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pedicle complex tissue flap transfer for reconstruction of duplicated thumbs with unequal size

World Journal of Clinical Cases 2021年第35期9卷 10909-10918页

作者： De-Hua Wang Gui-Ping Zhang Zeng-Tao Wang Meng Wang Qin-Yi Han Fan-Xiao Liu Department of Hand and Foot Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021Shandong ProvinceChina Department of Anesthesiology The Affiliated Hospital of Shandong University of Traditional Chinese MedicineJinan 250000Shandong ProvinceChina Department of Hand and Foot Shandong Provincial Hospital Affiliated to Shandong UniversityJinan 250021Shandong ProvinceChina Department of Orthopaedics Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021Shandong ProvinceChina

BACKGROUND Thumb polydactyly is one of the most common congenital hand deformities,and the Bilhaut-Cloquet procedure or a modified one is often ***,controversy remains over the rare instances in which both thumbs are not of similar length or far apart in *** To evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal *** From January 2014 to December 2020,15 patients underwent duplicated thumb reconstruction by pedicle complex tissue flap transfer at our hand surgery *** technique was used when it was necessary to combine different tissues from both severed and preserved thumbs that were not of similar length or far apart in *** parents’evaluations and functional outcomes(ALURRA and TATA criteria)were *** alignment deviation,instability,range of motion(percent of opposite thumb)of the interphalangeal and metacarpophalangeal joints,and the aesthetic aspects,including circumference,length,nail size,and nail deformity,were used to assess the clinical *** The average age of patients at the time of surgery was 13 mo,and the mean final follow-up occurred at 42 *** appropriate volume with a stable joint and good appearance was obtained in 14 reconstructed *** unstable interphalangeal joint occurred in one *** flexion-extension arc at the metacarpophalangeal joint was good,while that at the interphalangeal joint was *** of the parents were satisfied with the cosmetic and functional results of the reconstructed *** mean ALURRA score was 21.8(range:20-24),and the Tada score was 6.9(range:5-8).Compared with the non-operated side,the length of the operated thumb was approximately 95%,the girth was 89%,and the nail width was 82.9%.The mean ranges of motion were 62.1%of that of the unaffected thumb in the interphalangeal joint and 78.3%in the metacarpophalangeal *** Harvesting a pedicle flap from a severed

关键词： Thumb duplication Deformity pedicle flap pedicle

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Diaphragmatic flap: Technique of Preparation and Indications for Use

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World Journal of Cardiovascular Surgery 2022年第9期12卷 207-218页

作者： Farid Gharagozloo Mark Meyer Institute for Advanced Thoracic Surgery University of Central Florida College of Medicine Orlando Florida USA

Background: The use of a vascularized pedicle flap of diaphragmatic muscle (DF) for reconstructive procedures in the chest has many advantages. Yet, despite the excellent reported results, the use of DF has not been widespread. Some factors for the less widespread use of DF have been, concern about diaphragmatic function, hesitation to use such a vital muscle for reconstructive purposes, and most importantly, the technical aspects for the preparation of the flap. Methods: Using a cadaveric model, the vascular anatomy of the diaphragm and the steps for the preparation of the DF was defined and illustrated for both the right and left hemidiaphragm. Results: No perioperative mortality with the use of DF has been recorded. Function of the native diaphragm has not been impaired. Bronchopleural fistulas and pericardial defects have healed in all instances. Excellent repair has been achieved in all patients with esophageal lesions. The disruption of the repaired native diaphragm and visceral herniation has been reported but it has been attributed to the learning curve and the technique of repair. Conclusion: With a better understanding of the vascular anatomy of the diaphragm and a formal methodical approach to harvesting the DF, more surgeons will be encouraged to use DF with excellent results.

关键词： Diaphragmatic flap Diaphragmatic pedicle flap Muscle flap Bronchial Stump Reinforcement Esophageal Reinforcement Vascularized flap pedicle flap

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