Search

Objective: To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect., Methods: Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly., Results: All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis)., Conclusion: The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.

Objective: To explore the surgical technique, effectiveness, and safety of muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator for breast reconstruction., Methods: Between December 2016 and February 2019, 6 cases of early breast cancer received modified radical surgery, lower abdominal flap was applied for one- or two-staged breast reconstruction. The average age of the patients was 34.6 years (range, 29-56 years). The disease duration ranged from 2 to 16 months, with an average of 9.5 months. The tumor was located in the upper outer quadrant in 4 cases and the lower outer quadrant in 2 cases. Pathological examination showed that they were all invasive ductal carcinoma. Four cases of breast cancer were in stage Ⅰ and 2 cases was in stage Ⅱ. During operation, the inferior epigastric artery perforators were found to be close to the upper edge of the flap and/or near the umbilical cord in 4 cases, the inferior epigastric artery perforator vessels were relatively small (<0.3 mm) in 2 cases; and the breast was reconstructed with muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator. The length, width, and thickness of the flap were (28.9±0.2), (12.1±0.4), and (4.4±0.3) cm, respectively. The length of the vascular pedicle was (11.5±0.2) cm and the weight of the flap was (420.5±32.7) g., Results: All 6 muscle-sparing rectus abdominis myocutaneous flaps were successful, and the breast incisions healed by first intention. There was no vascular crisis, donor site effusion, hematoma, or infection. All 6 patients were followed up 12-36 months (mean, 26.8 months). The reconstructed breast had a good shape, good elasticity, and no flap contracture or deformation; only linear scars left at the donor site of the flap, and the abdominal wall function was not affected. During follow-up, there was no breast cancer recurrence and metastasis., Conclusion: When the inferior epigastric artery perforators are too close to the upper edge of the flap and/or near the umbilical cord, the vascularity of lower abdominal flap can be ruined, harvested in form of muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator can efficiently ensure blood supply safety.

Objective: To investigate the feasibility of one-stage thinning of latissimus dorsi muscle, rectus abdominis muscle and gracilis flap in reconstruction of the hand and foot defects., Methods: From June 2009 to April 2015,24 free muscle flaps were thinned during transfer operation by removing their superficial muscle layers on the basis of their vessel pedicles running in the deep surface of flaps. The surface of the muscle flaps were covered by split-thickness skin grafts. There were 16 latissimus dorsi muscle flaps,4 gracilis flaps and 4 rectus abdominis muscle flaps. Flap size ranged from 6 cm × 4 cm to 20 cm × 12 cm. Thinned muscle flaps were used to resurface 7 hand defects and 17 foot defects., Results: All muscle flaps survived the thinning procedures without any circulation problems except for one case which suffered total flap necrosis due to venous thrombosis. Skins grafts on muscle flaps also took well. One patient experienced partial skin loss. Two patients underwent secondary debridement and thinning procedure for infection and bulkiness. During the 0.3-20 months follow-up, the contour of thinned muscle flaps matched well with the recipient areas. Reconstructed feet are able to wear regular shoes., Conclusions: Intraoperative immediate thinning of free muscle flaps can be safely accomplished during the primary reconstruction procedure. This procedure prevents the limitations of muscle flap bulkiness and may provide an alternative for surface coverage.

Objective: To explore the feasibility to repair defect on the neck and chest with the rectus abdominis flap which pedicle is lengthened by measuring the width, thickness, and the intercostal space of the inferior costicartilage using CT angiography (CTA)., Methods: Thirty cases receiving CTA and three-dimensional reconstruction between July and December 2013 were included in the study. Of 30 cases, 17 were male and 13 were female, aged 44-70 years (mean, 56 years). The width and thickness of the 3rd to 7th costicartilages and the distance of the 3rd to 6th intercostal spaces were measured, and the lengthened pedicle was calculated after the 4th to 7th costicartilage was cut off. Between July 2012 and November 2013, the lengthened pedicle of the rectus abdominis flap was clinically used to repair the defect on the neck and chest in 4 cases., Results: The pedicle of the rectus abdominis flap was about 6 cm in length. When the left 7th, 6th, 5th, and 4th costicartilages were cut off, the average pedicle was lengthened by 4.07, 7.99, 12.50, and 17.48 cm respectively; when the right 7th, 6th, 5th, and 4th costicartilages were cut off, the average pedicle was lengthened by 4.63, 10.82, 16.64, and 22.05 cm respectively. In 4 flaps which were clinically used to repair defects, 3 flap completely survived, 1 flap had partial necrosis. Three patients were followed up 6 months, and the appearance and texture of the flap were satisfactory; 1 patient failed to be followed up., Conclusion: Resecting the inferior costicartilage can prolong the pedicle of the rectus abdominis flap, therefore it can be used to repair defect on the upper chest and the neck.

Objective: To observe the cellular morphological and histological changes of the reconstructed tongue defect by rectus abdominis musculoperitoneal flap of dogs with or without nerve., Methods: 12 Beagle dogs were randomly divided into two groups. Group A made rectus abdominis musculoperitoneal flap with the intercostal nerve while group B without the intercostal nerve. Nerve anastomosis was performed in Group A while not in Group B in the repairment. 12 weeks later, the length, width, surface area and cellular morphology and histological changes of the two transfer flaps were observed., Results: The length, width, surface area of transplanted rectus abdominis musculoperitoneal flaps in group A were greater than those in Group B, and the differences were statistically significant at 12th week (P < 0.01). The microscope study found that the transplanted rectus abdominis musculoperitoneal flaps of group A had part of muscle fiber atrophy with some connective and adipose tissue, loose muscle fiber arrangement, while the transplanted rectus abdominis musculoperitoneal flaps of Group B had muscle cells atrophy with some adipocyte. The structure of muscle cells in Group A was basically normal, but it was disorder in Group B. The type II muscle fibers of Group B was atrophy and substituted by a lot of connective tissue., Conclusion: After tongue defect reconstructed by rectus abdominis musculoperitoneal flap with nerve, the changes of muscle fibers could be similar to tongue muscles, providing a basis for the dynamic recovery of the tongue.

Objective: To explore the method for repairing circumferential wound in the wrist region due to high-voltage electrical burn., Methods: Six patients with circumferential wound in the wrist region after high-voltage electrical burn were admitted to our hospital from January 2009 to December 2011. After debridement, wounds in the wrist were repaired with combined abdominal axial pattern flaps. The wound of wrist on the flexor aspect was repaired with paraumbilical flap carrying a portion of rectus abdominis that filled the wound cavity of the wrist on the flexor aspect. The wound of wrist on the dorsal aspect was repaired with lower abdominal flap. Pedicle division was performed 4 - 5 weeks post surgery. Some donor sites were sutured directly, and the others were closed by skin grafting after the suture of anterior sheath., Results: Three flaps survived. Liquefaction necrosis of tissue was observed under two flaps, and they were healed after debridement. Radial artery embolism of wrist occurred in one flap when pedicle division was performed 5 weeks post surgery, and it was healed by a transplantation of a segment of the great saphenous vein to reconstruct radial artery right after debridement. Patients were followed up for 6 - 12 months, and satisfactory appearance and function of the flaps were observed., Conclusions: It is a feasible option to repair circumferential wound in the wrist region due to high-voltage electrical burn by using paraumbilical flap carrying a portion of rectus abdominis muscle combined with lower abdominal flap.

Objective: To explore the means for the reconstruction of extensive deep burn wounds with exposure of bone and joint in late stage., Methods: Among all the patients with extensive deep burn hospitalized between January 2009 and May 2011, 5 patients presented wounds with exposure of bone and joint in the late stage of treatment that could not be covered by free skin grafts or flaps. Two of the five patients had more than 2 and the other 3 patients had only one such wound(s). The wound size ranged from 8 cm×5 cm to 21 cm×8 cm. Wounds were repaired by transplantation of 7 free muscle flaps (including 4 free rectus abdominis flaps and 3 latissimus dorsi flaps) combined with split-thickness skin grafts harvested from scalp., Results: All the muscle flaps and skin grafts survived. Wounds with bone and joint exposure healed well. At one-year follow-up of some patients, good appearance of repaired areas and normal function of joints were observed with no signs of ulceration, arthritis, or osteomyelitis., Conclusions: Transplantation of free muscle flaps combined with split-thickness skin grafts harvested from the scalp provides satisfactory reconstruction for wounds with deep tissue exposure in patients with a shortage of skin donor site.

Objective: To investigate the clinical application of TRAM-RPAS flap in the one-stage breast reconstruction for patients with breast cancer, and to discuss the method to reduce the incidence of abdominal hernia and abdominal bulging., Methods: From 2002 to 2004, 16 cases of breast cancer (9 cases in stage I or II and 7 in stage III) received radical resection and breast reconstruction with TRAM-RPAS flaps at the same stage., Results: Good symmetry was achieved in 12 cases. In the other 4 cases, 3 cases had moderate breast poptosis and one case had breast hypoplasia on the unaffected side. All the flaps survived with only one case of abdominal bulging., Conclusions: TRAM-RPAS flap can achieve the same result as traditional TRAM-RPAS flap in the one-stage breast reconstruction, while the incidence of abdominal complication is lower for TRAM-RPAS flap.

Objective: To discuss the aesthetic effect and application of refined incisions in breast reconstruction for breast cancer patients by the transverse rectus abdominis myocutaneous (TRAM) flap., Methods: From January 2001 to October 2006, 77 cases with breast cancer were treated with TRAM flap to immediate breast reconstruction. The patients were all females, with an average age of 45 years (ranging from 26 years to 53 years). There were 39 cases of left breast and 38 cases of right breast. The disease course was from 1 day to 180 days. There were 11 cases of stage I, 60 cases of stage II and 6 cases of stage III, among which 34 cases were located in the upper outer quadrant, 15 in the lower outer quadrant, 22 in the upper inner quadrant and 6 in the lower inner quadrant. The size of tumors varied from 1 cm to 4 cm. As to the pathologic type, 60 cases were invasive ductal cancers, 12 ductal cancers in situ, 5 invasive lobular cancers; positive lymph node (number: 1-7) happened in 29 cases, while negative lymph node happened in 48 cases. Among the 77 cases, regular shuttle incisions were performed in 35 cases, and refined circle incisions were performed in 42 cases, which were 2 cm away from the breast tumor border. Axillary incision was necessary for the breast tumors located in upper inner, lower inner and upper outer quadrants in order to perform axillary mastectomy. Ten cases were nipple-areola sparing. The shape, symmetry and incision scar of the reconstructed breast were evaluated and graded., Results: There were 6 cases out of 77 cases of breast reconstruction in which partial necrosis happened and the necrosis rate was 7.79%. The time of follow-up was from 13 months to72 months, with an average of 39 months. No recurrence or metastasis happened in 76 cases, and distant metastasis happened only in 1 case. There were 40 cases out of 42 cases with refined incisions which were scored more than 3, and the satisfaction rate was 95.24%. There were 31 cases out of 35 cases with regular incisions which were scored more than 3, and the satisfaction rate was 88.57%., Conclusion: The reasonable refined incision based on the location of the tumor is effective to improve the satisfaction rate for the shape of the reconstructed breast.

Objective: To sum up the methods repairing the congenital bladder exstrophy, and to evaluate the value of the abdominal fascial flap and the lower abdominal skin flap, the tensor fascia lata musculocutaneous flap treating the bladder exstrophy., Methods: The abdominal rectus sheath and the fascia flap of obliquus externus abdominal and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap were used to repair the abdominal wall defection, meanwhile repair the epispadias. The maximum field of the musculocutaneous flaps was 8 cm x 10 cm., Results: 12 cases were cured. The bladder exstrophy and the abdominal wall defection were repaired very well. The musculus sphincter bladder neck was reconstructed. After the second operation, the cases could urinate under self-control. 2 skin flaps of 8 musculocutaneous flaps were necrosis and cured by skin grafting., Conclusions: Using the abdominal fascial flap and the lower abdominal skin flap, or the tensor fascia lata musculocutaneous flap, is feasible for repairing the bladder exstrophy and the lower abdominal wall defection. The continuous of the musculus sphincter bladder were renewed, and then the patients could urinate under self-control. When the ischemia of the musculocutaneous flaps had occurred, the tensor fascial was survived well.

Objective: To evaluate the application value of repairing the defects of the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis., Methods: From January 2002 to June 2005, five patients with defects in the chest wall underwent the prosthesis with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis under general anesthesia. Focal cleaning was performed first; then, the skin flap was designed and taken (15 cm x 10 cm); and finally, the defects of the chest wall were repaired with the muscle flap of the musculus rectus abdominis., Results: Of the 5 patients, 4 had the flap healing by the first intention, and 1 had the delayed healing, with no complication. The skin flap had a good appearance, without edema or pigmentation. The X-ray examination showed that the shadow of the sternal sequestrum disappeared. There was no recurrence or complication during the follow-up for 1-3 years (average, 18 mon)., Conclusion: The repairing of the defects in the chest wall with the thoracico-abdominal skin flap and the muscle flap of the musculus rectus abdominis is a simple and effective surgical treatment for defects of the chest wall around the sternum, and this kind of treatment is worth applying extensively in clinical practice.

Objective: To investigate the reconstructive operative procedures of funnel chest with "sternum-costicartilage" flap carried by the abdominal rectus pedicle., Methods: (1) In accordance with the lesioned area of funnel-like depressed deformity of anterior thoracic wall, a perpendicular median incision was designed and made; (2) The "sternum-costicartilage" flap carrying the abdominal rectus pedicle was used and reversed and transplanted to reconstruct severe funnel chest deformity., Results: The procedure was used in 7 cases from 1999 to 2005. The results of surgery were satisfactory. There were no recurrence after operation., Conclusions: The procedure reported here is rather safe, solid and sound with good therapeutic results, and is of great value in clinical practice.

Objective: To observe the effect of the early transplantation of double rectus abdominis musculo-cutaneous flaps on the repair of electrical injury of the wrist., Methods: The study involved six patients suffering from circumferential deep electrical burn with only small amount of normal skin left on the dorsal side. The wounds were covered with double rectus abdominis musculo-cutaneous flaps raised from the upper abdomen with pedicles in both proximal and distal ends at an early postburn stage. The postoperative recovery of wrist function and wound repair were evaluated., Results: The wrist wounds in all the 6 patients were primarily healed, with perfect function and appearance., Conclusion: Early application of double rectus abdominis musculocutaneous flaps on the electrically injured wrists can promote the wound healing processes and plays important roles in the preservation of wrist function.

Objective: To evaluate breast reconstruction with a combined skin flap of the deep inferior epigastric perforator (DIEP) and the transverse rectus abdominis musculocutaneous (TRAM)., Methods: The DIEP and TRAM united flap was elevated with the vessel pedicle of the deep inferior epigastric perforator on the affected side and the rectus abdominis muscle pedicle on the intact side. The reconstructive breast was shaped after the deep inferior epigastric vessels were anastomosed to the internal mammary vessels or the thoracodorsal vessels ipsilaterally., Results: We have used the DIEP and TRAM united flaps for breast reconstruction in 17 cases. All of the flaps survived, and the reconstructed breasts were well-shaped with the follow-up of 6-18 months., Conclusions: The DIEP and TRAM united flap possesses of advantages such as rich blood supply, abundant tissue volume and easy shaping. It is especially applicable to the cases who have large chest defect and need large volume tissue.

Objective: To investigate the outcome of surgical reconstruction of the tongue after hemiglossectomy with reinnervated rectus abdominis musculoperitoneal flaps in the treatment of tongue cancer., Methods: Five patients underwent immediate reconstruction of the tongue and oral floor defects with rectus abdominis musculoperitoneal flaps after resection of squamous cell carcinoma of tongue. The rectus abdominis musculoperitoneal flap consists of the rectus muscle, posterior rectus sheath, peritoneum, the 10 th, 11th, 12th intercostal nerves and the vascular pedicle that includes the deep inferior epigastric artery and veins. During the operation a reinnervated rectus abdominis musculoperitoneal free flap, in which the intercostal nerves were anastomosed to the descending branch of hypoglossal nerve, was grafted to remaining tongue stump., Results: All patients recovered uneventfully from surgery, with no immediate postoperative complications. All transplanted flaps survived. The peritoneum was replaced by squamous epithelium 8 weeks after surgery. The average follow-up period was 10 months. During the follow-up period the contour of the reconstructed tongues was satisfactory. The patients demonstrated good functional mobility of the reconstructed and remaining tongue. The swallowing and speech function was nearly at normal levels and the patients could ingest a solid or semisolid diet., Conclusions: Reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy is a suitable, cosmetically acceptable method. Long-term follow-up is needed for reaching some final conclusions.

Objective: To evaluate the early outcomes of breast reconstruction with free transverse rectus abdominis myocutaneous (TRAM) flaps after resection of breast cancer., Methods: A total of 12 free TRAM flaps were performed after breast cancer surgery in The University of Texas Health Science Center at San Antonio from July 2003 to November 2003. Average patient age was 43.5 years, and average weight was 68.6 kg. Reconstruction was undertaken as an immediate procedure after mastectomy in two patients (16.7%) and as a delayed procedure in 10 patients (83.3%). The flap was harvested based on the deep inferior epigastric vessel on the opposite side to the affected breast. Of the 12 patients, 2 patients underwent reconstruction using the thoracodorsal vessels and 10 patients underwent reconstruction using the internal mammary vessels as the receipt vessels. Mean follow-up time was 2.8 months. The surgical technique, complications and the early results of breast reconstruction are reported., Results: The free TRAM flap Reconstruction was successfully performed in all patients at a success rate of 100% . Average operating time was 495 minutes, and average hospital stay was 9.4 days. The contralateral breast reduction was performed in 5 (41.7%) of the patients. Six complications occurred in 3 of 12 reconstructions (25%). Complications included three haematoma or seroma formation, two delayed wound healing and one partial fat necrosis. There were no major postoperative complications such as partial flap loss, total flap loss, wound infection or abdominal wall hernia. RESULTS were considered extremely satisfactory or satisfactory in 11 cases (91.7%), less satisfactory in one case (8.3%). No case was dissatisfied with her reconstruction. Conclusions This study suggests that the free TRAM flap for breast reconstruction is a safe and reliable technique which provides an excellent cosmetic outcome with a high degree of patient satisfaction.

Objective: To investigate the enhancement of the transverse rectus abdominis musculocutaneous (TRAM) flap survival in local ischemic area by recombinant adenovirus mediated vascular endothelial growth factor 165 gene (Ad-VEGF165)., Methods: The vascular pedicle TRAM flaps were made in the right abdomen of 30 SD rats and they were randomly divided into 5 groups. The Ad-VEGF165 was injected into the subcutaneous tissue of epigastria(group 1), the subcutaneous tissue of epigastria and rectus abdominis muscle (group 2), and the rectus abdominis muscle (group 3); Adenovirus mediated green fluorescent protein (Ad-GFP) and DMEM were injected into the subcutaneous tissue of epigastria and rectus abdominis muscle as auto-control (group 4) and blank control (group 5), respectively. The survival areas of TRAM flap was measured after 7 days of operation. The microvascular density (MVD) and the integral optical density (IOD) were tested with anti-rat CD34 and with VEGF immunohistochemistry and in situ hybridization histochemistry (ISHH), respectively., Results: The survival areas of TRAM flap in groups 1, 2 and 3 (14.19 +/- 2.77, 15.18 +/- 2.18 and 8.30 +/- 1.28 cm2) were higher than those in groups 4 and 5(4.12 +/- 1.86 and 3.60 +/- 1.95 cm2), being significant differences (P < 0.05). The CD34 MVD of the TRAM flap in groups 1, 2 and 3 was higher than that in groups 4 and 5; the positive expression for VEGF and ISHH were shown in groups 1, 2 and 3 and there was significant difference when compared with groups 4 and 5 (P < 0.05)., Conclusion: Treatment by recombinant Ad-VEGF165 gene is an effective option for enhancement of the TRAM flap survival in the local ischemic area.

Objective: To investigate a method to reconstruct the breast and repair the chest wall defects at the same time., Methods: The operation procedure combined the transverse rectus abdominis myocutaneous (TRAM) flap with the latissimus dorsi muscle(LDM) flap for breast reconstruction and repair of chest wall defect. Two patients underwent delayed breast reconstruction using this technique., Results: 8 flaps in the four patients survived completely. The aesthetic results were very good., Conclusion: This method can be used to reconstruct breast and repair the defect of chest wall at the same time, avoiding the disadvantage in the flap transfer of TRAM or LDM.

Objective: Breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap was performed to enhance the mental and physical well-being of patients., Methods: The experience with TRAM breast reconstruction in 42 patients was reviewed. The patient selection, flap design and our operative technique were introduced in detail., Results: TRAM breast reconstruction was performed as immediate reconstruction in 25 patients, as delayed reconstruction in 17 cases. 2 cases had partial skin necrosis in the abdominal donor site. 2 had partial necrosis of the TRAM flap. One patient had abdominal hernia., Conclusions: The additional vascular anastomosis or double-pedicle TRAM flap with intramuscular dissection was the key points to reduce complications. Due to the difficulty of TRAM flap reconstruction, thorough understanding of the technique and surgical accuracy are necessary for both flap safety and aesthetic pleasing results.

Objective: To investigate the effectiveness of polypropylene path (Prolene) in hernia prevention following harvesting of rectus abdominis is myocutaneous flap., Methods: From November 1999 to October 2000, Prolene patches were applied in 26 cases to repair the anterior rectus sheath following harvesting free rectus abdominis myocutaneous flap. Data concerning each case included size of rectus flap, defect of rectus sheath, size of patch used, wound healing and complications., Results: Prolene patch showed good biocompatibility with abdominal tissue. No foreign-body rejection occurred after operation. Seroma developed in 1 case, and was drained bedside without complication. All prolene patches healed well in the body during follow-up. Hernia formation and abdominal bulge were not observed., Conclusion: Prolene patch is a satisfactory material for repair of the anterior rectus sheath after harvesting free rectus abdominis myocutaneous flap.

Objective: To investigate the clinical results of transposition of muscular skeletal flap pedicled with straight head of rectus femoris for treatment of avascular necrosis of adult femoral head., Methods: Eight patients with avascular necrosis of femoral head were adopted in this study. There were 6 males and 2 females, the ages were ranged from 24 to 56 years. According to the criteria of Ficat, there were 5 cases in stage II and 3 cases in stage III. The Smith-Peterson incision was used to expose the capsule of the hip. After complete curettage of the necrotic bone from the femoral head, the muscular skeletal flap pedicled with straight head of rectus femoris was resected and transposited into femoral head. Finally, conventional decompression of head was performed., Results: All the cases were followed up for 1 to 3 years. There were excellent results in 5 cases, good in 2 cases and moderate in 1 case. The rate of excellent and good results were 87.5%., Conclusion: Comparing with other pedicled bony flaps, the muscular skeletal flap pedicled with straight head of rectus femoris is characterized by its convenience and efficacy. It is suitable for the treatment of avascular necrosis of femoral head in stage II or III, but the contour of the femoral head should be nearly normal.

Objective: An innovated transverse rectus abdominis musculocutaneous flap, the three-lobe TRAM flap was designed for breast reconstruction., Methods: A triangle-shaped skin over the upper part of the rectus abdominis muscle was included in the conventional TRAM flap for the purpose of adding more skin for breast reconstruction and enhancing blood supply of the skin portion of the TRAM flap., Results: In this group of six patients subjected to mastectomy and radiation therapy for breast cancer, complete survival of the three-lobe TRAM flap was obtained in 4 cases. Two patients had minor skin necrosis and fat liquefaction. Better breast contour and contracture release of the axilla were also achieved., Conclusion: This innovation of conventional TRAM flap for breast reconstruction has some advantages. It is especially useful for patients complicated with radiation lesions on the chest and axilla areas.

Breast reconstruction was carried out with rectus abdominis musculocutaneous flap on 7 women (8 breasts) with defect of breast, and perfect result was obtained on all the patients. The flap which was normally excised in an abdominal lipectomy was used to cover the defect of breast. The rectus abdominis of the flap was used to fill the reconstractive breast and to carry the vascularization from the internal mammary artery. The advantages of the method are as follow: (1) the waist-line is reduced by closing the musculoaponeurtic defect; (2) The scar of the donor area is well hidden by the abdominoplasty; (3) The breast reconstruction need not use an implant. The disadvantage is a risk of postoperative herniation if the suture tears.

5 cases of complete bladder exstrophy were treated by one stage reconstruction with abdominal wall skin flap and rectus abdominis muscle flap. Closure of the abdominal wall and bladder defect were achieved satisfactorily in all the patients. 4 patients have been followed up for 1.5-10.5 years. 3 patients whose bladder neck had been augmented by rectus abdominis muscle flap were continent but 1 patient whose bladder neck had not been, had giggle incontinence. The renal functions were all normal in these patients.