Download PDF
J Reconstr Microsurg 2009; 25(6): 361-367
DOI: 10.1055/s-0029-1215543
© Thieme Medical Publishers

An Overview of Skin Flap Surgery in the Mainland China: 20 Years' Achievements (1981 to 2000)

Shi-Min Chang1 , Chun-Lin Hou2 , Da-Chuan Xu3
  • 1Department of Orthopedic Surgery, Tongji University Tongji Hospital, Shanghai
  • 2Department of Orthopedic Surgery, Changzheng Hospital, Shanghai
  • 3Institute of Clinical Anatomy, Nanfang Medical University, Guangzhou, People's Republic of China
Further Information

Publication History

Publication Date:
13 March 2009 (online)

    Permissions and Reprints

ABSTRACT

Microsurgical anatomy and clinical applications have been widely and extensively practiced throughout the mainland of China since late 1970s. During the 1980s to 1990s, Chinese surgeons and anatomists developed many new flap donor sites and modifications, most of which were published in Chinese literature. These achievements were not fully realized by the Western surgeons. In this overview, we attempt to give a brief introduction of these contributions made by the Chinese authors in the mainland. Of the new flaps first or independently described by the Chinese, most were in the limbs. These flaps can be classified into three categories. First are free flaps with a main artery trunk, such as the radial forearm flap with radial artery, the medial leg flap with posterior tibial artery, and lateral leg flap with peroneal artery. Second are reverse-flow island flaps based on distal main vascular bundles (e.g., the radial artery and venae comitantes, the ulnar, the posterior tibial, and the peroneal arteries). Third are septocutaneous perforator flaps that avoid sacrifice of the main artery trunk, which include the anterolateral thigh flap, lateral lower-leg flap, dorsoulnar flap, distally adipofascial pedicled radial forearm flap, and so on.

KEYWORDS

Radial forearm flap - reverse-flow island flap - septocutaneous flap

REFERENCES

  • 1 Chen C W, Chien Y C, Pao Y S. Salvage of the forearm following complete traumatic amputation: report of a case.  Chin Med J (Engl). 1963;  82 633-638
    PubMedGoogle Scholar
  • 2 Chen C W, Chien Y C, Pao Y S, Lin C T. Further experience in the restoration of amputated limbs: report of 2 cases.  Chin Med J (Engl). 1965;  84 225-231
    PubMedGoogle Scholar
  • 3 Yang D Y, Gu Y D. Free second toe transplantation to thumb: a report of 40 cases [in Chinese].  Chin J Surg (Zhonghua Wai Ke Za Zhi). 1977;  15 13-16
    PubMedGoogle Scholar
  • 4 Dongyue Y, Yudong G. Thumb reconstruction utilizing second toe transplantation by microvascular anastomosis: report of 78 cases.  Chin Med J (Engl). 1979;  92 295-309
    PubMedGoogle Scholar
  • 5 Yang D Y, Gu Y D. Free flap transfer with vascular anastomosis for repair of a cheek defect after cancer resection [in Chinese].  Natl Med J China (Zhonghua Yi Xue Za Zhi). 1974;  54 163-165
    PubMedGoogle Scholar
  • 6 Chen ZW. Free muscle transplantation by microvascular anastomoses: report of a case.  Chin Med J (Engl). 1976;  2 47-50
    PubMedGoogle Scholar
  • 7 Chen Z W, Bao Y S. Microsurgery in China.  Clin Plast Surg. 1980;  7 437-473
    PubMedGoogle Scholar
  • 8 Chen Z W, Yang D Y, Chang D S. Microsurgery. New York; Springer-Verlag 1982
    Google Scholar
  • 9 Zhong S Z, Kong J M. Microsurgical anatomy in China.  Surg Radiol Anat. 1989;  11 115-123
    CrossrefPubMedGoogle Scholar
  • 10 Zhong SZ, Kong JM, William WC Clinical Microsurgical Anatomy. Hong Kong; Med Info Publisher Co. 1991
    Google Scholar
  • 11 Chen Z W, Ni A M. Microsurgery in China.  Microsurgery. 1994;  15 293-296
    CrossrefPubMedGoogle Scholar
  • 12 Buncke H J. Replantation surgery in China: report of the American Replantation Mission to China.  Plast Reconstr Surg. 1973;  52 476-489
    PubMedGoogle Scholar
  • 13 Buncke H J. Forty years of microsurgery: what's next?.  J Hand Surg [Am]. 1995;  20(3 Pt2) S34-45
    PubMedGoogle Scholar
  • 14 Buncke H J, Chang D W. History of microsurgery.  Semin Plast Surg. 2003;  17 5-16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Hallock GG Fasciocutaneous Flaps. Boston; Blackwell Scientific Publications 1992: 181-193
    Google Scholar
  • 16 Cormack GG, Lamberty BGH The Arterial Anatomy of Skin Flaps. 2nd ed. Edinburgh; Churchill Livingstone 1994: 2-13
    Google Scholar
  • 17 Martin D. Ten years of skin flaps: 1984–1994.  Ann Chir Plast Esthet. 1995;  40 527-582
    PubMedGoogle Scholar
  • 18 Masquelet A C, Gilbert A. An Atlas of Flaps of the Musculoskeletal System. London; Martin Dunitz Ltd. 2001: 20-23
    Google Scholar
  • 19 Yang G F, Chen B J, Gao Y Z et al.. The forearm free skin flap transplantation: 56 cases [in Chinese].  Natl Med J China (Zhonghua Yi Xue Za Zhi). 1981;  61 139-141
    PubMedGoogle Scholar
  • 20 Song R, Gao Y, Song Y, Yu Y, Song Y. The forearm flap.  Clin Plast Surg. 1982;  9 21-26
    PubMedGoogle Scholar
  • 21 Lu K H. The forearm radial arterial turnover flap and its clinical applications [in Chinese].  Chin J Surg (Zhonghua Wai Ke Za Zhi). 1982;  20 695-697
    PubMedGoogle Scholar
  • 22 Wang W, Chang T S, Guan W X. Reversed radial forearm island flap in application of hand trauma [in Chinese].  Bulletin Shanghai Second Med Univ. 1982;  2(suppl 1) 31-33
    PubMedGoogle Scholar
  • 23 Guan G C, Zhong S Z. Reversed radial forearm flap with a piece of radius for one-stage thumb reconstruction [in Chinese].  Med J PLA (Jiefangjun Yi Xue Za Zhi). 1983;  8 29-31
    PubMedGoogle Scholar
  • 24 Song R, Song Y, Yu Y. The upper arm free flap.  Clin Plast Surg. 1982;  9 27-35
    PubMedGoogle Scholar
  • 25 Yang L M, Shi W Y, Guo Y J. Scapular osteocutaneous free flap by vascular anastomosis [in Chinese].  Med J PLA (Jiefangjun Yi Xue Za Zhi). 1983;  8 253-256
    PubMedGoogle Scholar
  • 26 Chen Z W, Wang Y. The study and clinical application of the osteocutaneous flap of the fibula.  Microsurgery. 1983;  4 11-17
    CrossrefPubMedGoogle Scholar
  • 27 Zhang S C, Li J M, Song K Q. Medial lower leg free flap: report of 9 cases [in Chinese].  Chin J Surg (Zhonghua Wai Ke Za Zhi). 1983;  21 743-746
    PubMedGoogle Scholar
  • 28 Zhang S C. Clinical use of island turnover grafts with a posterior-tibial vascular pedicle [in Chinese].  Chin J Surg (Zhongua Wai Ke Za Zhi). 1984;  22 685-687
    PubMedGoogle Scholar
  • 29 Hwang W Y, Chen S, Han L, Chang T S. Medial leg skin flap: vascular anatomy and clinical applications.  Ann Plast Surg. 1985;  15 489-491
    CrossrefPubMedGoogle Scholar
  • 30 Hong G, Steffens K, Wang F B. Reconstruction of the lower leg and foot with reverse pedicled posterior tibial fasciocutaneous flap.  Br J Plast Surg. 1989;  42 512-516
    CrossrefPubMedGoogle Scholar
  • 31 Liu K, Li Z T, Lin Y, Cao Y. The reverse-flow posterior tibial artery island flap: anatomic study and 72 clinical cases.  Plast Reconstr Surg. 1990;  86 312-316
    PubMedGoogle Scholar
  • 32 Jin Y T, Guan W X, Chang T S. Radial forearm reverse fascial flap for hand surgery [in Chinese].  Chin J Surg (Zhonghua Wai Ke Za Zhi). 1984;  22 203-204
    PubMedGoogle Scholar
  • 33 Jin Y T, Guan W X, Shi T M, Quian Y L, Xu L G, Chang T S. Reversed island forearm fascial flap in hand surgery.  Ann Plast Surg. 1985;  15 340-347
    CrossrefPubMedGoogle Scholar
  • 34 Xu D C, Zhong S Z, Liu M Z. Anatomic study of anterolateral thigh flap [in Chinese].  Chin J Clin Anat (Zhongguo Lin Chuang Jie Po Xue Za Zhi). 1984;  2 158-160
    PubMedGoogle Scholar
  • 35 Luo L S, Gao J H, Xu D C, Zhong S Z. Anatomy and clinical applications of the anterolateral thigh flap [in Chinese].  Chin J Plast Surg Burns (Zhonghua Zheng Xing Wai Ke Za Zhi). 1985;  1 50-52
    PubMedGoogle Scholar
  • 36 Song Y G, Chen Z J, Song Y L. The free thigh flap: a new free flap concept based on the septocutaneous artery.  Br J Plast Surg. 1984;  37 149-159
    Google Scholar
  • 37 Xu D C, Zhong S Z, Kong J M et al.. Applied anatomy of the anterolateral femoral flap.  Plast Reconstr Surg. 1988;  82 305-310
    CrossrefPubMedGoogle Scholar
  • 38 Gu Y D, Wu M M, Li H R. Lateral lower leg skin flap.  Ann Plast Surg. 1985;  15 319-324
    CrossrefPubMedGoogle Scholar
  • 39 Gu Y D. Lateral lower leg skin flap (report of 7 cases) [in Chinese].  Natl Med J China (Zhonghua Yi Xue Za Zhi). 1985;  65 281-283
    PubMedGoogle Scholar
  • 40 Gu Y D, Wu M M, Zhang G M. Reversed lateral lower leg flap for foot injury [in Chinese].  Chin J Microsurg (Zhonghua Xian Wei Wai Ke Za Zhi). 1986;  9 148-150
    PubMedGoogle Scholar
  • 41 Li Z T, Cao Y D, Liu K. Ulnar forearm reverse flow island flap in application of hand surgery [in Chinese].  Bulletin Bai-Qiu-En Med Univ. 1985;  10 625-627
    PubMedGoogle Scholar
  • 42 Li Z T, Liu K, Chen Y D. The reverse flow ulnar artery island flap: 42 clinical cases.  Br J Plast Surg. 1989;  42 256-259
    CrossrefPubMedGoogle Scholar
  • 43 Wang C Q, Fan Q S, Zhong S Z. Anatomy and clinical applications of lateral calcaneal flap [in Chinese].  Med J PLA (Jiefangjun Yi Xue Za Zhi). 1985;  10 104-106
    PubMedGoogle Scholar
  • 44 Hou C L, Bao J L, Gou S H, Wei J C, Zhang W M. Repair of digital pup defect by a digital artery flap with the dorsal branch of digital nerve [in Chinese].  Chin J Microsurg (Zhonghua Xian Wei Wai Ke Za Zhi). 1986;  6 202-204
    PubMedGoogle Scholar
  • 45 Yang Q Y. Reversed dorsal pedis island flap for coverage of the first metatarsal joint exposure: a case report [in Chinese].  Chin J Plast Surg Burns (Zhonghua Zheng Xing Wai Ke Za Zhi). 1986;  2 287
    PubMedGoogle Scholar
  • 46 Gu Y D, Zhang G M, Yan J G. Free flap with arterialized venous trunk: report of 4 cases [in Chinese].  Chin J Surg (Zhonghua Wai Ke Za Zhi). 1987;  25 260-262
    PubMedGoogle Scholar
  • 47 Gu Y D, Zhang G M, Chen D S, Yan J G, Cheng X M. Arterialized free flap. Report of four cases.  Chin Med J (Engl). 1989;  102 140-144
    PubMedGoogle Scholar
  • 48 Lu L J, Wang S F, Yang J. Dorsal forearm reversed flap based on the posterior interosseous artery [in Chinese].  Chin J Hand Surg (Zhonghua Shou Wai Ke Za Zhi). 1987;  3 34-35
    PubMedGoogle Scholar
  • 49 Chen B J, Sun X L, Cui C Y. Thumb reconstruction with reversed island flap from the first dorsal metacarpal [in Chinese].  Chin J Reparat Reconstr Surg (Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi). 1988;  2 52-53
    PubMedGoogle Scholar
  • 50 Lu L J, Jiang Y C. Applied anatomy of reversed dorsal hand flap [in Chinese].  Chin J Clin Anat (Zhongguo Lin Chuang Jie Po Xue Za Zhi). 1991;  9 153-156
    PubMedGoogle Scholar
  • 51 Lu L J. Clinical application of retrograde island flap from back of the hand [in Chinese].  Chin J Surg (Zhonghua Wai Ke Za Zhi). 1991;  29 593-595
    PubMedGoogle Scholar
  • 52 Li P J. Reversed digital artery island flap for finger pulp reconstruction [in Chinese].  Chin J Microsurg (Zhonghua Xian Wei Wai Ke Za Zhi). 1988;  11 188
    PubMedGoogle Scholar
  • 53 Zhang Y T, Wang X F, Zhou Z F, Di S Y, Sun Y C, Chang J. The reversed forearm island fasciocutaneous flap in hand reconstruction: 10 successful cases [in Chinese].  Chin J Plast Surg Burns (Zhonghua Zheng Xing Wai Ke Za Zhi). 1988;  4 41-42
    PubMedGoogle Scholar
  • 54 Chang S M, Chen Z W. The distally based radial forearm fascial flap without the radial artery [in Chinese].  Chin J Microsurg (Zhonghua Xian Wei Wai Ke Za Zhi). 1990;  13 143-145
    PubMedGoogle Scholar
  • 55 Chang S M, Chen Z W. The distally based radial forearm fascia flap.  Plast Reconstr Surg. 1990;  85 150-151
    PubMedGoogle Scholar
  • 56 Chang S M, Hou C L, Zhang F, Lineaweaver W C, Chen Z W, Gu Y D. Distally based radial forearm flap with preservation of the radial artery: anatomic, experimental and clinical studies.  Microsurgery. 2003;  23 328-337
    CrossrefPubMedGoogle Scholar
  • 57 Zhang G. Reversed anterolateral thigh island and myocutaneous flap transplantation [in Chinese].  Natl Med J China (Zhonghua Yi Xue Za Zhi). 1990;  70 676-678
    PubMedGoogle Scholar
  • 58 Zhang G M, Gu Y D, Xu J G, Zhang L Y. Forearm cutaneous flap based on ulnar artery branch above the wrist [in Chinese].  Chin J Microsurg (Zhonghua Xian Wei Wai Ke Za Zhi). 1991;  14 69-70
    PubMedGoogle Scholar
  • 59 Gu Y D, Zhang G M, Zhang L Y, Yu C. Hypothenar flap [in Chinese].  Chin J Hand Surg (Zhonghua Shou Wai Ke Za Zhi). 1992;  8 65-66
    PubMedGoogle Scholar
  • 60 Zhang G M, Gu Y D, Zhang L Y, Yu C, Hu J P. The flap based on the fascia perforating branch of radial artery in anatomical snuff box [in Chinese].  Chin J Hand Surg (Zhonghua Shou Wai Ke Za Zhi). 1992;  8 67-68
    PubMedGoogle Scholar
  • 61 Jiang H, Guo E T, Ji Z L, Zhang M L, Lu F. Free abductor hallucis muscle transfer with neurovascular anastomoses for one-stage treatment of late facial paralysis [in Chinese].  Chin J Surg (Zhonghua Wai Ke Za Zhi). 1992;  30 420-423
    PubMedGoogle Scholar
  • 62 Jiang H, Guo E T, Ji Z L, Zhang M L, Lu F. One-stage microneurovascular free abductor hallucis muscle transplantation for reanimation of facial paralysis.  Plast Reconstr Surg. 1995;  96 78-85
    CrossrefPubMedGoogle Scholar
  • 63 Chen B S, Sun H. Experiences on the tongue reconstruction with radial forearm free flap: report of 7 cases [in Chinese].  Bulletin Second Milit Med Univ PLA. 1982;  4 281-283
    PubMedGoogle Scholar
  • 64 Chang T S, Hwang W Y. Forearm flap in one stage reconstruction of the penis.  Plast Reconstr Surg. 1984;  74 251-258
    CrossrefPubMedGoogle Scholar
  • 65 Pei G X, Xie C P, Li K D. Free myocutaneous flap transfer bridged by antero- or retro-grade posterior tibial vascular flaps from the healthy leg [in Chinese].  Chin J Traumatol. 1992;  8 266-268
    PubMedGoogle Scholar
  • 66 Xu Y Q, Li Z Y, Li Q X. Reconstruction of large area skin defects in leg with free vascularized thoracoumbilical flap with reverse flow of the distal stump of anterior or posterior tibial artery [in Chinese].  Chin J Microsurg (Zhonghua Xian Wei Wai Ke Za Zhi). 1997;  20 4-6
    PubMedGoogle Scholar
  • 67 Xu Y, Li J, Lin Y et al.. The free thoracoumbilical flap for resurfacing large soft-tissue defects of the lower extremity.  Plast Reconstr Surg. 2003;  111 1167-1173
    CrossrefPubMedGoogle Scholar
  • 68 Yu G R, Yang S Y, Hua C. Clinical application of the second dorsal metacarpal artery free flap [in Chinese].  Chin J Microsurg (Zhonghua Xian Wei Wai Ke Za Zhi). 1993;  16 50
    PubMedGoogle Scholar
  • 69 Yu G R, Yuan F. Free transplantation of the second metacarpal artery flap [in Chinese].  Chin J Microsug (Zhonghua Xian Wei Wai Ke Za Zhi). 1999;  22 174-175
    PubMedGoogle Scholar
  • 70 Zhong S Z, Sun B, Liu M Z, Xu D C. Anatomical study of septocutaneous vessels [in Chinese].  Chin J Surg (Zhonghua Wai Ke Za Zhi). 1983;  21 596-598
    PubMedGoogle Scholar
  • 71 Sun B, Zhong S Z, Zheng Y M. Anatomic study of venous drainage in reversed radial forearm island flap [in Chinese].  Chin J Clin Anat (Zhongguo Lin Chuang Jie Po Xue Za Zhi). 1983;  1 8-10
    PubMedGoogle Scholar
  • 72 Chang S M, Gu Y D, Li J F. Comparison of venous drainage in reverse-flow island flaps: an experimental study of the rabbit saphenous fasciocutaneous flap.  Ann Plast Surg. 2003;  51 177-181
    CrossrefPubMedGoogle Scholar
  • 73 Timmons M J. William Harvey revisited: reverse flow through valves of the forearm veins.  Lancet. 1984;  2 394-395
    PubMedGoogle Scholar
  • 74 Situ P, Chen J, Chen J H. Pedicled flaps with exposure of subdermal vascular plexus [in Chinese].  Bulletin First Milit Med Univ PLA. 1986;  6 60-62
    PubMedGoogle Scholar
  • 75 Chang S M, Chen Z W. Can superficial veins reverse-flow through valves in distally-based fasciocutaneous flaps?.  Plast Reconstr Surg. 1991;  87 995-996
    CrossrefPubMedGoogle Scholar
  • 76 Chang S M, Chen Z W. Venous drainage in distally based radial forearm fasciocutaneous flaps [in Chinese].  Chin J Hand Surg (Zhonghua Shou Wai Ke Za Zhi). 1992;  8 72-73
    PubMedGoogle Scholar
  • 77 Chang S M, Liu D X, Zhang L S, Han P L. Characteristics of blood circulation in distally based flaps and its clinical implications [in Chinese].  Chin J Clin Anat (Zhongguo Lin Chuang Jie Po Xue Za Zhi). 1998;  16 103-106
    PubMedGoogle Scholar
  • 78 Chang S M, Hou C L. Role of large superficial veins in distally based flaps of the extremities.  Plast Reconstr Surg. 2000;  106 230-231
    CrossrefPubMedGoogle Scholar
  • 79 Chang S M, Gu Y D, Li J F. Comparison of different management of large superficial veins in distally based fasciocutaneous flaps with a veno-neuro-adipofascial pedicle: an experimental study in the rabbit model.  Microsurgery. 2003;  23 555-560
    CrossrefPubMedGoogle Scholar
  • 80 Chang S M, Zhang L S, Han P L. The anatomic basis of chain-type vascularization of fasciocutaneous flaps and its clinical applications [in Chinese].  Chin J Clin Anat (Zhongguo Lin Chuang Jie Po Xue Za Zhi). 1994;  12 62-65
    PubMedGoogle Scholar
  • 81 Chang S M, Hou C L. Chain-linked directional vascular plexuses of the integument and link-pattern vascularized flaps in distal extremities.  Plast Reconstr Surg. 1998;  101 2013-2015
    CrossrefPubMedGoogle Scholar
  • 82 Hou CL, Gu YD Flap Surgery. Shanghai; Science and Technological Press 2006
    Google Scholar
  • 83 Hou C L, Chang S M, Zhang F. The seventh congress of Chinese Society of Microsurgery.  Microsurgery. 2003;  23 539-546
    CrossrefPubMedGoogle Scholar

Shi-Min ChangM.D. Ph.D. 

Department of Orthopedic Surgery, Tongji Hospital, Tongji University

389 Xincun Road, Shanghai 200065, People's Republic of China

Email: shiminchang@yahoo.com.cn

      >