Objective To determine the effect of resurfacing completely degloved thumbs by free perforator flaps in a spiral fashion.Methods A retrospective case series study was made on 22 patients with completely degloving injury of the thumb treated by different free perforator flaps in a spiral fashion from June 2009 to December 2014,including 19 male and 3 female patients at the age of 18-46 years (mean,27.8 years).A total of 13 patients were reconstructed using the medial arm perforator flaps ranging in size from 8.0 cm × 3.0 cm-14.5 cm × 3.5 cm,and 9 patients were reconstructed using the peroneal artery perforator flaps ranging in size from 6.0 cm × 3.5 cm-21.0 cm × 10.0 cm.Follow-up was made to evaluate the sensation,appearance and function of the thumbs and the recovery of flap donor sites.Results All flaps survived completely,with no occurrence of postoperative vascular crisis and infection.Only one medial arm flap and one soleus perforator flap distal flap showed blood flow disorder in the distal sections and were healed uneventfully after conservative therapy.Function and cosmetic recovery of the reconstructed thumbs were good.Follow-up ranged from 9 to 22 months (mean,14.5 months).Twopoint discrimination test of the flaps was recovered to 6-13 mm.No linear scar contracture was left.Flap donor site wound healed primarily.All patients were satisfied with the overall results.Conclusion The free perforator flap in a spiral fashion can avoid linear scar contracture,maximally decrease donor site morbidity and achieve satisfactory functional recovery and good aesthetic restoration,indicating a good candidate for reconstruction of thumb degloving injury.

Objective To investigate the results of defect reconstruction using anterolateral thigh free flap in medial and lateral approaches.Methods We reviewed the soft tissue defect reconstruction in 200 patients from February 2010 to June 2014 with anterolateral thigh flap in medial or lateral approach,to compare the operative time and donor site morbidity.Results The mean time of flap raising in medial group was (45 ± 4.5) minutes,while in lateral group was (65 ± 3.5) minutes.In medial group,fascial lata was closed directly in 39 cases (39％),while fascial lata was closed directly in all the cases (100％) in lateral group.All the 200 flaps survived uneventfully.All the donor sites healed smoothly.No infection occurred.An 8 to 32 months follow-up revealed a high satisfactory rate from the patients.No sensory deficit or functional impairment was noted in the donor sites.Conclusions Both in medial and lateral approach can achieve safely harvesting free anterolateral thigh flap.

Objective To investigate the therapeutic effect of modified dorsal metacarpal artery island flap of index finger without skin graft in repairing different types of soft tissue defect of thumb tip.Methods From August,2015 to October,2017,25 patients with soft tissue defect of the thumb tip were included in the study.Sixteen cases were males and 9 cases were females.Seventeen defects were in thumb dorsal and 8 cases were in thumb pulp.A modified dorsal island flap of index finger was used and the dorsal metacarpal superficial vein fascial flap could be harvest and combined to repair the thumb pulp defect if necessary.A relaying perforator flap pedicled on the second dorsal metacarpal artery was raised through the same incision to cover the donor site without skin graft.Followed-up was made by clinic,telephone and WeChat.Results The patients were followed-up for 6 to 18 months.All flaps survived completely without complications.The color,texture and contour of the flaps was good.Only 1 linear scar was left in the dorsum of the hand and no skin grafts.The second dorsal metacarpal artery flap was used to cover the donor site.Twenty-one cases (84％) were satisfied with the postoperative appearance of the thumb.The function was assessed as excellent in 16 fingers,good in 6 fingers and fair in 3 fingers.No complication occurred in the donor site.Conclusion It is possible to use the modified dorsal island flap of index finger to repair different types of thumb tip defects.A second dorsal metacarpal artery flap can be used as a relaying flap to cover the donor site without skin grafts.

Objective: To investigate the effect of modified distally based propeller sural perforator flap for defect at foot and ankle and lateral gastrocnemius artery perforator flap for defect at donor site. Methods: From January 2014 to January 2016, 12 cases with defects at foot and ankle were reconstructed by modified distally based propeller sural perforator flaps. The result ed defects at donor sites were reconstructed by lateral gastrocnemius artery perforator flaps.The flaps size ranged from 5.5 cm×3.5 cm to 13.0 cm×7.0 cm for modified distally based propeller sural perforator flaps, and 7.0 cm×4.0 cm to 10.0 cm×6.0 cm for lateral gastrocnemius artery perforator flaps. The 12 cases included 10 males and 2 females, aged from 14 to 48 years (25.7 years on average). Results: The lateral gastrocnemius artery perforators existed consistently in all cases. All flaps survived completely with no vascular crisis, wound dishesecense or obvious swelling. Primary healing was achieved in both recipient and donor sites. 12 cases were followed up for 6-14 months (12.4 months on average) with satisfactory esthetic and functional result in both recipient and donor sites, only linear scar was left on the donor sites. Conclusions The lateral gastrocnemius artery perforator flap is suitable for defect left by modified distally based propeller sural perforator flap. Combination of the two flaps is an optional choice for defects at foot and ankle.

Objective To investigate the therapeutic results of completely degloved digital injury using a parallelogram free flap from the medial arm in a spiral fashion.Methods From January 2011 to June 2013,13 defects in 13 patients with non-replantable degloved digital injury were treated with a parallelogram free flap from the medial arm in a spiral fashion.The longitudinal axis of the flap was along the line from the axilla to the medial humeral epicondyle.The medial brachial cutaneous nerve of the arm was harvested for sensory restoration.The non-replantable degloved finger was reconstructed with the medial arm flap in a spiral fashion.The digital artery and dorsal veins were prepared as the recipient pedicle,and the medial brachial cutaneous nerve was sutured to the digital nerve stump.All the wounds at the donor sites were closed directly.Results The dimension of the flaps ranged from 5.0 cm × 2.0 cm to 7.5 cm × 4.0 cm.Excetp for one partial flap loss,all the other flaps survived uneventfully with conservative therapy.The static 2-point discrimination test varied from 6 to 13 mm.No linear scar contracture was recorded in these patients.All the patients were satisfied with the overall results.Conclusions Resurfacing the defect in a spiral fashion is a valuable and reliable technique for the reconstruction of complete finger degloved injuries.The medial arm flap is a good option for this procedure,with satisfactory functional recovery and good aesthetic restoration.

Objective To investigate the therapeutic results of completely degloved digital injury using a parallelogram free flap from the medial arm in a spiral fashion.Methods From January 2011 to June 2013,13 defects in 13 patients with non-replantable degloved digital injury were treated with a parallelogram free flap from the medial arm in a spiral fashion.The longitudinal axis of the flap was along the line from the axilla to the medial humeral epicondyle.The medial brachial cutaneous nerve of the arm was harvested for sensory restoration.The non-replantable degloved finger was reconstructed with the medial arm flap in a spiral fashion.The digital artery and dorsal veins were prepared as the recipient pedicle,and the medial brachial cutaneous nerve was sutured to the digital nerve stump.All the wounds at the donor sites were closed directly.Results The dimension of the flaps ranged from 5.0 cm × 2.0 cm to 7.5 cm × 4.0 cm.Excetp for one partial flap loss,all the other flaps survived uneventfully with conservative therapy.The static 2-point discrimination test varied from 6 to 13 mm.No linear scar contracture was recorded in these patients.All the patients were satisfied with the overall results.Conclusions Resurfacing the defect in a spiral fashion is a valuable and reliable technique for the reconstruction of complete finger degloved injuries.The medial arm flap is a good option for this procedure,with satisfactory functional recovery and good aesthetic restoration.

Objective:To explore the clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers.Methods:This study was a retrospective observational study. From March 2021 to March 2022, 15 patients with stage Ⅳ ischial tuberosity pressure ulcers who met the inclusion criteria were admitted to Dezhou Dongcheng Hospital, including 11 males and 4 females, aged 31 to 72 years. The pressure ulcer wound size ranged from 6.0 cm×4.5 cm to 10.0 cm×6.0 cm, with cavity diameters of 10-14 cm. Five cases were complicated with ischial tuberosity bone infection. After clearing the lesion, the biceps femoris long head muscle flap with an area of 10.0 cm×4.0 cm-18.0 cm×5.0 cm and the semitendinosus muscle flap with an area of 8.0 cm×4.0 cm-15.0 cm×5.0 cm combined with the posterior femoral cutaneous nerve nutrient vessel flap with an area of 6.5 cm×5.5 cm-10.5 cm×6.5 cm was transplanted to repair the pressure ulcer wound. The flap donor area was directly sutured, and the closed lavage with tubes inserted into the wound cavity was performed for 2-3 weeks. The postoperative survival of the muscle flaps and skin flaps, the wound healing of the donor and recipient areas were observed. The recurrence of pressure ulcers, the appearance and texture of flaps, and scar conditions of the donor and recipient areas were followed up.Results:All the muscle flaps and skin flaps in the 15 patients successfully survived after surgery. Two patients experienced incisional dehiscence at one week after surgery due to improper turning over, during which the incision in the recipient area was pressed on, and the wounds healed after dressing changes of 3 to 4 weeks; the wounds in the donor and recipient areas healed well in the other patients. All patients received follow-up after surgery. During the follow-up period of 6 to 12 months, none of the patients experienced pressure ulcer recurrence, and the texture, color, and thickness of the skin flaps closely resembled those of the surrounding skin at the recipient site, with only linear scar left in the donor and recipient areas.Conclusions:When using the posterior femoral muscle flaps combined with the posterior femoral cutaneous nerve nutrient vessel flap and closed lavage to treat stage Ⅳ ischial tuberosity pressure ulcers, the tissue flap can be used to fully fill in the dead space of the pressure ulcers. After treatment, the wound heals well, the appearance of the donor and recipient areas is better, and the pressure ulcers are less prone to reoccur.

Objective:To evaluate the clinical effect of the modified transfer of the proximal interphalangeal joint (PIPJ) from the second toe in the treatment of a finger PIPJ defect.Methods:A total of 13 patients with finger PIPJ defects caused by traumatic injury were enrolled from May, 2017 to March, 2020. All the PIPJ defects had primary traumatic repairs. The causes of injury: 5 patients were caused by strangulation, 4 by chainsaw, 2 by strangulation and 2 by crushing. Of which, 7 patients had index finger injury, 3 middle fingers and 3 ring fingers. The operations were carried out 3-7 months after the first stage of treatment. The grafting of the PIPJ of the second toe with modified vascular anastomosis were performed. The ipsilateral second toe was taken in 10 patients, and the contralateral second toe in 3 patients. The grafted joints all carried observation skin islands, with an area of 1.0 cm×1.5 cm-1.0 cm×2.0 cm. All the secondary bone defects in the donor site of the toe were reconstructed with iliac bone grafts, and the length of the iliac bone strips was 4.0-6.0 cm. At the same time, the island flap on the fibular side of the great toe was removed and repaired at the donor site, with an area of 1.1 cm×1.6 cm - 1.1 cm×2.1 cm. Early postoperative rehabilitation was performed. The patients were followed-up through outpatient visits, telephone and WeChat interviews.Results:All the 13 finger PIPJ and donor site island flaps survived. Bone healing were observed in all patients with the healing time in 8-12(average 10) weeks. Three patients with severe adhesion of joint and tendon were treated with secondary release. All the patients were followed-up for 10 - 18 months without degeneration of PIPJ. Active range of motion of PIPJ ranged: 45°-90° in flexion and 0°-10° in extension, the average motion activity was 66.3°. Seven patients were in excellent, 4 in good and 2 in fair, according to the function assessment proposed by the Society of Hand Surgery of Chinese Medical Association. The appearance on donor site was good and the walking was normal in the longterm follow-up. Only one linear scar was left in the ilioinguinal donor site without obvious discomfort.Conclusion:It was possible to use the modified transfer of the PIPJ from the second toe in the treatment of a finger PIPJ defect. An iliac bone graft and an island flap of the first toe transfer can preserve the appearance and function of the toes.

Objective:To investigate the therapeutic effect of modified sural neuro-fasciocutaneous perforator flap in reconstruction of foot and ankle soft tissue defects.Methods:Sixteen patients undergoing the modified flap for foot and ankle reconstruction were included in this study between June, 2016 and June, 2018. The 16 patients were 11 males and 5 females with an average age of 32.5 (range 21 to 51) years. Ten defects were in heel and 6 in ankle and dorsal side of foot. A "Z" -shape skin incision was performed to explore the perforator vessels. A peroneal-based perforator, a superficial vein, and the vascular axis of the sural nerve were included in the pedicle. A relaying island perforator flap was used to close the donor site without skin graft. Follow-up was carried out through outpatient service, telephone follow-up and Wechat photo transmission.Results:The patients were followed-up for 12 to 18 months. All flaps survived completely without complications. The colour, texture and apperance of the flaps were good. The area of the flaps ranged from 12 cm×5 cm to 30 cm×15 cm. The diameter of the pedicle ranged from 1 to 2 cm. No complication occurred in the donor sites. A relaying perforator island flaps were used in 10 cases for donor site closure and without a skin graft. All cases were satisfied with appearance and function at the final followed-up.Conclusion:It is possible to use the modified sural neuro-fasciocutaneous perforator flap to repair foot and ankle soft tissue defects. A relaying island perforator flap can be used as a relaying flap to cover the donor site without skin graft.

Objective:To scientifically measure and morphologically evaluate the anatomical shape of the skin in the first web space based on cadavers, and to guide the design of flap in this area.Methods:Sixteen human cadavers fixed with 10% formaldehyde without injury or deformity on the hand were selected in the Department of Hand Surgery, the Third Hospital of Suqian. According to the characteristics of the first web area, marker points were selected for measurement and morphological observation. Morphological characteristics of the first web with thumb radial abduction(r) or palmar abduction(p) were measured and compared. The t-test was used for statistical analysis. P<0.05 was considered statistically significant. According to the results of measurement, standardised shapes and parameters of the skin were obtained for flap repair of defect of the first web. Results:When the thumb was in palmar abduction, the maximum distance [a(p)] of the first web of female(F) and male(M) was 5.78/8.42 cm(F/M), and the skin [S(p)] was 17.09/23.63 cm 2(F/M), both were significantly greater than the distance [a(r)] at 4.86/6.28 cm and the area of skin area [S(r)] at 14.39/20.15 cm 2 when thumb was in the radial abduction position( P<0.05). There was no significant difference in the length of [b(r)] and [b(p)] alone the long axis of flap between palmar and radial abductions(7.54/9.38 cm and 7.34/9.74 cm, respectively) of the thumb( P>0.05). It was found that the area of first web was not shaped as a symmetrical spindle, but an irregular quadrilateral inclined to the index finger. Conclusion:Design and measurement of a flap for the first web space should take the maximum palmar abduction of a thumb as a reference. The asymmetric quadrilateral flap design is more in line with the anatomical and characteristics in the region.