面的同时能重建断指血运,这是对细小穿支皮瓣的较好改进方法,具有特殊的适应证和应用价值.%Objective To investigate the clinical application of flow-through ulnar artery proximal perforator flaps for wound coverage of palm defects.Methods From February 2012 to October 2012,flowthrough ulnar artery proximal perforator flap was used to treat 5 cases of traumatic skin and soft tissue defects of the palm along with metacarpal artery injury and compromised finger perfusion.The vessel of the flap was inset between the ends of the injured metacarpal artery to repair the metacarpal artery so both the flap and the fingers were perfused.Postoperatively patency of the vessel was monitored by ultrasound.Patients' satsfaction of flap aesthetics was assessed by a questionnaire.Pain,touch and temperature sensations,two-point discrimination and finger movement were tested.Results All five flaps survived well.The patients were follow-up for 12 to 18 months.The flaps were thin and had good appearance.The flow through vessel was patent in all the cases.Primary healing was achieved in the donor sites.The patients were highly

  4. Clinical application of free peroneal artery perforator flap transplantation for forefoot defects reparation%腓动脉穿支皮瓣游离移植修复前足创面的临床应用

    Institute of Scientific and Technical Information of China (English)

    官士兵; 寇伟; 许兰伟; 赵雁

    2014-01-01

    目的 分析小腿外侧腓动脉穿支皮瓣的特点,探讨腓动脉穿支皮瓣游离移植修复前足创面的临床应用. 方法 回顾性分析小腿外侧腓动脉穿支皮瓣游离移植修复前足创面患者9例,皮肤缺损面积为4.5 cm×4.0cm~13.5 cm×6.5 cm;着重分析前足创面的特点以及小腿外侧腓动脉穿支皮瓣的设计、切取、血管吻合匹配等,术后随访皮瓣的成活、外观及踝足的功能恢复情况等. 结果 9例均在小腿外侧以腓骨小头与外踝连线中点稍上方附近找到发自腓动脉的较大肌皮穿支,且有明显的2条静脉伴行.移植皮瓣静脉修复:1例腓动脉穿支动脉伴行静脉-足(跖)背动脉伴行静脉端端吻合2条,5例腓动脉穿支动脉伴行静脉-足(跖)背动脉伴行静脉端端吻合1条;3例腓动脉穿支动脉伴行静脉-足(跖)背动脉伴行静脉端端吻合1条加腓动脉穿支动脉伴行静脉-足背浅静脉端端吻合1条.术后9例皮瓣全部成活,未发生血管危象,修复1条静脉与修复2条静脉皮瓣肿胀情况肉眼观察无明显差异;受区、供区创面均一期愈合;术后随访2~6个月,1例因皮瓣臃肿术后5个月行皮瓣整形,其他皮瓣皮肤质地、颜色满意. 结论 小腿外侧腓动脉穿支皮瓣游离移植摆脱了带蒂皮瓣的束缚,使手术设计和实施相对自由,对皮瓣供区、受区的创伤均得到有效控制.该皮瓣的血管解剖相对稳定、血供可靠、切取简单、皮肤质地与足部接近修复效果好、供区受区可在同一麻醉同一个止血带下完成,是修复前足部创面一个很好的选择.%Objective To analyze features of the lateral leg peroneal artery perforator free flap,and study the clinical application of free peroneal artery perforator flap transplantation for repairing forefoot defects.Methods Retrospectively analyzed 9 patients with forefoot defects which had been repaired with free lateral leg peroneal artery perforator flap

  5. 应用胫前动脉骨膜穿支皮瓣修复小腿软组织缺损%Using anterior tibial artery periosteal perforator flap repairs soft tissue defects of shank

    Institute of Scientific and Technical Information of China (English)

    中立林; 蔺翠霞; 孙雪生; 朱涛; 李强; 李新霞

    2013-01-01

    目的 探讨应用胫前动脉骨膜穿支皮瓣修复小腿皮肤软组织缺损的治疗效果. 方法 采用同侧胫前动脉骨膜穿支皮瓣180°逆转修复11例小腿皮肤软组织缺损,供区采用中厚皮片植皮修复. 结果 移植的11例皮瓣全部成活,术后随访3个月~2年,骨折全部愈合,皮瓣质地良好,外观无臃肿、肤色正常,恢复了较好功能. 结论 胫前动脉骨膜穿支皮瓣修复小腿软组织缺损,具有操作简单、创伤小、不损伤知名血管、成活率高、皮瓣薄、不用二期修整等优点.%Objective To explore the effect of repairing soft tissure defects of shank by anterior tibial artery periosteal perforator flap.Methods Eleven patients received the operation using anterior tibial artery periosteal perforator flap after reversing 180° repairs soft tissue defects of the same shank.The defect after the flap transfer was closed by skin-grafting.Results All the flaps of these 11 cases were successful.The fellow-up time was 3 months to 2 years.All fractures healed,and the appearance and the skin's color were satisfied.Conclusion The operation using anterior tibial artery periosteal perforator flap repairs soft tissue defects of shank has lots of merits:it is handled easily and causes small trauma and retains anterior tibial artery.It has a good success rate.The flap is thin that has a good appearance.

  6. [Outcome of relaying anterolateral thigh perforator flap in resurfacing the donor site wound following free anteromedial thigh perforator flap transfer for reconstruction of defect after oral tumor radical resection].

    Science.gov (United States)

    Song, D J; Li, Z; Zhou, X; Zhang, Y X; Peng, X W; Zhou, B; Lyu, C L; Yang, L C; Peng, W

    2017-02-20

    Objective: To observe the outcome of relaying anterolateral thigh (ALT) perforator flap in resurfacing the donor site wound following free anteromedial thigh (AMT) perforator flap transfer for reconstruction of defect after oral tumor radical resection. Methods: From January 2013 to January 2016, 28 patients with oral tumor underwent radical resection in our hospital, leaving defects with size ranged from 6.5 cm×3.5 cm to 11.0 cm×7.5 cm which were reconstructed by free AMT perforator flaps with size ranged from 7.0 cm×4.0 cm to 12.0 cm×8.0 cm. All the arteries of AMT perforators were anastomosed with superior thyroid arteries, while the venae comitants were anastomosed with superior thyroid venae or internal jugular venae. The donor site wounds of free AMT perforator flaps were reconstructed by relaying ALT perforator flaps with size ranged from 8.0 cm×3.5 cm to 14.0 cm×7.5 cm. The relaying ALT perforator flap and wound edge were closed directly with layer interrupted suture. Postoperatively, the patients stayed in bed and received diet through nasal feeding tube, and the ordinary diet and lower extremity exercise were carried out from one week after operation. Results: The AMT and ALT perforators existed consistently in all patients. In 16 patients the venae comitants of AMT perforator arteries were anastomosed with superior thyroid venae in end-to-end fashion, while in 12 patients with internal jugular venae in end-to-side fashion. All flaps survived uneventfully about 2 weeks after operation, and the wounds healed smoothly. All patients were followed up for 6 to 30 months after operation. The sites repaired with free AMT perforator flaps were not bulky in appearance, with two-point discrimination distances ranged from 8 to 15 mm. The movement of tongue was not obviously affected, and patients could speak and eat normally. The texture and color of the sites repaired with relaying ALT perforator flaps were close to those of the adjacent tissue, and the two

  7. Temporary Ectopic Implantation of a Single Finger Using a Perforator as a Feeding Vessel, and Subsequent Prefabricated Chimeric Flap Transplantation

    Science.gov (United States)

    Takumi, Yamamoto; Hisako, Hara; Yusuke, Yamamoto; Azusa, Oshima; Kazuki, Kikuchi; Harunosuke, Kato; Kumiko, Sata; Kentaro, Doi; Takeshi, Todokoro; Jun, Araki; Makoto, Mihara; Takuya, Higashino; Takuya, Iida; Isao, Koshima

    2012-01-01

    Objective: Ectopic implantation was first reported by Godina in 1986. We herein present 2 cases in which amputated fingers were salvaged and reconstructed by means of temporary ectopic implantation utilizing perforator anastomoses and chimeric flaps. Methods: Case 1. A 30-year-old man injured his right hand. All of the fingers were completely crushed with the exception of the little finger. We performed an ectopic implantation by using the superficial circumflex iliac artery perforator. Three months later, the little finger was transplanted with the superficial circumflex iliac artery perforator flap, vascularized nerve, and the 2nd metacarpal bone. Case 2. A 29-year-old man suffered a degloving injury of the index finger. The digital artery was anastomosed to deep inferior epigastric artery perforator. One month later, a deep inferior epigastric artery perforator flap containing the ectopically transplanted index finger was transplanted, but the index fingertip became pale and necrotized. After debridement, a hemipulp transplantation was performed. Results/Conclusions: As the diameter of perforators is similar to that of digital arteries, and perforators are capable of supplying large areas of tissue, they can be used as recipient vessels for ectopic implantation in finger salvage procedures. Another advantage of perforators as feeding vessels in ectopic implantation is the possibility of forming an ectopic chimera; the finger can be incorporated as a part of the chimeric reconstructive flap. With respect to these advantages, the perforator can be used as a feeder in an ectopic implantation of single finger. PMID:27648114

  8. Reconstruction of the soft-tissue defects of the hand with free medial sural artery perforator flap%游离腓肠内侧动脉穿支皮瓣修复手部创面

    Institute of Scientific and Technical Information of China (English)

    张龙春; 陈莹; 王鹏; 丁晟; 马亮; 姚建民

    2015-01-01

    目的 探讨腓肠内侧动脉穿支皮瓣修复手部皮肤软组织缺损的临床疗效.方法 自2010年1月至2013年6月收治手部皮肤软组织缺损患者12例,采用游离腓肠内侧动脉穿支皮瓣移植修复.其中感染创面8例,清洁创面4例,创面面积为5cm×4cm~13cm×8cm;切取皮瓣面积为6 cm×4 cm~ 14 cm×9 cm.皮瓣的动脉与鼻烟窝处的桡动脉或分支吻合,静脉和桡动脉的伴行静脉或头静脉吻合.2例皮瓣通过缝合皮神经重建感觉.结果 术后10例皮瓣顺利存活;1例皮瓣边缘出现水泡,经拆线处理后存活;1例皮瓣下积血出现静脉危象,经清除积血引流处理后危象解除,皮瓣存活.受区和供区创面均Ⅰ期愈合,随访3~ 12个月,皮瓣色泽与受区相似,无明显臃肿,质地柔软,无一例发生溃疡,2例缝合皮神经的皮瓣感觉恢复到S3.9例皮瓣供区遗留线性瘢痕,3例遗留植皮瘢痕,肢体活动无影响.结论 腓肠内侧动脉穿支皮瓣的血管解剖较恒定,分离鳃剖皮瓣相对简单,皮瓣薄而柔软,受区外形较美观,供区创伤小,不损伤小腿主要血管和腓肠肌,是修复手部中小创面的良好选择.%Objective To evaluate the clinical results of soft tissue coverage of the hand using free medial sural artery perforator flap.Methods From January 2010 to June 2013,12 cases of soft tissue defects of the hand with bone and tendon exposure were treated with medial sural artery perforator flap transfer.Of these defects,4 were clean wounds while the other 8 had infections.The sizes of the defect ranged from 5 cm × 4 cm to 13 cm× 8 cm.The sizes of the flaps ranged from 6 cm× 4 cm to 14 cm × 9 cm.The feeding artery of the flap was anastomosed with the radial artery or its branch in the anatomical snuff box.The flap vein was anastomosed with the radial concomitant vein or the cephalic vein.Sensation of the flap was restored in 2 cases with cutaneous nerve coaptation.Results Postoperatively 10 flaps

  9. Repair of soft tissue defect in hand or foot with lobulated medial sural artery perforator flap%腓肠内侧动脉分叶皮瓣修复手、足软组织缺损

    Institute of Scientific and Technical Information of China (English)

    赵风景; 姚建民; 张兴群; 马亮; 张龙春; 徐一波; 王鹏; 祝震

    2015-01-01

    Objective To explore the clinical effect of the lobulated medial sural artery perforator flap in repairing soft tissue defect in hand or foot.Methods Since March 2012 to September 2014, 6 cases with soft tissue defects in hands or feet were treated by lobulated medial sural artery flaps pedicled with 1st musculo-cutaneous perforator and 2st musculo-cutaneous perforator of the medial sural artery.The size of the flaps ranged from 4.5 cm × 10.0 cm to 6.0 cm × 17.0 cm.Results 5 cases of lobulated flap survived smoothly, only 1 lobulated flap had venous articulo, but this flap also survived after the articulo was removed by vascular exploration.All flaps had desirable appearance and sensation and the two-point discrimination was 6 mm in mean with 4 to 12 months follow-up(average, 7 months).Linear scar was left in donor sites in 3 cases and skin scar in 3 cases.There was no malfunction in donor sites.Conclusions Lobulated medial sural artery perforator flap is feasible and ideal method for the treatment of soft tissue defect in hand or foot with satisfactory effect.%目的 探讨腓肠内侧动脉分叶皮瓣修复手、足软组织缺损的临床效果.方法 2012年3月至2014年9月,以腓肠内侧动脉为主干,第1、2肌皮穿支构成分叶皮瓣移植修复手、足部软组织缺损6例,皮瓣面积4.5 cm×10.0 cm~6.0 cm×17.0 cm.结果 5例腓肠内侧动脉分叶皮瓣顺利成活,1例分叶皮瓣因皮瓣下产生积血,出现静脉危象,经血管探查、清除积血后危象解除,皮瓣成活.术后随访4~12个月,平均7个月,皮瓣外观和功能恢复良好,分叶皮瓣平均两点辨距觉为6 mm;3例皮瓣供区遗留线性瘢痕,3例遗留植皮瘢痕,肢体活动不受影响.结论 腓肠内侧动脉分叶皮瓣游离移植修复手、足软组织缺损,方法可靠,效果较好.

  10. Clinical application of free KISS lateral femoral circumflex artery perforator flap in repairing defects of limbs%游离旋股外侧动脉穿支KISS皮瓣修复四肢创面的临床应用

    Institute of Scientific and Technical Information of China (English)

    唐修俊; 魏在荣; 王波; 王达利; 孙广峰; 金文虎; 李海

    2015-01-01

    Objective To summarize the clinical efficacy of free KISS lateral femoral circumflex artery perforator flap in repairing defects of limbs.Methods Twelve cases were suffered wound surface defects on hands and feet.And the defects were repaired by flap construction from October,2010 to May,2013,based on the characteristics of the defects combined with anatomical features of the free lateral femoral circumflex artery perforator flap.Length of flap was adopted as the width for direct suture in the flap donor.Results Postoperative flap and donor area preliminarily healed.There was no vascular crisis.Twelve cases received 6-18 months followed-up (averaged of 12 months).The skin flap was good in color and texture.The dorsal flap was a bit bloated.Linear scar was remained in distal flap donor area.The quadriceps muscle power level 5,knee flexion,extension 10°-180°.Quadriceps strength,knee flexion and stretch activities were all normal.The flaps recovered protective sense.Four cases had tendon adhesion after hand tendon transplantation.The finger function was well recovered after release.At the last followup,the functions of the upper limbs were evaluated according to the trial evaluation standard of the Hand Surgery Association of Chinese Medical Association:6 cases were excellent,1 case was good,and 1 case was qualified.Conclusion The design of the lobulated tissue flap of the lateral femoral circumflex artery descending branch is flexible.Large area of the surface defect can be repaired.The flap donor area is directly sutured.It is an ideal method to repair the wound tissue defect.%目的 总结游离旋股外侧动脉穿支KISS皮瓣在修复四肢创面中的临床疗效. 方法 2010年10月-2013年5月,根据手足部创面的特点,结合旋股外侧动脉穿支解剖特点设计分叶皮瓣,通过皮瓣重组(KISS)修复手足部创面缺损12例,将皮瓣的长度变成宽度使皮瓣供区直接缝合. 结果 术后皮瓣及供区Ⅰ

  11. 第一跖底动脉穿支皮瓣的解剖学基础%Anatomical basis of the flap based on the perforator of the first plantar metatarsal artery

    Institute of Scientific and Technical Information of China (English)

    谢志平; 梁成; 郑和平; 林涧; 郝攀登; 张发惠

    2014-01-01

    artery or the branch of the medial plantar artery on the superior margin of the abductor hallucis,forming a longitudinal arterial chain,through which small branches were given off to the skin of the medial aspect of the foot.The perforator was (1.1 ± 0.2) mm in diameter and (3.2 ± 0.2) cm in length.Conclusion The flap based on the perforator of the first plantar metatarsal artery can be harvested as an axial flap to repair the defects of soft tissue on the forefoot.

  12. 游离腓动脉穿支筋膜瓣修复手部皮肤缺损%Free adipofascial flap from peroneal perforator artery for repair of hand skin defects

    Institute of Scientific and Technical Information of China (English)

    李学渊; 滕晓峰; 黄剑; 陈宏; 章伟文; 陈德松

    2010-01-01

    Objective To explore the surgical technique and clinical outcomes of applying the free adipofascial flap nourished by musculocutaneous perforators of the peroneal artery to repair soft tissue defects of the hand. Methods Six cases of skin defects in the hand were treated from December 2007 to October 2009 with free peroneal artery perforator fascial flap. The size of the raised flaps ranged from 5.0 cm × 4.5 cm to 10 cm × 7 cm. In most cases the musculocutaneous branch was chosen as the vascular pedicle for anastomosis.The blood vessels were anastomosed in an end-to-side fashion. The transferred fascial flap was covered with split thickness skin graft, while the donor site was closed directly. Results All the adipofascial flaps survived uneventfully. The skin graft over the fascial flap showed over 90% survival in 4 cases and 80% survival in 2 cases after 7 days. Follow-up time ranged from 3 to 12 months. Flap bulkiness was seen in one case which underwent debulking procedure 3 months later. The appearance of other 5 cases was satisfactory with only slight flap bulkiness. Only a linear scar was left at the calf donor site. Conclusion The free adipofascial flap was a modification of peroneal perforator flaps to minimize morbidity and improve cosmoses of the donor site. The adipofascial flap can also fill the void caused by soft tissue defects and provide better condition for functional reconstruction.%目的 探讨应用游离腓动脉穿支筋膜瓣修复手部软组织缺损,减少供区损伤的方法和临床效果.方法 2007年12月至2009年10月,对6例手部皮肤缺损患者,应用游离腓动脉肌皮穿支筋膜瓣进行修复,切取面积为5.0 cm×4.5 cm~10.0 cm×7.0 cm,以肌皮穿支为蒂.动脉血管蒂与受区血管采用端侧吻合,受区筋膜瓣行断层植皮覆盖.供区创面直接缝合.结果 术后6例筋膜瓣全部存活;术后7 d,筋膜表面植皮成活大于90%4例,80%2例.随访时间为3~12个月,1例皮瓣臃肿,术后3

  13. Pedicled perforator flaps in the head and neck.

    Science.gov (United States)

    Hofer, Stefan O P; Mureau, Marc A M

    2010-10-01

    Perforator flaps, since their first description in 1989, have in many ways revolutionized reconstructive surgery. Whereas little more than a decade ago many surgeons were still hesitant to fully trust perforator flaps to be a reliable option, nowadays these flaps are often first choice. Investigators have to remain critical, however, of their advances and realize that not every reconstruction will require or benefit from a perforator flap, as previously well-established, nonperforator flaps still have their indication and can give excellent results. The most important skill in reconstructive surgery of the head and neck is not cutting the flap but assessing the defect, planning the reconstruction, and choosing wisely from the ever-increasing options available.

  14. The Versatility of Perforator-Based Propeller Flap for Reconstruction of Distal Leg and Ankle Defects

    Directory of Open Access Journals (Sweden)

    Durga Karki

    2012-01-01

    Full Text Available Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result.

  15. Free superficial peroneal artery perforator flap free transplantation for wound coverage in the hand%腓浅动脉穿支皮瓣游离移植修复手部创面

    Institute of Scientific and Technical Information of China (English)

    杨晓东; 刘杨武; 杨锦; 张根福; 丁茂超; 梅劲; 唐茂林

    2014-01-01

    目的 探讨应用腓浅动脉穿支皮瓣游离移植修复手部创面的临床效果.方法 2008年3月至2012年3月,应用腓浅动脉穿支皮瓣游离移植修复手部创面共9例,其中手掌侧创面4例,虎口区创面1例,手指侧方创面1例,手背创面3例;缺损面积为3.0 cm×4.5 cm~ 5.0 cm×10.0 cm.其中4例与受区桡动脉头静脉吻合,4例与指总动脉浅静脉吻合,1例与尺动脉贵要静脉吻合.5例供区直接缝合,4例供区创面植皮修复.结果 本组9例皮瓣全部存活,未出现血管危象.术后随访3~ 12个月,原缺损部位外形及功能恢复满意,供区外形功能无明显影响.结论 应用腓浅动脉穿支皮瓣游离移植修复手部创面,临床效果满意,值得推广应用.%Objective To investigate the clinical outcomes of repairing wound in the hand with free superficial peroneal artery perforator flap transplantation.Methods From March 2008 to March 2012,9 cases of wound in the hand were treated with free superficial peroneal artery perforator flap transplantation.There were 4 cases of volar defects,1 case of first web space wound,1 case of lateral finger defect and 3 cases of dorsal defects.The size of the wounds ranged from 3.0 cm× 4.5 cm to 5.0 cm × 10.0 cm.The perforator flap vascular pedicle was anastomosed to the radial artery and cephalic vein of the recipient area in 4 cases,to the proper digital artery and superficial vein in 4 cases,and to the ulnar artery and basilic vein in 1 case.The donor site was closed directly in 5 cases and covered with skin graft in 4 cases.Results All of the 9 flaps survived completely.No vascular crisis occurred.Postoperative follow-up ranged from 3 to 12 months.The appearance and function of the repaired sites were satisfactory.Conclusion Free superficial peroneal artery perforator flap transfer for coverage of wound in the hand can lead to satisfactory clinical results.It is an effective method that is worth wide clinical application.

  16. 带监测皮岛的胫前动脉穿支骨膜瓣设计的显微解剖学研究%The design of the perforator periosteal flap with monitoring flap pedicled with the anterior artery perforator

    Institute of Scientific and Technical Information of China (English)

    江钦文; 黄东; 吴伟炽; 葛军委; 黄国英

    2011-01-01

    Objective To provide anatomic basis for clinical application of the anterior tibial artery perforator periosteal flap. Methods On 18 adult cadaveric lower limb specimens, the origins, courses,branches, distributions and anastomosis of the lateral tibial periosteal vessels were microdissected. Results 1.On the upper section of tibia, 1-3 periosteal branches from the anterior tibial recurrent artery and the anterior tibial artery located in the front and external periosteum of the tibia lateral condyle, and on the middle and lower sections, the anterior tibial artery gave off 5-7 muscular periosteal branches and direct periosteal branches to the external periosteum of the tibia. the periosteal branches were accompanied by two veins, with a length of its pedicle of (1.2±0.3) em and a diameter of (0.7±0.2)mm. 2. Periosteal branches from the anterior tibial artery showed a segmental distribution and gave out ascending, descending and cutaneous branches at the anterior border of the tibia. The adjacent descending and ascending branches dovetailed into vascular chain and periosteal vessel net. The cutaneous branches supplied the anterolateral skin of the crus. Conclusions The perforator periosteal flap with monitoring flap pedicled with the anterior tibial artery perforator could be designed for the treatment of nonunion and defect of bone through free transplantation.%目的 为胫前动脉穿支骨膜瓣临床应用提供解剖学基础.方法 在18侧成人下肢标本上解剖观测了胫骨外侧骨膜血管来源、走行、分支分布及吻合情况.结果 (1)胫骨上段有胫前返动脉骨膜支1-3支和胫前动脉骨膜支,分布于胫骨外侧髁前面及外侧面骨膜,中、下段为来自胫前动脉的肌骨膜支和直接骨膜支5~7支,分布于胫骨外侧骨膜.骨膜支蒂长(1.2±0.3)cm,外径(0.7±0.2)mm,伴行静脉两条.(2)胫前动脉骨膜支呈节段性分布,于胫骨前缘分出升支、降支和皮支.相邻升、降支彼此吻合

  17. The anatomical characteristics and clinical application of the lateral superior genicular artery perforator iliotibial band flap%膝上外侧动脉穿支髂胫束皮瓣的解剖特点与临床应用

    Institute of Scientific and Technical Information of China (English)

    高建明; 徐达传; 储旭东; 郭峰; 卢绪; 骆宇春; 刘云鹏

    2010-01-01

    Objective To discuss anatomical characteristics and clinical results of the lateral superior genicular artery perforator iliotibial band flap. Methods From September 1999 to July 2009, the origin,course, branches and distribution of the lateral superior genicular artery and blood supply of iliotibial band were observed on 40 sides adult lower limbs perfused with red latax. Five perforator iliotibial band and 4 perforator iliotibial band flaps of 9 cases were treated with anastomosis of lateral superior genicular artery perforating rami. Results The lateral superior genicular artery of 35 cases (80%) originates from the popliteal artery. Its originated external diameter was (1.8 ± 0.4) mm. It divides into ascending branch and descending branch, and they gives off septofascio-cutaneous perforator, or anatomoses the lateral uppermost genicular artery in the vastus lateralis muscle, and then formes the musculocutaneous perforator of iliotibial band. The originated external diameter of the larger perforator of iliotibial bands was ( 1.0 ± 0.2) mm and they provides for the skin and iliotibial band of lateral superior genicular area. Nine cases, including 5 cases of simple Achilles tendon defects, two cases of achilles tendon defects with skin defects, and 2 cases of lower extremity and foot soft tissue defects were treated with transplantation of the vascularized iliotibial band (flap) with perforator vascular anastomoses. All cases were followed up 6 - 92 months. The results showed significant improvement in "heel test" and Thompson sign in the rerupture of the Achilles tendon occurred. Four perforator iliotibial band flaps survived well. Conclusion The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and new donor in the reconstruction of soft tissue and composite defects.%目的 探讨膝上外侧动脉穿支髂胫束皮瓣的解剖学基础与临床应用效果.方法 自1999年9月至2009年7月,在40侧经动脉灌注红

  18. Anatomical study and clinical application of the medial sural artery perforator flap%吻合腓肠内侧血管穿支皮瓣的应用解剖和临床应用

    Institute of Scientific and Technical Information of China (English)

    程天庆; 柴益民; 曾炳芳

    2008-01-01

    目的 报道腓肠内侧血管穿支皮瓣的解剖学研究与游离移植的临床效果.方法 用明胶-氧化铅液灌注12侧标本的胭动脉,观测腓肠内侧血管及其穿支的分支、蒂长、管径等;取下标本皮肤软组织拍摄X线片,利用Photoshop与Scion Image分析穿支分布的趋向性和供血面积.临床上吻合腓肠内侧血管穿支皮瓣修复5例手部软组织缺损,皮瓣面积为7 cm×4 cm~12 cm×8 cm. 结果 所有标本的腓肠内侧血管至少存在1支穿支,平均2.1支;位于距横纹9~18 cm、距后中线1~5 cm的范围内;其深筋膜处的外径为(1.03±0.22)mm;穿支供血的总面积为(107.5±23.9)cm2,单穿支的供血面积为(58.3±17.0)cm2.5例移植皮瓣全部成活,随访6~12个月,手部修复后外形与功能恢复满意.结论 明胶-氧化铅液灌注造影是皮瓣血管解剖学研究的可靠方法;腓肠内侧血管恒定存在的穿支,可作为腓肠内侧血管穿支皮瓣的血供来源;该皮瓣外形美观,是修复手部中、小面积皮肤软组织缺损的良好选择.%Objective To report the anatomical study and clinical application of the medial sural artery pertorator flaps. Methods The anatomical study involved 12 fresh adult cadaver lower legs, the arteries of which were perfused with suspensions of lead oxide and gelatine. The bifurcation, location, length, diameter and blood territories of the medial sural artery and its perforating vessels were recorded by dissection, angiography and photography. The integument of the leg was dissected and ridiographed. The tendency of the vessels was analyzed, the surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image. With the aid of anatomic study, a series of five clinical cases was reported, including five free medial sural flaps for ipsilateral hand reconstruction. Results There was at least one perforating vessel in the medial sural areas of the specimen. A mean

  19. Increased Flap Weight and Decreased Perforator Number Predict Fat Necrosis in DIEP Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Carolyn L. Mulvey, BS

    2013-05-01

    Conclusions: Flaps with increasing weight have increased risk of fat necrosis. These data suggest that inclusion of more than 1 perforator may decrease odds of fat necrosis in large flaps. Perforator flap breast reconstruction can be performed safely; however, considerations concerning race, body mass index, staging with tissue expanders, perforator number, and flap weight may optimize outcomes.

  20. 高频超声引导下胸背动脉穿支移植皮瓣的设计%Thoracic dorsal artery perforating flap transplantation under high-frequency ultrasound guidance

    Institute of Scientific and Technical Information of China (English)

    沈美华; 阿里木江·阿不来提; 艾合买提江·玉树甫; 董建; 王伟; 刘亚飞

    2014-01-01

    BACKGROUND:The most advanced and representative diagnosis techniques for perforating branch of blood vessels include digital subtraction angiography, CT, MRI and other imaging techniques. These methods can visualize blood vessels clearly and have a high precision, but there are some trauma and less popular. OBJECTIVE:To apply high-frequency ultrasound for detection of thoracic dorsal artery and perforating branch, and provide a reference for preoperative design of thoracic dorsal artery perforating flap. METHODFifteen patients candidate for thoracic dorsal artery perforating flap were included in this study. Before surgery, we used high-frequency ultrasound to detect the perforating branch, including vascular contorts, diameter, the location of the perforators and surface markers. The thick, superficial, paral el perforating branch was selected as the main blood vessels, to design and cur the skin flap. RESULTS AND CONCLUSION:In the involved 15 cases, thoracic dorsal artery were derived from the subscapular artery, thoracic dorsal artery and its main branches, as wel as more than 1 mm main perforating branch in 13 cases were clearly visible. It was consistent with intraoperative measurement results. The perforating branch less than 1 mm only showed strip-like blood flow signal or no blood flow and spectrum signal, and there was an unclear boundary to surrounding tissue. One case appeared distortion and variation of blood vessels before surgery, thus changed to other surgery. Two cases had no perforating branch by preoperative detection, which was then confirmed by intraoperative anatomy. High-frequency ultrasound has a significant effect on preoperative position of perforating branch, and the combination with computer tomography angiography and magnetic resonance angiography can support a more comprehensive and reliable reference.%背景:国内外最先进的、具有代表性的研究穿支血管的诊断学技术有数字减影血管造影、CT、MRI等影像

  1. Horn shaped perforator flap pedicled with the angular artery:anatomy basis and clinical application%内眦动脉为蒂的角形穿支皮瓣的解剖基础与临床应用

    Institute of Scientific and Technical Information of China (English)

    马大梦; 李小静; 宁金龙; 丁茂超; 李心怡; 姚文德; 陈钊; 葛礼正

    2015-01-01

    目的 探讨应用内眦动脉角形穿支皮瓣修复中面部缺损的解剖学基础及临床应用效果.方法 ①对10具新鲜成人尸体行一次性动脉造影及螺旋CT扫描,数据以DICOM格式输入MIMICS图像工作站,进行三维可视化处理,观测内眦动脉穿支血管的分布规律等.②2012年7月至2014年7月,应用内眦动脉为蒂的角形穿支皮瓣修复中面部皮肤缺损创面21例,其中鳞状细胞癌10例,基底细胞癌9例,色素痣2例,切取的皮瓣面积1.5 cm×3.5 cm~2.5 cm×5.0 cm.结果 面动脉在口角外侧约1 cm处发出侧鼻动脉,后向内眦延续为内眦动脉,角动脉与鼻背动脉、眶下动脉有丰富的吻合支.临床应用内眦动脉为蒂的角形穿支皮瓣修复21例缺损均成活,供、受区创面愈合良好,经1个月至2年随访,色泽、质地、外形恢复较好.结论 内眦动脉角形穿支皮瓣,设计灵活、简便,血供可靠,切口隐蔽,供区可直接拉拢缝合,是修复中面部缺损的一种较好的方法.%Objective To explore the anatomic basis and clinical application of the horn shaped perforator flap pedicled with the angular artery for the reconstruction of midface defect.Methods ①10 fresh cadavers were perfused with a modified guiding oxide gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise' s interactive medical image control system,MIMICS).The origin and distribution of the angular artery perforator were observed.②Between July 2012 and July 2014,twenty-one patients underwent operations for the reconstruction of midface defect.Ten patients had squamous cell carcinoma,nine patients had basal cell carcinoma and two patients had nevus.The flaps' size ranged from 1.5 cm × 3.5 cm to 2.5 cm × 5.0 cm.Results The facial artery branches the lateral nasal artery 1 cm from the outside corner of the mouth,subsequently strenches to inner canthus

  2. Refinement of Nasal Reconstruction with a V/Y-alar-perforator Flap

    Science.gov (United States)

    Langer, Martin F.; Roldán, J. Camilo

    2017-01-01

    Background: The ala of the nose is vascularized by a dense net of perforators originating from the lateral nasal artery or the angular artery. These vessels reach the ala in a cascade fashion from the alar groove/lateral nasal wall. Based on these vessels, a V/Y flap can be dissected with a wide range of mobility. Materials and Methods: Nineteen patients underwent reconstruction of the nose by means of a V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap from the lateral nasal wall and/or from the nasal dorsum for reconstruction of defects at the nasal tip, ala of the nose, and/or lateral nasal wall. All patients were followed up 8 months after surgery in average. Results: There was no prolonged congestion or any tissue loss. All patients presented postoperatively with excellent aesthetic results, and no nasal distortion was observed. Conclusion: The V/Y-alar-perforator flap alone or in combination with a myocutaneous rotation flap proved to be a reliable tool in the armamentarium for reconstruction of nasal tip and alar defects providing good aesthetic results. PMID:28203497

  3. [Intraoperative verification of a perforator flap vascularization by indocyanine green angiography].

    Science.gov (United States)

    Royer, E; Rausky, J; Binder, J-P; May, P; Virzi, D; Revol, M

    2014-02-01

    After Koshima and Soeda first described perforator flaps in 1988, Wei has improved the technique by describing the "free style perforator flap". These flaps have the advantage of being performed on all skin perforators and in reducing donor site morbidity. The disadvantage, however is that the size of their angiosome is not defined and the evaluation of their relay on the experience of the surgeon. An evaluation of the size of an angiosome by conducting intraoperative angiography is proposed. Intraoperative angiography is performed after injection of indocyanine green. Stimulation of the indocyanine green by infrared causes the emission of fluorescent radiation. This fluorescence is then detected by a specific camera that displays real-time visualization of the skin's perfusion. We present the case of a 39-year-old patient who had an open tibial pilon fracture, for which we performed a pedicled propeller flap based on a posterior tibial perforator. Angiography was used to determine accurately the optimal skin perfusion of the propeller flap, which was based on a perforator from the posterior tibial artery. Angiography identified several levels of skin perfusion with a high fluorescence, intermediate and absent. The non-vascularized part of the skin paddle was resected. Given the unreliability of this technique, hypoperfused area was retained. Debridment of this area, however was necessary at day 5 postoperative with repositionning of the flap. Indocyanine green angiography may be a useful decision-making tool for intraoperative surgeon. It allows to adjust the size of the propeller flap's skin paddle to it angiosome. However, this evaluation method needs to be improved with the introduction of a quantitative threshold.

  4. Optimización en el uso del colgajo de segunda perforante intercostal de la arteria mamaria interna Optimizing the use of the second intercostal perforator flap of the internal mammary artery

    Directory of Open Access Journals (Sweden)

    D. Sicilia Castro

    2012-06-01

    Full Text Available El colgajo en isla basado en perforantes de la arteria mamaria interna (colgajo IMAP se emplea de manera reciente como técnica reconstructiva en cabeza y cuello. El objetivo de esta revisión es corroborar las posibilidades del arco de rotación de dicho colgajo cuando se realiza una amplia disección de su pedículo vascular. Presentamos 4 pacientes de edades comprendidas entre 46 y 75 años, todos ellos varones, con defectos faríngeos parciales, en los que empleamos un colgajo pediculado basado en la segunda perforante de la arteria mamaria interna para reconstrucción del defecto faríngeo. El tamaño medio del defecto a cubrir fue de 3,2 cm (desviación estándar +/- 1,5 cm en sentido horizontal y 4,5 cm (desviación estándar +/- 2,2 cm en sentido vertical. En todos los casos se disecó un colgajo en isla con un tamaño medio de 6 X 8 cm. La longitud media del pedículo fue de 5,5 cm (desviación estándar +/- 1,51 cm. En todos los casos fue posible sellar el defecto faríngeo sin necesidad de resecar costilla o de incorporar parte de la arteria mamaria interna correspondiente. El colgajo IMAP es un colgajo rápido de realizar que permite la reconstrucción de defectos faríngeos parciales de la región anterior del cuello y hasta la base de la lengua sin necesidad de resección costal o incorporación parcial de los vasos mamarios.The island flap based on perforators of the internal mammary artery (IMAP flap is recently used in reconstruction of head and neck defects. The aim of this review is to verify the possibilities of the arc of rotation of the flap when it's necessary to carry out an extensive dissection of the vascular pedicle. We present reconstruction of partial pharyngeal defects in 4 patients, aged between 46 and 75 years and all men, using a pedicle flap based on the second perforator of the internal mammary artery. The average size of the defect was 3.2 cm (SD +/- 1.5 cm horizontally and 4.5 cm (SD +/- 2.2 cm vertically. In

  5. Anatomy study and clinical application of proximal ulnar artery perforator flap%尺动脉近端穿支皮瓣的应用解剖与临床应用

    Institute of Scientific and Technical Information of China (English)

    魏义涛; 钟桂午; 梅劲; 唐茂林

    2013-01-01

    目的 探讨尺动脉近端穿支皮瓣的应用解剖及临床应用. 方法 自2008年起收集国人新鲜尸体10具(20侧),使用动脉显影技术进行灌注,所有标本进行层次解剖,观察尺动脉穿支血管穿出位置、穿支管径、蒂长及供血面积,重点观察尺动脉近端穿支相关指标;自2011年10月至2012年11月,针对手指及腕背皮肤软组织缺损病例,临床应用尺动脉近端穿支皮瓣游离移植修复手部缺损患者18例,应用该皮瓣面积3.0cm×2.5 cm~10.0cm×5.5 cm,18例供区均直接缝合,术后随访其疗效.穿支定位及皮瓣设计:自肱骨内上髁向豌豆骨作一直线,其近、中1/3交界点即为该穿支入皮点.以此点为中心设计带蒂或游离皮瓣. 结果 解剖显示近端穿支直径0.5 ~0.9 mm,穿支蒂长33.0 ~47.0 mm.从尺动脉发出营养前臂内侧的穿支数目为5~9支.所有病例均获得随访,随访时间6 ~ 14个月,皮瓣色泽正常、质地良好、厚薄适中,两点辨别觉5 ~8 mm,无一例臃肿需要二期修整.供区外观、功能正常. 结论 尺动脉近端穿支易于定位,穿支出现恒定,管径较大,尺动脉近端穿支皮瓣适合于修复手及前臂等部位的中、小面积缺损.%Objective To provide anatomical information and clinical application of flaps based on the proximal ulnar artery perforators.Methods Ten fresh cadavers who underwent injected with artery imaging technology and dissected with layer by layer;Eighteen patients who sought surgical treatment with proximal ulnar artery perforator flap for soft tissue defects of the finger and dorsum wrist at our hospital between October 2011 and November 2012 were included in this study.Results The diameter and superficial length of the main perforator respectively were 0.5-0.9 mm and 33.0-47.0 mm in our dissection.There were 5-9 perforators given from the ulnar artery to supply skin over the medial side of the forearm.All of the 18 flaps survived after surgeries

  6. Free peroneal perforator-based sural neurofasciocutaneous flaps for reconstruction of hand and forearm

    Institute of Scientific and Technical Information of China (English)

    CAI Pei-hua; LIU Sheng-he; CHAI Yi-min; WANG Hai-ming; RUAN Hong-jiang; FAN Cun-yi

    2009-01-01

    Background Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap. Methods Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm × 7 cm to 24 cm × 10 cm in size in hand and forearm after injured by motor vehicle accidents (2 cases) or crushed by machine (8 cases). Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the pereneal artery anastomosed to the radial (or ulnar) artery and the peroneal veins to one of the radial (or ulnar) veins and the cephalic vein respectively. The flap sizes ranged from 18 cm × 8 cm to 25 cm × 12 cm. The donor areas were closed by skin grafts. Results All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months' follow-up. Conclusions Peroneal

  7. Anatomic basis of the proximal ulnar artery perforator neurocutaneous flap%尺动脉近段穿支蒂皮神经营养血管皮瓣的解剖基础

    Institute of Scientific and Technical Information of China (English)

    陈超勇; 岳素琴; 魏在荣; 林加福; 郑和平; 张发惠

    2011-01-01

    目的 为尺动脉近段穿支蒂前臂内侧皮神经营养血管皮瓣提供解剖学基础.方法 在30侧动脉内灌注红色乳胶的成人上肢标本上解剖观测:①前臂内侧皮神经的走行与分布;②尺动脉近段穿支与前臂内侧皮神经营养血管间吻合关系.另在1侧新鲜标本上进行摹拟手术设计.结果 ①前臂内侧皮神经前支较粗长,与贵要静脉伴行,在前臂沿尺侧腕屈肌内侧缘或尺侧腕屈肌与掌长肌肌腱之间的浅筋膜中下行,分布于前臂掌面尺侧,远侧可达腕横纹;②营养血管为多节段、多源性,其中尺动脉近段穿支的位置相对恒定,自尺动脉起始后,先经指浅、深屈肌之间,后沿指浅屈肌与尺侧腕屈肌之间下行,在肱骨内上髁下8.7 cm处穿过深筋膜浅出至皮下组织中,并分出众多的细小血管与前臂内侧皮神经的神经旁和神经干血管链的分支密切吻合,在指浅屈肌与尺侧腕屈肌之间形成顺沿肌间隙和前臂内侧皮神经纵轴的血管丛.穿支蒂干长(2.0±0.2)cm,外径(0.9±0.2)mm.结论 可形成尺动脉近段穿支蒂前臂内侧皮神经营养血管皮瓣转位修复肘部软组织缺损.%Objective To provide anatomic basis for clinical application of the neurocutaneous flap pedicled with proximal ulnar artery perforator.Methods 30 embalmed upper limbs from adult cadavers perfused with red latex were used for this anatomic study, and the followings were observed: ①The course and distribution of the medial forearm cutaneous nerve.② Aanastomoses between the proximal ulnar artery perforator and nutrient vessels of medial forearm cutaneous nerve.③Mimic operation was performed on one fresh specimen.Results ① Anterior branch of the medial forearm cutaneous nerve (MFCN), with the relative large diameter, companied with basilic vein and coursed through superficial fascia located in flexor carpi ulnaris and palmaris longus.The MFCN distributed on medial forearm and distally

  8. 游离腓动脉穿支皮瓣修复手足软组织缺损%Free flap pedicled with peroneal artery perforator to repair soft tissue defects at hands and feet

    Institute of Scientific and Technical Information of China (English)

    刘勇; 康彦忠; 李文龙; 兰天亮; 赵春成; 刘刚义

    2015-01-01

    Objective To explore the clinical effects of free flap pedicled with peroneal artery perforator in repair of soft tissue defects at hands and feet.Methods From July 2010 to December 2012,36 patients with soft tissue defects at hands and feet were repaired by free flaps pedicled with peroneal artery perforator.They were 30 men and 6 women,21 to 50 years of age (average,32.6 years).Twenty-one patients had skin defects at distal 1/3 dorsum of foot;of the 15 patients with hand soft tissue defects,8 had skin defects and tendon exposure at dorsum of hand,3 had skin defects between the thumb and the index finger,and 4 had skin defects and tendon exposure at the palm.The defective areas varied from 3.0 cm × 2.0 cm to 8.5 cm ×4.0 cm,the flap harvesting area varied from 4.0 cm × 3.0 cm to 10.0 cm × 5.0 cm.the time from injury to operation was from 3 to 78 hours (average,12.8 hours).Twenty-nine flaps were pedicled with intramuscular perforating branches,and 6 with intermuscular perforating branches.The blood vessels were anastomosed end to end.The function of affected limbs in the 15 cases of hand soft tissue defect was evaluated at the last follow-up according to the criteria by Hand Surgery Society,Chinese Medical Association (HSSCMA);the 21 patients with soft tissue defect of the feet was evaluated according to criteria by Japanese Orthopaedic Association (JOA);the functional recovery of skin sensation in the 36 patients was evaluated according to the criteria by British Medical Research Council (BMRC).Results All the transferred free flaps survived uneventfully.The 36 patients were followed up for 6 to 24 months (average,11 months).The flaps showed no pigmentation but fine texture,appearance,and wear-resistance.According to HSSCMA criteria,the function of affected limbs was excellent in 12 cases,good in 2 and fair in one.According to JOA criteria the 21 patients with soft tissue defect of the feet scored an average of 90.6 points (rang,from 80 to 98 points

  9. Inferior Flap Tympanoplasty: A Novel Technique for Anterior Perforation Closure

    Directory of Open Access Journals (Sweden)

    Haim Gavriel

    2013-01-01

    Full Text Available Objective. To report a novel tympanoplasty modification for anterior tympanic membrane perforation closure. Materials and Methods. A prospective study on 13 patients who underwent inferior tympanoplasty between December 2008 and May 2011 was carried out. In our technique, an inferior rather than a posterior flap is raised and the graft is laid from the inferior direction to obtain better access to the anterior part of the tympanic membrane perforation and provide better support. Results. A total of 13 patients underwent the novel inferior tympanoplasty technique with a mean age of 33 years. Six patients had undergone tympanoplasties and/or mastoidectomies in the past, 3 in the contralateral ear. A marginal perforation was observed in 3 cases, total perforation in 2 and subtotal in 1 case. The mean preoperative pure-tone average was 40.4 dB (10 to 90 dB, compared to 26.5 dB (10 to 55 dB postoperatively. All perforations were found to be closed but one (92.3% success rate. Conclusions. The inferior tympanoplasty technique provides a favorable outcome in terms of tympanic membrane closure and hearing improvement for anterior perforations, even in difficult and complex cases. It is based on a well-known technique and is easy to implement.

  10. Color Doppler Ultrasonography-Targeted Perforator Mapping and Angiosome-Based Flap Reconstruction

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Tei, Troels; Thomsen, Jørn Bo

    2016-01-01

    Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)-targeted perforator mapping and angiosome-based flap reconstr......Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)-targeted perforator mapping and angiosome-based flap...

  11. Planning digital artery perforators using color Doppler ultrasonography: A preliminary report.

    Science.gov (United States)

    Shintani, Kosuke; Takamatsu, Kiyohito; Uemura, Takuya; Onode, Ema; Okada, Mitsuhiro; Kazuki, Kenichi; Nakamura, Hiroaki

    2016-05-01

    Digital artery perforator (DAP) flaps have been applied for the coverage of finger soft tissue defects. Although an advantage of this method is that there is no scarification of the digital arteries, it is difficult to identify the location of the perforators during intraoperative elevation of the DAP flap. In this study, anatomically reliable locations of DAPs were confirmed using color Doppler ultrasonography (US) in healthy volunteers. A successful case using an adiposal-only DAP flap for the coverage of a released digital nerve using preoperative DAP mapping with color Doppler US is also described. A total of 40 digital arteries in 20 fingers of the right hands of five healthy volunteers (mean age: 32.2 years old) were evaluated. The DAPs were identified using color flow imaging based on the beat of the digital artery in the short axial view. In total, 133 perforators were detected, 76 (an average of 3.8 per finger) arising from the radial digital artery and 57 (an average of 2.9 per finger) arising from ulnar digital artery. Sixty-three perforators (an average of 3.2 per finger) in the middle phalanges and 70 (an average of 3.5 per finger) in the proximal phalanges were found. Overall, an average of 1.7 perforators from each digital artery was detected in the proximal or middle phalanges. Moreover, at least one DAP per phalanx was reliably confirmed using color Doppler US. Preoperative knowledge of DAP mapping could make elevating the DAP flap easier and safer.

  12. 前臂背侧远端动脉穿支显微解剖与前臂后皮神经营养血管移植皮瓣的设计%Micradissection of distal antebrachial arterial perforators of dorsal forearm and design of flap pedicled with nutrient vessels of posterior antebrachial cutaneous nerve

    Institute of Scientific and Technical Information of China (English)

    张发惠; 郑和平; 张国栋

    2007-01-01

    BACKGROUND: Posterior antebrachial skin is beneficial for repairing injury of dorsum of hand; however, according to lacking operative researches on distal pedicel arterial perforators of posterior antebrachial cutaneous nerve nutrient vessel flap, it is still a confusing problem in clinic.OBJECTIVE: To investigate the features of distal antebrachial arterial perforators of dorsal forearm and provide anatomical theories for suitable designing pedicle flap and compound flap at distal flap pedicled with nutrient vessels of posterior antebrachial cutaneous nerve.DESIGN: Single sample observation.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIAL5: The experiment was carried out at the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from May to October, 2004. Thirty-three upper limbs of adult cadavers perfused with red latex through arteries were provided by Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of PLA.METHODS: Thirty-three adults upper limbs were dissected and observed with microscope with taking rhe styloid process of ulna and radius as pivot point.MAIN OUTCOME MEASURES: ① Distal antebrachial arterial perforators of dorsal forearm; ② nutrient vessels of distal posterior antebrachial cutaneous nerve; ③ their blood supply relationship with nearby muscle, bone and skin.RESULTS: ① Along extensor digitorum communis muscle, distal antebrachial arterial perforators of dorsal forearm were perforated along bilateral muscular interspace and tendon interspace to form lateral and interior inosculated vascular plexuses of fascia. The axis of lateral muscle interspace, dorsal antebrachial lateral vascular plexuses consisted of lateral branch of dorsal carpal branch of

  13. PIV study of near-field tip vortex behind perforated Gurney flaps

    Science.gov (United States)

    Lee, T.

    2011-02-01

    The impact of Gurney flaps, of different heights and perforations, on the growth and development of a tip vortex, both along the tip and in the near field of a finite NACA 0012 wing, at Re = 1.05 × 105 was investigated by using particle image velocimetry (PIV). Wind-tunnel force balance measurements were also made to supplement the PIV results. This study is a continuation of the work of Lee and Ko (Exp Fluids 46(6):1005-1019, 2009) on the near-wake measurements behind perforated Gurney flaps. The present results show that along the tip, the overall behavior of the secondary vortices and their interaction with the primary, or tip, vortex remained basically unchanged, regardless of flap height and perforation. The peak vorticity of the tip vortex, however, increased with flap height and always exhibited a local maximum at x/ c = 0.8 (from the leading edge). In the near field, the strength and structure of the near-field tip vortex were found to vary greatly with the flap height and perforation. The small flaps produced a more concentrated tip vortex with an increased circulation, while the large Gurney flaps caused a disruption of the tip vortex. The disrupted vortex can, however, be re-established by the addition of flap perforation. The larger the flap perforation the more organized the tip vortex. The Gurney flaps have the potential to serve as an alternative off-design wake vortex control device.

  14. Reconstrucción de la extremidad inferior con colgajos de perforantes locales Perforator local flaps in lower limb reconstruction

    Directory of Open Access Journals (Sweden)

    T. C. Teo

    2006-12-01

    Full Text Available Las innovaciones técnicas en el diseño y elevación de colgajos y los recientes avances en el conocimiento de la perfusión arterial de los mismos, ha conducido hacia un tipo de reconstrucción más refinada para todas las partes del cuerpo. El concepto de colgajos basados en vasos perforantes ha evolucionado a partir de estos avances. La reconstrucción de la extremidad inferior se ha beneficiado particularmente de este desarrollo de los colgajos de perforantes, tanto pediculados como libres. El colgajo fasciocutáneo en isla de base distal, basado en una sola perforante, permite la reconstrucción de defectos del tercio inferior de la extremidad inferior, con una técnica de rápida ejecución y con una instrumentación básica. Describimos la anatomía, diseño, ejecución, aplicaciones y ventajas de los colgajos de perforantes locales en la reconstrucción del miembro inferior.Technical innovations in the approach to flap design and dissection and recent advances in unders tanding of the arterial basis of flap perfusion have led to more refined reconstruction in all areas of the body. The concept of perforator vessel based flap has evol ved from this improved knowledge. Lower limb reconstruction has certainly benefited from this development of perforator flaps, both pedi cled and free. The distally based island fasciocutane ous flap, based on a single perforator, has allowed defects on the often awkward distal third of the lower limb to be covered reliably, with a quicker procedure and the simplest of instrtuments. We describe the anatomy, design, technique, appli cations and advantages of perforator local flaps in lower limb reconstruction.

  15. Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!

    Directory of Open Access Journals (Sweden)

    Nikhil Panse

    2014-01-01

    Full Text Available Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV.

  16. Color Doppler Ultrasonography-Targeted Perforator Mapping and Angiosome-Based Flap Reconstruction.

    Science.gov (United States)

    Gunnarsson, Gudjon Leifur; Tei, Troels; Thomsen, Jørn Bo

    2016-10-01

    Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)-targeted perforator mapping and angiosome-based flap reconstruction throughout the body. The CDU was used to identify the largest and best-located perforator adjacent to the defect to target the reconstruction. The cutaneous or fasciocutaneous flaps were raised, mobilized, and designed according to the reconstructive needs as rotation, advancement, or turnover flaps. We performed 148 reconstructions in 130 patients. Eleven facial reconstructions, 118 reconstructions in the body, 7 in the upper limbs, and 12 in the lower limbs. The propeller flap was used in 135 of 148 (91%) cases followed by the turnover design in 10 (7%) and the V to Y flap in 3 (2%) cases. The flaps were raised on 1 perforator in 98 (67%), 2 perforators in 48 (33%), and 3 perforators in 2 (1%) flaps. The reconstructive goal was achieved in 143 of 148 reconstructions (97%). In 5 cases, surgical revision was needed. No flaps were totally lost indicating a patent pedicle in all cases. We had 10 (7%) cases of major complications and 22 (15%) minor complications. The CDU-targeted perforator mapping and angiosome-based flap reconstruction are simple to perform, and we recommended its use for freestyle perforator flap reconstruction. All perforators selected by CDU was identified during surgery and used for reconstruction. The safe boundaries of angiosomes remain to be established.

  17. The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects.

    Science.gov (United States)

    Posch, N A S; Mureau, M A M; Flood, S J; Hofer, S O P

    2005-12-01

    Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps have become standard of care. The anterolateral thigh flap (ALT) donor site is popular. With the ALT flap varying sizes of vastus lateralis (VL) muscle can be harvested as a MC flap. The skin islands of these flaps have a great range of freedom when dissected on their perforator. It was hypothesised that the VL-ALT perforator flap would offer adequate tissue volume combining maximal freedom in planning with minimal donor site morbidity. From November 2001 to February 2003 a free partial VL with ALT perforator flap was used in 11 patients to reconstruct large defects. Indications for adding a muscular component were exposed bone, skull base, (artificial) dura, or osteosynthesis material, open sinuses, and lack of muscular bulk. Flaps were planned as standard ALT flaps, after which three types of dissection were performed: I. true MC flap; II. muscle flap with a skin island on one perforator, which could be rotated up to 180 degrees ; III. chimera skin perforator flap with muscle being harvested on a separate branch from the source vessel or on a side branch of the skin perforator. Mean skin size of the MC-ALT flaps was 131 cm2. Mean muscle part size of the MC-ALT flaps was 268 cm3. Muscular parts were custom designed for all defects. No total or partial flap failures were seen. Colour mismatch was seen in 6 of 8 patients, when skin was used in the facial area in this all white population. Excessive flap bulk was found in 8 of 11 patients at 6 weeks, however, only in 2 of 11 patients after 6 months. Patients were satisfied with the functional result (8 of 11 patients) as well as the cosmetic result of their reconstruction (7 of 11 patients). All less satisfied patients had received their flap for external facial skin reconstruction. Donor site morbidity was minimal. The combined free partial VL with ALT perforator flap proved valuable as a (chimera type) MC flap with maximal

  18. Microdissection of distal artery perforator of the medial leg and design of skin flap pedicled with nutrient vessels of the saphenous nerve%小腿内侧远端动脉穿支显微解剖与隐神经营养血管皮瓣设计

    Institute of Scientific and Technical Information of China (English)

    张发惠; 郑和平; 张国栋

    2007-01-01

    以胫后动脉肌间隙支、内踝前动脉穿支和以踝管区动脉穿支血管蒂的3种隐神经-大隐静脉营养血管远端蒂皮瓣或复合瓣,旋转轴点在内踝平面,适宜小腿远段、踝足部及其远侧的组织缺损修复.%BACKGROUND: The distally based skin flap pedicled with nutrient vessels of saphenous nerve has provided a method with higher achievement ratio to repair the tissue defect of ankle and foot, due to its high rotation point, lacking of distributive characteristics of distally pedicled vessels description for the specific operations, so it is still difficult in clinical application.OBJECTIVE: To investigate the distal artery perforators of medial leg, so as to suggest an anatomical theory for the reasonable design of the distally based compound flap pedicled with nutrient vessels of saphenous nerve-great saphenous vein.DESIGN: A single sample experiment.SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out in the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from May to October, 2004.Thirty-four adult specimens perfused with red emulsion at lateral arteries of upper lower limbs were provided by the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: Specimens of the distal medial legs were dissected with microscope taking the most prominent point of medial malleolus as the pivot point.MAIN OUTCOME MEASURES: ① Distal artery perforators of medial leg; ② Distal nutrient vessels of saphenous nerve-great saphenous vein; ③ Blood supply correlation of nutrient vessel with neighboring muscle, bone and skin.RESULTS: ① The distal artery perforators of medial leg derived from 9 main

  19. Free anterolateral thigh perforator flap for sacroiliac defect: First case report in pediatric population

    Directory of Open Access Journals (Sweden)

    Alejandro E. Ramirez

    2016-08-01

    Full Text Available Soft tissue defects of the sacroiliac area, usually can be covered by local flaps. However, for more complex defects, free flap transfers became necessary. We report a case of reconstruction with a free anterolateral thigh (ALT perforator flap for coverage of a sacroiliac bone exposure in a child. A six-years-old boy, suffered a car accident, resulting in pelvic and sacral fractures, as well as degloving injuries of the left thigh, buttocks, and trunk. The patient evolved with an unstable scar over the sacroiliac region with bone exposure. ALT free flap was performed. Left superior gluteal vessels were used as the recipient vessels. A stable coverage was achieved without complications. This is the first case reported of a free ALT perforator flap for sacroiliac coverage in the pediatric population. In cases of complex reconstruction in children, free perforator flap is a safe choice and should be considered in the algorithm of treatment.

  20. Anatomy of perforator flap of the lateral plantar artery of the fifth metatarsal bone and its clinical application%足底外侧动脉第5跖骨穿支皮瓣解剖与临床应用

    Institute of Scientific and Technical Information of China (English)

    林涧; 郑和平; 谢志平; 张天浩; 王之江; 张豪杰; 陆骅

    2015-01-01

    Objective To explore the clinical anatomy of perforator flap of the lateral plantar artery of the fifth metatarsal bone and its application. Methods Investigated 31 sides of adult foot cadavers which were injected with red latex. The origin, course, branches, distribution and anastomosis of the lateral plantar artery of the fifth metatarsal bone with the vessels in lateral dorsum of foot were observed. In the light of the anatomical basis, we transferred the designed perforator flap of the lateral plantar artery of the fifth metatarsal bone to repair the forefoot defects in 7 cases. Results After the operation which based on the anatomy of perforator flap of the lateral plantar artery of the fifth metatarsal bone, all the flaps were survived and the wounds got healed by first intention. In the follow-up period of 1~18 months, the flaps had good textures, no discomfort of wearing shoes or limited walking, all 7 patients were satisfied with the treatment effect. Conclusion As the surgical procedure is uncomplicated, the perforator flap of the lateral plantar artery of the fifth metatarsal bone which had constant anatomical structures and rich blood supply, is ideal for repairing the small and medium-size forefoot soft tissue defects.%目的 探讨足底外侧动脉第5跖骨穿支皮瓣应用解剖及临床应用疗效. 方法 根据30侧动脉内灌注红色乳胶的成人足标本解剖观测研究,获得足底外侧动脉第5跖骨穿支起源、走行、分支分布及第5跖骨穿支与足背外侧区血管吻合特点, 在前足外侧设计并切取足底外侧动脉第5跖骨穿支皮瓣转位修复前足缺损创面7例.结果 本组皮瓣术后全部顺利成活,创面一期愈合.术后经1~18个月随访,皮瓣质地良好,供区未发现穿鞋不适、行走受限等异常,患者对治疗效果满意.结论 足底外侧动脉第5跖骨穿支解剖恒定,血供丰富,手术操作简单,是修复前足软组织缺损中小创面较为理想的皮瓣.

  1. Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction

    NARCIS (Netherlands)

    Hekner, D.D.; Roeling, TAP; van Cann, EM

    2016-01-01

    The aim of this study was to investigate the vascular anatomy of the distal forearm in order to optimize the choice between the radial forearm free flap and the ulnar forearm free flap and to select the best site to harvest the flap. The radial and ulnar arteries of seven fresh cadavers were injecte

  2. Deep inferior epigastric perforator flap for breast reconstruction: experience with 43 flaps

    Institute of Scientific and Technical Information of China (English)

    YAN Xiao-qing; YANG Hong-yan; ZHAO Yu-ming; YOU Lei; XU Jun

    2007-01-01

    Background In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap.Methods Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap (3 patients had bilateral procedures), 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up.Results The mean age of the patients was 38.6 years (range, 28-50). The size of the flaps was 11 cm×26 cm in average (height 10-12 cm, width 15-33 cm). The mean length of the vascular pedicles was 9.3 cm (range, 7-12). The patients were followed up for a mean of 16 months (range, 6-30 months). During the follow-up, 2 (5%) patients had total flap loss, 2 (5%) had partial necrosis, 4 (9%) had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal.Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce

  3. Measuring the Pressure in the Superficial Inferior Epigastric Vein to Monitor for Venous Congestion in Deep Inferior Epigastric Artery Perforator Breast Reconstructions : A Pilot Study

    NARCIS (Netherlands)

    Smit, Jeroen M.; Audolfsson, Thorir; Whitaker, Iain S.; Werker, Paul M. N.; Acosta, Rafael; Liss, Anders G.

    2010-01-01

    During deep inferior epigastric artery perforator (DIEP) flap dissection, we noted that in many cases the superficial vein on the ipsilateral side of the flap was engorged and tense, and in others, it was empty. This led us to believe that the pressure is increased as the result of preferential outf

  4. Distally based lateral sural cutaneous nerve nutrient vessels island flap pedicled by posterior tibial artery perforator: anatomical basis and clinical applications%胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣的临床解剖与应用

    Institute of Scientific and Technical Information of China (English)

    张宇; 高秋明; 李泽宇; 刘畅; 时培晟; 邓小文

    2016-01-01

    目的 研究胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣移位修复足踝创面的临床解剖与应用.方法 选取红色乳胶动脉灌注的2侧新鲜和8侧4%甲醛固定下肢标本于手术显微镜下进行解剖研究,观察胫后动脉、腓肠外侧皮动脉及腓肠外侧皮神经的解剖学特征.根据解剖学结果设计皮瓣.纳入2007年2月至2012年6月行胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣修复的患者15例,观察疗效.结果 设计以胫后动脉在小腿远端穿支为蒂的胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣,胫后动脉穿支由腓肠外侧皮神经-腓肠神经营养血管链、穿支与腓肠外侧皮动脉间吻合血管两条供血通路逆行灌注.15例患者中移植皮瓣全部成活13例;9例静脉回流良好,移植皮瓣完全成活,6例术后出现静脉危象,其中2例移植皮瓣远端部分坏死.随访12例,随访34~ 98个月,皮瓣质地及外观良好,术后6个月皮瓣两点辨别觉(12 ±4) mm;踝关节功能优5例、良5例、中3例、差2例.结论 胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣血供充分且受解剖变异影响小,可用于踝周和足底内侧负重区皮肤缺损的修复.%Objective To study the anatomical basis of distally based lateral sural cutaneous nerve nutrient vessels island flap pedicled by posterior tibial artery perforator and its clinical application in foot ankle wound repair.Methods Eight sides of 4% formaldehyde-fixed and 2 sides of fresh cadavers were infused with colored red latex and dissected under operating microscope.The posterior tibial artery,lateral sural cutaneous artery,lateral sural cutaneous nerve were observed.Based on the results of anatomic study,the flaps were designed for clinical reparative application.From February 2007 to June 2012,15 patients underwent reparative operation of in foot ankle wound with distally based lateral sural cutaneous nerve nutrient vessels island flap

  5. Free digital artery flap: an ideal flap for large finger defects in situations where local flaps are precluded.

    Science.gov (United States)

    Wong, Chin-Ho; Teoh, Lam-Chuan; Lee, Jonathan Y-L; Yam, Andrew K-T; Khoo, David B-A; Yong, Fok-Chuan

    2008-03-01

    The heterodigital arterialized flap is increasingly accepted as a flap of choice for reconstruction of large finger wounds. However, in situations where the adjacent fingers sustained concomitant injuries, the use of this flap as a local flap is precluded. This paper describes our experience with the free digital artery flap as an evolution of the heterodigital arterialized flap. Four patients with large finger wounds were reconstructed with free digital artery flap. Our indications for digital artery free flap were concomitant injuries to adjacent fingers that precluded their use as donor sites. The arterial supply of the flap was from the digital artery and the venous drainage was from the dominant dorsal vein of the finger. The flap was harvested from the ulnar side of the finger. The digital nerve was left in situ to minimize donor morbidity. The donor site was covered with a full-thickness skin graft and secured with bolster dressings. Early intensive mobilization was implemented for all patients. All flaps survived. No venous congestion was noted and primary healing was achieved in all flaps. In addition to providing well-vascularized tissue for coverage of vital structures, the digital artery was also used as a flow-through flap for finger revascularization in one patient. Donor-site morbidity was minimal, with all fingers retaining protective pulp sensation and the distal and proximal interphalangeal joints retaining full ranges of motion. In conclusion, the free digital artery flap is a versatile flap that is ideal for coverage of large-sized finger defects in situations where local flaps are unavailable. Donor-site morbidity can be minimized by preservation of the digital nerve, firmly securing the skin graft with bolster dressings, and early mobilization of the donor finger.

  6. Free deep inferior epigastric perforator flap used for management of post-pneumonectomy space empyema.

    Science.gov (United States)

    Manley, Kate; Gelvez, Sandra; Meldon, Charlotte J; Levai, Irisz; Malata, Charles M; Coonar, Aman S

    2013-04-01

    Various solutions exist for management of post-pneumonectomy space empyema. We describe the use of a free deep inferior epigastric perforator (DIEP) flap to fill the space and close a pleural window. Previously, flaps involving abdominal muscle or omentum have been used for this purpose. Abdominal surgery to harvest such flaps can impair ventilatory mechanics. The DIEP flap--harvested from the abdomen, and composed primarily of skin and muscle avoids this problem, thus is a desirable technique in patients with impaired lung function. We believe this is the first report of the DIEP flap to close a postpneumonectomy empyema space.

  7. Perforator-based chimaeric thoracodorsal flap for foot reconstruction.

    Science.gov (United States)

    Rausky, Jonathan; Binder, Jean-Philippe; Mazouz-Dorval, Sarra; Hamou, Cynthia; Revol, Marc

    2013-12-01

    The reconstruction of severe defects of the ankle and foot is a challenge. The ideal solution should combine a thin skin flap on the dorsum to allow shoe fitting and a muscle flap with a split-thickness skin graft on the weight-bearing area. Perforator-based thoracodorsal chimaeric flaps allow us to achieve these two goals with minimal donor-site morbidity. We present a reconstruction of an extended circumferential defect of the ankle with an exposed heel using a chimaeric thoracodorsal perforator flap with a serratus muscle flap. The skin flap was transferred on the dorsal foot, whereas the serratus anterior muscle was transferred on the exposed heel. Postoperative recovery was uneventful and the patient began full weight bearing after 3 months. Twelve months after reconstruction, natural shape and walking function were successfully achieved.

  8. Colgajos de las perforantes del pie: problemas y posibles soluciones Foot perforator flaps: problems and possible solutions

    Directory of Open Access Journals (Sweden)

    E. Prousskaia Peregudova

    2010-06-01

    Full Text Available A pesar de diversas publicaciones existentes sobre el colgajo mediano plantar tradicional, los colgajos de las perforantes del pie no están suficientemente estudiados. Es necesario ampliar nuestros conocimientos sobre la anatomía vascular de esta región, los problemas que pueden surgir durante la disección de la zona y las posibles soluciones. Realizamos disección anatómica de 10 pies de cadáver utilizando relleno vascular con látex coloreado. Definimos la secuencia de la disección de las perforantes de la arteria plantar medial. Medimos los puntos de salida de las perforantes dominantes en relación con 3 puntos de referencia, diámetro y longitud de cada perforante. Evaluamos la utilidad de cada colgajo para su uso en reconstrucción local o a distancia en función del diámetro y la longitud de la perforante, grosor del colgajo y morbilidad de la zona donante. Los colgajos de los vasos perforantes del pie son una buena opción para la reconstrucción tanto local como a distancia, con una mínima morbilidad de la zona donante y con un buen resultado funcional gracias a las características del tejido del pie cuando se usa para reconstrucción en mano.Traditional medial plantar flap is widely described in the literature, but foot perforator flap is a relatively new subject which still needs more detailed anatomical investigation. We need to amplify our knowledge about this surgically challenging region, dissection difficulties and possible solutions. We performed anatomical dissection on 10 cadaver feet with dyed latex intravascular injection and then dissected out the perforators arising from the medial plantar artery. We measured the origin of the dominant perforators in relationship to 3 reference points, diameter and length of each perforator. We analyzed the application of flaps based on these perforators as local and free flaps in relation to pedicle length and diameter, flap thickness and donor site morbidity. Foot perforator

  9. Posterior interosseous artery flap, fasciosubcutaneous pedicle technique: a study of 25 cases.

    Science.gov (United States)

    Puri, Vinita; Mahendru, Sanjay; Rana, Roshani

    2007-01-01

    This study was undertaken in an attempt to improve the versatility of the posterior interosseous artery flap (PIA flap) and to decrease flap complication rate. The PIA flap was used for resurfacing 25 cases of the hand and distal forearm over a 2-year period. Observations were made on the anatomy of the PIA flap and its distal reach. Doppler analysis was made a mandatory part of the preoperative planning. Flaps were also raised from the zone of injury if Doppler confirmed the presence of good perforators. No attempt was made to identify the anastomosis between the anterior interosseous artery (AIA) and the PIA prior to flap raising since its presence was ascertained preoperatively with a Doppler and flap raising could begin straightway, saving precious tourniquet time. The surgical technique was further modified to include a large amount of fascia and subcutaneous tissue with the flap. This could perhaps be the reason for survival of larger flaps, absence of venous congestion and the low complication rate seen in our series. These flaps were used to resurface defects involving the dorsum of the hand, palm, distal forearm, wrist and fingers (both dorsal and volar surfaces). The distal reach of the flap was improved by exteriorising the pedicle and bowstringing it across the wrist which was kept in extension. The flap could thus easily reach the distal interphalangeal joint. This exteriorised pedicle was covered with a split thickness skin graft and was divided 3 weeks later under local anaesthesia making it a two-stage procedure. Adipofascial and osteocutaneous PIA flaps were also used depending on the requirement. Out of 25 flaps, 23 were of the adipofascial variety and one each of the fascial and osteocutaneous type. The majority of the patients were between 21 and 30 years old. Trauma was the leading cause of tissue deficit in our series (19/25). Within the trauma group occupational mishap (entrapment of hand in roller machine, presser machine, etc.) was the

  10. Foot and ankle reconstruction: an experience on the use of 14 different flaps in 226 cases.

    Science.gov (United States)

    Zhu, Yue-Liang; Wang, Yi; He, Xiao-Qing; Zhu, Min; Li, Fu-Bin; Xu, Yong-Qing

    2013-11-01

    The aim of this report was to present our experience on the use of different flaps for soft tissue reconstruction of the foot and ankle. From 2007 to 2012, the soft tissue defects of traumatic injuries of the foot and ankle were reconstructed using 14 different flaps in 226 cases (162 male and 64 female). There were 62 pedicled flaps and 164 free flaps used in reconstruction. The pedicled flaps included sural flap, saphenous flap, dorsal pedal neurocutaneous flap, pedicled peroneal artery perforator flap, pedicled tibial artery perforator flap, and medial plantar flap. The free flaps were latissimus musculocutaneous flap, anterolateral thigh musculocutaneous flap, groin flap, lateral arm flap, anterolateral thigh perforator flap, peroneal artery perforator flap, thoracdorsal artery perforator flap, medial arm perforator flap. The sensory nerve coaptation was not performed for all of flaps. One hundred and ninety-four cases were combined with open fractures. One hundred and sixty-two cases had tendon. Among 164 free flaps, 8 flaps were completely lost, in which the defects were managed by the secondary procedures. Among the 57 flaps for plantar foot coverage (25 pedicled flaps and 32 free flaps), ulcers were developed in 5 pedicled flaps and 6 free flaps after weight bearing, and infection was found in 14 flaps. The donor site complications were seen in 3 cases with the free anterolateral thigh perforator flap transfer. All of limbs were preserved and the patients regained walking and daily activities. All of patients except for one regained protective sensation from 3 to 12 months postoperatively. Our experience showed that the sural flap and saphenous flap could be good options for the coverage of the defects at malleolus, dorsal hindfoot and midfoot. Plantar foot, forefoot and large size defects could be reconstructed with free anterolateral thigh perforator flap. For the infected wounds with dead spce, the free latissimus dorsi musculocutaneous flap remained to

  11. The lateral superior genicular artery perforator iliotibial band flap for the treatment of scar contraction of popliteal fossa%膝上外侧动脉穿支髂胫束皮瓣修复腘窝部瘢痕挛缩

    Institute of Scientific and Technical Information of China (English)

    郑鑫; 安洪宾; 陈滔; 王海宝

    2013-01-01

    Objective:To discuss clinical results of the lateral superior genicular artery perforator iliotibial band flap for the treatment of scar contracture of popliteal fossa. Methods: Form January 1999 to December 2011,11 patients with scar contraction of popliteal fossa were treated with the lateral superior genicular artery perforator iliotibial band flap. Among the patients , 7 patients were male and 4 patients were female, ranging in age from 24 to 58 years old, with an average of 33 years old. The operation time ranged from 3 months to 1 year after trauma. Eight patients had injuries in the right side and 3 patients had the injuries in the left. Five patients had the injuries caused by traffic, 3 patients had the injuries caused by hot compression and other 3 patients suffered from burns. The flap area ranged from 7.0 cm×4.0 cm to 20.0 cm×8.0 cm. Results:AH the flaps survived. Three patients had epidermis necrosis. After 5 months to 2 years follow-up period,the knee function recovered,the flap shape was favorable and the skin firmness was moderated. Conclusion: The lateral superior genicular artery perforator iliotibial band flap is a practical, simple and an ideal donor in the reconstruction of popliteal fossa scar contracture.%目的:探讨膝上外侧动脉穿支髂胫束皮瓣治疗腘窝部瘢痕挛缩的临床疗效,为腘窝区瘢痕挛缩寻找最佳的手术方式.方法:自2009年1月至2011年12月,应用膝上外侧动脉穿支髂胫束动脉皮瓣修复腘窝瘢痕挛缩11例,男7例,女4例;年龄24~58岁,平均33岁;病程3个月~1年,平均6.5个月;右膝关节8例,左膝关节3例;交通伤5例,热压伤3例,烧伤3例.采用膝上外侧动脉穿支髂胫束皮瓣局部转移修复创面,切取皮瓣面积最大20.0 cm×8.0 cm,最小7.0 cm×4.0 cm.结果:术后皮瓣全部成活,3例远端血运差,局部色素沉着,表皮坏死脱痂.术后随访5个月~2年,膝关节活动均恢复正常,皮瓣外形良好,皮肤松紧度适中.

  12. Radial artery perforator flap for repair of soft tissue defect after palm postoperative scar contracture%桡动脉穿支皮瓣逆行转移修复手掌瘢痕挛缩术后软组织缺损

    Institute of Scientific and Technical Information of China (English)

    王刚; 姚有榕; 邓盼; 张一智; 徐云钦; 申屠刚

    2016-01-01

    Objective To explore the clinical effect of the radial artery perforator flap on repairing soft tissue defect after palm postoperative scar contracture. Methods Eighteen patients with palm scar contracture were selected. The palm soft tissue defect was repaired by radial artery perforator flap after the operation of scar removal and soft tissue release. The areas of soft tissue ranged from 5 cm × 3 cm to 8 cm × 5 cm. The area of donor flap exceeds 20%of the wounds area, and wounds were repaired by free skin grafting. Six months after operation, the hand function was compared with that before operation. Results All the patients were followed up for 6-15 months (mean 10.8 months), all flaps survived with good shape, and flap donor site wounds were healed by skin grafting. The patients were evaluated 6 months after operation according to the Chinese Medical Hand Surgery Society of upper part of functional assessment criteria: excellent in 11 cases, good in 5 cases and general in 2 cases, but preoperative functional evaluation was excellent 0 case, good in 3 cases, general in 7 cases and poor in 8 cases. Compared with that before operation, the postoperative function was significantly improved. Conclusions It is a commendable approach of repairing soft tissue defect after postoperative palm scar contracture by radial artery perforator flap, because it can provide reliable blood supply, and significantly improve hand function with exactly clinical effect.%目的 探讨桡动脉穿支皮瓣逆行转移修复手掌瘢痕挛缩术后软组织缺损的临床疗效.方法 选取手掌瘢痕挛缩患者18例,均行瘢痕切除、软组织松解,缺损创面予以桡动脉穿支皮瓣逆行转移修复,缺损创面面积5cm×3cm~8cm×5cm,皮瓣供区创面放大20%切取,创面均予以游离植皮修复.术后6个月随访比较术前、术后手功能变化.结果 所有患者均获得随访,随访时间为6~15个月(平均10.8个月),所有皮瓣均完全成活,皮瓣供

  13. Perforator-based flaps for the treatment of burn scar contractures: a review.

    Science.gov (United States)

    Stekelenburg, C M; Marck, R E; Verhaegen, P D H M; Marck, K W; van Zuijlen, P P M

    2017-01-01

    Patients with burn scars often experience functional problems because of scar contractures. Surgical treatment may be indicated for those burn scar contractures. If the contractures are small and linear, the contraction bands can be treated with local transposition flaps like the Z-plasty. Broader, diffuse contractures are more challenging and require a different surgical approach, such as the use of local tissue. The use of perforator-based flaps is promising; however, their true clinical significance for this type of burn reconstructions still needs to be determined. Therefore, we performed a review to evaluate the role of perforator-based flaps for burn scar contracture treatment. Electronic databases were searched using a predefined search strategy. Studies evaluating the long-term outcome of perforator-based flaps for the treatment of burn scar contractures were included. The methodological quality was tested and data was summarized. Five hundred and ten papers were identified of which eleven met the inclusion criteria. One study was a randomized controlled trial; ten were cohort studies of a pre-postoperative design. The papers described outcomes of free flaps and local flaps. Most studies had methodological shortcomings and used inappropriate statistical methods. Perforator-based interposition flaps appear to be highly relevant for burn scar contracture treatment. However, due to the paucity and low quality of the studies that were assessed, no definitive conclusions about the true clinical significance could be reached. And therefore, only recommendations could be given for improvement of the quality of further primary research on the effectiveness of perforator-based flaps for burn scar contracture release.

  14. Anatomic study and clinical application of perforator free flap in posterior region of thigh%游离股后侧穿支动脉皮瓣的解剖学研究及临床应用

    Institute of Scientific and Technical Information of China (English)

    王剑利; 王根; 赵刚; 郭永强; 王五洲

    2013-01-01

    Objective To study how design and harvest perforating artery free flaps in posterior region of thigh based on research of the anatomical features and distribution regularities of those perforating artery.Methods Using 8 fresh bodies specimen with latex leaded perfusion of inferior gluteal area to study perforator artery anatomy structure and distribution of rear thigh.Screen the fitting perforator arteries for perforator free flap both in caliber and length.Total 7 cases were performed with perforator free flap in posterior thigh,the flap size:from 3 cm × 8 cm-8 cm × 16 cm,and the first perforating artery flap carried out in 4 cases,the second perforating artery flap in 2 cases,the third perforating artery flap in Ⅰ case.Results Anatomic study showed that perforating artery suitable for free flap in this area were in teams of 4 to 5,the average diameter were in range of 0.4 to 2.8 mm,the average length was 2.2-9.0 cm.Seven cases had been applied with perforator flap and all survived.Followed-up from 5 to 11 months,the wounds repaired by the perforator flap of posterior thigh presented fine elasticity,thin flap,beautiful appearance.Conclusion The distribution,length and diameter of perforating artery in posterior region of thigh are suitable for perforator free flap.Being hidden,direct close the posterior region of thigh expected to acchive satisfactory clinical effects.%目的 通过研究股后侧区的穿支动脉解剖特点和分布规律,设计切取以该区域穿支血管为蒂的游离皮瓣. 方法 利用新鲜尸体8具乳胶加铅灌注标本对股后侧区域内血管解剖结构尤其是穿支血管走行及分布进行研究,筛选口径、长度及走行适合做吻合血管蒂的穿支.临床上实际应用7例,均为穿支游离皮瓣,皮瓣大小:3 cm×8 cm~8 cm×16 cm,第一穿动脉皮瓣3例,第二穿动脉皮瓣2例,第三穿动脉皮瓣1例,第一穿动脉上无名穿支皮瓣1例. 结果 解剖研究发现,该区域适

  15. The reverse extended peroneal artery perforator flap for soft tissue defects of the ankle and fool%腓动脉及穿支血管蒂皮瓣逆行转移修复足踝部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    阮洪江; 蔡培华; 柴益民; 范存义

    2009-01-01

    目的 探讨应用腓动脉及穿支血管蒂皮瓣逆行转移修复足踝部软组织缺损的手术方法 和临床效果.方法 2007年4月至2008年2月,收治10例足踝部软组织缺损患者.男7例,女3例;年龄8~52岁,平均34.2岁.致伤原因:车祸伤6例,坠落伤2例,慢性溃疡1例,烫伤1例.在患肢小腿外侧区沿腓动脉轴线设计皮瓣,术中游离包含于皮瓣内的1~3支腓动脉穿支,于腓动脉穿支近端结扎切断腓动脉及静脉,向远端游离至外踝尖上约5 cm并以此为旋转点,连同皮瓣向远端逆行转移覆盖足踝软组织缺损区.切取皮瓣范围为10 cm×5 cm~25 cm×15 cm,血管蒂长6~17 cm.结果术后10例皮瓣全部成活.仅1例皮瓣远端局部回流不畅、浅表坏死,经换药及抗感染治疗后愈合.供区均Ⅰ期愈合.全部病例获5~14个月(平均9.5个月)随访,所有患者皮瓣外形及功能满意,行走正常.结论 腓动脉及穿支血管蒂营养皮瓣血管蒂长,蒂部细小易转移而不易受压,血供可靠,切取范围大,皮肤质地良好,用于足踝部皮肤软组织缺损的修复效果满意.%Objective To investigate the operative technique and clinical results of repairing soft tissue defects of the ankle and foot with reverse extended peroneal artery perforator flap. Methods From April 2007 to February 2008, 10 patients, 7 men and 3 women, were treated with this technique, with an av-erage age of 34.2 years (ranged from 8 to 52 years). The initial wounds were caused by trauma, burn injury and chronic ulcer, with bone and/or tendon exposure. The flap was designed overlying the course of the per-oneal artery, which corresponds to the palpable posterior border of the fibula when mapped to the surface.The flap was raised by dividing the peroneal artery and veins proximally and elevating them distally, which covered for the defects of the ankle and foot. The pivot point was placed at the level of the ankle joint dis-tally. Thus the flap was

  16. Study of distribution of dominant perforators arising from peroneal artery with color Doppler flow imaging and its clinical significance for sural neurocutaneous flap%腓动脉主穿支彩超定位对穿支腓肠神经营养血管皮瓣的临床意义

    Institute of Scientific and Technical Information of China (English)

    陈雪松; 徐永清; 肖茂明; 王元山; 马志显; 管力; 张黎明; 江珉

    2010-01-01

    Objective To study the distribution of the dominant perforators(the diameter ≥ 0.8mm)of the peroneal artery with color Doppler flow imaging(CDFI)for the purpose of anatomical preparations for the perforator sural neurocataneous flap. Methods The dominant perforators of the peroneal artery(DPPA)were studied with CDFI on bilateral legs of 20 healthy volunteers.The numbers,diameters and locations of the perforators were recorded for a statistical analysis.From Jan.2005 to Jan.2009,51 free or pedicled sural neurocutaneous flaps supplied by a single DPPA were designed and harvested to repair the defects near the ankle(n =22),at the leg(n = 15)and the forefoot or hand dorsum (n = 14).The perforators were located preoperatively with CDFI and accuracy of CDFI was evaluated intraoperatively.The causes of false results were analysed to improve examining techniques. Results The average number of DPPA was 4.2 with the average diameter of(1.13 ±0.24)mm(0.80-1.90 mm).They were located in the second to ninth segment of the line from the fibular caput to the tip of lateral malleolus which was equally divided into nine segments.The largest DPPA was(1.43 ± 0.29)mm(1.00-1.90mm)in diameter and most of them were located in the third to fifth segment(80.4%).The average diameter of the lowest DPPA was(1.02 ±0.16)mm(0.80-1.30 mm)and they were located between the sixth to ninth segment.The total 169 DPPA as well as the largest ones mostly appeared in the middle third of the leg.All of the 51 flaps were transplanted successfully without necrosis,and no vascular problems occurred.Preoperative CDFI examination had a 93.6% true-positive rate and an 88.0% positive predictive value.What should be demonstrated was that if just considered the cases after Dec.2007,the true-positive rate was 97%,and the positive predictive value was 93.9%. Conclusions According to the distribution characteristics of DPPA,a sural neurocutaneous flap pedicled with one of this relatively large perforator can be

  17. 胸背动脉穿支扩张皮瓣游离移植修复面颈部大面积瘢痕的临床研究%Clinical study of expansion of thoracic dorsal artery perforators flap transplantation in repairing large scar in faciocervical region

    Institute of Scientific and Technical Information of China (English)

    吴丹凤

    2015-01-01

    Objective To explore the clinical effect of expansion of thoracic dorsal artery perforators flap transplanta-tion in repairing large scar in faciocervical region. Methods 46 patients with large scar in faciocervical region from October 2010 to October 2014 of our hospital were selected.Patients were divided into two groups according to random number table.23 patients in control group were given shift of the upper arm medial expansion flap repair,23 patients in observation group were given expansion of thoracic dorsal artery perforators flap transplantation.Repair effects between two groups were compared. Results In observation group,the recovery of cervical chin angle range was (87.96±11.02)o, postoperative neck angle was(41.20±5.27)o,postoperative neck left angle was(44.28±1.06)o and postoperative neck right angle was(44.31±1.15)o,which were significantly more than that were respectively(74.63±10.19)o,(37.46±3.98)o,(40.03±0.87)oand (40.12±0.79)oin control group.The incidence rate of complications was 4.3% in observation group,significant lower than 26.1%in control group and the difference was statistics significance(P<0.05). Conclusion Expansion of tho-racic dorsal artery perforators flap transplantation in repairing large scar in faciocervical region has better effect and less complications,which is easily accepted by patients.%目的:探讨胸背动脉穿支扩张皮瓣游离移植修复面颈部大面积瘢痕的临床效果。方法选择本院2010年10月~2014年10月诊治的面颈部大面积瘢痕患者46例,采用随机数字表法分为两组,23例患者采用上臂内侧扩张皮瓣移位修复为对照组,23例患者采用胸背动脉穿支扩张皮瓣游离移植修复为观察组,比较两组患者的修复效果。结果观察组患者术后颈颏角恢复范围(87.96±11.02)º、术后颈后伸角度(41.20±5.27)º、术后颈左偏角度(44.28±1.06)º、术后颈右偏角度(44.31±1.15)º均明显大于对照组的(74.63±10.19)º

  18. 旋髂浅动脉穿支嵌合骨皮瓣修复四肢骨与软组织缺损%Transplantation of the chimerical osteocutaneous perforator flap with superficial circumflex iliac artery for repair of bone and skin defect in limbs

    Institute of Scientific and Technical Information of China (English)

    潘朝晖; 蒋萍萍; 薛山; 刘学胜; 李洪飞; 赵玉祥

    2010-01-01

    目的 探讨旋髂浅动脉穿支嵌合骨皮瓣修复四肢骨与软组织缺损的应用特点.方法 2008年2月至2009年4月应用旋髂浅动脉穿支嵌合骨皮瓣修复四肢骨与软组织缺损5例,男4例,女1例;年龄22~44岁,平均31.2岁.车祸伤3例,机器挤压伤2例.掌骨2例,足2例,腓骨1例.皮肤缺损面积5 cm×2 cm~16 cm×5 cm.骨瓣切取范围2 cm×1 cm×0.8 cm~8 cm×2 cm×0.5 cm,皮瓣切取范围6cm×3 cm~18 cm×6 cm.血管吻合除1例动脉端侧吻合外,均采用端端吻合方式.骨瓣以钢板螺钉固定4例,克氏针固定1例.结果 1例术后第2天出现动脉危象,探查后发生皮瓣边缘浅表性坏死,经植皮愈合,其余皮瓣全部存活.供区伤口8~27 d愈合.全部患者随访8~19个月,皮瓣外观满意,无须特殊保护.骨愈合时间3~6个月.髋部外形轮廓未改变,无髋区疼痛,无瘢痕增生.修复手部缺损者患手恢复握持功能,基本恢复对掌功能;修复下肢缺损者患肢可负重,无疼痛.结论 旋髂浅动脉穿支嵌合骨皮瓣供区损伤小,是修复小面积骨缺损,尤其是合并较大范围软组织缺损的一种较好方法.%Objective To investigate the applied methods and effects of the chimerical osteocuta-neous perforator flap with superficial circumflex iliac artery for reconstruction of bone and skin defect in limbs. Methods From February 2008 to April 2009, five patients in whom bone and skin defect in limbs were reconstructed with free chimerical osteocutaneous perforator flaps using superficial circumflex iliac vessel, in-cluding 4 males and 1 female with an average age of 31.2 years. Of 5 patients, 2 were used for the recon-struction of composite metacarpal bone and soft-tissue defects, 2 for foot reconstruction, and 1 for fibula re-construction. The area of cutaneous deficiency was about 5 cm×2 cm to 16 cm×5 cm. The size of osseous flaps ranged from 2 cm×1 cm×0.8 cm to 8 cm×2 cm×0.5 cm, and the size of cutaneous flaps ranged

  19. Free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps for breast reconstruction: a systematic review of flap complication rates and donor-site morbidity.

    Science.gov (United States)

    Sailon, Alexander M; Schachar, Jeffrey S; Levine, Jamie P

    2009-05-01

    Free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps represent increasingly popular options for breast reconstruction. Although several retrospective, small-scale studies comparing these flaps have been published, most have failed to find a significant difference in flap complication rates or donor-site morbidity. We systematically reviewed the current literature, and subsequently pooled and analyzed data from included studies. Included studies reported flap complications and/or donor site morbidities for both flap types. Eight studies met the inclusionary criteria. For flap complications, there was a statistically significant difference between deep inferior epigastric perforator and free transverse rectus abdominis myocutaneous flaps in fat necrosis rates (25.5 +/- 0.49 vs. 11.3% +/- 0.41%, P flap options.

  20. Comparison of bacterial inoculation and transcutaneous oxygen tension in the rabbit S1 perforator and latissimus dorsi musculocutaneous flaps.

    Science.gov (United States)

    Guerra, Aldo Benjamin; Gill, Paul Singh; Trahan, Chris G; Ruiz, Bernardo; Lund, Kerstin M; Delaune, Christie L; Thibodeaux, Brett A; Metzinger, Stephen Eric

    2005-02-01

    Muscle and musculocutaneous flaps have been used reliably in reconstruction of soft-tissue defects for many years. Previous experimental studies have shown musculocutaneous flaps to be superior to the random pattern and fasciocutaneous flaps in the management of infected wounds. Over the past decade, perforator flaps have gained acceptance as alternative methods of reconstruction in the clinical setting that can decrease donor-site morbidity and hospital stay, and increase patient satisfaction. The authors theorized that perforator flaps may be able to handle infected wounds better than random pattern and fasciocutaneous flaps because their blood supply is essentially the same as many of their musculocutaneous counterparts. The goal of this study was to compare the S1 perforator-based skin flap and latissimus dorsi musculocutaneous flap in the dorsal flank of the rabbit with the introduction of bacteria to simulate both superficial and deep wound infection. Measurements of oxygen tension and regional perfusion index were performed on both types of flaps to ascertain their viability and capacity to heal. The authors found no statistical significance between latissimus dorsi musculocutaneous and S1 perforator flaps in the rabbit with respect to superficial and deep wound infections. The regional perfusion index was calculated for postoperative days 1, 2, and 4. No statistically significant difference between the two flaps using the regional perfusion index could be identified. Additionally, regional perfusion for both types of flaps was greater than 0.6, indicating that their capacity to heal wounds is similar.

  1. Advances in the practice of microsurgery: focusing on free anterolateral thigh perforator flap

    Directory of Open Access Journals (Sweden)

    Theddeus O.H. Prasetyono

    2007-12-01

    Full Text Available The purpose of this paper was to discuss an overview of the current clinical practice of microsurgery with a specific use of free anterolateral flap as one of the commonest flaps used in reconstructive surgery. A systematic review was performed through all English publication that goes to Pubmed during the period of 1997 to 2006 using keywords: “anterolateral thigh perforator flap.” The studies involved were retrospective case reviews on using microsurgical technique and involves free anterolateral thigh flap only without muscle involvement. Evaluation was done to search the indications, contraindications, area or organ to reconstruct, the cause of defects need reconstructive surgery, morbidities, functional and aesthetic results, techniques in regard of suture material, and instruments. Using 7th edition EndNote program, 230 abstracts were successfully retrieved in term of “anterolateral thigh perforator flap” of ANY FIELD and Boolean logic OR. Fifty six abstracts from many journals matched the criteria. Due to our limitation to get all of those articles, finally, 8 articles from Plastic and Reconstructive Surgery became the resources of this paper. The overall success rate in terms of flap viability is 98% (525 from 535 flaps with partial necrosis is as low as 2.2% (12 from 535 flaps. Thinning procedure is commonly applied with regards of the thin flap needed. The recipient sites from 8 articles varies and can be any part of the body includes facial, neck, pharyngoesophagus, breast, upper and lower extremity. Four out of 8 papers mentioned functional evaluation and all stated satisfactory to excellent outcome. There are also 4 papers mentioning the aesthetic evaluation. Overall evaluation was mentioned as good to excellent. It is concluded that free anterolateral thigh perforator flap is a well established choice in most soft tissue reconstruction. It can be indicated to any area needed reconstruction especially head and neck

  2. Endoscopic closure of large septal perforations with bilateral Hadad-Bassagasteguy flaps.

    Science.gov (United States)

    Morera Serna, Eduardo; Ferrán de la Cierva, Luis; Fernández, Meritxell Tomás; Canut, Santiago Quer; Mesquida, Jacoba Alba; Purriños, Francisco José García

    2017-03-01

    Surgical closure of nasal septal perforations is one of the most challenging procedures in nasal surgery. Defects greater than 2 cm are especially difficult to repair with the traditional approaches due to the challenges of mobilizing enough mucosa to close big gaps, and avoiding airway stenosis in the process. We present a new technique to endoscopically close major septal perforations using bilateral Hadad-Bassagasteguy flaps. Four consecutive patients with septal perforations greater than 2 cm were operated at our institution. Bilateral Hadad-Bassagasteguy flaps were endoscopically raised, one of them above the defect and the other one below it, and rotated to partially cover the defect on each side. A deep temporalis fascia graft was sandwiched between the two flaps to provide a scaffold for schneiderian mucosa growth. Both flaps were covered with a silicone sheet for 3 weeks. A complete closure of the defect was accomplished in three of the four patients; partial closure was achieved in the other. Nasal crusting, epistaxis, and nasal breathing improved in all patients. Large defects of the nasal septum may be closed in selected cases by rotation of bilateral pedicled septal mucosal flaps partially covering the defect area, followed by secondary healing of the nasal mucosa over an autologous graft acting as an epithelial scaffold.

  3. Dorsalis pedis arterialized venous flap for hand and foot reconstruction

    Institute of Scientific and Technical Information of China (English)

    YU Guang; LEI Hong-yu; GUO Shuang; HUANG Jian-hua; YU Hao

    2012-01-01

    Objective:To report the results of repair of skin defects in the extremities with arterialized venous flap harvested from the lateral aspect of the dorsum of the foot.Methods:Six cases of skin and soft tissue defects over the foot and hands were resurfaced by free arterialized venous flaps,including five patients with skin defects of the hands,and one with defects at the dorsum of the foot.The flaps were harvested from the lateral aspect of the dorsum of the foot with the sizes ranging from 2 cm×5.5 cm to 6 cm×11 cm.Two veins at the proximal margin of the flap were retained,one of which was anastomosed to a recipient bed artery to provide arterial inflow and the other was anastomosed to a recipient bed vein for venous outflow.Results:All flaps demonstrated mild edema and survived completely.Blisters appeared on four flaps.Using this technique,we achieved good functional and cosmetic results in this series.Conclusions:Dorsalis pedis arterialized venous flap with rich vascular communications could enhance peripheral perfusion and decrease congestion of venous flaps,thereby improves reliability and utility for extremity reconstruction.

  4. Perforator flap transplantation assisted by the multislice spiral computed tomographic angiography: the clincal report%MSCTA辅助穿支皮瓣移植的初步报告

    Institute of Scientific and Technical Information of China (English)

    高建明; 薛峰; 夏云宝; 储旭东; 华国军; 李坤; 骆宇春; 潘功茂

    2011-01-01

    目的 探讨MSCTA在穿支皮瓣移植中应用的可行性.方法 自2009年5月~2010年9月,我们对6例小腿、足踝软组织缺损病人拟行穿支皮瓣移植修复术,术前行MSCTA检查,下肢血管三维成像,术中根据穿支皮瓣的穿支血管的位置、直径、分布情况,设计穿支皮瓣的血管蒂,皮瓣轴心线,以及皮瓣的大小,行穿支皮瓣移植手术.结果 MSCTA图像显示:2例膝上外侧动脉穿支、4例胫后动脉穿支图像清晰,而且与皮瓣移植手术中解剖穿支血管情况完全一致.2例穿支皮瓣行吻合血管游离移植,4例穿支皮瓣带蒂转移,手术顺利完成.5例皮瓣完全成活,1例皮瓣边缘坏死,1个月后皮瓣整形后愈合良好.结论 MSCTA图像在穿支皮瓣移植手术中提供有价值的解剖路径,对穿支血管显影有良好的敏感性,缩短了手术时间,明显提高手术的准确性.因此,MSCTA在穿支皮瓣移植中的应用具有良好的可行性.%Objective To investigate the potentiality of multislice spiral computed tomographic angiography(MSCTA) on preoperative planning of the perforator flap transplantation. Methods From May 2009 to September 2010, 6 cases with soft tissue defects of lower extremity, ankle and foot were treated in our department using perforator flaps. MSCTA was performed preoperatively in all patients scheduled for tissue transfer. MSCTA showed three dimensional images of blood vessels of the lower extremities and perforators. During perforator surgery, MSCTA image assessment allowed us to plan the axis, size and shape of perforator flaps according to the position, calibre and course of pedicled vessels. Results MSCTA images showed perforator vessels clearly, including lateral superior genicular artery perforating rami and posterior tibial artery perforating rami in 2 and 4 cases respectively, which was consistant to the course of perforator vessels observed during the operation. 2 cases were treated with the vascularized

  5. Reconstruction of weightbearing forefoot defects with digital artery flaps.

    Science.gov (United States)

    Liu, Lifeng; Cao, Xuecheng; Cai, Jinfang

    2015-01-01

    Reconstruction of a defect of the weightbearing forefoot region remains a challenging problem owing to the limited alternatives available. The digital artery flap can be used for coverage of defects in the weightbearing forefoot. The present study reports our results using a digital artery flap for reconstruction of soft tissue defects of the weightbearing forefoot in 8 patients. The mean patient age was 35 ± 11.3 years. The etiology of the soft tissue defects included 4 (50%) traumatic events, 2 (25%) dysfunctional scars, and 2 (25%) neuropathic ulcerations. The mean postoperative follow-up duration was 22 ± 11.1 months (range 12 months to 4 years). All 8 flaps survived successfully. The complications included 1 case of delayed healing of a neuropathic ulceration. The digital artery flap is a good alternative for soft tissue defects of the weightbearing forefoot. The surgical techniques for harvesting the flaps are easy to manage.

  6. Planificación preoperatoria de los colgajos de perforantes Preoperative planning on perforator flaps

    Directory of Open Access Journals (Sweden)

    J Masià

    2006-12-01

    Full Text Available La valoración preoperatoria precisa de la anatomía vascular es altamente valiosa para conseguir la mejor planificación quirúrgica y poder realizar colgajos de perforantes de una forma más rápida y segura. La localización de la mejor perforante y la valoración de su trayecto hasta el vaso origen es esencial para definir la perforante ideal para nuestro colgajo. Por tanto, después de estudiar el tipo de defecto a reconstruir, el punto clave será el encontrar una perforante con un flujo sanguíneo adecuado, una localización apropiada y una disección sencilla.An accurate preoperative evaluation of the vascular anatomy is extremely valuable in improving the surgical strategy in perforator flaps and performing safer and faster procedures. The placement of the best perforators and the assessment of their course to the source vessel is essential to define the ideal perforator for our chosen flap. Therefore, after assessing the quality and the dimensions of the soft tissue requirements, the key step in the surgical planning is to find a perforator with a good blood supply, a suitable location inside our flap and an easy dissection route.

  7. Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

    Science.gov (United States)

    Miyagi, Kana; Forouhi, Parto

    2016-01-01

    Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer. PMID:27651974

  8. Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

    Directory of Open Access Journals (Sweden)

    Joseph W. Duncumb

    2016-01-01

    Full Text Available Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™ used for administering primary chemotherapy in breast cancer.

  9. The use of a combined bipedicled axial perforator based fasciocutaneous flap for the treatment of a traumatic diabetic foot wound: a case report

    Directory of Open Access Journals (Sweden)

    Ioannis A. Ignatiadis

    2011-02-01

    Full Text Available The axial and perforator vascularised fasciocutaneous flaps are reliable and effective treatment methods for covering lower limb post-traumatic, septic, Charcot, and diabetic foot wounds. The authors describe the unique utilisation of a hybrid flap as an axial-perforator flap combination for the treatment of a traumatic diabetic foot wound.

  10. What Is Safe Limit of the Perforator Flap in Lower Extremity Reconstruction? Do We Have Answers Yet?

    Directory of Open Access Journals (Sweden)

    Nikhil S. Panse

    2011-01-01

    Full Text Available We make an attempt to define the safe extent of local perforator flap for lower limb reconstruction by comparing it with the limb length of the patient. The maximum flap length from the perforator was compared to the limb length in 35 patients using EPI info 6.04 D software. On comparison of flaps that were less than one-third of limb length to those which were more than one-third of limb length, the statistical values were significant. The odds ratio calculated was 6, which means that there is a six times more chance that a local perforator flap will necrose if it is more than one-third of the limb length as compared to a flap which is less than one-third of the limb length.

  11. Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

    OpenAIRE

    Joseph W. Duncumb; Kana Miyagi; Parto Forouhi; Malata, Charles M.

    2016-01-01

    Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdomi...

  12. A Renal Perforating Artery Mistaken for Arterial Bleeding after Percutaneous Renal Biopsy: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ye Lim; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min [Korea University College of Medicine, Seoul (Korea, Republic of)

    2009-12-15

    Perirenal hematoma after a renal biopsy is a common complication that usually resolves spontaneously, but this rarely requires transfusions or surgical/radiological intervention. We report here on a case of a renal perforating artery that was mistaken for renal arterial bleeding in a 53-year-old woman who was complicated with perirenal hematoma after undergoing a percutaneous renal biopsy. On the color and pulsed wave Doppler ultrasonography, linear blood flow was seen in the perirenal hematoma, which extended perpendicularly from the renal parenchyma into the perirenal space, and this linear blood flow exhibited an arterial pulse wave. On CT angiography, the renal perforating artery was demonstrated as a curvilinear vessel coursing tangentially to the renal margin and we decided that it was a pseudolesion caused by the renal perforating artery. A renal perforating artery may be mistaken for renal arterial bleeding after a percutaneous renal biopsy. A renal perforating artery and arterial bleeding can be differentiated by the location and shape seen on a color Doppler examination and the pulse waves characteristics

  13. Pedicled Supraclavicular Artery Island Flap Versus Free Radial Forearm Flap for Tongue Reconstruction Following Hemiglossectomy.

    Science.gov (United States)

    Zhang, Senlin; Chen, Wei; Cao, Gang; Dong, Zhen

    2015-09-01

    This study investigated the tongue function and donor-site morbidity of patients with malignant tumors who had undergone immediate flap reconstruction surgery. Twenty-seven patients who had undergone immediate reconstruction after hemiglossectomy were observed. Twelve patients were reconstructed using the pedicled supraclavicular artery island flap (PSAIF) and 15 patients using the free radial forearm flap (FRFF). Flap survival, speech and swallowing function, and donor-site morbidity at the 6-month follow-up were evaluated. All the flaps were successfully transferred. No obvious complications were found in either the transferred flaps or donor regions. Age, sex, defect extent, speech and swallowing function were comparable between the 2 groups. Donor-site complications were less frequent with PSAIF reconstruction than FRFF reconstruction. The PSAIF is reliable and well suited for hemiglossectomy defect. It has few significant complications, and allows preservation of oral function.

  14. Novel biomarkers of arterial and venous ischemia in microvascular flaps.

    Directory of Open Access Journals (Sweden)

    Gerard K Nguyen

    Full Text Available The field of reconstructive microsurgery is experiencing tremendous growth, as evidenced by recent advances in face and hand transplantation, lower limb salvage after trauma, and breast reconstruction. Common to all of these procedures is the creation of a nutrient vascular supply by microsurgical anastomosis between a single artery and vein. Complications related to occluded arterial inflow and obstructed venous outflow are not uncommon, and can result in irreversible tissue injury, necrosis, and flap loss. At times, these complications are challenging to clinically determine. Since early intervention with return to the operating room to re-establish arterial inflow or venous outflow is key to flap salvage, the accurate diagnosis of early stage complications is essential. To date, there are no biochemical markers or serum assays that can predict these complications. In this study, we utilized a rat model of flap ischemia in order to identify the transcriptional signatures of venous congestion and arterial ischemia. We found that the critical ischemia time for the superficial inferior epigastric fasciocutaneus flap was four hours and therefore performed detailed analyses at this time point. Histolgical analysis confirmed significant differences between arterial and venous ischemia. The transcriptome of ischemic, congested, and control flap tissues was deciphered by performing Affymetrix microarray analysis and verified by qRT-PCR. Principal component analysis revealed that arterial ischemia and venous congestion were characterized by distinct transcriptomes. Arterial ischemia and venous congestion was characterized by 408 and 1536>2-fold differentially expressed genes, respectively. qRT-PCR was used to identify five candidate genes Prol1, Muc1, Fcnb, Il1b, and Vcsa1 to serve as biomarkers for flap failure in both arterial ischemia and venous congestion. Our data suggests that Prol1 and Vcsa1 may be specific indicators of venous congestion and

  15. Repair of a Perforated Sinus Membrane with a Subepithelial Palatal Conjunctive Flap: Technique Report and Evaluation

    Directory of Open Access Journals (Sweden)

    S. A. Gehrke

    2012-01-01

    Full Text Available The maxillary sinus grafting procedure has proven to be an acceptable modality for bone augmentation to provide a base for endosseous implants, routinely used for the rehabilitation of posterior maxilla. Perforation of the membrane is the most common complication in this type of procedure. This paper presents a technique for repairing a perforated Schneiderian membrane with a conjunctive connective tissue graft harvested from the palate and shows the histological and radiographic evaluation of the results. Ten consecutives cases with the occurrence of membrane perforation were included in this study. All were repaired with a flap of tissue removed from the palatine portion near to the surgical site. The technique is demonstrated through a clinical case. The results showed successful integration of 88.8% of the implants after 12 months from prosthesis installation. Histological evaluation of the samples showed that the use of nanocrystalized hydroxyapatite showed an adequate stimulation of boné neoformation within 6 months. Radiographic evaluation revealed a small apical implant bone loss, not compromising their anchorages and proservation. Thus, it can be concluded that the use of conjunctive technique with collected palate flap for sealing the perforation of the membrane of the sinus may have predictable result.

  16. The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature

    Directory of Open Access Journals (Sweden)

    Fok Margaret

    2008-04-01

    Full Text Available Abstract Background Reverse flow sural neurocutaneous flap has been utilized more frequently during the past decade to cover vital structures around the foot and ankle area. The potential advantages are the relatively constant blood supply, ease of elevation and preservation of major vascular trunks in the leg. The potential disadvantages remain venous congestion, donor site morbidity and lack of sensation. Methods This descriptive case series was conducted at Queen Mary Hospital, Hong Kong, from 1997 to 2003. Ten patients having undergone reverse flow sural neurocutaneous flap were identified through medical records. There were six females (60% and four males (40%, with an average age of 59.8 years. The defects occurred as a result of trauma in five patients (50%, diabetic ulcers in four (40% and decubitus ulcer in one (10% paraplegic patient. The defect site included non weight bearing heel in four (40%, tendo Achilles in two (20%, distal tibia in two (20%, lateral malleolus in one (10% and medial aspect of the midfoot in one patient (10%. The maximum flap size harvested was 14 × 6 cm. Preoperative doppler evaluation was performed in all patients to identify perforators and modified plaster of paris boot was used in the post operative period. A detailed questionnaire was developed addressing variables of interest. Results There was no flap failure. Venous congestion was encountered in one case. The donor site was relatively unsightly but acceptable to all patients. The loss of sensation in the sural nerve distribution was transient in all patients. Conclusion Reverse sural artery flap remains to be the workhorse flap to resurface the soft tissue defects of the foot and ankle. Anastomosis of the sural nerve to the digital plantar nerve can potentially solve the issue of lack of sensation in the flap especially when used for weight bearing heel.

  17. 游离穿支皮瓣修复创伤性前足皮肤缺损疗效评价%Efficacy evaluation for traumatic forefoot tissue loss reconstruction with free perfora-tor flaps

    Institute of Scientific and Technical Information of China (English)

    朱跃良; 赵泽雨; 李福兵; 金涛; 陈太邦; 李阳; 张西正

    2016-01-01

    Objective To explore the treatment outcome of traumatic forefoot tissue loss reconstructions with free perforator flaps. Methods A total of 41 patients underwent traumatic forefoot tissue loss reconstructions with free perforator flaps. There were 5 types of free perforator flaps to be used in reconstructions:32 cases of free anterolateral thigh perforator flaps, 2 cases of free fibular flaps,5 cases of free lateral arm perforator flaps,1 case of free medial arm perforator flap and 1 case of free thoracodorsal artery perforator flap. Results Patients were followed up for (26. 7 ± 9. 3) months. There were 38 ca-ses postoperative healed well,3 cases to be re-explored,1 case healed and 2 cases failed. The overall functional and cosmet-ic outcomes were excellent. Conclusion Forefoot reconstruction with a free perforator flap provides satisfactory cosmesis, normal weight-bearing and gait good function.%目的:探讨游离穿支皮瓣修复创伤性前足皮肤缺损的治疗效果。方法选取41例创伤性前足缺损患者,采用游离穿支皮瓣进行修复。本组使用5种游离穿支皮瓣进行修复,游离股前外侧穿支皮瓣32例,游离腓动脉穿支皮瓣2例,游离臂外侧穿支皮瓣5例,游离臂内侧穿支皮瓣1例,游离胸背动脉穿支皮瓣1例。结果患者随访(26.7±9.3)个月,38例术后愈合顺利,3例术后探查,1例愈合,2例失败。修复后的前足功能和外形满意。结论游离穿支皮瓣修复前足,外形满意,负重恢复和步态良好。

  18. Endoscope-assisted repair of large nasal septal perforation using a complex mucoperichondrial flap and free tissue graft

    Institute of Scientific and Technical Information of China (English)

    张庆泉; 张杰; 李树峰

    2003-01-01

    Objective To improve the closure rate of large nasal septal perforations. Methods Using an endoscope, complex mucoperichondrial/mucoperiosteal flaps on one side and free tissue graft on the other, we designed a procedure to repair large nasal septal perforations.Results In our series, 8 patients were operated on with this procedure, resulting in complete closure of the perforation and subsequent relief of symptoms. Conclusion This technique may be used as an alter*$native for the repair of large nasal septal perforations.

  19. Relationship and flap design on the perforators of the posterior leg%小腿后部各区穿支间的关系与皮瓣设计

    Institute of Scientific and Technical Information of China (English)

    徐象党; 戴开宇; 周鹏; 杨新东; 唐茂林

    2009-01-01

    Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.%目的 研究小腿后部各区穿支间的关系,为穿支皮瓣的临床应用提供解剖学依据.方法 选择6具动脉灌注明胶-氧化铅混悬液的新鲜成人整尸标本,将小腿后部分为上、中、下三等份,层次解剖观测各区穿支的分布状况,拍摄X

  20. Angiotomografía computerizada, colgajos de perforante, cirujano y OsiriX Computed tomography angiography, perforator flaps, surgeon and OsiriX

    Directory of Open Access Journals (Sweden)

    M. Rodríguez-Vegas

    2013-03-01

    consecuencia, parece aconsejable que el cirujano plástico relacionado con los colgajos de perforante se involucre decididamente en el postprocesamiento de las imágenes de angiotomografía computerizada. El visor de imágenes DICOM gratuito OsiriX es una alternativa eficiente, comparable a aplicaciones más profesionales sólo disponibles en servicios de Radiología.With the advent of perforator-based skin transfer, computed tomography angiography has emerged as an invaluable tool in the preoperative planning of perforator flaps. But most likely, the exploitation of the technique is less than desirable. Through our experience with 144 patients, we evaluate the use of the free DICOM viewer OsiriX for Mac in the preoperative planning of perforator flaps with three objectives: 1 increase the present knowledge related with the preoperative planning of perforator flaps with computed tomography angiography, 2 evaluate the OsiriX application in the image post-processing of perforator flaps and 3 evaluate the performance of the procedure when performed by a surgeon (not specialized in Radiology. The experience has shown that the image post-processing performed by the surgeon with the OsiriX application usually allows an adequate evaluation of different structures and parameters of great preoperative interest in perforator flap surgery: 1 source artery, 2 diameter of artery and vein/s at the hypothetical site of microsurgical anastomoses, 3 course and branching pattern of the flap pedicle, 4 perforator course in the subcutaneous fat (theoretical flap axis, 5 measurement of the skin and fat where the perforator pierces the deep fascia (theoretical flap thickness , 6 measurement of the distance between the point of entrance of the perforator in the subcutaneous fat to the source artery (theoretical maximal pedicle length and 7 measurement of the perforator diameter where it pierces the deep fascia. Ultimately, in the authors' opinion, those plastic surgeons involved in perforator flap

  1. Displaying inguinal lymph nodes before transplantation in a deep inferior epigastric perforator flap breast reconstruction using an innovative projection method

    NARCIS (Netherlands)

    Hummelink, S.L.; Schultze Kool, L.J.; Ulrich, D.J.

    2016-01-01

    INTRODUCTION: Lymphedema of the arm is a common postoperative complication as a result of breast cancer surgery. One of the surgical treatments comprises modification of a deep inferior epigastric perforator (DIEP) flap breast reconstruction to facilitate additional lymph node transplantation from t

  2. Combined vascular reconstruction and free flap transfer in diabetic arterial disease.

    Science.gov (United States)

    Vermassen, F E; van Landuyt, K

    2000-01-01

    Gangrenous lesions of the foot or lower leg due to severe diabetic arterial disease resulting in extensive soft tissue defects with exposed bones or tendons often result, even after successful revascularisation, in staged or primary amputation. We present our experience with 45 such patients treated with combined arterial reconstruction and free tissue transfer for limb-salvage. All presented with peripheral vascular disease of diabetic origin, and extensive gangrenous lesions that could not be treated by simple wound closure or skin-grafting without major amputation. A total of 53 arterial reconstructions and 47 free-flap transfers were performed. In the majority of patients, the distal anastomosis was on a pedal or tibial vessel. These bypass grafts or a native revascularized artery served as the inflow tract for the free flap which was anastomosed using microsurgical techniques. Venous anastomoses were preferentially performed on the deep venous system. Donor muscles were Musculus rectus abdominis (n=37), Musculus latissimus dorsi (n=5), Musculus serratus anterior (n=3), and a perforator flap (n=2) tailored to the size of the defect and covered with a split thickness graft (STG). The operation was set up as a combined procedure in 39/45 patients, two teams working simultaneously, limiting the mean operative time to 6 h. Early reinterventions had to be performed in 14 patients resulting in five flap losses of which two could be treated with a new free flap transfer and three were amputated. Three other patients died in the postoperative period, leaving us with a total of 39/45 patients leaving the hospital with a full-length limb. Independent ambulation was achieved in 32 of these 39 patients. During late follow-up (mean 26 months) eight bypasses occluded resulting in two amputations and two new vascular reconstructions. Combined survival and limb-salvage rate was 84% after 1 year, 77% after 2 years and 65% after 3 years. The advantages of this combined technique

  3. Combined free toe and free deep inferior epigastric perforator flap for reconstruction of the thumb and thumb web space.

    Science.gov (United States)

    Li, X J; Tong, J; Wang, Y

    2000-08-01

    To repair a complexly injured hand with composite loss of the thumb and the thumb web space in one stage, the combined transfer of a free second toe and a free deep inferior epigastric perforator flap was designed. It was used to simultaneously reconstruct the thumb and thumb web space of the injured hand in five cases. All flaps survived and there were no complications at any donor site after the reconstructions. In follow-up averaging 35.6 months, the final functional and cosmetic outcomes of the reconstructed thumbs and thumb web spaces were satisfactory. Results demonstrated that the combined transfer of a free second toe and a free deep inferior epigastric perforator flap is a valid method for simultaneous reconstruction of the thumb and the thumb web space of the injured hand.

  4. Rare occurrence of simultaneous coronary artery perforation and intracoronary thrombus formation following angioplasty

    Institute of Scientific and Technical Information of China (English)

    Su-Yan Bian; Liu-Fa Duan

    2013-01-01

    Both coronary artery perforation and intracoronary thrombus formation are life-threatening complications of percutaneous coronary interventions, which rarely occur simultaneously during angioplasty. We herein report a case of stent-related, left circumflex artery perforation, and subsequently acute left main artery thrombosis after the leakage was embolized with 7 microcoils. Intracoronary thromboectomy and systemic anticoagulant therapy were carefully used with good results. This case also represents some of our uncertainties regarding the best management of the patient.

  5. Propeller TAP flap

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Bille, Camilla; Wamberg, Peter;

    2013-01-01

    The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection...... major complications needing additional surgery. One flap was lost due to a vascular problem. Breast reconstruction can be performed by a propeller TAP flap without cutting the descending branch of the thoracodorsal vessels. However, the authors would recommend that a small cuff of muscle is left around...

  6. Treatment of delayed jejunal perforation after irreducible femoral hernia repair with open abdomen management and delayed abdominal closure with skin flap approximation

    Directory of Open Access Journals (Sweden)

    Fahri Yetişir

    2015-01-01

    Conclusion: Delayed bowel perforation may develop after irreducible femoral hernia surgery. OA management with NPT and DAC with skin flap approximation are optimal treatment modalities for the hemodynamically instable patient.

  7. Complex lower face reconstruction using a combined technique of Estlander flap and subscapular artery system free flaps.

    Science.gov (United States)

    Hamahata, Atsumori; Saitou, Takashi; Beppu, Takeshi; Shirakura, Satoshi; Hatanaka, Akio; Yamaki, Takashi; Sakurai, Hiroyuki

    2013-12-01

    When advanced mandibular carcinoma is resected, the defect may include lip and oral commissure. Free flap insertion is commonly used to reconstruct the lip defect. Although improvements in the oral reconstructive method via free flap use have been reported, functional and aesthetic results of the oral sphincter remain limited. This case report describes two individuals presenting with massive lower face defects, including a lower lip defect and a mandibular bone defect. Reconstruction was accomplished using the Estlander flap and free subscapular system of flaps. In both cases, the free subscapular artery system flap was elevated from the mandibular bone defect and other mucosal defect. The lower lip and oral commissure defect was reconstructed via Estlander flap. Free flaps survived 100% and both cases healed without complication. Patients regained good oral sphincter function with no reports of drooling. Thus, in cases involving massive lower face resection, including that of the lower lip and mandibular bone, this method of reconstruction when combined with lip-switch flap and subscapular artery system flap can prove to be useful.

  8. Persistent trigeminal artery: in situ thrombosis and associated perforating vessel infarction.

    Science.gov (United States)

    Gaughen, John R; Starke, Robert M; Durst, Christopher R; Evans, Avery J; Jensen, Mary E

    2014-06-01

    We report a patient with progressive brainstem infarction despite medical therapy. The patient was transferred to our institution for potential angioplasty of basilar stenosis. Imaging review demonstrated persistent trigeminal artery in situ thrombosis and associated perforating vessel infarction. Persistent trigeminal arteries are commonly associated with an atretic basilar artery and interventional treatment can result in significant morbidity and mortality.

  9. Colgajo en hélice de perforante interósea posterior: Un nuevo procedimiento reconstructivo Propeller interoseous posterior perforator flap: A new reconstructive procedure

    Directory of Open Access Journals (Sweden)

    A. Fernández García

    2009-03-01

    reconstruction. This flap is based on the integrity of the dorsal carpal anastomosis between the anterior interosseous artery and the posterior interosseous artery. Hence, when the dorsal carpal anastomosis is not available, it is not possible to perform a distally-based posterior interosseous flap. We report a propeller perforator flap proximallybased, available without the dorsal carpal supply, and useful for the coverage of the distal third of the forearm, wrist and hand. We report the surgical technique, its applications, advantages and disadvantages and review the use o this flap in different clinical cases. A patient suffered a severe crush injury of their left upper limb. He presented osteosynthesis plate exposure in the radius and thrombosis of the revascularization anastomosis. The absence of reverse flow in the posterior interosseous artery was proven with Doppler Ultrasounds. A propeller interosseous posterior perforator flap was performed to cover a new by-pass and the osteosynthesis plate. Another patient suffered an automobile accident. He presented closed fractures of radius and ulna of their left upper limb. The radial column of carpus suffered a severe crush injury. After the osteosynthesis, a propeller interosseous posterior perforator flap was performed. The flap provided appropriate coverage of the dorso-radial aspect of the wrist and hand. In our clinical cases the propeller interosseous posterior perforator flap provided excellent coverage of the carpus and hand with low donor site morbidity. Propeller interosseous posterior perforator flap provide a versatile and reliable coverage option in upper limb reconstruction, available in absence of the dorsal carpal anastomosis and without sacrifice of the interosseous posterior artery.

  10. Anatomic basis of posterolateral midforearm perforator flap%前臂后外侧中段穿支皮瓣的解剖学基础

    Institute of Scientific and Technical Information of China (English)

    郑和平; 林涧; 张志宏; 陈超勇; 张发惠

    2011-01-01

    Objective To observe the anatomy of the perforator flap of the posterolateral midforearm. Methods Lateral condyle of the humems wag taken as the observation mark on 30 specimens of adult upper limb perfused with red latex.The surgical magnifier Wag used to obse~e the origin,branches and distribution of the perforating branches of the posterolateral midforearm as well as alanagtomosis between perforating branches and peripheral vessels.Mimic operation WaS performed on the two sides of the fresh specimen.Results The perforating branches of the posterolateral midforearm originated from the radial musculoculancous branches of the posterior interosseous artery,the intermuscular branches of the radial artery and the direct periosteal branch of the radial artery had relatively stable location of piercing the deep fascia.Then,the perforating branches of the posterolateral midforearm pagsed through the deep fascia to the subcutaneous part among the spatium intermusculare of extensor digitorum and extensor carpi radialis brevis,supinator and abductor pollicis longus(within 12.5-15.8 cm below the lateral condyle of the humerus).Large number of small blood Vessels were also separated and closely aligned with the musculoculancous branches vascular,perineural and neural stem vascular chain of lateral branches of posterior antebrachial cutaneous nerve.Then,the vascular plexus was formed along the spatium intermusculare and lateral branches of posterior antebrachial cutaneous nerve longitudinal axis between extensor digitorum and extensor carpi radialis brevis. Conclusion The axial pattern flaps or cross-regional blood supply skin flap pedicled with the perforating branches of the posterolateral midforearm Can be formed to repair the soft tissue defect of tlle forearm and wrist.%目的 观察前臂后外侧中段穿支皮瓣的解剖学.方法 在30侧动脉内灌注红色乳胶的成人上肢标本上,以肱骨外上髁为观测标志点,手术放大镜下重点解剖观测:(1)

  11. Angiosome of the fibular artery as anatomic basis for free composite fibular flap

    OpenAIRE

    Manojlović Radovan; Milisavljević Milan; Tabaković Dejan; Ćetković Mila; Bumbaširević Marko

    2007-01-01

    Introduction. The free osteoseptocutaneus fibular flap is, anatomically, an angiosome of the fibular artery. Knowledge of detailed topography anatomy of the fibular artery and its branches is necessary for successful creation and elevation of the flap. Objective. The aim of the study was to determine topography of the tissue of the leg supplied only by the fibular artery, to describe topography relations of the branches of the fibular artery, their number, anastomoses, vascular plexus and the...

  12. Versatility of the facial artery myomucosal island flap in neopharyngeal reconstruction

    DEFF Research Database (Denmark)

    Frisch, Thomas

    2017-01-01

    BACKGROUND: The facial artery myomucosal (FAMM) island flap is a cheek flap, pedicled on the facial artery and suitable for small to medium-sized reconstructions of the oral cavity and neighboring areas. A novel transposition of the flap to the hypopharynx after laryngectomy is presented...... donor-site morbidity, and recipient tissue similarity count among the advantages. © 2016 Wiley Periodicals, Inc. Head Neck 39: E29-E33, 2017....

  13. New Possible Surgical Approaches for the Submammary Adipofascial Flap Based on Its Arterial Supply

    Directory of Open Access Journals (Sweden)

    Ehab M. Elzawawy

    2016-01-01

    Full Text Available Introduction. Submammary adipofascial flap (SMAF is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length. Materials and Methods. The flap was designed and dissected on both sides in 10 female cadavers. SMAF outline was 10 cm in length and 7 cm in width. The flap was raised carefully from below upwards to identify the perforator vessels supplying it from all directions. These vessels were counted and the following measurements were taken using Vernier caliper: diameter, total length, length inside the flap, and distance below the submammary skin crease. Conclusions. The perforators at the lateral part of the flap took origin from the lateral thoracic, thoracodorsal, and intercostal vessels. They were significantly larger, longer, and of multiple origins than those on the medial part of the flap and this suggests that laterally based flaps will have better blood supply, better viability, and more promising prognosis. Both approaches, medially based and laterally based SMAF, carry a better prognosis and lesser chance for future fat necrosis than the classical cranially based flap.

  14. Bases anatómicas vasculares de los colgajos perforantes cutáneos Vascular anatomical basis of perforator skin flaps

    Directory of Open Access Journals (Sweden)

    S. Morris

    2006-12-01

    ía vascular clínicamente relacionada de los colgajos perforantes.Over the past 2 decades the use of musculocutaneous perforator flaps has increased worldwide as microsurgeons have become more comfortable with the technique. Perforator flaps have now become well established as a part of the evolution of microsurgery. Since perforator flaps are based on individual musculocutaneous or septocutaneous perforators, it is imperative that the reconstructive microsurgeon has the detailed anatomical information necessary to plan perforator flap transfers. The goal of this paper is to review the various angiographic techniques which are available to study the vascular anatomy of the human body and to present our current vascular injection technique. We will show illustrative examples using the lead oxide gelatin injection technique to elucidate the relevant anatomy of perforator flap donor sites. The lead oxide gelatin injection technique has been previously reported by Salmon and Rees and Taylor. The injection technique may be used for arterial or venous injections but we have primarily used it for arterial injections. The injection steps are detailed in the paper. Over the past five years we have dissected a total of 21 human fresh cadavers after lead oxide gelatin arterial injection studies. A total of over 7000 radiographs have been reviewed and summarized. We present summarized results of the anatomical research in the areas of head and neck, upper limb, torso and lower limb regions. The lead oxide gelatin injection technique is simple and inexpensive and the computer analysis technique is straight forward and provides excellent visualization of the architecture of the human skin. The fine details identified using this injection technique provides useful information to surgeons planning transfers of skin, muscle, bone and nerve and therefore our understandingly of clinically related vascular anatomy of perforator flaps can be improved.

  15. 三种游离穿支皮瓣修复足背及前足组织缺损%Repair of forefoot or acrotarsium tissue defect with three different free perforator flaps

    Institute of Scientific and Technical Information of China (English)

    胡稷杰; 金丹; 王钢; 余斌; 任高宏; 黎健伟

    2015-01-01

    目的探讨游离膝降动脉穿支皮瓣、隐动脉穿支皮瓣及股前外穿支皮瓣修复足背及前足软组织、复合组织缺损的疗效。方法纳入2010年8月至2014年10月35例足背及前足组织缺损患者,创面面积为9cm×4.5cm~26cm×13cm。采用游离膝降动脉穿支皮瓣修复12例(A组),游离隐动脉穿支皮瓣修复8例(B组),游离股前外穿支皮瓣修复15例(C组)。若为开放性损伤,则在皮瓣移植术前应用负压封闭引流装置覆盖5~7 d。结果术后34例皮瓣全部成活,仅1例(女童,7岁)股前外穿支皮瓣远端1/3坏死,2周后经削痂植皮后创面愈合。术后随访3~38个月,平均12.3个月。皮瓣修复后外形大多令人满意,术后3个月A组有3例、B组有2例进行二次修薄手术。A组有1例出现小腿持续肿胀,1例出现供区切口愈合不良;B组有5例出现供区肢体持续肿胀,3例出现供区切口愈合不良,4例供区远端出现皮疹。结论游离膝降动脉穿支皮瓣及游离隐动脉穿支皮瓣修复后大多需行二次修薄手术。游离股前外穿支皮瓣质地好,切取面积大,可避免二次修薄手术,受区影响较小,但仅可用于单纯足背或前足软组织覆盖。游离膝降动脉穿支皮瓣可制备皮‐骨或皮‐肌(肌腱)复合瓣用于修复足部复合组织缺损。%Objective To evaluate clinical efficacy of the treatment for forefoot or acrotarsium tissue defect with three different free perforator flaps .Methods Thirty‐five cases of forefoot or acrotarsium tissue defect were involved in this study from August 2010 to October 2014 ,and the wound sizes varied from 9 cm × 4 .5 cm to 26 cm × 13 cm .Twelve cases were repaired by free descending genicular artery perforator flaps (group A) ,8 cases were repaired by free saphenous artery perforator flaps (group B) ,15 cases were repaired by free anterolateral thigh perforator flaps (group C) .All

  16. Pathological internal mammary lymph nodes in secondary and tertiary deep inferior epigastric perforator flap breast reconstructions.

    Science.gov (United States)

    Hofer, Stefan O P; Rakhorst, Hinne A; Mureau, Marc A M; Moolenburgh, Sanne E; van Huizum, Martine A; van Geel, Albert N

    2005-12-01

    Use of internal mammary vessels during breast reconstruction provides information on part of the internal mammary chain lymph nodes (LNs). It was evaluated whether our current practice of screening should be changed to identify those delayed breast reconstruction patients with tumor-positive internal mammary nodes (IMNs) and whether breast reconstruction should be continued, in case suspicious IMNs were found intraoperatively. From February 2002 to December 2004, 81 patients had received 98 deep inferior epigastric perforator flaps for delayed breast reconstruction. Prospectively collected data for suspicious internal mammary LNs were evaluated. In 13 patients (16%) who had received a delayed breast reconstruction, macroscopically suspicious LNs were detected in the course of the internal mammary chain. Three patients (4%) had a pathologic diagnosis of malignancy, which was found to match their primary tumor. No relationship between positive internal mammary chain LNs and location of the primary tumor, TNM-stage, or previously administered adjuvant therapy was found. Suspicious internal mammary chain LNs found during recipient vessel dissection for breast reconstruction can have important consequences for treatment of malignant disease in individual patients. Presented data do not support changing the current perioperative approach of delayed breast reconstruction.

  17. Distally based sural perforator propeller flap for foot and ankle reconstruction: technical pedicle evolufion%小腿远端蒂穿支皮瓣修复足踝创面的蒂部改进

    Institute of Scientific and Technical Information of China (English)

    张世民; 王欣; 陶友伦; 张英琪; 黄轶刚

    2012-01-01

    patients,with 180 degrees rotation to cover foot and ankle defects.Postoperatively,flap swelling,survival and functional recovery were evaluated. Results There were 7 posterior tibial artery perforator flaps from the posteromedial and 5 peroneal artery perforator flaps from the posterolateral sural region. The proximal fasciocutaneous flap measured 4 cm × 8 cm-6 cm × 18 cm, and the distal cutaneous flaps measured 2 cm × 2cm-4 cm × 4 cm.Flap swelling was noted under grade 2 in 9 cases,grade 3 in 2 cases,and grade 4 in 1case with some distal superficial skin necrosis,which occurred in the largest flap in our series.All flaps survived eventfully.After average 13 months follow up,the wound were cured successfully,and all patients recovered walking and shoe wearing function. Conclusion Pedicle evolution by keeping some adipofascial tissue around the pivot perforator, can preserve more venous return routes and relieve flap swelling. This technique should be recommended in perforator pedicled propeller flaps,as it enhances flap safety,and without increasing the difficulty of 180 degrees rotation.

  18. Free Medial Plantar Flap Connection with a Posterior Tibial Artery Flap in Reconstruction of Fore–Mid Foot Skin Defect

    Science.gov (United States)

    Wu, Hao; Sheng, Jia-Gen

    2016-01-01

    Background: Although there are many surgical treatments for covering the skin defect of the fore–mid foot, how to reconstruct the weight-bearing region remains a challenge. The weight-bearing region of the sole needs to withstand the pressure and shearing stresses of walking, so the plantar skin is anatomically different from other skins in the areas of texture, thickness, subcutaneous tissue, etc. Medial plantar flaps that are harvested from the instep region are regarded as the first choice for weight-bearing region reconstruction because of their excellent functional and aesthetic long-term result. However, when facing an extensive skin defect on a weight-bearing area such as a fore–mid foot avulsion, the application of this flap is limited because if we put the flap in a weight-bearing area of the forefoot, the set of vessels will be exposed to outside. Methods: We suggest 2 connected free flaps (posterior tibial artery flap and medial plantar flap) pedicled with 1 set of vessels. The medial plantar flap was used to cover the skin defect of the weight-bearing area in the forefoot. The dorsal skin defect of the injured foot was covered with a posterior tibial artery flap and supplied the medial plantar flap with the posterior tibial vessel. The midfoot skin defect was repaired by a full-skin grafting. Results: Long-term follow-up results showed that the shape and function of the injured limbs recovered almost entirely. Conclusion: This method of connected flaps is suitable for repairing large skin defects of the fore–mid foot. PMID:27975013

  19. A Novel Technique of Preserving Internal Mammary Artery Perforators in Nipple Sparing Breast Reconstruction

    Science.gov (United States)

    Swistel, Alexander; Small, Kevin; Dent, Briar; Cohen, Oriana; Devgan, Lara

    2014-01-01

    Summary: As nipple-sparing mastectomy with implant-based reconstruction has increased, attention must be paid to the viability of the nipple-areolar complex. This article describes the use of preoperative Doppler ultrasound to identify the internal mammary artery perforators. Preserving the internal mammary artery improves vascular supply to the nipple-areolar complex. PMID:25426381

  20. A Novel Technique of Preserving Internal Mammary Artery Perforators in Nipple Sparing Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Alexander Swistel, MD

    2014-08-01

    Full Text Available Summary: As nipple-sparing mastectomy with implant-based reconstruction has increased, attention must be paid to the viability of the nipple-areolar complex. This article describes the use of preoperative Doppler ultrasound to identify the internal mammary artery perforators. Preserving the internal mammary artery improves vascular supply to the nipple-areolar complex.

  1. 预扩张的脐旁穿支皮瓣修复肘关节瘢痕挛缩畸形%Reconstruction of elbow scar contracture using pre-expanded perforator-based paraumbilical flaps

    Institute of Scientific and Technical Information of China (English)

    李广学; 穆籣; 刘岩; 臧梦青; 刘元波

    2016-01-01

    .Therefore,a distant flap sometimes is needed to reconstruct the extensive defect of the elbow.The anterior truck provide abundant well-pefused flap, such as superficial inferior epigastric artery (SIEA ) flap, intercostal artery flap and perforator-based paraumbilical flaps.However,the usage of these flaps was limited because of insufficient soft tissue when dealing with large defect,thick abdominal portion and limited pedicle length. The pre-expanded perforator-based paraumbilical flaps overcome these limitations and provide thin,reliable coverage with the best functional and aesthetic results.We present our experience in reconstructing elbow scar contracture using pre-expanded perforator-based paraumbilical flaps.Methods The elbow scar contracture was corrected in 1 8 cases with pre-expanded perforator-based paraumbilical flaps,with 8 cases in the left side and 10 cases in the right side including 11 male cases and 7 female cases.Aged 4 years to 46 years with an average age of 18.8 years.Burn inj ury causes:1 3 cases were inj uried with hot liquid and 5 case were flame burns,the median time was 18 months from 6 months to 6 years after burn.Elbow joint movement was obviously limited preoperatively,and there were no abundant skin surrounding the elbow to repair the defect after the scar contracture release.Operative method:During the first-stage procedure,the expander was implanted into the ispilateral normal abdominal subcutaneous tissues.First of all,the elbow scar and contracture deformity was marked,and the extent of the defect after scar contracture release was estimated according to the contralateral elbow joint and the extent of the ispilateral side. The flap for reconstruction was slightly larger than the defect.Then two large perforators were detected in the ipsilateral paraumbilical area with hand-held ultrasound Doppler,the axis of the flap was oriented along the axis between the umbilicus and the ipsilateral inferior angle of scapula.The incision was made at the superior

  2. Use of lateral circumflex femoral artery system free flaps in skull base reconstruction.

    Science.gov (United States)

    Camporro, Daniel; Fueyo, Angel; Martín, Clara; Carnero, Susana; Llorente, José L

    2011-05-01

    We present a 10-year retrospective study at a tertiary center designed to evaluate the advantages, complications, and comparative results using lateral circumflex femoral artery (LCFA) system free flaps for cranial base reconstruction. In this study, a cranial base defect refers to exposed intracranial contents to the skin, paranasal sinuses, nasopharynx, oropharynx, or oral cavity. These defects resulted from resections of primary or recurrent neoplasms or from secondary problems after cranial base surgery. We performed 20 flaps in 20 patients. The selection of flap was as follows: 8 combinations of anterolateral/anteromedial thigh flaps with vastus lateralis muscle or tensor fascia lata flaps, 6 ALT fasciocutaneous flaps, and 6 muscle/myocutaneous flaps. The flap's success rate was 95% (19/20). Early major complications included 1 perioperative death, and there was 1 myocardial infarction. Minor complications included 1 partial (12%) flap loss, 2 temporal cerebrospinal fluid leak, 2 donor-site hematoma, 2 minor wound breakdown, 3 facial nerve weakness, and 4 donor-site numbness. Among 20 patients undergoing LCFA system flap reconstruction, 12 are alive and disease free. Local recurrence occurred in 1 patient. She underwent ablative surgery and a new successful free flap (forearm flap); after 2 years, the patient is disease free. The LCFA system flaps in skull base reconstruction provide versatility in flap design and availability of adequate tissues to fill dead space, and it offers vascularized fascia to augment dural repairs. It also provides a very long pedicle and allows simultaneous flap harvest with low donor-site morbidity.

  3. Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

    OpenAIRE

    Dae-Sung Lee; Sun-Il Jung; Deok-Woo Kim; Eun-Sang Dhong

    2013-01-01

    We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topi...

  4. Application of perforator flaps to repair chronic osteomyelitis with soft tissue defect in the distal lower extremity%应用穿支皮瓣治疗下肢远端慢性骨髓炎并皮肤缺损

    Institute of Scientific and Technical Information of China (English)

    潘朝晖; 王剑利; 蒋萍萍; 薛山; 刘学胜

    2010-01-01

    Objective To evaluate free or pedicled perforator flaps for repairing chronic osteemylitis with soft-tissue defect in the distal lower extremity. Methods From May of 2006 to October of 2007, 28 consecutive patients of chronic osteomylitis with soft-tissue defect in the distal lower extremity underwent surgical debridement and reconstruction with free or pedicled perforator flaps. There were 13 free flaps. The free anterolateral thigh flaps were used in 2 cases to repair the soft defects in the front of leg, 3 cases in the front of the malleolus, 2 cases in the dorsum of foot, 2 cases in the heel. The free lateral crural flaps nourished by perone al artery were used in 4 cases to repair the soft defects in the dorsum of foot. There were 15 pedicled flaps. Posterior tibial artery perforator flaps were used in 4 cases to repair the soft defects in the front of leg, and 2 cases in the medial malleolus. Lateral retromalleolar perforator flaps nourished by peroneal artery were used in 6 cases to repair the soft-defects in the heel, 1 case in the lateral malleolus and 1 case in the dorsum of foot, the first dorsal metatarsal artery perforator flap was used to repair the proximal dorsum of hallux. The wound was closed with irrigation-suction in 7 cases and with vancomycin-impregnated gelatin in 8 cases. Results All 27 flaps were successfully survived except insuffcient vein refluence in 1 posterior tibial artery perforator flap, which resulted in a superficial necrosis and healed spontaneously. The follow-up period from 6 months to 2 years revealed that recurrence developed in two diffuse type patients and both were treated once and twice with success, respectively. The others healed without any signs of recurrences. No debulking procedure was necessary in any case. Secondary bone graft was performed in 3 cases. All patients were ambulatory and fully weight-bearing with normal clinical parameters at the time of last review. According to the evaluating criteria for the

  5. 小腿穿支皮瓣修复踝周皮肤软组织缺损%Using lower leg perforator flaps to repair soft tissue defect on ankle

    Institute of Scientific and Technical Information of China (English)

    丰波; 张志; 呼和; 庞有明; 张澜; 王永军; 牛克成

    2014-01-01

    flaps of lower legs,with 10 cases of posterior tibial artery perforator flaps on the medial malleolus,12 cases of front top flaps of com peroneal artery on external ankle,40 cases of back top flaps of peroneal artery on external ankle.The sizes of the flap ranged from 4.0 cm ×5.5 cm to 9.0 cm × 15.0 cm.Ten cases were applied direct suturing in donor site,and other cases were applied skin grafts to repair the defect.Results Flaps in 56 cases completely survived.Partial necrosis appeared in 3 cases of front top flaps of peroneal artery on external ankle,one perforator flap of posterior tibial artery on the medial malleolus and 2 cases of back top flaps of peroneal artery on external ankle.All these cases recovered after careful dressing changes.Sixty two cases were followed up for 3-12 months.Texture of flaps was soft with good elasticity.All of the donor skin grafts in patients survived.Conclusion Perforator flaps have the advantage of easy operation,little damage to the main blood vessels,high reliability in flap survival,less destroy to donor site.It is important that individualized flap is selected given different position of defect.

  6. Perforator-based chimeric anterolateral thigh flap for head and neck reconstruction after en bloc resection%股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损

    Institute of Scientific and Technical Information of China (English)

    徐中飞; 代炜; 张恩礁; 段维轶; 刘法昱; 谭学新; 黄绍辉; 秦兴军; 孙长伏

    2012-01-01

    PURPOSE; To discuss and report the operative techniques for harvesting perforator-based chimeric flap in anterolateral thigh region and the advantages for head and neck reconstruction after en bloc resection. METHODS: A retrospective review was performed of perforator -based chimeric anterolateral thigh (ALT)flap for head and neck reconstruction since December of 2007 to March of 2011. 66 perforator-based chimeric flaps were harvested including a skin paddle and a muscular flap supplied by one mother pedicle-descending branch of lateral circumflex femoral artery(d- LCFA). 32 flaps were used for the mobile tongue and floor of mouth reconstruction, 30 flaps for base of the tongue and parapharyngeal walls, two for the buccal skin, one for hemimandible and one for parotid. The muscular flap were used to eliminate the dead space of submandibular area. Flaps size ranged from 7cmx4cm to 16cmx7cm and muscular flap was 3cm x4cm approximately. The complications and functions of both donor and recipient sites were recorded and the operative techniques of perforator-based chimeric flap elevation were generalized. RESULTS: All 65 flaps survived completely and the total survival percentage was 98.5%. Only one flap failed and was removed 5 days postoperatively. No complications (fistula, infection, hematoma, seroma et al) were observed in recipient and donor sites. Two anteromedial thigh flaps (AMT) were used for reconstruction due to no sizable perforators in the ALT region. All cases were followed up for 0.5-3 years. The flaps didn't atrophy after six months and the contour was satisfactory. The functions of speech and swallow were recovered well. All the donor sites were closed primarily and the scar was not obvious. The leg's function recovered well. CONCLUSIONS: Using a combination of retrograde and antegrade dissection is a safe and versatile method for harvesting a perforator-based chimeric flap. A chimeric flap including multiple components can meet therequirements of

  7. Reconstruction of an extended defect in the axilla using a thoracodorsal fasciocutaneous perforator flap

    NARCIS (Netherlands)

    Visconti, Giuseppe; Eltahir, Yassir; Van Ginkel, Robert J; Werker, Paul M N

    2008-01-01

    BACKGROUND: Ectopic primary carcinoma of breast tissue is a rare entity, and its diagnosis often is delayed. The axilla is the most common site involved. The Limberg flap as a random flap is easy and practicable for coverage of many defects including those involving the axilla. In the reported case,

  8. Colgajo bilateral de perforantes lumbares para la reconstrucción de un severo defecto tóracolumbar Bilateral lumbar perforator flap in reconstruction of a wide toracolumbar defect

    Directory of Open Access Journals (Sweden)

    P. Benito Duque

    2006-06-01

    Full Text Available En la reconstrucción de los defectos toracolumbares se han empleado numerosas técnicas quirúrgicas. Ocasionalmente se puede utilizar el cierre directo, injertos de piel, colgajos de dorsal ancho volteado y lumbosacro transverso, colgajos de transposición o de rotación tipo random, pero están limitados cuando los tejidos circundantes están radiados o presentan cicatrices por cirugías previas. Igualmente, la extensión del defecto puede hacerlos inviables. Los colgajos de perforantes están especialmente indicados en pacientes con deambulación conservada, haciendo posible el aporte de una gran superficie de piel y tejido subcutáneo bien vascularizado, basado en los vasos perforantes y evitando así el sacrificio de vasos principales o músculos. Presentamos el caso de una paciente con un defecto en la espalda de 17 cm. De diámetro secundario a la resección de un tumor espinocelular con exposición de cuerpos vertebrales, tratado mediante la transposición de dos colgajos basados en las arterias perforantes lumbares asociados a un colgajo de rotación de dorsal ancho miocutáneo.Thoracolumbar defects have been treated by a variety of surgical methods. Primary closure, skin grafting, reverse latissimus dorsi musculocutaneous flap, transverse lumbosacral back flap, local randomly designed rotation, or transposition flaps may be indicated in occasional cases, but there is limited indication for their use in some cases with a wide lesion or when the surrounding tissues have been compromised by previous surgery or irradiation. Perforator flaps are specially indicated for ambulatory patients, in which large amounts of well-vascularized skin and subcutaneous tissue are transfered easily based on one perforator vessel without sacrificing main vessels or muscles. The authors present a patient with a 17 cm wide defect in the midback region and exposed bone after excision of a squamous cell carcinoma, treated by two perforator flaps based on

  9. An anatomic and clinical study of the adductor magnus tendon-descending genicular artery bone flap.

    Science.gov (United States)

    Huang, Dong; Wang, Hai-Wen; Xu, Da-Chuan; Wang, Hong-Gang; Wu, Wei-Zhi; Zhang, Hui-Ru

    2011-01-01

    The composite tissue flap of the descending genicular vessels with the adductor magnus tendon is a newly developed, reliable method to repair the Achilles tendon and relevant skin defects. The aim of this study was to evaluate the anatomy of the adductor magnus tendon-descending genicular artery bone flap, and the feasibility and value for the repair of the Achilles tendon and relevant skin defects. There were 34 adult specimens used for the anatomy of this flap. The descending genicular artery originates 10.5 ± 1.6 cm above the adductor tubercle, with a diameter of 1.8 ± 0.6 mm and a length of 1.2 ± 0.5 cm. Its articular branch is distributed in the adductor magnus tendon and the medial condyle of the femur. The saphenous branch has a diameter of 1.1 ± 0.3 mm and is distributed in the skin of the upper medial calf. A total of 16 cases of trauma-induced Achilles tendon damage and calcaneus and skin defects were repaired with the vascularized adductor magnus tendon bone flap, including the reconstruction of Achilles tendon insertion and repair of relevant skin defects. All of the composite tissue flaps were viable, the skin sensation of the flaps was recovered, and all patients walked with a normal gait. Our results suggested that the adductor magnus tendon-descending genicular artery bone flap is an alternative method to repair composite tissue defects of the Achilles tendon.

  10. Application of Orthodromic Island Flap Prosthetics of Homo-Digital Artery in Finger-Tip Defect

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    Daming Lu

    2014-03-01

    Full Text Available Objective: To investigate the clinical efficacy of orthodromic island flap prosthetics of homodigital artery on finger-tip defect. Methods: A total of 21 patients with finger-tip defect from December, 2010 to April, 2013 were given orthodromic island flap prosthetics of homo-digital artery, with the maximum and minimum sizes of flaps being 20 mm×22 mm and 10 mm×15 mm, respectively. Results: All patients with finger-tip defect survived from the flap surgery and the wounds were favorably healed. 3 - 12 months follow-up after operation, the flaps were observed with approving appearance, soft texture and favorable elasticity, with two-point discrimination being 6 - 8 mm. According to TAM detection of hand functions, flaps were excellent healed in 19 cases, good and fairish in 1 case respectively, with effective rate being 95.2%. Conclusion: Orthodromic island flap prosthetics of homo-digital artery is simple and safe in operation with satisfactory effcacy, being the most ideal method for the repair of finger-tip defect.

  11. Reconstrucción mamaria con colgajos microquirúrgicos de perforantes Breast reconstruction with microsurgical perforator flaps

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    J. A. Lozano

    2005-01-01

    Full Text Available La reconstrucción mamaria autógena se realiza frecuentemente con tejido abdominal, ya que se obtiene el mejor resultado estético perdurable en el tiempo, con una nueva mama muy similar en textura, consistencia y ptosis a la contralateral. La secuela a nivel de la zona donante abdominal es el principal problema que plantea este tipo de reconstrucciones. Los colgajos de perforantes se desarrollan como el gran recurso para solventar dicho problema, ya que apenas dañan el músculo y su fascia. El colgajo DIEP (Deep Inferior Epigastric Perforator ha demostrado ser una alternativa reconstructiva destinada a gran cantidad de mujeres, con bajas tasas de complicaciones locales, debido a la falta de sacrificio del músculo recto abdominal, e importante grado de satisfacción por el resultado obtenido. Como inconveniente presenta su mayor dificultad técnica y la necesidad de un equipo quirúrgico que domine la microcirugía vascular. No obstante, el colgajo DIEP se presenta como una técnica quirúrgica con una demanda en importante ascenso.Autogenous breast reconstruction is frequently carried out with abdominal tissue, since a better and lasting aesthetic result is obtained, providing a new breast that is very similar in texture, consistency and ptosis to the contralateral breast. The main problem presented by this type of reconstruction is the sequel at the level of the donor abdominal area. Perforator flaps are being developed as the main resource for solving this problem, as they hardly damage the muscle and its fascia. The DIEP flap (deep inferior epigastric perforator has proved itself to be an alternative for reconstruction for many women, with low rates of local complications, due to the absence of any sacrifice of the abdominis rectus muscle, and a significant level of satisfaction with the result obtained. One drawback is its greater technical difficulty and the need for a surgical team that is expert in vascular microsurgery. However, the

  12. Repair of a Perforated Sinus Membrane with a Subepithelial Palatal Conjunctive Flap: Technique Report and Evaluation

    OpenAIRE

    Gehrke, S. A.; S. Taschieri; Del Fabbro, M.; Corbella, S.

    2012-01-01

    The maxillary sinus grafting procedure has proven to be an acceptable modality for bone augmentation to provide a base for endosseous implants, routinely used for the rehabilitation of posterior maxilla. Perforation of the membrane is the most common complication in this type of procedure. This paper presents a technique for repairing a perforated Schneiderian membrane with a conjunctive connective tissue graft harvested from the palate and shows the histological and radiographic evaluation o...

  13. Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot.

    Science.gov (United States)

    Sato, Tomoya; Ichioka, Shigeru

    2016-01-01

    Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot.

  14. Submental Artery Island Flap in Reconstruction of Harde Plate after wide Surgical Resection of Veruccous Carcinoma. Two case reports

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    Amin Rahpeyma

    2013-06-01

    Full Text Available Introduction: Reconstruction of intraoral soft tissue defects is important in restoring function and esthetic. In large defects, there will be demand for regional pedicle flaps or free flaps. Hard palate separates nasal and oral cavities. Due to the small surface area between flap and remaining palate after surgical resections, optimal blood supply of the flaps for hard palate reconstructions are needed. This article demonstrates immediate reconstruction of two edentulous hemimaxillectomy patients with submental artery Island flap and brief review of this flap discussed. 

  15. Using propensity score analysis to compare major complications between DIEP and free muscle-sparing TRAM flap breast reconstructions

    NARCIS (Netherlands)

    Zhong, Toni; Novak, Christine B.; Bagher, Shaghayegh; Maass, Saskia W. M. C.; Zhang, Jing; Arad, Udi; O'Neill, Anne C.; Metcalfe, Kelly A.; Hofer, Stefan O. P.

    2014-01-01

    BACKGROUND: Previous studies comparing muscle-sparing transverse rectus abdominis myocutaneous (TRAM) versus deep inferior epigastric artery perforator (DIEP) free flaps have not considered procedure selection bias. Propensity score analysis provides a statistical approach to consider preoperative f

  16. Reverse peroneal artery flap for large defects of ankle and foot: A reliable reconstructive technique

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    Jose Tharayil

    2012-01-01

    Full Text Available Background: Large soft tissue defects around the lower third of the leg, ankle and foot always have been challenging to reconstruct. Reverse sural flaps have been used for this problem with variable success. Free tissue transfer has revolutionised management of these problem wounds in selected cases. Materials and Methods: Twenty-two patients with large defects around the lower third of the leg, ankle and foot underwent reconstruction with reverse peroneal artery flap (RPAF over a period of 7 years. The mean age of these patients was 41.2 years. Results: Of the 22 flaps, 21 showed complete survival without even marginal necrosis. One flap failed, where atherosclerotic occlusion of peroneal artery was evident on the table. Few patients had minor donor site problems that settled with conservative management. Conclusions: RPAF is a very reliable flap for the coverage of large soft tissue defects of the heel, sole and dorsum of foot. This flap adds versatility in planning and execution of this extended reverse sural flap.

  17. The reverse digital artery island flap: clinical experience in 120 fingers.

    Science.gov (United States)

    Han, S K; Lee, B I; Kim, W K

    1998-04-01

    Fingertip injuries represent the most common type of injuries seen in the upper extremity. Their management is functionally and aesthetically important but at the same time very controversial. The aim of this study is to report usefulness and postoperative results of reverse digital artery island flaps for fingertip reconstruction. From July of 1984 to December of 1995, 120 fingers in 110 patients with defects of the distal phalanx were reconstructed by reverse digital artery island flaps at Korea University Guro Hospital. We reviewed the medical records of our cases and analyzed them in several aspects. In 21 cases, neurorrhaphy was performed to improve sensibility. In the majority of the cases, the defect was covered primarily, whereas in 27 cases it was covered secondarily after composite graft, replantation, and so on. All the flaps survived except for one. Long-term follow-up for more than 6 months was possible in 44 fingers in 41 patients. Light touch and temperature sensation could be detected in all the evaluated flaps. The mean values of the static two-point discrimination test in sensate and insensate flaps were 6.2 and 10.2 mm, respectively. The reverse digital artery island flap is a safe and reliable procedure with a high survival rate and therefore is an excellent choice for coverage of fingertip defects.

  18. 股前内侧穿支皮瓣游离移植修复手部创面%Clinical application of anteromedial thigh perforator flap transplantation for repairing wounds in the hand

    Institute of Scientific and Technical Information of China (English)

    杨晓东; 刘杨武; 杨锦; 陈逸民; 付尚俊; 周阳; 丁建波; 楼旭鹏

    2012-01-01

    Objective To investigate the clinical effects of repairing wounds in the hand with free anteromedial thigh perforator flap transplantation. Methods From June 2008 to June 2011,15 cases were treated with free anteromedial thigh perforator flap transplantation for repairing the wound in the hand.There were 5 cases of volar defects,4 cases of defects on the ulnar aspect of the hand,1case of first web space wound and 5 cases of dorsal defects.Wound sizes ranged from 6 cm × 4 cm to 13 cm × 9 cm.Flap pedicles were anastomosed to the radial artery and cephalic vein of the recipient site in 11cases,and to the ulnar artery and basilic vein in 4 cases.Direct closure of the donor rite was possible in 9 cases,while skin graft was necessary in 6 cases. Results All the transplants survived.There was no vascular crisis.Postoperative follow-up ranged from 3 to 12 months.Satisfactory clinical results were recorded. Conclusion Anteromedial thigh perforator flap transfer is an effective method of repairing wounds in the hand.%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.

  19. Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

    Directory of Open Access Journals (Sweden)

    Dae-Sung Lee

    2013-05-01

    Full Text Available We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

  20. Anterograde intra-arterial urokinase injection for salvaging fibular free flap.

    Science.gov (United States)

    Lee, Dae-Sung; Jung, Sun-Il; Kim, Deok-Woo; Dhong, Eun-Sang

    2013-05-01

    We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

  1. Homodigital dorsal adipofascial reverse flap: anatomical study of distal perforators and key points for safe dissection.

    Science.gov (United States)

    Delia, G; Casoli, V; Sommario, M; Risitano, G; D'Alcontres, F Stagno; Colonna, M R

    2010-07-01

    Dorsal adipofascial flaps have been used in the surgical reconstruction of complex injuries distal to the eponychial fold. Such injuries produce nail matrix devascularization/necrosis so that nail bed reconstruction can be a challenging technical problem. Irregular scarring of the nail bed and regrowth anomalies of the nail lamina can result, with both functional and cosmetic impairment of the finger. This study aimed to define the precise vascular anatomy of the dorsal adipofascial flap that has previously been used to reconstruct such complex soft tissue defects. Specifically, the purpose was to identify the key points of safe dissection for these flaps. Anatomical dissections were performed on 32 long fingers. The vascular tree was injected with suitable contrast and the distal dorsal region of the long fingers was studied.

  2. Clinical application of modified deep inferior epigastric perforator flap%改良腹壁下动脉穿支皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    谢庆平; 郭恩琪; 王亮; 范奔; 倪建平; 许新伟; 晋培红

    2009-01-01

    Objective To improve the techniques of harvesting the deep inferior epigastric perforator (DIEP) flap and broaden the clinical application of the flap. Methods A modified DIEP flap (or DIEP osteofasciocutaneous flap with iliac or rib) involving perforating vessels of the bilateral deep inferior epigastric vasculature with a muscle cuff was used to cover large defects of the extremities. There were 5 cases of defects of the forearm and 6 cases with defects of the hand and wrist. The areas of the defects were 10.0 cm × 5.0 cm to 45.0 cm × 20.0 cm. All flap transfers were done in the emergent setting. Results 10 of the 11 flaps survived completely while one flap survived with partial necrosis. Follow up ranged from 3 to 61 months. The flaps healed well. Function of the hand was satisfactory. There was no abdominal wall hernia at the donor sites. Conclusion The modified DIEP flap involving bilateral pedicles is the procedure of option for reconstruction of large defects.%目的 探讨腹壁下动脉穿支皮瓣(deep inferior epigastric perforator flap,DIEP皮瓣)切取方式的改进,扩大DIEP皮瓣的临床应用范围.方法 采用双腹壁下血管蒂仅带肌袖的DIEP皮瓣(并可通过筋膜蒂携带髂骨或肋骨)修复四肢大面积软组织缺损,其中前臂缺损5例,手腕部缺损6例,创面面积为10.0 cm×5.0 cm~45.0cm×20.0 cm,均为急诊修复.结果 术后11例皮瓣中全部存活10例,大部分存活1例.随访时间3~61个月,皮瓣愈合良好,手功能恢复满意.所有供区均未发生腹壁疝.结论 改良DIEP皮瓣是修复大面积皮肤缺损的首选皮瓣之一.

  3. 穿支血管蒂螺旋桨皮瓣修复足踝部软组织缺损%Perforator pedicled propeller flaps for soft tissue coverage of the lower leg and foot defects

    Institute of Scientific and Technical Information of China (English)

    董凯旋; 徐永清; 范新宇; 徐龙江; 苏锡雄; 龙海; 许立奇; 何晓清

    2013-01-01

    caused by car accidents.The wounds and soft tissue defect area were from 2 cm × 8 cm to 5 cm × 20 cm.The course of disease was from 7 days to 60 days.These flaps included terminal branch of the peroneal artery perforator flap in 15 cases,posterior tibia artery perforator flap in 5 cases.The flap size ranged from 5 cm×ll cm to 7 cm×28 cm.The color Doppler ultrasound were used for the locating of all perforator vessel,the caliber diameter of the perforator artery ranged from 0.8 mm to 1.0 mm.Results The coincidence rate intraoperatively of the the color Doppler ultrasound was 96.7%.The donor sites were sutured directly in 12 cases and cured with skin-grafting in 8 cases.One case suffered from venous crisis in 24 hour was cured by the removal of part of the suture and bloodletting.All cases were followed up for 1 month to 18 months,and all flaps survived well and pedicle were smooth with a satisfied appearance.The patient were extremely satisfied with the results for repair.Conclusion The perforator pedicled propeller flap is a simple,without vascular anastomosis,safe and effective.Compared with other pedicle flap,it has more unique advantages for soft tissue coverage of the lower leg and foot defects.

  4. Reverse flow first dorsal metacarpal artery flap for covering the defect of distal thumb.

    Science.gov (United States)

    Checcucci, Giuseppe; Galeano, Mariarosaria; Zucchini, Maura; Zampetti, Pier Giuseppe; Ceruso, Massimo

    2014-05-01

    Reconstruction of distal thumb injuries still remains a challenge for hand surgeons. Surgical treatment includes the use of local, regional, and free flaps. The purpose of this report is to present the results of the use of a sensitive reverse flow first dorsal metacarpal artery (FDMA) flap. The skin flap was designed on the radial side of the proximal phalanx of the index finger based on the ulnar and radial branch of the FDMA and a sensory branch of the superficial radial nerve. This neurovascular flap was used in five patients to cover distal soft-tissue thumb defects. All flaps achieved primary healing except for one patient in whom superficial partial necrosis of the flap occurred, and the defect healed by second intention. All patients maintained the thumb original length and were able to return to their previous daily activities. The reverse flow FDMA flap is a reliable option to cover immediate and delayed defects of distal thumb, offering acceptable functional and cosmetic outcomes in respect to sensibility, durability, and skin-match.

  5. Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

    Energy Technology Data Exchange (ETDEWEB)

    Mehta, Vimal, E-mail: drvimalmehta@yahoo.co.in; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay [G.B. Pant Institute of Postgraduate Medical Education and Research (India)

    2016-01-15

    We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.

  6. Revision breast and chest wall reconstruction in Poland and pectus excavatum following implant complication using free deep inferior epigastric perforator flap.

    Science.gov (United States)

    Dionyssiou, Dimitrios; Demiri, Efterpi; Batsis, Georgios; Pavlidis, Leonidas

    2015-01-01

    This study aims to present the case of a female patient with Poland's syndrome and pectus excavatum deformity who underwent breast and chest wall reconstruction with a pre-shaped free deep inferior epigastric perforator flap. A 57-year-old female patient with Poland's syndrome and pectus excavatum presented with a Baker III capsular contracture following a previously performed implant-based right breast reconstruction. After a chest and abdominal CT angiography, she was staged as 2A1 chest wall deformity according to Park's classification and underwent implant removal and capsulectomy, followed by a pre-shaped free abdominal flap transfer, providing both breast reconstruction and chest wall deformity correction in a single stage operation. Post-operative course was uneventful, and the aesthetic result remains highly satisfactory 24 months after surgery. Deep inferior epigastric free flap represents an interesting reconstructive solution when treating Poland's syndrome female patients with chest wall and breast deformities.

  7. Awkward defects around the elbow: The radial recurrent artery flap revisited

    Directory of Open Access Journals (Sweden)

    Maksud M Devale

    2016-01-01

    Full Text Available Background: Soft tissue defects on the posterior aspect of the elbow are commonly seen in patients treated with internal fixation for fractures around the elbow joint. An axial flap based on the radial recurrent artery (RRA is very useful for such defects, especially if a posterior midline arm incision has been taken for skeletal fixation. The aim of this study is to describe the usefulness of RRA flap (based on the RRA in the management of such defects. Materials and Methods: We present a retrospective analysis of 4 cases managed with the RRA flap for soft tissue reconstruction of defects around the elbow joint at our institute from January 2015 to August 2016. All the patients were males with a history of exposed implant following internal fixation of olecranon/distal humerus fracture. The size of defects ranged from 4 cm × 4 cm to 7 cm × 5 cm. Results of the analysis are presented here. Results: All flaps survived completely. There was no infection, hematoma or distal neurovascular deficit. There was minimal donor site morbidity. Conclusion: The RRA flap is a useful, simple flap for defects around the elbow joint in select patients providing one stage, reliable, cosmetically acceptable coverage.

  8. Use of anteromedial thigh perforator flap and immunological implications of Gorlin-Goltz syndrome: a case study.

    Science.gov (United States)

    Scalise, A; Calamita, R; Tartaglione, C; Bolletta, E; Di Benedetto, G; Pierangeli, M

    2016-12-02

    Gorlin-Goltz syndrome is mainly characterised by the development of numerous multicentric and relapsing cutaneous basal cell carcinomas (BCCs). A major problem for patients with Gorlin-Goltz syndrome is the large amount of BCCs that can invade the deep underlying structures, especially the face. Here, we describe the case of a 23-year-old male affected by Gorlin-Goltz syndrome. He had recurrent BCCs on a hairless scalp and dorsum since he was 17 years old and underwent four surgical procedures to excise BCCs, including a reconstruction with anteromedial thigh perforator flap. For each of the surgical procedures, a phenotypic study on peripheral blood mononuclear cells using flow cytometry was performed on the same day of surgery, and on days 7, 14 and 21 after surgery. The role of the tumour-specific cytolytic immune response as a potential future treatment of syndromic BCCs and its trend in relation to surgical ablation of large portions of tumour tissue was examined, and the cosmetic and therapeutic results are shown.

  9. 前臂后外侧中段穿支皮瓣的解剖与临床研究%Anatomical Study and Clinical Application of the Perforator Flap in the Posterolateral Mid-forearm

    Institute of Scientific and Technical Information of China (English)

    岳素琴; 林涧; 郑和平; 林加福; 张发惠

    2011-01-01

    Objective: To investigate and evaluate the clinical application of the posterolateral aspect of the mid - forearm ( PLMF ). Methods:30 embalmed upper limbs of adult cadavers perfused with red latex were used for this study, the origin, branches, and distribution of the perforating arteries at posterolateral aspect of the mid - forearm were observed through meticulous dissection on one fresh cadaver, HAES - steril and ink compound was perfused through the brachial artery, after which the staining area of the skin isolated on the perforating arteries was measured. Based on the anatomical study, 11 cases of perforator flaps at the posterolateral aspect of the mid - forearm were harvested to repair soft tissue defects in the forearm and wrist. Results: Perforating branches of posterolateral midforearm originated from the radial musculoculancous branches of the posterior interosseous artery, the intermuscular branch and direct periosteal branch of the radial artery traveled through the space between extensor digitorum and extensor carpi radialis brevis supinator and abductor pollicis longus, supi-nator and abductor pollicis longus, emerging from the deep fascia subcutaneously at 12.5~15.8 cm below the lateral condyle of humerus. Several minute branches were emitted from these perforating branches to participate in the formation of the paraneural and intraneural vascular plexuses of the posterior antebrachial cutaneous nerve. The diameter of the perforating arteries after piercing the deep fascia was ( 1.0±0. 3 )cm,( 0. 9 ±0. 2 ) cm and ( 0. 6 ±0. 2 )cm, respectively. The ink staining area was 13 cm x7 cm. Clinically, all flaps in 13 cases survived uneventfully without cyanose, swelling or blister. After 3 ~ 15 months of following - up, the colors and appearances of these flaps were excellent. Conclusions: The anatomy of the perforating arteries at the posterolateral aspect of the mid - forearm are relatively constant; and the flap based on them are profuse in blood

  10. Preoperative Angiographic Criteria for Predicting Free-Flap Transfer Outcomes in Patients With Lower-Extremity Peripheral Arterial Disease.

    Science.gov (United States)

    Park, Sang Woo; Kim, Junhyung; Choi, Jaehoon; Kim, Jun Sik; Lee, Jeong Hwan; Park, Young Sook

    2016-09-29

    Patients scheduled for microsurgical reconstruction of the lower leg often receive preoperative assessment of recipient vessels using angiography. However, no clear standard is available for evaluating angiographic results to predict free-flap survival outcomes. We developed angiographic criteria for predicting surgical outcome in patients with lower-extremity peripheral arterial disease based on abnormality of the anterior tibial and posterior tibial arteries. We applied the criteria to a small number of patients scheduled for microsurgical reconstruction of the lower leg. Angiographies with arterial abnormalities were classified into 3 groups: favorable free-flap survival, compromised free-flap survival, and postsurgical pedal ischemia. The study enrolled 50 patients between 2005 and 2013. In 42% of patients, arterial abnormalities were observed by angiography. Age >65 years was the strongest risk factor for development of lower-leg arterial abnormality (P free-flap survival and compromised free-flap survival groups, free-flap transfers were attempted in 7 patients but intraoperatively abandoned in 2 patients, with postoperative failure in 1 patient. In the postsurgical pedal ischemia group, free-flap transfers were attempted in 10 patients but intraoperatively abandoned in 6 patients, with postoperative failure in 3.

  11. Imaging Evaluation of Blood Supply in Deep Inferior Epigastric Perforator Skin Flap%影像学评估腹壁下动脉穿支皮瓣血运的研究进展

    Institute of Scientific and Technical Information of China (English)

    孙敬岩

    2012-01-01

    应用不同影像学方法评估游离皮瓣的穿支血管走行及血供特性在乳房再造术中的重要作用.腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣属穿支皮瓣,穿支血管细小,解剖变异大,术前影像评估穿支血管的位置,管径大小及其走行,对提高手术成功率和安全性具有重要意义.评估血管的方法包括手持多普勒、色彩双超声、数字减影血管造影、CT血管造影、核磁血管造影、多层螺旋CT以及吲哚菁绿激光辅助的血管造影等,本文初步介绍不同检查方法评估DIEP皮瓣血管走行及血供特性的优缺点,辅助乳腺癌乳房再造术中血管分布的评估.%The use of various imaging methods to evaluate the characteristics of vascular direction and blood supply in the perforator artery of the free flap plays an important role in breast reconstruction. The deep inferior epigastric perforator ( DIEP ) flap has tiny blood vessels but its anatomy varies in individuals. The use of preoperative imaging on vascular position, pipe diameter size, and vascular direction can improve the success rate and safety of surgery. The evaluation methods used in blood circulation include hand-held doppler, color duplex ultrasound examination, digital subtraction angiography, angiography, imaging angiography, modified discrete cosine transform, and indocyanine green laser-assisted angiography. This article introduces the merits and demerits of different preliminary inspection methods used in evaluating the features of vascular direction and blood supply of the DIEP flap, as well as the distribution of blood vessels during adjuvant breast reconstruction.

  12. Utility of Indocyanine Green Angiography in Arterial Selection during Free Flap Harvest in Patients with Severe Peripheral Vascular Disease

    OpenAIRE

    Maxwell, Anne K.; Deleyiannis, Frederic W.-B.

    2016-01-01

    Summary: Indocyanine green angiography (SPY) was used to guide arterial selection for an anterolateral thigh free flap in the setting of severe peripheral vascular disease. SPY technology serves as a novel and sensitive intraoperative tool to predict decreased tissue perfusion from vessel sacrifice for flap harvest. Change in SPY time parameters measuring superficial blood flow distal to the donor site while temporarily intraoperatively clamping different possible arterial pedicles can optimi...

  13. Occult stenosis of the common carotid artery complicating mandibular reconstruction with a fibular free flap.

    Science.gov (United States)

    Bater, M C; Brennan, P A; Mellor, T K; Tilley, E

    2006-02-01

    An unsuspected severely stenosed common carotid artery that compromised a free flap for mandibular reconstruction is described. To our knowledge no one has advocated the assessment of the carotid tree before transfer of free tissue. We suggest that patients with several risk factors for peripheral vascular disease should have colour flow duplex imaging of the carotid system if transfer of free tissue is being considered.

  14. 腹壁下动脉穿支皮瓣在小儿足踝部软组织缺损中的应用%Repair of foot and malleolus defects with deep inferior epigastric perforator flap in children

    Institute of Scientific and Technical Information of China (English)

    高曙光; 唐举玉; 罗令; 雷光华; 李雄; 李康华

    2009-01-01

    目的 探讨腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣移植修复小儿足踝部软组织缺损的可行性及临床疗效.方法 2005年8月-2007年10月,采用DIEP皮瓣移植修复小儿足踝部软组织缺损18例.左13例,右5例.致伤原因均为交通伤.软组织缺损面积最小11 cm ×6 cm,最大17 cm ×6 cm,均合并肌腱和骨关节外露.DIEP皮瓣面积最小12 cm×7 cm,最大18 cm ×7 cm,9例腹壁下动静脉与胫前动静脉吻合,4例腹壁下动静脉与足背动静脉吻合,5例腹壁下动静脉与胫后动静脉吻合,腹部皮瓣供区直接缝合.结果 18例DIEP皮瓣移植术后顺利成活,皮瓣受区与供区创口Ⅰ期愈合.术后随访3~20个月,平均10.3个月,皮瓣颜色、血运好,外形不臃肿,足踝功能恢复良好,13例恢复保护性感觉,腹部供瓣区外形恢复好,腹壁功能无明显影响,无腹壁薄弱、腹壁疝等并发症发生.结论 DIEP皮瓣保留了传统下腹部横形腹直肌皮瓣乳房再造所具有的优点,可最大限度保留腹直肌的功能,避免术后出现腹壁薄弱、腹壁疝等并发症,其皮瓣薄,修复足踝部创面不需Ⅱ期修薄整形,是修复小儿足踝部软组织缺损的较好方法.%Objective To discuss the feasibility and the preliminary clinical effect of deep inferior epigastric perforator (DIEP) flap in repair of foot and malleolus defects in child.Methods From August 2003 to October 2006,18 child patients with foot and malleolus defects were treated with DIEP flap.There were 10 males and 8 females,at age range of 3-7 years (average 4.6 years).The defects were on the left joints in 13 patients and on the right in five.All soft tissue defects were caused by traffic accidents that resulted in exposure of the tendons and skeleton.The size of the defect ranged from 11 cm ×6 cmto 17 cm ×6 cm.The minimum DIEP flap in size was 12 cm ×7 cm.The maximum DIEP flap in size was 18 cm × 7 cm.The inferior epigastric artery ( vein

  15. Predictive risk factors of free flap thrombosis in breast reconstruction surgery.

    Science.gov (United States)

    Masoomi, Hossein; Clark, Emily G; Paydar, Keyianoosh Z; Evans, Gregory R D; Nguyen, Audrey; Kobayashi, Mark R; Wirth, Garrett A

    2014-11-01

    Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.1%), free superficial inferior epigastric artery (SIEA) flap (2%), and free gluteal artery perforator (GAP) flap (1.3%). The overall rate of flap thrombosis was 2.4 %, with the highest rate seen in the SIEA group (11.4%) and the lowest in the TRAM group (1.7%). Peripheral vascular disease (adjusted odds ration [AOR] 10.61), SIEA flap (AOR, 4.76) and delayed reconstruction (AOR, 1.42) were found to be statistically significant risk factors for flap thrombosis. Other comorbidities were not linked. While the overall rate of flap thrombosis in free flap breast reconstruction was relatively low (2.4%), Plastic Surgeons should be aware that patients with peripheral vascular disease and those undergoing free SIEA flap are at higher risk of flap thrombosis and they should closely monitor flaps to increase the chance for early salvage.

  16. Right coronary artery perforation by an active-fixation atrial pacing lead resulting in life-threatening tamponade.

    Science.gov (United States)

    Nakagawa, Eiichiro; Abe, Yukio; Komatsu, Ryushi; Naruko, Takahiko; Itoh, Akira

    2015-10-01

    Cardiac tamponade resulting from perforation of a cardiac chamber is a relatively rare complication of pacemaker implantation. We report the first case of perforation of the right coronary artery related to the implantation of a screw-in atrial pacing lead, presenting as life-threatening cardiac tamponade. We report the case of a 72-year-old woman with complete atrioventricular block and dyspnea on exertion. A permanent pacemaker was implanted with bipolar Medtronic active-fixation leads positioned in the right atrial appendage and at the right ventricular basal septum without any difficulty. Approximately 3.5 h after the procedure, the patient complained of nausea, and the systolic blood pressure decreased to less than 60 mmHg. Echocardiography revealed a large pericardial effusion. Because the effects of pericardiocentesis lasted for less than an hour, the patient underwent a thoracotomy. After evacuation of a massive hemopericardium, bright red blood was seen gushing out from the right coronary artery, which was located on the opposite site of the right atrial appendage where a small portion of the screw tip was observed to be penetrating the atrial wall. The right coronary artery perforation was repaired using autologous pericardium-reinforced 7-0 prolene mattress sutures. Perforation of the right coronary artery is a potential complication and should be part of the differential diagnosis of cardiac tamponade after pacemaker implantation.

  17. A study of the use of the supraclavicular artery flap for resurfacing of head, neck, and upper torso defects

    Directory of Open Access Journals (Sweden)

    Telang Parag

    2009-01-01

    Full Text Available The head and neck region is an aesthetically demanding area to resurface because of its high visibility. Tissue defects in this area often require distant flaps or free flaps to achieve an aesthetically acceptable result. The use of the Supraclavicular artery flap represents an extremely versatile and useful option for the resurfacing of head, neck and upper torso defects. Furthermore, islanding the flap gives it a wide arc of rotation and the color and texture match is superior to that of free flaps harvested from distant sites. In our study, we used the flap (both unexpanded and expanded predominantly for resurfacing neck defects resulting from the release of post-burn contractures. However, its applicability in other indications would also be similar. Except one, all our flaps survived almost completely and the post-operative morbidity was very low. We conclude that the supraclavicular artery flap not only provides a reasonably good color and texture match but also maintains the multi-directional activity in the neck region.

  18. CT and MRI findings of cerebral ischemic lesions in the cortical and perforating arterial system

    Energy Technology Data Exchange (ETDEWEB)

    Kameyama, Masakuni; Udaka, Fukashi; Nishinaka, Kazuto; Kodama, Mitsuo; Urushidani, Makoto; Kawamura, Kazuyuki; Inoue, Haruhisa; Kageyama, Taku [Sumitomo Hospital, Osaka (Japan)

    1995-07-01

    It is clinically useful to divide the location of infarction into the cortical and perforating arterial system. Computerized tomography (CT) and magnetic resonance imaging (MRI) now make the point of infarction a simple and useful task in daily practice. The diagnostic modality has also demonstrated that risk factors and clinical manifestations are different for infarction in the cortical as opposed to the perforating system. In this paper, we present various aspects of images of cerebral ischemia according to CT and/or MRI findings. With the advance of imaging mechanics, diagnostic capability of CT or/and MRI for cerebral infarction has markedly been improved. We must consider these points on evaluating the previously reported results. In addition, we always consider the pathological background of these image-findings for the precise interpretation of their clinical significance. In some instances, dynamic study such as PET or SPECT is needed for real interpretations of CT and/or MRI images. We paid special reference to lacunar stroke and striatocapsular infarct. In addition, `branch atheromatous disease (Caplan)` was considered, in particular, for their specific clinical significances. Large striatocapsular infarcts frequently show cortical signs and symptoms such as aphasia or agnosia in spite of their subcortical localization. These facts, although have previously been known, should be re-considered for their pathoanatomical mechanism. (author).

  19. Modified superficial peroneal neurocutaneous flap pedicled with lateral supramalleolar artery arising from peroneal artery for forefoot defect%跨区供血腓动脉外踝上穿支蒂腓浅神经营养血管皮瓣修复足前部缺损

    Institute of Scientific and Technical Information of China (English)

    陈雪松; 肖茂明; 王元山; 管力; 张黎明; 江珉

    2010-01-01

    Objective To report the operative techniques and clinical results of modified distally based superficial peroneal neuroeutaneous flap for skin defect of the forefoot. Methods A reversed superficial peroneal nerocutaneous flap pedicled with the lateral superamalleolar perforating artery or its descending branch, which vascularized the flap through the nutrient vessel chain of the nerve, which linked vascular territories of superamalleolar perforating artery, cutaneous branches of the anterior tibial artery and superficial peroneal artery, was designed to repair skin defects in the forefoot. Results The modified flaps were applied in 17 cases. All flaps were survived successfully with no complication. The largest size of the flap was 20 cm × 8 cm. The flap could reach as far as the proximal end of the second and third toes or weight-bearing areas under the fifth metatarsal caput. Conclusions The modified flap has reliable blood supply with a relatively large size and long rotation are. It is a simple and safe for covering medium to large defects in the forefoot.%目的 探讨改良腓浅神经营养血管皮瓣修复足前部缺损的手术方法及临床效果.方法 对足前部皮肤软组织缺损创面,设计切取以外踝上穿支或其降支为蒂,经其升支、胫前动脉皮穿支及腓浅动脉跨区供血的腓浅神经营养血管皮瓣修复.结果 2005年2月至2008年2月,于临床应用17例,最远修复至第2、3趾基底部及第5跖骨头负重区,最大切取面积20 cm×8 cm;皮瓣均全部成活,术后随访6~12个月,皮瓣质地优良,外形与足踝功能恢复满意.结论 该皮瓣神经血管丛粗大而丰富,蒂部供血确切,旋转修复距离可达足趾,适用于涉及足前部的足背中、大面积皮肤软组织缺损的修复.

  20. The clinical analysis of sacral pressure ulcers utilizing perforator flaps%臀部穿支皮瓣治疗骶尾部褥疮100例临床分析

    Institute of Scientific and Technical Information of China (English)

    杜丽平; 傅荣; 游晓波

    2012-01-01

    Objective To explore the clinical effects of various types Perforator Flap in the Reconstruction of Sacral Pressure Ulcers. Complications were analyzed. Methods A retrospective study from 100 operated cases using the superior gluteal artery perforator (SGAP) for sacral pressure ulcer is reported. According to defect parts and size, the patients are divided into two groups, which were designed with pure pedicle or island flaps respectively. Results The defect areas ranged from 4cmX5cm-10cmX12cm and 84 cases of 100 were healed primarily. We analyze two group's Complications and assess their risk factors. There is a statistical difference between the two groups. Conclusion The perforator flaps is an ideal method for the treatment of Ischia-sacral pressure ulcer. The pure pedicle flap operation is simple with low risk, but has low mobility, which is applicable to smaller defects. The island flap is a relatively complicated operation and has high mobility! The operation is applicable to ulcer bigger defect.%目的 探讨应用各种类型臀部穿支动脉皮瓣修复骶尾部褥疮的手术方法及临床效果.方法 对应用穿支皮瓣修复治疗骶尾部褥疮的100例病例按皮瓣类别分组进行分析.根据缺损部位及大小分为两组,分别设计单纯带蒂穿支皮瓣(旋转或移位皮瓣)、岛状穿支皮辨(推进或移位)修复骶尾部褥疮,并对其治愈率、并发症发生率和复发率等进行分析.结果 100例病例中84例皮瓣全部成活,伤口均一期愈合.随访1~7年,皮瓣质地优良,外形满意,溃疡无复发.结论 穿支蒂皮辩设计灵活,切取方便,血供可靠,不损伤臀部肌肉,供区无需植皮,是修复臀骶部褥疮的理想方法;旋转或移位皮瓣手术操作较简单,成功率高,但移动性差,仅适用于皮肤缺损小的褥疮;岛状皮瓣移动性高,操作相对复杂,手术风险大,适用于皮肤缺损较大或周围瘢痕较多的褥疮.

  1. Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

    Directory of Open Access Journals (Sweden)

    George S. Georgiadis

    2015-01-01

    Full Text Available Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents.

  2. Decision Making in Double-Pedicled DIEP and SIEA Abdominal Free Flap Breast Reconstructions: An Algorithmic Approach and Comprehensive Classification

    OpenAIRE

    Malata, Charles M.; Nicholas Grant Rabey

    2015-01-01

    Introduction The deep inferior epigastric artery perforator free flap is the gold standard for autologous breast reconstruction. However, using a single vascular pedicle may not yield sufficient tissue in patients with midline scars or insufficient lower abdominal pannus. Double-pedicled free flaps overcome this problem using different vascular arrangements to harvest the entire lower abdominal flap. The literature is, however, sparse regarding technique selection. We therefore reviewed ou...

  3. Repair of soft tissue defects in the upper limbs using multiple types of posterior interosseous artery flaps%多种骨间后动脉皮瓣修复上肢软组织缺损

    Institute of Scientific and Technical Information of China (English)

    梁钢; 丁健; 孙建平; 徐宝成; 谷云峰

    2011-01-01

    Objective To summarize the therapeutic effect of multiple types of posterior interosseous artery flaps for repair of soft tissue defects in the upper extremities. Methods From March 2003 to June 2010, 42 cases with soft tissue defects in the upper limbs resulting from burn and traumatic injuries were treated using multiple types of posterior interosseous artery flaps, including retrograde flaps and composite flaps, antegrade flaps , and free flaps. Flap size ranged from 2.5 cm× 2.0 cm-14.0 cm×9.0 cm. The defects in the donor sites were closed directly or covered by skin graft. Results The conventional retrograde posterior interosseous artery flaps were used in 11 cases, the modified retrograde posterior interosseous artery flaps were used in 13 cases, the retrograde posterior interosseous artery composite flaps incorporating partial extensors were used in 2 cases, the antegrade posterior interosseous artery flaps were used in 3 cases, the free posterior interosseous artery flaps were used in 7 cases, and the free perforator flap based on the radiodorsal septocutaneous perforator of the posterior interosseous artery were used in 6 cases. Partial necrosis happened in one case at the distal portion of the flap. Muscular branch of the posterior interosseous nerve was injuried in one case with conventional reverse posterior interosseous artery flaps. All the other flaps survived uneventually with no complication. All wounds were primarily healed. 32 cases were followed up for 1 to 48 months with satisfactory aesthetic and functional results both in the donor sites and in the recipent areas. The color,texture and thickness of the flaps were satisfied as well. Conclusions The posterior interosseous artery flap has a constant vascular anatomy and a great flexibility, which is practical and suitable for repair of soft tissue defect in the upper extremities arising from burn and traumatic injury.%目的 总结多种骨间后动脉皮瓣修复上肢烧(创)伤软组

  4. Application of Orthodromic Island Flap Prosthetics of Homo-Digital Artery in Finger-Tip Defect

    Institute of Scientific and Technical Information of China (English)

    Lu Daming; Lu Xiangrong; Lu Zehnliang; Zhu Jinhong

    2014-01-01

    Objective:To investigate the clinical efficacy of orthodromic island flap prosthetics of homo-digital artery on ifnger-tip defect. Methods: A total of 21 patients with ifnger-tip defect from December, 2010 to April, 2013 were given orthodromic island lfap prosthetics of homo-digital artery, with the maximum and minimum sizes of lfaps being 20 mm×22 mm and 10 mm×15 mm, respectively. Results: All patients with ifnger-tip defect survived from the lfap surgery and the wounds were favorably healed. 3~12 months follow-up after operation, the lfaps were observed with approving appearance, soft texture and favorable elasticity, with two-point discrimination being 6~8 mm. According to TAM detection of hand functions, lfaps were excellent healed in 19 cases, good and fairish in 1 case respectively, with effective rate being 95.2%. Conclusion:Orthodromic island flap prosthetics of homo-digital artery is simple and safe in operation with satisfactory effcacy, being the most ideal method for the repair of ifnger-tip defect.

  5. Second look procedure for large burn defect by banana peel pericranial flap based on one artery

    Directory of Open Access Journals (Sweden)

    Veličkov Asen

    2014-01-01

    Full Text Available Introduction. Scalp and calvarial defects may result from trauma, thermal or electrical burns, resection of benign or malignant tumors, infections or radionecrosis. Reconstruction of large scalp defects is a demanding procedure. The reconstructive ‘‘ladder’’ are applicable to scalp and calvarial defects reconstruction. Case Outline. A 68-year-old female was admitted to our clinic due to the nine-day old scalp burn wound, incurred under unclear circumstances. Third degree burn wound affected the left frontal-parietal, temporal and part of the occipital region with carbonification of the whole left ear lobe. The treatment was carried out in two stages. Radical full thickness necrectomy of the scalp was performed, the defect margins were curetted to the active bleeding, and the ear lobe was amputated. The defect sized 23 x 15 cm was reconstructed using the “banana peel” transposition galea-cutaneous flap from the remainder of the scalp, which was based only on the right occipital artery. Two months after the surgery the appearance was satisfactory, and all wounds were healed. Conclusion. Designing of large-scale flaps is very hazardous, especially in elderly people. Scalp reconstruction based on one artery has to be planned in detail and performed when the possibility of complication is reduced to minimum. Our case report underlines possible reconstruction as delayed procedure even with the exposed bone (second look procedure, as well as the reconstruction of half scalp with the local flap based on one pericranial artery. [Projekat Ministarstva nauke Republike Srbije, br. III 41018

  6. Revision breast and chest wall reconstruction in Poland and pectus excavatum following implant complication using free deep inferior epigastric perforator flap

    Directory of Open Access Journals (Sweden)

    Dimitrios Dionyssiou

    2015-01-01

    Full Text Available This study aims to present the case of a female patient with Poland′s syndrome and pectus excavatum deformity who underwent breast and chest wall reconstruction with a pre-shaped free deep inferior epigastric perforator flap. A 57-year-old female patient with Poland′s syndrome and pectus excavatum presented with a Baker III capsular contracture following a previously performed implant-based right breast reconstruction. After a chest and abdominal CT angiography, she was staged as 2A1 chest wall deformity according to Park′s classification and underwent implant removal and capsulectomy, followed by a pre-shaped free abdominal flap transfer, providing both breast reconstruction and chest wall deformity correction in a single stage operation. Post-operative course was uneventful, and the aesthetic result remains highly satisfactory 24 months after surgery. Deep inferior epigastric free flap represents an interesting reconstructive solution when treating Poland′s syndrome female patients with chest wall and breast deformities.

  7. 游离胫后动脉穿支皮瓣修复(足母)趾腓侧皮瓣供区创面%Free posterior tibial perforator flap for coverage of donor defect of the big toe after free lateral pulp flap transfer

    Institute of Scientific and Technical Information of China (English)

    赵风景; 张兴群; 张龙春; 姚建民; 马亮; 陈莹

    2011-01-01

    目的 介绍应用游离胫后动脉穿支皮瓣修复(足母)趾腓侧皮瓣供区创面,为减少供区损伤提供治疗方法.方法 2009年6月至2010年12月,对5例拇、手指软组织缺损,采用(足母)趾腓侧皮瓣游离移植修复,对(足母)趾供区创面同时采用游离胫后动脉穿支皮瓣进行移植修复,小腿供区创面直接缝合.结果 术后5例游离(足母)趾腓侧皮瓣和胫后动脉穿支皮瓣全部存活,皮瓣外观和功能恢复良好,平均随访时间7个月,(足母)趾腓侧皮瓣和胫后动脉穿支皮瓣两点分辨觉平均为5mm和7mm.结论 游离(足母)趾腓侧皮瓣修复拇、手指软组织损伤的同时应用胫后动脉穿支皮瓣一期修复(足母)趾供区创面,避免了术后局部疼痛、皮肤破溃等并发症,是一种理想的覆盖供区创面的治疗方法.%Objective To explore the application of free posterior tibial artery perforator (PTP) flap for coverage of donor defect of the big toe after free lateral pulp flap transfer and decreasing donor site morbidity.Methods From June 2009 to December 2010,5 cases of solt tissue defect of the thumb and tingers were treated by free transfer of the lateral pulp flap from the big toe.The resulting defects d the donor big toes were repaired by free PTP flap transplantation.Flap donor sites at the calf were directly closed.Results All flans survived with desirable appearance and sensation.Mean follow-up time was 7 months.Two-point discrimination in the lateral pulp flaps transferred to the thumb and fingers and in the PTP flaps was 5 mm and 7 mm,respectively.Conclusion PTP flap transfer for coverage of donor big toe defect resulted from free lateral pulp flap transferis an ideal surgical procedure.It prevents donor site morbidities such as pain and ulceration.

  8. A novel use of the facial artery based buccinator musculo-mucosal island flap for reconstruction of the oropharynx.

    Science.gov (United States)

    Khan, K; Hinckley, V; Cassell, O; Silva, P; Winter, S; Potter, M

    2013-10-01

    The buccinator musculo-mucosal island or Zhao flap can be used to reconstruct a wide range of intra-oral defects including floor of mouth, tonsillar fossa and lateral tongue. We describe our experience with the inferiorly based facial artery buccinator musculo-mucosal flap for a novel use in the reconstruction of oropharyngeal tumours at the tongue base and lateral pharyngeal wall. We prospectively reviewed all patients who underwent buccinator musculo-mucosal island flap reconstruction examining indication, operative details, and post-operative outcomes. We describe our technique for its novel use in lateral pharynx/tongue base reconstruction through neck dissection access. Deeper flaps were adequately visualised and monitored using flexible nasoendoscopy. There were no flap failures with all patients achieving primary healing with minimal complications. All donor sites closed directly with minimal scarring. Two patients reported mild tightness on mouth opening and two patients reported transient weakness of the mandibular branch of the facial nerve. In our experience the buccinator musculo-mucosal island flap is an extremely versatile 'like for like' local flap option due to its long arc of rotation. As inset can be achieved via neck dissection access, this avoids lip/jaw split as per conventional oropharyngeal surgical management further minimising morbidity. We present the first series of its effective use in oropharyngeal reconstruction.

  9. Estudo anatômico das artérias perfurantes do músculo gastrocnêmio medial Anatomical study of perforator arteries of the medial gastrocnemius muscle

    Directory of Open Access Journals (Sweden)

    Diogo Mesquita Rebouças

    2008-04-01

    distance of 14.0 cm from the popliteal fold and between 16.5 cm and 34.0 cm from the medial malleolus. CONCLUSION: MGM irrigation by ASM and its perforating arteries is adequate for the use of the muscle as a myocutaneous flap of in the lower limb.

  10. Successful Endovascular Repair of an Iatrogenic Perforation of the Superficial Femoral Artery Using Self-Expanding Nitinol Supera Stents in a Patient with Acute Thromboembolic Limb Ischemia

    Directory of Open Access Journals (Sweden)

    Tom Eisele

    2016-01-01

    Full Text Available The treatment of acute thromboembolic limb ischemia includes well-established surgical thrombectomy procedures and, in recent times, also percutaneous rotational thrombectomy using Straub Rotarex® system. This modality not only enables efficient treatment of such thrombotic occlusion but also in rare cases may imply the risk of perforation of the occluded artery. Herein, we report the case of a perforation of the superficial femoral artery (SFA in an elderly female patient with thromboembolic limb ischemia. The perforation was successfully treated by implantation of self-expanding nitinol Supera stents and without the need for implantation of a stent graft.

  11. The role of septal perforators and "myocardial bridging effect" in atherosclerotic plaque distribution in the coronary artery disease.

    Science.gov (United States)

    Wasilewski, Jarosław; Roleder, Marcin; Niedziela, Jacek; Nowakowski, Andrzej; Osadnik, Tadeusz; Głowacki, Jan; Mirota, Kryspin; Poloński, Lech

    2015-01-01

    The distribution of atherosclerotic plaque burden in the human coronary arteries is not uniform. Plaques are located mostly in the left anterior descending artery (LAD), then in the right coronary artery (RCA), circumflex branch (LCx) and the left main coronary artery (LM) in a decreasing order of frequency. In the LAD and LCx, plaques tend to cluster within the proximal segment, while in the RCA their distribution is more uniform. Several factors have been involved in this phenomenon, particularly flow patterns in the left and right coronary artery. Nevertheless, it does not explain the difference in lesion frequency between the LAD and the LCx as these are both parts of the left coronary artery. Branching points are considered to be the risk points of atherosclerosis. In the LCx, the number of side branches is lower than in the LAD or RCA and there are no septal perforators with intramuscular courses like in the proximal third of the LAD and the posterior descending artery (PDA). We hypothesized that septal branches generate disturbed flow in the LAD and PDA in a similar fashion to the myocardial bridge (myocardial bridging effect). This coronary architecture determines the non-uniform plaque distribution in coronary arteries and LAD predisposition to plaque formation.

  12. The Role of Septal Perforators and “Myocardial Bridging Effect” in Atherosclerotic Plaque Distribution in the Coronary Artery Disease

    Science.gov (United States)

    Wasilewski, Jarosław; Roleder, Marcin; Niedziela, Jacek; Nowakowski, Andrzej; Osadnik, Tadeusz; Głowacki, Jan; Mirota, Kryspin; Poloński, Lech

    2015-01-01

    Summary The distribution of atherosclerotic plaque burden in the human coronary arteries is not uniform. Plaques are located mostly in the left anterior descending artery (LAD), then in the right coronary artery (RCA), circumflex branch (LCx) and the left main coronary artery (LM) in a decreasing order of frequency. In the LAD and LCx, plaques tend to cluster within the proximal segment, while in the RCA their distribution is more uniform. Several factors have been involved in this phenomenon, particularly flow patterns in the left and right coronary artery. Nevertheless, it does not explain the difference in lesion frequency between the LAD and the LCx as these are both parts of the left coronary artery. Branching points are considered to be the risk points of atherosclerosis. In the LCx, the number of side branches is lower than in the LAD or RCA and there are no septal perforators with intramuscular courses like in the proximal third of the LAD and the posterior descending artery (PDA). We hypothesized that septal branches generate disturbed flow in the LAD and PDA in a similar fashion to the myocardial bridge (myocardial bridging effect). This coronary architecture determines the non-uniform plaque distribution in coronary arteries and LAD predisposition to plaque formation. PMID:25922625

  13. No-drain DIEP Flap Donor-site Closure Using Barbed Progressive Tension Sutures

    OpenAIRE

    Nagarkar, Purushottam; Lakhiani, Chrisovalantis; Cheng, Angela; Lee, Michael; Teotia, Sumeet; Saint-Cyr, Michel

    2016-01-01

    Background: The use of progressive tension sutures has been shown to be comparable to the use of abdominal drains in abdominoplasty. However, the use of barbed progressive tension sutures (B-PTSs) in deep inferior epigastric artery perforator (DIEP) flap donor-site closure has not been investigated. Methods: A retrospective chart review was performed on patients with DIEP flap reconstruction in a 3-year period at 2 institutions by 2 surgeons. Patients were compared by method of DIEP donor-sit...

  14. Anatomy basis and clinical application of the flap based on the perforator of plantar arch%足底动脉弓足背穿支皮瓣解剖与临床应用

    Institute of Scientific and Technical Information of China (English)

    林涧; 郑和平; 张天浩; 王之江; 胡德庆; 陆骅

    2016-01-01

    Objective To report the anatomy basis and clinical application of the flap based on the perforator of plantar arch.Methods From December 2013 to June 2016,25 cadaveric feet which were injected with a mixture of red gelatin were used to observe:the origins,courses,branches,distributions of the dorsal perforators flap based on the plantar arch;the anastomoses between the back perforators of plantar arch and rete arteriosum of dorsale pedis.Based on the anatomy research,11 cases with soft tissue defect at forefoot were treated with the perforator flaps.Results 11 flaps survived completely with primary healing.The flaps were followed up for 2-36 months with good match of texture and color.Conclusions The flap based on the perforator of plantar arch has constant and rich blood supply.The technique is easily performed and can be used as an optional flap without major vessel for defect at forefoot.%目的 探讨足底动脉弓足背穿支皮瓣解剖学基础和临床疗效.方法 根据25侧动脉灌注红色乳胶的成人足标本,研究足底动脉弓足背穿支皮瓣供区穿支血管的起源、走行、分支、分布及足底动脉弓足背穿支与足背动脉网吻合等解剖特点.并于临床应用足底动脉弓足背穿支皮瓣修复足前部缺损创面11例.结果 术后11例皮瓣全部成活,创面一期愈合,随访2~36个月,皮瓣质地优良、色泽接近正常,外观较好.结论 足底动脉弓足背穿支皮瓣解剖位置恒定、血液供应良好、手术方法简单,是修复足前部软组织缺损的非主干血管蒂皮瓣供区的补充术式.

  15. Application of anterolateral thigh perforator flap for repair of soft tissue defect of the hand%股前外侧穿支皮瓣修复手部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    张兴奎; 李虎; 夏勇; 王彬; 张桂红; 唐阳平; 苗峰; 丁桂友; 张亮; 董中洋; 郭彬; 马晓辉

    2012-01-01

    目的 探讨应用游离修薄股前外侧穿支皮瓣修复手部软组织缺损的临床效果.方法 对28例手部软组织缺损创面,采用股前外侧皮瓣游离移植修复.术中切取游离皮瓣至仅剩血管蒂相连时,修薄皮瓣,从外周至血管皮支穿出点附近按次序阶梯样修剪,保留穿出点周围1.5~2.0cm组织不予修剪,同时观察皮瓣血供,防止穿支损伤,皮瓣修薄后游离移植修复手部创面.结果 28例皮瓣全部存活.25例获得3~ 12个月的随访,3例失访.术后皮瓣质地柔软,弹性好,无臃肿,肤色接近正常皮肤,恢复部分感觉功能,手功能及外形恢复良好.结论 修薄股前外侧穿支皮瓣是股前外侧皮瓣的改进,皮瓣存活后疗效满意,是修复手部创面的理想方法之一.%Objective To explore the application of free anterohteral thigh perforator flap in repairing soft tissue defects of the hand and evaluate the clinical results.Methods Free anterolateral thigh perforator flap was transferred to repair soft tissue defects of the hand in 28 cases.During flap harvesting trimming of the flap was carried out when the flap was freed and only connected with its vascular pedicle.A step-wise defatting was done from the periphery of the flap towards the vascular pedicle with 1.5 to 2.0 cm tissue around the perforator preserved.Flap circulation was carefully observed to prevent damage to the perforators.The vascular pedicle was then disconnected and the flap transferred to the hand to cover the defect.Results All the 28 flaps survived.Twenty-five cases were follow-up for 3 to 12 months,while 3 cases were lost to follow-up.The flaps were supple and elastic with near normal color.There was no bulkiness.Partial sensation was restored.The function and appearance of the hand were good.Conclusion The thin anterolateral thigh perforator flap is an improvement of the traditional anterolateral thigh flap.The survived flaps are ideal in terms of covering hand defects and

  16. Effect of Transcatheter Embolization by Autologous Fat Particles in the Treatment of Coronary Artery Perforation During Percutaneous Coronary Intervention

    Institute of Scientific and Technical Information of China (English)

    Li-Yun He; Jiang-Li Han; Li-Jun Guo; Fu-Chun Zhang; Ming Cui; Wei Gao

    2015-01-01

    Background:Coronary artery perforation (CAP) is a rare but severe complication of percutaneous coronary intervention (PCI).The aim of our study was to evaluate the effect and safety of transcatheter embolization by autologous fat particles in the treatment of CAP.Methods:Once the CAP was confirmed,a little autologous subcutaneous fatty tissue was obtained from the groin of the patient and then was made into 1 mm× 1 mm fat particles.The perforated vessel was embolized by fat particles via a micro-catheter.There were eight patients undergoing transcatheter embolization by autologous fat particles in the treatment of CAP during PCI in Peking University Third Hospital from February 2009 to June 2014,and the clinical data of these patients were collected and analyzed retrospectively.Results:The lesion morphology of the patients was classified based on the American College of Cardiology/American Heart Association Task Force classification,there were one patient with Class B2 lesion and seven patients with Class C lesions (there were five patients with chronic total occlusion lesions).According to the Ellis classification of CAP,there were six patients with Class Ⅱ perforations and two patients with Class Ⅲ perforations.The causes of perforation included that seven patients induced by guide wire and one patient by balloon predilation.Three patients had pericardial effusion.All of the eight patients with CAP underwent transcatheter embolization by autologous fat particles.Coronary angiography confirmed that all of them were embolized successfully.There was no severe complication after the procedure.The coronary angiography of one patient at l week and another patient at 2 years after the embolization showed that the embolized arteries had recanalized.The median follow-up time was 20.3 months (8.8-50.2 months),the event-free survival rate was 100%.Conclusions:Transcatheter embolization by autologous fat particles was an effective,safe,cheap,and easy way to treat the

  17. Assessment of blood flow velocity and pulsatility in cerebral perforating arteries with 7-T quantitative flow MRI.

    Science.gov (United States)

    Bouvy, W H; Geurts, L J; Kuijf, H J; Luijten, P R; Kappelle, L J; Biessels, G J; Zwanenburg, J J M

    2016-09-01

    Thus far, blood flow velocity measurements with MRI have only been feasible in large cerebral blood vessels. High-field-strength MRI may now permit velocity measurements in much smaller arteries. The aim of this proof of principle study was to measure the blood flow velocity and pulsatility of cerebral perforating arteries with 7-T MRI. A two-dimensional (2D), single-slice quantitative flow (Qflow) sequence was used to measure blood flow velocities during the cardiac cycle in perforating arteries in the basal ganglia (BG) and semioval centre (CSO), from which a mean normalised pulsatility index (PI) per region was calculated (n = 6 human subjects, aged 23-29 years). The precision of the measurements was determined by repeated imaging and performance of a Bland-Altman analysis, and confounding effects of partial volume and noise on the measurements were simulated. The median number of arteries included was 14 in CSO and 19 in BG. In CSO, the average velocity per volunteer was in the range 0.5-1.0 cm/s and PI was 0.24-0.39. In BG, the average velocity was in the range 3.9-5.1 cm/s and PI was 0.51-0.62. Between repeated scans, the precision of the average, maximum and minimum velocity per vessel decreased with the size of the arteries, and was relatively low in CSO and BG compared with the M1 segment of the middle cerebral artery. The precision of PI per region was comparable with that of M1. The simulations proved that velocities can be measured in vessels with a diameter of more than 80 µm, but are underestimated as a result of partial volume effects, whilst pulsatility is overestimated. Blood flow velocity and pulsatility in cerebral perforating arteries have been measured directly in vivo for the first time, with moderate to good precision. This may be an interesting metric for the study of haemodynamic changes in aging and cerebral small vessel disease. © 2015 The Authors NMR in Biomedicine Published by John Wiley & Sons Ltd.

  18. Identification of independent risk factors for flap failure: A retrospective analysis of 1530 free flaps for breast, head and neck and extremity reconstruction.

    Science.gov (United States)

    Las, David E; de Jong, Tim; Zuidam, J Michiel; Verweij, Norbert M; Hovius, Steven E R; Mureau, Marc A M

    2016-07-01

    Reconstructive microsurgery is a powerful method of treating various complex defects. However, flap loss remains a possibility, leading to additional surgery, hospitalisation and costs. Consequently, it is important to know which factors lead to an increased risk of flap failure, so that measures can be undertaken to reduce this risk. Therefore, we analysed our results over a 20-year period to identify risk factors for flap failure after breast, head and neck and extremity reconstruction. The medical files of all patients treated between 1992 and 2012 were reviewed. Patient characteristics, surgical data and post-operative complications were scored, and independent risk factors for flap loss were identified. Reconstruction with a total of 1530 free flaps was performed in 1247 patients. Partial and total flap loss occurred in 5.5% and 4.4% of all free flaps, respectively. In all flaps, signs of compromised flap circulation were a risk factor for flap failure. More specifically, the risk factors for flap failure in breast reconstruction were previous radiotherapy, venous anastomosis revision, gluteal artery perforator (GAP) flap choice and post-operative bleeding. In head and neck reconstruction, pulmonary co-morbidity and anastomosis to the lingual vein or superficial temporal artery were risk factors, whereas a radial forearm flap reduced the risk. In extremity reconstruction, diabetes, prolonged anaesthesia time and post-operative wound infection were risk factors. Independent pre-, intra- and post-operative risk factors for flap failure after microvascular breast, head and neck and extremity reconstruction were identified. These results may be used to improve patient counselling and to adjust treatment algorithms to further reduce the chance of flap failure.

  19. Severe atherosclerosis of the radial artery in a free radial forearm flap precluding its use.

    NARCIS (Netherlands)

    Bree, de R.; Quak, J.J.; Kummer, J.A.; Simsek, S.; Leemans, C.R.

    2004-01-01

    The free radial forearm flap is the most frequently used free flap for head and neck reconstructions. Survival of free flaps is dependent on adequate blood supply. A 69-year old woman was scheduled for excision of a T3N0M0 oropharyngeal carcinoma, neck dissections and reconstruction with a free vasc

  20. Analysis of deep inferior epigastric perforator (DIEP) arteries by using MDCTA: Comparison between 2 post-processing techniques

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca, E-mail: lucasaba@tiscali.it [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Atzeni, Matteo; Ribuffo, Diego [Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Mallarini, Giorgio [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Suri, Jasjit S. [Biomedical Technologies Inc., Denver, CO (United States); Idaho State University (Aff.), ID (United States)

    2012-08-15

    Purpose: Our purpose was to compare two post-processing techniques, Maximum-Intensity-Projection (MIP) and Volume Rendering (VR) for the study of perforator arteries. Methods: Thirty patients who underwent Multi-Detector-Row CT Angiography (MDCTA) between February 2010 and May 2010 were retrospectively analyzed. For each patient and for each reconstruction method, the image quality was evaluated and the inter- and intra-observer agreement was calculated according to the Cohen statistics. The Hounsfield Unit (HU) value in the common femoral artery was quantified and the correlation (Pearson Statistic) between image quality and HU value was explored. Results: The Pearson r between the right and left common femoral artery was excellent (r = 0.955). The highest image quality score was obtained using MIP for both observers (total value 75, with a mean value 2.67 for observer 1 and total value of 79 and a mean value of 2.82 for observer 2). The highest agreement between the two observers was detected using the MIP protocol with a Cohen kappa value of 0.856. The ROC area under the curve (Az) for the VR is 0.786 (0.086 SD; p value = 0.0009) whereas the ROC area under the curve (Az) for the MIP is 0.0928 (0.051 SD; p value = 0.0001). Conclusion: MIP showed the optimal inter- and intra-observer agreement and the highest quality scores and therefore should be used as post-processing techniques in the analysis of perforating arteries.

  1. 腓动脉穿支蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损与骨髓炎创面%Repair of soft tissue defect and osteomyelitis wound in the ankle and foot with peroneal perforator-based sural neurofasciocutaneous flap

    Institute of Scientific and Technical Information of China (English)

    彭辉煌; 吴建伟

    2012-01-01

    Objective To study the clinical effects for reconstruction the soft tissue defect and osteomyelitis wound in the ankle and foot with sural neurocutaneous vascular flap pedicled on the perforating branch of peroneal artery. Methods 26 patients with soft tissue defect in the heel and foot were treated with sural neurocutaneous vascular flap. The size of soft tissue defect was from 5 cm ×3. 5 cm to 18cm x 10cm, and the size of obtained flaps were from 6. 0 cm × 4 cm to 18 cm × 12 cm. Results All flaps survived through the postoperative follow-up( range from 3 to 12 months ). Vascular crisis occurred in 2 patients and obtained improvement after suture release and hyperbaric oxygen therapy. The margin necrosis of flap occurred in 2 patients, wound infection occurred in 2 patients and donor skin grafts necrosis in one. All wound healed after dressing change. The texture and function of flaps were satisfactory. Conclusions The sural neurocutaneous vascular flap pedicled on the perforating branch of peroneal artery is ideal flap for reconstruction the defect in the ankle and foot for reliable blood supply,less invasive and unstricted microsur-gical technique.%目的 探讨腓动脉穿支腓肠神经营养血管逆行岛状皮瓣修复足踝部创面的临床疗效.方法 采用腓动脉穿支腓肠神经营养血管逆行岛状皮瓣修复足踝部创面26例,创面缺损范围5 cm×3.5 cm~18 cm×10 cm,皮瓣切取面积6.0 cm×4 cm~18 cm×12 cm.结果 26例均得到随访,时间3~12月.患者皮瓣均存活.术后发生皮瓣血管危象2例,予拆除缝线、高压氧治疗好转;皮瓣边缘部分坏死2例,供区植皮坏死1例、感染2例,均经换药治愈.皮瓣外观及功能满意.结论 腓动脉穿支腓肠神经营养血管逆行岛状皮瓣血供可靠,损伤小,不需要显微外科技术,是修复足踝部软组织缺损的较理想皮瓣.

  2. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural artery flap.

    Science.gov (United States)

    Abhyankar, Suhas V; Kulkarni, Ananta; Agarwal, Naveen Kumar

    2009-10-01

    Ruptured tendoachilles along with skin defect is a complex problem to reconstruct. Both things require a priority. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural arterial flap allows us to perform both. This procedure gives excellent result, shortens the stay, thereby reducing the cost. This method is a simple solution to the complex problem like ruptured tendoachilles with skin defect. In this study, 6 patients with rupture of tendoachilles tendon due to penetrating injury, with skin defect are presented. The repair was done using aponeurotic part of tendoachilles tendon, taken from proximal part of tendoachilles in the midline measuring around 2 to 2.5 cm in width and 8 to 10 cm in length, with intact distal attachment. The tendon was turned upside down by 180 degrees and sutured to the distal stump of the tendoachilles tendon without tension. The skin defect was covered using distally based superficial sural artery flap in the same sitting. The follow-up period was 9 to 30 months. All patients showed good results. In one patient there was distal necrosis of 1.5 cm of the distally based superficial sural artery flap, which healed satisfactorily with conservative treatment. Single stage tendoachilles reconstruction can be used with good functional result and patient satisfaction.

  3. Patient-Reported Assessment of Functional Gait Outcomes following Superior Gluteal Artery Perforator Reconstruction

    Directory of Open Access Journals (Sweden)

    Kevin Hur, BA

    2013-08-01

    Conclusions: SGAP flap surgery causes no statistically significant differences in overall LEFS. However, SGAP patients did report donor-site morbidity with decreased ability to perform certain activities and increased fatigue and pain in the longer follow-up period. We feel that patients should be educated regarding gait issues and undergo physical therapy during the early postoperative period.

  4. Supercharging and Augmenting Venous Drainage of an Anterolateral Thigh Free Flap: Options and Indications

    Directory of Open Access Journals (Sweden)

    Frederic W.-B. Deleyiannis, MD, MPhil, MPH

    2014-04-01

    Full Text Available Summary: This study introduces the options for supercharging and augmenting venous drainage of an anterolateral thigh free flap. Clinical indications and options for additional microvascular anastomoses are reviewed in 5 consecutive patients. The indications were simultaneous mucosal and cutaneous defects, divergent mucosal defects, and extensively wide and long cutaneous defects. Three additional vascular pedicles were anastomosed: the transverse branch of the lateral circumflex (n = 3, a perforator coming directly off the superficial femoral artery (n = 1, and a posterior perforator from the profundus femoral artery (n = 1. The anastomosis of a separate pedicle from the superior, medial, and/or posterior-lateral thigh may be a useful technique when confronted with an extensive defect that may not reliably be reconstructed with a routine anterolateral thigh flap based on a single perforator.

  5. Quantifying Blood Flow in the DIEP Flap: An Ultrasonographic Study

    Directory of Open Access Journals (Sweden)

    Joseph Richard Dusseldorp, BCom, MBBS(Hons

    2014-10-01

    Conclusions: This study confirms that perforator size is a critical factor in optimizing blood flow in perforator-based free tissue transfer. Further research is required to understand the flow dynamics of perforator flaps based on multiple perforators. However, surgeons should be cognizant that a single large perforator may have substantially higher flow rates than multiple small perforators. Routine FVI calculation is recommended to ensure complete flap survival.

  6. 股前外侧游离穿支皮瓣移植修复头面四肢肿瘤切除术后的软组织缺损%Anterolateral thigh perforator free flaps transplantation for repair of head and extremeties soft tissue defects after tumor resection

    Institute of Scientific and Technical Information of China (English)

    李利平; Peter C.Neligan; 姚刚

    2007-01-01

    males and 3 females aged from 26 to 72 years. The anterolateral thigh perforator free flap for reconstruction of the soft tissue defects and/or bone exposure occurred on the head (nine cases, mean age of 50 years) or extremities (seven cases, mean age of 39 years) following tumor resection. All patients provided the informed consent.METHODS: After general anaesthesia with tracheal intubation, a two-team approach was used for resection of the tumor, and harvest of the free flap simultaneously or successively. The tumor was removed by head and neck surgeon or orthopedic surgery. And the plastic surgeons assumed the responsibility for reconstruction of the defects following the tumor resection. The dissection of recipient blood vessels (e.g., superior thyroid artery, facial artery, a branch of internal jugular vein, or external jugular vein, artery and vein of dorsal of foot, anterior tibial artery or vein) was performed. In addition, the ends of sural nerve at recipient sites that need be repaired with the anterolateral thigh cutaneous nerve were utilized in two cases with soft tissue defect on the lateral malleolus. The dimensions of the anterolateral thigh perforator flaps were determined on the basis of the defect size. The perforator flap design: A line was drawn between anterosuperior iliac spine and lateral-superior patella for the longitudinal axis of the flap. The required perforator was sought at the middle point of the longitudinal axis in the anterolateral thigh. In general, there would be one to two major perforating branches were confirmed with an ultrasound Doppler monitoring device in the flap. In this article, the biggest anterolateral thigh perforator flap measured 28 cm×15 cm with two major perforating branches. Incision of the skin and subcutaneous tissue was carried out along the periphery of the flap, and dividing and separating subcutaneous tissue layer from deep fascia layer was performed under surgical loupe magnification little by little

  7. Breast reconstruction with superficial inferior epigastric artery flap%腹壁浅动脉蒂游离腹壁皮瓣乳房再造术的初步临床应用

    Institute of Scientific and Technical Information of China (English)

    穆大力; 栾杰; 穆兰花; 严义坪

    2010-01-01

    Objective To present a method for breast reconstruction with the superficial inferior epigastric artery (S1EA) flap and to summarize the operative experiences. Methods The diameter and distribution were evaluated with multipledetector-row computed tomography (MDCT) angiography and doppler perfusion flowmeter. Bipedicle superficial inferior epigastric artery flap was designed below umbilicus. Superficial inferior epigastric artery and vein were anastomosed to the internal mammary artery and vein. Results Since 2007, we have used the superficial inferior epigastric artery flap in 4 cases of breast reconstruction. Four flaps survived completely. With the follow-up of 6-12 months, the reconstructed breasts were well-shaped and there were no complications such as abdominal hernia, bulge and weakness in donor sites. Conclusions Breast reconstruction using the superficial inferior epigastric artery flaps can not only preserve the advantages of the traditional method using the deep inferior epigastric perforator flaps, but also retain the maximal function of the fascia and the rectus abdominal muscle and prevent the occurrence of abdominal weakness and hernia. It is an ideal alternative method of breast reconstruction on condition that definitive preoperative assessment of vessels and skilled surgical technique are provided.%目的 探讨采用腹壁浅动脉(superficial inferior epigastric artery,SIEA)蒂游离腹壁皮瓣乳房再造术方法 、特点及适应证.方法 术前采用多层螺旋CT(multipledetector-row computed tomography,MDCT)三维血管造影及多普勒血流探测仪检查SIEA的直径、走行及分布,于脐与阴阜上缘之间设计皮瓣,采用单蒂或双蒂SIEA,与胸廓内动,静脉吻合,腹部供区直接拉拢缝合.结果 4例乳房再造病例皮瓣全部存活,皮瓣和腹部供区无脂肪液化、坏死、切口裂开、腹壁薄弱及腹壁疝等并发症的出现,再造乳房外形效果满意.结论 SIEA蒂游离腹壁皮瓣与腹

  8. 胸腹部扩张后穿支皮瓣跨区远位修复颌面部及上肢瘢痕术后缺损%REPAIR OF FACE AND UPPER LIMB DEFECTS WITH EXPANDED DELTO-PECTORAL AND ABDOMINAL PERFORATOR FLAPS

    Institute of Scientific and Technical Information of China (English)

    张淼淼; 赵宇; 汪春兰; 孙伟

    2012-01-01

    Objective To investigate the method and effectiveness of expanded delto-pectoral and abdominal perforator flaps in repairing large defects of the face and upper limb after scar excision. Methods Between August 2000 and February 2011, 25 patients with large scars on face and upper limb were treated. There were 14 males and 11 females with an average age of 27 years (range, 7-36 years). Scars causes were burn and scald in 25 cases with a disease duration of 6 months to 7 years (mean, 4.5 years). The hypertrophic scars located at face in 15 cases, and at upper limb and hand in 10 cases. The soft tissue expanders (300-500 mL in volume) were implanted in the delto-pectoral zone and abdominal region in one-stage operation. In two-stage operation, after scars were resected, defects (9 cm×7 cm to 17 cm×8 cm) were repaired with the delto-pectoral perforator flaps (17 cm×7 cm to 20 cm×8 cm) in 15 facial scar cases and with the deep inferior epigastric artery perforator flaps (10 cm×9 cm to 25 cm×14 cm) in 10 upper limb and hand scar cases. The donor sites were sutured directly. Results Partial necrosis of the flaps occurred in 2 cases after operation, then the flap survived after expectant treatment. The other flaps and skin grafts survived successfully, and the incisions healed by first intention. Ten patients were followed up 6 months to 4 years. The appearance, texture, and color of the flaps were similar to those at the donor site. Conclusion It is an effective method to use the delto-pectoral perforator flap and the deep inferior epigastric artery perforator flap for repairing soft tissue defects of the face and upper limb after scar excision.%目的 探讨胸腹部扩张后穿支皮瓣跨区远位修复颌面部及上肢瘢痕切除后创面的方法及疗效. 方法 2000年8月-2011年2月,收治25例颌面部及上肢烧烫伤后瘢痕患者.男14例,女11例;年龄7~36岁,平均27岁.颌面部瘢痕15例,其中双侧6例;上肢及手部瘢痕10

  9. The pedicled thoraco-umbilical flap: A versatile technique for upper limb coverage

    Directory of Open Access Journals (Sweden)

    Mishra Sharad

    2009-01-01

    Full Text Available Injuries to upper limb has been on the increase and is invariably associated with significant soft tissue loss requiring a flap cover. Local tissue may not be available for cover in a majority of situations, necessitating import of tissue from a distant source. We have utilized the thoraco-umbilical flap taken from the trunk for this purpose. This flap is based on the perforators of the deep inferior epigastric artery that are maximally centred on the periumbilical region.This flap was used in 83 patients. The patients were observed for at least 3 weeks and any flap or donor site complications were recorded. The patients were again followed up at 3 months interval and the donor site scar was assessed. The flaps survived in 81 patients; there was marginal flap necrosis in five patients and partial flap necrosis in two patients. None of these patients required any additional procedure for coverage. The flap is technically easy to plan, almost effortless to drape around upper limb defects, with no significant donor site morbidity and also the post operative immobilization was fairly comfortable. The thoraco-umbilical flap thus is a very useful technique for coverage of the upper limb and is recommended as a first line flap for this purpose.

  10. Reconstruction of front feet skin defects using the peroneal artery perforator-based propeller%游离腓动脉穿支皮瓣修复前足皮肤缺损

    Institute of Scientific and Technical Information of China (English)

    欧学海; 许玉本; 尚驰; 杜小龙; 朱建军; 夏雷

    2013-01-01

    Objective To investigate the use of free transplantation of peroneal artery perforator-based propeller to the repair of the front feet skin defect.Methods Thirteen cases with front foot skin defect patients repaired through transplation of propeller flap of the peroneal artery from January 2009 to September 2012.The wound range was 5 cm ×4 cm-11 cm × 14 cm.The propeller flap of the peroneal artery designed according to the position of the propeller of the peroneal artery in a leg.The wound of the leg were repaired through suture directly or transplantation of skin.Results All 13 cases of free propeller flap were survived,the wound healing goodly.One case with the postoperatie blood vessels were removed by the surgical exploration.The time of follow-up between 3 and 17 months(mean 9.4 months).The quality of free flap was good.The function of walk of the foot repaired were not significantly affect.The patients were satisfactory to the results.The wound of the leg healed well ; The leg had no obvious muscle cicatricial adhesion.According to the foot disease treatment effect evaluation standard (JOA) evaluation,the result for 77-100 points,an average of 85.5 points.Conclusion Using propeller flap of the peroneal artery to repair the skin defect of front feet with a little injury,the skin texture more close to the repaired area,it is a reasonable approach.%目的 探讨利用小腿腓动脉穿支皮瓣游离移植修复前足皮肤缺损. 方法 2009年1月至2012年9月,共收治13例前足部皮肤缺损患者,创面范围5 cm×4cm~11 cm×14 cm.依据腓动脉于小腿发出的穿支设计小腿后外侧腓动脉穿支皮瓣游离移植修复前足创面;小腿创面采用直接缝合或全厚皮片移植覆盖. 结果 13例患者术后游离皮瓣均成活,创面均一期愈合,其中1例术后出现血管危象,经手术探查解除.术后随访3 ~17个月,平均9.4个月.游离皮瓣质地良好,修复足功能行走无明显影响,患者对疗效满意.

  11. Flow-through posterior interrosseous artery flaps for repair of digital wounds combined with artery injury%游离骨间后动脉血流桥接皮瓣修复伴指动脉缺损的手指创面

    Institute of Scientific and Technical Information of China (English)

    李涛; 陈振兵; 丛晓斌; 艾方兴; 周攀; 洪光祥

    2014-01-01

    .Conclusions Flow-through posterior interrosseous artery flaps are safe and effective to cover digital wounds and restore blood circulation.The technique improves the clinical application of perforator flaps.

  12. Lateral supramalleolar antidromic perforator flap for skin and soft tissue defects of the forefoot and midfoot%外踝上逆行穿支皮瓣修复前中足皮肤软组织缺损

    Institute of Scientific and Technical Information of China (English)

    高翔; 尤涛; 邓英虎; 王欣; 张可可; 李胜华

    2014-01-01

    目的:探讨外踝上逆行穿支皮瓣修复前中足皮肤软组织缺损的临床疗效。方法采取回顾性方法对我院2008年1月至2013年10月间15例足背皮肤软组织缺损患者应用外踝上逆行穿支皮瓣修复的治疗效果进行分析。结果本组皮瓣13例全部成活,2例皮瓣部分边缘坏死,经换药后愈合。随访时间为6~19个月,平均随访时间(12.5±0.5)个月。术后未见有皮瓣和皮片磨损的情况发生,且外观比较满意,穿鞋也无影响。患者的临床治疗总有效率100%。结论临床中外踝上逆行穿支皮瓣修复足背皮肤软组织缺损效果显著,能够有效的提高患者的临床治疗效果,且避免二次手术,值得临床中应用与推广。%Objective To investigate the clinical effects of lateral supramalleolar antidromic per-forator flap on repairing skin and soft tissue defects of the forefoot and midfoot.Methods The therapeutic effects of lateral supramalleolar antidromic perforator flap were retrospectively analyzed in 15 patients with skin and soft tissue defects of the dorsal foot from January 2008 to December 2013.Results The flap sur-vived in 13 cases.Two cases had flap edge necrosis and healed after dressing change.The follow-up time ranged from 6 months to 19 months,with an average of(12.5 ±0.5 )months.No abrasions of flap or skin graft were observed.The appearance was satisfactory and it did not affect wearing shoes.The total effective rate was 100%.Conclusion In the treatment of skin and soft tissue defects of the dorsal foot,lateral su-pramalleolar antidromic perforator flap can effectively improve clinical efficiency and avoid reoperation, which is worthy of being spread in clinical practice.

  13. Reconstrucción de la extremidad inferior con colgajos de perforantes locales Perforator local flaps in lower limb reconstruction

    OpenAIRE

    T. C. Teo

    2006-01-01

    Las innovaciones técnicas en el diseño y elevación de colgajos y los recientes avances en el conocimiento de la perfusión arterial de los mismos, ha conducido hacia un tipo de reconstrucción más refinada para todas las partes del cuerpo. El concepto de colgajos basados en vasos perforantes ha evolucionado a partir de estos avances. La reconstrucción de la extremidad inferior se ha beneficiado particularmente de este desarrollo de los colgajos de perforantes, tanto pediculados como libres. El ...

  14. Clinical Effects of Conjunctival Flap Surgery on Perforated Corneal Ulcers%结膜瓣遮盖术治疗角膜溃疡穿孔临床观察

    Institute of Scientific and Technical Information of China (English)

    郎绍文

    2012-01-01

    Objective To evaluate the therapeutic effect of conjunctival flap surgery on perforated corneal ulcers. Methods Thirteen patients(13 eyes) with perforated corneal ulcers were referred between February 2005 and August 2010. The perforation occurred in the areas of pupil in 8 patients ( 8 eyes) , in the areas of periphery in 5 patients ( 5 eyes ) . The perforations were caused by corneal ulceration in all cases. The conjunctival flap surgery was performed to cover the perforations. The healing of corneal perforation and the status of anterior chamber were observed. All patients were followed up for 3 - 12 months( mean 7. 5 months) . Results All patients were followed up for 3-12 months. All corneas ulcers were healed and normal anterior chamber depth were recovered. The visual acuity of treated eyes was improved. The vision of patients with perforations around cornea was improved to 0. 8 or higher, and of patients with perforations of center was improved to 0. 02 to 0. 40. The 0. 5 - 2. 0 mm leukomas were formed. The nebula was formed on ulcers areas of cornea. No neovascularization invading into the corneas. Conclusion The conjunctival flap surgery for the perforated corneal ulcers is helpful to the healing of corneal and the forming of anterior chamber;it can also improve the vision of patients. It is a safe, easy-operated and effective method to treat perforated corneal ulcers.%目的 探讨结膜瓣遮盖术治疗角膜溃疡穿孔的疗效.方法 选择2005年2月-2010年8月治疗角膜溃疡穿孔患者13例13眼,穿孔在角膜瞳孔区8例8眼,周边区5例5眼,穿孔原因:均为角膜溃疡所致;采用结膜瓣遮盖术治疗;观察角膜溃疡穿孔愈合情况及前房形成情况,随访3 ~12个月,平均7.5个月.结果 随访时间3~12个月,角膜溃疡愈合良好,所有病例前房均形成,治疗眼视力均有不同程度提高,其中角膜周边区穿孔视力恢复均在0.8或以上,角膜中央区穿孔视力恢复在0.02 ~0.40,

  15. Detection on distribution and flowing dynamics of cutaneous perforators of tibial anterior arteries with col-or Doppler flow imaging%彩色多普勒超声对胫前动脉穿支皮瓣血管的研究

    Institute of Scientific and Technical Information of China (English)

    高慧; 胡建群

    2015-01-01

    ).In the distal segment, we found relatively few perforators.The perforating points of cutaneous branches mostly (55.5%case) ap-peared within 15-27 cm length above the lateral maleollus of fibula.There were no significant differences in the peak systolic velocity between left and right cutaneous perforators.Conclusion The color Doppler ultrasonography with high resolution could show the distri-bution and location clearly, assess the quality of the blood flow of perforators artery, and provide scientific basis for planning skin flap.

  16. Clinic application of micro-dissected perforator flap technique for defatting bulky flap at the second stage%显微削薄穿支皮瓣技术在臃肿皮瓣二期削薄中的应用

    Institute of Scientific and Technical Information of China (English)

    唐举玉; 周征兵; 吴攀峰; 俞芳; 肖勇兵; 潘丁; 庞晓阳; 曾磊; 卿黎明

    2016-01-01

    Objective To explore the feasibility and clinic effect of the micro-dissected perforator flap technique for defatting bulky flap at the second stage.Methods From October, 2013 to June, 2014, 9 patients had been performed to preserve 3-5 mm thickness of fascia-fatty tissue on the recipient site, remove the subcutaneous tissue uniformly around the perforator under microscope and protect the vascular pedicle and perforator vessel carefully.Results The 9 bulky flap which were taken defatting procedure survived and the wounds got healed primarily.All the patients were followed up for 3-12 months (average 6 months), the flap bulky appearance significantly reduced, and the function were improved obviously.Conclusion The micro-dissected perforator flap technique is an ideal method for defatting the bulky flap at the second stage as it can keep reliable blood supply, get good appearance and the procedure can be finished at one time.%目的 探讨显微削薄穿支皮瓣技术应用于臃肿皮瓣二期削薄的可行性与临床疗效.方法 从2013年10月至2014年6月,应用显微削薄穿支皮瓣技术治疗皮瓣移植术后臃肿畸形9例,手术显微镜下分离并保护好穿支血管,保留真皮下脂肪3~5mm,去除多余脂肪组织.结果 9例术后皮瓣无1例坏死,创口均一期愈合.术后随访3~12个月,平均6个月.皮瓣色泽正常,质地良好,受区外形及功能明显改善.结论 应用显微削薄穿支皮瓣技术对臃肿皮瓣二期削薄能一次完成手术,术后皮瓣血供可靠,外形良好,是一种理想的皮瓣削薄新方法.

  17. DIEP Flap Breast Reconstruction Using 3-dimensional Surface Imaging and a Printed Mold

    Directory of Open Access Journals (Sweden)

    Koichi Tomita, MD, PhD

    2015-03-01

    Full Text Available Summary: Recent advances in 3-dimensional (3D surface imaging technologies allow for digital quantification of complex breast tissue. We performed 11 unilateral breast reconstructions with deep inferior epigastric artery perforator (DIEP flaps (5 immediate, 6 delayed using 3D surface imaging for easier surgery planning and 3D-printed molds for shaping the breast neoparenchyma. A single- or double-pedicle flap was preoperatively planned according to the estimated tissue volume required and estimated total flap volume. The DIEP flap was then intraoperatively shaped with a 3D-printed mold that was based on a horizontally inverted shape of the contralateral breast. Cosmetic outcomes were assessed as satisfactory, as confirmed by the postoperative 3D measurements of bilateral breasts. We believe that DIEP flap reconstruction assisted with 3D surface imaging and a 3D-printed mold is a simple and quick method for rebuilding a symmetric breast.

  18. Experience with peroneus brevis muscle flaps for reconstruction of distal leg and ankle defects

    Directory of Open Access Journals (Sweden)

    Babu Bajantri

    2013-01-01

    Full Text Available Objective: Peroneus brevis is a muscle in the leg which is expendable without much functional deficit. The objective of this study was to find out its usefulness in coverage of the defects of the lower leg and ankle. Patients and Methods: A retrospective analysis of the use of 39 pedicled peroneus brevis muscle flaps used for coverage of defects of the lower leg and ankle between November 2010 and December 2012 was carried out. The flaps were proximally based for defects of the lower third of the leg in 12 patients and distally based for reconstruction of defects of the ankle in 26 patients, with one patient having flaps on both ankles. Results: Partial flap loss in critical areas was found in four patients requiring further flap cover and in non-critical areas in two patients, which were managed with a skin graft. Three of the four critical losses occurred when we used it for covering defects over the medial malleolus. There was no complete flap loss in any of the patients. Conclusion: This flap has a unique vascular pattern and fails to fit into the classification of the vasculature of muscles by Mathes and Nahai. The unusual feature is an axial vessel system running down the deep aspect of the muscle and linking the perforators from the peroneal artery and anterior tibial artery, which allows it to be raised proximally or distally on a single perforator. The flap is simple to raise and safe for the reconstruction of small-to moderate-sized skin defects of the distal third of the tibia and all parts of the ankle except the medial malleolus, which is too far from the pedicle of the distally based flap. The donor site can be closed primarily to provide a linear scar. The muscle flap thins with time to provide a good result aesthetically at the primary defect.

  19. A conservative surgical approach for management of iatrogenic pulmonary artery perforation

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    Monodeep Biswas

    2012-01-01

    Full Text Available Accidental malposition of a chest tube in the pulmonary artery is a potentially fatal complication. Here we describe a 66 year-old obese woman with prior cardiac transplantation, intubated for respiratory failure and felt to have a large left pleural effusion. A chest tube was inserted using a trocar tube, and resulted in near-exsanguinating hemorrhage immediately, with development of hypovolemic shock. Prompt clamping of the tube proved life-saving, and CT scan confirmed placement of the tube in the main pulmonary artery. Initial stabilization, followed by a planned surgical approach, resulted in successful removal of the tube.

  20. Complex Technique of Large Sural Flap: An Alternative Option for Free Flap in Large Defect of the Traumatized Foot

    Directory of Open Access Journals (Sweden)

    Naser Mohammadkhah

    2011-04-01

    Full Text Available The distally based sural fasciocutaneous flap has become a main part of the reconstruction of the lower leg, heel and foot. However, perfusion problems and venous congestion have been reported. Over the past decade, several flap modifications have been reported to improve flap viability and to solve a myriad of reconstructive needs. The purpose of this paper is to describe our experience in harvesting the reversed large sural flap from the proximal and middle third of the leg for large defects on the foot. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot. The technique was done in 3 parts: 1- the flaps were designed in the proximal third of the leg five centimeter lipofascial tissue was protected around the pedicle in distal part; 3- The pivot point was located in seven to eight cm proximal the lateral malleolus before the first fasciocutaneous perforators arising from the peroneal artery. Sural flaps from the proximal and middle third of the leg were designed in13 patients who had large defects on their foot. No flap necrosis or split thickness skin graft loss occurred. The flaps healed by the 3rd week excluding two patients. This study supports the application of our technique as a safe, easy and useable method in large defects of the foot. The results showed low rates of ischemia, venous congestion, dehiscence, infection and flap necrosis. Proximal extended and large distally based sural flap is an alternative to free tissue transfer for large defect reconstruction of the foot.

  1. Use of preoperative ultrasound in designing the true pectoralis major myocutaneous island flap

    Institute of Scientific and Technical Information of China (English)

    CHEN Xiao-hong; ZHAO Han-xue; FANG Ju-gao; YU Zhen-kun; HUANG Zhi-gang

    2012-01-01

    Background Traditional techniques used for harvesting the pectoralis major myocutaneous (PMMC) flap have accompanying disadvantages,such as the necessity for an upper chest skin incision,the bulkiness of myocutaneous tissue at the pedicle of the flap,and the risk of total or partial necrosis of flap tissue.The aim of this study was to develop a safe and fast method for preparing PMMC island flaps using preoperative ultrasonography for vessel detection.Methods Forty-one PMMC island flaps were used for one-stage reconstruction of head and neck defects,including 21 cases in the treatment group and 20 cases in the control group.In the treatment group,ultrasonography was used to mark out the course of the thoracic branches of the thoracoacromial artery and the lower end of this artery perforating from the fascia into the muscles,as well as the largest perforating branch of the fourth or fifth internal mammary artery entering the PMMC flap.A line,from the lower end of the thoracic branch to the largest perforating branch of the fourth or fifth internal mammary artery,was drawn to determine the axis of the PMMC flap.In the control group,PMMC island flaps were designed according to conventional methods without using ultrasonography.Results According to the ultrasonic marks,the distance from lower end of thoracic branch to the midpoint of the margin of the inferior clavicular was (5.1±1.2) cm.The time from designing to transferring the island flap was significantly shorter in the treatment group ((51.0±10.5) minutes) compared with the control group ((78.0±13.9) minutes,P <0.01).The rate of partial necrosis was 4.7% (1/21) in the treatment group and 35.0% (7/20) in the control group.There was one case of flap failure in the control group due to vascular injury during vascular pedicle dissection.Conclusion Preoperative vessel detection by ultrasonography facilitates easy and safe harvesting of the true PMMC island flap.

  2. 腓血管蒂腓骨嵌合组织瓣设计的解剖学基础%Anatomical basis for design of the chimeric fibular composite flap based on the peroneal artery

    Institute of Scientific and Technical Information of China (English)

    谢志平; 庄跃宏; 郑和平; 章一新; 梁成; 郝攀登; 张发惠

    2014-01-01

    Objective To provide anatomical basis for design of the chimeric fibular composite flap based on the peroneal artery. Methods 30 cadaveric lower extremities were used for this study. The fibular head and the lateral malleolus were used as the landmarks and the calves were divided into the upper, middle and lower segments, respectively. Dissection of the calves was carried out and the following contents were investigated: ① The origin, course and branches of the peroneal arteries; ② The number of the musculocutaneous or septocutaneous perforators of the three segments and the periosteal branches from the peroneal arteries. Results The peroneal artery originated from the tibial artery and travelled immediately posteriorly to the fibular bone after it coursed to the middle segment of the fibular. It continued as the lateral calcaneal artery, giving off the branches to nourish the adjacent bones, muscles, and the skin on the lateral aspect of the lower leg. Among the branches given off, 2 to 8 branches were to the periosteum of the middle and lower 1/3 of the fibular bone, averaging 0.5 to 1.1 in diameter, which were termed fibular periosteal arteries; 1 to 3 branches were to the middle and lower 1/3 of the tibial periosteum, averaging 0.6 to 0.8 in diameter, which were termed tibial periostal arteries; 4 to 8 branches were the musculocutaneous or septocutnaoues perforators supplying the skin on the lateral aspect of the middle and lower segments of the lower leg. After piercing the deep fascia, the septocutaneous perforators anastomosed with the perforators from the anterior and posterior tibial arteries. Conclusions It is anatomically feasible to harvest the chimeric fibular composite flap based on the peroneal artery, depending on the practical clinical needs;one type or multiple types of chimeric flaps can be harvested to reconstruct combined defects of bone and soft tissue.%目的:为腓血管蒂腓骨嵌合组织瓣设计提供解剖学依据。方法用30

  3. 激光脱毛在头皮扩张穿支皮瓣制备过程中的应用%Application of Laser Hair Removal in Preparation of Expanded Perforator Scalp Flap

    Institute of Scientific and Technical Information of China (English)

    董继英; 金锐; 谢峰; 昝涛; 王棽

    2015-01-01

    Objective To study the safety and efficacy of laser hair removal during expansion of the expanded perforator scalp flap. Methods From January 2014 to April 2015, 22 patients received expanded scalp flap preparation for reconstruction of facial soft tissue deformation were included. Diode laser therapy was used to remove hair during tissue expansion period. Results All patients completed the multiple-stage treatment:expander implantation-saline injection-laser hair removal-flap translocation. All flaps were survived after flap translocation. No thick hair was observed in 19 patients, small area of hair remaining was observed in 2 patients, and psilosis at hair edge was observed in 1 patient. Transient blister was observed in one patient after laser hair removal, which subsided without treatment. No long-term adverse events were observed. Conclusion Laser hair removal technique can be safely and effectively used for the preparation of expanded scalp flap. Improvements of facial appearance and satisfaction can be achieved.%目的:探讨在头皮扩张皮瓣的扩张期进行激光脱毛的安全性及疗效。方法2014年1月到2015年4月,选择22例应用头皮扩张穿支皮瓣修复面部软组织缺损的患者,在注水扩张期使用半导体激光进行脱毛治疗。结果22例患者均完成了扩张器置入-注水扩张-激光脱毛-转移修复的序贯疗程。转移修复术后皮瓣均存活,19例皮瓣表面无明显粗长毛发,2例皮瓣仍有少量毛发残留,1例发际边缘小面积秃发。1例患者在激光治疗后出现水疱,1周后自愈,未观察到长期并发症。结论激光脱毛技术可安全有效地应用于头皮扩张穿支皮瓣的制备过程,改善皮瓣修复术后患者面部外观,提高手术满意率。

  4. Decision making in double-pedicled DIEP and SIEA abdominal free flap breast reconstructions: An algorithmic approach and comprehensive classification.

    Directory of Open Access Journals (Sweden)

    Charles M Malata

    2015-10-01

    Full Text Available Introduction: The deep inferior epigastric artery perforator (DIEP free flap is the gold standard for autologous breast reconstruction. However, using a single vascular pedicle may not yield sufficient tissue in patients with midline scars or insufficient lower abdominal pannus. Double-pedicled free flaps overcome this problem using different vascular arrangements to harvest the entire lower abdominal flap. The literature is, however, sparse regarding technique selection. We therefore reviewed our experience in order to formulate an algorithm and comprehensive classification for this purpose. Methods: All patients undergoing unilateral double-pedicled abdominal perforator free flap breast reconstruction (AFFBR by a single surgeon (CMM over 40 months were reviewed from a prospectively collected database. Results: Of the 112 consecutive breast free flaps performed, 25 (22% utilised two vascular pedicles. The mean patient age was 45 years (range=27-54. All flaps but one (which used the thoracodorsal system were anastomosed to the internal mammary vessels using the rib-preservation technique. The surgical duration was 656 minutes (range=468-690 mins. The median flap weight was 618g (range=432-1275g and the mastectomy weight was 445g (range=220-896g. All flaps were successful and only three patients requested minor liposuction to reduce and reshape their reconstructed breasts.Conclusion: Bipedicled free abdominal perforator flaps, employed in a fifth of all our AFFBRs, are a reliable and safe option for unilateral breast reconstruction. They, however, necessitate clear indications to justify the additional technical complexity and surgical duration. Our algorithm and comprehensive classification facilitate technique selection for the anastomotic permutations and successful execution of these operations.

  5. [Fasciocutaneous flap of the posterior surface of the thigh with distal pedicle. Anatomical study and surgical value. A propos of 3 cases].

    Science.gov (United States)

    Lambert, F; Cariou, J L; Couturaud, B; Bellavoir, A

    1996-04-01

    In the light of previous studies, the authors conducted an anatomical study on 21 cadaveric dissections with injection in order to define the characteristics of the distally based fasciocutaneous flap of the posterior surface of the thigh, described for the first time in 1988 by Maruyama. This leaf-shaped flap extends from the popliteal region to the gluteal sulcus. It possesses an axial arterial network derived from the popliteal artery, reinforced by the perforating arteries derived from the vessel or the profunda femoris artery. The venous return is ensured by venae comitantes and the communicating saphenous vein. The flap raising technique is described. From 1991 to 1994, 3 patients were operated in order to cover a defect of the knee (1 case) and amputation stumps (2 cases). The postoperative course was uneventful and the results were considered to be stable and of excellent quality with a follow-up of 2 to 4 years.

  6. The study of the treatment of Modified conjunctival flap microsurgery to the cornea infective ulcer with perforation or nearly perforation%改良结膜瓣遮盖术治疗穿孔或近穿孔感染性角膜溃疡的探讨

    Institute of Scientific and Technical Information of China (English)

    吴洁; 龙潭; 朱海峰; 马挺; 杜蕊; 程燕; 梁厚成

    2008-01-01

    Objective To investigate the treatment of the modified conjunctival flap microsurgery (m-CFM) to the cornea infective ulcer with perforation or nearly perforation. Methods The m-CFMs were operated to the 12 patients with perforated cornea ulcer and 52 ones with nearly perforated ulcer. Before surgeries, it should be done as possible as we could to control the infection. Then while surgery, the ulcers were cleared, and the conjunctival flap and the Tennon's capsule were sew on the cornea to envelope the ulcer in file. Results Among the patients with nearly perforation, the infections in 47 eyes were controlled by one surgery, as the same time, the flaps on other 5 eyes were dissolved in 2 weeks (the second surgeries were done to the 3 eyes of them, and succeeded, and the other 2 were abandoned), the surgeries to 12 eyes with perforation were all succeed, though 3 of them catch a secondary glaucoma. Conclusions The m-CFM could be done when the infection of the cornea ulcer was be controlled, and that is so easy to operate that it could be done at the elementary hospital, especially could be done to shorten the cure circle and to protect the eyes when the cornea transplantation couldn't be done.%目的 探讨应用改良结膜瓣遮盖术治疗感染基本控制的穿孔或近穿孔的感染性角膜溃疡.方法 选择感染基本控制的角膜溃疡穿孔12例、近穿孔病例52例(共64只眼).手术中溃疡面修剪清创,4%碘酊烧灼溃疡面或边缘(穿孔者),在临近角膜溃疡处转移球结膜瓣,将Tenon囊组织单层或多层于创面修剪后间断固定缝合,再将已转移的球结膜瓣遮盖于表面间断固定缝合.结果 47只角膜溃疡近穿孔患眼于术后一次成功,术后2W内余5只眼结膜瓣溶解脱落(3例再次结膜瓣手术成功,2例放弃治疗)手术一次成功率92.19%.角膜溃疡穿孔患眼术后成功率达100%,但是有3只眼术后发生继发性青光眼.结论 改良结膜瓣遮盖手术在角膜溃疡感

  7. (足母)趾胫侧底动脉蒂足内侧缘静脉营养血管皮瓣的临床应用%Clinical application of venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot

    Institute of Scientific and Technical Information of China (English)

    林涧; 梁成; 郑和平; 陆骅; 张天浩; 王之江; 万华俊

    2015-01-01

    目的 报道(足母)趾胫侧底动脉蒂足内侧缘静脉营养血管皮瓣的临床应用效果.方法 根据跨趾胫侧底动脉与足内侧缘静脉营养血管间吻合关系,以第1跖趾关节近端(2.2±0.7) cm 处的(足母)趾胫侧底动脉穿出点为旋转点,以旋转点与内踝尖之间足内侧缘静脉走向为轴心线,设计(足母)趾胫侧底动脉蒂足内侧缘静脉营养血管皮瓣,转位修复(足母)趾皮肤软组织缺损.结果 临床应用共5例,皮瓣均成活,创面一期愈合,经1~12个月随访,皮瓣质地优良、色泽接近正常,外形美观.结论 (足母)趾胫侧底动脉蒂足内侧缘静脉营养血管皮瓣可转位修复跨趾皮肤软组织缺损.%Objective To introduce the clinical application of venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot.Methods Based on the anastomoses between the medial plantar artery of the hallux and the nutritional vein,the flap was designed with the perforator of medial plantar artery adjacent to the first metatarsal bone as the rotation point.The flap axis was along the vein at the medial aspect of the foot between rotation point and medial malleolus.Results 5 cases were treated with primary healing and complete survival flaps.The patients were followed up for 1-12 months with good match of texture and color.Conclusions The venous nutrition flap pedicled by medial plantar artery of the hallux on the medical aspect of the foot can be transpositioned to repair the defect at forefoot.

  8. Ⅰ期移植复合股前外侧穿支皮瓣治疗ⅢC型开放性损伤%Primary composite anterolateral thigh perforator flap transfer for treatment of Gustilo type Ⅲ C open fracture

    Institute of Scientific and Technical Information of China (English)

    王欣; 潘佳栋; 黄耀鹏; 周丹亚; 胡瑞斌; 杨科跃; 陈宏; 章伟文

    2014-01-01

    Objective To investigate the procedure techniques and clinical effects for treatment of cases on the brink of amputation with composite anterolateral thigh perforator flap (ALTP) in primary surgery.Methods From July 2008 to December 2012,9 cases on the verge of amputation received primary composite ALTP transfer to perform limb salvage surgery.All cases were Gustilo type Ⅲ C open injuries resulted from traffic accidents which involved upper extremities in 3 cases and lower extremities in 6 cases.Emergent fracture fixation was done for 5 cases; primary external fixation followed by definitive bone grafting was done for 4 cases combined with bone defects.Types of flaps consisted of flow-through ALTPs in 4 cases,chimeric ALTPs in 2 cases,flow-through + chimeric ALTPs in 2 cases,flow-through + chimeric + polyfoliate ALTP in 1 case.Size of flaps ranged from 10 cm × 6 cm-22 cm × 9 cm.Donor sites were closed primarily.Results Limb salvage succeeded for all the 9 cases.Six flaps survived uneventfully,but another 3 flaps developed tension blisters and survived eventually after stitches removing and blood-letting.Postoperative follow-up was 5-36 months.All cases achieved bone union in 4.5-8 months (mean,6.3 months).Conclusion Emergent composite ALTP transfer can not only save the limb,but also reduce the recovery time and complications and contribute to the early recovery of limb function.%目的 探讨急诊Ⅰ期移植复合股前外侧穿支皮瓣(anterolateral thigh perforator flap,ALTP)挽救濒临截肢患者肢体的手术方法与临床疗效. 方法 2008年7月-2012年12月对9例濒临截肢的患者采用Ⅰ期移植复合ALTP进行保肢手术.所有患者均为交通伤所致的GustiloⅢC型开放性损伤.上肢3例,下肢6例,其中急诊行骨折内固定5例,伴骨缺损Ⅰ期予外固定、Ⅱ期行植骨内固定4例.移植单纯桥接动脉型ALTP 4例,单纯嵌合型AL-TP 2例,桥接动脉+嵌合型ALTP 2例,桥接动脉+嵌合+分叶型ALTP 1

  9. Repair of defects in lower extremities with peroneal perforator-based sural neurofasciocutaneous flaps%腓动脉穿支蒂腓肠神经营养血管皮瓣修复下肢缺损

    Institute of Scientific and Technical Information of China (English)

    王先成; 李晓芳; 方柏荣; 鲁青; 杨丽嫦; 孙杨; 阿米特; 高远; 唐亮

    2013-01-01

    目的 探讨应用腓动脉穿支蒂腓肠神经营养血管皮瓣修复下肢皮肤软组织缺损的手术方法及临床效果. 方法 2009年1月-2012年3月,笔者单位收治26例小腿下段及足部皮肤软组织缺损患者,其中车祸伤致小腿下段肌腱或骨外露9例,高压电击伤致足踝部皮肤坏死4例,小腿及足部慢性溃疡8例,足底压疮5例.彻底清创后,皮肤软组织缺损范围为11 cm×5 cm~18 cm×13 cm.根据缺损部位及大小设计切取腓动脉穿支蒂腓肠神经营养血管皮瓣,逆行转移修复皮肤软组织缺损.皮瓣切取面积12 cm ×6 cm ~20 cm× 15 cm.供瓣区直接拉拢缝合或植皮修复. 结果 25例皮瓣完全成活,1例皮瓣远端约2 cm×1 cm的区域坏死,经换药后愈合.随访6~12个月,皮瓣外形和局部感觉良好,无溃疡,行走正常. 结论 腓动脉穿支蒂腓肠神经营养血管皮瓣手术操作相对简便,血供可靠,蒂部臃肿不明显,能切取蒂部较长,皮瓣可切取面积较大,是修复小腿下段及足部皮肤软组织缺损的较佳方法.%Objective To explore the operative technique and clinical results of using peroneal perforator-based sural neurofasciocutaneous flaps to repair skin and soft tissue defects in lower extremities.Methods From January 2009 to March 2012,26 patients with skin and soft tissue defects at distal region of leg and foot were hospitalized.Among them,9 patients suffered from tendon or bone exposure at the distal region of leg after injury due to traffic accident; 4 patients suffered from skin defects in the ankle as a result of electric injury; 8 patients suffered from chronic ulcer at the distal part of leg and foot; 5 patients suffered from plantar pressure ulcer.After debridement,soft tissue defect sizes ranged from 11 cm × 5 cm to 18 cm ×13 cm.According to the position and size of the defects,peroneal perforator-based sural neurofasciocutaneous flaps were designed and procured to repair the skin and soft tissue

  10. The possibility for use of venous flaps in plastic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Baytinger, V. F., E-mail: baitinger@mail.tomsknet.ru; Kurochkina, O. S., E-mail: kurochkinaos@yandex.ru; Selianinov, K. V.; Baytinger, A. V. [Research Institute of Microsurgery, Tomsk (Russian Federation); Dzyuman, A. N. [Siberian State Medical University, Tomsk (Russian Federation)

    2015-11-17

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  11. The possibility for use of venous flaps in plastic surgery

    Science.gov (United States)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  12. Dual-dermal-barrier fashion flaps for the treatment of sacral pressure sores.

    Science.gov (United States)

    Hsiao, Yen-Chang; Chuang, Shiow-Shuh

    2015-02-01

    The sacral region is one of the most vulnerable sites for the development of pressure sores. Even when surgical reconstruction is performed, there is a high chance of recurrence. Therefore, the concept of dual-dermal-barrier fashion flaps for sacral pressure sore reconstruction was proposed. From September 2007 to June 2010, nine patients with grade IV sacral pressures were enrolled. Four patients received bilateral myocutaneous V-Y flaps, four patients received bilateral fasciocutaneous V-Y flaps, and one patient received bilateral rotation-advanced flaps for sacral pressure reconstruction. The flaps were designed based on the perforators of the superior gluteal artery in one patient's reconstructive procedure. All flaps' designs were based on dual-dermal-barrier fashion. The mean follow-up time was 16 months (range = 12-25). No recurrence was noted. Only one patient had a complication of mild dehiscence at the middle suture line, occurring 2 weeks after the reconstructive surgery. The dual-dermal fashion flaps are easily duplicated and versatile. The study has shown minimal morbidity and a reasonable outcome.

  13. Peroneal island flap for wound coverage in complex injuries of the lower extremity

    Directory of Open Access Journals (Sweden)

    Fazal A

    2012-01-01

    Full Text Available Akil Fazal1, Haroon-ur-Rashid1, Tahseen Cheema21Section of Orthopedics, Department of Surgery, Aga Khan University, Karachi, Pakistan; 2Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USABackground: Complex injuries of the lower extremity pose a therapeutic challenge owing to limited availability of local soft tissue for coverage. One option in this region is the pedicled fasciocutaneous flap based on perforators of the peroneal artery. In this case series, we present our experience of the peroneal island pedicled flap for reconstruction of lower extremity wounds.Methods: Records of 18 cases of peroneal island flap admitted consecutively to the Section of Orthopedics at Aga Khan University Hospital from January 1996 to December of 2009 were studied and their outcomes determined.Results: The most common indication for coverage was open wounds due to a road traffic accident (n = 10, followed by burns (n = 3. The most common area exposed was the lower third of the leg followed by the middle third. The tibia was exposed in 11 patients. The flaps ranged in size from 35 cm2 to over 200 cm2. In 13 patients, the flaps healed uneventfully, while in the remaining five there was partial flap necrosis. In four of the latter patients, the residual wound healed with conservative measures only, but the fifth patient required further surgery to achieve acceptable coverage.Conclusion: The peroneal artery flap appears to be a simple, useful, and reliable flap in the armamentarium of the surgeon when planning soft tissue coverage of the lower extremity.Keywords: leg injuries, surgical flaps, lower extremity

  14. Application of longus colli muscle flap in the repair of pyriform sinus perforation%颈长肌在梨状窝穿孔修补术中的应用

    Institute of Scientific and Technical Information of China (English)

    程庆; 刘邦华

    2014-01-01

    Objective To investigate the result of repair of pyriform sinus perforation using longus colli muscle flap and to provide a new material of esophageal perforation repair.Methods A retrospective clinical analysis was conducted on eight cases with pyriform sinus perforation from 2003-2013.Of the patients,5 were males and 3 females,aged 45 to 68 years with a median age of 51 years.The causes included the esophagoscopy surgery (5 cases),anesthesia intubation (2 cases) and one case of swallowing foreign body.The duration were from seven days to 8 months,with a median duration of one month.All patients were associated with significant neck pain and swallowing pain.The complications were happened in all cases,including high fever in 5 cases,subcutaneous emphysema or mediastinal emphysema in 5 cases,and mediastinal abscess in 3 cases.The longus colli muscle flap was used to repair the perforation.Results The success rate of surgical repair was 100% in all 8 cases.No recurrence or esophageal stricture occured during the follow-up of six months to 10 years.Three cases complicated by mediastinal abscess and 1 case by piriform sinus-mediastinum-pleural fistula,which cured after combined treatment.Conclusions Traumatic pyriform sinus perforation may cause serious complications.Early surgical repair is needed.The longus colli muscle flap is an ideal material for the repair of pyriform sinus perforation.%目的 探讨颈长肌在梨状窝穿孔修补术中的应用,提供一种新的食管穿孔修补材料.方法 回顾性分析2003-2013年8例经保守治疗无效的梨状窝穿孔患者临床资料.其中男5例,女3例;年龄45~68岁,中位数51岁.5例为食管镜术后,2例为麻醉插管引起,1例为吞异物自虐引起.病程在7天~8个月,中位数1个月.所有患者均伴有明显的颈部疼痛和吞咽痛,均出现并发症,其中高热5例次,皮下气肿或纵隔气肿5例次,3例合并上纵隔脓肿.均采用颈长肌修补术,在食管后壁和颈椎

  15. Immediate breast reconstruction with a deep inferior epigastric perforator flap.%应用腹壁下动脉穿支皮瓣即刻乳房重建

    Institute of Scientific and Technical Information of China (English)

    栾杰; 张保宁; 穆大力; 宣立学; 穆兰花; 辛敏强; 刘霞

    2011-01-01

    Objective To summarize the experiences of immediate breastreconstruction with deep inferior epigastric perforator ( DIEP) flap and to evaluate indications and advantages of the technique. Methods From April 2003 to June 2009. immediate breast reconstruction following mastectomy using DIEP flap was performed in 21 patients who had received mastectomy for stage Ⅰ andⅡ breast cancer ( radical mastectomy in 6 cases and modified radical mastectomy in 15 ). Before the operation the location of DIEP was determined by using MDCT ( multidetector computed tomography) angiography and Doppler perfusion flowmeter. When mastectomy was completed DIEP was dissected to obtain DIEP flap simultaneously. And the deep inferior epigastric vessels were anastomosed to the thoracodorsal vessel for immediate breast reconstruction. Results The follow-up time was 6months to 6 years. Among the 21 patients 20 had their flaps completely survived postoperatively , fat necrosis of the distal part ( 1/3 ) occurred in one. One case suffered from hematoma in recipient site. No complications such as abdominal hernia and bulge or fat necrosis in donor sites were found. The reconstructed breasts were well-shaped. Conclusion Immediate breast reconstruction using DIEP flap possesses the advantages of satisfactory recipient condition. abundant tissue volume and minimal donor site injury.%目的 总结乳腺癌切除同时应用腹壁下动脉穿支(DIEP)皮瓣行即刻乳房重建的手术经验,探讨DIEP皮瓣即刻乳房重建的适应证及优点.方法 2003年4月~2009年6月,中国医学科学院肿瘤医院乳腺中心接受乳腺癌切除术患者21例(根治术6例,改良根治术15例),术前应用多排螺旋CT(MDCT)血管造影及多普勒血流仪探明穿支位置,乳腺癌切除的同时,解剖腹壁下动脉穿支,形成腹壁下动脉穿支蒂皮瓣,与患侧胸背血管吻合,进行即刻乳房重建.结果 术后随访6个月至6年.21例患者中,20例皮瓣全部存活,1

  16. Antebrachial interosseous artery free flap for repair of finger soft tissue defect%前臂骨间背侧动脉穿支游离皮瓣修复手指创面

    Institute of Scientific and Technical Information of China (English)

    吕乾; 朱跃良; 梅良斌; 徐永清

    2012-01-01

    目的 探讨手指皮肤缺损时应用前臂骨间背侧动脉穿支游离皮瓣修复的临床效果.方法 应用前臂骨间背侧动脉穿支游离皮瓣修复6例手指皮肤缺损,并长期观察其疗效.结果 6例游离皮瓣完全存活,随访8~18个月,皮瓣外形、色泽、弹性恢复良好,厚薄适中,不需要Ⅱ期修薄.结论 前臂骨间背侧动脉穿支游离皮瓣是修复手指皮肤缺损的理想方法.%Objective To discuss the clinical effect of antebrachial interosseous artery free flap in repairing finger soft tissue defect. Methods Antebrachial interosseous artery free flaps were applied in repairing finger soft tissue defect in 6 cases and the curative effect was recorded. Results Free flaps survived completely in the 6 cases. And the 6 cases were followed up for 848 months, showing good recovery of flap shape , color, elasticity and thickness. All flaps didn't require secondary repair. Conclusion Applying antebrachial interosseous artery free flap is a good way to repair finger soft tissue defect.

  17. Repair of upper lip defect with inferior labial artery island flap%下唇动脉岛状皮瓣修复上唇缺损

    Institute of Scientific and Technical Information of China (English)

    刘杨; 王绍峰; 何晓宁; 刘强

    2012-01-01

    目的 探讨下唇动脉岛状皮瓣修复上唇缺损的可行性及效果.方法 采用单侧下唇动脉岛状皮瓣修复上唇唇红及白唇局部缺损,皮瓣蒂部包括1条下唇动脉和2条下唇静脉.自2005年7月至2011年5月,共修复上唇缺损患者7例.结果 本组7例患者,术后随访3~6个月,皮瓣全部成活,颜色、质地与周围皮肤相近,无明显的挛缩,皮瓣感觉功能良好,水从口中漏出明显改善,无口轮匝肌功能障碍,患者对上唇功能及外观都满意.其中,3例患者于术后3个月行唇弓、唇珠、人中成形术.结论 应用单侧下唇动脉岛状皮瓣修复上唇唇红联合白唇局部缺损是一种比较理想的方法.%Objective To explore the feasibility and effect of inferior labial artery island flap for the repair of upper lip defect. Methods The inferior labial artery island flap which was designed on the lower lip with a vascular pedicle including one inferior labial artery and two veins, was used to repair the defects of the ipsilateral upper lip on totally 7 patients received from July 2005 to May 2011. Results After 3 to 6 months follow-up in all 7 cases, all flaps survived completely and had not visible contraction. The coloration and texture were closed to surrounding, and liquid leakage from the lip and the appearance of the injured area were clearly improved. Dysfunction of the orbicularis oris muscle was not observed, and sensory function was recovered within 6 months. The patient was satisfied not only with the function but also with the appearance of his lip. Conclusion The inferior labial artery island flap is an optimal method for the repair of ipsilateral upper lip defect.

  18. EFFECTIVENESS OF PERFORATOR FLAPS FOR ELDERLY PATIENTS WITH ISCHIA-SACRAL ULCERS%臀部穿支皮瓣治疗老年患者骶尾部褥疮的疗效

    Institute of Scientific and Technical Information of China (English)

    傅荣; 杜丽平; 游晓波

    2011-01-01

    Objective To investigate the operative technique and the effectiveness of perforator flaps for the treatment of elderly patients with ischia-sacral ulcers. Methods Between January 2005 and June 2010, 29 elderly patients with ischia-sacral ulcers were treated. There were 16 males and 13 females, aged from 61 to 75 years (mean, 68 years), including 11 cases of degree Ⅲ and 18 cases of degree Ⅳ according to the standard of the National Pressure Ulcer Advisory Panel (NPUAP). The disease duration was from 5 months to 10 years (median, 5.5 years). The size of ulcers ranged from 7 cm ×6 cm to 12 cm × 10 cm. Of them, 8 cases were companied by cerebral vascular disorders, 6 cases by Alzheimer disease, 11 cases by paraplegia, and 4 cases by others. The flap size ranged from 8 cm × 6 cm to 14 cm × 12 cm. The donor sites were sutured directly. Results Distal flap necrosis occurred in 3 cases (10.3%) 2 days after operation and healed after symptomatic treatment, and the remaining flaps survived and wound healed by first intention with first intention rate of 89.7%. The incisions of donor sites healed primarily. Two cases (6.9%) had infection 1 week after operation and 1 case (3.4%) had wound dehiscence 10 days after operation. Twenty-seven patients were followed up 6 months to 5 years (mean, 3 years). Two cases recurred at 1 and 3 years after operation, respectively. One died of infection, and the other healed by debridement and suture. The flaps of other patients had good texture, color, and elasticity. Conclusion As long as the indications are controlled strictly, good effectiveness can be achieved in the treatment of elderly patients with ischia-sacral ulcers by using perforator flaps.%目的 探讨应用臀部穿支皮瓣治疗老年患者骶尾部褥疮的临床效果.方法 2005年1月-2010年6月,收治29例老年骶尾部褥疮患者.男16例,女13例;年龄61~75岁,平均68岁.病程5个月~10年,中位病程5.5年.根据美国国家褥疮顾问小

  19. Freestyle-Like V-Y Flaps of the Eyebrow: A New Outlook and Indication of an Historical Technique

    Directory of Open Access Journals (Sweden)

    Angelo Alberto Leto Barone

    2013-01-01

    Full Text Available The eyebrow region is of utmost importance for facial movement, symmetry, and the overall cosmetic appearance of the face. Trauma or tumor resection often leave scars that may dislocate the eyebrow producing an alteration both in static symmetry of the face and in the dynamic expressivity. The authors present a technique for eyebrow’s defects repair using the remaining eyebrow advancement by means of a “freestyle-like” V-Y flap. In the past two years a total of eight consecutive patients underwent excision of skin lesions in the superciliary region and immediate reconstruction with this technique. On histology, six patients were affected from basal cell carcinomas, one from squamous cell carcinoma, and one from congenital intradermal melanocytic nevus. The pedicle of the flap included perforators from the supratrochlear, supraorbital, or superficial temporalis artery. Advancement of the entire aesthetic subunit that includes the eyebrow using a V-Y perforator flap was performed successfully in all cases achieving full, tension-free closure of defects up to 3.0 cm. “Freestyle-like” V-Y flaps should be considered as a first-line choice for partial defects of the eyebrow. The greater mobility compared to random subcutaneous flaps allows to reconstruct large defects providing an excellent cosmetic result.

  20. Tertiary resurfacing after one of the first free flaps in Europe, a reflection on 30 years of microsurgical progress.

    Science.gov (United States)

    Hart, A M; Tollan, C J; Dabernig, J; Acland, R; Taggart, I

    2007-01-01

    Free flaps have been used for over 30 years. During this period, improved anatomical understanding has increased donor options and available pedicle lengths, permitting safer, single-stage reconstructions with simpler anastomoses. Refinements, such as perforator flaps in particular, have greatly improved donor morbidity, recipient site cosmesis, and the ability to replace 'like with like' while retaining options for innervation. This case highlights the evolution from one of Europe's first free tissue transfers, effectively a perforator flap, through the advent of free muscle flaps to the current generation of contourable perforator flaps. Free flap transfer has become increasingly sophisticated, safer, and more predictable, yet the potential quality of reconstructive outcome has changed little.

  1. Foot and ankle reconstruction:an experience on the use of 14 different flaps in 226 cases%足踝软组织重建的皮瓣选择策略:14种皮瓣226例分析

    Institute of Scientific and Technical Information of China (English)

    朱跃良; 梅良斌; 吕乾; 王毅; 范新宇; 李福兵; 吴一鹏; 徐永清

    2014-01-01

    ,pedicled peroneal artery perforator flap,pedicled tibial artery perforator flap,and medial plantar flap.The free flaps were latissimus musculocutaneous flap,anterolateral thigh musculocutaneous flap,groin flap,lateral arm flap,anterolateral thigh perforator flap,peroneal artery perforator flap,thoracdorsal artery perforator flap,and medial arm perforator flap.The sensory nerve coaptation was not performed for all of flaps.One hundred and ninety-four cases were combined with open fractures.One hundred and sixty-two cases had tendon ruptures.Results Of the 62 pedicled flaps,11 had partial loss.Among 164 free flaps,8 flaps were completely lost,and 5 were partly lossed.The resiudal defects were managed by the secondary procedures.Among the 57 flaps for plantar foot coverage (25 pedicled flaps and 32 free flaps),ulcers were developed in 5 pedicled flaps and 6 free flaps after weight bearing,and infection was found in 14 flaps.All of patients except for one regained protective sensation from 3 to 12 months postoperatively.All of limbs were preserved and the patients regained walking and daily activities.Conclusion Our experience showed that the sural flap and saphenous flap could be good options for the coverage of the defects at malleolus,dorsal hindfoot and midfoot.Plantar foot,forefoot and large size defects could be reconstructed with free anterolateral thigh perforator flap.For the infected wounds with dead space,the free latissimus dorsi musculocutaneous flap remained to be the optimal choice.

  2. Perforating pilomatricoma.

    Science.gov (United States)

    Zulaica, A; Peteiro, C; Quintas, C; Pereiro, M; Toribio, J

    1988-12-01

    A case of perforating pilomatricoma is described. A few published cases have shared the following features: rapid development, reddish exophytic clinical appearance with surface alterations suggestive of perforation, relatively shallow location making contact with the epidermis, and the occurrence of transepithelial elimination phenomena.

  3. Free superficial iliac circumflex artery skin flap : the clinical application and management of donor site defects%旋髂浅动脉游离皮瓣的临床应用及供瓣区处理

    Institute of Scientific and Technical Information of China (English)

    韩军涛; 谢松涛; 陶克; 张万福; 计鹏; 胡大海

    2013-01-01

    Objective To investigate the clinical application of free superficial iliac circumflex artery skin flaps,as well as the management of donor site defects.Methods 17 free superficial iliac circumflex artery skin flaps were applied for the traumatic defects or deformities on face,neck,foot,hand,ankle and lower leg,respectively.The donor site defects were closed directly or covered by paraumbilical island flaps.Results The 17 flap size ranged from 5 cm× 3 cm to 19 cm × 14 cm.16 flaps survived completely except 1 flap with partial necrosis,which was closed by free skin graft.The donor site defects were closed directly in 10 cases,and covered by paraumbilical island flaps in 7 flaps without no flap necrosis.The abdomen had a good appearance.Conclusions Good appearance can be achieved with free superficial iliac circumflex artery skin flaps for the dcfects on face,neck,foot,hand,ankle and lower leg.Paraumbilical island flap can be used for the donor site defects.%目的 探讨旋髂浅动脉皮瓣游离移植的临床适应证及供瓣区的修复方法.方法 根据创面大小设计旋髂浅动脉皮瓣,并分别游离移植修复17例面颈部、足踝部及小腿等处创伤及畸形,对供瓣区无法直接拉拢缝合者,设计同侧脐旁岛状皮瓣转移进行修复.结果 17例旋髂浅动脉游离皮瓣,最大面积19 cm×14 cm,最小5 cm×3 cm,16例术后成活良好,1例皮瓣部分坏死,术后2周移植皮片修复.10例供瓣区直接缝合,7例行脐旁岛状皮瓣转移修复,皮瓣全部成活,术后经3个月至2年随访,腹部外形良好.结论 旋髂浅动脉皮瓣游离移植,对于面颈部及手足等处具有良好的修复效果,而同侧脐旁岛状皮瓣亦可使供瓣区得到良好的修复.

  4. Thoraco-epigastric flap for breast reconstruction in cancer

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhayev,

    2015-01-01

    Full Text Available Reconstructive surgery for breast cancer are an integral method of rehabilitation of cancer patients. Breast reconstruction may be delayed and instantaneous. The article presents a description of the thoraco-epigastric flap for breast reconstruction in cancer. The operation involves the replacement of the remote volume (after radical resection of the breast and the breast skin adjacent tissues adjacent to the inframammary crease from the side of the anterior abdominal wall. Surgery is indicated when the tumor in the lower parts of the breast, closest to the skin, in combination with small size breast cancer. The article presents a clinical example of this operation. Described in detail the operation, received a good cosmetic result. The advantage of the application of thoraco-epigastric flap is in the simplicity of the technique of its execution, good blood supply, donor wound is easily sutured due to the possible wide separating cellular adjacent skin and subcutaneous tissue. The disadvantage of this method is limited and the need for careful monitoring of perforating branches of the upper epigastric artery. Thus, thoraco-epigastric flap, can be applicable when performing reconstructive operations for breast cancer in compliance with the necessary requirements for the formation of the flap and the correct attitude to feeding the flap vessels, and virtually eliminates possible complications with the healing of the flap. Undoubtedly, reconstructive plastic surgery for breast cancer, during the testimony and technical capabilities, are an essential component of surgical treatment.

  5. Combining rhinoplasty with septal perforation repair.

    Science.gov (United States)

    Foda, Hossam M T; Magdy, Emad A

    2006-11-01

    A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair.

  6. 指固有动脉终末背侧支皮瓣修复指端缺损的疗效观察%Repair of fingertip defect with double flaps based on the end dorsal branches of the digital artery and dorsal metacarpal artery

    Institute of Scientific and Technical Information of China (English)

    于吉文; 霍永峰; 顾光学; 厉雷明; 王彤; 盛路新

    2015-01-01

    目的 探讨应用指固有动脉终末背侧支皮瓣修复指端组织缺损的临床疗效. 方法 2007年3月—2011年10月,应用指固有动脉终末背侧支岛状皮瓣修复指端组织缺损6例. 结果 术后6例皮瓣全部成活,随访1~12个月,平均7.3个月,皮瓣血运良好,色泽及弹性与受区周围皮肤基本一致. 皮瓣无明确皮神经支配,感觉恢复较差,术后6~12个月,皮瓣两点辨别觉为6~8 mm,对冷热觉不敏感,对针刺等疼痛刺激有感觉. 结论 指固有动脉终末背侧支岛状皮瓣修复指端组织缺损是一种可行手术方法.%Objective To study the effect of flap based on the end dorsal branches of the digital artery on repairing of fingertip soft tissue loss. Methods From March 2007 to October 2008, the reverse flap of the end dorsal branches of digital artery was harvested for coverage of fingertip soft tissue loss for 6 cases, at the same time the reverse flap of dorsal metacarpal artery to repair dorsal donor site. Among the 6 patients, 2 cases were index fingers, 1 case was middle finger, 3 cases were ring fingers. Results All flaps survived completely. Follow-up of 1~12 months in the 6 cases, averaged 7.3 months. The blood supply and texture of the flaps was fine, and the color and elasticity was of little difference to the ambient. The skin nerves of the double flaps were not connected, and the sensibility of the flaps was poorly recovered, and the two-point discrimination was 6~8 mm in sensate flap which based on the end dorsal branches of digital artery, while it was 8-10 mm in sensate flap which based on the dorsal metacarpal artery during 6-12 months postoperative. Conclusion Double flaps based on the end dorsal branches of the digital artery and dorsal metacarpal artery is a realistic and effective method to repair fingertip defect.

  7. PERFORATION OF INFERIOR ALVEOLAR NERVE BY MAXILLARY ARTERY. LA PERFORACION DEL NERVIO ALVEOLAR INFERIOR POR LA ARTERIA MAXILAR

    OpenAIRE

    Vanishree S Nayak; Ramachandra Bhat K; Prakash Billakanti Babu

    2011-01-01

    Infratemporal fossa is clinically important anatomical area for the delivery of local anesthetic agents in dentistry and maxillofacial surgery. Variations in the anatomy of the inferior alveolar nerve and maxillary artery were studied in infratemporal dissection. During routine dissection of the head in an adult male cadaver an unusual variation in the origin of the inferior alveolar nerve and its relationship with the surrounding structures was observed. The inferior alveolar nerve originate...

  8. The applied anatomy of iliac tissue flap pedicled on the iliolumbar artery%髂腰动脉蒂髂骨组织瓣的应用解剖

    Institute of Scientific and Technical Information of China (English)

    秦建忠; 马彬; 季建; 何炎; 左一智; 王培吉; 董启榕

    2015-01-01

    Objective To provide anatomical basis for elevating iliac tissue flap pedicled on the iliolumbar artery.Methods The course,number,outer diameter and distribution of iliolumbar artery were observed on 13 human cadavers.Results All the iliolumbar artery originated from the internal iliac artery.The iliolumbar artery gave off 2 branches (iliacus branch and lumbar branch) when passing between the obturator nerve and the lumbosacral trunk,posteriorly to the psoas major.The mean distance between origin of the iliolumbar artery and bifurcation point to iliacus and lumbar branches was 7.1 (7.1 ± 0.5) cm.The iliacus branch divided into two branches:one artery curved forward and anastomosed with the iliacus branch of deep circumflex iliac artery; the other artery supplied the tissue around the posterior superior iliac spine.The lumbar branch supplied the psoas major and the quadratus lumborum.Conclusion The iliolumbar artery and the iliacus branch is one of the most constant and reliable vessels supplying the iliac bone,and can be used as the pedicle of free or pedicled iliac tissue flaps.%目的 为髂腰动脉蒂髂骨组织瓣的切取提供解剖学依据. 方法 在13具成人尸体标本上,对髂腰动脉的走行、数量、管径以及分布情况进行解剖学研究. 结果 髂腰动脉均发自髂内动脉,发出后经腰大肌深层、闭孔神经和腰骶丛之间分为髂骨支和腰支.从髂腰动脉起点到分出髂骨支和腰支的分叉点的距离为7.1(7.1±0.5) cm.髂骨支在髂骨壁内发出2个分支,1支沿髂骨内侧壁向上、向髂前上棘走行,在髂骨壁中段与旋髂深动脉的髂骨支相吻合;另1支向上营养髂后上棘附近组织.腰支发出后向上走行营养腰大肌和腰方肌. 结论 髂腰动脉的髂骨支是营养髂骨的恒定、可靠的血管,可作为独立的营养血管蒂设计成游离或带蒂髂骨组织瓣.

  9. Variabilidad en el diseño y composición del colgajo de perforante de tibial posterior para la reconstrucción de defectos en la pierna Versatility on design and composition of the tibial posterior perforator flap for reconstruction of leg defects

    Directory of Open Access Journals (Sweden)

    C. Laredo Ortiz

    2011-03-01

    perforators allows the use of muscular and tendinous cuffs in the same flap to solve more complex defects, becoming something more than a free flap alternative. We present a serie of 43 patients to describe the reconstructive possibilities of the tibialis posterior perforator flap in its propeller form, as for design variability and composed flap use, with the aim of minimizing donor site morbility even more without the use of grafts.

  10. Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

    Institute of Scientific and Technical Information of China (English)

    QU Zhi-gang; LIU Yu-jie; HE Xu; DING Xiao-hen; FANG Guan-grong

    2012-01-01

    Objective:To report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocutaneous flaps.Methods:Six patients with large skin and soft tissue defects were included in this report.There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar.All wounds were in the upper extremity.The sizes of defects ranged from 15 cm×6 cm to 30 cm× 18 cm.Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissimus dorsi.The thoracodorsal artery and its perforators were carefully protected during surgery.Results:All flaps healed primarily without flap congestion,margin necrosis or infection.The skin donor sites either received split-thickness skin graft (3 cases,mostly from the anterior thigh) or was closed primarily (3 cases)and had minimal morbidity.Follow-up of 6-12 months showed that the contour of flap was aesthetic and the function of limb was excellent.Conclusion:Our experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for reconstruction of large skin and soft tissue defects in the upper extremity.

  11. Clinical Application of Skin Flap Pedicled with Dorsal Carpal Branch of Ulnar Artery%尺动脉腕上支皮瓣在手部皮肤缺损中的应用

    Institute of Scientific and Technical Information of China (English)

    任静; 张金鹏; 范永红; 宋家祥; 张勇; 刘峰; 吕晓峰; 李智; 赵爱彬; 朱明雨; 朱庭标; 顾浩

    2013-01-01

      目的:总结应用尺动脉腕上支皮瓣修复手、腕部软组织缺损。方法:对11例手、腕部软组织缺损应用尺动脉腕上支皮瓣修复的治疗进行回顾性分析。结果:除2例皮瓣边缘部分坏死,其余皮瓣全部成活,术后稍显臃肿,功能恢复满意。结论:尺动脉腕上支皮瓣具有取材方便、血供可靠、不牺牲主干血管等优点,是修复手、腕部软组织缺损的理想皮瓣。%Objective:To summary clinical application of skin flap pedicled with dorsal carpal branch of ulnar artery to reconstruct soft tissue defects of hand or wrist.Methods: Surgical outcome of 11 cases of soft tissue defects of hands or wrists which were reconstructed by skin flap pedicled with dorsal carpal branch of ulnar artery were retrospectively analyzed. Results: Good coverage of the defects has been achieved except partial necrosis of flap edge in two cases. The limbs seem to be slightly Bulging after surgery but function well. Conclusion:The major advantage of skin flap pedicled with dorsal carpal branch of ulnar artery should be it’ s easy dissection and reliable blood supply. In the same time, major vascular do not need to be sacrificed. Skin flap pedicled with dorsal carpal branch of ulnar artery might be an ideal choice to reconstruct soft tissue defect of hand or wrist.

  12. 足跗外侧动脉岛状皮瓣修复足前部皮肤缺损%Reconstruction of forefoot skin defect with island flap pedicled with lateral tarsal artery

    Institute of Scientific and Technical Information of China (English)

    张继春; 张伟; 夏晓明; 张亮; 韩金豹

    2012-01-01

    目的 探讨足跗外侧动脉岛状皮瓣修复足前部皮肤缺损的临床疗效.方法 2007年3月至2009年1月,应用足跗外侧动脉逆行岛状皮瓣修复足前部皮肤缺损患者12例.结果 12例皮瓣均完全成活.随访8 ~ 22个月,平均13个月.皮瓣及皮片质地柔软,色泽与周围正常皮肤相似,外观无臃肿,无需二期皮瓣修整.受区皮瓣感觉以深痛觉为主,皮瓣边缘1 ~2 cm范围有浅触觉和痛觉恢复,即皮瓣边缘感觉为S1 ~S2级.供区皮片有浅触觉和痛觉恢复,未发现皮瓣磨损及破溃,穿鞋无影响,患者步态正常.结论 跗外侧动脉岛状皮瓣对足部的影响较小,是修复足前部软组织缺损的良好选择.%Objective To investigate the therapeutic effect of island flap pedicled with lateral tarsal artery for forefoot skin defect.Methods From March 2007 to January 2009,12 cases with forefoot skin defects were treated by reversed island flap pedicled with lateral tarsal artery.Results All the flaps survived completely with a followed-up period of 8-22 months,13 months in average.The flaps and skin grafts had soft texture and a similar color as the surrounding skin.The flaps had a suitable thickness with deep pain sensation.Shallow touch and pain sensation recovered in the skin graft and within 1-2 cm of the flap edge,which was graded as S1-S2.There was no problem in shoes-wearing and walking.No flap ulcer happened.Conclusion Island flap pedicled with lateral tarsal artery is suitable for forefoot skin defect,leaving less morbidity to donor site.

  13. The one-stage rhinoplasty septal perforation repair.

    Science.gov (United States)

    Foda, H M

    1999-08-01

    A combined septal perforation repair and rhinoplasty was performed in 20 patients (12 males, eight females; age range 16-36, mean age 29.6) presenting with septal perforations (size 1-4 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. The perforation was totally closed in 18 cases (90 per cent) with complete resolution of the pre-operative symptoms occurring in 16 (80 per cent). Cosmetically, 19 cases (95 per cent) were very satisfied with their aesthetic result. The exposure provided by the external approach proved to be very helpful in the process of septal perforation repair. Our results show that septal perforation repair could safely be combined with rhinoplasty and that some of the rhinoplasty manoeuvres used could even facilitate the process of septal perforation repair.

  14. 带神经削薄的游离股前外侧穿支分叶皮瓣修复足踝部软组织缺损%Clinical application of free super-thin anterolateral femoral perforator lobulated skin flap with nerve for repair of tissue defect of the foot and ankle

    Institute of Scientific and Technical Information of China (English)

    董玉金; 张铁慧; 钟声; 任远飞

    2016-01-01

    Objective To explore the clinical outcome of free super⁃thin anterolateral femoral perforator lobulated skin flap with nerve for repairing the tissue defect of the foot and ankle. Methods Free super⁃thin anterolateral femoral perforator lob⁃ulated skin flap with nerve was transferred to repair soft tissue defects of the foot and ankle in 32 cases. There were 20 males and 12 females with an average age of 35.5 years (range, 21-50 years). The wounds located in dorsal and plantar ankle skin with ten⁃don, bone and/or internal fixation exposed. The defect area was from 12 cm×10 cm to 20 cm×15 cm. At first the site of perforator vessels were determined by Doppler, according to the wound shape and size, the flaps were designed and harvested with the site as center;the femoral lateral cutaneous nerve was carried and most tensor fascia was reserved. During flap harvesting trimming of the flap was carried out, the flap was freed and only connected with its vascular pedicle. A step⁃wise defatting was done from the pe⁃riphery of the flap towards the vascular pedicle with 1.0 to 2.0 cm tissue around the perforator preserved. Flap circulation was care⁃fully observed to prevent damage to the perforators. The vascular pedicle was disconnected and formed a split leaf skin flap, and then the flap was transferred to the foot and ankle to cover the defect. Results All the 32 flaps were survived. No vascular crisis happened and all skin grafts were survived in donor sites. Necrosis of 1.5 cm×1.0 cm of the distal flap occurred in 1 case five days after surgery and it was healed by dress changing. All the 32 cases were followed⁃up for 6 to 24 months (average, 13 months). The flaps were supple and elastic with near normal color. There was no bulkiness. Sensory function was recovered well and two point discrimination (2⁃PD) was about 3.0-5.0 mm. The function and appearance of the foot and ankle were good. According to the Chi⁃nese Medical Association of hand surgery

  15. Posterior interosseous free flap: various types.

    Science.gov (United States)

    Park, J J; Kim, J S; Chung, J I

    1997-10-01

    The posterior interosseous artery is located in the intermuscular septum between the extensor carpi ulnaris and extensor digiti minimi muscles. The posterior interosseous artery is anatomically united through two main anastomoses: one proximal (at the level of the distal border of the supinator muscle) and one distal (at the most distal part of the interosseous space). In the distal part, the posterior interosseous artery joins the anterior interosseous artery to form the distal anastomosis between them. The posterior interosseous flap can be widely used as a reverse flow island flap because it is perfused by anastomoses between the anterior and the posterior interosseous arteries at the level of the wrist. The flap is not reliable whenever there is injury to the distal forearm or the wrist. To circumvent this limitation and to increase the versatility of this flap, we have refined its use as a direct flow free flap. The three types of free flaps used were (1) fasciocutaneous, (2) fasciocutaneous-fascia, and (3) fascia only. Described are 23 posterior interosseous free flaps: 13 fasciocutaneous flaps, 6 fasciocutaneous-fascial flaps, and 4 fascial flaps. There were 13 sensory flaps using the posterior antebrachial cutaneous nerve. The length and external diameter of the pedicle were measured in 35 cases. The length of the pedicle was on average 3.5 cm (range, 3.0 to 4.0 cm) and the external diameter of the artery averaged 2.2 mm (range, 2.0 to 2.5 mm). The hand was the recipient in 21 patients, and the foot in 2. All 23 flaps covered the defect successfully.

  16. Colgajo de avance en V-Y de gastrocnemio medial basado en perforante para cierre de defectos del tercio medio de la pierna V-Y advancement gastrocnemius perforant based flap for closure of defects of the medial third of the leg

    Directory of Open Access Journals (Sweden)

    V. Spröhnle

    2010-06-01

    Full Text Available Los colgajos de avance en V-Y han sido una alternativa popular para el cierre de heridas profundas, pero su movilidad es limitada. Los colgajos basados en perforantes son especialmente útiles cuando se necesita un mayor avance y cobertura. Diseñamos un colgajo de gastrocnemio que utiliza ambas técnicas para cubrir los defectos del tercio medio y superior de la pierna en sus caras lateral y posterolateral. Evaluamos en forma retrospectiva 5 pacientes con heridas en el tercio medio y superior de la pierna, tratados entre enero de 2005 y septiembre de 2007 en un solo centro y por un mismo cirujano. Todos fueron varones, con un promedio de edad de 48 años y la etiología fue traumática en todos los casos. El vaso perforante se evaluó preoperatoriamente por medio de doppler color en todos los casos. Valoramos telefónicamente la satisfacción del paciente en el postoperatorio tardío. En todos los casos, encontramos los vasos perforantes identificados en el preoperatorio; el tiempo operatorio promedio fue de 1.8 horas. No hubo complicaciones; la cobertura fue exitosa en todos los casos y los pacientes se mostraron satisfechos en la encuesta realizada. El tiempo medio de seguimiento postoperatorio fue de 19 meses. En conclusión, creemos que el colgajo de avance en V-Y de gastrocnemio basado en perforante se presenta como una alternativa segura para el cierre de defectos del tercio medial y superior de la pierna, en un sólo tiempo quirúrgico y con buenos resultados estéticos y funcionales a largo plazo.Advancement V-Y flaps have been a popular choice for closure of deep wounds but their mobility is limited. Perforant based flaps are specially useful when greater advancement and bigger coverage are needed. We designed a gastrocnemius based flap that uses both techniques for covering the defects of the medial third of the leg. We follow a retrospective evaluation of 5 patients that had their wounds in the medial and superior third of the leg

  17. Retrospective study of reverse dorsal metacarpal flap and compound flap: a review of 122 cases

    Institute of Scientific and Technical Information of China (English)

    LU Lai-jin; GONG Xu; LIU Zhi-gang; ZHANG Zhi-xin

    2006-01-01

    Objective:To evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand.Methods: From 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively.Results: In the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours,colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery(British Medical Research Council, BMRC ), the sense function of the flaps resumed S3 after operation for 1 year.In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months.Conclusions: To soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries.Postoperative flap color and texture are similar to normal fingers.

  18. Colgajo sural medial: un nuevo colgajo de perforantes para la reconstrucción del territorio maxilofacial Medial sural flap: a new flap for maxillofacial reconstruction

    Directory of Open Access Journals (Sweden)

    Ignacio Arribas-García

    2012-12-01

    Full Text Available Introducción: La reconstrucción microquirúrgica de defectos mucocutáneos craneofaciales se realiza con técnicas descritas desde hace muchos años y se basan fundamentalmente en el colgajo radial, el anterolateral de muslo y el lateral de brazo, entre otros. Se presenta un nuevo colgajo microvascularizado fasciocutáneo para la reconstrucción de defectos en el territorio de cabeza y cuello, el colgajo de perforantes dependiente de la arteria sural medial. Material y métodos: Se presentan 4 pacientes con carcinoma epidermoide de cavidad oral, donde se realizaron 4 colgajos dependientes de la arteria sural medial para la reconstrucción de sus defectos tras la cirugía ablativa de la lesión tumoral. Resultados: El colgajo sural medial presentó una excelente adaptabilidad y una adecuada viabilidad en todos los casos, con unos buenos resultados funcionales, estéticos y con escasa morbilidad de la zona donante. Conclusión: Se presenta una nueva técnica reconstructiva en defectos de cabeza y cuello.Introduction: Microsurgical reconstruction of craniofacial mucocutaneous defects have been performed for many years using well-known techniques, that are mainly based on flaps from the radial forearm, the anterolateral thigh and lateral arm, among others. We present the medial sural artery perforator flap, a new vascularized fasciocutaneous flap for head and neck reconstruction. Material and methods: We present four patients with oral squamous cell carcinoma. A medial sural artery flap was performed for the oral reconstruction after tumour ablation surgery. Results: The medial sural flap showed excellent adaptability and adequate viability in all cases, with good functional and aesthetic results and low donor site morbidity. Conclusion: We present a new reconstructive technique in head and neck defects.

  19. 颞浅动脉顶支扩张岛状皮瓣在修复头皮缺损中的应用%Application of the parietal branches of superficial temporal artery island flap in complex scalp defects

    Institute of Scientific and Technical Information of China (English)

    王楷; 李爱林; 赵月强; 余墨声; 罗定安; 吴晓蔚

    2013-01-01

    Objective To investigate the application of the parietal branches of superficial temporal artery island flap in the complex scalp defects.Methods A parietal branches of superficial temporal artery island flap on the ectatic scalp flap was designed to repair the complex scalp defects in 25cases and the repairing effect was observed.Results The island flaps were survived completely in 24patients,in which 1 patient had partial necrosis because of the flap tension was too large,but healed after local dressing and debridement.After followed up 6~ 12 months,the color and texture of the flap were the same to the surrounding normal scalp,and the shape was satisfactory.The flap donor site of hair growth was good,with well healing and no obvious complications.Conclusions The parietal branches of superficial temporal artery island flap can repair the complex scalp defects with the flexible flap design and movement.The flap survives well and the repair area is large.The flap and the surrounding scalp connects good.Therefore,it is a good method strongly recommended for small area complex scalp defects repair in clinics.%目的 探讨颞浅动脉顶支扩张岛状皮瓣在修复复杂头皮缺损中的应用.方法 通过在扩张头皮瓣上设计以颞浅动脉顶支为蒂的岛状皮瓣,转移修复复杂头皮缺损25例,并观察其愈合和修复效果.结果 25例患者,24例皮瓣完全存活,1例患者因皮瓣张力过大出现部分坏死,但通过清创及换药后愈合.术后随访6~12个月,头皮缺损修复部位与周围皮肤色泽、质地相似,外形恢复满意,皮瓣供受区毛发生长良好,创面愈合良好,无并发症发生.结论 应用颞浅动脉顶支为蒂的岛状扩张皮瓣修复复杂头皮缺损,皮瓣存活良好,皮瓣设计、转移灵活,修复范围较大,皮瓣与周边头皮衔接良好,是修复复杂头皮缺损的一种良好方法,值得应用和推广.

  20. Clinical application of island skin flap of pollical dorsal digital arteries in repairing defect of soft tissue%拇指背动脉岛状皮瓣的临床应用及血供障碍处理

    Institute of Scientific and Technical Information of China (English)

    蒋良福; 周飞亚; 李志杰; 杨景全; 褚庭纲; 池征璘; 高伟阳

    2011-01-01

    Objective:To introduce clinical experience of repairing defect of pollical soft tissue with island skin flap of pollical dorsal digital arteries,and explore the reasons of disturbance of blood supply and its therapeutic method. Methods: From July 2005 to December 2008,21 thumbs in 21 patients with defect of soft tissue were treated with surgery. There were 16 males and 5 females,ranging in age from 16 to 55 years with an average of 39 years. Defects of extremity-radialis soft tissues of thumb in 4 cases were repair with island skin flap of dorsal-radial pollical arterial;and defects of ulnaris ,finger pulp, hyponychium of thumb in 17 cases were repair with island skin flap of dorsal-ulnar pollical arterial. The pivoting point of flap was 0.5 cm proximal to interphalangeal joint. The size of flap was from 2 cm×1.5 cm to 4 cm×2.5 cm. Results:Blood articulo was found in 6 cases during operation and after operation and the flaps survived after corresponding treatment. The patients were follow-up from 3 months to 2 years. The texture and shap of flap was good, only had slightly pigmentation. Range of motion was normal in metacarpophalangeal joints and interphalangeal joint. All the flaps of prothetic finger pulp had sensory recovery with two point discrimination for 4-10 mm. Conclusion:It is easy and effective in repairing defect of pollical soft tissue with island skin flap of pollical dorsal digital arteries. The treatment of pedicle is key to success,the length,width and compression of pedicle can effect on blood supply of flap.%目的:介绍拇指背动脉岛状皮瓣修复拇指软组织缺损的临床经验,并探讨血供障碍的因为及处理方法.方法:自2005年7月至2008年12月,外科治疗21例21指拇指软组织缺损,男16例,女5例:年龄16~55岁,平均39岁.应用拇指背桡侧动脉岛状皮瓣修复拇指远节桡侧软组织缺损(4例),拇指背尺侧动脉岛状皮瓣修复拇指尺侧、指腹及甲床缺损(17例),皮

  1. MORPHOLOGICAL STUDY OF MEDIAL CIRCUMFLEX FEMORAL ARTERY IN HUMAN CADAVERS

    Directory of Open Access Journals (Sweden)

    Brijesh R. Aghera

    2014-10-01

    Full Text Available Background: Medial circumflex femoral artery is an important branch of Profunda femoris artery. It is an important artery in supplying blood to the head and neck of the femur, the adductor muscles and form anastomosis around head of femur. So study of variation of medial circumflex femoral artery great value for surgeon and orthopaedic surgeries. Materials and Methods: The present study includes 102 lower limbs of adult formalin fixed human cadavers used for the routine dissection procedure for under graduate and post graduate students in the department of Anatomy, M.R. Medical College, KBN Medical college and H K E Homeopathic College, Gulbarga (India during 2011-2014.The study was done by dissection method as per Cunningham’s manual of practical Anatomy. Result: In present study, we found that 25 extremities (25.49% medial circumflex femoral artery was originated directly from femoral artery. In 10 extremities (9.80% a common trunk was observed form medial circumflex femoral with femoral artery. Normal study was observed in 66 extremities (64.70%. Conclusion: In present study and other past studies we conclude that knowledge of variation in this artery is very important to preventing injury to vessels during surgical procedures around hip joint and also has important value in plastic surgery operations as the vascular pedicle of grafts such as the transverse upper gracilis (TUG flap, medial thigh flap and medial circumflex femoral (gracilis perforator free flap. During case of selective arteriography in ischaemic necrosis of the femoral head to know the arterial supply of the femoral head it is used.

  2. Clinical observation of ankle cutaneous defect repaired by flap prosthetics%皮瓣修复踝关节周围软组织缺损的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王道明; 曾荣铭; 余榕

    2016-01-01

    Objective To investigate the repair of ankle cutaneous defect with flap prosthetics. Methods There were 30 cases ankle cutaneous defect, who had been repaired with 6 kinds of skin flaps. Local gyral flap in 7 cases, distal sural neurocutaneous flap in 5 cases, distal perforators peroneal artery flap in 6 cases, posterior tibial artery perforators flap in 6 cases, reverse lateral supramalleolar island flap in 1 case, and free anterolateral femoral cutaneous flap in 5 cases. The dimensions of the flap ranged from 3 cm ×3 cm to 19 cm ×9 cm. Results 26 cases were one-stage survival, 2 cases of distal sural neurocutaneous flap partly necrosised and healed after change dressings, 1 case of posterior tibial artery perforators flap distal 1/4 portion necrosised and healed after two stage skin-grafting, 1 case of distal perforators peroneal artery flap venous crisis occurred and healing under-scab after distal portion bleeding therapy. Conclusion The application of flap prothesis can cure kinds of ankle cutaneous defect nicely.%目的:探讨应用外科皮瓣技术修复常见的踝关节周围软组织缺损的临床疗效。方法对2007-2014年收治的踝关节周围软组织缺损30例,行6种外科皮瓣技术修复,其中局部转移皮瓣7例,远端蒂腓肠神经皮瓣5例,远端蒂腓动脉皮穿支皮瓣6例,胫后动脉皮穿支皮瓣6例,逆行外踝上岛状皮瓣1例,游离股前外侧穿支皮瓣5例。切取皮瓣最小3 cm×3 cm,最大19 cm×9 cm。结果30例皮瓣中26例Ⅰ期全部成活;2例远端蒂腓肠神经岛状皮瓣远端部分坏死,经局部换药治疗后创面愈合;1例胫后动脉皮穿支皮瓣远端1/4部分坏死,经Ⅱ期植皮后闭合创面;1例远端蒂腓动脉皮穿支皮瓣术后出现静脉危象,行远端放血处理后,后期皮瓣皮肤脱痂愈合。随访3个月~5年,皮瓣质地好。结论应用皮瓣修复技术,可使骨科各类常见的踝关节周围软组

  3. 颞浅动脉组织瓣修复儿童头面部畸形%REPAIRING DEFORMITY OF THE HEAD AND FACE WITH TISSUE FLAP PEDICLED WITH THE SUPERFICIAL TEMPORAL ARTERY IN CHILDREN

    Institute of Scientific and Technical Information of China (English)

    傅跃先; 向代理; 张显文; 邱林; 唐毅; 王珊

    2001-01-01

    目的 评价颞浅动脉组织瓣在修复儿童头面部畸形中的作用。方法 1986年10月~1996年12月,采用颞浅动脉组织瓣修复13例儿童头面部畸形,其中先天性畸形9例,烧伤瘢痕3例,感染后瘢痕1例。采用颞部皮瓣1例,颞部毛发皮瓣3例,额部皮瓣1例,耳后浅筋膜瓣与皮瓣8例。组织瓣大小为5.0 cm×1.2 cm~10.0 cm×5.0 cm,皮瓣蒂长5~8 cm。结果 术后组织瓣均Ⅰ期愈合。术后10例获得随访,时间6个月~12年,皮瓣色泽似邻近皮肤,质地柔软,厚薄适中,毛发瓣毛发生长良好,耳后浅筋膜瓣与皮瓣满足耳再造需要。所有病例术后切口瘢痕隐蔽,外观获明显改善。结论 颞浅动脉组织瓣血供丰富,邻近受区,易操作且形态良好,适用于儿童头面部多种畸形的修复。%Objective To evaluate the effect of tissue flap pedicled with the superficial temporal artery in repairing deformity of the head and face in children. Methods From October 1986 to December 1996, 13 children with deformity of the head and face were repaired by this tissue flap. Among them, there were congenital deformity in 9 cases, burned scar in 3 cases and infection scar in 1 case. Among the flaps, 1 was temporal skin flap, 3 were temporal flap with hairbearing scalp, 1 was frontal skin flap, and 8 were posterio-uricular superficial fascia flap and skin flap. The area of tissue flap was ranged from 5.0 cm×1.2 cm to 10.0 cm×5.0 cm. The length of the pedicle was 5~8 cm. Results All tissue flaps healed with first intention. Followed up for 6 months to 12 years, the appearance and function of tissue flaps were satisfactory. Conclusion The tissue flap pedicled with the superficial temporal artery is suitable to repair many kinds of deformities of the head and face in children. It has the advantages of good blood supply, closely acceptor area, easy operation and satisfactory appearance.

  4. Repairing of fingertip defect with topographical anterograde flap pedicled with digital artery trunk or branch%带指掌侧固有动脉或其分支局部顺行皮瓣修复指端缺损

    Institute of Scientific and Technical Information of China (English)

    林宏伟; 吴杰; 江标; 连素文; 邹育才; 肖瑛; 赵资坚; 林丽贤

    2015-01-01

    目的:探讨带指掌侧固有动脉或其分支局部顺行皮瓣修复指端缺损的临床效果。方法总结2011年6月至2014年6月期间,采用带指掌侧固有动脉或其分支局部顺行皮瓣转移修复的83例118个指端缺损的临床资料。结果92个皮瓣顺利成活。7个背侧旋转皮瓣、5个V-Y推进皮瓣在术后24 h内出现动脉危象,9个背侧旋转皮瓣、5个掌侧旋转皮瓣在术后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周边、蒂部部分缝线,皮瓣小切口放血,皮瓣按摩,改变手指体位,患指制动等方法处理。动脉危象皮瓣4个存活,8个部分坏死。静脉危象皮瓣8个存活,6个部分坏死。皮瓣供区植皮57/62例(91.9%)全部成活。67例99指获得3~12个月、平均5.5个月的随访。皮瓣色泽红润、质地柔软、外观自然、不臃肿,与周围皮肤接近。皮瓣蒂部不臃肿。指端饱满,外形良好。两点辨别觉8~12 mm,无痛性瘢痕形成,无严重触痛。患指各关节活动基本正常,无关节坚硬。患者能适应正常工作与生活,对指端感觉及伤指外形均较满意。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63指,良20指,可16指,优良率83.8%。结论带指掌侧固有动脉或其分支局部顺行皮瓣修复指端缺损,方法简便,无需复杂显微外科技术,效果满意,对供区影响小,成功率高,值得临床推广应用。%Objective To investigate the clinical outcomes of repairing fingertip defects by transferring topographical anterograde flaps pedicled with digital artery trunk or branch. Methods From Jun. 2011 to Jun. 2014, 118 fingers in 83 cases with fingertip defects were treated with topographical anterograde flaps pedicled with digital artery trunk or branch. We recorded and generalized the clinical materials. Results 92 flaps survived uneventfully. 7 digital artery dorsal

  5. The Clinical Application of Anterolateral Thigh Flap

    Directory of Open Access Journals (Sweden)

    Yao-Chou Lee

    2011-01-01

    Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe.

  6. Free flap pulse oximetry utilizing reflectance photoplethysmography

    OpenAIRE

    Zaman, T.; Kyriacou, P. A.; Pal, S.

    2013-01-01

    The successful salvage of a free flap is dependent on the continuous monitoring of perfusion. To date there is no widely accepted and readily available post-operative monitoring technique to reliably assess the viability of free flaps by continuously monitoring free flap blood oxygen saturation. In an attempt to overcome the limitations of the current techniques a reflectance photoplethysmographic (PPG) processing system has been developed with the capability of real-time estimation of arteri...

  7. REVERSED FASCIA PEDICLED PERONEAL PERFORATING BRANCH SURAL NEUROFASCIOCUTANEOUS FLAP FOR REPAIRING SOFT TISSUE DEFECT IN DORSAL PEDIS%腓动脉穿支筋膜蒂腓肠神经营养血管皮瓣修复足背皮肤软组织缺损

    Institute of Scientific and Technical Information of China (English)

    郑磊; 董忠根; 郑稼; 肖海滨; 刘立宏

    2011-01-01

    Objective To summarize the clinical experience of repairing soft tissue defect in dorsal pedis with reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flap, and to explore surgery matters needing attention and measures to prevent flap necrosis. Methods Between August 2000 and April 2009, 31 patients with soft tissue defects in dorsal pedis were treated with reversed fascia pedicled peroneal perforating branch sural neurofasciocutaneous flaps.There were 23 males and 8 females with a median age of 34 years (range, 3-65 years). Defects were caused by traffic accident in 20 cases, by machine in 2 cases, and by crush in 2 cases. The time from injury to admission was 1-32 days (mean, 15 days).And 6 cases had chronic ulcer or unstable scar excision with disease duration of 6 months to 10 years, and 1 case had squamous carcinoma with disease duration of 5 months. The wounds were located in medial dorsal pedis in 12 cases and lateral dorsal pedis in 19 cases; including 14 wounds near the middle metatarsal and 17 wounds beyond the middle metatarsal (up to the metatarsophalangeal joint in 10 cases). All cases accompanied with bone or tendon exposure. Five cases accompanied with long extensor muscle digits tendon rupture and defect, 1 case accompanied with talus fracture, 1 case accompanied with talus fracture and third metatarsal fracture. The size of the wounds ranged from 6.0 cm × 4.5 cm to 17.0 cm x 10.0 cm. The size of the flaps ranged from 8.0 cm × 5.5 cm to 20.0 cm × 12.0 cm. The donor sites were resurfaced by skin graft. Results Seventeen flaps survived uneventfully, wounds healed by first intention. Distal epidermal or superficial necrosis occurred in 6 flaps at 5-12 days after operation, wounds healed by dressing change or skin graft. Distal partial necrosis occurred in 8 flaps (7 in medial dorsal pedis and 1 in lateral dorsal pedis) at 7-14 days after operation, wounds healed by skin graft in 3 cases, by secondary suture in 3 cases

  8. Coverage of donor site defects on dorsum of the foot after dorsalis pedis flap transfer with pedicled lateral supramalleolar artery flaps%外踝上动脉皮瓣修复足背组织移植供区缺损的临床研究

    Institute of Scientific and Technical Information of China (English)

    李涛; 陈振兵; 翁雨雄; 丛晓斌; 艾方兴; 周攀; 洪光祥

    2014-01-01

    Objective To investigate the clinical application of pedicled for coverage of donor site defects resulted from dorsalis pedis flap transfer.Methods From October 2008 to September 2012,the flap pedicled on the lateral supramalleolar artery was reverse transferred to cover the defect on the dorsum of the foot resulted from dorsalis pedis flap harvest in 11 cases.Among these cases 6 had second toe combined with dorsalis pedis flap transfer and 5 had dorsalis pedis flap transfer.Postoperatively the appearance of the flaps,pain and touch sensation,temperature perception and two-point discrimination were evaluated.AOFAS assessment of donor foot function was performed.Results Flaps of the 11 cases all completely survived.Primary wound healing was achieved at the flap donor site.Nine cases were follow-up for 12 to 24 months while 2 were lost to follow-up.The flaps had good appearance.There were no excessive scar,pain or ulcer.The patients were satisfied with the aesthetic results.Perception of pain,temperature and touch was restored.At 12 months postoperatively,twopoint discrimination was (10.1 ± 2.2) mm on average.Sensory recovery was S3+,while the mean foot and ankle AOFAS score was 90.7.Conclusion Reverse transfer of pedicled lateral supramalleolar artery flap is a good option for coverage of dorsum foot soft tissue defect.It reduces donor site morbidity and restores good appearance and function of the donor foot.%目的 探讨外踝上动脉皮瓣带蒂逆行转移修复足背组织移植供区缺损的临床效果.方法 2008年10月至2012年9月,对11例手外伤其中6例行第二足趾加足背皮瓣游离移植,5例足背皮瓣移植的患者采用外踝上动脉皮瓣带蒂逆行转移,修复足背组织移植后供区缺损创面.术后对皮瓣外形满意度,痛触觉、温度觉、两点分辨觉及对患足功能行AOFAS评分.结果 术后11例皮瓣全部顺利存活,供区伤口均Ⅰ期愈合.9例获得12~ 24个月的随访,2例失访.皮瓣具有

  9. Dorsal hand coverage with free serratus fascia flap

    DEFF Research Database (Denmark)

    Fotopoulos, Peter; Holmer, Per; Leicht, Pernille

    2003-01-01

    serratus fascia flap, the connective tissue over the serratus muscle, for dorsal hand coverage. The flap consists of thin and well-vascularized pliable tissue, with gliding properties excellent for covering exposed tendons. It is based on the branches of the thoracodorsal artery, which are raised...... in the flap, leaving the long thoracic nerve intact on the serratus muscle. Coverage of the flap with split-thickness skin graft is done immediately. The free serratus fascia flap is an ideal flap for dorsal hand coverage when the extensor tendons are exposed, especially because of low donor-site morbidity....

  10. Design and application of tension skin flap of the pedicle of distally based skin flap or reverse-flow island flap%远端蒂皮瓣或逆行岛状皮瓣转移术蒂部减张皮瓣的设计与应用

    Institute of Scientific and Technical Information of China (English)

    王培吉; 秦建忠; 董启榕

    2008-01-01

    目的 探讨在远端蒂皮瓣或逆行岛状皮瓣蒂部设计减张皮瓣的可行性和临床应用效果.方法 临床应用胫后动脉内踝上皮支逆行岛状皮瓣修复9例,胫后动脉小腿内侧穿支远端蒂皮瓣修复2例,腓动脉外踝上皮穿支逆行岛状皮瓣修复8例,腓浅神经营养血管逆行岛状皮瓣修复4例,远端蒂腓肠神经营养血管皮瓣修复3例,掌背筋膜蒂逆行岛状皮瓣修复2例.蒂部减张瓣呈梭形或圆形,面积为1.0 am×1.0 cm~5.0 cm×3.5 cm.结果 28例皮瓣术后血运良好,无肿胀、淤血,全部成活,随访皮瓣质地良好,外形美观,供区均一期愈合,疗效满意.结论 在远端蒂皮瓣或逆行岛状皮瓣蒂部设计减张皮瓣是可行的.可有效地防止蒂部血管受压或血管网破坏而影响皮瓣的血运,是一种可靠的预防远端蒂皮瓣或逆行岛状皮瓣血供障碍的新方法.%Objective To explore the feasibility and clinical resuhs of the tension skin flap of the pedicle of distally based skin flap or reverse-flow island flap. Methods Nine cases were repaired using reversed island flap pedicled with cutaneous branches of medial supramalleolar of posterior tibial artery in clinic,2 cases using distally based skin flap pedicled with the medial perforator of the posterior tibial artery,8 cases using reversalisland flap of peroneal artery lateral mulleolus skin perfarator 4 cases using reversed island flap pedicled with superficial peroneal nerve and its nutrient vessels. 3 cases using distally based sural neurocutaneous flap,and 2 cases using reversed island flap pedicled with dorsal fascia of hand.The area of the tension flap was 1.0 cm×1.0 cm to 5.0 am×3.5 cm. Results All the flaps completely survived.On the postoperative years follow-up,the texture of the flap was excellent,and primary healing was obtained at the donor site. Conclusion It's effective to design at the pedicle of the distally based flap or reversed island flap a tension skin

  11. Versatility of the Anterolateral Thigh Free Flap: The Four Seasons Flap

    Science.gov (United States)

    Di Candia, Michele; Lie, Kwok; Kumiponjera, Devor; Simcock, Jeremy; Cormack, George C.; Malata, Charles M.

    2012-01-01

    Presented at the following academic meetings: ○ 56th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery (SICPRE) Fasano (Brindisi), Italy, September 26-29, 2007 ○ 42nd Meeting of the European Society for Surgical Research (ESSR), Warsaw, Poland, May 21-24, 2008 ○ Winter Meeting, British Association of Plastic, Reconstructive and Aesthetic Surgeons, (BAPRAS) London, December 1-3, 2009 Background: The anterolateral free flap has become increasingly popular at our institution year on year. We decided to review our experience with this flap and study the reasons for this trend. Methods: A retrospective review of all anterolateral thigh free flaps performed at Addenbrooke's University Hospital from the available charts was carried out. This chart review included patients' demographics, indications, flap size, recipient vessels used, ischemia time, flap, and donor site outcomes. All flap perforator vessels were located preoperatively using a handheld Doppler ultrasound probe. Results: From October 1999 to December 2008, 55 anterolateral thigh flaps were performed in 55 patients to reconstruct a variety of soft-tissue defects (upper and lower limbs, chest wall, skull base, head and neck). Flap size ranged 12 to 35 cm in length and 4 to 11 cm in width. During flap elevation, the main supply to the flap was found to be a direct septocutaneous perforator in 41% (n = 23) of the cases as opposed to a musculocutaneous perforator, which was found in 59% (n = 32). The mean ischemia time was 82 minutes (range, 62-103). The overall flap success rate was 100%. Two flaps were successfully salvaged after reexploration for venous congestion. The donor site morbidity was minimal. The mean follow-up time was 18 months (range, 2-48). Discussion and Conclusion: The anterolateral thigh free flap was found to be a very reliable flap (100% success) across a wide range of clinical indications. It facilitates microvascular anastomoses as evidenced by the short

  12. Distal run-off vessel of descending branch of lateral femoral circumflex artery used for reconstruction of extremity defects with free anterolateral thigh flap%旋股外动脉降支远端血管在股前外侧游离皮瓣修复四肢创面中的应用

    Institute of Scientific and Technical Information of China (English)

    何晓清; 朱跃良; 徐永清; 梅良斌; 王毅; 范新宇; 董凯旋

    2015-01-01

    .They were 13 men and one woman,with an average age of 34.6 years (from 8 to 57 years).The soft tissue defects involved the ankle and foot in 8 cases,leg in 3 and hand in 3,ranging from 5.5 cm × 4.5 cm to 25.0 cm × 14.0 cm in area.The distal run-off vessel was used in a flow-through flap for vascular reconstruction and wound coverage in 4 cases,in a flow-through flap for preservation of vascular continuity at the recipient site in 6 cases,in a recombinant chimeric flap for toe-to-2nd finger transplantation and simultaneous flap resurfacing in one case,in a flap with connected transverse and perforating branches for repair of massive defects at the dorsal foot in one,and as a backup vessel to salvage a dying flap in postoperative exploration of vascular crisis in 2 cases.Results The dissection time of distal run-off vessel was between 3 and 7 minutes (average,4.6 minutes).The lengths of distal run-off vessels averaged 3.8 cm (from 1.5 to 6.0 cm).None complication occurred at the donor site due to removal of distal run-off vessel.The 14 patients obtained an average follow-up of 6.4 months (from 2 to 18 months).All the 14 flaps survived thoroughly.Follow-ups revealed no infection or necrosis but fine texture and colour.The foot recovered locomotion with good blood supply to the distal foot in 8 cases of ankle and foot defects and in 3 cases of leg defects.Three cases of hand defects gained fine functional recovery.Conclusions In surgery with free anterolateral thigh flap,the distal run-off vessel of the descending branch of the lateral circumflex femoral artery can play an important role because its easy dissection causes no additional injury to the donor site,an appropriate length can be harvested according to different operational needs,and it can be used in a flow-through or a recombinant chimeric flap or as a backup vessel.

  13. "A Free thenar flap – A case report"

    OpenAIRE

    Chow Shew; Fung Boris KK; Garg Rajesh; Ip Wing

    2007-01-01

    Abstract We present a case report of a free thenar flap surgery done for a volar right hand middle finger, distal and middle phalanx degloving injury. A free thenar flap is a fasciocutaneous sensate flap supplied by a constant branch of the superficial radial artery and its variable nerve supply. It has a distinct advantage of low donor site morbidity, better cosmesis and texture of the flap. No immobilization is required postop. The donor site can be closed primiarily.

  14. 腹壁下动脉穿支皮瓣在乳腺癌术后一期乳房再造中的应用%Application of Free Grafting with the Deep Inferior Epigastric Perforator Flap on One-stage Breast Reconstruction Following Adenomammectomy

    Institute of Scientific and Technical Information of China (English)

    付忠平; 李赞; 肖高明; 江勃年; 周晓

    2011-01-01

    Objective To evaluate the clinical application of free grafting with the deep inferior epigastric perforator (DIEP) flap on one-stage breast reconstruction following adenomammectomy. Method Clinical results were retrospectively analyzed in 17 sufferers of breast cancer underwent free grafting with DIEP flap one-stage breast reconstruction following radical or modified radical adenomammectomy. Results All flaps survived, and all the reconstructions appeared good outline and good elasticity without fat liquefaction, contractural change,ventral hernia or bulge of abdominal wall. In the 15 cases who were followed up for 1 to 5 years,1 patient died of multiple metastases after 2 years and another patient abandoned treatment because of chest wall recurrence. Conclusions It is demonstrated that mammaplasty through DIEP flaps has much merits such as satisfactory outline, few complications in belly donor site, fine blood supply and abdominal wall reshaping simultaneously. It may be an ideal method of mammaplasty, and chemo or radiotherapy shows no impacts on the growth of flaps.%目的 探讨腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣游离移植在乳腺癌术后一期乳房再造中的临床应用.方法 17例行根治术或改良根治术并同期应用DIEP皮瓣再造乳房的乳腺癌患者,其中Ⅱ期9例,Ⅲ期7例,Ⅳ期1例,行改良根治术Ⅰ式13例,Ⅱ式2例,常规根治术2例.Ⅲ、Ⅳ期患者术前常规新辅助化疗2~3周期.10例术后行放化疗.结果全部皮瓣均成活,再造乳房外形可,弹性好,无脂肪液化、皮瓣挛缩变形; 无腹壁疝和腹壁膨出.15例获随访,平均2.4(1~5)年,1例2年后死于全身转移,1例8个月后胸壁局部复发放弃治疗.结论 乳腺癌术后一期应用DIEP皮瓣游离移植再造乳房,具有皮瓣血运良好、再造乳房外形满意、腹部供区并发症少,可同时行腹壁整形等优点,是乳腺癌术后乳房再造的理想方法之一.

  15. Spontaneous external gallbladder perforation

    Energy Technology Data Exchange (ETDEWEB)

    Noeldge, G.; Wimmer, B.; Kirchner, R.

    1981-04-01

    Spontaneous perforation of the gallbladder is one complication of cholelithiasis. There is a greater occurence of free perforation in the peritoneal cavity with bilary pertonitis, followed by the perforation into the stomach, small intestine and colon. A single case of the nowadays rare spontaneous perforation in and through the abdominal wall will be reported. Spontaneous gallbladder perforation appears nearly asymptomatic in its clinical course because of absent biliary peritonitis.

  16. Blood flow autoregulation in pedicled flaps

    DEFF Research Database (Denmark)

    Bonde, Christian T; Holstein-Rathlou, Niels-Henrik; Elberg, Jens J

    2009-01-01

    INTRODUCTION: Clinical work on the blood perfusion in skin and muscle flaps has suggested that some degree of blood flow autoregulation exists in such flaps. An autoregulatory mechanism would enable the flap to protect itself from changes in the perfusion pressure. The purpose of the present study...... was to evaluate if, and to what extent, a tissue flap could compensate a reduction in blood flow due to an acute constriction of the feed artery. Further, we wanted to examine the possible role of smooth muscle L-type calcium channels in the autoregulatory mechanism by pharmacological intervention with the L......-type calcium channel blocker nimodipine and the vasodilator papaverine. MATERIAL AND METHODS: Pedicled flaps were raised in pigs. Flow in the pedicle was reduced by constriction of the feed artery (n=34). A transit time flow probe measured the effect on blood flow continuously. Following this, three different...

  17. Segmental embolization of the gastroduodenal artery in a case of a perforated pseudoaneurysm and gastrointestinal bleeding; Segmentembolisation der Arteria gastroduodenalis bei perforiertem Pseudoaneurysma und gastrointestinaler Massivblutung

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany); Inst. fuer Diagnostische und Interventionelle Radiologie der Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany); Cavallaro, A.; Bautz, W. [Inst. fuer Diagnostische Radiologie der Friedrich-Alexander-Univ. Nuernberg-Erlangen (Germany)

    2004-07-01

    We present the history of a woman suffering from an extensive gastrointestinal bleeding due to liver cirrhosis and chronic pancreatitis. Selective angiogram of the celiac artery revealed a pseudoaneurysm of the gastroduodenal artery caused by inflammatory wall penetration. The life-threatening hemorrhage was completely stopped by embolization with three stainless steel coils after microcatheter engagement of the gastroduodenal artery. The particularity of this case is the restricted embolization of the aneurysm vessel segment, so the collateral circulation of the gastroduodenal and pancreaticoduodenal artery could be preserved. (orig.)

  18. The use of thermography to design tissue flaps – experimental studies on animals

    Science.gov (United States)

    Łokaj, Marek; Falkowski, Aleksander; Prowans, Piotr

    2014-01-01

    Introduction Methods allowing one to locate the position of a cutaneous perforator do not allow one to determine the boundaries of the vascularized skin. In clinical practice this causes complications in the form of marginal necrosis of the flap. Aim To examine the usefulness of thermography to assess the extent of vascularization of the skin and subcutaneous tissue by a single perforator. Material and methods Thirty-one male rats were used. Using dynamic thermography the perforators on the abdominal skin were located. Afterwards the flap was prepared on a randomly chosen perforator. After 24 h the extent of vascularization of the skin by a single perforator was examined. Results In 22.5% of cases the number of perforators marked in the thermography was equal to the number of perforators marked intraoperatively, in 64.5% it was lower and in 13% higher. The use of thermography has shown that basing the flap vascularization on the perforator with low efficiency resulted in statistically more frequent occurrence of ischemia and partial necrosis of the flap (p = 0.024). Partial necrosis of the flap occurred in 12 of 31 cases, always in the area in which during the preoperative thermography no perforators were found. The areas of necrosis occurred irrespectively of the distance from the supplying vessel. Conclusions When designing the shape of the flap, the distribution of all perforators must be considered. The perforators need to be included in the area of prepared tissues because their location indicates the area with a more efficient network of vessels. PMID:25337153

  19. 大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄的关系%Relationship between the patterns of acute middle cerebral artery deep perforator infarctions and arterial stenosis

    Institute of Scientific and Technical Information of China (English)

    郑晋华; 邵蓓; 牛晓婷; 吕志坤

    2010-01-01

    目的 探讨大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄之间的关系.方法 回顾性连续分析2007年2月至2009年4月我院住院的152例脑梗死患者的临床资料.依据磁共振弥散加权成像(DWI)分为大脑中动脉深穿支小梗死组(小PAI组,直径≤3.20 cm)、大脑中动脉深穿支大梗死组(大PAI组,直径>3.20 cm)、大脑中动脉深穿支+大脑中动脉皮质支梗死组(PAI+PI组)、大脑中动脉深穿支+分水岭梗死组(PAI+BZ组)、大脑中动脉深穿支+大脑中动脉皮质支+分水岭梗死组(PAI+PI+BZ组).比较各组之间动脉狭窄检出率及动脉重度狭窄或闭塞检出率.结果 各组动脉狭窄检出率分别为16/87、9/11、17/17、11/12、23/25,小PAI组与其余4组相比差异有统计学意义(χ~2=21.780、48.065、30.567、55.523,P值均为0.000);各组动脉重度狭窄或闭塞检出率分别为1/87、2/11、12/17、9/12、21/25,小PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=56.505、55.465、79.283,P值均为0.000),大PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=7.337、7.425、11.633,P值分别为0.007、0.006、0.001);小PAI两亚组(2.00 cm<直径≤3.20 cm亚组与直径≤2.00 cm亚组)动脉狭窄检出率差异无统计学意义(χ~2=0.253,P=0.615).结论 小PAI组动脉狭窄检出率及动脉重度狭窄或闭塞检出率均较低;大PAI组、PAI+PI组、PAI+BZ组及PAI+PI+BZ组动脉狭窄检出率均较高,且PAI+PI组、PAI+BZ组、PAI+PI+BZ组动脉苇度狭窄或闭塞检出率均较高.%Objective To explor the relationship between the different types of perforating artery fresh infarcts of the middle cerebral artery and related arterial stenosis.Methods All 152 acute ischemic stroke patients hospitalized in our hospital from February 2007 to April 2009 were retrospectively reviewed.Lesions of middle cerebral artery were classified on diffusion weighted imaging

  20. 颞浅动脉岛状皮瓣修复重度感染性义眼座暴露%The repair surgery of severe infectious orbital implants exposure with superficial temporal artery island flaps

    Institute of Scientific and Technical Information of China (English)

    杨鸿斌; 刘素芝; 包俊辉; 刘萍

    2013-01-01

    Objective To discuss the method and efficacy of repairment of large severely infectious orbital implants exposure with superficial temporal artery island flaps.Methods To analyse retrospectively the clinical data in ophthalmology department of Xinjiang Hospital of Occupational Disease:6 eyes from 6 cases,with exposure of diameters over 10 mm or concurrent infections in orbital implants.Results After partial penetration and flush for infection control,the patient' s ipsilateral superficial temporal artery island flaps were implanted into the ocular prosthesis to repair the large defect of the conjunctiva sac all at once.All the flaps of 6 cases survived,with stable blood supply,good wear resistance and smooth union with the conjunctiva sac tissues.The ocular prosthesis moved smoothly in all quadrants.Except for the long hair after surgery in 2 cases,no other postoperative complications appeared in the follow-up of 1 to 5 years,with good effect of the treatment.Conclusion The effective partial anti-inflammatory therapy,combined with the superficial temporal artery island flap,is a feasible and effective surgery procedure to repair severe ocular prosthesis exposure and the co-infection.%目的 探讨颞浅动脉岛状皮瓣一次性修复感染性义眼座大面积暴露的方法和效果.方法 新疆职业病医院眼科6例(6眼)义眼座暴露直径>10 mm或合并感染的回顾性分析.结果 经过局部贯穿并冲洗控制感染,取同侧颞浅动脉岛状皮瓣,植入义眼一次性修复大面积结膜囊缺损,6例全部成活,皮瓣血供稳定,耐磨性良好,与结膜囊内组织愈合平整.安装义眼各象限活动自如.术后2例出现毛发过长,需修剪,未见其它术后并发症,随访1~5年,手术效果良好.结论 局部有效抗炎结合颞浅动脉岛状皮瓣,一次性修复严重义眼座暴露合并感染,是可行有效的手术方式.

  1. Clinical Application of Sural Neurocutaneous Flap Retained Perforating Branch to Repair Soft Tissues Defect of Lower Leg, Ankle and Foot%腓肠神经营养血管皮瓣修复下肢远端软组织缺损的疗效评价

    Institute of Scientific and Technical Information of China (English)

    谢昀; 郑力峰; 方心俞; 曾锦源; 叶君健

    2012-01-01

    目的 介绍保留穿支腓肠神经营养血管皮瓣修复小腿及踝足部软组织缺损的临床经验及手术操作技巧.方法 对2006年7月~2011年9月所完成的保留穿支腓肠神经血管营养皮瓣病例进行回顾性调查.临床病例共计74例,男性51例,女性23例,年龄中位数38岁(23~74岁),随访时间平均11月(3~28月).其中创伤及其并发症导致小腿下段软组织缺损并骨外露28例,胫骨下段慢性骨髓炎并窦道形成7例,小腿下段软组织肿瘤2例,跟骨骨折术后骨髓炎并跟骨外露11例,跟腱断裂修复术后跟腱外露6例,足部软组织缺损并骨外露12例,肌腱外露3例,足跟部皮肤慢性溃疡4例,脂溢性角化病1例.结果 皮瓣的临床效果满意,74例中全部成活45例,远端部分表皮坏死11例,伤口愈合延迟6例、远端皮瓣部分坏死9例,其中经换药后自行愈合7例,再次缝合后愈合2例,3例皮瓣大部分坏死,仍有骨质外露,手术失败.皮瓣最大面积为22 cm×12 cm,最小为7 cm×5 cm.所有负重区的皮瓣修复皆恢复保护性感觉,负重后无再次发生溃疡.结论 保留穿支的腓肠神经营养血管皮瓣相对确保皮瓣的血供,扩大皮瓣的切取面积及修复范围,进一步提高皮瓣的成活率和增加手术成功率.%Objective To introduce the clinical experience and surgical technic of the sural neurocutaneous flap retained perforating branch to repair soft tissues defect of lower leg , ankle and foot. Methods Retrospective study were completed on 74 sural neurovascular flaps applied to repair soft tissue defect of the lower leg , ankle and foot between July 2006 to September 2011. 51 males and 23 females with a mean age of 38 years old (range from 23 to 74 years) were treated and follow-up from 3 months to 28 months with a mean time of 11 months . Among them , 28 cases were soft tissue defect in distal end of lower leg due to trauma and its complications , and 7 cases were chronic osteomyelitis

  2. The application of three dimensional psychological nursing for Deep Inferior Epigastric Perforator flap breast reconstruction patients%三维心理护理在腹壁下动脉穿支皮瓣乳房再造患者治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    周蓓; 梅文星; 李俊

    2012-01-01

    目的:探讨三维心理护理在腹壁下动脉穿支(Deep Inferior Epigastric Perforator,DIEP)皮瓣乳房再造治疗中的应用.方法:乳腺癌术后希望进行乳房再造就诊患者为主要人群,通过在术前、术后及随访中,与其本人及家属,以医生和护士为沟通主体对其进行心理疏导.结果:本组患者32例,接受DIEP乳房再造者26例,手术效果满意,心理状态良好.结论:三维心理护理在DIEP皮瓣乳房再造治疗中起着辅助作用,对于患者的生活状态及术后康复有巨大影响,值得临床推广应用.%Objective To explore the application of three dimensional psychological nursing for Deep Inferior Epigastric Perforator flap breast reconstruction. Methods We performed the psychological guidance to the women who would like to take breast reconstruction operation because of absence of breast due to breast cancer during preoperative period, postoperative period and follow-up period. And their family members received the psychological guidance as well. Results There are 32 women got the three dimensional psychological nursing, 26 patients were willing to accept the surgery, all of them were satisfied with the effects with psychological well -being. Conclusion The dimensional psychological nursing produces positive effects on the DIEP breast reconstruction, plays an important role in the patients' quality of life and postoperative rehabilitation, and is well worth clinical application.

  3. Haemodynamics and viability of skin and muscle flaps

    Energy Technology Data Exchange (ETDEWEB)

    Clarke, H.M.

    1985-01-01

    In reconstructive surgery, occasional free flap failures occur despite the clinical and technical advances in microsurgery of the past few years. To minimize these losses a better understanding of basic flap physiology must be achieved. The objectives of this work were the investigation of the haemodynamic characteristics of skin and muscle flaps in normal and compromised circumstances, the viability of skin and muscle flaps after pedicle ligation or ischaemia, and the possible interrelationship of haemodynamics and viability. A Wistar rat groin island skin flap model was used to assess flap survival following vascular compromise produced by vessel ligation. Survival was seen earliest following loss of the artery and was not dependent on circulation through the vascular pedicle after 5 days. A study using free groin flaps in rats gave similar results. Normal free groin flaps were then transferred to irradiated Fischer F344 rats. Delayed neovascularization was shown at a time corresponding to the onset of the late phase of the response to skin radiation. A canine inferior epigastric free skin flap model was established to determine the normal haemodynamic parameters during free flap transfer. A canine gracilis free muscle flap model was developed. Normal haemodynamic parameters are given. These parameters were examined after ischaemia. Survival of the muscle followed ischaemia of 4 hours or less. Flap survival is not dependent solely on arterial input or venous drainage. More complex phenomena such as the reactive hyperaemia following ischaemia are implicated in survival.

  4. What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 334 Latissimus Dorsi Flaps From a Universal Donor Site.

    Science.gov (United States)

    Kim, Jeong Tae; Kim, Sang Wha; Youn, Seungki; Kim, Youn Hwan

    2015-07-01

    Microsurgical free tissue transfer is regarded as the best available method of tissue reconstruction for intractable defects. The ideal soft tissue flap is thought to be the anterolateral thigh flap. On the basis of 334 procedures involving the latissimus dorsi (LD) flap, we discuss the advantages of the LD flap over the current universal option, and we aimed to establish whether the LD could also gain universal status in all reconstructive fields.Three hundred thirty-four reconstructive procedures using the LD flap were performed in 322 patients between September 2002 and July 2012. In accordance with defect characteristics, we performed 334 procedures using flaps, which included the LD muscle flap with skin graft, the myocutaneous flap, the muscle-sparing flap, the perforator flap, the chimeric flap, and the 2-flap technique using the serratus anterior branch.Flap-related complications occurred in 21 patients (6.3%), including total and partial flap failure. In 253 cases, the donor site was closed primarily, and in the remaining cases, we used split-thickness skin grafts. Donor-site complications occurred in 20 cases (6%). In 11 of the 182 cases, no suitable perforators were identified during surgery.The advantages of the LD as a donor site include the possibility of various harvesting positions without position change, versatility of components, availability of muscle to fill extensive defects, and presence of thick fascia to enable full abdominal reconstruction. On the basis of our experience, we concluded that this flap has the potential to be used as widely as, or in preference to, the anterolateral thigh flap in most reconstructive areas.

  5. Reactive perforating collagenosis

    Directory of Open Access Journals (Sweden)

    Yadav Mukesh

    2009-01-01

    Full Text Available Reactive perforating collagenosis is a rare cutaneous disorder of unknown etiology. We hereby describe a case of acquired reactive perforating collagenosis in a patient of diabetes and chronic renal failure.

  6. Surgical exploration of 71 free flaps in crisis following head and neck reconstruction.

    Science.gov (United States)

    Yang, X; Li, S; Wu, K; Hu, L; Liu, W; Ji, T; Hu, Y; Xu, L; Sun, J; Zhang, Z; Zhang, C

    2016-02-01

    The medical records of patients who had undergone a free flap reconstruction after radical resection of oral cancer between January 2009 and December 2013 at the study hospital in China were reviewed retrospectively. Of the 1550 patients who underwent free flap reconstructions, 71 were explored for suspected flap compromise caused by postoperative thrombosis. Patient demographic data, clinicopathological data of the tumour, details of the free flaps, and operative findings were assessed, and the medical records were analyzed to identify the reasons for intervention and the outcomes. Of the 71 flaps in crisis, 47 (66.2%) were salvaged. Free flap failure was 6.2-times more likely to develop in patients undergoing surgical exploration after 72 h (95% confidence interval 2.090-18.197, P=0.001). Of the 19 flaps identified as subject to delayed exploration, 14 failed and three had partial necrosis. Free flap failure was 3.4-times more likely to develop in patients with perforator flaps (95% confidence interval 1.222-9.719, P=0.019). The early detection of free flap failure is critical to flap salvage. The salvage success rate decreases significantly at >72 h after the initial operation. It appears to be more difficult to salvage a perforator flap.

  7. A Case of Urethral Reconstruction Using a Superficial Circumflex Iliac Artery

    Directory of Open Access Journals (Sweden)

    Kun-Woon Yoo

    2012-05-01

    Full Text Available A radial forearm free flap has been conventionally used for urethral reconstruction. However,aesthetic and functional complications occur frequently at the donor site. The use of asuperficial circumflex iliac artery perforator (SCIP flap can resolve these disadvantages.Here, we report our case with a review of literature. A 69-year-old man visited our hospitalwith multiple contusions of the abdomen and genital amputation. After necrotic tissuedebridement, the length of the residual corpus carvernosum was 1.5 cm and that of thecorpus spongiosum and urethra was 1 cm. For the reconstruction of the penis, a SCIP flap andanterolateral thigh free flap was performed. The primary closure was performed at the donorsite. Three weeks postoperatively, the patient had a urethral foley catheter removed. Theneourethra was functioning well without stricture. Four months postoperatively, the patienthad no complications such as urethral stricture. A good recovery was also achieved withno aesthetic deficits at the donor site. SCIP flap is appropriate for urethral reconstruction.Because of its proximity to the recipient sites, it makes surgical preparation easier and theprimary closure at the donor site available. It is also advantageous in that its location isalmost unnoticeable.

  8. 双干型静脉皮瓣在撕脱性断指再植中的应用%Application of arterialized venous flap with double vein trunks in replantation of degloved fingers

    Institute of Scientific and Technical Information of China (English)

    周晓; 芮永军; 许亚军; 寿奎水; 姚群

    2011-01-01

    目的 报告双干型静脉皮瓣在撕脱性断指再植中的应用和临床效果.方法 2007年3月至2009年6月,采用前臂双干型静脉皮瓣游离移植修复伴有皮肤软组织缺损的撕脱性断指6例,损伤至入院时间为30 min至8 h,切取皮瓣面积为1.8cm×1.8cm~2.2 cm×5.8cm,供区创面直接缝合.结果 术后6例伤口均Ⅰ期愈合,断指再植全部存活;5例静脉皮瓣无肿胀,顺利存活;1例皮瓣早期肿胀明显,紫红色,并见散在小水泡,经拆除部分缝线、换药等对症处理后顺利存活.术后随访时间为6个月至2年.皮瓣及再植手指血运好,皮瓣质地软,弹性好、耐磨.根据中华医学会手外科学会断指再植功能评定试用标准评定;优4例,良1例,可1例;优良率为82.5%.结论 采用前臂掌侧双干型静脉皮瓣游离移植修复伴有皮肤软组织缺损的撕脱性断指,能最大程度地恢复手指的功能和外形.%Objective To report the application and results of venous flap with double vein trunks in replantation of degloved fingers.Methods From March 2007 to June 2009, 6 cases of soft tissue defect in the degloved finger were replanted with venous flap with double vein trunks.The interval between injury and operation was 30 minutes to 8 hours.All fingers were replanted by arterialized free venous flap from the ipsilateral forearm with double vein trunks.The flap was 1.8 cm×1.8 cm to 2.2 cm× 5.8 cm in size.The donor site was directly closed.Results Primary wound healing was observed in all 6 cases postoperatively.All the replanted fingers survived completely.In 5 cases the venous flaps survived uneventfully.In 1 case there was partial superficial necrosis of the flap which healed with conservative management.Postoperative follow-up ranged from 6 to 24 months.The flaps and fingers had good circulation, good texture and color match.According to the criteria for functional assessment of amputated finger issued by the Chinese Hand Surgery Society, the

  9. 鼻烟窝皮瓣在手部皮肤缺损中的应用%Application of snuff-box flap in repairing skin defects of the hand

    Institute of Scientific and Technical Information of China (English)

    陶水良; 曾林如; 汤样华

    2010-01-01

    目的 探讨应用带蒂鼻烟窝皮瓣修复手部中小面积软组织缺损的方法和临床效果.方法 2005年7月至2009年5月,对22例手部软组织缺损的患者,应用鼻烟窝皮瓣进行修复.结果 术后1例皮瓣远端部分坏死,经换药后愈合;余皮瓣全部存活.术后随访6~24个月,皮瓣质地、色泽及外观良好,皮瓣无臃肿及萎缩,感觉良好.结论 以桡动脉皮支为蒂的鼻烟窝皮瓣血管解剖恒定,是修复手部中小面积软组织缺损的有效方法.%Objective To explore the surgical technique and clinical outcomes of pedicled snuff-box flap to repair skin defects in the hand of small to medium sizes. Methods From July 2005 to May 2009 , the snuff-box flap was used to repair soft tissue defects of the hand in 22 cases. The survival rate, texture, colour and sensation of the flaps were evaluated. Results All 22 flaps survived except the partial distal necrosis in 1 case. Postoperative follow-up period ranged from 6 to 24 months. The texture, colour and appearance of the flaps were good. There was no bulkiness and atrophy of the flap. Flap sensation was good. Conclusion The snuffbox flap based on perforator of the radial artery has constant vascular anatomy. It is an effective procedure to repair small to medium size defects of the hand.

  10. 膝关节周围动脉为蒂骨膜(骨)瓣的应用解剖及临床意义%Anatomical study and clinical application of the periosteal (bone ) flaps pedicled with arteries around knee joint

    Institute of Scientific and Technical Information of China (English)

    祝少博; 陈振光; 谭金海; 方成; 张发惠; 郑和平

    2001-01-01

    Objective To provide anatomical basis for repairing nonunion and defect around knee joint. Methods The origin, course, branches, distribution and anastomosis of the vessel netwo rk around knee joint were observed and measured in 30 adult cadaver lower limb specimens infused with red dye via artery. Results There were abundant vessel network around knee joint, which was composed of the end b ranches and communicating branches of femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery, etc. Conclusion  The periosteal (bone) flaps pedicled with arteries around knee is one of the mos t important donors.%目的 为带蒂骨膜(骨)瓣移位治疗膝关节周围骨不连、骨缺损提供解剖学依据。方法 在30侧经动脉灌注的成人下肢标本上,观察并测量膝关节周围动脉网有关血管的起始、走行、口径、分布及其吻合情况。结果 膝关节周围存在着丰富的血供,其主要由月 国动脉、股动脉、胫前动脉、胫后动脉的终末支及相互间的交通支和吻合网恒定构成。结论 以膝关节周围动脉为蒂的骨膜(骨)瓣,是进行局部转位和吻合血管游离移植的重要供区之一。

  11. Vacuum sealing drainage and free coupling chain-link posterior tibial artery flap in the reconstruction of degloving injury of propodium%负压封闭引流联合游离胫后动脉串联皮瓣修复前足脱套伤

    Institute of Scientific and Technical Information of China (English)

    王相; 张威凯; 王海兵; 毛根莲; 李建

    2013-01-01

    Objective To present the methods of vacuum sealing drainage and free coupling chain-link flap of posterior tibial artery flap and medial plantar flap in the reconstruction of degloving injury of propodium.Methods From Oct.2008 to Dec.2011 five cases with degloving injury of propodium underwent debridement and vacuum sealing drainage on the first stage.Free chain-link flap of posterior tibial artery flap and medial plantar flap were applied to close the wound at the secondary stage.The nerve was included in the coupling flaps.The size of posterior tibial artery flap ranged from 14 cm × 10 cm to 11 cm × 8 cm,and the size of medial plantar flap ranged from 12 cm × 8 cm to 8 cm × 6 cm.Results All flaps were survived with no vascular crisis.The flap sensation recoverd to S3-S3+ during the follow-up period of 6-21 months.The texture and appearance of flaps were satisfied.The plantar had not ulcer and corpus callosum.Conclusion Vacuum sealing drainage and free chain-link flap of posterior tibial artery flap and medial plantar flap with nerve are the ideal methods for the reconstruction of degloving injury of propodium.%目的 探讨应用负压封闭引流技术联合游离胫后动脉皮瓣串联足底内侧皮瓣瓦合修复前足脱套伤的方法和临床效果.方法 2008年10月至2011年12月,一期应用负压封闭引流技术处理创面,延期应用带神经的游离胫后动脉皮瓣串联足底内侧皮瓣瓦合修复前足脱套伤5例.皮瓣切取面积为:胫后动脉皮瓣14 cm×10 cm~11 cm×8 cm,足底内侧皮瓣12 cm×8 cm~8 cm×6cm.结果 本组5例皮瓣全部成活,无血管危象发生.术后随访6~21个月,感觉恢复S3~S3+级,皮瓣质地、外形均良好,跖底无溃疡及胼胝发生.结论 应用负压封闭引流技术联合带神经的游离胫后动脉皮瓣串联足底内侧皮瓣瓦合修复前足脱套伤,是一种有效可行的方法.

  12. Treatment of the donor site after wound healing of semi-toe nail flap%半趾甲瓣移植手术供区创面的修复处理

    Institute of Scientific and Technical Information of China (English)

    郑晓菊; 王保山; 仇永锋

    2011-01-01

    Objective To explore the wound healing of semi-toe nail flap donor site after transplantation. Methods To repair small wounds,on 13 toes the first metatarsal dorsal flaps were applied,and on 7 toes the second toe digital flaps were applied.While,to repair large wounds,free flaps were applied,including foot inside flaps on 3 toes,peroneal artery perforator flaps on 5 toes,tarsal lateral artery flaps on 2 toes,and phil bowel artery inside branch flaps on 3 toes.Wounds remaining on semi-toe nail flaps of 7 toes were all covered with fibular island flaps of the first toes. Results Twenty cases were followed up,and the rang between 6 months to 5 years.The nail margin was exposed out of the lateral flaps in 2 cases.The first toes and the second toes appeared nearly normal in the other 18 cases.The flaps appeared smooth,flexible appearance with nice color and no ulceration.Seven cases applied with free flaps recovered protective sensibility with no complaint. Conclusion To cover wounds on semi-toe nail flaps of the first toes and the second toes with flaps is an ideal treatment method.The method of free flap transplantation is superior to vascular pedicle flap graft.%目的 探讨半趾甲瓣移植术的供区创面修复方法.方法 自2004年2月至2010年9月,采用带蒂或游离皮瓣修复趾甲瓣足趾供区创面36例40指.趾供区面积较小者13趾采用第一跖背皮瓣、7趾用第二趾动脉皮瓣修复;面积大者采用游离皮瓣修复,其中足底内侧皮瓣3趾,腓动脉穿支皮瓣5趾,跗外侧动脉皮瓣2趾,腓肠动脉内侧支皮瓣3趾.第二趾半趾甲瓣再造手指7趾,其创面均采用(母)趾腓侧岛状皮瓣覆盖.结果 20例术后获得6个月至5年随访,其中2例甲缘外露在皮瓣外,18例(母)趾、第二足趾外观近似正常,皮瓣平整无破溃,皮瓣颜色质地好;游离皮瓣中有7例恢复保护性感觉;修复足趾屈伸活动正常,行走无不适感.结论 用皮瓣移植覆盖(母)趾及第二趾半趾

  13. Fasciocutaneous flaps

    NARCIS (Netherlands)

    D.E. Tolhurst (David)

    1988-01-01

    textabstractAbout that time the concept of independent myocutaneous vascular territories (Me Craw and Dibbell, 1977) was beginning to take hold but the deep fascia, sandwiched between muscles and the skin, was largely regarded as an isolating layer of dense, avascular fibrous tissue from which flaps

  14. 腹壁下动脉穿支皮瓣和带蒂横行腹直肌皮瓣在乳房重建中的对比研究%Comparison of the deep inferior epigastric perforator and pedicled transverse rectus abdominis myocutaneous flap

    Institute of Scientific and Technical Information of China (English)

    李亮; 刘军涛; 蔡海峰; 张文龙; 侍朋举; 郑宏明; 赵刚

    2015-01-01

    目的 比较应用腹壁下动脉穿支(DIEP)皮瓣和带蒂横行腹直肌(TRAM)皮瓣行乳房重建术的术后并发症发生率和成本.方法 回顾性分析2000年1月至2014年12月河北联合大学附属医院和唐山市人民医院行DIEP皮瓣和TRAM皮瓣乳房重建患者的临床资料.11例应用TRAM皮瓣进行了即刻乳房重建,19例应用了DIEP皮瓣.比较两组的治疗费用、住院时间和术后2年的并发症.结果 主要并发症方面,脂肪液化在TRAM组有5例,DIEP组有1例,两组发生率差异有统计学意义(P=0.016),皮瓣坏死在TRAM组有1例,DIEP组无该并发症发生,两组均无腹壁疝气发生,两组差异均无统计学意义(P均>0.05).次要并发症方面,术后血肿在TRAM组有4例,DIEP组1例,两组差异有统计学意义(P=0.047),伤口裂开在TRAM组有2例,DIEP组有1例,感染仅在TRAM组有1例,差异均无统计学意义(P均>0.05).TRAM组平均治疗费用为(14 133.12±1 546.88)元,DIEP组为(16838.94±3 006.05)元,差异有统计学意义(P=0.010).TRAM组平均住院时间为(17.28±2.08)d,DIEP组为(18.39±2.87)d,两组差异无统计学意义(P>0.05).结论 近年来发展的DIEP皮瓣乳房重建技术临床结局更好,但经济负担更高.%Objective To compare the complication and cost-effectiveness of the deep inferior epigastric perforator(DIEP) flap and transverse rectus abdominis myocutaneous(TRAM) flap.Methods From January 2000 to December 2014,all patients who underwent DIEP flap and TRAM flap in the People's Hospital of Tangshan and the Affiliated Hospital of North China University of Science and Technology, were selected.Eleven patients underwent immediate breast reconstruction with TRAM flaps and 19 patients with DIEP flaps.The treatment cost,length of hospitalization, and complication in the two year after surgery for each group were compared.Results For the major complications,there were 5 cases appeared fat necrosis in TRAM group, and 1 case in DIEP group

  15. Detection of Perforators Using Smartphone Thermal Imaging.

    Science.gov (United States)

    Hardwicke, Joseph T; Osmani, Omer; Skillman, Joanna M

    2016-01-01

    Thermal imaging detects infrared radiation from an object, producing a thermogram that can be interpreted as a surrogate marker for cutaneous blood flow. To date, high-resolution cameras typically cost tens of thousands of dollars. The FLIR ONE is a smartphone-compatible miniature thermal imaging camera that currently retails at under $200. In a proof-of-concept study, patients and healthy volunteers were assessed with thermal imaging for (1) detecting and mapping perforators, (2) defining perforasomes, and (3) monitoring free flaps. Preoperative, intraoperative, and postoperative thermograms can assist in the planning, execution, and monitoring of free flaps, and the FLIR ONE provides a low-cost adjunct that could be applied to other areas of burns and plastic surgery.

  16. Application of a new laser Doppler imaging system in planning and monitoring of surgical flaps

    Science.gov (United States)

    Schlosser, Stefan; Wirth, Raphael; Plock, Jan A.; Serov, Alexandre; Banic, Andrej; Erni, Dominique

    2010-05-01

    There is a demand for technologies able to assess the perfusion of surgical flaps quantitatively and reliably to avoid ischemic complications. The aim of this study is to test a new high-speed high-definition laser Doppler imaging (LDI) system (FluxEXPLORER, Microvascular Imaging, Lausanne, Switzerland) in terms of preoperative mapping of the vascular supply (perforator vessels) and postoperative flow monitoring. The FluxEXPLORER performs perfusion mapping of an area 9×9 cm with a resolution of 256×256 pixels within 6 s in high-definition imaging mode. The sensitivity and predictability to localize perforators is expressed by the coincidence of preoperatively assessed LDI high flow spots with intraoperatively verified perforators in nine patients. 18 free flaps are monitored before, during, and after total ischemia. 63% of all verified perforators correspond to a high flow spot, and 38% of all high flow spots correspond to a verified perforator (positive predictive value). All perfused flaps reveal a value of above 221 perfusion units (PUs), and all values obtained in the ischemic flaps are beneath 187 PU. In summary, we conclude that the present LDI system can serve as a reliable, fast, and easy-to-handle tool to detect ischemia in free flaps, whereas perforator vessels cannot be detected appropriately.

  17. Reconstruction of through-and-through oromandibular defects by the double-skin paddle fibula osteocutaneous flap: can the skin paddle always be divided?

    Science.gov (United States)

    Kubo, Tateki; Osaki, Yoko; Hattori, Ryo; Kanazawa, Shigeyuki; Hosokawa, Ko

    2013-02-01

    Reconstruction of the through-and-through defects of the oral cavity, involving oral mucosa, bone, and external skin is a major challenge. A single fibula osteocutaneous flap providing two skin islands is an option for such composite reconstruction. The number, location, and size of skin perforators were studied in the distal two thirds of the lower legs in 22 cases of fibula osteocutaneous flap mandibular reconstruction, and whether the skin paddle of the fibula flap could always be divided completely based on two distal perforators was examined. In this study, only 50% of the flaps had two or more distal perforators; thus, it was concluded that the skin paddle of the fibula osteocutaneous flap could not always be divided based on two distal skin perforators.

  18. Prospective evaluation of outcome measures in free-flap surgery.

    LENUS (Irish Health Repository)

    Kelly, John L

    2004-08-01

    Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +\\/- 29 min) and in those that survived (92 +\\/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival.

  19. [Osteomuscular serrato-costal free flap: application to mandibular reconstruction].

    Science.gov (United States)

    Breton, P; Henry, J F; Crezoit, E; Souchere, B; Freidel, M

    1992-06-01

    The serrato-costal free flap provides a large costal flap vascularized by a digitation of the serratus anterior muscle supplied by the dorsal thoracic artery. The flap is easy and rapid to raise with low morbidity. The repair obtained is functionally very satisfactory, but does not allow insertion of an implant. Six cases are reported. The indications of this technique of mandibular reconstruction are discussed.

  20. Women's Experiences With Flap Failure After Autologous Breast Reconstruction: A Qualitative Analysis.

    Science.gov (United States)

    Higgins, Kristen S; Gillis, Joshua; Williams, Jason G; LeBlanc, Martin; Bezuhly, Michael; Chorney, Jill M

    2016-10-06

    Clinical experience suggests that flap failure after autologous breast reconstruction can be a devastating experience for women. Previous research has examined women's experiences with autologous breast reconstruction with and without complications, and patients' experiences with suboptimal outcomes from other medical procedures. The authors aimed to examine the psychosocial experience of flap failure from the patient's perspective. Seven women who had experienced unilateral flap failure after deep inferior epigastric perforator flap surgery in the past 12 years completed semistructured interviews about their breast cancer treatments, their experiences with flap failure, the impact of flap failure on their lives, and the coping strategies they used. Interpretive phenomenological analysis, a type of qualitative analysis that provides an in-depth account of participant's experiences and their meanings, was used to analyze the interview data. From these data, patient-derived recommendations were developed for surgeons caring for women who have experienced flap failure. Three main themes (6 subthemes) emerged: coming to terms with flap failure (coping with emotions, body dissatisfaction); making meaning of flap failure experience (questioning, relationship with surgeon); and care providers acknowledging the emotional experience of flap failure (experience of being treated "mechanically," suggestions for improvement). In conclusion, flap failure in breast reconstruction is an emotionally difficult experience for women. Although there are similarities to other populations of patients experiencing suboptimal outcomes from medical procedures, there are also unique aspects of the flap failure experience. A better understanding of women's experiences with flap failure will assist in providing more appropriate supports.

  1. The interpectoral fascia flap.

    Science.gov (United States)

    Beer, Gertrude M; Manestar, Andrew; Manestar, Mirjana

    2008-09-01

    Despite the great number of pedicled and free flaps that are available for defect and contour repair, the number of fascia flaps with an axial blood supply are sparse. Such flaps with their gliding function are mandatory, whenever coverage with very thin, well-vascularized tissue is necessary. To the currently established fascia flaps, (the temporoparietal fascia flap, the radial forearm fascia flap, the lateral arm fascia flap, and the serratus anterior fascia flap), we want to add a new fascia flap, the interpectoral fascia flap. We dissected the interpectoral fascia flap from 20 cadavers. In each of the 40 hemichests, the trunk of the thoracoacromial vessels was selectively injected with red polyurethane and the tissue containing the pectoral branches was separated from the overlying pectoralis major muscle and converted into an independent fascia flap. The maximum flap length was 13.5 cm and the maximum breadth was 10.3 cm. The length of the vascular pedicle before entering the flap was 3.9 cm +/- 1.4 cm with a range of 1.5-6.8 cm. Concerning the arc of rotation, all 40 flaps reached the posterior axillary fold, and 29 flaps (73%) reached the mandibular border. This new fascia flap has applications as pedicled and as free flap. The pedicled flap is used in the neck region, in the axillary region and as gliding tissue between the nipple-areola complex and the pectoralis major muscle. The usage of the fascia flap as a free flap has similar characteristics as the other fascia flaps.

  2. Retrograde vascularisation of fibula free flap in composite oro-mandibular reconstruction

    Directory of Open Access Journals (Sweden)

    G I Nambi

    2013-01-01

    Full Text Available We present a case of composite oromandibular reconstruction with fibula free flap in which the vascularity to the flap was established in a retrograde direction through the distal end of the peroneal pedicle vessels. The flap was initially designed in such a way so as to anastomose with superior thyroid artery. However after initial good flow, the superior thyroid artery flow became insufficient. Therefore, an attempt was made to vascularise the flap by anastomosing the distal end of peroneal vessels with the facial artery and a tributary of the internal jugular vein so that the flap was perfused in a retrograde direction. This was successful and the retrograde flow was adequate to ensure flap survival. We believe this to be the first successful case of reverse vascular flow reported for composite oromandibular reconstruction with the fibula free flap.

  3. Strategies in Perforated Diverticulitis

    NARCIS (Netherlands)

    J. Vermeulen (Jefrey)

    2010-01-01

    textabstractAlthough diverticulitis is a common disease affecting the gastrointestinal tract, few is known about the optimal surgical treatment of its most severe form: perforated diverticulitis. Regardless of the selected operation, perforated diverticulitis is associated with mortality rates up to

  4. Repair of electrical burns in the limbs with flap%四肢电烧伤创面的皮瓣修复

    Institute of Scientific and Technical Information of China (English)

    金秀; 王涛; 蒋子平; 于家傲; 路来金

    2015-01-01

    artery flap,1 case was treated by free latissimus dorsi flap,3 cases were treated by free anterolateral thigh flaps;1 case was treated by reverse island forearm posterior interosseous flap,2 cases were treated by posterior perforator reversed island flaps of the lower leg,1 case was treated by anterolateral perforator reversed island flaps of the lower leg.The area of flap was from 42.0 cm × 13.0 cm to 6.0 cm × 3.0 cm.The survival rate of the flap,the appearance and function of limb were observed.Results All these patients were followed up from 4 months to 3 years 6 months,the mean time was 6 months and 20 days.Thirty-five flaps survived completely,accounting for 92.1%,and 3 cases suffered partial necrosis at the distal end,accounting for 7.9%.Secondary healing was achieved by dress changing.The appearance of the limbs was satisfactory.Among the 28 cases whose bums were on the hands,the total number of excellent and good was 15,medium was 8,and 5 poor cases.The excellent and good rate was 57.1%.Conclusion Early repairing of the electrical burns with flaps is the effective method for protecting the deep structures of the limb,preventing and control the secondary infections and preserve the function of the limbs.

  5. Análisis de perforantes de la epigástrica inferior profunda con Angio TC 3D, Eco Doppler color y Doppler simple de ultrasonidos en colgajo DIEP: resultados preliminares Analysis of deep inferior epigastric perforating vessels with 3D CT angiography, color Doppler ultrasonography and Doppler in diep flaps: preliminary results

    Directory of Open Access Journals (Sweden)

    J. Castro García

    2008-09-01

    Doppler ultrasound, Colour-Duplex and Angio-CT with three-dimentional reconstruction. Surgical procedure findings were considered as the reference value. The evaluation procedure included the election of the most suitable perforator vessels, taking account of the location, caliber and anatomical relationships with the muscle. The Angio-CT with three-dimentional reconstruction showed 100% specificity (CI 95% 75.3-100, and very high positive predictive value. In this way, this technique could be considered as an excellent tool for preoperative evaluation of perforators flaps. Color-Duplex showed that in 46,1% of the patients (CI 95% 19,2-74% the selected perforator matched with the intraoperatively selected. Using Doppler ultrasound only in 30,8% of the cases (IC 95% 9,1-61,4% this result was observed. In this report, Angio-CT with three-dimentional reconstruction has revealed as a very high specificity technique, that allows a great account of important information, only comparable with anatomical dissection and ahead from Doppler ultrasound and color-Dupplex.

  6. Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face.

    Science.gov (United States)

    Longo, Benedetto; Laporta, Rosaria; Pagnoni, Marco; Campanale, Antonella; Grippaudo, Francesca Romana; Santanelli Di Pompeo, Fabio

    2015-03-01

    Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represent the gold standard, providing superior functional and aesthetic restoration. Purpose of this study was to assess reliability of skin-grafted latissimus dorsi (LD) flap, for a pleasant and symmetric reconstruction of the lateral aesthetic units of the face compared to a control group of patients addressed to perforator flaps. From November 2008 to June 2012, 5 patients underwent skin-grafted LD flap reconstruction of defects involving the lateral aesthetic units of the face, with 8.1 ± 0.5 × 9.7 ± 1.3 cm mean size. A 1-to-4 Likert scale was used to assess skin color, texture, shape, and bulkiness. Using the Pressure-Specified Sensory Device epicritic, proprioceptive, and protopathic sensitivities were tested. Outcomes were compared with those of a control group of 5 patients addressed to reconstruction with perforator flaps (3 anterolateral thigh flap, 2 vertical deep inferior perforator flap). At mean 21-month follow-up all flaps healed uneventfully without need for revisions, all developing more satisfactory results in terms of skin color (P = 0.028) and texture (P = 0.021) match, shape (P = 0.047) and bulkiness (P = 0.012) compared with perforator flaps. No differences in epicritic, proprioceptive, and protopathic sensitivities were observed (P > 0.05) between the two groups. Skin-grafted LD flap may be a suitable option for reconstruction of wide defects of the lateral aesthetic units of the face.

  7. Perforation of the Right Ventricle Induced by Pulmonary Artery Catheter at Induction of Anesthesia for the Surgery for Liver Transplantation: A Case Report and Reviewed of Literature

    Directory of Open Access Journals (Sweden)

    Maria Auxiliadora-Martins

    2009-01-01

    Full Text Available We report a case of a 45-year-old male patient diagnosed with liver cirrhosis by hepatitis C and alcohol, with a Child-Pugh score C and a model for end-stage liver disease (MELD score of 27, and submitted to liver transplantation. The subject underwent insertion of the pulmonary artery catheter (PAC in the right internal jugular vein, with technical difficulty concerning catheter advance. There was sudden hypotension, increase in central venous pressure (CVP, and decrease in SvO2 15 minutes after the PAC had been inserted, followed by cardiorespiratory arrest in pulseless electrical activity (PEA, which was promptly assisted with resuscitation. Pericardiocentesis was performed without success, so the individual was subjected to a subxiphoid pericardial window, which led to output of large amounts of blood as well as PEA reversal to sinus rhythm. Sternotomy was performed; rupture of the apex of the right ventricle (RV was detected, and suture of the site was accomplished. After hemodynamic stabilization, the patient was transferred to the ICU, where he developed septic shock and, despite adequate therapy, died on the eighteenth day after ICU admission.

  8. Repair of the hand′s soft tissue defect with free flap taken from the supra-wrist branch of the ;ulnar artery%尺动脉腕上支皮瓣修复手部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    鹿亮; 刘彬; 尚希福

    2015-01-01

    Objective To evaluate clinical effect of free flap taken from the supra-wrist branch of ulnar artery in re-construction of extensive soft tissue defects of hands. Methods 15 patients of skin and soft tissue defects were re-paired with free flaps taken from supra-wrist branch of ulnar artery. The defect sizes were 5 cm × 8 cm~6 cm × 13 cm. Results All the free flaps survived completely without vascular crisis or necrosis. All the patients were followed up from 6 months to 12 months. Texure,color,appearance and function of skin flaps had a good recovery. Conclu-sions Free flap taken from supra-wrist branch of ulnar artery used in the reconstruction of extensive soft tissue de-fects of the hands can achieve good clinical efficacy with advantages of safety and reliability.%目的:探讨应用尺动脉腕上支皮瓣修复手部软组织缺损的临床疗效。方法采用尺动脉腕上支皮瓣修复15例手部软组织缺损患者,创面面积为5 cm ×8 cm~6 cm ×13 cm。结果15例15块皮瓣全部成活,未发生血管危象,无皮瓣边缘坏死。15例均获随访,时间6~12个月。皮瓣质地、色泽外观及感觉功能恢复满意。结论应用尺动脉腕上支皮瓣修复手部软组织缺损疗效满意。

  9. 逆行足背动脉蒂跗外侧动脉皮瓣修复前足内侧皮肤软组织缺损%Lateral tarsal artery flap with retrograde dorsal artery pedicle for repairing soft tissue defects of the forefoot

    Institute of Scientific and Technical Information of China (English)

    尹光明

    2012-01-01

    Objective To explore the operative method and effects of lateral tarsal artery flap with retro-grade dorsal artery pedicle in repairing the soft tissue defect of forefoot.Methods Retrograde transposition was ap-plied for repairing medial forefoot wound,and anastomosis was achieved between the lateral dorsal nerve of foot and the nerve stump based on the design of lateral tarsal artery skin pedicled with dorsal artery.The donor site was re-paired with full thickness skin graft.Results All the 8 skin flaps survived and the wound healed in the primary stage.Vascular crisis occurred in 1 ease due to the extreme bandaging tightness of the skin grafting area on the first postoperatve day,then the skin flap survived after the operation.Partial margin necrosis occurred in the flap in 1 case,and the flap survived after dressing.All the patients were followed up for 6-24 months(average 13 months).The texture of the smwived flaps were soft;the color was similar to the surrounding normal skin;the appearance was not bloated or ruptured.The patients could wear shoes and walk normally.Six months after operation,the distanse sense was between 4-10 mm.For non-anastomosis of nerves,the flap could restore only part of the protective feel-ing.Conclusion Lateral tarsal artery flap with retrograde dorsal artery pedicle has advantages of suitable thick-hess,constant vascular anatomy,long vascular pedicle,large caliber,sufficient blood supply and being able to recon-struct the skin feeling in the grafting area.It is a good method to repair soft tissue defect of forefoot skin.%目的 探讨逆行足背动脉蒂跗外侧动脉皮瓣修复前足内侧皮肤软组织缺损的手术方法及临床疗效.方法 于足背外侧设计以足背动脉为蒂的跗外侧动脉皮瓣,以足背动脉足底穿支为旋转点,逆行移位修复前足内侧创面,将足背外侧皮神经与受区神经残端吻合.供区采用全厚皮片植皮修复.结果 术后8例皮瓣均

  10. 颏下动脉岛状瓣在颜面部软组织缺损修复中的应用%Application of the Submental Artery Island Flap for Repairing Facial Soft Tissue Defect

    Institute of Scientific and Technical Information of China (English)

    王贺红; 汪春兰; 赵宇

    2015-01-01

    Objective To explore the application of the submental artery island flap in repairing facial soft tissue defect. Methods From July 2007 to 2014, 10 cases with facial soft tissue defect were admitted in this study. Primary lesions in-cluded trauma (2 cases), buccal mucosa squamous cell carcinoma (SCC, 4 cases), buccal basal cell carcinoma (BCC, 1 case), and scar hyperplasia caused by burning or scalding (3 cases). Flaps ranging from 3 cm ×6 cm to 4 cm×10 cm were designed according to the size and location of the facial defects to repair facial soft tissue defects. Results Pale, swell and/or conges-tion were observed in all flaps postoperative, but the situation improved 5 days later. Partial necrosis was observed in 1 case but healed by dressing. All the patients were followed up for 3-12 months, full thickness skin which was used to cover the donor-site in 3 cases shrank inordinately during followed-up. Appearance and functions of the recipient site were satisfacto-ry. The scar of the donor-sites was not conspicuous. Conclusion The submental artery island flap is similar with the facial soft tissue on color and texture, and it offers the advantages of simplicity, reliability and aesthetic result, so it is an excellent choice for repairing facial defects and deformity.%目的:探讨颏下动脉岛状瓣在修复颜面部软组织缺损中的应用。方法2007年7月至2014年3月,收治颜面部软组织缺损患者10例,其中外伤2例,面部鳞癌4例,面部基底细胞癌1例,烫伤或烧伤后瘢痕增生3例。根据缺损位置及大小设计颏下动脉岛状瓣进行修复,最小为3 cm×6 cm,最大为4 cm×10 cm。结果术后皮瓣存在不同程度的肿胀苍白及淤血,5 d后逐渐改善。1例皮瓣远端出现坏死,经换药处理愈合。术后随访3~12个月,3例供皮区采用全厚皮覆盖创面,随访期间发现皮片不同程度收缩。其余受区外观及功能均较满意,供区瘢痕隐蔽。结论颏下

  11. 指固有动脉皮支血管链逆行侧方皮瓣修复手指软组织缺损%Flap Pedicled with Lateral Vascular Chain of Cutaneous Branch of Digital Artery to Repair the Soft Tissue Defect of the Distal Finger

    Institute of Scientific and Technical Information of China (English)

    李超; 王浩; 潘朝晖

    2014-01-01

    目的:探讨指固有动脉皮支血管链逆行侧方皮瓣修复手指远端软组织缺损的效果。方法以指固有动脉背侧皮支上行支、下行支形成的链式吻合供血,在手指近节侧方切取皮瓣。皮瓣的轴线是手指侧方中线,皮瓣旋转点为中节指体中远端,皮瓣的蒂部宽度为0.5~1.0cm。皮瓣携带指背神经与创面指神经断端进行缝合修复,重建手指感觉。逆行移位皮瓣修复指端创面32例。结果32例皮瓣全部成活。术后随访6个月~1年,皮瓣外形与正常相近,弹性、色泽良好。缺损饱满而不臃肿,质地柔软,有排汗功能,两点辨别觉达5~9 mm。结论采用指固有动脉皮支血管链逆行侧方皮瓣一期修复指端缺损,疗程短,效果好,操作简单,血供可靠,不牺牲指固有动脉、神经,供区损伤小,术后并发症少,并且能重建皮瓣感觉,是一种理想的手术修复方法。%Objective To explore the effect of flap pedicled with lateral vascular chain of cutaneous branch of digital artery to re -pair the soft tissue defect of the distal finger .Methods The flap based on the dorsal cutaneous branch of digital artery ,the ascending branch and the descending branch formation of supply vascular chain in the finger's lateral.The axis of the flap was finger lateral midline , the rotation point of flap was the middle finger of the distal , and the pedicle width of flap was 0.5~1.0cm.Flap repaird dorsal nerve and stump nerve , reconstructed of the finger's feeling.Retrograde transposition of flap in 32 cases to repair finger end .Results All flaps survived in 32 cases. After followed up for 6 months~1 years,flap had the normal close,elastic,good colour.Defect was full and not bloated , and soft texture,had the function that discharge sweat ,two-point discrimination Jueda 5~9mm.Conclusion Flap pedicled with lateral vascular chain of cutane-ous branch of digital artery to repair the

  12. Vaginal reconstruction using perineal-thigh flaps with subcutaneous pedicle.

    Science.gov (United States)

    Chen, Z; Chen, C; Chen, M; Zhang, J; Wu, N; Wang, J

    1991-03-01

    A technique of vaginal reconstruction using bilateral, perineal-thigh flaps with subcutaneous pedicle is described. In this procedure, the flaps were raised bilaterally and introduced into an artificial space between the urinary bladder and rectum. The blood supply for the flaps flows from the perineal artery through anastomotic branches to the external pudendal artery. The authors used the technique on four patients, and all the flaps survived entirely. There was no complication. According to a more than two-year follow-up survey, the reconstructed vaginas are expansible and contract little. No stent is needed. There is good sensitivity in the wall of the artificial vagina because sensory nerves run through the flaps.

  13. Spiral CT localization of the point where superior epigastric artery perforates rectus abdominis muscle%对腹壁上动脉穿腹直肌点的螺旋电子计算机断层扫描定位及其意义

    Institute of Scientific and Technical Information of China (English)

    张佳琦; 张金明; 陈宇宏; 冀晨阳

    2013-01-01

    目的 通过应用螺旋电子计算机断层扫描(CT)血管造影对腹壁上动脉进行定位,以评估乳房再造术后其预防供区并发症的意义.方法 对50例无上腹部手术史患者进行螺旋CT血管造影.建立坐标系,以脐为原点,平脐水平线为X轴,脐垂直线为Y轴.在上述坐标系中定位腹壁上动脉穿腹直肌点(下简称穿肌点)的位置.结果 50例患者在CT检测下共发现392个穿肌点,平均每例7.84个穿肌点.第1象限的穿肌点横轴主要分布在1.45~5.47 cm,纵轴主要分布在2.52~16.38 cm.第2象限的穿肌点横轴主要分布在2.02~6.80 cm,纵轴主要分布在2.30~14.46 cm.结论 螺旋CT血管造影具有高度的敏感性和特异性,进行腹壁上动脉穿肌点的定位可以避免术中切取多余的腹直肌,对减少腹壁供区的并发症有很大意义.%Objective To locate the points where the superior epigastric artery perforates the rectus abdominis muscle by using the spiral CT,in order to evaluate its control on abdominal complications after breast reconstruction.Methods Fifty cases had received abdominal spiral CT angiography,respectively.Then the coordinate system was established,with the umbilicus as the origin,the umbilicus horizontal line as X axis,vertical umbilical level line as Y axis.The point where superior epigastric artery perforates the rectus abdominis muscle in the coordinate system was located as described above.Results There were 392 perforating points in the rectus abdominis muscle in all 50 cases,with a mean of 7.84 perforators per patient.In the first quadrant,the points where superior epigastric artery perforate the rectus abdominis muscle were located in the range from 1.45 cm to 5.47 cm on the X axis,and in the range from 2.52 cm to 16.38 cm on the Y axis,respectively.In the second quadrant,the points where superior epigastric artery perforates the rectus abdominis muscle were located in the range from 2.02 cm to 6.80 cm on the X axis,and in

  14. Monitoring of free TRAM flaps with microdialysis.

    Science.gov (United States)

    Udesen, A; Løntoft, E; Kristensen, S R

    2000-02-01

    The aim of this investigation was to follow the metabolism of free TRAM flaps using microdialysis. Microdialysis is a new sampling technique that provide opportunities to follow the biochemistry in specific organs or tissues. A double-lumen microdialysis catheter or probe, with a dialysis membrane at the end, is introduced into the specific tissue. Perfusion fluid is slowly pumped through the catheter and equilibrates across the membrane with surrounding extracellular concentrations of low molecular weight substances. The dialysate is collected in microvials and analyzed by an instrument using very small volumes. Glucose, glycerol, and lactate concentrations were measured in the flaps and compared with those in a reference catheter that was placed subcutaneously in the femur. The investigation continued 72 hr postoperatively. The study group consisted of 14 women who underwent reconstruction with a free TRAM flap, and one woman with a double TRAM flap. During flap ischemia, the concentration of glucose was reduced, while the lactate and glycerol levels increased. The differences between the flaps and controls were statistically highly significant. After reperfusion of the flaps, the concentrations of glucose, lactate, and glycerol approached normal. One flap failed because of an arterial anastomosis thrombosis. This was clearly demonstrated by the samples from the microdialysis: the concentration of glucose fell to an unmeasurable level; the concentration of lactate increased for a period before it stopped due to lack of glucose; and the concentration of glycerol increased to a very high level, probably because ischemia caused damage to the cell membranes of which glycerol is an important part. The authors concluded that microdialysis can detect ischemia in free flaps at an early stage, making early surgical intervention possible.

  15. Interosseous dorsal artery retrograde island flap to repair hand machine and nursing care of skin defect%骨间背动脉逆行岛状皮瓣修复手部机器绞伤皮肤缺损的护理

    Institute of Scientific and Technical Information of China (English)

    韦亚红; 姜傲; 倪晓威; 孟宜

    2016-01-01

    Objective In order to summarize the nursing experiences and improve nursing quality,we explore the perioperative nursing methods in patients reconstructing skin defects with posterior interosseous artery flaps. Methods The 13 patients with skin defects were treated with debridements and vacuum sealing drainage system,and then the skin defects were covered with posterior interosseous artery flaps. In the perioperative period,we give united nursing interven-tion to the patients,including basic nursing,psychological nursing,controlling infection,carefully observing the vascular crisis,instructing exercise,and discharge guidance. Results All the 13 flaps survive well. Conclusion The effects of posterior interosseous artery flaps covering skin defects of hand is well. Based on the characteristics of the blood supply of this flap,we carry out comprehensive perioperative nursing,and can judge the occurance of vascular crisis effectively. United nursing intervention is effective in improving the surviving rate of the posterior interosseous artery flap.%目的:探讨骨间背侧动脉逆行岛状皮瓣修复手外伤皮肤缺损围手术期的护理方法,总结护理经验,提高护理质量。方法对13例机器绞伤先期行清创、VSD负压吸引术,后期行骨间背动脉逆行岛状皮瓣的患者进行综合护理干预,包括注重心理护理、加强基础护理、术后控制感染、严密观察血管危象、指导功能训练、重视出院指导等。结果13例患者皮瓣血运良好,全部成活。结论骨间背侧动脉逆行岛状皮瓣修复手外伤皮肤缺损疗效满意,根据皮瓣血运的特点开展全面的围术期护理,可有效判断血管危象的实际发生情况,进而提高皮瓣移植成活率。

  16. 以上唇动脉为蒂的逆行鼻唇沟瓣修复鼻眶下区缺损的临床研究%The clinical effect of reversed nasolabial flap pedicled with superior labial artery for the reconstruction of nasal and infraorbital defects

    Institute of Scientific and Technical Information of China (English)

    刘平; 李勇; 郑田; 季平; 邱丽华; 李颖; 张碧; 鲁琦; 赵洪伟

    2014-01-01

    Objective To evaluate the clinical effect of reversed nasolabial flap pedicled with superior labial artery for the recon-struction of nasal and infraorbital defects .Methods From September 2006 to May 2013 ,13 cases with large nasal and infraorbital defects were reconstructed by the reversed nasolabial flap pedicled with superior labial artery .In all patients these defects were re-sulted by the excision of carcinomas .The disease course ranged from 2 months to 28 years .The size of nasal and infraorbital defects was from 2 .0 cm × 1 .2 cm to 4 .0 cm × 3 .6 cm .All defects were restored by the reversed nasolabial flap pedicled with superior labial artery in 10 cases and by the island flap in 3 cases .The size of flap was similar to that of defects .The donor areas were sutured di-rectly .Results All flaps were completely survived .The incision at the donor and accepted sites healed in the first stage .In 4 pa-tients flap revision was performed after 6-12 months because of mild swelling at the pedicles of skin flaps .Patients were followed up for 4-60 months (the mean was 28 .4 months) .All patients were satisfied with the nasal ventilatory function and appearance , flap texture and color .No obvious scars were found at donor sites .Conclusion Reversed nasolabial flap pedicled with superior labial artery is a better choice to repair the nasal and infraorbital defect after excision of carcinomas .%目的:探讨以上唇动脉为蒂的逆行鼻唇沟瓣修复鼻眶下区缺损的手术方法和疗效。方法2006年9月至2013年5月,收治鼻眶下缺损患者13例。所有患者为肿瘤切除术鼻眶下区缺损,病程为2个月至28年。缺损范围为2.0cm×1.2cm~4.0 cm ×3.6 cm。术中采用同侧上唇动脉为蒂的逆行鼻唇沟瓣修复缺损,其中10例为带蒂皮瓣,3例为轴型岛状皮瓣;皮瓣切取范围与缺损大小相近。供区直接对位缝合。结果所有皮瓣全部成活,供、受区切口全

  17. Reverse adipofascial flap after resection of a malignant perineurioma of the forearm.

    Science.gov (United States)

    Takahashi, Mitsuhiko; Kasai, Tokio; Nishisho, Toshihiko; Takai, Michihiro; Endo, Hideko; Hirose, Takanori; Sairyo, Koichi

    2014-07-01

    The authors describe a patient with recurrent perineurioma arising in the subcutaneous tissue of the dorsal forearm and extending along the forearm fascia. Soft tissue perineurioma is a rare, originally benign peripheral nerve sheath neoplasm arising from the perineurium, a protective cell barrier surrounding the individual fascicles in peripheral nerves. Perineurioma has only recently been recognized as an entity distinct from other nerve sheath tumors, such as schwannoma and neurofibroma, with unique morphologic, ultrastructural, and immunoreactive features. The recurrent tumor had converted into malignant perineurioma, defined as increased nuclear pleomorphism and cellularity. The ill-marginate feature extending along the fascia required wide resection, leaving a substantial defect on the distal forearm. Surgical repair of large forearm skin defects is challenging because of limited skin extensibility for flap creation, the prominence of the site in terms of aesthetic outcome, and the risk of damage to extrinsic muscles that control delicate hand movements. The reverse forearm adipofascial flap, which was based on distal perforators of the radial artery, was suitable for the current case to cover the exposed myotendinous junctions of the forearm extensor muscles. This flap did not sacrifice skin, a major vessel, or skeletal muscles, and preserved function at both the donor and the recipient sites. The texture of the graft was similar to that of the surrounding skin. The clinical and histopathologic features of this rare tumor are also described to aid in the differential diagnosis and as a reference for surgeons who treat soft tissue neoplasms and may encounter this type of soft tumor.

  18. Comparison of outcome of microvascular bony head and neck reconstructions using the fibular free flap and the iliac crest flap.

    Science.gov (United States)

    Mücke, Thomas; Loeffelbein, Denys J; Kolk, Andreas; Wagenpfeil, Stefan; Kanatas, Anastasios; Wolff, Klaus-Dietrich; Mitchell, David A; Kesting, Marco R

    2013-09-01

    Several microvascular free flaps are available for reconstruction of the osseous components after resections for head and neck cancer. We have prospectively evaluated patients treated by bony microsurgical reconstruction to identify predictors of adverse outcomes for delayed wound healing and failure of free flaps. All patients from July 2007 to June 2011 who had reconstructions with microvascular fibular or iliac crest flaps immediately after resection of the tumour were evaluated. There were a total of 156 bony free flaps: 120 (77%) fibular and 36 (23%) iliac crest flaps. A total of 133 (85%) were successful. Delayed wound healing was more common with the iliac crest flap (p=0.01) at the intraoral site (p=0.04). Significantly more iliac crest free flaps failed (p=0.02). Anastomosis to the facial artery (p=0.05) and facial vein (p=0.04), and duration of overall operating time were associated with a significantly higher risk of failure of the flap. Patients with cancer of the head and neck who require microsurgical bony reconstruction are at increased risk of postoperative complications. Significantly more complications were found with the iliac crest flap, whereas the fibular flap was associated with a significantly longer operating time.

  19. 低位皮支高位切取骨间背侧动脉逆行岛状皮瓣的临床应用%Clinical Application of Low Cutaneous Branches in High Cutting Took Bone between Dorsal Artery Retrograde Island Flap

    Institute of Scientific and Technical Information of China (English)

    吴迪; 利春叶; 黄河; 刘华红; 罗勇坚; 魏建营

    2011-01-01

    目的:介绍低位肌间隙筋膜皮肤穿动脉改良传统骨间背侧皮瓣的切取方法以及对各种不同受伤类型的治疗效果.方法:设计倒水滴状皮瓣,利用其皮角携带前臂中下1/3低位肌间隙皮肤穿动脉切取高位骨间背侧皮瓣11例,评价术后手指总的主动活动度.结果:术后皮瓣全部顺利成活,优9例,良和可各1例.结论:该术式避免了传统骨间背侧皮瓣切取中骨间背侧神经的解剖与损伤,使手术大为简化.%Objective: To introduce low muscle fascia and skin clearance improve wear the traditional posterior interosseous artery flap cut. Method: Inverted teardrop-shaped flap, with its leather carrying angle of the forearm in the 1 / 3 lower of the low clearance of skin muscle arteries cut through the high posterior interosseous flap in 11 cases, the total active finger was evaluated activity. Result: All flaps survived well, excellent in 9 cases, good and could be in 1. Conclusion: This technique avoids the traditional posterior interosseous flap in the posterior interosseous nerve anatomy and injury, the surgery greatly simplified.

  20. De-epithelialised fasciocutaneous turnover flap: An alternative for defects in lower thigh and knee joint

    Directory of Open Access Journals (Sweden)

    Sharma R

    2004-01-01

    Full Text Available We describe the use of proximally based de-epithelialised fasciocutaneous flap for coverage of defects in the lower thigh and knee joint. These flaps are based on a number of perforators around the knee joint and can be based either posteriorly, posteromedially or posterolaterally depending upon the location of the defect. The whole of the flap including the bridge segment is de-epithelialised and turned over by 180 degrees and a split thickness graft is placed over the flap and the donor site. The flaps can be raised quickly, have minimum morbidity and are reliable even in the presence of extensive injuries. These flaps have remained stable and trouble free during a follow up period of 2-4 years.

  1. 动脉化静脉皮瓣Ⅰ期塑形修复指腹及甲廓缺损%The arterialized venous flap for one-stage repairing finger pulp and nail folds defect

    Institute of Scientific and Technical Information of China (English)

    李亮; 高增阳; 万华; 李程科; 何明飞; 黄忠明; 雷彦文; 张敬良

    2016-01-01

    Objective To summarize the method and effect of the arterialized venous flap for one- stage re-pairing finger pulp and nail folds defect. Methods From March, 2013 to October, 2015, 32 cases of cubitus arterial-ized venous flap of affected limbs one-stage for repairing finger pulp and nail folds defect. Results All cases of flaps were survival. The patients were followed up from 3 to 10 months (average 6.5 months), and the static two-point dis-crimination was 5.0-7.5 mm. All refers to the finger pulp appearance was full, the elasticity was good, wear-resisting, armour profile shape lifelike. According to the Standard Functional Evaluation Issued by Hand Surgery Association of Chinese Medical Association, 28 cases were evaluated as excellent, 4 cases were as good, the rate of excellent or good results being 100%. Conclusion Dissociative arterialized venous flap can be used as a good method for one-stage re-pairing finger pulp and nail folds defect.%目的:总结动脉化静脉皮瓣Ⅰ期塑形修复拇、手指指腹及甲廓皮肤缺损的方法及效果。方法2013年3月至2015年10月,根据患指缺损大小及血管修复的要求,采用以患肢前臂动脉化静脉皮瓣Ⅰ期塑形修复拇、手指指腹及甲廓缺损32例,其中24例并有指骨骨折,8例并有指固有神经缺损。缺损面积2.0 cm ×1.8 cm ~4.3 cm ×2.4 cm ,切取皮瓣最小面积为1.1 cm ×1.0 cm ~1.5 cm ×1.3 cm ,最大面积为3.0 cm ×2.2 cm ~4.1 cm ×4.5 cm。供区取中厚皮片移植修复,打包加压包扎。结果1例皮瓣因蒂部缝合过紧,术后发生血液循环障碍,经间断拆线后解除。2例皮瓣术后出现水泡,1周后消失。其余皮瓣均顺利成活,切口及供区植皮均Ⅰ期愈合。20例患者术后随访3~10个月(平均6.5个月),均采用患者来门诊复查进行直接回访。主要随访皮瓣外形、质地、感觉及供区恢复情况。随访截止时间为2016年4

  2. Assessment of skin flaps using optically based methods for measuring blood flow and oxygenation.

    Science.gov (United States)

    Payette, Jeri R; Kohlenberg, Elicia; Leonardi, Lorenzo; Pabbies, Arone; Kerr, Paul; Liu, Kan-Zhi; Sowa, Michael G

    2005-02-01

    The objective of this study was to compare two noninvasive techniques, laser Doppler and optical spectroscopy, for monitoring hemodynamic changes in skin flaps. Animal models for assessing these changes in microvascular free flaps and pedicle flaps were investigated. A 2 x 3-cm free flap model based on the epigastric vein-artery pair and a reversed MacFarlane 3 x 10-cm pedicle flap model were used in this study. Animals were divided into four groups, with groups 1 (n = 6) and 2 (n = 4) undergoing epigastric free flap surgery and groups 3 (n = 3) and 4 (n = 10) undergoing pedicle flap surgery. Groups 1 and 4 served as controls for each of the flap models. Groups 2 and 3 served as ischemia-reperfusion models. Optical spectroscopy provides a measure of hemoglobin oxygen saturation and blood volume, and the laser Doppler method measures blood flow. Optical spectroscopy proved to be consistently more reliable in detecting problems with arterial in flow compared with laser Doppler assessments. When spectroscopy was used in an imaging configuration, oxygen saturation images of the entire flap were generated, thus creating a visual picture of global flap health. In both single-point and imaging modes the technique was sensitive to vessel manipulation, with the immediate post operative images providing an accurate prediction of eventual outcome. This series of skin flap studies suggests a potential role for optical spectroscopy and spectroscopic imaging in the clinical assessment of skin flaps.

  3. Pectoralis myocutaneous flap for salvage of necrotic wounds

    Energy Technology Data Exchange (ETDEWEB)

    Price, J.C.; Davis, R.K.; Koltai, P.J.

    1985-02-01

    The authors have utilized six pectoralis major myocutaneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull-up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis. These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means. This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. The authors conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis.

  4. Breast reconstruction using a latissimus dorsi flap after mastectomy

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian Torsten

    2015-01-01

    , in contrast to our first choice, the deep inferior epigastric perforator flap, no microsurgical expertise is needed. METHODS: This is a systematic review of patient files for all LD breast reconstructions performed in the 2004-2013 period, at Rigshospitalet, Copenhagen, Denmark. RESULTS: A total of 135...... of 13 patients (10%) had local complications and were re-operated within the first 30 days. We observed one flap loss and only one systemic complication; a urinary tract infection. In all, 38 patients (28%) received antibiotic treatment after the operations and 27 (20%) developed a seroma at the donor...

  5. 游离旋股外侧动脉降支皮瓣在小腿难治性创面软组织缺损的修复应用%The repair application of the lateral femoral cutaneous artery flap for soft tissue defects of refractory ;wounds on leg

    Institute of Scientific and Technical Information of China (English)

    刘伟; 刘圣曜; 刘强; 陈铭青; 严志强; 区广鹏; 黄瑞良; 余斌

    2016-01-01

    目的:游离旋股外侧动脉降支皮瓣在小腿难治性创面修复软组织缺损中的临床疗效。方法:2007年10月至2016年1月,先用VSD促进肉芽组织的生长,待肉芽组织生长满意后再应用游离旋股外侧动脉降支解剖特点设计皮瓣,修复创面缺损患者12例,旋髂浅腹股沟皮瓣8例,切取皮瓣后与受区血管吻合修复缺损创面。结果:20例患者随访,随访时间6~24个月,平均12个月,皮瓣全部成活,仅1例皮瓣边缘小面积坏死,经换药创面愈合,皮瓣色泽、质地良好。股四头肌肌力正常,膝关节伸、屈0°~150°。结论:旋股外侧动脉降支皮瓣修复难治性创面软组织缺损,皮瓣供区直接缝合,缩短治疗周期,安全有效,因此是修复创面组织缺损的理想皮瓣之一。%Objective The clinical effect of the lateral femoral cutaneous artery flap for soft tissue defects of leg wounds. Methods From October 2007 to January 2016, VSD was firstly used to promote the growth of granulation tissue. When the growth of granulation tissue became satisfactory, flaps were designed based on the anatomical characteristics of the lateral femoral cutaneous artery. We repaired 20 cases of wound defects by cutting flaps that coincide with the recipient vessels. Result 20 cases were followed up for 6 to 24 months, 12 months on average. All flaps were survived and only one case had small area of necrosis flap which was healed by replacing medicines. In all cases, wounds were healed and flaps showed good color and good texture. The strength of quadriceps muscle was good and the extension of knee flexion was 0° to 150°. Conclusion To The lateral femoral cutaneous artery flap is used for soft tissue defects of refractory wounds on leg , flap donor sites are sutured directly, the treatment period is shorten and the method is safe and effective. The lateral femoral cutaneous artery flap is one of ideal choices for wound tissue

  6. Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap.

    Science.gov (United States)

    Jamjoom, Hytham; Alnoman, Hatem; Almadani, Yasser

    2016-12-01

    The keystone flap, an emerging reconstructive option that can be used in many parts of the body, is gaining popularity among reconstructive surgeons. These reliable and versatile flaps can be used for large myelomeningocele closure. A modified bilateral keystone flap was used to achieve tension-free closure of a large thoracolumbar myelomeningocele associated with severe kyphosis in a newborn girl. The flap was modified by undermining in the subfascial plane in the medial aspect of the middle third. This undermining was performed to facilitate flap movement while preserving random musculocutaneous perforators captured within the island of tissues. Laterally, we approached the border of the latissimus dorsi and dissected in the submuscular plane instead of the subfascial plane to preserve more muscular fasciocutaneous perforators. We achieved soft-tissue coverage that was durable, stable, and protective. Wound healing was prompt, and the patient had a satisfactory cosmetic result. No postoperative complications were observed, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The proposed modified keystone flap is a promising addition to the armament of reconstructive surgeons that might improve outcomes and minimize complications in myelomeningocele repair. Keystone flaps provide an ideal reconstructive option for large thoracolumbar myelomeningocele repair. They are reliable, robust, and aesthetically acceptable.

  7. An ideal and versatile material for soft-tissue coverage: experiences with most modifications of the anterolateral thigh flap.

    Science.gov (United States)

    Ozkan, Omer; Coşkunfirat, O Koray; Ozgentaş, H Ege

    2004-07-01

    Free anterolateral thigh flaps are a popular flap used for the reconstruction of various soft-tissue defects. From April, 2002 to June, 2003, 32 free anterolateral thigh flaps were used to reconstruct soft-tissue defects. Twenty-three of these flaps were used for lower extremity reconstruction, and nine were used for head and neck reconstruction. There were 24 male and eight female patients, with ages between nine and 82 years. The size of the flaps ranged from 11 to 32 cm in length and 6 to 18 cm in width. Five flaps required reoperation for vascular compromise in four patients and for twisting of the pedicle in another patient. While four of these were salvaged, one flap was lost due to recipient vessel problems. Musculocutaneous perforators were found in 23 cases, and septocutaneous perforators were found in nine cases. In four cases, thinning of the flap was performed. The flap was used as a flow-through type for lower extremity reconstruction in three patients. In two patients, the flap was used as a neurosensory type for foot reconstruction. Eighteen cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed primarily. In three patients, the donor areas required a partial skin regrafting procedure. No infections or hematomas were observed. Despite some variations in its vascular anatomy, the anterolateral thigh flap offers the following advantages: 1) it has a long and large-caliber vascular pedicle; 2) it has a wide, reliable skin paddle; 3) it may be harvested as a neurosensory flap; 4) it can be harvested whether its pedicle is septocutaneous or musculocutaneous; 5) it can be designed as a flow-through flap; 6) it can be elevated as a thin or musculocutaneous flap; and 7) the procedure can be performed by two teams working simultaneously, and no positional changes are required.

  8. Spontaneous Perforation of Pyometra.

    Science.gov (United States)

    Sharma, Nalini; Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-04-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted.

  9. [Pedicled versus free TRAM flap for breast reconstruction].

    Science.gov (United States)

    Galla, T J; Lukas, B; Feller, A M

    1999-03-01

    In breast reconstruction, the free TRAM-flap offers many advantages over the pedicled TRAM-flap. Due to its superior perfusion, the free flap rarely develops necrosis. Shaping of the flap is easier due to the lack of the thick muscle pedicle. Because the rectus muscle is spared, there is minimal donor site morbidity. However, the necessary microvascular anastomoses reduced the acceptance of the free TRAM-flap. During a 13-months period, 51 breast reconstructions were performed in 41 patients, 31 unilateral and ten bilateral. 45 flaps served for delayed reconstruction and six flaps for immediate reconstruction. The operations were performed by two teams working simultaneously. The average operating time was 3.9 hours for unilateral and 6.9 hours for bilateral delayed reconstruction. For immediate reconstruction, 6.2 and 6.3 hours were required for uni- and bilateral procedures, respectively. In 38 flaps, the thoracodorsal vessels served as recipient vessels; 13 flaps were anastomosed to the internal mammary artery and vein. Postoperative complications were observed in 13 patients. Three vessel anastomoses had to be revised. In one flap, a partial necrosis occurred; in two flaps hematoma evacuation was necessary. Two patients suffered from fat necroses at the abdomen and one umbilicus was lost. Skin irritations and seromas at the abdomen occurred in five patients. Pulmonary embolism was diagnosed in one patient three weeks postoperatively. Abdominal hernias or bulging in the epigastric area were not observed up to 15 months after reconstruction. These results reveal a low complication rate for breast reconstruction with the free TRAM-flap. The advantages of this technique as compared to the pedicled technique are discussed.

  10. Spontaneous corneal perforation in an eye with Peters' anomaly

    Directory of Open Access Journals (Sweden)

    Kim M

    2013-07-01

    Full Text Available Moosang Kim, Seung-Chan Lee, Seung-Jun Lee Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, South Korea Abstract: A premature female infant underwent her first ophthalmologic examination at the age of 4 weeks. The initial examination of the baby was requested for evaluation of a ‘white spot’ on the surface of her right eye. She had been hospitalized in the neonatal intensive care unit because of systemic abnormalities, such as a right clavicle fracture and microcephaly. Slit-lamp examination of the right eye showed a central corneal opacity, corneal thinning, and an iridocorneal adhesion. The lens and fundus of the right eye could not be observed. We observed no pathologic findings in the left eye. The baby's parents were informed of the high risk for spontaneous corneal perforation without external pressure. At 42 days of age, an ophthalmologic examination of the infant was again requested for evaluation of ‘tears’ from her right eye 3 hours previously. Examination revealed corneal perforation, iris protrusion, and a flat anterior chamber. We performed emergent conjunctival flap surgery. Three months following surgery, the patient's right eye was successfully preserved with no sign of inflammation or leakage. Keywords: conjunctival flap, corneal perforation, Peters' anomaly

  11. 缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损%Repair of fingertip defect with proper digital artery lateral cutaneous branch-chain flap accompanied with dorsal digital nerve or dorsal branch of proper digital nerve coaptation

    Institute of Scientific and Technical Information of China (English)

    孙涛; 魏鹏; 周丹亚; 胡瑞斌; 滕晓峰; 陈宏

    2011-01-01

    Objective To explore the effect of using proper digital artery lateral cutaneous branch-chain flap with dorsal digital nerves or dorsal branch of proper digital nerye for repairing of fingertip defect.Methods From December 2008 to November 2009, 24 cases (26 digits) of fingertip defect were treated with proper digital artery lateral cutaneous branch-chain flap.The flap was designed on the lateral side of the proximal phalanx of the injured finger with its long axis running on the lateral midline of the finger.The vascular pedicle was 0.8 to 1.0 cm wide.The pivot point was at the distal 1/3 of the middle phalanx upon which the flap was reversed to repair the defect of the fingertip.The dorsal digital nerve or dorsal branch of proper digital nerve was included in the flap and coapted with the nerve in the wound to reconstruct sensation of the injured finger.Results All 26 flaps survived.Postoperative follow-up period was 6 to 8 months.All these flaps recovered with satisfying and quality, excellent sensation with 4 to 8 mm two-point discrimination.ROM of the interphalangeal joint of the injured finger was good.Conclusion Proper digital artery lateral cutaneous branchchain flap transfer with nerve coaptation is an ideal method for repairing fingertip defect.The surgery is simple.Reliable blood supply can be achieved without sacrificing the proper digital artery.Coaptation of the nerve restores sensation at the fingertip.There is minor donor site damage and very few complications.%目的 探讨缝合神经的指固有动脉背支血管链皮瓣修复指远端皮肤缺损的疗效.方法 2008年12月至2009年11月,对24例26指指远端皮肤缺损患者,以指固有动脉背侧支形成的血管链为血供,于近节指体侧方设计皮瓣,皮瓣轴线为指体侧方中线,皮瓣蒂宽0.8~1.0cm,皮瓣转折点为中节指体中远端,逆行转移修复指远端皮肤缺损,皮瓣携带指固有神经背侧支或指背神经与创面指神经断端进行缝合

  12. Adipofascial Anterolateral Thigh Flap Safety: Applications and Complications

    Directory of Open Access Journals (Sweden)

    Tommaso Agostini

    2013-03-01

    Full Text Available Background A thinned anterolateral thigh (ALT flap is often harvested to achieve optimalskin resurfacing. Several techniques have been described to thin an ALT flap including anadipocutaneous flap, an adipofascial flap and delayed debulking.Methods By systematically reviewing all of the available literature in English and French, thepresent manuscript attempts to identify the common surgical indications, complications anddonor site morbidity of the adipofascial variant of the ALT flap. The studies were identifiedby performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database ofSystematic Reviews, Current Contents, PubMed, Google, and Google Scholar.Results The study selection process was adapted from the Preferred Reporting Items forSystematic Reviews and Meta-Analyses statement, and 15 articles were identified usingthe study inclusion criteria. These articles were then reviewed for author name(s, year ofpublication, flap dimensions and thickness following defatting, perforator type, type of transfer,complications, thinning technique, number of cases with a particular area of application anddonor site morbidity.Conclusions The adipofascial variant of the ALT flap provides tissue to fill large defects andimprove pliability. Its strong and safe blood supply permits adequate immediate or delayeddebulking without vascular complications. The presence of the deep fascia makes it possibleto prevent sagging by suspending and fixing the flap for functional reconstructive purposes(e.g., the intraoral cavity. Donor site morbidity is minimal, and thigh deformities can bereduced through immediate direct closure or liposuction and direct closure. A safe bloodsupply was confirmed by the rate of secondary flap debulking.

  13. AN ANATOMIC STUDY OF ADIPOFASCIAL FLAP OF THE LEG

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To investigate the vascular anatomy of the subcutaneous tissues and fascias of the leg. Methods Four fresh cadaver legs which had been injected with colored latex were dissected under magnification to identify the origin, course an distribution of vessels from the subfascial level to the skin. The adipofascial flap was harvested from the whole medial side of the leg and fascial flap from other leg of the same cadaver. The posterior tibial artery and its first and second supra-malleolus septal arteries were retained in these flaps. Selective injection of China ink through posterior tibial artery was carried out, and dimension of ink- stained areas was recorded. Results Three main trunk vessels of the leg gave off branches to deep fascia and subcutaneous tissues, forming a large vascular plexus in the subcutaneous tissues on the deep fascia and a deli- cate, but dense and well anastomosed vascular plexus beneath the deep fascia. The vascular plexus in the subcu- taneous tissues ran deeper than the superficial venous system. The areas stained by selective injection in adipo- fascial flaps were larger than those in the fascial flaps. Conclusion Subcutaneous tissues and deep fascia can be considered as an anatomic entity nourished by two very well developed vascular networks which lie on both sides of deep fascia. Incorporation of the deep fascia can not only protect the subcutaneous tissue from being lacerated during raising of the flap, but also enhance vascularity of the adipofascial flap. Leaving superficial veins intact while raising the skin flap does not jeopardize the vascular plexus in the subcutaneous tissues and can preserve the superficial lymnphatic vessels, so that postoperative edema of the flap or the leg could be avoided.

  14. Perforated peptic ulcer

    DEFF Research Database (Denmark)

    Søreide, Kjetil; Thorsen, Kenneth; Harrison, Ewen M

    2015-01-01

    Perforated peptic ulcer is a common emergency condition worldwide, with associated mortality rates of up to 30%. A scarcity of high-quality studies about the condition limits the knowledge base for clinical decision making, but a few published randomised trials are available. Although Helicobacte...

  15. Anatomía arterial de los colgajos musculares de extensor carpi radialis longus y extensor carpi radialis brevis para su uso en transferencia muscular funcional libre Arterial anatomy of the extensor carpi radialis longus and extensor carpi radialis brevis muscle flaps related to its use in free functioning muscle transfer

    Directory of Open Access Journals (Sweden)

    A. Rodríguez Lorenzo

    2008-09-01

    ón anatómica del nervio radial con el pedículo del ECRL hace que no sea posible su transferencia como colgajo libre sin sacrificar la rama motora del nervio radial en la mayor parte de los casos.The arterial anatomy of the Extensor Carpi Radialis Longus and Brevis (ECRL, ECRB flaps is herein described in order to provide the vascular basis to be used as free muscle transfer for facial reanimation. We used 29 fresh above-elbow human arms injected by means of two diferent techniques.Latex-injection was performed in 18 arms and the modified lead oxide-gelatine injection technique was performed in 11 arms. The ECRL and ECRB with their pedicles were dissected, photodocumented and radiographied.The number, length and calibers of the muscle pedicles were recorded. The intramuscular vascular pattern and the relations of the main pedicles of the muscles with the radial nerve were also noted. Two vascular patterns were found following the Mathes and Nahai Classification of the Vascular Anatomy of the Muscles (number of pedicles and its dominance: Type I (37,9% of ECRL and 20,7% of ECRB dissections and Type II (62,1% of ECRL and 79,3% of ECRB dissections. The dominant pedicle for the ECRL (with an average caliber of 1,73 mm and an average length of pedicle of 32,32 mm is a branch of the radial recurrent artery in 100% of the dissections and the dominant pedicle for the ECRB (with an average caliber of 1,11 mm and an average length of pedicle of 27,77 mm a branch of the radial artery in 68,9% of the dissections and a branch of radial recurrent artery in 31,1% of the cases. As a conclusion, ECRL and ECRB muscle flaps present two types of vascular patterns: type I and type II.Type II pattern is the most common in our study. The anatomical features of both muscles (vascular basis,presence of an important fascial layer, contour and length of the muscle, make them reliable as free muscles flaps for facial reanimation, however, the relation between the dominant pedicle for the ECRL

  16. Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Xiangfei Wang

    2014-01-01

    Full Text Available Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.

  17. [Vestibularly displaced flap with bone augmentation].

    Science.gov (United States)

    Bakalian, V L

    2009-01-01

    The aim of this study is to achieve esthetic gingival contours with the help of less traumatic mucogingival surgeries. 9 Patients were operated with horizontal deficiencies in 9 edentulous sites, planned to be restored with fixed partial dentures. In all cases there was lack of keratinized tissues. Temporary bridges were fabricated to all patients. Before surgery the bridges were removed and the abutment teeth were additionally cleaned with ultrasonic device. A horizontal incision was made from lingual (palatal) side between the abutment teeth, which was connected with two vertical releasing incisions to the mucogingival junction from the vestibular side. The horizontal incision was made on a distance 6-10 mm from the crest of the alveolar ridge. A partial thickness flap in the beginning 3-5 mm, then a full thickness flap up to the mucogingival junction, then a partial thickness flap was made. The flap was mobilized and displaced vestibularly. In the apical part the cortical bone was perforated, graft material was put and the flap was sutured. In all 9 cases the horizontal defect was partially or fully eliminated. The width of the keratinized tissues was also augmented in all cases. The postoperative healing was without complications, discomfort and painless. The donor sites also healed without complications. The application of Solcoseryl Dental Adhesive Paste 3 times a day for 7-10 days helped for painless healing of the donor site. The offered method of soft tissue and bone augmentation is effective in the treatment of horizontal defects of edentulous alveolar ridges of not big sizes. It makes possible to achieve esthetic results without traumatizing an additional donor-site.

  18. 鼻烟窝皮瓣修复拇指大面积皮肤缺损的临床应用%Snuff-box Flap for Treatment of Thumb Large Area Skin Defects

    Institute of Scientific and Technical Information of China (English)

    张扬; 林平; 高峰

    2014-01-01

    探讨鼻烟窝皮瓣在修复拇指大面积皮肤缺损中的方法和治疗效果。从2008年1月~2013年10月间应用桡动脉在解剖鼻烟窝穿支为血管蒂的鼻烟窝皮瓣,逆行修复拇指大面积皮肤缺损26例,年龄17岁~55岁。术后平均随访时间25个月,皮瓣全部成活。皮瓣色泽及质地与健侧拇指背侧皮肤相近,拇指活动度基本正常。因此,鼻烟窝皮瓣是一种简便经济、效果理想、患者易于接受的术式,适合应用于拇指大面积皮肤缺损的治疗。%To explore the surgical technique and clinical outcomes of snuff-box flap to repair large area skin defects in thumbs ,26 patients ,age 17 to 55 years old ,had the snuff-box flap ,which used the perforator vessel of radial artery in snuff-box as pedicle vascular to repair large area skin defects in the thumb from January 2008 to October 2013 were included .All the flaps are alive .The patients were followed up with an average of 25 months .The color and texture of the flaps are similar to that of the contralateral thumb .The sphere of thumb movement is relatively normal .The operation of using snuff-box flap to repair large area skin defects in thumbs has economic material benefit ,ideal effect and be accepted .

  19. [Antecubital flap: advantages in elbow coverage. An anatomical study and experience of five clinical cases].

    Science.gov (United States)

    Duteille, F; Rocchi, L; Dautel, G; Merle, M

    2001-02-01

    The antecubital flap is a fasciocutaneous strip that has its blood supply provided by the first proximal collateral of the radial artery. This flap was described for the first time in 1983 by Lamberty and Cormack, but it has not been widely used and there have been only a few reports in the literature concerning this procedure. The aim of the present investigation was to demonstrate via an anatomical study and a report on five cases the viability of the various anatomical features of this cutaneous flap, and also its positive contribution to elbow reconstruction. The anatomical study involved eight fresh cadavers (eight upper limbs). An injection of colored prevulcanized latex was made in the humeral artery in the lower third of the arm. The aim was to determine which artery provided blood supply to the flap, its anatomical location, and also to look for possible distal anastomoses which would permit a distal pedicled flap to be removed. Contrary to the findings of other authors, in the present study it was found that the vessel providing blood to the antecubital flap always branched off from the radial artery. However, no anastomoses with distal vascularization were detected, which would have permitted a distal pedicled flap to be obtained. The use of the antecubital flap for elbow coverage was then illustrated by five clinical cases of soft tissue defects of the elbow. This method was found to be reliable, practical, and the flap could be rapidly dissected. Moreover, this particular technique is sensitive, and has an interesting rotational arc. The distal cutaneous island flap has the advantage of limiting scar tissue. A comparison between the antecubital flap and other pedicled flaps has then been made. In conclusion, it appears that this little-known procedure has definite advantages, and that it should be included in the range of surgical techniques that are available for soft tissue reconstruction in the case of elbow defects.

  20. The submental island flap.

    Science.gov (United States)

    Sterne, G D; Januszkiewicz, J S; Hall, P N; Bardsley, A F

    1996-03-01

    The submental island flap is a reliable source of skin of excellent colour, contour and texture match for facial resurfacing and leaves a well hidden donor site. The flap is safe, rapid and simple to raise. We report on its use in 12 cases of facial or intraoral reconstruction. Complications were few. However, there was one case of complete flap loss following its use in a reverse flow manner, due to the presence of an unreported, but constant, valve in the venous system of the face. We believe this flap to be a worthwhile addition to the existing surgical armamentarium.

  1. Harmonic Scalpel versus electrocautery and surgical clips in head and neck free-flap harvesting.

    Science.gov (United States)

    Dean, Nichole R; Rosenthal, Eben L; Morgan, Bruce A; Magnuson, J Scott; Carroll, William R

    2014-06-01

    We sought to determine the safety and utility of Harmonic Scalpel-assisted free-flap harvesting as an alternative to a combined electrocautery and surgical clip technique. The medical records of 103 patients undergoing radial forearm free-flap reconstruction (105 free flaps) for head and neck surgical defects between 2006 and 2008 were reviewed. The use of bipolar electrocautery and surgical clips for division of small perforating vessels (n = 53) was compared to ultrasonic energy (Harmonic Scalpel; Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) (n = 52) free-tissue harvesting techniques. Flap-harvesting time was reduced with the use of the Harmonic Scalpel when compared with electrocautery and surgical clip harvest (31.4 vs. 36.9 minutes, respectively; p = 0.06). Two patients who underwent flap harvest with electrocautery and surgical clips developed postoperative donor site hematomas, whereas no donor site complications were noted in the Harmonic Scalpel group. Recipient site complication rates for infection, fistula, and hematoma were similar for both harvesting techniques (p = 0.77). Two flap failures occurred in the clip-assisted radial forearm free-flap harvest group, and none in the Harmonic Scalpel group. Median length of hospitalization was significantly reduced for patients who underwent free-flap harvest with the Harmonic Scalpel when compared with the other technique (7 vs. 8 days; p = 0.01). The Harmonic Scalpel is safe, and its use is feasible for radial forearm free-flap harvest.

  2. 皮瓣延迟术对大鼠三血管体穿支皮瓣成活的影响及其机制%Effects of surgical delay procedure on the survival of perforator flap with three angiosomes in rat and its mechanism

    Institute of Scientific and Technical Information of China (English)

    李俊杰; 高自勉; 高伟阳; 李浙峰

    2014-01-01

    8)、(63±13)、(69 ±9)、(67±8)、(64±13) μm]及单纯延迟组术后3、7d闭塞区域2Ⅱ血管外径显著高于常规皮瓣组相应时相点血管外径水平[术后0、1、2、3、7d分别为(46±10)、(40 ±9)、(43±13)、(46±12)、(47±11)μm],q值为7.29~10.79,P值均小于0.05.常规皮瓣组、单纯延迟组大鼠术后3、7d以及延迟皮瓣组大鼠术后0、1、2d组内闭塞区域1与闭塞区域2间血管外径比较,差别明显(q值为5.32~9.56,P值均小于0.05).术后3、7d,常规皮瓣组及延迟皮瓣组大鼠闭塞区域1、单纯延迟组大鼠闭塞区域2血管外径显著高于组内术后0d(q值为6.12~8.13,P值均小于0.05).(2)术后7d内,常规皮瓣组、延迟皮瓣组大鼠皮瓣内来自蒂部的血液都顺利通过闭塞区域1覆盖血流动力学供区.术后0d,2组大鼠皮瓣内的血液越过闭塞区域1后均发生持续约3 min的血流阻塞现象,常规皮瓣组出现在闭塞区域2附近,延迟皮瓣组出现在闭塞区域2远端约1 cm处.(3)术后7d,延迟皮瓣组大鼠皮瓣成活率为(95±12)%,显著高于常规皮瓣组的(80±9)%(t=2.91,P <0.01),皮瓣部分坏死仅出现在潜在供区.(4)术后7d,与未行手术的左侧皮肤血管相比,常规皮瓣组大鼠皮瓣内闭塞区域1的血管扩张明显,相邻血管树间界限模糊,而闭塞区域2的血管变化轻微;延迟皮瓣组大鼠皮瓣内2个闭塞区域的血管均明显扩张. 结论 本实验的延迟方法可促进大鼠三血管体穿支皮瓣潜在供区的成活,其主要是通过皮瓣术前扩张闭塞区域2的闭塞血管实现的.%Objective To observe the effects of surgical delay procedure on the survival of perforator flap with three angiosomes in rat,and to explore its possible mechanism.Methods The flap model was a perforator flap with three angiosomes which located on the right dorsal side of a rat based on thc right deep circumflex iliac vessel.The two connection areas between the three angiosomes were

  3. Spontaneous Perforation of Pyometra

    OpenAIRE

    Sharma, Nalini; Singh, Ahanthem Santa; Bhaphiralyne, Wankhar

    2016-01-01

    Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perfor...

  4. 桡动脉肌间隙远、近段皮支链皮瓣的解剖学基础%The radial artery cutaneous branches-chain flap:anatomy and clinical application

    Institute of Scientific and Technical Information of China (English)

    孙超; 徐聪; 张伟; 李宏亮; 谭为; 丁自海

    2012-01-01

    目的 为桡动脉肌间隙远、近段皮支链皮瓣带蒂转位修复腕部及肘部小范围组织缺损提供解剖学基础.方法 选用新鲜男尸正常上肢标本12侧:10侧乳胶灌注显微解剖,2侧制作铸型标本研究桡动脉从肱桡肌与桡侧腕屈肌肌间隙发出皮支的解剖形态学特点.以桡骨茎突至外上髁连线中点为分界划分前臂远、近两段.结果 (1)桡动脉发出肌间隙皮支9.1支,其中前臂远段发出皮支6.8支,直径(0.45±0.14)mm,蒂长(1.2±0.48 )cm;前臂近段发出皮支2.3支,直径(0.68±0.12)mm,蒂长(1.9±0.53 )cm.桡动脉在前臂远、近两段发出的肌间隙皮支的参数差异比较均有统计学意义(P<0.05);(2)在桡骨茎突近端(3.0±0.67)cm和肱骨外上髁远端(9.01 ±1.74)cm,分别有直径(0.59±0.08)mm,蒂长(1.41±0.26)cm和直径(0.67±).09)mm,蒂长(1.87±0.62 )cm恒定粗大皮支从肌间隙穿出;(3)相邻皮支穿深筋膜后,其终末支间形成与肌间隙长轴平行的血管链.结论 以桡动脉肌间隙远、近段皮支设计带蒂转位皮支链皮瓣可用于修复腕部及肘部小范围软组织损伤,避免了其主干动脉的破坏.%Objective To provide anatomic information for repairing small tissue defects in hands and forearm with cutaneous branches-chain flaps pedicled with radial and ulnar arteries. Methods A total of 12 male cadaveric specimens were included in the study: 10 underwent latex perfusion for microanatomy, 2 were made into vessel cast for morphologic observation of cutaneous branch of radial artery passed between the brachioradialis muscle and the flexor carpi radialis muscle. Forearm was divided into proximal and distal segments by the midpoint between the radial styloid and the lateral epicondyle. Results ①A total of 9.1 intermuscular cutaneous branches issued from radial artery, of which, 6.8 from the distal forearm and 2.3 from the proximal end, with the diameter of (0.45±0.14) mm and pedicle length of (1.2±0

  5. [Identification of perforating vessels by augmented reality: Application for the deep inferior epigastric perforator flap].

    Science.gov (United States)

    Bosc, R; Fitoussi, A; Pigneur, F; Tacher, V; Hersant, B; Meningaud, J-P

    2017-03-07

    The augmented reality on smart glasses allows the surgeon to visualize three-dimensional virtual objects during surgery, superimposed in real time to the anatomy of the patient. This makes it possible to preserve the vision of the surgical field and to dispose of added computerized information without the need to use a physical surgical guide or a deported screen.

  6. Gastric conduit perforation.

    Science.gov (United States)

    Patil, Nilesh; Kaushal, Arvind; Jain, Amit; Saluja, Sundeep Singh; Mishra, Pramod Kumar

    2014-08-16

    As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.

  7. The role of temporalis fascia for free mucosal graft survival in small nasal septal perforation repair.

    Science.gov (United States)

    Jeon, Eun-Ju; Choi, Jin; Lee, Joo-Hyung; Kim, Sung-Won; Nam, In-Chul; Park, Yong-Su; Jin, Sang-Gyun; Cheon, Byung-Jun

    2014-01-01

    Temporalis fascia has been used widely as a interposition graft for mucosal rotation flap in nasal septal perforation repair. However, the exact role of temporalis fascia in healing process has not yet been clarified. For the pedicle of rotation flap has been considered as a major vehicle for nutrition distribution, the role of temporalis fascia has been devaluated. In this study, we experienced small nasal septal perforation repairs using free mucosal graft not having pedicles but covered by temporalis fascia. Three patients with small nasal septal perforations not larger than 1 × 1 cm were included. In 2 patients, the perforations were repaired using free composite grafts from the inferior turbinate mucosa covered by continuous temporalis fascia not divided, and the surgical results were successful with complete healings. In 1 patient, however, the temporalis fascia was divided into 2 parts to better fit the shape of the perforation, and the graft failed to survive. These surgical results suggest that the temporalis fascia might have an important role in healing process of nasal septal defect and could be used as a beneficial options for small mucosal defect repair surgeries using free mucosal grafts.

  8. Cervicofacial flap revisited

    Directory of Open Access Journals (Sweden)

    Dhananjay V. Nakade

    2016-11-01

    Conclusions: Cervicofacial flap is simple, easy to operate, consume less operating time as compared to microvascular flap. It is less complicated and especially useful in diabetic, hypertensives and old debilitated patients with high risk of anaesthesia. [Int J Res Med Sci 2016; 4(11.000: 4669-4674

  9. Duodenal perforation in childhood dermatomyositis

    Energy Technology Data Exchange (ETDEWEB)

    Magill, H.L.; Hixson, S.D.; Whitington, G.; Igarashi, M.; Hannissian, A.

    1984-01-01

    Perforation of the duodenum is an uncommon, but serious complication which may occur in children with dermatomyositis. In this disease vasculitis may involve the bowel to a variable extent and result in radiologic manifestations of intestinal injury ranging from benign pneumatosis intestinalis to signs of bowel perforation. We report two children with dermatomyositis in whom perforation of the second portion of the duodenum occurred. This serious complication should be considered in any child with dermatomyositis when extraluminal gas is suspected on abdominal radiographs.

  10. Perforating disorders of the skin

    Directory of Open Access Journals (Sweden)

    Kalpana Arora

    2013-01-01

    Full Text Available Background: Perforating disorders of the skin, is an often overlooked entity characterized by transepidermal elimination of material from the upper dermis and are classified histopathologically according to the type of epidermal disruption and the nature of the eliminated material. They include Kyrle′s disease, perforating folliculitis, reactive perforating collagenosis, and elastosis perforans serpiginosa. Aim: The aim of this study was to delineate the clinical and histopathological features of perforating disorders of the skin. Materials and Methods: In our study, we reviewed last 2 years skin biopsies received by us. Hematoxylin and eosin sections were re-examined and histochemical stainings (elastic van Gieson and Masson trichrome stains were also used for histopathological evaluation. Results: We reviewed five cases of perforating disorders of skin which included two cases of Kyrle′s disease, two cases of reactive perforating collagenosis and a single case of perforating folliculitis. Two patients had family history of perforating dermatosis in their siblings and three had associated systemic disease. Conclusion: Perforating disorders of the skin should be considered when ulcer with keratotic plugs is found.

  11. Tug 'O' war: challenges of transverse upper gracilis (TUG) myocutaneous free flap breast reconstruction.

    Science.gov (United States)

    Locke, Michelle B; Zhong, Toni; Mureau, Marc A M; Hofer, Stefan O P

    2012-08-01

    Autologous tissue microsurgical breast reconstruction is increasingly requested by women following mastectomy. While the abdomen is the most frequently used donor site, not all women have enough abdominal tissue excess for a unilateral or bilateral breast reconstruction. A secondary choice in such women may be the transverse upper gracilis (TUG) myocutaneous flap. This study reviews our experience with TUG flap breast reconstruction looking specifically at reconstructive success rate and the requirement for secondary surgery. A total of 16 free TUG flaps were performed to reconstruct 15 breasts in eight patients over a period of five years. Data were collected retrospectively by chart review. Follow up ranged from 14 to 41 months. During the follow up period, there was one (6.3%) complete flap loss in an immediate breast reconstruction patient. Four further flaps (25%) failed in their primary aim of breast reconstruction, as they required additional significant reconstruction with either deep inferior epigastric perforator (DIEP) flaps (two flaps (12.5%), one patient) or augmentation with silicone breast implants (two flaps (12.5%), one patient), giving a successful breast reconstruction rate with the TUG flap of only 66.7%. In all of the remaining reconstructed breasts, deficient flap volume or breast contour was seen. Eight flaps were augmented by lipofilling. A total of 62.5% of the donor sites had complications, namely sensory disturbance of the medial thigh (25%) and poor scar (37.5%) requiring revision. This series demonstrates a high rate of reconstructive failure and unsatisfactory outcomes from TUG flap breast reconstruction. We feel this reinforces the necessity of adequate pre-operative patient assessment and counselling, including discussion regarding the likelihood of subsequent revisional surgery, before embarking on this form of autologous breast reconstruction.

  12. Arteriovenous Loop-Independent Free Flap Reconstruction of Sternal Defects after Cardiac Surgery.

    Science.gov (United States)

    Dornseifer, Ulf; Kleeberger, Charlotte; Ehrl, Denis; Herter, Frank; Ninkovic, Milomir; Iesalnieks, Igors

    2016-09-01

    Background Sternal defects following deep wound infections are predominantly reconstructed using local and regional flaps. The lack of appropriate recipient vessels after cardiac surgery may explain the minor role of free flaps. To date, arteriovenous loops have been the leading solution to enable microsurgical closure of these defects. However, the related surgical effort and the risk of flap failure are increased. We reviewed our experiences with the right gastroepiploic vessels as alternative recipient vessels for free flap reconstructions. Methods Between September 2010 and July 2015, 12 patients suffering deep wound infection after cardiac surgery underwent sternal reconstruction with free flaps anastomosed to the right gastroepiploic vessels. Gracilis flaps (n = 8) and anterolateral thigh perforator flaps (n = 4) were used for sternal reconstruction. Recipient vessels were harvested by laparoscopic dissection in five patients. Half of the free flaps were variably combined with omental flow-through flaps. Results Healing of all flaps was uneventful with no partial or total flap loss. Simultaneous interdisciplinary harvesting of recipient vessels by laparoscopy significantly shortened mean operative time from 313 to 216 minutes (p = 0.018). One incisional hernia was observed in the laparotomy group. Revision of a gracilis donor site was necessary in another patient due to postoperative bleeding. No recurrent sternal infection occurred during a mean follow-up of 20 months (range, 3-59 months). Conclusions The concept of gastroepiploic recipient vessels allows reliable free flap reconstructions of sternal defects in such high-risk patients without the need for arteriovenous loops.

  13. 中节指动脉及其背侧支为蒂逆行岛状皮瓣修复指端缺损%Repair of fingertip defect with reverse island flap based on middle phalange of digital artery and its dorsal branches

    Institute of Scientific and Technical Information of China (English)

    陈乐锋; 柯于海; 周望高; 熊懿; 张振伟; 游楚红

    2015-01-01

    目的:介绍一种对手指供区损伤较小的皮瓣修复手指指端缺损的方法。方法对15例手指指端缺损患者,以指固有动脉中段及其背侧支为蒂,设计手指中节指背岛状皮瓣进行修复。若需重建皮瓣感觉,则在切取皮瓣时,于皮瓣近端切取适当长度的指固有神经背侧支,与伤指指固有神经缝合。结果15指皮瓣及植皮全部成活,5指术后2 d皮瓣远端出现水疱,未予处理,术后7 d水疱开始萎缩吸收,术后2周水疱消失。术后随访3~9个月,皮瓣成活好,质地柔软,外形满意,颜色与患指周围皮肤相近,两点辨别觉6~9 mm,远指间关节屈伸功能无明显障碍。手功能根据ATM法评定:优10例,良5例。结论中节指动脉及其背侧支为蒂逆行岛状皮瓣是修复指端缺损较理想的方法之一。%Objective To introduce a flap which injured slightly on the donor sites, in repairing the fingertip defect. Methods 15 cases with defect on 15 fingers tip were treated with this island flaps. When the flap was used to repair defect at finger pulp, the dorsal branch of the digital proper nerve in the flap was kept to be anastomosed to the digital proper nerve at the recipient finger. Results All the flaps and skin grafts survived. Blister happened in 5 flaps 2 days after operation, which healed spontaneously without necrosis. The blister begin to shrink and be obsorption 7 days after operation, and disappear 2 weeks after operation. All cases were followed up for 3~9 months. The color, texture and contour of the flaps were good. The two-point discrimination distance was 6~9 mm on the flaps. No obvious functional problem was found in DIP motion. The hand function was assessed as excellent in 10 fingers, good in 5 fingers. Conclusion The reverse island flap based on middle phalange of digital artery and its dorsal branches is an ideal method to repair the fingertip defect.

  14. Flap monitoring by transcutaneous PO2 and PCO2: importance of transcutaneous PCO2 in determining follow-up treatment for compromised free flaps.

    Science.gov (United States)

    Hashimoto, Ichiro; Nakanishi, Hideki; Takiwaki, Hirotsugu; Takase, Maki Toda; Yamano, Masahiro; Sedo, Hiromichi

    2007-07-01

    The authors conducted a two-part study to determine whether transcutaneous oxygen pressure (TcPO (2)) and transcutaneous carbon dioxide pressure (TcPCO (2)) can be used to monitor flap viability after transplantation. The first part was an animal study in which TcPO (2) and TcPCO (2) were measured in 10 epigastric island flaps subjected to arterial or venous ischemia. The second part was a clinical study in which both were measured in 27 free skin flaps. In the experimental study, TcPO (2) decreased to nearly 0 mmHg after 10 minutes of arterial and venous ischemia. TcPCO (2) increased to 100 mmHg after 60 minutes of either type of ischemia. In the clinical study, congestion was suspected in six flaps on the basis of clinical signs alone. Three congested flaps with TcPCO (2) more than 90 mmHg were selected for intervention. The remaining three congested flaps, with TcPCO (2) 80 mmHg or less, survived completely without further treatment. The TcPO (2) of all treated flaps and of the six flaps not requiring further treatment was 0 mmHg. Results of experimental study indicate that TcPO (2) is more sensitive than TcPCO (2) to flap ischemia. However, results of clinical study suggest that it is very hard to distinguish congested flaps from healthy flaps by TcPO (2) alone. The authors believe that a congested flap with a TcPCO (2) more than 90 mmHg requires further treatment.

  15. The effect of early detection of anterolateral thigh free flap crisis on the salvage success rate, based on 10 years of experience and 1072 flaps.

    Science.gov (United States)

    Yang, Q; Ren, Z H; Chickooree, D; Wu, H J; Tan, H Y; Wang, K; He, Z J; Gong, C J; Ram, V; Zhang, S

    2014-09-01

    The aim of this study was to assess the effectiveness of early exploration of anterolateral thigh (ALT) free flap compromise in head and neck reconstruction and to correlate this with the salvage success rate. The perioperative data of 1051 patients with 1072 ALT flap reconstructions were reviewed retrospectively for the period January 2002 to December 2012. Outcome measures included ethnicity, defect type, incidence and timing of flap compromise, type of flap compromise, causes of vascular occlusion, and salvage rate. The success rate of free flap reconstruction was 97.3% (1043/1072). Of the 29 failures, 21 were complete and eight were partial failures (10-40% of the flap). Venous occlusions occurred in 39 flaps (83.0%) and arterial occlusions in five flaps (17.0%). Six cases were detected within 8h postoperatively, 13 at 8-16 h postoperatively, seven at 16-24h postoperatively, and 18 at 24-48 h postoperatively, with respective salvage rates of 66.7%, 61.5%, 28.6%, and 22.2%; three cases detected after 48 h failed. The salvage rate at ≤16 h (62.2%) was much higher than that at >16 h (21.4%, P=0.0039). Early detection, re-exploration, and effective handling of the flap crisis increases the rate of flap salvage tremendously.

  16. The propeller flap for chronic osteomyelitis of the lower extremities: a case report.

    Science.gov (United States)

    Rubino, C; Figus, A; Mazzocchi, M; Dessy, L A; Martano, A

    2009-10-01

    The goals of the treatment of chronic osteomyelitis are infection eradication with systemic antibiotic therapy and local management with radical excision of the infected tissue and obliteration of the remaining dead space. Adequate debridement and coverage with a well-vascularised tissue are mandatory for successful outcomes. Use of muscle covering for chronic osteomyelitis in the lower extremities is considered the best procedure. However, there have been instances where debridement of the bone tissue did not leave a deep cavity along the leg bones and fasciocutaneous flaps can be used in these instances to cover the defect and to restore function without recurrence of the disease. Recently, free non-muscle flaps have been used and assessed for chronic osteomyelitis or covering of exposed bone. Perforator flaps have been shown to be well vascularised due to a structural haemodynamic enhancement. In the light of these findings we report a successful case of chronic osteomyelitis of the right fibula treated with excision of the affected tissue and covering with a propeller flap. Instead of free flap covering, in order to optimise surgical reconstruction, reducing the operative time, donor and recipient site morbidity and risk of total flap failure, local perforator flaps and particularly the propeller flap may be indicated in the treatment of chronic osteomyelitis in selected patients when the defect is limited and there is no need to fill a deep bone cavity or a dead space. To our knowledge, this the first report of the use of a propeller flap in the treatment of chronic osteomyelitis in the lower extremities.

  17. [Perforating necrobiosis lipoidica].

    Science.gov (United States)

    Peteiro, C; Zulaica, A; Toribio, J

    1986-01-01

    This is the case history of a woman with a 6 year history of insulin-dependent diabetes mellitus and a 5 year history of tuberous lesions on the dorsal aspect of the metacarpophalangeal joints. Histological examination revealed multiple necrobiotic foci throughout the dermis and subcutaneous tissue, with varying degrees of degeneration, alternating with fibrotic areas. This picture is compatible with lipoid necrobiosis. The existence of various foci of epithelial perforation, manifested clinically by a point hyperkeratosis similar in appearance to blackheads, suggests transfollicular elimination. This would explain the total absence of a pilosebaceous follicles in the lesion.

  18. Clinical application of lateral lower leg flap to repair skin defect of the hand%小腿外侧皮瓣修复手部皮肤缺损的临床应用

    Institute of Scientific and Technical Information of China (English)

    庄加川; 李敏姣; 陈国荣; 白印伟; 吴耿; 柯于海; 林慧鑫; 张振伟

    2012-01-01

    目的 探讨小腿外侧皮瓣修复手部皮肤缺损的临床应用.方法 对15例手部皮肤缺损面积大小约2.5 cm×3.2 cm~3.8 cm×5.0 cm的患者,采用小腿外侧皮瓣游离移植修复.皮瓣穿支动脉与手部动脉、伴行静脉或皮下静脉与手背静脉吻合,小腿供区创面直接缝合.结果 15例皮瓣全部存活,1例皮瓣术后出现血管危象,行手术探查重新吻合血管后存活,4例皮瓣术后3个月行皮瓣整形术.术后随访时间为2个月至2年,平均11个月,手部皮瓣外观满意,功能恢复良好;小腿供区隐蔽,创面仅留线状瘢痕.结论 小腿外侧皮瓣修复手部皮肤缺损是一种较理想的方法.%Objective To explore the clinical applications of lateral lower leg flap to repair skin defects of the hand.Methods The lateral lower leg flap was used to cover skin defect of the hand in 15 patients with defect area measuring approximately 2.5 cm × 3.2 cm to 3.8 cm × 5.0 cm.The flap was transferred by anastomosing the flap perforator artery to the artery of the hand,the venae commitante or subcutaneous vein of the flap to the veins on dorsum of the hand.The donor site was dosed directly.Results All 15 flaps survived.Postoperative vascular crisis occurred in one flap.The flap survived after surgical exploration and re-anastomosis of the vessels.Flap plasty was done in 4 cases 3 months after the primary surgery.Postoperative follow-up ranged from 2 months to 2 years,with an average of 11 months.The skin flaps at the hand had satisfactory appearance.Hand function recovered well.The donor site was concealing.Only a linear scar was left.Conclusion Lateral lower leg flap is a relatively ideal method to repair skin defect of the hand.

  19. Noninvasive Free Flap Monitoring Using Eulerian Video Magnification

    Directory of Open Access Journals (Sweden)

    Yuan Fang Liu

    2016-01-01

    Full Text Available Eulerian Video Magnification (EVM can enhance subtle changes in videos to reveal what was once invisible to the naked eye. In this proof of concept study, we investigated using EVM as a novel form of free flap monitoring. Free flaps with skin paddles were filmed in the operating room with manipulation of their pedicles. In a representative 77-year-old female who received a latissimus dorsi-serratus-rib composite free flap, EVM was able to detect blockage of arterial or venous supply instantaneously, providing a visible representation through degree of color change in videos. EVM has the potential to serve as a powerful free flap monitoring tool with the benefit of being noninvasive, sensitive, easy-to-use, and nearly cost-free.

  20. A totally laparoscopic peritoneal free flap for reconstruction of hand

    Institute of Scientific and Technical Information of China (English)

    En-Qi Guo; Qing-Ping Xie

    2016-01-01

    Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons.Here,we present a case of hand reconstruction with a totally laparoscopic peritoneal flap.The anterior rectus sheath was preserved in situ.The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand.The defect of the dorsal hand was 17 cm × 12 cm.The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications.A following split-thickness skin graft offered the successful wound closure.Motor and sensory function improved gradually within the first year follow-up.The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue defects accompanied by exposed tendons on the hand and foot.

  1. The Vascularized Medial Femoral Corticoperiosteal Flap for Thumb Reconstruction

    Science.gov (United States)

    Amin, Kavit; Darhouse, Nagham; Sivakumar, Bran; Floyd, David

    2015-01-01

    Summary: We present an interesting method of shaping a vascularized medial femoral condyle (MFC) flap into a “neophalanx” for phalangeal reconstruction. Our patient presented with limited strength and function secondary to fracture nonunion of the proximal phalanx of the dominant thumb. Following excision of the pseudarthrosis, an MFC corticoperiosteal flap was harvested, sculpted into a prism shape and inset. The superomedial genicular pedicle was anastomosed to the princeps pollicis artery and a cephalic tributary. On follow-up, new bone growth was seen on radiographs and the patient had substantially improved function, with full metacarpophalangeal extension, a Kapandji score of 9, and a markedly reduced Disabilities of the Arm, Shoulder and Hand score of 2.68. The MFC flap is useful for reconstruction of bony defects, with minimal donor morbidity. This versatile vascularized flap can be crafted to requisite shapes and is useful for small defects in the hand, including phalangeal reconstruction. PMID:26495205

  2. Estudio preoperatorio de vasos receptores en reconstrucción mamaria con colgajo DIEP Preoperative planning of receiver vessels in breast reconstruction with DIEP flap

    Directory of Open Access Journals (Sweden)

    C. Tejerina Botella

    2011-09-01

    Full Text Available El estudio preoperatorio vascular de cualquier colgajo microquirúrgico es esencial para el buen desarrollo del mismo. En el colgajo DIEP (colgajo de perforante de arteria epigástrica inferior profunda aplicado a la reconstrucción mamaria, se han establecido durante los últimos años diferentes técnicas para la planificación preoperatoria de la anatomía de los vasos perforantes de la arteria epigástrica inferior. Sin embargo, pensamos, que también es muy importante la planificación anatómica preoperatoria de los vasos receptores, que en la mayoría de los casos son la arteria y vena mamarias internas. Estos vasos sufren en ocasiones variaciones anatómicas, llegando incluso a no existir en algunos pacientes. El conocimiento exacto de la localización, permeabilidad y calibre de estos vasos receptores hará que la intervención sea mas rápida y sencilla.An accurate preoperative vascular evaluation of microsurgical flaps is essential for a good procedure. In DIEP (deep inferior epigastric perforator flap, in breast reconstruction, have been described different preoperative techniques to study the anatomy of the deep inferior epigastric perforators. We think that preoperative planning of the receiver vessels, (internal mammary artery and vein, in most of cases is very important too. These vessels have anatomic changes in some patients. To know the exact location, permeability, and calibre of these vessels will help us to have a more easy and quick operation.

  3. Primary appendiceal adenocarcinoma of colonic type with perforating peritonitis.

    Directory of Open Access Journals (Sweden)

    Noguch H

    2001-10-01

    Full Text Available Primary adenocarcinoma of the appendix is rare, especially the colonic type. We report a case of appendiceal adenocarcinoma of colonic type associated with perforating peritonitis after aorto-femoral artery bypass surgery. A 79-year-old woman presented with fever and pain in the right lower abdomen. She had undergone aorto-femoral artery bypass surgery due to arteriosclerosis obliterans 6 months earlier. Abdominal ultrasonography and computed tomography showed a suspected pool of fluid surrounding the artificial vessel and a mass lesion in the upper end of the fluid collection. These findings suggested localized peritonitis due to appendiceal perforation. Emergency laparotomy showed a pool of pus around the artificial vessel and inflamed appendix, which adhered to the surrounding tissue. The mass was excised in combination with an ileocaecal resection, followed by an ileocolic anastomosis. The histological diagnosis was moderately differentiated adenocarcinoma of the appendix, colonic type. The tumour had infiltrated and obstructed the lumen of the orifice of the appendix, which may have caused perforation of the appendix. She was examined at regular periodic follow-ups and no evidence of recurrence or metastasis was noted in the 12-month postoperative period. These findings indicate that, in cases of acute appendicitis, especially with perforation, the possibility of appendiceal adenocarcinoma should be considered.

  4. [Microdialysis of cutaneous free flaps to monitor results of maxillofacial surgery].

    Science.gov (United States)

    Brix, M; Muret, P; Mac-Mary, S; Ricbourg, B; Humbert, P

    2006-02-01

    The development of in vivo microdialysis has made it possible to monitor cutaneous free flaps in maxillo-facial surgery. A microprobe inserted in the free flap dermis collects a microdialysate enabling measurement of dermal metabolites such as glucose, lactate, pyruvate, or glycerol. The monitoring curves are predictive of ischemia-related tissue injury. Hourly measurements provide a reliable method for early diagnosis of venous or arterial thrombosis. Revision surgery can then be undertaken if needed to repair microanastomoses before clinical alteration. This technique has been compared with validated flaps monitoring systems such as temperature probe, transcutaneous oxygen tension monitoring, and laser Doppler flowmetry. Microdialysis has several advantages: objective measurements, different curves for venous and arterial thrombosis, early diagnosis. Accessibility to oral cavity or pharyngeal flaps requires careful clinical analysis (microprobe fixation, anatomy and choice of flap).

  5. Anatomy and clinic application of reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle%拇指尺侧指背动脉为蒂的虎口背侧逆行岛状皮瓣的解剖与临床应用

    Institute of Scientific and Technical Information of China (English)

    史增元; 尹维刚; 俞淼; 董文伟; 毛海蛟; 唐旭

    2014-01-01

    Objective To explore a surgical treatment of skin defects on the thumb by reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle.Methods The origin,courses and distribution of dorsoulnar artery of thumb from 70 adult cadaveric hand specimens perfused by red latex were explored.Skin defects on the thumb of 8 cases were repaired with reverse-flow island flaps on dorsal thumb web.The cut areas of flaps vary from 4.5 cm × 3.0 cm to 7.5 cm × 4.0 cm.Results There were 4 types of the dorsoulnar artery of thumb basing on the origin and courses.Type Ⅰ was outside the first dorsal interosseous muscle type,which was the dorsoulnar artery of thumb mainly originated from the first dorsal metacarpal artery and cross through the surface of the first dosal interosseous muscle(42.9%).Type Ⅱ was under the first dorsal interosseous muscle type,which was from the thumb principal artery or deep branch of radial artery and run under the first dorsal interosseous muscle(41.4%).Type Ⅲ was mixed type from the anastomose point of above two arteries at the level of the first metacarpophalangeal joint(11.4%).Type Ⅳ was absence type (4.3%).Eight flaps fully survived.Excellent texture and satisfying appearance of the flaps as well as normal thumb web function were verified after 8 months' follow-up.Conclusion It is significant to determine the type of dorsoulnar artery of thumb to decide different operations due to the artery's considerable variation.The reverse-flow island flap on dorsal thumb is an ideal method to repair soft tissue defect on the thumb for its convenient operating and little effect in the donor area.%目的 探讨拇指尺侧指背动脉为蒂虎口背侧逆行岛状皮瓣修复拇指皮肤缺损的手术方法.方法 用70侧成人尸手标本,经动脉灌注红色乳胶,解剖观测拇指尺侧指背动脉的来源、走行和分布范围.在临床上应用该逆行岛状皮瓣修复8例拇指

  6. [Harvesting technique of chimeric multiple paddles fibular flap for wide oromandibular defects].

    Science.gov (United States)

    Foy, J-P; Qassemyar, Q; Assouly, N; Temam, S; Kolb, F

    2016-08-01

    Carcinological head and neck reconstruction still remains a challenge due to the volume and varied tissues needed. Large and wide oromandibular defects require, not just the bone but also soft tissues for the pelvilingual reconstruction and therefore, a second free flap may become necessary in addition to a fibular flap. The option of an unique chimeric flap based on the fibular artery and its branches is less known whereas it offers the advantage of a unique flap with bone, muscle and multiple skin paddles, independent of each other. The aim of this technical note is to present step by step the surgical procedure of this chimeric flap and share this method that avoids a second free flap.

  7. Spontaneous Flapping Flight

    Science.gov (United States)

    Vandenberghe, Nicolas; Zhang, Jun; Childress, Stephen

    2004-11-01

    As shown in an earlier work [Vandenberghe, et. al. JFM, Vol 506, 147, 2004], a vertically flapping wing can spontaneously move horizontally as a result of symmetry breaking. In the current experimental study, we investigate the dependence of resultant velocity on flapping amplitude. We also describe the forward thrust generation and how the system dynamically selects a Strouhal number by balancing fluid and body forces. We further compare our model system with examples of biological locomotion, such as bird flight and fish swimming.

  8. Spontaneous Perforation of Pyometra

    Directory of Open Access Journals (Sweden)

    Begüm Yildizhan

    2006-01-01

    Full Text Available Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01–0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy. Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.

  9. Familial reactive perforating collagenosis

    Directory of Open Access Journals (Sweden)

    Bhat Yasmeen

    2009-01-01

    Full Text Available Background: Reactive perforating collagenosis (RPC is one of the rare forms of transepidermal elimination in which genetically altered collagen is extruded from the epidermis. This disease usually starts in early childhood as asymptomatic umbilicated papules on extremities, and the lesions become more conspicuous with age. Aims: The objective of our study was to determine the clinico-pathological features of RPC and the response to various treatment modalities. Methods: Ten patients of RPC, belonging to five different families, were studied clinically. Various laboratory investigations were carried out and diagnosis was made by histopathology of the lesions. Patients were given various topical and oral treatments. Results: RPC is familial in most cases without any definite inheritance pattern. It begins in childhood and the lesions are usually recurrent and become profuse and large with age. Systemic diseases have no role in the onset of lesions. Conclusion: Oral and topical retinoids in combination with emollients is the best treatment option.

  10. 带蒂尺动脉腕上皮支皮瓣修复对侧手指脱套伤%REPAIR OF COMPLICATED DEGLOVING INJURIES OF OPPOSITE FINGER WITH AKIN UNITED FLAPS PEDICLED WITH DORSAL CARPAL BRANCH OF ULNAR ARTERY

    Institute of Scientific and Technical Information of China (English)

    阳运康; 鲁晓波; 张忠杰; 葛建华

    2011-01-01

    Objective To evaluate the clinical efficacy of akin united flaps pedicled with dorsal carpal branch of ulnar artery in repairing complicated degloving injuries of the opposite fingers. Methods Between August 2005 and August 2009, 11 cases of complicated degloving injuries of single finger were treated, including 8 males and 3 females with an average age of 26 years (range, 19-55 years). The defect locations were thumb in 1 case, index finger in 7 cases, and middle finger in 3 cases, including 9 cases of mechanical injury and 2 cases of traffic accident injury. The extent of skin avulsion was the proximal segments or beyond the middle segment of finger with a defect range from 5.0 cm × 4.5 cm to 8.0 cm x 5.5 cm. Complicated injuries included phalangeal fracture in 2 cases, extensor tendon injury in 3 cases, flexor and extensor tendon injuries in 1 case,digital vascular injury in 9 cases, and digital nerve injury in 6 cases. The time from injury to operation was 2-18 hours (mean, 4.8 hours). The akin united flaps were designed on the basis of anatomical distribution of the dorsal carpal branch of ulnar artery. The proximally pedicled flaps enclosed palmar finger, and the distally pedided flaps enclosed dorsal finger. The size of flaps ranged from 10 cm × 3 cm to 16 cm × 3 cm. The donor sites were sutured directly. After 3 weeks, the pedicle was cut. Results Light yellow secretion and eczema on the flap were observed in 1 case at 3 days, were cured after 2 weeks of dressing change; other flaps survived and healing of incisions by first intention was achieved. The incisions at donor sites healed by first intention. The secondary plastic operation was performed in 2 cases because of bulky flaps at 3 months after operation. Eleven patients were followed up postoperatively 6-12 months (8 months on average). The texture and appearance of all the flaps were satisfactory.The two-point discrimination was 12-20 mm with satisfactory recovery of finger function at 6 months

  11. Rett syndrome and gastric perforation.

    Science.gov (United States)

    Shah, Malay B; Bittner, James G; Edwards, Michael A

    2008-04-01

    Rett Syndrome is associated with decreased peristaltic esophageal waves and gastric dysmotility, resulting in swallowing difficulties and gastric dilation. Rarely, gastric necrosis and perforation occur. Our case represents the third reported case of gastric necrosis and perforation associated with Rett Syndrome. A 31-year-old female after 11 hours of intermittent emesis and constant, sharp abdominal pain presented with evidence of multiorgan system failure including hypovolemic shock, metabolic acidosis, coagulopathy, and hepatorenal failure. A chest radiograph revealed intra-abdominal free air necessitating emergent laparotomy. During exploration, a severely dilated, thin-walled stomach with an area of necrosis and gross perforation was noted. Wedge resection of the necrotic tissue and primary closure were performed. Despite aggressive perioperative resuscitation and ventilation support, the patient died 3 hours postoperatively secondary to refractory shock and hypoxemia. Severe gastric dilation can occur with Rett Syndrome and may cause gastric necrosis and perforation. Prolonged elevated gastric pressures can decrease perfusion and may contribute to perforation. Timely decompression via percutaneous endoscopic or surgical gastrostomy could decrease the risk of perforation particularly when significant gastric distention is present. Consideration of gastric necrosis and perforation in patients with Rett Syndrome may lead to earlier intervention and decreased mortality.

  12. Versatility of free SCIA/SIEA flaps in head and neck defects.

    Science.gov (United States)

    Nasir, Serdar; Aydin, Mustafa Asim

    2010-07-01

    Reconstruction of head and neck defects may require replacement of the bony structures, external soft tissue, and intraoral mucosa. Most cases, including maxillary defects, often require repair using only soft tissue flaps. Recently, the authors used free superficial circumflex iliac artery/superficial inferior epigastric (SCIA/SIEA) flaps for head and neck reconstruction. This was their first choice over other free flaps due to its versatile advantages. Fifteen patients underwent head and neck reconstruction with free SCIA/SIEA flaps (n = 16). No flap loss was observed; however, emergency vascular reanastomosis was performed in 3 cases to restore the blood supply in compromised flaps. Flap thinning and secondary debulking procedures were performed in 4 cases. The functional and aesthetic results were deemed as acceptable in all patients. Based on our results, we believe that the free SCIA/SIEA flap is useful for soft tissue defect reconstruction in the head and neck. It has the following advantages: (1) Large flap elevation is possible for reaching distant recipient vessels, (2) Two surgical teams may work at the same time preparing the donor and recipient regions, and (3) The flap design uses an abdominoplasty incision, which has minimal donor site morbidity.

  13. Radial forearm free flap morbidity: A rare case of a normal preoperative arteriogram and acute intraoperative hand ischemia

    OpenAIRE

    Bruner, Terrence W.; Hanasono, Matthew M.; Skoracki, Roman J

    2011-01-01

    The radial forearm free flap is ideal for reconstructive microsurgery due to its thin, pliable fasciocutaneous tissue, reliable anatomy and ease and simplicity of flap elevation. However, one of the major complications is hand ischemia due to sacrifice of the radial artery, although it is a rare occurrence. A case involving a 73-year-old man who developed intraoperative hand ischemia after elevation of a radial forearm free flap is presented.

  14. Coverage of clavicular area by a pectoralis minor pedicle flap: anatomical study and description of three clinical cases.

    Science.gov (United States)

    Bourdais, Ludovic; Bellier-Waast, Frederique; Perrot, Pierre; Delpierre, Jean; Pannier, Michel; Duteille, Franck

    2009-10-01

    As the data in the literature concerning the vascularization of the pectoralis minor were conflicting, we conducted a new anatomic study on cadavers preliminary to clinical application of a pedicle flap for clavicular coverage in 3 patients. Twenty flaps were dissected, yielding numerous anatomic variations. In all cases, the principal arteries penetrated the muscle in its upper part, either posteriorly or posterolaterally. This anatomic study justified the use of the pectoralis minor as a pedicle flap, with turnover just below the coracoid process. Accordingly, 3 cases of clavicular defects were treated successfully. Reports in the literature propose an adipofascial turnover flap or a pectoralis major flap for clavicular coverage. The pectoralis minor pedicle flap is easy to dissect and reproducible, involving minor esthetic sequelae and no functional complications. This flap, which has never been described in this application, would appear to be suitable for first-line treatment in this indication.

  15. Multiple bowel perforation and necrotising fasciitis secondary to abdominal liposuction in a patient with bilateral lumbar hernia

    Directory of Open Access Journals (Sweden)

    Vincent Delliere

    2014-01-01

    Full Text Available We present a rare complication of abdominal liposuction: bowel perforation and necrotizing fasciitis. Because of bilateral lumbar hernia, a 56-year-old woman had caecum and descending colon perforation during lipoplasty. She had septic shock syndrome at her admission. The authors treated this complex wound with several debridement, omental flap, NPWT and split-thickness skin graft. The incidence of abdominal wall perforation with visceral injury is 14 in 100,000 liposuctions performed. There are only 12 cases of bowel perforation in literature but this complication is probably underestimated. Prompt surgical debridement is absolutely mandatory in this life threatening scenario. Lumbar hernia is very rare and should be ruled out before every abdominal liposuction clinically or with imaging modalities.

  16. 带腓动脉的腓浅神经营养血管皮瓣修复前足软组织缺损%Reconstruction of forefoot soft tissue defect with superficial peroneal neurotropphic vascular flap with peroneal artery

    Institute of Scientific and Technical Information of China (English)

    李俊明; 李艳华; 易先达; 李智浩; 黄贺军; 李道选; 代彭威; 贺喜顺

    2013-01-01

    Objective To observe the clinical effect of retrograde transferring of Superficial peroneal nerve nutrition vessel flap for repairing the soft tissue defect of forefoot.Methods From January 2007 to December 2011,twelve patients with soft tissue defect in forefoot were treated with superficial peroneal nerve nutrition vessel flap by retrograde transfer repair.The flap ranged in size from 6 cm × 4 cm to 18 cm × 12 cm.Results Only 1 flap appeared blood stasis and swelling,and the distal end of skin flap became effusion under the epidermis.Considering it may because we sew it up too tight,we removed sort of suture timely.The flap became ruddy and survived.And the others smoothly survived without special handling.Eight patients had our follow-up visit and they were satisfied with the shape of their flaps,the flap was wear-resisting.Five cases get followed-up of the 7 patients which had neural anastomosis surgery,the 2PD was 10-14 mm of the flap.Conclusion With a good shape,this type of flap supplying with plentiful blood,easily chipped,transferred with a strong randomness,is one of the ideal methods to repair the rather large area skin soft tissue defect in the forefoot.%目的 总结带腓动脉的腓浅神经营养血管皮瓣逆行转位修复前足皮肤软组织缺损的临床效果. 方法 2007年1月至2011年12月,应用带腓动脉的腓浅神经营养血管皮瓣逆行转移对12例前足皮肤软组织缺损进行修复,皮瓣切取面积为6cm×4cm~18cm×12cm. 结果 仅1例术后36 h出现皮瓣瘀血肿胀,皮瓣远端出现表皮下积液,与蒂部缝合过紧有关,及时拆除蒂部部分缝线,皮瓣转红润,顺利成活,其余皮瓣均顺利成活.8例得到3个月~3年的随访,皮瓣外形满意,耐磨.吻合神经的7例中有5例得到随访,皮瓣两点辨别觉在10 ~ 14 mm. 结论 带腓动脉的腓浅神经营养血管皮瓣血供丰富,切取简便,随意转移性强,外观好,是修复前足较大面积皮肤软组织缺损理想的方法之一.

  17. Anatomical features and clinical application of compound flap pedicled with arterial arch of palpebral margin%以睑缘动脉弓为蒂的睑缘复合组织瓣的解剖学及临床应用

    Institute of Scientific and Technical Information of China (English)

    赵天兰; 程新德; 熊绍虎; 谢晓明; 余道江

    2008-01-01

    目的 通过对眼睑血供解剖的详细观测,为应用以睑缘动脉弓为蒂的睑缘复合组织瓣修复眼睑缺损提供解剖学依据,并证明该方法是一种修复睑缘全层缺损的理想方法.方法 对15具尸体30侧眼睑进行解剖学观测,重点研究睑缘动脉弓的血供来源、走行分布、外径及吻合情况.对30例临床病例进行回顾性总结,评价本术式的治疗效果.结果 眼睑由内向外可分为皮肤、皮下组织、肌肉层、睑板层、结膜层5层.眼睑内的大部分血管互相吻合,血液循环丰富.鼻背动脉的分支和泪腺动脉的分支共同组成睑缘动脉弓和周边动脉弓,共同营养睑板前后的组织.临床30例睑缘复合组织瓣全部成活,伤口Ⅰ期愈合,无明显继发畸形,外形满意.结论 以睑缘动脉弓为蒂的睑缘复合组织瓣血供可靠,用于睑缘全层缺损的修复为同类组织修复,是一种理想并且效果满意的修复睑缘缺损的方式.%Objective To explore the anatomical basis for clinical application of the compound flap pedicled with arterial arch of palpebral margin by observing eyelid blood supply and anatomical structure and to prove that it is an ideal method of repairing the eyelid defect for clinical application. Methods 15 adult cadavers (30 eyelids) were dissected. The origin, course, branches, diameters and vessel networks of palpebral margin arterial arch were observed particularly. 30 cases of eyelid marginal defect were reviewed and the therapeutic effect of this method evaluated. Results Eyelid was constituted by 5 layers: skin, subcutaneous tissue, muscle, tarsal plate and conjunctival layers. Most eyelid vessels were mutually anastomosed to form a constant vessel network. Palpebral margin arterial arch and peripheral arterial arch were formed by dorsal nasal artery branches and lacrimal artery branches, both of which nourished the eyelid tissue. All the compound flaps of 30 cases survived completely without

  18. 组合皮瓣修复小腿及足踝部大面积软组织缺损%Repairing massive soft tissue defects below the knee with combined flaps

    Institute of Scientific and Technical Information of China (English)

    任高宏; 任义军; 王钢; 胡稷杰; 黎润光; 裴国献

    2009-01-01

    local transferred gastrocnemius muscular flaps in 3 cases, free anterolateral thigh perforator flap plus free thoraco-umbilical flap in 1 case, free anterolateral thigh flap and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibia] vessel from the healthy limb to form vascular pedicles in 1 case. Results In 33 cases, flaps survived completely and their wounds were healed primarily. Vessel exploration was carried out following vascular crisis in 3 cases. After the artery crisis was relieved, the free flap survived well in 1 case, 1 case experienced marginal necrosis because of the arterial thrombosis in and 1 case partial necrosis because of the vein thrombosis. The overall flap success rate was 97.2% (35/36) . Follow-ups for a mean of 16 (4 to 36) months showed that all the flaps survived with good quality and shape and the affected foot and ankle obtained good function. Conclusions It is a feasible and effective method to repair massive soft tissue defects below the knee using differently combined flaps. Although the surgery can be risky, the method can effectively reduce the rate of limb disability, restore the limb function and shorten the course of treatment.

  19. Perforated midgut diverticulitis: Revisited

    Institute of Scientific and Technical Information of China (English)

    Milan Spasojevic; Jens Marius Naesgaard; Dejan Ignjatovic

    2012-01-01

    AIM:To study and provide data on the evolution of medical procedures and outcomes of patients suffering from perforated midgut diverticulitis.METHODS:Three data sources were used:the Medline and Google search engines were searched for case reports on one or more patients treated for perforated midgut diverticulitis (Meckel's diverticulitis excluded)that were published after 1995.The inclusion criterion was sufficient individual patient data in the article.Both indexed and non-indexed journals were used.Patients treated for perforated midgut diverticulitis at Vestfold Hospital were included in this group.Data on symptoms,laboratory and radiology results,treatment modalities,surgical access,procedures,complications and outcomes were collected.The Norwegian patient registry was searched to find patients operated upon for midgut diverticulitis from 1999 to 2007.The data collected were age,sex,mode of access,surgical procedure performed and number of patients per year.Historical controls were retrieved from an article published in 1995 containing pertinent individual patient data.Statistical analysis was done with SPSS software.RESULTS:Group I:106 patients (48 men) were found.Mean age was 72.2 ± 13.1 years (mean ± SD).Age or sex had no impact on outcomes (P =0.057 and P =0.771,respectively).Preoperative assessment was plain radiography in 53.3% or computed tomography (CT)in 76.1%.Correct diagnosis was made in 77.1% with CT,5.6% without (P =0.001).Duration of symptoms before hospitalization was 3.6 d (range:1-35 d),but longer duration was not associated with poor outcome (P =0.748).Eighty-six point eight percent of patients underwent surgery,92.4% of these through open access where 90.1% had bowel resection.Complications occurred in 19.2% of patients and 16.3% underwent reoperation.Distance from perforation to Treitz ligament was 41.7 ± 28.1 cm.At surgery,no peritonitis was found in 29.7% of patients,local peritonitis in 47.5%,and diffuse

  20. 旋股外侧动脉降支侧支皮瓣修复下肢软组织缺损%CLINICAL RESULTS OF FLAP PEDICLED WITH COLLATERAL BRANCH OF DESCENDING RARUS OF LATERAL CIRCUMFLEX FEMORAL ARTERY FOR REPAIRING LOWER LIMB SOFT TISSUE DEFECTS

    Institute of Scientific and Technical Information of China (English)

    刘智伟; 余斌; 覃承诃; 罗吉伟; 胡岩君

    2011-01-01

    Objective To investigate the clinical results of the flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery with digital three-dimensional reconstruction technique for lower limb soft tissue defects. Methods Between March 2009 and January 2010, 7 patients with lower limb soft tissue defects were treated with free flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery. There were 6 males and 1 female with an age range from 6 to 51 years. They were injured by traffic accident (4 cases), or by object hit from height (3 cases). The locations were foot in 2 cases, ankle in 2 cases, and anterior tibia in 3 cases. The disease duration was 8 hours to 40 days (mean,20 days). All the cases complicated by exposure of tendons or bones. The areas of soft tissue defect ranged from 12 cm × 7 cm to 20 cm × 14 cm. Free flaps were transplanted at 4 to 16 days after symptomatic treatment. Before operation, all the flaps were designed with digital three-dimensional reconstruction technique. The size of flaps ranged from 15 cm × 9 cm to 22 cm × 16 cm.The donor sites were closed directly in all cases. Results All the flaps survived. The wounds and incisions at donor sites healed by first intention. All the patients were followed up 6 to 12 months. The texture, appearance, and function of the flaps were satisfactory, and no complication occurred. All the flaps had protective sensation, which could meet the requirement of the daily life. The function of ankle was satisfactory with normal walk; the extension was 19-22° and the flexion was 30-36°. No obvious scar formed at donor sites. Conclusion The flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery has reliable blood supply, easy operation, little influence on the donor site, and high success rate with digital three-dimensional reconstruction technique. It is an excellent option for repairing lower limb soft

  1. Early Mobilization after Free-flap Transfer to the Lower Extremities: Preferential Use of Flow-through Anastomosis

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    Shimpei Miyamoto, MD

    2014-03-01

    Conclusions: This study demonstrates that early mobilization after free-flap transfer to the lower extremity is made possible by flow-through anastomosis for both arteries and veins. Flow-through flaps have stable circulation from the acute phase and can tolerate early dangling and ambulation.

  2. Unusual presentation of gallbladder perforation

    OpenAIRE

    Jayasinghe, G.; Adam, J.; Abdul-Aal, Y.

    2016-01-01

    Introduction: Gall bladder perforation is associated with high mortality rates and therefore must be recognised and managed promptly. We present an unusual presentation of spontaneous gall bladder perforation. Case presentation: An elderly lady with multiple medical co-morbidities was admitted with sepsis following a fall. Initial assessment lead to a diagnosis of pneumonia, however a rapidly expanding right flank mass was incidentally noted during routine nursing care. Imaging studies wer...

  3. Helicobacter pylori in gastroduodenal perforation

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    Bharat B Dogra

    2014-01-01

    Full Text Available Background:peptic ulcers were earlier believed to be caused by dietary factors, gastric acid, and stress. However, in 1983, Warren and Marshall identified the correlation between Helicobacter pylori (H. pylori and peptic ulcers. It is now well established that most of the peptic ulcers occur as a result of H. pylori infection. But the co-relation between perforated peptic ulcer and H. pylori infection is not yet fully established. Aims and objectives : to study the prevalence of H. pylori infection in patients with perforated peptic ulcer. Materials and methods: this was a prospective study carried out in all cases of perforated peptic ulcer reporting in surgical wards of a medical college during 2008-2010. A total of 50 cases, presenting as acute perforation of duodenum and stomach during this period, formed the study group. After resuscitation, all the cases were subjected to emergency exploratory laparotomy. The exact site of perforation was identified, biopsy was taken from the ulcer margin from 2-3 sites and the tissue was sent for H. pylori culture and histopathological examination. Simple closure of perforation, omentoplasty, thorough peritoneal lavage and drainage was carried out. Results: out of the 50 cases of perforated peptic ulcer, 38 happened to be males, and only 12 were females. The age of the patients ranged from 20 to 70 years. All the patients underwent only emergency laparotomy. As many as 46 cases (92% turned out to be positive for H. pylori and only four cases (8% were negative for this infection. Postoperatively, patients who were found to be positive for H. pylori were put on anti-H. pylori treatment. Conclusion: there was a high prevalence of H. pylori infection in patients with perforated gastroduodenal ulcers.

  4. Spontaneous Perforation of Rectosigmoid Colon

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    Farhad Haj Sheikholeslami

    2010-12-01

    Full Text Available Spontaneous perforation of the sigmoid colon or rectom is definedas a sudden perforation of the colon in the absence of diseasessuch as tumors, diverticulosis or external injury. It is avery rare finding, and if neglected, results in severe peritonitisand high mortality. The causes of this rare condition are numerous,and in this case it might be due to the chronic constipationinduced by an anticholinergic antipsychotic.Iran J Med Sci 2010; 35(4: 339-341.

  5. Soft tissue augmentation for restoration of facial contour deformities using the free SCIA/SIEA flap.

    Science.gov (United States)

    Nasir, Serdar; Aydin, Mustafa Asim; Altuntaş, Selman; Sönmez, Erhan; Safak, Tunç

    2008-01-01

    Reconstruction for facial contour deformities is still a challenging process and treatment for most cases is achieved only by soft tissue augmentation. The use of free tissue transfer offers the advantage of one step vascularized soft tissue augmentation. This article summarized the authors' use of de-epithelialized free superficial circumflex iliac artery/superficial inferior epigastric artery flap for facial contour deformities. Of these patients, two had hemifacial microsomia, one depressed scar, and one had hemifacial progressive atrophy. Stable restoration of the facial contour was achieved in all patients. The advantages of this flap are numerous. Two surgical teams may work at the same time for flap harvesting and recipient area preparation. A wide flap may be planned for large contour deformity to achieve one single stage augmentation. Pedicle course of this flap allows primary de-fating without disturbing distal flap circulation when in need of a thin flap for mild contour deformity. Donor site may be closed with bikini (abdominoplasty) incision, which has excellent esthetic outcome compared to other flaps.

  6. An Innovative Solution to Complex Inguinal Defect: Deepithelialized SIEA Flap With Mini Abdominoplasty

    Science.gov (United States)

    Daggett, Justin; Harrington, Michael; Dayicioglu, Deniz

    2017-01-01

    Introduction: We describe a novel technique of contralateral pedicled deepithelialized superficial inferior epigastric artery flaps, followed by abdominal advancement coverage, as an alternative treatment of radiated complicated inguinal or lower abdominal defects, avoiding the donor-site defect typically seen with other methods of coverage. Methods: Two male patients with histories of liposarcoma after excision and radiation to one side of lower abdomen/inguinal area presented with complicated wounds that were reconstructed with this technique. Results: Successful obliteration of dead space and wound closure were achieved with the combination of a superficial inferior epigastric artery flap with an abdominal advancement flap. In each case, patients went on to heal uneventfully without need for any secondary procedures. Discussion: The use of a superficial inferior epigastric artery flap for lower abdomen/groin defect closure is an option as an alternative to rectus abdominis myocutaneous flap and anterolateral thigh flaps and should be considered in patients with vascular anatomy conducive for this muscle-sparing procedure. Conclusions: A second layer-overlay coverage with an abdominal advancement flap creates a more durable repair in the complicated radiated wound and a well-concealed abdominoplasty scar.

  7. Reverse island flap with dorsal branch of the proper palmar digital artery for repair of distal finger skin defect in 60 cases%指掌侧固有动脉背侧支逆行岛状皮瓣修复手指远端皮肤缺损60例

    Institute of Scientific and Technical Information of China (English)

    郑晓东; 黄辉强; 陈锦涛; 张沛钠; 张先强; 吴喜钦

    2016-01-01

    目的 报道指掌侧固有动脉背侧支逆行岛状皮瓣修复手指远端皮肤缺损的临床疗效. 方法 自2011年1月至2015年1月,应用指掌侧固有动脉背侧支逆行岛状皮瓣修复手指远端皮肤缺损60例60指.其中示指30指,中指15指,环指10指,小指5指.切取皮瓣面积1.2cm×1.7cm~3.2cm×3.6cm,皮瓣内携带指同有神经背侧支与创面指神经断端进行显微修复,重建皮肤的感觉.供区取腕部或上臂内侧远端全厚植皮.采用英国医学研究会对感觉评定标准对感觉恢复进行评定. 结果 本组60例60指,皮瓣全部成活.12指皮瓣出现张力性水泡,经拆线后,皮瓣顺利成活.随访根据中华医学会手外科学会上肢部分功能评定试用标准TAM法评定:优50指,良10指,优良率100%;48指皮瓣感觉恢复至S4级,12指恢复至S3级;两点辨别觉5~8mm,平均6.5 mm;患者远、近指间关节平均活动度恢复优良.皮瓣肤色红润,质地柔软,无臃肿,无色素沉着,无畏寒表现,无瘢痕增生及挛缩,皮肤痛觉无过敏及再次手术. 结论 此皮瓣对于手指远端皮肤缺损修复是一种简单易行、不损伤主要动脉及神经、感觉恢复良好、术后并发症少、皮瓣成活优良的方法,值得基层医院推广.%Objective To explore the clinical effect of dorsal digital artery reverse island flap in the repair of distal finger skin defect.Methods From January,2011 to January,2015,60 fingers of 60 cases with dorsal branch of the digital artery were used to repair the defect of the distal finger skin.The 30 refers to the index finger,middle finger 15 fingers,10 ring fingers and 5 little fingers.Harvested area of 1.2 cm ×1.7 cm to 3.2 cm × 3.6 cm,the wrist or distal medial arm full thickness skin graft donor site.Evaluation of sensory recovery by the British Medical Research Association.Results All flaps survived.Twelve finger flap tension blisters,and the flaps survived after the stitches.Follow-up of 60 cases

  8. CLINICAL STUDY OF DUODENAL PERFORATION

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    Sambasiva Rao

    2016-04-01

    Full Text Available BACKGROUND The duodenal injury can pose a formidable challenge to the surgeon and failure to manage it properly may have devastating results. Over the centuries, there was little to offer the patient of acute abdomen beyond cupping, purgation and enemas, all of which did more harm than good. It was not until 1884 that Mikulicz made an attempt to repair a perforation. Recent statistics indicate roughly 10% of population develop gastric or duodenal ulcer in life time. Roughly 1-3% of population above the age of 20 years have some degree of peptic ulcer activity during any annual period. A detailed history with regards to the signs and symptoms of the patient, a meticulous examination, radiological and biochemical investigations help to arrive at a correct preoperative diagnosis. In this study, a sincere effort has been put to understand the demographic patterns, to understand the underlying aetiology and to understand the effectiveness of the standard methods of investigation and treatment in use today. METHODS This is a 24 months prospective study i.e., from September 2011 to September 2013 carried out at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation. The study included the patients presenting to Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation to emergency ward with signs and symptoms of hollow viscus perforation. The sample size included 30 cases of duodenal perforation. RESULTS Duodenal ulcer perforation commonly occurs in the age group of 30-60 years, but it can occur in any age group. Majority of the patients were male. Smoking and alcohol consumption were risk factors in most cases (53.3% for the causation of duodenal ulcer perforation. Sudden onset of abdominal pain, situated at epigastrium and right hypochondrium was a constant symptom (100%. Vomiting, constipation and fever were not so common. CONCLUSION The emergency surgical management for perforated duodenal ulcer is by

  9. The iliac periosteal flap with ascending branch of lateral femoral circumflex artery for the treatment of Legg-Calvé-Perthes disease%带旋股外侧动脉升支髂骨骨膜瓣植入治疗儿童股骨头缺血性坏死

    Institute of Scientific and Technical Information of China (English)

    傅维民; 赵德伟; 王本杰; 马志杰; 王建川

    2015-01-01

    目的 探讨应用带旋股外侧动脉升支髂骨骨膜瓣植入治疗儿童股骨头缺血性坏死的临床效果及意义. 方法 分析自2008年1月至2012年5月在我院应用带旋股外侧动脉升支髂骨骨膜瓣植入治疗的18例患者资料.随访时间24~60个月,平均38个月,随访时间截止2014年5月.随访时行X线片检查并进行临床体格检查,Harris评分系统评估手术效果. 结果 X线见16例患者术后骨膜瓣愈合良好,骨骺高度逐渐恢复,股骨头变圆.2例股骨头出现变扁、塌陷.Mose法结合X线所得结果优良率为88.9%.Harris评分从术前平均(72.3±4.9)分提高到术后平均(91.3±2.4)分,两者比较差异有统计学意义(P<0.05). 结论 应用带旋股外侧动脉升支髂骨骨膜瓣植入是儿童股骨头缺血性坏死的一种有效治疗方法.%Objective To investigate the clinical effect of the iliac periosteal flap with ascending branch of lateral femoral circumflex artery for the treatment of Legg-Calvé-Perthes disease.Methods Followed-up 18 patients with Legg-Calvé-Perthes disease who had undergone the treatment of iliac periosteal flap with ascending branch of lateral femoral circumflex artery from January,2008 to May,2012 in our hospital.Minimum follow-up time was from 24 to 60 months,and the average time was 38 months.The followed-up period ended in May,2014.Assessed the effect of surgery by X-ray,clinical examination and Harris scoring system.Results Sixteen patients had good healing with iliac periosteal flap according to X-ray show.Their epiphyseal height recovered and the femoral head rounded gradually.Two cases became flat and collapse.The result of excellent and good rate was 88.9% by Mose method combined with the results of X-ray.The average Harris hip score improved from 72.3 ± 4.9 points preoperatively to 91.3 ± 2.4 points postoperatively.The difference of the result was statistically significant (P < 0.05).Conclusion The transfer of iliac periosteal

  10. 带监测皮岛的胫前动脉穿支骨膜瓣治疗骨不连的临床应用%The treatment of bone nonunion with perforator periosteal flap with monitoring flap pedicled with the anterior tibial artery

    Institute of Scientific and Technical Information of China (English)

    吴伟炽; 黄东; 张惠茹; 江奕恒; 林浩

    2014-01-01

    目的 探讨带监测皮岛的胫前动脉穿支骨膜瓣治疗骨不连的临床效果.方法 应用带监测皮岛的胫前动脉穿支骨膜瓣治疗骨不连25例,总结手术方法和操作要点,观察临床效果.结果 术中切取的骨膜瓣大小适宜,监测皮岛血运良好,术后伤口大部分一期愈合,2例皮岛边缘少许坏死,换药后愈合.25例术后随访10~24个月,平均15.1个月,原骨不连处骨痂生长良好,髓腔再通,骨折线在3~6个月消失,骨折愈合后关节功能恢复均较满意.结论 带监测皮岛的胫前动脉穿支骨膜瓣治疗骨不连,手术成功率高,是治疗骨不连的一种有效可行的方法.

  11. Posterior repair with perforated porcine dermal graft

    Directory of Open Access Journals (Sweden)

    G. Bernard Taylor

    2008-02-01

    Full Text Available OBJECTIVE: To compare postoperative vaginal incision separation and healing in patients undergoing posterior repair with perforated porcine dermal grafts with those that received grafts without perforations. Secondarily, the tensile properties of the perforated and non-perforated grafts were measured and compared. MATERIALS AND METHODS: This was a non-randomized retrospective cohort analysis of women with stage II or greater rectoceles who underwent posterior repair with perforated and non-perforated porcine dermal grafts (PelvicolTM CR Bard Covington, GA USA. The incidence of postoperative vaginal incision separation (dehiscence was compared. A secondary analysis to assess graft tensile strength, suture pull out strength, and flexibility after perforation was performed using standard test method TM 0133 and ASTM bending and resistance protocols. RESULTS: Seventeen percent of patients (21/127 who received grafts without perforations developed vaginal incision dehiscence compared to 7% (5/71 of patients who received perforated grafts (p = 0.078. Four patients with vaginal incision dehiscence with non-perforated grafts required surgical revision to facilitate healing. Neither tensile strength or suture pull out strength were significantly different between perforated and non-perforated grafts (p = 0.81, p = 0.29, respectively. There was no difference in the flexibility of the two grafts (p = 0.20. CONCLUSION: Perforated porcine dermal grafts retain their tensile properties and are associated with fewer vaginal incision dehiscences.

  12. Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA)

    DEFF Research Database (Denmark)

    Børsen-Koch, Mikkel; Gunnarsson, Gudjon L; Udesen, Ann;

    2015-01-01

    BACKGROUND: The latissimus dorsi (LD) flap is considered one of the working horses within the field of breast reconstruction and it offers several advantages. However, donor-site morbidity may pose a problem. This article describes a new and modified technique for delayed breast reconstruction co...... there is a learning curve, this simple modified technique does not demand any perforator or other vessel dissection. Any trained plastic surgeon should be able to adopt the technique into the growing armamentarium of breast reconstruction possibilities....

  13. Infraareolar pectoralis major myocutaneous island flap as treatment of first choice for deep sternal wound infection.

    Science.gov (United States)

    Simunovic, Filip; Koulaxouzidis, Georgios; Stark, G Bjoern; Torio-Padron, Nestor

    2013-02-01

    Deep sternal wound infection (DSWI) is a grave complication of median sternotomy, associated with high morbidity, mortality and escalating treatment costs. There is general consensus that optimal treatment comprises radical debridement followed by coverage with a vascularised flap. However, there is ongoing debate regarding the ideal operative procedure. We present our experience with the infraareolar pectoralis major island myocutaneous flap (PEC-MI flap) as treatment of first choice in DSWI. Following a retrospective chart review, data pertaining to patient demographics, type of cardiac surgery performed, prevalence of known DSWI risk factors, identified pathogens, duration of surgery, flap-related complications, duration of hospital stay and antibiotic therapy, as well as mortality were noted. Additionally, we describe the operative technique and review the relevant literature. Twenty-five patients underwent coverage with the PEC-MI flap in our department. The average age was 69.2 years. Nineteen patients underwent coronary artery bypass surgery, 10 valve replacement, two aortic replacement surgery and one pericardiectomy. In six cases, no internal mammary artery was used in cardiac surgery, in 11 cases one and in seven cases both internal mammary arteries were used. The average duration of surgery was 154.2 min and the average hospital stay was 28.4 days. Complications which required revision surgery were haematoma in three cases, one wound dehiscence and one recurrent infection. Two cases required coverage with an additional regional flap. The PEC-MI flap has been used as flap of first choice in our clinic for treatment of DSWI. It is sufficient to raise the flap unilaterally, and it does not require skin grafting. The combination of immunocompetent bulky muscle tissue used to obliterate the sternal cavity and the large skin paddle enabling a low-tension skin closure allows reliable and efficient treatment of this severe complication.

  14. Perforating Disseminated Necrobiosis Lipoidica Diabeticorum

    Directory of Open Access Journals (Sweden)

    Paula Lozanova

    2013-01-01

    Full Text Available Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female patient with a 7-year history of diabetes on insulin therapy, referred to our clinic with a 3-year history of multiple asymptomatic firm plaques disseminated on the upper and lower extremities. The clinical and histological findings proved the diagnosis of perforating necrobiosis lipoidica.

  15. Triple gastric peptic ulcer perforation.

    Science.gov (United States)

    Radojkovic, Milan; Mihajlovic, Suncica; Stojanovic, Miroslav; Stanojevic, Goran; Damnjanovic, Zoran

    2016-03-01

    Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Nevertheless, little is known about gastroduodenal perforation in cancer patients. Described in the present report is the case of a 41-year old woman with stage IV recurrent laryngeal cancer, who used homeopathic anticancer therapy and who had triple peptic ulcer perforation (PUP) that required surgical repair. Triple gastric PUP is a rare complication. Self-administration of homeopathic anticancer medication should be strongly discouraged when evidence-based data regarding efficacy and toxicity is lacking.

  16. Intestinal perforation--a unique cause.

    Science.gov (United States)

    Kansal, G; Agrawal, V

    2000-04-01

    An illiterate, 65 years old, male attended surgery emergency with features of perforation peritonitis. Exploratory laparotomy revealed perforation in the terminal ileum and a sharp metallic object pointing at the perforation site. This, on removal, was found to be the sharp edge of a blister pack (with intact tablet within). The perforation was repaired. The abdomen was closed after leaving a drain. Postoperatively the patient had a morbid period and ultimately responded to management.

  17. Fibular flap for mandibular reconstruction: are there old tricks for an old dog?

    Science.gov (United States)

    Pitak-Arnnop, P; Hemprich, A; Dhanuthai, K; Pausch, N C

    2013-02-01

    Fibular free flap is considered as an "old dog" in reconstructive surgery because it was first described by Taylor and his colleagues in 1975, and was then introduced for mandibular reconstruction by Hidalgo in 1989. There are some "tricks" for fibular free flap that have been used and recognized in many European maxillofacial surgical units over the past decade. These include: 1) harvesting the distal fibula when recipient vessels are distant; 2) flap selection based on the anatomy of perforators; 3) use of the skin paddle for postoperative flap monitoring; 4) protection of the flap's soft-tissue cuff; 5) preventing venous thrombosis which is essential to reduce flap complications; 6) aligning fibular struts and protecting the vascular pedicle when the double-barrel technique is used; 7) minimizing the gap between the double-barrel struts and implementing a long-term follow-up of dental implants; 8) selecting osteosynthesis materials; and 9) learning curve and clinical competence in microvascular reconstruction. We also reviewed current data from the literature, which would be useful for maxillofacial reconstructive surgeons. With these tricks, one can teach an "old dog" "old tricks".

  18. Systemic Nicardipine as an Adjunct to Combat Vasospasm after Prior Flap Failure

    Directory of Open Access Journals (Sweden)

    Brett F. Michelotti, MD

    2013-10-01

    Full Text Available Summary: Unrecognized or untreated vasospasm in microsurgery can lead to flap hypoperfusion and failure. Numerous strategies have been explored for their efficacy in potentiating vasodilation. We present a case of unrecognized vasospasm leading to flap failure followed by a second free flap reconstruction in which severe vasospasm was treated with systemic nicardipine used as an adjunct to other more commonly employed antispasmodics. Although the literature investigating the use of systemic calcium channel blockade in microsurgery is limited, it should be considered an alternative when addressing arterial vasospasm.

  19. Anatomic study and clinical application of neuromyocutaneous flap based on nutritional vessel of median nerve palmar cutaneous branch%正中神经掌皮支营养血管远端蒂肌皮复合瓣解剖学研究及临床应用

    Institute of Scientific and Technical Information of China (English)

    陶圣祥; 喻爱喜; 郑晓晖; 余国荣

    2008-01-01

    目的 探讨正中神经掌皮支营养血管肌皮瓣转移术修复拇指组织缺损的解剖学依据及临床效果.方法 对30侧成人尸体手标本进行解剖,系统观测正中神经掌皮支营养血管链的组成、分支、分布及其同大鱼际肌相互交通吻合的情况.2007年2月以来,临床应用正中神经掌皮支营养血管远端蒂肌皮瓣转移术修复拇指组织缺损17例.结果 桡动脉掌浅支恒定地向拇短展肌和拇短屈肌发出3~5支肌皮穿支,节段性参与正中神经掌皮支营养血管链,肌皮穿支平均外径为[(0.3±0.1)mm,x±s,下同],均有1条静脉伴行.17例术后肌皮瓣全部存活,拇指外观及功能满意,11例患者在术后1周皮瓣两点分辨觉为(6.1~8.2)mm.结论 正中神经掌皮支营养血管链同拇短展肌和拇短屈肌肌皮穿支恒定吻合,该肌皮瓣是修复拇指组织缺损的良好供区.%Objective To investigate the anatomical features of neuromyocutaneous flap based on nutritional vessel of median nerve palmar cutaneous branch and evaluate the clinical application of this flap for repairing soft tissue defect of the thumb. Methods Thirty adult cadaver hand specimens were dissected after red Latex perfusion. The configuration, branches, and distributions of the nutritional vessel of median nerve palmar cutaneous branch and its anastomoses with thenar musole vessels were observed. Since February 2007, neuromyocutaneous flap distally based on the nutritional vessel of median nerve palmar cutaneous branch was transferred to repair soft tissue defect of 17 thumbs. Results Superficial palmar branch of the radial artery gives out 3-5 myocutaneous perforators to abductor pollicis brevis and flexor pollicis brevis. Those perforators form the nutrient vessel chain of palmar cutaneous branch of the median nerve. The external diameter of the perforators was (0.3±0.1 )mm on average. It is accompanied by one. vein. All of the 17 cases of neuromyocutaneous flap

  20. Hyperbilirubinemia as a predictor for appendiceal perforation

    DEFF Research Database (Denmark)

    Burcharth, J; Pommergaard, Hans-Christian; Rosenberg, J;

    2013-01-01

    Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum...... bilirubin as a predictor for appendiceal perforation....

  1. Early Management Experience of Perforation after ERCP

    Directory of Open Access Journals (Sweden)

    Guohua Li

    2012-01-01

    Full Text Available Background and Aim. Perforation after endoscopic retrograde cholangiopancreatography (ERCP is a rare complication, but it is associated with significant mortality. This study evaluated the early management experience of these perforations. Patients and Methods. Between November 2003 and December 2011, a total of 8504 ERCPs were performed at our regional endoscopy center. Sixteen perforations (0.45% were identified and retrospectively reviewed. Results. Nine of these 16 patients with perforations were periampullary, 3 duodenal, 1 gastric fundus, and 3 patients had a perforation of an afferent limb of a Billroth II anastomosis. All patients with perforations were recognized during ERCP by X-ray and managed immediately. One patient with duodenal perforation and three patients with afferent limb perforation received surgery, others received medical conservative treatment which included suturing lesion, endoscopic nasobiliary drainage (ENBD, endoscopic retrograde pancreatic duct drainage (ERPD, gastrointestinal decompression, fasting, broad-spectrum antibiotics, and so on. All patients with perforation recovered successfully. Conclusions. We found that: (1 the diagnosis of perforation during ERCP may be easy, but you must pay attention to it. (2 Most retroperitoneal perforations can recover with only medical conservative treatment in early phase. (3 Most peritoneal perforations need surgery unless you can close the lesion up under endoscopy in early phase.

  2. Dissecting Sub-epicardial Hematoma Due to Coronary Perforation and Non-developing Stent

    Institute of Scientific and Technical Information of China (English)

    Guo Hangyuan; Xing Yangbo; Lee JongDae

    2007-01-01

    We report a 65-year-old man who presented with anastomotic perforation of the distal right coronary artery due to stent deployment, complicated by a small and stable dissecting sub-epicardial hematoma,and non-developing stent. The cause was unknown.

  3. Distally Based Iliotibial Band Flap: Anatomic Study with Surgical Considerations.

    Science.gov (United States)

    Wong, Victor W; Higgins, James P

    2016-09-01

    Background Reconstruction of high-risk fascia, tendon, or ligament defects may benefit from vascularized tissue. The iliotibial band (ITB), a thick fibrous tract of connective tissue, serves as a potential donor site for free tissue transfer but its blood supply has not been thoroughly investigated. The aim of this anatomical study was to investigate the vascular supply to the distal ITB and its role as a free fascial flap. Methods We dissected 16 fresh-frozen cadaveric legs and injected latex into the superolateral geniculate artery (SLGA). A distal ITB fascial flap was designed and measurements were taken for flap dimensions, pedicle length and size, and SLGA perfusion territory. Results The SLGA perfused 11.5 ± 2.3 cm of distal ITB (proximal to the lateral femoral epicondyle) and provided 6.4 ± 0.7cm of pedicle length to the ITB flap. Conclusions Chimeric options to include bone (from the lateral femoral condyle), cartilage (from the lateral femoral trochlea), muscle (from vastus lateralis or biceps femoris), and skin are possible. Surgical harvest techniques are proposed, including preservation of ITB insertions to minimize lateral knee instability. Clinical validation is needed to determine the role of the distal ITB free fascial flap in reconstructive microsurgery.

  4. 扩张的颈肩峰区锁骨上皮瓣修复面颈部软组织缺损%Pre-expanded cervico-acromial flap based on the supraclavicular artery for resurfacing soft tissue defects of head and neck

    Institute of Scientific and Technical Information of China (English)

    杨喆; 刘伟; 李养群; 王乃利; 唐勇; 赵穆欣; 马宁; 王维新

    2015-01-01

    Objective To investigate the therapeutic effect of pre-expanded cervico-acromial flap based on the supraclavicular artery for resurfacing soft tissue defects of head and neck. Methods In this series,from Jan 2008 to Jan 2014,24 patients with ages between 5 and 42 years suffering from facial and cervical scar or nevis or port-wine stain were treated.In the first stage,the tissue expander (600ml to 800ml in volume) was implanted on the deep fascia layer of the cervicoacromial region;600 to 800ml saline were injected during a 10 to 16 weeks period.In the second stage after expansion, sufficient skin and tissue was obtained to resurface the defects of head and neck. Results All 24 flaps healed primarily with good functional and cosmetic results.The maximum size of the flap was 23cm × 16cm,whereas the minimum size was 20cm × 8cm.After an average follow-up time of 12 months, significant improvement in function with good esthetic outcomes were achieved,and the donor sites scar seemed acceptable.There were no significant complications. Conclusion The pre-expandedcervico-acromialfasciocutaneous flap based on the supraclavicularartery can provide a large amount of thin tissue with both good color and texture,and without the need for microsurgery, and avoid the disadvantages of donor-site morbidity.This flap is reliable and safe for resurfacing large skindefects of the head and neck.%目的:探讨扩张的颈肩峰区锁骨上皮瓣修复面颈部较大面积软组织缺损的临床治疗效果。方法:2008年1月至2014年1月对24例面颈部软组织缺损患者,年龄5~42岁,采用以锁骨上动脉为蒂的预扩张的颈肩峰区筋膜皮瓣修复。一期在颈肩峰区域深筋膜浅层埋置1~2枚扩张器(600~800ml),定期注水,二期切除面颈部瘢痕或色素病变,以扩张皮瓣带蒂转移修复组织缺损,供区多可直接缝合。结果:本组24例患者扩张皮瓣切取面积为20cm×8cm~23cm×16cm,皮瓣均成活

  5. Perforation due to ileocaecal salmonellosis

    NARCIS (Netherlands)

    Willemsen, PJ

    2002-01-01

    A 54-year old male patient was admitted with a tentative diagnosis of biliary pancreatitis. After 3 days, he developed an acute abdomen with a pneumoperitoneum. A laparotomy was performed : multiple perforations of the terminal ileum and a necrotic gallbladder were found. A right hemicolectomy with

  6. Perforated Peptic Ulcer: new insights

    NARCIS (Netherlands)

    M.J.O.E. Bertleff (Marietta)

    2011-01-01

    textabstractMuch has been written on perforated peptic ulcer (PPU) during the last hundred years. In 1500, when necropsies were first allowed, often a small hole was found in the anterior wall of the stomach, giving an explanation for symptoms of acute abdominal pain, nausea, vomiting which often le

  7. The Gradual Expansion Muscle Flap

    Science.gov (United States)

    2014-01-01

    defects can usu- ally be obtained with a rotational flap , larger size defects commonly require free tissue transfer. A number of techni- ques have...feasible.21,22 Because limb salvage situations occur in which rota- tional muscle coverage is inadequate and free flap coverage is less desirable, we...larger defects which previously would have required free tissue transfer. Surgical Technique The GEM flap for large soft tissue defects of the leg requires

  8. Postpartum spontaneous colonic perforation due to antiphospholipid syndrome

    Institute of Scientific and Technical Information of China (English)

    Kamran Ahmed; Amir Darakhshan; Eleanor Au; Munther A Khamashta; Iraklis E Katsoulis

    2009-01-01

    The antiphospholipid syndrome (APS) is a multi-systemic disease being characterized by the presence of antiphospholipid antibodies that involves both arterial and venous systems resulting in arterial or venous thrombosis, fetal loss, thrombocytopenia, leg ulcers, livedo reticularis, chorea,and migraine. We document a previously unreported case of a 37-year-old female in whom APS was first manifested by infarction and cecal perforation following cesarean section. At laparotomy the underlying cause of colonic perforation was not clear and after resection of the affected bowel an ileo-colostomy was performed. The diagnosis of APS was established during post-operative hospital stay and the patient was commenced on warfarin.Eventually, she made a full recovery and had her stoma reversed after 4 mo. Pregnancy poses an increased risk of complications in women with APS and requires a more aggressive approach to the obstetric care. This should include full anticoagulation in the puerperium and frequent doppler ultrasound monitoring of uterine and umbilical arteries to detect complications such as preeclampsia and placental insufficiency.

  9. Sliding flap tracheoplasty.

    Science.gov (United States)

    Gates, G A; Tucker, J A

    1989-12-01

    The optimal method for surgical management of subglottic stenosis is based upon careful assessment of the location, caliber, length, and maturity of the stenotic segment, as well as associated conditions. For patients with a mature stenosis of short length, excision of the anterior arch of the cricoid and first ring and immediate reconstruction by means of a sliding flap of the next two to three rings of trachea offer a one-stage definitive treatment without the need for grafting. We report four cases of subglottic stenosis and one case of cricoid chondroblastoma in which reconstruction of the airway was successful and prompt. For carefully selected cases, sliding flap tracheoplasty may be a useful alternative to procedures in which the airway is expanded by means of grafting.

  10. Facial contour deformity correction with microvascular flaps based on the 3-dimentional template and facial moulage

    Directory of Open Access Journals (Sweden)

    Dinesh Kadam

    2013-01-01

    Full Text Available Introduction: Facial contour deformities presents with varied aetiology and degrees severity. Accurate assessment, selecting a suitable tissue and sculpturing it to fill the defect is challenging and largely subjective. Objective assessment with imaging and software is not always feasible and preparing a template is complicated. A three-dimensional (3D wax template pre-fabricated over the facial moulage aids surgeons to fulfil these tasks. Severe deformities demand a stable vascular tissue for an acceptable outcome. Materials and Methods: We present review of eight consecutive patients who underwent augmentation of facial contour defects with free flaps between June 2005 and January 2011. De-epithelialised free anterolateral thigh (ALT flap in three, radial artery forearm flap and fibula osteocutaneous flap in two each and groin flap was used in one patient. A 3D wax template was fabricated by augmenting the deformity on facial moulage. It was utilised to select the flap, to determine the exact dimensions and to sculpture intraoperatively. Ancillary procedures such as genioplasty, rhinoplasty and coloboma correction were performed. Results: The average age at the presentation was 25 years and average disease free interval was 5.5 years and all flaps survived. Mean follow-up period was 21.75 months. The correction was aesthetically acceptable and was maintained without any recurrence or atrophy. Conclusion: The 3D wax template on facial moulage is simple, inexpensive and precise objective tool. It provides accurate guide for the planning and execution of the flap reconstruction. The selection of the flap is based on the type and extent of the defect. Superiority of vascularised free tissue is well-known and the ALT flap offers a versatile option for correcting varying degrees of the deformities. Ancillary procedures improve the overall aesthetic outcomes and minor flap touch-up procedures are generally required.

  11. Effects of hyperbaric oxygen preconditioning on ischemia-reperfusion inflammation and skin flap survival

    Institute of Scientific and Technical Information of China (English)

    QI Zheng; GAO Chun-jin; WANG You-bin; MA Xue-mei; ZHAO Ling; LIU Fu-jia; LIU Xue-hua

    2013-01-01

    Background Hyperbaric oxygen preconditioning (HBO) is a new method of ischemia preconditioning.In this study,we examined its effects on skin flap survival and the mechanisms involved.Methods Thirty-six rats were divided into three groups:HBO preconditioning,control,and sham groups.An extended epigastric adipocutaneous flap based on the right superficial epigastric artery and vein was raised.A 3-hour period of flap ischemia was induced by clamping the pedicle vessels with a microvascular clamp.At the end of ischemia induction,the clamp was removed and the flap was resutured.Rats in the HBO preconditioning group were treated with HBO four times before surgery.Microcirculation in the skin flap was measured on postoperative days 1,3 and 5.The size of the flap was measured on postoperative day 5,before the animals were sacrificed.Samples of the skin flap were prepared and stained with hematoxylin and eosin.The levels of tumor necrosis factor (TNF)-o,interleukin (IL)-1β,and IL-6 in the flap samples were measured.Results Surviving flap size was significantly higher in the HBO preconditioning group compared with controls,with a reduced inflammatory response and increased perfusion.IL-1,TNF-α,and IL-6 levels in the HBO preconditioning group were lower than in controls.Conclusions HBO preconditioning improved flap survival in this ischemia-reperfusion rat model.The mechanisms responsible for this effect may relate to attenuation of the inflammatory response and increased flap perfusion following HBO preconditioning.

  12. The efficacy of the Cook-Swartz implantable Doppler in the detection of free-flap compromise: a systematic review protocol

    OpenAIRE

    Agha, Riaz A.; Gundogan, Buket; Fowler, Alexander J.; Bragg, Thomas W H; Orgill, Dennis P.

    2014-01-01

    Introduction The Cook-Swartz implantable Doppler monitors venous or arterial blood flow from free flaps and can detect free-flap compromise. Previous studies have shown that the use of this Doppler can improve detection and salvage rates as it provides an earlier warning than the current method of clinical assessment. Such studies assert that the implantable Doppler is of great value in monitoring free flaps in current microsurgical units. This systematic review aims to compare the efficacy o...

  13. Cross finger flaps.

    Science.gov (United States)

    Kisner, W H

    1979-01-01

    Proper fingertip reconstruction requires good skin and soft tissue coverage, preservation of function and as normal an appearance as possible. The cross finger flap results in negligible joint stiffness, minimal morbidity and little work-time loss. An important factor is the conservation of finger length permitted by this technique. This method of repair is underutilized. It is indicated in several types of fingertip amputations where bone shortening would be detrimental.

  14. The Simplified Posterior Interosseous Flap.

    Science.gov (United States)

    Cavadas, Pedro C; Thione, Alessandro; Rubí, Carlos

    2016-09-01

    Several technical modifications have been described to avoid complications and simplify dissection. The authors describe some technical tips that make posterior interosseous flap dissection safer and more straightforward.

  15. Unusual duodenal perforation following endoscopic retrograde cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Martin Kobborg

    2011-02-01

    Full Text Available Perforation is a known but rare complication to Endoscopic retrograde cholangiopancreatography (ERCP with endoscopic sphincterotomy (ES. Most of the perforations are located in the periampullary area due to ES. This report presents an unusual perforation in the third part of the duodenum following ES. The patient an eigthy-sixt-year-old man underwent ERCP with ES. The patient had Magnetic Resonance Cholangio-pancreatography (MRCP and Computerized Tomography (CT verified cholelithiasis and intra- and extrahepatic cholestasis. The perforation was not found under the ERCP procedure but was clinically revealed when the patient developed pneumoscrotum after the procedure. A CT-scan with oral contrast later confirmed the duodenal perforation.

  16. Keystone flaps in coloured skin: Flap technology for the masses?

    Directory of Open Access Journals (Sweden)

    Satish P Bhat

    2013-01-01

    Full Text Available Introduction: Viscoelastic properties of skin in coloured ethnic groups are less favourable compared to Caucasians for executing Keystone flaps. Keystone flaps have so far been evaluated and reported only in Caucasians. The potential of Keystone flaps in a coloured ethnic group is yet unknown. Aim: This article reviews the experience to reconstruct skin defects presenting in a coloured ethnic group, by using Keystone flaps, with a review of existing literature. Design: Uncontrolled case series. Materials and Methods: This retrospective review involves 55 consecutive Keystone flaps used from 2009 to 2012, for skin defects in various locations. Patient demographic data, medical history, co-morbidity, surgical indication, defect features, complications, and clinical outcomes are evaluated and presented. Results: In this population group with Fitzpatrick type 4 and 5 skin, the average patient age was 35.73. Though 60% of flaps (33/55 in the series involved specific risk factors, only two flaps failed. Though seven flaps had complications, sound healing was achieved by suitable intervention giving a success rate of 96.36%. Skin grafts were needed in only four cases. Conclusions: Keystone flaps achieve primary wound healing for a wide spectrum of defects with an acceptable success rate in a coloured skin population with unfavorable biophysical properties. By avoiding conventional local flaps and at times even microsurgical flaps, good aesthetic outcome is achieved without additional skin grafts or extensive operative time. All advantages seen in previous studies were verified. These benefits can be most appreciated in coloured populations, with limited resources and higher proportion of younger patients and unfavorable defects.

  17. The Effect of Statins and Other Cardiovascular Medication on Ischemia-Reperfusion Damage in a Human DIEP Flap Model: Theoretical and Epidemiological Considerations

    NARCIS (Netherlands)

    van den Heuvel, M.G.; Bast, A.; Ambergen, A.W.; van der Hulst, R.R.

    2012-01-01

    Background. Statins and other cardiovascular medication possess antioxidant capacity. It was examined whether chronic use of these medications protects from the development of ischemia-reperfusion (I/R) related complications after DIEP (Deep Inferior Epigastric Perforator Free Flap) surgery. This pa

  18. Bilobed skin paddle fibula flap for large oromandibular defects.

    Science.gov (United States)

    Longo, Benedetto; Belli, Evaristo; Pugliese, Pierfrancesco; Ferri, Germano; Santanelli, Fabio

    2013-07-01

    Although the fibula free flap (FFF) is a useful choice for mandible reconstruction, its application for large oromandibular defects is still debated upon. We report the use of FFF with a bilobed perforator-based skin paddle for combined hemiglossectomy, floor-of-the-mouth, tonsillar pillar, and mandibular body defect. A case of an 84-year-old woman with a 2.5 × 3.5-cm exophytic ulcerated mass on the right side of the tongue, extended to omolateral gengival fornix, tonsillar pillar, and mandibular body, is reported. An osteocutaneus FFF with a 7-cm bone strut and a 17 × 10-cm bilobed shaped skin paddle was performed. The longer lobe was used to restore tongue shape, whereas the smaller lobe was used to line the pelvic floor, gingival, and tonsillar pillar. The postoperative period was uneventful. The patient was capable to protrude her neotongue beyond the virtual incisors line and to touch the hard palate at different degrees of mouth opening. The bilobed perforator-based skin paddle FFF is felt to be a sound option for large compound oromandibular defects offering the possibility to safely base the skin component on a single peroneal perforator while achieving effective tongue mobility preservation.

  19. Observation on the therapeutic effects of breast reconstruction using deep inferior epigastric perforator flap after resection of breast cancer%乳腺癌切除术后腹壁下动脉穿支皮瓣乳房重建疗效观察

    Institute of Scientific and Technical Information of China (English)

    丁科; 毛岸荣; 胡婷玉; 黄河

    2015-01-01

    目的:采用保留乳头乳晕的乳腺病灶切除术后,即刻腹壁下动脉穿支( DIEP)皮瓣乳房重建,探讨乳腺癌术后DIEP即刻乳房重建的近期疗效。方法对我院2011年1月至2015年1月期间接受DIEP乳房再造的14例乳腺癌患者进行回顾性分析,探讨该术式的特点及临床适应证,并对其美容效果及术后并发症进行评估。术后随访1~24个月。结果14例患者乳房重建均获成功,所有皮瓣全部成活,2例出现皮瓣远端坏死,胸部受区出现1例血肿。术后随访1~24个月,重建乳房外形满意,供区无腹壁疝、腹壁膨出、腹壁薄弱等并发症发生。结论使用DIEP重建乳房是安全可靠的,切口隐蔽,同时具有受区组织条件好、皮瓣组织量丰富、供区损伤小及并发症少的优点,能同时满足肿瘤治疗及形体美观的要求。%Objective To evaluate the early outcomes of breast reconstruction with immediate deep inferior epigastric perfora -tor ( DIEP) flaps after resection of breast cancer with DIEP reconstruction after modified radical mastectomy with papilla and mammary areola reserving .Methods A retrospective analysis of 14 breast cancer patients who were hospitalized and received breast reconstruc -tion from January 2011 to January 2015 was made, so as to investigate the features of the surgery and its clinical indications .Then, e-valuations were performed on the cosmetic effects and postsurgical complications .A 1-24-month medical follow-up was made after sur-gery.Results Breast reconstruction surgery was successful in all the 16 patients, all the flaps completely survived postoperatively , with 2 cases of distal skin flap necrosis and 1 case of hematoma in the surgical site .No complications such as abdominal hernia or bulge in donor sites were found and the reconstructed breast was well-shaped.Conclusion The immediate DIEP reconstruction is safe and relia-ble, at the same time, it has the

  20. Papilla Preservation Flap as Aesthetic Consideration in Periodontal Flap Surgery

    Directory of Open Access Journals (Sweden)

    Sandra Olivia

    2013-07-01

    Full Text Available Flap surgery is treatment for periodontal disease with alveolar bone destruction. Surgical periodontal flap with conventional incision will result in gingival recession and loss of interdental papillae after treatment. Dilemma arises in areas required high aesthetic value or regions with a fixed denture. It is challenging to perform periodontal flap with good aesthetic results and minimal gingival recession. This case report aimed to inform and to explain the work procedures, clinical and radiographic outcomes of surgical papilla preservation flap in the area that requires aesthetic. Case 1 was a surgical incision flap with preservation of papillae on the anterior region of teeth 11 and 12, with a full veneer crown on tooth 12. Case 2 was a surgical incision flap with preservation of papillae on the posterior region of tooth 46 with inlay restoration. Evaluation for both cases were obtained by incision papilla preservation of primary closure was perfect, good aesthetic results, minimal gingival recession and the interdental papillae can be maintained properly. In conclusion, periodontal flap surgery on the anterior region or regions that require high aesthetic value could be addressed with papilla preservation incision. Incision papilla preservation should be the primary consideration in periodontal flap surgery if possible.DOI: 10.14693/jdi.v19i3.144

  1. A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

    Science.gov (United States)

    Casal, Diogo; Pais, Diogo; Iria, Inês; Mota-Silva, Eduarda; Almeida, Maria-Angélica; Alves, Sara; Pen, Cláudia; Farinho, Ana; Mascarenhas-Lemos, Luís; Ferreira-Silva, José; Ferraz-Oliveira, Mário; Vassilenko, Valentina; Videira, Paula A.; Gory O'Neill, João

    2017-01-01

    Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat. This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue. Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training. PMID:28117814

  2. [Cocaine-related gastric perforation].

    Science.gov (United States)

    Ring, A; Stein, E; Stern, J

    2010-06-01

    Since the 1980s the abuse of cocaine has been -associated with gastroduodenal perforations in the United States. Here, we report the case of a 28-year-old man who came to our hospital with severe abdominal pain after smoking cocaine. Physical examination revealed generalised abdominal guarding. His X-ray did not show any free intraperitoneal air. However, there was a slightly elevated white blood cell count. Upon laparoscopic exploration of the abdomen, the -patient was found to have a generalised peritonitis secondary to a perforation of the prepyloric anterior wall. The operative procedure consisted of ulcer excision and primary closure with a pyloroplasty as well as an extensive abdominal irrigation after laparotomy.

  3. CT in acute perforated sigmoid diverticulitis

    Energy Technology Data Exchange (ETDEWEB)

    Lohrmann, Christian [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany)]. E-mail: lohrmann@mrs1.ukl.uni-freiburg.de; Ghanem, Nadir [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Pache, Gregor [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Makowiec, Frank [Department of Surgery, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Kotter, Elmar [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany); Langer, Mathias [Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, 79106 Freiburg (Germany)

    2005-10-01

    Background: To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease. Methods: Thirty patients with acute perforated sigmoid diverticulitis underwent computed tomography prior to surgery. Computed tomography scans were compared with the surgical and histopathological reports, utilizing the Hinchey classification. Results: In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography. Conclusions: Computed tomography is a valuable imaging tool for determining the degree of acute perforated sigmoid diverticulitis, by means of which patients can be stratified according to the severity of the disease; furthermore, this tool is of assistance in surgical planning.

  4. Colonic perforation in Behcet's syndrome

    Institute of Scientific and Technical Information of China (English)

    Catherine M Dowling; Arnold DK Hill; Carmel Malone; John J Sheehan; Shona Tormey; Kieran Sheahan; Enda McDermott; Niall J O'Higgins

    2008-01-01

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet's syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.

  5. Colonic perforation in Behcet's syndrome.

    Science.gov (United States)

    Dowling, Catherine-M; Hill, Arnold-Dk; Malone, Carmel; Sheehan, John-J; Tormey, Shona; Sheahan, Kieran; McDermott, Enda; O'Higgins, Niall-J

    2008-11-14

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet's syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.

  6. Perforating Disseminated Necrobiosis Lipoidica Diabeticorum

    OpenAIRE

    Paula Lozanova; Lyubomir Dourmishev; Snejina Vassileva; Ljubka Miteva; Maria Balabanova

    2013-01-01

    Perforating necrobiosis lipoidica is a very rare clinical variant which consists of degeneration and transepidermal elimination of the collagen with few cases reported in the literature. In two-thirds of the patients it associates with diabetes, with no relation with the glucose control. We present a 42-year-old female