1.Morphologic observation of the regenerated nerve in reconstructed penis with sensory nerve implantation in rabbit.
Bao-jin WU ; Hua JIANG ; Wen-peng LI ; Ying-fan ZHANG ; Gang CHEN
Chinese Journal of Plastic Surgery 2007;23(5):416-419
OBJECTIVETo investigate the mechanism of sensory nerve regeneration of the reconstructed penis with sensory nerve implantation and to explore a new surgical technique to improve the postoperative sensory function in phallic reconstruction.
METHODSAdult male New Zealand rabbits were randomly divided into experimental group (n = 20, with sensory nerve implantation) and control group (n = 20, without sensory nerve implantation), which were both performed phalloplasty with a superficial epigastric faciovascular pedicle flap. Postoperatively, the nerve regeneration process of the reconstructed penis was observed histologically.
RESULTSIn experimental group, the amount of CGRP positive nerve fibers increased markedly with the time prolonged, whereas merely a few CGRP positive fibers scattered in deep dermis 6 months later in the other group. The cutaneous sensory nerve regeneration of the reconstructed penis in experimental group shows the procedure that the myelinated axon began to exist within 3 months, thereafter the myelinated axon and unmyelinated axon were both observed under the electron microscope.
CONCLUSIONThese findings show that the rabbit model of phalloplasty with sensory nerve implantation can acquire well sensory reinnervation, and bring a light to clinical application for restoration of sensory function in reconstructed penis.
Animals ; Male ; Nerve Regeneration ; Penis ; innervation ; surgery ; Rabbits ; Surgical Flaps ; innervation
2.Delayed of reverse sural nerve flap to repair large soft tissue defect on foot: a case report.
Jun-Lin YANG ; Gong-Lin ZHANG ; Lai-Xu ZHAO
China Journal of Orthopaedics and Traumatology 2013;26(11):906-907
Adult
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Foot
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innervation
;
surgery
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Humans
;
Male
;
Soft Tissue Injuries
;
surgery
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Sural Nerve
;
surgery
;
Surgical Flaps
;
innervation
3.Anatomic characteristics and clinic significance of the lateral femoral cutaneous nerve.
Juyu TANG ; Kanghua LI ; Jiawu REN ; Jun LIU ; Songlin XIE ; Dajiang SONG
Journal of Central South University(Medical Sciences) 2012;37(12):1255-1259
OBJECTIVE:
To explore the reasons of poor sensation recovery after anterolateral thigh flap (ALTF) transplantation and to improve the design and sensation reconstruction of ALTF.
METHODS:
Lower limbs from 21 adult cadavers were chosen, and the lateral femoral cutaneous nerves (LFCN) were dissected. Their courses, shape, distribution and anatomic variation were observed, the distance from original sites of LFCN's posterior and anterior branches to the anterior superior iliac spine (ASIS) were measured, and the external diameter of their main trunks,after piercing out from the inferior margin of inguinal ligament or sending out their posterior branches and their anterior branches, were measured.
RESULTS:
The plane which the posterior branches sent out from the LFCN located at 4.8 (0~16.9) cm below the ASIS. The plane which the anterior branches sent out from the LFCN located at 14.2 (6.7~24.1) cm below the ASIS. There were 6 branches of the LFCN, namely ordinary three branches (9/21), high-level posterior branch (5/21), posterior branch absent (3/21), anterior branch absent (1/21), tiny branch, (2/21) and LFCN absent (1/21). The section of the LFCN was oblate, the external diameter of the LFCN,s main trunk after piercing out from the inferior margin of inguinal ligament or sending out its posterior branch and its anterior branch was 2.68 (1.18-4.52) mm, 2.18 (0.80-4.10) mm and 1.63 (0.44-2.60) mm, respectively.
CONCLUSION
Poor sensation recovery after ALTF transplantation is due to anatomic variation of the posterior branch of the LFCN. The sensory recovery of ALTF may be improved if the 2/3 low to median part of the anterolateral thigh and the main trunk of the LFCN or its plane before sending out the anterior branch is chosen for anastomosis.
Cadaver
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Female
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Humans
;
Ilium
;
anatomy & histology
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Inguinal Canal
;
anatomy & histology
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Male
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Skin
;
innervation
;
Surgical Flaps
;
innervation
;
Thigh
;
innervation
4.Primary reconstruction of skin avulsion injury on both feet.
Yong LIU ; Chengjin ZHANG ; Xingmao FU ; Jianli WANG ; Xuetao ZHANG ; Lei WANG ; Zhiqiang SUI
Chinese Journal of Plastic Surgery 2014;30(2):102-105
OBJECTIVETo investigate the therapeutic effect of primary reconstruction of skin avulsion injury with bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.
METHODSFrom June 2005 to Aug. 2011, 4 cases with skin avulsion injury on both feet were treated. The bilateral anterolateral thigh flaps, including with anterolateral thigh cutaneous nerves, were transferred to cover the feet plantar. The thorax umbilicus flap or latissimus dorsi flap were used to cover the feet dorsum.
RESULTSAll the skin avulsion injury were reconstructed primarily. All the flaps survived completely with good cosmetic and functional results. The patients were followed up for 6 months to 2 years with good sensory recovery (two point discrimination: 14-18 mm).
CONCLUSIONThe skin avulsion injury on both feet can be primarily reconstructed by bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.
Adolescent ; Follow-Up Studies ; Foot Injuries ; surgery ; Humans ; Lacerations ; surgery ; Myocutaneous Flap ; transplantation ; Reconstructive Surgical Procedures ; Skin ; injuries ; innervation ; Surgical Flaps ; innervation ; transplantation ; Thigh ; innervation
5.Anatomy study of superior and inferior gluteal artery perforator flap.
Lan-Hua MU ; Yi-Ping YAN ; Jie LUAN ; Fei FAN ; Sen-Kai LI
Chinese Journal of Plastic Surgery 2005;21(4):278-280
OBJECTIVETo find anatomic basis for clinically modifying technique of harvesting superior and inferior gluteal artery perforator flap, in order to avoid muscle lossing in conventional superior and inferior myocutaneous flaps, keep the advantage such as large rich supplied volume soft tissue.
METHODS5 cases 10 sides adult cadaver were used to study the numbers, position, Course of superior and inferior gluteal artery perforators. The position of perforators was located by ultrasound Doppler in 6 cases and 12 sides in patient's superior and inferior gluteal area.
RESULTSSuperior and inferior gluteal artery originated from internal iliac artery. Several main perforators of large caliber were found in the paraischia and central portions of the gluteal muscle, its number was 10 - 15. The length of the vessels varies from 3 to 8 cm and their diameter from 1 - 1.5 mm. These significant perforators pass through the muscle itself and the fascial portion of the muscle to the overlying skin on the gluteal region. The dorsal branches of nervorum lumbalium perforate the deep fascia just above the iliac crest, lateral to the posterior superior iliac spine. If a nerve branch with a substantial diameter crosses the incision line, the nerve can be harvested within the flap. This nerve can be anastomosed to the anterior ramus of the lateral branch of the 4th intercostals nerve. In adult female, 3 - 5 perforators were located by ultrasound Doppler. They distributed in the triangle area among posterior superior iliac crest, the great trochanter and the coccyx.
CONCLUSIONSThe area and diameter of perforators of superior gluteal artery were relatively confirmed. It's possible to harvest the perforator flap without any muscle. It has the advantage of conventional myocutaneous flap with out of its disadvantages. It's easy to detect those perforator by ultrasound Doppler clinically. The nerve can be harvested and anastomosed simultaneously. Because the inferior gluteal area is a weight loading area, we suggested to use superior gluteal artery perforator flap. This flap can be transferred pedicled to treat sacral pressure sores or to be transferred freely for the breast reconstruction.
Adult ; Arteries ; anatomy & histology ; Buttocks ; blood supply ; innervation ; Female ; Humans ; Male ; Skin Transplantation ; Surgical Flaps ; blood supply ; innervation
6.Reparation of deep burn wound with skin flap grafting.
Chinese Journal of Burns 2002;18(6):327-329
Burns
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surgery
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Humans
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Skin
;
blood supply
;
innervation
;
physiopathology
;
Skin Transplantation
;
methods
;
Surgical Flaps
;
Wound Healing
7.Application of modified reversed neurovascular flaps nourished by cutaneous nerve-superficial vein in lower extremity.
Jin-Long NING ; Xiao-Jing LI ; Zong-Bao ZUO ; Lin ZHANG ; Fei ZHU ; Wang ZHAN ; Guang-Ming HAN
Chinese Journal of Plastic Surgery 2008;24(2):108-111
OBJECTIVETo investigate the application and therapeutic effect of modified neurovascular flaps nourished by sural nerve and small saphenous venous, or saphenous nerve and great saphenous venous.
METHODSAccording to the anatomy and recipient area, we made some modifications for the two neurovascular flaps. 1) The small and great saphenous venous were ligated or anastomosed with the venous in recipient area; 2) The flap was delayed for 8 - 14 days if the donor area was above the middle and upper one third of leg; 3) The sural nerve and its branch were anastomosed to the nerve in recipient site to restore the sense of flap; 4) the lower turning point could be designed just 3 cm above the point of internal and external malleolus; 5) Partial gastrocnemius or soleus muscle could be included in the flap if needed; 6) Reversed cross leg flap was considered if the adjacent flap in the affected side could not be used. Sometimes, we adopted more than one modification in one patients.
RESULTSFrom Sep, 1994 to Apr, 2007, 63 cases were treated, including 51 cases of sural and 12 cases of saphenous neurovascular flaps. Partial necrosis (about 1 - 2 cm width) happened in the distal end of flaps in 2 cases which healed after dress changing. The patients were followed up for 3 months to 2 years with satisfied functional and cosmetic results.
CONCLUSIONSThese two modified flaps have reliable blood supply and survival rate. The operation is easily performed and very practical. The flaps, or combined with other methods can repair about 70% of the refractory defects in legs.
Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Lower Extremity ; innervation ; Male ; Middle Aged ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Veins ; surgery ; Young Adult
8.Repair of skin defects at forepart of feet with reverse saphenous nerve neurocutaneous flaps.
Zai-Rong WEI ; Guang-Feng SUN ; Xiu-Jun TANG ; Da-Li WANG ; Yu-Ming WANG
Chinese Journal of Plastic Surgery 2009;25(4):266-268
OBJECTIVETo investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects at forepart of feet.
METHODSFrom January 2004 to October 2008,15 cases of skin defects at forepart of feet were repaired with reverse saphenous nerve neurocutaneous flaps. The flap size ranged from 3.5 cm x 3.0 cm to 8 cm x 5 cm. The wounds at donor site were closed with skin graft.
RESULTSAll the flaps survived completely with no ulcer at the donor site. 10 patients were followed up for 1 to approximately 9 months. The skin color and texture were satisfactory. The patients could walk very well.
CONCLUSIONSIt is reliable to repair the skin defects at forepart of feet with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity.
Adolescent ; Adult ; Child ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Skin ; injuries ; Skin Transplantation ; Surgical Flaps ; blood supply ; innervation ; Young Adult
9.Reverse fasciocutaneous flap pedicled with perforator branch of anterior medial malleolus artery for soft tissue defect on the dorsal side of foot.
Qi-Wen HU ; Xue-Song WANG ; Feng XUE ; Wei-Fang SUN ; Wan-Xiang SHEN ; Jia-Yi ZHAO
Chinese Journal of Plastic Surgery 2009;25(3):184-186
OBJECTIVETo report the therapeutic effect of reverse fasciocutaneous flap pedicled with perforator branch of anterior medial malleolus artery for soft tissue defect on the dorsal side of foot.
METHODSThe perforator branch was located under the guidance of Doppler flowmeter. The flap was designed along the saphenous neurovascular axis. Then the flap was transferred reversely with the perforator branch as rotation point.
RESULTSFrom Feb. 2002 to Mar. 2008, 12 cases were treated and followed up for 6 - 18 months. All the flaps survived completely. The flap size ranged from 13.5 cm x 3.0 cm to 8 cm x 3 cm. The perforator branch located at 0.5 - 1.5 cm anterior-inferior to the medial malleolus. Both the cosmetic and functional results were satisfactory.
CONCLUSIONSThe flap has a reliable blood supply and a flexible design. It is easily performed for soft tissue defect on the dorsal side of foot. It is a new type flap which combined neurocutaneous vascular flap with the perforator flap.
Adult ; Fascia ; transplantation ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; innervation
10.Anatomic study of mandibular bone flap pedicled with temporal muscle for midface bone defect.
Zhong-hua MENG ; Kai ZHANG ; Shi-wen CHEN ; Yong-feng CHEN ; Xiao-min WANG ; Jun-ju WANG
Chinese Journal of Plastic Surgery 2010;26(6):448-452
OBJECTIVETo study the anatomy of mandibular bone flap pedicled with temporal muscle for midfacial bone defects.
METHODSThe shape and blood supply of the temporal muscle and mandibular ramus, as well as their relationship, were observed and measured in 30 sides of adult head specimens.
RESULTSThe temporal muscle has a fan-shaped main portion, then is scattered into three bundles as anterolateral, anteromedial, posterior bundles, which end respectively at anterior border of ramus, the temporal ridge and posterior portion of coronoid process. Then the muscle goes downward until it reaches the distal side of the third medial surface molar and attaches the 3/4 of medial surface of anterior portion of ramus. The blood supply of temporal muscle includes the medial temporal artery with external diameter of (0.76 +/- 0.20) mm, the anterior deep temporal arteries with external diameter of (0.79 +/- 0.21) mm, posterior deep temporal arteries with external diameter of (0.98 +/- 0.64) mm, the accessory deep temporal artery formed by many little branches. The anterior part of ramus is supplied by the periosteal arteries and the bony perforator of the deep temporal arteries. Rectangular ramus of mandible was divided into anterior portion and posterior portion by the line linking the lowest point of mandibular notch, mandibular foramen and mandibular canal. Anterior portion can supply a bone flap with a size of (46.67 +/- 6.85) mm x (17.98 +/- 2.64) mm x (11.49 +/- 0.99) mm.
CONCLUSIONSThe mandibular bone flap pedicled with temporal muscle has a reliable blood supply and abundant bone volume. It is feasible to design a mandibular bone flap pedicled with temporal muscle for midfacial bone defect.
Adult ; Bone Transplantation ; Female ; Humans ; Male ; Mandible ; anatomy & histology ; surgery ; Surgical Flaps ; Temporal Muscle ; anatomy & histology ; blood supply ; innervation