Free Skin Graft Research Articles

Clinical efficacy of Mohs surgery combined with topical photodynamic therapy for facial basal cell carcinoma.

The purpose of this study is to investigate the clinical efficacy of Mohs surgery in combination with topical photodynamic therapy (PDT) for facial basal cell carcinoma. Eighty-six patients with facial basal cell carcinoma treated in our department from April 2011 to December 2013 were included. Mohs surgery was used to remove the lesions followed by direct suturing, skin flap grafting, or medium thickness free-skin grafting to repair the incisions. Topical PDT was performed three times, at an interval of 2 weeks, immediately after the sutures were removed. The patients were followed up for 2 years after the operation to evaluate tumor recurrence. Recurrence was not observed within 1 year after Mohs surgery combining PDT; however, one case of recurrence was found at the 2-year follow-up. The efficacy of Mohs surgery combining topical PDT is a definite treatment for facial basal cell carcinomas, as it reduced the tumor recurrence rate and maintained the relative integrity of the local tissues and appearance. This method could be a new effective treatment method for the facial basal cell carcinoma.

Clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area

Objective: To explore the clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area. Methods: Eleven patients (7 males and 4 females, aged from 18 to 73 years) with soft tissue defects of finger web area in distal dorsal side were admitted to Xinhua Hospital (Chongming) of Shanghai Jiao Tong University School of Medicine from October 2010 to September 2018. The sizes of skin and soft tissue defects ranged from 2.5 cm×1.5 cm to 6.0 cm×2.5 cm. According to the origin, course, branches, and distribution of the dorsal perforator of deep palmar arch, and the anatomical characteristics with vascular network of dorsal carpal and dorsal metacarpal, dorsal perforator fascia pedicle flaps of the deep palmar arch from the back of the injured hands were designed and transferred to repair the wounds of finger web area in distal dorsal side. The sizes of the flaps of patients ranged from 3.5 cm×2.0 cm to 6.5 cm×3.0 cm. The donor sites were sutured directly or covered with free forearm full-thickness skin graft. The clinical effects and swelling degree of flaps in early and late stages were evaluated during the follow-up of 3 to 36 months post surgery. Results: All the flaps survived in 11 patients, the incisions in donor and recipient sites were healed. During the follow-up of 3 to 36 months post surgery, the survival of flaps was good, and the appearance, color, and elasticity were close to normal skin, with two-point discrimination distance of 7 to 10 mm and sensory function recovery of grade S(3). The wounds in donor site had small scar without infection. The efficacy was evaluated as satisfactory in 8 patients, general in 3 patients, and dissatisfactory in no patient. Flap swelling rating in early stage was 1st degree in 7 patients, 2nd degree in 2 patients, and 3rd degree in 2 patients. Flap swelling rating in late stage was 1st degree in 8 patients, 2nd degree in 2 patients, and 3rd degree in 1 patient. The extension and flexion of the metacarpal and interphalangeal joints were basically normal and the patients were satisfied with the outcomes. Conclusions: Based on the dorsal perforator of deep palmar arch, dorsal perforator fascia pedicle flap of the deep palmar arch is reliable to transfer to repair skin and soft tissue defects of finger web area in distal dorsal side, which is worthy of promotion in clinic.

Revascularization of Free Skin Grafts Overlying Modified Hughes Tarsoconjunctival Flaps Monitored Using Laser-Based Techniques.

It has recently been shown that the flap pedicle does not supply blood to a tarsoconjunctival graft in the modified Hughes procedure in patients. This raises questions concerning the rate of revascularization of the free skin graft commonly used to reconstruct the anterior lamella. The aim of this study was, thus, to monitor the course of revascularization in free skin grafts overlying modified Hughes tarsoconjunctival flaps, using laser-based techniques. Free skin grafts from the upper eyelid or upper arm in 9 patients were used to cover a tarsoconjunctival flap according to the modified Hughes procedure. Blood perfusion was monitored using laser speckle contrast imaging, and vascular reactivity was studied with laser Doppler velocimetry after heating the tissue to 44°C. Measurements were made at the time of surgery (baseline) and at 1, 3, 8, and 16 weeks postoperatively. The gradual increase in perfusion of the free skin grafts during the healing process indicates revascularization. A slight increase in perfusion was seen already after 1 week. Perfusion reached 50% of the baseline after 3 weeks, and complete restoration of perfusion was seen after 8 weeks. The vascular function monitored with heat-induced hyperemia increased in a similar fashion. Full-thickness skin grafts revascularize within 3 to 8 weeks, despite overlying a tarsoconjunctival flap, which has recently been reported to be avascular. This provides further evidence that it should be possible to repair large eyelid defects using free full-thickness eyelid grafts.

Application of reverse dermal revascularization combined with vacuum sealing drainage in the large area of skin avulsion of the lower extremities

To summarize the clinical effect of emergency subcutaneous vascular network reverse skin replantation combined with vacuum sealing after drainage of large area skin avulsion injury. Clinical data of 30 patients with extensive skin avulsion of the lower limb treated between July 2010 and March 2018 were collected. There were 20 males and 10 females, ranging in age from 16 to 67 years old, with an average of(48±13) years old. Cause of injury: 19 cases of car accident injury, 11 cases of crush injury. The surgery time was 3 to 10 h, with an average of (5±1) h. All cases were completely debrided in stage I. The subdermal vascular network was reversed and skin grafted with multiple incision drainage combined with negative pressure closed drainage technique for 7 to 10 days. The wounds were removed by VSD observation:if the necrotic area is large, debridement is required. After the granulation growth of the wound is satisfactory, the skin grafting is performed again after electrification; the small area of necrotic skin strengthens the dressing and heals. 30 patients were followed up for 7 to 48 months, with an average of (20±11) months.No infection in 1 case appeared, 30 patients, living area more than 85% of the wound after treatment survival in the stage I; The skin necrosis ranged from about 12% in 5 patients in the stage II. The second stage was healed after redebriding free skin grafts. The other patients were healed after the dressing, capillary meshwork layer of skin color, good elasticity, feeling, wearable pressure, each joint activities is good, no obvious skin adhesion cause physical activity is limited. Reverse skin grafting combined with VSD for the treatment of large skin avulsion of lower limb can greatly reduce wound infection rate, promote the application of skin and wound, conducive to drainage, improve the survival rate of reverse skin grafting and improve the function of lower limb joints.

Repair of donor site of reverse digital artery island flap with transverse V-Y fascial advancement flap of proximal dorsum of the finger

Objective To summarize the clinical efficacy of transverse V-Y fascial advancement flap of proximal dorsum of the finger for the repair of the donor site of reverse digital artery island flap. Methods From January 2017 to February 2018, 14 patients with fingertip defect were treated, including 4 emergency cases and 10 sub-emergency cases. The range of fingertip defect was 1.6 cm×0.6 cm to 2.5 cm×1.4 cm. The fingertip wound was repaired by reverse digital artery island flap and the donor site was covered by transverse V-Y fascial advancement flap of proximal dorsum of the finger. Results The flaps survived uneventfully after operation, and all the donor and recipient wounds achieved primary healing. The follow-up period ranged from 9 to 15 months with an average of 10.6 months. The skin flaps were of good texture, color, shape and no tenderness at the fingertips. At the last follow-up, the two-point discrimination of reverse digital artery island flaps was 7 to 12 mm, with an average of 8.6 mm. The two-point discrimination of V-Y advancement flaps of dorsal fingers was 5 to 9 mm, with an average of 6.2 mm. There was no web contracture, and the maximum abduction angle was 38° to 45° with an average of 42°. According to the total active range of motion (TAM) system, 12 cases were excellent and 2 cases were good. Conclusion The transverse V-Y fascial advancement flap of proximal dorsum of the finger was used to repair the donor site of reverse digital artery island flaps. The appearance, function and sensation of the fingers recovered well, and the related complications of free skin grafting were avoided. Key words: Finger injuries; Surgical flaps; Donor site; Wound repair

The use of bacteriophages for prevention of infections in the surgical area at free skin grafting

The purpose of the study : prevention of infectious complications in the field of skin plastics by immobilization of bacteriophages relevant for the medical organization in the field of recipient wounds. Materials and methods . A method has been developed in which bacteriophages are immobilized in the area of operation with a hydrogel dressing prepared ex tempore. To monitor the viability and effectiveness of bacteriophages in hydrogel dressings, they performed in vitro and in vivo bacteriological studies. Results. It has been revealed that bacteriophages retain viability, bioavailability and lytic activity in a hydrogel dressing for 4-5 days. The possibility and safety of the use of bacteriophages for the protection of a cleaved autodermal transplant from hospital infection has been confirmed. Conclusions . The use of bacteriophages for the prevention of local infectious complications with free skin grafting is promising and technically possible.

Features of the microbiological landscape of chronic soft tissue wounds

The article is devoted to the analysis of the qualitative composition and dynamics of the microbiological landscape in the treatment of chronic soft tissue wounds. The purpose of the study is to study the changes in the quantitative and qualitative composition of pathogens of wound infection in the treatment of patients with chronic soft tissue wounds in a surgical hospital. Materials and methods . In order to study changes in the quantitative and qualitative composition of pathogens of wound infection in the treatment of patients with chronic soft tissue wounds, a retrospective analysis of bacteriological studies was performed in 206 patients with chronic soft tissue wounds. Results . After the wound defect was closed by the method of free skin grafting with a split graft, pathogen change on the 4-5th day occurred in 59% of cases. Lysis and melting of the graft in the group of patients with a change of microflora were observed in 37,5% of cases. Most often, these complications were associated with the presence in the wound of St. pyogenes and non-fermentative gram-negative bacteria. Conclusions . In patients with chronic soft tissue wounds, associations of microorganisms are detected in 13,5% of cases; S. aureus is the main causative agent among monocultures of microorganisms (32,5%). The presence of a wound Ps. aeruginosa, Acinetobacter spp., Streptococcus pyogenes (serogroup A) is a contraindication to skin-plastic surgery.

Clinical effect of free anterolateral thigh flap in repairing large annular soft tissue defect of lower leg after burn

Objective: To explore the clinical effect of free anterolateral thigh flap in repairing large annular soft tissue defect of lower leg after burn. Methods: From January 2014 to December 2018, 9 patients with large annular soft tissue defects of lower legs after burns were hospitalized in Zhengzhou First People's Hospital, including 1 case with wounds on both legs. After debridement, area of wounds was 16 cm×11 cm-38 cm×21 cm, and the burn wounds were repaired with free anterolateral thigh flaps in the area of 18 cm×12 cm-32 cm×24 cm. End-to-end anastomosis of posterior tibial vessels or anterior tibial vessels with lateral circumflex femoral vessels was performed in manual way or by microvascular stapler. For the affected legs without condition for anastomosis, the sound medial lower leg flaps with areas of 10 cm×8 cm-15 cm×10 cm were excised and made into skin tubes, the posterior tibial vessels of the flaps were anastomosed with the vessels of free anterolateral femoral flaps, and the wounds of the injured lower legs were repaired by bridge-type cross-over free transplantation of anterolateral thigh flaps. The pedicles were broken 4 to 5 weeks later. The donor site was transplanted with autologous intermediate split-thickness skin graft from thigh. The outcome of the treatment, the number of perforators included in the flaps, and the anastomotic vessel in the recipient area of patients were recorded. The anastomosis time between manual way and microvascular staplers was recorded and compared. The patency of blood vessels, methods of free transplantation, and follow-up condition were recorded. Data were processed with Wilcoxon rank sum test for two independent samples. Results: All the 10 free flaps and skin grafts of 9 patients survived, and all the wounds were closed by primary operation. Seven flaps contained two perforators each, and three flaps contained three perforators each. The anastomotic vessels were posterior tibial vessels in 6 recipient areas and anterior tibial vessels in 4 recipient areas. Microvascular stapler was used to anastomose 12 veins, while 8 veins and 10 arteries were anstomosed manually. The time consumed by the former method was 4.00 (3.55, 4.38) min, significantly shorter than 12.80 (12.13, 13.40) min of the latter (W=78.00, P<0.01). The patency rates of veins and arteries were 100%. There was no vascular crisis due to vascular anastomosis. Three patients underwent bridge-type cross-over free transplantation, while the others underwent conventional free transplantation. Follow-up for 3 to 30 months showed that the donor site of the thigh had good motor function, without numbness or pain, but hypertrophy of scar could be seen. Four patients had slightly overstaffed flaps transplanted in the recipient area of the lower legs, while the other patients were satisfied with their appearance, and the walking function of the affected limbs gradually recovered. Conclusions: Free anterolateral thigh flap transplantation is a safe and reliable clinical limb salvage method for the repair of large annular soft tissue defect of lower leg after burn. Intraoperative application of microvascular stapler for venous anastomosis can shorten the time of vascular anastomosis and has great clinical application value.

Repair of soft tissue defect of fingers with modified arterialized venous flap

To summarize the effectiveness of modified arterialized venous flaps in repairing soft tissue defect of fingers. Between January 2017 and April 2018, 16 patients with soft defects of fingers were treated. There were 12 males and 4 females, with an average age of 41 years (range, 24-74 years). One case was resulted from resection of cicatricial contracture and 15 cases was caused by mechanical strangulation. The defects located at thumb in 3 cases, index finger in 5 cases, middle finger in 4 cases, ring finger in 2 cases, and little finger in 2 cases; and at the palmar aspect in 4 cases, and dorsal aspect in 12 cases. The size of defect ranged from 3 cm×2 cm to 10 cm×3 cm. All flaps were harvested from the palmar aspect of the ipsilateral forearm. The distal ports of the two veins were ligation. Partial fat was eliminated and the all connecting minute branches between the two veins were ligation under microscope in order to achieve the thorough shunt restriction. Then the flaps were positioned over the recipient site without inversion. The size of flap ranged from 3.5 cm×2.5 cm to 10.5 cm×3.5 cm. All donor sites were directly sutured except that 1 case was recovered with free skin graft. All flaps survived entirely except that 1 case happened vein crisis. Three flaps demonstrated mild-to-moderate venous congestion without any treatment and the swelling of flaps gradually subsided after 1 week. Skin grafting at donor site survived and all incisions healed by first intension. Thirteen patients were followed up 8-16 months (mean, 11 months). The textures and appearances of the flaps were satisfactory. At last follow-up, the mean size of the Semmes-Weinstein (SW) monofilament test of the flaps was 4.01 g (range, 2.83-4.56 g); the mean static two-point discrimination of the flaps was 12 mm (range, 6-20 mm). Modified arterialized venous flaps with thoroughly restriction of arteriovenous shunting can offer decreased congestion of venous flaps and improve survival rate. Better effectiveness can be achieved by using this flap to repair soft tissue defect of finger.

Results of Surgical Treatment of Patients with Congenital Auditory Canal Atresia and Microtia

Purpose: Creation and implementation effective methods of complex anatomical, functional and aesthetic rehabilitation for different categories of patients with atresia of the external auditory canal (AEAC) and microtia. Methods: Fourty seven patients (n = 47) with congenital atresia of external auditory canal and microtia of different grade underwent surgery on the base of ear diseases department of Federal Scientific and Clinical Center of Otorhinolaryngology (FSCCO) of Federal Medico-Biological Agency of Russian Federation. All patients were divided into three groups. The first group included patients with EACA and 1 grade microtia. The second group included patients with EACA and 2-3 grade microtia. The third group included patients with AECA and 2-3 grade microtia who underwent different types of surgeries previously, had unsufficient development of local tissue, history of trauma, radiation or auricular cancer. To all of them one of three surgical approaches was performed due to individual features and indications: formation of an EAC, tympanoplasty with ossicular chain reconstruction (n = 23) to the 1st group of patient; formation of an EAC, tympanolasty with ossicular chain reconstruction and concomitant reconstruction of an auricle by use of MEDPORto the 2nd group of patients (n = 9) or fixation of cranial osseointegrated implants (COI) to the 3rd group of patients (n = 15). Results: During the observation period which covered on average 3.2 years (+/- 9 months) achieved stable anatomical result. The air-bone gap was on the average 17,0±3.2 dB. Medpor reconstruction provided reliable aesthetic results. The removable auricural prosthesis completely covered up a congenital defect and was a reflection of a healthy ear. Conclusion: The application of the method of lining the formed bone walls of the external auditory canal with a skin pedicled flapand free skin grafts makes it possible to achieve stable anatomical result. Ossiculoplasty with titanium prostheses and tympanoplasty with auto-fascia graft provide a significant hearing improvement in patients with congenital atresia of the external auditory canal. Simultaneous surgical interventions with atresia repair; tympanoplasty and Medpor implantation or setting of ectoprosthetic on COI can be successfully used to improve hearing, replace abnormal ear in different categories of patients according to indications and return them to the social life.

Effects of free superficial temporal fascia flaps and skin grafts in repairing deep wounds in posterior ankle region of extensively burned patients

Objective: To observe the effects of the method of combining free superficial temporal fascia flaps with skin grafts in repairing deep wounds in posterior ankle region of extensively burned patients. Methods: From September 2013 to February 2017, 11 extensively burned patients with deep tissue defects in posterior ankle region were treated in our unit. Two patients had tissue defects in bilateral posterior ankle regions. The wound sizes ranged from 5.8 cm×4.6 cm to 11.7 cm×5.2 cm. Free superficial temporal fascia flaps with the same sizes as the wounds were designed and resected to repair wounds in posterior ankle regions after debridement. The proximal end of superficial temporal veins and posterior tibial veins were performed with end-to-end anastomosis, and superficial temporal arteries and posterior tibial arteries were performed with end-to-side anastomosis. Skin grafts were resected to cover the superficial temporal fascia flaps according to patients' condition of donor sites. The donor sites were sutured directly. Results: All fascial flaps in 11 patients survived, while 2 skin grafts had partial necrosis, and they healed after secondary skin graft. All patients were followed up for 6 to 13 months, and the shape and function of the operation sites in all patients recovered well. Conclusions: The method of combining free superficial temporal fascia flaps with skin grafts can repair deep wounds in posterior ankle regions of extensively burned patients. It has the advantages of good appearances in the recipient sites, strong resistances to infection of fascia flaps, minimal damages to the donor sites, short course of disease, and good prognosis of patients.

Skin Extension by Multiple Incisions (SEMI).

There is a need for a simple and atraumatic technique for wound closure in soft tissue defects. The aim of this study was to evaluate the technique of skin extension by multiple incisions in the healing of soft tissue defects following trauma. This is a retrospective clinical study on soft tissue defects after trauma. The dimensions of the defects were measured intra-operatively. Exclusion criteria were combined techniques of skin extension by multiple incisions with local flaps or free skin grafts, preoperative numbness, and incomplete data. Complications until wound healing were documented. One hundred soft tissue defects were evaluated. Uneventful healing occurred in 81. Minor complications were found in 15, and revision was performed in 4. Sensitivity to touch was normal in all. Skin extension by multiple incisions is very easy to learn and can be performed without special instruments. The survival rate of the extended skin is high. Sensitivity to touch and mobility of the skin can be preserved, which results in a very durable nearly normal skin.

Application of modified digital artery island flap for repair of the middle and distal segment wounds of the same finger

Objective To investigate the clinical outcomes of modified digital artery island flap pedicled with metaphysis branch of the middle phalanx for repair of the middle and distal segment wounds of the same finger with the second palmar anastomotic branch injury. Methods From August 2014 to March 2017, 11 cases of soft tissue defects with the second palmar anastomotic branch injury were treated with modified digital artery island flap pedicled with metaphysis branch of the middle phalanx. The dorsal digital nerve of the flap was sutured to the contralateral digital nerve to restore flap sensation. The donor site was covered with free skin graft. Results All the flaps and skin graft survived completely. All the patients were follow-up from 6 to18 months. The flaps had good appearance and supple texture. The two-point discrimination was 7 to 11 mm. The Cold Intolerance Severity Score (CISS) ranged from 5 to 39 with an average of 21. Ten fingers had mild cold intolerance, while 1 finger had moderate cold intolerance. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 8 cases, good in 2 cases, and fair in 1 case. Conclusion The application of modified digital artery island flap pedicled with metaphysis branch of the middle phalanx is a simple method with satisfactory sensory recovery and reliable blood supply for repair of the middle and distal segment wounds of the same finger with the second palmar anastomotic branch injury. Key words: Finger injuries; Surgical flaps; Treatment outcome; Proper digital artery

Application of foot commonpedicle bilobed flap combined with iliac crest bone graft for repair of penetrating finger injuries

Objective To investigate the clinical efficacy of foot commonpedicle bilobed flap combined with iliac crest bone graft for reconstruction of penetrating finger injuries. Methods From November 2013 to December 2017, 7 cases of penetrating finger injuries were treated by foot commonpedicle bilobed flap or tibial second toe flap with iliac crest bone graft. The donor site of the toe was covered by lower abdominal free skin graft. Results All the flaps survived uneventfully. Partial necrosis of the toe donor site occurred in 1 case which healed after dressing change. The rest donor sites achieved primary healing. The healing time of bone was 2. 0 to 2. 5 months. Postoperative follow-up ranged from 3 to 12 months with an average of 6 months. No bone resorption was found in the transplantation of iliac bone. The flap had good texture and no obvious bulky appearance. The sensation of fingers and flaps recovered to S2to S4. Local scar hyperplasia in the donor site occurred in 1 case. There was no significant scar contracture and influence on foot function. The proximal interphalangeal joint activity of 6 cases without involvement of the proximal interphalangeal joint injuries ranged from 60° to 80° averaging 70°. Joint fusion in functional position was performed in 1 case of damaged proximal interphalangeal joint. Conclusion Foot commonpedicle bilobed flap combined with iliac crest bone graft is an ideal method for reconstruction of penetrating finger injuries. Key words: Finger injuries; Surgical flaps; Commonpedicle; Microsurgery

Cheek-midface lift for revision following failed excessive lower eyelid blepharoplasty

Iatrogenic ectropion with sagging of the lower eyelid after failed excessive lower eyelid blepharoplasty is asevere complication in aesthetic surgery. Traditionally, free skin grafting is the method of choice for correction. This overview presents the cheek-midface lift as auseful and powerful method for the correction of ectropion following excessive lower eyelid blepharoplasty. This technique, which can be performed with the patient under local anesthesia, enables good functional as well as aesthetic outcomes.

Transfer of gastrocnemius muscle flap for postoperative infection with patellar internal fixation

To investigate clinical effect of gastrocnemius muscle flap for repairing postoperative infection of patellar internal fixation. From January 2011 to January 2017, 15 patients with postoperative infection of patellar internal fixation were treated, including 9 males and 6 females ranged from 31 to 66 years old with an average age of (42.5±11.2) years old. The courses of disease ranged from 2 to 8 months with an average of (4.3±1.5) months. All wounds were repaired by gastrocnemius muscle flap after debridement. The coverage of muscle flap was performed by free skin graft and donor site was closed directly. Survival of muscle flap, healing of incision were observed. HUANG Yong-xin clinical criteria and KSS score criteria were used to evaluate knee joint function 9 after operation. All muscle flaps were survived without necrosis. Incision of 13 patients were healed at stageI, and 2 patients had wound dehiscence after operation and healed after symptomatic treatment. All patients were followed up from 9 months to 30 months with an average of(20.6±8.3) months. No recurrence of infection was observed, and texture of muscle flap, skin color, appearance were good. According to HUANG Yong-xin clinical criteria, 13 excellent and 2 moderate. The clinical score of KSS score was 83.3±7.8, and functional score of KSS score was 86.3±10.4. Gastrocnemius muscle flap is an effective method in repairing postoperative infection of patellar internal fixation with stable curative effect and low recurrence rate, which is worthy popularizing.

Analysis of the causes and the countermeasures for the serious complications after perforating pedicle flap of lower leg

Objective To analysis causes of the serious complications after the operation of the lower leg perforator pedicle screw flap, and to explore the corresponding countermeasures. Methods From June, 2012 to August, 2016, 60 cases of soft tissue defect of ankle and foot were repaired with propeller flaps pedicled with perforator of lower legs. with the area were soft tissue defect ranged from 3.0 cm×2.0 cm to 19.0 cm×9.0 cm, and all with bone exposure. Two cases of traumatic tissue defect, 7 cases were chronic osteomyelitis of the distal tibia, 13 cases were incision infection and necrosis after the operation of ankle joint fracture and Pilon fracture, 10 cases were simple incision necrosis after calcaneal fracture, 18 cases were calcaneal osteomyelitis, 1 case were soft tissue defect after the ankle tumor operation, 6 cases were soft tissue necrosis after the Achilles tendon rupture, and 3 cases were soft tissue defect of the dorsum with infection. The posterior tibial artery perforator pedicled propeller flap was used in 18 cases. The pedicle of the vascular pedicle was 6.0-18.0 cm from the medial malleolus, the flap rotation was 135°-180°. There were 42 cases of the perforator pedicle propeller flap of the peroneal artery, 5.0-18.0 cm from the pedicle of the vascular pedicle and 120°-180° rotation in the flap. The area of the flap was 9.0 cm×3.0 cm-34.0 cm×18.0 cm. There were 32 cases of direct suture in the donor site and 28 cases of free skin grafting. Results The color, swelling, elasticity, capillary reaction and healing of donor site were observed after operation. There was no flap ischemia occurred in 60 patients. Fourteen cases had venous reflux obstruction, all of which had swelling above II degree, 8 cases had swelling above III degree with obvious purple blood stasis, resulting in partial flap necrosis in 4 cases, all necrosis in 1 case, including 4 cases of free skin grafting, 1 case of flap transplantation and repair. There were 3 cases of necrosis after skin grafting in the flap area, all of which were partial necrosis. There was case of necrosis of the wound surface after direct suture of the donor site and 1 case of skin disintegration after disassembly, and all wounds healed after the replacement of the wound and the external use of the dried blood powder. All the 60 patients were followed-up for 12 to 30 (mean, 24.5)months. The flaps survived and the donor site scars healed well. The range of motion of the ankle was from -10°to 10°(mean, 5.6 °) and the flexion of the plantar was from 20 °to 50 °(mean, 37.8 °). Fourteen patients with venous reflux disorder were followed up for 15 to 28(mean, 22.3)months. The flap and skin graft survived well. Ankle dorsiflexion ranged from -10° to 10 °(mean, 2.4 °) and plantar flexion from 20° to 45 °(mean, 35.6 °). There was no obvious limp in walking. Conclusion Although the overall effect of the lower leg perforator pedicle propeller flap to repair the soft tissue defect of the foot and ankle is satis-factory, there are still various serious complications, which are mainly due to iatrogenic. Doctors should strictly follow the basic principles of skin flap surgery from preoperative to postoperative, and during operation and postoperative man-agement, so as to reduce the incidence of complications. Key words: Lower leg; Perforator vessel; Propeller flap, perforator flap; Ankle and foot; Complication

Justin Ivlianovich JANELIDZE – Chairman of the all-Union society of surgeons, Chief surgeon of the Soviet Navy, chief editor of the journal "Bulletin of surgery" (135th anniversary of birth)

In 1883 in Georgia in a peasant family was born Justin Ivlianovich Janelidze. After graduating from the Kutaisi classical gymnasium (1903) studied in Kharkiv (1903-1905) and Geneva universities (1905 – 1909). Defended his thesis on the topic: "the question of teratoma and testicular tumors" (1909). In 1910 I. I. Dzhanelidze returned to Russia and received the title of doctor with honors, doctor of medicine (1911). From 1911 to 1914 he worked at the St. Petersburg women's medical Institute at the Department of hospital surgery. In 1911 G. I. Janelidze made a successful operation a patient with a wound of the right ventricle of the heart, in 1913 - world's first stitched the wound of the ascending aorta. During the first world war Justin Ivlianovich was a doctor of the field hospital trains. On his return from the army he worked as an assistant Professor, Department of General surgery (1921) the Petrograd medical Institute. In 1927, I. I. Janelidze was elected to the chair of hospital surgery of I Leningrad medical Institute, headed until 1943 1932 he is also scientific Director of the Leningrad Institute of emergency care. In 1939, Justin Ivlianovich - chief surgeon of the Navy of the USSR. In 1943, I. I. Janelidze was appointed chief of the Department of hospital surgery educated in the naval medical Academy.&#x0D; &#x0D; I. Janelidze is the author of over 100 scientific works, including monographs: "the Wounds of the heart and their surgical treatment", "Free skin grafting in Russia and the Soviet Union," "Bronchial fistula gunshot origin." He developed methods of surgical treatment of wounds of the heart, mediastinum, arterial and arteriovenous aneurysms of the carotid, subclavian and femoral arteries, plastic surgery, methods of reduction of dislocated shoulder and hip.&#x0D; &#x0D; Most famous was his monograph "Bronchial fistula gunshot origin", for which he was awarded the State prize of the USSR (1948). In 1946 he was elected Chairman of the all-Union society of surgeons and remained in this post until the end of life. He was editor-in-chief of the journal "Bulletin of surgery" (1937-1941 gg.), the editor of "war surgery" in the "Encyclopedic dictionary of military medicine", member of the editorial Board and the author of several chapters of the multivolume work "the Experience of Soviet medicine in great Patriotic war 1941-1945", magazines "Surgery" and "New surgical archive". I. I. Janelidze was elected Deputy of the Leningrad city Council of people's deputies. He was awarded two orders of Lenin, order of the red banner, the Gold medal "hammer and Sickle" and many medals. January 14, 1950 I. I. Janelidze died.

Aesthetic Auricular Reconstruction in Adult Patients with Rib Cartilage Calcification Using a Modified Two-Step Technique.

It is very important for congenital microtia patients to achieve better aesthetic appearance, craniofacial balance and mental health through auricular reconstruction. But there are great challenges for plastic surgeons on how to perform this technique in adult patients with tough and rigid rib cartilage because of the different extent of calcification. To lower the harvest of the cartilage and reduce the suffering during the operation, in this study, we report a modified two-step method for adult patients who suffered rib cartilage calcification in auricular reconstruction. From January 2012 to January 2018, 89 adult patients (aged from 24 to 50) with cartilage calcification were enrolled and received auricular reconstruction using the modified two-step technique. The whole procedure was performed in two surgical stages. In the first stage, rib cartilages were harvested and modified cartilage frameworks were designed, fabricated and grafted, which included an ear-shaped framework and a C-shaped base part. The ear-shaped framework was inserted into the mastoid region through a W-shaped incision, but the C-shaped base part was embedded subcutaneously in the donor site. In the second stage, the C-shaped base part was transplanted into the mastoid region to elevate the reconstructed ear. A retro-auricular fascia flap and a free skin graft were used to cover the posterior side of the reconstructed ear. The patients were followed for 6 to 24 months. During the follow-up visiting, 80 cases (89%) were satisfied with the outcomes in size, shape, location and details of reconstructed ears. Our modified technique is safe and effective for auricular reconstruction, reduces the harvest of cartilage and decreases the suffering as well in adult patients with congenital microtia and rib cartilage calcification. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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.