[Cross-bridge vascular anastomosis free tissue transplantation in repairing tissue defects of extremities].
OBJECTIVE
To investigate the application and effect of the cross-bridge vascular anastomosis free flap transplantation for tissue defects of extremities.


METHODS
From May 1982 to November 2005, 110 cases of tissue defects of extremities were treated with cross-bridge vascular anastomosis free tissue transplantation. Of 110 patitents, 80 were male and 30 were female with a median age of 30 years(5 to 54 years). Tissue defects were caused by traffic accidents (59 cases), machine injuries (32 cases) and mangled injuries (19 cases). The locations were the forearms in 2 cases and the legs in 108 cases. And 69 cases had simple soft tissue defects, 6 cases had simple bone defects, and 35 cases had complicated defects. The length of bone defect ranged from 5 cm to 19 cm and the area of soft tissue defect ranged from 6 cm x 10 cm to 15 cm x 35 cm. The graft tissue included latissimus dorsi musculocutaneous flap, vastus anterolateral flap,cutaneous fibula flap, osseous fibula flap, and cutaneous iliac flap. The cross-bridge of the two lower extremities was performed in 106 cases, the cross-bridge of the two upper extremities in 2 cases, and the cross-bridge of the upper-lower extremities in 2 cases. The composite tissue transplantation was used if the graft tissues were two or more. The wounds of donor site was directly sutured in 67 cases, and partly sutured with skingrafting in 43 cases.


RESULTS
Vascular crisis occurred in 9 cases. Vascular crisis was relieved in 5 cases and grafting tissues was survival after exploring the vessel; 4 cases failed. The graft tissue was survival in 101 cases, and the survival rate was 96.4%. The follow-up time was 4 months to 22 years with an average of 6.3 years. Graft bone healed and mean healing time was 4 months. The flap appearance was satisfactory and extremity function was restored to normal. One case became necrosis in the edge of the flap and cured by debridement, dressing and skingrafting, the other got primary healing at 2-3 weeks after operation.


CONCLUSIONS
The application of the cross-bridge vascular anastomosis free tissue transplantation for tissue defects of extremities is an effective method, when extremities have no vessel anastomosed.
Jiang
Peizhu
P
Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, 200233, PR China. jpzh999@sina.com
Fan
Cunyi
C
Cai
Peihua
P
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005543:Forearm Injuries / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D016038:Skin Transplantation; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult