OBJECTIVE: To investigate the feasibility and clinical outcomes of emergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery. METHODS: A retrospective analysis was conducted of 10 patients with traumatic dynamic muscle defects treated between March 2020 and April 2024. There were 8 males and 2 females, aged 23-52 years (mean, 36.7 years). Injuries included 7 cases of Gustilo type ⅢB forearm trauma (2 with flexor muscle group defects, 3 with extensor muscle group defects, and 2 with combined flexor and extensor muscle group defects), 1 case of right first metacarpal defect with concomitant thenar muscle and skin defect, 1 case of complete transection of the right upper arm musclecutaneous nerve extracted from the biceps brachii muscle, and 1 case of Gustilo type ⅢC lower-limb trauma with extensor hallucis longus and toe extensor defects. Soft tissue defects ranged from 10 cm×8 cm to 36 cm×11 cm. Preoperative musculoskeletal ultrasound of the contralateral side was used to measure cross-sectional area, length, and pennation angle of the target muscles. Based on these parameters, anterolateral thigh flaps combined with one or two superficial vastus lateralis muscle segments were designed and transplanted to the recipient sites. The grafts were used to cover wounds, reconstruct major missing muscle groups, and were fixed in place. Vascular and neural anastomoses were performed simultaneously with repair of bone and soft tissue injuries to restore limb perfusion and function. Postoperative evaluation included musculoskeletal ultrasound, electrophysiology, and dynamic assessment of muscle strength during follow-up. RESULTS: All transplanted muscles and flaps survived primarily without vascular or neural complications. All the 10 patients were followed up 10-38 months, with an average of 22.8 months. The muscle strength recovery reached M₅ in 6 cases, M₄ in 3 cases, and M3+ in 1 case. Patients achieving M₄ or above regained their original work capacity; limb contours were symmetrical, with no joint deformities, and patients achieved effective ranges of motion; functional recovery included the ability to push or lift weights of 2-30 kg, perform opposition, and achieve grasping function. All flaps were soft and lustrous, and the protective sensation restored in all patients. There was no discomfort in the donor site and knee joint. Musculoskeletal ultrasound showed that the average cross-sectional area of the transplanted muscles increased by 4%-66% in 10 cases at 1 month after operation, and the ratio of the average cross-sectional area of the transplanted muscles in contraction and relaxation was 1.37±0.16 in 7 cases at 6 months after operation. Electrophysiological examination showed that motor potential could be detected in 8 cases at 2 months after operation, and then the amplitude increased gradually, and 2 cases were not detected. CONCLUSION Emergency reconstruction of traumatic dynamic muscle defects using functional superficial vastus lateralis chimeric perforator flap based on descending branch of lateral femoral circumflex artery achieves near-normal muscle strength recovery and effective joint motion. This technique allows for reconstruction of one or two major muscle groups as clinically required.
Humans ; Male ; Adult ; Female ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Middle Aged ; Quadriceps Muscle/transplantation* ; Femoral Artery/surgery* ; Young Adult ; Muscle, Skeletal/surgery* ; Treatment Outcome ; Forearm Injuries/surgery*

Objective:To compare the clinical outcomes of reconstruction of oral and maxillofacial soft tissue defects using superficial circumflex iliac artery perforator flap （SCIA PF） and radial forearm free flap （RFF）. Methods:A retrospective analysis was conducted on 90 patients with head, neck, and maxillofacial tumors who were treated in our department from June 2019 to January 2024. Patients were divided into two groups based on the surgical method used: the SCIA group（n=45）, who underwent reconstruction with SCIA PF, and the RFF group（n=45）, who received RFF reconstruction. Six months postoperatively, clinical efficacy was evaluated by comparing flap swelling, flap survival rate, and patient satisfaction. Oral function was assessed using standardized scoring systems before surgery, at 1 week, 3 months, and 6 months post-surgery. Hemorheological parameters, including high-shear viscosity（shear rate 200/s）, low-shear viscosity（shear rate 30/s）, plasma viscosity, erythrocyte aggregation index, and erythrocyte sedimentation rate（ESR）, were also measured at each time point. Results:Compared with the RFF group, the SCIA group showed significantly larger flap size, longer flap harvesting and reconstruction times, earlier nasogastric tube removal and oral intake initiation, higher scores in all aspects of oral function, reduced flap edema and faster resolution, higher flap survival rates, and greater overall satisfaction （all P<0.05）. During the follow-up period （preoperative, 1 week, 3 months, and 6 months post-surgery）, hemorheological indices including high-and low-shear viscosity, plasma viscosity, erythrocyte aggregation index, and ESR progressively decreased in the SCIA group （P<0.05）. In the RFF group, these parameters improved significantly by 6 months postoperatively compared with preoperatively and 1-week postoperatively, with a notable decrease in erythrocyte aggregation index at 6 months （P<0.05）. Conclusion:Compared with RFF, SCIA PF provides larger flaps, better functional recovery, higher patient satisfaction, improved flap survival, fewer complications, and more favorable hemorheological profiles following reconstructive surgery for oral and maxillofacial defects.
Humans ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Free Tissue Flaps ; Iliac Artery/transplantation* ; Forearm/surgery* ; Male ; Female ; Soft Tissue Injuries/surgery* ; Head and Neck Neoplasms/surgery* ; Middle Aged ; Treatment Outcome ; Adult

The aim of this study was to evaluate the vascular dominance in the forearm as a factor in determining the choice of invasive vascular procedures in arteries of the forearm, using 3D-computerized tomography (3D-CT) angiographies of 92 forearms. The diameters of the ulnar and radial arteries were measured just distal to the bifurcation of the brachial artery, at the midpoint between the bifurcation and the wrist, and at the wrist crease. In 79 cases, the ulnar artery was larger than the radial artery after the bifurcation of the brachial artery. However, no statistically significant difference was observed at either the mid-forearm or the wrist crease. In the remaining 13 cases, the diameter of the radial artery was larger or the same as that of the ulnar artery after the bifurcation, but at the more distal sites no regular pattern could be detected. The findings suggest that 3D-CT angiography offers valuable preoperative details of the forearm vessels for cases requiring invasive vascular procedures on the forearm.
Adult ; Aged ; Aged, 80 and over ; Angiography/*methods ; Female ; Forearm/blood supply/radiography/surgery ; Functional Laterality ; Humans ; Imaging, Three-Dimensional/methods ; Male ; Middle Aged ; Patient Selection ; Preoperative Care/methods ; Radial Artery/*radiography/*surgery ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Ulnar Artery/*radiography/*surgery ; Vascular Surgical Procedures/methods ; Young Adult

OBJECTIVETo dicuss the application and therapeutic effect of middle-forearm flap based on perforator of ulnar artery for electrical burn wound on the wrist.

METHODSFrom Oct. 2009 to Oct. 2012, 10 cases of electrical burn wounds on the wrist were treated. A line from radialis medial epicondyle of humerus to the interior radialis pisiform bone was connected as flap axis. At the midpoint of the line, Doppler flow imaging meter was used to detect the emerging point of perforator vessel. The flap was designed and harvested. The flap was transferred reversely, with superficial vein retaining which was anastomosed with vein at recipient sites in 3 cases. The wounds in the donor sites were closed directly in 2 cases, and with skin graft in 8 cases.

RESULTSAll the 10 flaps survived completely. 7 cases without vein anastomosis underwent obvious flap edema during 2-4 days postoperatively, which resovled 1 week later. Sub-flap tissue necrosis and infection happened in 2 cases, which healed after dressing and drainage. Patients were followed up for 3-36 months with satisfactory results.

CONCLUSIONSThe middle-forearm flap based on perforator of ulnar artery has a stable and reliable blood supply. It offers a new choice for the electric burn wound on the wrist, especially at the ulnar side.

Burns, Electric ; surgery ; Forearm ; Humans ; Reconstructive Surgical Procedures ; Skin Transplantation ; Surgical Flaps ; blood supply ; transplantation ; Ulnar Artery ; Wrist Injuries ; surgery

OBJECTIVETo investigate the clinical application of pedicled superficial circumflex iliac artery (SCIA) flaps in Burns and Plastic Surgery.

METHODS19 cases with skin and soft tissue defects were repaired with the Superficial circumflex iliac artery flaps. The defects located in the hand and forearm, the lower abdomen and perineal area, the radicle area of thigh, etc. Before the SCIA flaps were transfered to the recipient areas, 15 cases with different kinds of wounds were debrided thoroughly, 3 cases with scar were removed directly. The size of the flaps ranged from 3.0 cm x 4.5 cm to 26.0 cm x 22.0 cm, and the pedical was 5 cm to 7 cm in length.

RESULTSThe flaps in the 18 cases survived completely. Skin necrosis in the distal end of the flap appeared in 1 case, and the wound healed after the second repair. The follow-up period rang from 3 to 18 months. The apperance and function of the hand or foot was satisfactory.

CONCLUSIONSBecause the pedicled SCIA flaps can be obtain conveniently and contain sufficient blood-supply, so the flap is easy to survive and the flap can be designed in a large size. We believe it is an ideal method to use this flap to repair skin and soft tissue defects located in hands, forearms, the lower abdomen and perineal areas, the radicle area of thigh and so on.

Burns ; surgery ; Forearm ; Graft Survival ; Hand ; Humans ; Iliac Artery ; Necrosis ; Reconstructive Surgical Procedures ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; pathology ; transplantation ; Thigh ; Wound Healing

OBJECTIVETo observe the effects of forearms devascularization on the volt-ampere (V-A) characteristics of Neiguan (PC 6) and Taiyuan (LU 9) so as to investigate the relationship among functions of acupoints, qi and blood in human body and V-A characteristics of acupoints.

METHODSEither forearms of 23 healthy volunteers were devascularized and the changes of V-A characteristics in ipsilateral Neiguan (PC 6) and Taiyuan (LU 9) in normal and devascularization statuses were detected by home-made intelligent V-A detecting system.

RESULTSCompared with the normal status, both range-increasing and range-decreasing V-A areas of Neiguan (PC 6) and Taiyuan (LU 9) were significantly increased in devascularization status (P < 0.05, P < 0.01), and the change rates of these two V-A areas of Neiguan (PC 6) were larger than those of Taiyuan (LU 9) (both P < 0.05). The inertia areas of Neiguan (PC 6) but not Taiyuan (LU 9) became significantly larger after devascularization (P < 0.01).

CONCLUSIONThe changes in V-A characteristics of Neiguan (PC 6) and Taiyuan (LU 9) can reflect the alteration of local blood supply, and Neiguan (PC 6) is more sensitive to changes of blood flow than Taiyuan (LU 9).

Acupuncture Points ; Adult ; Blood Circulation ; Electrophysiology ; Female ; Forearm ; blood supply ; physiology ; Humans ; Male ; Young Adult

OBJECTIVETo investigate the applied anatomy of the proximal posterior interrosseous artery perforator flap (PIAP) and report the clinical results of repairing the soft tissue defects in hands.

METHODSBetween September 2007 and January 2011, 21 patients with 24 soft tissue defects in hands were repaired with the free proximal PIAP flap transplantation. The size of the flaps ranged from 2.0 cm x 1.5cm to 7cm x 5cm. The longest length of these flaps was 9 cm. 9 flaps were dissected with one additional superficial vein to anastomose with the superficial vein at the recipient sites.

RESULTS19 flaps survived completely. Bubbles and violet color happened in 4 flaps which survived finally after partial suture removal. Flap necrosis occurred in one flap. The clinical results were satisfactory after 6-25 months of following-up, and the scars at the donor sites were not obvious.

CONCLUSIONSThe free PIAP flaps have constant, reliable blood supply, and good texture. It is a good option for repairing soft-tissue defects in the hands.

Forearm ; Graft Survival ; Hand Injuries ; surgery ; Humans ; Perforator Flap ; blood supply ; transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps

OBJECTIVETo evaluate the curative effects of manipulative reduction for children's type III humeral supracondylar fracture and the preventions of ischemic contracture of forearm in the early period.

METHODSFrom September 2008 to September 2011, 38 patients with humeral supracondylar fractures were treated with manipulative reduction and plaster stabilization, including 20 males and 18 females with an average age of 7.5 years (ranged, 2 to 13 years); the average time from injury to visit was 1.8 days(ranged,0.5 h to 6 d). There were 21 cases in straighten-ulnar deviation type and 17 cases in straighten-radial deviation type, 1 case in flexion type,all of them without vascular nerve injury. It was important to process swelling correctly in early stage of fracture. To decide fixed position according to the original displacement, and make a regular X-ray review, if found another displacement to correct it in 1-2 weeks after injury in time. Dismantle the plaster on the basis of bone healing and guide the functional exercise of elbow joint. According to Dodgt standard to evaluate clinical effects.

RESULTSAll patients were followed up from 3 months to 1 year with an average of 7 months. All fractures healed. According to Dodgt standard, 14 patients got an excellent results, 19 good, 4 fair and 1 poor. The excellent and good rate was 86.84%.

CONCLUSIONIt can obtain satisfactory clinical effects to treat humeral supracondylar fracture in children with closed manipulative reduction and plaster stabilization, while without vascular nerve injury. Early correct processing swelling and paying attention to gypsous angle can effectively prevent the ischemic contracture of forearm.

Adolescent ; Casts, Surgical ; Child ; Child, Preschool ; Female ; Forearm ; blood supply ; Humans ; Humeral Fractures ; therapy ; Ischemic Contracture ; prevention & control ; Male ; Manipulation, Orthopedic

OBJECTIVETo summarize the therapeutic effect of multiple types of posterior interosseous artery flaps for repair of soft tissue defects in the upper extremities.

METHODSFrom March 2003 to June 2010, 42 cases with soft tissue defects in the upper limbs resulting from burn and traumatic injuries were treated using multiple types of posterior interosseous artery flaps, including retrograde flaps and composite flaps, antegrade flaps ,and free flaps. Flap size ranged from 2.5 cm x 2.0 cm-14.0 cm x 9.0 cm. The defects in the donor sites were closed directly or covered by skin graft.

RESULTSThe conventional retrograde posterior interosseous artery flaps were used in 11 cases, the modified retrograde posterior interosseous artery flaps were used in 13 cases, the retrograde posterior interosseous artery composite flaps incorporating partial extensors were used in 2 cases, the antegrade posterior interosseous artery flaps were used in 3 cases, the free posterior interosseous artery flaps were used in 7 cases, and the free perforator flap based on the radiodorsal septocutaneous perforator of the posterior interosseous artery were used in 6 cases. Partial necrosis happened in one case at the distal portion of the flap. Muscular branch of the posterior interosseous nerve was injured in one case with conventional reverse posterior interosseous artery flaps. All the other flaps survived uneventually with no complication. All wounds were primarily healed. 32 cases were followed up for 1 to 48 months with satisfactory aesthetic and functional results both in the donor sites and in the recipient areas. The color,texture and thickness of the flaps were satisfied as well.

CONCLUSIONSThe posterior interosseous artery flap has a constant vascular anatomy and a great flexibility, which is practical and suitable for repair of Soft tissue defect in the upper extremities arising from burn and traumatic injury.

Adolescent ; Adult ; Burns ; surgery ; Female ; Forearm ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome ; Young Adult

OBJECTIVETo discuss the therapeutic effect and clinical experience of a new technique of digital reconstruction with the free mesio-forearm flap based on perforator of ulnar artery.

METHODSWe marked the line from the pisiformis to the condylus medialis humeri as the axis of the flap. We used Doppler to detect the site of the mesio-forearm ulnar perforator which is usually 9-10 cm proximal to the condylus medialis humeri as center of the flap. We designed the flap that contained perforator artery with its accompanying vein of the ulnar artery and a superficial vein around the center spot along the axis of ulnar artery. The wound at donor site was sutured directly. Neurorrhaphy was not conducted in any cases.

RESULTSFrom June 2005 to June 2009, all 12 flaps survived with good quality and aesthetic contour. And no necrosis occurred. We conducted 6-36 months follow-up, and the result was satisfactory. The function of the fingers was reserved. Two-point discrimination differed from 6 cm to 12 cm.

CONCLUSIONSThe free ulnar perforator flap on mesio-forearm can repair digital defect with good therapeutic effect, leaving less morbidity at donor site.

Adolescent ; Adult ; Female ; Forearm ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome ; Ulnar Artery ; surgery ; Young Adult