拇趾腓侧皮瓣修饰性修复拇手指掌侧皮肤缺损

目的 介绍一种修复拇、手指掌侧皮肤缺损的理想手术方法. 方法 2001年7月-2006年7月,采用(足母)趾腓侧皮瓣游离移植修复拇、手指掌侧皮肤缺损28例.男16例,女12例;年龄14～46岁.挤压伤11例,冲床伤7例,刀具割伤3例,火器伤3例,咬伤2例,慢性溃疡2例.拇指4例,示指7例,中指7例,环指6例,小指4例.皮肤缺损2.0 cm×1.5 cm～4.0 cm×2.5 cm.病程3 h～7 d.皮瓣切取范围2.5 cm×1.5 cm～4.5 cm×2.5 cm.供区直接缝合或全厚植皮修复.结果术后28例供受区伤口均Ⅰ期愈合,移植皮瓣及供区植皮均成活.28例获随访6个月～5年.皮瓣外形逼真,有罗纹,质地良好,两点辨别觉4～6mm.按中华医学会手外科学会上肢部分功能评定试用标准优25例,良3例.供足行走、跑、跳功能正常. 结论 (足母)趾腓侧皮瓣修复拇、手指掌侧皮肤缺损,供区损伤小,对受区周围组织破坏小,修复后效果佳,能达到修饰性修复目的.     

四肢关节部位创面的修复

四肢关节部位创面的修复王剑利魏海温张成进王成琪１９７８年～１９９１年，共收治四肢各关节部位创面２１６例。急诊６９例，均在１２ｈ以上，创面污染严重；慢性感染创面１４７例，其中病程在１个月以内６４例，３个月以内４１例，６个以内２８例，１年以内１２...     

吻合血管的骨皮瓣移植修复小腿严重创伤12例

1990年3月～1994年10月，我们急诊应用吻合血管的骼骨皮瓣，或胖骨皮瓣移植，一期修复小腿严重外伤性皮肤和胫骨缺损，取得良好效果。1临床资料1．1一般情况本组男9例，女3例；年龄15～52岁。压轧伤7例，绞挫伤5例。皮肤缺损最小6cmX10cm，最大12cmX22cm。胫骨缺损长3～16cm。l·2手术方法1．2．正清创内固定（1）（1）因手术时间长，采用高位持续硬膜外麻醉；（2）用肥皂乳刷洗伤四周围皮肤3遍共8～10min佣l：5000氯己定（洗必泰）液泡洗伤口3遍约5min，再用3％过氧化氢液泡3min。常规消毒患肢，铺手术巾；（3）麻醉同时输入500ml有旋糖前…     

短伸肌腱修复供足第1跖骨深横韧带(附55例报告)

目的在第2足趾移植再造拇指术中,应用     

肢体缺血再灌注损伤防治的研究进展

肢体的创伤、断肢再植、血栓形成、组织移植及止血带的应用时间过长均可引起肢体缺血。随着血流的恢复,在随后的一段时间内组织损伤不仅不减轻反而加重,这种现象称缺血再灌注损伤(Ischemia/Reperfusion Injury,I/R I)。对其发生机制,不同学者尚持有不同的观点,但I/R I时氧自由基的产生、钙超载、白细胞的活化及内皮细胞自稳态失衡却     

第二足趾整形后再造拇指一例

笔者于2007年2月23日,利用第二足趾整形后再造拇指毁损1例,疗效满意。1临床资料患者,男性,21岁,因电烧伤致左手拇指毁损。X线示左手拇指自掌骨远1/3处缺失(图1),残断愈合良好。大鱼际肌部分缺损。常规在硬膜外及臂丛神经麻醉下手术:①受区准备:拇指残断矢状面切口,修整第一掌骨     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

第二足趾游离移植再造拇指

拇指一旦缺失,捏、夹、握、抓等功能就难以进行。要想再造一个有利于患者生活与劳动的新拇指,必须具备以下几点:①有足够的长度和稳定性;②能对指,能活动,有力量;③有良好的感觉和血运;④外形较好;⑤很少影响其他手指的功能;⑥疗程短,