British journal of plastic surgery最新文献

The facial artery musculomucosal flap, technically a combination of the nasolabial flap and the buccal mucosal flap, has been a reliable, versatile flap, either superiorly or inferiorly based for reconstruction of a wide variety of postcancer excision intraoral mucosal defects including defects of the palate, alveolus, lips and floor of mouth. We have used it 17 times in 16 patients with no failures and one flap with terminal necrosis. Almost all flaps developed venous congestion which settled on its own by conservative management.

As relevant literature is scarce, this study was undertaken to assess the donor site morbidity of cross-finger flaps. It included 23 patients who had undergone reconstruction of a finger defect with a cross-finger flap. Any additional trauma to the donor finger was an exclusion criterion. Split thickness skin grafts were employed for donor site closure in 13 cases, full thickness skin grafts were used in 10 cases. Follow-up time averaged 83 months. Active and passive total range of motion of the donor finger and maximal pinch grip strength in kilopascals were measured. Both parameters were compared to the corresponding finger of the other hand. The donor site scar was evaluated for instability and pain in the donor finger was determined subjectively with a visual analogue scale. Cold intolerance and the cosmetic appearance of the donor site were also assessed.

Active total range of motion of the donor fingers averaged 156°. Average active total range of motion of the contralateral control fingers was 173.6°. There was a significant difference between the donor fingers and the control fingers (p=0.03) but not between split thickness and full thickness grafted donor sites (p=0.91). Grip strength was significantly impaired in the donor fingers (p=0.03), but there was no significant difference between split thickness and full thickness grafted donor sites. Subjective cosmetic evaluation by the patients revealed significantly better results for full thickness grafted donor sites. Donor finger pain averaged 2.4 with a range of 0–8. Five of the 13 patients with split thickness grafted donor sites and two of the 10 patients with full thickness grafted donor sites mentioned cold intolerance.

In conclusion, the cross-finger flap is a secure and valuable option. There is, however, significant donor site morbidity. Our results suggest that alternative solutions should also be considered and if a cross-finger flap is employed, donor sites should be closed with full thickness grafts.

The aim of this study is to grade the intraoperative findings seen in carpal tunnel syndrome (CTS) based on severity, and compare it with clinical and electrodiagnostic severity.

Thirty-one hands surgically treated for CTS were graded according to the severity of clinical signs, and electrodiagnostic tests. Oedema, vascularisation, and fibrosis were graded on a scale of 1–3. Pseudoneuroma or ‘hour-glass’ formation were graded as either 0 or 1. The hands were allocated by an observer into an assumptive severity group, from grade 1 to 3. Clinical severity and electrodiagnostic severity were statistically compared with each other, and with each intraoperative severity criteria.

A high statistical correlation (p<0.01) was found between clinical severity and vascularisation, fibrosis, and the assumptive intraoperative severity. No correlation could be demonstrated between electrodiagnostic severity and the intraoperative criteria.

Intraoperative grading should be regarded as a supportive measure to the clinical evaluation in order to obtain a sound base for surgical intervention and internal neurolysis.

The skin of the lower leg is nourished by a number of perforating vessels arising from the named arteries which travel in the longitudinal axis of the limb. The distribution of these perforating arteries has been elucidated using a combination of techniques but which are essentially based on cadaveric studies. Clinically, this knowledge has provided the basis for methods of local tissue transfer in the lower limb. A common finding with the use of local fasciocutaneous flaps is venous congestion. The relationship of the veins to the arteries in perforating vessels of the lower limb has not been investigated. We studied the veins accompanying these arteries by dissecting them in 40 lower limbs (20 cadavers). A total of 40 pedicles were dissected. We concentrated our analysis of the arterial/venous relationship on the most distal vessels on the medial aspect of the lower limbs (the vascular basis for the commonly used distally based fasciocutaneous flap). We found that 25 of these arteries were accompanied by one perforating vein whereas 12 were accompanied by two or more veins. When there was a single vein this was usually larger than the artery in external diameter and lay inferior to the artery 76% of the time. When there were two veins or more, there was an interconnection between the two around the artery in over half of the samples (7/12). Surprisingly, three vessels did not have any accompanying vein. This study sheds some light on the variation in venous drainage important to the initial survival of these flap transfers.

We present an anatomical study that describes the distribution of the cutaneous perforators (CP) of both heads of the biceps femoris muscle.

Material and methods

In this study, we dissected 18 legs from nine cadavers. The study was centered on the biceps femoris muscle and musculocutaneous perforator arteries from both muscular heads. Only perforator arteries with comitant vein diameters of over 0.5 mm were selected. The vascular origin and length were also studied. In all cases, measurements were taken from the bicondyle line.

Results

The measurements taken from the muscle bellies of the biceps gave the following results; for the long head 33.91 cm as medium length (SD=2.70) and for the short head 23.85 cm as medium length (SD=2.96).

The total number of perforator arteries obtained from the two muscle bellies was 139, with the greatest percentage located in the lower half of the thigh. The majority follow an intramuscular route (80.48%) and less frequently they are septals (19.52%).

The lengths of perforator arteries from its origin in the axial vessel of the muscle to the subcutaneous fat were, for the short head 5.01±1.33 (3.0–10.0), whereas the same measurement, in the long head was 4.54±1.36 (2.5–9.0).

The principal vascular origin of the perforator arteries was the popliteal artery in both muscle bellies, whilst the second arterial vessel in importance was the first and second profunda perforator artery.

Conclusion

From the results obtained in our work, we can deduce that it is always possible to locate perforator arteries in both muscle bellies; most frequently they have intramuscular distribution and are located in the proximity of the vascular septum. Their most common origins are the popliteal artery and first and second profunda perforator artery. Finally, it is possible to design pedicle and free flaps, with less morbidity and more versatility than musculocutaneous flaps.

The objective of this study was to evaluate the effect of incorporating basic fibroblast growth factor (bFGF)-impregnated gelatin microspheres into an artificial dermis on impaired wound healing using a pressure-induced decubitus ulcer model in genetically diabetic mice.

Daily 10 h prolonged pressure at 500 g/cm² was loaded for 2 consecutive days over the femoral trochanter tertius of mice to produce ischemic necrosis. Five days after completion of the pressure load, the necrotic tissues were resected. Then, an artificial dermis incorporating bFGF-impregnated gelatin microspheres or bFGF in solution was implanted into the wound (n=5). Mice were sacrificed at 5, 7, and 10 days after implantation, and a full-thickness biopsy was taken and stained with hematoxylin and eosin for histological analysis.

All experimental animals were infected because diabetic mice have little tolerance for infection. Seven days after implantation, the incorporation of bFGF into the artificial dermis reduced infection and accelerated fibroblast proliferation and capillary formation. However, the accelerated effects were more significant with the incorporation of bFGF-impregnated gelatin microspheres than with free bFGF.

We conclude that the incorporation of bFGF-impregnated gelatin microspheres into an artificial dermis induced tissue regeneration in an artificial dermis in an impaired wound healing model.