Researches on strabismus focus on improving local symptoms and visual function,while neglect it's influence on psychology development.With the development of modern medicine,some researchers are turning their attention to these problems,and have found that strabismus can lead to cognition obstacle,social adjustment deficits and mentality disorder.

OBJECTIVETo explore the feasibility and the effect of free chimeric perforator flap with deep inferior epigastric artery for the soft tissue defect on the lower extremity with deep dead space.

METHODSFrom Mar. 2010 to Aug. 2011, 8 patients with soft tissue defects on the lower extremities combined with dead space, bone or joint exposure were reconstructed with free hinged perforator flaps with deep inferior epigastric artery. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The defects on the donor sites were closed directly.

RESULTSAll the flaps survived with primary healing. Good color and texture was achieved. The patients were followed up for 12-24 months, with an average of 16 months. 2 over-thick flaps were treated by flap-thinning surgery. Only linear scar was left on the donor site on abdomen with no malfunction.

CONCLUSIONSThe free chimeric perforator flap with deep inferior epigastric artery can simultaneously construct the dead space and superficial defect with only anastomosis of one set of vascular pedicle. It is an ideal method with good results on recipientsites and less morbidity on donor sites.

Cicatrix ; Epigastric Arteries ; transplantation ; Feasibility Studies ; Follow-Up Studies ; Humans ; Leg Injuries ; surgery ; Lower Extremity ; Perforator Flap ; transplantation ; Soft Tissue Injuries ; surgery ; Time Factors ; Wound Healing

Objective To describe a technique to achieve primary donor-site closure, extend applications and minimize donor-site morbidity by applying the double skin paddle principle.Methods All 16 cases of the double skin paddle anterolateral thigh perforator flap reconstruction from May, 2008 to June, 2014 were reviewed.Defects locations included calf, dorsum pedis or planta pedis.A long anterolateral thigh perforator flap was marked out using standard points of reference.At least two separate cutaneous perforator vessles were identified on hand-held Doppler.Separating and dissecting flap at superficial layer of fascia lata was adopted in all cases.Then skin paddle was then divided between the two cutaneous perforators to give two separate paddles with a common vascular supply which was the descending branch of the lateral circumflex femoral artery.The skin paddles could be used to cover complex skin defects, whilst still allowing for primary donor-site closure.Results Fifteen patients were successfully treated with the double skin paddle anterolateral thigh perforator flap with no major complications.One case was suffered with partial skin flap necrosis.The type A dumbbell-like flaps was used to cover defects involving two different units of the foot.The type B pattern were stacked side by side on a flap inset, effectively doubling the width of the flap, to resurface a large defect of a single unit of the calf.The type C pattern was used to repair adjacent skin defects.In all cases, the donor site was closed directly.All patients were satisfied with their outcomes.Conclusion The double skin paddle anterolateral thigh perforator flap is an excellent method of resurfacing large defects of the extremity involving multiple subunits with improved morbidity and cosmesis of the donor site.

Objective To explore the clinical effect and experience of separating deep circumflex iliac artery osteocutaneous perforator flap (DCIAP) from the bone flap.Methods According to local applied anatomy of groin,vascularized chimerical flaps of deep iliac circumflex artery was designed and applied.From May,2008 to June,2012,12 patients who combined bone and composite skin and soft-tissue defects were positioned by color dopplar ultrasound before operation and treated with vascularized chimerical flaps of deep iliac circumflex artery.The deep circumflex iliac perforator flaps was 8 to 19 cm in length and 2 to 6 cm in width,and the iliac bone grafts ranged from 5 to 8 cm in length.Results All flaps were fully survival.After 8-10 months postoperative followed-up,all the bone defect gained healing.The function and appearance of cutaneous flaps were satisfactory.There was no serious complication in donor sites of groin.The average time of healing was 9 (8-10) months.Conclusion Vascularized iliac bone graft and a perforator flap are nourished by the same deep circumflex iliac artery.There is more mobile scope and only 1 blood vessel between the bone graft and skin flap,which should be called chimeric perforator flap based on the deep iliac circumflex artery,and is a kind of good method to repair bone and soft-tissue defects of limbs.

Objective To explore a reliable parameter for primary closure of the donor site of the descending branch of the circumflex femoral lateral artery perforator flap and analysis its effective factors.Methods Between August,2014 and December,2015,149 patients undergoing reconstructive procedures using the descending branch of the circumflex femoral lateral artery perforator flaps were included in the study.All patients were divided into two groups:primary closure of the donor site (135 cases) and none primary closure of the donor site (14 cases).The receiver operating characteristic curve for biostatistical analysis was performed to identify the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap.The parameter,including the age,patients' body mass index,subcutaneous fat thickness,thigh circumference and the maximum flap width,were recorded in 79 patients who were randomly choose from all patients.The method through stretching donor site skin was used to assess the maximum flap width.The maximum flap width-to-thigh circumference ratio was calculated.The Pearson test was used to analysis the correction between those parameters.Results Primary closure of the donor site was possible in 135 patients and impossible in 14 patients.The receiver operating characteristic curve for biostatistical analysis identifying the reliable width of the descending branch of the circumflex femoral lateral artery perforator flap was 8.75cm.The method assessed the reliable width of the flap was (8.37±1.67) cm through stretching donor site skin.the reliable width of the flap was (8.55±1.65) cm in the male patients and (7.42±1.5) cm in the female patients.There was significant different between the two group (P ＜ 0.05).Primary closure can be achieved if the flap width-to-thigh circumference ratio was less than (17.23±3.84) percent.There was a significant negative correlation between subcutaneous fat thickness and the ratio (R=-0.299,P ＜ 0.05) and between body mass index and the ratio (R=-0.21,P ＜ 0.05).Conclusion The width of flap less than 8.75 cm is a reliable parameter for primary closure of the descending branch of the circumflex femoral lateral artery perforator flap donor site.The patient's body mass index and subcutaneous fat thickness of the thigh should be taken into consideration.

Objective:To introduce a novel surgical technique for dissecting perforator vessels (orderly retrograde four-side dissection) in anterolateral thigh perforator flap (ALTPF) and explore its clinical outcome.Methods:Respective analysis of 94 patients who underwent reconstruction of soft tissue defects with ALTPF which were dissected by orderly retrograde four-side dissection between June, 2013 and December, 2016. After surgery, the survival of flaps, recovery in shape and function of the recipient sites, and the effect on shape and function of the donor sites were observed.Results:The size of ALTPF ranged from 7 cm×5 cm to 32 cm×10 cm. Ninety-four perforators were included in 94 ALTPF, which were 89 perforators of the descending branch of circumflex femoral lateral artery, 4 perforators of the transverse branch of circumflex femoral lateral artery and 1 perforator of femoral medial artery. The time for flap harvesting was 35-95(54.39±16.39) min. Success rate of perforator harvesting was 98.9%, only 1 perforator was injured and another encountered vasospasm during surgery. Three cases had vascular crisis after flap transfer with 2 venous crises and 1 artery crisis. All of the flaps completely survived except 1 that had a partial necrosis. The follow-up time was (12.91±9.17) months. No muscular weakness on donor sites was shown in all cases.Conclusion:Orderly retrograde four-side dissection of perforator vessels in the ALTPF has achieved less donor site morbidity, shorter surgical time and is safer than the traditional techniques. It is a reliable technique to harvest perforator flaps.

OBJECTIVE: To explore the effect of length-width ratio (LWR)on partial necrosis in distally based sural neurofasciocutaneous flap. METHODS: Clinical data and operative pictures of 157 distally based sural neurofasciocutaneous flaps were reviewed and analysed. LWR of the flaps ranged from 2.83:1 to 7.14:1. Based on the LWR of the flaps, the flaps were divided into 5 groups: Group A(LWR≤3:1), Group B(3:1RESULTS: Of the 157 flaps, 125 survived uneventfully, 8 had distal epidermical necrosis, wound dehiscence occurred in 6 flaps, 18 flaps(11.5%) had distal partial necrosis. Partial necrosis occurred in none of the 6 flaps in Group A(0%), 4 of 26 flaps in Group B(12.5%), 2 of 56 flaps in Group C (3.6%), 8 of 50 flaps in Group D (16.0%), and 4 of 19 flaps in Group E(21.5%). There were no statistical differences in partial necrosis ratio between Group A and B, Group B and C, Group D and E(P>0.05). Partial necrosis ratio was higher in Group D than that in Group C(P<0.05). It was lower in the LWR<5:1 group (Group A+Group B+Group C) (6.8%, 6/88) than that in the LWR≥5:1 group (Group D+Group E) (17.4%, 12/69) (P<0.05). CONCLUSION When LWR of the flap is less than 5:1, probability of partial necrosis occurring in distally based sural neurofasciocutaneous flaps is low, and the flap can survive more reliably. The maximum LWR of the surrival flaps can reach 6-7:1.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Foot Injuries ; surgery ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged ; Necrosis ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; innervation ; pathology ; Young Adult

Objective To investigate the clinical efficiency of posterior tibial artery perforator pedicle propeller flaps for soft tissue coverage of the lower leg and foot defects.Methods From May,2008 to May,2016,30 cases with soft tissue defects of the lower leg and foot were cured by using posterior tibial artery perforator pedicle propeller flaps.The size of flaps ranged from 8.0 cm×4.0 cm to 24.0 cm×9.0 cm.Fascia flap was harvested in 5 cases,8 cases with deep fascia,and 6 cases with saphenous vein and saphenous nerve.The degree of flap rotation were from 160° to 180°.The donor sites were closed directly in 27 cases,and covered with skin grafting in 1 case,and with sequential flap in 2 cases.The shape,color,texture and satisfaction of the flaps were recorded during follow-up.Results Twenty-five flaps survived completely.The distal part of skin flap necrosis occurred in 3 cases and the wound healed well after dressing change.The distal part of flap necrosis occurred in 1 case,and free anterolateral thigh perforator flap was used to repair in the second phase.The complete necrosis of the flap occurred in 1 case,healing with scar after 2 months dressing treatment.All cases were followed-up from 4 months to 4.5 yeas (average 1.7 years).All flaps were smooth with a satis fied appearance and high patient satisfaction.Conclusion Posterior tibial artery perforator pedicle propeller flap which has reliable blood supply,less donor-site morbidities,cosmetic shape,simple operation and less postoperative complications,is an ideal method for soft tissue coverage of the lower leg and foot defects.

Objective To investigate the feasibility and efficacy of using the propeller flaps based on the terminal dorsal branch of proper palmar digital arteries for fingertip reconstruction.Methods From September,2013 to September,2016,25 fingers (25 patients) underwent fingertip reconstruction by using propeller flaps pedicled with the terminal dorsal branch of digital arteries.There were 18 males and 7 females with mean age of 33 years.The injured fingers requiring reconstruction included 13 index,6 middle,5 ring and 1 little fingers.The size of the propeller flaps:small paddles were 0.6 cm×0.4 cm-2.1 cm×0.4 cm;big paddles were 3.0 cm×1.3 cm-5.5 cm ×2.0 cm.The donor sites were closed directly in 16 cases,and skin graft appiled in 9 cases.Results Twenty-three cases fingertip defects were successfully reconstructed with this flap.One case of flap necrosis occurred,requiring secondary revision using a cross-finger flap.Donor sites healed without any complication.The mean follow-up period was 11.5 months (range:7-29 months).Fingers restored good shape and function.At 6 months after surgery,the 2-point discrimination value was 6.5 mm (range,6-10 mm).In 2 cases,protective sensation was successfully restored.The postoperative extension and flexion function was evaluated by the total active movement (TAM) system of finger joints:excellent in 20 fingers,good in 4 fingers and fair in 1 finger.The excellent and good rate was 96％.Conclusion The propeller flap based on the terminal dorsal branch of the proper palmar digital arteries to repair fingertip defect has advantages of achieving good function,appearance and minimized damage to the donor site,which is a effective method in reconstructing the fingertip defect.

Objective To investigate the feasibility and clinical effects of chimeric perforator flap based on the descending branch of lateral circumflex femoral artery (d-LCFA) for reconstructing the three-dimensional tissue defect in lower extremities. Methods From May, 2008 to June, 2017, 79 cases of soft tissue defects with dead space were repaired by using a d-LCFA chimeric perforator flap, in which 33 cases of car accident trauma, 12 cases of chronic tibial osteomyelitis, 10 cases of plowing machine injury, 9 cases of chronic calcaneal osteomyelitis, 6 cases of falling injury, 5 cases of crushing injury, 3 cases of spoke injury, and 1 case of suppurative knee arthritis. These patients were accompany with different degrees of infection and dead space after radical debridement. The dead cavity was filled by muscular flap, and perforator flap covered the superficial wound. Recording the flap 's appearance, color, texture, osteomyelitis recurrence and the patient 's knee extension at 1, 3, 6, 9 and 12 months followed-up. Results Seventy-five flaps survived without complications, and the donor sites were closed directly. All patients had no post-operative hematoma or secondary infection. Vascular crisis occurred in 2 days after the operation in 4 flaps, 1 flap had an arterial crisis on the second-postoperative-day, and the flap was necrotic after surgical exploration. The deep cir-cumflex iliac artery chimeric perforator flap was used for repairing. Three flaps with venous crisis during 48 h after operation, in which 2 flaps survived eventually after surgical exploration, and another flap was necrosis and repaired by skin graft. The followed-up periods ranged from 3 months to 30 months (mean, 9.7 months). All flaps had satisfied with appearance and texture. There were no osteomyelitis recurrence and any ranges of motion limitations in the hip and knee joints of the operated leg. Conclusion The chimeric perforator flap with d-LCFA merely anastomosed 1 group vascular pedicle can make the dead space be filled and cover the superficial wound simultaneously. It is an ideal option for reconstructing the skin defect with dead space in lower extremity, which can improve the quality of restoration of recipient site and reduce the damage of donor site.