Objective To investigate the application of venous superdrainage technique based anterolateral thigh flap based on oblique branch for the soft tissue defect of proximal shank.Methods Between October,2012 and March,2017,11 cases of the soft tissue defect in proximal shank were treated.There were 8 males and 3 females with a mean age of 43 (range,26-59) years.Causes of injury:7 cases of traffic injury,3 cases of bruise,1 case of machine wound;The defect sizes ranged from 10 cm×5 cm to 13 cm×10 cm,with fracture or plate exposure.Accord ing to the size of the defect,the distally based anterolateral thigh flap was designed to repair the defect.The flap sizes ranged from 14 cm×6 cm to 16 cm×8 cm.The oblique branch and their accompanying vein with great saphenous vein was anastomosed to construct the venous superdrainage,and the donor site suture directly.Three cases followed-up by WeChat,and 8 cases by return visit.Results Distally based anterolateral thigh flaps were derived from oblique branches,and no arteriovenous crisis occurred postoperatively.Eleven flaps healed well after operation.There were no distal end blood supply disorder.Followed-up for 6-12 months,the flaps survived well.The texture was closed to the surrounding skin,and no ulcer exposed.There were no serious complications in donor site.And the thighs were linear scars.Conclusion The distally based anterolateral thigh flap based on oblique branch have a long vascular pedicle.The venous superdrainage technique can effectively avoid venous crisis,and improve the survival quality of the flap and the survival rate.

Objective:To evaluate the effect of free interosseous posterior artery perforator flap in small hand defects.Methods:We retrospectively analyzed the case data of small hand skin and soft tissue defects treated with free interosseous posterior arterial perforator flaps from March 2019 to August 2020 in the Department of Burn Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University. According to the size of the defect during the operation, we designed free interosseous posterior artery perforator flap transplantation to repair wounds, and the perforating branch of the posterior interosseous artery is anastomosed with the proper digital artery and the common digital artery. The donor valve area is sutured directly. After the operation, the survival of the flaps was observed, and the repair effect of the flaps, hand function and complications were followed up.Results:Twenty-one cases were included, among whom there were 15 males and 6 females with a median age of 46 years (range, 23-61years). There were several causes of injury: 7 cases of heavy object injuries, 11 of machine strangulation, 3 of burns and scalds. For 8 cases, the defect sites were on the palms and 13 on the dorsal sites. The defect size ranged from 1.5 cm×2.0 cm to 3.0 cm×9.0 cm with exposed tendons and bones. The flap size ranged from 2.0 cm×2.0 cm to 3.5 cm×9.0 cm. Among them, compound tissue transplantation with tendon was used to reconstruct finger extension function in 1 case while tissue transplantation with nerve was used to repair the palmar wounds in 2 cases. The bilobed flaps were used in 4 cases, and the remaining 14 cases were single leaf free skin flaps. No arteriovenous crisis occurred in the flaps after the operation. All flaps of 21 patients survived, and there was no blood supply disorder in the flaps. After 6-12 months of follow-up, the texture and color of the flap were similar to adjacent skin, and unrestricted hand function was unrestricted. The two-point discernibility of the skin flap for patients with nerve grafts was 10-12 mm, serious complication in the donor sites, but the forearm donor area with linear scars.Conclusions:The application of interosseous posterior artery perforator flap is flexible. It can repair two adjacent small wounds at the same time with free bilobed transplantation, and can carry free cutaneous nerve transplantation to repair the palm side wound. This flap is one of the ideal flaps for repairing small defects on the hand.

Objective:To evaluate the effect of free interosseous posterior artery perforator flap in small hand defects.Methods:We retrospectively analyzed the case data of small hand skin and soft tissue defects treated with free interosseous posterior arterial perforator flaps from March 2019 to August 2020 in the Department of Burn Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University. According to the size of the defect during the operation, we designed free interosseous posterior artery perforator flap transplantation to repair wounds, and the perforating branch of the posterior interosseous artery is anastomosed with the proper digital artery and the common digital artery. The donor valve area is sutured directly. After the operation, the survival of the flaps was observed, and the repair effect of the flaps, hand function and complications were followed up.Results:Twenty-one cases were included, among whom there were 15 males and 6 females with a median age of 46 years (range, 23-61years). There were several causes of injury: 7 cases of heavy object injuries, 11 of machine strangulation, 3 of burns and scalds. For 8 cases, the defect sites were on the palms and 13 on the dorsal sites. The defect size ranged from 1.5 cm×2.0 cm to 3.0 cm×9.0 cm with exposed tendons and bones. The flap size ranged from 2.0 cm×2.0 cm to 3.5 cm×9.0 cm. Among them, compound tissue transplantation with tendon was used to reconstruct finger extension function in 1 case while tissue transplantation with nerve was used to repair the palmar wounds in 2 cases. The bilobed flaps were used in 4 cases, and the remaining 14 cases were single leaf free skin flaps. No arteriovenous crisis occurred in the flaps after the operation. All flaps of 21 patients survived, and there was no blood supply disorder in the flaps. After 6-12 months of follow-up, the texture and color of the flap were similar to adjacent skin, and unrestricted hand function was unrestricted. The two-point discernibility of the skin flap for patients with nerve grafts was 10-12 mm, serious complication in the donor sites, but the forearm donor area with linear scars.Conclusions:The application of interosseous posterior artery perforator flap is flexible. It can repair two adjacent small wounds at the same time with free bilobed transplantation, and can carry free cutaneous nerve transplantation to repair the palm side wound. This flap is one of the ideal flaps for repairing small defects on the hand.

OBJECTIVE: To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus. METHODS: Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures. RESULTS: All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal. CONCLUSION Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.
Male ; Female ; Humans ; Adult ; Pilonidal Sinus/surgery* ; Treatment Outcome ; Surgical Flaps ; Plastic Surgery Procedures ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Sutures ; Perforator Flap

OBJECTIVE: To explore the effectiveness of hairpin shaped incision combined with cover-lifting flap in plastic surgery of huge fat pad on nape and back. METHODS: Between March 2019 and March 2023, 10 patients with huge fat pad on the nape and back were treated. There was 1 male and 9 females with an average age of 52 years (range, 39-57 years). All patients had soft tissue bulge on the nape and back. Preoperative MRI showed the subcutaneous fat thickening. The length of the longitudinal axis of the fat pad ranged from 10.0 to 25.0 cm (mean, 14.1 cm), the length of the transverse axis ranged from 6.0 to 15.0 cm (mean, 10.8 cm); the thickness of the fat pad ranged from 2.5 to 5.1 cm (mean, 3.9 cm). Under general anesthesia, the patient was placed in a prone position and a hairpin shaped incision was made. The flap was lifted to remove the fat pad according to the marked area. The dressing was changed every 2 days after operation. RESULTS: The operation time was 35-110 minutes (mean, 72 minutes). The intraoperative blood loss was 35-80 mL (mean, 49.5 mL). The drainage tube was removed at 2-5 days after operation (mean, 3.4 days). All incisions healed by first intention without incision dehiscence, infection, subcutaneous bruising, hematoma, or other related complications. All patients were followed up 2-24 months (mean, 12 months). All patients had a good shape of the nape and back and no noticeable scar on the incision. According to the Vancouver Scar Scale evaluation criteria, the incision scar score was 3-5 (mean, 3.7) at 2 months after operation. Patients had good neck movement with no recurrence. CONCLUSION For the huge fat pad on the nape and back, the plastic surgery using hairpin shaped incision and cover-lifting flap has the advantages of fully exposing the fat pad, concealed incision, simple operation, and natural shape of the nape and back after operation.
Female ; Humans ; Male ; Middle Aged ; Surgery, Plastic ; Cicatrix ; Lifting ; Plastic Surgery Procedures ; Surgical Wound ; Adipose Tissue