Objective To investigate the effectiveness of distally pedicled peroneus brevis muscle flaps and reverse sural neurovascular island flaps for post-traumatic chronic calcaneal osteomyelitis and soft tissue defects. Methods Between January 2008 and January 2012, 9 patients suffering from post-traumatic chronic calcaneal osteomyelitis and soft tissue defects were treated, including 8 males and 1 female with an average age of 33 years (range, 18-46 years). The left heel was involved in 4 cases, and right heel in 5 cases. Infection occurred after reduction and internal fixation of closed fractures of the calcaneus in 7 cases, and open calcaneal fracture and soft tissue defect in 2 cases. The disease duration was 2 months to 3 years (mean, 5 months). Purulent secretion, tissue necrosis, or sinus formation was observed in all wounds. The results of bacterial culture were positive. X-ray and CT examination showed uneven density of calcaneus and bone cavity or dead bone formation. After thorough debridement, the size of bone defect ranged from 3 cm × 3 cm × 3 cm to 6 cm × 4 cm × 3 cm; the size of soft tissue defect ranged from 7 cm × 3 cm to 12 cm × 7 cm. The distally pedicled peroneus brevis muscle flaps (11 cm × 3 cm-16 cm × 4 cm) were used for bone defect repair, and reverse sural neurovascular island flaps (8 cm × 4 cm-14 cm × 8 cm) for soft tissue defect. The donor site was directly sutured in 6 cases and repaired by skin graft in 3 cases. Results After operation, reverse sural neurovascular island flaps survived in 9 cases, and all wounds healed by first intention. No necrosis or liquefaction of distally pedicled peroneus brevis muscle flaps was observed. Incision at donor site healed by first intention, and skin grafts at donor site survived. All cases were followed up 6-24 months (mean, 13.5 months). The flaps had good texture. No recurrence of osteomyelitis was observed. Basic weight-bearing walking function was restorated. No obvious calcaneal collapse happened. Conclusion The distally pedicled peroneus brevis muscle flap combined with reverse sural neurovascular island flap is one of the effective methods to treat post-traumatic chronic calcaneal osteomyelitis with soft tissue defect, with the advantages of simple operation and good blood supply.
Objective To investigate the effectiveness of reverse island flaps of digital artery parallel for repairing degloved injuries of the fingerti p. Methods Between June 2008 and January 2010, 13 cases of degloved injuries of the fingertip were treated. There were 8 males and 5 females with an average age of 34 years (range, 19-62 years). The causes of injuries were as follow: impact and press injury in 5 cases, wringer injury in 7 cases, and crush injury in 1 case. The injured fingers were comprised of index finger in 6 cases, middle finger in 4 cases, ring finger in 2 cases, and l ittle finger in 1 case. The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm to 3.0 cm × 2.5 cm. Three cases compl icated by fracture of thedistal phalanx, 1 case by rupture of the insertion of extensor tendon, and 1 case by rupture of the insertion of flexor tendon. The average time from injure to surgery was 4 hours (range, 1 hour and 30 minutes-12 hours). Two neighboring skin flaps located in the same course of digital artery were adopted to repair defect of the fingertip. The size of proximal skin flap ranged from 1.2 cm × 1.0 cm to 2.0 cm × 1.5 cm and the size of distal skin flap ranged from 1.1 cm × 1.0 cm to 1.5 cm × 1.3 cm. The free skin grafts were used to repair the donor sites. Results Circulation crisis occurred in 1 case at 2 hours after operation and was el iminated by interval disconnecting. The other flaps and skin grafts survived and the wounds healed by first intention. The patients were followed up 6-18 months (mean, 10 months). All flaps presented the satisfactory appearance and texture, and the flexion and extension function of wounded fingers recovered to normal. Two-point discrimination ranged from 7 to 11 mm at last follow-up. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion Based on the anatomical features of communicating branches of distal interphalangeal joint, two neighboring flaps located in the same course of digital artery are adopted to repair soft tissue defect of the fingertip. This surgical method is a simple and effective method.
Objective To investigate the method and effectiveness of repairing fingertip defects with reverse island flappedicled with terminal dorsal branch of digital artery with sense reconstruction. Methods Between December 2008 and March2010, 32 patients (40 fingers) with fingertip defects were treated. There were 20 males (23 fingers) and 12 females (17 fingers), aged from 20 to 62 years (mean, 42 years). The time between injury and admission was from 1 to 8 hours. The injured fingers included thumb (2 cases), index finger (6 cases), index finger and middle finger (3 cases), middle finger (7 cases), middle finger and ring finger (3 cases),ring finger (8 cases), ring finger and little finger (2 cases), and little finger (1 case). The defect area ranged from 1.2 cm × 1.0 cm to 2.2 cm ×1.8 cm, and the flap area ranged from 1.5 cm × 1.0 cm to 2.5 cm × 2.0 cm. The fingertip defects were repaired by the reverse island flaps pedicled with terminal dorsal branch of digital artery and branch of digital nerve, and the branch of digital nerve was anastomosed withstump of proper digital nerve. The donor sites were repaired with free skin grafts. Results Bl isters occurred in 6 cases (9 fingers) andpartial necrosis of the flaps in 2 cases (2 fingers), which were cured after symptomatic treatment. The other flaps and skin grafts survived and the wounds healed by first intention. Thirty cases (38 fingers) were followed up 6 months postoperatively. The shape, contour of the reconstructed fingertip, and motivation of the fingers were satisfactory. The superficial sensation and deep pain sensation recovered after 6 months of operation. The two-point discrimination was 4-6 mm in 24 fingers, 7-10 mm in 13 fingers, and none in 1 finger. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, S3 was achieved in 1 finger, S3+ in 13 fingers, and S4 in 24 fingers. Conclusion It is simple and safe to harvest the reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction; at the same time, the blood supply of the flap is rel iable and its sense can be reconstructed. It is one of effective methods for repairing fingertip defects.
Objective To investigate the operative procedure and the cl inical results of the modified island flap based on the reversed dorsal metacarpal artery for repairing finger tissue defect. Methods From January 2004 to March 2009, 38 patients (43 fingers) with finger tissue defect were treated with the modified island flaps based on the reversed dorsal metacarpal artery. The deverting point was altered from the dorsal point to the palm. There were 27 males (31 fingers) and 11 females (12 fingers) with an average age of 43.6 years (range, 12-67 years). Defect was caused by crash injury in 18 cases, crush injury in 14 cases, and cutting injury in 6 cases. Of them, 11 index fingers, 23 middle fingers, 7 ring fingers, and 2 l ittle fingers were involved. The area of the defect ranged from 1.0 cm × 0.7 cm to 3.2 cm × 2.5 cm. The area of flaps ranged from 1.2 cm × 1.0 cm to 3.5 cm × 2.8 cm. The donor sites were sutured directly. Results Tension vesicular scabbing occurred in distal part of flap, and was cured after dressing change in 3 cases. The other flaps survived and incision healed primarily. All incision at donor sites healed primarily. Thirty-one patients (35 fingers) were followed up 6-29 months (15.3 months on average). All flaps survived with satisfactory appearance, sensation, and function. Two-point discrimination was 6-9 mm (7.9 mm on average). The results were excellent in 20 fingers, good in 13 fingers, and fair in 2 fingers according to the total active movement (TAM) standards; the excellent and good rate was 94.3%. Conclusion The treatment of finger tissue defect with the modified island flap based on the reversed dorsal metacarpal artery is recommendable. The deverting point was altered from the dorsal point to the palm. The vessel pedicle is extended. It can be easily and conveniently performed for more cases.