皮肤扩张术在治疗面颈部瘢痕中的应用及随访观察

目的:探讨皮肤扩张器在面颈部瘢痕治疗中的临床应用,观察远期治疗效果。方法:手术分两期:1期于瘢痕附近正常皮下置入皮肤扩张器,充分扩张皮肤,2期行扩张器取出、瘢痕切除、皮瓣转移。结果:18例患者共置入扩张器29个,扩张器并发症6处(20%),所有患者均得到有效治疗,修复效果满意,长期随访中部分患者有更精细的要求。结论:皮肤扩张器修复面颈部瘢痕效果良好,需要更精细的操作满足患者要求。     

游离皮瓣联合预构扩张皮瓣修复面颈部瘢痕

目的:探讨游离皮瓣联合预构扩张皮瓣修复面颈部大面积瘢痕的疗效。方法:2017年6月-2019年6月,应用游离皮瓣联合预构扩张皮瓣修复6例烧伤后患者的面颈部瘢痕。一期设计游离皮瓣修复颈部瘢痕的同时于前躯正常皮肤处设计预构扩张皮瓣,取长约10～14cm的旋股外侧动脉降支血管蒂作为预置血管,将扩张器及预置血管一同置入预扩张的皮瓣内。待扩张器扩张满意后,行二期手术,修复面部瘢痕。结果:分区(面部为一区,颈部为另一区)分次(一期修复颈部瘢痕及置入扩张器,待扩张器扩张满意后二期修复面部瘢痕)修复面颈部大面积瘢痕,两个皮瓣融合良好,未发生术后并发症。随访3～12个月,面部术区与周围皮肤色泽质地及厚薄均相近,张口及表情功能良好,下颌弧度接近正常,颈部活动得到明显改善,两处供瓣区仅留两条线性瘢痕。结论:游离皮瓣联合预构扩张皮瓣是修复面颈部大面积瘢痕较好的方法,供区损伤小,患者满意。     

皮肤软组织扩张术在面颈部瘢痕修复中的应用

目的：通过对临床资料的回顾,总结皮肤软组织扩张术在面部瘢痕修复中的应用经验及教训。方法：系统回顾自2001年以来54例面颈部瘢痕应用皮肤软组织扩张术治疗的病例,通过对术前设计、扩张器置入技巧、皮瓣应用、修复效果和并发症等资料的总结。探讨颜面部扩张术治疗的经验和教训。结果：临床应用54例,发生血肿2例,感染和切口外露各1例,所有并发症经及时对症处理后未影响手术效果。随访6—36个月,48例患者满意,6例患者主诉切口瘢痕增生明显,需进行二期瘢痕整形术。结论：应用扩张器修复面颈部瘢痕,虽然可以获得良好的效果,但对并发症的预防不可忽视。     

皮肤软组织扩张术治疗面颈部瘢痕23例临床分析

目的 总结应用皮肤软组织扩张技术治疗面颈部瘢痕的临床经验.方法 对23例面颈部瘢痕患者分别采用单个或多个皮肤软组织扩张器置入面颈部正常皮肤下,经1～2个月注水扩张后,利用扩张后皮瓣直接推进或形成异位皮瓣修复面颈部瘢痕切除后创面.观察治疗过程中的并发症,术后皮瓣的成活、皮肤的色泽,以及最后面部的瘢痕情况.从而判断治疗的临床效果.结果 本组患者23例,其中1 例术后出现血肿、1例发生扩张器渗漏、2例在扩张过程中出现感染,经处理后正常扩张.扩张后皮瓣均满足修复区所需.术后随访6～12个月患者面颈部皮肤色泽正常,外形良好,无功能障碍,面部为线状瘢痕,较为平整,无增生性瘢痕,治疗效果满意.结论 采用皮肤软组织扩张术治疗面颈部瘢痕方法 简单,效果满意,是一种行之有效的方法.     

皮肤软组织扩张术治疗面颈部瘢痕46例效果观察

目的观察皮肤软组织扩张术治疗面颈部瘢痕的效果。方法采用单个或多个皮肤软组织扩张器置入46例面颈部瘢痕患者的面颈部正常皮肤下,经注水扩张后,再将扩张的皮肤软组织合理转移到要修复的瘢痕区整形缝合。观察术后皮瓣成活率、皮肤色泽、瘢痕恢复情况和治疗过程中的并发症。结果 46例患者术后皮瓣全部成活,2例患者面部扩张器埋置术后感染,3例出现面部皮瓣下血肿,均经对症处理后痊愈,对手术效果无影响,并发症发生率为10.87%。无扩张失败终止治疗病例。术后随访6~12个月,患者面颈部局部皮瓣转移后血运、色泽正常,外形良好,无功能障碍,面颈部为线状瘢痕,较为平整,无增生性瘢痕出现。结论采用皮肤软组织扩张术治疗面颈部瘢痕,操作简单、效果满意,是皮肤烧伤整形外科中修复创面的理想方法。     

应用皮肤扩张术修复面颈部瘢痕

目的:应用皮肤扩张修复面颈部瘢痕。方法:应和扩张器置入面颈部正常皮肤下,扩张后修复面部瘢痕切除后创面30例。面颈部皮瓣的设计不同,面部多采用直接推进皮瓣修复,颈部多采用易位皮瓣修复。结果:30例瘢痕切除后无继发畸形,1例皮瓣部分血运障碍,经换药后痊愈。随访显示皮瓣颜色、质地均佳,切口轻度瘢痕。结论:皮肤扩张术为面颈部瘢痕切除后创面修复的首选方法。     

扩张皮瓣在头面颈部皮肤缺损修复中的应用

目的:探讨皮肤扩张皮瓣在头面、颈部皮肤各类缺损修复中的手术方法及临床疗效。方法:总结自2004年以来,应用扩张皮瓣修复头面、颈部皮肤缺损患者23例,根据缺损不同部位情况设计扩张器的大小、形状及埋置方式,二期以旋转,推进,轴形皮瓣方式转移扩张皮瓣修复缺损区。结果:所有23例患者的共使用扩张器36只,一次修复缺损面积最大16.0cm×12.0cm,出现扩张器渗漏1例及扩张器外露1例则选择二期扩张器置入,并发血肿、感染1例,发生率约13%。术后皮瓣均成活,修复后形态自然。随访3个月至5年,疗效满意。结论:充分做好术前设计,提高手术技巧的前提下应用扩张皮瓣是修复头面、颈部皮肤缺损的理想选择。     

皮肤软组织扩张治疗小儿面颈部瘢痕

目的总结皮肤软组织扩张器在小儿面颈部烧伤后瘢痕修复中的“V”型切口应用技巧，评价扩张术的应用效果。方法对32例患儿应用97枚扩张器行扩张皮瓣修复治疗面颈部烧伤后瘢痕。在瘢痕区内设计“V”型切口，切开皮肤全层后直视下分离出与扩张器大小相宜的皮下腔隙，置入扩张器，容量为80－300ml，注射壶外置。每2、3天注水一次，扩张时间约60d，超量扩张满意后行Ⅱ期手术修复面颈部瘢痕畸形。结果术后发生血肿2例，皮瓣坏死1例，切口裂开1例。随访6～12个月，32例患儿经Ⅱ期手术修复后取得良好的功能和外观效果，皮瓣质地、色泽理想。结论应用皮肤软组织扩张期治疗小儿面颈部烧伤瘢痕，节约皮源，减少供皮区瘢痕，可以达到良好的功能、外观修复效果，是首选治疗方法。     

应用皮肤软组织扩张器修复头面颈部瘢痕58例

目的探讨扩张器在治疗头面颈部瘢痕中的临床应用。方法分两期手术治疗：先于瘢痕附近正常皮下置入扩张器，皮肤充分扩张后行扩张器取出、瘢痕切除、局部皮瓣转移。结果本组58例患者，其中血肿3例，术后发生扩张囊外露2例，感染2例，经对症处理后痊愈。术后随访6个月以上，修复效果均满意。结论扩张器修复头面颈部瘢痕效果良好，同时尽量预防并发症的发生。     

应用多个扩张器扩张皮肤软组织修复颈部挛缩瘢痕的护理

目的 探讨应用多个扩张器皮肤软组织扩张术修复颈部挛缩瘢痕的护理体会。方法 1998年1月～2003年6月应用多个扩张器置入颈部正常皮肤下，扩张皮瓣修复颈部瘢痕切除后创面15例，手术前后制定护理细则，保证病情观察的规范化。结果 13例患者扩张皮瓣转移后无继发畸形，1例皮瓣部分血运障碍，1例扩张器外露、切口感染，经换药后均痊愈。结论 皮肤软组织扩张术是修复较大颈部瘢痕切除后创面的首选方法，规范化的护理，能有效预防术后并发症，提高手术效果。     

三种阴道成形术的比较

目的：比较三种阴道成形术的优缺点，寻找损伤小，疗效好的手术方法。方法：1979年1月－1998年12月对86例先天性无阴道患者，分别采用腹部皮片，胎儿皮及阴股沟皮瓣阴道成形术，对手术时间，住院时间，供皮区切口愈合和阴道湿润度进行对比观察。结果：胎儿皮与腹部皮片，阴股沟皮瓣相比，手术时间最短（P＜0．01），胎儿皮的住院时间短于腹部皮片（P＜0．01），与阴股光皮瓣比较无显著差异（P＜0．05），胎儿皮无供皮区，损伤最小，且人工阴道湿润度最高（P＜0．01）。结论：胎儿皮阴道成形术损伤小，再造的人工阴道近似正常女性阴道，是目前阴道成形术中一种较理想的术式。     

氨甲环酸对损伤后皮肤纹理的修复作用

目的:探讨氨甲环酸对化学损伤和物理损伤后皮肤纹理的修复作用。方法:5%SLS溶液反复涂抹形成化学损伤模型,3MED照射后形成物理损伤模型。两种不同皮肤损伤模型同时应用5%氨甲环酸水溶液进行涂抹。应用皮肤扫描仪对氨甲环酸组和自我修复组的皮肤纹理改变进行14天观察。结果:氨甲环酸可有效改善化学损伤后质地参数,物理损伤中仅可改善NRJ;氨甲环酸可改善两种损伤后的皮肤表面光滑度和细纹。结论:氨甲环酸在14天内对因化学或物理损伤引起的皮肤表面纹理有显著改善作用。     

两种薄中厚皮片治疗皮肤撕脱伤临床效果对比研究

目的:对比研究撕脱皮肤反取薄中厚皮片与常规切取薄中厚皮片在治疗皮肤撕脱伤中的移植效果。方法:选取2008年6月~2012年6月就诊的52例四肢皮肤撕脱伤患者为研究对象,其中23例因撕脱皮肤毁损严重无法利用,只能采用常规切取薄中厚皮片游离移植修复撕脱伤创面,其余29例利用撕脱皮肤反取制备薄中厚皮片,全部薄中厚皮片打孔直径1cm,术后均采取加压包扎。结果:所有移植皮片均成活,常规切取薄中厚皮片移植的23例患者中,Ⅰ期愈合者21例,Ⅰ期愈合率为91.3%;撕脱皮肤反取薄中厚皮片的29例患者中,Ⅰ期愈合者24例,Ⅰ期愈合率为82.8%。结论:常规切取薄中厚皮片移植与撕脱皮肤反取薄中厚皮片移植的Ⅰ期愈合率相仿,临床应尽可能利用撕脱皮肤反取制备薄中厚皮片移植修复撕脱伤创面,如撕脱皮肤难以利用则应选用薄中厚皮片移植修复。     

Surgical procedures for melanoma in public and private New South Wales hospitals, 2001-2002

BACKGROUND: Evidence suggests that there is considerable variation in the types of procedures used to treat cancer. This variation may result in suboptimal or cost-ineffective care. The present study examined the variation in surgical treatment of melanoma before the establishment of a Melanoma Network that could promote more uniform high-quality care in New South Wales (NSW). The variations in the use of surgical procedures for melanoma by NSW Area Health Service of patient residence were examined. METHODS: Data in the Health Information Exchange of NSW Health collected on procedures carried out on patients with a diagnosis of melanoma in NSW public and private hospitals from 1 July 2001 to 30 June 2002 were examined. Data were aggregated by Area Health Services of patient residence. These data were compared with the numbers of new cases of melanoma notified to the NSW Central Cancer Registry in the same areas in 2001-2002. Excision of skin lesions, skin grafting and numbers and types of lymph node procedures were examined. RESULTS: During the study period, the Central Cancer Registry reported that there were 3085 notifications of melanoma, whereas hospital inpatient data recorded that 6864 procedures were carried out for patients with a melanoma diagnosis in NSW public and private hospitals. Sixty-seven per cent of procedures were carried out in private hospitals. A total of 852 skin grafting procedures were recorded. Of these, 60% were carried out in private hospitals. The average proportion of skin grafts associated with excisions in NSW was 30% (range, 0-53%). Eight hundred and fifty-eight lymph node procedures were recorded for 747 NSW residents. These were biopsies, excisions or both. Forty per cent were carried out in private hospitals. The average proportion of new cases of melanoma associated with a lymph node procedure in NSW was 28% (range, 0-47%). CONCLUSION: Most of the inpatient procedures for patients with melanoma were carried out in private hospitals. The proportions of new cases that underwent skin grafting after excision, or underwent lymph node dissection, varied more than fivefold from one Area Health Service to another. This may indicate variations in casemix, variations in clinical practice or both.     

游离足背皮瓣修复足背大面积皮肤缺损的临床应用

目的探讨游离足背皮瓣修复足背大面积皮肤缺损的临床效果。方法对12例足背大面积皮肤缺损患者应用游离足背皮瓣修复治疗。结果 12例均获随访,时间1个月～4年。游离皮瓣全部成活,受区运动、感觉及外观良好;供区植皮全部成活,双足功能无明显影响。结论游离足背皮瓣可以解决足背大面积皮肤缺损修复的问题,且组织相似性高;供区只要保留完整腱周膜即可解决植皮生长不理想的问题。游离足背皮瓣是修复足背大面积皮肤缺损的较理想选择。     

特重度烧伤后伴多处严重畸形的功能重建

To explore new measures for functional reconstruction of multiple severe deformities as a result of extensive deep burn( total burn surface area ≥90% TBSA, including deep burn ≥ 70% TBSA)in late stage. Twelve severe bum patients with above-mentioned deformities were hospitalized in our ward during 1960 ～ 2005,the sears resulted from bums were distributed from head to foot with 173 deformities, including 27 scar ulcers. All patients lacked of self-care ability, among them some could not stand. Due to inadequate skin source, deformities were corrected by skin from matured scars expanded with subcutaneous balloon at late postburn stage. Following our former clinical experience, anatomic investigation and experimental re search, we chose the following methods to correct deformities and restore functions: application of split-thickness scar skin after expansion(88 wounds) ; use of sear skin flap/scar-Achilles tendon flaps (59 wounds) ; combination of thin split-thickness skin grafts from scar and allogeneic acellular dermal matrix (composite skin,40 wounds).All grafts survived, the appear ance and function were improved obviously without complica tions. Follow-up 1～ 40 years, all patients could take care them selves with satisfactory function and appearance, and among them 8 patients returned to work ( one had worked for 40 years),2 pa tients married and had children. The above-mentioned measures are safe, reliable and effective for functional reconstruction of deformities.     

Nasal Correction in Hyperteleorbitism: The Short and the Long Nose

The soft tissue deformities associated with hyperteleorbitism often present serious reconstructive problems. Although skeletal correction is the basic preliminary step, the final result depends on the quality of the soft tissue and nasal repair. The patients are not interested in the postoperative intercanthal distance or the appearance of the X-ray film. What they want is a good aesthetic appearance and this is closely related to the shape and size of the nose. The short wide noses of the true hyperteleorbitism must be differentiated from the long noses associated with meningoencephalocele and pseudohypertelorism. For the first group, narrowing of the nose and the use of a forehead flap is indicated according to the severity of the problem. For the second group, shortening of the nose is accomplished by transverse resection of skin via a U shaped incision or skin replacement with a forehead flap. Downward sliding of forehead and brows may be necessary. The indication for each procedure is discussed and the different techniques are described.     

Microclimate and development of pressure ulcers and superficial skin changes

This study aims to evaluate the microclimate and development of pressure ulcers and superficial skin changes. A prospective cohort study was conducted in an acute care ward in Indonesia. Risk factors for pressure ulcers and superficial skin changes were identified based on the Bergstrom Braden conceptual model. Microclimate data were collected every 3 days for 15 days while the development of pressure ulcers and superficial skin changes was observed every day. Pressure ulcers and superficial skin changes were developed in 20 of the 71 participants. Total mean difference in skin temperature was higher for patients with pressure ulcers and superficial skin changes (0·9 ± 0·6°C) compared with controls (0·6 ± 0·8°C) (P = 0·071). Binary logistic regression predictor values for pressure ulcers and superficial skin changes were 0·111 for type of sheet and 0·347 for Braden Scale results. In conclusion, difference in skin temperature seems to be a predictor for pressure ulcer development and superficial skin changes, while synthetic fibre sheets are able to maintain a beneficial microclimate.