Chin-Wei Tsai

The distally based posterior tibial arterial adipofascial flap

A distally based posterior tibial artery adipofascial flap with skin graft was used for the reconstruction of soft tissue defects over the Achilles tendon in three cases and over the heel in three cases. Good resurfacing with protective sensation of these wounds was achieved. There was no breakdown of the graft or morbidity of donor sites, which were closed primarily. We believe there were many advantages to this adipofascial flap and that it is an ideal choice for the reconstruction of soft tissue defects in the lower third of the leg and foot, especially over the Achilles tendon.

Reconstruction of soft tissue defects of the lower leg with the distally based medial adipofascial flap

A distally based medial adipofascial flap, based on the lower perforator originating from the posterior tibial vessels, is described. It has been used successfully to cover tibial bone and/or plate exposure on the lower leg in 5 patients.

Innervated reverse digital artery flap through bilateral neurorrhaphy for pulp defects

To provide sensation to the reverse digital artery (RDA) flap, both the dorsal branch from the proper digital nerve and the superficial sensory branch from the corresponding radial or ulnar nerve are sectioned at their proximal ends and included with the RDA flap. These are then anastomosed with the distal ends of both radial and ulnar digital nerves at the recipient wound. Three cases of pulp defects reconstructed by this technique achieved very favourable functional and cosmetic results. The RDA flap, innervated through bilateral neurorrhaphy, seems to be an excellent option for one-stage reconstruction of major pulp defects.

Microskin autograft with pigskin xenograft overlay: a preliminary report of studies on patients

Split-thickness pigskin graft (STPSG) was used to replace allograft skin for microskin grafting in 16 patients, nine of whom were burn patients, five suffered from traumatic defects and two from diabetic ulcers. The expansion ratios used in these patients ranged from 8:1 to 12:1. The STPSG preparation described was found to be safe for clinical application. The autogenous donor skin was excised from the inguinal area, and the donor site was primarily closed. There were no instances of donor site morbidity. The majority of the STPSG overlays adhered to the wound firmly. Histological examination showed that the microskin grafts proliferated actively immediately beneath the STPSG overlay. The time for the wound to be fully resurfaced varied from 13 to 21 days depending on the expansion ratio employed. There were only two episodes of pseudomonas infection and no further grafting was required in any of the patients. In this study the pigskin xenograft was found to provide a suitable environment for the epithelialization of microskin autografts. When allograft is not available, this is an alternative way of ensuring successful microskin grafting.

Reverse digital artery neurovascular cross-finger flap

Soft tissue loss with digital nerve defect in the finger was reconstructed with the reverse digital artery neurovascular cross-finger flap in two cases with favorable results. The flap harvested from the lateral side of the proximal phalanx of the neighboring healthy finger is nourished by a distally based digital artery. The flap contained a segment of digital nerve dorsal branch, which is used to bridge the nerve gap in the wound while the flap is used to reconstruct the soft tissue defect concomitantly. The reverse digital artery neurovascular cross-finger flap seems to be a useful addition to the options for complicated finger damage involving soft tissue loss and nerve defect.

Clinical application of adipofascial turn-over flaps for burn wounds

Local adipofascial turn-over flaps overlaid with skin grafts were used successfully to reconstruct nine deep burn wounds following electric injuries or contact burns in seven patients. Durable flap coverage of the exposed tendons, joints or bones can be achieved with a one-stage procedure. Appropriate length-to-width ratio and flap-to-base area ratio, and the tension-free insetting of the flap are essential for flap survival. The non-adherent characteristic of the adiposal component of the flap enables the underlying involved tendons or joints to glide through without adherence, and the rich vascular network in the fascia provides an ideal bed for the skin graft. The adipofascial turn-over flap is a reliable and simple technique for reconstruction of certain deep burn wounds if the surrounding soft tissue is available. The functional and cosmetic results in our series have been rewarding and satisfactory.

Microskin grafting of rabbit skin wounds with Biobrane overlay

Biobrane was used to overlay micrografts and the wound using the microskin grafting technique with an expansion ratio of 10:1 in 16 rabbits. The rabbits were divided randomly into four groups, with four rabbits in each group, for evaluating the wound conditions on days 7, 10, 12 and 14. Histological examination of the removed Biobrane showed a variable degree of entrapment of inflammatory cells within the nylon fabric. Biobrane adhered well to the wounds although many wrinkles containing fluid accumulations were noted on day 7. By 10, 12 and 14 days all the wounds become dry and their Biobrane adhered completely. Histological examination of the grafted wound on day 7 showed active proliferation and spread of micrografts. In the later groups, the neoepidermis increased in thickness and differentiated into skin with a normal texture. On day 10, the wounds were almost completely resurfaced with neoepithelium. The growth of these grafts progressed smoothly as the adherent Biobrane was kept on the wound for 12 or 14 days. In these animal studies, the overlain Biobrane provided favourable conditions for the successful growth of micrografts.

Running Y-V-plasty for burn scar contracture

Seventeen patients with 24 regions received running Y-V-plasties to release burn scar contractures over a 3-year period. The scar band can be completely interrupted and lengthened without the need for undermining and transposition of the skin flaps, circulatory embarrassment of the flaps can be avoided. The wound morbidity was extremely low, and no recurrence of the contracture was noted during follow-up periods. The running Y-V-plasty has unique advantages for the treatment of cord-like or linear burn scar contractures. This approach resulted in shorter hospital stay and allows early mobilization of the involved extremities.

An easy way to prepare microskin grafts

The conventional technique to produce microskin grafts is a relatively time-consuming procedure. We developed an easy method by using a trimmed circular dermacarrier with the non-grooved side up and driving forward in the meshgraft instrument through six different angles that were 30 degrees apart. The tiny skin particles obtained by this method not only saved operation time but also survived well in the grafted wounds.

Tracheal Deviation: an Unusual Complication of Platysma Myocutaneous Flap

Reconstruction of the intraoral defect caused by tongue cancer was done for a patient by using a platysma myocutaneous flap. The relatively short neck, scar contracture, and inactive movement of the involved side of the neck resulted in tracheal deviation, an unusual complication not appearing in previous reports. In order to avoid airway problems during intubation, the surgeon and anesthestist should seriously consider the possibility of this rare complication in patients who have had the platysma myocutaneous flap technique. Careful preoperative evaluation and skillful intubation of the fiberoptic bronchoscope are demanded in cases where next general anesthesia is needed.