Objective To investigate the method and effectiveness of perforator flaps in repairing soft tissue defects of extremities. Methods Between June 2002 and December 2009, 81 patients with soft tissue defect of extremities were treated. There were 69 males and 12 females with an average age of 54 years (range, 13-75 years). Defect causes were injury in 35 cases (the disease duration ranged from 1 hour to 45 days), tumor resection in 19 cases, and scar resection in 27 cases. The defect located at limb and foot in 56 cases, forearm and hand in 25 cases. The defect size ranged from 3 cm × 3 cm to 23 cm × 18 cm. The perforator flaps included the peroneal artery perforator flap in 26 cases, the radial artery perforator flap in 18 cases, the medial plantar artery perforator flap in 18 cases, and the lateral circumflex femoral artery perforator flap in 19 cases. The flap size ranged from 4 cm × 3 cm to 25 cm × 18 cm. The donor site was sutured directly or repaired by free skin graft. Results Partial necrosis of the flaps occurred in 4 cases at 3-7 days after operation, then the flap survived after expectant treatment. The other flaps and free skin grafts survived successfully, and the incisions healed by first intention. All patients were followed up 1 to 16 months with an average of 9 months. The appearance, texture, and colour of the flaps were similar to those of the donor site. Conclusion It is an effective method to use the perforator flap for repairing soft tissue defect of the extremities.
Objective To review the treatment methods of the extremity skin avulsion, and to point out the problems at present as well as to predict the trend of development in this field. Methods Domestic and abroad l iterature concerning the treatment methods of the extremity skin avulsion in recent years was extensively and thoroughly analyzed. Results The timely and accurate evaluation of viabil ity and blood circulation of avulsed skin was the key to treat extremity skin avulsion. At present, there were many methods to treat extremity skin avulsion and the vacuum seal ing drainage (VSD) technology played an important role in the treatment of skin avulsion. Artificial skin had been used to treat skin avulsion. Conclusion The conventional method to treat skin avulsion is rigorous debridement, defatting of the avulsed flap, planting back avulsed skin flap. The combined use of the VSD technology helps skin avulsion treatment. It may be a trend that artificial skin will be used in treating extremity avulsion.
Objective To explore devising and clinical effect of ladder-shaped osteotomy and guide apparatus. Methods From February 2002 to January 2004, with the application of guide apparatus devised,the ladder-shaped osteotomy was designed and completed by bone drill and linear saw. The experiment of ladder-shaped osteotomy was carried out on a fresh bone trunk amputated. Clinically, 3 cases were replanted by shortening humerus by means of laddershapedosteotomy. The lengths of bone shortened were 3 to 7 cm. The bone length of ladder-shaped osteotomy was 2 to 3 cm. Two cases of radius defect was repaired with free fibula. The lengths of bone transplanted were 7 and 11 cm. The bone length of ladder-shaped osteotomy was 1 cm. Results It took 2 to 3 minutes to complete the laddershaped osteotomy on the two ends of bone defect. The ends of ladder-shaped osteotomy was integrated closely. All 5 cases were followedup for 10 to 16 months. All fractures healed during 14 to 20 weeks. Of 3 cases shortening humerus, the function of elbow joint was normal in 1 case, the activity range of elbow joint was 0 to 100° in 1 case,and 0 to 80° in 1 case, respectively. Of 2 cases undergoing fibula transplantation, the function of wrist and elbow joint were normal;the pronation and supination ranges of the forearm was 30° and 40° in one, 50° and 45° in the other. Conclusion With the introduction of guide apparatus, the laddershaped osteotomy by bone drill and linear saw is a recommendable procedure because of many advantages such as simple apparatus, shortcut, laborsaving and precision.
Objective To repair defects at both ends of theblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities by phleboplasty of branched and double autogenous veins. Methods Three kinds of phleboplasties——funnel-shaped, raincape-shaped and transposed Y-shaped were designed. Experiments in fresh blood vessels in vitro were completed successfully. These methods were used clinically to repair injured external iliac veins, femoral arteries and veins, and popliteal arteries and veins, to replant severed fingers and to transplant toenail flaps on thumbs by harvesting autogenous great saphenous veins,small saphenous veins and forearm veins in 36 cases, including 35 cases in emergency operation and 1 case in selective operation.The length of grafted blood vessels ranged from 1.0 cm to 15.0 cm. Results The phleboplasties of funnel-shaped could enlarge the diameter by 1.0-1.25 times inanastomotic stomas. The phleboplasty of raincape-shaped could enlarge the diameter large enough to meet the demands for various blood vessels in extremities. The phleboplasty of transposed Y-shaped could provide large vein transplants. In36 grafted veins, 35 were in patency. The blood supply in extremities was normal.ConclusionThe funnel-shaped and raincape-shaped phleboplasties of branched veins can enlarge the anastomotic stomas of grafted veins. The transposed Y-shaped phleboplasty of double femoral veins is an ideal way to repair injured primaryblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities.
The defatted whole thickness skin flap from the large sized avulsed skin was sutured back to the original wound of the extremity in 366 cases. The patients were followed up for an average of 12 years and 3 months. The functions of the extremities were good, and the surface of the grafted area was smooth, with good luster and good looking. This type of repair provided a high survival rate, simple and less traumatic. The avulsed skin even had abrasion or mild contusion could still be used. The peculiarities of the large sized skin avulsion and the advantages and disadvantages of other reparative methods were discussed.
Since November 1974 to December 1993, 110 cases with malignant tumors of the extremities were treated by en bloc resection and limb salvage procedure in our hopsital. There were 57 males and 53 females. Their ages ranged from 14 to 70 years. The diagnosis of all patients were confirmed by pathology. Among them, 68 cases were malignant bone tumor, 42 cases were malignant tumor of soft tissue. If the soft tissue was involved by the malignant tumors, the tumor was resected radically and myocutaneous or skin flap was transferred to covered the defect. Among the 42 cases, 5 were free vascularized and 37 were pediculated flaps. The maximal size of the flap was 15×25 cm and the minimal was 6×8 cm. For the malignant bone tumors, en bloc resection was performed and the bone defect was reconstructed with autogenous free vascularized fibular graft, autograft of massive bone with fusion or allograft of cryogenic massive bone. If the joint was involved, limited excision with replacement of prosthesis was recommended. When both soft tissue and bone were involved, segmental resection of tumor was indicated in 17 cases. The patients were followed up for 2 to 9 years, the results of 53 cases were still alive with a survival rate of 48.2%. We emphasized that the local extensive resection should be performed with a safety margin of 3 to 5 cm beyond the tumor. A djuvant chemotheapy and radiotherapy had definite value in the treatment of some malignant tumors, so that preoperative or postoperative chemotherapy or radiotherapy was necessary. Sometimes radical resection of regional lymph rodes was necessary. The indications and causes of recurrence were discussed.