Objective:To explore the classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography and its impact on their donor sites.Methods:A retrospective analysis was conducted of the data of 67 patients with large soft tissue defects who had been repaired with anterolateral thigh perforator flaps at Department of Orthopaedics, The Hospital Affiliated to The Second Medical University of Shandong, Department of Orthopaedics, The 80th Group Army Hospital of the People's Liberation Army, and Department of Orthopaedics, Weifang Traditional Chinese Medicine Hospital. The patients were divided into 2 groups according to their flaps used: a unilobar group and a bilobar group. In the unilobar group, 36 cases [25 males and 11 females with an age of (40.3±8.3) years] were repaired with a unilobar anterolateral thigh perforator flap from March 2015 to April 2019. In the bilobar group, 31 cases [22 males and 9 females with an age of (38.9±7.4) years] were repaired with a bilobar anterolateral thigh perforator flap from May 2019 to August 2023. Color Doppler ultrasonography was used to classify the bilobar flaps into 4 types according to the different distributions of perforating vessels: common trunk type, separate trunks type, fascia dependent type, and composite mixed type. The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were compared with the intraoperative findings in the bilobar group. One year after operation, recovery rate of donor muscle strength, rate of skin paresthesia, scar length at the donor site, the widest scar width and motor function were compared between the 2 groups.Results:The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were consistent with the intraoperative findings ( P<0.05). There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). One year after operation in the bilobar group, the recovery rate of donor muscle strength was 96.8% (30/31), significantly higher than that in the unilobar group [77.8% (28/36)], the rate of skin paresthesia 6.5% (2/31), significantly lower than that in the unilobar group [27.8% (10/36)], the scar length at the donor site (22.18±5.02) cm, significantly longer than that in unilobar group [(17.35±3.11) cm], the widest scar width (7.26±1.58) mm, significantly narrower than that in the unilobar group [(43.72±9.81) mm], and the scores of Vancouver Scar Assessment Scale and Fugl-Meyer lower limb motor function scale were (1.95±0.57) points and (8.39±2.17) points, respectively, significantly lower than those in the unilobar group [(6.38±1.72) points and (14.02±3.54) points] ( P<0.05). Conclusions:Preoperative classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography may provide guidance for flap harvesting and lobe layout of the flap. Compared to traditional unilobar flaps, bilobar ones may minimize tissue damage at a donor site.

Objective:To explore the classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography and its impact on their donor sites.Methods:A retrospective analysis was conducted of the data of 67 patients with large soft tissue defects who had been repaired with anterolateral thigh perforator flaps at Department of Orthopaedics, The Hospital Affiliated to The Second Medical University of Shandong, Department of Orthopaedics, The 80th Group Army Hospital of the People's Liberation Army, and Department of Orthopaedics, Weifang Traditional Chinese Medicine Hospital. The patients were divided into 2 groups according to their flaps used: a unilobar group and a bilobar group. In the unilobar group, 36 cases [25 males and 11 females with an age of (40.3±8.3) years] were repaired with a unilobar anterolateral thigh perforator flap from March 2015 to April 2019. In the bilobar group, 31 cases [22 males and 9 females with an age of (38.9±7.4) years] were repaired with a bilobar anterolateral thigh perforator flap from May 2019 to August 2023. Color Doppler ultrasonography was used to classify the bilobar flaps into 4 types according to the different distributions of perforating vessels: common trunk type, separate trunks type, fascia dependent type, and composite mixed type. The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were compared with the intraoperative findings in the bilobar group. One year after operation, recovery rate of donor muscle strength, rate of skin paresthesia, scar length at the donor site, the widest scar width and motor function were compared between the 2 groups.Results:The number of perforating vessels and type of perforator flap found by preoperative color Doppler ultrasound were consistent with the intraoperative findings ( P<0.05). There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). One year after operation in the bilobar group, the recovery rate of donor muscle strength was 96.8% (30/31), significantly higher than that in the unilobar group [77.8% (28/36)], the rate of skin paresthesia 6.5% (2/31), significantly lower than that in the unilobar group [27.8% (10/36)], the scar length at the donor site (22.18±5.02) cm, significantly longer than that in unilobar group [(17.35±3.11) cm], the widest scar width (7.26±1.58) mm, significantly narrower than that in the unilobar group [(43.72±9.81) mm], and the scores of Vancouver Scar Assessment Scale and Fugl-Meyer lower limb motor function scale were (1.95±0.57) points and (8.39±2.17) points, respectively, significantly lower than those in the unilobar group [(6.38±1.72) points and (14.02±3.54) points] ( P<0.05). Conclusions:Preoperative classification of bilobar anterolateral thigh perforator flaps assisted by color Doppler ultrasonography may provide guidance for flap harvesting and lobe layout of the flap. Compared to traditional unilobar flaps, bilobar ones may minimize tissue damage at a donor site.

Objective To explore the value of a set of combined vascular anastomosed flap.Methods The 36 cases were injured,the site of injury in knee and leg or ankle and foot,upper limb.Skin defect with bone and joint,tendon exposure.Selection of anastomosis of blood vessel with large flap,wherein the subscapular vascular anastomosis scapular-lateral thoracic flap in 7 cases,the maximum was 70 cm × 10 cm; anastomosis of subscapular artery lateral thoracic-latissimus dorsi muscle flap in 9 cases,the maximum was 42 cm× 24 cm.Anastomosis of subscapular artery of the scapular-back the latissimus dorsi muscle flap in 2 cases; anastomotic lateral circumflex femoral vessels with lateral femoral cutaneous nerve thigh anterior medial-tensor fascia latae flap in 8 cases; anastomosis of anterior tibial artery and the superficial peroneal nerve in the anterior ankle-dorsal foot flap in 5 cases; anastomosis of dorsal vessels and superficial peroneal nerve of the extensor digitorum brevis muscle-dorsal foot joint flap in 5 cases.Results Following up 8 months to 25 years,twenty-three cases were 19 years.All flaps survived and all the wounds were covered,infection were cured,the skin have aesthesia,fracture healing.Five cases were performed muscle tendon and arthrosis solution for creating conditions for the functional recovery of limb.Conclusion Anastomosis of blood vessel anastomosis combined flap can replace multiple vascular flaps combination,saving,convenient,high success rate,widen the indications.

Objective To investigate the technique of design and cutting method of the thoraco- um-bilicus flap.Methods (1) Made the skin flap include not only the vascularity skin of this side,but also the opposite side,to repair overlength and overbreadth wound surface.(2) Improvement of skin flap cutting steps:first to find the blood vessel under the lower abdominal wall,then to cut the skin flap,if not find to have another donor area.(3)Technology of making thin skin flap:when cutting open the skin,made the surgical blade inclined to the flap,beveling to 2/3 of the skin flap length and in hypogastrium cutting to all over the flap with the fat keep stay in the abdomen so to make the skin flap thiner.Results There was 1 case necrosis because of infection in all 54 cases be repaired.The achievement ratio was 98.1％.Follow up with 1-5 years,skin flaps appearance was good,joint extend- bend was gratification.Soft tissue infection was cured.Conclusion Modified technology of thoraco-umbilicus flap is reasonable design and easily to cut,and the achievement ratio is higher.

Objective To investigate the usage of cutaneous-muscular flap in the treatment of leg long segmental osteonecrosis.MethodOsteonecrosis models of tibia was made in 48 rabbits and divided randomly into control goup of tibia necrotic bone covered with free skin graft and experimental group with cutaneous-gastrocnemius flap. All of them were examined with ECT, radiograph, osteocalcin measurement and histological observation in 2, 4, 8, 12 weeks postoperatively. Treatment of tibia long segmental necrosis with covering of cutaneous-gastrocnemius flap in 436 patiens were reviewed.ResultAbsorptive radioactivity in arterio-phase and delay-phase of ECT in experimental group were higher than those in control group(P

[Objective] To approach the methods of emergency microsurgery repair and one stage functional restoration in tretment of severe tissue defect of the hand.[Method]Fifteen cases of large skin compounded defects of thumb,'hukou',back of hand and palm were repaired with second toes along with anterior malleolus flap,and extend flap of dorsum of foot.Two hundreds and fifty-two cases of compounded defects of 'hukou',back of hand palm and forearm were repaired with second toes or big nail skin flap along with flap transplantation and thumb reconstruction.Thoracoumbilical flap was used in other 372 cases with bone and muscle defect or the big skin defect of the forearm.The lateral thoracic flap and scapular flap was used in repair of 18 cases of the avulsion of the hand.The lateal thoracic flap covered the raw surface of the back hand,the scapular flap covered the raw surface of the palm,so as to completely wrap up the hand or the hand complic forearm.[Result]Seven cases were found vessel crisis in the free skin flap and tissue flap,they all survived after surgical exploration and reanastomosis of blood vessel.One stage healing was gained in 619 cases,two stage healing was gained in 38 cases.All cases were followed up for 1~15 years.According to the criteria of upper limb of C.M.A hand surgery institute,there were excerllent in 340 cases,good in 228 cases,fair in 65 cases,bad in 24 cases,with the satisfactory rate of 86.5%.[Conclusion]It is an effective method of emergency microsurgery repair and one stage functional restoration in tretment of severe tissue defect of the hand.

Objective To investigate the applied value of combined flap that was anastomosed a set of blood vessels. Methods This team includs 26 cases, all cases were injured in traffic accident. The wound parts were knee, calf or ankle. All skin defaults was combined with osseous exposure, chronic inflammation and the wound area was huge. So all cases were terminal repair. After drastically debriding,the wound was repaired through transplanting combined flap that was anastomosed a set of blood vessels. The 6 types flaps were selected. It demonstrates signs of adequate circulation. Its longest was 70 cm, its largest was 42 cm x 42 cm. Results All flaps were alive, the wounds were closed up, the fractures were healed up, the feet or calves were reserved. All above was condition for function reservation. Conclusion THe applying of combined flap that anastomosed a set of blood vessels could substitutes the built-up flaps that was anastomosed a group of blood vessels. The procedure have spent smaller time, and have higher successful ratio. So it would be prone to applying and popularizing in clinical.

Objective To explore the available methods in repairing and restoring the composite tissue defects after trauma of the lower extremities Methods One hundred and sixty four cases were studied in this article,each has a large area of skin defect and soft tissue defect,or combined with other tissue defects such as bone,muscle tendon,blood vessel,while blood supply to the foot of the injuried limb in all the cases was deficiency of bloodless which we called"sever trauma of the lower limb" According to the varied tissue defects and its injuried degree,five operating procedures were designed and introduced Result None of the limbs was severed,a 5～10 year follow up found a good result in 96 3% in all the cases Conclusion The five surgical means mentioned above were satisfied in repairing and restoring varied tissue defects following severe trauma of the lower limbs,and the injuried limbs may be saved

Objective To investigate the effective method of the treatment of the infective, complex defect of skin and bone in crus. Methods On the basis of through anti-infection, the infective surface of wound with bone and skin complex defect was completely debrided. The infective and necrotic skin and bone were moved away, and the wound surface was covered with flaps having abundant circulation. The anti-infection therapy was continued after operation. When the infection healed and the normal skin covered the wound, the bone defect was renovated at the second stage. Result The transplanted flaps all survived and the skin covering the wound remained normal. After the follow-up of four to five years, all the transplanted bones healed completely. No limbs were amputured because of wound infection or the complex defect of bone and skin. Conclusion After the infective surface of wound was completely debrided, the skin defect was renovated with flaps having abundant circulation. On the basis of infection being totally cured, the lone-piece-bone defect was renovated. This method can maintain the limbs and creat conditon for the functional recovery.

Objective To study the effect of operation on transplanted fibula healing,which repaired long and thick and burnden bone defects by two fibula compound transplanation under periosteum with vascular loop. Methods Seventy-two healthy rabbits were divided randomly into three groups.Group A is the mono-fibular transplanation group;group B,the double fibular transplanation extra-periosteum and group C,the double fibular transplanation under-periosteum.Each group consisted of 24 rabbits.Animal models of 10mm tibial defects were established and three operation patterns were performed.the serum were obtained to determine the level of ALP and BGP bone and mineral density and biomechanic index at 2,4,8,12,16 weeks.4 rabbits of each group were examined roentgenographically and histologically.the condition of the bone healing and contour were observed.The different effects of each operation were compared with such observation index. Results The X-ray showed that the area of the external callus were larger in C groups than that in A,B and eht bone trabecula were in order,the fibula showed significant bone hypertrophy.the serum ALP,BGP and mineral density level were higher in C group than that in A,B.the difference has statistical significance (P