Pedicled abdominal flap using deep inferior epigastric artery perforators for forearm reconstruction: A case report

BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.

Clinical applications of free medial tibial flap with posterior tibial artery for head and neck reconstruction after tumor resection

Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection. We discussed the anatomy, surgical technique, and the advantages and disadvantages of the flap. We found several benefits for the flap, such as, it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect; a two-team approach can be used because the donor site is far away from the head and neck; and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft. Thus, the medial tibial flap could replace the forearm flap for certain applications.

Supraclavicular artery island flap for reconstruction of hypopharynx and upper esophagus defects:A case report and literature review

We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy.To reconstruct the hypopharynx,upper esophagus,and neck skin defect,we used a supraclavicular artery island flap(SCAIF)for one-stage reconstruction.SCAIF offered reliable blood supply,minimal donor site morbidity,and excellent cosmetic outcomes.Although a small portion of the flap developed necrosis,it healed without surgical intervention.We also conducted a literature review of previously published articles on SCAIF for head and neck reconstruction.Our review highlights the advantages and limitations of SCAIF as a promising option for one-stage reconstruction of complex hypopharyngeal and upper esophageal defects with neck skin defects in selected patients.This case report provides valuable insights into the use of SCAIF in complex head and neck reconstructions,which can help improve patient outcomes and quality of life.

Role of Reversed Sural Artery Flap in Reconstruction of Lower Third of the Leg, Ankle and Foot Defects

Introduction: Coverage of defects of the distal lower extremity and foot remains a challenging reconstructive prcedure. Free tissue transfer remains the standard for the management of these defects. However, there are some disadvantages like;longer operative times, bulky contour, and the need for highly skilled expertise. The reverse superficial sural artery flap (RSSAF) is a distally based fasciocutaneous or adipo-fascial flap that is used for coverage of defects that involve the distal third of the leg, ankle, and foot. A significant advantage of this flap is a constant blood supply that does not require sacrifice of a major artery. Methods: Twenty RSSAF flaps were harvested for reconstruction of different traumatic soft tissue defects of the lower third of leg, ankle and foot. Follow up for 6 months postoperative. Results: Twenty Patients;twelve males and eight females underwent reconstruction of different soft tissue defects over the foot and ankle using RSSAF. The overall complications occurred in 6 flaps;4 minor and 2 major complications. The remaining 14 flaps passed an uneventful follow up. Conclusions: The reverse superficial sural artery flap RSSAF can be used as a reliable alternative to free tissue transfer in reconstruction of defects over the lower third of leg, ankle, and foot. Venous congestion is the major threat to the flap but its incidence can be minimized by wide pedicle, less kink of the flap, and keep the venae comitants around the artery.

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.

The Effect of Fascial Pedicled Island Flap of the First Metacarpal Radial Dorsal Artery Skin Branch Chain on the Repair of Thumb Tissue Defect

Objective To analyze the effect of fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain on the repair of thumb tissue defect.Methods take the 100 patients with thumb tissue defects treated in our hospital from 2017.01 to 2019.01 as the research objects,and divide them into control group and observation group randomly,50 cases in each group.In the observation group,the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain is used for repair,and in the control group,the thumb tissue is repaired with abdominal flap.Compare the DASH scores and outcomes of two groups.Results After treatment,the DASH score in the observation group is significantly lower than that in the control group,which is statistically significant(P<0.05);The operation time and intraoperative blood loss of Observation Group is significantly lower than Control Group,which is statistically significant(P<0.05).Conclusion Repairing defected thumb with the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chaint has the advantages of simple operation and easy mastery,and has significant curative effect on patients.It is an effective way to repair partial thumb defect,and worth popularizing.

Applied anatomy of radial midforearm flap pedicled with intermuscular branch of radial artery

To provide anatomic basis for transposition of vascularized radial midforearm flap.Methods On 40 adult cadaveric upper limb specimens injected with red dye,the origin,course,branchs,diameters and anastomosis of intermuscular branch of radial artery and its cutaneous branch were observed.Results Originating from radial artery,intermuscular branch of radial artery descended along periosteum closely between pronator teres and supinator,the main stem was (4.8±1.0)cm in length and (1.2±0.2)mm in diameter.After its periosteal branches were sent off to distribute over middle and inferior shaft of radius,its cutaneous branch perforated from intermuscle and deep fascia and anastomosed with some other cutaneous branches in the forearm.Perforating point of the cutaneous branch was located (11.1±1.3)cm beneath lateral epicondyle of humerus,its diameter was about (0.6±0.1)mm.Conclusion Radial midforrarm flap pedicled with intermuscular branch of radial artery can be transferred to repair soft tissue defect of elbow,forearm or hand.7 refs.

Application of fascial flaps of supraclavicular artery in repair of neck scar contracture

Objective To observe eflect uf fascial flaps of supraclavicular artery on treatment of neck scar contracture. Methods The supraclavicular flaps were designed according to direction of supraclavicular arteries and transferred into detective areas caused by scar releasing.

Repairing small wounds around ankle by medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus

Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle Methods From Jan. 2005 to Jun. 2009,10 cases with small wounds around ankle

Bilateral Pedicled Superficial Epigastric Flap in the Management of Circumferential Combined Degloving and Full Thickness Burn Hand Injury—A Case Report

We report a case of combined hand trauma in the form of circumferential degloving injury of the hand with full thickness friction burns of the hand, forearm and the distal part of the upper arm. On exploration the hand was found avascular with loss of vital structures and full thickness burns. As a salvage procedure the hand was embedded in the subcutaneous tissue of the abdomen for 4 weeks and after that elevated as an inferiorly based flap on the bilateral superficial inferior epigastric arteries. Two weeks later the hand was freed by division of the base of the flap bilaterally. The details and description of the injury, the procedure and the outcome are discussed.

Devastating complication of negative pressure wound therapy after deep inferior epigastric perforator free flap surgery:A case report

BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.

Macro-micro-anatomy of myocutaneous flaps on the dorsum of foot

Thirty feet of Chinese adult cadavers were dissected under an operativemicroscope to observe the extensor hallucis brevis and extensor digitorum brevisand their vessels and nerves in order to design myocutaneous flaps.It was be-lieved that the lateral tarsal artery and the lateral branch of the deep peronealnerve are the best choice to be included in the pedicle when muscle flaps ormyocutaneous flaps are to be obtained from the dorsum of foot.The size of themuscles may be enlarged both laterally and medially as the clinicalcondition requires.

Double Forehead Expanded Flaps for Reconstruction of Total Nasal Defect: A Case Report

Objective To introduce a method for total nasal defect reconstruction with a double forehead expanded flap.Case presentation A 55-year-old man underwent three-stage total nasal reconstruction for a complete nasal defect due to electrical injury.The skin expander was implanted during the 1st stage.Total nasal reconstruction was performed with double expanded forehead flap transfer during the 2nd stage.The unilateral forehead flap was used for lining and the contralateral forehead flap,together with the autologous cartilage and titanium mesh framework,were used for skin replacement.The forehead donor defect was covered with a skin graft.Pedicle division and inset were performed in the 3rd stage.Results There was no flap loss,infection,hematoma,rhinostenosis,or implant exposure over the 2-year follow-up,and satisfactory aesthetic results were achieved.Conclusion The double forehead expanded flap method is useful for the reconstruction of large composite nasal defects in patients who are not suitable for nasolabial flaps and those who may not tolerate free tissue transfer.The operation has fewer complications and is uncomplicated.

Adipo Fascio Cutaneous Perforator Based, Shape Modified Radial Forearm Flap: Vascular Analysis of Perforators &Its Clinical Applications in Head &Neck Reconstruction

Resume of the study & Background: Radial forearm free flap with all its present day modifications is the workhorse of soft tissue reconstruction. Although there are several advantages, it requires sacrifice of a major artery of forearm. Several modifications are described in harvesting a forearm flap. In order to achieve a reliable, safe flap harvest & design one must have a very clear understanding of radial artery perforators, relative to its distribution, territory & flow. The purpose of this study is to determine the location, size & vascular territory of the radial artery cutaneous perforators & to demonstrate application of shape modification of radial forearm free flap based on its distal & proximal perforators in various head & neck defects. Materials & Methods: Anatomical Study: 12 fresh human cadavers & 24 cadaveric forearms were dissected to determine the number, location, size & vascular territory of radial artery perforator. The cutaneous territory of distally dominant perforators was analyzed using methylene blue injections & three-dimensional computed tomographic angiogram to determine the vascular network. Clinical Study: 15 patients with various head neck defects following oncological resections were reconstructed with shape modified adipo-fascio cutaneous free forearm flap. All these patients were prospectively followed for donor site healing, motor & sensory nerve deficit, function & quality of life questioner for donor site assessment. Results: 12 fresh human cadavers & 24 cadaveric forearms were dissected, and a total of 222 perforators were dissected for an average of 18.5 perforators per forearm. 118 were smaller than 0.5 mm in diameter (53.15%) & were not clinically significant. 104 perforators were greater than 0.5 mm in diameter (46.84%) & were clinically significant. 127 perforators (57.20%) were radially distributed & 95 perforators (42.79%) had ulnar distribution. 90 perforators (40.54%) were identified on distal side (Radial styloid) & 132 perforators (59.45%) were identified on proximal side (Lateral epicondyle). Mean number of perforators, on radial side was 10.6 & 7.9 on ulnar side;comparison of both using student t paired test gives a P value of 0.006, which is significant. Comparison of mean number of perforators on the distal side was 7.5 & proximal side was 11.0;Student Paired t test gives a P value of 0.003, which was statistically significant. Comparison of mean diameter of perforators on Distal side (1.11) & Proximal side (0.86), side using Student Paired t test gives a P value of 0.01 which was statistically significant. A chi square test was done to compare mean diameter of perforators on distal side, which was more than 1 mm (80%) & less than 1 mm (20%) & on proximal side more than 1 mm (35.6%) & less than 1 mm (64.4%). Chi square value of 42.406 was obtained, degree of freedom value was 1 & P value of Conclusion: Increase in knowledge of vascular territory of radial artery perforators with regards to numbers, size, location, & cutaneous territory can lead to expanded use of radial forearm flap based on either distal or proximal perforator alone. Shape modified technique for harvesting radial forearm flap allows primary closure of donor site. Donor site is better healed and shows a predicted pattern, which is functionally and aesthetically good.

Anatomical study of Rubens'flap in breast reconstruction

Objective:To investigate the anatomical basis of Rubens'flap based on the deep circumflex iliac artery,and to apply more donor site tissue amount for big chest wall defect.Methods:Gross anatomical study was carried on 8 sides of fresh specimens of 4 cases and data was measured by mean of the Vernier caliper.Besides,the surgical simulation was carried on 1 specimen(2 sides).Results:At the inguinal segment,the via artery gave off(9.16±6.22)branches;the diameter of the origin was(3.97±0.86)mm;the distance from starting point to the first branch was(15.87±9.24)mm;amount of osteomusculocutaneous branch was 3.12±1.34;the biggest diameter of perforator was(1.48±1.02)mm;pedicle length was(132.51±48.24)mm.In the surgical simulation,the layers of Ruben's flap from up to down ranged in skin,subcutaneous tissue,obliquus externus abdominis,oblique internal abdominis and transversus abdominis.Conclusion:Rubens'flap,with large tissue amount,based on the deep circumflex iliac artery,near to traditional abdominal flap,has a good clinical application prospect in breast reconstruction and repair of big chest wall defect,for its thin waist effect and slight donor site defect.

Expanded Forehead Stepped Flaps for Delayed Three-Stage Repair of Midface Skin Lesions

Background The forehead flap is the best flap for nasal defect repair and nasal reconstruction.It is also an ideal option for repairing skin lesions in the midface(including the nasal area,inner area of the cheek,and upper lip of the perioral area).However,the traditional frontal myocutaneous flap is relatively bulky for repairing pure skin lesions.In addition,the original forehead flap is generally not sufficient to cover a large wound area.If a large forehead flap is removed,the donor site cannot be sutured in one stage.In this study,an expanded forehead stepped flap was used to overcome the shortcomings of the traditional frontal myocutaneous flap.Methods In stage one surgery,a rectangular expander(80–100 mL)was implanted on the side of the forehead.The expansion pot was built-in,and the excess expansion amount was 160–200 mL.After 4 weeks of rest,stage two operation was performed to remove the skin lesions in the midface.The pulsation point of the supratrochlear artery on one side was used as the pedicle,and the flap was designed diagonally to the upper region of the opposite side.The flap was designed according to the size and shape of the wound.The distal portion of the flap was separated in the superficial layer of the frontalis muscle,approximately 1.7 cm above the superior orbital edge,and cut into the submuscle.The flap pedicle was cut from the superficial layer of the periosteum to form a stepped flap.Then,the flap was rotated downward to repair the wound in the midface.Five weeks later,stage three of the operation which involved flap pedicle division,was performed.Results Expanded forehead stepped flaps were used in 12 cases with 6–36 months of follow-up.In all cases,the blood supply to the flaps was good,and their color,texture,and thickness matched well with those of the surrounding skin.All patients were satisfied with the outcome of the repair.Conclusion Expanded forehead stepped flaps present an ideal option for repairing wounds after large skin lesion resections in the midface since they have multiple edges from a reliable blood supply,easiness to transfer,and well-matched color,texture,and thickness to those of the surrounding skin of the face to no need for many auxiliary incisions.

Unusual disposition of lateral circumflex femoral artery: Anatomical description and clinical implications

The anatomical knowledge of arterial variations of lower limb is of utmost significance for the present day surgeons and interventional radiologists for minimizing complications during vascular reconstructive procedures, catheterization procedures and surgical intervention for embolism. Lateral Circumflex Femoral Artery(LCFA) isan important branch of Profunda Femoris artery and precise knowledge of its variations can be of great relevance during surgical and radiological procedures in femoral region. The present study reports a unique case of anomalous route taken by LCFA posterior to femoral nerve associated with a prominent muscular branch from Femoral artery mimicking the course of LCFA. Documentation of such variations is highly significant. It may serve as guideline for surgeons in reducing the incidence of postoperative complications where LCFA is used as a long vascular pedicle in anterolateral perforator thigh flap and in breast reconstruction after mastectomy. Ignorance of such variations can lead to fatal intraoperative haemorrhage and incapacitating sensory and motor deficit due to injury to femoral nerve branches which are closely related to these vessels.

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。

分叶股前外侧穿支皮瓣在四肢软组织缺损修复中的应用

目的报道应用分叶股前外侧穿支皮瓣修复四肢大面积软组织缺损的临床效果。方法2014年11月至2024年4月,应用分叶股前外侧穿支皮瓣修复四肢复杂软组织缺损168例。皮瓣切取面积24 cm×7 cm~37 cm×10 cm。穿支皮瓣的动脉、静脉、皮神经分别与受区动脉、静脉、皮神经吻合,168例供区均一期直接缝合。术后随访5个月~7年,随访方式门诊及微信,内容包括皮瓣血运、色泽及质地、外观、感觉恢复及供区愈合情况。结果165例皮瓣全部成活,无感染发生。1例单叶皮瓣坏死,2例皮瓣完全坏死,二次手术清创,待创面清洁后予以游离皮片移植,创面愈合。皮瓣供区一期美容缝合,无骨筋膜室综合征发生。术后随访5个月~7年,成活皮瓣血运良好,色泽、质地与受区相近,其中3例外形略臃肿,二期行皮瓣整形手术,术后外形满意。皮瓣供区术后呈线形瘢痕,位置隐蔽,无明显增生。结论股前外侧穿支皮瓣由旋股外侧动脉滋养,该动脉解剖分支位置相对稳定,穿支多,适合进行分叶皮瓣的设计。分叶设计及切取的方式既可以修复位置相近的多处创面;又可以将受区的宽度转化为供区的长度,使供区一期闭合创口;同时,在手足解剖分界部位通过分叶设计可以展现良好的生理折线。分叶股前外侧穿支皮瓣是一种理想的的修复四肢复杂软组织缺损的方法。