OBJECTIVE: To investigate the effectiveness of free latissimus dorsi myocutaneous flap transplantation combined with external fixation in the treatment of bone and soft tissue defects around the knee joint. METHODS: A retrospective analysis was conducted on the clinical data of 13 patients with high-energy trauma-induced bone and soft tissue defects around the knee joint admitted between January 2016 and July 2023. Among them, 11 were male and 2 were female, the age ranged from 23 to 61 years, with an average of 35.7 years. The causes of injury included 10 cases of traffic accident, 2 cases of machine entanglement injury, and 1 case of heavy object crush injury. According to the Gustilo-Anderson classification, 11 cases were type Ⅲ B and 2 cases were type Ⅲ C. Post-injury, 2 cases had wound infection and 2 cases had popliteal artery injury. The time from injury to flap repair was 40-49 days, with an average of 27.5 days. The wound size was 18 cm×13 cm to 32 cm×20 cm, all accompanied by distal femoral bone defects and quadriceps muscle defects. After primary debridement, vacuum sealing drainage combined with external fixation was used for treatment. In the second stage, free latissimus dorsi myocutaneous flaps were transplanted to repair soft tissue defects, with the flap size ranging from 20 cm×15 cm to 34 cm×22 cm. The donor sites of 9 flaps were directly sutured, and 4 cases with large tension were repaired with a keystone flap based on the posterior intercostal artery perforator. At 6-15 months postoperatively, with an average of 10.5 months, 11 patients underwent knee arthrodesis surgery; 2 patients with large bone defects at the distal femur and proximal tibia underwent multi-segment bone transport reconstruction of the bone defect. At last follow-up, the recovery of the flap and the donor site was recorded, and the function of the shoulder joint was evaluated by the American Shoulder and Elbow Surgeons (ASES) score, and the function of the affected knee joint was evaluated by the Knee Society Score (KSS). RESULTS: All the flaps survived after operation, the wounds and donor site incisions healed by first intention. All 13 patients were followed up 15-55 months, with an average of 21.6 months. Four patients who underwent the restoration of the donor site with the thoracodorsal keystone perforator flap had obvious scar hyperplasia around the wound, but no contracture or symmetrical breasts on both sides. At last follow-up, the appearance and texture of the flaps were good; the bony fusion of the knee joint was good, and the range of motion and function recovered well; the shoulder joint function on the flap-harvested side was not significantly affected, and the range of motion was satisfactory. The ASES shoulder joint score of the latissimus dorsi muscle-harvested side was 85-95, with an average of 89.5. The knee joint function KSS score was 75-90, with an average of 81.2. CONCLUSION Free latissimus dorsi myocutaneous flap transplantation combined with external fixation for the treatment of bone and soft tissue defects around the knee joint caused by high-energy trauma can repair bone and soft tissue defects and reconstruct the stability of the knee joint, effectively preserve the integrity of the limb and soft tissues, and improve the patient's ability of self-care.
Humans ; Male ; Female ; Adult ; Middle Aged ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Plastic Surgery Procedures/methods* ; Superficial Back Muscles/transplantation* ; External Fixators ; Myocutaneous Flap/transplantation* ; Knee Joint/surgery* ; Young Adult ; Treatment Outcome ; Knee Injuries/surgery* ; Free Tissue Flaps/transplantation*

Objective:To investigate the clinical effect on sural neurovascular flap of small saphenous vein super drainage in reconstruction of soft tissue defects in foot and ankle.Methods:A retrospective case study was conducted to analyse the data of 22 patients who had transfer of sural neurovascular flaps of small saphenous vein with super drainage for reconstruction of soft tissue defects in foot and ankle in the Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University from June 2018 to September 2023. The patients were 19 males and 3 females aged from 16 to 70 years, with an average age of 39.0 years. Seven patients had the injury caused by compression cut, 2 of car accident, 4 of falling from height, 8 of infective wound and 1 of burning scar. The flaps were 7.0 cm × 5.0 cm - 15.0 cm × 9.0 cm in size. High frequency CDU was employed before surgery to detect the velocity of blood flow of the super drainage small saphenous vein. The patients who received transfer of sural neurovascular flap of small saphenous vein super drainage were entered in scheduled follow-up at outpatient clinic or via telephone interviews after surgery to observe the flap appearance, healing of donor and recipient sites, and the function of the affected limb. High frequency CDU was used to detect the velocity of blood flow of the small saphenous vein super drainage in follow-up.Results:All patients were included in the postoperative follow-up for 8-36 months, with an average of 20.15 months. Twenty-one flaps survived completely. One flap had partial necrosis at the edge. High frequency CDU detected an average velocity of blood flow at 2.80 cm/s in the small saphenous vein super drainage. The flaps had good colour and texture without swelling, and the wound in the recipient site healed well. The function of the affected limb was evaluated according to the functional assessment criteria of American Orthopaedic Foot and Ankle Society (AOFAS), with 21 patients in excellent and 1 in good. All patients had gained normal ankle function.Conclusion:The sural neurovascular flap with a super perfused small saphenous vein can establish effective venous reflux, reduce the risk of distal necrosis of the flap, and is an effective method for reconstruction of soft tissue defects around foot and the ankle.

Objective:To preliminarily explore and compare the efficacy of free fibular flap transfer with vascular anastomosis and Ilizarov bone transport in treatment of infected bone defects after internal fixation of humeral fractures.Methods:A retrospective analysis was conducted on 29 patients who were treated by transfer of free fibular flap and Ilizarov bone transport for infected nonunion of humeral fractures after internal fixation in the Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University between January 2017 and January 2023. Twelve patients with humeral defects at 4.0 - 6.0 cm in length (5.1 cm in average) were treated with free fibular flap transfer (flap transfer group) and 17 patients with humeral defect at 6.0-10.0 cm in length (7.3 cm in average) were treated by Ilizarov bone transport (bone transport group). All patients were included in the scheduled postoperative follow-up through a combination of outpatient visits and WeChat and telephone interviews. Follow-up included observation of humeral X-ray and shoulder-elbow function. Data were analysed using SPSS 27.0. Homogeneity tests were conducted on the basic data of the 2 groups, such as age, gender, length of bone defect, bone healing time and follow-up period. P<0.05 was considered statistically significant for the difference. Results:All 29 patients had completed the postoperative follow-up that lasted 8-89 months with 41.3 months in average. The lengths of bone defects were 5.2 cm±0.5 cm and 7.0 cm±1.2 cm, the bone healing time was 6.4 months±1.8 months and 14.2 months±4.6 months, and the follow-up time was 17.6 months±6.8 months and 34.4 months ±18.2 months in flap transfer group and bone transport group, respectively. Constant-Murley shoulder score was recorded of 86.0 ± 8.6 and 82.4±10.0 respectively for flap transfer group and bone transport group. Enneking Lower Extremity Functional Score in the flap transfer group was 25.0 ± 3.4, while that for bone transport group was not evaluated due to the absence of lower extremity surgery. There were statistically significant differences in bone defects, bone healing time, and follow-up time between the 2 groups ( P<0.01). There was no statistically significant differences in Constant-Murley shoulder score between the 2 groups ( P>0.05). However, in the flap transfer group, 1 patient developed a haematoma at fibular donor site after surgery, and the haematoma was removed in a secondary surgery, after which the surgical site healed smoothly. The external fixator had gone loose in 1 patient and resulted in a fracture of the transferred fibula. After the external fixator was re-fixed, the fracture healed at 8 months after surgery, and the external fixator was removed at 10 months after surgery. In the bone transport group, 3 patients had poor bone healing at fracture ends. Two patients had axial shifting of bones, the external fixator was adjusted during the bone transport process to correct the bone shifting. One patient suffered an incomplete radial nerve injury, and the radial nerve exploration and release surgery was performed. For that patient, an improvement of muscle strength was seen at 3 months and the wrist and digital extensions regained at 7 months after the radial nerve release surgery. The rest of humeri healed smoothly. Conclusion:In treatment of an infected humeral defect, it was found that a bone transport might be a better option for a larger humeral defect, while the free fibular flap transfer would be more suitable for a smaller humeral defect.

AIM:To investigate the effect of Toll-like receptor 9(TLR-9)gene rs5743836(1237 T/C)single nucleotide polymorphism on recurrent infec-tion in patients with diabetic foot(DF).MEHTODS:A total of 128 DF patients admitted to our hospital from June 2020 to June 2022 were collected and di-vided into an infected group(n=53)and a non-in-fected group(n=75)according to the presence or absence of recurrent infection.The general data and TLR-9 gene polymorphism were compared be-tween the two groups.The genotypes and allele frequencies of TLR-9(1237 T/C)gene polymor-phism were detected and compared between the two groups.Logistic regression was used to analyze the correlation between TLR-9 gene 1237 T/C poly-morphism and recurrence of DF patients.RESULTS:There were significant differences between the two groups in invasive operation,course of antibiotic use and peripheral vascular disease of both lower limbs(P＜0.05).The wild type TT homozygote pro-duced two fragments of 108 bp and 27 bp in length,the variant CC homozygote produced three fragments of 60 bp,48 bp and 27 bp in length,and the heterozygous TC produced four fragments of 108 bp,60 bp,48 bp and 27 bp in length.The TLR-9(1237 T/C)gene identity was 100％.The genotype frequencies met the Hardy-Weinberg genetic equi-librium(P＞0.05).There were significant differences in CC gene frequency,TC gene frequency,TT gene frequency,C gene distribution and T gene distribu-tion between the two groups(P＜0.05).Logistic re-gression analysis showed that TLR-9 CC genotype increased the risk of recurrent infection in DF pa-tients in the co-dominant model(OR=5.357,95％CI:1.901-15.100).After adjusting for sex,age and smoking(OR=5.341,95％CI:1.874-15.015,P＜0.01),the C allele significantly increased the risk of recur-rent infection in DF patients(OR=2.328,95％CI:1.874-15.015,P＜0.01).1.078-5.936),and the differ-ence was statistically significant(P＜0.01).The TT genotype and CC+TC genotype of TLR-9 were not significantly associated with smoking history,Wag-ner grade,peripheral neuropathy,retinopathy,hy-pertension,osteoporosis and lower extremity arte-riosclerosis obliterans in DF patients(P＞0.05).There were significant differences in the course of DM,DF,levels of HbAlc,LDL-C,CRP and PCT be-tween patients with CC genotype and patients with TT+TC genotype(P＜0.05).CC genotype,DM dura-tion ≥9 years,DF duration ≥5 months,HbAlc＜5.00％,LDL-C≥3.03 mmol/L,CRP≥23.25 mg/mL,PCT≥0.87 ng/mL were risk factors for recurrent infec-tion in DF patients(P＜0.05).HbAlc,LDL-C,CRP and PCT all showed interaction with TLR-9(1237 T/C)gene.The risk of recurrent infection in DF patients with abnormal HbAlc,LDL-C,CRP and PCT levels and TLR-9(1237 T/C)gene polymorphism interac-tion combination was 2.659 times higher than that in DF patients without the above combination,and the difference was statistically significant(P＜0.05).CONCLUSION:CC genotype and C allele of TLR-9 gene 1237 T/C are independent risk factors for re-current infection in DF patients.

AIM:To investigate the effect of Toll-like receptor 9(TLR-9)gene rs5743836(1237 T/C)single nucleotide polymorphism on recurrent infec-tion in patients with diabetic foot(DF).MEHTODS:A total of 128 DF patients admitted to our hospital from June 2020 to June 2022 were collected and di-vided into an infected group(n=53)and a non-in-fected group(n=75)according to the presence or absence of recurrent infection.The general data and TLR-9 gene polymorphism were compared be-tween the two groups.The genotypes and allele frequencies of TLR-9(1237 T/C)gene polymor-phism were detected and compared between the two groups.Logistic regression was used to analyze the correlation between TLR-9 gene 1237 T/C poly-morphism and recurrence of DF patients.RESULTS:There were significant differences between the two groups in invasive operation,course of antibiotic use and peripheral vascular disease of both lower limbs(P＜0.05).The wild type TT homozygote pro-duced two fragments of 108 bp and 27 bp in length,the variant CC homozygote produced three fragments of 60 bp,48 bp and 27 bp in length,and the heterozygous TC produced four fragments of 108 bp,60 bp,48 bp and 27 bp in length.The TLR-9(1237 T/C)gene identity was 100％.The genotype frequencies met the Hardy-Weinberg genetic equi-librium(P＞0.05).There were significant differences in CC gene frequency,TC gene frequency,TT gene frequency,C gene distribution and T gene distribu-tion between the two groups(P＜0.05).Logistic re-gression analysis showed that TLR-9 CC genotype increased the risk of recurrent infection in DF pa-tients in the co-dominant model(OR=5.357,95％CI:1.901-15.100).After adjusting for sex,age and smoking(OR=5.341,95％CI:1.874-15.015,P＜0.01),the C allele significantly increased the risk of recur-rent infection in DF patients(OR=2.328,95％CI:1.874-15.015,P＜0.01).1.078-5.936),and the differ-ence was statistically significant(P＜0.01).The TT genotype and CC+TC genotype of TLR-9 were not significantly associated with smoking history,Wag-ner grade,peripheral neuropathy,retinopathy,hy-pertension,osteoporosis and lower extremity arte-riosclerosis obliterans in DF patients(P＞0.05).There were significant differences in the course of DM,DF,levels of HbAlc,LDL-C,CRP and PCT be-tween patients with CC genotype and patients with TT+TC genotype(P＜0.05).CC genotype,DM dura-tion ≥9 years,DF duration ≥5 months,HbAlc＜5.00％,LDL-C≥3.03 mmol/L,CRP≥23.25 mg/mL,PCT≥0.87 ng/mL were risk factors for recurrent infec-tion in DF patients(P＜0.05).HbAlc,LDL-C,CRP and PCT all showed interaction with TLR-9(1237 T/C)gene.The risk of recurrent infection in DF patients with abnormal HbAlc,LDL-C,CRP and PCT levels and TLR-9(1237 T/C)gene polymorphism interac-tion combination was 2.659 times higher than that in DF patients without the above combination,and the difference was statistically significant(P＜0.05).CONCLUSION:CC genotype and C allele of TLR-9 gene 1237 T/C are independent risk factors for re-current infection in DF patients.

Objective:To investigate the clinical effect on sural neurovascular flap of small saphenous vein super drainage in reconstruction of soft tissue defects in foot and ankle.Methods:A retrospective case study was conducted to analyse the data of 22 patients who had transfer of sural neurovascular flaps of small saphenous vein with super drainage for reconstruction of soft tissue defects in foot and ankle in the Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University from June 2018 to September 2023. The patients were 19 males and 3 females aged from 16 to 70 years, with an average age of 39.0 years. Seven patients had the injury caused by compression cut, 2 of car accident, 4 of falling from height, 8 of infective wound and 1 of burning scar. The flaps were 7.0 cm × 5.0 cm - 15.0 cm × 9.0 cm in size. High frequency CDU was employed before surgery to detect the velocity of blood flow of the super drainage small saphenous vein. The patients who received transfer of sural neurovascular flap of small saphenous vein super drainage were entered in scheduled follow-up at outpatient clinic or via telephone interviews after surgery to observe the flap appearance, healing of donor and recipient sites, and the function of the affected limb. High frequency CDU was used to detect the velocity of blood flow of the small saphenous vein super drainage in follow-up.Results:All patients were included in the postoperative follow-up for 8-36 months, with an average of 20.15 months. Twenty-one flaps survived completely. One flap had partial necrosis at the edge. High frequency CDU detected an average velocity of blood flow at 2.80 cm/s in the small saphenous vein super drainage. The flaps had good colour and texture without swelling, and the wound in the recipient site healed well. The function of the affected limb was evaluated according to the functional assessment criteria of American Orthopaedic Foot and Ankle Society (AOFAS), with 21 patients in excellent and 1 in good. All patients had gained normal ankle function.Conclusion:The sural neurovascular flap with a super perfused small saphenous vein can establish effective venous reflux, reduce the risk of distal necrosis of the flap, and is an effective method for reconstruction of soft tissue defects around foot and the ankle.

Objective:To preliminarily explore and compare the efficacy of free fibular flap transfer with vascular anastomosis and Ilizarov bone transport in treatment of infected bone defects after internal fixation of humeral fractures.Methods:A retrospective analysis was conducted on 29 patients who were treated by transfer of free fibular flap and Ilizarov bone transport for infected nonunion of humeral fractures after internal fixation in the Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University between January 2017 and January 2023. Twelve patients with humeral defects at 4.0 - 6.0 cm in length (5.1 cm in average) were treated with free fibular flap transfer (flap transfer group) and 17 patients with humeral defect at 6.0-10.0 cm in length (7.3 cm in average) were treated by Ilizarov bone transport (bone transport group). All patients were included in the scheduled postoperative follow-up through a combination of outpatient visits and WeChat and telephone interviews. Follow-up included observation of humeral X-ray and shoulder-elbow function. Data were analysed using SPSS 27.0. Homogeneity tests were conducted on the basic data of the 2 groups, such as age, gender, length of bone defect, bone healing time and follow-up period. P<0.05 was considered statistically significant for the difference. Results:All 29 patients had completed the postoperative follow-up that lasted 8-89 months with 41.3 months in average. The lengths of bone defects were 5.2 cm±0.5 cm and 7.0 cm±1.2 cm, the bone healing time was 6.4 months±1.8 months and 14.2 months±4.6 months, and the follow-up time was 17.6 months±6.8 months and 34.4 months ±18.2 months in flap transfer group and bone transport group, respectively. Constant-Murley shoulder score was recorded of 86.0 ± 8.6 and 82.4±10.0 respectively for flap transfer group and bone transport group. Enneking Lower Extremity Functional Score in the flap transfer group was 25.0 ± 3.4, while that for bone transport group was not evaluated due to the absence of lower extremity surgery. There were statistically significant differences in bone defects, bone healing time, and follow-up time between the 2 groups ( P<0.01). There was no statistically significant differences in Constant-Murley shoulder score between the 2 groups ( P>0.05). However, in the flap transfer group, 1 patient developed a haematoma at fibular donor site after surgery, and the haematoma was removed in a secondary surgery, after which the surgical site healed smoothly. The external fixator had gone loose in 1 patient and resulted in a fracture of the transferred fibula. After the external fixator was re-fixed, the fracture healed at 8 months after surgery, and the external fixator was removed at 10 months after surgery. In the bone transport group, 3 patients had poor bone healing at fracture ends. Two patients had axial shifting of bones, the external fixator was adjusted during the bone transport process to correct the bone shifting. One patient suffered an incomplete radial nerve injury, and the radial nerve exploration and release surgery was performed. For that patient, an improvement of muscle strength was seen at 3 months and the wrist and digital extensions regained at 7 months after the radial nerve release surgery. The rest of humeri healed smoothly. Conclusion:In treatment of an infected humeral defect, it was found that a bone transport might be a better option for a larger humeral defect, while the free fibular flap transfer would be more suitable for a smaller humeral defect.

Objective:To investigate the clinical effect of two types of free gracilis musculocutaneous flap in transverse or vertical for reconstruction of the complex wound in calf.Methods:A retrospective series case study was conducted to analyse the clinical data of 22 patients who were treated in the Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University for complex single wounds in calf from August 2019 to January 2023. The patients were 12 males and 10 females and aged 26-58 years old, with 46.7 years old in average. There were 12 wounds on the left calf and 10 on the right. Nine of the wounds were of car accident, 8 of iatrogenic complications, 3 of bone infection and 2 of tumour resection. The wounds sized at 10.0 cm× 5.0 cm - 15.0 cm×7.0 cm. Sixteen transverse gracilis myocutaneous flaps and 6 vertical gracilis myocutaneous flaps were designed and harvested to reconstruct complex wounds in calf. The flaps were 12.0 cm×6.0 cm - 22.0 cm×9.0 cm in size. Time for the gracilis myocutaneous flap harvesting and the time for whole surgery were recorded. The time for flap harvest was 40-60 minutes and the time for the whole surgery was 3- 5 hours. Flap donor sites were directly sutured. All patients were included in the regular postoperative follow-up at outpatient clinic or through telephone and WeChat interviews and the flap survival, long-term flap appearance, healing of donor and recipient sites and limb functions were observed.Results:All 22 flaps survived after surgery. One flap had a blue edge with blood oozing. Urgent surgical exploration revealed that embolization occurred at the anastomotic site between the great saphenous vein at the proximal end of the flap and the great saphenous vein at the recipient site. After removal of the thrombus, the veins were re-anastomosed and flap survived. All the donor sites healed in stage one and functioned well. All patients entered postoperative follow-up for 5-25 months, 14.42 months in average. The flaps were in satisfactory appearance with good texture. All recipient sites healed without complication. The infected wounds were controlled. Function of the limbs was evaluated according to the Punor functional assessment criteria with excellent for 15 patients, good for 5 and fair for 2.Conclusion:Application of free transverse and vertical layout of gracilis musculocutaneous flap is an effective method to reconstruct a complex wound in calf. The anastomosis of the great saphenous vein at the proximal end of the gracilis muscle flap with great saphenous vein or small saphenous vein at the recipient site can reduce the occurrence of venous occlusion.

Objective:To evaluate the efficacy of pedicled latissimus dorsi flaps in reconstruction of large soft tissue defects around elbow.Methods:From January 2012 to January 2022, 12 patients with large soft tissue defects around elbow received reconstructive surgery with pedicled latissimus dorsi flaps in Department of Microreconstructive Surgery, The First Affliliated Hospital of Xinjiang Medical University. Partial latissimus dorsi flaps were employed to reconstruct The soft tissue defects around the posterolateral side of elbow in 6 patients. Functional reconstruction of anteromedial soft tissue defect around elbow with functional latissimus dorsi myocutaneous flap combined with biceps muscle dynamic reconstruction was performed on other 6 patients. All patients were males and aged 18 to 57 years old, at 31.4 years old in average. Causes of injury: machine strangulation in 5 patients, traffic accident in 4 patients, machine crush in 2 patients, and fall from height in 1 patient. Injured sites: 5 patients had injury on right elbow and 7 on the left. The size of soft tissue defect ranged from 18.0 cm×10.0 cm to 51.0 cm×13.0 cm. The size of the flaps were at 30.0 cm×7.0 cm-55.0 cm×14.0 cm. The wounds at donor site were directly sutured. Follow-up included postoperative reviews via telephone, WeChat and visit to outpatient clinic. Mayo elbow performance scores(MEPS) at the last follow-up were recorded.Results:All 12 flaps survived, and all donor and recipient sites healed at stage I. The follow-ups lasted for 3 months to 2 years for all patients, with 18 months in average. Three months after operation, 1 patient underwent additional surgery for flap reduction due to a bloated flap and poor appearance. Six patients who received dynamic reconstruction myocutaneous flaps achieved grade IV in elbow flexion. Six patients with lateral elbow repaired with partial latissimus dorsi myocutaneous flap showed that the appearance of the flap was not bulky and had no effect on the flexion and extension function of the elbow joint. All flaps survived well at the last follow-up, with soft texture and colour close to the surrounding normal skin. All donor sites healed well, leaving only linear scars. Motion of all elbows was good. The MEPS at the final follow-up was(90.6±6.4), with 10 patients in excellent and 2 in good.Conclusion:According to the location of elbow joint soft tissue defect, different types of latissimus dorsi myocutaneous flaps are used for reconstruction, which can achieve good clinical results.

Objective:To explore the clinical effect of keystone flap (KF) on repair of soft tissue defects at the donor site after flap transfer.Methods:From October 2020 to December 2022, in the Department of Microsurgical Rapair of First Affiliated Hospital of Xinjiang Medical University, 12 patients were repaired with KF after transfer of flaps. There were 3 donor sites for lateral thigh myocutaneous flap, 3 for sural nerve nutrient vascular flap, 4 for latissimus dorsi myocutaneous flap and 2 for medial supramalleolar island flap. Size of the KF was 15.0 cm × 12.0 cm-30.0 cm × 20.0 cm. Types of KF were: 3 of type I, 5 of type IIA, 2 of type IIB and 2 of type Sydney Melanoma Unit (SMU) modification KF design. Four patients were reviewed by telephone follow-up, 5 by WeChat and 3 with outpatient clinic visits to observe the appearance of the transferred KF and postoperative complications. Appearance of flaps was scored and analysed using Vancouver Scar Scale (VSS) and Scar Cosmesis Assessment and Rating (SCAR) .Results:The average follow-up period was 15.9 (2-27) months. The colour and texture of the transferred KF were similar to that of the surrounding skin, together with good sensation recovery. No complication such as osteofascial compartment syndrome, necrosis, wound dehiscence and venous congestion occurred in all patients. At the final follow-up, the scores for VSS was 2.17±0.58 and the score for SCAR was 5.33±1.23, with satisfactory repairing outcomes.Conclusion:As a relay flap, the KF is a simple and effective flap for reconstruction of the defects at the donor site and it can avoid complications that can be caused by direct closure of the soft tissue defect or a wound dehiscence after skin grafting.