扩张的额部复合皮瓣预制法鼻再造术

目的：探讨一种应用扩张的额部复合皮瓣预制进行鼻再造的手术方法。方法：2008年7月～2010年1月,对7例鼻缺损患者分四期行鼻再造术。一期：埋植额部扩张器,同时额部皮下移植自体软骨,额肌深面中厚植皮;二期：取扩张器,行额部扩张复合皮瓣转移鼻再造术;三期断蒂;四期修整。结果：7例患者手术后随访6～12个月,手术均取得较好的效果。结论：扩张的额部复合皮瓣预制法鼻再造术为修复鼻全层缺损提供了一种新的术式选择。     

应用额部扩张皮瓣修复鼻缺损

目的:探讨应用额部扩张皮瓣修复鼻缺损的效果。方法:经过三期手术,完成对23例多种原因造成的鼻缺损的修复。Ⅰ期:额部扩张器置入术;Ⅱ期:鼻再造术;Ⅲ期:断蒂术。结果:本组23例患者,转移额部扩张皮瓣均成活,随访0.5~1年,再造鼻形态良好、逼真,色泽、质地均较匹配,鼻通气良好,额部供区瘢痕不明显。结论:利用额部扩张皮瓣修复鼻缺损是较为理想的治疗方案。     

The Naso-labial and lateral forehead flaps as a single stage: A case report and review of literature

We present here the case of a patient with a major traumatic nasal loses who had a near-total nasal reconstruction as a single-stage procedure. A 35 year-old civil servant who was involved in a road traffic injury about two years before presentation. He sustained extensive and multiple facial injuries with complete loss of nasal cover and lining. Reconstruction was performed by using superiorly based, bilateral, nasolabial flaps to line the floor and the nasal septum, and a paramedian forehead flap for skin cover. The patient did well postoperatively and was discharged home on the 7^th postoperative day. If the principles concerning cover, support, and lining are adhered to, excellent functional and aesthetic results can be achieved as we have obtained in our patient.     

额部扩张皮瓣法半鼻再造术修复部分鼻缺损

目的：探讨应用扩张额部皮瓣行半鼻再造术修复部分鼻缺损的效果。方法：2008年6月～2010年12月,收治部分鼻缺损患者5例,男1例,女4例,均采用额部扩张皮瓣法半鼻再造术修复。手术分3期进行：Ⅰ期行额部额肌下扩张器置入术皮肤扩张;Ⅱ期行额部扩张皮瓣转移半鼻再造术;Ⅲ期行鼻根部皮瓣断蒂修整术。结果：术后患者均愈合良好,无明显并发症发生。5例患者均获随访,随访时间6月～1年。再造鼻形态满意,颜色、质地与周围皮肤较为匹配,额部供区无明显瘢痕及畸形。结论：额部扩张皮瓣法行半鼻再造术修复鼻缺损,手术方法简单可靠,术后效果满意。     

应用扩张额部斜行皮瓣修复鼻部缺损

目的：探讨扩张一侧滑车上动脉的额部斜行皮瓣修复鼻部缺损的效果。方法：对13例伴有鼻尖鼻翼大部分缺损的病例,在额部一侧滑车动脉走行区域下斜向植入80～120ml不同容积扩张器,经过2～3.5个月的扩张,获得多余的皮肤软组织。设计滑车上动脉额部斜行薄皮瓣转移修复鼻部缺损,对鼻支架破坏的病例同期植入肋软骨支架或鼻假体,1个月后断蒂并对鼻外形进行修整。结果：全部病例扩张顺利,转移的皮瓣成活。获得足够的鼻长度、鼻尖突度,修复效果满意,额部供区无明显瘢痕遗留。结论：该方法能获得比较理想的修复效果,应作为修复伴有鼻尖鼻翼大部分缺损修复的首选方法。     

同期假体置入额部扩张皮瓣鼻再造术

目的：探讨同期假体置入使用额部扩张皮瓣行鼻再造的效果。方法：8例鼻缺损的患者,使用额部扩张皮瓣行鼻再造术,同期置入肋软骨或PTFE假体。结果：鼻再造术后随访1～5年,再造鼻均获成功,鼻的外形及通气功能良好,患者满意。结论：同期假体置入使用额部扩张皮瓣行鼻再造可以获得良好的效果。     

通过鼻再造术一次性修复鼻及鼻周缺损

目的：探索一次性修复鼻及鼻周缺损的治疗方法。方法：1995年～2008年,收治34例鼻及鼻周缺损的患者,男21例,女13例;年龄17～70岁。先行额部扩张器置入术。二期手术,利用缺损周围的局部翻转皮瓣形成鼻衬里,将缺损纳入鼻前庭;额部扩张皮瓣移位行鼻再造术。三期断蒂。病程6～26月。结果：34例患者,32例疗效满意。结论：将鼻周的缺损视作术后新鼻部解剖区的一部分,再造全鼻并修复缺损,重建面部美学解剖分区。该方法与传统方法相比,能够获得更为满意的效果。     

全鼻再造手术方法的探讨

目的　介绍 4种全鼻再造的手术方法及适应证。方法　 1975～ 2 0 0 3年我们应用①上臂皮管全鼻再造术、②传统前额正中皮瓣全鼻再造术 额部植皮术、③额部正中皮瓣全鼻再造术 双侧额颞皮瓣滑行修复额部供区、④额部皮瓣扩张术后行额正中皮瓣全鼻再造术 ,对 2 2例行上述全鼻再造术者进行了回顾性分析 ,并讨论了上述手术方法的优缺点及其适应证。结果　本组病例均获成功 ,外形及通气功能效果良好。应用第 2种方法虽然再造鼻外形满意 ,但在额部留下明显而深暗的凹陷痕迹 ,影响美观 ;而应用第 1种方法额部不留任何痕迹 ,但鼻再造所需时间较长 (约 2个月 ) ,且需将上臂与头部间固定 3周 ,是其不足之处。结论　如采用前额正中皮瓣法行全鼻再造时 ,建议对鼻型较小者应用第 3种方法 ;而对鼻型较大者以用第 4种方法为好 ;而对于不接受在额部造成新的创伤或额部组织不足者 ,应选用第 1种方法为宜     

桡动脉皮支岛状皮瓣全鼻再造

应用桡动脉细小皮支血管岛状前臂皮瓣进行全鼻再造,保留了桡动脉。自1987年以来共做5例全部成功,鼻外形满意。     

额部扩张皮瓣鼻再造术后光子脱毛的临床治疗体会

目的：探讨光子脱毛在额部扩张皮瓣鼻再造术后多毛患者中的临床应用及治疗体会。方法：28名患者，采用Alma工作平台，选择不同能量密度和相应脉宽，行鼻部皮瓣脱毛治疗，进行治疗前后毛发减少量对比,评估光子脱毛有效率及患者满意度。结果：28名患者经5～8次治疗，25例治愈，治愈率为89.29%；3例显效，显效率为10.71%；无一例无效患者。结论：光子脱毛治疗额部扩张皮瓣鼻再造术后多毛患者，疗效明显、方法简便，可广泛应用于临床。     

ISOLATED TUBERCULOUS TENOSYNOVITIS OF THE FLEXOR TENDON OF THE FOURTH FINGER OF THE HAND: Case report

A 21-year-old woman presented with a painful swelling of her palm which prevented her from fully extending her fourth finger. Magnetic resonance imaging showed synovial thickening around the flexor tendon and fluid in the tendon sheath. The mass was excised and histopathological examination showed tuberculosis. She had a six-month course of antituberculous treatment and was perfectly well three years later.     

THE FASCIOCUTANEOUS ISLAND FLAP: AN EXTENSION OF THE ANGIOTOME CONCEPT

The concept of the fasciocutaneous island flap (FCIF) has been established as a result of clinical experience in which over 180 cases have been compiled. It is a reconstructive design principle based on vascular and neural anatomy. Even though the flap pattern varies from region to region, it is the trilaminate composition of skin, fat and fascia supplied by fasciocutaneous, musculocutaneous and septocutaneous vessels, which is the basis for its success. Sometimes regional variations in this arrangement occur, for example: there is no deep fascia evident in the trigeminal nerve (CN-V); and in the hand and the foot, the local vascular anatomy still supports this island flap idea without any defined fascial lining. Following their use in the head and neck region, and as more successful ones were designed, the flaps seemed to follow the circumferential layout on the trunk and the longitudinal distribution in the limbs, similar to the dermatomal markouts. Such dermatomal charts thus became the basis of unexplored flap potentials with or without axial vessels. In the past, the clinical word ‘angiotome’ (which means a vascularized segment) has been used in world literature to describe flap vasculature with axial input. Thus flaps with a fasciocutaneous basis may well be described as a fasciocutaneous angiotome.     

TREATMENT OF SUBCAPITAL FRACTURES OF THE FIFTH METACARPAL BONE: A PROSPECTIVE RANDOMISED COMPARISON BETWEEN FUNCTIONAL TREATMENT AND REPOSITION AND SPLINTING

We did a prospective study to compare the results of treatment of subcapital fractures of the fifth metacarpal bone by closed reduction and splinting or by functional treatment. Twenty-nine consecutive patients were randomly divided into the two treatment groups (functional n = 14, and reposition and splinting n = 15). The results of treatment were satisfactory in both groups. Functionally treated patients recovered their grip force and range of movement of the affected hand a little sooner. All fractures in both groups had united within three months. There were no complications. We conclude that subcapital fractures of the fifth metacarpal bone can successfully be treated without closed reduction and splinting.     

以掌背动脉为蒂尺骨远段背侧骨瓣移位术的应用解剖

目的 为以掌背动脉为蒂的尺骨远段背侧骨瓣移位修复第３、４、５掌骨头缺损提供解剖学依据。方法 在３０侧成人上肢标本上解剖,观察腕背动脉网的构成及分支。结果 腕背动脉网由桡动脉及尺动脉腕背支及与骨间后动脉终末支,骨间前动脉腕背支吻合形成,由该网发生第２、３、４掌背支,第２、３、４掌背动脉由掌背支与掌深弓所发深支吻合而成。结论 以第３、４掌背动脉为蒂的尺骨远端背侧半片骨瓣,可修复第３、４、５掌骨头缺损。     

The role of near‐infrared fluorescence imaging with indocyanine green dye in pedicle division with the paramedian forehead flap

The paramedian forehead flap is considered the gold standard for nasal reconstruction following oncologic surgery. During the 21‐day delay in two‐stage surgery protocols, many patients report considerably reduced quality of life because of the pedicle. This prospective case series study examined the usefulness of near‐infrared (NIR) fluorescence with indocyanine green (ICG) for flap perfusion assessment and identified variables associated with time to flap perfusion. Ten patients (mean age 75.3 ± 11.6 years) with diagnosis of basal cell carcinoma (n = 9) or squamous cell carcinoma (n = 1) underwent intravenous indocyanine injection and NIR fluorescence imaging for assessment of flap vascularisation 2 to 3 weeks after stage 1 surgery. NIR fluorescence imaging showed 90% to 100% perfusion areas in all patients after 14 to 21 days. Early pedicle division occurred in two patients on postoperative days 14 and 16. One minor complication (wound healing disorder) was seen following flap takedown after 14 days. There were no associations between time to flap perfusion and defect size or flap area. NIR fluorescence imaging with ICG dye is a useful method for non‐invasive perfusion assessment when used in conjunction with clinical assessment criteria. However, a decision for early pedicle division may raise risk of complications in specific patient groups and must therefore be made with great care.     

利用鼻中隔粘骨膜复合瓣修复半侧鼻下部衬里缺损的临床研究

目的:探讨一种半侧鼻下部全层缺损衬里修复的手术方法.方法:根据衬里缺损的面积,设计对侧相应大小鼻中隔粘膜软骨膜复合组织瓣,通过鼻中隔背部跨越鼻中隔软骨,将血运良好的复合组织瓣固定在缺损周边的骨膜上.对8例半侧鼻下部全层缺损患者采用此方法修复衬里,其中3例男性,5例女性,并同时运用局部皮瓣或额部皮瓣修复外层,耳软骨或肋软骨重建支架,随访6～12个月,了解鼻衬里恢复情况.结果:本组8例患者再造鼻衬里均血运良好,鼻腔大小及通气正常,鼻中隔形态正常,供区呼吸性上皮覆盖,无穿孔、感染或偏曲.结论:在半侧鼻下部全层缺损的衬里再造中,应用此方法进行衬里修复,组织性质最接近,血运好且薄,柔软且挛缩程度小,同时为软骨支架提供良好血供,保持了鼻部组织的完整及自然形态,是一种良好的鼻部衬里修复方式.     

COMPRESSION NEUROPATHY OF THE SUPERFICIAL BRANCH OF THE RADIAL NERVE

We present two cases of hypoaesthesia over the dorsal radial aspect of the hand with an associated painful mass in the wrist. At operation a dorsal wrist ganglion was compressing the superficial branch of the radial nerve at the anatomical snuff-box. After removal of the ganglion the hypoaesthesia was relieved.