Objective To investigate the clinical effect of different types of skin flap transplantation in repairing forefoot lesion.Methods From January 2016 to June 2019,62 patients with forefoot damage were selected and their...Objective To investigate the clinical effect of different types of skin flap transplantation in repairing forefoot lesion.Methods From January 2016 to June 2019,62 patients with forefoot damage were selected and their clinical data were retrospectively analyzed.All the selected patients received skin flap transplantation and repair,of which 26 patients received free myocutaneous flap transplantation and repair,and were treated as group A.The other 36 patients underwent retrograde foot flap transplantation and repair.They were taken as group B,and the clinical treatment methods and curative effects were summarized.Results Among the 26 patients in group A,the skin flaps of 21 patients survived completely,while those of the other 5 patients showed partial necrosis at the edge of the skin flaps.They were treated with free skin grafting and healed after regular dressing change.All the skin flaps survived.Follow-up for at least 6 months showed that 11 patients had mild claudication and skin flap sensation was slightly poor.Among the 36 patients in group B,only 2 cases suffered from distal partial necrosis after the operation,which was caused by large tension after dorsum pedis flap transplantation.After systematic treatment and regular dressing change by doctors,the flaps of 2 patients healed.In addition,venous reflux disorder occurred in 3 patients with medial saphenous nerve nutrient vessel flap of the foot,which was related to swelling factors.The flaps of other patients survived,healed well and did not show infection symptoms.Conclusion According to the actual condition of patients with forefoot damage,the flap repair method is formulated,which has good short-term and long-term therapeutic effects and plays an important role in repairing forefoot damage.展开更多
Background The radial forearm skin flap(RFSF)was first introduced by the Chinese scholar Guofan Yang and has since been used for nearly 40 years.The many advantages of RFSF have been investigated in this study.Case pr...Background The radial forearm skin flap(RFSF)was first introduced by the Chinese scholar Guofan Yang and has since been used for nearly 40 years.The many advantages of RFSF have been investigated in this study.Case presentation In this case,a female patient underwent RFSF surgery in 1979.In 2016 and 2018,two interviews were held to evaluate her subjective postoperative experience.In addition,overall donor site evaluation was conducted based on general health checkups and tests;tests for appearance,tactile sensitivity,muscle strength,and motor function;and CTA.Results The flap survived well,and the donor site recovered without hand necrosis in the 1970s.In 2018,the patient was in good health condition and expressed her satisfaction with the surgery.The patient did not suffer from any postoperative complications such as diminished sensation of the donor site or donor site dysfunction;in the evaluation of hand and finger function,there was no point where functional reduction of the donor site was noted.CTA revealed compensatory blood supply with enlargement in the diameter of the ulnar and interosseous artery.Conclusion After a nearly 40-year follow-up,the patient who underwent the first free radial forearm flap transplantation expressed satisfaction with the operative outcomes.The examination showed good results at the recipient site with little donor site deformities and good compensatory blood supply.展开更多
Aim:Post-operative protocols following lower limb free flap surgery are not well defined,with a lack of consensus in the literature around limb dependency and weight bearing.The aim was to compare the complication rat...Aim:Post-operative protocols following lower limb free flap surgery are not well defined,with a lack of consensus in the literature around limb dependency and weight bearing.The aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling(day 3 vs.day 4)and weight bearing(day 5 vs.day 14)post lower limb free flap surgery.Methods:All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap database.Patient data were collected from the comprehensive lower limb free flap database,medical notes,and electronic records.Patients prescribed an extended non-weight-bearing period due to the method of bone fixation were excluded.Results:A total of 37 patients,15 pre-and 22 post-enhanced protocol,were identified for comparison.The mean age was 43(17-72)with a M:F of 3:1.There was no difference in the type of flap reconstruction between groups,with the anterolateral thigh flap being the most common in both groups.No differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol,with the mean length of stay reduced from 12.1 to 10.6 days(P=0.34).Conclusion:The new enhanced protocol remains the standard of care in our unit,as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.展开更多
Background: Ballistic high-energy trauma has substantially increased the severity of non-fatal extremity injuries incurred in modern warfare. Expedient medical care, refinement in surgical techniques, and soft tissue ...Background: Ballistic high-energy trauma has substantially increased the severity of non-fatal extremity injuries incurred in modern warfare. Expedient medical care, refinement in surgical techniques, and soft tissue coverage have brought about a paradigm shift in the management of lower extremity wounds during the last decade with an increased emphasis on limb salvage.Methods: A literature-based study was conducted to analyze reconstructive modalities based on the location, depth, and severity of wounds, as well as mechanism of injury, concomitant vascular injuries and open fractures, choice of flap, timing of definitive reconstruction, and complications.Results: Extremity injuries account for over 60% of injuries in the recent conflicts in Iraq and Afghanistan, with the majority secondary to explosive devices. The severity of these injuries is profound compared with civilian registries, and conventional injury scoring systems have failed to accurately predict outcomes in combat trauma. The mainstay of treatment is serial debridement, negative pressure therapy, fracture stabilization, and treatment of concomitant injuries by the forward medical teams with subsequent definitive reconstruction after transport to an advanced military treatment facility. Autologous reconstruction with free tissue transfer and pedicled flaps remains the primary modality for soft tissue coverage in limb salvage. Adjunct innovative modalities, such as external tissue expansion, dermal substitutes, and regenerative matrices, have also been successfully utilized for limb salvage.Conclusion: Lower extremity injuries account for the vast majority of injuries in modern warzones. Explosive devices represent the most common mechanism of injury, with blast impact leading to extensive soft tissue injuries necessitating complex reconstructive strategies. Serial debridement, negative pressure therapy, and autologous reconstruction with free tissue transfer and pedicled flaps remain the mainstay of treatment in recent conflicts.展开更多
Aim:Free tissue transfer is essential for extremity reconstruction following traumatic injuries,oncologic resection,and diabetic complications.However,given the circumferential shape of the arm and leg,a small amount ...Aim:Free tissue transfer is essential for extremity reconstruction following traumatic injuries,oncologic resection,and diabetic complications.However,given the circumferential shape of the arm and leg,a small amount of ongoing edema can prevent a tension-free closure.Additionally,intraoperative thrombosis,vascular disease can lead to proximal exposure of the pedicle or vein grafts.This study evaluates the outcomes of microvascular transfers that utilized a skin graft for closure over the pedicle,in comparison with a matched cohort with a tension-free primary closure.Methods:A retrospective review was completed of all patients that underwent free flap reconstruction of an extremity defect from January 2014 to December 2017 at a single academic institution.Flaps that utilized skin grafting for closure were compared to those closed primarily.Adjunct operative procedures,demographics,and complications were evaluated.Results:A total of 71 patients fulfilled the inclusion criteria.The 11 flaps in 10 patients underwent skin grafting over the pedicle.The two cohorts were comparable in age,gender,BMI,and co-morbidities,excluding renal disease which was present in 40%(n=4)of skin grafted group compared to 6.5%(n=4)in the primary closure group.Flap area,operative time,and anastomosis technique were comparable between the two groups.There was no significant difference in the rates of post-operative complications including partial flap loss,complete flap loss,infection.Mean follow up time in the skin grafting group was 14.2 months and 20.2 months for the primary closure group. ;Conclusion:As per the principal,a tension-free closure is paramount to preventing tissue complications including direct compression of a microvascular pedicle.However,with ongoing tissue edema skin grafting should be considered as a reliable technique to ensure both protection of the pedicle as well as prevention of direct compression without additional complications and comparable post-operative outcomes.展开更多
文摘Objective To investigate the clinical effect of different types of skin flap transplantation in repairing forefoot lesion.Methods From January 2016 to June 2019,62 patients with forefoot damage were selected and their clinical data were retrospectively analyzed.All the selected patients received skin flap transplantation and repair,of which 26 patients received free myocutaneous flap transplantation and repair,and were treated as group A.The other 36 patients underwent retrograde foot flap transplantation and repair.They were taken as group B,and the clinical treatment methods and curative effects were summarized.Results Among the 26 patients in group A,the skin flaps of 21 patients survived completely,while those of the other 5 patients showed partial necrosis at the edge of the skin flaps.They were treated with free skin grafting and healed after regular dressing change.All the skin flaps survived.Follow-up for at least 6 months showed that 11 patients had mild claudication and skin flap sensation was slightly poor.Among the 36 patients in group B,only 2 cases suffered from distal partial necrosis after the operation,which was caused by large tension after dorsum pedis flap transplantation.After systematic treatment and regular dressing change by doctors,the flaps of 2 patients healed.In addition,venous reflux disorder occurred in 3 patients with medial saphenous nerve nutrient vessel flap of the foot,which was related to swelling factors.The flaps of other patients survived,healed well and did not show infection symptoms.Conclusion According to the actual condition of patients with forefoot damage,the flap repair method is formulated,which has good short-term and long-term therapeutic effects and plays an important role in repairing forefoot damage.
文摘Background The radial forearm skin flap(RFSF)was first introduced by the Chinese scholar Guofan Yang and has since been used for nearly 40 years.The many advantages of RFSF have been investigated in this study.Case presentation In this case,a female patient underwent RFSF surgery in 1979.In 2016 and 2018,two interviews were held to evaluate her subjective postoperative experience.In addition,overall donor site evaluation was conducted based on general health checkups and tests;tests for appearance,tactile sensitivity,muscle strength,and motor function;and CTA.Results The flap survived well,and the donor site recovered without hand necrosis in the 1970s.In 2018,the patient was in good health condition and expressed her satisfaction with the surgery.The patient did not suffer from any postoperative complications such as diminished sensation of the donor site or donor site dysfunction;in the evaluation of hand and finger function,there was no point where functional reduction of the donor site was noted.CTA revealed compensatory blood supply with enlargement in the diameter of the ulnar and interosseous artery.Conclusion After a nearly 40-year follow-up,the patient who underwent the first free radial forearm flap transplantation expressed satisfaction with the operative outcomes.The examination showed good results at the recipient site with little donor site deformities and good compensatory blood supply.
文摘Aim:Post-operative protocols following lower limb free flap surgery are not well defined,with a lack of consensus in the literature around limb dependency and weight bearing.The aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling(day 3 vs.day 4)and weight bearing(day 5 vs.day 14)post lower limb free flap surgery.Methods:All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap database.Patient data were collected from the comprehensive lower limb free flap database,medical notes,and electronic records.Patients prescribed an extended non-weight-bearing period due to the method of bone fixation were excluded.Results:A total of 37 patients,15 pre-and 22 post-enhanced protocol,were identified for comparison.The mean age was 43(17-72)with a M:F of 3:1.There was no difference in the type of flap reconstruction between groups,with the anterolateral thigh flap being the most common in both groups.No differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol,with the mean length of stay reduced from 12.1 to 10.6 days(P=0.34).Conclusion:The new enhanced protocol remains the standard of care in our unit,as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.
文摘Background: Ballistic high-energy trauma has substantially increased the severity of non-fatal extremity injuries incurred in modern warfare. Expedient medical care, refinement in surgical techniques, and soft tissue coverage have brought about a paradigm shift in the management of lower extremity wounds during the last decade with an increased emphasis on limb salvage.Methods: A literature-based study was conducted to analyze reconstructive modalities based on the location, depth, and severity of wounds, as well as mechanism of injury, concomitant vascular injuries and open fractures, choice of flap, timing of definitive reconstruction, and complications.Results: Extremity injuries account for over 60% of injuries in the recent conflicts in Iraq and Afghanistan, with the majority secondary to explosive devices. The severity of these injuries is profound compared with civilian registries, and conventional injury scoring systems have failed to accurately predict outcomes in combat trauma. The mainstay of treatment is serial debridement, negative pressure therapy, fracture stabilization, and treatment of concomitant injuries by the forward medical teams with subsequent definitive reconstruction after transport to an advanced military treatment facility. Autologous reconstruction with free tissue transfer and pedicled flaps remains the primary modality for soft tissue coverage in limb salvage. Adjunct innovative modalities, such as external tissue expansion, dermal substitutes, and regenerative matrices, have also been successfully utilized for limb salvage.Conclusion: Lower extremity injuries account for the vast majority of injuries in modern warzones. Explosive devices represent the most common mechanism of injury, with blast impact leading to extensive soft tissue injuries necessitating complex reconstructive strategies. Serial debridement, negative pressure therapy, and autologous reconstruction with free tissue transfer and pedicled flaps remain the mainstay of treatment in recent conflicts.
文摘Aim:Free tissue transfer is essential for extremity reconstruction following traumatic injuries,oncologic resection,and diabetic complications.However,given the circumferential shape of the arm and leg,a small amount of ongoing edema can prevent a tension-free closure.Additionally,intraoperative thrombosis,vascular disease can lead to proximal exposure of the pedicle or vein grafts.This study evaluates the outcomes of microvascular transfers that utilized a skin graft for closure over the pedicle,in comparison with a matched cohort with a tension-free primary closure.Methods:A retrospective review was completed of all patients that underwent free flap reconstruction of an extremity defect from January 2014 to December 2017 at a single academic institution.Flaps that utilized skin grafting for closure were compared to those closed primarily.Adjunct operative procedures,demographics,and complications were evaluated.Results:A total of 71 patients fulfilled the inclusion criteria.The 11 flaps in 10 patients underwent skin grafting over the pedicle.The two cohorts were comparable in age,gender,BMI,and co-morbidities,excluding renal disease which was present in 40%(n=4)of skin grafted group compared to 6.5%(n=4)in the primary closure group.Flap area,operative time,and anastomosis technique were comparable between the two groups.There was no significant difference in the rates of post-operative complications including partial flap loss,complete flap loss,infection.Mean follow up time in the skin grafting group was 14.2 months and 20.2 months for the primary closure group. ;Conclusion:As per the principal,a tension-free closure is paramount to preventing tissue complications including direct compression of a microvascular pedicle.However,with ongoing tissue edema skin grafting should be considered as a reliable technique to ensure both protection of the pedicle as well as prevention of direct compression without additional complications and comparable post-operative outcomes.
