Repair of facial skin defect with a skin flap of SMAS pedicle

Repair of facial skin defect with a skin flap of SMAS pedicle@王晓军$Dpet Plast Surg Peking Union Med Col Hosp,Beijing 100032     

Application of free vein skin flap on the anterior aspect of wrist in the case of finger injury with vessel and skin defect

Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomosis the vein with artery or vein of the finger. Results Seven cases were treated with this method,among which 5 cases have sikin defect on the palm aspect of fingers, the rest have skin defect on the dorsal aspect skin of finger. All fingers survived with good shape and function. Conclusion This is a simple and effective method of finger reconstruction for the patients with defect of vessels and skin. 6 refs.     

Applied anatomy of radial midforearm flap pedicled with intermuscular branch of radial artery

Applied anatomy of radial midforearm flap pedicled with intermuscular branch of radial artery@谢昀$Dept Microsurg,Zhongnan Hosp,Wuhan Univ,Wuhan 430071     

Subcutaneous pedicle Limberg flap for repairing skin defects in the face

Skindefectsinthefaceduetotheexcisiono skintumorsorscarsareverycommoninplastic surgery,andthereconstructionissometimesa clinicalchallengeinrespectofaesthetic considerations[1-3].TheLimbergflaphasbeenin usefordecadesandproventobeasafealternative methodformedium-sizedskindefectswhendirec suturingisnotsuitable[4,5].However,theresidua dog-eararisingfromtheflaptransposition sometimesinfluencespostoperativecosmetic outcomes,especiallyintheface,andasecond operationisoftenneeded[6].Wehavedevelopedan in…     

LaMa minora skin flap vaginoplasty using tissue expansion

Objective This is to introduce a method for vagina reconstruction using the expanded labia minora flap. Methods Two tissue expanders were implanted in the labia minora bilaterally and expanded slowly over 4 weeks. In the operation, the expanded labial tissue was advanced as a bipedicle flap to line the reconstructed vagina. Five patients were treated with this methcxi. Postoperative stent placement and dilation resulted in a vaginal canal exceeding 8 cm in depth. Results During the follow-up of 6 months to 2 years, four of the five patients got married. The vulva exhibited almost indistinguishable appearance. The reconstructed vagina had sensory and secretary functions. Its morphology and depth well meet the physiological demand. Conclusion The modified method of tissue expansion vaginoplasty using the labia minora bipedicle flap is a good option for vagina surgery. The reconstructed vagina possesses the anatomical and physiological resemblance. 11 refs,3 figs.     

Vertical frontal subtotal laryngectomy and immediate reconstruction of larynx with cervical skin flap.

Vertical frontal subtotal laryngectomy, a procedure that can remove as much as 90% of the larynx, was used to produce a functionally acceptable neolarynx with adjacent cervical skin flaps. Thirty-four patients with laryngeal carcinoma underwent this operation. All patients were staged according to their physical findings before operation. Of these patients, 1 was lost to follow-up and 2 died from other causes 6 months and 4 years after operation respectively. The remainder are living and well without recurrence. The longest follow-up was 8 years and the shortest 14 months. Laryngeal functions were restored completely in 27 patients and partially in 7. We conclude that the procedure is best suited for the removal of anterior commissure tumor extending from both vocal cords to the anterior 1/3 or the entire length of the true cords and that if the tumor extends to the supraglottis or subglottis, this procedure is adequate as long as the posterior part of the larynx is not involved, leaving a sufficient safety margin.

     

Advances in TCM Treatment of Senile Vascular Dementia

Senile vascular dementia refers to organic lossof intellectual function due to cerebral damagescaused by insufficient blood supply.The following isa summary on achievements in its etiology,pathogenic mechanism,type identification and     

The application of tunica veginalis flap in urethral repair

Objective We have studied 4 generations 12 patients in a family which has blepharophimosis-ptosis-epicanthus-inversus syndrome （BPES） for the gene,FOXL2,the group also have 12 normal members in this family and other 80 normal individuals for contrast.Methods The FOXL2 gene was amplified by polymerase chain reaction and then analyzed by direct genomic sequencing.     

Effects of Erigeron Injection on Vascular Endothelium in Patients

Objective： To observe the levels of serum C-reactive protein （CRP）, endothelin-1 （ET-1）, nitric oxide （NO）, and superoxide dismutase （SOD） in patients after intracoronary stenting （ICS）, and the effects of Erigeron Injection （E1） on them. Methods： Seventy-two patients, who received ICS and had symptoms of chest stuffiness, palpitation and chest pain, were randomly divided into two groups, with 36 patients in the control group treated with Plavix alone for anti-platelet aggregation, and the other 36 patients in the treated group treated with Plavix and El in combination. CRP, ET-1, NO and SOD were determined and compared before and 1, 2 and 3 weeks after treatment. Results： As compared with those in the control group, improvement of symptoms in the treated group was significantly better, with the levels of CRP and ET-1 lower and levels of SOD and NO higher or approaching to normal ranges and significant difference was shown between the two groups （P〈0.01）. Conclusion： El could alleviate uncomfortable feelings such as chest stuffiness in patients after lOS, and improve the function of vascular endothelium.     

The usage of the whole palate flap in maxillofacial surgery

The usage of the whole palate flap in maxillofacial surgery@张令达$Dept Oral Maxilofacial Surg,1st Affil Hosp Anhui Med Univ,Hefei 230022     

小腿皮瓣筋膜血管的解剖学

目的：系统并定量研究小腿皮瓣筋膜的血管，探讨筋膜皮瓣成活机制，并为临床应用提供形态学基础。方法：对１３例成人标本进行了巨微解剖，组织透明，切片观察和图像分析。结果：小腿筋膜有４种动脉来源，而以肌间隔皮动脉为主。各种动脉在深筋膜的分支均显示浅支多而粗；深筋膜血管网也以浅血管网较密。深筋膜血管面积百分比值大于浅筋膜。结论：深筋膜血管特别是深筋膜浅血管网是小腿筋膜皮瓣的血供基础，筋膜蒂宜放在动脉链状吻合     

带蒂筋膜瓣骨膜瓣髋关节成形术的应用解剖

目的对髋关节邻近的腹壁筋膜,大腿筋膜和股骨中、上段骨膜进行了解剖学观测,给髋关节成形术提供术式的应用解剖学基础．方法在３６例灌注颜料的成尸标本上,观察了腹壁下部筋膜、大腿前内侧部筋膜和股骨中、上段骨膜的血供和分布,测量了血管蒂的长度及筋膜瓣和骨膜瓣的利用面积．结果观测到以旋股外动脉降支为蒂的大腿筋膜瓣和股骨中、上段骨膜瓣,以及腹壁浅动脉为蒂的腹壁筋膜瓣．它们的血管蒂长,瓣膜可取面积大,血管间吻合丰富,血供充足,质地坚韧致密．结论带旋股外动脉降支的大腿筋膜瓣和股骨中、上段骨膜瓣与带腹壁浅动脉的腹壁筋膜瓣,可作为髋关节成形术选择术式的填充材料．     

颈深筋膜的薄层断面解剖研究

目的 为颈部外科手术定位及诊治感染蔓延、肿瘤浸润提供解剖学依据。方法 利用低温冰冻技术，制作了15套颈部连续薄层横断面标本，在断面上观察了颈深筋膜的分层及特征。结果 颈深筋膜分为四层，舌骨下筋膜是单独的一层；颈深筋膜深层分为翼筋膜和椎前筋膜；颈深筋膜各层均参与颈动脉鞘的形成。结论 得出颈深筋膜分布模式图。     

带蒂小腿内侧皮瓣同侧逆行对侧交叉移位修复下肢创伤缺损

目的:探讨带蒂小腿内侧皮瓣同侧逆行、对侧交叉移位修复下肢复杂创伤的方法和临床疗效。方法:对2003～2008年收治的12例复杂性小腿、踝、足跟、足底创伤,行同侧逆行、健侧小腿内侧皮瓣顺行或逆行交叉移位治疗。结果:12例皮瓣全部成活,2～3周断蒂,外形及功能恢复满意。结论:应用带蒂小腿内侧皮瓣同侧逆行、对侧交叉移位修复复杂性下肢创伤,疗效满意,有较好的临床应用价值。     

带蒂精索外筋膜瓣在尿道下裂手术中的应用

目的：阐述在尿道下裂术中,应用带蒂精索外筋膜瓣覆盖尿道的手术方法,探讨提高尿道下裂Ⅰ期治愈率的措施。方法：在尿道下裂术中,完成各种尿道成形术后,根据新建尿道的大小和长度,游离合适大小的带蒂精索外筋膜瓣,转移覆盖新建尿道,将其边缘缝合固定在阴茎白膜及尿道海绵体上,使尿道完全被带蒂精索外筋膜瓣覆盖。对是否应用带蒂精索外筋膜瓣覆盖尿道病例的Ⅰ期治愈率、并发症等进行统计学分析。结果：与对照组相比,应用带蒂精索外筋膜瓣覆盖尿道者,包皮岛状皮瓣尿道成形术Ⅰ期治愈率由76.2%提高到95.7%（P〈0.01）,尿道瘘发生率由15.4%降低到2.4%。阴囊中隔皮瓣尿道成形术Ⅰ期治愈率由81.3%提高到96.6%（P〈0.01）,尿道瘘发生率由6.8%降到3.4%。膀胱黏膜尿道成形术Ⅰ期治愈率由66.7%提高到86.7%（P〈0.01）,尿道瘘发生率由22.2%降到6.7%。结论：应用带蒂精索外筋膜瓣覆盖尿道能增加新建尿道及吻合口的组织覆盖面及厚度,提供良好的血供,有效地提高尿道下裂Ⅰ期治愈率,减少术后尿道瘘的发生。     

小腿外侧逆转皮瓣修复足前部损伤应用解剖学

在３０侧成人下肢标本上，对小腿外侧逆转皮瓣的血供和静脉回流作了解剖学观测。腓动脉终末穿支在外踝上６．１±０．８ｃｍ处穿出小腿骨间膜，分为升支和降支。升支分布到小腿下外侧皮肤区，降支行走在深筋膜深面，经外踝前面进入外踝和距骨隆突之间，至第５跖骨底附近浅出。在踝关节前下发出分支与外踝前动脉、附外侧动脉、跟外侧动脉和足底外侧动脉相吻合，上述动脉均有２条静脉伴行，２条静脉间有丰富吻合。故设计以腓动脉终末穿支降支为血管蒂的小腿外侧逆转皮瓣，皮瓣逆转后，静脉血可通过交通吻合支而回流。用于修复足前部损伤。     

股前外侧穿支皮瓣联合阔筋膜修复足背肌腱及皮肤缺损

目的探讨股前外侧穿支皮瓣联合阔筋膜修复足背肌腱及皮肤缺损的临床效果。方法回顾性分析2014年1月至2018年3月收治的12例足背肌腱及皮肤缺损患者的临床资料。12例患者均采用阔筋膜修复肌腱缺损,股前外侧穿支皮瓣游离移植覆盖创面。结果 12例皮瓣全部成活,患者均获随访,时间6～24个月,平均10个月,皮瓣外形及穿鞋满意。皮瓣感觉功能恢复良好,两点辨距觉10～15 mm。结论股前外侧穿支皮瓣联合阔筋膜修复足背肌腱及皮肤缺损,具有疗程短,对供区创伤小,外形与功能满意等优势,是一种修复足背肌腱及皮肤缺损的可靠手术方法。     

小腿内侧皮瓣在足跟及踝部软组织缺损修复中的应用观察

目的观察分析小腿内侧皮瓣在足跟及踝部软组织缺损修复中的应用效果。方法随机选取我院2010年1月-2012年1月收治的20例应用小腿内侧皮瓣进行足跟与踝部软组织缺损修复患者的临床资料进行回顾性分析。结果 20例患者均顺利拆线出院,随访一年半,18例患者达到一期愈合,其余2例患者在二期愈合,患者皮肤及肢体功能均恢复正常。无出血及磨损等现象。结论小腿内侧皮瓣在足跟及踝部软组织缺损修复中有着良好的应用效果,术后患者创面及肢体功能恢复快,且愈合美观,可以在临床上广泛推广。     

浅筋膜削痂自体大张中厚皮瓣治疗手深度烧伤

目的:探讨浅筋膜削痂自体大张中厚皮瓣治疗手深度烧伤的可行性。方法:手术消毒前上好气压止血带,并调整好参数,术中仔细辨认烧伤界限,做好标记,分离至浅筋膜层进行切痂术,保护脂肪颗粒不受显露,术中注意预防误伤手背浅静脉从,切痂后,松开止血带,加压压迫,同时取大张自体中厚皮备用,10 min后冲洗创面,将已备好的大张自体中厚皮进行移植,术后加压包扎,随访1年,并比较不同时间患者对手术效果的满意度。结果:本组患者211例,术后第10天可见205例成活达到良好,成活率为97.2%。另外6例中,4例皮片加压包扎不良,致使皮片与组织分离,经换药重新加压包扎后痊愈;1例出现感染后经对症处理无好转,最后截肢;1例手术失败。不同时间随访患者满意度没有差别。结论:浅筋膜削痂自体大张中厚皮瓣治疗手深度烧伤后,皮片成活率高,操作简单,术后恢复良好,值得临床推广。     

额肌眼轮匝肌筋膜瓣悬吊术临床观察

目的观察额肌眼轮匝肌筋膜瓣悬吊术治疗中重度上睑下垂。方法对21例(36眼)上睑下垂患者施行额肌眼轮匝肌筋膜瓣悬吊术,并进行术后6个月的随访。结果随访结果显示,额肌眼轮匝肌筋膜瓣悬吊术矫治中重度上睑下垂效果可靠。结论额肌眼轮匝肌筋膜瓣悬吊术矫治中重度上睑下垂是当前较理想的手术方法。