On 25th September 2021, a patient was admitted in the Department of Hand Microsurgery, Chongqing Great Wall Orthopaedic Hospital with an infectious proximal tibia defect and soft tissue defect after the resection of a giant cell tumour of tendon sheath (GCTTS). After relevant examinations, it was found that there was a large bone defect at proximal medial tibia, with an extremely thin of medial tibial plateau. Size of bone defect was 8.0 cm×3.5 cm×3.0 cm, and soft tissue defect was 6.0 cm×8.0 cm. A phased surgery was planned: firstly, the internal fixation was removed with thorough debridement and then the cavity was filled by antibiotic bone cement for control of the infection; In the phase-Ⅱ surgery, a series of anterolateral thigh myocutaneous flap (the volume of the muscle flap was 6.0 cm×2.5 cm×2.0 cm, and the size of flap was 4.0 cm×9.0 cm) and an iliac bone flap were used and the cavity of medial proximal tibia was filled with calcium sulphate and anterolateral thigh muscle graft. A piece of iliac bone graft was transferred to support the tibial plateau, and the wound was covered by flap (the volume of the iliac bone fragment was 12.0 cm×5.0 cm×2.0 cm, and the size of flap was 4.0 cm×9.0 cm). At 3 years of postoperative follow-up, the fracture healed well, the cavity at medial proximal tibia was significantly reduced. Appearance of flaps was good with restored protective sensation. Function of the affected knee was close to normal with a score of 94 according to Lysholm Knee Scale.

On 25th September 2021, a patient was admitted in the Department of Hand Microsurgery, Chongqing Great Wall Orthopaedic Hospital with an infectious proximal tibia defect and soft tissue defect after the resection of a giant cell tumour of tendon sheath (GCTTS). After relevant examinations, it was found that there was a large bone defect at proximal medial tibia, with an extremely thin of medial tibial plateau. Size of bone defect was 8.0 cm×3.5 cm×3.0 cm, and soft tissue defect was 6.0 cm×8.0 cm. A phased surgery was planned: firstly, the internal fixation was removed with thorough debridement and then the cavity was filled by antibiotic bone cement for control of the infection; In the phase-Ⅱ surgery, a series of anterolateral thigh myocutaneous flap (the volume of the muscle flap was 6.0 cm×2.5 cm×2.0 cm, and the size of flap was 4.0 cm×9.0 cm) and an iliac bone flap were used and the cavity of medial proximal tibia was filled with calcium sulphate and anterolateral thigh muscle graft. A piece of iliac bone graft was transferred to support the tibial plateau, and the wound was covered by flap (the volume of the iliac bone fragment was 12.0 cm×5.0 cm×2.0 cm, and the size of flap was 4.0 cm×9.0 cm). At 3 years of postoperative follow-up, the fracture healed well, the cavity at medial proximal tibia was significantly reduced. Appearance of flaps was good with restored protective sensation. Function of the affected knee was close to normal with a score of 94 according to Lysholm Knee Scale.

Objective:To investigate the clinical effects of free dorsal interosseous artery perforator flaps in repairing multi-finger skin and soft tissue defects.Methods:The study was a retrospective observational study. From April 2020 to June 2022, 7 patients with multi-finger skin and soft tissue defects were admitted to the Department of Hand Microsurgery of the Chongqing Great Wall Orthopaedic Hospital, including 4 males and 3 females, aged 27 to 54 years. A total of 18 fingers were injured in 7 patients, of which 4 fingers were involved in 1 case, 3 fingers were involved in 2 cases, and 2 fingers were involved in 4 cases. The area of skin and soft tissue defects after stage Ⅰ debridement ranged from 3.0 cm×2.0 cm to 7.5 cm×3.0 cm. All the patients underwent stage Ⅰ debridement, stage Ⅱ interosseous dorsal artery perforator flap transplantation to repair the wound, and stage Ⅲ flap pedicle division and finger-split. The incision area of the flap was 4.0 cm×2.5 cm to 10.5 cm×3.5 cm. The interosseous dorsal artery was anastomosed with the proper digital artery by end to end, and the concomitant veins of 2 interosseous dorsal arteries were anastomosed with 2 superficial subcutaneous veins of the fingers by end to end. The donor area was treated by subcutaneous suture after full reduction of tension. The survival of flap after stage Ⅲ was observed. Follow-up was conducted once every 3 months after the stage Ⅲ operation to observe the appearance, texture, sensation of the operative areas in fingers, the range of motion of the finger joint, and the wound healing of the donor area. At the last follow-up, the function of fingers was assessed according to the trial standard of upper limb partial function assessment of the Hand Surgery Society of Chinese Medical Association.Results:All the flaps in 7 patients survived after stage Ⅲ operation. During follow-up of 6 to 36 months after stage Ⅲ operation, only 3 patients with bloated flap underwent the flap volume reduction operation in 3 months and later, and the finger appearance in the other patients recovered well. Only linear scar remained in the donor areas of 6 patients; 1 patient had scar hyperplasia in the donor area, which was significantly improved after laser treatment. At the last follow-up, the finger function was evaluated as excellent in 5 cases and good in 2 cases.Conclusions:The flaps pedicled with multiple interosseous dorsal artery perforators were used to repair multi-finger skin and soft tissue defects, and only one set of blood vessel needs to be anastomosed during the operation without damaging the main vessels, which reduces the incidence of postoperative vascular crisis. Besides, the procedure of finger-splitting operation is simple and the appearance and function in the donor and recipient areas are good. This method is worthy of clinical promotion.

Objective:To investigate the effect of inferior epigastric artery perforator flap transplantation in repairing traumatic soft tissue defects of lower limbs.Methods:A retrospective case series study was conducted to analyze the clinical data of 34 patients with traumatic soft tissue defects of lower limbs admitted to Chongqing Great Wall Hospital from January 2019 to May 2021, including 31 males and 3 females; aged 12-65 years [(38.5±5.6)years]. There were 8 patients with defects on the calf and 26 on the ankle. All wounds were found with exposed tendons, muscles and/or bones. The area of soft tissue defects ranged from 10 cm×6 cm to 40 cm×11 cm. All patients were repaired with inferior epigastric artery perforator flap. The wound healing, flap survival and recovery were observed. The visual analogue scale (VAS) and American Orthopedic Foot and ankle Society (AOFAS) ankle-hindfoot score were used to evaluate pain and ankle function before operation and at 3 days, 7 days, 14 days, 1 month, 3 months, 6 months and 12 months after operation. The complications were observed.Results:All patients were followed up for 12-36 months [(19.5±5.3)months]. All wounds were healed by stage I, showing the healing time of 14-24 days [(17.6±2.8)days]. All flaps survived with good color, soft texture and satisfactory appearance, with no obvious swelling. All flaps produced protective sensation. The VAS was (4.3±0.8)points, (3.3±0.7)points, (1.4±0.5)points, (1.2±0.3)points, (0.8±0.2)points and (0.4±0.1)points at 7 days, 14 days, 1 month, 3 months, 6 months and 12 months after operation, decreased gradually from preoperative (7.4±1.3)points (all P<0.05). The AOFAS ankle-hindfoot score was (35.6±3.1)points, (42.6±3.6)points, (50.3±4.3)points, (56.2±5.6)points, (60.3±6.8)points and (65.3±9.0)points at 7 days, 14 days, 1 month, 3 months, 6 months and 12 months after operation, increased from preoperative (22.4±2.5)points (all P<0.05). The ankle function was excellent in 25 patients, good in 5 and fair in 4 at 12 months after operation, with an excellent and good rate of 88.2%. Venous crisis occurred in 3 patients after operation, and the flaps survived completely after venous reanastomosis or venous bridging. Conclusion:For traumatic soft tissue defects of lower limbs, inferior epigastric artery perforator flap transplantation has advantages of enhanced survival of flaps, satisfactory appearance, attenuated pain, good functional recovery and few complications.