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The use of chest flap, anterolateral thigh flap for dorsal foot soft tissue defects in children (report of 2 cases)


Research is mainly engaged in trauma surgery. 47, No. 42 overall from Dali University illl Science piercing point of a cutaneous artery. According to pre-position and flap vascular anatomy of the design 6cmX9cm the anterolateral thigh flap, the flap should be designed so that light falls on a point by the midpoint of the upper half of the flap near the flap is designed to start at the inside flap edge of skin incision, extending to the midpoint of the inguinal ligament to expose the descending branch of lateral circumflex femoral artery vascular pedicle. Then cut the skin of the deep surface of fascia lata along the rectus femoris and vastus lateralis muscle gap between the femoral artery descending branch to identify and accompanying veins. Carefully peel the first musculocutaneous flap artery and traced to the beginning part of the musculocutaneous arteries. Musculocutaneous arteries will cover the vastus lateralis muscle of its isolated and cut off the beam, you can fully reveal the cutaneous branches of the muscle and skin arteries with veins, and then cut the outer edge of the flap, the flap surrounding completely free. Cut under the conditions required by the area of ​​vascular length. 1.2 flap graft recipient wound debridement to remove necrotic tissue, making it a good edge and basal blood circulation. At the same time prepare for the vessels, the selected artery dorsalis pedis artery and vein great saphenous vein. From the rear of the flap with a slight infusion of heparin solution, go to the affected area when the first flap is temporarily sutured to the number of needles, so that when the vascular anastomosis to maintain a certain tension. After the flap donor site on both sides were sutured directly to the chest incision closed flap donor site before, the focus should be strengthened before suturing the rectus sheath and cut off part of the rectus abdominis, rectus abdominis weak to prevent incisional hernia occurred . For vascular anastomosis in the beginning before the 30rain intravenous injection of low molecular weight dextran, 250ml, anastomosis to the intravenous infusion of papaverine injection 15rag. Anastomotic veins before and after arterial anastomosis. Observed flap a few minutes to determine flap blood supply and return are good, the suture of skin flap, suture anastomosis vascular pedicle skin Do not allow compression and distortion. Place base flap drainage strip 2. After conventional heat treatment after 1.3, antibiotic and sedative drugs, low molecular weight dextran 250ml, 24h vein maintenance, papaverine 15rag, intravenous injection every 6h. Close observation of skin flap blood supply and return, timely dressing flap fluid drainage. 2 Results Both operations were successful, the operation time of about 5h, intraoperative blood loss 200ml. Case 1 after 2h vascular crisis, immediate vascular exploration found that arterial anastomotic thrombosis, thrombolysis, fit again after the crisis was no recurrence. Two cases of flaps survived well, the healing of skin flap a 48 for the area healed well after direct suture, skin and soft tissue defects by the district, the organization exposed all been fixed, infection control, line after 14d was recovered. 2 cases were followed up after operation l0 months and 4 months, dorsal skin soft, flexible, slightly bloated appearance, function satisfaction. 3 Discussion less dorsal skin and soft tissue, once the skin defect, easily lead to tendon, bone and joint organizations such as exposed, which requires early surgical closure of the wound, or lead to the exposure of tissue necrosis, thus affecting the function. Because these organizations exposed, early use of skin graft is difficult to succeed, which requires a way to repair using skin flap. However, as this group of patients defect area, and located in the distal limb, there is no suitable adjacent flaps are available to repair. Cross-leg flap can choose to use or free flap. Cross-leg flap for long hospital stay, and patient pain and not easily accepted, free flap can avoid the above drawbacks. We use chest flap and anterolateral thigh flap graft wounds, mainly because of its constant vascular anatomy with flaps, pedicle length, large diameter, large area of ​​flap, etc., these advantages are conducive to flap survived. As a child, the difficulty and risks of surgical skin flap are large, replantation in children under 6 years old the incidence of vascular crisis 绁 significantly higher than other age groups. Small blood vessels of the child's tender thin, poor flexibility, tensile strength is small, so the surgical operation of skill and experience requirements higher. To ensure the operation is successful, the quality of anastomosis is the key, you must have high-quality small vessel anastomosis to ensure patency, so grasp the flap and recipient vessels of the vascular anatomy and vascular anastomosis master microsurgical techniques is essential. On the other hand, the observation after treatment is also very important discovery that vascular crisis should be promptly handled. Association with children's response to severe trauma, and communication difficulties, difficult co-operation and other physiological characteristics, in order to avoid crying, anxiety,[link widoczny dla zalogowanych], pain stimulation caused by vascular spasm, so in addition to conventional treatment, but also use of sedative drugs, to ensure the smooth skin flap survival . [
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