皮瓣修复腕部高压电烧伤创面的手术时机选择

〔摘 要〕 目的：分析对腕部高压电烧伤患者创面进行手术修复的过程中选取不同手术时机对于患者治疗效果的影响。 方法：选取2018年11月至2019年11月期间娄底市第一人民医院烧伤整形外科收治的100例腕部高压电烧伤患者为研究对象, 依据手术时机的不同将其分为对照组和观察组,各 50 例。对照组患者经其他治疗后进行皮瓣修复治疗,观察组患者在受伤 当日即进行皮瓣修复治疗,对两组患者临床治疗效果进行比较。结果：观察组患者手术用时、皮瓣移植面积以及住院用时 情况均优于对照组,差异具有统计学意义（P ＜ 0.05）;在清创后面积方面,组间比较,差异无统计学意义（P ＞ 0.05）。 在患者恢复情况方面,观察组患者在桡神经、尺神经、正中神经、中腕部屈曲能力以及屈指肌腱功能等方面的恢复效果均 优于对照组,差异具有统计学意义（P ＜ 0.05）。结论：在对腕部高压电烧伤患者进行皮瓣修复的过程中,尽早开展手术, 对于患者手术指标与功能恢复的优化具有一定价值。     

An algorithm to improve outcomes of radial forearm flap donor site

Background: Due to the high rate of donor site complications the Radial Forearm Flap (RFF) has lost ground in favor of the Antero-lateral tight flap (ALT) and other flaps. We have designed a reconstruction algorithm for reconstruction of its donor site. The goal of this study was to retrospectively evaluate the impact of this algorithm on RFF donor site complication rates.

Methods: The authors analyzed retrospectively 31 patients who underwent free radial forearm flap reconstruction between November 2009 and May 2013. Donor site complications were compared with data from patients treated before introdutction of the algorithm. Within the group were compared patients in which the flap was harvested suprafascial with those in which the flap was harvested as subfascial.

Results: Before application of the algorithm, there was a 23.3% complication rate at the RFF donor site, in our experience. After introduction of the algorithm, complication rate has dropped to 3.2%, consisting in a partial skin graft necrosis treated by local wound-care and healed without further intervention.

Conclusions: Application of the algorithm described has led to a significant reduction in RFF donor site complication rates. This demonstrates that if flap donor sites are analyzed and tailor treated in the same way as primary defects are, instead of being given secondary importance and just grafted, outcomes improve.     

Limberg flap in management of pilonidal sinus disease: systematic review and a local experience

Objectives: To review published evidence of Limberg flap (LF) use in pilonidal sinus disease (PSD). We also included our local experience of LF.

Methods: Medline and Embase database were searched for the words ‘pilonidal, sinus, Limberg, flap’. Non-English articles and those not-related to our scope of search were omitted. We included a retrospective study of patients underwent LF in our district hospital. Data including length of hospital stay, post-operative complications and recurrence were collected.

Results: Literature review revealed 68 studies (22 case series, 35 comparative studies, nine RCTs and two meta-analyses). Recurrence rate was 0–7.4% in case series. Recurrence rate in comparative studies was 0–8.3%, compared to 4–37.7% for primary closure and 0–11% for Karydakis flap. RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap. About 26 patients included in the cohort study (16 male, average age 27 years). Six patients presented with recurrent disease. Post-operative length of hospital stay was four to seven days. Post-operative complication rate was 11.5% – [two partial wound dehiscence, one wound infection]. Recurrence rate was 7.7%. Average follow-up was 18 months.

Conclusions: Limberg flap presents a safe and effective method that can be offered for patients with primary or recurrent PSD.     

咽后壁瓣法治疗前后静止位时舌位置的研究

目的:通过对咽后壁瓣治疗前后舌位置变化的研究,了解咽后壁瓣对颌面生长发育的影响。方法:对15例咽后壁瓣治疗前后舌位置的测量及舌与软腭接触关系进行研究,并与正常对照组比较,了解其变化趋势。结果:对照组10例有2例,术前组15例有5例,术后组15例有12例舌腭无接触,两组比较差异无显著性(P=0.27)。术后组与术前及对照组比较有明显统计学意义(P=0.025,P=0.015)。结论:咽后壁瓣术后舌腭接触趋向消失,舌尖向后缩,舌位变低。唇舌肌肉平衡失调,可能为面中1/3发育受限的原因之一。     

三角瓣完全换位+患侧鼻翼切口修复三度唇裂的体会

目的观察三角瓣完全换位＋患侧鼻翼切口修复先天性三度唇裂的术后效果，探讨该手术方法的优缺点及临床应用价值。方法将26例先天性三度唇患者（术前拍照片，术后拍照片）采用三角瓣完全换位＋患侧鼻翼切口的手术方法，与传统的方法进行近期比较。结果26例先天性三度唇裂患者，均获得显著的优于传统手术方法的效果。结论三角瓣换位＋惠侧鼻翼切口修复三度唇裂手术设计简单可靠，效果显著。