[The anatomy basis and clinical application of the horn fasciocutaneous perforator flaps for the reconstruction of the defects on finger soft tissue].

Objective: To discuss the clinical effect of horn perforator flaps for the treatment of finger soft tissue defect. Methods: ① Lead oxide-gelatin mixture injection and CT scanning were performed in 4 fresh adult cadavers and the data was put into mimics 17.0 to achieve the three-dimensional reconstruction. The regulation and origins of the perforator vessel in proper palmar digital artery was observed. ② From July 2012 to July 2015,9 cases with finger soft tissue defects were treated with horn perforator flaps. The defect areas ranged from 0.6 cm × 0.8 cm to 1.2 cm × 1.5 cm and the flap size ranged from0.8 cm×2.5 cm to 1.6 cm×4.2 cm. We put the head end of flaps at defect side. The horn perforator flap was designed with 1-2 perforator vessel and rotated to cover the defect. The defect at donor site was closed directly. Results: We got 4 symmetric arteries in palmar and back surfaces of fingers,2 for proper palmar digital arteries and 2 for dorsal digital arteries. The proper palmar digital arteries have a larger diameter which is the main source of blood supply for fingers. All 9 flaps survived after the operation. Both the recipient area and donor areas received sound healing. With 2 months to 1.5 years of follow-up visit, the shape, color and luster, texture and function all had good healing. Conclusions: The horn perforator flaps for repair finger soft tissue defect have advantages of flexible design, reliable perforator vessels. The defect at donor site can be closed directly with no skin graft. This method considers both shape and function and is a good way for finger soft tissue defect.

[Clinical application of the adjacent horn shaped perforator fasciocutaneous flap in the trunk area].

OBJECTIVE: To study the anatomy basis for the clinical application of the adjacent horn shaped perforator fasciocutaneous flap for the reconstruction of small and medium-sized defects in the trunk area. METHODS: (1) Ten adult antiseptic cadavers (20 sides) were perfused with red latex. The skin blood supply, line of the blood vessels, branches in accordance with the distribution and crossing were observed. (2) Fifteen cases with defects in the trunk were treated with the adjacent horn shaped perforator fasciocutaneous flaps. The defects size ranged from 5 cm x 5 cm to 13 cm x 13 cm with the size of the flaps ranging from 10 cm x 6 cm to 35 cm x 15 cm. RESULTS: The trunk skin is supplied by mainly 17 groups arteries such as thyrocervical trunk, internal thoracic artery, posterior intercostal arteries, superior epigastric artery, arteria epigastrica inferior, lumbar arteries, and so on. The perforators (diameter > 0.5 mm) numbers are about 20, 40, 24, 6, on the chest, abdomen and perineum, upper back, waist, respectively. All the flaps survived completely with primary healing both on donor and recipient sites. The flaps color, texture, function and appearance were satisfactory during the follow-up period of 1-24 months. CONCLUSIONS: The adjacent horn shaped perforator fasciocutaneous flap should be designed flexibly. The defects in the donor sites could be closed directly without skin graft. It is an effective, easy and ideal method for the reconstruction of large defects in the trunk.

[Application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar].

OBJECTIVE: To investigate the application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar. METHODS: The proximal end of the plantar fasciocutaneous perforator flaps were at the edge of defects. The deep fascia was cut off at the both sides of flaps. The plantar fascia should be included into the flaps. Then the flaps were rotated to cover the defects, containing two or three perforators. If necessary, the original supplying vessels could be cut off to facilitate the advancement of flaps. RESULTS: From Jan. 2010 to Oct. 2012, 7 cases with plantar defects were treated with the horn shaped perforator flaps. The defects size ranged from 1.5 cm x 2.0 cm to 4.0 cm x5. 0 cm with the size of the flaps ranging from 7 cm x 3 cm to 13 cm x 7 cm. All the flaps survived completely with primary healing both on donor and recipient sites. The flap color, texture, function and appearance were satisfactory during the follow-up period of 3-24 months. CONCLUSIONS: The plantar horn shaped perforator flap can reconstruct the defects at plantar weight-bearing area with the similar thick skin tissue, which facilitates the functional reconstruction. No skin graft is necessary for the defect at donor site.

Experience of 56 patients using a retrograde sural neurovascular flap to repair lower limb tissue defects.

This study was made to investigate the clinical effects of repairing lower limb defects with an improved retrograde sural nerve flap. From November 1996 to September 2010, a total of 56 patients with soft-tissue defects of the lower limb received improved retrograde sural neurocutaneous flap repair. There were 21 women and 35 men ranging in age from 12-73 years (average age 45.9). Eight patients had dorsal foot defects, five patients had foot bottom defects, four patients had heel defects, six patients had defects around the ankle, and 15 patients had defects below the lower third of the leg. Of these, 10 patients had exposed wounds and six cases had exposed tendons. The size of the surgical repair was between ∼6 cm × 5 cm and ∼25 cm × 9 cm. Four patients retained the donor's sural neurovascular flap and normal sural nerve function, and 10 patients retained the retrograde sural neurovascular flap with a thin layer of muscle. All grafted flaps survived in all 56 patients. Patient follow-up lasted between 3 months and 3 years. The shape and function of their lower limbs were satisfactory. Two-point discrimination detection in the donor area and nerve-control area revealed that the sensory function recovered well in the four patients with retained nerves. The partial necrosis of the distal flap in two patients healed successfully after dressing, and no other adverse reactions or complications were observed. Through clinical treatment of the 56 patients, good experience was accumulated. The operation methods made the flap blood supply more abundant, improved the survival rate, and retained the sensory function of the donor site of the lower limb flap. This reduced the damage to the donor site and made the operation safer.

[Application of 1% lauromacrogol in the treatment of facial refractory hemangioma and vascular malformations].

OBJECTIVE: To investigate the clinical effect of 1% lauromacrogol for the treatment of facial refractory hemangioma and vascular malformation. METHODS: From Sept 2009 to Nov 2011, 55 patients (20 male, 35 female, 1 month to 30 years) with different types of facial hemangiorwa and vascular malformation about 1.0 cm x (0. 5-5.0) cm x 10.0 cm in size, underwent 1% lauromacrogol intratumor injection therapy. Generally, the injection dose, concentration, frequency were determined by the age of the patients, the volume and depth of the lesion. The dose was limited to 10 mg every time. The injection interval is 14 weeks. RESULTS: After followed up for 3-16 months, 41 cases were cured, 9 cases were greatly improved, and 5 were partially improved. Skin necrosis happened in only 2 cases. CONCLUSIONS: Lauromacrogol is safe, simple and effective as a sderosing agent for the treatment of facial refractory hemangioma and vascular malformation. It provides a new and alternative way for the treatment of facial refractory hemangioma and vascular malformation.

[The application of the horn shaped fasciocutaneous flap in lower leg].

OBJECTIVE: To explore the application of the horn shaped fasciocutaneous flap for the middle or small defect of low leg. METHODS: Between April 2008 and November 2010,12 cases were covered the defects with horn flap in the leg, in which 4 cases were male, and 8 cases were female, such as squamous cell carcinoma, basal cell carcinoma, angioneoplasm, trauma and so on. Surgical repair of tissue defect size of about 3 cm x 3 cm-5 cm x 5 cm. RESULTS: Twelve cases were treated. Vascular deficiency happened at the distal end of one flap. All the other 11 flaps survived. The appearance and functional results were satisfactory with following up for 6 to 24 months. CONCLUSIONS: The horn shaped fasciocutaneous flap is simple, reliable, easy to perform, has a low complication rate, is cosmetically acceptable

[Application of modified peroneal tendofascial compound flap with partial tendon of peroneal long muscle in lower leg refractory defects with Achilles tendon rupture].

OBJECTIVE: To investigate the feasibility of using modified peroneal tendofascial compound flap with partial tendon of peroneal long muscle in lower leg refractory defect with Achilles tendon rupture. METHODS: Based on the application experience of peroneal tendofascial compound flap for lower leg refractory defects, partial tendon of peroneal long muscle was included in the flap to repair the Achilles tendon rupture. RESULTS: 6 cases were treated. The maximum size of modified compound flap reached 5 cm x 5 cm. The maximal included tendon in the flap was 5 cm in length. All the flaps survived completely. Partial epidermis necrosis happened in one case between the skin graft at the donor site and the edge of the flap pedicle. The patients were followed up for 5 months to 2 years with satisfactory cosmetic and functional results. CONCLUSIONS: The modified compound flap has reliable blood supply and can be easily transposed, leaving less morbidity at the donor site. It is very suitable for lower leg refractory defect with the Achilles tendon rupture.

[Application of modified reversed neurovascular flaps nourished by cutaneous nerve-superficial vein in lower extremity].

OBJECTIVE: To investigate the application and therapeutic effect of modified neurovascular flaps nourished by sural nerve and small saphenous venous, or saphenous nerve and great saphenous venous. METHODS: According to the anatomy and recipient area, we made some modifications for the two neurovascular flaps. 1) The small and great saphenous venous were ligated or anastomosed with the venous in recipient area; 2) The flap was delayed for 8 - 14 days if the donor area was above the middle and upper one third of leg; 3) The sural nerve and its branch were anastomosed to the nerve in recipient site to restore the sense of flap; 4) the lower turning point could be designed just 3 cm above the point of internal and external malleolus; 5) Partial gastrocnemius or soleus muscle could be included in the flap if needed; 6) Reversed cross leg flap was considered if the adjacent flap in the affected side could not be used. Sometimes, we adopted more than one modification in one patients. RESULTS: From Sep, 1994 to Apr, 2007, 63 cases were treated, including 51 cases of sural and 12 cases of saphenous neurovascular flaps. Partial necrosis (about 1 - 2 cm width) happened in the distal end of flaps in 2 cases which healed after dress changing. The patients were followed up for 3 months to 2 years with satisfied functional and cosmetic results. CONCLUSIONS: These two modified flaps have reliable blood supply and survival rate. The operation is easily performed and very practical. The flaps, or combined with other methods can repair about 70% of the refractory defects in legs.

[Anatomic study of peroneal tendofascial flap combined with adipofascial flap for the repair of heel tissue defects].

OBJECTIVE: To study the anatomy of peroneal tendofascial flap combined with adipofascial flap for the repair of heel tissue defects. METHODS: The lower extremities of five cadavers (10 sides) were perfused with red latex, the blood supply of peroneal tendofascial flap and vicinity adipofascial flap were observed. The diameter, course, branches and location of the blood vessels were measured. Eight fresh cadavers (16 sides) were perfused with lead oxide-gelatine mixture. The covering fascia tissues of the lower extremities was obtained and photographed by X-ray. The vascular anastomosis and association of nutrient vessel of peroneal tendofascial flap and vicinity adipofascial flap were observed. Two adult lower extremities specimens (4 sides) were used to construct vessel diagrams for observation of the course, distribution and anastomosis of the vessels. Eight cases were treated successfully with theses flaps. RESULTS: The blood supply of the combined fascial flap is multi-originated. For the area within 4 cm below and above the lateral malleolus cusp, the blood supply includes 2-5 branches from heel lateral artery with an average diameter of (0.5 +/- 0.2) mm, 1-2 branches from posterior lateral malleolus artery with an average diameter of (0.6 +/- 0.2) mm and 2-3 branches from the descending part of perforating branches of peroneal artery with an average diameter of (0.5 +/- 0.2) mm. The blood supply of area 4 cm above lateral malleolus cusp is 1-3 branches from intermuscular septum perforating branches of peroneal artery with an average diameter of (1.0 +/- 0.2) mm. These above branches are anastomosed each other and also send off many smaller branches to form vascular net around tendon. The fascial flaps and free skin grafts in eight patients were completely survived. All patients were followed up for 3-24 months, the donor and recipient sites were healed very well. The functional and cosmetic results were satisfactory. CONCLUSIONS: Peroneal tendofascial flap combined with adipofascial flap, with proximal pedicle or reverse distal pedicle, can be used to repair the defect at the lower leg and refractory small- and medium-sized defects at the heel.

[The thoracodorsal artery musculocutaneous perforator flap: anatomic study and clinical significance].

OBJECTIVE: To investigate the feasibility of clinical application of the thoracodorsal artery musculocutaneous perforator flap (TAMPF). METHODS: (1) The morphosis and blood supply of TAP flap on 15 formalized adult cadavers(30 sides) were examined by microsurgery anatomy. (2) An imitative operation of the TAMP flap and latissimus dorsi flap on 1 formalized adult cadavers (2 sides) was conducted. RESULTS: (1) A total of 102 musculocutaneous perforators larger than 0.5 mm were found in 16 specimens(32 sides). 56 perforators (55%) were originated from the medial branch and 46 (45%) originated from the lateral branch. The biggest perforator is (0.82 +/- 0.11) mm (0.68 - 1.08 mm). There was an average of 1.9 perforators (range, 1 - 3 perforators) of the medial branch and an average of 1.8 perforators (range, 1 - 3 perforators) of the lateral branch. Additionally, there were 24 perforators samller than 0.5 mm, and 76 perforators originated from intercostal artery and lumbar artery. (2) Musculocutaneous perforators over 0.5 mm were found only in proximity of the medial and lateral branches within a distance of 8.5 cm (6.4 cm - 9.2 cm) distal to the neurovascular hilus. CONCLUSIONS: With the characteristics of constant position, large caliber, long pedicle, the thoracodorsal artery musculocutaneous perforator was suitable to be musclocutaneous perforator flaps and "fan-shaped" flaps.

[Heel deep tissue defects were repaired by perineal tendofascial flap conjoined with adipofascial flap].

OBJECTIVE: To explore a new method and estimate its outcome to repair deep heel tissue injuries with local tissue flap. METHODS: At lower cnemis, a fat fascial flap combined with perineal tendofascial flap were designed and elevated between the lateral malleolars blank, the largest area is 6 cm x 13 cm, which were transplanted to cover naked calcaneal tendon and calcaneal bone, full-thickness free skin graft or middle-thickness free skin graft were grafted on flap. RESULTS: 6 patients suffered from heel tissue defects had been treated from January 2004 to November 2005. The smallest area was 3.5 cm x 4.0 cm and the largest was 4 cm x 6 cm. All fascial flaps and free skin grafts were successfully survived after operations. All patients were followed up 3-23 months, the operation areas were healed, the functions and configurations were satisfied. CONCLUSIONS: Perineal tendofascial flap conjoined with adipofasical flap and free skin graft are used to repair heel deep tissue defects, which is a handy, dependable way for repairing of the small tissue defects of the lower third of leg and heel.

[Preauricular lateral maxillocervical fasciocutaneous flap].

OBJECTIVE: To investigate the design and blood supply type of the reverse narrow pedicle lateral maxillocervical fasciocutaneous flap. METHODS: The reverse narrow pedicle lateral maxillocervical fasciocutaneous flap with its pedicle locate in front of auricle was designed to repair the defect caused by removing the malignant tumor in aged patients. The largest size is about 10 cm x 6 cm, the width of pedicle ranged from 2.5-3.0 cm, 2-4 cm in length. RESULTS: The flaps were used in 4 patients, age from 57 to 83 years old and the flap was designed as lateral maxillocervical fasciocutaneous flap. The flap was survived well in all patients, donor site can be closed without strain, no tumor relapsed. CONCLUSION: The flap should be included to be a reverse axial flap and it should be designed from jaw edge to chin. The pedicle couldn't be too narrow, in this way, donor site can be closed directly, and less surgical operation time needed. The patients can accept synthesize treatment early, for example actinotheraphy. It is an ideal choice for repair the defect caused by removing the malignant tumor in aged patients.

[Effect of the endoexpander pressure of continuous and constant pressure expansion on the drug permeability].

OBJECTIVE: To investigate the effect of the endoexpander pressure of continuous and constant pressure expansion on the drug permeability. METHODS: The expanders were divided into two groups, the normal expansion and the continuous and constant pressure expansion (4.6 kPa). Each expander was filled with 0.2% Metronidazole, then the expanders were immersed wholly in normal saline and sealed totally. At several intervals over 72 hours, the surrounding saline was sampled and the drug concentration of the sample was measured respectively. RESULTS: Both groups were permeable to the Metronidazole and the concentration outside the expander would reach the effective concentration in 48 hours. The drug concentration of the continuous and constant pressure expansion was higher than that of the normal one and there was significant difference between the two groups (P < 0.01). CONCLUSION: The endoexpander pressure in continuous and constant pressure expansion can enhance the drug permeability. In view of this, in the course of continuous and constant pressure expansion, 0.2% Metronidazole can be used to prevent and control the infection.