OBJECTIVETo investigate the therapeutic effect of V-Y advanced flap pedicled with posterior perforator from medial malleolus for small skin defect at achilles tendon region.

METHODSFrom Mar. 2011 to Sep. 2012, 7 cases with small skin defect at achilles tendon region were treated by V-Y advanced flap pedicled with posterior perforator from medial malleolus. The flaps was 6.0 cm x 3.0 cm-9.0 cm x 4.5 cm in size. The defects at the donor sites were closed directly.

RESULTSAll flaps survived completely. 7 cases were followed up for 6-8 months after operation. The flaps had good texture and color match. The function of ankle was normal. All patients were satisfied with postoperative function and shape.

CONCLUSIONIt is an ideal reconstruction method for skin defect at achilles tendon region with V-Y advanced flap pedicled with posterior perforator from medial malleolus. It is easily performed with low risk and short recovery time.

Achilles Tendon ; injuries ; Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Surgical Flaps ; Treatment Outcome ; Young Adult

Objective To investigate the clinical efficiency of repairing ankle and calf wounds by antegrade or retrograde perforating flap of posterior tibial artery. Methods 13 cases with skin defects of ankle and calf wounds were reviewd. The defects were repaired using antegrade or retrograde perforating flap of posterior tibial artery from January 2011 to February 2013, 8 males and 5 females; aged 19 to 65 years old. Wounds were located in the ankle and calf, area which the tibial artery support contu-sioned slightly;defects were associated with exposed bone or tendon, exposed blood vessels. Of the 13 cases, 5 cases have multiple ankle fracture with blood circulation disorders, internal and external fracture fixation were performed emergency with blood ves-sels and nerves exposed, at the same time emergency line wound repair by posterior tibial artery perforating flap. The other 8 cases have no blood vessels and nerves exposure, and accepted vacuum sealing drainage emergency external fixation and flap surgery. Seven cases accepted V-Y antegrade perforating flap of posterior tibial artery, 6 cases using retrograde tibial artery perforator flap. Whose defects were ranged from 1.5 cm×2.0 cm to 9.0 cm×5.0 cm. Antegrade or retrograde perforating flap of posterior tibial ar-tery with 1.5 cm×3.0 cm to 14.0 cm×7.0 cm was used to repair ankle or lower leg medial defect. Antegrade flap donor site sutured directly, but retrograde flap donor site take full thickness skin graft repair from abdomen. Results Circulations of the all 13 cases were stable, with wound healing well after 2 weeks. The patients were followed up for 6 months to 24 months, average of 13 months. All flap graft survived, pedicle no bloated andcat eardeformity. Flaps were soft, no bloated appearance;color was con-sistent with normal skin. Fracture line in the 5 patients was disappeared. Bone healing time was 3.0 to 4.0 months. At the direct su-ture skin donor sites, postoperative scar was small;skin graft donor sites had no obvious scar. Postoperative ankle dorsiflexion 10° to 25°, plantar flexion 15° to 45°. Patients were extremely satisfied with the results of repair. Conclusion Using antegrade or ret-rograde posterior tibial artery perforator flap without sacrificing the main vessel, it is a simple and effective method to repair the medial malleolus and calf wounds.

Objective To introduce the surgical method of reverse radial side of dorsal artery the fascial pedicle island bone flap for the treatment of thumb composite tissue defects,and to evaluate its short term clinical outcome.Methods From May 2010 to March 2012,9 cases with composite tissue defects at thumb were treated with reverse radial side of dorsal artery the fascial pedicle island bone flap,including 5 males and 4 female with an average age of 38 years (range,13-68).All injuries were caused by planer.The time of injury to operation was 3-8 hours,all patients showed in both thumb root plane beyond volar or dorsal,skin and soft tissue defect accompanied by distal phalanx defect.Skin and soft tissue of thumb defect size was 1.0 cm ×1.8 cm to 2.0 cm × 2.2 cm.Preoperative hands anteroposterior and lateral X-ray were routine taken.Imaging findings were associated with the thumb base beyond the distal phalanx fractures,bone defect length was 0.4-0.7 cm.We cut thumb radial side of the dorsal artery fascia flap during surgery operation according to the thumb side wound defect case.The size of the bone flap was 0.2 cm× 0.6 cm to 0.4 cm × 0.8 cm,properly inserting intramedullary distal phalanx fixed base,9-0 line will flap inside the dorsal nerve and a nerve suture flap reconstruction feeling.Results All bone flaps were survived completely,no case occur venous disorders,flap blood circulation was stable,donor skin graft was survival in stage Ⅰ.This group of patients incision were healing 2 weeks after surgery.All the patients were followed up as scheduled,and the follow-up time was 6-12 months.All flaps survived,and the colors,texture,contour of the flaps were good.The two-points discrimination distance was 7.0-10.0 mm on the flap,Thumb distal phalanx healing time was 1.0-1.5 months.Bone absorption was not observed in graft.The thumb function was assessed as excellent in 7 fingers,good in 2 fingers,no complication occurred in donor site.Conclusion The main artery and nerve will not be sacrifice,when the bone flap is used.There are blood into the backbone of the first metacarpal nearly 1/3 of the bone to reconstruct thumb bone defect,the operative procedures is available and easy to be performed,which is a new method for the treatment of thumb composite tissue defects.

Objective To research the clinical outcomes of repairing donor site of abdomen flap by V-Y flap pedicled with deep circumflex iliac artery perforator musculocutaneous.Methods Nine cases with skin defects of hand were treated with lower abdomen flap from December, 2011 to March, 2013, abdominal donor sites could not be directly sutured, and pedicled with deep circumflex iliac artery perforator musculocutaneous.The flap was 8 cm × 16 cm-12 cm × 24 cm in size.Results The average healing time of the V-Y flap pedicled with deep circumflex iliac artery perforator musculocutaneous was 17 days.The patients were followed-up for 3 months to 18 months, averaged of 9 months.The appearance and the texture of the flaps were good.Abdominal wound healing was flat, with no significant depression and navel no significant skew.Patients were satisfied with function and appearance.Conclusion This procedure is easy and effective.The treatment result is satisfactory.It is improvement for repairing donor site of tradition abdomen flap.

OBJECTIVETo investigate the therapeutic effect of V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus for small skin defect on children heel.

METHODSFrom Mar. 2012 to Jan. 2014, 9 children with small skin defects on heel were treated with adjacent V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus. The flaps were 8.0 cm x 4.0 cm to 9.0 cm x 4.5 cm in size and the wounds at donor sits were directly closed.

RESULTSAll flaps survived completely with primary healing. 9 cases were followed up for 6-12 months( average, 9 months). The flaps had good match with surrounding tissue in texture and color. The function of ankle was normal. All the parents were satisfied with functional and cosmetic results.

CONCLUSIONSIt is a safe and practical method for treatment of small skin defect on children heel with adjacent V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus.

Ankle ; Child ; Fibula ; Heel ; injuries ; Humans ; Perforator Flap ; blood supply ; transplantation ; Reconstructive Surgical Procedures ; Skin ; injuries ; Skin Transplantation ; Tibial Arteries ; Wound Healing

OBJECTIVETo summarize the therapeutic effect of free perforator hypothenar flap for thumb pulp defect.

METHODSFrom Jun. 2012 to Mar. 2013,8 cases with thumb pulp defect accompanied with exposure of phalanges ans tendons were treated by free ipsilateral perforator hypothenar flap. The flaps were 1.4 cm x 2.0 cm-1.8 cm x 2.2 cm in size. Ulnar finger artery in the flap was anastomosed with thumb artery. The accompanied veins and superficial veins were respectively anastomosed with thumb dorsal veins. Nerve branches in flaps were sutured with unilateral finger nerve to reconstruct flap feeling with 9-0 thread. Wounds in the hypothenar donor site were sutured directly.

RESULTSAll the flaps survived completely with primary healing both in donor and recipient area. 8 cases (8 fingers) were followed up for 6-13 months (average 9 months). The flaps appearance, texture were good. The two-point discrimination distance on flap was 7-10 mm. The active and passive movement of thumb joints was normal. There was no complain about the feeling at the donor site. Linear scar was left on the donor site. Patients hand grip strength was not decreased.

CONCLUSIONSThe free perforator hypothenar flap which has constant vascular anatomy is a new method for thumb soft tissue defect with less morbidity to donor site. The operative procedures are relatively simple.

Cicatrix ; etiology ; Finger Phalanges ; Fingers ; blood supply ; Hand Strength ; Humans ; Perforator Flap ; transplantation ; Tendons ; Thumb ; injuries ; Ulnar Artery ; surgery ; Veins ; Wound Healing

OBJECTIVETo investigate the clinical application of V-Y flap pedicled with the lateral superior genicular perforator for donor site defect after harvesting anterolateral thigh flap.

METHODSFrom June 2011 to June 2012, 9 cases with defects at hands and feet were treated with anterolateral thigh flaps. The defects left at the donor sites were consequently reconstructed with V-Y flap pedicled with the lateral superior genicular perforator. The defects left by V-Y flap were closed directly.

RESULTSAll the 9 anterolateral thigh flap survived completely. 5 flaps underwent thinning surgery 6-8 months after operation. The flaps had a good appearance, texture, color and elasticity. The 8 perforator flaps survived completely with partial necrosis in 1 flap at the proximal end. The average healing time was 17 days. There was no obvious depression at donor sites with normal function.

CONCLUSIONSThe method is easily performed with optional therapeutic effect. It is a modified improvement for the anterolateral thigh flap.

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Thigh ; surgery ; Young Adult

Objective To evaluate the role of phosphatase and tensin homologue deleted on chromosome 10 (PTEN) in diabetes mellitus-induced reduction of hypoxic postconditioning (HPO)-induced protection of cardiomyocytes and the relationship with glycogen synthase kinase-3β (GSK-3β)-mediated mitochondrial apoptotic pathway.Methods H9c2 cells incubated in high-glucose (30 mmol/L) medium for 24 h were divided into 6 groups (n =5 each) using a random number table:normoxia group (group N),hypoxia-reoxygenation (H/R) group,group HPO,PTEN gene silencing normoxia group (group P-N),PTEN gene silencing H/R group (group P-H/R),and PTEN gene silencing HPO group (group P-HPO).H9c2 cells were exposed to 95％ N2-5％ CO2 for 4 h followed by 2 h reoxygenation with 90％ O2-10％ CO2.HPO was induced by 3 cycles of 5 min reoxygenation followed by 5 min hypoxia before reoxygenation.At the end of reoxygenation,the level of lactate dehydrogenase (LDH) in the supernatant was detected by enzyme-linked immunosorbent assay,the changes in mitochondrial membrane potential (MMP were assessed by JC-1 fluorescence assay,the cell apoptosis was detected by AnnexinV-FITC/PI flow cytometry,and the expression of PTEN and phosphorylated GSK-3β (p-GSK-3β) was determined by Western blot.The JC-1 monomer/polymer ratio and apoptosis rate were calculated.Results Compared with group N,the amount of LDH released,JC-1 monomer/polymer ratio and apoptosis rate were significantly increased,and the expression of PTEN was up-regulated in H/R and HPO groups (P＜0.05).There was no significant difference in the parameters mentioned above between group H/R and group HPO (P＞0.05).Compared with group HPO,the amount of LDH released,JC-1 monomer/polymer ratio and apoptosis rate were significantly decreased,PTEN expression was down-regulated,and the expression of p-GSK-3β was up-regulated in group P-HPO (P＜0.05).Compared with group N,the expression of PTEN was significantly down-regulated,and no significant changes were found in the other parameters mentioned above in group P-N (P＞0.05).Compared with group H/R,the expression of PTEN was significantly down-regulated,and no significant changes were found in the other parameters mentioned above in group P-H/R (P＞0.05).Conclusion PTEN is involved in diabetes mellitus-induced reduction of HPO-induced protection of cardiomyocytes,and the mechanism is associated with PTEN-induced activation of GSK-3β-modulated mitochondrial apoptotic pathway.

Objective To evaluate the mechanism of reduction of protection induced by hypoxic postconditioning (HPO) in diabetic myocardiocytes subjected to hypoxia-reoxygenation (H/R),and the relationship with DJ-1 expression.Methods H9c2 cells cultured in normal culture atmosphere were randomly divided into 6 groups (n=36 each) using a random number table:control group (group C),group H/R,group HPO,plasmid carrying DJ-1 gene transfection group (group D),plasmid carrying DJ-1 gene transfection + H/R group (group DH),and plasmid carrying DJ-1 gene transfection + H/R + HPO group (group DHH).H/R was induced by 4 h of hypoxia followed by 2 h of reoxygenation.H9c2 cells were cultured in high glucose culture medium (30 mmol/L) for 48 h in C,H/R and HPO groups.H/R model was established in H/R and HPO groups.HPO was induced by 3 cycles of 5 min reoxygenation and 5 min hypoxia before the onset of reoxygenation in group HPO.In D,DH and DHH groups,the plasmid carrying DJ-1 gene (pEX-2-EGFP-DJ-1) was transfected into the cells,and then the cells were cultured in high glucose culture medium and subjected to H/R and HPO,respectively.At 2 h of reoxygenation,the cell survival rate was measured using the cell counting kit-8 assay,and the level of lactate dehydrogenase (LDH) in the supernatant was detected by enzyme-linked immunosorbent assay,the autophagosomes were examined with a transmission electron microscope,and the expression of DJ-1 and p62 and ratio of microtubule-associated protein 1 light chain 3 Ⅱ / Ⅰ (LC3 Ⅱ / Ⅰ) in cells were detected by Western blot.Results Compared with group C,the cell survival rate and DJ-1 expression were significantly decreased,and the LDH activity was significantly increased in H/R and HPO groups (P＜0.01).There was no significant difference in the parameters mentioned above between H/R and HPO groups (P＞0.05).Compared with group D,the cell survival rate was significantly decreased,and the LDH activity was significantly increased in group DH (P＜0.01).Compared with group DH,the cell survival rate,the number of autophagosomes and LC3 Ⅱ / Ⅰ ratio were significantly increased,and the LDH activity and p62 expression were significantly decreased in group DHH (P＜0.01).There was no significant difference in the parameters mentioned above between H/R and DH groups (P＞0.05).Conclusion The mechanism of reduction of protection induced by HPO in diabetic myocardiocytes subjected to H/R is related to high glucose-induced inhibition of DJ-1 expression and decrease in autophagy.

The incidence of dextrocardia is lower. The dextrocardia is often associated with congenital anatomical abnormalities. The patient with normal cardiac structure of dextrocardia and severe coronary heart disease that needs coronary artery bypasss is rarer. This article summarizes the perioperative management and surgical experience of dextrocardia with bypass surgery via a clinical case.