Free Skin Flap Research Articles

Operation nursing matching study of foot ankle tissue defect renovation by free tissue skin flap

Objective To discuss the skills of operation nursing matching of foot ankle tissue defect renovation by free skin flap.Methods A total of 75 patients with foot ankle trauma renovation by free tissue skin flap were divided into two groups:the observation group 38 and the control group 37.All the patients were on the basis of routine preoperative preparation and postoperative nursing.Active nursing matching methods were taken to the patients of the observation group:making enough preoperative preparation,putting emphasis on psychogenic nursing,making skilled effective nonrandom rational standard nursing matching plans,observing the patients'conditions strictly and ensuring the operation going smoothly.Results The time-span of operation and hospitalization in the observation group were shorter than those of those in the control group(t =4.87,P ＜0.01;t=2.06,P ＜0.05).The differences had significance.But the success rates of both groups had no statistics significance(X2 = 3.85,P ＜ 0.05).Conclusions Taking active operation matching method can shorten operation time-span and hospitalization time-span,increase operation success rate and decrease operative complication. Key words: Foot ankle trauma defect; Free skin flap; Operation matching

Free flap microcirculatory monitoring correlates to free flap temperature assessment

Salvage rates of free flaps have been reported to be inversely related to the time interval between the onset of ischaemia and its clinical recognition. Consecutively, monitoring of free flaps remains of major importance. The aim of this study was to analyse the correlation of postoperative free flap microcirculation and free flap skin temperature as a potential tool of postoperative flap monitoring. Free flap skin temperature correlates to free flap capillary microcirculation. Fifty-four free flaps were prospectively monitored during the study. Postoperative flap monitoring was performed using a regular digital infrared surface thermometer (Medisana FTD, Germany) simultaneously to microcirculatory assessment using combined Laser-Doppler and photospectrometry (Oxygen-to-see, Lea Medizintechnik, Germany). Mean microcirculatory blood flow was 105±35 arbitrary units (AU). Mean temperature was 34.9±2.2 °C. We found a significant correlation between free flap temperature and free flap capillary blood flow (Pearson correlation r=0.48; p<0.001) and postcapillary venous filling pressure (r=-0.32; p=0.021) in 54 free flaps. A 1 °C less free flap temperature was associated with a decrease of the mean microcirculatory capillary blood flow by 37 relative units. Our study demonstrates free flap skin temperature related to capillary microcirculation. Our primary hypothesis was confirmed. We postulate an acute temperature drop of 3 °C at the centre of the skin island as indicative of arterial thrombosis, whereas a 1-2 °C uniform temperature drop of the flap is indicative of venous compromise. Consecutively, free flap skin temperature assessment might be a reliable and inexpensive adjunct monitoring method in plastic reconstructive surgery to improve patients' safety.

Small animal wound management: Options for wound closure

This article looks at wound closure once a healthy wound bed has been achieved. It discusses simple techniques for the avoidance of skin tension and includes skin stretching and vacuum assisted wound closure. Finally, techniques and recommendations for free skin grafts and skin flaps are presented.

Free Flap Skin Temperature Correlates to Microcirculatory Free Flap Capillary Blood Flow

Free Flap Skin Temperature Correlates to Microcirculatory Free Flap Capillary Blood Flow

Pedicled mandible myo‐osseous flaps combined with free skin flaps for reconstruction of complex lateral mandibular defects

This study presents an alternative in reconstruction, using free skin flaps in combination with pedicled mandible bone flaps for complex lateral mandibular defects. In all, 13 patients were included in this prospective study. Pedicled mandible myo-osseous flaps were used for reconstruction of bone defects of the lateral mandible in combination with free skin flaps, including radial forearm flaps (n = 3), anterolateral thigh (ALT) flaps (n = 9), and local tongue flap (n = 1). Postoperatively, a (99m)Tc-methyl diphosphonate bone scan was performed to assess bone flap viability. All patients had acceptably contoured mandibles. The major complications consisted of 1 failed ALT flap and 2 nonviable bone flaps. The bone scan confirmed viable bone flaps in 11 cases. Ten patients (77%) were able to resume soft to full diets. For complex lateral mandibular defects (≤6 cm), a combination of the pedicled mandible myo-osseous flaps and free skin flaps is an alternative in reconstruction.

Reconstruction of Severe Anophthalmic Orbits and Atresic Eye Sockets After Enucleation and Irradiation of Retinoblastoma by Vascular Anastomosed Free Dorsalis Pedis Flaps' Transplantation

Retinoblastoma is a common malignant intraocular tumor in childhood, and most patients require enucleation or exenteration even with irradiation. Severe anophthalmic orbits and atresic eye sockets are not rare. We conducted a retrospective study to evaluate the results of surgical management of reconstruction of severe anophthalmic orbits and atresic eye sockets with vascular anastomosed free dorsalis pedis flap transplantation. There were 5 patients (5 eyes) who underwent reconstructive surgery of severe anophthalmic orbits and atresic eye sockets after enucleation and irradiation of retinoblastoma in our hospital during the 3 years. All patients had enucleation and irradiation immediately after the retinoblastoma was diagnosed and had never worn artificial eyes because of the atresic eye sockets. Vascular anastomosed free dorsalis pedis flaps, whose dimensions were typically 6.5 × 5.5 cm(2), were transplanted to reconstruct the severe anophthalmic orbits and atresic eye sockets. The donor sites were covered by free abdominal skin flaps. All the vascular anastomosed free dorsalis pedis flaps were valid after more than 6 months of follow-up. And then all the 5 patients underwent secondary autogenous dermal fat implantation to augment the supraorbital area depression. After the 2-stage reconstruction surgery, the dimensions of the eye sockets were adequate, and all patients were able to wear their prosthesis and had a satisfactory cosmetic result. Implantation of alloplastic materials is not recommended because of insufficient blood supply of the irradiated orbital area.

The Anatomical (Angiosome) and Clinical Territories of Cutaneous Perforating Arteries: Development of the Concept and Designing Safe Flaps

Island "perforator flaps" have become state of the art for free-skin flap transfer. Recent articles by Saint-Cyr et al. and Rozen et al. have focused on the anatomical and the clinical territories of individual cutaneous perforating arteries in flap planning, and it is timely to compare this work with our angiosome concept. The angiosome concept, published in 1987, was reviewed and correlated with key experimental and clinical work by the authors, published subsequently at different times in different journals. In addition, new data are introduced to define these anatomical and clinical territories of the cutaneous perforators and to aid in the planning of safe skin flaps for local and free-flap transfer. The anatomical territory of a cutaneous perforator was defined in the pig, dog, guinea pig, and rabbit by a line drawn through its perimeter of anastomotic vessels that link it with adjacent perforators in all directions. The safe clinical territory of that perforator, seen not only in the same range of animals but also in the human using either the Doppler probe or computed tomography angiography to locate the vessels, was found reliably to extend to include the anatomical territory of the next adjacent cutaneous perforator, situated radially in any direction. The data provided by Saint-Cyr et al. and Rozen et al., coupled with the authors' own original work on the vascular territories of the body and their subsequent studies, reinforce the angiosome concept and provide the basis for the design of safe flaps for patient benefit.

Scalp Reconstruction with Inverted Myocutaneous Latissimus Free Flap and Unmeshed Skin Graft

Limited skin paddle size, peripheral thinning, or lack of cerebral expansion after radiotherapy may necessitate secondary sculpting after latissimus free flap reconstruction of large scalp defects. This series presents a novel modification of the myocutaneous latissimus dorsi free flap for use in large scalp defects. After superficial artery isolation, titanium mesh is placed into the calvarial defect to recapitulate the inner table. The myocutaneous latissimus flap is harvested in standard fashion, deepithelialized, and inverted. The skin paddle is placed over titanium mesh to fill the calvarial defect, then sewn over a drain. The inverted latissimus muscle is draped over the defect and extended peripherally beneath the pericranium. The flap is sewn to the scalp internally using a vest-over-pants suture pattern, and the thoracodorsal and superficial temporal vessels are anastomosed and left facing outward. Unmeshed skin graft is draped over the muscle and vessels then sutured loosely. Patients with complex scalp defects whose soft tissue defect exceeded the size of latissimus skin paddle available with primary closure were considered eligible for inverted latissimus free flap reconstruction. Follow-up range was 6 months to 12 months. Over a 2-year period, five patients underwent inverted latissimus free flap reconstruction. Scalp defects ranged in size from 10 × 8 cm to 17 × 11 cm. The calvarial defect was smaller than the soft tissue defect in all cases. All flap donor sites were closed primarily. All five flaps took, and donor site outcomes were acceptable. Aesthetic outcomes were satisfactory with well-contoured, calvarial-shaped results. Cosmesis was most notably limited by skin graft joint lines. No patients underwent secondary surgical revision. The inverted myocutaneous latissimus free flap is a safe and effective method for reconstructing large or irradiated scalp defects.

Trapeze-Flap Plasty: An Effective Technique for Postburn Edge Elbow Contracture Elimination

Background Scar flexion elbow contracture is a common complication of burns that restricts upper limb function and requires surgical elimination. In spite of the many surgical techniques that have been suggested, the contracture reconstruction still presents a challenge for surgeons. Methods One hundred and twenty-six patients with 174 edge elbow contractures were operated on. Edge elbow contracture, comprising 70% of all elbow contractures, is characterized by the presence of the fold located on the medial or/and lateral edge of cubital fossa. A crescent-shaped fold consists of a lateral sheet, comprising scars; the medial sheet and cubital fossa consists of healthy skin. The fold's crest is the edge of the scar sheet. The contracture is caused by the scar sheet's surface deficit in length; the scar's surface deficit is present all the way from the fold's crest to the joint rotation axis, and possesses a trapezoid shape. The best tissue for scar sheet deficit compensation and contracture elimination the comprises healthy skin of the cubital fossa and medial fold sheet. After fold sheet division, scar sheet dissection and joint extension, the trapeze-shaped wound is formed as a rule. The adipose-cutaneous trapezoid flap, which includes all the cubital fossa and medial fold sheet surface, is elevated. The flap advances on the wound with tension. As a result of flap tension, the adjacent skin of the contralateral side and the back surfaces of the elbow are displaced towards the cubital fossa, participating in donor wound coverage and contracture elimination. Results Mild edge elbow contractures were eliminated with a single trapezoid flap. In the case of moderate and severe contractures, additional trapezoid adipose-scar flaps were elevated from the scar sheet in order to cover the donor wound on the sides of the main flap. The adipose-cutaneous and adipose-scar trapezoid flaps are large, have no acute angles, do not undergo rotation and have steady blood circulation. Contractures were eliminated completely in 166 cases. Local flap end necrosis of the adipose-scar flap occurred in eight cases. The extended healthy flap's skin continued to grow. Full range of flexion and extension was achieved in all cases, except for eight cases with articular changes; there was no contracture recurrence and no re-operations were needed. The cubital fossa as the donor site preserved a normal shape as a result of growth of the stretched skin. Conclusion The single-staged trapeze-flap technique using cubital fossa flap is easy to plan and perform; edge elbow contractures of different severity were eliminated in full and definitively without skin grafting, pedicled and free flaps.

Regeneration of tendo Achillis

A child with traumatic laceration of the tendo Achillis developed secondary infection after primary repair. This resulted in the loss of 5 cm of the distal part of the tendon and overlying soft tissue. The patient was treated with a free skin flap to cover the wound and to control the infection leaving reconstruction for a second-stage procedure. However, when he was assessed two years after the skin-flap, delayed reconstruction proved to be unnecessary since he had regained normal ankle function spontaneously and could demonstrate equal function in both tendons.

Treatment of Gustilo grade III leg fractures by external fixation associated with limited internal fixation

Objective To explore the clinical effects of external fixation associated with limited internal fixation on treatment of Gustilo grade III leg fractures. Methods From July 2006 to December 2008, 40 cases of Gustilo grade III leg fractures were emergently treated in our unit with external fixation frames. Soft tissue injuries were grouped according to the Gustilo classification as IIIA in 17 cases, IIIB in 13 cases, and IIIC in 10 cases. All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment. Limited internal fixation with plates and screws were performed on all the Gustilo IIIA cases and 10 Gustilo IIIB cases at the first operation. But all the Gustilo IIIC cases and 3 Gustilo IIIB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage (VSD). Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation. Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved. Results The first operations were completed within 90-210 minutes (170 minutes on average). The blood transfusions were from 400 ml to 1500 ml (those used for anti-shock preoperatively not included). All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average. The lower limb function was evaluated according to the comprehensive evaluation standards of leg function one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor. Conclusion External fixation associated with limited internal fixation to treat Gustilo grade III leg fractures can get satisfactory early clinical therapeutic effects.

Dorsal urethroplasty with labia minora skin graft for female urethral strictures

to report a new dorsal labia minora skin-graft urethroplasty as a simple, safe and effective therapeutic alternative for female urethral strictures, as although distal urethral strictures can be treated by meatoplasty, proximal and mid-urethral strictures need appropriate urethroplasty. eight women with a confirmed proximal or mid-urethral stricture had indications for urethroplasty with the use of a thin free labia minora skin graft using a dorsal (6 o'clock position) urethroplasty technique. Full informed consent was obtained. From the inner aspect of one labium minora a thin free skin flap was prepared. The strictured urethra and the anterior vaginal wall were transected and the graft sutured into the defect. All scar tissue was removed and the anterior vaginal wall closed in two layers over the area of the urethroplasty. Continence was evaluated by a stress test with a full bladder. all patients were operated on with no complications during or after surgery. After 1 and 2 years of follow-up seven and six of the eight patients had no recurrence of stricture disease. All patients remained continent. the urethroplasty using an inlay of free thin genital skin graft was safe, uncomplicated and effective.

Comparison of Free Muscle and Perforator Skin Flaps for Soft Tissue Reconstruction of the Foot and Ankle

Free tissue transfer is generally required for reconstruction of soft-tissue defects of the foot and ankle region because of the limited local tissue available. This type of reconstruction may interfere with postoperative function and footwear if a bulky flap is used. Twenty-nine patients had free tissue transfers to the foot and ankle region during a period of 3 years. Sixteen had reconstruction with free anterolateral thigh perforator flaps (ALT) and 13 had reconstruction with free muscle flaps. The outcomes of both types of reconstructions were compared according to flap scores and complications, operative time, hospitalization, gait and shoewear problems. The patients in the ALT group were younger compared with those of the free muscle flap group (p = 0.022). The operative time and flap complication rate was significantly higher (p = 0.007 and 0.040, respectively) in the ALT group. ALT was generally used for reconstruction of the dorsal foot, heel and plantar regions. Muscle flaps were preferred in the ankle region, where open fractures of the tibia and fibula were frequently present, and for the patients with increased risk of perioperative morbidity. Free ALT flap consisting of skin and adaptable subcutaneous tissue, both diminishes donor site morbidity and is ideally suited for most soft-tissue reconstruction of the dorsal foot, heel and plantar foot. Free muscle flaps, however, may offer relatively less complicated tissue transfers and are preferred at the ankle region in the presence of open tibia fractures, and in high risk patients to decrease the perioperative morbidity.

Repair of the large skin and vessel defect of upper arm with free anterolateral thigh flap

To explore an effective method for repairing the large skin and vessel defect of upper arm. The large skin defect was repaired by the free anterolateral thigh flap. The vessel defect was reconstructed with the end branch of descending branch from lateral femoral circumflex artery, or the large muscular branch through bridge-like vascular anastomosis. Since 2003, 5 cases were treated. All the flaps survived completely with a soft tissue texture. They were followed up for 8-24 months. The cosmetic and functional results were both satisfactory with less morbidity in the donor sites. The blood supply of the flap and the end of extremities was not affected by weather. Anterolateral thigh flap is very suitable for large skin and vessel defect of upper arm.

Free anterolateral femoral skin flap addied radiotherapy and chems repair primarily the raw surface of malignant tumor cut on lower limbs

Objective To study the effect of free anterolateral femoral skin flap addied radiotherapy and chems primary repair the raw surface of malignant tumor cut on lower limbs.Methods Superficial malignant tumor were given radiotherapy 10～30 times with 3000～7000Gy,and large dose comprehensiveness chems must be given if osseous metastasis occurred.The raw surface of malignant tumor cut on lower limbs were repaired with free anterolateral femoral skin flap,after the operation,radiotherapy were given with 5000～6000Gy,and chems routly.Results All the raw surface of malignant were repaired successfully,most of the patients were retained with labour ability and full self-care.Survival rate of five years was reached to 92.2%.According to the survival quality evaluation criterion,68.6% of patients were gained good effect.Conclusion Free anterolateral femoral skin flap addied radiotherapy and chems could repair primary the raw surface of malignant tumor cut on lower limbs,the effect were good. Key words: Anterolateral femoral skin flap; Malignant tumor; Raw surface; Repair

Clinical analysis to repairs of electrical burn of wrist

Objective To choose a better metherds to repair electrical burns of Wrist.Methods We had treated 72 limbs of 64 patients between 1994 to 2008 which were divivided into two groups by differents choice of opperations.The abdominal pedicle flap were used in one group,local axial flap and free skin flap were used in another group.Results There was no differences between two groups in the injury,age and operation time,but was significant differences in the wound healing rate,preservation of the important deep fissure and complications(P＜0.01).Conclusion It's more worthy recommendating to use local axial flap and free flap to repair electrical burns of wrist. Key words: Electrical burn; Repair; Wrist

Comparison of free anterolateral thigh flaps and free muscle‐musculocutaneous flaps in soft tissue reconstruction of lower extremity

The objective of this study was to compare the free muscle-musculocutaneous flaps and free perforator skin flaps used for soft tissue reconstruction of the lower extremities. Fifty-three patients whose skin and soft tissue of the lower extremities had been reconstructed were divided into two groups: a perforator flap group, reconstructed using anterolateral thigh (ALT) free flap (23 cases), and a muscle-musculocutaneous flap group, in whom latissimus dorsi and rectus abdominus muscle-musculocutaneous free flaps were used (30 cases). Postoperative complications, long-term results, and donor site morbidities were studied in the two groups. Complete flap survival was 78.3% with four total and one partial flap loss in the ALT group and 90.0% with one total and two partial failure in the muscle-musculocutaneous flap group. Muscle-musculocutaneous flaps were the flaps of choice in Gustillo grade IIIB-C injuries and for reconstruction of more proximal localizations. ALT was preferred in relatively younger patients and was typically used for coverage of the distally localized defects. Flap complication rate was significantly higher in the ALT group, but the overall complication rate was similar between the groups. ALT perforator flap is a precious option for lower extremity soft tissue reconstruction with minimal donor site morbidity. Nevertheless, the beginners should be attentive to an increased rate of flap complications with the ALT flap and free axial muscle-musculocutaneous flaps would still be the tissue of choice for coverage of leg defects for a surgeon before gaining enough experience with perforator flap dissection.

Focal injection of vancomycin combined with surgical debridement–dermatoplasty in the treatment of pseudo-epitheliomatous granuloma

Background Pseudo-epitheliomatous granuloma (PEG) can occur in some small skin wounds with secondary infections resulting from improper treatments. It is difficult to heal and can easily relapse. Objectives This study explores the clinical and pathological characteristics of PEG and effective treatments. Patients and methods Tissue specimens of PEG obtained from 11 patients (age range: 2–67 years) were sent for microbial examination and histological observation. The local lesions were treated by focal injection of vancomycin combined with surgical debridement–dermatoplasty. Results The diagnosis of PEG was based on histological examination, which revealed long epithelial peduncle encapsulated granulation tissue-like honeycomb in which more vessels, macrophages, lymphocytes and mast cells and less extracellular matrix were distributed. Bacteria such as Staphylococcus aureus, Bacillus pyocyaneus, ethylene-type Streptococcus, stool Streptococcus and F-citric acid Bacillus were found in the microbial culture of the specimens. They were tolerant to celbenin but sensitive to vancomycin. PEG could be cured by focal application of vancomycin combined with free skin or skin flap after thorough debridement. The relapse of PEG could be prevented by the therapy. Conclusion Focal injection of vancomycin combined with surgical debridement–dermatoplasty is an effective therapy for PEG.

Surgical treatment for well-differentiated thyroid carcinoma invading the larynx,trachea,esophagus and hypopharynx

Objective:To explore the surgical treatment for well-differentiated thyroid carcinoma(WDTC) invading the larynx,trachea,esophagus and hypopharynx. Methods: Primary tumor resection was performed in 17 patients with advanced WDTC.All the 17 cases had laryngotracheal involvement and received different kinds of surgical treatment: including 14 receiving local shaving-off,wedge tracheal resection with direct suture,window tracheal resection with sternocleidomastoid myoperiosteous flap reconstruction,sleeve tracheal resection with tracheal anastomosis or tracheal reconstruction by forearm free skin flap,and 3 receiving total laryngectomy or near-total laryngectomy. Eleven cases with esophagus and hypopharynx involvement received muscular layer resection or esophageal and hypopharynx partial resection with pectoralis major myocutaneous flap reconstruction. For 12 cases with recurrent laryngeal nerve involvement,9 were treated by nerve decompression,nerve resection combined with one-stage arytenoid within-shift and/or recurrent laryngeal nerve transposition,3 by simple laryngectomy. Results: The patients were followed up for 1 to 12 years. Sixteen patients survived and one died of tumor metastasis. The 5-year survival rate was 93.3%; the post-operation complication rate was 23.5%.Tumor relapses were found in 2 cases who had undergone local shaving-off or partial cervical trachea resection. The voice quality of the 9 patients receiving recurrent laryngeal nerve decompression or voice rehabilitation was greatly improved,and 5 of them had normal voice. Conclusion: The curative rate and quality of life of WDTC patients with extrathyroidal extension can be improved by one-stage resection and reconstruction. Operation modes should be chosen according to the location, involvement of tumor, the invasion of recurrent laryngeal nerve and the disease course. Operation is invasive and reconstruction is a complicated process, with many complications.

Effects of Radiation on Tissue Engineered Mucosa

Oral cancer accounts for approximately 4% of all cancers in the world. After oncological resection the defects is reconstructed using free skin flaps. Drawbacks of this procedure include donor site defects, lack and saliva production and hair bearing of the flaps. Tissue-engineered mucosa (TEM) can be used to reconstruct the defects after resection.