口腔护理液温度对口腔移植皮瓣血液循环的影响

目的探讨口腔护理液温度对口腔移植皮瓣血液循环的影响，从而筛选出口腔护理液的最佳温度。方法将13例患者随机分成3组，分别采用32~34℃（A组）、35~38℃（B组）、39-43℃（C组）生理盐水100ml进行口腔护理，并观察口腔移植皮瓣血液循环情况。结果B、C组口腔移植皮瓣局部弹性评分及毛细血管充盈时间显著优于A组（均P〈0.05）。结论采用35~43℃生理盐水进行口腔护理，可促进口腔移植皮瓣局部血液循环和皮瓣成活，有利于切口早日愈合。     

高压氧治疗移植皮瓣血液循环障碍效果观察

皮瓣是具有带血供的皮肤和皮下组织。皮瓣的血液循环与营养在早期完全依赖蒂部 ,皮瓣的蒂部既可是含血供的皮肤及皮下组织 ,也可是单一的血管蒂 (包括吻合血管蒂 )。良好的血液循环是皮瓣存活的基本条件。 1 998年 6月至 2 0 0 0年 8月 ,我院对37例皮瓣移植术后并发血液循环障碍病人行高压氧治疗 ,效果较好。报告如下。1　资料与方法1 .1　一般资料37例中 ,男 2 1例、女 1 6例 ,年龄 6～ 5 0岁 ,平均 32 .3岁。其中高压电击伤 7例 ,皮肤撕脱伤 5例 ,溃疡创面 4例 ,肿瘤切除后创面 2例 ,瘢痕切除创面1 9例。损伤面积为体表总面积的 1 %～ 3%…     

温度对动脉化静脉皮瓣微循环的影响

用红外线烤灯于兔耳透明窗内动脉化静脉皮瓣局部加温，观察加温前及皮温升到２８℃、３２℃、３５℃、４０℃、４５℃时微循环变化情况，可见对皮瓣有明显作用，随着皮温升高起到加速血流、扩张血管及增加血流量的作用，但超过４０℃到达４５℃时则出现凝血倾向、血管开放数减少。经图象分析及统计学处理发现皮温在３２－４０℃范围内均可使皮瓣处于较好的微循环状态，而其中３５℃左右最佳。     

不同口腔护理液对口咽置管患者口腔内环境的影响

目的探讨4种口腔护理液对口腔内环境的影响。方法将120例口咽置管脑卒中患者随机分为四组各30例,分别采用生理盐水、0.3%过氧化氢、口洁液、2%碳酸氢钠作为护理液进行口腔护理。分别统计口腔pH及口臭和口腔炎发生率。结果过氧化氢组和口洁液组口腔护理后口腔平均pH值在正常范围。碳酸氢钠组、过氧化氢组、口洁液组口臭发生率相对低于生理盐水组。口洁液组口腔感染发生率最低。结论口咽置管患者可首选口洁液进行口腔护理。     

前臂皮瓣游离移植在口腔颌面部的应用

前臂皮瓣游离移植在口腔颌面部的应用陈亚多，温玉明，唐休发我院自１９８２年～１９９２年间，应用前臂皮瓣游离移植修复口腔颌面部组织缺损共５５例，取得了较好的效果。现报道如下。１临床资料本组５５例，男３９例，女１６例。年龄１６～６５岁。４３例为口腔颌面部肿...     

前臂游离皮瓣行口底再造术的术后护理

总结50例口底癌病人行口底部分或全口底切除,前臂游离皮瓣行口底再造术术后护理.提出术后加强病室准备,保持口腔清洁,及时观察皮瓣色泽、质地,预防移植皮瓣血栓形成对皮瓣的成活十分重要.     

21例移植皮瓣远端血液循环障碍原因分析及护理

目的探讨有效护理措施,提高移植皮瓣成活率。方法将21例发生移植皮瓣术后血液循环障碍者以皮瓣的血管吻合近端为标志分为A区、B区、C区,动态观察各区血氧饱和度变化,发现变化及时对症处理。结果 21例中18例皮瓣远端血液循环危象解除或改善,皮瓣成活;3例皮瓣远端部分发生坏死行二次手术植皮。结论分区观察法有利于皮瓣远端血液循环障碍的早期发现,为有效及时处理提供依据,从而提高组织皮瓣移植效果。     

游离皮瓣移植的护理体会

随着显微外科技术的不断发展和推广 ,游离皮瓣移植得到广泛应用 ,但要获得成功 ,除手术者要有较高的专业知识外 ,术前及术后护理也至关重要。我科从1 995年至 1 999年间共为 8例患者进行游离皮瓣移植手术 ,由于我们重视术前、术后及心理护理 ,对手术成功起到了重要作用 ,现总结如下。1　临床资料　　病人手术情况见附表附表　病变部位与皮瓣选择病变部位皮瓣种类 病例数肋部巨大溃疡 (放射性 )并骨外露小腿内侧皮瓣 2肋部放射性溃疡 下腹部横形岛状皮瓣 1足跟部鳞癌肩胛皮瓣 1足背溃疡并骨外露背阔肌皮瓣 1胫骨皮肤缺损并开放性骨折 髂骨皮…     

口腔颌面部肿瘤术后组织缺损移植修复术皮瓣坏死发生状况及其影响因素

目的 探讨口腔颌面部肿瘤术后组织缺损移植修复术皮瓣坏死发生状况及其影响因素.方法 回顾性分析2018-09—2020-09于新乡市第二人民医院创面修复科行皮瓣移植修复术的80例口腔颌面部肿瘤术后组织缺损患者的临床资料.男37例,女43例;年龄(53.67±10.23)岁.记录患者的临床资料,统计术后随访3个月皮瓣坏死发...     

应用前臂皮瓣修复半舌或口腔软组织缺损

目的 回顾6年内在舌癌根治或口腔黏膜癌扩大切除后,应用吻合血管的前臂桡侧皮瓣进行半舌再造或软组织缺损修复的经验和体会.方法 对12例舌癌和10例口腔黏膜癌患者在根治术中应用前臂桡侧皮瓣行一期半舌再造或软组织缺损修复,在皮瓣设计、制备、供区血管选择和血管吻接等方面加以灵活运用.结果 22例患者中术后21例移植皮瓣全部成活,伤口一期愈合,1例因皮瓣静脉回流障碍失败.随访1～6年.再造舌外形基本满意,运动灵活,语音较清晰,感觉于术后3～6个月逐渐恢复,口腔软组织缺损修复区无臃肿,咀嚼和吞咽功能正常.结论 吻合血管的前臂桡侧皮瓣是修复舌癌或口腔黏膜癌根治术后软组织缺损的良好材料,可较好的满足缺损区的修复要求.     

腓肠神经营养血管皮瓣的临床应用

目的　探讨带腓肠神经营养血管皮瓣临床应用范围。方法　临床应用带腓肠神经营养血管皮瓣 31例。其中急诊一期修复胫腓骨开放性骨折 7例 ;二期修复小腿中下段创面 15例 ,修复足部创面 9例。结果　皮瓣全部成活。经随访皮瓣外观、质地及功能良好。皮瓣供区无功能障碍。结论　应用带腓肠神经营养血管皮瓣修复小腿中下段及足部创面 ,皮瓣切取简便 ,成活率高 ,皮瓣面积大 (10 cm× 15 cm)。皮瓣成活关键在于手术操作和蒂部处理     

Effect of Aspirin and Heparin on Random Skin Flap Survival in Rats

BACKGROUND Aspirin and heparin are commonly given to patients undergoing microvascular procedures to increase flap survival and patency, yet there is scant information concerning the effect these flaps have on nonmicrovascular flaps.
OBJECTIVE The objective was to obtain baseline values concerning the effect of aspirin and heparin on the viability of standardized flap tissues.
METHODS AND MATERIALS One hundred rats were divided into five groups receiving high-dose aspirin, low-dose aspirin, high-dose aspirin in combination with heparin, and heparin alone and the final group were controls. The viability of the tissue was measured at 1 week by fluorescein florescence.
RESULTS There was significant improvement in flap survival in the high-dose aspirin and high-dose aspirin combination groups.
CONCLUSIONS It appears that high-dose aspirin increases survival of ischemic flap tissue irrespective of the presence of microvascular anastomosis and may be of clinical benefit in all flap surgery.     

脂肪基质血管成分移植促进随意皮瓣成活的实验研究

目的探讨脂肪基质血管成分(Stromal vascular fraction,SVF)移植是否可以促进随意皮瓣成活,及其作用的相关机制。方法分离4周龄Wistar大鼠脂肪中的SVF及骨髓中的单个核细胞(BM-MNCs),RT-PCR检测VEGF和bFGF在两种细胞中的表达。根据移植细胞的不同,将24只Wistar大鼠分成3组,分别为对照组、BM-MNCs组和SVF组。在大鼠背部设计一个10 cm×3 cm大小的矩形皮瓣,分别将含有5×107个SVF及BM-MNCs的混悬液各1 mL均匀注射至皮下组织层,对照组单纯注射1 mL PBS。2 d后,皮瓣掀开原位缝合,术后7 d统计皮瓣的成活率。取各组皮瓣相同部位的组织,实时定量PCR检测组织中VEGF和bFGF基因的表达。结果 SVF和BM-MNCs细胞中VEGF和bFGF的表达无明显差别(P>0.05)。皮瓣原位缝合后7 d,SVF组和BM-MNCs组皮瓣的成活率分别为(72.2±2.0)%和(76.4±3.1)%,均明显高于对照组的(56.8±4.6)%(P<0.05)。实时定量PCR检测发现SVF组和BM-MNCs组皮瓣组织中VEGF和bFGF基因的表达明显升高。结论 SVF移植入皮瓣后可以通过旁分泌生长因子如VEGF和bFGF等增加皮瓣的成活面积。     

VEGF Application on Rat Skin Flap Survival

ABSTRACT

Background: Induction of angiogenesis has been shown to be mediated by a number of glycoproteins called growth factors. Growth factors control the growth, differentiation, and metabolism of cells. Vascular endothelial growth factor (VEGF) is believed to be the most potent regulator of this process. The effect of its exogenous administration on the distal third of a long random skin flap was examined. Materials and Methods: Eighteen Wistar rats were divided into two groups of nine. Rats were anesthetized, and a skin flap, measuring 1.5 × 7.5 cm, was elevated at their dorsum. The flap was standardized by centering the pedicle between the lower angles of the scapulae and by using a frame with the previously mentioned dimensions. The length of the flap was five times greater than its width. In group A (n = 9), the flap was elevated, one milliliter of normal saline was injected subdermally, at the distal third, and it was sutured back at its original place. In group B (n = 9), the flap was elevated, injections of 10 μg of VEGF were administrated subdermally, at the distal third, and it was again sutured back. Rats were euthanized a week later and flaps were excised. All specimens were measured, photographed, put in formalin 10%, and were sent for image and histological analysis. Image analysis was used both for the estimation of viable area and for the calculation of mean vessel density per mm². Results: Necrotic areas of the flaps were clearly demarcated within a week's time. In group A, the mean flap survival percentage was 38.9%. In group B, the percentage was 80.4%. Histological analysis demonstrated angiogenesis in group B, with mean vessel density per mm² being higher in group B than in group A. Conclusions: Administration of VEGF injections at the distal part of a long random skin flap (length to width ratio 5:1) has been shown to improve the survival rate of the flap and thus contributing to the salvage of greater peripheral segment of the flap. Neovascularization induced by exogenous VEGF seems to be the biological mechanism, which leads to the improvement of flap survival.     

Effect of Human Placental Extract Treatment on Random-Pattern Skin Flap Survival in Rats

Background: Human placental extract (HPE), prepared from the placentas of healthy, postpartum females, displays various physiological activities, including antioxidative properties. In this study, a dorsal skin flap model was used to investigate the effect of HPE on flap viability in rats. Materials and methods: Forty male Sprague-Dawley rats underwent random-pattern skin flap surgeries. The animals were randomly divided among a control group and three treatment groups (localized injection (LI), 10 mg/kg/d localized HPE injections; low-dose treatment (LT), 10 mg/kg/d systemic HPE injections; high-dose treatment (HT), 40 mg/kg/d systemic HPE injections). Surviving skin flap areas were measured 7 days after surgery and tissue samples were stained with hematoxylin and eosin; vascular endothelial growth factor expression was determined immunohistochemically. To evaluate the antioxidant and antiapoptotic effects of HPE, malondialdehyde, glutathione peroxidase, and caspase-3 levels were examined. Results: Seven days after surgery, HPE-treated animals had significantly reduced necrotic areas, rats receiving the highest HPE dose demonstrated the greatest flap survival. In the HPE groups, the histopathological scores were lower than for the control group. Immunohistochemistry showed markedly more numerous vascular endothelial growth factor-positive cells in the HT group than in the C group. Malondialdehyde levels were significantly lower and glutathione peroxidase levels were higher in the HT group than in the C group. HPE treatment significantly inhibited apoptosis by lowering caspase-3 activity. Conclusions: HPE treatment yielded positive effects on flap survival, due to its antioxidant and antiapoptotic properties. These results suggest a new therapeutic approach for enhancing flap viability and accelerating wound repair.     

内生式置换液预冲透析器的应用效果观察

目的探讨内生式置换液代替无菌生理盐水冲洗透析器的临床应用效果。方法将 1 0 0 0套血路管、透析器随机分为实验组和观察组各 5 0 0套 ,实验组采用GAMBROAK 2 0 0ULTRA血液净化机产生的内生式置换液进行透析前预冲洗 ,对照组则用无菌生理盐水进行冲洗。对冲洗后的透析器进行细菌培养和内毒素检测。结果两组透析器均未检出细菌和内毒素 ;实验组透析器冲洗、排气能一次完成 ,冲管工序简单、节省人力、费用少 ,与对照组比较 ,差异有显著性意义 (P <0 .0 5 ,P <0 .0 1 )。结论采用内生式置换液对血路管、透析器进行冲洗 ,安全 ,成本低     

胫前皮肤缺损的筋膜皮瓣的合理设计

胫前皮肤缺损伴骨外露或骨髓炎的皮肤覆盖是一难题。筋膜皮瓣有简单,损伤小,成功率高,抗感染力强等优点。筋膜皮瓣类型很多,选择手术方式和皮瓣类型仍有很多分歧[1～4]。我们收治12例胫骨外露,根据局部情况,解剖学基础合理选择筋膜皮瓣类型进行治疗,获得好的效果,现报道如...