Application Of Medial Crural Free Skin Flap In Upper Extremity Trauma Of The Large Areas Of Skin And Soft Tissue Defect

With the development of transportation and construction, large areas of defects of the upper extremity skin and soft tissue is very common in clinical practice, often accompanied by nerves, blood vessels, tendons, bone, or exposed internal fixation. Amongst the most complications, disease scrap rate is one of the most challenging orthopedic problems. The treatment depends critically on the early local wound treatment, however simple vascular grafts can’t make it, which requires skin flap repair. Lots of clinical flap can be used for large area wound repair, such as latissimus dorsi flap, groin flap, anterolateral thigh flap, Lateral chest flap.Although the wound could be repaired with the flaps mentioned above, it is difficult to repair the wound which accompany aorta, veins and nerves within the flaps. Therefore, Bridge graft of medial leg flap, with posterior tibial artery and vein as axis containing the great saphenous vein, the saphenous nerve, has become the focus of attention.ObjectiveThrough clinical retrospective study to discuss the free flap of crus’inside to repair brachial blood vessels and nerve damage and badly broken-down soft tissue’s feasibility and clinical effect, explore a new way to treat brachial large skin and soft tissue defects.MethodsBetween2003and2007, there were24patients whose arms were wounded with large area’s defects and injuries of nerves and blood vessels. After admission (within six hours of injury) first wounds were actively bandaged and then the associated shock was dealt with and then the other united injuries were treated. After the patient was in the stable condition, surgical team proficient in microsurgery with the help of CDUS managed to cut medial crural free skin flap, and the other team did the work of debridement, signed and processed vessels of recipient site. With the help of microscope, the repair of the vessels and nerves of arm was well done. The maximum of transplant flap area is14cm×9cm, while the minimum is25cm×13cm.16patients were randomly selected by area with flap hidden nerve anastomosis, cutaneous nerve8cases don’t control neural bridge repair. Postoperative after transplantation, flap was kept warm, negative pressure drainage tube was used, routine antibiotics were used for infection control, anticoagulant and resisting vasospasm drugs were used as well. Coagulant after hospital discharge. All the cases were followed up for6months and above, close observations were done on flap survival rate, color, temperature, capillaries filling and flap feeling recovery etc, Timely discovery and dealing with vascular crises was done as soon as possible.ResultAll of the surgeries of the24cases were finished in6hours successfully and the average operation time was4hours. Before the wounds healing,24patients had stayed in hospital for15to25days, with the means time of20days. All cases were followed up from6to36months (with the mean of20months)10patients visiting the hospital, telephone follow-up in3cases,3cases of letters, home visits in8cases.22of all flaps survived completely, however,1case was healed by anti-infection treatment and dressing treatment after being infected, and1case after the vascular crisis (the next day) was given timely surgical exploration and re-anastomoses which later improved (flap survival, wound healing).24cases of distal end body and flap all survived without the occurrence of vascular crisis, all the flaps survived with well shape, color similar to the recipient site, sense of touch and pressure and pain recovered, flap wear, no ulceration was seen. The function of recipient site was recovered to some extent according to the situation of the patients.The donor site healed well with good appearance. Overall survival rate was100%.16cases of Saphenous nerve anastomoses in14patients recovered protective sensation, recovery rate was87.5%; not matching the8cases of Cutaneous nerve in2patients with protective sensation, recovery rate of25.0%. Nerve anastomoses group and the group without nerve anastomoses, protective sensation recovery rate was significantly different (P<0.05).Conclusion:Through the24cases of patients, It’s a good technique to repair the blood vessel, nerves and soft tissue defect in upper extremity by Tandem transplant of vessels and nerves with the medial crural free skin flap. This not only solves the limb defects and restore limbs blood supply, it is also an ideal way for the treatment of complex limb trauma. With repair in time, the exact effect, etc, and easy for the patients to accept, the clinical application can be widely created as a new vascular anastomosis method.This method can reduce the probability of seaming to the opposite side wall, reduce the incidence of vascular crisis, improve the speed and quality of surgical operations and also vascular anastomosis’single operation to provide an ideal method.