Objective To investigate and compare the effectiveness of perichondrial cutaneous graft (PCCG) of dorsal auricle for repairing defect after excision of melanocytic nevus in different parts of the face. Methods Between February 2008 and October 2012, 29 cases of facial melanocytic nevus were admitted. There were 11 males and 18 females, aged 3-25 years (median, 11 years). The locations were the upper eyelid in 5 cases, the nose in 15 cases, and the buccal region in 9 cases. The size of the nevi ranged from 1.2 cm × 1.0 cm to 4.0 cm × 2.2 cm. Defects after excision of nevi were repaired by PCCG of the dorsal auricle, which size ranged from 1.5 cm × 1.5 cm to 4.2 cm × 2.5 cm. The postoperative effectiveness was scored by patients according to color match, scar formation, and flatness of the reception site. The satisfaction evaluations were compared by the score among different parts. Results All the PCCG survived. All the patients were followed up 7-15 months (mean, 10 months). All the reception site had good color match and acceptable scar formation. The nasal part had good flatness, and the upper eyelid had poor flatness. Score comparison showed no significant difference in color match between 3 parts (P gt; 0.05). Nasal part had significantly less scar formation than buccal region and upper eyelid (P lt; 0.05), but no significant difference between buccal region and upper eyelid (P gt; 0.05). Nasal part and buccal region both had significantly better flatness than upper eyelid (P lt; 0.05), but no significant difference between nasal part and buccal region (P gt; 0.05). The overall evaluation score of nasal part and buccal region was significantly higher than that of the upper eyelid group (P lt; 0.05), and the score of the nasal part was significantly higher than that of the buccal region (P lt; 0.05). Conclusion PCCG of dorsal auricle has a good color match in repair of facial defect, especially in repair of nasal defect with good flatness and no obvious scar formation.
Objective To study the effectiveness of one-stage repairing pharyngeal defect with the tongue flaps after resection of advanced stage hypopharyngeal neoplasm and laryngeal neoplasm. Methods Between June 2006 and March 2011, 20 patients with hypopharyngeal neoplasm (8 cases) and laryngeal neoplasm (12 cases) with advanced stage were treated. There were 19 males and 1 female, aged 47-78 years (mean, 62.8 years). All neoplasms were squamous cell carcinomas. The disease duration was 1-8.5 months (mean, 3.9 months). According to the standards of International Union Against Cancer (UICC, 1987), 12 cases were in stage III and 8 cases were in stage IV. The size of pharyngeal defect was 5 cm × 2 cm to 4 cm × 4 cm after resection of tumor. Defects were repaired by the whole base of the tongue flaps in 16 cases and by the horizontal base of the tongue flaps in 4 cases. The size of the flaps ranged from 5 cm × 2 cm to 4 cm × 4 cm. Postoperative radiotherapy and chemotherapy were regularly performed. Results The 20 tongue flaps were alive. Healing of incision by first intention was achieved in 18 cases and delayed healing in 2 cases because of subcutaneous fluid. The patients were followed up 12-63 months (mean, 36.7 months). The patients had normal feeding ability and tongue function. Of 20 cases, 12 died and 1 of local recurrence was alive with tumor. The 3-year survival rate was 69.2% (9/13). Conclusion One-stage repair of pharyngeal defect with the tongue flaps after resection of hypopharyngeal neoplasm and laryngeal neoplasm can obtain good effectiveness because the tongue flap is easy-to-obtain and easy-to-survive, and has abundant blood supply.
Objective To investigate an operative method of repairing large skin defect of the forearm and the hand. Methods From July 2003 to September 2008, 11 patients with large skin defect of the forearm and the hand were repaired using bilateral groin flaps in complex with abdominal flaps, including 7 males and 4 females aged 17-55 years old (average33.5 years old). Among the 11 cases, 5 were caused by carding machine and 4 by traffic accident, and the interval between injury and operation was 90 minutes to 6 hours (average 3.5 hours); 2 cases suffered from severe cicatricial contracture deformity in the late stage of burn injury, and the interval between injury and operation was 7 months and 19 months, respectively. The size of skin defect ranged from 42 cm × 12 cm to 60 cm × 16 cm. The flaps harvested during operation was 45.0 cm × 10.5 cm - 62.0 cm × 18.0 cm in size. Pedicle division of the combined flaps was performed 4 weeks after operation. The donor site wound was repaired by direct suturing in 7 cases and by free skin grafting in 4 cases. Results All flaps survived. All incisions healed by first intention. The donor site wound all healed by first intention. Skin graft all survived. All patients were followed up for 2 months to 3 years. The flaps were soft in texture, full in contour, and normal in color. Sensory recovery of the flaps was evaluated according to the Criteria of UK Medical Research Council (1954), 4 cases were in grade S1, 6 in grade S2, and 1 in grade S3. Hand function was assessed by the Criteria of Chinese Hand Surgery Society, 7 cases were graded as excellent, 2 as good, 2 as poor, and the excellent and good rate was 81.8%. Conclusion Combined use of bilateral groin flaps and abdominal flap is an effective approach to repair large skin defect of the forearm and the hand due to its simple operative procedure and satisfying effect.
Objective To report 4 methods of reconstructing soft tissue defects in oral and maxillofacial regions after tumors resection using cervical pedicle tissue flaps. Methods One hundred seventy-two soft tissue defects were repaired with cervical myocutaneous flaps after resection of oral and facial cancer( 165 cases of squamous cell carcinoma and 7 cases of salivary carcinoma). The clinical stage of the tumors was stage Ⅰ in 21 cases, stage Ⅱ in 116 cases and stage Ⅲin 35 cases. Primary sites of the lesions were the tongue (59 cases), buccal mucosa (55 cases), lower gingiva (26 cases), floor of the mouth (25 cases), parotid gland (4 cases) and oropharynx (3 cases). Infrahyoid myocutaneous flaps were used in 60 cases, platysma flaps in 45 cases, sternocleidomastoid flaps in 59 cases and submental island flaps in 8 cases. The sizes of skin paddle ranged from 2.5 cm×5.0 cm to 5.0 cm ×8.0 cm. Results Among 153 survival flaps, there were55 infrahyoid myocutaneous flaps, 40 platysma flaps, 52 sternocleidomastoid flaps and 6 submental island flaps. There were 11 cases of total flap necrosis and8 cases of partial flap necrosis. The success rates were 91.67%(55/60) for infrahyoid myocutaneous flap, 88.89%(40/45) for platysma flap, 88.14% (52/59) for sternocleidomastoid flap and 75%(6/8) for submental island flap. After a follow-up of 3 11 years(5.7 years on average) among 101 cases local reccurence in 18 cases, cervical reccurence in 4 cases, distance metastasis in 2 cases. The survical rate at 3 years were 83.17%(84/101). Conclusion Cervical pedicle tissue flaps haveclinical value in reconstruction of small and medium-sized soft tissue defects after resection of oral and maxillofacial tumors.
ObjectiveTo investigate the feasibility of the bipaddled split pectoralis major myocutaneous flap for immediate reconstruction of oral mucosal defects and neck defects after resection of recurrent oral cancer. MethodsSix patients with oral mucosal defects combined with neck defects after recurrent oral cancer resection were treated with bipaddled split pectoralis major myocutaneous flap between September 2013 and September 2014. There were 5 males and 1 female with an average age of 54.7 years (range, 45-62 years), including 4 cases of recurrent tongue cancer, 1 case of recurrent mandibular gingival cancer, and 1 case of mouth floor carcinoma. All patients underwent local recurrence at 8 to 14 months after first operation, with no distant metastasis. The defects of the intraoral mucosa was 4.0 cm×2.5 cm to 6.5 cm×3.5 cm and the defect of the neck skin was 5.5 cm×3.5 cm to 7.5 cm×5.0 cm. The pectoralis major myocutaneous flaps (14.0 cm×3.5 cm to 17.0 cm×5.5 cm) were incised at the level of the 3rd to the 4th rib, and then split down along the muscle fiber till about 2 cm away from the thoracoacromial vessels, forming 2 independent skin paddles with 1-2 branch vessels to the pedicles of the distal ones. The distal skin paddles were used for oral reconstruction while the proximal paddles for repair of neck defects. The chest donor sites were sutured directly. ResultsCervical haematoma and infection happened in 1 patient respectively after operation, and were cured after symptomatic treatment. All 6 split pectoralis major myocutaneous flaps with 12 skin paddles completely survived. All patients were followed up 6 to 18 months (mean, 11 months). One patient died of pulmonary metastasis at 8 months after operation and the other 5 survived without relapse or metastasis during follow-up. The intraoral paddles showed good shape with satisfactory speech function and swallowing recovery. The paddles also healed perfectly on the neck with flat outlooks, and all patients obtained full appearance and free movement of the neck. No fistula formed on the submandibular region and neck. ConclusionThe bipaddled split pectoralis major myocutaneous flap can complete simultaneous immediate reconstruction of oral mucosal defect and neck defect. It is very useful in the treatment of recurrent oral cancer.
ObjectiveTo explore the feasibility and technical essentials of soft tissue defect reconstruction following malignant tumor removal of limbs using perforator propeller flaps. MethodBetween July 2008 and July 2015, 19 patients with malignant limb tumor underwent defect reconstruction following tumor removal using the perforator propeller flaps. There were 13 males and 6 females with an average age of 53.4 years (range, 20-82 years). The disease duration ranged from 1 to 420 months (mean, 82 months). The tumors located at the thigh in 10 cases, at the leg in 2 cases, at the arm in 1 case, at the forearm in 1 case, around the knee in 2 cases, and around the elbow joint in 3 cases. Totally 23 flaps (from 8 cm×3 cm to 30 cm×13 cm in size) were used to reconstruct defects (from 4 cm×4 cm to 24 cm×16 cm in size). The potential source arteries included the femoral artery (n=2) , profunda femoral artery (n=3) , superficial circumflex iliac artery (n=1) , lateral circumflex femoral artery (n=6) , superior lateral genicular artery (n=2) , peroneal artery (n=2) , anterior tibial artery (n=1) , brachial artery (n=4) , and radial artery (n=1) . The remaining one was a free style perforator flap. ResultsPartial distal flap necrosis occurred in 3 cases after surgery with rotation angles of 180, 150, and 100° respectively, which were reconstructed after debridement using a free-style perforator flap in 1 case and using free skin grafting in the other 2 cases. The other 20 flaps survived completely after surgery. Primary healing of incisions was obtained at the donor and recipient sites. There was no severe complication such as infection, hematoma, and total flap failure. All patients were followed up 3 months to 5 years (mean, 19 months). One patient with malignant melanoma around the elbow joint had tumor recurrence, and underwent secondary tumor resection. The appearance, texture, and color of the flaps were similar to those at the recipient site. ConclusionsFor patients with malignant tumor of the limb, the perforator propeller flap can be an alternative option for soft tissue defect reconstruction after tumor resection, with the advantages of relatively simple operation and remaining the main vessels.
ObjectiveTo investigate the clinical application of the modified Zitelli bilobed flaps in repairing soft tissue defect of lower one-third nose. MethodsBetween February 2009 and February 2014, 26 patients with soft tissue defect of lower one-third nose after resection of basal cell carcinoma underwent reconstruction using modified Zitelli bilobed flaps. There were 15 males and 11 females, aged 48-65 years (mean, 56 years). Tumor involved the skin layer in all patients. According to TNM staging, 19 cases were rated as TisN0M0 and 7 cases as T1N0M0. The disease duration was 1-5 years (mean, 3 years). The mass size ranged from 1.0 cm×0.5 cm to 1.5 cm×1.0 cm. The defect size ranged from 1.5 cm×1.0 cm to 2.0 cm×1.5 cm after resection of basal cell carcinoma. The modified ipsilateral Zitelli bilobde flaps were designed and harvested for one-stage repair of defect, and the double-leaf flap size ranged from 2.5 cm×2.0 cm to 3.0 cm×2.5 cm and 1.5 cm×1.0 cm to 2.0 cm×1.5 cm. The donor site defects were sultured directly. ResultsTwenty-six flaps survived and incision healed primarily. No postoperative complications of hematoma, infection, and necrosis of skin flap occurred. No stretching deformation of local organs, the shape of the nose and face was symmetric. Twenty-six patients were followed up 3-24 months (mean, 13 months). Nasal and facial appearance was good and had no obvious scar formation, and patients were satisfied with the appearance. There was no tumor recurrence during follow-up. ConclusionThe modified Zitelli bilobed flap to repair soft tissue defect of lower one-third nose (the defect diameter within 2.0 cm) can obtain satisfactory effectiveness in appearance.