Modified classification and single-stage microsurgical repair of posttraumatic infected massive bone defects in lower extremities.

Posttraumatic infected massive bone defects in lower extremities are difficult to repair because they frequently exhibit massive bone and/or soft tissue defects, serious bone infection, and excessive scar proliferation. This study aimed to determine whether these defects could be classified and repaired at a single stage. A total of 51 cases of posttraumatic infected massive bone defect in lower extremity were included in this study. They were classified into four types on the basis of the conditions of the bone defects, soft tissue defects, and injured limb length, including Type A (without soft tissue defects), Type B (with soft tissue defects of 10 × 20 cm or less), Type C (with soft tissue defects of 10 × 20 cm or more), and Type D (with the limb shortening of 3 cm or more). Four types of single-stage microsurgical repair protocols were planned accordingly and implemented respectively. These protocols included the following: Protocol A, where vascularized fibular graft was implemented for Type A; Protocol B, where vascularized fibular osteoseptocutaneous graft was implemented for Type B; Protocol C, where vascularized fibular graft and anterior lateral thigh flap were used for Type C; and Protocol D, where limb lengthening and Protocols A, B, or C were used for Type D. There were 12, 33, 4, and 2 cases of Types A, B, C, and D, respectively, according to this classification. During the surgery, three cases of planned Protocol B had to be shifted into Protocol C; however, all microsurgical repairs were completed. With reference to Johner-Wruhs evaluation method, the total percentage of excellent and good results was 82.35% after 6 to 41 months of follow-up. It was concluded that posttraumatic massive bone defects could be accurately classified into four types on the basis of the conditions of bone defects, soft tissue coverage, and injured limb length, and successfully repaired with the single-stage repair protocols after thorough debridement.

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

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.

Anatomical study to the vessels of the lower limb by using CT scan and 3D reconstructions of the injected material.

PURPOSE: To find out the advantages and insufficiency of the 3D reconstruction and traditional anatomy by comparing them with each other. METHODS: 1. Infused with the radio-opaque material from the arteries and veins, respectively, fresh lower extremity specimens were subjected to spiral CT scanning and then 3D reconstruction was conducted to obtain 3D vessels. 2. Anatomizing the specimens to show the vessel system. 3. Comparing the images of 3D reconstruction and photos of the dissected specimens. RESULTS: 3D software could dissect and reconstruct the bones, vessels, skin and muscles, and the reconstructed photos could be shown, respectively or combinedly. On the other hand, the course, distribution, and anastomoses of the vessels could be viewed from different aspects and different layers, but the results were not completely correct, so they were not suitable for data acquisition. While the vessel systems could be observed clearly on the dissected specimens, so could the origin, course, distribution and the anastomoses of any vessel. The data acquisition could be conducted. CONCLUSIONS: The method of angiography with 3D reconstruction is very good and has considerable advantages for observing the 3D state of human blood vessels, and their distribution at different angles and different levels, but it cannot totally represent or replace the traditional dissected specimens.

Measurement and analysis of the perforator arteries in upper extremity for the flap design.

The aim of this study was to provide the anatomical basis for the skin flap pedicled with the nutrient vessels of the cutaneous nerves and cutaneous veins of the upper extremity. Radio-opaque material was injected into the common carotid arteries of five fresh cadavers. The skin and the fascia were meticulously dissected, removed, and radiographed. The Photoshop CS and Scion image 4.02 were used to analyze the cutaneous arteries, the density of vessels, and the vascular territories of the perforator arteries. The results showed that the cutaneous arteries of the upper extremity came from 16 original arteries, and accordingly, the superficial tissue of the upper extremity could be divided into 16 vascular territories. The external diameter and the area of blood supply of each perforator were growing downwards from the proximum to the distal end. But the points at which the perforator arteries came out from the deep tissue were concentrated near the cutaneous nerves and cutaneous veins, and the arteries formed vascular chains. The density of the arteries near the cutaneous nerves and cutaneous veins was much higher than that of other areas. This article discussed the regularity of the nutrient vessels of the cutaneous nerves and veins on the basis of the experimental results.

Demonstration of three injection methods for the analysis of extrinsic and intrinsic blood supply of the peripheral nerve.

BACKGROUND: The use of free vascularized nerve grafts requires an intimate and accurate knowledge of the blood supply of peripheral nerve. This study was designed to compare the advantages and disadvantages of three methods employed to reveal the blood supply of the peripheral nerve, and to provide morphological basis for vascularized nerve grafts. METHODS: The blood supply of brachial plexus and its main branches (ulnar, median, radial, musculocutaneous and axillary nerve) were observed using three vascular injection techniques: three specimens were injected with red latex through the thoracic aorta; two side specimens were injected with a Chinese ink solution, through the subclavian artery, for diaphanization and histology; one fresh cadaver was injected with the gelatin-lead oxide mixture through the femoral artery for radiography. RESULTS: The blood supply of the brachial plexus and its main branches was well examined using the three different vascular injection techniques. Perfusion with red latex exposed the extrinsic blood supply. Diaphanization and histology showed the intrinsic blood supply, while gelatin-lead oxide injection technique interactively displayed both the intrinsic and extrinsic blood supply to the peripheral nerve. CONCLUSION: The standard method for the study of the extrinsic blood supply to the peripheral nerve is the red latex perfusion; diaphanization and histology are very suitable to study the intrinsic blood supply of the peripheral nerve; while gelatin-lead oxide technique is the standard for visualization of the integral topography of the blood supply of the peripheral nerve.

[Anatomic evaluation the entry point of C2 pedicle screw].

OBJECTIVE: To study the relevant position of C(2) pedicle to C(2) inferior articular process, set up a technique of C(2) pedicle screw placement with the inferior articular process of axis as an anatomic landmark. METHODS: Fifty C(2) bone specimens were used to measure the distance from the sagittal midline to the medial border, the midpoint and the lateral border of C(2) inferior articular process or C(2) pedicle; the width and the height of the C(2) pedicle were also evaluated. The anatomic relation between the measurements data of C(2) pedicle and that of C(2) inferior articular process were analyzed, and the technique of C(2) pedicle screw fixation was established. RESULTS: The medial border of C(2) inferior articular process was averaged (3.67 +/- 0.41) mm lateral to that of C(2) pedicle, and the midpoint C(2) inferior articular process was averaged (1.15 +/- 0.44) mm lateral to the lateral border of C(2) pedicle, respectively. Using the C(2) inferior articular process as landmark, two techniques was established for C(2) pedicle screw placement. The entry point of method A was located in 2 mm medial and superior to the central point of C(2) inferior articular process; the entry point of method B was at the crossing point of the medial border C(2) inferior articular process with the superior quarter of C(2) inferior articular process. CONCLUSIONS: There is a steady anatomic relation between C(2) pedicle and C(2) inferior articular process, the C(2) inferior articular process could be as a convenient key anatomic landmark to determine the location of C(2) pedicle and the position of C(2) pedicle screw entry point.

[Anatomic identification of the location of the pedicle of atlas with the lateral mass of C2 to C4 as the landmark].

OBJECTIVE: To study the relevant position of the pedicle of C1 to the lateral mass of C(2-4), set up an identification technique for the entry point decision of C1 pedicle screw by using the lateral mass of C(2-4) as anatomic landmarks. METHODS: Twenty cadaver specimens were used to measure the distance from the sagittal midline of spine to the medial border, the midpoint and the lateral border of C1 pedicle or the lateral mass of C2, C3 or C4. The anatomic relation between the measurements data of C1 pedicle and that of the lateral masses of the cervical vertebrae were analyzed, and the technique of C1 pedicle screw fixation was established. RESULTS: The average medial border of the lateral mass of C2, C3 and C4 was 0.37 mm, 0.27 mm and 0.24 mm lateral to that of C1 pedicle, the average midpoint of the lateral mass of C2, C3 and C4 was 1.18 mm, 1.41 mm and 1.74 mm lateral to that of C1 pedicle, and the average lateral border of the lateral mass of C2, C3 and C4 was 1.96 mm, 2.54 mm and 3.24 mm lateral to that of C1 pedicle, respectively. CONCLUSION: There is a steady anatomic location relation between C1 pedicle and the lateral mass of C2, C3 or C4. As well as the lateral mass of C2, the lateral mass of C3 or that of C4 could be convenient anatomic landmarks to determine the location of C1 pedicle and the position of C1 pedicle screw entry point.

The first metatarsal web space: its applied anatomy and usage in tracing the first dorsal metatarsal artery in thumb reconstruction.

OBJECTIVE: To clarify the anatomical relationship of the structures in the first toe webbing space for better dissection of toes in thumb reconstruction. METHODS: The first dorsal metatarsal artery, the first deep transverse metatarsal ligament and the extensor expansion were observed on 42 adult cadaveric lower extremities. Clinically the method of tracing the first dorsal metatarsal artery around the space of the extensor expansion was used in 36 cases of thumb reconstruction. RESULTS: The distal segments of the first dorsal metatarsal artery of Gilbert types I and II were located superficially to the extensor expansion. The harvesting time of a toe was shortened from 90 minutes to 50 minutes with 100% survival of reconstructed fingers. CONCLUSIONS: The distal segment of the first dorsal metatarsal artery lies constantly at the superficial layer of the extensor expansion. Most of the first metatarsal arteries of Gilbert types I and II can be easily located via the combined sequential and reverse dissection around the space of the extensor expansion.

[Prevention of the zygomatic branch of the facial nerve in rhytidectomy: an anatomical study].

OBJECTIVE: To investigate the anatomical distribution of the zygomatic branch of the facial nerve and discuss its clinical significance in the rhytidectomy. METHODS: The distribution of the zygomatic branch of the facial nerve was observed on 30 halves of the fifteen candaveric specimens (10 antiseptic cadaveric specimens and 5 fresh cadavers). RESULTS: The zygomatic branch made its way through the upper or the anterior border of the parotid gland, giving rise to 2 or 3 rami, which could be divided into the superior and the inferior rami. The superior rami, which were thin and superficial, crossed the zygomatic arch at its inner one-third or ran along the inferior margin of the zygomatic arch, and then entered beneath the zygomatic ligaments. The inferior rami were comparatively thick and deep, lying 1.0+/-0.3 cm inferior to the superior rami. The inferior and superior rami joined each other on the surface and deep side of the zygomatic major muscle. CONCLUSION: In the prevention of the zygomatic branch damage in rhytidectomy, the areas where caution should taken were the anterior border of the zygomatic major muscle in sub-SMAS dissection and the zygomatic arch in the subperiosteal dissection. The sharp dissection and excess tension should be avoided to reduce the nerve injury.

Brow fat pad flap transfer for repairing depressed deformity of the upper eyelids.

OBJECTIVE: To study the new surgical approach to repair depressed deformity of the upper eyelids by transferring brow fat pad flap that retains blood supply and similar construction with the orbital septum. METHOD: An incision was made in the inferior margin of the brow to dissect and expose the brow fat pad under the orbicular muscle of the eye and frontal muscle plane in the lateral superior orbit, and the flap was removed from above the periosteum and pedicled under the orbital rim. Through the incision in the double-eyelid fold, a tunnel was dissected upward from the plane under the orbicular muscle to reach the brow incision. The brow fat pad flap was then turned over to cover the deformity, followed by fixation and suture of the flap and a double-eyelid operation. RESULT: Four patients with the upper eyelid deformity were successfully treated using this new procedure with satisfactory results and no complications were encountered. Fat absorption was not observed in the one-year follow-up. CONCLUSION: This procedure has the merits that (1) the fat tissue transferred to the recipient site has blood supply, thus fat absorption is prevented and the surgical results can be almost permanently maintained; (2) The similarity between the construction of the brow fat pad and the orbital septum fat may ensure better result with more natural look of the eyelids; (3) The donor site is adjacent to the recipient site to facilitate the brow fat pad transferring; (4) The operation leaves no obvious scars at the donor site.

Reconstruction of the distal ulnar epiphysis with vascularized proximal fibula including epiphysis in children after osteochondroma resection: report of two cases.

BACKGROUND: Osteochondromas, especially multiple hereditary osteochondromas, usually cause various deformities of the joints. The authors sometimes find ulnar shortening and acquired wrist varus deformity in distal ulnar osteochondromas and even radial head dislocation resulting in ulnar shortening. In this study, the authors present the clinical outcomes of distal ulnar epiphysis reconstruction in two children using vascularized proximal fibula including the epiphysis after osteochondroma resection. METHODS: The authors used vascularized proximal fibula including the epiphysis as a substitute to reconstruct the distal ulnar epiphysis after osteochondroma resection and investigated the clinical outcome in two patients (aged 4 and 9 years). RESULTS: The wrist deformity was corrected successfully for both cases. Bone union between fibular grafts and hosts was found 2 months postoperatively. The reconstructed distal ulna and contralateral limbs were growing almost simultaneously. The morphology and function were also satisfactory at 1- and 8-year follow-up, respectively. CONCLUSIONS: It is possible to reconstruct the distal ulna after osteochondroma resection and simultaneously keep the ulna in longitudinal growth by using vascularized proximal fibula including the epiphysis in children. However, the growth plate in the reconstructed distal ulnar epiphysis might be prematurely closed approximately 8 years after reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Anatomic study of selective neurectomy of gastrocnemius muscle for calf reduction in Chinese.

BACKGROUND: Selective neurectomy of the innervating nerves of the gastrocnemius muscle is a popular method employed for calf reduction. However, accidental injury to the untargeted adjacent nerves could happen. This study aims to provide detailed morphometry of the motor branches from the tibial nerve innervating the gastrocnemius muscle, the soleus and the medial sural cutaneous nerve in the popliteal fossa. METHODS: 23 lower legs from female cadavers were dissected to explore the origin, length of and the spatial relationship between the four branches given off from the tibial nerve in the popliteal fossa. RESULTS: Our study showed there were seven origin patterns existing among the four nerve branches; the origin of the branches to the medial and lateral heads of the gastrocnemius muscle was located ranging from -16 mm to 22 mm away from the midpoint of the line between the lateral and medial condyles of the femur; In 95% of the specimens, the location of the origin of the nerve branch to the medial head was proximal to its lateral counterpart. The nerve to the medial head was often given off from the medial aspect or the posteromedial aspect of the tibial nerve, while the other three often from the lateral aspect. CONCLUSIONS: A variety of origin patterns among the nerves to the lateral and medial gastrocnemius muscle, the nerve to the soleus muscle and the sural cutaneous nerve exist, necessitating the formulation of diversifying surgical strategies preoperatively and the meticulous and sequential dissection intra-operatively to ensure the lowest level of accidental injury.

A novel in vivo technique for observations of choke vessels in a rat skin flap model.

BACKGROUND: Choke vessels are reduced-caliber vessels that link adjacent vascular territories throughout the body. The behavior of choke vessels determines flap survival. Therefore, it is important to develop a reliable technique with which to study these vessels. The purpose of this report is to document a novel in vivo technique for the study of choke anastomotic vessels in a rat skin flap model. METHODS: This study was divided into two parts. In part I, 30 adult Sprague-Dawley rats underwent whole-body lead oxide/gelatin injection and the skin was removed for radiography to analyze the skin vasculature. In part II, a dorsal skin flap was elevated in 12 rats, and a skinfold chamber was installed to observe the choke vessels between the iliolumbar artery perforator and the posterior intercostal artery perforator for 8 days. Evans blue dye was injected through the lateral tail vein. Blood flow velocity was calculated. RESULTS: In part I, three distinct patterns of dorsal cutaneous vasculature were found. A three-territory, 3.5×10-cm flap can be elevated on the dorsum of the rat. In part II, an increase in diameter of the choke arteries and the choke veins was observed, particularly in the fine venules. Blood flow velocity across the arterial segment of the choke zone was found to be 2.5 mm/second. CONCLUSIONS: The observation chamber technique for in vivo study of the choke anastomotic region of the rat dorsal skin flap model is a promising novel method for studying skin microcirculation. The time sequence of microvascular events in the choke anastomotic zone of this rat model was documented.

Vasculature at the medial aspect of the foot and clinical application of flaps based on it for forefoot reconstruction.

BACKGROUND: Detailed knowledge of the vasculature of the medial aspect of the foot has rarely been reported, but it is of tremendous importance for harvesting the flap in this area to cover defects of the foot and hand. Repair of soft-tissue defects at the dorsal forefoot remains a challenge in reconstructive surgery. The authors describe the use of the distally based saphenous neurovenofasciocutaneous flap at the medial aspect of the foot to cover this region. METHODS: This study was divided into two parts: an anatomical study and clinical application. In the anatomical study, 35 cadaveric feet were injected with red gelatin, five others were made as corrosive vascular casts, and then the main vessels distributed at the medial aspect of the foot were observed. Clinically, six cases of soft-tissue defects at the dorsal forefoot were reconstructed with distally based saphenous neurovenofasciocutaneous flaps. RESULTS: The anatomical study showed that (1) the vasculature pattern could roughly be classified into three types and (2) there were constant anastomoses between the above-mentioned arteries around the midpoint of the first metatarsal bone. In terms of clinical application, all flaps completely survived, and one patient had partial loss of skin graft. CONCLUSIONS: The blood supply to the medial aspect of the foot has multiple origins, on the basis of which of several flaps can be harvested, either a pedicled or free. Of particular clinical significance is the distally based saphenous neurovenofasciocutaneous flap, which is thin, is in the immediate vicinity of the forefoot, and has a reliable retrograde blood supply. This flap should be considered as a preferential way to reconstruct soft-tissue defects of the dorsal forefoot.

Transoral atlantoaxial reduction plate internal fixation with transoral transpedicular or articular mass screw of c2 for the treatment of irreducible atlantoaxial dislocation: two case reports.

STUDY DESIGN: Retrospective report of two surgical cases and review of the literature. OBJECTIVE: To report the clinical application of transoral atlantoaxial reduction plate (TARP) internal fixation with a novel technique of transoral transpedicular or articular mass screw of C2 in the treatment of irreducible atlantoaxial dislocation and basilar invagination with ventral spinal cord compression. SUMMARY OF BACKGROUND DATA: Current surgical treatments for IAAD have various disadvantages, such as posterior decompression followed by atlantoaxial or occipitocervical fusion with unsatisfactory decompression, transoral decompression, and one-stage posterior instrumentation needing two approaches although with satisfactory decompression, resection of dens and/or clivus with potential risk of spinal cord injury and CSF leakeage. METHODS: TARP system with a novel technique of transoral transpedicular screw or articular mass screw of C2 was designed and employed for two patients with irreducible atlantoaxial dislocation, during which one case was with basilar invagination. The histories of the cases and the novel technique of transoral articular mass screw and transpedicular screw insertion of C2 were reported in detail. RESULTS: The two case examples demonstrate the efficacy of this one-stage single transoral approach to the surgical treatment of irreducible anterior atlantoaxial dislocation with spinal cord compression especially in the case of basilar invagination. The role of the TARP in affecting and maintaining the reduction while promoting successful fusion is illustrated. CONCLUSION: The authors' one-stage anterior procedure employing the TARP for the surgical treatment of irreducible anterior atlantoaxial dislocation and basilar invagination was effective in these two cases. This method was able to avoid the need for dens and clivus resection and/or a posterior instrumentation and fusion procedure. The technique of transoral articular mass screw and transpedicular screw insertion of C2 was valuable for transoral atlantoaxial plate internal fixation.

[Three-dimensional reconstruction and anatomic variation of the portal vein based on 64-slice spiral CT data].

OBJECTIVE: To investigate the three-dimensional reconstruction methods of the portal vein using 64-slice spiral CT data and the anatomical variation of the portal vein. METHODS: Three-dimensional reconstruction of the portal vein was performed using Mimics software based on the 64-slice spiral CT data of 64 cases. Each model of the portal vein and its branches was evaluated according to the presentation rate, depiction quality and anatomic variation. RESULTS: The reconstructed model showed a depiction rates of 100% for the 4-grade branches of the portal vein. The stem of the portal vein and the left and right branches of the level III or above were all displayed, but in 2 cases the superior mesenteric vein and in 1 case the spleen vein was displayed only to the level IV. Of the 64 cases, 50 (78.1%) had normal portal vein and 14 (21.9%) showed anatomical variations. CONCLUSION: The 3D model vividly mimics the anatomic variations of the portal vein to provide valuable information for surgical plans.

Anatomical study of position of the rib head for placing anterior vertebral body screws in a chinese population.

In this study, the variability of rib head position in a Chinese population in terms of the spinal canal and vertebral body was analyzed using computed tomography (CT). Images from transverse CT scan of the T4 to T12 vertebral bodies of 30 normal individuals were 3-dimensionally reconstructed, and analyzed for measurement of parameters that define the relative anatomic position of the rib head. We have found that the distance between the anterior border of the rib head and the posterior margin of the vertebral body, posterior safe angle, and the distance between the most inferior border of the rib head and inferior end plate in the sagittal plane gradually decrease. However, the distance between the anterior boarder of the rib head and the anterior margin of the vertebral body, transverse dimension, anterior safe angle, and the distance between the most inferior border of the rib head and superior end plate in the sagittal plane gradually increase from T4 to T12. This indicates that the position of the rib head is oriented from a more anterior position to a more posterior position and from a more superior position to a more inferior position as the number of the vertebra increases, which is different from what has been reported from western populations. Our study has identified useful parameters to define the position of the rib head, and provides a comprehensive reference guide for accurate and safe instrumentation of vertebral body screws in treating related spine diseases.

Anatomy of the transversus nuchae muscle and its relationship with the superficial musculoaponeurotic system.

BACKGROUND: Previous studies have proved the existence of muscle fibers in the superficial musculoaponeurotic system (SMAS) of the parotid and masseter region; however, no studies have investigated the origination of the muscle fibers in the SMAS. Theoretically speaking, the muscle fibers within the SMAS in the parotid and masseter region might originate from a certain muscle with a definite origin and insertion. Based on this hypothesis, the authors' study investigated the origination of the muscle fibers in the SMAS of the parotid and masseter region to provide anatomical evidence that can improve our understanding of the SMAS. METHODS: An anatomical study was performed on 20 halves of seven fixed and three fresh adult cadavers (seven male and three female cadavers). A traditional bilateral face-lift incision was designed in each cadaver, and the muscle fibers within the SMAS in the parotid and masseter region, along with the origin and insertion, were investigated, dissected, analyzed, and photographed. RESULTS: The transversus nuchae muscle can be divided into two sections according to the origin of its tendons. The muscular fasciculi of the two sections run transversely across the sternocleidomastoid muscle, insert into the superficial fascia above the parotidomasseteric fascia, and terminate in the zygomatic region. The muscle fibers within the SMAS in the parotid and masseter region come from the transversus nuchae muscle. CONCLUSIONS: The authors' study first investigated the transversus nuchae muscle combined with the SMAS and clarified the issue that has been neglected by previous studies for more than 30 years. The authors hope this will unify their understanding of the SMAS and offer plastic surgeons and readers a brief insight into the SMAS.

An overview of skin flap surgery in the mainland China: 20 years' achievements (1981 to 2000).

Microsurgical anatomy and clinical applications have been widely and extensively practiced throughout the mainland of China since late 1970s. During the 1980s to 1990s, Chinese surgeons and anatomists developed many new flap donor sites and modifications, most of which were published in Chinese literature. These achievements were not fully realized by the Western surgeons. In this overview, we attempt to give a brief introduction of these contributions made by the Chinese authors in the mainland. Of the new flaps first or independently described by the Chinese, most were in the limbs. These flaps can be classified into three categories. First are free flaps with a main artery trunk, such as the radial forearm flap with radial artery, the medial leg flap with posterior tibial artery, and lateral leg flap with peroneal artery. Second are reverse-flow island flaps based on distal main vascular bundles (e.g., the radial artery and venae comitantes, the ulnar, the posterior tibial, and the peroneal arteries). Third are septocutaneous perforator flaps that avoid sacrifice of the main artery trunk, which include the anterolateral thigh flap, lateral lower-leg flap, dorsoulnar flap, distally adipofascial pedicled radial forearm flap, and so on.

[The nasal development after one-staged correction of nose deformity and unilateral complete cleft lip in infancy].

OBJECTIVE: To introduce one-staged correction of nasal deformity and unilateral complete cleft lip in infancy and to observe the nasal development after the operation. METHODS: The unilateral complete cleft lip and nasal deformity were corrected in one stage in27 cases. They were followed up for several years. With post-operative photos, the anthropometric method was used to analyze the nasal development. RESULTS: The long-term results were excellent in 10 cases, good in 14 cases, and poor in 3 cases. CONCLUSIONS: Based on the anatomic findings of nasal blood supply, one-staged correction of nasal deformity and unilateral complete cleft lip in infancy can be performed with no obvious interference with nasal development. The secondary nasal deformity before school age can be alleviated or avoided.