Aesthetic aspects in reconstructive microsurgery

The reconstruction of a part of the body that has lost or inhibited function has been the most important aspect of reconstructive surgery in the past. Because of the existence of better techniques and the patient's wish for social reintegration, the plastic surgeon today is forced to consider the aesthetic results of his work more than in the past. Sometimes microsurgical procedures in reconstructive surgery are the only chance for the patient to be healed or palliated. Experience with more than 350 free tissue transfers gave us the opportunity to estimate the value of a donor flap with respect to the requirements of the receiving site. To satisfy the high aesthetic demands in these cases, it was necessary for the right place and shape the flap to fit as closely as possible, even if further corrections were necessary to achieve a satisfactory result. The transfer of latissimus dorsi and radial forearm flaps to the face and lower leg is discussed in cases of tumorus diseases and severe injuries of young and old patients.Presented to the IXth Congress of the International Society of Aesthetic Plastic Surgery, New York, October 13, 1987     

真皮-脂肪颗粒混合液注射移植修复面部凹陷性组织缺损

目的探索一种新的面部凹陷性组织缺损的修复方法。方法将真皮颗粒和脂肪颗粒混合制成真皮-脂肪颗粒混合液,用2mm脂肪抽吸针注射移植修复面部凹陷性组织缺损。结果本组18例,17例1次填充成功,仅1例因缺损面积过大而补充填充1次,全部病例伤口均Ⅰ期愈合,无感染,外形明显改善。结论真皮-脂肪颗粒混合移植修复面部凹陷性组织缺损,手术简单易行,术后吸收少,效果较好,值得推广。     

Selective dorsal rhizotomy: long-term experience from Cape Town

Introduction Given the large number of cerebral palsy patients who have undergone selective dorsal rhizotomy in the past two decades, it is clearly imperative that the clinical community be provided with objective and compelling evidence of the long-term sequelae of the procedure. Materials and methods In the early 1980s, Peacock in Cape Town shifted the site of the rhizotomy from the conus medullaris to the cauda equina, and in the past 25 years, more than 200 children have been operated on. We have studied the incidence of spinal deformities after multiple-level laminectomy and recorded a 20% incidence of isthmic spondylolysis or grade-I spondylolisthesis. We have also conducted a long-term prospective gait analysis study on a cohort of 14 ambulatory patients who were operated on in 1985. Results Ten years after surgery, our patients had increased ranges of motion that were within normal limits. Step length was significantly improved, although cadence was unchanged postoperatively and was significantly less than normal age-matched control subjects. Discussion We have recently tracked down all 14 patients from the original cohort and are currently completing a 20-year prospective follow-up analysis of their neuromuscular function and gait. Our preliminary data suggest that selective dorsal rhizotomy is not only an effective method for alleviating spasticity but it also leads to long-term functional benefits.     

咬肌与颅面形态的关系

目的探讨咬肌与颅面形态之间的关系，了解咬肌体积与邻近骨骼结构的大小及形态的相关性。方法对40例要求改变脸型者进行磁共振成像（MRI）测量，人体测量，头部正位、侧位和下颌骨曲面断层X线检查，测量并计算咬肌体积（MsV），测量头长（HL）、头宽（HB）、面长（FL）、面宽（FB）、下颌角间宽（IB）、下颌骨体长（CL）、下颌角切线长（MAL）、下颌角角度（JA），计算颜面形态指数FI（FL／FB）、头颅指数C（IHB／HL）。用SPSS11．5软件统计分析MsV与HI。HB、FL、FB、IB、CL、MAL、JA、FI、CI之间的相关性。结果MsV与JA呈明显负相关，与CL、MAL、IB、FB、HL呈明显正相关，与CL、FI、HB无明显相关性。结论咬肌肥大可能是方脸面型的成因之一，是影响面型的重要因素。     

小针刀辅助自体脂肪颗粒移植在面部除皱及凹陷充填中的应用

目的探讨小针刀辅助自体脂肪颗粒注射除去额部、眉间、鼻唇沟等部位皱纹及充填面部凹陷的效果。方法利用自制小针刀,离断真皮与其下方的"纤维粘连",然后用自体脂肪颗粒注射除皱和充填凹陷部位。结果本组共68例。修复面积最大约10cm×8cm,最小约1.5cm×0.5cm。随访45例,随访时间3～18个月,效果满意或基本满意。结论小针刀辅助自体脂肪移植具有操作简单、快捷、价廉、安全、无排异、不留瘢痕、术后恢复快等优点,患者易于接受,是除去额部、眉间、鼻唇沟等部位皱纹及填充面部凹陷的有效方法。     

颜面凹陷畸形的临床分型及整复

目的为规范各类颜面凹陷畸形的临床治疗提供参考性建议。方法根据凹陷部位支撑组织的异常或被覆组织的异常情况。临床上将凹陷畸形分为三型：Ⅰ型为骨性凹陷畸形，包括先天性发育不良。后天性局部骨组织缺损、错位或塌陷；Ⅱ型为软组织凹陷畸形。包括局部软组织萎缩、缺损或黏连；Ⅲ型为复合性凹陷畸形。骨与软组织同时存在萎缩、缺损或较严重的塌陷。并依照此分型分别采用游离皮瓣、肌皮瓣或带蒂肌皮瓣填充法。局部组织瓣填充法。带蒂组织瓣加医用材料混合填充法，游离脂肪颗粒填充法。HA人工骨填充法。硅胶假体填充法。有机玻璃填充法，奥美定填充法。复杂凹陷畸形的综合治疗整复方法。为216例患者修复颜面凹陷畸形。结果随访216例患者6个月至5年，未发现严重并发症，外观效果满意。结论此颜面凹陷畸形的临床分型简单、合理。便于临床对颜面凹陷畸形的整复。具有一定的实用价值。     

选择性周围神经部分切断术治疗脑瘫性肢体痉挛

目的观察选择性周围神经部分切断术治疗痉挛性脑瘫的效果。方法采用显微神经外科手术治疗的68例痉挛型脑瘫病例,根据患者肢体痉挛的不同情况采用相应的选择性周围神经部分切断术,包括胫神经、坐骨神经和正中神经,其中选择性胫神经切断术36侧,选择性正中神经切断术28侧,选择性坐骨神经切断术28侧,共计92侧。结果全部患者经3-15个月的随访,术后即刻肢体痉挛状态缓解率为97.8%(90/92),随访期间为94.6%(87/92),随访期间运动功能改善率为76.5%(52/68),术后肢体痉挛状态不同程度复发5侧(5.4%)。结论选择性周围神经部分切断术对降低痉挛性脑瘫患者肌张力、纠正痉挛性畸形近期疗效满意,手术创伤小,治疗效果能够被医患双方同时认可。     

脑瘫患儿脑干听觉诱发电位研究

本文采用日本光电公司生产的 MEB-5304K 诱发电位测定仪,对101名6月-14岁脑瘫患儿和40名正常儿测定了脑干听觉诱发电位(BAEP)。结果表明:给予80dBNHL,20Hz 刺激时 BAEP 异常率为45.54%,随刺激强度减小及刺激重复率增加,BAEP 阳性率提高。BAEP 改变与病情、病型及并发症有关。为脑瘫的发病机理及病理生理学研究提供神经电生理学依据。对脑瘫合并听力障碍者有助于及早选用助听装置,解决其听力障碍问题。     

Ultrastructural characterization of the tau-immunoreactive tubules in the oligodendroglial perikarya and their inner loop processes in progressive supranuclear palsy

Coiled bodies and interfascicular threads are conspicuous white matter abnormalities of brains of patients with progressive supranuclear palsy (PSP). Both structures are argyrophilic and immunoreactive for the microtubule-binding protein tau. This report concerns the ultrastructural localization of interfascicular threads and their relationship to coiled bodies in five PSP patients. We showed for the first time that abnormal tubules with a 13- to 15-nm diameter and fuzzy outer contours were the common structures of coiled bodies in the oligodendroglial perikarya and of interfascicular threads. Moreover, the tubules were immunolabeled by anti-tau antibodies. The abnormal tau-positive tubules of interfascicular threads were located in the inner loop of the myelin sheath. Our study further indicated that the thread-like structures in the white matter comprised, at least in part, oligodendroglial processes, and that they were also present in gray matter. We consider that the formation of coiled bodies in the perikarya and of interfascicular threads represents a common cytoskeletal abnormality of the oligodendroglia of PSP patients. Moreover, even though the white matter alterations of PSP resemble those of corticobasal degeneration, there are certain ultrastructural differences in the abnormal oligodendroglial tubules of the two diseases. Received: 4 October 1996 / Accepted: 6 December 1996