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Objective: To investigate the effectiveness of free-style perforator flap in repairing the soft tissue defect of knee., Methods: Between December 2011 and October 2017, 13 patients with the soft tissue defects of knees were repaired with the free-style perforator flaps. There were 9 males and 4 females, with an average age of 40 years (range, 14-65 years). The injuries were caused by traffic accident in 7 cases, crushing in 4 cases, and falling from height in 2 cases. The soft tissue defects in 9 cases formed after 2 weeks-2 months (mean, 1 month) of lower extremity fractures fixation. The other 4 cases were urgently admitted to the hospital after injury, and the time from injury to admission was 0.5-18.0 hours (mean, 8 hours). The size of soft tissue defect ranged from 3 cm×2 cm to 12 cm×8 cm after debridement. Nine propeller flaps, 6 rotating flaps, and 2 V-Y advanced flaps were used; and 9 cases were repaired by single flap and 4 cases were repaired by combined flaps. The size of flap ranged from 7.5 cm×2.5 cm to 20.0 cm×6.0 cm. The donor sites were sutured directly., Results: The flaps survived smoothly and incisions healed by first intention in 12 cases. The congestion occurred in 1 case, which obtained delayed healing after symptomatic treatment. All incisions at donor sites healed by first intention. All patients were followed up 3-24 months with an average of 6 months. The shape and motions of knee were satisfactory., Conclusion: The free-style perforator flap can maximize the utilization of the donor area around the knee wound, with reliable blood supply, small trauma, and easy operation. It is an ideal flap for the soft tissue defect of knee.

Objective: To evaluate the effectiveness of double pedicled flap and technique of geometric broken line (GBL) for primary repair of serious dog bite wound., Methods: Between October 2006 and December 2014, 9 patients with serious dog bite wound were treated. There were 3 males and 6 females with an average age of 34.5 years (range, 8-68 years), and with a mean disease duration of 4 hours (range, 30 minutes to 24 hours). The defect ranged from 1.7 cm×0.5 cm to 15.0 cm×8.0 cm, with the mean depth of 0.5 cm (range, 0.3-0.8 cm). Deep tissue exposure was observed. After routine debridement, a vacuum sealing drainage (VSD) was equipped to suck and irrigate for 1 day, then wound was repaired. The superomedial edge of defect was trimmed, then a GBL shape mainly with square and rectangular was designed. According to defect size, a double pedicled flap was designed at the lateroinferior edge of defect, which size ranged from 1.7 cm×1.5 cm to 18.0 cm×15.0 cm. The donor site was sutured directly. VSD was used for 3 days after operation., Results: All flaps survived and wound healed, and donor site incision healed well, with invisible scar. All patients were followed up 6 months to 8 years (mean, 4 years). The wounds were repaired well, and the patients had good facial appearance. No rabies attack was observed during follow-up., Conclusions: It is an ideal repair method to chose double pedicled flap and technique of GBL for primary repair of dog bite wounds. Satisfactory cosmetic appearance can be obtained.

Objective: To investigate the clinical application of the modified keystone perforator island flap for reconstruction of skin defects at head and face., Methods: From January 2013 to September 2014,13 cases with skin defects at head and face were repaired by modified keystone perforator island flap. The skin defects ranged from 0.8 cm× 1.0 cm to 20.0 cm × 10.0 cm. And the flap size ranged from 1.5 cm × 1.0 cm to 22.0 cm × 12.0 cm. The flap was designed along the edge of the defect, the vascular supply was supported by muscular perforators. In order to relieve suture tension and have a good cosmetic effect, auxiliary incisions should be as less as possible. Flap should be designed to hide parts of facial incision or surgical margins within the natural borders of each facial unit, or along the direction of striae. Incision within the hairline should be taken to minimize damage to the hair follicles. The direction of hair growth shouldn't be changed after the flap transfer., Results: All cases had 1-12 months' follow-up period.12 flaps survived completely, with one partial flap necrosis. The flaps had good appearance with high aesthetic satisfactory., Conclusions: The modified keystone perforator island flap produces excellent aesthetic results. It can be a very useful flap for the individual reconstruction of skin defects at head and face.