To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March ...To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March 2004,using lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle in 11 cases.Cause of injuring:traffic accident 7 cases,crushing 1 case,saw injury 1 case,skin cancer 1 case,chronic ulcer 1 case.Areas:foot heel 6 cases,shank lower section 2 cases,heel tendon 2 cases,the distant back of the foot 1 case.Using the flap axis point was 1～3 cm above the pin of the external heel,average 2 cm.The scope of the flap was 6.0 cm×8.0 cm～12.0 cm～18.0 cm.Results All sural nerve flaps were alive.Of them,2 cases have distant part necrosis,accompanying with subcutaneous tissue,1 case heels after change dressings,another heels after skin grafting.All case can walk as usual,the flap was wear-resisting and keenly feel.Conclusion Lower rotating point nutrient vessels of sural nerve flap,donner area was fine,available area was large,skin in the pink,easy grafting,without main blood vessel damage,survival rate high,it is a good donner area in repairing around heel,foot and shank lower section.7 refs,1 tab.展开更多
Background Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely...Background Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap. Methods Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm × 7 cm to 24 cm × 10 cm in size in hand and forearm after injured by motor vehicle accidents （2 cases） or crushed by machine （8 cases）. Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial （or ulnar） artery and the peroneal veins to one of the radial （or ulnar） veins and the cephalic vein respectively. The flap sizes ranged from 18 cm × 8 cm to 25 cm × 12 cm. The donor areas were closed by skin grafts. Results All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months＇ follow-up. Conclusions Peroneal perforator-based sural neurofasciocutaneous flap has favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation, and minimal influence on the donor site. The free transplantation of this flap offers a satisfactory alternative for repairing the large soft tissue defects of forearm and hand.展开更多
Traumatic limb injury is a prevalent lesion in Iran. Motorcycle accidents are responsible for most of these traumatic lesions. Despite various reported techniques, the coverage of the Achilles tendon, malleoli, ankle ...Traumatic limb injury is a prevalent lesion in Iran. Motorcycle accidents are responsible for most of these traumatic lesions. Despite various reported techniques, the coverage of the Achilles tendon, malleoli, ankle and heel is still daunting and demanding procedure. S-shaped reverse sural flap is a modified technique of reconstruction. In this report of 6 patients underwent surgical reconstruction by this modified technique we discuss about the technique as a simple and safe technique with low morbidity rate and recommend using this technique in complex injuries.展开更多
Delayed pedicled flaps are a reliable reconstructive tool for limb salvage.Determining the optimal timing for pedicle division is critical for surgical success and minimizing complications.Assessment of optimal timing...Delayed pedicled flaps are a reliable reconstructive tool for limb salvage.Determining the optimal timing for pedicle division is critical for surgical success and minimizing complications.Assessment of optimal timing has traditionally relied on arbitrary timing or subjective measures.This study explores the use of indocyanine green(ICG)angiography in the office setting as an objective guide for timing the delayed pedicled flap pedicle division,aiming to improve surgical outcomes and resource efficiency.In the outpatient setting,ICG is administered intravenously while the flap pedicle is under tourniquet control.If the distal flap opacifies with the tourniquet still applied,appropriate revascularization has occurred,and the pedicle may be safely divided.We present the example of a 47-year-old male with multiple previous flap reconstructions who eventually required a reverse sural artery flap.Initial intraoperative ICG imaging on postoperative day(POD)23 revealed insufficient perfusion,prompting the postponement of pedicle division.Subsequent office-based imaging on POD 47 revealed a persistent lack of neovascularization.Adequate vascularization was demonstrated on POD 81,enabling successful pedicle division in the operating room on POD 121 without complications.ICG fluorescent angiography can guide the timing of division for delayed pedicled flaps.We recommend its use in the outpatient setting to decrease unnecessary operating room usage and anesthetic events and reduce the risk of wound healing complications from early pedicle division.展开更多
文摘To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle.Methods Lay a foundation of anatomic studying from february 2003 to March 2004,using lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle in 11 cases.Cause of injuring:traffic accident 7 cases,crushing 1 case,saw injury 1 case,skin cancer 1 case,chronic ulcer 1 case.Areas:foot heel 6 cases,shank lower section 2 cases,heel tendon 2 cases,the distant back of the foot 1 case.Using the flap axis point was 1～3 cm above the pin of the external heel,average 2 cm.The scope of the flap was 6.0 cm×8.0 cm～12.0 cm～18.0 cm.Results All sural nerve flaps were alive.Of them,2 cases have distant part necrosis,accompanying with subcutaneous tissue,1 case heels after change dressings,another heels after skin grafting.All case can walk as usual,the flap was wear-resisting and keenly feel.Conclusion Lower rotating point nutrient vessels of sural nerve flap,donner area was fine,available area was large,skin in the pink,easy grafting,without main blood vessel damage,survival rate high,it is a good donner area in repairing around heel,foot and shank lower section.7 refs,1 tab.
文摘Background Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap. Methods Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm × 7 cm to 24 cm × 10 cm in size in hand and forearm after injured by motor vehicle accidents （2 cases） or crushed by machine （8 cases）. Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial （or ulnar） artery and the peroneal veins to one of the radial （or ulnar） veins and the cephalic vein respectively. The flap sizes ranged from 18 cm × 8 cm to 25 cm × 12 cm. The donor areas were closed by skin grafts. Results All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months＇ follow-up. Conclusions Peroneal perforator-based sural neurofasciocutaneous flap has favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation, and minimal influence on the donor site. The free transplantation of this flap offers a satisfactory alternative for repairing the large soft tissue defects of forearm and hand.
文摘Traumatic limb injury is a prevalent lesion in Iran. Motorcycle accidents are responsible for most of these traumatic lesions. Despite various reported techniques, the coverage of the Achilles tendon, malleoli, ankle and heel is still daunting and demanding procedure. S-shaped reverse sural flap is a modified technique of reconstruction. In this report of 6 patients underwent surgical reconstruction by this modified technique we discuss about the technique as a simple and safe technique with low morbidity rate and recommend using this technique in complex injuries.
文摘Delayed pedicled flaps are a reliable reconstructive tool for limb salvage.Determining the optimal timing for pedicle division is critical for surgical success and minimizing complications.Assessment of optimal timing has traditionally relied on arbitrary timing or subjective measures.This study explores the use of indocyanine green(ICG)angiography in the office setting as an objective guide for timing the delayed pedicled flap pedicle division,aiming to improve surgical outcomes and resource efficiency.In the outpatient setting,ICG is administered intravenously while the flap pedicle is under tourniquet control.If the distal flap opacifies with the tourniquet still applied,appropriate revascularization has occurred,and the pedicle may be safely divided.We present the example of a 47-year-old male with multiple previous flap reconstructions who eventually required a reverse sural artery flap.Initial intraoperative ICG imaging on postoperative day(POD)23 revealed insufficient perfusion,prompting the postponement of pedicle division.Subsequent office-based imaging on POD 47 revealed a persistent lack of neovascularization.Adequate vascularization was demonstrated on POD 81,enabling successful pedicle division in the operating room on POD 121 without complications.ICG fluorescent angiography can guide the timing of division for delayed pedicled flaps.We recommend its use in the outpatient setting to decrease unnecessary operating room usage and anesthetic events and reduce the risk of wound healing complications from early pedicle division.
