ObjectiveTo introduce the surgical method and effectiveness of repairing skin and soft tissue defect in the palm or dorsum of the hand and forearm with epigastric bilobed flap. MethodsBetween October 2010 and December 2013, 4 male patients with skin and soft tissue defect in the palm or dorsum of the hand and forearm were treated, aged from 36 to 62 years. Of them, 3 cases had degloving injury caused by machines and 1 case had necrosis of fingers and skin after surgery of crush injury. The time from injury to hospitalization was from 3 hours to 15 days. Among the 4 cases, the size of palmar defect was 7 cm×4 cm to 16 cm×6 cm, and the size of dorsal defect was 10 cm×7 cm to 20 cm×10 cm. The epigastric bilobed flap was designed based on the axial vessel which was formed by inferior epigastric artery, superior epigastric artery, and intercostals arteries. The size of flap ranged from 12 cm×4 cm to 18 cm×6 cm in the vertical direction, 15 cm×8 cm to 22 cm×11 cm in the oblique direction. The donor site was directly closed. The pedicles were cut at 22 to 24 days after repairing operation. ResultsAll the flaps survived well with the wound healing by first intention. Four patients were followed up 3 months to 1 year and 2 months. The other flaps had good appearance and texture except 1 bulky flap. The flap sensation basically restored to S2-S3. The function of the hands recovered well. ConclusionSkin and soft tissue defect in the palm or dorsum of the hand and forearm can be repaired with the epigastric bilobed flap, because it has such advantages as big dermatomic area and adequate blood supply. Besides, the operation is practical, safe, and simple.
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.
ObjectiveTo explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.MethodsBetween January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.ResultsIn antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups (χ2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant (P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).ConclusionThe modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.