Surgical Flaps Research Articles

The Effect of Platelet Rich Fibrin (PRF) and Bone Graft (Carbonate Apatite) Applications on Platelet Derived Growth Factor-BB Post Flap Surgery in Patients with Chronic Periodontitis

Chronic periodontitis characterized by a periodontal pocket over 5 mm, alveolar bone resorption accompanied by tooth mobility, requires periodontal surgical treatment. Conventional surgical treatment can not achieve the regeneration of periodontal tissue and thus requires regenerative procedures, such as with the addition of PRF. PDGF-BB is a growth factor that plays an important role in wound healing. Developments in additional bioactive ingredients in surgical procedures are used to regulate inflammation and increase the speed of the healing process. The purpose of this study was to determine the effect of PRF and bone graft (carbonate apatite) on PDGF-BB levels post-surgical flap in patients with chronic periodontitis. The experimental study with open label and consecutive sampling was conducted on 10 subjects of chronic periodontitis who received surgical flap treatment with bone graft and PRF; and 10 subjects without PRF. GCF samples were collected immediately before surgery and 7 days post flap surgery for examination of PDGF-BB levels by ELISA method. The data were calculated statistically by Mann-Whitney test (p <0.05). The results showed that the mean difference of PDGF-BB level in PRF group was 9.44 pg/ml (-1.20 – 37.79 pg/ml) with p value (0.013) and Non-PRF group was 7.97 pg/ml (-6.62 - 44.42 pg/ml) with p value (0.059). The p value in the PRF group > 0.05 means a significant increase in PDGF-BB levels on the 7th day post flap surgery. Examination of PDGF levels, especially PDGF-BB, should be done in each healing phase of the wound from the inflammatory phase to the maturation and remodeling phase, for example on the 3rd, 7th, 14th and 28th days when PDGF levels approach zero and the healing process it's almost over, referring to the results of Alzahrani's research (2018) and also Matsuoka and Grotendorst (1989) which showed higher levels of PDGF-BB and VEGF in GCF on days 1, 3, 7 and 14 after surgery with minimally invasive surgery (MIS) technique. The conclusions of this study showed that the application of Platelet Rich Fibrin (PRF) and bone graft had an effect on the level of Platelet Derived Growth Factor (PDGF-BB) post-surgical flap in patients with chronic periodontitis, and elevated levels of PDGF-BB post-surgical flap with PRF application higher than surgical flap without the PRF application. Increased levels of PGDF-BB in the group applied to the PRF were higher than those that were not applied PRF, although statistically significant differences were not found, there was a tendency for the healing process of the PRF group to be better than the Non PRF group.

Considerations for patient selection: Prepectoral versus subpectoral implant-based breast reconstruction.

BackgroundIn recent years, breast implants have been frequently placed in the subcutaneous pocket, in the so-called prepectoral approach. We report our technique of prepectoral implant-based breast reconstruction (IBR), as well as its surgical and aesthetic outcomes, in comparison with subpectoral IBR. We also discuss relevant considerations and pitfalls in prepectoral IBR and suggest an algorithm for the selection of patients for IBR based on our experiences.MethodsWe performed 79 immediate breast reconstructions with a breast implant and an acellular dermal matrix (ADM) sling, of which 47 were subpectoral IBRs and 32 were prepectoral IBRs. Two-stage IBR was performed in 36 cases (20 subpectoral, 16 prepectoral), and direct-to-implant IBR in 43 cases (27 prepectoral, 16 subpectoral). The ADM sling supplemented the inferolateral side of the breast prosthesis in the subpectoral group and covered the entire anterior surface of the breast prosthesis in the prepectoral group.ResultsThe postoperative pain score was much lower in the prepectoral group than in the subpectoral group (1.78 vs. 7.17). The incidence of seroma was higher in the prepectoral group (31.3% vs. 6.4%). Other postoperative complications, such as surgical site infection, flap necrosis, implant failure, and wound dehiscence, occurred at similar rates in both groups. Animation deformities developed in 8.5% of patients in the subpectoral group and rippling deformities were more common in the prepectoral group (21.9% vs. 12.8%).ConclusionsThe indications for prepectoral IBR include moderately-sized breasts with a thick well-vascularized mastectomy flap and concomitant bilateral breast reconstruction with prophylactic mastectomy.

Induced membrane technique and microsurgery for open leg fractures of Gustilo types IIIB-C

Objective To evaluate the induced membrane technique combined with microsurgery for repair of open leg fractures of Gustilo types ⅢB-C. Methods This retrospective study reviewed 15 patients who had been treated for open leg fractures of Gustilo types ⅢB and ⅢC by the induced membrane technique and microsurgery between January 2015 and January 2017 at Institute of Orthopedics, 920 Hospital, The Joint Logistic Service of The People’s Liberation Army. They were 10 men and 5 women, aged from 18 to 41 years(average 32 years). There were 9 cases of Gustilo type IIIB and 6 ones of Gustilo type IIIC. After thorough debridement, the fractures were reduced and fixated temporarily using external frames. The bone defects were filled with antibiotic bone cement to induce biofilm formation. After necessary reconstruction of limb structures, including neurovascular repair and transposition of tendon and nerve, crucial soft-tissue wounds were covered with surgical flaps. In the secondary surgery 6 to 8 weeks later, with the external frames replaced by internal fixation or not, the bone cement was removed without damaging the biofilm before graft reconstruction with autogenous cancellous bone. Results The 15 legs were all salvaged successfully. The in-hospital time ranged from 21 to 39 days (mean, 29 days). Crucial wounds were repaired primarily without any severe or persistent infection. Follow-ups ranged from 12 to 24 months (average, 15 months). Bone union time ranged from 10 to 17 months (average, 11.2 months) with satisfactory aesthetic and functional recovery of the leg. Conclusion Reconstruction of open leg fractures of Gustilo types Ⅲ B-C with induced membrane technique and microsurgery can result in decreased therapeutic duration, reduced complications and positive outcomes. Key words: Fractures, open; Surgical flaps; Microsurgery; Leg; Induced membrane technique

One-stage repair of soft tissue defects in open leg fracture

Objective To evaluate one-stage repair of leg open fracture with soft tissue defect by fixation plus skin flap. Methods From January 2011 to January 2018, 34 patients with leg open fracture plus soft tissue defect were treated at Department of Orthopedics, The Second Affiliated Hospital to Harbin Medical University. They were 31 males and 3 females, aged from 13 to 54 years(average, 35 years). According to the Gustilo classification, the defects were type ⅢA in 31 cases and type ⅢB in 3 cases. The wound size ranged from 6 cm×3 cm to 25 cm×10 cm. All patients were treated with emergency fracture fixation and flap repair by one stage after thorough debridement. Internal bone plating was performed in 32 patients and external fixation at a single arm in 2 patients. All defects were repaired with a free anterolateral thigh flap. Flap survival, vascular crisis and bone infection were followed up postoperatively. Results All the free flaps survived in the 34 cases with no vascular crisis. These patients were followed up for 6 months to 3 years (average, 10 years). The flaps healed well, with good appearance and soft texture. No bone infection occurred at the defective sites. After postoperative rehabilitation, the knee extension ranged from 160° to 180°, knee flexion from 90° to 110°, ankle dorsal extension from 90° to 110°, and ankle plantar flexion from 100° to 120°. Conclusion Soft tissue defects in leg open fracture can be effectively treated by flap repair after thorough debridement at the same time of fracture fixation, because the primary wound healing can avoid infection and lead to fine survival of the flap. Key words: Fractures, open; Soft tissue defects; Surgical flaps; Reconstructive surgical procedures; Legs

Laparoscopic Vecchietti - Minimally Invasive Treatment for Vaginal Agenesis

Video Objective To describe the surgical steps and postoperative care utilized when performing a laparoscopic Vecchietti procedure for the treatment of complete vaginal agenesis. Setting 21 year old female with complete vaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) who desires surgical management and creation of a neovagina. Interventions The laparoscopic Vecchietti procedure is a simple, minimally-invasive technique for the creation of a neovagina in patients with complete vaginal agenesis. Unlike other vaginoplasty techniques, this method does not rely on the use of grafts or surgical flaps. Instead, this procedure creates a neovagina through continuous invagination of the vaginal dimple by an olive-shaped vaginal dilator. The vaginal “olive” is connected to a spring-loaded tensioning device on the patient's abdomen via laparoscopically placed sub-peritoneal sutures. Following placement of the system in the operating room, the sutures are tensioned by 1 to 2 cm each day and a 10 cm neovagina is created over the course of 7 to 10 days. The vaginal olive and sutures are removed in the office, and the patient is instructed to perform daily vaginal dilation using handheld dilators to prevent shortening and stenosis of the neovagina. Conclusion The laparoscopic Vecchietti is a simple and effective procedure to treat complete vaginal agenesis using a minimally-invasive approach.

The clinical application of anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels for repair of dorsal hand wounds in children

Objective To analyze the clinical efficacy of anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels for repair of dorsal hand wounds in children. Methods From January 2014 to January 2019, 7 cases of children with skin and soft tissue defects on the dorsum of hand ware covered by anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels by preoperative color Doppler ultrasound. The area of the flaps ranged from 4 cm×6 cm to 5 cm×7 cm. The donor sites were sutured directly. Results There were no infection, vascular crisis and necrosis of skin flaps after operation. All the children were follow-up for 6 to 42 months, with an average of 23.5 months. The skin flaps had satisfactory shape, soft texture, moderate thickness, good elasticity, good sweating function, partial superficial sensation recovery, good thumb web function and no complications such as thumb web skin contracture. Five children underwent liposuction at 5 months after operation. Mild scar hyperplasia of donor sites occurred in 4 cases. Conclusion The anterolateral thigh perforator flap with snuffbox cutaneous branch of the radial artery as recipient vessels is safe and effective in repairing the dorsal hand wound in children. It can shorten the time of skin flap removal, reduce the injury of donor site and not sacrifice the dorsal metacarpal branch of the radial artery. It is suitable for clinical promotion. Key words: Hand injuries; Surgical flaps; Repair; Microsurgery

Clinical application of proximal periosteal perforator bone-skin flap of anterior tibial artery for repair of the composite tissue defects of the hand and foot

Objective To investigate the clinical efficacy of proximal periosteal perforator bone-skin flap of anterior tibial artery for repair of the composite tissue defects of the hand and foot. Methods March 2015 to October 2017, 24 cases of the composite tissue defects of the hand and foot were repaired by free transplantation of the proximal periosteal perforator bone-skin flap of anterior tibial artery, including 12 cases of hand and 12 cases of foot. There were 6 cases of tendon injury and 1 case of joint defect. The skin defect area ranged from 3.0 cm × 0.8 cm to 10.0 cm × 5.5 cm. The size of bone defects ranged from 1.7 cm×1.5 cm ×1.0 cm to 5.0 cm×1.0 cm×1.0 cm. The anterior tibial margin of the talus-tibial tubercle (3.2 ±0.8) cm was the penetrating point, and the bone-skin flaps were designed with this as the center. After operation, hand function was followed up according to Michigan Hand Function Evaluation Standard, and foot function was evaluated according to Maryland Foot Score Standard. Results All the flaps survived, of which 21 cases were follow-up for 6 to 24 months, with an average of 12.3 months, and 3 cases were lost. The skin flaps were soft, elastic, moderately thick and nearly normal skin. At the last follow-up, the sensation of the flaps restored to S2 to S3. The two-point discrimination was 6 to 11 mm, with an average of 8.9 mm. Two-stage thinning operation of fingertip flaps was performed in 3 cases. Finger shape and function recovered well. The healing time of the transplanted bone and skin flaps ranged from 2 to 4 months, with an average of 2.3 months. No delayed or nonunion occurred. There was no influence on leg and foot weight-bearing walking. Michigan hand function score was excellent and good in 8 cases and Maryland foot score was excellent and good in 12 cases. Conclusion The proximal periosteal perforator of anterior tibial artery has a constant position. Its bone and skin flaps are suitable for repairing small and medium-sized composite tissue defects in hand and foot. Key words: Surgical flaps; Treatment outcome; Anterior tibial artery; Periosteal perforator; Composite tissue defects

Ischemic Preconditioning of Surgical Dermal Pedicle Flaps with DNA Plasmid Expressing Hypoxia-Inducible Factor-1α

Chang, Kai-Hua MD; Shoureshi, Pouria MD; Lay, Frank BS; Abraham, John PhD; Born, Louis J. BS; Habibabady, Zahra Alikhassy MD; Sebastian, Raul MD; Harmon, John W. MD, FACS Author Information

Two Cases of Recurrent Nasopharyngeal Stricture Treated with Nasoseptal Flap

The treatment of total or near-total nasopharyngeal stenosis is challenging because of frequent restenosis. Many treatment strategies including scar release with CO2 laser, mitomycin C application, balloon dilatation or nasopharyngeal stent had been proposed to reduce the restenosis of nasopharynx. But nasopharyngeal patency often fail even after multiple surgical trials. We report two successful cases of nasopharyngeal reconstruction with resurfacing by nasoseptal flap for patients with restenosis history. Key words: Nasal septum ㆍ Nasopharyngeal disease ㆍ Surgical flaps

MRI of surgical flaps in pelvic reconstructive surgery: a pictorial review of normal and abnormal findings.

Surgical flaps are commonly used for pelvic reconstruction in a subgroup of patients with locally advanced or recurrent anorectal and gynecologic malignancies and following complications of pelvic irradiation. Surgical scenarios where flaps may be placed include (but are not limited to) extended or radical abdominal perineal resection (APR) and total pelvic exenteration (PE). Surgical flaps in pelvic reconstruction serve several functions, including reducing dead space and providing structural support, facilitating wound closure and cosmetic appearance, enhancing the postsurgical healing process, protecting anastomosesand helping to prevent adhesions of organs and viscera to adjacent structures and the pelvic side wall. The most commonly used surgical flaps in pelvic reconstruction surgery include the VRAM (Vertical Rectus Abdominis Muscle), MRAM (Modified Rectus Abdominis Myocutaneous flap), gracilis, sartoriusand omental flaps. Surgical flaps can be mistaken for recurrent or residual tumor by radiologists who are not familiar with the appearance or surgical methods of flap placement, since flaps may have a mass-like appearance on cross sectional imaging, including CT and MRI. Recurrent neoplasm may be difficult to differentiate from postoperative changes of flap placement and associated postsurgical anatomic distortion. This review article focuses on understanding the nuances of surgically placed pelvic flaps and identifying their normal and abnormal appearances on magnetic resonance imaging (MRI) along a time continuum. Postsurgical complications, including hematoma, postoperative fluid collections, infection, ischemia, and necrosis as well as tumor recurrence on the initial and follow-up magnetic resonance imaging are illustrated and discussed.

Post-surgical flap placement following osseous surgery: A short-term clinical evaluation.

The purpose of this study is to examine the relationship between immediate post-surgical flap position and subsequent probing depth measurements following osseous surgery. Twenty-four patients treatment planned for osseous surgery after completion of initial therapy and re-evaluation were enrolled. Pressure molded stents were fabricated to serve as a reference for probing depth and relative attachment level measurements prior to surgery. After osseous recontouring was completed, flaps were sutured and compressed, and bone sounding measurements were made as designated by the stent. Patients returned at 3- and 6 months for repeat measurements of probing depth and attachment level. Twenty-four patients completed surgical treatment and follow-up measurements with a total of 402 treated sites. A statistically significant moderate correlation between immediate post-surgical bone sounding measurements and subsequent probing depth was found at 6 months (R=0.56, P<0.001). There was no significant difference between this correlation at 3 and 6 months. The probability of having 6 month probing depth ≤3mm was 93.5% when the surgical flap was placed within 3mm of the alveolar crest (286/306 sites) as opposed to 50% when the surgical flap was >3mm away from the alveolar crest (48/96 sites). Interproximal sites were significantly more likely (P <0.01) to have probing depths>3mm at 3 and 6 months. Results suggest a statistically significant relationship between immediate post-surgical flap placement and subsequent probing depths. Positioning the surgical flap more closely to the alveolar crest when performing osseous surgery resulted in shallower probing depths at 3 and 6 months.

Clinical study and prognostic analysis of composite flap transplantation combined with traditional Chinese medicine for the skin repair and bone defects of limbs

Objective To explore the clinical effect and prognosis of composite skin flap transplantation combined with traditional Chinese medicine for the skin repair and bone defects of extremities. Methods A total of 80 patients with extremities' bone defect were selected in our hospital between March 2016 and March 2015. The patients were randomly divided into two groups according to the orders of the alternaive medical treatment. The observation group (n=40) was treated with compound skin flap transplantation combined with Chinese traditional medicine steaming and washing. The control group (n=40) was treated with a single compound flap transplantation. The skin flaps, transplant survival rate, flap swelling, treatment effect and complications were observed. Results The survival rate of the observation group was 95% (38/40), and the survival rate of the control group was 75% (30/40). The survival rate between two groups was statitically significant difference (χ2=6.274, P<0.05). The proportion of degree Ⅰ of the skin flap in the observation group significantly higher than that in the control group (χ2=8.584, P=0.003), while the proportion of degree Ⅳ of the skin flap in the observation group significantly lower than that in the control group (χ2=4.210, P=0.040). The total effective rate in the observation group was 97.5% (39/40), the control group was 77.5% (31/40), and the difference between two group was significant (χ2=7.314, P<0.05). The incidence of complications in the observation group was 2.5% (1/40). The incidence of complications in the control group was 17.5% (7/40). The incidence of complications in the observation group was significantly lower than that in the control group (χ2=5.000, P<0.05). Conclusions The combination of skin flap transplantation and Chinese medicine could repair bone defect of the extremities, lower swelling degree of the skin flap after transplantation and improve curative effect, and the incidence of complications after treatment is low and the clinical value is high. Key words: Surgical flaps; Transplantation; Reconstructive; Steaming washing therapy; Extremities; Bone defect

Using Flow-through flap pedicled with superficial palmar branch of radial artery for bridging finger replantation complex defect of soft tissue and vessel

Objective To evaluate the surgical technique and clinical effect of applying Flow-through flap pedicled with superficial palmar branch of radial artery for bridging finger replantation complex defect of soft tissue and vessel. Methods From February, 2013 to March, 2018, 9 cases of severed fingers composited defect of soft tissue and vessel were treated with Flow-through flap pedicled with superficial palmar branch of radial artery. The flap was designed from the proximal end of rasceta and the donor sites were sutured directly. The size of flaps was 3.0 cm ×1.5 cm-4.0 cm×2.2 cm. The superficial branch of the radial artery in the flap was used to bridge the finger artery. And the vein of proximal and distal ends in the finger was bridged by the subcutaneous vein. The proper palmar digital nerve defect was bridged by palm skin graft of median nerve. The appearance, feeling and joint function of fingers was followed-up regularly after operation. Results All transfering flaps survived and all cases were followed-up for 7 to 33 months. The donor sites got primary healing with straight scars. The appearance and texture of the flaps were satisfactory. Two-point discrimination ranged from 8 to 11 mm. The pain sensation, warmth sensation and touch sensation of the flaps got better. And the appearance and functions of severed fingers recovered well. Conclusion The Flow-through flap pedicled with superficial palmar branch of radial artery is easy to harvest and anastomose, which is masked and a small incision for the donor site. It is an ideal method for bridging severed fingers and repairing of finger wound. Key words: Surgical flap; Superficial palmar branch of the radial artery; Flow-through; Replantation of severed digits

Surgical resection and skin graft repair for a case of angiolymphoid hyperplasia with eosinophilia of the posterior ear

A 34-year-old female patient presented with itchy nodules on the left posterior ear for 7 years. Skin examination showed clustered light-red or brown-black nodules measuring about 4 cm × 5 cm in size on the left posterior auricle, as well as from the posterior sulcus of the auricle to the anterior border of the hair line on the posterior auricle. Histopathological examination of the skin lesion revealed epidermal hyperkeratosis, proliferation of a lot of small blood vessels in the dermis, swelling vascular endothelial cells with enlarged nuclei and eosinophilic cytoplasm bulging into vascular cavity, and perivascular infiltration of lymphocytes and many eosinophils. The patient was diagnosed with angiolymphoid hyperplasia with eosinophilia. After extended surgical resection, a skin graft from the left lower abdomen was used to repair the defect. After the surgery, the flap survived well, and the appearance of the auricle was improved. No recurrence was observed during 1 year of follow-up. Key words: Angiolymphoid hyperplasia with eosinophilia; Surgical procedures, operative; Surgical flaps

Application of local flaps in repair of defects after resection of nasal skin tumors

Objective To evaluate the effect of local flaps on repair of defects after surgical removal of nasal skin tumors. Methods A total of 65 patients with nasal skin tumors were enrolled from Department of Dermatology, People′s Hospital of Xinjiang Uygur Autonomous Region between March 2015 and August 2016, and subjected to surgical removal of the nasal skin tumors. According to the location, size, shape and surrounding skin of the nasal defects, nasolabial fold flaps, modified rhomboid flaps, bilobed flaps or frontal nasal flaps were chosen to repair skin and soft tissue defects. Results Of the 65 patients with nasal skin tumors, 38 had basal cell carcinoma, 20 pigmented nevus, 5 keratoacanthoma, and 2 had squamous cell carcinoma. The lengths of the defects after resection were all below 2.5 cm. Nasolabial fold flaps were used in 32 cases, modified rhomboid flaps in 16, bilobed flaps in 12, and frontal nasal flaps in 5. All the flaps survived after the surgery, and no obvious deformation of the nose was observed. No recurrence was observed during 1 year of follow-up. Conclusion For skin defects with the length ≤ 2.5 cm after resection of nasal skin tumors, nasolabial fold flaps, modified rhomboid flaps, bilobed flaps and frontal nasal flaps can be used to repair wounds, with satisfactory efficacy. Key words: Skin neoplasms; Nasal surgical procedures; Surgical flaps; Local flaps

Application of finger lateral local flaps for repair of dorsal skin defect of fingers

Objective To investigate the clinical efficacy of finger lateral local flaps in repairing dorsal skin defect of proximal and middle segments of fingers. Methods From July 2017 to July 2018, 17 cases of dorsal skin defect of proximal and middle segments of fingers were treated by transfer of finger lateral local flaps, including 6 cases of dorsal proximal segment and 11 cases of dorsal middle segment. The size of the flaps ranged from 1.0 cm×1.5 cm to 1.5 cm×3.5 cm. Full thickness skin grafts were used to repair the donor sites. Results The follow-up time ranged from 3 to 12 months, with an average of 4 months. All the flaps survived. All the incisions achieved primary healing. The appearance and texture of the flaps were good. According to the upper extremity functional evaluation criteria issued by the Hand Society of the Chinese Medical Association, the results were excellent in 11 cases, good in 4 cases and fair in 2 cases. Conclusion The transfer of finger lateral local flaps is simple to operate and has satisfactory clinical efficacy. It is safe and reliable to repair the dorsal skin defect of the finger. Key words: Finger injuries; Surgical flaps; Skin defects

Clinical application of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot

Objective To explore the clinical efficacy of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot. Methods From January 2014 to March 2018, 18 patients with dorsal skin and tendon defects of hand and foot were repaired with single or bilobed free anterolateral thigh flaps with fascia lata, including 14 cases of dorsal hand wound and 4 cases of dorsal foot wound. Among them, 1 case was accompanied with 1 tendon defect, 5 cases with 2 tendon defects, 8 cases with 3 tendon defects, 3 cases with 4 tendon defects, and 1 case with 5 tendon defects. There were 12 cases of single lobed flaps and 6 cases of bilobed flaps. 6 cases underwent secondary flap plastic surgery and tenolysis after operation. Results All the 18 flaps survived and the wound achieved primary healing. The donor site of thigh healed well with only linear scar. The follow-up period was 6 to 24 months with an average of 13 months. 14 cases of dorsal skin defects in hand were evaluated according to the criteria issued by the Hand Surgery Society of the Chinese Medical Association with the results being excellent in 6 cases, good in 7 cases, poor in 1 case. 4 cases of dorsal skin defects in foot had good functional recovery, no toe droop and no limitation of walking function. The appearance and texture of the flaps were excellent in 11 cases. No re-rupture or adhesion of extensor tendon occurred. 6 cases underwent second operation to thin the skin flaps 3 months after operation because of unsatisfactory shape. 4 of them had tendon adhesion after hand wound repair. The tenolysis was performed at the same time of skin flaps thinning. The appearance and function of the flaps recovered satisfactorily. Conclusion The single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot have little damage to donor site. It is an ideal method for repairing such injuries for good recovery of hand and foot function. Key words: Surgical flaps; Treatment outcome; Fascia lata; Skin defects; Tendon defects

Clinical application of Reading man flap for repair of the wound of donor site at the dorsum of the finger

Objective To introduce the surgical technique and clinical efficacy of Reading man flap for repair of the wound of donor site at the dorsum of the finger. Methods From February 2016 to August 2018, 9 cases (9 fingers) of fingertip defects were treated with reverse dorsal digital island flap of the same finger. The donor site of dorsal digital flaps was repaired with Reading man flap. After repair of fingertip defects, the defect area of dorsal digital donor site ranged from 2.0 cm×1.3 cm to 2.5 cm×1.6 cm. Results All the flaps survived uneventfully. The average hospitalization time was 10 days. The follow-up time was 3 to 9 months. The texture, color, plumpness and elasticity of the dorsal digital donor site were good. No tendon adhesion, interphalangeal joint and metacarpophalangeal joint stiffness occurred. All the patients were satisfied with the appearance and function of the injured fingers. Conclusion The repair of the dorsal digital donor site with Reading man flap takes into account both appearance and durability, which is beneficial to the early rehabilitation of injured finger and less damage to donor site. The method of operation is safe and simple. It is an improvement on the repair of the donor site of the reverse dorsal digital island flap of the same finger. Key words: Finger injuries; Surgical flaps; Reading man flap; Flap donor site

Comparison of two kinds of flaps in repair of oblique wounds on the palmar of the fingertip

Objective To compare the clinical efficacy of V-Y flap with neurovascular pedicle and dorsal branch of the terminal digital artery flap in repairing oblique wounds on the palmar side of the fingertip. Methods From September 2016 to June 2018, 42 patients with oblique fingertip wounds were treated. Among them, 20 cases were repaired with V-Y flaps with neurovascular pedicles (Group A), and 22 cases were repaired with dorsal branch of the terminal digital artery flaps (Group B). The operation time, complications, functional evaluation results and patient satisfaction scores were compared between the two groups. Results The postoperative follow-up time of group A was 5 to 25 months, with an average of 12.9 months, while that of group B was 5 to 26 months, with an average of 13.1 months. There was no significant difference in follow-up time between the two groups (P>0.05). The average operation time in group A was (27.1±1.9) minutes shorter than that in group B (38.0±4.9) minutes, and the incidence of complications in group A was 15.0% higher than that in group B 4.5%. The differences were statistically significant (P 0.05). According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were graded as excellent in 13 cases and good in 4 cases with the excellent and good rate being 85.0% for group A; the results were graded as excellent in 11 cases and good in 9 cases with the excellent and good rate being 90.9% for group B. The excellent and good rate of functional assessment for group A was lower than that for group B. The difference was statistically significant (P<0.05). Conclusion Compared with V-Y flaps with neurovascular pedicles, the dorsal branch of the terminal digital artery flaps have more advantages in repairing oblique wounds on the palmar side of the fingertip. Key words: Finger injuries; Surgical flaps; Fingertip wound; Effect comparison

Combined transplantation of bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery for the reconstruction of large area tissue defects of upper limbs

Objective To explore the feasibility and clinical efficacy of combined transplantation of bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery for the reconstruction of large area tissue defects of upper limbs. Methods From January 2014 to June 2018, 22 patients with large area skin and soft tissue defects of upper extremities were treated with bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery. The donor site was closed directly. The wound involved upper arm, forearm, hand and elbow stump. The area of defect ranged from 16 cm×13 cm to 40 cm×15 cm. Results Twenty-one cases (95.45%) of the combined flaps survived completely. One case had partial necrosis of the distal part of the flap, which was healed by second-stage skin grafting. The donor sites of the flaps were closed directly and achieved primary healing without complications. The follow-up period ranged from 3 to 38 months with an average of 20 months. All the cases had good wound healing and limb functional recovery. Conclusion The combined transplantation of bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery is an effective method for repairing large skin and soft tissue defects of upper extremities. The operation is simple, the perforator vessel is reliable and the flaps can be cut in large area with less damage to donor site. Key words: Upper extremity; Surgical flaps; Descending branch of lateral circumflex femoral artery; Upper extremity reconstruction