ObjectiveTo explore the application value of digital subtraction angiography (DSA) in repairing foot and ankle wounds with posterior tibial arterial perforator flaps. MethodsBetween January 2010 and May 2014, 12 cases of foot and ankle wounds were repaired using posterior tibial arterial perforator flaps. There were 7 males and 5 females with an average age of 36 years (range, 22-54 years). The causes were machine injury in 2 cases, falling injury in 3 cases, and traffic accident injury in 7 cases. The disease duration ranged from 7 to 45 days (mean, 16 days). The size of wound ranged from 6 cm×4 cm to 10 cm×5 cm. Preoperative DSA was performed to observe the orientation and distribution of the posterior tibial arterial perforator and the relationship between perforator vessels. Correspondently, the flaps were designed and harvested. The size of flap ranged from 7 cm×5 cm to 11 cm×6 cm. The donor sites were repaired with skin grafts. ResultsPosterior tibial arterial perforator vessels send out ascending branches and descending branches while going down in the superficial layer. All branches were connected to form vertical chain-form anastamosis, and its orientation was consistent with limb vertical axis. According to DSA results, the flaps were designed and harvested easily. All flaps survived after operation. Meanwhile, wounds healed by first intention. All skin grafts at donor site survived. All patients were followed up 6 months. The flaps had good appearance, color, and texture. No ulcer was found. Affected feet had normal walking function. ConclusionThe size, distribution, and chain-form anastamosis condition of the posterior tibial arterial perforator vessels can be accurately observed by DSA, which provides imaging evidence for harvesting posterior tibial arterial perforator flaps and improves the success rate for repairing foot and ankle wounds.
ObjectiveTo investigate the effectiveness of the free medial sural artery perforator flap for repairing anterior dorsal foot wound. MethodsBetween January 2010 and April 2015, 16 patients with skin and soft tissue defects of the anterior foot dorsal side were treated. There were 12 males and 4 females with the average age of 35 years (mean, 16-58 years). The disease causes included burn in 5 cases, traffic accident injury in 8 cases, and crush injury in 3 cases. The time from injury to admission was 2-30 hours (mean, 6.5 hours). The wound area ranged from 4 cm×3 cm to 10 cm×7 cm; combined injury included defects of lateral collateral ligament and joint capsule in 3 cases, and bone exposure in 12 cases, and all had exposure of tendon. Wounds were repaired with the medial sural artery perforator flap in 13 cases, and with medial sural artery perforator composite tissue flap carrying of medial head of gastrocnemius muscle flap in 3 cases. The size of flaps ranged from 5 cm×4 cm to 11 cm×8 cm. The donor site was sutured directly or was repaired with skin grafting. ResultsAll flaps survived well and wounds healed with stage I; skin grafts at donor site survived and the incision healed with stage I. All patients were followed up 6-36 months (mean, 11 months). The appearance of skin flap was satisfactory, without overstaffed; the joint of reconstructed ligament was stable, without secondary deformity. There was no obvious depression at the donor site, and no effect on the function. ConclusionThe medial sural artery perforator flap has the advantages of relatively constant perforator anatomy, reliable blood supply, and carries the gastrocnemius muscle flap for repair of compound tissue defect. It is one of better ways to repair the anterior dorsal foot wound.
ObjectiveTo study the effectiveness of surgical treatment of congenital type V thumb syndactyly. MethodsBetween March 2010 and May 2015, 12 cases of congenital type V thumb syndactyly were treated. There were 7 males and 5 females, aged from 1 to 25 years (mean, 8 years). The right thumb was involved in 8 cases, and the left thumb in 4 cases. There were 2 cases of radial type, and 10 cases of ulnar type. The basement of polydactylism was far away from the carpometacarpal joint in 7 cases, and was close to the carpometacarpal joint in 5 cases (slight ulnar deviation in 1 case). X-ray films showed that the main first thumb metacarpal bone and trapezium fitted well, and 2 cases had the first metacarpal bone deformity. Preoperative individualized treatment plan was made, and polydactylism was excised by the "S" or "Z" incision and simultaneous reconstruction of thenar muscle insertions or adductor muscle insertions was performed; if necessary, wedge osteotomy was used for correction. ResultsAll incisions healed by first intention with no complication. All cases were followed up 6 to 24 months (mean, 12 months). The thumb appearance, flexion and extension, the function of opposition, abduction function were improved significantly in 11 cases with no scar contracture deformity, small first web space, and deviation deformity. One case had slightly narrow first web space. According to hand function criterion, the results were excellent in 10 cases, good in 1 case, poor in 1 case; excellent and good rate was 91.7%. ConclusionBased on the condition of the type V thumb syndactyly, the individualized treatment plan is made, which can better restore the shape and function of the thumb.
ObjectiveTo investigate the effectiveness of free superficial iliac circumflex artery perforator flap for repair of foot skin and soft tissue defect. MethodsBetween January 2010 and December 2015, 16 patients with ankle skin and soft tissue defect were treated. There were 13 males and 3 females with an average age of 32 years (range, 5-56 years). The causes included traffic accident injury in 8 cases, machinery injury in 3 cases, falling injury in 3 cases, and electrically injury in 2 cases. The time from injury to hospital was 1 to 6 hours (mean, 3.5 hours). The wound sites included foot dorsum skin defect in 6 cases, ankle skin defect in 5 cases, the back foot and ankle skin defect in 5 cases. The skin defect size ranged 5 cm×4 cm to 16 cm×7 cm. All patients had tendon exposure, and 8 patients had fracture. An emergency repair was performed in 6 cases, and selective surgery in 10 cases. The free iliac circumflex artery perforators flap was used to repair defect; the flap size was 6 cm×5 cm to 17 cm×8 cm, and the flap thickness was 0.4 to 1.1 cm (mean, 0.8 cm). ResultsThe flaps survived in the other 15 patients with primary healing of wounds except 1 patient because the iliac circumflex artery was too small to provide good blood supply, who underwent repair with local skin flap. Incision at donor site healed by first intention. The 15 cases were followed up 6-24 months (mean, 13 months). The appearance of the foot was satisfactory, and the flap had good texture without bulky flaps. ConclusionFree iliac circumflex artery perforators flap is one of ideal flaps in repair of skin defect of the foot and ankle because of hidden donor site, reliable blood supply, less injury to donor site, and full use of the flap.
ObjectiveTo investigate the effectiveness of medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery in the repair of palm soft tissue defect. MethodsBetween September 2013 and December 2015, 9 cases of palm soft tissue defects were repaired with medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery. There were 7 males and 2 females with a mean age of 33 years (range, 21-52 years). The causes included traffic accident injury in 4 cases, crushing injury by heavy object in 3 cases, and electrical injury in 2 cases. The time between injury and admission was 3 hours to 2 days (mean, 9 hours). Five cases had pure soft tissue; combined injuries included tendon exposure in 2 cases, median nerve defect in 1 case, and exposure of tendon and nerve in 1 case. After debridement, the soft tissue defect area ranged from 6 cm×4 cm to 11 cm×6 cm. The flap size ranged from 7.0 cm×4.5 cm to 13.0 cm×7.0 cm. The vascular pedicle length was from 6 to 10 cm (mean, 7.5 cm). The donor sites were covered with ilioinguinal full thickness skin graft. ResultsNine flaps survived, primary healing of wound was obtained. Partial necrosis occurred at the donor site in 1 case, and the other skin graft successfully survived. All patients were followed up 6-20 months (mean, 10 months). All flaps had soft texture and satisfactory appearance; the cutaneous sensory recovery time was 4-7 months after operation (mean, 5 months). At last follow-up, sensation recovered to grade S4 in 4 cases, to grade S3+ in 3 cases, and to grade S3 in 2 cases; two-point discrimination was 7-10 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the hand function was excellent in 5 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. ConclusionThe medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery can repair soft tissue defect of the palm, and it has many advantages of soft texture, satisfactory function, and small injury at donor site.