趾腹腓侧皮瓣移植修复指腹缺损

目的　介绍游离趾腹腓侧皮瓣移植修复拇、手指腹缺损的临床效果。方法　 2 0 0 0年 9月起 ,亚急诊行游离趾腹腓侧皮瓣修复拇、手指全指腹缺损 6例。结果　 6例皮瓣全部成活 ,术后随访 3个月～ 3年 ,拇、手指外形满意 ,皮瓣两点分辨觉达 6～ 10mm ,手指活动功能良好。结论　趾腹腓侧皮瓣移植术是修复拇指指腹缺损的首选方法 ,也适用于修复示、中指指腹缺损。     

应用拇趾腓侧游离皮瓣修复单手指指腹缺损

目的探讨拇趾腓侧游离皮瓣修复单手指指腹缺损的临床疗效。方法采用拇趾腓侧游离皮瓣修复30例单手指指腹缺损,缺损面积2. 5 cm×1. 5 cm～3. 5 m×3. 0 cm,皮瓣切取面积稍大于指腹缺损面积。结果术后皮瓣全部成活。患者均获得随访,时间12个月。皮瓣质地、弹性及手指外形良好,具有保护性感觉和排汗功能。结论拇趾腓侧游离皮瓣修复单手指指腹缺损,疗效满意。     

拇趾腓侧皮瓣修复指腹软组织缺损

目的 探讨拇趾腓侧皮瓣修复手指指腹缺损的临床疗效.方法 自2005年3月至2009年4月,应用白体吻合足拇趾趾底动脉的拇趾腓侧皮瓣转移的方法,对18例手指指腹软组织缺损的患者进行修复.结果 术后皮瓣全部成活.随访其中的12例患者6～40个月,按照中华医学会手外科学会上肢功能评定标准其均为优良.结论 应用吻合足拇趾趾底动脉的拇趾腓侧皮瓣转移修复手指指腹软组织缺损,手指的外形和功能均良好,足拇趾功能未受影响.     

游离拇腓侧皮瓣修复手指指腹缺损

目的 探讨游离拇腓侧皮瓣修复手指指腹缺损的临床疗效.方法 采用游离拇腓侧皮瓣对15例手指指腹缺损患者进行修复,供区直接缝合或游离皮片移植.结果 15例皮瓣全部成活.患者均获得12个月随访.术后3个月指腹皮瓣外形饱满、逼真、耐磨.术后5个月两点辨别觉为5～8 mm,手指屈伸功能恢复良好,供区愈合良好.术后12个月按中华医...     

足部皮瓣移植修复拇、手指皮肤缺损

目的 探讨应用5种足部皮瓣移植修复拇、手指皮肤缺损的疗效。方法 1987年5月-2003年6月，对93例拇、手指皮肤缺损的患者，采用5种不同类型的足部皮瓣进行移植修复。其中采用趾腹皮瓣移植修复指腹缺损27例；趾甲瓣移植修复指甲与指背皮肤缺损8例；[足母]甲瓣或第二趾趾甲皮瓣移植修复拇、手指皮肤脱套伤48例；[足母]趾腓侧半月形皮瓣移植修复拇、手指近节与（或）中节皮肤环形缺损6例；足背三叶或二叶皮瓣移植修复2～3个手指部分皮肤缺损4例。结果 术后皮瓣成功90例，失败3例，成功率为96．8％。供区3例[足母]甲瓣切取后创面不愈．经扩创、植皮后愈合。术后随访8个月～6年．平均2年，皮瓣质地、弹性及拇、手指外形功能良好．指腹皮瓣两点分辨觉达5～8mm。供区行走无影响。结论 选择不同类型的足部皮瓣游离移植是修复拇、手指不同部位皮肤缺损的理想、有效的治疗方法。     

(足母)趾腹腓侧皮瓣移植修复拇手指指腹缺损

手指指腹在手的功能及美容方面均具有十分重要的地位。手指指腹缺损后的修复方法较多，如交臂皮瓣、邻指随意皮瓣等，但均须二期断蒂，且外形臃肿，感觉差。带指神经血管蒂的岛状皮瓣，虽有感觉但供区手指瘢痕在不同程度上影响了外形与功能。2003年以来，我院应用[足母]趾腹腓侧皮瓣游离移植修复拇手指指腹缺损，取得了满意的疗效。     

改良(足母)趾腓侧皮瓣修复拇手指指腹缺损

目的介绍改良躅趾腓侧皮瓣修复拇、手指指腹缺损的手术方法。方法对15例拇、手指指腹缺损的患者，采用改良的躅趾腓侧皮瓣移植修复。该皮瓣在传统躅趾腓侧皮瓣设计方法基础上，将皮瓣腓侧缘及近端分别向背侧及趾蹼侧移动，从而避开口径细小又紧贴于皮下的躅趾腓侧浅静脉，直接游离第一跖背浅静脉；皮瓣的动脉和神经游离仍以常规方式进行。结果术后15例皮瓣全部成活，未发生动、静脉危象。12例获得4～11个月随访，3例失访。手功能评定：优10例，良2例。皮瓣两点分辨觉为4～8mm，12例对皮瓣外形满意。供区行走无影响，步态正常。10例对供区外观满意，2例欠满意，其中1例蹲趾腓侧偶有触痛。结论应用改良躅趾腓侧皮瓣可显著降低手术难度，提高成功率。     

游离皮瓣移植修复手部及前臂皮肤缺损407例分析

目的 探讨游离皮瓣移植修复手部及前臂皮肤缺损的疗效。方法 1990年5月—2005年9月，选用18种游离皮瓣移植修复手部及前臂皮肤缺损407例。其中躅趾腓侧趾腹皮瓣39例，躅趾或第二趾趾甲瓣11例，躅甲瓣或第二趾趾甲皮瓣60例，躅趾腓侧半月形皮瓣6例，躅趾腓侧或第二趾胫侧半侧甲瓣7例，足背三叶或二叶皮瓣6例，带足背皮瓣的足趾移植144例，第一趾蹼皮瓣12例，足底内侧皮瓣4例，足背皮瓣10例，足外侧皮瓣8例，小腿内侧皮瓣21例，小腿外侧腓骨皮瓣2例，肩胛皮瓣2例，股前外侧皮瓣9例，胸脐皮瓣27例，背阔肌皮瓣5例，桡动脉皮瓣5例，跗甲瓣或第二趾与游离皮瓣组合移植29例。结果术后成功401例，成功率为98．5％。术后经6个月～8年（平均3．5年）的随访，皮瓣血运、质地、弹性良好。不同类型的足趾组织瓣或足部皮瓣移植修复后的拇、手指外形良好，指腹两点分辨觉为5至8mm。结论 游离皮瓣移植是修复手部及前臂皮肤缺损的理想方法之一。尤其对拇手指皮肤缺损，选用不同类型的足部游离皮瓣移植修复，功能与外形优于其他方法。     

拇趾腓侧足背皮瓣修复多指背缺损伤

目的探讨应用拇趾腓侧足背皮瓣I期修复多指背缺损伤的手术方法及临床效果。方法2008年9月至2011年12月．对6例多指背缺损伤患者，应用游离拇趾腓侧足背皮瓣I期修复。并指后指背创面大小4．Ocmx2．Oem～7cmx2．6cm。结果术后皮瓣全部存活。术后随访时间为3-12个月。皮瓣外观及弹性良好，手指功能与外观满意。结论根据缺损部位、范围以及术者的技术水平，应用拇趾腓侧足背皮瓣I期修复邻多指指背缺损的有效方案之一。     

拇趾腓侧皮瓣修复手指掌侧皮肤缺损

目的探讨拇趾腓侧皮瓣修复手指掌侧皮肤缺损的临床应用及效果。方法应用拇趾腓侧皮瓣游离移植修复手指掌侧皮肤缺损12例．结果本组皮瓣全部成活,10例获6个月～2年随访,皮瓣质地良好,外形逼真,有罗纹,两点辨别觉4-7mm．按中华医学会手外科学会上肢部分功能评定试用标准评定：优7例,良3例。供足行、走、跑、跳功能正常。结论应用拇趾腓侧皮瓣修复手指掌侧皮肤缺损能最大程度地恢复患指外形和功能,治疗效果满意。     

Assessment of thumb to index pulp to pulp pinch grip strengths

In this study of fifty men and women with normal hand function, the strength of thumb to index finger pulp to pulp pinch grip was assessed with the remaining fingers either flexed or extended. When the pinch grip was performed with the remaining fingers flexed the value was up to 92% higher than when the remaining fingers were extended. In future studies where thumb to index finger pinch grip is used as an objective test of function then the position of the remaining fingers must be defined to aid interpretation of the results.     

趾腹游离皮瓣移植修复指腹缺损19例

目的 研究拇指及其他手指指腹缺损修复的一种可行方法。方法 对1987年来应用吻合血管游离趾腹皮瓣移植，修复拇指及其他手指指腹缺损19例。结果 19例移植皮瓣全部成功。术后随访3个月－12年，修复的指腹外观饱满，皮纹清晰，两点分辨觉为6－8mm，修复指持物时无疼痛；供足于移植术后以皮片修复，无瘢痕及胼胝形成，无任何功能影响。结论 与其他修复指腹缺损的方法相比，趾腹游离皮瓣移植对单一的指腹缺损修复更加理想。     

Free toe pulp transfer to restore traumatic digital pulp loss

Nine toe pulp flaps based on the first dorsal metatarsal artery for reconstruction of thumb and index pulp loss are reviewed. The method is capable of giving excellent results, and particular indications are noted.     

Free toe pulp flap for finger pulp and volar defect reconstruction

Background:Fingertip injury requiring flap cover is very common in the modern era. The ideal cover should fulfill both functional and aesthetic improvement.Results:Five flaps survived completely, one suffered partial loss, and one flap failed completely. The median follow-up period was 9 months. The median duration of surgery was 255 min (range 210 to 300 min). The median two-point discrimination was 6.5 mm (range 4–8 mm). There was the return of temperature sensation in all patients; two had cold intolerance. The Semmes-Weinstein monofilament score varied from 3.61 to 5.07 (median filament index value 4.31/pressure value of 2 g/mm²). Three patients had delayed donor site wound healing.Conclusions:The free toe pulp flap is an efficient choice for fingertip and volar finger defects reconstruction with an excellent tissue match.KEY WORDS: Finger defect, free toe pulp flap, pulp defect, reconstruction, volar defect     

Pilonidal sinus of the finger pulp

A case of pilonidal sinus of the finger-tip pulp in a male barber is reported. The site appears to be previously unreported for this condition.     

手指指腹缺损的修复

目的　研究用手指皮瓣修复指腹缺损的临床效果。方法　应用手指掌侧推进皮瓣 ,指侧方神经血管蒂岛状皮瓣、指侧方逆行岛状皮瓣、指背侧皮瓣修复指腹缺损 78例。创面面积为 1.0cm×1.0cm～ 3 .0cm× 5 .0cm。结果　 78例的皮瓣全部存活。术后随访 1～ 3年 ,指腹外形满意 ,感觉恢复良好。结论　应用手指皮瓣修复指腹缺损 ,手术简单、效果好、供区影响小 ,是理想的手术方法。     

Nd:YAG laser irradiation of the human dental pulp: implications as a predictor of pulp hemodynamics

BACKGROUND AND OBJECTIVE: The aim of study this was to evaluate in vivo the pulpal blood flow rate, pulpal responsiveness, systemic blood pressure, and pulse rate during Nd:YAG laser irradiation of an isolated tooth. STUDY DESIGN/MATERIALS AND METHODS: Thirteen volunteers from the Tsurumi Dental University faculty participated in this study after giving their consent to the Nd:YAG laser irradiation test protocol. Gingivobuccal areas adjacent to mandibular canines were used for clinical evaluation. Each area was coated with India ink and treated with a Nd:YAG laser for 30 sec at 120-mJ pulses at 10 pulses/sec. Pulpal blood flow was measured by a laser Doppler flowmeter during Nd:YAG laser irradiation of the tooth. All pulp responses were measured by an electric pulp tester before and after Nd:YAG laser irradiation. In addition, the systemic blood pressure and pulse rate were monitored throughout the laser irradiation procedure. RESULTS: For all subjects involved in this study, the pulpal blood flow rate increased during laser irradiation. Threshold values of the electric pulp tests increased in six cases and decreased in six cases. One case showed no change. After 1 month, the threshold values for each subject had returned to previously recorded values. Neither systemic blood pressure nor pulse rate was affected during Nd:YAG laser irradiation. Pulpal blood flow was strongly influenced immediately after Nd:YAG laser irradiation, seen as an increase in the flow rate. CONCLUSION: The results of this study suggest that effects of the Nd:YAG laser irradiation are similar to those of low power laser for the improvement of local blood flow.     

牙髓干细胞研究进展

干细胞是一类具有自我更新、高度增生能力和多相分化潜能的细胞,能够产生高度分化的功能细胞,包括胚胎干细胞和成体干细胞。目前,已在体外成功地扩增出人体多种组织的成体干细胞,自从2000年Gronthos等[1]发现人牙髓组织中存在成体干细胞即牙髓干细胞（dental pulp stemcells,DPSCs）后,近十年来国内外学者对牙髓干细胞的培养、生物学特性、细胞表型、分化能力及重组为诱导性多潜能干细胞（induced pluripotent stem cells,iPSCs）等方面已进行了大量研究,本文就牙髓干细胞的研究现状综述如下。