The modified bitemporal flap for the treatment of bitemporal recessions

A modified version of the bitemporal flap can be used effectively for the treatment of bitemporal recessions in one step. The geometry of this flap is discussed along with several precautionary points concerning its use.     

Release of severe post-burn axillary contracture with the latissimus dorsi flap

Summary One stage reconstruction of the anterior axillary fold, in a case of severe post-burn axillary contracture, with the island latissimus dorsi musculocutaneous flap is described. Postoperatively the patient had a full range of active abduction and a good cosmetic result.     

Limbus-based versus Fornix-based conjunctival flap in filtering surgery

Summary A randomized prospective study was performed to compare the results of filtering surgery using a Limbusbased versus a Fornix-based conjunctival flap. The wound closure of the Fornix-based flap was performed using a running 10/0 nylon suture at the limbus. No statistical significant difference of IOP regulation was found between the two groups. There was a tendency of reduced occurrence of shallow anterior chamber and of less vascularized filtering blebs in the Fornix-based technique.     

Digital mucoid cyst excision by using the bilobed flap technique and arthroplastic resection

There are a number of proposed causes and treatment approaches for digital mucoid cysts. The described treatment outcomes for this cyst have been variable, with the highest success rate reported with complete excision and single-lobe skin flap closure. This report describes a bilobed flap reconstruction in conjunction with resection of the head of the middle phalanx. A retrospective review was undertaken to evaluate the recurrence rate, complications, and patient satisfaction with this combined procedure. Fifteen patients with an average follow-up of 4.6 years were evaluated. There were no recurrences, flap failures, or other major complications. The use of this flap allows for greater exposure than traditional semi-elliptical incisions while allowing the wide excisional defects to be closed primarily.     

地塞米松对扩张皮瓣血运障碍的救治

目的寻求扩张皮肤Ⅱ期手术形成皮瓣时出现血运障碍及防止坏死的有效治疗方法。方法皮瓣出现血运障碍时，立即静脉给予地塞米松0．4mg／kg，然后逐渐减量，术后6d停药。10d时观察判断皮瓣成活情况。结果35例出现血运障碍的皮瓣，经救治完全成活33例，大部分成活2例。成活后皮瓣色泽、弹性均好。结论及时用地塞米松是防止扩张皮瓣出现血运障碍及坏死的良好方法。     

皮(肌)瓣治疗小腿长段骨坏死实验研究与临床应用

[目的] 探讨皮（肌）瓣治疗骨坏死的可行性。[方法]应用新西兰大白兔48只，随机分为对照组、实验组。按实验方法将胫骨制成骨坏死模型。对照组用游离皮片覆盖坏死骨；实验组用腓肠肌皮瓣覆盖坏死骨。术后2、4、8、12周行ECT、X线片、骨钙素（BGT）、组织切片检查。临床应用436例。[结果]ECT显示实验组动脉相放射摄入值及延迟相放射摄入值明显高于对照组（P〈0．02）；血清BGP水平实验组各时段均比对照组高（P〈0．001）；组织学检查4周实验组髓腔中可见增生的血管，大量骨细胞；X线片12周实验组的胫前皮质骨接近正常骨，而对照组皮质骨仍为坏死、骨质硬化。临床应用小腿外观好，足部肿胀消退，创面感染治愈，坏死骨成活，骨髓腔再通。[结论]用血运丰富的皮（肌）瓣覆盖坏死胫骨段后，血运改善，坏死骨可以成活。     

头面颈部毛细血管畸形的手术治疗

目的 探讨手术治疗头面部不同类型毛细血管畸形的适应证,手术方法及疗效.方法 对适合手术的23例头面颈部患者,根据病灶的面积和手术前的条件分别采用了植皮,扩张器局部皮瓣转移修复和游离皮瓣修复等方法,并进行术后评价和随访.结果 除一例特别原因造成皮片下积血,皮片部分成活不良二期再植,一例同位素治疗后扩张器病例远端发生血运障碍后改植皮以外,其余皮片,皮瓣均成活良好,但随访皮片有较明显的色差,而皮瓣色泽,质地良好.结论 皮瓣修复效果较好,其中扩张的局部皮瓣转移修复效果最佳.游离皮瓣较适合有皮下组织萎缩的大面积的病例,而其他大面积病灶可采用分期分区植皮.     

逆行岛状皮瓣修复手部软组织缺损

目的报道手部软组织缺损逆行岛状皮瓣修复方式的选择及临床效果。方法根据手部软组织缺损的不同部位，应用六种不同的手与前臂逆行岛状皮瓣进行修复。结果本组57块皮瓣中，除4块皮瓣远端部分坏死外，其余皮瓣成活良好，外观满意，弹性、质地良好，两点辨别觉6～12mm。结论手与前臂逆行岛状皮瓣切取简便，创伤小。根据手部软组织缺损不同部位，选择不同的逆行岛状皮瓣进行修复，可获得满意的临床效果。     

Closure of a large bronchial fistula with a latissimus dorsi myocutaneous flap

We describe a case of a large bronchial fistula and empyema after right upper lobectomy that was treated successfully with open window thoracostomy followed by a latissimus dorsi myocutaneous flap and limited thoracoplasty. A latissimus dorsi myocutaneous flap can provide immediate airtight closure of a large bronchial fistula, allowing lavage and curettage of the empyema cavity to reduce the chance of postoperative infection. An important aspect of this technique is that the deepithelialized skin side rather than muscle is sutured to an opening of the bronchus. As compared with other techniques, a latissimus dorsi myocutaneous flap is superior in that it requires a single incision and does not require an intraop-erative change of position. In addition, the technique causes little dysfunction of the chest and shoulder and preserves the vascular supply to ensure the viability of the flap even if it was divided in a previous operation.     

定向皮肤扩张器在面颈部瘢痕治疗中的应用

目的:探讨定向扩张器在治疗面颈部瘢痕中的临床应用。方法:回顾性分析我科2000年至2004年用定向扩张器治疗48例面颈部瘢痕患者。手术分两期:先于瘢痕附近正常皮下置入定向扩张器,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:48例患者共治疗56处瘢痕,置入扩张器60个,一次修复最大面积为12cm×16cm,除5例遗留部分瘢痕经第二次皮肤扩张修复外,所有患者均得到有效治疗;扩张期并发症18处(30%),以扩张器外露最多见。结论:定向皮肤扩张器在面颈部瘢痕治疗中有很大的应用价值。但应重视预防并发症。