Objective:To compare the incidence of postoperative complications of single- and multiple-perforator flaps, to provide reference for future clinical decision.Methods:Literatures on the comparison of postoperative complications of single- and multiple-perforator flaps at home and abroad from January 1995 to December 2020 were searched in PubMed, Cochrane Library, Embase, Wanfang, CNKI, VIP database. The literatures were screened and extracted according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3 software.Results:8 studies were included, including 1 008 flaps. There were 535(53%) single-perforator flaps, 473(47%) multiple-perforator flaps. Compared with multiple-perforator flaps, single-perforator flaps had a higher rate of venous crisis ( OR=2.29, 95% CI: 1.25-4.21, Z=2.67, P=0.008) and a higher rate of fat necrosis ( OR=2.04, 95% CI: 1.02-4.10, Z=2.10, P=0.040), the total necrosis rate of flaps was higher ( OR=2.71, 95% CI: 1.26-5.86, Z=2.54, P=0.010), and the differences were statistically significant. There were no significant differences in the incidence of arterial crisis ( OR=1.18, 95% CI: 0.48-2.90, Z=0.37, P=0.710) and partial necrosis of flaps ( OR=1.20, 95% CI: 0.61-2.36, Z=0.52, P=0.600). Conclusion:Compared with multiple-perforator flap, single-perforator flap may have higher incidence of venous crisis, fat necrosis and complete necrosis.

Objective:To compare the incidence of postoperative complications of single- and multiple-perforator flaps, to provide reference for future clinical decision.Methods:Literatures on the comparison of postoperative complications of single- and multiple-perforator flaps at home and abroad from January 1995 to December 2020 were searched in PubMed, Cochrane Library, Embase, Wanfang, CNKI, VIP database. The literatures were screened and extracted according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.3 software.Results:8 studies were included, including 1 008 flaps. There were 535(53%) single-perforator flaps, 473(47%) multiple-perforator flaps. Compared with multiple-perforator flaps, single-perforator flaps had a higher rate of venous crisis ( OR=2.29, 95% CI: 1.25-4.21, Z=2.67, P=0.008) and a higher rate of fat necrosis ( OR=2.04, 95% CI: 1.02-4.10, Z=2.10, P=0.040), the total necrosis rate of flaps was higher ( OR=2.71, 95% CI: 1.26-5.86, Z=2.54, P=0.010), and the differences were statistically significant. There were no significant differences in the incidence of arterial crisis ( OR=1.18, 95% CI: 0.48-2.90, Z=0.37, P=0.710) and partial necrosis of flaps ( OR=1.20, 95% CI: 0.61-2.36, Z=0.52, P=0.600). Conclusion:Compared with multiple-perforator flap, single-perforator flap may have higher incidence of venous crisis, fat necrosis and complete necrosis.

Objective To explore the correlation between old anterior cruciate ligament (ACL) injury with medial menis-cal tears and posterior slope of tibial plateau. Methods Between July 2014 and February 2016, retrospective analyzed 177 pa-tients diagnosed with old ACL injury (injured to surgery time>3 months) who has been underwent arthroscopic treatment. 93 pa-tients included in this study contained 65 male and 28 female,the average age was (32.36±4.50) years old (ranged from 21 to 44 years). All patients were diagnosed with ACL rupture and no associated medial meniscus tear by MR examination at the time of in-jury and before operation. Posterior slope angle of tibial plateau was measured via MR. The patients were divided into two groups according to the presence of medial meniscus tear by preoperative MR examination. Statistical analysis was employed to analyze the difference between the two groups of patients's age, body mass index (BMI), posterior slope angle of tibial plateau, gender and side. The patients were divided into group of posterior slope of tibial plateau ≥10° and posterior slope of tibial plateau<10° re-spectively. Statistical analysis was employed to analyze the incidence of concomitant medial meniscus tear between the two groups. Result All 93 patients in this study were followed up for the average of 8.63 ± 3.74 months. 51(51/93, 55%) patients were com-firmed of concomitant medial meniscus tear and 42 (42/93, 45%) patients without medial meniscus tear through MR and arthro-scope. There was no statistical difference between two groups in age (t=0.843, P=0.843), gender (χ2=1.027, P=0.338), BMI (t=0.568, P=0.571) and side (χ2=0.110, P=0.438). There was a certain correlation between the medial meniscal tears and posterior slope angle of tibial plateau in this group and the values were considered statistically significant ( r=0.602, P=0.000). Posterior slope angle of tibial plateau of medial meniscus tear group (10.51°±2.83°) was significantly higher than that in non medial menis-cus tear group (7.39°±4.62°). Values were considered statistically significant .71.15%(37/51) of the patients showed medial meniscus tear in the group of posterior slope of tibial plateau ≥10° , however, only 34.14%(14/42) patients indicated medial meniscus tear in group of posterior slope of tibial plateau<10°, and the difference was statistically significant(χ2=12.677,P=0.000). Con-clusion There is a certain correlation between old ACL injury with medial meniscal tears and posterior slope angle of tibial pla-teau. With the continuous increase of ACL injury time, high posterior slope angle of tibial plateau (≥10°) is more likely to increase the incidence of medial meniscus tear.

Objective:To explore the clinical value of modified infrared thermal imaging assisted design of peroneal artery perforator propeller flap.Methods:From March 2019 to May 2021, tourniquet-reperfusion augmented thermal imaging method (TRATIM) was used to locate the perforating vessels in 14 patients for surgery or peroneal artery perforator propeller flap. The sensitivity, positive predictive value and detection time were calculated and compared with the perforating vessels located by color Doppler ultrasound(CDU), P<0.05 is statistially significant. Results:After operation, 13 flaps survived completely, but 1 flap with distal surface necrosis and healed after dressing change. Only one linear scar was left in 12 cases, and 2 cases healed well by skin grafts. Followed-up for 6-13 months, and showed that the colour and texture of the flaps were similar to the surrounding skin, without obvious swelling. The sensitivity of TRATIM and CDU in location of peral perforator vessels were 88.0% and 92.0%, respectively, and the positive predictive value was 93.6% and 95.8%, with no statistical difference between TRATIM and CDU( P>0.05). The time of positioning perforator was (3.71±0.80) min for TRATIM and(16.21±4.97) min for CDU, There was significant difference between TRATIM and CDU( P<0.01). Conclusion:With TRATIM, a surgeon can locate the peroneal perforator vessels simply, quickly and accurately, and help in design more accurate peroneal artery perforator propeller flap.

Objective:To investigate the effects of thinned anterolateral thigh perforator flaps combined with finger splitting and webplasty in sequential treatment of degloving destructive wound of total hand.Methods:This study was a retrospective observational study. From January 2012 to January 2023, a total of 15 cases who met the inclusion criteria with degloving destructive wound of total hand were admitted to Ningbo No.6 Hospital, including 10 males and 5 females, aged 17-75 years. The wounds were all combined with exposed bones or tendon. Emergency debridement and vacuum sealing drainage were performed in all cases before flap transplantation in stage Ⅰ. After thorough debridement, the wound area was 11.0 cm×3.0 cm-23.0 cm×13.5 cm. One or both anterolateral thigh perforator flaps with size of 12.5 cm×5.0 cm-25.0 cm×15.5 cm were designed, cut, and thinned to repair the skin and soft tissue defects of the hand. The donor site was sutured directly or repaired with medium-thickness skin graft from the opposite thigh. As needed, the flap was reconstructed by finger splitting and webplasty once or more times every 3 months after stage Ⅰoperation. The survival and complications of flap and wound healing at the donor site were observed after stage Ⅰoperation. The appearance of flap, two-point discrimination distance, and hand function were observed during the follow-up. At the final follow-up, the function of the affected hand was evaluated by the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association.Results:After the operation of stage Ⅰ, all the flaps of 15 cases of patients survived completely, including 1 case that had arterial crisis of flap but survived completely after exploration and re-anastomosis of blood vessels; all the wounds at the donor site healed. During the follow-up period of 6 to 18 months after stage Ⅰ, the flap was slightly swollen, with a little pigmentation, and the two-point discrimination distance in the finger flap was 8-11 mm. The fingers could complete the basic life actions such as flexion, extension, pinch, and grip. At the final follow-up, 3 cases were excellent, 9 cases were good, and 3 cases were acceptable in function evaluation of the affected hand.Conclusions:For degloving destructive wound of total hand, free transplantation of one or both thinned anterolateral thigh perforator flaps is used for repair in stage Ⅰ, and finger splitting and webplasty are used to reconstruct the flaps in the later stage, which can basically restore the pinch and grip function of the affected hand that is required for daily life, and is worthy of clinical promotion.

Objective:To investigate the effect of tourniquet-reperfusion augmented infrared thermography(TRAIRT) on locating the dominant perforator to assist design of free medial sural artery perforator flap.Methods:The data of patients with skin soft tissue defect of upper limb repaired by free medial sural artery perforator flap in Department of Hand Surgery, Ningbo Sixth Hospital from May 2019 to January 2022 were retrospectively analyzed. Color Doppler ultrasonography (CDU) and TRAIRT were used to locate the dominant perforator auxiliary flap design before surgery and after anesthesia. In the TRAIRT video, the hot spot with "early emergence, high brightness and fast expansion" was selected as the advantageous perforator. During the operation, the flap was elevated and transferred to the affected area to cover the defect wound according to the designed mark points, and fixed by the absorbable sutures with an interrupted suturing method, then end-to-end vascular anastomosis was performed successively. The donor area was sutured directly or sutured with full thickness skin grafts depending on the area of the wound. The donor and recipient areas of the flap were observed and the patients’ satisfaction was recorded. The gold standard was the actual location of the perforating vessel found during the operation. Compared with the gold standard, the location of the perforating vessel explored by TRAIRT and CDU was considered to be accurate (positive) if the distance was less than 10 mm. The sensitivity (accurate number of perforators/actual number of perforators during operation ×100%) and positive predictive value (accurate number of perforators/total number of perforators×100%) of the two methods were calculated, expressed as %, and the sensitivity of the two methods was compared by paired χ2 test. Kappa coefficient was used to analyze the consistency of the two methods to detect perforating vessels. The perforator detection time of TRAIRT and CDU were recorded, expressed as Mean±SD, and statistically analyzed by paired sample t-test. Results:A total of 23 patients were included, consisting of 14 males and 9 females, agd 21-70 years old, average age of 43 years old. The wounds were on forearm in 5 cases, wrist in 2 cases, and hand in 16 cases. The wound area was 4.5 cm × 5.5 cm-6.5 cm × 12.0 cm. Intraoperative flap incision area was 5.0 cm × 6.0cm-7.0 cm × 13.0 cm. After operation, 22 cases of flaps survived, 1 case had superficial necrosis at the distal end, which healed after repeated dressing change. The donor area of flaps healed well, with primary suture in 20 cases and full thickness skin grafting in 3 cases. Postoperative follow-up was 5-16 months (mean 8.4 months). The flaps had no bulge, swelling and abrasion. The texture and color were similar to the medial calf skin, and the scars in the donor and recipient areas were not obvious. The patients were satisfied with the recovery. Among the 23 patients, 49 perforators were found by TRAIRT, 50 perforators were found by CDU, and 53 perforators were found intraoperatively. The sensitivity of TRAIRT and CDU was 88.7% (47/53) and 90.6% (48/53), with no significant differences ( P>0.05), and the positive prediction value was 95.9% (47/49) and 96.0% (48/50) respectively. The Kappa coefficient was 0.89, indicating a good consistency between the two methods. The time required for TRAIRT to detect perforators was significantly shorter than that of CDU, with statistical significance [(6.52±2.02) min vs. (17.87±2.49) min, P<0.01]. Conclusion:TRAIRT has a good consistency with CDU in detection of medial sural artery perforator. The application of TRAIRT in designing medial sural artery perforator flap for wound repair is good, and it has advantages of short time taking, simple operation, economy and non-invasiveness.

Objective:To investigate the effect of tourniquet-reperfusion augmented infrared thermography(TRAIRT) on locating the dominant perforator to assist design of free medial sural artery perforator flap.Methods:The data of patients with skin soft tissue defect of upper limb repaired by free medial sural artery perforator flap in Department of Hand Surgery, Ningbo Sixth Hospital from May 2019 to January 2022 were retrospectively analyzed. Color Doppler ultrasonography (CDU) and TRAIRT were used to locate the dominant perforator auxiliary flap design before surgery and after anesthesia. In the TRAIRT video, the hot spot with "early emergence, high brightness and fast expansion" was selected as the advantageous perforator. During the operation, the flap was elevated and transferred to the affected area to cover the defect wound according to the designed mark points, and fixed by the absorbable sutures with an interrupted suturing method, then end-to-end vascular anastomosis was performed successively. The donor area was sutured directly or sutured with full thickness skin grafts depending on the area of the wound. The donor and recipient areas of the flap were observed and the patients’ satisfaction was recorded. The gold standard was the actual location of the perforating vessel found during the operation. Compared with the gold standard, the location of the perforating vessel explored by TRAIRT and CDU was considered to be accurate (positive) if the distance was less than 10 mm. The sensitivity (accurate number of perforators/actual number of perforators during operation ×100%) and positive predictive value (accurate number of perforators/total number of perforators×100%) of the two methods were calculated, expressed as %, and the sensitivity of the two methods was compared by paired χ2 test. Kappa coefficient was used to analyze the consistency of the two methods to detect perforating vessels. The perforator detection time of TRAIRT and CDU were recorded, expressed as Mean±SD, and statistically analyzed by paired sample t-test. Results:A total of 23 patients were included, consisting of 14 males and 9 females, agd 21-70 years old, average age of 43 years old. The wounds were on forearm in 5 cases, wrist in 2 cases, and hand in 16 cases. The wound area was 4.5 cm × 5.5 cm-6.5 cm × 12.0 cm. Intraoperative flap incision area was 5.0 cm × 6.0cm-7.0 cm × 13.0 cm. After operation, 22 cases of flaps survived, 1 case had superficial necrosis at the distal end, which healed after repeated dressing change. The donor area of flaps healed well, with primary suture in 20 cases and full thickness skin grafting in 3 cases. Postoperative follow-up was 5-16 months (mean 8.4 months). The flaps had no bulge, swelling and abrasion. The texture and color were similar to the medial calf skin, and the scars in the donor and recipient areas were not obvious. The patients were satisfied with the recovery. Among the 23 patients, 49 perforators were found by TRAIRT, 50 perforators were found by CDU, and 53 perforators were found intraoperatively. The sensitivity of TRAIRT and CDU was 88.7% (47/53) and 90.6% (48/53), with no significant differences ( P>0.05), and the positive prediction value was 95.9% (47/49) and 96.0% (48/50) respectively. The Kappa coefficient was 0.89, indicating a good consistency between the two methods. The time required for TRAIRT to detect perforators was significantly shorter than that of CDU, with statistical significance [(6.52±2.02) min vs. (17.87±2.49) min, P<0.01]. Conclusion:TRAIRT has a good consistency with CDU in detection of medial sural artery perforator. The application of TRAIRT in designing medial sural artery perforator flap for wound repair is good, and it has advantages of short time taking, simple operation, economy and non-invasiveness.

Objective:To explore the surgical techniques and effects of transfer of the free chimeric functional thoracodorsal artery perforator flap (TDAPF) with latissimus dorsi in reconstruction of dynamic muscle and soft tissue defects in forearm.Methods:From January 2014 to December 2020, a total of 13 transfer surgery of free chimeric functional TDAPF with vascularised latissimus dorsi were performed in the Department of Hand Surgery, Plastic & Reconstructive Surgery, Ningbo Sixth Hospital, to reconstruct forearm composite defects. The patients were 12 males and 1 female with an average age of 33.2 years old. They all had open forearm injuries, with 5 in the left and 8 in the right. Removal of inactivated muscles, exploration and repair of blood vessels and nerves were performed in emergency surgery, and VSD were applied after the surgery. Phase II reconstructive surgery were completed within 4 to 12 days, with 7.5 days in average. The wounds and flaps sized were 9.0 cm×8.0 cm - 21.0 cm×11.0 cm and were 10.0 cm×9.0 cm - 22.0 cm×12.0 cm, respectively. The volume of transferred muscles ranged were 9.0 cm × 2.0 cm × 1.5 cm - 19.0 cm × 9.0 cm × 1.5 cm. Free chimeric functional muscular flaps were transferred to reconstruct the musculus flexor digitorum profundus in 4 patients, the musculus extensor digitorum communis in 8 patients, the musculus flexor carpi radialis in 3 patients, and the musculus flexor pollicis longus in 1 patient. Reconstruction of both of musculus flexor carpi radialis and musculus extensor digitorum communis with 2 functional sub-blocks of latissimus dorsi were performed in 3 patients. All donor sites were closed primarily. All patients were included in the postoperative follow-up to evaluate the appearance of flaps, range of motion of the digits, recovery of muscle strength and gripping power, at the outpatient clinics or through the telephone interview.Results:A total of 12 flaps survived uneventfully after reconstructive surgery. One flap developed a vascular crisis and it was rectified after surgical exploration. Postoperative follow-up ranged from 17 to 52 months, with a mean of 34.1 months. Appearances of limbs and flaps were good without obvious bulky, hyperpigmentation or scar contracture. Four patients with reconstructed musculus flexor digitorum profundus showed muscle strength recovery of M 4, with the fingertips measured lower than 2.0 cm from the centre of palm when clenching a fist, and the average gripping strength of the hand reached 27.5% (20%-35%) to the healthy side. Five patients with reconstructed musculus extensor digitorum communis showed muscle strength recovery of M 4, and there was no obvious limitation in fingers flexion and extension, with the average gripping strength of the hand reached 75.4% (65%-80%) to the healthy side. Of the 3 patients with reconstruction of both power muscles, the recovery of muscle strength of musculus flexor carpi radialis was at M 4 in all the 3 patients, and the musculus extensor digitorum communis was at M 4 in 1 and M 3 in 2 patients. However, the patient who received reconstruction of musculus flexor pollicis had no significant recovery in muscle strength. Conclusion:Transfer of free chimeric functional TDAPF combines the benefits of a perforator flap and a functional muscle transfer together. This surgical technique can effectively reconstruct damaged muscle groups in forearm and resulting in good hand movement. Additionally, it can also restore the aesthetic appearance of forearm, hence makes it an excellent option for complex wound coverage.