The applications of cross-bridge free flap for reconstructions of severe soft tissue defects
10.3760/cma.j.cn114453-20210601-00241
- VernacularTitle:游离皮瓣桥式移植修复严重皮肤软组织缺损
- Author:
Jiaomiao PEI
1
;
Yan HAN
;
Yang LI
;
Juan ZHANG
;
Baoqiang SONG
Author Information
1. 空军军医大学第一附属医院整形外科，西安 710032
- Keywords:
Microsurgery;
Surgical flaps;
Cross-bridge transplantation;
Free skin flap;
Soft tissue defect
- From:
Chinese Journal of Plastic Surgery
2022;38(7):780-786
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the application and efficacy of cross-bridge free flaps to repair severe soft tissue defects.Methods:The clinical data of severe defects with vascular damage in the recipient site from February 2008 to February 2017 were retrospectively analyzed in the First Affiliated Hospital of Air Force Military Medical University. Latissimus dorsi myocutaneous flaps, anterolateral thigh flaps, or thoracomphalum flaps were applied in these cases. These flaps were nourished by ipsilateral or contralateral limb vessels, named as bridge blood supply. The radial artery and cephalic vein of the ipsilateral forearm were bridged to repair defects of the head, face, and trunk. The vessels of the unaffected lower extremity were bridged to repair leg and foot wounds. The flap donor sites were closed directly or covered by skin grafting. Division procedures were performed after circulation reestablishment for five weeks. The complications, survival of flaps and skin grafts were observed and followed up.Results:A total of 12 patients were selected, including nine males and three females, aged 18-59 years old. The cases included four head and facial defects, one hip tumor excision, six lower extremities injuries, and one dorsal foot injury. The defect areas ranged 18.0 cm × 7.0 cm-23.5 cm × 13.0 cm, and the flaps size ranged 20.0 cm × 8.0 cm-25.0 cm × 15.0 cm. Latissimus dorsi myocutaneous flaps were applied in 10 cases. The other two cases were treated by a thoracic umbilical and an anterolateral thigh flap. The vascular crisis occurred in one case, and the graft survived well after the timely removal of the venous thrombosis. One case of partial skin graft necrosis occurred on the back donor site, which healed after dressing changes. The other donor sites recovered well. Two cases of flap bloating appearances were improved by thinning procedures six months later. The follow-ups lasted 1 to 1.5 years. The patients were satisfied with the appearance of the transferred flaps. The color and texture of the flaps were different from the surrounding areas. There were no malformations and functional disorders in donor sites of the extremities. Some pigmentation and superficial scar were left on the thighs.Conclusions:For large and severe soft tissue defects where no anastomotic vessels were available, the application of free flap by bridge transplantation is an alternative with good outcomes.
