Objective To investigate the clinical application of neighboring digital artery flow-through flaps for one-staged skin coverage and revascularisation after severe finger injuries.Methods From May 2008 to July 2010,there were ischemic fingers had severe injuries,aged 19 to 52 years old,which were male in 5 cases,female in 2 cases,with skin and arterier defected.One-staged coverage and revascularisation of traumatised fingers were used with neighboring digital artery flow-through flaps.Functional exercise and physical therapy were done 3 weeks later.All cases had more than 12 months' fellowed-up periods.The sensibility testing,Questionnaire of the flap aesthetic satisfactory and TAM evaluations were all performed in all patients.All the results were measured and evaluated.Results All flaps survived completely and digit blood circulations were good in 7 patients.The flaps had good appearance and aesthetic satisfactory (100％).At 12 months after operations,the pain and touch perception reinnervated until 6 months and two-point discrimination testing were 6.1 to 9.6 mm,mean was (7.1 ± 1.3) mm,and the flap sensibility assessment were S3 * and TAM evaluation ratio were 0.81 ±0.16.Conclution Neighboring digital artery flap ideally suited as a thin and pliable flow-through flap in digital replantation/revascularization.It is helpful for salvage of the ischemic fingers after injury with skin and arteries defects.

OBJECTIVETo investigate the clinical effect of anastomosis of superficial veins for improving the drainage of perforator propeller flaps.

METHODSFrom Sept. 2011 to Dec. 2012, 11 cases with soft tissue defects and chronic ulcer wound at extremities were treated with adjacent perforator propeller flaps, which were pedicled by the peroneal artery(5 cases), or the lateral supramalleolar artery(3 cases), or the ulnar artery (2 cases), or the posterior interrosseous artery (1 case). The wound size ranged from from 3.0 cm x 2. 5 cm to 11. 0 cm x 4. 0 cm, and the falps size ranged from 6 cm x 3 cm to 21 em x 5 cm. One superficial vein in all the flaps was anastomosed with superficial vein in the recipient area. The blood supply of the flaps were recorded after operation 1 - 3 months after operation, the fluency of anastomosed vein was detected by color Doppler ultrasound. Flap swelling evaluations were performed in early 3 months and later 3 - 6 months, and the results were classified into 4 grading degrees. 6 months later, Questionnaire of the flap aesthetic satisfactory was performed for seven patients during follow-up period.

RESULTS9 flaps survived completely, two flaps had partial marginal skin necrosis in the distal end, which were both managed with surgical debridement, and both wounds healed in two months. 9 cases were followed up for more than 12 - 19 months. The early rsults of flap swelling evaluations were: I degree 0 case, II degree 8 cases, III degree 3 cases, IV degree 0 case, and the later results were: I degree 7 cases, II degree 4 cases, III degree 0 case, IV degree 0 case. The flaps had ideal appearance, good contour, and high aesthetic satisfactory (100%). The mean flap survival area rate of veins anastomosed was (98. 6 ± 9. 7) %.

CONCLUSIONSPerforator propeller flaps with anastomosis of superficial veins can improve the flap venous drainage, avoid transient venous venous congestion, so as to increase the flap survival. It is an effective way for improving the vein drainage.

Anastomosis, Surgical ; methods ; Debridement ; Extremities ; blood supply ; Graft Survival ; Humans ; Leg Ulcer ; pathology ; surgery ; Perforator Flap ; transplantation ; Regional Blood Flow ; Tibial Arteries ; Ulnar Artery ; Ultrasonography, Doppler, Color ; Veins ; surgery

OBJECTIVETo investigate the clinical application of flow-through deep inferior epigastric perforator flaps for reconstruction of large defects at the extremities.

METHODSThe deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. Free deep inferior epigastric perforator flaps were harvested in flow- through manners to reconstruct associated arterial defect in the wound. The sensation assessment,Enneking score,and questionnaire of the flap aesthetic were all performed during follow-up period.

RESULTSFrom December 2011 to September 2012, 5 patients with large defects at extremities were treated. The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. The wound defects ranged form 11 cm x 5 cm to 30 cm x 11 cm. And the flap size ranged from 13 cm x7 cm to 33 cm x 13 cm. All flaps survived completely. The recipient arteries were all bypassed well documented by color Doppler examinations. All cases had 12-24 months' follow-up period. The flaps had good appearance and high aesthetic satisfactory(100%). 12 months after operations, sensation assessment were all S3+, and the Enneking score ratios were 82%-95% ,with 87.2% in average.

CONCLUSIONSFlow-through deep inferior epigastric perforator flaps are reliable and effective for reconstruction of large defects at the extremities with maintenance of the vascular status of the extremities. The flaps can also be designed in transverse or oblique mode for clinical application.

Aged ; Arteries ; Epigastric Arteries ; Esthetics ; Extremities ; blood supply ; surgery ; Humans ; Leg Injuries ; surgery ; Perforator Flap ; blood supply ; Reconstructive Surgical Procedures

Objective To investigate the methods and clinical effects of flow-through posterior interrosseous artery flaps for reconstructing digital wounds combined with artery injury.Methods From December 2011 to September 2013,11 patients with traumatic digital defect combined with artery injury were repaired with flow-through posterior interrosseous artery flaps.Flap aesthetic satisfaction was assessed using questionnaires; flaps were tested for pain and touch sensation,temperature perception,and two-point discrimination; finger activity was detect using the total active movement (TAM) ratio of the injured and uninjured side.Results All flaps and injured fingers survived.Wounds healed by the first intension.Nine patients were followed up for 12-24 months.Two-point discrimination of the flaps recovered at postoperative 6 months and averaged (9.7 ± 2.1) mm at postoperative 12 months,with S3 +grade in sensation evaluation.TAM ratio of the injured and uninjured side was 0.85 ±0.17.All patients expressed the satisfaction to flap appearance.Conclusions Flow-through posterior interrosseous artery flaps are safe and effective to cover digital wounds and restore blood circulation.The technique improves the clinical application of perforator flaps.

Objective To investigate the clinical application of flow-through latissimus dorsi musculocutaneous flaps for functional reconstruction of musculus flexor digitorum defects.Methods 9 forearm traumatic patients were selected admitted from March 2011 to February 2013,aged 22 to 57 years old (average age 39.2),including 5 male and 4 female.All cases were combined injuries.The flexion of the fingers was constrained.The injury areas ranged from 15 cm×6 cm to 21 cm×9 cm while the flaps were 17 cm×7 cm at least and 24 cm×10 cm at most.For traumatic musculus flexor digitorum,skin,soft tissue and radial artery defects were all well repaired with functional flow-through latissimus dorsi musculocutaneous flaps.Functional exercise and physical therapy were done 3 weeks later.Electromyography,grip strength,and pinch strength evaluation were performed at the 6,12months after operating.Enneking evaluation was scored during follow-up periods from 12 to 24 months.All the results were measured and evaluated.Results All flaps survived completely in 9 patients and recipient radial artery were bypassed well.The flaps had good appearance and high aesthetic satisfactory.Seven cases had more than 12 months' follow-up periods.Muscle contraction can be touched 3 months after transplantion.Diagram of EMG tracing showed that the maximum voluntary contraction action potentials presented simple phase at 3 months,intermix phase at 6 months,and interference phase at 12 months.The average grip strength of the second to fifth finger was 8.97±2.91 g/mm2 at 6 months,11.69±3.71 g/mm2 at 12 months.The average pinch strength of thumb and the index finger was 1.39±0.22 g/mm2 at 6 months,1.67±0.34 g/rmm2 at 12 months.For the muscle power recovery and motor nerve function scale,4 cases were M3+,3 cases were M3.The average ratio of Enneking evaluation score with nomal was 65.7％± 15.9％.Conclusion As functional musculocutaneous flaps,flow-through latissimus dorsi musculocutaneous flaps are effective for reconstruction of musculus flexor digitorum and wound defects.The vascular status of the extremities are protected and maintained,which is extremely useful in forearm-salvage procedures from both functional and structural viewpoints.

Objective To investigate the methods and results of lateral leg propeller pedicled flaps based on multi-perforators for coverage of soft-tissue defects on the foot and ankle.Methods From May,2012 to June,2013,8 patients with soft-tissue defects were treated,including 5 cases by trauma,2 cases by chronic unlcers,1 case by infection on the foot and ankle with exposed osseous and tendinous.Lateral leg propeller pedicled flaps based on multi-perforators were elevated and rotated with the angle from 150° to 180° for coverage of soft-tissue de-fects.Flap size ranged from 15.0 cm × 7.0 cm to 23.0 cm × 9.0 cm.Skin graft was applied to cover the donor sites.After the operation,the blood supplies of flaps were observed severely over 10 days.Questionnaire of the flap aesthetic satisfactory and AOFAS evaluation were performed in 7 patients during fellowed-up periods.Results Seven flaps were all survived well,1 flap had partial marginal skin necrosis on the distal,which was managed with surgical debridement,and wound healed in 1 month.Seven patients had a mean of 10.7 months' fellowed-up periods.The flaps had like-like appearance,good contour,and high aesthetic satisfactor (100％).The mean AOFAS score was 90.5.Conclusion Lateral leg propeller pedicled flaps based on multi-perforators can supply the blood of the larger volume of tissue,which can be safely sustained to repair distal and larger defects on the foot and ankle.