胸壁慢性放射性溃疡的分型及手术治疗

目的:探讨胸壁慢性放射性溃疡的分型对临床治疗的指导意义。方法:对于2001年～2010年我科收治胸壁慢性放射性溃疡患者58例,根据其病情轻重分为轻、中、重共三型,并根据类型不同分别采用保守手术、临近皮瓣转移修复及剔骨皮瓣修复等三种方法。结果:根据分型标准,轻型溃疡11例,采用保守手术治愈;皮瓣转移修复中型溃疡39例,其中4例皮瓣远端部分坏死,经清创植皮愈合;剔骨皮瓣修复重型溃疡8例,1例皮瓣感染,1例因坏死锁骨清创不彻底形成瘘道,行Ⅱ期手术后完全愈合。结论:根据胸壁慢性放射性溃疡的临床表现可分为三型,根据不同类型采用相应的手术方法。胸壁慢性放射性溃疡的分型对手术方法的选用具有明确的指导意义。     

应用腹直肌皮瓣修复乳癌放疗后放射性溃疡

目的：探讨腹直肌肌皮瓣在乳癌放射性治疗（以下简称放疗）后放射性溃疡修复中的应用。方法：2007年以来应用健侧单蒂腹直肌肌皮瓣转移修复乳癌放疗后放射性溃疡16例。9例采用纵行腹直肌肌皮瓣,其中3例合并臂丛神经损伤的患者为其行臂丛神经松解术并局部注射间充质干细胞;7例采用横行腹直肌肌皮瓣修复,其中4例同时行乳房再造术。结果：1例患者皮瓣远端部分坏死,清创术后采用局部皮瓣修复;2例术后出现皮瓣下渗出积液,手术予以再次清创。其余皮瓣成活良好,创面修复满意。结论：腹直肌肌皮瓣血运可靠,是修复乳癌放疗后放射性溃疡的一种较为有效、简单和安全的方法,应根据具体的病变程度、范围设计适宜的肌皮瓣转移方式。     

乳腺癌术后放射性溃疡的皮瓣修复

乳腺癌术后放射性溃疡创面愈合困难,多需手术修复.我们1999年4月至2010年1 2月,应用不同皮瓣修复乳腺癌术后放射性溃疡10例,效果满意. 一、临床资料 本组10例,均为女性,年龄33～52岁,平均(41.95±8.52)岁,均为乳腺癌根治术后放射性溃疡患者.溃疡最小面积5 cm×3 cm,最大15 cm×12 cm.其中单纯皮肤溃疡5例,溃疡伴胸骨、肋骨不同程度破坏3例,10例中明确创面感染者8例.     

乳癌放疗后放射性溃疡的治疗

目的　探讨乳癌放射性治疗 (下简称放疗 )后放射性溃疡的治疗方法 ,阐述放疗后臂丛神经损伤的广泛性和严重性。方法　 1999年以来分别应用腹直肌肌皮瓣转移、皮肤软组织扩张、局部皮瓣转移和局部延迟皮瓣转移等方法修复乳癌放疗后放射性溃疡 16例 ,并常规行肌电图检查了解臂丛神经损伤的情况。结果　除 1例患者因创口感染而皮瓣部分坏死外 ,其余皮瓣成活良好 ,创面修复满意 ;10例行肌电图检查的患者中 ,有 7例合并有臂丛神经损伤。结论　乳癌放疗后引起的放射性溃疡常伴有臂丛神经损伤 ,这些损伤呈慢性、进行性和不可逆性改变 ;应用血运良好的皮瓣可有效地修复溃疡创面。     

应用皮瓣修复乳腺癌术后放射性溃疡

目的探讨应用皮瓣修复乳腺癌根治术后放疗所致放射性溃疡的疗效.方法回顾性分析9例乳腺癌术后放射性溃疡患者,分别采用背阔肌肌皮瓣修复5例、腹直肌肌皮瓣修复1例和局部侧胸皮瓣转移3例修复.结果除1例因局部缺血出现皮瓣部分坏死外,其余皮瓣成活良好,创面修复满意.结论应用血运良好的皮瓣可有效修复乳腺癌手术放疗后放射性溃疡创面.     

颈部放射性溃疡的治疗

目的:探讨颈部放射性溃疡的手术方法。方法:彻底或姑息性切除颈部放射性溃疡组织后,根据颈部组织损伤程度的不同,分别用同侧胸三角皮瓣或胸大肌肌皮瓣进行颈部缺损的修复,供区使用全厚皮片修复。结果:11例胸三角皮瓣、3例胸大肌肌皮瓣全部成活,愈合良好,术后患者生活质量明显改善。结论:胸三角皮瓣与胸大肌肌皮瓣血运可靠,是修复颈部放射性溃疡的有效、简单和安全的方法。     

颈部放射性溃疡的特点及修复

颈部放射性溃疡的特点及修复颜玲＊高建华＊罗锦辉＊王雪红＊我科自１９８５年～１９９５年，收治了１４例颈部放射性溃疡患者，采用邻近皮瓣修复及综合治疗，取得满意效果。报道如下。１临床资料本组１４例，男８例，女６例。年龄２６～６８岁。原发病因：鼻咽癌８例，乳...     

放射性溃疡的皮瓣修复

目的探讨应用皮瓣或肌皮瓣修复放射性溃疡的临床效果.方法用各种皮瓣或肌皮瓣修复不同部位的放射性溃疡创面21例,包括背阔肌皮瓣6例,侧腹壁皮瓣2例,脐旁皮瓣2例,臀大肌皮瓣3例,小腿内侧皮瓣1例,胸三角皮瓣4例,股前外侧皮瓣3例.其中吻合血管的游离皮瓣修复4例,带蒂转移皮瓣修复17例.皮瓣面积最大18 cm×11cm,最小8 cm×5 cm.结果1例因静脉栓塞皮瓣部分坏死,1例因术后出血,血肿形成,皮瓣远端坏死,其余19例皮瓣全部愈合,术后随访6个月～3年,未见有溃疡复发,皮瓣质地良好.结论应用皮瓣或肌皮瓣移植修复放射性溃疡疗效满意,可有效预防溃疡复发.     

腓动脉穿支皮瓣修复足踝皮肤软组织缺损的临床效果

目的 探讨腓动脉穿支皮瓣修复足踝皮肤软组织缺损的临床效果。方法 选取2019年1月-2022年 12月本院收治的30例足踝皮肤软组织缺损患者为研究对象，均应用腓动脉穿支皮瓣进行修复，观察术后 皮瓣成活情况，比较患者治疗前后的足踝功能及生活质量。结果 30例患者皮瓣成活率为96.67%；治疗后 皮肤外观、疼痛程度、皮肤感觉及功能评分均高于治疗前，差异有统计学意义（P＜0.05）；治疗后躯体 功能、角色功能、社会功能、睡眠质量、情绪状态均高于治疗前，差异有统计学意义（P＜0.05）。结论 腓动脉穿支皮瓣修复足踝皮肤软组织缺损的临床效果良好，术后皮瓣成活率较高，可有效改善患者的足 踝功能及生活质量。     

慢性放射性溃疡创面的综合治疗

目的:探讨应用整形外科技术修复慢性放射性溃疡的方法。方法:2007年1月至2016年1月,采用肌皮瓣、轴形皮瓣、任意皮瓣修复慢性放射性溃疡12例,其中腹直肌肌皮瓣3例,臀大肌肌皮瓣1例,阴股沟皮瓣1例,腰横筋膜皮瓣2例,任意型皮瓣4例,富血小板血浆(platelet-rich plasma,PRP)+网状皮片移植修复1例。应用负压封闭引流技术(vacuum sealing drainage,VSD)5例。结果:12例移植皮瓣或皮片均成活良好。术后随访4个月~8年,平均2.9年,除1例因原发病死亡外,无溃疡复发。结论:彻底清除创面坏死组织,保持良好的创基和湿润环境是创面修复成功的关键,持续VSD及PRP技术是放射性溃疡治疗的辅助手段。     

严重放射性溃疡的修复

目的探讨严重放射性溃疡的修复方法及其临床效果。方法 自１９８８年８月～１９９８年１２月,采用肌瓣或肌皮瓣移位修复严重放射性溃疡１２例,其中胸大肌肌瓣１例,三叶状横形腹直肌肌皮瓣３例,背胸肌肌皮瓣２例,阔筋膜张肌肌皮瓣１例,纵形腹直肌肌眼瓣与阔筋膜张肌肌眼瓣１例,腓肠肌肌瓣１例,臀大肌肌眼瓣１例,下肢巨大别骨肌皮瓣１例,上肢剔骨肌皮瓣１例。结果 肌瓣、肌皮瓣全部成活,伤口期愈合９例,２期愈合３例。２     

应用下斜方肌皮瓣修复颈部放射性溃疡

目的探讨鼻咽癌放射治疗后颈部放射性溃疡的治疗方法;阐述放疗后臂丛神经损伤的广泛性和严重性。方法1999年以来应用下斜方肌皮瓣岛状转移的方法修复颈部慢性放射性溃疡15例,并常规行肌电图检查了解臂丛神经损伤的情况。结果除1例面积为9 cm×10 cm的肌皮瓣因创面严重感染而坏死外,其余肌皮瓣成活良好,创面修复满意;该组病例中同时存在的并发症有臂丛神经麻痹、耳聋、老年性痴呆、声带麻痹和甲状腺功能低下。结论应用血运良好的下斜方肌皮瓣可有效地修复颈部上段的放射性溃疡创面。     

难治性褥疮的综合治疗

目的总结难治性褥疮的临床治疗经验。方法1998年5月~2005年3月,收治22例29处褥疮患者,年龄36~92岁。褥疮范围4cm×2cm~18cm×15cm。骶尾部18处,坐骨结节部6处,股骨大转子部5处。口服肠内营养素,创口采用五黄一号药纱布贴敷包扎8~15d后手术。其中3例合并糖尿病术前采用胰岛素控制血糖。根据患者年龄、褥疮部位、范围及深度等选择皮瓣类型。采用局部皮瓣修复3处,皮瓣范围6cm×4cm~12cm×10cm;筋膜皮瓣修复10处,皮瓣范围10cm×7cm~20cm×17cm;臀大肌皮瓣修复9处,皮瓣范围13cm×11m~17cm×14cm;股二头肌长头肌皮瓣修复6处,皮瓣范围11cm×6cm~14cm×7cm;直接缝合修复1处。术后睡气流悬浮床7~14d。结果22例29处褥疮,术前加强营养支持,创口用五黄一号换药,治疗8~15d,血红蛋白超过100g/L,白蛋白超过30g/L,褥疮部位坏死组织脱净,肉芽组织红润,创面分泌物减少,创周无红肿,全身营养状况明显改善。术后皮瓣均成活,切口期愈合。获随访6个月~5年,原手术部位无褥疮复发,皮瓣质地柔软,外形满意。结论应用综合方法治疗难治性褥疮效果显著,手术成功率高。     

应用颈浅动脉皮瓣修复颈部放射性溃疡

目的探讨应用颈浅动脉皮瓣修复颈部放射性溃疡的方法和临床效果。方法2016年1月至2019年6月,暨南大学附属广州红十字会医院烧伤整形科采用颈浅动脉皮瓣修复颈部放射溃疡11例。溃疡发生距放疗平均13.4年,面积1 cm×2 cm~3 cm×7 cm,广泛纤维化。术前取材病理检查,清创宽度包括溃疡及周围纤维化组织,控制深度,避免损伤颈部大血管。清创后创面大小6 cm×9 cm~8 cm×13 cm。以肩峰水平脊柱旁4~5 cm处为皮瓣旋转点,以术前多普勒血流探测仪探测的颈浅动脉筋膜皮支血管走行方向为长轴设计皮瓣,旋转点到皮瓣近侧缘的距离大于其到创面近侧缘距离约2 cm,皮瓣大小超出创面大小约2 cm。分离出蒂部血管后顺行切取皮瓣,转移到颈部修复放射性溃疡切除后缺损。供区边缘适当游离2~3 cm,如缝合张力较小可行真皮层远位减张直接缝合,如张力较大则采用部分缝合,缩小创面后以中厚皮片移植修复。观察患者术后情况。结果本组11例患者的溃疡组织病理检查均提示明显纤维组织增生胶原化并小灶状钙化,局部区域坏死,间质大量淋巴细胞、单核细胞等慢性炎性细胞并少量中性粒细胞等急性炎性细胞浸润,排除肿瘤复发。11例患者中4例行供瓣区预扩张,其余7例均为皮瓣一期切取后转移,皮瓣大小8 cm×11 cm~10 cm×15 cm。8例采用颈肩胛皮瓣修复,3例采用颈背皮瓣修复。供瓣区8例真皮层远位减张后直接缝合,3例缩小创面后中厚皮片移植修复。其中10例皮瓣完全成活,伤口一期愈合。1例皮瓣远端小范围坏死,通过创面换药和二期植皮后痊愈。随访6~24个月,溃疡无复发。所有患者放射性溃疡均得到有效修复,术区外观、功能良好。结论颈部放射性溃疡是颈部放疗后较严重的远期并发症,颈浅动脉皮瓣靠近颈部、血运丰富、解剖恒定、供区隐蔽,是治疗颈部放射性溃疡切实可行的方法之一。     

Distally based sural flap in treatment of chronic venous ulcers

The treatment of venous ulcers of the leg often fails to heal because venous ulcers are mostly associated with severe lipodermatosclerosis. These complicated ulcers may require correction of local hemodynamics, excision of ulcer with surrounding lipodermatosclerotic skin, and replacement of the defect with healthy tissue. We present our experience with the use of the distally based sural flaps for the reconstruction of soft-tissue defects of the distal region of the lower limb in patients with chronic venous ulcer. Between 2001 and 2003, 12 patients with venous ulceration were treated with distally based sural flaps. At operation, the ulcer and its surrounding lipodermatosclerotic skin were excised. The defects after excision ranged from 3 x 3 to 11 x 17 cm. The distally based sural artery flap was inset within the defect. In all patients, the flap survived completely, and in only 1 patient, distal venous congestion was seen and was treated successfully with leeches. There was donor site skin graft loss in 2 patients. Two flaps had minor local complications that healed with local wound care. No recurrent ulcers were identified after average 19.7 months. In conclusion, the distally based sural flaps can be used reliably for treatment of venous ulcers. Our approach in treatment of chronic venous ulcers improves venous hemodynamics and provides local flap alternative that should be considered prior to a free-flap transfer for closure of the defect.     

Classification of Achilles tendon shortening induced by scar contracture and corresponding treatment strategies for pediatric patients — A single unit experience

BackgroundAchilles tendon shortening of pediatric patients caused by scar contracture poses a challenge for us. It always impairs walking function. In this article, we attempted to introduce a new classification of Achilles tendon shortening of pediatric patients and corresponding treatment strategies in our single center.MethodsFrom 2001 to 2018, 65 patients (aging from 13 to 17-years-old, 34 females and 31 males, 21 cases with unilateral Achilles tendon shortening and 44 cases with bilateral Achilles tendon shortening) were recruited. The causes included trauma (n = 13), scald (n = 20) and burn (n = 32). The distance between the heel and the ground was from 3 to 18 cm. They were classified into three types: ≤5 cm, mild, n = 9; 5–10 cm, moderate, n = 30; ≥10 cm, serious, n = 26. They had a history from 7 months to 4 years (28 cases with less than 1.5 years and 37 cases with more than 1.5 years). Treatment methods: Scar-Achilles-Tendon (SAT) flaps and skin graft were used for moderate cases before special external fixation shoes were used for fixation for at least 6 months. External special shoes fixation was used for mild cases except 5cases still received SAT flap and skin graft. In serious cases, bone extraction was used for at least 6 months before receiving SAT flap and skin graft.ResultsThe distance between the heel and the ground was 0 cm after treatment in 54 cases (mild, n = 9; moderate, n = 28; serious, n = 18). Recurrence was found in 11 cases (mild, n = 0; moderate, n = 5; serious, n = 6) after six months follow-up. There were 13 cases of tangential excision of eschar and 8 cases of escharectomy (P < 0.05) with flap necrosis affection. Among them, 9 cases with a medical history of less than 1.5 years had partial necrosis, 6 cases with a medical history of more than 1.5 years had partial flap necrosis(P < 0.05). Local necrosis was covered by skin graft again. Bone exposure was found in 5 serious cases. It was repaired by negative pressure therapy first and then skin graft was used. The walking ability (P < 0.05) and function (P < 0.05) of lower limbs were statistically improved after treatment.ConclusionsDifferent methods can be used according to the shortening degree of Achilles tendon of pediatric patients based on the new classification, which may be useful for future clinical work.     

杯状耳畸形的整形美容

目的探讨修复杯状耳畸形的方法和效果.方法轻中度杯状耳畸形应用V-Y推进皮瓣及耳后皮瓣转移法修复,重度杯状耳畸形采用耳甲复合组织瓣上旋法及耳后皮瓣转移修复.自2000年3月至2004年12月,共修复16例23只杯状耳畸形,男11例,女5例,年龄8～36岁,其中轻中度杯状耳12例（5例为双侧）,重度杯状耳4例（2例双侧）.16例中13例遗有耳廓或耳甲腔皮肤缺损,采用耳后皮瓣修复,其中皮瓣供区原位缝合7例,皮片移植修复6例.结果皮瓣全部成活,切口愈合良好,术后随访6个月至2年,耳廓和耳甲腔的外形改善明显,外耳形态满意,单侧畸形耳与健侧基本对称.结论采用V-Y推进法及耳甲复合组织瓣上旋法分别是修复轻中度及重度杯状耳畸形的较好方法,耳后皮瓣的合理应用及外耳的固定塑形也是不可忽视的手术成功的关键.     

High-pressure injection injuries of the hand in a Chinese population

We performed a retrospective review of 28 digits in 28 patients who suffered high-pressure injection injuries of the hand during the last 10 years. They were all men, with a mean age of 36 years. All were work injury and the injuries were classified into mild, moderate and severe and were either treated conservatively or surgically. There were seven patients with mild injuries and six of these were successfully treated by conservative methods. Sixteen patients had moderate injuries and all were successfully treated with repeated debridement and delayed direct closure. The index fingers of two severely injured patients were salvaged with digital artery flaps and the remainder of the involved fingers were amputated. The authors advocate proper identification of mild injuries to allow conservative treatment, the application of digital artery flaps for resurfacing large finger defects and have formulated a treatment protocol according to the severity of the injury.     

A practical electrophysiological guide for non-surgical and surgical treatment of carpal tunnel syndrome

In the present study, we illustrate the use of an electrophysiological classification as a guide to the treatment of carpal tunnel syndrome (CTS). A total of 113 CTS patients were assessed with symptom severity scores, hand functional scores and electrophysiological studies. By setting criteria of electrophysiological tests, 179 hands in 113 patients were classified into mild, moderate and severe degrees of CTS. Of these, the 41 hands with severe CTS were referred for surgery. The 58 hands with moderate CTS and 80 hands with mild CTS received conservative treatment. The improvement ratios in the severe group were greater than that in the moderate and mild groups, both at 6 months and at 1 year. Eighteen hands with moderate or mild CTS returned to normal electrophysiology with the conservative treatments. No patient recovered to normal electrophysiology in the severe group. This electrophysiological classification is objective and it may serve as a useful guide for non-surgical and surgical treatment of CTS.     

护士与病人癌痛评估差异性比较

目的观察护士与病人对癌痛程度评估差异及护士的癌痛评估对止痛治疗效果的影响.方法 85例癌痛病人和护士分别用目测模拟疼痛程度分级法进行疼痛评估,随即按病人意愿分为病人评估组(轻度疼痛20例,中、重度疼痛29例)和护士评估组(轻度疼痛14例,中、重度疼痛22例)进行止痛治疗.结果以病人评估为基准,护士评估轻、中、重度疼痛的符合率分别为85.3%、63.0%和58.3%;护士与病人对中、重度癌痛评估存在明显差异(均P＜0.05);病人与护士评估轻度疼痛完全缓解率分别为95.0%、85.7%,差异无显著性意义(P＞0.05);中、重度疼痛完全缓解率分别为82.8%、45.6%,病人评估组准确性明显优于护士评估组(P＜0.05).结论护士对癌症疼痛严重程度的评估存在不足并导致止痛效果不佳,对癌痛的治疗应基于病人的自评.