Free Skin Flap Transplantation Research Articles

Treatment of hard-to-heal wound after huge scalp tumor resection and reconstruction: a case report

Introduction and importance: Free skin flap transplantation and titanium mesh reconstruction can effectively repair the scalp and skull defects caused by massive scalp tumour resection. Postoperative flap infection is a common complication. Due to the presence of titanium mesh, once infection occurs, a second operation is required to remove the titanium mesh, which brings a great physical and economic burden to the patient. Case presentation: In this case of postoperative infection, the authors used a conservative treatment based on dressing change, preserved the titanium mesh and flap, avoided secondary surgery, and successfully controlled the infection. Clinical discussion: The treatment strategy is mainly divided into three steps: the first stage is to control infection, the authors use complexed iodine to repeatedly disinfect wounds, subcutaneous dead space, exposed titanium mesh, and antibiotic treatment for bacterial culture results; the second stage is to promote granulation growth, After infection control, the authors remove old granulation after each wound disinfection, and then instill fibroblast growth factor to promote subcutaneous granulation growth to fill dead space, and also provide a base platform for epidermal growth; the third stage is mainly epidermal healing, Change the dressing every day to observe the growth of the epidermis. Conclusion: This case suggests that conservative treatment strategy based on dressing change is also a potential treatment option for postoperative infection of the flap with exposure of the titanium plate.

Retracted: Application of Free Skin Flap Transplantation in Skin Malignant Tumor Resection.

[This retracts the article DOI: 10.1155/2022/7510330.].

Ways and methods of closing tissue defects of the middle zone of the facial skull after removal of malignant tumors with intracranial spread (case from practice)

A clinical case of locally advanced basal cell skin cancer with bone destruction is presented. Patient Ya., born in 1936, was under the supervision of doctors for basal cell skin cancer since 1982 (for 38 years). She was hospitalized in the department of extracerebral tumors of Romodanov Institute of Neurosurgery NAMS of Ukraine 09.27.2019. Multispiral computer and magnetic resonance imaging were performed.Considering the duration and spread of the tumor, the patient was offered an operation to remove the tumor within healthy tissue with resection of the auricle and parotidectomy. When receiving informed consent for surgical treatment, the patient put forward conditions regarding the scope of the operation: preservation of symmetry of the face, appearance of the face and integrity of the auricle. Surgery was performed, followed by symptomatic treatment. Reconstructive technologies for closing defects of the soft tissue of the facial skull were applied. She was operated on on October 4, 2019. The postoperative period was uneventful. Healing occurred by primary tension. The patient was discharged from the hospital in satisfactory condition on the 18th day (October 22, 2019). Postoperative distant gamma therapy was performed on the projection area of ​​the primary focus and the predominant anatomical routes of lymph drainage (total focus dose ‒ 45 Gy). Catamnesis postoperative ‒ 13 months. After 37 years, a relapse occurred with the tumor process involving all branches of the facial nerve, bones of the skull, metastasis to regional lymph nodes. The treatment was carried out at the Romodanov Institute of Neurosurgery NAMS of Ukraine. The patient did not consent to the extended scope of the surgical intervention, setting the condition of preserving the appearance. In this regard, the removal of affected tissues was carried out along the edge of the tumor invasion (without a reserve of healthy tissues) while preserving the trunk and branches of the facial nerve, i.e. in violation of the generally recognized principles of ablastics. The presented case of the course of the disease proves that timely radiation therapy at the first signs of a skin tumor contributes to a good clinical effect, which made it possible to achieve a long relapse-free period with a decent quality of life and full socialization. The progressive course of the disease (recurrence) justifies the feasibility of replacing large facial skull tissue defects after radical removal of parotid skin cancer with intracranial spread using the method of combining local plastic surgery and free skin flap transplantation, developed and implemented in the Department of Extracerebral Tumors.

Application of Free Skin Flap Transplantation in Skin Malignant Tumor Resection.

One of the most important surgical approaches for restoring cutaneous abnormalities caused by tumor resection is the insertion of a skin flap. Flap transplantation has been used to cover and fill different deficiencies after tumor removal. However, distal necrosis is among the most prevalent postsurgical consequences for skin flaps, particularly when treating large regions. Blood circulation failure causes flap necrosis, which may lead to serious problems, particularly in patients undergoing body cavity reconstruction following tumor excision. ADSCs (adipose-derived stem cells) are a kind of stem cell separated from the adipose tissue that has multilineage differentiation, simple availability, high proliferation capability, and self-renewal capabilities. This paper uses human adipose-derived stem cell (ADSC) therapy for skin flap transplantation in skin malignant tumor resection. ADSC-based therapy is an applicable technique for assisting flap transplantation. The isolation of ADSC is performed using different trypsin concentrations, and then, the population doubling time is determined. The isolated ADSCs are differentiated and then employed for the skin flap model. The performance of the suggested method is analyzed using various assays. The usage of adipose-derived stem cells to boost the vitality of the skin flaps proved successful.

Clinical analysis of oral and oropharyngeal cancer resection through oral approach

Objective:To investigate the treatment effect of oral and oropharyngeal cancer resection through oral approach. Methods:Forty-eight patients who with oral and oropharyngeal cancer were admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2015 to January 2018, and all received preoperative chemotherapy, surgical treatment and postoperative radiotherapy. Among them, twenty-four patients who were treated with tumor resection through oral approach in the experimental group, the other twenty-four patients were treated with tumor resection by external approach in the control group. During the operation, both groups of patients were underwent selective neck lymph node dissection and free skin flap transplantation, and preventive radiotherapy were performed after the operation. The operation time, blood loss, and the positive rate of the wound around the wound and the undercut margin of the two groups were compared, and the survival rate of the skin flap was analyzed. The Kaplan-Meier method was used to calculate the survival rate after 3 years of regular follow-up after surgery, and the difference between the curves of the two surgical methods were compared by the Log-rank test, and the quality of life of patients in one year after operation was investigated and analyzed by Washington University students'quality questionnaire 4. Results:The operation time and blood loss of the experimental group were less than the control group, but the difference was not statistically significant（P>0.05）. The positive rate of frozen margins in both groups was 0. The flap survival rate was 95.8% in the experimental group and 91.7% in the control group, there was no significant difference between the two groups（P>0.05）, the overall flap survival rate in the two groups was 93.8%. The survival rates of the experimental group were 91.7%, 83.3%, and 74.8% in the 1-, 2-, and 3-years after surgery, and 87.5%, 79.2%, and 75.0% in the control group, there was no statistically significant difference between the experimental group and the control group（P>0.05）. The 1-year, 2-year and 3-year overall survival rates of the two groups were 93.1%, 83.7% and 78.8% respectively. Compared with the control group, the scores of appearance, activity, recreation, swallowing, chewing, speech and mood in the experimental group were significantly higher（P<0.05）. Conclusion:Resection of oral cancer tumors through the oral approach with free skin flap repair is in line with the concept of minimally invasive surgery, which improves the quality of life of patients after surgery while ensuring the survival rate, and is worthy of clinical application and promotion.

Application and effect evaluation of nursing quality target management in free flap transplantation for hand injury.

To explore application and effect of nursing quality target management in free flap transplantation for hand injury. 140 patients with free skin flap transplantation for hand injury admitted to the hand and foot surgery ward of the hospital from January 2017 to December 2019 were selected as the research objects. They were randomly divided into observation group and control group. There were 70 patients in each group, and both groups of patients received microscopic free flap transplantation. The observation group adopted traditional nursing mode and nursing quality target management mode to carry out nursing, while the control group adopted traditional nursing mode to carry out nursing. The treatment compliance, skin flap survival, occurrence of vascular crisis, occurrence of complications, VAS and Barthel comparison score of the two groups were compared. The treatment compliance of patients in the observation group was significantly higher than that in the control group (P < 0.05). The survival rate of skin flap in the observation group was higher than that in the control group (P < 0.05). The incidence of vascular crisis in the observation group was lower than that in the control group (P < 0.05). The postoperative pain in the observation group was better than that in the control group (P < 0.05). There was no significant difference in Barthel score between the observation group and the control group at admission (P > 0.05), but the improvement range of Barthel score in the observation group was higher than that in the control group at discharge (P < 0.05), The satisfaction of patients in the observation group to nurses was higher than that in the control group (p < 0.05). The application of nursing quality target management can improve the treatment compliance of patients, improve the survival rate of free skin flap transplantation for hand injury, reduce the incidence of vascular crisis within 48 hours after operation, reduce the occurrence of postoperative complications, relieve the pain of patients, improve self-care ability and ensure the quality of life.

The clinical study of partial perineum area and wound repair in males

To explore the suitable division of male genitalia subunits and the effectiveness of large-area perineum defect repair under its guidance. According to the anatomical and functional characteristics of male genitalia, the subunit division scheme was proposed: area Ⅰ, glans penis; area Ⅱ, body of penis; area Ⅲ, scrotum; area Ⅳ, scrotum. Between April 2017 and July 2019, 12 patients with large genitalia defects were treated, with an average age of 60.9 years (range, 57-66 years) and an average disease duration of 2.7 years (range, 2-5 years). The defect area involved area Ⅰ in 1 case, area Ⅱ in 7 cases, area Ⅲ in 5 cases, and area Ⅳ in 8 cases; the size of area ranged from 6 cm×4 cm to 23 cm×16 cm. The causes of defect included 3 cases of trauma, 6 cases of Paget disease, 2 cases of squamous cell carcinoma, 1 case of spindle cell tumor. According to the design of the corresponding repair scheme, the main repair methods were to rotate and advance the skin flap and pedicled skin flap in the same area. When the defect was large, the free skin flap transplantation, free skin grafting, and free mucosa transplantation were used to repair the defect. All the patients were followed up 6-13 months with an average of 8.6 months. Skin flap, skin graft, and mucosa survived in one stage in 10 patients; infection occurred in 1 case after the scrotal flap of area Ⅲ was transferred to repair the defect in area Ⅱ, 1 case had distal venous crisis at 2 days after repair area Ⅲ defect used free anterolateral thigh flap, and after active treatment, the condition improved. The appearance of the receiving area and the supplying area was good, and the local feeling was recovered satisfactorily. The range of motion of hip joint was good in 10 cases, and 2 cases were slightly stretched but did not affect normal life. All patients had normal urination and defecation function, and were satisfied with the treatment effectiveness. The subunits of male genitalia can be used to guide the repair of the defect, which can better restore the physiological appearance and function, and has positive clinical significance.

The clinical application of free skin flap transplantation in the one-stage repair and reconstruction after total glossectomy

Objective:To investigate the clinical application of free skin flap in the one-stage repair and reconstruction after total glossectomy in patients with advanced tongue cancer. Method:Twenty-eight patients who underwent total glossectomy for advanced tongue cancer and treated with the one-stage repair and reconstruction with free skin flap ranged from January 2008 to July 2018 were recruited in this study. Among them, there were 12 cases of squamous cell carcinoma, 8 cases of adenocarcinoma, and 8 cases of adenoid cystic carcinoma. The free radical forearm flap and perforator flap of posterolateral peroneal calf peroneal artery were used in 16 and 12 cases, respectively. All patients were treated with outpatient functional rehabilitation sequence and postoperative radiotherapy within 6 months, and were followed up regularly for 1, 3 and 5 years to understand their living conditions, and Washington University students' quality questionnaire 4 was used to investigate the functional factors of the healthy patients in different periods of time after surgery. Result:The survival rate of the free skin flap was 94%. The radical forearm flap was immediately changed to perforator flap posterolateral peroneal calf peroneal artery in 2 cases due to the necrosis of the artery. The hospitalization time of the patients was 10-14 days, with an average of 12.5 days. The wounds inside and outside of the mouth were healed by first intention at the time of discharge. All nasogastric tube and tracheal tube were removed safely within 45 days after the surgery and the functions of swallowing, breathing, language and chewing were gradually restored. According to the questionnaire survey, patients' attention to quality of life gradually shifted from function to feeling. With the direct calculation method, the 1-,3-, and 5-year survival rate was 96.40%, 64.71%, 55.60%, respectively, while tumor-free survival rate was 85.70%, 58.82%, 55.60%, respectively. Conclusion:The comprehensive treatment based on free tissue flap repair and reconstruction of tissue defects can significantly improve the radical cure rate of patients with advanced tongue cancer, and can effectively restore the functions of swallowing, breathing, language, chewing and so on. It is a kind of treatment method worthy of promotion.

Comparison on two kinds of surgical methods for correction of deformity after exenteration of orbit

Objective To compare the efficacy of two kinds of corrective surgery for deformity after exenteration of orbit. Methods A retrospective study.One case with deformity after orbit exenteration received free skin flap transplantation.After correction, the effect of wearing prosthesis was poor with skin burst. Without the blood supply and healing wound for long time lead to the second surgery failure.Another case received orbital temporal muscle flap transplantation, and then underwent staging operation of the conjunctiva and eyelid deformity correction.The follow-up time was 4 years after operation. Results The efficacy of free skin flap transplantation surgery was poor with many complications.The efficacy of pedicled temporal muscle flap transplantation surgery was better, implantation stability and with good cosmetic effect. Conclusion Pedicled temporal muscle flap transplantation is relatively simple and reliable. Key words: Exenteration orbit; Deformity, correction; Transplantation, temporal muscle flap, pedicle; Comparison

Clinical study on local application of low-dose insulin for promoting wound healing after operation for deep burns.

Transplanted free skin flaps are often needed to treat deep burns; their survival, however, is less than optimal. This study examined whether local low-dose insulin injections can promote flap survival and wound healing after surgery. A total of 165 patients who underwent free skin flap transplantation for simple deep burns were enrolled in the study and divided into 5 groups of 33 patients each: Blank control group (no local subcutaneous drug injections), saline control group (saline injections), low-dose insulin group (0.5 units regular insulin injections), medium-dose group (1.0 units regular insulin injections) and high-dose group (2.0 units regular insulin injections). Wound healing and flap survival conditions were assessed and compared among groups. The best wound healing rate found was that of the low-dose insulin injection group where all the parameters measured improved significantly: The healing time was shorter; the blood flow volume, the flap survival, the number of fibroblasts and new vessels increased; the re-epithelialization occurred faster; the infiltration of inflammatory cells was reduced; the expression levels of heat shock protein-90, vascular endothelial growth factor, transforming growth factor-β and interleukin-1 were higher; and the plasma glucose levels only fluctuated slightly. The results clearly demonstrate that a local low-dose insulin regime after flap transplantation can accelerate the healing time and improve the surgical outcome without exerting detrimental secondary effects on the glucose plasma level of deep burn patients.

Reconstruction of lateral malleolus with a free iliac bone graft

Objective To explore reconstruction of lateral malleolus with a free iliac bone graft. Methods The clinical data of 5 patients with traumatic compound loss of lateral malleolus and skin were retrospectively analyzed who had been treated at our department from June 2010 to April 2012. They were 3 males and 2 females, 23 to 56 years of age (average, 35.4 years). The bone defect was on the left side in 2 cases, on the right side in 3 cases, and beyond the inferior syndesmosis in all. The bone defects ranged from 3.2 cm to 4.5 cm in length. In the staged treatment, the wounds were repaired by free skin flap transplantation in the first stage while the lateral malleolus defects were rebuilt with a free iliac bone graft in the second stage. Results The skin flaps survived primarily in all the 5 cases. All the cases were followed up for 33 to 38 months (average, 35.4 months). The bone healing time was from 5.5 to 8.0 months (average, 6.8 months). Arthritis occurred 11 months after surgery and limping gait was found 35 months after surgery in one case whose lateral articular surface of the talus was found partially stripped intraoperatively. No limping gait or pain was found in the other 4 cases who obtained a stable ankle with nearly a full range of motion. Their joint surface was matching, and their joint clearance was normal. No secondary fractures occurred. According to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, they scored more than 90 points at the final follow-ups. Conclusion Reconstruction of lateral malleolus with a free iliac bone graft can lead to positive therapeutic effects and ideal long-term outcomes. Key words: Ankle; Wounds and injuries; Ilium; Reconstructive surgical procedures; Transplantation

Patients' self-care management after eyelid reconstructing with free flap-skin

Objective To explore the method of self-care management education for patients who have received the eyelid reconstruction surgery by transplanting with free flap-skin. Methods There were 11 cases (15 eyes) who achieved self-care management and continued nursing, including the preoperative, postoperative nursing care of the donor-skin area, eye nursing, diet guidance, medication guidance, safety protection and its like. Results None of the cases revealed infection and all the grafts showed good biological activity among the 11 cases (15 eyes). Conclusions After self-care management education and continued nursing, the averaged hospitalization days of the patients are shortened; the cost is reduced, and the successful rate of the eyelid's construction by free skin-flap transplantation is enhanced. Self-care management education and continued nursing care played an important role in promoting the healing and improving the successful rate of eyelid's skin-flap transplantation. Key words: Free skin-flap transplantation; Eyelid reconstruction; Self-care management

Forearm free skin flap transplantation. (Chinese)

Forearm free skin flap transplantation. (Chinese)