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Publications (9)4.21 Total impact

  • Yiping Song, Fahui Zhang, Hongbin Liu
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    ABSTRACT: To explore the clinical outcomes of repairing limb wound with distal based neurocutaneous flap. From June 2003 to June 2009, 187 cases with wounds in the hand, foot, and distal leg were treated. There were 127 males and 60 females aged 20-70 years old (average 37.5 years old). The wound was caused by traffic accident in 130 cases, crush injury in 38 cases, machinery accident in 16 cases, and explosion injury in 3 cases. Among them, the soft tissue defect was in the dorsal and palmar aspects of the hand in 35 cases, the distal leg in 50 cases, the dorsal aspect of foot in 40 cases, the region around ankle in 27 cases, the tendon area in 11 cases, the medial side of foot in 4 cases, the heel and sole of foot in 5 cases, and the forefoot area in 15 cases. The size of skin soft tissue defect was 5.0 cm x 3.0 cm-17.5 cm x 10.0 cm. Four cases suffered from nonunion of heel and 15 cases suffered from tibia defect (3-7 cm). The course of disease was 3 days-8 years. During operation, 35 cases with wound in the hand were treated with three types of lower rotation point of forearm neurocutaneous flaps with rotation points 0-3 cm above the wrist joint, 66 cases were treated with distal based saphenous nerve and saphenous vein neurovascular flaps, muscle flaps and bone flaps with rotation points 2-5 cm above the medial malleolus, and 86 cases were treated with sural and saphenous flaps, muscle flaps and bone flaps with rotation points 1-5 cm above the external malleolus. The flap was 5 cm x 3 cm-17 cm x 15 cm in size, the muscle flap was 5 cm x 3 cm x 1 cm-10 cm x 6 cm x 2 cm in size, the fibula flap was 4.0 cm x 2.5 cm-10.0 cm x 8.0 cm in size. The ligation of the superficial veins was performed below the rotation point of the flap in 163 cases, and the cutaneous nerve ending anastomosis was performed in 22 cases. The donor site was repaired by split thickness skin grafting from the inner side of the thigh. Various degree of skin flap swelling occurred, and the swelling extent in the patients receiving the superficial vein ligation was obvious less than that of patients with no ligation. At 4-7 days after operation, 6 cases had necrosis at the edge of flaps and 6 cases had blister, all of them healed after changing dress. The rest skin flaps and skin grafting in the donor site survived uneventfully, and the incision healed by first intention. All the patients were followed up for 2 months to 3 years. The appearance of the flap was satisfactory, the hand function and the foot function of walking and weight-bearing recovered. The two point discrimination of the patients 1 year after cutaneous nerve ending anastomosis was 8-12 mm. The grafted fibula in the patients with bone defect reached union 8-10 months after operation. The appearance and the movement of the donor site were normal. The new type distal based neurocutaneous flap has such advantages as simple operative procedure, less invasion, high survival rate, and recovery of the sensory function of the hand and the foot. It is suitable to repair the tissue defect in the hand, the foot, and the distal leg.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 12/2009; 23(12):1435-9.
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    ABSTRACT: Improvements were made by us in several distally based pedicled flaps of the nutrient vessels of the saphenous nerve with lower rotation points. However, these flaps are still insufficient for trauma complicated by bone defects. Accordingly, we conducted a systematic study of the anatomic theory on distally based pedicled compound flaps of the nutrient vessels of the saphenous nerve and great saphenous vein with 30 lower limbs of adult cadavers injected with red gelatin through the femoral artery. It is found that the nutrient vessels of the saphenous nerve-great saphenous vein consist of arteria saphena, fascial cutaneous branches of the inferior medial genicular artery intermuscular spatium branches of the posterior tibial artery, osteocutaneous perforators, superior ankle perforators, medial anterior malleolus perforators, and fascial perforators of the ankle tunnel region. Musculocutaneous perforators of the interior gastrocnemius muscle also enter the nutrient vessels of cutaneous nerve-superficial vein. From May 2004 to February 2007, 23 cases of skin flaps for treating defective and infectious wound, 10 cases of musculocutaneous flaps for treating ulcus in the lower segment of the leg, medullitis, and exposure of bone, 3 cases for medial calcaneus medullitis, 7 cases of skeletal flaps for treating tibial defects and nonunion of calcaneal bone. In 2-15-month follow-ups all cases presented with survived flaps, and healed surfaces of the wound and the osteomyelitis. For cases of bone nonunion, it showed that the nonunion healed after 18 weeks, with recovery of work ability after year. Three types of the distally based pedicled flaps or compound flaps of vessels of different perforating branches can be designed for repairing tissue defects caused by trauma, such as bone defects in the distal leg, nonunion, large necrotic space as well as traumatic surface of the foot and ankle.
    Annals of plastic surgery 08/2009; 63(1):81-8. · 1.29 Impact Factor
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    ABSTRACT: A distally based flap pedicled with the nutrient vessel of the sural nerve has been widely applied in the clinic. An attempt was carried out to modify the distally based flap pedicled with the nutrient vessel of the lower rotation point sural nerve to reconstruct the soft-tissue defects in foreleg. For cases with complex bone defects, this flap was unsatisfactory for the reconstruction. A compound flap pedicled with the sural nerve and the lesser saphenous veins was investigated in the lower extremities of 30 human cadavers arterially infused with red gelatin. The results showed that the sural nerve and the lesser saphenous vein had the identical source of blood supply as the nutrient vessel of muscle, fibula, and skin. The sural lateral artery, the peroneal artery, the lateral posterior malleolus artery, the perforating branches of the heel lateral artery, and the musculocutaneous perforators from the gastrocnemius formed a vascular chain for the sural nerve and lesser saphenous vein. The distally based compound flaps of sural nerve and lesser saphenous vein were applied for the reconstruction of 20 patients in the present study, from January 2004 to January 2007. The musculocutaneous flaps were applied for the repair of lower leg ulcers, osteomyelitis, or bone exposures in 10 cases and for medial calcaneus osteomyelitis in 3 cases. The osteocutaneous flaps and the myo-osteocutaneous flaps were used for tibial bone defects in 7 patients. In the 5- to 18-month follow-ups, all cases presented with survived flaps, healed wound surfaces, and with osteomyelitis. The musculocutaneous flaps were satisfactory and the appearance and movement of the donor site was normal. The transplanted fibulas of the patients with bone defects were healed after 3 to 4 months on average with a recovery of the ability for movement and support. The distally based compound flap pedicled with the nutrient vessel of sural nerve and lesser saphenous vein was convenient and reliable to employ due to its advantages of infection control, high percentage survival, and rapid healing. It was satisfactorily adapted for reconstruction of leg bone defects, missing skin, and foot and ankle defects.
    Annals of plastic surgery 05/2009; 62(4):395-404. · 1.29 Impact Factor
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    ABSTRACT: The purpose of this study was to elucidate anatomical features of perforating branch flaps based on the muscular branches of the medial vastus muscle and to seek a new, applicable technique that could be used in repairing soft tissue defects around human knees. In this study, the origin, the course, the branches, the distribution, and the distal anastomosis of the muscular branch of the medial vastus muscle were observed in 30 sides of adult cadaveric lower limb specimens with the adductor tubercle, the patella midpoint, and the inguinal ligament midpoint as the observation markers. The specimens had been perfused arterially with red gelatin before they were supplied. It was observed that the femoral artery gave constant muscular branches into the medial vastus muscle at the tip of the femoral triangle. The artery entered the muscle via the hilum and ran laterally downwards along the muscular bundle until it reached the lateral patella to anastomose with the arterial circle around the bone. Along its course, it also gave 1-3 (1/77%) musculocutaneous perforating branches (0.5-0.9 mm in diameter). It then extended vertically through the medial vastus muscle into the deep fascia and ran superficially to the overlying skin of the muscle. A flap based on the perforating branch of the medial vastus muscle could be harvested at a size of about 8.5 cm x 15.0 cm and might be transferred retrograde to repair the soft tissue defect around the knee.
    Microsurgery 02/2008; 28(1):61-4. · 1.62 Impact Factor
  • Wancheng Tian, Fahui Zhang, Dacheng Zhu
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    ABSTRACT: To report the clinical result of the improved island skin flap with distally-based sural nerve nutrient vessels in repairing skin defect in the heel, ankle or foot. From August 2004 to April 2005, 15 patients with skin defect in the heel, ankle or foot at distal part were treated by the improved island skin flap with distally-based of sural nerve nutrient vessels. Of 15 flaps, 12 were simplex flaps and 3 were complex flaps. These flap area ranged from 7 cm x 6 cm to 11 x 8 cm. The donor sites were sutured directly and covered with free flap. All flaps survived without flap swelling and disturbance of blood circulation. The wounds of donor and recipient sites healed by first intention. The follow-up period ranged from 3 to 6 months. The texture of flap was soft and the color of flap was similar to that of normal skin. The foot function was excellent. The improved island skin flap with distally-based sural nerve nutrient vessels is an ideal skin flap for repairing skin defect in the heel, ankle or foot distal part in clinical. The operation is simple and need not to anastomose blood vessel.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 12/2006; 20(11):1090-2.
  • Songqing Lin, Fahui Zhang, Hao Xu
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    ABSTRACT: To explore the effect of transferring adjacent non-main vessel pedicle flap on repairing the heel skin defect. From February 2000 to April 2004, 4 kinds of flaps with non-main vessel pedicle were used to repair 30 cases of heel skin defect. Of the 30 patients, 19 were male and 11 were female, whose ages ranged from 8 to 65. Among them, 19 cases were crush injury, 5 cases were press injury, 3 cases were electric saw injury, 2 cases were osteomyelitis, and 1 case was squamous cell carcinoma. Fourteen cases were with defect area ranged from 6.0 cm x 5.5 cm to 16.5 cm x 11.0 cm. All the 14 cases were repaired with distant pedicled sural vascular flap of nutrient vessels and saphenous vascular flap of nutrient vessels. The sizes of the dissected flap ranged from 6.0 cm x 5.0 cm to 18.0 cm x 12.0 cm. And the other 16 cases with defect area ranged from 2.5 cm x 2.0 cm to 5.5 cm x 4.5 cm were repaired with foot lateral flap and foot base medial flap. The sizes of the dissected flap ranged from 4.0 cm x 3.0 cm to 8.0 cm x 7.0 cm. All cases were followed up for 6 to 12 months. The flaps all survived with satisfactory appearance and no ulceration. Callus appeared in 2 cases. The sense of pain and touch was partly or completely restored. The two-point discrimination sense recovered to 1.0-3.2 cm. As it is easily accessible, highly flexible and causes little damage to blood circulation, transferring adjacent non-main vessel pedicle flap, is effective in repairing foot heel skin defect.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 02/2006; 20(1):47-9.
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    ABSTRACT: To investigate the anatomic structure of the compound flap of distally-based saphenous nerve-great saphenous vein nutritional vessels so as to provide anatomic basis for the clinical operation. The origin, branches, anastomosis of nutritional vessels of sural nerve-great saphenous vein, and the relation of blood supply of tibia and soleus muscle were observed on 30 low limb specimens of adult cadaver, which were perfused with red gelatin to dissect from the artery. The nutritional vessels of sural nerve-great saphenous vein originated from: the saphenous artery 3-5 branches with a diameter of 0.7+/-0.4 mm; the cutaneous branches of medial inferior genicular artery, diameter of 0.7+/-0.2 mm; the intermuscular space perforating branches of posterior tibial artery 2-7 branches with a diameter of 1.0+/-0.2 mm, the internus half side of the muscular branches nutrient soleus muscle; the perforating osteoseptocutaneous 1-2 branches with a diameter of 1.3+/-0.3 mm; the perforating branches of superior malleolus with a diameter of 0.6+/-0.2 mm; the perforating branches of medial anterior malleolus with a diameter of 0.8+/-0.3 mm. A vascular network of 3 layers, which included periosteum, deep artery, and fascia nerve and superficial vein, was formed by those branches of deep artery, fascia branches, periosteum branches, and nerve-vein nutrition branches. The nutritional vessels of saphenous nerve-great saphenous vein has the same origin as muscles, bones, and cutaneous nutritional vessels. It provides anatomic basis for the compound flap of distally-based saphenous nerve nutritional vessels.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 10/2005; 19(9):733-6.
  • Fahui Zhang, Qiyang Xie, Heping Zheng
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    ABSTRACT: To investigate the distribution of the perforating branches artery of distally-based flap of sural nerve nutrient vessels and its clinical application. The origins and distribution of perforating branches artery of distally-based flap were observed on specimens of 30 adult cadaveric low limbs by perfusing red gelatin to dissect the artery. Among the 36 cases, there were 21 males, 15 females. Their ages ranged from 6 to 66, 35. 2 in average. The defect area was 3.5 cm x 2.5 cm to 17.0 cm x 11.0 cm. The flap taken ranged from 4 cm x 3 cm to 18 cm x 12 cm. The perforating branches artery of distally-based flap had 2 to 5 branches and originated from the heel lateral artery, the terminal perforating branches of peroneal artery (diameters were 0.6+/-0.2 mm and 0.8+/-0.2 mm, 1.0 +/- 1.3 cm and 2.8 +/- 1.0 cm to the level of cusp lateral malleolus cusp). The intermuscular septum perforating branches of peroneal artery had 0 to 3 branches. Their rate of presence was 96.7%, 66.7% and 20.0% respectively (the diameters were 0.9 +/- 0.3, 1.0 +/- 0.2 and 0.8 +/- 0.4 mm, and their distances to the level of cusp of lateral malleolus were 5.3 +/- 2.1, 6.8 +/- 2.8 and 7.0 +/- 4.0 cm). Those perforating branches included fascia branches, cutaneous branches, nerve and vein nutrient branches. Those nutrient vessels formed longitudinal vessel chain of sural nerve shaft, vessel chain of vein side and vessel network of deep superficial fascia. The distally-based superficial sural artery island flap was used in 18 cases, all flaps survived. Distally-based sural nerve, small saphenous vein, and nutrient vessels of fascia skin have the same origin. Rotation point of flap is 3.0 cm to the cusp of lateral malleolus, when the distally-based flap is pedicled with the terminal branch of peroneal artery. Rotation point of flap is close to the cusp of lateral malleolus, when the distally-based flap is pedicled with the heel lateral artery.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 08/2005; 19(7):501-4.
  • Fahui Zhang, Songqing Lin, Heping Zheng
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    ABSTRACT: To investigate the origin of small saphenous vein of distally-based of sural nerve nutrient vessels flap and its clinical application. The origins of nutrient vessels of small saphenous vein and communicating branches of superficial-deep vein were observed on specimens of 30 adult cadaveric low limbs by perfusing red gelatin to dissect the artery. The nutrient vessels of small saphenous vein originated from the heel lateral artery, the terminal perforator branches of peroneal artery and intermuscular septum perforating branches of peroneal artery. There were 2 to 5 branches of such distally-based perforating branches whose diameters ranged from 0.6 to 1.0 mm. Those perforating branches included fascia branches, cutaneous branches nerve and vein nutrient branches. Those nutrient vessels formed a longitudinal vessel chain of clinical nerve shaft, vessel chain of vein side and vessel network of deep superficial fascia. The small saphenous vein had 1 to 2 communicating branches of superficial-deep vein whose diameter was 1.7+/-0.5 mm, 3.4+/-0.9 cm to the level of cusp of lateral malleolus, and converged into the fibular vein. Distally-based sural nerve, small saphenous vein, and nutrient vessels of fascia skin have the same region. The communicating branches of superficial-deep vein is 3 to 4 cm to the level of cusp lateral malleolus. These communicating branches could improve the venous drainage of the flap.
    Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 08/2005; 19(7):505-7.