Flap Healing Research Articles

Application of the first dorsal metacarpal artery flap for repair of soft tissue defects of finger by free transplantation

Objective To summarize the operative procedure and clinical efficacy of the first dorsal metacarpal artery flap for repair of the finger soft tissue defects with bone and tendon exposure by free transplantation. Methods From June 2014 to June 2017, 10 cases of the finger soft tissue defects with bone and tendon exposure were treated by the first dorsal metacarpal artery flap transplantation, and the sensation of the flap was reconstructed using the superficial branch of the radial nerve. The area of the flap ranged from 1.5 cm×4.5 cm to 5.2 cm×6.0 cm. The donor sites were closed directly or by skin graft. Results All the flaps survived successfully without vascular crisis. Primary healing of the flaps and donor sites was achieved. All the cases were follow-up for 6 to 20 months, with an average of 10 months. The shape and color of the flap were close to the healthy side, and the texture was soft. Two-point discrimination was 7 to 12 mm with an average of 8.5 mm. Hand function was evaluated by the total active range of motion of the fingers. The results were excellent in 6 cases, good in 3 cases and fair in 1 case. Conclusion The free first dorsal metacarpal artery flap, which selectively included the superficial branch of the radial nerve, is a reliable and simple procedure. It can effectively cover the wound with lighter injury in donor site and obtain an ideal appearance, function and sensory recovery. Key words: Finger injuries; Surgical flaps; Microsurgery; The first dorsal metacarpal artery

PS02.244: PEDICLED FLAPS IN ESOPHAGEAL SURGERY: WHERE THORACIC-, PLASTIC- AND ENT- SURGEONS MEET

Abstract Background Esophageal, esophago-hypopharyngeal and esophago-tracheobronchial fistulae or strictures arising either de novo or following therapeutic interventions constitute serious therapeutic challenges. If conservative measures fail, pedicled muscular or myocutaneous flaps are life-saving assets. Methods During the last 10 years we treated 13 patients (11 males, 2 females; mean age: 59; range: 44–82y) with complex esophageal/hypopharyngeal problems by using pedicled muscle flaps. Results All had but one case of lye ingestion had underlying malignant disease, all but two of the latter had had chemo- and or radiotherapy. At the time of the intervention eight patients were in a critical, septic condition. There were 5 esophago-tracheal, 2 esophago-bifurcational, one esophago-colo-bronchial, and one hypopharyngo-tracheal fistula, as well as one pharyngo-cutaneous fistula all following resection/reconstruction and/or attempts of surgical closure. One patient had stricture following external irradiation, another one anastomotic stricture. We applied a total of 17 pedicled flaps: 10 pectoralis major flaps (7 of them myocutaneous, three split flaps), 5 deltoideo-pectoral myocutaneous flaps and 2 sternocleidomastoideus flaps. In 11 patients additional intermittent stenting was used. In 6 patients the respective condition healed, 4 patients could be discharged but had minor recurrent fistulae that could be handled conservatively, in three cases persisting sepsis and multiorgan failure could not be overcome. Conclusion Muscle flaps can be life-saving in large fistulae of the esophagus and the hypopharynx and are useful for refractory cervical stenosis. In presence of multiorgan dysfunction, however, healing of flaps however initially vital, is often impaired. Disclosure All authors have declared no conflicts of interest.

Assessment of the Gliding of Extensor Tendons in Post-Traumatic Hand Defects Reconstructed Using Muscle Flaps Versus Fascio-Cutaneous Flaps

Background: Use of fascio-cutaneous or fascial flaps arewell known methods of reconstruction of dorsal hand defectsto preserve the gliding movement of the extensor tendons.Whilst reconstruction of large hand defects extending to thewrist or the distal forearm entails use of larger flaps withlarge donor sites, so muscle flaps may have an advantage overthe fascial or fascio-cutaneous flaps in coverage of these largedefects. The aim of this study is to compare the gliding of theextensor tendons underneath fascio-cutaneous and muscleflaps on the dorsum of the hand.Patients and Methods: The study included 20 patientswith dorsal hand trauma with exposed extensor tendons, tendefects were reconstructed by free muscles flap and splitthickness skin graft and the other ten were reconstructed withfascio-cutaneous flaps. Early rehabilitation in all cases wasdone by a single dedicated physiotherapist. Tendon glidingwas assessed by measurement of active flexion and extensionat the metacarpo-phalangeal joint using goniometer aftercomplete flap healing four months following flap inset.Results: There was no statistically significant differencein gliding for extensor tendons in patients with hand defectsreconstructed by free muscle flaps and skin graft versus fasciocutaneousflaps.Conclusion: Both fascio-cutaneous and free muscle flapshad comparable results concerning the extensor tendons glidingunderneath.

Extracorporal Shock Wave Therapy Enhances Receptor for Advanced Glycated End-Product-Dependent Flap Survival and Angiogenesis.

Loss of skin flaps due to deteriorated wound healing is a crucial clinical issue. Extracorporal shock wave therapy (ESWT) promotes flap healing by inducing angiogenesis and suppressing inflammation. The receptor for advanced glycation end-products (RAGEs) was identified to play a pivotal role in wound healing. However, to date, the role of RAGE in skin flaps and its interference with ESWT are unknown. Caudally pedicled musculocutanous skin flaps in RAGE and wt mice were treated with low-dose extracorporal shock waves (s-RAGE, s-wt) and analyzed for flap survival, histomorphologic studies, and immunohistochemistry during a 10-day period. Animals without ESWT served in each genotype as a control group (c-RAGE, c-wt). Statistical analysis was carried out by repeated-measures analysis of variance. Flap necrosis was significantly reduced after ESWT in wt animals but increased in RAGE-deficient animals. Morphometric differences between the 4 groups were identified and showed a delayed wound healing with dysregulated inflammatory cells and deteriorated angiogenesis in RAGE animals. Furthermore, spatial and temporal differences were observed. The RAGE controls inflammation and angiogenesis in flap healing. The protective effects of ESWT are dependent on intact RAGE signaling, which enables temporary targeted infiltration of immune cells and neoangiogenesis.

Comparison of standard modified shrobingers incision versus transverse cervical incision for neck dissection – our experience

AimTo compare the feasibility and outcomes of Transverse Cervical incision and Modified Schobinger's incision for neck dissection. Materials and methodsPatients having oral cavity cancer with positive metastatic nodal disease in the neck requiring ablative surgery were included. Patients requiring a lip split incision for tumor ablation were excluded from the study. A total of forty patients were selected and were randomized in two groups. Transverse Cervical incision was placed in group A for neck dissection and a standard Modified Schobinger's incision in group B. These two groups were then compared on the basis of criteria's like adequacy of surgical access, flap dehiscence or necrosis, number of lymph nodes retrieved, length of incision, wound contracture, length of hospital stay and cosmetic result. ResultsResult of our study show that Transverse Cervical incision had adequate surgical access, adequate lymph node retrieval, and better cosmetic result, less postoperative complications with early discharge of patient as compared to Modified Schobinger's incision for neck dissection. ConclusionAccording to our experience, we believe that this transverse cervical incision in oral cancer patients can be very useful which fulfills all the requirements for neck dissection in terms of required surgical access, adequate lymph nodes retrieval, good healing of skin flaps and better cosmetic result without any postoperative complications.

Effects of Aloe vera on the healing of skin flaps in oophorectomized rats

Effects of Aloe vera on the healing of skin flaps in oophorectomized rats

Studies on reconstruction of large skin defects following mammary tumor excision in dogs

Aim:The main objective of the study was to describe the use of skin fold advancement flaps (SFAFs) and other reconstructive techniques for closure of large skin defects following mammary tumor excision in dogs.Materials and Methods:Twelve dogs underwent reconstruction of large ventral skin defects following mammary tumor excision with wide margins. Skin fold flaps (flank fold flap and elbow fold flap) were elevated from the flank and elbow region, respectively, and transposed and sutured onto the large ventral skin defect following mastectomy in all the dogs. In addition to the skin fold flaps, other reconstructive techniques such as undermining, walking sutures, and tension-relieving suture techniques were followed during surgery in the closure of large skin defects without skin tension and compromising limb mobility. The skin flap viability was assessed subjectively by gross observation of the flap such as color, temperature, capillary perfusion, and cosmetic appearance, and scoring (1-4) was done. Tissue samples were collected from a surgical site on days 3, 6, and 12 post-operatively for histopathological evaluation and healing status of the skin flap.Results:All the surgical wounds healed primarily, without any major complications and the skin flap remained healthy throughout the healing process post-operatively. Distal flap necrosis was noticed in one case and necrosis of skin flap between two suture lines was noticed in another case in which the necrotized distal portion healed by secondary intention after 7 days. The mean survival of subdermal plexus flap in the above cases was 98% which was a subjective evaluation based on surface area of the skin defect measured by Image’ J software and the flap dimensions. The average healing of skin flap in days was 14.91±0.86.Conclusion:The SFAFs along with other reconstructive techniques help in the reconstruction of large ventral skin defects following mastectomy in dogs without much compromising limb mobility.

Характеристика приживления и гистоструктуры васкуляризованных кожно-фасциальных лоскутов в условиях применения микроинъекций лиофилизата мозговой ткани

Purpose To reveal a possible effect of subdermal injections of cerebrolysin on the parameters of healing and histomorphometric characteristics of the biological model of an extended fasciocutaneous flap with axial blood supply. Materials and methods A flap based on the superficial inferior epigastric artery (SIEA) and extended to the cranial side according to a template with an area of 18 cm2 was formed in 29 rats. After 90 minutes of femoral artery clipping, it was re-planted at the site of SIEA origination. After the operation, microinjections of cerebrolysin (0.1 ml) were performed subdermally. Four of them were injected in the mezhangiosomal zone in group Cer 1, and six were uniformly distributed over the area of the flap in group Cer 2. Comparison groups (Comp 1 and Comp 2) had injections of saline in similar number and zones. Negative control group had flaps without injections. Conditional normal sites were contralateral areas of the skin. Twelve days after the operation, the animals are euthanized. The methods of the study were computer planimetry, histomorphometry, and immunohistochemistry. Results In groups Cer 1 and Cer2, when compared with the negative control and placebo, relative areas of the epidermal defects associated with partial flap necrosis or delayed wound healing (2.15 % and 0.23 % vs. 13.72 % and 11.33 %, respectively) were reliably reduced. In Cer 1, hypovascularization of the hypodermis, thinning of the epidermis and dermis were noted. In Cer 2, compared with the control and Cer 1, the largest thickness and capillarity of the dermis and hypodermis were revealed, as well as the thickness of the epidermis and the numerical density of the skin appendages. Discussion The pronounced decrease in polymorphic cell infiltration of the dermis and hypodermis in the experimental groups indicates that the angiogenesis in the dermis stimulated by subdermal microinjections of cerebrolysin occurred by inhibition of inflammatory reactions and was caused by the direct action on endothelial cells. Conclusion To optimize the healing of fasciocutaneous flaps with axial blood supply in cases where their area exceeds the territory of the blood supplying artery, it is advisable to use microinjections of cerebrolysin uniformly distributed over the entire area of the flap, including its angiosomal and interangiosomal zones.

Soft Tissue Coverage in Distal Lower Extremity Open Fractures: Comparison of Free Anterolateral Thigh and Free Latissimus Dorsi Flaps

When microsurgical transfers are required in posttraumatic lower limb reconstruction, surgeons must choose among many types of free flaps. Historically, surgeons have advocated muscular flaps for coverage of open lower extremity wounds, but fasciocutaneous free flaps are now often used with good results. This study aimed to compare the functional and aesthetic outcome of reconstruction by free muscular latissimus dorsi (LD) flap and free fasciocutaneous anterolateral thigh (ALT) flap used for soft tissue coverage of distal lower extremity open fractures. We performed a single-center, retrospective study of subjects with distal lower limb open fractures treated with LD flaps or ALT flaps between 2008 and 2014. Patients with limited follow-up or incomplete data were excluded from the analysis. Donor and recipient sites, early complications and long-term outcomes (functional and aesthetic) were studied and compared according to the type of flap. A total of 47 patients were included: 27 patients in the LD flap group and 20 patients in the ALT flap group. No significant difference was found regarding early and late complications and long-term functional outcomes (bone healing, infectious bone complications, flap healing). As for aesthetic outcome and donor-site morbidity, reconstruction using the ALT free flap had significantly better results (p < 0.05). In posttraumatic lower limb injury, either LD or ALT free flaps can be used for wound coverage with comparable long-term functional outcomes. The ALT flap provides better cosmetic results than LD.

Osteochondritis dissecans—Does platelet rich plasma really help

Osteochondritis dissecans is a common disorder of knee and can be treated by various methods, depending on age of patient and stability of chondral fragment. In Osteochondritis dissecans ICRS type III lesion i.e. articular cartilage discontinuity but no dislocation, variable rate of union as well as high rate of non-union was observed in previous studies when treated with arthroscopic or open reduction and fixation. In previous study it has been also shown that platelet rich plasma help in fracture healing. In this study we are trying to extend the benefit of platelet rich plasma to Osteochondritis dissecans lesion. We took six patients with OCD, ICRS scale of OCD type III lesion. All Patients were operated Arthroscopiclly. Chondral flap of OCD lesion were fixed with stainless steel cannulated cancellous screw. To enhance union we used platelet rich plasma injections. .We access the union of chondral fragment to parent bone and knee function. Chondral fragment united to parent bone in all patients. To access knee function we used Tagner- Lysholm knee scoring system, in this study preoperatively score was 52.8 where as postoperatively it was 91.8. This study showed PRP is helpful in healing of chondral flap as all the chondral flap of osteochondral lesion united in this study.

Histomorphometrical evaluation of the effects of Aminogam® gel in oral healing process of post-surgical soft tissue

Wound healing is a dynamic process that involves a complex interaction of inflammatory cells, cytokines and mediators of extracellular matrix [1]. One of the processes that occur during tissue regeneration is angiogenesis and it is considered to have a pivotal role in wound repair. Previous studies have shown that a topical application of proteins and sodium hyaluronate to wounds can expedite the repair of damaged tissue [2]. The aim of this preliminary study is to evaluate the efficacy of Aminogam® gel (A®) (ErreKappa Euroterapici SpA, Milano), a topical medication which contains 4 amino acids (glycine, leucine, proline, lysine) and sodium hyaluronate, used to improve and accelerate gingival flap healing following molar extraction by analyzing collagen fibers amount, orientation and microvascular distribution (MVD). Ten patients (mean age 49ys) were included in the study. Two teeth (38 and 48) were extracted at an interval of 30 days. The “test” site (AM) was treated with A® while the “control” site (no AM) was not. Dental extraction was performed and the flaps were sutured with a consequent excess of tissue for histological processing (T0). A® had been applied only at the AM site for 10 days post-extraction. At suture removal, a gingivoplasty was performed and the exceeding tissue was histologically analysed (T1). Paraffin blocks were cut and slides were stained with haematoxylin-eosin and Sirius Red. No signs of inflammatory infiltrate or necrosis were observed. Sirius Red staining highlighted a lower degree of organized collagen fibers at T1 vs T0. At T0 the fibers were organized in closely packed and well-oriented bundles. At T1-no AM fibers were thin and formed a disorganized grid. At T1-AM fibers appeared thicker and the tissue appeared more mature compared to T1-no AM. Immunohistochemistry against CD31 was performed to mark endothelial cells and to calculate MVD by stereological method [3]. MVD resulted highest at T1-AM. The T1 data normalized on T0 presented a statistically significant difference (p=0.012) between AM and no AM group. In conclusion, A® gel seems to increase new blood vessels formation and to promote collagen deposition and organization.

Clinical observation on the early replantation of autologous periosteum-preserved skull flap

Objective To investigate the feasibility of preservation of the skull flap covered with periosteum in vivo and early cranioplasty in patients with decompressive craniectomy. Methods Sixty-seven patients underwent autologous cranioplasty using periosteum-covered skull flap preserved subcutaneously after decompressive craniectomy from January 2012 to December 2015 at Neurosurgery Department of Rizhao People's Hospital. Their data were retrospectively reviewed. Cranioplasty was conducted within 4-8 weeks after decompression for all patients. Part of the skull flap tissue was obtained in cranioplasty for identification of the bone activity by pathological examination. At follow-up, all patients received CT scan and 34 patients underwent SPECT to assess the healing and survival of skull flap. Results The size of skull flap in the 67 patients with cranioplasty remained the same as that at the time of decompression. Bones were not destructed, focal dead bone was not observed by the pathological examination. The postoperative follow-up lasted 1-2 years and CT scans revealed that the healing rate was 0%, 62.7% (42/67), and (67/67), 100% (53/53) at 1, 6, 12, 24 months after cranioplasty. No skull resorption was reported. Bone survival and good blood supply of the skull flap were demonstrated by SPECT. During the follow-up period, 1 (1.5%) patient had small subcutaneous hematoma, 4 (6.0%) patients developed subcutaneous effusion, and no intracranial or subcutaneous infection was observed. Conclusion Biological activities of skull flap in patients with decompressive craniectomy could remain well through subcutaneous preservation with periosteum, which might be useful for facilitating the good outcome of cranioplasty. Key words: Decompressive craniectomy; Periosteum; Transplantation, autologous; Cranioplasty; Preservation in vivo

Comparative effectiveness study between negative pressure wound therapy and conventional wound dressing on perforator flap at the Chinese tertiary referral teaching hospital

BackgroundPerforator flap techniques with conventional wound dressing have being extensively used in the management of soft-tissue defects. However; the flap's survival rate is not always guaranteed and the wound healing time always long. The aim of this study was to investigate the clinical effectiveness use of a freshly transplanted perforator flap in conjunction with Vacuum-assisted closure (VAC) for better clinical outcomes. MethodsA prospective, randomized, effectiveness study comparing the clinical outcomes of VAC versus traditional wrap and bandages for the treatment of open wounds that required hospital admission and operative debridement using perforator flaps, was carried out from March 1, 2014 to March 31, 2016 at Wuhan University Zhongnan Hospital. Fifty-one eligible patients were randomized into two groups; study group (perforator flaps covered by VAC) and control group (perforator flaps covered by traditional wrap and bandages). The measured clinical endpoints included the time of the first post-operative dressing change, pain visual analogical scale, perforator flap infection rate, 95% perforator flap healing time and percentage of survived perforator flap. ResultsThere was no statistically significant difference in the demographic profiles in the two cohorts. There were statistically significant differences in the clinical endpoints in the two groups (p < 0.001; p < 0.05, Table 2). ConclusionsIn summary, VAC combining with perforator flap technique, can diminish accumulated exudation of the transferring flap, protect against postoperative infection, prolong the interval between perforator flap relocation and first postoperative dressing change, decrease pain during removal of dressing, increase perforator flap survival rate, and shorten wound healing time, with a good aesthetic outcome, a good mobility and a satisfactory therapeutic result.

Combination of vascularized fibular head epiphysis and superficial peroneal neurovascular reverse flap repair defects of bone and skin in lateral malleolus in children

Objective To explore the clinical effect of combination of vascularized fibular head epiphysis and peroneal neurovascular reverse flap repair defects of bone and skin in lateral malleolus in children. Methods Eight children with defects of bone and skin in lateral malleolus were recruited from May, 2009 to September, 2014. The age of children was ranging from 4 to 12 years old. Four children were injured by wheel twist, 2 children were injured by traffic accident, 1 was injured by machinery, and 1 was crashed with heavy object. The size of soft-tissue defect was ranging from 3 cm × 5 cm to 7 cm × 9 cm. The flap and bone healing along with ankle joint function scoring were evaluated. Patients were reviewed every 4 to 6 weeks during one year after their surgery, and they were reviewed every 6 months one year later. Results Secondary repair were conducted in all children. The curative effect got well after follow up for 6 months to 2 years(mean, 12 months). The flap and fibular head epiphysis were well developed. The ossification of fibular head epiphysis did not found. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle function evaluation criteria, the results were excellent in 5 cases, good in 2 cases and poor in 1 at 10 months after operation. The shape and function of ankle joint were good, with one exception. The average motion degree of ankle joint was (68±5.12) °. Conclusion Combination of vascularized fibular head epiphysis and peroneal neurovascular reverse flap repair defects of bone and skin in lateral malleolus in children is effective. Key words: Lateral malleolus injury; Fibular head; Superficial peroneal neurovascular reverse flap; Children

Clinical application of circumferential ethanol infiltration method making corneal flap in LASEK

Objective To investigate the feasibility, advantages and disadvantages of making corneal flap with circumferential ethanol infiltration method in LASEK. Methods Total of 172 eyes of 86 cases with myopia underwent LASEK. The left eyes of all cases as observation group received modified circumferential ethanol infiltration to make corneal flap, and the right eyes as the control group received conventional ethanol infiltration to make corneal flap. The production process of corneal flap, irritation symptom after operation, incidence of flap healing of corneal epithelium and haze were observed. Results There was no statistical significance in corneal flap of grade 1 between observation group and the control group during the surgery (79: 82, u=0.997, P=0.378). After operation, irritation symptom was significantly less in observation group than that of in the control group (80: 33, u=7.697, P=0.003). There were significant difference between the observation group and the control group on postoperative corneal flap of grade 1 (82: 41, u=7.012, P=0.004), the observation group was better. There was statistical significant between the observation group and the control group (84: 70, u=3.537, P=0.019) on haze of grade 0. Conclusion The method of application circumferential ethanol infiltration making epithelial flap in LASEK is simple and easy to learn. It can be effective in reducing postoperative eye irritation and reduce the incidence of haze. Key words: LASEK; Corneal epithelial flap; Circumferential ethanol infiltration

How reliable is the vomer flap in early hard palate repair?

Hard palate closure with a vomer flap at the time of lip repair has been widely adopted. A recent study by Deshpande etal. showed a high rate of failure of the vomer flap and led the authors to abandon the technique. We conducted a retrospective study of vomer flap healing in a consecutive series of cases performed by the senior author (D.O.). The case records of 71 patients who underwent repair of unilateral cleft lip and palate with a vomer flap at the time of lip repair were studied. Vomer flap healing was assessed and documented by the senior author at the time of definitive palate closure, and this was recorded. Adequate records were available for 66 cases. Twelve patients (18%) had associated syndromes and were included in the analysis. The median age at the time of lip and vomer flap repair was 3.5 months, and that at the time of palate repair was 8 months. At definitive palatoplasty, the vomer flap was intact in 62 patients (94%). Four patients (6%) had partial or complete failure of the vomer flap. All failures occurred in cases where the vomer flap was sutured directly to the nasal mucosa, a technique since abandoned in favour of double-breasting the flap to the raw surface of the oral mucosa. Five patients had incomplete healing of the palate following definitive palatoplasty, two of whom had a previous vomer flap failure. Contrary to Deshpande etal., we found the vomer flap to be highly reliable in closing the hard palate at the time of primary lip repair.

Chronic Open Infective Lateral Malleolus Bursitis Management Using Local Rotational Flap.

Background Using a sinus tarsi rotational flap is an uncommon approach to treating chronic open infective lateral malleolus bursitis. Methods We treated eight patients, including six males, using this approach. First, we debrided all the infected tissues and used a negative pressure wound closure system where needed. After acute infection had been controlled, the local rotational flap was used for cases where the wound could not be closed by a simple suture or bone exposure. The rotational flap was detached with a curved skin incision at the sinus tarsi next to the open wound and sutured to the defect, paying careful attention to the superficial peroneal nerve. The donor site was managed with a split-thickness skin graft. Results The patients' mean age was 74.1 years. Six patients had a wound after suppurative infection, but two patients had ulcer-type bursitis. Six patients demonstrated full flap healing, but two patients had venous congestion necrosis. Conclusion A sinus tarsi rotational flap is a useful method to ensure healing and coverage of chronic open lateral malleolus bursitis, especially for small to medium wounds with cavity and bone exposure.

Head and neck reconstruction with pedicled flaps in the free flap era.

SUMMARYNowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. The records of consecutive patients who underwent free flap or pedicled flap reconstruction after head and neck cancer ablation from 2006 to 2015, from a single surgeon, in the AOUC Hospital, Florence Italy were analysed. A total of 93 patients, the majority with oral cancer (n = 59), were included, of which 64 were pedicled flap reconstructions (69%). The results showed no significant differences in terms of functional outcome, flap necrosis and complications in each type of reconstruction. Multivariate regression analysis of flap necrosis and functional impairments showed no associated factors. Multivariate regression analysis of complicated flap healing showed that only comorbidities remained an explaining factor (p = 0.019). Survival analysis and proportional hazard regression analysis regarding cancer relapse or distant metastasis, showed no significant differences in prognosis of patients concerning both types of reconstruction. In this retrospective, non-randomised study cohort, pedicled flaps were not significantly inferior to free flaps for reconstruction of head and neck defects, considering functionality, complications and prognosis.

The multiple factors analysis of distal pedicle flap to treat incision delayed healing for soft tissue defect in Ningxia region

Objective To evaluate the related factors influencing the prognosis of pedicle flap to treat incision delayed healing for soft tissue defect in Ningxia region. Methods All 93 cases of patients with soft tissue defect were collected between September, 2012 and November, 2015, and were treated with pedicle skin flap after radical debridement, the situation of the primary healing of the wound and skin flap necrosis was evaluated in first intention. The patient’s gender, age, history of smoking, diabetes, anemia and exposure factors such as serum albumin, prealbumin indicators were collected, the single factor chi-square test was used to select the risk factors, and then multiariable Logistic regression analysis was used to analyze the related factors for influencing the flap survival further. Results Among 93 cases, 59 cases had class A healing, 7 cases of patients with complete skin flap necrosis was needed surgical treatment again, 19 cases had class B healing and needed long time to heal after the change dressings, 8 cases of patients with skin edge necrosis was needed open treatment healed after debridement surgery. The results of Uniariate chi-square test was showed that had flap delay healing the relevant on age, smoking history, diabetes, whether anemia, whether to have hypoalbuminemia, whether to have relevant serum prealbumin lower (P < 0.05), multiariable Logistic regression analysis showed further the independent risk factors of skin flap necrosis was the decrease of serum prealbumin. Conclusion The decrease of serum prealbumin may affect flap healing. Key words: Pedicle flap; Soft tissue defect; Delayed union; Multivariate analysis

Transplantation of free proximal interphalangeal joint of the second toe with toe preservation for repair of traumatic digital arthritis

Objective To evaluate the clinical outcome of reconstruction of traumatic digital arthritis by transfer of free proximal interphalangeal joint of the second toe with toe reserving technique. Methods The study enrolled nineteen patients with traumatic digital arthritis treated from May 2013 to April 2016. The patients consisted of fifteen males and four females, and mean age was 27.3 years (range, 18-52 years). Finger involved included index fingers in 10 patients, middle fingers in seven and ring fingers in two. The joint of digit was reconstructed by transplanting the proximal interphalangeal joint of the second toe with a monitoring flap, and bone defect of the second toe was repaired with autogenous iliac bone graft. Wound was closed directly in six patients and covered by island flap from the foot dorsum in 13 patients. Evaluation indicators contained survival rate of the free joint and island flap, appearance and fracture healing of the finger and toe and motion of the proximal digital joint. Finger function was studied using the evaluation standard of upper limb function set up by hand surgery branch of Chinese Medical Association. Healing in the donor site, foot function and related complications were observed. Results All the free joint and island flap survived. Period of follow-up was 6-30 months (mean, 14 months). The fractured finger healed at 2.5 months on average, and appearance of the finger was good. Flexion range of the proximal digital joint was 63°-80°(mean, 74°) and extension range was -20°--10°(mean, -14°). Finger function was excellent in eleven patients and good in eight patients, with the excellent-good rate of 100%. Hematoma of the dorsal region of the foot occurred in one patient and the cut healed well after taking out some stitches and drainage. All fractured toe healed at 2.6 months. Except that one patient had fracture malunion with minor outward inclination, all presented good appearance of the toe without influencing walking and running. On the part of iliac, there was only one inconspicuous linear scar without any discomfort. Conclusions Transfer of free proximal interphalangeal joint of the second toe with toe preservation restores the anatomy structure and function of the digital joint. Meantime, autogenous iliac bone grafting combined with island flap from the foot dorsum for coverage of donor site defect retains the toe length and reduces injury of the donor site. Key words: Finger joint; Arthritis, traumatic; Toe phalanges; Bone transplantation