ObjectiveTo summary the application and effectiveness of the posterior radial collateral artery (PRCA) compound flap in reconstruction of soft tissue defect after tongue cancer excision. MethodsBetween August 2011 and October 2011, 5 patients with squamous cell carcinoma underwent tongue defects reconstruction with compound flap with extended lateral arm free flap (ELAFF) and triceps muscle flap (TMF) after ablation in one-stage. All patients were male with an average age of 59 years (range, 43-71 years). The disease duration was 25-60 days (mean, 42 days). After extended resection, 3 cases had 1/3 tongue and mouth floor defect, and 2 cases had 1/2 tongue and mouth floor defect. The size of ELAFF ranged from 7 cm × 5 cm to 9 cm × 5 cm, and the size of TMF ranged from 3 cm × 3 cm to 4 cm × 4 cm. The donor sites were directly sutured. ResultsAll compound flaps survived. The wounds at donor sites and recipient sites healed primarily. The patients were followed up 6 months. After operation, the tongue had good appearance and motion; the patients had clear voice and no dysphagia. No recurrence was observed during follow-up. Local numbness appeared at the donor sites, but the function of the elbows was normal. ConclusionThe application of the compound flap of ELAFF and TMF based on PRCA perforator is a better option to reconstruct tongue defects for its reliable blood supply, appropriate thickness, easy operative procedures, and less complication.
Objective To analysis the electrophysiological dominance weight of the triceps brachii muscle/extensordigitorum communis muscle innervated by brachial plexus and to conclude its effect on the ipsilateral C7 transfer so as to offer electrophysiological data for the safety and indication of i psilateral C7 transfer. Methods From August 2007 to October 2007, 15 patients with complete brachial plexus nerve root avulsion received contralateral C7 transfer. There were 13 males and 2 females aged 18-49 years (28 years on average). Injury was caused by fall ing in 1 case, by crush in 2 cases and by traffic accident in 12 cases, involving left side in 8 cases and right side in 7 cases. The upper, middle and lower trunk of the brachial plexus were stimulated respectively, the compound muscle action potential (CMAP) at the triceps brachii muscle/extensor digitorum communis muscle was recorded, and then the electrophysiological dominance weight of the triceps brachii muscle/extensor digitorum communis muscle innervated by brachial plexus was confirmed according to the comparison of the ampl itude percentage of the CMAP by three trunks. The muscle strength of triceps brachii muscle/extensor digitorum communis muscle was evaluated and the electromyogram was taken 6 months after operation. Results All patients were followed up for 6 months. Concerning the electrophysiological dominance weight, the triceps brachii muscle was mainly innervated by uppermiddle trunk in 3 cases (20%), by middle-lower trunk in 3 cases (20%), by whole trunk in 7 cases (47%) and by middle trunk in 2 cases (13%). While the extensor digitorum communis muscle was mainly innervated by middle-lower trunk in 3 cases (20%), by whole trunk in 10 cases (67%) and by lower trunk in 2 cases (13%). Concerning the triceps brachii muscle, 2 patients got the muscle strength of 4 grade with recruitment simple phase at 1 month after operation and returned to normal at 3 month after operation, while 13 patients got the muscle strength of 5 grade with recruitment simple or mixed phase at 1 month after operation. Concerning the extensor digitorum communis muscle, the muscle strength and the recruitment phase of all 15 patients recovered to normal at 1 month after operation. Conclusion To patients with various kinds of electrophysiological dominance weight, the cutting of C7 does not substantially damage the triceps brachii muscle or extensor digitorum communis muscle, indicating that the ipsilateral C7 transfer is safe and feasible. However, it should be appl ied prudently for the patients with high dominance weight since it may result in the short-term decrease of triceps brachii muscle strength.
OBJECTIVE: To study the morphological character of long head of triceps muscle for clinical application in reconstruction of shoulder abduction. METHODS: Forty-four upper extremities of fixed human adult cadavers were carefully dissected. The origins and the pedicles of blood vessels and nerves of long head of triceps muscle, as well as the maximum available size of the muscles, were measured. Six cases of clinical application of long head of triceps muscle for reconstruction of shoulder abduction were followed up for 3 to 11 months. RESULTS: The origins in the dorsal side of long head of triceps muscle were muscular and the ventral side were tendinous, which was 7.6 to 13.3 cm in length and 1.6 to 3.4 cm in width. The distance from the origin to the neurovascular pedicle was 5.7 to 11.4 cm. The radial nerve, which innervated the muscles, could be dissected for 2.9 to 11.8 cm in length. The blood supplies to the triceps muscle were from humeral artery (43.2%), 1.0 to 6.0 cm in length and 1.6 to 2.4 mm in diameter, and from humeral profundus artery (45.5%), 1.5 to 4.4 cm in length and 0.9 to 2.4 mm in diameter, if the vessel was separated to the humeral artery, the length was 1.5 to 6.3 cm. The neurovascular pedicles were multiple branched. In the 6 cases of clinical application of the triceps muscles, the operated shoulder could abduct from 5 degrees preoperatively (0 degree to 10 degrees) to 77.3 degrees (50 degrees to 90 degrees) postoperatively. CONCLUSION: In accordance to the anatomical character of the triceps muscles, the long head of triceps muscle is a suitable choice for reconstruction of shoulder abduction with optimistic outcomes.