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Volume 37 Issue 12
Dec.  2021
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2021  >  37(12): 1110-1115
Li PC,Jia CY,Li DJ,et al.Clinical effects of partially de-epithelized local flaps in repairing tubercular chest wall defects[J].Chin J Burns,2021,37(12):1110-1115.DOI: 10.3760/cma.j.cn501120-20210929-00337.
Citation: Li PC,Jia CY,Li DJ,et al.Clinical effects of partially de-epithelized local flaps in repairing tubercular chest wall defects[J].Chin J Burns,2021,37(12):1110-1115.DOI: 10.3760/cma.j.cn501120-20210929-00337.
shu

Clinical effects of partially de-epithelized local flaps in repairing tubercular chest wall defects

doi: 10.3760/cma.j.cn501120-20210929-00337
  • 1.

    Senior Department of Burns and Plastic Surgery of the Fouth Medical Center of PLA General Hospital, Beijing 100048, China

  • 2.

    Department of Burns and Plastic & Wound Repair Surgery, Xiang'an Hospital of Xiamen University, Xiamen 361102, China

  • 3.

    Department of Thoracic Surgery, the Eighth Medical Center of PLA General Hospital, Beijing 100193, China

Funds:

Major Program of Military Logistics Research Plan ALB18J001

Beijing Science and Technology Plan Z151100004015199

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  • Corresponding author: Shen Chuan'an, Email: shenchuanan@126.com
  • Received Date: 2021-09-29
    Abstract
  •   Objective  To explore the clinical effects of partially de-epithelized local flaps in repairing tubercular chest wall defects.  Methods  A retrospective observational study was conducted. From April 2010 to February 2021, twelve patients who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Eighth Medical Center of PLA General Hospital, including 9 males and 3 females with age of (42±18) years. The sizes of tubercular chest wall defects of patients were ranged from 4 cm×3 cm×2 cm to 16 cm×8 cm×5 cm, which were all repaired with partial de-epithelized local flaps. The widths of flaps were equal to the widths of the defects, and the lengths of flaps were 2 cm longer than those of the defects. In one patient, the local flap was too large to close the donor site directly by suturing, so an autologous back free medium thickness skin graft was used for repair. In other patients, the collection areas of local flaps were small, and the donor areas of flaps were directly closed. The duration of operation, intraoperative bleeding, and postoperative drainage volume and indwelling time of drainage tube were observed and recorded. In two weeks after operation, the survival, color, and texture of flaps, the presence of subcutaneous hydrops and skin ulcer, and donor site healing including wound disruption, local infection, hematoma were observed. Chest X-ray, CT scan, or nuclear magnetic resonance imaging was performed in one month after operation to check whether new local hydrops and bone destruction occurred in the chest wall defects and the concomitant tuberculose focus of patients. All patients were followed up for more than 6 months to record whether the surgical incisions of the chest wall defects of the patients were complicated by hypertrophic scar, redness, swelling, and sinus.  Results  In surgery, the patient had (104±18) min of operation duration, (119±53) mL of intraoperative bleeding, (134±49) mL of cumulative drainage of drainage tube, and (5.3±1.7) days of drainage tube indwelling time. In two weeks after operation, all the grafted local flaps survived, and the color and texture of flaps were similar to the surrounding normal skin. One patient had fluid leakage from the incision of chest wall defect area with the incision partially dehisced, which healed well after a phase Ⅱ operation; no wound infection, subcutaneous hydrops, or wound rupture occurred in other patients. The incisions of donor sites in all the patients healed well and no wound disruption, local infection, or hematoma occurred. One month after operation, no new bone destruction was observed in the operative region by chest imaging examination. Patients were followed up for 6 to 96 months, with one patient having wound swelling, ulceration, and sinus in the operative area of the chest wall defect in 12 months after surgery, which healed after phase Ⅱ operation; the incisions of chest wall defect wounds in other patients healed well and had no scar, redness and swelling, or sinus.  Conclusions  Partially de-epithelized local flap could be used in repairing tubercular chest wall defect wounds, with the advantages of flexible flap design, minimal donor site injury, and good postoperative wound healing.

     

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