Tissue Flap Transplantation Research Articles

Reendothelialization of Acellular Adipose Flaps under Mimetic Physiological Dynamic Conditions.

The extensive soft-tissue defects resulting from trauma and tumors pose a prevalent challenge in clinical practice, characterized by a high incidence rate. Autologous tissue flap transplantation, considered the gold standard for treatment, is associated with various drawbacks, including the sacrifice of donor sources, postoperative complications, and limitations in surgical techniques, thereby impeding its widespread applicability. The emergence of tissue-engineered skin flaps, notably the acellular adipose flap (AAF), offers potential alternative solutions. However, a critical concern confronting large-scale tissue-engineered skin flaps currently revolves around the reendothelialization of internal vascular networks. In our study, we have developed an AAF utilizing perfusion decellularization, demonstrating excellent physical properties. Cytocompatibility experiments have confirmed its cellular safety, and cell adhesion experiments have revealed spatial specificity in facilitating endothelial cells adhesion within the adipose flap scaffold. Using a novel mimetic physiological fluid shear stress setting, endothelial cells were dynamically inoculated and cultured within the acellular vascular network of the pedicled AAF in our research. Histological and gene expression analyses have shown that the mimetic physiological fluid dynamic model significantly enhanced the reendothelialization of the AAF. This innovative platform of acellular adipose biomaterials combined with hydrodynamics may offer valuable insights for the design and manufacturing of 3D vascularized tissue constructs, which can be applied to the repair of extensive soft-tissue defects.

Salvage treatment of acute respiratory failure after autogenous tissue flap transplantation for chronic empyema with chest wall sinus: a case report and literature review

BackgroundChronic empyema with chest wall sinus is a difficult and complex disease caused by multiple causative factors. It is difficult to control local infection due to its possible combination of bronchopleural fistula (BPF) and residual bone.The relevant literature emphasizes some risk factors for empyema progression after pneumonectomy, while the correlation between empyema and BPF after pneumonectomy increases mortality by infecting the remaining lungs. After pneumonectomy, the lung function of the contralateral side is particularly important.Case presentationThis paper reports a 62-year-old male patient who underwent right pneumonectomy for squamous cell carcinoma of the lung 12 years ago and began to develop empyema with anterior chest wall sinus 3 years ago. After admission, chest computed tomography (CT) showed right pleural effusion and formation of chest wall sinus. According to his clinical symptoms and imaging examination, he was diagnosed as chronic empyema with chest wall sinus.Due to the huge residual cavity of the patient,the clinical effect of using free vastus lateralis myocutaneous flap combined with pedicled pectoralis major muscle flap to fill the abscess cavity was satisfactory,but acute respiratory failure occurred due to left lung aspiration pneumonia after operation.ConclusionsAfter a series of treatment measures such as tracheal cannula, tracheotomy, anti-infection, maintenance of circulatory stability, and rehabilitation training, the patient was ultimately rescued and cured. Postoperative follow-up showed that the muscle flaps survived and empyema was eliminated.

Application of free serratus anterior muscle-fascial composite tissue flap and facial lipofilling in repairing progressive hemifacial atrophy

IntroductionProgressive hemifacial atrophy (PHA) is a nonnegligible disease, and its treatment currently lacks consensus. We aim to conduct an analysis of PHA patients to summarize the postoperative effect. Moreover, we introduced the free serratus anterior muscle-fascial composite tissue flap as a safe and novelty surgical procedure for moderate-severe PHA. MethodsThis clinical study included four patients who received a free serratus anterior muscle-fascial composite tissue flap and 19 patients who received Coleman fat transplantation. Preoperative (preoperative photograph and imageological examination) and postoperative (postoperative photograph, complications, therapeutic effect, and satisfaction) assessments were performed for all PHA patients. Body Image Concern Inventory (BICI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) were performed preoperatively and postoperatively. ResultsAll the cases were cured with a good appearance with two kinds of operations. Free serratus anterior muscle-fascial composite tissue flap could correct face defects in one surgery and achieve good long time and short-time postoperative satisfaction in moderate-severe PHA. Fat transplantation could also enhance appearance in numerous operations for mild-moderate PHA. The volume of free-fat grafts decreased obviously after implantation in many cases. So, many patients (42.11%) accepted a series of operations to achieve satisfied postoperative effect. BICI, SAS, SDS score decreased a year later in all patients. ConclusionFree serratus anterior muscle-fascial composite tissue flap transplantation is an effective and safe treatment for moderate to severe PHA.

Repair of ischial tuberosity pressure ulcer with a perigluteal muscle flap

Background: Pressure ulcers are caused by long-term pressure on tissues. Hip pressure ulcers are the most common type. Pressure ulcers in the buttocks are classified into three types: sacrococcygeal, ischial tuberosity, and femoral tuberosity. Methods: We used perigluteal muscle tissue flaps to treat nine cases of grade IV pressure ulcers from January 2016 to August 2018. A retrospective study was conducted on all patients who had an ischial tuberosity pressure ulcer repaired with a perigluteal muscle flap. The gluteus maximus myocutaneous flap was combined with the gluteal fasciocutaneous flap, the biceps femoris myocutaneous flap was combined with the gluteal fasciocutaneous flap, the gracilis myocutaneous flap, the biceps femoris myocutaneous flap, and the semitendinosus and semimembranosus myocutaneous flap. Wounds of different sizes and depths were encountered, the details of which are discussed in treatment methods. Data from patients, including age, gender, cause of injury, wound dimensions, the timing of flap coverage, and complications, were analyzed. Results: The appearance of the skin flap was complete after muscular tissue flap repair, with no visible scar hyperplasia. However, after six to 12 months of follow-up, the flap was soft and left a small linear scar. Conclusions: In the repair of an ischial tuberosity pressure ulcer, a peri gluteal muscle flap provides both aesthetic and functional results. Before using muscle tissue flap transplantation, it is recommended to perform multiple debridement + VSD to improve the wound foundation.

A new way of repairing special wounds

PurposeWound repair has always been the basic method of burn surgery, but not all wounds in clinical work can regain both function and appearance. For relatively small wounds with irreversible functional damage accompanied by necrotic bone, joint and tendon exposure, and the wounds in non-functional sites with necrotic bone, tendon exposure and poor surrounding tissue conditions, the value and significance of tissue flap transplantation for wound repair are debatable. This paper discusses a new repair method as a supplementary choice for tissue flap transplantation: autologous granulation tissue and autologous thin split-thickness skin graft, which not only repairs the wound in a simple way but also avoids the cost of tissue flap transplantation. MethodsA total of 11 patients were collected from June 2019 to July 2022, with a total of 20 exposed wounds of bone, joint and tendon necrosis. During the operation, the necrotic exposed bone tissue and the completely necrotic tendon tissue were removed, and the necrotic soft tissue around the wound was completely excised until the wound appeared bleeding. We cut granulation tissue from other parts of the patient's body with a thickness of about 0.5–0.8 mm, cover the deep wound after thorough debridement with granulation tissue, and transplant autologous thin split-thickness skin to the deep wound covered with granulation tissue. The surgical area was compressed and immobilized. ResultsIn 11 patients, 20 wounds were surgically treated, and the wounds healed 15–25 days after the operation, and no bone tissue, joints, or tendons were exposed. No case underwent secondary surgery after surgery. Some wounds were treated with bedside allograft with the consent of the patient due to a small amount of residual granulation wound healing after transplantation. ConclusionUsing autologous granulation tissue and autologous thin split-thickness skin transplantation to repair some special wounds can not only repair the wounds simply and effectively but also avoid the cost of tissue flap transplantation.

Exosomes Derived from Bone Marrow Mesenchymal Stem Cells Alleviate Ischemia-Reperfusion Injury and Promote Survival of Skin Flaps in Rats.

Free tissue flap transplantation is a classic and important method for the clinical repair of tissue defects. However, ischemia-reperfusion (IR) injury can affect the success rate of skin flap transplantation. We used a free abdomen flap rat model to explore the protective effects of exosomes derived from bone marrow mesenchymal stem cells (BMSCs-exosomes) against the IR injury of the skin flap. Exosomes were injected through the tail vein and the flaps were observed and obtained on day 7. We observed that BMSCs-exosomes significantly reduced the necrotic lesions of the skin flap. Furthermore, BMSCs-exosomes relieved oxidative stress and reduced the levels of inflammatory factors. Apoptosis was evaluated via the terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay and Western blot analysis of Bax, Bcl-2. Simultaneously, BMSCs-exosomes promoted the formation of new blood vessels in the IR flap, as confirmed by the increased expression level of VEGFA and the fluorescence co-staining of CD31 and PCNA. Additionally, BMSCs-exosomes considerably increased proliferation and migration of human umbilical vein endothelial cells and promoted angiogenesis in vitro. BMSCs-exosomes could be a promising cell-free therapeutic candidate to reduce IR injury and promote the survival of skin flaps.

Effects of comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome

Objective: To investigate the characteristics and comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome. Methods: A retrospective observational study was conducted. From May 2012 to December 2021, the data of 19 patients with iatrogenic Cushing's syndrome discharged from the Department of Burns and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University were collected, including 8 males and 11 females, aged 28-71 (56±11) years, with 12 cases of infected acute wounds and 7 cases of infected chronic wounds. The lesions were located in the limbs, perianal, and sacrococcygeal regions, with original infection ranging from 9 cm×5 cm to 85 cm×45 cm. After admission, the patients were performed with multidisciplinary assisted diagnosis and treatment, and the wounds were treated with debridement and vacuum sealing drainage, according to the size, severity of infection, suture tension, and bone and tendon tissue exposure of wounds, direct suture or autologous skin and/or artificial dermis and/or autologous tissue flap transplantation was selected for wound repair. The levels of cortisol and adrenocorticotropic hormone (ACTH) of patients at 8:00, 16:00, and 24:00 within 24 h after admission were counted. After admission, the number of operations, wound repair methods, and wound and skin/flap donor site healing of patients were recorded. During follow-up, the wounds were observed for recurrent infection. Results: The cortisol levels of 16 patients at 8:00, 16:00, and 24:00 within 24 h after admission were (130±54), (80±16), and (109±39) nmol/L, respectively, and ACTH levels were (7.2±2.8), (4.1±1.8), and (6.0±3.0) pg/mL, respectively; and the other 3 patients had no such statistical results. After admission, the number of surgical operation for patients was 3.4±0.9. The following methods were used for wound repair, including direct suturing in 4 cases and autologous skin and/or artificial dermis grafting in 9 cases, of which 2 cases underwent stage Ⅱ autologous skin grafting after artificial dermis grafting in stage Ⅰ, and 6 cases had pedicled retrograde island flap+autologous skin grafting. The wound healing was observed, showing that all directly sutured wounds healed well; the wounds in 6 cases of autologous skin and/or artificial dermis grafting healed well, and the wounds in 3 cases also healed well after the secondary skin grafting; the flaps in 4 cases survived well with the wounds in 2 cases with distal perforators flap arteries circumfluence obstacle of posterior leg healed after stage Ⅱ debridement and autologous skin grafting. The healing status of skin/flap donor sites was followed showing that the donor sites of medium-thickness skin grafts in the thigh of 4 cases were well healed after transplanted with autologous split-thickness grafts from scalp; the donor sites of medium-thickness skin grafts in 3 cases did not undergo split-thickness skin grafting, of which 2 cases had poor healing but healed well after secondary skin grafting 2 weeks after surgery; the donor sites of split-thickness skin grafts in the head of 2 patients healed well; and all donor sites of flaps healed well after autologous skin grafting. During follow-up of more than half a year, 3 gout patients were hospitalized again for surgical treatment due to gout stone rupture, 4 patients were hospitalized again for surgical treatment due to infection, and no recurrent infection was found in the rest of patients. Conclusions: The infected wounds in patients with iatrogenic Cushing's syndrome have poor ability to regenerate and are prone to repeated infection. Local wound treatment together with multidisciplinary comprehensive treatment should be performed to control infection and close wounds in a timely manner, so as to maximize the benefits of patients.

Transplantation of free fibula composite tissue flap to repair bone and soft tissue defect after open fracture of proximal tibial

Objective To explore the clinical application and effect of free fibula composite tissue flap trans-plantation to repair bone and soft tissue defect after open fracture of proximal tibial. Methods From June, 2012 to June, 2018, free fibula composite tissue flap transplantations were applied to repair bone and soft tissue defect after open fracture of proximal tibial in 11 cases. Of the 11 cases, there were 10 males and 1 female(their ages ranged from 32 to 56, 36 on average); Six cases were caused by traffic accident, and 5 by crash. There were 3 fresh wounds and 8 chronic and infective wounds. Free fibular flaps were used in 7 cases, and free fibular flexor hallucis myocutaneous flaps were used in 4 cases. The fibular length with transplantation was 7-18 cm. The area of flaps or muscle flaps was ranged from 4 cm×8 cm to 8 cm×20 cm. Bone fracture healing was observed at 3, 6 and 12 months after operation. The function of injured extremity was evaluated in 1 year after surgical operation. Results All were successfully repaired, and composite tissue flaps survived. Of which, 10 wounds healed by first intention, and 1 wound healed by secondary intention, with the healing time of 12-18 days. All 11 cases were followed-up. The mean followed-up time was 18 months. The bone healing time ranged from 6 to 9 months (7 months on average). The Enneking Score System was applied to evaluate the leg function. Of the 11 cases, the mean scores was 25 (ranged from 22 to 27). The donor sites were not found malfunctional. Conclusion Transplantation of free fibula composite tissue flap can reduce the treatment time with good mechanical strength. It is an ideal method to repair bone and soft tissue defect after open fracture of proximal tibial. Key words: Fibula composite tissue flap; Fracture of tibial; Open fracture; Microsurgical technique

Advances in the research of poststernotomy dehiscence and repair with tissue flap transplantation

Sternotomy is a routine surgical pathway for heart, lung, and mediastinal surgery. Poststernotomy dehiscence is a common complication of sternotomy, in which infection after poststernotomy dehiscence is one of the most serious postoperative complications in cardiothoracic surgery. Previously, conventional dressing, negative pressure wound therapy, and skin stretching device were used in the treatment of poststernotomy dehiscence, but the outcome of each single method was poor, which caused great pain and burden to the patients and their families. In recent years, tissue flap containing rich blood supply has drawn a lot of attention because of its good wound cover, stable thoracic reconstruction, low infection recurrence rate, and less postoperative complication. In this paper, we reviewed the epidemiological characteristics of poststernotomy dehiscence, and summarized the various classifications for poststernotomy dehiscence and the therapeutic effects of different tissue flap repair. We hope that this review would provide a basis for further construction of the treatment system for poststernotomy dehiscence and the formation of a treatment guideline.

Repair of composite tissue defect of lower extremity with free fibula composite tissue flaps assisted by 3D-CT angiography

Objective To investigate the clinical efficacy of free fibula composite tissue flap transplantation for repair of composite tissue defects of lower extremity assisted by three-dimensional CT angiography (3D-CTA). Methods From May 2013 to February 2018, 16 patients with severe lower extremity trauma were treated with fibular composite tissue flaps. The course, distribution and vascular variation of peroneal artery were determined by preoperative 3D-CTA. The survival and appearance of the flaps were observed after the operation. X-ray examination was performed 6 weeks, 3 months, 6 months and 1 year after the operation to observe the healing of the fracture and evaluate the functional recovery of the affected limbs. Results The anatomical structure of composite tissue flaps can be clearly displayed by 3D-CTA. The findings during operation were basically consistent with the preoperative design. The follow-up period ranged from 6 to 24 months, with an average of 13 months. All the flaps survived and the fracture healed well. According to Enneking system score the average point was 22. The lower extremity function recovered to 73% of that of the normal side. Ankle joint activity was normal in donor area, and there was no abnormal sensation in common peroneal nerve innervation area. Conclusion At the same time of repairing bone defects with free composite tissue flaps, the combined skin flaps can repair soft tissue defects, which effectively solve the problem of wound coverage and restore the function of affected limbs. The patients are satisfied with the prognosis. Key words: Lower extremity; Treatment outcome; Three-dimensional CT angiography; Fibula composite tissue flap

Precision repairing of compound tissue defect at limbs by 3-Dimentional contrast printing and fibular head compound tissue flap transplantation

Objective To explore the clinical application and effect of fibular head compound soft tissue flap transplantation on precision repairing of compound tissue defect at limb joints assisted by 3 -Dimensional contrast printing technology. Methods From March, 2014 to September, 2017, 9 patients with bone and soft tissue defect at limb joints were selected. In which, 2 were distal radius bone defect with joint capsule and ligament defect, 2 were lower segment tibia bone and soft tissue defect, 2 were femur under section of the bone and soft tissue defect, 2 were medial malleolus bone and ligament defect, and 1 was external ankle ligament and bone defect. Using 3-Dimensional printing to conduct bilateral mirror-image contrast prior to the operation, morphology of bone defect at limb joints was acquired. Based on the texture printed out, corresponding fibular head compound blocks with blood vessels were removed from the donor site and transplanted to the recipient site before anastomosing the blood vessels and restoring the blood flow. The regular post-operative followed-up was performed. Results The 9 transplanted tissue blocks survived. The donor sites and the recipient sites were healed. The followed-up for restoration of limb function was from 9 to 35 (average, 17.5) months. The ankle function was assessed according Kofoed scale, resulted in 2 excellent and 1 good; The wrist function was assessed according Mayo scale, resulted in 1 excellent and 1 good. The medial malleolus bone defect and criteria bone defect were healed at 6 months. The patients were satisfied with the efficacy. Conclusion The application of 3-Dimensional contrast printing of fibular head compound tissue flap transplantation in repairing compound tissue defects at limb joints can reduce damage to the donor site, realizing precise repairing on limb tissue defect, and make good function restoration. Key words: Fibular head transplantation; 3-Dimensional printing; Tissue defects; Repair; Microsurgical technique

Clinical application of tibial composite saphenous nervetissue flap for the treatment of traumatic bone-skin defect of leg

To investigate the effect of tibial composite saphenous nerve tissue flap in repairing traumatic bone-skin defect of leg. From February 2009 to May 2015, 23 patients with focile skin defect caused by trauma were treated, including 18 males and 5 females, aged from 8 to 59 years old with an average age of 35.6 years old. Length of tibia bone cortex defect ranged from 4 to 12 cm, width ranged from 2 to 2.5cm, skin defect ranged from 8 cm× 3 cm to 18 cm× 11 cm, all the wound surfaces had purulent exudation. Cross shift and ipsilateral shift methods of tibial composite saphenous nerve tissue flap were used to reconstruct continuity of the injured limb tibial brace and repair wound surface. Cutting flap ranged from 9 cm× 4 cm to 20 cm × 12 cm, bone flap length was 6 to 15 cm, width was 1.5 to 2.5 cm. Fracture healing time and recovery of limb function were observed. At 3 to 5 months after operation, bone flap and area of affected area were healed with an average of 4.7 months. Twenty-three cases were followed up for 6 months to 5 years with an average of 30.3 months. Thirteen patients were able to walk without abnormal gait and could be engaged into original work. According to Enneking evaluation systems, 13 patients obtained excellent results, 8 moderate and 2 poor. With tibial composite saphenous nerve tissue flap transplantation at stage one to repair tibia and skin defects according to specific condition of affected limbs has a high rate of success and creates less damage to region of limb injury, which is an ideal method to repair skin defect of focile.

Ilizarov technique used in treatment of bone and soft tissue defects of the tibia

Objective To report our clinical outcomes of treating tibial defects combined with soft tissue defects using Ilizarov technique. Methods From May 2010 to February 2015, 52 patients with combined bone and soft tissue defects of the tibia were treated at our department. They were 41 males and 11 females, aged from 19 to 65 years (average, 37.7 years). By Gustilo classification, 49 cases were type ⅢB and 3 type ⅢC. The areas of soft tissue defect ranged from 7 cm×3 cm to 28 cm×15 cm, and the tibial defects ranged from 5 cm to 15 cm in length (average, 12.6 cm). The schemes of Ilizarov technique depended on the location and size of the tibial defects. Open wound dressing combined with bone transport was adopted in 21 cases, limb shortening followed by bone lengthening with compression at the fracture ends in 12 cases, and tissue flap transplantation combined with bone transport or lengthening in 19 cases. Results The follow-up time of the 52 patients ranged from 13 to 61 months (average, 27.1 months). The distance of bone transport or lengthening ranged from 5.0 cm to 13.6 cm (average, 10.8 cm); the bone transport speed averaged 0.81 mm/day. The tibiae united in all the 52 patients; the time for external fixation ranged from 13 to 21 months (average, 15.3 months); the external fixation index was 2.3 months/cm. According to the Paley functional criteria, 23 cases were excellent, 19 good, 9 fair, and one poor, yielding an excellent to good rate of 80.7%. Conclusion According to the location and size of the bone and soft tissue defects of the tibia, the 3 schemes of Ilizarov technique can be rationally chosen to obtain fine clinical outcomes. Key words: Tibia; Injury; External fixator; Ilizarov technique

Neo-digit functional reconstruction of mutilating hand injury using transplantation of multiple composite tissue flaps.

Functional reconstruction of mutilating hand injuries poses a challenge to the surgeon. We present our experience with use of multiple composite tissue flaps transplant for functional reconstruction of hand in patients with mutilating hand injuries. The associated merits and demerits of these surgical approaches are briefly discussed. From August 2004 to October 2014, functional reconstruction of hand with transplantation of multiple composite tissue flaps was performed in 8 patients. These included the toe with dorsal pedis artery flap, the reverse posterior interosseous artery flap, and the anterolateral thigh flap. Mean interval from injury to functional reconstruction was 10.6 days. All transplanted skin flaps and reconstructed neofingers survived completely. Only 1 patient developed wound infection at the recipient site (hand), which resolved without any debridement or revision surgery. At the donor site (foot), partial skin necrosis was observed in 1 patient, which healed with local wound care. In other patients, all wounds healed without any complications. The average range of movement at the neofinger metacarpophalangeal and interphalangeal joints was 38° and 73°, respectively. None of the patients required revision surgery. Use of negative pressure wound therapy and multiple composite tissue flap transplantation appears to be an effective strategy for hand functional reconstruction in patients with mutilating hand injuries. Among the multiple composite tissue flaps, use of toe transplantation combined with reverse posterior interosseous artery flap appears to be the best option.

Reconstruction of thumb and fingertip defects with wrap-around flap from the big toe

Objective To evaluate the method and clinical outcomes of big toe composite tissue flap transplantation with fibular branch of the proper plantar artery as feeding vessel for coverage of thumb and finger tip defects. Methods From January 2013 to June 2015, 6 cases with thumb tip defects and 9 cases with fingertip defects were repaired by the big toe composite tissue flap transplantation with anastomosing fibular branch of the proper plantar artery to the feeding vessel. Donor site of the big toe was covered by a tibial side flap. Results All 15 wrap-around flaps from the big toe survived. Postoperative follow-up ranged from 3 to 14 months. All the reconstructed digits had favorable functions and nail growth. The reconstructed nail was smooth in 13 cases and uneven in 2 cases. Scar hyperplasia and contracture was seen in 1 case. There is no abrasion or ulceration of the flaps that covered the donor site. Conclusion Big toe composite tissue flap transplantation with fibular branch of the proper plantar artery as feeding vessel is a less invasive and reliable method for coverage of thumb and fingertip defects. Key words: Surgical flaps; Finger injuries; Proper plantar artery

Surgical Repair Involving Tissue Flap Transplantation with Vascular Pedicle in Treating Refractory Pressure Ulcers Around Hip and Sacral Region

Objective: To explore the therapeutic methods on surgical repair of refractory pressure ulcers around hip and sacral region, and to conclude the focuses of the surgical treatment. Materials and Methods: From January 2007 to December 2013, tissue flap transport with vascular pedicle was applied to repair 77 cases refractory pressure ulcers (96 wounds) around hip sacral region, with the patients aging from 21 to 82. For the positions of the 96 wounds, 34 wounds were on the sacrococcygeal region, 21 in femoral major trochanteric portion, and 41 on the ischial tuberosity. The size of smallest pressure ulcer was 1cm×2cm, and the biggest was 12×16cm, all were accompanied by infections with different degrees. Among all the cases, 38 wounds were repaired by gluteus maximus myocutaneous flaps, 11 wounds were repaired by gracilis myocutaneous flaps, and 12 wounds were repaired by long end of musculus biceps femoris myocutaneous flaps; 34 wounds repaired by fasciocutaneous flaps, including 10 wounds by posterior fasciocutaneous flaps; and 5 cases were healed by hip disarticulation and repaired by bone musculocutaneous flaps. Results: 75 of the 77 patients were healed after the operation, while 2 failed to be healed because of their old age and poor nutritional status. According to the follow-ups, 4 of the healed patients with pressure ulcers on ischial tuberosities relapsed 1 year after the operation, and were thoroughly healed by second operation of biceps femoris myocutaneous flaps transport; the transplanted myocutaneous flaps of other cases all survived and no recurrence of pressure ulcers happened, that the surgical treatment received satisfactory results. Conclusion: Combining the supportive therapeutics of nutritional support and control of the infections, surgical treatment of tissue flap transport with vascular pedicle could reach satisfactory results for repair refractory pressure ulcers around hip and sacral region. Keywords: Follow-up, refractory pressure ulcers, surgical repair, therapy, tissue flap with vascular pedicle.

Tissue flap transplantation plus bone transportation for repair of massive multi-tissue defects at the leg

Objective To report the clinical effects of treating massive multi-tissue defects at the leg with tissue flap transportation and bone transportation.Methods The clinical data was analyzed retrospectively of 92 patients who had been treated from January 2005 to December 2011 for massive soft tissue and large segmental bone defects at the leg.They were 71 males and 21 females,with a mean age of 38.3 years (range,19 to 56 years).They were treated by herbal dressing on wounds before operation.At the subacute stage,massive skin and large segmental bone defects were treated with skin flap transplantation plus bone transportation and damaged muscular function and large segmental bone defects were managed with musculocutaneous flap transplantation plus bone transportation.After operation,traditional Chinese medication was administered for anticoagulation in all cases.Results All operations were completed successfully without infection.Vascular anastomoses were conducted in free transplantation of 106 pieces of tissue.All transplanted tissues survived except for tip necrosis of one skin flap.On average,each patient received 2.6 operations and had an average duration of 256 days for treatment.The follow-up periods for all the patients ranged from 10 to 48 months (mean,24.6 months).According to Paley criteria,53 cases were rated as excellent,26 as good,9 as fair,and 4 as poor,giving a good to excellent rate of 85.9％.Conclusion As tissue flap transplantation plus bone transportation can restore the function of the leg as much as possible,it is an effective treatment of massive multi-tissue defects at the leg. Key words: Tissue transplantation; Soft tissue defect; Reconstructive surgical procedures; Bone transportation

Clinical repairing complex defect of soft tissue and bone in limbs caused by traffic accident

Objective To report the clinical result of repairing complex tissue defect in limb caused by traffic accident using both tissue flap transplantation and external fixer. Methods The vascular tissue flap including bone flap and muscular flap to repair the complex tissue defection(soft tissue, bones, joints) in forearm, hand, leg, ankle and foot were applied in 36 cases. At the same time in surgery, injured bones and joints were fixed by external fixer for stabilizing and accelerating cure. Results All 56 eases were applied successfully with transplanted tissue combined with external fixation. The external fixers were moved away about 10-16 weeks(upper extremity) or 6-8 months(lower extremity) later and all the cases recovered satisfactorily. Conclusion It is a reliable method for repairing the complex tissue defection in the limb caused by traffic accident by external fixer of traumarology and microsurgery technique. And it is also characterized as a minor injury method on transplanted bones, enables early exercise for joints, convenient observation of flap circulation and easy nursing. Key words: Traffic accident; Limbs; Tissue flap; Transplantation; Microsurgery

Nursing on external fixator repairing defects of limbs caused by traffic accidents

Objective To report the clinical result of repairing complex tissue defect in limb caused by traffic accident using both tissue flap transplantation and external fixer. Methods The vascular tissue flap including bone flap and muscular flap to repair the complex tissue defection ( soft tissue, bones, joints) in forearm, hand, leg, ankle and foot were applied in 36 cases. At the same time in surgery, injured bones and joints were fixed by external fixator for stabilizing and accelerating cure. Results All 36 cases were applied successfully with transplanted tissue combined with external fixator. The external fixator were moved away about 10～16 weeks post - operation in upper extremity or 6～8 months post - operation in lower extremity and all the cases recovered satisfactorily. Conclusions It is a reliable method for repairing the complex tissue defection in the limb caused by traffic accident by external fixator with traumatology and microsurgery technique. And it is also characterized as a minor injury method on transplanted bones, enables early exercise for joints, convenient observation of flap circulation and easy nursing. Key words: Traffic accident; Complex defection; Tissue flap transplantation; External fixator; Nursing

Application of vacuum-sealing drainage for early infection in Gustilo III open fractures

Objective To study management of early infection in Gustilo Ⅲ open fractures and explore the effects of region- and layer-wise applications of Vacuum-Sealing Drainage (VSD). Methods Early in-fections in 46 cases of Gustilo Ⅲ open fracture were treated with VSD from December 2006 to January 2008. Of them, 11 cases were type Ⅲ A; 28 type Ⅲ B, and 7 type Ⅲ C. The area of infected wound surface or skin necrosis ranged from 3 cm × 2 cm to 50 cm×35 cm in all the patients who had previously undergone fixation and vessel repair. After they were treated with debridement, change of fracture fixation or position adjustment of outer fixation device, VSD was applied in a region- and layer-wise manner in the inter-muscular space, inter-joint space and the inter-fracture space of the infection region. The sequence and time of tube withdrawal were dependent on tube position and drainage pattern. After fresh granulation tissue grew, 12 cases underwent flap and muscle graft and 34 cases (36 lesions) underwent skin graft or suture to cover the wounds. Three to 6 months after wound healing, retention of former fixation or change to a permanent fracture fixation was de-termined according to the healing condition and the stability of the fixation. Results All the cases ob-tained fine fracture healing and effective control of infection after debridement and VSD. Forty-four cases of skin graft and tissue flap transplantation showed one-time full recovery, and 2 cases of free skin graft still had a small part of wound unhealed after first transplantation but fully recovered after re-transplantation. All pa-tients had normal body temperature and hemogram, no local fistula or pain. Fractures united within 5 to 12 months with fine limb functional recovery. Conclusions Early detection and timely treatment of early infection in Gustilo Ⅲ open fractures may result in preferable prognosis, and region- and layer-wise application of VSD is effective to control the infection. Key words: Fractures, open; Infection; Drainage; Occlusive dressings