Objective:To explore the applications of deep inferior epigastric artery perforator (DIEP) flaps in the repair of scrotal avulsions and provide the reference for reconstructions of large soft tissue defects in the scrotum.Methods:The reconstructions of five cases in large scrotal skin and soft tissue avulsion injuries by DIEP flaps in Xijing Hospital, Air Force Medical University from October 2010 to December 2016 were retrospectively analyzed and summarized. The patients were 3 to 24 years old with an average age of 14.6. The defects of the scrotum and adjacent areas were ranged from 11 cm×6 cm to 25 cm×12 cm.Results:Blood supplies of all transferred flaps were good, and there was no serious complication observed, such as abdominal hernia, hematoma, and infection in the donor or recipient sites. Patients were followed up for 12 to 24 months. The scrotum’s appearances and functions in four cases were good, with a high patient satisfaction level. One case with swelling was obtained good results after a subsequent defatting procedure. The sensation of flaps partially recovered six months later.Conclusions:Thinned DIEP flaps provided sufficient tissue volumes for repairing large defects of the scrotal, which provided reliable blood flow and strong anti-infection capacity. The flap tissues could protect the scrotal contents. These advantages improved the patients’ satisfaction postoperatively. The thinned DIEP flap is a feasible choice to repair large defects of the scrotum.

Objective:To investigate the clinical effects of free transplanted pre-expanded scapular flap in reconstructing scar contracture deformity of neck.Methods:A retrospective observational study was conducted. From February 2010 to August 2020, 17 cervical scar deformity patients (9 males and 8 females, aged 8-42 years) who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients underwent skin and soft tissue expander (hereinafter referred to as expander) implantation in scapular region in stage Ⅰ procedures, and the free transplanted pre-expanded flaps were used to resurface the wounds followed by neck scar resection in the stage Ⅱ procedures. The wound size after neck scar release was 12.0 cm×6.0 cm-30.0 cm×24.0 cm, and the size of the flap ranged from 13.0 cm×7.5 cm to 31.5 cm×25.0 cm. The wounds in donor site of 15 patients were sutured directly, and the wounds in donor site of 2 patients were covered with full-thickness skin graft from abdominal area. The survival of flaps was observed after the operation of stage Ⅱ. Six months after stage Ⅱ surgery, Z plasty was performed to treat the incision scar contracture in 2 patients. For the 5 patients of overweight or bloating appearance in the 1/3 proximal flap underwent debulking procedures in 6-9 months after stage Ⅱsurgery. Before the stage Ⅰ surgery and six months after the last procedure (stage Ⅱ or stage Ⅲ), mental cervical angle (MCA) and cervical mandibular angle (CMA) were measured and the improvement of neck scar was evaluated by the angle values. The cervical motor function, skin color and texture in recipient areas, and scar in the donor sites assessed by Vancouver scar scale (VSS) were observed during follow-up. Data were statistically analyzed with paired sample t test. Results:After stage Ⅱ surgery, 15 patients' flaps survived well; venous crisis occurred in 2 flaps within 24 h after operation, and the flaps survived well after emergency exploration and thrombus removal+vascular re-anastomosis. Compared with the angle values of MCA of (126±12)° and CMA of (148±13)° of patients before the stage Ⅰ surgery, the angle values of MCA of (107±12)° and CMA of (123±11)° of patients in six months after the last procedure were significantly decreased (with t values of 10.68 and 6.54, respectively, P<0.05). After 2 years of follow-up, the patient's neck dorsiflexion, lateral bending, or other motor functions were not restricted; the color and texture of the flap in recipient site were close to those of the normal neck skin; the patient cases with VSS scores of scarring of 3, 4, 5, 6, and 7 were 1, 3, 7, 5, and 1 case, respectively. Conclusions:The free transplantation of the pre-expanded scapular flaps can provide sufficient tissue for wound coverage after the release of cervical scar contracture deformity; the expanded skin tissue is featured by thin soft tissue and good pliability, which is conducive to restore the neck appearance; the donor sites are relatively covert with less tension, therefore, the treatment is an effective method for correcting the contracture in the neck.

Objective:To explore the applications of deep inferior epigastric artery perforator (DIEP) flaps in the repair of scrotal avulsions and provide the reference for reconstructions of large soft tissue defects in the scrotum.Methods:The reconstructions of five cases in large scrotal skin and soft tissue avulsion injuries by DIEP flaps in Xijing Hospital, Air Force Medical University from October 2010 to December 2016 were retrospectively analyzed and summarized. The patients were 3 to 24 years old with an average age of 14.6. The defects of the scrotum and adjacent areas were ranged from 11 cm×6 cm to 25 cm×12 cm.Results:Blood supplies of all transferred flaps were good, and there was no serious complication observed, such as abdominal hernia, hematoma, and infection in the donor or recipient sites. Patients were followed up for 12 to 24 months. The scrotum’s appearances and functions in four cases were good, with a high patient satisfaction level. One case with swelling was obtained good results after a subsequent defatting procedure. The sensation of flaps partially recovered six months later.Conclusions:Thinned DIEP flaps provided sufficient tissue volumes for repairing large defects of the scrotal, which provided reliable blood flow and strong anti-infection capacity. The flap tissues could protect the scrotal contents. These advantages improved the patients’ satisfaction postoperatively. The thinned DIEP flap is a feasible choice to repair large defects of the scrotum.

Objective:To investigate the application and efficacy of cross-bridge free flap to repair severe soft tissue defects.Methods:The clinical data of severe defects with vascular damage in recipient site from February 2008 to February 2017 was retrospectively analyzed in the First Affiliated Hospital of Air Force Military Medical University. Latissimus dorsi myocutaneous flaps, anterolateral thigh flaps or thoracomphalum flaps were applied in these cases. These flaps were nourished by ipsilateral or contralateral limb vessels which named bridge blood supply. The radial artery and cephalic vein of ipsilateral forearm were bridged for repairing defects of head, face and trunk. The vessels of the unaffected lower extremity were bridged to repair leg and foot wounds. The flap donor sites were closed directly or resurfaced by skin grafting. Division procedures were performed after circulation reestablished for 5 weeks. The complications, survival of flaps and skin grafts were observed and followed up.Results:A total of 12 patients were selected, including 9 males and 3 females, aged 18-59 years old. The cases consisted of 4 head and facial defects, 1 hip tumor excision, 6 lower extremities and 1 dorsal foot injuries. The defect areas were ranged 18. 0cm×7. 0 cm- 23. 5 cm × 13. 0 cm, and the flaps were harvested by 20. 0 cm× 8. 0 cm- 25. 0 cm× 15. 0 cm. Latissimus dorsi myocutaneous flaps were applied in 10 cases. The other two cases were treated by thoracic umbilical and anterolateral thigh flap. Vascular crisis occurred in 1 case, and the graft survived well after venous thrombosis removed timely. One case of partial skin graft necrosis occurred on the back donor site which healed after dressing changes. The other donor sites recovered well. Two cases of flap bloating appearances were improved by thinning procedures six months later. The follow-ups were lasted 1 to 1. 5 years. The patients were satisfied with the appearance of the transferred flaps. The color and texture of the flaps were different from the surrounding areas. There were no malformations and functional disorders in donor sites of the extremities. But some pigmentation and superficial scar was left on the thighs.Conclusions:For large and severe soft tissue defect where no anastomotic vessels available, the application of free flap by bridge transplantation is an alternative for good outcomes.

Objective:To investigate the application and efficacy of cross-bridge free flaps to repair severe soft tissue defects.Methods:The clinical data of severe defects with vascular damage in the recipient site from February 2008 to February 2017 were retrospectively analyzed in the First Affiliated Hospital of Air Force Military Medical University. Latissimus dorsi myocutaneous flaps, anterolateral thigh flaps, or thoracomphalum flaps were applied in these cases. These flaps were nourished by ipsilateral or contralateral limb vessels, named as bridge blood supply. The radial artery and cephalic vein of the ipsilateral forearm were bridged to repair defects of the head, face, and trunk. The vessels of the unaffected lower extremity were bridged to repair leg and foot wounds. The flap donor sites were closed directly or covered by skin grafting. Division procedures were performed after circulation reestablishment for five weeks. The complications, survival of flaps and skin grafts were observed and followed up.Results:A total of 12 patients were selected, including nine males and three females, aged 18-59 years old. The cases included four head and facial defects, one hip tumor excision, six lower extremities injuries, and one dorsal foot injury. The defect areas ranged 18.0 cm × 7.0 cm-23.5 cm × 13.0 cm, and the flaps size ranged 20.0 cm × 8.0 cm-25.0 cm × 15.0 cm. Latissimus dorsi myocutaneous flaps were applied in 10 cases. The other two cases were treated by a thoracic umbilical and an anterolateral thigh flap. The vascular crisis occurred in one case, and the graft survived well after the timely removal of the venous thrombosis. One case of partial skin graft necrosis occurred on the back donor site, which healed after dressing changes. The other donor sites recovered well. Two cases of flap bloating appearances were improved by thinning procedures six months later. The follow-ups lasted 1 to 1.5 years. The patients were satisfied with the appearance of the transferred flaps. The color and texture of the flaps were different from the surrounding areas. There were no malformations and functional disorders in donor sites of the extremities. Some pigmentation and superficial scar were left on the thighs.Conclusions:For large and severe soft tissue defects where no anastomotic vessels were available, the application of free flap by bridge transplantation is an alternative with good outcomes.

Objective:To investigate the application and efficacy of cross-bridge free flap to repair severe soft tissue defects.Methods:The clinical data of severe defects with vascular damage in recipient site from February 2008 to February 2017 was retrospectively analyzed in the First Affiliated Hospital of Air Force Military Medical University. Latissimus dorsi myocutaneous flaps, anterolateral thigh flaps or thoracomphalum flaps were applied in these cases. These flaps were nourished by ipsilateral or contralateral limb vessels which named bridge blood supply. The radial artery and cephalic vein of ipsilateral forearm were bridged for repairing defects of head, face and trunk. The vessels of the unaffected lower extremity were bridged to repair leg and foot wounds. The flap donor sites were closed directly or resurfaced by skin grafting. Division procedures were performed after circulation reestablished for 5 weeks. The complications, survival of flaps and skin grafts were observed and followed up.Results:A total of 12 patients were selected, including 9 males and 3 females, aged 18-59 years old. The cases consisted of 4 head and facial defects, 1 hip tumor excision, 6 lower extremities and 1 dorsal foot injuries. The defect areas were ranged 18. 0cm×7. 0 cm- 23. 5 cm × 13. 0 cm, and the flaps were harvested by 20. 0 cm× 8. 0 cm- 25. 0 cm× 15. 0 cm. Latissimus dorsi myocutaneous flaps were applied in 10 cases. The other two cases were treated by thoracic umbilical and anterolateral thigh flap. Vascular crisis occurred in 1 case, and the graft survived well after venous thrombosis removed timely. One case of partial skin graft necrosis occurred on the back donor site which healed after dressing changes. The other donor sites recovered well. Two cases of flap bloating appearances were improved by thinning procedures six months later. The follow-ups were lasted 1 to 1. 5 years. The patients were satisfied with the appearance of the transferred flaps. The color and texture of the flaps were different from the surrounding areas. There were no malformations and functional disorders in donor sites of the extremities. But some pigmentation and superficial scar was left on the thighs.Conclusions:For large and severe soft tissue defect where no anastomotic vessels available, the application of free flap by bridge transplantation is an alternative for good outcomes.

Objective:To investigate the application and efficacy of cross-bridge free flaps to repair severe soft tissue defects.Methods:The clinical data of severe defects with vascular damage in the recipient site from February 2008 to February 2017 were retrospectively analyzed in the First Affiliated Hospital of Air Force Military Medical University. Latissimus dorsi myocutaneous flaps, anterolateral thigh flaps, or thoracomphalum flaps were applied in these cases. These flaps were nourished by ipsilateral or contralateral limb vessels, named as bridge blood supply. The radial artery and cephalic vein of the ipsilateral forearm were bridged to repair defects of the head, face, and trunk. The vessels of the unaffected lower extremity were bridged to repair leg and foot wounds. The flap donor sites were closed directly or covered by skin grafting. Division procedures were performed after circulation reestablishment for five weeks. The complications, survival of flaps and skin grafts were observed and followed up.Results:A total of 12 patients were selected, including nine males and three females, aged 18-59 years old. The cases included four head and facial defects, one hip tumor excision, six lower extremities injuries, and one dorsal foot injury. The defect areas ranged 18.0 cm × 7.0 cm-23.5 cm × 13.0 cm, and the flaps size ranged 20.0 cm × 8.0 cm-25.0 cm × 15.0 cm. Latissimus dorsi myocutaneous flaps were applied in 10 cases. The other two cases were treated by a thoracic umbilical and an anterolateral thigh flap. The vascular crisis occurred in one case, and the graft survived well after the timely removal of the venous thrombosis. One case of partial skin graft necrosis occurred on the back donor site, which healed after dressing changes. The other donor sites recovered well. Two cases of flap bloating appearances were improved by thinning procedures six months later. The follow-ups lasted 1 to 1.5 years. The patients were satisfied with the appearance of the transferred flaps. The color and texture of the flaps were different from the surrounding areas. There were no malformations and functional disorders in donor sites of the extremities. Some pigmentation and superficial scar were left on the thighs.Conclusions:For large and severe soft tissue defects where no anastomotic vessels were available, the application of free flap by bridge transplantation is an alternative with good outcomes.