Pedicle Skin Research Articles

Pedicled partial thickness clavicular graft for oromandibular reconstruction

To report our experience on pedicled partial-thickness clavicular graft (PPCG) for oromandibular reconstruction. PPCG was used for oromandibular reconstruction after tumor resection in 23 patients with early-stage gingival carcinoma but were eager for postoperative dental implant therapy for restoration of good occlusal function. PPCG was harvested during neck dissection. The sternocleidomastoid (SCM) myocutaneous flap was also harvested in 18 cases. Dental implants were placed in the clavicular graft of 19 cases, and the other 4 declined because of financial concerns. Postoperative viability of the flaps and the dental implants were assessed. All the clavicular grafts survived without necrosis and implant-supported dentures of 19 patients provided satisfactory occlusion and masticatory function. Complications, although low in occurrence, included partial skin pedicle loss, nonunion between the clavicular graft and the remaining inferior border of the mandible, and clavicular bone fracture. PPCG is a simple but reliable procedure for reconstruction of severe alveolar defects. Correct preoperative evaluation and precise surgical technique contribute to higher success rates and lower complication rates. It is a viable reconstructive option for early-stage gingival carcinoma requiring neck dissection without postoperative radiation therapy.

AdVEGF-All6A+ Preconditioning of Murine Ischemic Skin Flaps Is Comparable to Surgical Delay.

Background:Surgical flap delay is commonly used in preconditioning reconstructive flaps to prevent necrosis. However, staged procedures are not ideal. Pharmacologic up-regulation of angiogenic and arteriogenic factors before flap elevation poses a nonsurgical approach to improve flap survival.Methods:Male Sprague Dawley rats were divided into control (n = 16), surgical delay (Delay), AdNull, AdEgr-1, and AdVEGF (n ≥ 9/group) groups. Delay rats had a 9 cm × 3 cm cranial based pedicle skin flap incised 10 days prior to elevation. Adenoviral groups received 28 intradermal injections (109 pu/animal total) throughout the distal two thirds of the flap 1 week prior to elevation. At postoperative day (POD) 0 flaps were elevated and silicone sheeting was placed between flap and wound bed. Perfusion analysis in arbitrary perfusion units of the ischemic middle third of the flap using laser Doppler imaging was conducted preoperatively and on POD 0, 3, and 7. Clinical and histopathologic assessments of the skin flaps were performed on POD 7.Results:AdVEGF (50.8 ± 10.9 APU) and AdEgr-1 (39.3 ± 10.6 APU) perfusion levels were significantly higher than controls (16.5 ± 4.2 APU) on POD 7. Delay models were equivalent to controls (25.9 ± 6.8 APU). AdVEGF and Delay animals showed significantly more viable surface area on POD 7 (14.4 ± 1.3 cm2, P < 0.01 and 12.4 ± 1.2 cm2, P < 0.05, respectively) compared with Controls (8.7 ± 0.7 cm2).Conclusions:AdVEGF preconditioning resulted in flap survival comparable to surgical delay. Adenoviral preconditioning maintained perfusion levels postoperatively while surgical delay did not.

Simultaneous expander and deep inferior epigastric perforator reconstruction: indications and alloderm sling technique for protecting the anastomosis

Aim: Autologous tissue is considered the gold standard for breast reconstruction today. However, little is known about deep inferior epigastric perforator (DIEP) flap reconstruction in combination with tissue expander (TE)/implant. The authors describe a series of combined DIEP flap/TE reconstruction, including its indications and technique to ensure protection of the pedicle during the expansion process. Methods: Between January 2009 and December 2012, patients undergoing immediate DIEP with TE reconstruction were retrospectively reviewed. Oncologic, comorbid conditions, intraoperative, postoperative expansion, complications, and technique data points were collected. Photographs were taken postoperatively and patient's satisfaction surveys were obtained to assess overall satisfaction. Results: Five patients underwent immediate DIEP flap/TE reconstruction utilizing our alloderm sling technique. There were no complications to the pedicle, flap, expander, or mastectomy skin perioperatively or postoperatively. All patients describe being very satisfied, often with improved breast volume and projection as compared to their preoperative appearance. Conclusion: The results of this study suggest that DIEP flap/TE reconstruction is safe, in particular when utilizing the alloderm sling technique, and should be considered in patients who lack sufficient abdominal tissue, have existing breast asymmetries, or do not desire the scar deformity of latissimus dorsi.

A rare case of giant multiseptated thoracic myelomeningocele with segmental placode.

A rare case of giant multiseptated thoracic myelomeningocele with segmental placode.

Application of anti skin grafting and two pedicled abdominal flap to repair the whole hand degloving injury

Objective To explore the application of anti skin grafting and two pedicled abdominal flap to repair the whole hand degloving injury.Methods From June,2007 to December,2013,20 cases of hand degloving injury of skin and skin graft,waste application and combined application of VSD vacuum suction and two fingers abdominal pedicled skin flap repair,postoperative fingers activity,strength,degree of sensory recovery and function of four standards,respectively.After doing comprehensive evaluation.Evaluation standard:excellent for 13-16,good for 9-12 minutes,could be 5-8,difference of 4 points.Results Excellent functional recovery in 19 cases,accounting for 95％.In 1 patient the pain was not combined with exercise induced proximal interphalangeal joint part stiffness function can,accounted for 5％.Metacarpophalangeal joint activity of about 80 °-90 °,proximal interphalangeal joint activity of about 85 °-90 °.The 6 cases of sensory recovery grade S5,14 cases of abdominal two-way two subdermal vascular network flap for repair of sensory recovery S3.The patients were followed up for 2-6 years,results of 19 cases of activity were 4 points,1 case of active degree was 3,16 cases of power:4 points,3 points in 3 cases,1 case of 2 points.Feel:18 cases was 3,2 cases of 2 points.Function:18 cases was 4,2 cases of 3 points.Conclusion The operation method of small trauma,no multiple finger operation,avoids the contracture of the first web space and joint stiffness,for basic level hospital. Key words: Hand; Degloving injury ; Vacuum sealing pressure drainage technique ; Skin graft ; Microsurgical operation

Long-term efficacy of penile skin flaps for reconstruction of anterior urethral stricture

Objective To evaluate the long-term efficacy of using penile skin flaps for urethroplasty in the treatment of anterior urethral strictures.Methods Between Jan 2006 and Dec 2012,138 patients with anterior urethral stricture were treated by using penile skin flaps for urethroplasty.The mean age was 38 years (range,7-82 year).The etiology of stricture included trauma in 78 cases,iatrogenicity in 41 cases,infection in 17 cases,unknown reason in 2 cases.The penile urethral stricture was found in 110 cases and the bulbourethral stricture was found in 28 cases.The mean length of anterior urethral stricture was 6.5 cm (range 3-14 cm).Among them,the length of urethral stricture was more than 10 cm in 48 patients.Basing on location,length of stricture and condition of penile skin,different penile skin flaps were chosen,including vertical pedicle skin flap,pedicle circular flap,L-flap,Q-flap.Three different techniques were used for urethroplasty,such as lateral patch flap urethroplasty (group1,n=80),dorsal and ventral inlaid flap urethroplasty (group 2,n =42) and tubularized flap urethroplasty (group 3,n =16).Results 4 patients were lost during follow-up.The mean duration of follow-up in the remaining 134 patients was 39 months (range,8-84 months).Complications developed in 29 of 134 patients (21.6％),including strictures recurrence in 17 (group 1,n =12,group 2,n=2 and group 3,n =3),urethrocutaneous fistulas in 7 (group 1,n =5,group 2,n=1 and group 3,n =1) and urethral diverticulum in 5 (group1,n =4,and group 3,n =1).105 cases voided well and the urinary peak flows ranged from 13-49 ml/s (mean 25 ml/s),The overall success rate was 78.4％ (105/134).Conclusions Penile skin is thinner,rich in blood supply and easy to be manipulated,which is one of the excellent materials for the urethral reconstruction.Q-flap or L-flap urethroplasty is an effective technique for the treatment of long-segment urethral strictrues (≥ 10 cm). Key words: Penile skin flap; Urethroplasty; Anterior urethral strictures

Mastopexy and reduction mammoplasty pedicles and skin resection patterns.

Summary:Mastopexy and reduction mammoplasty share techniques of pedicle formation and skin excision patterns, with the main difference being the amount of breast tissue resected. Various types of excision patterns and orientation of pedicles were developed throughout the years, each with flares of popularity at different times. This article reviews the multiple techniques of pedicle orientation and skin excision patterns separately and gives the advantages and disadvantages of each.

Tissue Transplantation

The transplantation of tissues from one site to another has been the subject of surgical endeavour for many centuries. Simple flap procedures for the repair of defects in the skin of the nose, mouth and cars were known to the Greeks and Romans of the first century A.D., and a form of rhinoplasty was carried out by Indian surgeons, using local flaps, more than two thousand years ago. A more sophisticated technique of rhinoplasty, involving the transfer of a pedicled skin flap from the arm, was used by Tagliacozzi in the fourteenth century. Powerful opposition to such interference in the works of the Almighty came from the Ecclesiastical authorities, and not only was Tagliacozzi discredited, but further progress in this field was firmly suppressed until the eighteenth century.In 1785, in Edinburgh, a series of experiments of some interest were carried out by a certain Mr. Fife and other members of the Royal Medical Society, and their work is recorded in the Society’s Experimental Committee Records for that year. They were interested in the possibility of blood transfusion, and used as their experimental subjects pairs of calves, one of each pair being bled via the carotid artery into a jugular vein of the other. In one instance they used as a conduit a pair of ivory cannulae connected by a piece of intestine which they had previously removed from a cat, and on other occasions they used simple metallic tubes.

Angiogenic response pattern during normal and impaired skin flap re-integration in mice: A comparative study

BackgroundDistal skin flap necrosis represents a severe complication in surgery. This study investigated angiogenic responses in healthy and impaired pedicled skin flap tissue in normal and diabetic mice. MethodsHistologic, qRT-PCR, ELISA and immunoblot techniques determined expression and localization of angiogenesis-related growth factors, receptors and cell types upon skin flap re-integration. ResultsSkin flap tissue re-integration was severely disturbed in diabetic mice. Impaired skin flap tissue lost early VEGF expression from wound margin keratinocytes and markedly reduced expression of endothelium-specific receptors Tie-2 and FLT-1. Numbers of blood vessels were reduced in impaired flaps. In addition, HIF-1α protein was absent from disturbed skin flap tissue. Reduced VEGF expression and the loss of epithelium in disturbed skin flaps were paralleled by the appearance of VEGF expressing inflammatory infiltrate. ConclusionIn summary, our data show a dysregulated spatial and temporal pattern of angiogenic processes during skin flap re-integration in diabetic mice. Our data suggest that reduced expression of angiogenic receptors in skin flap tissue might contribute to a loss of VEGF function in impaired tissue.

Super-microdissected local flaps for the coverage of temporal defects.

Skin graft is still a method of choice for the coverage of temporal defects. But there are some disadvantages like a "patch" appearance, the need of dressing or longer healing time. Numbers of local flaps have been described for closing skin defects on temporal region. Yet, they may cause distortion of the surrounding tissues, especially in the temporal hairline and eyebrow. We present a series of seven local flaps based on small branches (SB) of the superficial temporal artery (STA) for the coverage of temporal defects, and discuss their advantages. Supermicrodissection of SB of the STA was performed to obtain local flaps for reconstruction of temporal defects after skin cancer excisions in seven patients. Patient's age ranged from 70 to 88 years old and the diameter of defects ranged from 4 to 6 cm. All procedures were performed under local anesthesia except one. In all cases, defects were obtained after skin cancer excisions. The operative time ranged from 55 to 75 min. All flaps survived with an average follow-up of 8 months, reconstructions have maintained a cosmetically pleasing result. We believe that SB flaps may be a new option for reconstruction of temporal defects with the advantages of local flaps, without the inconvenience of a skin pedicle. Moreover, these flaps raise the question of the use of SB based flaps for the coverage of moderate-sized skin defects anywhere in the body, and open new fields in reconstructive surgery.

The surgical management of angiosarcoma of the breast—a single institution experience

Angiosarcoma of the breast is a rare and aggressive tumour of the vascular endothelium. It may arise spontaneously or secondary to radiation. We present our experience of managing breast angiosarcoma, the largest single institution case series from the UK to date along with a summary of the relevant literature. Data on all patients with breast angiosarcoma treated in our unit were prospectively recorded (2002–2014). Demographics, surgical details and outcomes were analysed. Eighteen female patients presented with breast angiosarcoma. Sixteen patients previously underwent adjuvant radiotherapy following surgery for breast carcinoma; the mean duration between radiotherapy and angiosarcoma development was 8.4 years (range 3–21). Resections were as follows: radical mastectomy (n = 14), simple mastectomy (n = 1) and wide local excision (n = 3). Reconstruction was undertaken as follows: pedicled lattisimus dorsi (LD) musculocutaneous flap (n = 5), pedicled LD muscle flap and split skin graft (n = 7), free deep inferior epigastric perforator (DIEP) flap (n = 1), pedicled vertical rectus abdominus muscle (VRAM) flap and split skin graft (n = 1), pedicled LD muscle and pedicled VRAM muscle flaps and split skin graft (n = 1), pedicled LD muscle and pedicled (contralateral) pectoralis major muscle flaps and split skin graft (n = 1) and direct closure (n = 2). Three patients developed local recurrence; mean duration from resection to recurrence was 12 months (range 9–19). Three patients developed metastasis. Seven patients (38.8 %) died; median survival from presentation was 19 months (range 2–55 months). The remaining eleven patients remain well with no disease recurrence; mean follow-up was 38 months (range 4–125). The estimated 5-year survival (Kaplan-Meier equation) in our cohort was 49 %. Breast angiosarcomas are rare and challenging to manage. Successful outcomes can be achieved by early, aggressive resection and appropriate reconstruction. Level of Evidence: Level IV, therapeutic study.

Extended Reverse Dorsal Metacarpal Artery Flap for Coverage of Finger Defects Distal to the Proximal Interphalangeal Joint

Finger reconstruction distal to the proximal interphalangeal (PIP) joint is a challenging task for hand surgeons. Although extended reverse dorsal metacarpal artery (RDMA) flaps were described for coverage of finger defects, reports on repairs beyond the PIP joint are limited. The occurrence of venous congestion of the flaps and their treatments require further clarification. Extended RDMA flaps were used to cover the finger defects extending from the PIP joints to the fingertips in a series of 16 patients. The reconstructed fingers included the index, middle, ring, and little fingers; thumb reconstruction was not included in this study. The flap size ranged from 2.5×1.8 to 5×3 cm. A composite flap with a segment of tendon was applied for a complex reconstruction in 4 cases. Either superficial branch of radial nerve or dorsal branch of ulnar nerve was included in flap elevation because of its perineural vascular network contributing to the flap perfusion. The pivot point was located at the level of the middle point of the proximal phalanx, where the communicating branches between the proper palmar digital artery and the dorsal metacarpal artery exist. A teardrop skin pedicle was used to reduce the tension of the flap pedicle. All flaps totally survived except that 1 flap had epidermal loss later salvaged by secondary skin grafting. Venous congestion occurred in the distal part of 5 flaps and was effectively relieved after multiple subcutaneous heparin injections. Neither of the 2 cases of nerve repair resulted in significant improvement in sensation. All donor sites were primarily closed. Extended RDMA flaps can be effectively applied in the reconstruction of finger defects beyond PIP joint. Its advantages include a simple dissection, single-stage reconstruction, and preservation of digital artery and nerve. The donor site can be primarily closed if the flap width is less than 3 cm. Multiple subcutaneous heparin injection is a preferred solution in cases where venous congestion occurs in the flap.

Giant plexiform neurofibroma of the upper limb

Sir, Plexiform neurofibroma (PNF), which is a pathognomonic of neurofibromatosis type I (NF1), is frequently located on the trunk, head and neck, and rarely on the limbs [1].We present a patient with PNF, who was remarkable because of its location, large size, and associated bone lesions. A 43-year-old multigravida woman was referred to us with a large tumor of the left upper limb. She had a tumor with two pedicles located on the left upper limb since the age of 9 years. This tumor had been resected 10 years earlier when she was 33 years old (Fig. 1). A diagnosis of PNF was reached on pathologic examination of the resected tumor. Because the patient had financial difficulties, no other explorations were performed. The patient was lost to follow-up until she was 43 years of age. The present tumor grew slowly over a period of 10 years, causing disfiguration and psychological disability that affected her activities of daily living. The patient recalled that the onset of recurrence was less than 1 year after resection. The tumor had a “bag-like” appearance on the thigh and was hanging down on a skin pedicle that extended from the shoulder to the elbow area (Fig. 2). It measured 63 cm in its long axis, was covered by a thin skin with visible venous varicosities, and was devoid of any elasticity. The tumor was painless and skin sensitivity of the limb was maintained. The patient wrapped the tumor with a loincloth and tied it around her waist to reduce neck ache due to the weight of the tumor. She was unable to lift her left arm, but use of the elbow and wrist was maintained. On clinical examination, the patient weighted 65 kg and had a height of 155 cm. She had stigmata of NF1: multiple “cafe au lait” spots, skin, and subcutaneous nodules of varying sizes scattered all over the body, axillary and inguinal freckling, and upper left eyelid ptosis associated with Lisch nodules and kyphoscoliosis. Her father had NF1.

Preconditioned hyperbaric oxygenation protects skin flap grafts in rats against ischemia/reperfusion injury

Hyperbaric oxygen (HBO) therapy is an effective therapy for ischemia/reperfusion (I/R) injury of the brain, small intestine, testes and liver. However, the detailed molecular mechanisms underlying the effect of HBO therapy remain undetermined. In the current study, the hypothesis that preconditioning rats with HBO protects grafted skin flaps against subsequent I/R injury was investigated. In addition, the molecular mechanisms underlying HBO therapy were characterized by analyzing the roles of the following important inflammatory factors: High mobility group protein 1 (HMGB1) and nuclear factor-κ B (NF-κB). A total of 40 rats were randomly divided into the following five groups: (i) Sham surgery (SH); (ii) ischemia followed by reperfusion 3 days following surgery (I/R3d); (iii) ischemia followed by reperfusion 5 days following surgery (I/R5d); (iv) HBO preconditioning (HBO-PC) and ischemia followed by reperfusion 3 days following surgery (HBO-PC+3d); and (v) HBO-PC and ischemia followed by reperfusion 5 days following surgery (HBO-PC+5d). For the surgical procedure, all pedicled skin flaps were first measured and elevated (9×6 cm). The feeding vessels of the skin flaps were subsequently clamped for 3 h and released to restore blood flow. The rats in the HBO-PC+3d and HBO-PC+5d groups received 1 h HBO for 3 and 5 consecutive days, respectively, prior to surgery. Following surgery, the rats were euthanized, and grafted tissues were collected for western blotting and immunohistochemistry. HBO-PC increased blood perfusion in epigastric skin flaps and attenuated I/R injury following skin flap graft. Additionally, the elevated expression of HMGB1 and NF-κB proteins during I/R injury was attenuated by HBO-PC treatment. HBO-PC may therefore be applied to reduce I/R injury and improve the survival rate of grafted skin flaps. The molecular mechanisms underlying the effect of HBO therapy are associated with the attenuation of inflammatory responses.

Distal urethrectomy for localized penile squamous carcinoma in situ extending into the urethra: an updated series

The presence of squamous carcinoma in situ (CIS) of the distal penis extending into the urethral meatus is generally considered a contraindication for glans-sparing procedures. Distal urethrectomy with subsequent reconstruction can provide an alternative approach toward urethral resection while providing penile preservation in select cases. Unfortunately, long-term oncologic outcomes with this approach are ill-defined. Between 1988 and 2012, five patients at Indiana University Medical Center underwent distal urethrectomy with reconstruction for penile squamous CIS extending into the urethral meatus. This cohort was retrospectively reviewed to evaluate functional and oncological outcomes. Of the five patients, four presented with glanular lesions and were initially managed with Mohs procedure in three cases, and local excision in one. The final patient presented with extensive urethral disease and was managed with primary urethrectomy. Reconstruction was performed with penile skin pedicle grafts in four patients and perineal urethrostomy in one. Final pathologic stage was T1 in one patient and Tis in the remaining four. Follow-up ranged from 6 to 96 months. One local recurrence was verified; however, it occurred outside the urethral area. This was confirmed in the pathologic analysis after the patient underwent a partial penectomy. Meatal dilation was necessary in two patients 12 and 7 months after the procedure. Distal urethrectomy for penile squamous CIS extending into the urethral meatus is a valid alternative to achieve negative surgical margins while preserving a penile function. Oncologic outcomes appear acceptable but larger series are still warranted to confirm our findings.

Giant basal cell carcinoma of the anterior chest wall with bone invasion

Giant basal cell carcinoma (BCC) of the chest wall is rare and poses challenges related to resection and reconstruction. A 69-year old man presented with giant BCC invading sternum. Wide resection and reconstruction with polymethylmethacrylate and mesh was performed. The soft tissue defect was covered with a pedicled omental flap and skin graft. He developed an infection requiring removal of the mesh construct; however, debridement and antibiotics cleared the infection. This case illustrates the locally aggressive nature of this disease and the need for tertiary-level care.

Superficial peroneal neurocutaneous vascular axial adipofascial-cutaneous flap pedicled with lateral supramalleolar perforator for coverage of donor site defects at foot dorsum

To report the operative techniques and clinical results of modified superficial peroneal neurocutaneous propeller adipofascial-cutaneous flap for reconstruction of donor site defects at foot dorsum. A propeller adipofascial flap with a skin pedicle (4-6 cm in width) based on the lateral superamalleolar perforating artery which vascularized the flap through the nutrient vessel chain of the superficial peroneal nerve was designed to repair defects after harvesting of foot pedicled dorsal flap. The defects at donor site of the leg was closed directly and split-thickness skin grafting was performed on the adipofascial surface of the flap primarily or secondarily. From May 2007 to Oct. 2011, 7 cases were treated. All flaps were transplanted successfully with satisfactory cosmetic and functional results. The flaps size ranged from 19 cm x 8 cm to 30 cm x 11 cm. The flap has reliable blood supply with a relatively large vascularized area, long rotation are and minimum donor-site cosmetic morbidity. It' s a simple and safe procedure which is suitable for covering donor sites defects after harvesting foot pedicled dorsal flap.

Effects of stromal cell derived factor-1 and CXCR4 on the promotion of neovascularization by hyperbaric oxygen treatment in skin flaps

Hyperbaric oxygen (HBO) is known to increase the survival of skin flaps by promoting neovascularization; however, the detailed mechanisms involved are not fully understood. In the present study, we aimed to characterize the effects of HBO treatment on neovascularization and skin flap survival. We also analyzed the mechanisms associated with the expression of angiogenic molecules, such as stromal cell derived factor-1 (SDF‑1) and its specific receptor CXCR4, to assess the effects of SDF-1 and CXCR4 on the promotion of neovascularization by HBO treatment in skin flaps. The epigastric pedicle skin flap model was established in rats that were randomly divided into the following groups: i) sham‑operated (SH group); ii) ischemia followed by reperfusion and analysis on the third and fifth day (IR3d and IR5d groups, respectively) postoperatively; iii) ischemia followed by reperfusion, HBO treatment and analysis on the third and fifth day (HBO3d and HBO5d groups, respectively) postoperatively. In the two HBO groups, animals received 1 h of HBO treatment in a 2.0 ATA chamber with 100% O2 twice per day for 3 days and then daily for 2 consecutive days following surgery. On the postoperative third and fifth day, skin flap survival measurement, histological analysis, immunohistochemical staining and western blotting for SDF‑1 and CXCR4 expression, were performed. Compared with those of the IR groups, skin flap survival, microvessel density (MVD) and expression of SDF‑1 and CXCR4 proteins were significantly increased in the HBO groups. Pearson's correlation analysis demonstrated a positive correlation between MVD and the high expression of SDF‑1 and CXCR4 following HBO treatment. Results of this study suggested that the effects of HBO treatment in promoting neovascularization may be explained by the upregulation of SDF‑1 and CXCR4 expression in the skin flaps of rats.

Choices of pedicle skin flaps in repairing cutaneous defects of foot and ankle

Objective To explore and summarize the choices of pedicle skin flaps in repairing cutaneous defect of foot and ankle.Methods Defects of forefoot,pedal dorsum,pedal plantar and ankle were repaired with pedicle skin flaps such as dorsal pedal flap,medial plantar flap,plantar metatarsal flap,fibular hallux flap,tibial flap of 2nd toe,anterior tibial artery flap,posterior tibial artery flap,sural nerve flap,lateral tarsal artery flap,anterior ankle artery flap peroneal artery flap etc.Results Except for necrosis of 2 cases of flap,the other 249 flaps all survived.Blood vessel crisis was induced in 5 patients on 1st postoperative day,and in 2 cases on 2nd postoperative day,by tight package of transplanted skin,which was treated by emergent explorative operation.Finally 135 cases got 3 to 96 months' followed up(average of 16 months).There were 4 cases of medial pedal flap and 3 cases of plantar metatarsal flap received secondary reshaping for treating skin wear out.Nine cases of posterior tibial artery flap,and 6 cases of sural nerve flap were reshaped secondarily to improve bulk shape.Other flaps did not need secondary reshaping.Among them,in medial pedal flap,fibular-side flap of hallux,and tibialside flap of 2nd toe,sensory nerve were all transferred together with the flap,and normal sensory was got,with 4-10 mm two point discrimination.Condusion In covering tissue defects on heel or plantar side of forefoot,medial plantar artery flap is ideal.For defects on plantar side of forefoot,plantar metatarsal flap,fibular hallux flap,tibial flap of 2nd toe have the advantages of wear resistance and nerve innervation.While dorsal pedal flap,anterior tibial artery flap,posterior tibial artery flap,sural nerve flap,lateral tarsal flap,anterior ankle artery flap,and peroneal artery perforator flap have the advantages of large size,thinness,similar color with recipient site,and constant anatomical position,they are feasible for repairing defects on dorsum of foot or near ankle. Key words: Foot ; Ankle ; Surgical flap; Transplantation; Microsurgery

Observation of blood circulation change in different flaps repair surgery for hand tissue

Objective To compare the color,temperature,tension and capillary filling in different flaps repair surgery,including free physiological flap,fascial pedicle skin flap,venous skin flap and cutaneous neurotrophic skin flap,so as to provide some directions for clinical observation.Methods From March 2011 to December 2011,totals of 221 patients with 223 flaps were involved in this study.They were divided into four groups:free physiological flap group(n =50),fascial pedicle skin flap group(n =66),venous skin flap group (n =57),cutaneous neurotrophic skin flap group (n =48).The peri-operation investigation was adopted,and the color,temperature,tension and capillary filling in different flaps after operation were observed and compared.Results In free physiological flap group,the incidence of grey and dark red respectively was 20％and 38％,and the rate of tension bullae and disappearing of capillary filling respectively was 32％ and 8％,which was significantly lower than that in others groups (x2 =20.64,49.90,36.99,36.16,respectively;P ＜0.01).Conclusions The blood circulation change must be paid more attention within 24 hours after operation in all the four flap.The observation of grey stage could be shortened to 2 hours,and the disappearing of capillary filling could be 12 hours.The four index of blood circulation of fascial pedicle skin flap must be observed within 7days after operation. Key words: Blood circulation; Free physiological flap; Fascial pedicle skin flap; Venous skin flap; Cutaneous neurotrophic skin flap