Objective:To discusses the feasibility and clinical efficacy of the chimeric musculocutaneous flap pedicled with a superior gluteal artery perforator (SGAP) in treatment of Grade Ⅳ pressure sore around ischial tuberosity.Methods:A retrospective case study was conducted on 8 patients with Grade Ⅳ pressure sores around ischial tuberosity and treated in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University from May 2019 to June 2023. The patients included 5 males and 3 females, aged 66.8 (40-78) years. All patients had paraplegia for 2 months to 10 years (mean, 59.2 months) and were complicated with hypoproteinemia. Two of the patients were also with sepsis. History of the Grade Ⅳ pressure sore was up to 1 month to 3.5 years (mean, 19.3 months). The sores were located on the right hip in 5 patients and left hip in 3 patients. The tissue defects of the pressure sore measured at 5 cm×5 cm to 6 cm×9 cm in size and all extended to the ischial tuberosity. Chimeric musculocutaneous flaps pedicled with a SGAP were used in the treatment of defect. The flap size ranged from 4 cm×8 cm to 7 cm×15 cm, and the muscular flap were at 8 cm×4 cm×2 cm to 14 cm×7 cm×5 cm in size. The muscular flaps were used to fill the cavities formed by the ulcer, while the flaps were used to cover the wounds. Donor and recipient site were sutured directly. The postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews, and focused on evaluations of flap survival, complications, flap appearance and the recurrence of ulcer.Results:All the 8 flaps survived. All patients were included in the 3 to 16 months of postoperative follow-up, with 11.8 months in average. One flap had a partial edge split due to excessive pressure during negative pressure drainage, and healed after debridement and re-suture. Otherwise, the rest of 7 patients had primary healing at both the donor and recipient sites. All flaps had good appearance without ulceration, infection or recurrence of pressure sore.Conclusion:The chimeric musculocutaneous flap pedicled with SGAP offers a reliable blood supply, flexible rotation and sufficient tissue volume. It can be used to effectively reconstruct Grade Ⅳ pressure sore around ischial tuberosity with a reliable clinical effect.

Objective:To investigate the surgical technique and clinical outcomes of the tri-lobed chain medial plantar perforator flaps for reconstruction of soft tissue defects in palmar hand.Methods:A retrospective analysis was conducted on 6 patients (4 males and 2 females; aged 21-63 years with mean age of 39.2 years) who had soft tissue defects in palmar hands and were reconstructed with tri-lobed chain medial plantar perforator flaps in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University between July 2024 and April 2025. All defects were located on palmar aspect of the injured hands. Following admission, debridement, fracture reduction and fixation and tendon repairs were carried out in primary surgery for 5 patients who had traumatic injuries with digital or metacarpal fractures and tendon ruptures, and stage-II surgery for soft tissue reconstruction was conducted at 7-9 days later. The patient with scar contracture received preoperative evaluation then followed by a scar excision and release surgery, prior to a reconstructive surgery for soft tissue defects. Four patients presented with multi-site defects, of whom, 1 patient had proximal phalangeal defects of index and middle fingers and a defect of metacarpophalangeal joint of ring finger, 1 patient had a defect of metacarpophalangeal joint of index finger and defects of proximal phalanges of middle and ring fingers, 1 patient had defects of proximal phalanges of index, middle and little fingers, and 1 patient had defects of proximal phalanges of middle, ring and little fingers. Of the patients with finger defects, the sizes of defect ranged from 2.0 cm ×1.8 cm to 6.0 cm×2.8 cm and the defects were reconstructed with individually harvested tri-lobed chain medial plantar perforator flaps. Two patients had soft tissue defects in palmar hands and they were measured at 6.0 cm×5.5 cm and 6.0 cm×7.0 cm in size. The palmar defects were reconstructed using combined tri-lobed chain flaps with the sizes of individual lobulated flap ranging from 2.1 cm×1.9 cm to 6.0 cm×2.9 cm. All foot donor sites were primarily closed with interrupted sutures. Postoperative management included routine anti-inflammatory, anticoagulant and antispasmodic treatment. Patients were discharged at 8-10 days after surgery and the postoperative follow-ups were conducted at outpatient clinic to monitor flap survival, contour, hand function, donor site healing, scar formation and foot function.Results:All flaps survived with primary healing of donor sites. Over the 1 to 9 (mean 6.1) months of postoperative follow-up, all flaps survived well with colour and thickness matching with the surrounding hand skin. At 6 months after surgery, two-point discrimination (TPD) of flaps achieved to 8-11 (mean 8.6) mm. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 4 patients achieved function recovery of fingers in excellent and 2 in good. Donor sites exhibited linear scars without painful scarring or paraesthesia, with normal ankle function and gaits.Conclusion:Tri-lobed medial plantar perforator flaps can be used to reconstruct soft tissue defects in palmar hand with primary and direct closure of the flap donor sites. They can simultaneously reconstruct multiple or a large defects, and provide satisfactory aesthetic and functional outcomes. It is a feasible surgical option.

Objective:To discusses the feasibility and clinical efficacy of the chimeric musculocutaneous flap pedicled with a superior gluteal artery perforator (SGAP) in treatment of Grade Ⅳ pressure sore around ischial tuberosity.Methods:A retrospective case study was conducted on 8 patients with Grade Ⅳ pressure sores around ischial tuberosity and treated in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University from May 2019 to June 2023. The patients included 5 males and 3 females, aged 66.8 (40-78) years. All patients had paraplegia for 2 months to 10 years (mean, 59.2 months) and were complicated with hypoproteinemia. Two of the patients were also with sepsis. History of the Grade Ⅳ pressure sore was up to 1 month to 3.5 years (mean, 19.3 months). The sores were located on the right hip in 5 patients and left hip in 3 patients. The tissue defects of the pressure sore measured at 5 cm×5 cm to 6 cm×9 cm in size and all extended to the ischial tuberosity. Chimeric musculocutaneous flaps pedicled with a SGAP were used in the treatment of defect. The flap size ranged from 4 cm×8 cm to 7 cm×15 cm, and the muscular flap were at 8 cm×4 cm×2 cm to 14 cm×7 cm×5 cm in size. The muscular flaps were used to fill the cavities formed by the ulcer, while the flaps were used to cover the wounds. Donor and recipient site were sutured directly. The postoperative follow-ups were conducted at outpatient clinic and via telephone and WeChat interviews, and focused on evaluations of flap survival, complications, flap appearance and the recurrence of ulcer.Results:All the 8 flaps survived. All patients were included in the 3 to 16 months of postoperative follow-up, with 11.8 months in average. One flap had a partial edge split due to excessive pressure during negative pressure drainage, and healed after debridement and re-suture. Otherwise, the rest of 7 patients had primary healing at both the donor and recipient sites. All flaps had good appearance without ulceration, infection or recurrence of pressure sore.Conclusion:The chimeric musculocutaneous flap pedicled with SGAP offers a reliable blood supply, flexible rotation and sufficient tissue volume. It can be used to effectively reconstruct Grade Ⅳ pressure sore around ischial tuberosity with a reliable clinical effect.

Objective:To investigate the surgical technique and clinical outcomes of the tri-lobed chain medial plantar perforator flaps for reconstruction of soft tissue defects in palmar hand.Methods:A retrospective analysis was conducted on 6 patients (4 males and 2 females; aged 21-63 years with mean age of 39.2 years) who had soft tissue defects in palmar hands and were reconstructed with tri-lobed chain medial plantar perforator flaps in the Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University between July 2024 and April 2025. All defects were located on palmar aspect of the injured hands. Following admission, debridement, fracture reduction and fixation and tendon repairs were carried out in primary surgery for 5 patients who had traumatic injuries with digital or metacarpal fractures and tendon ruptures, and stage-II surgery for soft tissue reconstruction was conducted at 7-9 days later. The patient with scar contracture received preoperative evaluation then followed by a scar excision and release surgery, prior to a reconstructive surgery for soft tissue defects. Four patients presented with multi-site defects, of whom, 1 patient had proximal phalangeal defects of index and middle fingers and a defect of metacarpophalangeal joint of ring finger, 1 patient had a defect of metacarpophalangeal joint of index finger and defects of proximal phalanges of middle and ring fingers, 1 patient had defects of proximal phalanges of index, middle and little fingers, and 1 patient had defects of proximal phalanges of middle, ring and little fingers. Of the patients with finger defects, the sizes of defect ranged from 2.0 cm ×1.8 cm to 6.0 cm×2.8 cm and the defects were reconstructed with individually harvested tri-lobed chain medial plantar perforator flaps. Two patients had soft tissue defects in palmar hands and they were measured at 6.0 cm×5.5 cm and 6.0 cm×7.0 cm in size. The palmar defects were reconstructed using combined tri-lobed chain flaps with the sizes of individual lobulated flap ranging from 2.1 cm×1.9 cm to 6.0 cm×2.9 cm. All foot donor sites were primarily closed with interrupted sutures. Postoperative management included routine anti-inflammatory, anticoagulant and antispasmodic treatment. Patients were discharged at 8-10 days after surgery and the postoperative follow-ups were conducted at outpatient clinic to monitor flap survival, contour, hand function, donor site healing, scar formation and foot function.Results:All flaps survived with primary healing of donor sites. Over the 1 to 9 (mean 6.1) months of postoperative follow-up, all flaps survived well with colour and thickness matching with the surrounding hand skin. At 6 months after surgery, two-point discrimination (TPD) of flaps achieved to 8-11 (mean 8.6) mm. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 4 patients achieved function recovery of fingers in excellent and 2 in good. Donor sites exhibited linear scars without painful scarring or paraesthesia, with normal ankle function and gaits.Conclusion:Tri-lobed medial plantar perforator flaps can be used to reconstruct soft tissue defects in palmar hand with primary and direct closure of the flap donor sites. They can simultaneously reconstruct multiple or a large defects, and provide satisfactory aesthetic and functional outcomes. It is a feasible surgical option.

OBJECTIVE: To explore the feasibility and effectiveness of a foldable pedicled latissimus dorsi myocutaneous flap to repair soft tissue defects in the shoulder and back. METHODS: Between August 2018 and January 2023, the foldable pedicled latissimus dorsi myocutaneous flaps were used to repair soft tissue defects in the shoulder and back of 8 patients. There were 5 males and 3 females with the age ranged from 21 to 56 years (mean, 35.4 years). Wounds were located in the shoulder in 2 cases and in the shoulder and back in 6 cases. The causes of injury were chronic infection of skin and bone exposure in 2 cases, secondary wound after extensive resection of skin and soft tissue tumor in 4 cases, and wound formation caused by traffic accident in 2 cases. Skin defect areas ranged from 14 cm×13 cm to 20 cm×16 cm. The disease duration ranged from 12 days to 1 year (median, 6.6 months). A pedicled latissimus dorsi myocutaneous flap was designed and harvested. The flap was divided into A/B flap and then were folded to repair the wound, with the donor area of the flap being pulled and sutured in one stage. RESULTS: All 7 flaps survived, with primary wound healing. One patient suffered from distal flap necrosis and delayed healing was achieved after dressing change. The incisions of all donor sites healed by first intention. All patients were followed up 6 months to 4 years (mean, 24.7 months). The skin flap has a good appearance with no swelling in the pedicle. At last follow-up, 6 patients had no significant difference in bilateral shoulder joint motion, and 2 patients had a slight decrease in abduction range of motion compared with the healthy side. The patients' daily life were not affected, and linear scar was left in the donor site. CONCLUSION The foldable pedicled latissimus dorsi myocutaneous flap is an ideal method to repair the soft tissue defect of shoulder and back with simple operation, less damage to the donor site, and quick recovery after operation.
Male ; Female ; Humans ; Young Adult ; Adult ; Middle Aged ; Plastic Surgery Procedures ; Myocutaneous Flap/surgery* ; Shoulder/surgery* ; Skin Transplantation ; Superficial Back Muscles/transplantation* ; Soft Tissue Injuries/surgery* ; Wound Healing ; Treatment Outcome ; Perforator Flap

Objective:To explore the feasibility and clinical effect of a combined perforator flap that was perfused by dual perforators of lateral circumflex femoral artery and superficial circumflex iliac artery in reconstruction of limb wounds in children.Methods:A retrospective study was conducted on the childre treated in the Department of Plastic Surgery and Burms, the Affiliated Hospital of Zunyi Medical University from February 2019 to June 2023. Limb wounds of 6 children were treated by combined perforator flaps that carried dual perforators of lateral circumflex femoral artery and superficial circumilex iliac artery. The children were 4 boys and 2 girls of 2-12 years with an average of 6.8 years. The sizes of defect weres 19.0 cm×5.0 cm-28.0 cm×6.0 cm and all were reconstructed with the combined perforator flaps sized 20.0 cm×6.0 cm-30.0 cm×7.0 cm. Proximal vessels of the limb defect were end-to-side anastomosed with the pedicle vessels carried by the flap, and distal vessels of the limb defect were end-to-side or end-to-end anastomosed with the pedicle vessels carried by the flap. The flap recipient sites were sutured in stage I surgery. After the surgery, regular follow-ups were carried out at outpatient clinics, and via telephone and WeChat reviews. Wound healing, flap survival and functional recovery were observed.Results:All 6 flaps survived successfully. One donor site had a partial rupture, and healed after stage II debridement and sutures. The remaining 5 donor sites all achieved a stage I healing. All children were entered the postoperative follow-up for 6-16 months, with an average of 13.7 months. All flaps survived well without obvious swelling, and in satisfactory appearance without complication such as a rupture or an infection. Linear scars were left in the donor sites with soft edges without obvious contractures. Limb functions were not affected.Conclusion:The combined perforator flap perfused by dual perforators of the lateral circumflex femoral artery and the superficial circumflex iliac artery has an extended length, and a reliable blood supply to the flap. It can cover a long and wide defect in a single stage of surgery with a good clinical effect.

Objective:To explore the clinical effects of nerve-carrying peroneal artery perforator flaps in repairing nerve defects in the late stage of wrist electric burns.Methods:This study was a retrospective observational study. From December 2019 to May 2023, five patients with sensory dysfunction in hands due to nerve defects in the late stage of wrist electric burns were treated in the Affiliated Hospital of Zunyi Medical University and met the inclusion criteria. There were 4 males and 1 female, aged 7 to 48 years. Four patients had defects in both median nerve and ulnar nerve, one patient had a defect solely in median nerve, and the length of nerve defects ranged from 5 to 12 cm. Four patients underwent transplantation of peroneal artery perforator flaps carrying sural nerve and superficial peroneal nerve, and 1 patient underwent transplantation of peroneal artery perforator flap only carrying sural nerve. The wounds in flap donor sites were all directly sutured. One patient had tendon adhesion and release of tendon adhesion was performed during the same surgery; 3 patients had combined defects in the wrist flexor muscle group, including 2 patients received autologous tendon grafting during the same surgery, and one patient received reconstruction of finger flexion function with a gracilis myocutaneous flap in the second stage; 1 patient had combined wrist flexion contracture which was surgically released in the second stage. During follow-up after surgery, the survival of the flaps was observed, and the healing time of the incisions or sutures in flap donor and recipient sites and the recovery time of hand sensation were recorded. At the last follow-up, the scar formation and loss of sensation in the foot were observed, and flexor strength and sensory function of the fingers were evaluated based on the evaluation criteria for tendon and nerve repair standards of hands in the trial standards for evaluation of partial function of the upper extremity by the Hand Surgery Society of Chinese Medical Association.Results:All patients were followed up after surgery for 12 to 24 months, and all flaps of patients survived. The healing time for the incisions or sutures in flap donor and recipient sites was about 2 weeks, and the hand sensation recovered in 6 months after surgery. At the last follow-up, linear scar was left in the donor site on the lower leg; patients had partial sensory impairment on the dorsum of the foot, but there was no skin ulceration, which did not affect wearing shoes or walking; finger flexor strength was rated as grade 4 in 1 patient, grade 3 in 3 patients, and grade 2 in 1 patient; the sensory function of hands was evaluated as S3 + level in 4 patients, with the two-point discrimination distance of the skin ranging from 8 to 11 mm, while the sensory function of hands was evaluated as S3 level in 1 patient, with the two-point discrimination distance of the skin of 13 mm. Conclusions:Using the nerve-carrying peroneal artery perforator flaps to repair the nerve defects in the late stage of wrist electric burns, the sensation of hands can be restored in 6 months after surgery, with only linear scar in the flap donor sites and hypoesthesia in some areas of the dorsum of the foot. When combined with the reconstruction of finger flexion function, the overall function of hands can be effectively improved.

Objective:To explore the feasibility and clinical effect of a combined perforator flap that was perfused by dual perforators of lateral circumflex femoral artery and superficial circumflex iliac artery in reconstruction of limb wounds in children.Methods:A retrospective study was conducted on the childre treated in the Department of Plastic Surgery and Burms, the Affiliated Hospital of Zunyi Medical University from February 2019 to June 2023. Limb wounds of 6 children were treated by combined perforator flaps that carried dual perforators of lateral circumflex femoral artery and superficial circumilex iliac artery. The children were 4 boys and 2 girls of 2-12 years with an average of 6.8 years. The sizes of defect weres 19.0 cm×5.0 cm-28.0 cm×6.0 cm and all were reconstructed with the combined perforator flaps sized 20.0 cm×6.0 cm-30.0 cm×7.0 cm. Proximal vessels of the limb defect were end-to-side anastomosed with the pedicle vessels carried by the flap, and distal vessels of the limb defect were end-to-side or end-to-end anastomosed with the pedicle vessels carried by the flap. The flap recipient sites were sutured in stage I surgery. After the surgery, regular follow-ups were carried out at outpatient clinics, and via telephone and WeChat reviews. Wound healing, flap survival and functional recovery were observed.Results:All 6 flaps survived successfully. One donor site had a partial rupture, and healed after stage II debridement and sutures. The remaining 5 donor sites all achieved a stage I healing. All children were entered the postoperative follow-up for 6-16 months, with an average of 13.7 months. All flaps survived well without obvious swelling, and in satisfactory appearance without complication such as a rupture or an infection. Linear scars were left in the donor sites with soft edges without obvious contractures. Limb functions were not affected.Conclusion:The combined perforator flap perfused by dual perforators of the lateral circumflex femoral artery and the superficial circumflex iliac artery has an extended length, and a reliable blood supply to the flap. It can cover a long and wide defect in a single stage of surgery with a good clinical effect.

Objective:To explore the value of clinical application of the infrared ray thermal imaging (IRTI) combined with the method of "two longitudinal and five transverse lines" in locating the perforators in the transfer of free anterolateral thigh perforator flap (ALTPF) in children.Methods:From November 2018 to November 2022, 13 children (8 boys and 5 girls) aged 2 to 12 years old (6.3 years old in average) who received free ALTPF transfers were included in this study. Causes of injury were 6 by car accidents, 2 by falls, 3 by crushing injuries and 2 by burning scars. Injury sites were 2 in head, 1 in trunk, 5 in hand and 5 in ankle. The size of soft tissue defect was 2.0 cm×4.2 cm-9.0 cm×16.0 cm, and the size of ALTPF was 2.3 cm×4.5 cm-6.0 cm×20.0 cm. The remaining wound was covered with medium thick skin grafts. IRTI combined with the method of "two longitudinal and five transverse lines" was applied to preoperatively locate the pedicle and design the ALTPF. Intraoperatively, the pedicles were explored within the region of anterolateral thigh. The rate of perforrator location and sensitivity of the infrared thermography were calculated. All donor sites were directly sutured. Standard postoperative management included anti-infection, anti-coagulation, anti-convulsion and blood volume expansion with adequate warming. Regular outpatient follow-ups were conducted through various means such as home visits, telephone calls, WeChat and text messages to observe flap survival and donor site healing.Results:All 13 patients completed the 3 to 35 (11.0±1.5) months of postoperative follow-up. All 13 flaps survived well, with good colour and texture, and without obvious bloating. Only one bloated flap had a local repair at the inner ankle with a flap thinning surgery in the stage Ⅱ surgery. Then all flaps achieved satisfaction appearance in all patients. All the donor sites healed at stage I. Two patients showed significant early scar hypertrophy in the donor site, which then gradually stabilised 12 months later. All patients had good functional recovery. Before surgery, a total of 38 perforators were discovered and 40 perforators were found intraoperatively. Of the 40 perforators, 3 were not explored before operation, which were located in the proximal part of Zone Ⅰ, Zone Ⅲ and Zone Ⅳ, respectively. The sensitivity of infrared thermography was found at 92.5% in preoperative detection and location of perforators, with a positive prediction at 97.3%.Conclusion:IRTI combined with the method of "two longitudinal and five transverse lines" in locating perforators is safe and reliable in the design of ALTPFs in children. It provides an additional and reliable option for location of perforator in the design and harvesting of ALTPFs in children.

OBJECTIVE: To investigate the effectiveness of tibial transverse transport (TTT) combined with modified neurolysis in treatment of diabetic foot ulcer (DFU) through a prospective randomized controlled study. METHODS: The patients with DFU and diabetic peripheral neuropathy, who were admitted between February 2020 and February 2022, were selected as the research objects, of which 31 cases met the selection criteria and were included in the study. The patients were divided into two groups by random number table method. The 15 patients in the trial group were treated with TTT combined with modified neurolysis, and the 16 patients in the control group received treatment with TTT alone. There was no significant difference in gender, age, duration of DFU, ulcer area, Wagner classification, as well as preoperative foot skin temperature, visual analogue scale (VAS) score, ankle-brachial index (ABI), motor nerve conduction velocity (MNCV) of the common peroneal nerve, MNCV of the tibial nerve, MNCV of the deep peroneal nerve, two-point discrimination (2-PD) of heel, and cross-sectional area (CSA) of the common peroneal nerve between the two groups ( P>0.05). The time for ulcer healing, foot skin temperature, VAS scores, ABI, 2-PD of heel, and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups. The differences in MNCV of the common peroneal nerve, MNCV of the tibial nerve, and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated. RESULTS: All patients in both groups were followed up 12-24 months (mean, 13.9 months). The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase. Ulcer wounds in both groups healed successfully, and there was no significant difference in the healing time ( P>0.05). During the follow-up, there was no ulcer recurrences. At 12 months after operation, the MNCV of the common peroneal nerve, the MNCV of the tibial nerve, and the MNCV of the deep peroneal nerve in both groups accelerated when compared to preoperative values ( P<0.05). Furthermore, the trial group exhibited a greater acceleration in MNCV compared to the control group, and the difference was significant ( P<0.05). The foot skin temperature, VAS score, ABI, 2-PD of heel, and CSA of the common peroneal nerve at 6 and 12 months after operation significantly improved when compared with those before operation in both groups ( P<0.05). The 2-PD gradually improved over time, showing significant difference ( P<0.05). The 2-PD of heel and VAS score of the trial group were superior to the control group, and the differences were significant ( P<0.05). There was no significant difference in ABI, foot skin temperature, and CSA of the common peroneal nerve between groups after operation ( P>0.05). CONCLUSION Compared with TTT alone, the TTT combined with modified neurolysis for DFU can simultaneously solve both microcirculatory disorders and nerve compression, improve the quality of nerve function recovery, and enhance the patient's quality of life.
Humans ; Diabetic Foot/surgery* ; Microcirculation ; Prospective Studies ; Quality of Life ; Treatment Outcome ; Diabetes Mellitus