超大面积逆行腓肠神经营养血管皮瓣修复足部及远端皮肤软组织缺损

目的探讨超大面积逆行腓肠神经营养血管皮瓣在治疗足部及远端皮肤软组织缺损的临床应用。方法对14例足部及远端皮肤软组织缺损和骨外露应用超大面积逆行腓肠神经营养血管皮瓣进行创面修复。结果本组皮瓣全部生长良好,无坏死,术后随访2个月～1年,皮瓣外观恢复满意。结论经采取一定措施后大面积的逆行腓肠神经营养血管皮瓣血供可靠,能满意地修复足部大部分及远端软组织缺损。     

逆行第一趾背皮神经营养血管皮瓣修复足第一趾趾端皮肤缺损及骨外露

足第1趾趾端外伤后软组织缺损往往伴有骨外露，植皮难以成活．为闭合创面而选择趾骨缩短对患者足部外形及生物力学稳定性有较大影响。自2003年2月～2006年8月．笔者使用逆行第1趾背皮冲经营养血管皮瓣修复6例第1趾远端软组织缺损及骨外露，效果满意。现报告如下。     

主穿支皮神经营养血管皮瓣一期修复小腿及足踝部高能损伤创面

目的 探讨主穿支供血型小腿皮神经营养血管皮瓣一期修复小腿及足踝部创面的方法及效果.方法 回顾性分析2003年7月至2011年2月,对收治的39例高能损伤导致的小腿及足踝部损伤,单独或组合选择腓动脉主穿支供血游离或穿支蒂腓肠神经营养血管皮瓣、外踝上穿支蒂腓浅神经营养血管皮瓣、胫后动脉主穿支供血游离或穿支蒂隐神经营养血管皮瓣进行一期修复.结果 39例44处创面,采用腓动脉主穿支供血腓肠神经营养血管皮瓣32块(穿支蒂27块、游离5块),胫后动脉主穿支供血隐神经营养血管皮瓣6块(穿支蒂5块、游离1块),外踝上穿支蒂腓浅神经营养血管皮瓣6块,最大切取面积22 cm×10 cm.术后皮瓣均全部成活,平均住院23 d(12～36 d).术后随访6～15个月,皮瓣质地优良,外形与足踝功能恢复满意,吻合神经者两点辨距觉2.5～5 cm,未吻合神经者术后1年以上均存在保护性感觉.结论 上述3种主穿支皮神经营养血管皮瓣血供确切,合理个体化选择应用可修复不同类型小腿及足踝部创面;一期修复解剖清晰、血管条件好、手术设计灵活,可减少感染机会及肉芽瘢痕,利于功能恢复并缩短治疗周期.     

末节断指再植23例

目的：总结末节断指再植23例。方法：回顾性分析末节断指再植23例的术式、方法及术后治疗等。结果：23例27指中，拇指6指，占22．2％；食指、中指17指（63．0％）；无名指、小指4指（14．8％）。顺利成活25指，成活率92．6％；优8例，良6例，可1例，优良率为93．3％。结论：末节断指再植随着显微外科的发展，其成功率有了较大提高，且术后有外形好，感觉和恢复好等特点，应尽量断指再植。     

吻合穿支游离腓肠神经营养血管腓骨皮瓣的临床应用

目的：探讨单一穿支腓肠神经营养血管腓骨皮瓣游离移植修复肢体软组织、骨联合缺损的手术方法及临床效果。方法：切取由腓动脉发出单一主皮穿支腓肠神经营养血管腓骨皮瓣，单纯吻合穿支动静脉或吻合穿支动脉、小隐静脉，游离移植修复涉及远足的合并骨缺损创面。结果：临床应用5例，骨皮瓣面积12cm×7cm～18cm×11cm，均全部成活，随访时间7～16个月，外观满意，质地优良，感觉恢复均达S3级以上，移植腓骨愈合时间4～10个月。结论：该术式结合了游离皮瓣、穿支皮瓣与皮神经营养血管皮瓣的优点，骨皮瓣设计灵活，切取方便，修复部位随意，血供可靠，符合生理，是肢体创伤修复重建的一种可取方法。     

有氧健身舞锻炼对中老年女性血液流变学部分指标的影响

本文通过对部分中老年女性进行健身舞锻炼的实验研究，发现健身舞锻炼对中老年女性的血液流变学指标：全血粘度，血浆粘度，红细胞沉降率，均有不同程度的改善，证明长期坚持有氧健身舞锻炼对中老年女性血液流变学部分指标有改善作用。     

腓动脉主穿支蒂腓肠神经营养血管皮瓣修复足踝部中小面积软组织缺损

目的 总结不依赖低位穿支的单一腓动脉主穿支蒂腓肠神经营养血管皮瓣修复足踝部中小软组织缺损的手术方法 及临床效果. 方法 2004年7月-2007年2月,收治14例足踝部中小面积软组织缺损忠者.男9例,女5例:年龄19～53岁.跟腱断裂术后皮肤坏死4例,交通伤后软组织缺损3例,重物压砸伤、慢性感染溃疡及跟骨骨折术后皮肤坏死各2例,黑色素瘤切除术后1例.软组织缺损范围4 cm×2 cm～9 cm×5 cm;位于踝周12例,跟底负重区2例.均合并深部肌腱或骨组织外露.急诊入院3例,其余患者于伤后12 d～13个月入院.术中切取以腓动脉主穿支为单一蒂的腓肠神经营养血管皮瓣修复创面,范围为13 cm × 5 cm～36 cm × 6 cm.供区均直接缝合. 结果 术后皮瓣全部成活,创面及供区Ⅰ期愈合.患者均获随访,随访时间7～23个月.皮瓣质地优良,外形、色泽良好,两点辨别觉7～12 mm.踝关节功能恢复满意,可正常穿鞋行走. 结论 不依赖低位穿支的单一腓动脉主穿支蒂腓肠神经营养血管皮瓣血供可靠,操作简便,创面修复平整美观,肢体功能恢复满意,适合未涉及前足的踝周、跟底中小面积软组织缺损修复,尤其适合低位缺乏满意穿支者.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.