Applied distally based peroneus brevis muscle flaps for coverage of the soft tissue defects over the lower one-third of the leg, ankle and foot

Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applied for coverage of the soft tissue defects over the lower one-third of the leg,the ankle and the foot. The muscle flaps were covered with split-thickness skin grafts. Results The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot in 16 cases. The larges area of the soft tissue defect was 5 cm × 7 cm. The smallest was 3 cm × 4 cm. Primary healing occured in 14 cases undergoing muscle flap construction, second-stage healing occured in 2 cases, no total flap necrosis occured in any cases. Conclusion ThisChina Medical Abstracts(Surgery) technigue is a simple and complication are lesser. The successful rates are higher. This muscle flap is suitable to the mudium or small soft tissue

Versatility of Reverse Sural Fasciocutaneous Flap for Reconstruction of Distal Lower Limb Soft tissue Defects

Summary： In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried out from Oct. 2010 to Dec. 2012 in our department. The series consisted of 36 patients, including 21 men and 15 women with an average age of 46.2 years （14-83 years） and with a medium followp period of 18 months （12-24 months）. Of all the cases of acute trauma, there were 10 eases of trauma of distal tibia, 9 cases of trauma of perimalleolus, and 17 cases of trauma of midfoot and forefoot. Related risk factors in the patients were diabetes （2 cases）, advanced age （〉65 years, 3 cases） and ciga- rette smoking （6 cases）. The reverse flow sural island flap irrigation depended on lower perforators of the peroneal artery. The fasciocutaneous pedicle was 3-4 cm in width and the anatomical structures consisted of the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The most proximal border of the flap was only 1.5 cm away from the popliteal skin crease and the pivot point was 5-7 cm above the tip of the lateral malleolus. All the flaps survived. No arterial crisis occurred in any case. The venous congestion occurred in 2 cases and got better after raising the limbs and bloodletting. Only in an old man, 1.5 cm necrosis of distal margin of his flap occurred and finally healed after continuous dressing change. One-stage skin grafting was performed, and all the donor sites were sutured and successfully healed. It was concluded that the reverse sural fasciocutaneous flap is safe and reliable to extend to the proximal third even near the popliteal skin crease. We also concluded this flap can be safely and efficiently used to treat patients with large and far soft-tissue defects from the distal leg to the forefoot with more versatility and it is easier to reach the recipient sites.

Experimental study on early repair of oromaxillofacial perforating soft tissue defect due to gunshot in dogs

The left cheek of 8 adult male mongrel dogs was shot with M1935.56mm bul-let fired through an US-made M16 rifle to result in a perforating soft tissue defect.Pri-mary debridement was performed immediately and the secondary debridement 72h alter in-jury.After the secondary thorough debridement,the cutaneous side of the defect was re-paired with a saphenous artery-vein free skin(muscular)flap using microvascularanastomosis,and the oral side of the defect was repaired by drawing the surroundingmucosa together and fixing with sutures or with a local sliding mucous membrane flap.All the animals were kept under observation for 2～6 months.It was believed that the pri-mary debridement and secondary thorough debridement were both essential. The survivalrate of the free tissue flap was 75%(6/8).These facts suggest that early repair ofthe oromaxillofacial perforating soft tissue defect due to gunshot is practicable.

Lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing soft tissue defect of foot and ankle

To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March 2004,using lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle in 11 cases.Cause of injuring:traffic accident 7 cases,crushing 1 case,saw injury 1 case,skin cancer 1 case,chronic ulcer 1 case.Areas:foot heel 6 cases,shank lower section 2 cases,heel tendon 2 cases,the distant back of the foot 1 case.Using the flap axis point was 1～3 cm above the pin of the external heel,average 2 cm.The scope of the flap was 6.0 cm×8.0 cm～12.0 cm～18.0 cm.Results All sural nerve flaps were alive.Of them,2 cases have distant part necrosis,accompanying with subcutaneous tissue,1 case heels after change dressings,another heels after skin grafting.All case can walk as usual,the flap was wear-resisting and keenly feel.Conclusion Lower rotating point nutrient vessels of sural nerve flap,donner area was fine,available area was large,skin in the pink,easy grafting,without main blood vessel damage,survival rate high,it is a good donner area in repairing around heel,foot and shank lower section.7 refs,1 tab.

Oral and maxillofacial-head and neck reconstruction with soft tissue free flaps of 41 cases: A single team's experience

Objective To retrospectively review the single team's experience of oral and maxillofacialhead and neck reconstruction involving 41 soft tissue free flap procedures.Methods From 1994 to 2012,41 patients who underwent oral and maxillofacial-head and neck soft tissue free flap reconstruction at the Department of Oral and Maxillofacial-Head and Neck Surgical Oncology,Hospital and College of Stomatology,Xi'an Jiaotong University,were reviewed with clinicopathologic data.Results The 41 patients included 24 men and 17 women with a mean age of 54 years.A total of 41 soft tissue free flaps were performed to reconstruct different anatomical structures in the head and neck region including oral mucosa,facial bone,head and neck skin.Two types of soft tissue free flaps were used to reconstruct surgical defects,including radial forearm flap and latissimus dorsi myocutaneous flap.Radial forearm flaps were used for 37cases and latissimus dorsi-myocutaneous flaps were 4 cases.Of 41 cases,39 were successful,with an overall success rate of 95.1%.There were 2 free flap failures,including one radial forearm flap and one latissimus dorsi-myocutaneous flap(partial flap necrosis);hence,the flap success rates for radial forearm flap and latissimus dorsimyocutaneous were,respectively,97.3% and 87.5%.Conclusions Radial forearm flap and latissimus dorsi-myocutaneous flap are reliable soft tissue free flaps to repair oral and maxillofacial-head and neck area with high success rate,which resulted in good functionally and cosmetically with fewer complications both donor and recipient sites.

Soft tissue defects of the hand:etiology and classification

Soft tissue defects of the hand may result from trauma,oncological procedures,or severe infections.Different etiologies have been discussed.In all cases,an accurate clinical examination is mandatory to understand which structures are involved and what must be reconstructed.It can be helpful to simplify the decision-making process to classify these lesions.However,there is no consensus on which classification is best to be used among those described in the literature.This review presents the most common ones,differentiating those classically used to describe tissue loss consequential to a traumatic event from those used to classify soft tissue defects consequent to other events.

Management of soft tissue defects of the thumb

Hand surgery has undergone substantial changes in recent years,especially for reconstructive surgery techniques.We discuss the management of soft tissue defects of the thumb,discussing indications,and operative pearls and pitfalls.We cover non-operative treatment and local advancement flaps for small distal soft tissue defects and pedicled flaps for more significant defects.We also discuss composite vascularized free flaps such as second-toe neurocutaneous flaps and partial hallux transfer for compound defects or total amputations.This article aims to provide hand surgeons with an update on reconstructing an injured thumb.

Application of a pre-filled tissue expander for preventing soft tissue incarceration during tibial distraction osteogenesis

BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.

Optimization of Material Coefficients in the Holzapfel-Gasser-Ogden Material Model for the Main Four Ligaments of the Knee Joint-A Finite Element Study

Accurate representation of soft tissue material properties plays a crucial role in computational biomechanics. Several material models have been used for knee ligaments in finite element (FE) studies, including the neo-Hookean model (widely used) and the Holzapfel-Gasser-Ogden (HGO) model (seldom used). While the coefficients of neo-Hookean models for the knee ligaments are available in the literature, limited data exists for the HGO model. Furthermore, no peer-reviewed comparison of these two material models for the knee ligaments while including the 3D representation of the ligaments for both material models is present in the literature. We used mechanical properties from the tensile test experiments in the literature for each ligament to obtain the HGO material coefficients while accounting for the ligaments’ viscoelastic behavior. Resultant coefficients were then used in an Abaqus/explicit knee model to simulate bipedal landing from a jump. The simulations were repeated with neo-Hookean values from the literature. Knee kinematics plus ACL and MCL strains were evaluated and compared for these two material models. The outputs from the simulations with HGO properties were predominantly within 1.5 standard deviations from the mean in-vitro data. When the material properties changed to Neo-Hookean, the outputs for kinematics and strain values were higher than the HGO case, and in most instances, they were outside the experimental range for ACL and MCL strains (by up to 11.35 SD) as well as some ITR angles (by up to 2.86 SD). Reported HGO material model with optimized coefficients produces a more realistic representation of the ligaments’ material properties, and will help improve the outcomes of FE models for more accurate predictions of knee behavior.

Application of radial collateral artery perforator flap in severe posterior elbow skin defect

exposed wound of deep tissue behind elbow. Methods From April 2016 to December 2018, 28 patients with posterior elbow skin and soft tissue defect with exposed bone and tendon were treated in our hospital. the radial collateral artery perforator flap was used to repair the wound. There were 19 cases of skin defect with ulna exposure after electric shock injury, 5 cases of hot compression injury and 4 cases of bone exposure caused by skin contusion after traffic accident. Results There is no complication after the operation, all the flaps were survived. The flaps had good quality and satisfactory recovery of appearance and function. Conclusion The lateral upper arm flap designed by perforating branch of radial collateral artery is an effective method for posterior elbow skin and soft tissue defect because of its constant anatomic position and long vascular pedicle.

Flap transplantation for treatment of pelvic fracture and defective hip

A case of flap transplantation for treatment of pelvic fracture and defective hip in the Third Affiliated Hospital of Inner Mongolia Medical University was collected and analyzed on the basis of diagnosis,physical examination and treatment.The patient was in serious condition with large necrotic area and prone to lead to various complications.The paper aims to share experience and provide references for similar cases amongst surgeons.

胸背动脉穿支皮瓣在肩胸背部创面修复中的临床应用

目的探讨胸背动脉穿支皮瓣在肩胸背部皮肤软组织缺损修复中的应用。方法自2019年1月至2022年12月,应用胸背动脉穿支皮瓣修复肩胸背部皮肤软组织缺损8例,致伤原因均为肿瘤切除术后。术前应用CTA和手持多普勒超声确认胸背动脉的存在、走行、分支及穿支位置。根据创面位置、面积设计胸背动脉穿支皮瓣。皮瓣仅携带穿支发出位置的极少量肌肉,将胸背动脉降支近端从肌肉内剥离,保留胸背动脉横支和胸背神经。如血管蒂长度不足,可切断横支。皮瓣带蒂转移修复创面。供瓣区拉拢缝合。结果8例皮瓣均存活,供瓣区切口愈合好。随访6个月到2年,所有患者受区外观满意,供瓣区无明显畸形,肩关节功能无明显影响。结论胸背动脉穿支皮瓣血供可靠,血管蒂长,且基本完整地保留了背阔肌功能,是修复肩胸背部邻近创面的良好选择。

早期应用跨关节外固定支架对胫骨平台骨折患者膝关节软组织的保护效果

目的 探讨早期应用跨关节外固定支架治疗,对Ⅵ型胫骨平台骨折患者膝关节软组织的保护效果。方法 选取2019年1月至2020年12月收治的Ⅵ型胫骨平台骨折患者122例为研究对象,以信封法进行随机分成研究组和对照组,每组61例。研究组患者给予早期(收治12 h内)跨关节外固定支架联合内固定手术;对照组患者给予延期(收治24~72 h内)跨关节外固定支架联合内固定手术。观察和比较2组患者的手术情况指标、术后恢复指标、膝关节疗效、膝关节功能评分、膝关节软组织损伤指标。结果 研究组外固定手术时间和内固定手术时间均短于对照组,外固定术后VAS评分低于对照组,内固定术中出血少于对照组;研究组康复时间和骨折愈合时间均短于对照组,差异均有统计学意义(P<0.05);2组并发症发生率和膝关键治疗优良率比较,差异无统计学意义(P>0.05);术后,2组患者各项膝关节功能评分均降低,且研究组低于对照组,差异均有统计学意义(P<0.05);研究组外固定术后水疱发生率低于对照组,外固定术后肿胀程度小于对照组,水疱痂皮愈合时间早于对照组,差异均有统计学意义(P<0.05)。结论 与延期时机相比,给予Ⅵ型胫骨平台骨折患者早期跨关节外固定支架联合内固定手术治疗,能够缩短手术时间,提升患者骨折愈合和术后康复进程,促进患者膝关节功能和膝关节软组织损伤的恢复。

游离背阔肌双叶皮瓣修复肢体软组织缺损的效果

目的探讨游离背阔肌双叶皮瓣修复肢体软组织缺损的效果。方法采用游离背阔肌双叶皮瓣修复9例肢体严重创伤患者,胸背动脉外侧分支背阔肌皮瓣切取范围为13.5 cm×6.5 cm~23.5 cm×9.0 cm,胸背动脉内侧分支背阔肌皮瓣切取范围为6.5 cm×5.5 cm~10.5 cm×7.5 cm。皮瓣切取后进行适当调整以修复各种不规则的缺损创面,皮瓣供区创面可直接缝合或仅需少量皮片移植修复。结果患者均获得随访,时间6~23个月。术后8例游离背阔肌双叶皮瓣全部成活,1例胸背动脉内侧支背阔肌皮瓣远端少部分坏死,经二期切除缺损创面直接缝合后愈合。7例因皮瓣臃肿行皮瓣修薄术,2例无需二次修整。末次随访时9例皮瓣质地及外形均良好,创伤肢体活动功能均恢复满意。7例供区直接缝合,遗留线状瘢痕,2例供区少量皮片移植修复。结论背阔肌皮瓣解剖恒定,血运可靠,供区隐蔽,切取面积范围大,是修复肢体严重创伤大面积软组织缺损的良好方法,而且采取双叶切取既有利于供区创面直接缝合,又有利于不规则创面的修复。

脱细胞真皮基质和带蒂颊脂垫瓣修复颊部软组织缺损的对比研究

目的比较脱细胞真皮基质(ADM)和带蒂颊脂垫瓣(PBFPF)修复颊部软组织缺损的效果。方法选取我院84例行颊黏膜缺损修复的患者,随机分为ADM组和PBFPF组,每组42例。ADM组患者采用ADM修复,PBFPF组患者使用PBFPF修复。比较2组患者修复时间、经口进食时间、住院时间。于术前、术后1周、术后1个月、术后6个月测量并比较患者的最大开口度,记录患者的修复有效率及并发症发生情况。观察患者术后口腔颌面部功能(吞咽功能、语言功能、咀嚼功能)改善情况。结果2组患者修复时间、经口进食时间、住院时间、并发症总发生率、术后吞咽功能、术后语言功能比较,差异均无统计学意义(P>0.05)。ADM组与PBFPF组患者最大开口度组间比较、组间与时点的交互效应差异无统计学意义(P>0.05),时点的比较差异有统计学意义(P<0.05)。PBFPF组中缺损面积为>13~20 cm2的患者修复有效率高于ADM组(P<0.05)。PBFPF组患者的咀嚼功能优于ADM组(P<0.05)。结论PBFPF及ADM用于口腔黏膜组织缺损的修复各有优势,对于黏膜缺损面积较大(>13~20 cm2)的患者,PBFPF的修复效果更好。

改良腓动脉穿支螺旋桨皮瓣在足踝部皮肤软组织缺损中的修复效果

目的:探讨足踝部皮肤软组织缺损患者采用改良腓动脉穿支螺旋桨皮瓣修复的效果。方法:选择2019年7月—2022年12月贵州省人民医院整形烧伤外科收治的100例足踝部皮肤软组织缺损行皮瓣修复的患者。按照随机数表法分为对照组和观察组,各50例,对照组予以腓动脉穿支皮瓣修复,观察组予以改良腓动脉穿支螺旋桨皮瓣修复。观察两组皮瓣情况(皮瓣一期成活率、增生性瘢痕、色素沉着发生率)、皮瓣感觉功能、踝关节活动度(踝关节跖屈、背伸角度)及踝关节功能[美国足踝外科协会(AOFAS)踝与后足评分系统评分]。结果:观察组皮瓣一期成活率为94.00%,高于对照组的80.00%,差异有统计学意义(P<0.05);两组术后增生性瘢痕、色素沉着发生率比较,差异无统计学意义(P>0.05)。观察组皮瓣感觉恢复优良率为88.00%,高于对照组的72.00%,差异有统计学意义(P<0.05)。术后6个月,两组踝关节跖屈、背伸角度高于术前,且观察组高于对照组,差异有统计学意义(P<0.05)。术后6个月,两组疼痛、力线及功能维度评分高于术前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:改良腓动脉穿支螺旋桨皮瓣在足踝部皮肤软组织缺损修复中血运可靠,能改善踝关节功能,促进皮瓣感觉功能恢复,提高皮瓣一期成活率。

Effect of a combination of local flap and sequential compression- distraction osteogenesis in the reconstruction of post-traumatic tibial bone and soft tissue defects

Background Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizarov osteogenesis in the reestablishment of severe combined defects of tibial bone and soft tissue. Methods Sixteen patients with bone and soft tissue defects were included. The mean age of the patients was 31.5 years. The average time from injury to initial surgery was 14.4 weeks. The average soft tissue and bone defect sizes were 92.9 cm2 and 8.7 cm, respectively. Local flaps were created to reconstruct the soft tissue defects. The Ilizarov external fixator or the Orthofix Limb Reconstruction System was used to reconstruct bony defects using delayed distraction osteogenesis. Results Two myocutaneous flaps and 14 reverse island flaps were applied. All transferred flaps survived. Fifteen patients healed with equal leg length, and one healed with a residual leg-length discrepancy of 1.5 cm. One patient with an Ilizarov external fixator developed ankle joint stiffening and a pin-track infection that was successfully treated with oral antibiotics. No patient developed pin loosening. All patients walked without assistance. Fifteen patients returned to their work, and one lost her job. The results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 14 and good in two patients. Functional assessment scores were excellent in 13, good in two, and fair in one patient. Conclusion The combination of local flaps and sequential distraction osteogenesis can be used for successful reconstruction of defects of incorporated bone and soft tissue.

股前外侧皮瓣修复足踝部复合组织缺损的临床疗效分析

目的研究分析股前外侧皮瓣修复足踝部复合组织缺损的临床疗效。方法回顾性分析2020年1月至2023年6月本院收治的足踝部复合组织缺损患者共92例,根据皮瓣修复手术方法不同将92例患者分为两组,其中观察组51例,行股前外侧皮瓣修复治疗,对照组41例,行小腿岛状穿支皮瓣修复治疗。结果观察组患者的手术治疗时间,皮瓣愈合时间均明显短于对照组患者,差异具有统计学意义(P<0.05);两组患者术后皮瓣均完全成活;术后3个月,观察组患者AOFAS评分明显高于对照组(P<0.05);术后3个月,观察组患者BMRC感觉功能恢复分级中,S3-S4级占比明显高于对照组患者(P<0.05);观察组患者术后并发症发生率(11.76%)与对照组患者术后并发症发生率(12.20%)无明显差异,比较无统计学意义(χ^(2)=0.8214,P>0.05)。结论采用股前外侧皮瓣修复足踝部复合软组织缺损,可以获得较好的临床疗效,患者术后足踝功能以及皮瓣感觉功能恢复更好,适合临床选择应用。

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

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.

Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects:a systematic review and meta-analysis of outcomes and complication rates

Background:Currently,various external tissue expansion devices are becoming widely used.Considering the scarcity of relevant application standards,this systematic review was performed to explore the effectiveness and safety of external tissue expansion techniques for the reconstruction of soft tissue defects.Method:A systematic review and meta-analysis on the efficacy and safety of external tissue expansion technique was conducted.A comprehensive search was performed in the following electronic databases:PubMed/Medline,Embase,Cochrane Library(Wiley Online Library),andWeb of Science.Studies reporting patients with soft tissue defects under the treatment of external tissue expansion technique were included.Results:A total of 66 studies with 22 different types of external tissue expansion devices met the inclusion criteria.We performed a descriptive analysis of different kinds of devices.A single-arm meta-analysis was performed to evaluate the efficacy and safety of the external tissue expansion technique for different aetiologies.The pooled mean wound healing time among patients with defects after fasciotomy was 10.548 days[95%confidence interval(CI)=5.796-15.299].The pooled median wound healing times of patients with defects after excisional surgery,trauma,chronic ulcers and abdominal defects were 11.218 days(95%CI=6.183-16.253),11.561 days(95%CI=7.062-16.060),15.956 days(95%CI=11.916-19.996)and 12.853 days(95%CI=9.444-16.227),respectively.The pooled wound healing rates of patients with defects after fasciotomy,excisional surgery,trauma,chronic ulcers and abdominal defects were 93.8%(95%CI=87.1-98.2%),97.2%(95%CI=92.2-99.7%),97.0%(95%CI=91.2-99.8%),99.5%(95%CI=97.6-100%),and 96.8%(95%CI=79.2-100%),respectively.We performed a subgroup analysis in patients with diabetic ulcers and open abdominal wounds.The pooled median wound healing time of patients with diabetic ulcers was 11.730 days(95%CI=10.334-13.125).The pooled median wound healing time of patients with open abdomen defects was 48.810 days(95%CI=35.557-62.063)and the pooled successful healing rate was 68.8%(95%CI=45.9-88.1%).A total of 1686 patients were included,265(15.7%)of whom experienced complications.The most common complication was dehiscence(n=53,3.14%).Conclusions:Our systematic review is the first to demonstrate the efficacy and safety of external tissue expansion in the management of soft tissue defects.However,we must interpret the meta-analysis results with caution considering the limitations of this review.Large-scale randomized controlled trials and long-term follow-up studies are still needed to confirm the effectiveness and evaluate the quality of healing.