理想的阴茎再造新方法——肩胛皮瓣阴茎再造术

目的　为了满足阴茎再造的理想要求 ,探索一种全新的手术方式。方法　应用肩胛皮瓣游离移植和硅胶—银丝棒阴茎假体植入行阴茎再造 6例。结果　 6例皮瓣全部成活 ,术后随访 6～ 12月 ,阴茎形态和功能良好 ,获得了良好的手术效果。结论　此方法设计合理、术后形态功能良好、供区无明显继发畸形 ,是阴茎再造的理想新方法 ,值得推广应用。     

应用阴茎阴囊皮瓣再造阴道的男变女变性手术

目的：探讨阴茎、阴囊皮瓣在男变女易性癖患者的外阴及阴道再造中的应用。方法：采用阴茎阴囊皮瓣再造阴道、外阴,以带阴茎背血管神经蒂部分龟头组织再造阴蒂。结果：2005年～2007年共手术治疗易性癖患者5例,阴茎阴囊皮瓣和阴蒂全部成活、外阴形态满意。术后随访6～24个月,无严重并发症,患者能与男性伴侣进行性生活,性感觉恢复,生活状态良好。结论：应用阴茎阴囊皮瓣再造阴道,可以充分利用患者本身的外生殖器材料,再造的阴道及女性外阴,形态及功能良好,是一种比较理想的手术方式。     

阴茎再造新术式探讨

目的:探讨再造阴茎的新方法.方法:应用肩胛游离皮瓣移植和银丝棒硅胶阴茎假体置入行一期阴茎再造术.其中3例保留残存阴茎体,待后期形成含有阴茎背神经血管束的岛状龟头瓣移植于再造阴茎体体表合适位置的患者,列为保留残存阴茎体组,其余病例做为对照组.结果:再造阴茎术后6例皮瓣全部成活.经随访6～12个月,再造阴茎形态良好,供区无明显继发畸形.保留残存阴茎体组再造阴茎的感觉和勃起功能较对照组更为满意.结论:该术式是一种全新的再造阴茎的新方法.保留残存阴茎体,后期可移植含有阴茎背神经血管束的岛状龟头瓣,有助于再造阴茎感觉功能的恢复和勃起功能的完成     

利用腹壁下动脉穿支皮瓣阴茎再造的临床研究

目的 探讨腹壁下动脉穿支(DIEP)皮瓣阴茎再造手术方法的临床疗效.方法 2003年12月至2006年11月收治体外热疗致阴茎严重烧伤2例、假两性畸形1例、动物咬伤致阴茎大部缺损1例.患者平均年龄31岁.术前残余阴茎常态下长度0.5～1.5 cm.应用DIEP皮瓣及第12肋骨植入行一期阴茎再造术.结果 4例手术均成功,皮瓣完全成活,术后未发生感染、尿道狭窄等并发症.3例术后随访5～32个月,再造阴茎外形逼真,阴茎定型长度7.5～11.0 cm,排尿正常,未发生严重感染及尿道狭窄,皮肤感觉与勃起功能良好.1例近期手术者随访3个月阴茎感觉仍在恢复中.结论 该手术方法设计合理,手术一期完成,术后再造阴茎形态功能良好,能满足患者及配偶性生活的要求.供区损伤小,是比较理想的阴茎再造方法.     

包皮内板游离移植耦合包皮岛状瓣治疗阴茎型尿道下裂

目的探索一种新的尿道下裂手术方法。方法应用包皮内板游离移植，耦合包皮岛状皮瓣再造尿道冶疗阴茎型尿道下裂。结果2002年10月至2004年3月共治疗10例阴茎型尿道下裂患者，术后随访1年，效果满意，再造尿道形态逼真，无一例发生尿瘘、尿道狭窄等并发症。结论本法综合运用了皮片、皮瓣移植的优点，手术方法简单，成功率高，是一种较理想的阴茎型尿道下裂修复方法。     

成人阴茎段尿道缺损的修复

目的 总结成人阴茎段尿道缺损的于术修复方法及阴囊中缝区皮瓣的临床应用。方法 2000年1月～2005年11月，对不同原因的阴茎段尿道缺损患者26例，年龄18～40岁。应用局部阴茎皮瓣再造缺损尿道，其中先天性阴茎型尿道下裂16例；外伤性阴茎中段尿道缺损6例。远段尿道缺损4例。外伤1～4年，曾行尿道造瘘术，反复尿道外口开大。应用以阴囊前、后动脉为蒂的阴囊中隔岛状皮瓣进行刚茎腹侧再造尿道表面创面的覆盖，皮瓣范围在阴囊中缝区宽2．5cm，长5．5cm内。结果 术后除4例患者并发感染而漏尿，术后2～4周内自行愈合外，其余患者伤口均Ⅰ期愈合。术后随访7个月～4年，阴茎无弯曲，排尿无异常。结论 应用阴茎局部皮瓣再造尿道及阴囊中缝区带蒂岛状皮瓣覆盖创面，是修复青春期后阴茎段尿道缺损一种良好的方法，下术操作简便，皮瓣血运可靠，修复后阴茎外形及功能均良好。     

“旗形”胸脐皮瓣结合自体肋软骨支架在阴茎再造术中的应用

目的:探讨利用"旗形"胸脐皮瓣结合自体肋软骨支架行阴茎再造的临床效果。方法:以腹壁下动脉为蒂设计脐旁皮瓣,皮瓣形态呈旗状,"旗杆"部为皮瓣血管蒂,"旗面"部用于阴茎成形及尿道成形。以"旗杆"为轴旋转180°转移至会阴部,将皮瓣翻转卷成管状形成尿道及阴茎体,并与会阴部尿道口吻合。手术同期切取自体肋软骨,雕刻为支撑材料置入阴茎体。术后半年可行二期手术修整阴茎形态,包括皮瓣去脂修薄、瘢痕切除等。结果:2010年8月-2016年8月供实施8例,术后皮瓣血运均良好,皮瓣供区均可于术中直接缝合关闭创面,伤口一期愈合。术后随访5～14个月,其中2例患者阴茎臃肿,于阴茎再造术后1年行皮瓣去脂修薄改善阴茎外形,满足性生活;2例术后3个月因尿瘘再次行手术修补;其余4例患者再造阴茎外观及功能均良好。所有患者均未见软骨外露,除脐部位置稍向皮瓣供区侧偏移,腹壁外形轮廓基本正常。结论:"旗形"胸脐皮瓣阴茎再造设计简单,术后效果较为理想,避免了传统胸脐皮瓣阴茎再造需要植皮覆盖创面的问题,减轻了腹壁继发畸形的发生,是一种可供选择及推广的阴茎再造术式。     

感觉神经植入兔带蒂皮瓣转移再造阴茎后的再生神经形态学观察

目的 观察兔隐神经与阴茎背神经吻接植入腹壁浅血管蒂岛状皮瓣阴茎再造术后，再造阴茎感觉神经的再生过程和机制，探索再造阴茎感觉功能重建的有效方法。方法 雄性新西兰兔40只随机均分为实验（神经植入）组和对照（未植神经）组。建立隐神经与阴茎背神经吻接植入腹壁浅血管蒂岛状皮瓣阴茎再造术的动物模型，术后1、2周及1、3、6个月，应用组织学、免疫组化及电镜等方法对再造阴茎感觉神经的再生情况进行形态学观察。结果 组织学观察发现实验组皮瓣内神经束数量不断增多，至术后6个月时尚可见神经长人脂肪层，对照组皮瓣内残存神经呈萎缩改变；免疫组化结果显示：术后实验组神经植入后再生感觉神经纤维、触觉小体、表皮内游离神经末梢的密度和数量明显高于对照组；电镜结果表明：术后3个月以内早期，皮肤感觉神经的再生以无髓神经纤维为主，之后有髓纤维和无髓纤维均有出现。结论 隐神经移植与阴茎背神经端端吻合植入兔腹壁浅血管蒂岛状皮瓣阴茎再造术，再造阴茎至少在6个月时可以获得良好的感觉神经再生和末梢感受器的神经再支配。     

重复应用阴囊纵隔皮瓣修复首次手术失败的尿道下裂

目的探讨首次手术失败后的尿道下裂再修复方法. 方法 1998年10月～2002年10月,再次采用阴囊纵隔皮瓣再造形成尿道,修复首次手术失败的阴茎阴囊型尿道下裂8例,患儿年龄4～8岁. 结果 8例术后皮瓣全部成活,再造的尿道宽大、通畅.随访6～12个月,阴茎形态及排尿状况良好,无并发症发生. 结论阴囊纵隔皮瓣是修复首次手术失败后尿道下裂的一种可行术式,手术方法简便易行,值得推广应用.     

前置龟头或残余阴茎的阴茎再造术

目的：解决阴茎发育不良但龟头发育基本正常或外伤性阴茎部分缺损等治疗的难题。方法：应用吻合血管神经的前臂皮瓣前置龟头或残余阴茎进行阴茎再造术，治疗１２例，随访１～１２年不等。结果：手术成功１１例，失败１例。随访见再造阴茎不仅保持良好的外形，而且具有良好的感觉和勃起功能，两点分辨觉５～８ｍｍ，有３例婚后已生育子女。结论：利用龟头或残余阴茎再造阴茎是一种较符合生理状态的手术治疗新方法。     

Penile reconstruction by the free scapular flap and malleable penis prosthesis

BACKGROUND:: Penile reconstruction has always been a challenging problem for plastic surgeons while facing patients with severe congenital deformities and gender dysphoria and those who have suffered penile loss because of trauma, self-amputation, malignancy, and so on. Since 1936, when Bogoras first constructed a total penis, attempts have been made by different techniques, including skin flaps or myocutaneous flaps. And with development of free tissue transfer and microsurgical techniques, various free skin flaps, such as the radial free forearm flap, the superficial inferior epigastric artery flap, the superficial circumflex iliac artery flap, have been attempted for phallic construction, with the goal of functional (including a competent neourethra that allows voiding while standing and sexual intercourse) and cosmetic result. The purpose of our study was to evaluate the scapular free flap and implantation of malleable penile prosthesis for penile reconstruction. PATIENTS AND METHODS:: Since March 2000, 20 patients with penile loss were reconstructed in a 1-stage procedure by transferring scapular flap and implantation of a malleable penile prosthesis. The age of the patients ranged between 21 and 36 years old. Of these patients, 12 had penile amputation resulting from an electric accident; the other 8 were self-amputated. RESULTS:: All the flaps remained 100% viable postoperatively. Follow-up ranged from 1 to 5 years. There were no cases of urethral fistula, urethral stenosis, prosthesis extrusion, or infection. The reconstructed penis yielded satisfactory function and esthetic appearance. CONCLUSION:: The scapular free flap is an ideal flap that achieves satisfactory function and esthetic appearance for penile reconstruction because of its adequate amount of tissue, reliable vascularity, acceptable donor-site morbidity, and reliable blood supply.     

A free scapular skin flap for penile reconstruction.

INTRODUCTION: There are many possible methods for penis reconstruction, among them, pedicled flaps, myocutaneous flaps, combined osseocutaneous flaps, and free skin flaps. This study evaluated the free scapular skin flap method for penile reconstruction. METHODS: Fifteen men aged 20 to 48 underwent the procedure between March 2000 and February 2006, with follow-up examinations from 6 months to 5 years. RESULTS: Fourteen of the reconstructions were successful, with patients enjoying good cosmetic results as well as functionality. CONCLUSION: The free scapular skin flap technique is a good method for penile reconstruction.     

吻合血管的游离组织瓣修复进行性单侧面萎缩症

目的用游离的股前外侧筋膜脂肪瓣充填修复进行性单侧面萎缩症。方法设计以旋股外侧动脉降支为血管蒂的游离股前外侧筋膜脂肪瓣或旋肩胛血管为血管蒂的肩胛真皮脂肪瓣，切取筋膜脂肪瓣或真皮脂肪瓣后将其转移至面部萎缩处，然后将旋股外侧动脉降支或旋肩胛血管和面动静脉相吻合。结果临床治疗8例，其中应用股前外侧筋膜脂肪瓣7例，肩胛真皮脂肪瓣1例，组织瓣全部成活，矫正的患侧面部形态与健侧基本对称，外形满意。结论游离组织瓣移植，尤其以旋股外侧动脉降支为血管蒂的股前外侧筋膜脂肪瓣能提供足够的组织量，是修复进行性单侧面萎缩症较好的方法。     

The scapular/parascapular flap in reconstruction of distal lower extremity soft tissue defects over the Achilles tendon

Combined defects of soft tissue and Achilles tendon are rare and are usually seen following repair of the tendon. Large size defects frequently cannot be reconstructed with local tissue. Various free flaps such as the radial forearm flap and the temporoparietal fascia flap have been described for reconstruction. In selected cases with concomitant Achilles tendon defect or loss of gliding tissue, the fasciocutaneous scapular/parascapular flap with an axial fascial extension offers considerable advantages. Three cases with soft tissue and Achilles tendon defects have been treated with a scapular/parascapular flap during an 18 months period. The defect size ranged from 8×9 or 6×15 cm. All flaps survived, donor site morbidity was not significant and primary donor site closure was possible in all cases. Achilles tendon function was good in two cases and fair in one case. One flap had to be revised to produce better contour, but the other flaps were aesthetically pleasing. The scapular/parascapular flap with fascial extension is a useful addition in reconstruction of combined soft tissue and Achilles tendon defects. The axial fascial part is versatile and can be wrapped around the tendon to provide tendon reinforcement, gliding tissue or both. The thickness of the flap is uniform and a custom tailored flap is possible. Received: 7 July 1997 / Accepted: 25 May 1998     

Free flaps for type III complex pharyngoesophageal defects after enlarged ablative surgery for advanced cancer of larynx and hypopharynx

Free tissue transfer has become a useful technique for reconstruction of type III complex pharyngoesophageal defects after enlarged laryngectomy and partial or total pharyngoesophageal resection. We present a retrospective analysis of our experience with 36 patients who received free flaps for reconstruction of complex pharyngoesophageal defects associated with skin and soft-tissue defects. Free fasciocutaneous flaps and jejunum combined with a deltopectoral flap and musculocutaneous pectoralis major flap, gastro-omental flap, and combined latissimus dorsi musculocutaneous and cutaneous scapular flaps were used for reconstruction. Adjuvant therapy included preoperative or postoperative radiotherapy. Free flap failure occurred in 2 of 36 patients. Twenty-eight patients had good swallowing function. Better results with fewer complications in reconstruction of type III complex pharyngoesophageal defects were obtained with the use of a combined latissimus dorsi and scapular flap.     

The optimum method for reconstruction of complex lateral oromandibular-cutaneous defects

BACKGROUND: Ablation of large intraoral cancers can create extensive through-and-through defects of the lateral face, resulting in loss of external facial skin, the lateral and anterior mandible, and the lateral mouth. Repair requires reconstruction of the lips, mandible, and full-thickness cheek defects. Ideal reconstruction with vascularized composite free flaps requires adequate bone and sufficiently large, yet versatile, skin flaps capable of resurfacing extensive intraoral and external defects. METHODS: A series of 12 patients with large lateral facial-mandibular defects is reviewed. All patients were treated for squamous cell carcinoma except for 1 patient with osteoblastic sarcoma of the mandible. All patients underwent primary reconstruction with various free flap techniques, including 6 scapular free flaps, 2 iliac crest free flaps, 3 free fibula flaps, and 1 radial forearm flap. Attainment of reconstructive goals, free flap survival, and complication rates were assessed. RESULTS: All defects were successfully reconstructed in the primary setting. No flap failures occurred. One venous occlusion was successfully salvaged. No orocutaneous fistulas or postoperative hematomas were noted. CONCLUSION: The reconstructive options for extensive defects of the lateral face and jaw are reviewed with attention to the complex three-dimensional soft tissue requirements. The superiority of the scapular composite flap is emphasized because this single free flap provides two independent and versatile skin paddles of optimal thickness in addition to adequate bone stock.     

Review of microsurgical posterior urethral reconstruction

Posterior urethra reconstruction can be a challenging proposition for both patient and surgeon. The vast majority of urethras can be successfully reconstructed with either anastomosis or grafting. However, there are some patients who have recurrent urethral strictures that require more complex reconstruction. There is some speculation that microsurgical penile revascularization may allow subsequent graft reconstruction with lower stricture rates, but this is not yet proven. For the most tenacious urethral strictures, free tissue transfer may be required. The free radial forearm flap is well suited for urethral reconstruction, and the free anterolateral thigh flap may also have a role for these patients. This article will review urethral trauma and strictures and microsurgery's role in reconstruction of the posterior urethra.     

Microsurgical penile reconstruction with a sensitive radial forearm free flap

A series of six consecutive cases of total penile reconstruction with a sensitive forearm free flap based on the radial artery is presented. A simple, reliable, and easily reproducible technique with an acceptable aesthetic appearance is described. No partial or complete flap losses were found. The only complication found in three patients was a urinary fistula on the distal third of the flap, which was repaired successfully with a secondary surgical procedure. The aesthetic and functional outcome was satisfactory to the patient and surgical team in all cases. A sensitive radial forearm free flap is a good choice of treatment for total penile reconstruction.     

游离皮瓣眶窝充填再造眼窝手术方法探讨

目的 探讨游离皮瓣修复眶窝空旷及眼窝闭锁畸形的效果。方法 2001年10月至2005年1月，我们为21例眶窝空旷及眼窝闭锁患者采用游离皮瓣移植，其中19例采用前臂游离皮瓣，2例采用肩胛游离皮瓣。利用显微外科血管吻合技术将游离皮瓣移植于眶窝内，以填充空旷和再造眼窝，同时根据移植后眶窝空旷程度选择性同期眶内充填羟基磷灰石材料，一期重建眼窝。结果 所有眶窝内移植的皮瓣均成活良好，术后随访4～42个月，外观佳，义眼配戴满意。结论 游离皮瓣移植修复重度的眶窝空旷畸形和再造眼窝是一种可取的方法。