Objective To explore the feasibility of repairing the large area skin and soft tissue defect in thefront upper of tibia by free flap with anastomosis of saphenous vessels.Methods From June,2009 to April,2014,16 cases (10 males and 6 females) of large area skin and soft tissue defect in the front upper of tibia were treatedwith free flap.The ages ranged from 24 to 56 years old,averaged of 34.5 years old.The supportive therapy and repeated debridement combined with VSD,and designed to use free anterolateral thigh flap with anastomosis of saphenous vessels before repairing operation.Results Fourteen patients accorded with preoperative design,in which 2 cases were adopted cross leg flap anastomosis posterior tibia vessels of the healthy side (1 case of saphenous artery diameter too small,and 1 case of saphenous artery long injury degeneration,unsuitable for vascular anastomosis).All 14 flaps survived,expect 2 cases were part-necrosis in the end of the flap,and gradually healed by dressing exchange.Conclusion Reconstruction of large area skin and soft tissue defect in the front upper of tibia with free flap can use anastomosis of saphenous vessels.

Objective:To observe the long-term effect of repairing soft tissue defect of the digital palmar with medial plantar artery perforators flap.Methods:From January, 2012 to February, 2015, 15 cases of digital palmar soft tissue defect were selected clinically, including 8 cases with phalangeal fracture, 5 cases with flexor tendon injury, and 9 cases with digital artery and nerve injury. The soft tissue defect area was 7.0 cm×2.5 cm-2.4 cm×3.0 cm. The medial pedis perforators flap with deep branch of medial plantar artery as pedicle and terminal cutaneous branch of saphenous nerve was cut out. The artery of the flap was anastomosed with the digital artery or common digital artery, 1 accompanying vein or superficial vein was selected to anastomose with the dorsal digital vein, and the cutaneous nerve was anastomosed with the digital nerve or common digital nerve. The perforating point, number, source of perforating vessels and the length of vessel pedicle were observed during the operation, and the color, shape, stability and TPD of the flap were observed through long-term followed-up. The good and excellent rate of the affected finger was evaluated and whether there was obvious scar, abnormal sensation and abnormal walking gait in the donor area.Results:All flaps survived and the wounds healed in one stage. All 15 patients were followed-up for 36-72 months, with an average of 48.5 months. The color and thickness of the flap were similar to that of the normal digital palmar, and the flap was wear-resistant, stable and strong in holding. The TPD was 9-12 mm. Twelve patients had transverse finger striations at the interphalangeal joint. According to the Trial Standard of the Function Evaluation of the Upper Limb of the Hand Surgery Society of Chinese Medical Association, 10 cases were excellent, 4 cases were good, 1 case was acceptable, and the good and excellent rate was 93.3%. There was no painful scar or abnormal sensation in the donor area. The ankle and foot function was good, and the gait was normal.Conclusion:The thickness, color and texture of the medial pedis perforator flap are similar to that of the palmar skin, and it is an ideal choice for repairing the palmar skin defect.