应用带蒂皮瓣修复阴茎皮肤全层缺损临床体会

目的:观察多种带蒂皮瓣修复阴茎皮肤全层缺损的临床应用效果。方法:根据阴茎皮肤缺损情况,对清创后需要行皮瓣修复的阴茎创面,设计相应带蒂皮瓣修复,观察术后皮瓣成活情况。结果:使用多种带蒂皮瓣修复31例阴茎创面,术后皮瓣成活良好,阴茎的外形及功能得到明显改善。结论:根据阴茎皮肤缺损情况设计不同的带蒂皮瓣修复阴茎创面可以取得良好的临床效果。     

隐匿性阴茎误诊误治后的矫治

目的:探讨隐匿性阴茎被误诊为包皮过长并行包皮环切术后的有效补救手术方法。方法:对21例隐匿性阴茎被误诊为包皮过长并行包皮环切术后的患者,采用改良的Devi ne术式矫治隐匿性阴茎和阴囊中隔带蒂皮瓣修复阴茎的皮肤缺损,观察其疗效。结果:21例患者阴茎外观均获恢复或接近正常,无一例出现皮瓣坏死,其中2例出现阴茎水肿,3月后恢复正常。随访1～2年无一例阴茎回缩,排尿勃起功能正常。结论:隐匿性阴茎误诊为包皮过长行包皮环切后,用改良的Devi ne术式治疗隐匿性阴茎和阴囊中隔带蒂皮瓣修复阴茎皮肤缺损是一种较好的手术补救方法。     

联合应用带血管蒂胸脐皮瓣与股前外侧皮瓣修复前臂皮肤缺损

目的探讨带血管蒂胸脐与股前外侧皮瓣联合应用修复前臂及手部大面积皮肤缺损的临床疗效。方法应用联合带血管蒂胸脐皮瓣和股前外侧皮瓣治疗前臂大面积缺损7例。结果7例14个联合应用皮瓣全部成活，术后预期断蒂，取得良好效果。结论前臂手部大面积皮肤缺损应用联合带血管蒂皮瓣的移植，有效解决了皮肤缺损和无可供吻合血管问题。     

阴囊前侧双蒂肉膜皮瓣移植覆盖在阴茎皮肤坏死早期处理中的应用

目的探索阴囊前侧双蒂肉膜皮瓣覆盖在阴茎坏死早期处理中的重要性。方法自2003—2019年,南方医科大学珠江医院整形美容外科共治疗了11例行包皮环切术后阴茎皮肤坏死缺损的患者,局部清创后即刻应用阴囊前侧双蒂肉膜皮瓣覆盖创面,供区直接缝合。结果 11例患者术后均未出现皮瓣坏死。其中9例就诊及时,患者对治疗后阴茎外观恢复较满意;1例就诊时尿道海绵体已严重缺损,伴有尿管外露,采用阴囊皮瓣修复后仍遗留尿瘘,但患者对阴茎外观基本满意;1例就诊时阴茎体前2/3组织坏死,因缺损严重,采用阴囊皮瓣手术治疗2周后,阴茎头部出现坏死脱落,但残余阴茎体形态尚可。结论阴囊前侧双蒂肉膜皮瓣的血运及皮源丰富,色泽、质地与阴茎皮肤相近,修复阴茎皮肤缺损后的感觉和形状均良好,故应用于包皮环切术后阴茎皮肤坏死缺损的早期覆盖,可阻止创面的进一步恶化,挽救阴茎,提高患者的生活质量。     

双侧髂腹股沟皮瓣带蒂转移修复阴囊和阴茎皮肤撕脱伤二例

目的 探讨阴囊、阴茎皮肤完全撕脱伤最佳的修复措施. 方法 2002年5月及2008年9月分别对2例阴囊、阴茎皮肤完全撕脱伤患者采用双侧髂腹股沟皮瓣带蒂转移修复,一侧皮瓣转移后修复阴囊皮肤缺损,一侧皮瓣转移后卷成皮管修复阴茎皮肤缺损. 结果 皮瓣成活良好,伤口一期愈合.术后3个月再次手术行皮瓣修薄术,经过2年半至3年的随访,会阴部外形良好,患者的性生活情况正常. 结论 阴囊、阴茎皮肤完全撕脱伤患者采用双侧髂腹股沟皮瓣带蒂转移,分别修复阴囊、阴茎皮肤,手术方法简便易行,外形美观,生理功能得到较好的保留.     

双侧股前外侧皮瓣临床应用的体会

目的 报道应用双侧股前外侧皮瓣修复大面积皮肤软组织缺损的临床治疗效果.方法 对大面积皮肤软组织缺损创面4例,实施双侧股前外侧皮瓣带蒂移位或游离移植修复,切取皮瓣面积最大为34 cm×17 cm.结果 皮瓣全部成活,术后随访1～2年.修复部位,外观,功能较满意.结论 双侧股前外侧皮瓣,是修复大面积皮肤软组织缺损创而的理想方法之一.     

应用阴囊前动脉皮瓣修复同种异体脱细胞真皮基质补片阴茎增粗术后皮肤坏死

目的 探索阴茎延长同期经冠状沟近端包皮环形切口入路同种异体脱细胞真皮基质(ADM)补片阴茎增粗术后发生皮肤坏死的原因,并探讨应用一侧阴囊前动脉皮瓣修复缺损的疗效.方法 自2009年3月至2011年10月,共治疗8例阴茎延长同期经包皮入路ADM补片阴茎增粗术后皮肤坏死的患者,缺损面积7.4～10.0cm2,平均8.5cm2,均采用一侧阴囊前动脉带蒂皮瓣修复创面,供区直接缝合.结果 本组8例皮瓣均完全成活,无一例取出ADM补片,受区及供区切口均Ⅰ期愈合,阴茎外观满意.术后随访3～6个月,阴茎勃起均正常.结论 阴茎延长术同期经冠状沟近端包皮环形切口入路行ADM补片阴茎增粗术易发生阴茎背侧皮肤缺血坏死,不宜同期手术.以一侧阴囊前动脉为蒂的带蒂阴囊皮瓣具有血供可靠,转移方便,色泽、质地与阴茎皮肤接近的优点,修复阴茎皮肤缺损后形态满意并可保留ADM补片,可作为治疗此类并发症的首选术式.     

阴茎皮肤大面积缺损修复15例临床分析

目的:探讨各种原因所致大面积阴茎皮肤缺损的手术修复方法与经验.方法:回顾分析15例大面积阴茎缺损的手术方法及临床效果.结果:15例均治愈.Ⅰ期手术12例,Ⅱ期手术3例.随访4月-3年.术后外形良好,生理功能恢复较为满意12例.为套脱伤原位缝合1例,阴囊皮瓣修复11例.术后外观臃肿2例:腹股沟皮瓣1例,下腹部皮瓣1例.术后局部皮肤感党迟钝3例.再次修整1例:下腹部皮瓣1例.结论:根据具体伤情选择手术方式是成功的保证.阴囊皮瓣转移修复阴茎皮肤缺损简便易行,创伤小,术后外形及功能恢复好,值得首先选择.     

小儿胸脐岛状皮瓣修复会阴部组织缺损

目的 探讨用一种带血管蒂的皮瓣移位修复会阴部组织缺损。方法 应用带腹壁下血管蒂的胸脐岛状皮瓣移位修复会阴部烧伤严重瘢痕挛缩畸形，外伤性会阴部皮肤坏死，阴茎阴囊皮肤撕脱伤共1l例。结果 皮瓣全部成活，创口一期愈合，外观满意。结论 用带血管蒂的胸脐皮瓣修复会阴部组织缺损是一种较理想的方法。     

髂腹部双叶皮瓣修复手部皮肤缺损30例报告

目的　应用髂腹部带蒂双叶皮瓣修复手部皮肤缺损。方法　双叶皮瓣为髂腹股沟皮瓣及下腹部皮瓣 ,此二皮瓣的轴心血管均起自股动脉 ,以股动脉为共同蒂部 ,以旋髂浅动脉和腹壁浅动脉的各自血管走行为双叶皮瓣的轴心线 ,来设计切取皮瓣。结果　 30例皮瓣全部成活 ,且手外观满意。结论　髂腹部双叶皮瓣是修复手部皮肤缺损的有效方法之一 ,该手术操作简便 ,尤其适合修复手部大面积皮肤缺损及不规则创面。     

尿道下裂术后阴茎部尿道瘘修补术式的比较

对１９７５～１９９５年间４３例尿道下裂术后阴茎部尿道瘘修补术的三种手术方式进行比较。初期１７例的术式为三层缝合法，失败率为３５．２９％，１９８９年后采用瘘口周围皮瓣横形ＹＶ成形法２１例，成功率达９５．２４％，另５例采用带蒂阴囊皮瓣转移法全部成功。认为瘘口周围皮瓣横形ＹＶ成形法成功率高，手术简便，特别适用于阴茎部尿道瘘。     

应用腹直肌前鞘-腹外斜肌腱膜瓣修复先天性膀胱外翻

目的总结先天性膀胱外翻的修复,探讨腹直肌前鞘—腹外斜肌腱膜瓣及肌蒂阔筋膜张肌肌皮瓣在修复膀胱外翻中的应用。方法应用腹直肌前鞘—腹外斜肌腱膜形成的前鞘—腱膜瓣加局部皮瓣或同侧肌蒂阔筋膜张肌肌皮瓣修复先天性膀胱外翻及腹壁缺损,局部皮瓣修复尿道上裂,肌皮瓣的应用面积最大为10cm×8cm。结果临床应用12例,膀胱外翻及腹壁的修复均达到了良好效果,膀胱括约肌功能基本恢复,二次尿道紧缩后12例均能控制排尿。肌蒂阔筋膜张肌肌皮瓣部分坏死2例,游离植皮后痊愈。结论选择性地应用腹直肌前鞘及腹外斜肌腱膜形成前鞘—腱膜瓣加强腹壁,局部皮瓣转移或应用同侧肌蒂阔筋膜张肌肌皮瓣转移修复腹壁缺损能有效地修复先天性膀胱外翻,恢复膀胱颈部括约肌的连续性及尿道紧缩,能达到自主控制排尿的目的。     

The use of scrotal septal neurovascular pedicle island skin flap in one-stage repair of hypospadias

A scrotal septum neurovascular pedicle skin flap was successfully used in one-stage repair of hypospadias in 30 patients with encouraging results. The hairless median scrotal skin flap, with the scrotal septum attached, rich in neurovascular plexus and with the flap tip continuous with the external urethral orifice, is ideal material for creating a new penile urethra without interference to its blood supply. Operative technique and clinical analysis are detailed.     

真皮下血管网皮瓣在手外伤修复中的应用

目的 总结真皮下血管网皮瓣修复手外伤创面手术时机及效果。方法1999年1月～2004年6月，应用胸腹部带蒂真皮下血管网皮瓣修复手部皮肤软组织缺损创面22例，其中男17例，女5例。年龄9～42岁。撕脱伤12例，碾压伤2例，热压伤5例，电烧伤3例；急诊手术13例，3～7d手术9例。手术依创面情况选择胸部或下腹部皮瓣，修薄皮下脂肪保留2～4mm。对于多指损伤，将皮瓣设计成2～3叶，形成多个带蒂真皮下血管网皮瓣，手部缺损区分别置于皮瓣内。结果术后1例皮瓣远端小部分坏死，经换药后愈合，余21例皮瓣完全成活。术后随访3个月～2年，受区皮肤平整、色泽好、质地软，断蒂后不须修整，外形美观，功能恢复满意。术后3～6个月有触觉及痛温觉恢复。结论应用胸腹部带蒂真皮下血管网皮瓣修复手部皮肤软组织缺损具有疗程短，术后手外形及功能恢复佳等优点，是较理想的一种修复方法。     

应用双蒂“风筝”皮瓣修复鼻唇沟旁皮肤缺损

目的探讨应用双蒂"风筝"皮下蒂皮瓣修复鼻唇沟旁肿物切除后皮肤缺损的方法及效果。方法在局部麻醉下完整切除鼻唇沟旁皮肤肿物,沿鼻唇沟走行方向设计以皮瓣两侧皮下组织为蒂的"风筝"皮瓣,推进修复皮肤缺损。结果本组共15例患者。术后皮瓣均成活较好。随访6~24个月,术区外观较满意,瘢痕不明显。结论采用双蒂"风筝"皮瓣修复鼻唇沟旁皮肤缺损是较理想的手术方法;掌握"风筝"皮瓣的手术要点,可进一步提升手术效果。     

Transplantation of thin pedicle skin flap: a new method in the treatment of skin defect of hand (a report of 54 cases)]

We used the transplantation of the thin pedicle skin flap to repair the skin defect on the hand and claw hand due to scar contracture in 54 patients. The results were improved. The size of the skin flaps was 16-8 cm x 6-4 cm. The average time of division of the pedicle was 10.5 days. In comparison with the free skin graft with a preserved subcutaneous vascular network, the whole thickness free skin graft, the random pattern skin flap (local flap, fascio cutaneous flap and traditional skin flap), the axial pattern skin flap (including island skin flap and myocutaneous flap), showed that the thin pedicle skin flap was superior over them. The indications, blood circulation and the points for attention in the operation were discussed.     

Split onlay skin flap for the salvage hypospadias repair

PURPOSE: Following failed hypospadias repair absence of the penile foreskin, a shortage of ventral skin and residual chordee may all contribute to poor long-term results. We describe a technique called the split onlay skin (SOS) flap that has improved our surgical outcomes in boys requiring salvage hypospadias repair. MATERIALS AND METHODS: The SOS flap uses a transverse island of penile shaft skin that is mobilized on its vascular pedicle and rotated into position to the ventrum of the penis at the site of the urethral defect. The flap is transected transversely, and half of the flap is used as an onlay to repair the urethra and the other half is used for additional skin coverage where needed on the penile shaft. We treated 11 boys 30 to 124 months old (mean age 60.3 months) who had a mean of 2 previous failed hypospadias repairs. All 11 boys presented with complex combinations of urethrocutaneous fistulas, stricture or urethral diverticula. RESULTS: Of the 11 patients 6 (54.5%) had development of postoperative fistulas. Five of these fistulas were surgically closed with no further complications. One penoscrotal fistula closed spontaneously after 7 months. Mild chordee from contraction of the flap and a urethral diverticulum developed in 1 boy. At a mean followup of 24.5 months all patients, including those who underwent closure of the secondary fistula, were voiding well with excellent appearance. CONCLUSIONS: In cases where little local tissue is present the SOS flap procedure is an excellent way to transfer healthy dorsal tissue to the ventrum for an onlay salvage urethroplasty while providing additional coverage of the urethral defect and a tension-free skin closure. Despite the high fistula rate we encountered following the initial SOS procedure, we endorse this technique because the transferred dartos provides additional tissue, which facilitates subsequent fistula repair. These boys can achieve a successful cosmetic result without incorporation of scrotal tissue or a free graft, which we believe leads to more predictable results.     

A ventral rotational skin flap to improve cosmesis and avoid chordee recurrence in epispadias repair

OBJECTIVE: To describe a technical modification that facilitates dorsal skin closure, improves cosmesis and eliminates chordee recurrence secondary to contracture of the dorsal penile skin in the repair of epispadias. PATIENTS AND METHODS: Eleven patients with penopubic epispadias (mean age 1.8 years) had the epispadias repaired using a modified ventral penile skin flap. Four patients had isolated epispadias and seven had had a previous primary closure of bladder exstrophy. Nine patients underwent the Cantwell-Ransley technique, leaving the meatus in a glanular position. Two patients were repaired using the penile disassembly technique of Mitchell and B?gli, because they had a short urethral plate. A ventral island skin flap was fashioned, starting at the base of the penis. Dissection was carried ventrally into the scrotum to allow for adequate dorsal flap transposition. The flap was rotated laterally to shift the suture line from the midline and to cover the dorsal aspect of the penis with untouched penile shaft skin. Redundant ventral foreskin was discarded. RESULTS: All patients had an uneventful course after surgery. Dorsal penile skin was viable in every case and no patient developed recurrence of chordee or a urethrocutaneous fistula. The cosmetic result was excellent in all patients. CONCLUSIONS: Dorsal skin closure using lateral rotation of ventral penile skin flap improves cosmesis after epispadias repair and eliminates the recurrence of chordee secondary to midline dorsal scarring.     

头皮缺损合并颅骨外露的皮瓣修复方法探讨

目的:探讨头皮缺损合并颅骨外露的皮瓣修复方法。方法:自2008年1月～2013年3月共收治头皮缺损合并颅骨外露30例,行局部头皮瓣、轴型头皮瓣转移结合皮片移植、上臂带蒂皮瓣修复。头皮缺损最大面积20cm×15cm,颅骨外露最大面积14cm×10cm。结果:共切取皮瓣34块、供瓣区植皮10例。皮瓣皮片均成活良好,术后随访6个月～4年,效果满意。结论:局部头皮旋转皮瓣是修复较小面积(直径小于7cm)头皮缺损优选方法,轴型头皮瓣修复较大面积(直径大于7cm)头皮缺损伴颅骨外露是有效方法,头皮缺损合并面部皮肤缺损行同侧上臂带蒂皮瓣修复也是较理想的方法。     

尿液转流在两种一期尿道下裂修复术中作用的比较

目的通过对４０例两种术式一期尿道下裂修复术的回顾性分析，比较尿液转流的作用。方法将４０例分为尿液转流组和非尿液转流组两组进行比较。结果尿液转流组：阴囊纵隔皮瓣法有２例（２／１４例，１４％）同时并发尿瘘和感染，阴茎腹侧皮肤岛状瓣法有１／１１例（９％）同时发生尿瘘及感染，非尿液转流组中阴茎腹侧皮肤岛状瓣法有４例（５０％）发生尿瘘，阴囊纵隔皮瓣法无一例并发感染和尿瘘。结论应用阴囊纵隔皮瓣一期再造尿道时可以不进行尿液转流，而在应用阴茎皮肤岛状瓣一期修复尿道下裂时，进行尿液转流有利于较小尿瘘的自行愈合及减少尿瘘的发生。