The anterior interosseous artery (AIA) plays an essential role in designing the posterior interosseous forearm flap (P.I.F.F). Understanding about anatomy of this artery permit us to find us to find out new solutions to design the P.I.F.F. in situations at which there are variations of the PIA. Objectives: (I) to evaluate the role of the anterior interosseous artery in the blood supplying to the posterior forearm region; (II) assessing the importance of anterior interosseous artery in designing the posterior interosseous forearm flap. Methods: 27 forearms of adults obove 25 years old, including 25 forearms fixed in formalin 4% and 2 fresh forearms, are objects for us to expose the AIA and PIA by different techniques. Results: There are 2-5 perforating branches of the AIA to the deep muscular layer of posterior. They connect to each other and to the muscular branch of the PIA, and their diameter becomes much larger in two cases of absence of the PIA. Branches from this series of arterial anastomoses distribute also to the skin of inferior half of posterior forearm. The posterior terminal branche of the AIA divides into the medial and recurrent branch. These two branches ascend and anastomose with the PIA and the muscular branch of the PIA, respectively. The medial branch of the posterior terminal branch is absent or disconnected with the PIA at two other cases. Conclusion: Our results indicate that the AiA supplies the inferior half and the deep muscular layer of the posterior forearm. The posterior interosseous forearm flap can still be raised in situations at which the posterior terminal branch of AIA communicates with the dorsal carpal arcus but not with the PIA and the PIA is absent.
Surgical Flaps, Surgery , Arteries

66 flaps including 6 controlled, were divided into two models, each includes 30 flaps and each model was divided into 5 groups, evaluated after 4, 8, 12, 16 and 20 days after implantation. From the random implantation of a isolated pedicle of artery or vena in an abdomen skin flap, new blood vessels occurred and connected with the existent system of vessels in the flap. After 20 days, new vascularity was established in both models, as the same in the control group. Blood supply was considered appropriate and the flap could be moved safely along the newly implanted pedicle
Arteries ; Surgical Flaps ; Therapeutics ; surgery ;

UNLABELLEDOBJECTIVE To investigate the application of pedicled internal mammary artery perforator (IMAP) flap for tracheostoma and anterior cervical defect.

METHODSFrom April to December 2009, 4 IMAP flaps, based on the second internal mammary artery perforator, were used for two cases of tracheostoma and two cases of anterior cervical skin defect. The flap size was (4-7) cm x (10-13) cm.

RESULTS3 of 4 flaps survived completely. Partial necrosis happened in one flap. The defects at donor sites were closed directly.

CONCLUSIONSThe IMAP flap is a new method for head and neck defect. It is very suitable for tracheostoma and cervical skin defect, with less morbidity at donor site.

Aged ; Humans ; Male ; Mammary Arteries ; surgery ; Middle Aged ; Neck ; surgery ; Surgical Flaps ; blood supply ; Tracheostomy

OBJECTIVETo investigate the reconstruction of 1/4 defect on upper-lip vermilion with a lower-lip vermilion compound tissue flap pedicled at oral commissure.

METHORDSAt the first stage, the lower lip mucosal flap pedicled by inferior labial artery was transposed to reconstruct the defect on upper lip vermilion and tubercle. The defect at the donor site was closed directly. At the second stage, the flap pedicle was cut off and revised.

RESULTS6 patients were treated with satisfactory aesthetic results. All the flaps survived completely. The oral commissure kept normal with no obvious scar at the donor sites.

CONCLUSIONSThe modified crosslip vermilion flap pedicled at oral commissure has the advantages of avoiding inconvenience in feeding, speaking and cleaning. The procedure is simple with available blood supply. Both aesthetic and functional results are satisfactory.

Arteries ; Esthetics ; Humans ; Lip ; surgery ; Mouth Mucosa ; transplantation ; Surgical Flaps ; blood supply ; Transplant Donor Site ; surgery

OBJECTIVETo study the course of branches of the superficial temporal artery (BSTA) and the accompanying pattern of their veins in order to provide anatomic basis for flap design.

METHODSHead and facial part of ten adult corpses (19 sides) were dissected and photographed. The coordinate system was set up with external auditory foramen as the point of origin, aided by the graph analysis software Digimizer. The course of the frontal branch and parietal branch of the superficial temporal artery (STA), and the accompanying pattern between the BSTA and the veins were measured and analyzed. The STA and its branches were located by Ultrasonic Doppler, and the corresponding branches of the superficial temporal vein (BSTV) were disclosed by bowing patient's head with breath holding or cerclaging the basement of the patient's skull. And then 10 sides of transposition (fascia) flaps with axis at the angular bisector between BSTA and BSTV were devised to repair wounds of 9 patients that hospitalized from February 2008 to December 2009. Data were processed with test of variance homogeneity.

RESULTSFrontal BSTV absence was found in 6 head sides, and the maximum distance between artery and vein was (2.1 ± 1.2) cm. Parietal BSTV absence was found in 3 head sides, and the maximum distance was (1.4 ± 0.7) cm. The distance between frontal BSTA and BSTV was larger than that between parietal BSTA and BSTV, and the dispersion degree of the former was higher than that of the latter (F = 0.0404, P = 0.0475). All the (fascia) flaps survived without congestion or necrosis.

CONCLUSIONSWhen branch of the superficial temporal vessel was selected as the axial vessel of flap, the flap design shall depend on the accompanying pattern of BSTV to avoid the flap necrosis due to poor venous return after surgery. The superficial temporal vein and its branches can be well disclosed by bowing head or cerclaging skull. The approach is simple, useful, safe, and reliable.

Adult ; Humans ; Male ; Surgical Flaps ; blood supply ; Temporal Arteries ; anatomy & histology ; surgery ; Veins ; anatomy & histology ; surgery

OBJECTIVETo explore the proposal using nearby perforator flaps as alternative reconstructive choices for anterolateral thigh (ALT) flap when lacking useful perforator.

METHODSFrom August 2010 to August 2012, 8 cases with head and neck cancer were found lacking reliable perforator during ALT flap elevation, a tensor fascia latae (TFL) flap or an anteromedial thigh (AMT) flap was used to complete the reconstruction.

RESULTSAll 8 alternative flaps were successfully harvested, other donor sites were not needed. Flap harvest time was 50-85 min. Of 5 TFL flaps, pedicle lengths were 6-10 cm, and the diameters of the arteries and veins were 2.5-3.0 mm and 2.5-3.5 mm respectively. Of 3 AMT flaps, pedicle lengths were 10-15 cm, the rectus femoris branch was used as pedicle in 1 flap, with artery and vein more than 1.0 mm in diameter, and the descending branch of the lateral circumflex femoral artery was used as pedicle in other 2 flaps, the diameters of the arteries were 3.5 and 3.0 mm respectively, the diameters of the veins were 3.5 mm. The donor sites were directly closed in 7 cases and skin graft was performed in another case. All the flaps were alive and no complication was found in the donor sites.

CONCLUSIONTFL or AMT flap is an good alternative to ALT flap lacking useful perforator.

Arteries ; Head and Neck Neoplasms ; surgery ; Humans ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps ; Thigh ; surgery

OBJECTIVETo investigate the microvascular structure of the transmidline scapular flap pedicled with the unilateral circumflex scapular artery.

METHODSLatex and ink mixture was injected into the unilateral circumflex scapular artery of 6 fresh cadavers. The transmidline scapular flap was dissected and the pellucid specimen was made. The artery perforators were traced to their underlying parent vessels that accompanied the segmental arteries. A series of cross-sectional studies were undertaken in one subject to illustrate the course of the perforators in the tissues of different depth.

RESULTSIn deep and superficial fascia, the subdermal and dermis layer, rich microvascular connection was found which showed in three patterns: the vascular arch, communicating branches, and the arterial rate. They interrelated to form a three-dimensional framework. The vascular tree not only passed the midline but also reached the contralateral acromion. The densest vessels were exhibited at the injection side of the back. In the midline area the vessels were in less density and at the contralateral side, the vessels mainly concentrated in the upper part of the back.

CONCLUSIONThe result evidenced the vascular pattern and the applicable safety of the transmidline scapular flap. In elevating a transmidline scapular flap, the distal part should mainly locate at the upper part of the back.

Adult ; Arteries ; anatomy & histology ; surgery ; Cadaver ; Humans ; Male ; Scapula ; blood supply ; Surgical Flaps ; blood supply

OBJECTIVETo evaluate the efficacy of pedicled supraclavicular artery island flaps for head and neck reconstruction.

METHODSReconstructive surgeries for head and neck oncologic defects were performed with the pedicled supraclavicular artery island flaps in 10 patients from May 2013 to December 2014 and the cases were review. Among them, 6 were performed for hypopharyngeal cancer, 2 for oral tongue cancer, 1 for oral base cancer and 1 for cervical esophageal cancer. The size of the flaps was measured in (5-8) cm × (6-12) cm.

RESULTSSeven flaps survived, one flap failured and two flaps had partial necrosis. Donor sites were closed primarily without morbidity.

CONCLUSIONThe pedicled supraclavicular artery island flap is an easy harvesting and reliable for head and neck reconstruction, especially suitable for otolaryngo-head and neck surgeon and maxillofacial surgeon in the local hospital.

Arteries ; Esophageal Neoplasms ; surgery ; Head ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Mouth Neoplasms ; surgery ; Neck ; surgery ; Reconstructive Surgical Procedures ; Surgical Flaps ; Tongue Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETo investigate the feasibility and therapeutic effect of free posterior interrosseous artery flap in a bridge fashion for combined skin and bilateral artery defects at palmar side of fingers.

METHODS6 cases with combined skin and bilateral artery defects at palmar side of fingers were treated with long-pedicled free posterior interrosseous artery flap in a bridge fashion. The flap size ranged from 3.5 cm x 2.0 cm to 6.5 em x 3.0 cm. The wounds at donor sites were closed directly.

RESULTSAll the 6 flaps survived completely without any complication, and the wounds healed primarily. The blood supply and vein drainage in all the 6 fingers were normal. 4 cases were followed up for 1-12 months (average, 7 months). Satisfactory cosmetic and functional results were achieved. The flaps looked a little bit thicker than the surrounding tissue.

CONCLUSIONSThe long-pedicled free posterior interrosseous artery flap in a bridge fashion is a good option for reconstruction of the combined skin and bilateral artery defects at palmar side of fingers in one stage.

Arteries ; Feasibility Studies ; Fingers ; blood supply ; surgery ; Free Tissue Flaps ; blood supply ; transplantation ; Humans ; Reconstructive Surgical Procedures ; Surgical Flaps ; blood supply ; transplantation ; Transplant Donor Site ; surgery ; Veins

OBJECTIVETo explore clinical effects of digital artery bilobed flap for the treatment of skin degloving injury of thumb.

METHODSFrom January 2007 to December 2012, 45 patients with skin degloving injury of thumb were treated with grafting of digital artery bilobed flap. There were 39 males and 6 females, ranging in age from 19 to 46 years, with an average of 32 years. The disease course ranged from 0.5 to 15 h. Eighteen patients suffered from defect of palmar skin above nail root and nail bed, 19 patients suffered from skin degloving injury of thumb phalangette, and 8 patients had whole skin degloving injury of thumb. The double lobe flaps were designed at the ulnar side of middle finger and the radial side of ring finger according to the defect of thumb skin. The arteria digitalis communis between the middle and ring fingers and its two branches of arteriae digitales propriae supplying the two fingers were used as a vessel pedicle. The flap with digitales proprii nervi was transposed and used to cover the exposed phalanx of thumb. Full thickness graft was used for the donor site. Observation of the appearance, texture, color and wear resistance of flap, appearance, color and depression of grafting area, skin feeling, and finger activities was conducted.

RESULTSAll the flaps and grafts were alive. Forty-three patients were followed up with an average duration of 25 months, and two patients lost follow-up. The color and texture of the flaps were similar to that of the contralateral thumb pulp. The average two point discrimination was 4.2 +/- 0.3 mm. The color of graft skin was slightly deeper than that of the surroundings skin.

CONCLUSIONDigital artery bilobed flap graft is an effective and ideal operation, which is of low risk and high success rates for skin degloving injury of thumb.

Adult ; Arteries ; surgery ; Female ; Finger Injuries ; surgery ; Humans ; Male ; Middle Aged ; Surgical Flaps ; Thumb ; blood supply ; injuries ; surgery ; Young Adult