Objective To discuss the clinical outcome of the modified super large dorsal metacarpal artery flap in reconstruction of circumferential fingertip avulsion. Methods Twenty-four patients with circumferential fingertip avulsion were treated by the modified super large dorsal metacarpal artery flap from January 2004 to August 2008. There were six index fingers, 11 middle fingers, five ring fingers and two little fingers with surface defects beyond the distal interphalangeal joint and the distal degloving length ranged from 0.8 cm to 3.1 cm. Emergency operation was performed on 22 fingers and stage Ⅱ surgery was done for distal skin necrosis of two fingers. Results Twenty-one patients with 21 fingers were followed up for 6-28 months, which showed that all flaps survived, with satisfactory appearance and function, and that the point discrimination of flap was for 6-9 mm ( average 7.6 mm). Conclusion Modified super large dorsal metacarpal artery flap is an ideal method for reconstruction of the circumferential fingertip avulsion with advantages of easiness, convenience and short treatment period.

Objective: To investigate the effect of repairing the skin and soft tissue defects of foot with the anterior tibial artery perforator flap. Methods: Nine patients received the operation using the anterior tibial artery periosteal perforator flap to repair distal foot lesion with skin and soft tissue defects.There were six males and three females.All cases were the distal foot defects of skin and soft tissue with tendon and bone exposure, including traffic accident injury in 5 cases, crush injury in 3 cases, other causes of injury in 1 case. The defects ranged from 5 cm×3 cm to 9 cm×6 cm. The flaps ranged from 7 cm×5 cm—11 cm×8 cm. The donor sites were repaired with direct suture or full-thickness skin grafts. Results: All the flaps were survived, without vascular crisis, congestion and blisters. 1 case had partial necrosis of flap margin, which was cured after dressing. All cases were followed up for 6 months to 34 months(mean 18 months). The appearance and function recovery of flaps were satisfactory. Conclusions It is an ideal flap donor site for repairing soft tissue defects of the distal foot with the anterior tibial artery perforator flap, which has the advantages of simple operation, less trauma, high skin flap survival rate and good appearance.

Objective: To investigate the clinical effect of reconstruction of bone defects of forearm using free vascularized fibular grafts(VFG). Methods: 22 patients with bone defects of forearm were treated with free VFG. 6 cases with upper limb bone and soft tissue defects were repaired with free vascularized osteoseptocutaneous fibula as a composite flap. The length of ulna defect ranged from 4 cm to 12 cm and radius defect from 5 cm to 14 cm. The length of harvested fibula ranged from 13 cm to 24 cm. The area of the skin flaps ranged from 12 cm×6 cm to 20 cm×11 cm. Results: All graft bone achieved bone union, with the healing time from 3 to 6 months (mean, 4.5 months). The operation incision healed primarily and all flaps survived with soft texture. All patients were followed up for 12-26 months (mean, 20.5 months). The function of forearm was recovered without refracture. The movement of ankle and the sensation in the leg were normal. According to the Anderson standard at last follow-up visit, the results were excellent in 9 cases, good in 11 cases and fair in 2 cases, with an excellent and good rate of 90.9%. Conclusions Vascularized fibular grafts VFG is an effective method to repair bone defects of forearm.