Objective To provide the applied anatomy of the posterior intercostal artery perforator flap and the clinical results of repairing the soft tissue defects with lateral perforator flap. Methods Six fresh adult cadavers were injected with a lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 64-slice spiral computed tomography scanner and specialized software (Materiaise's interactive medical image control system,MIMICS).The origin,course,diameter,and distribution of the the 6-10th posterior intercostal artery perforators in the thoroax region were observed and measured.Clinically,nine cases were treated with the lateral perforator flap supplied by 7-10th posterior intercostal artery transplantation for repairing wounds in upper limbs.The flap size was 9 cm × 7 cm-16 cm × 12 cm. Results The 6-10th posterior intercostal artery perforator (outer diameter 1.70 ± 0.14 mm) were from the artery in the chest region, which pierce in deep fascia near midaxillary line. The average pedicle length from the deep fascia was (87.56 ± 6.48) mm.All of 9 cases were repaired successfully,the clinical results were satisfactory.Conclusion The posterior intercostal artery perforator flap can be used to form many kinds of axial skin flaps,it is a good option for repairing soft-tissue defect.

Objective To report the method for repair of the heel and ankle.Method On the basis of applied anatomy,the reversed island flap based on sural neurovascular pedicle has been designed for repair of heel and ankle defects.Results The flaps have been used in 14 cases,the maximum size 9 cm×15 cm,and all flaps were survival compeletely except partial necrosis in one flap.Conclusion The blood supply of the flap is good.The length of pedicle can reach 12 cm.It is an effective method for repair of heel and ankle defects.

OBJECTIVETo study a new method to repair forefoot skin defects.

METHODSBased on anatomical studies, a reverse medialis pedis flap was designed for coverage of forefoot skin defect. The flap was based on the distal end of the medial plantar artery and had distal anastomosis with the lateral plantar artery and dorsal metatarsal artery.

RESULTSThe flap was used clinically in 6 cases. The size of the flap ranged from 4 x 3 cm to 11 x 9 cm. The pedicle of the flap was 6 to 11 cm. All flaps survived completely. The aesthetic and functional results were satisfactory after 6-24 months follow-up.

CONCLUSIONThe flap is one of the best choices for repairing of forefoot skin defects.

Adolescent ; Adult ; Female ; Foot ; anatomy & histology ; surgery ; Humans ; Male ; Surgical Flaps

Objective:To investigate the clinical validity of adopting temporary abdominal closure and anterolateral thigh flap for the sequential treatment of abdominal wall defect caused by electric burn.Methods:From June 2009 to June 2019, patients with large abdominal wall defect after electric burn were included in the Department of Burn and Skin Repair Surgery, Hainan General Hospital. The abdominal cavity was temporarily closed by xenogeneic acellular dermal matrix (ADM)+ vacuum sealing drainage (VSD) to protect the abdominal organs. After the abdominal organ injury were recovered, the anterolateral thigh flap(ALTF) and tensor fasciae latae free flaps was used to repair and reconstruct the abdominal wall sequentially. The patients were followed up to observe whether there were abdominal wall ulcers or ventral hernias, and whether there were complications such as intestinal obstruction or intestinal perforation.Results:A total of 5 patients were included, all male, aged 20-57 years, with an average of 37.4 years. All of them were suffered from different degrees of electrical injury in other regions, and even with abdominal organ injury. The area of abdominal wall defect was about 18 cm×12 cm -22 cm×14 cm. In this group of patients, after temporary abdominal closure, the abdominal organs injury healed, ALTF and tensor fasciae latae free flaps survived well, and the abdominal wall was repaired and reconstructed in appearance and function. During the follow-up period of 6 to 36 months, no complications such as abdominal wall ulcer and hernia appeared.Conclusions:Temporary abdominal closure and ALTF used for treating large abdominal wall defect of electrical burns sequentially rendered effective with few complications. It is a novel method for repairing and reconstructing of large abdominal wall defect.

Objective:To investigate the clinical validity of adopting temporary abdominal closure and anterolateral thigh flap for the sequential treatment of abdominal wall defect caused by electric burn.Methods:From June 2009 to June 2019, patients with large abdominal wall defect after electric burn were included in the Department of Burn and Skin Repair Surgery, Hainan General Hospital. The abdominal cavity was temporarily closed by xenogeneic acellular dermal matrix (ADM)+ vacuum sealing drainage (VSD) to protect the abdominal organs. After the abdominal organ injury were recovered, the anterolateral thigh flap(ALTF) and tensor fasciae latae free flaps was used to repair and reconstruct the abdominal wall sequentially. The patients were followed up to observe whether there were abdominal wall ulcers or ventral hernias, and whether there were complications such as intestinal obstruction or intestinal perforation.Results:A total of 5 patients were included, all male, aged 20-57 years, with an average of 37.4 years. All of them were suffered from different degrees of electrical injury in other regions, and even with abdominal organ injury. The area of abdominal wall defect was about 18 cm×12 cm -22 cm×14 cm. In this group of patients, after temporary abdominal closure, the abdominal organs injury healed, ALTF and tensor fasciae latae free flaps survived well, and the abdominal wall was repaired and reconstructed in appearance and function. During the follow-up period of 6 to 36 months, no complications such as abdominal wall ulcer and hernia appeared.Conclusions:Temporary abdominal closure and ALTF used for treating large abdominal wall defect of electrical burns sequentially rendered effective with few complications. It is a novel method for repairing and reconstructing of large abdominal wall defect.

Objective:To investigate the influence factors of poor efficacy after flap repair operation in patients with pressure ulcers.Methods:The retrospective case series study was conducted. From January 2011 to June 2021, 125 patients with stage Ⅲ and Ⅳ pressure ulcers treated in Hainan General Hospital met the inclusion criteria. There were 82 males and 43 females, aged 15-90 (57±20) years. According to the postoperative effects, the patients were divided into poor efficacy group (47 cases) and good efficacy group (78 cases). The clinical data of patients in the two groups were collected, including the age, gender, location, stage, size, and bone exposure of pressure ulcers, preoperative microorganism culture results of wound exudate sample, whether combined with osteomyelitis, diabetes, lower limb paroxysmal myospasm, and gatism or not, the number of surgical debridement combined with negative-pressure wound therapy, type of surgical flap, postoperative position, and preoperative albumin, leukocyte, C-reactive protein (CRP), and hemoglobin. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. The binary multivariate logistic regression analysis was conducted to screen the independent risk factors influencing the poor efficacy after flap repair operation in 125 patients with stage Ⅲ and Ⅳ pressure ulcers. Results:The ratio of patients with lower limb paroxysmal myospasm in poor efficacy group was 22/47, which was significantly higher than 3/78 in good efficacy group ( χ2=33.83, P<0.01). The preoperative hemoglobin level of patients in poor efficacy group was (102±17) g/L, which was significantly lower than (113±20) g/L in good efficacy group ( t=-3.24, P<0.01). The preoperative CRP level of patients was 39.1 (14.1, 91.6) mg/L in poor efficacy group, which was significantly higher than 15.3 (6.6, 42.0) mg/L in good efficacy group ( Z=-3.04, P<0.01). There were no statistically significant differences in other indexes between patients in the two groups ( P>0.05). Multivariate logistic regression analysis showed that age, lower limb paroxysmal myospasm, and preoperative hemoglobin level were the independent risk factors for poor efficacy after flap repair operation in patients with pressure ulcers (with odds ratios of 1.03, 40.69, and 0.97, 95% confidence intervals of 1.00-1.06, 9.18-180.39, and 0.95-1.00, respectively, P<0.05 or P<0.01). Conclusions:Poor efficacy after flap repair operation in patients with pressure ulcers is affected by many factors, among which the age, lower limb paroxysmal myospasm, and preoperative hemoglobin level are the independent risk factors.