Objective：To explore a surgical model of utilizing consecutive free scapular flap and adjacent pedicled flap transfer for repairing massive soft tissue defects on the dorsum of the hand while minimizing the donor sit...Objective：To explore a surgical model of utilizing consecutive free scapular flap and adjacent pedicled flap transfer for repairing massive soft tissue defects on the dorsum of the hand while minimizing the donor site morbidity.Methods：Six patients with massive soft tissue injuries on the opisthenar and forearm were treated with free scapular flaps.Afterwards,a pedicled flap adjacent to the donor site was transferred to cover the donor site defect by direct closure.Results：All six free scapular flaps survived without signs of infection.Three adjacent pedicled flaps presented minor signs of insufficient blood flow on the distal apex,which resolved after six weeks with only conservative therapy.All the incisions healed without other complications.At six-month follow-up,the patients regained full shoulder function.Conclusion：With the assistance of an adjacent pedicled flap,the scapular flap is a highly applicable approach in repairing massive soft tissue defects in the opisthenar.It can achieve positive outcomes in both reconstructive and aesthetic aspects.展开更多
Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period. Methods: Twenty-two flap reconstructions were performed to treat soft-tissue de...Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period. Methods: Twenty-two flap reconstructions were performed to treat soft-tissue defect of 22 patients with open tibial fracture Type IIIB (Gustilo) from 1993 to 1998. The cases were analyzed and discussed retrospectively after follow up of 12-61 months. Results: The size of the flap ranged from 6.6 cm 2 to 28.18 cm 2 and the rate of flap failure was 13.6%. Besides, 3 partial necrosis and 2 postoperative infections occurred in this series. Conclusions: For soft tissue defect of delayed open tibial fracture Type IIIB, flap reconstruction is still an optimal option. The experiences we obtained are ① to design a triangular skin extension or a small Z-plasty over the pedicle to reduce the flap tension; ② to select a unilateral external fixation to provide convenience for any secondary manipulation; and ③ to use serial debridement to diminish flap failure.展开更多
A 48-year-old man sustained a traffic accident injury to his left leg. It was an open fracture of the left tibia and fibula accompanied by a large soft tissue de- fect （27 cmx7 cm）. Doppler examination revealed the ...A 48-year-old man sustained a traffic accident injury to his left leg. It was an open fracture of the left tibia and fibula accompanied by a large soft tissue de- fect （27 cmx7 cm）. Doppler examination revealed the poste- rior tibial artery was occluded due to thrombosis. Three weeks after injury, the latissimus dots myocutaneous flap was elevated with a T-shaped vascular pedicle and was in- terposed between the two vascular ends of the posterior tibial vessel of the contralateral leg. Two end to end anasto- moses were performed between the two vascular ends of the posterior tibial vessel of the contralateral leg and the latissimus dors myocutaneous flap＇s T-shaped vascularpedicle. The latissimus dorsi myocutaneous flap was used for repair of a large soft tissue defect of the left leg. The vascular pedicle was cut off after 28 days and the flap sur- vived completely. After 3-years＇ follow-up postoperatively, a good contour was confirmed at the recipient area. The right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery ofcontralateral leg was demonstrated patent by clinical and Doppler examinations.展开更多
文摘Objective：To explore a surgical model of utilizing consecutive free scapular flap and adjacent pedicled flap transfer for repairing massive soft tissue defects on the dorsum of the hand while minimizing the donor site morbidity.Methods：Six patients with massive soft tissue injuries on the opisthenar and forearm were treated with free scapular flaps.Afterwards,a pedicled flap adjacent to the donor site was transferred to cover the donor site defect by direct closure.Results：All six free scapular flaps survived without signs of infection.Three adjacent pedicled flaps presented minor signs of insufficient blood flow on the distal apex,which resolved after six weeks with only conservative therapy.All the incisions healed without other complications.At six-month follow-up,the patients regained full shoulder function.Conclusion：With the assistance of an adjacent pedicled flap,the scapular flap is a highly applicable approach in repairing massive soft tissue defects in the opisthenar.It can achieve positive outcomes in both reconstructive and aesthetic aspects.
文摘Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period. Methods: Twenty-two flap reconstructions were performed to treat soft-tissue defect of 22 patients with open tibial fracture Type IIIB (Gustilo) from 1993 to 1998. The cases were analyzed and discussed retrospectively after follow up of 12-61 months. Results: The size of the flap ranged from 6.6 cm 2 to 28.18 cm 2 and the rate of flap failure was 13.6%. Besides, 3 partial necrosis and 2 postoperative infections occurred in this series. Conclusions: For soft tissue defect of delayed open tibial fracture Type IIIB, flap reconstruction is still an optimal option. The experiences we obtained are ① to design a triangular skin extension or a small Z-plasty over the pedicle to reduce the flap tension; ② to select a unilateral external fixation to provide convenience for any secondary manipulation; and ③ to use serial debridement to diminish flap failure.
文摘A 48-year-old man sustained a traffic accident injury to his left leg. It was an open fracture of the left tibia and fibula accompanied by a large soft tissue de- fect （27 cmx7 cm）. Doppler examination revealed the poste- rior tibial artery was occluded due to thrombosis. Three weeks after injury, the latissimus dots myocutaneous flap was elevated with a T-shaped vascular pedicle and was in- terposed between the two vascular ends of the posterior tibial vessel of the contralateral leg. Two end to end anasto- moses were performed between the two vascular ends of the posterior tibial vessel of the contralateral leg and the latissimus dors myocutaneous flap＇s T-shaped vascularpedicle. The latissimus dorsi myocutaneous flap was used for repair of a large soft tissue defect of the left leg. The vascular pedicle was cut off after 28 days and the flap sur- vived completely. After 3-years＇ follow-up postoperatively, a good contour was confirmed at the recipient area. The right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery ofcontralateral leg was demonstrated patent by clinical and Doppler examinations.
