颌面部软组织缺损的显微外科重建

目的探讨采用前臂游离皮瓣移植，修复重建颌面部缺损畸形的效果。方法对12例由几种原因所导致的颌面部软组织缺损患者，应用显微外科技术将前臂桡侧游离皮瓣移植于缺损区，修复缺损，并对颌面部重建效果进行评价。结果颌面部外形、丰满度及表情功能恢复较好，口腔功能明显改善。本组12例，成功11例，修复成功率91．66％。结论前臂桡侧游离皮瓣，特别适用于颌面部不规则、复杂缺损的修复与再造。     

带皮管蒂前臂皮瓣移植修复颌面部软组织缺损

目的：介绍前臂皮瓣带皮管蒂移植修复颌面部软组织缺损的方法。方法：应用带皮管蒂前辟以瓣移植修复颌面部软组织缺损4例,对其进行临床经验总结,结果：4例皮瓣均成活,软组织缺损修复后外形满意,无感染等并发症。结论：前臂皮瓣带皮管蒂移植解决了受区供给血管限制的问题,拓展了该皮瓣的应用途径,与局部区域条件差,无条件游离使用时,带皮管蒂前臂移植是颌面部软组织缺损修复可供采用的有效方法。     

严重下肢创伤后病理畸形与修复

目的：探讨下肢创伤后病理畸形与修复。方法：通过３３２例严重下肢创伤后病史、体征、Ｘ线检查等的分析及１１种手术方法修复软组织、骨缺损等的研究。结果：主要病理畸形：（１）皮肤肌肉变形与缺损。（２）骨关节变形与缺损。（３）血管神经变性与缺损。应用皮瓣修复创面２８４的成功。骨贩治疗骨不连、骨缺 均愈合。随访２￣５年，下肢功能改善，无１例因病废而截肢。结论：根据下肢不同病理畸形，选择最佳修复法，能获得良好效     

颌面部皮肤软组织缺损即时任意型皮瓣的修复

目的：火器伤颌面部皮肤软组织缺损即时任意型皮瓣探讨的修复方法。方法：9例火器伤颌面部皮肤软组织缺损,根据缺损的部位和形态,采用即时任意型皮瓣修复。结果 ：9例全部成活,随访9个月～7年,效果满意,面容恢复理想。结论：即时任意型皮瓣修复颌面部火器伤皮肤软组织缺损,减少了瘢痕,降低了畸形发生,避免了二次手术。     

耳甲软骨游离移植的临床应用

目的：研究自体耳甲软骨移植在耳、鼻畸形修复中的应用。方法：在唇例术后继发鼻翼塌陷畸形、下部缺损及杯状耳畸形的矫正中，采用耳甲软骨作为支架，重建缺损的软骨。结果：手术后鼻、耳外形明显改善，移植的软骨无感染及排出等并发症。结论：耳甲软骨移植具有切取方便、手术简单、并发症少的优点。同时耳甲软骨弹性较强，适合于耳、鼻等活动部位的应用。     

胸三角皮瓣在颌面部缺损修复中的应用

目的：总结胸三角皮瓣修复颌面部缺损的经验。方法：对我科收治的22例颌面部恶性肿瘤术后缺损患者进行胸三角皮瓣修复。结果：22例术后皮瓣均成活，无一例皮瓣坏死，修复效果满意。结论：应用胸三角皮瓣修复颌面部软组织缺损，操作简单，修复效果良好，是一种有效的修复方法。     

胸锁乳突肌单头肌(皮)瓣一期修复颌面部软组织缺陷

颌面部创伤所致面部凹陷畸形及下颌骨外露临床常见。我科2004年5月至2006年3月采用胸锁乳突肌胸骨头肌（皮）瓣修复颌面部软组织缺损4例取得较满意效果，现报告如下。     

胫前软组织缺损的皮瓣修复(附56例报告)

目的：探讨胫前软组织缺损的修复方法及临床效果，方法：对56例创伤，慢性溃疡及瘢痕癌等原因所致胫前软组织缺损采用6种皮瓣进行局部转位，交腿移植，游离移植及桥式游离移植修复，结果：除一例失败外，其余皮瓣均成活，颜色及外形均较满意，无一例截肢，结论：根据不同的创面选择相应的皮瓣修复胫前软组织缺损，可最大限度地恢复小腿外形及功能。     

吻合血管的皮瓣及肌皮瓣移植临床应用

目的：报道应用皮瓣及肌皮瓣移植修复四肢肤软组织缺损的临床效果。方法：应用吻合血管股前外侧皮瓣、背阔肌皮瓣及阔筋膜张肌皮瓣移植修复四肢皮肤软组织缺损合并肌腱或骨关节外露12例。结果：术后皮瓣及肌皮瓣均成活，随访1-2年，外观及功能良好。结论：吻合血管皮瓣及肌皮瓣移植是修复四肢皮肤软组织缺损合并肌腱或骨关节外露的有效方法。     

鼻尖区软组织缺损的即时修复

目的：探讨鼻尖区软组织缺损的即时修复的有效方法。方法：根据鼻尖及鼻小柱不同范围的软组织缺损，修复方法包括鼻唇沟皮瓣8例，轴型鼻背皮瓣3例，耳廓复合组织移植7例。结果：18例患者修复组织在色泽、质地上与受区接近，修复效果满意。结论：邻近部位皮瓣转移和耳廓复合组织移植是修复鼻尖端部不同范围的软组织缺损的较好方法。     

Distraction osteogenesis in management of composite bone and soft tissue defects

A soft tissue defect is one of the most difficult problems that may accompany bone defects. Plastic surgery is often required. During distraction osteogenesis, not only the bone but also the soft tissues are lengthened, which may help in spontaneous closure of the soft tissue defects. This study examines 11 cases of composite bone and soft tissue defects which were managed by distraction osteogenesis. After debridement of the necrotic tissues, the soft tissue defects ranged from three by four centimetres to five by 14 centimetres and the bone defects ranged from four to 12 centimetres. All the soft tissue defects healed during the process of bone transport without the need for plastic surgery, except in one case. The complications were successfully managed during the course of treatment. Distraction osteogenesis is a good method for simultaneous treatment of composite bone and soft tissue defects.     

MEDPOR生物材料在颅颌面畸形整复中的应用

目的：介绍Medpor生物材料在颌面畸形整复中的应用。方法：对6例不同原因所致颌面部畸形采用Medpor生物材料或Medpor复合软组织瓣整复畸形。结果：6例手术均获得满意效果，无感染等并发症，外形恢复好。结论：Medpor生物材料克服了组织移植特别是骨移植所存在的组织吸收的缺点，具有创伤小、可塑性强，并可与软组织移植复合整复颌面部畸形的特点。     

The thoracodorsal artery perforator-scapular osteocutaneous (TDAP-SOC) flap for reconstruction of palatal and maxillary defects

Despite technical advances over the past 3 decades, subtotal, total, and extended total maxillectomy defects remain challenging reconstructive problems. In particular, postoncologic resection of the maxilla results in complex 3-dimensional defects of the midface, which cause severe functional and esthetic deformities. Such defects generally require composite tissue flaps for reconstruction. Rebuilding the palate and maxilla is especially challenging because it requires reconstitution of the facial buttresses, occlusion, replacement of bony hard palate, and the thin intraoral and intranasal lining which normally constitute the soft palate. Various methods of reconstruction have been applied to this area in search of an ideal soft tissue-bone flap to restore the bony framework of the maxilla and palate while providing an internal lining. Osteocutaneous and osteomuscular flaps such originating from the scapular, iliac, peroneal, and radial vascular systems have been attempted with good success.We devised an osteocutaneous flap based on the scapular vascular system, which provided bone and soft tissue to successfully reconstruct the palate and maxilla in 2 patients. The skin paddle received its blood supply from the major perforating vessels of the thoracodorsal artery, and the scapular bone was nourished by the angular vessels. Although free tissue transfer using thoracodorsal perforator flaps has been described, this flap has not been previously reported in the literature as an osteocutaneous tissue transfer. With the use of rigid fixation, excellent results have been obtained with this technique for palatal and maxillary reconstruction.     

带血管蒂皮瓣、肌皮瓣修复四肢复杂性软组织缺损的临床应用

目的探讨带蒂皮瓣,肌皮瓣修复四肢,软组织缺损的临床疗效。方法应用12种皮瓣,肌皮瓣,其中躯干部2种5块,下肢6种67块,上肢4种56块,通过游离移植或带蒂转位的方法,修复四肢因创伤所致软组织缺损,肌腱及骨质缺损或外露。结果移植的组织共128块,其中成活124块,坏死4块,成活率96.8%。经6个月～4年(平均21个月)的随访,皮瓣成活良好,所有修复的肢体都保留和恢复了功能。结论利用带蒂皮瓣,肌皮瓣修复四肢软组织缺损疗程短、疗效好、能取得良好的临床效果。     

Intraoperative plasty of complex defects of the bones and soft tissues in a craniofacial region

The results of treatment of 159 patients, suffering craniofacial region tumors, were analyzed. In tumoral invasion of cranial bones with affection of the head soft tissues the bone defects dimensions were determined and the implants prepared preoperatively, the soft tissues defects were closed, using transposition or free microsurgical transplantation of the tissues composite complexes. The complex approach application have permitted to close the bones and soft tissues defects of the head craniofacial region with achievement of subsequent functional and aesthetic result.     

大面积皮肤软组织缺损伴严重感染创面的修复

目的探讨大面积皮肤软组织缺损感染创面的修复方法。方法对15例大面积皮肤软组织缺损伴创面严重感染的患者，经积极换药后均行两次清创手术，首先采用异体皮片移植暂时覆盖创面，再行自体皮肤移植或皮瓣转移修复创面。结果术后经6个月至4年的随访，自体的皮肤和皮瓣移植后均完全成活，创面修复良好。患者平均住院时间38d。结论两次彻底清创和异体皮片移植暂时覆盖创面是修复大面积皮肤软组织缺损严重感染创面的有效方法，值得推广应用。     

骨外固定架与髂骨皮瓣移植联合应用治疗小腿骨及软组织缺损

目的探讨骨外固定架与髂骨皮瓣移植I期联合修复胫骨缺损伴小腿软组织缺损的方法和临床效果。方法对28例胫骨及其周围软组织缺损早期应用骨外固定架与髂骨皮瓣移植治疗。皮肤缺损面积：5cm×5cm～9cm×20cm;手术切除皮瓣面积：5cm×7cm～12cm×23cm;切取髂骨块5cm×3.5cm～10cm×3.5cm。对于较大面积的骨皮组织缺损,应用同时携带旋髂深及旋髂浅双血管蒂的髂骨皮瓣移植治疗。结果髂骨植骨骨性愈合时间31周,无不愈合病例。骨皮瓣全部存活,无感染、坏死,外形及功能恢复满意。结论早期应用单侧外固定支架与髂骨皮瓣移植联合是修复合并骨及软组织缺损的小腿严重创伤的一种良好方法,双血管蒂为骨皮瓣的存活提供了可靠保障。     

掌背动脉逆行皮瓣及复合组织瓣的临床回顾性研究

目的 探讨用掌背动脉皮瓣及复合组织瓣修复手指组织缺损的临床效果。方法 对122例病例用掌背动脉逆行岛状皮瓣及复合组织瓣的临床应用做一回顾性分析。对手术病例就其手术适应证、组织供血特点、静脉回流方式、复合组织移植的种类及远期疗效进行总结和分析。结果 122例皮瓣及复合组织瓣术后均成活，受区手指外形及功能均满意；手背供区外形及功能正常。结论 掌背动脉逆行岛状皮瓣及复合组织瓣是修复手指软组织和功能重建的较为理想的手术方法，具有临床推广应用价值。     

Benefits of routine maxillectomy and orbital reconstruction with the rectus abdominis free flap.

Maxillary defects lead to functional and cosmetic deficiencies, especially with tumor invasion of the orbit and cribriform plate. Additionally problematic is the near-total palatal resection in patients with poor dentition (ie, not useful for anchoring obturators) and the desire for return of deglutition and useful speech. A series of 12 patients is presented in whom a rectus abdominis free flap was used for reconstruction of the palate, maxilla, and/or orbit. Nine of 12 free flaps were used to reconstruct defects involving the maxilla and orbit; all were successful in restoring hard palate continuity and function without the use of an obturator. The remaining 3 patients underwent successful repair of defects involving the orbit and medial maxilla without complication. Four of those 9 patients with palatal reconstruction augmented their dental rehabilitation with either their existing upper denture plate or the use of a cosmetic appliance anchored to their remaining dentition. Objectively, the rectus abdominis myocutaneous free flap proved to be a reliable and expeditious method of restoring function and acceptable cosmesis. We believe this technique should be routinely considered in the reconstruction of these defects.     

Surgical treatment of sequelae of burns of the anterior abdominal wall and lumbosacral region

The proposed method of surgical treatment of patients with scar deformations and defects of soft tissues of the anterior abdominal wall and lumbosacral zone was used in 30 patients. The method is based on large mobilization and acute distention of undamaged dermal flaps in neighboring with the scar defects zones. Acute dermotension permits to remove large scar defects and restore natural integument in patients with burn trauma.