下腹部局部皮瓣修复年长儿童膀胱外翻耻骨上腹壁缺损的价值

目的：探讨下腹部局部皮瓣修复长儿童膀胱外翻耻骨上腹壁缺损的临床应用价值。方法：对2例年长儿童膀胱外翻患者采用下腹部局部皮瓣修复耻骨上腹壁缺损。结果：2例局部皮瓣均存活并生长良好，能完全覆盖耻骨上腹壁缺损，外观满意，效果良好。结论：对年长儿童膀胱外翻患者采用下腹部局部皮瓣修复耻骨上腹壁缺损，创伤小，术后恢复快，外观满意。     

岛状股前外侧穿支皮瓣修复会阴部软组织缺损

目的探讨岛状股前外侧穿支皮瓣修复会阴部软组织缺损的临床疗效。方法 2009年至2013年,共收治8例会阴部缺损患者,创面预处理后,以岛状股前外侧穿支皮瓣带蒂转移修复创面,皮瓣面积7.0 cm×10.0 cm~13 cm×21 cm。供区直接拉拢缝合或取对侧股部断层皮片移植修复。结果 8例患者术后皮瓣均完全成活,皮瓣质地柔软,无继发瘢痕挛缩。随访6~24个月,肿瘤无复发,供区愈合良好,无下肢活动障碍。结论应用岛状股前外侧皮瓣修复会阴区缺损,效果良好,值得临床推广。     

耳后岛状皮瓣修复眼睑外翻琦形

采用耳后岛状皮瓣法修复眼睑外翻畸形３例，获得较好的效果。讨论了该手术方法的优缺点，手术适应证以及手术注意要点。     

逆行股前外侧岛状皮瓣修复膝关节周围软组织缺损

【摘要】目的 探讨采用股前外侧逆行岛状穿支皮瓣修复膝关节周围严重创伤性软组织缺损的疗效。方法 回顾性分析2008年至2012年,我院采用股前外侧逆行岛状穿支皮瓣修复膝关节周围严重创伤性皮肤软组织缺8例,术后观察皮瓣存活情况和恢复情况。结果 除了1例病例边缘小部分坏死,通过换药愈合外,其余皮瓣全部存活,皮瓣质地弹性好,外形满意。术后无明显感染及并发症。结论 采用股前外侧逆行岛状穿支皮瓣修复膝关节周围严重创伤性软组织缺损,具有血供可靠,血管蒂较长等优点,术后疗效满意。     

股前外-膝上外侧逆行岛状皮瓣修复小腿软组织缺损

目的 介绍股前外-膝上外侧逆行岛状皮瓣修复小腿软组织缺损的临床应用经验. 方法 对小腿大面积软组织缺损患者7例,采用股前外侧-膝上外侧逆行岛状皮瓣修复,术中皮瓣下端以膝上外侧动脉及降支终末支为蒂作带蒂转移,皮瓣上端以旋股外侧动脉降支或横支、高位皮支为蒂,在皮瓣转移后与小腿下段由足背动、静脉返流的胫前动、静脉作吻合. 结果 术后皮瓣均顺利完全成活,3～6个月随访皮瓣外观满意、伤口愈合良好、骨折在愈合中. 结论 利用股前外-膝上外侧逆行岛状皮瓣是修复小腿大面积软组织缺损的好方法.     

轴型皮瓣法膀胱外翻功能性修复术

报道10例先天性严重膀胱外翻合并多种畸形患者,采用皮瓣或骨皮瓣带蒂转移,Ⅰ期关闭外翻膀胱,延长尿道和膀胱颈,重建耻骨联合,修复腹壁缺损及成形会阴,延长阴茎等。随访6～28个月,膀胱功能达到或接近正常,控尿满意。讨论了手术方法及自控排尿的关键措施。临床效果显著高于目前国内外介绍的水平。     

带蒂腹壁皮瓣和腹直肌瓣一期修复膀胱外翻及尿道上裂

采用自行设计的带蒂腹壁皮瓣和腹直肌瓣一期修复５例完全性膀胱外翻及尿道上裂，效果满意。腹壁和膀肮前壁缺损均得以关闭。４例术后随访１．５～１０．５年。３例采用腹直肌瓣缠绕膀胱颈者，术后能控制排尿；另１例未缠绕者，术后腹压增加时，呈尿失禁状。术后复查肾功能均正常。     

岛状股前外侧皮瓣修复腹股沟及会阴部创面

目的探讨一种皮瓣修复会阴部及腹股沟创面的方法。方法设计以旋股外侧动脉降支为血管蒂的岛状股前外侧皮瓣,掀起皮瓣后经过皮下隧道将其转移至会阴部及腹股沟创面。结果临床治疗12例,皮瓣面积为8cm×11cm～18cm×20cm。除1例皮瓣靠近肛门处部分表皮坏死外,其余成活良好,外形恢复满意。结论以旋股外侧动脉降支为血管蒂的岛状股前外侧皮瓣是修复会阴部及腹股沟创面较好的方法。     

股前外侧穿支皮瓣修复小腿及足部软组织缺损

目的 报道股前外侧穿支皮瓣修复小腿及足部软组织缺损的临床效果. 方法 应用逆行股前外侧穿支皮瓣转移修复小腿上段软组织缺损22例,皮瓣面积16cm×10 cm～25 cm×14 cm;应用游离股前外侧穿支皮瓣移植修复小腿中下段及足部软组织缺损6例,皮瓣面积11 cm×7 cm～18cm× 10 cm. 结果 28例皮瓣全部成活,无并发症发生,合并骨折病例骨折愈合,经10个月～5年随访,皮瓣色泽好、质地优良,除2例足背受区皮瓣外观较为臃肿需二期手术修薄外,皮瓣功能及外观满意.结论 根据伤情,灵活应用股前外侧穿支皮瓣不同术式修复小腿及足部软组织缺损可获得良好的临床效果.     

游离股前外侧皮瓣修复四肢软组织缺损

股前外侧皮瓣是目前显微外科中比较常用的游离皮瓣之一。自1998年1月至2005年1月，我院应用游离股前外侧皮瓣修复四肢软组织缺损45例，效果良好，报道如下。     

Pedicled anterolateral thigh flap for contralateral groin composite defect

Pedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described.     

Reconstruction of complex thoraco-abdominal defects with extended anterolateral thigh flap

Background:

The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage.

Materials and Methods:

From 2004 to 2009, five patients with complex defects of the thoracic and abdominal wall following tumour ablation were reconstructed in one stage and were studied. The commonest tumour was chondrosarcoma. The skeletal component was reconstructed with methylmethacrylate bone cement and polypropylene mesh and the soft tissue with free extended anterolateral thigh flap. The flaps were anastomosed with internal mammary vessels. The donor sites of the flaps were covered with split-skin graft.

Result:

All the flaps survived well. One flap required re-exploration for venous congestion and was successfully salvaged. Two flaps had post operative wound infection and were managed conservatively. All flap donor sites developed hyper-pigmentation, contour deformity and cobble stone appearance.

Conclusion:

Single-stage reconstruction of the complex defects of the thoraco-abdominal region is feasible with extended anterolateral thigh flap and can be adopted as the first procedure of choice.     

Monitoring a free anterolateral thigh flap for pharyngeal reconstruction

Aim: To describe a novel way of monitoring a buried fasciocutaneous anterolateral thigh (ALT) flap used for pharyngeal reconstruction. Methods: A tubed ALT flap was used to reconstruct a circumferential pharyngeal defect following resection of a carcinoma. An island of skin based on a separate perforator and externalized through the neck incision was used to monitor the flap. It was removed as a bedside procedure on the fifth postoperative day. Results: The externalized skin island allowed easy monitoring of the buried tubed free‐flap used to reconstruct the pharynx. Simple clinical parameters such as temperature, colour and capillary refill were used to monitor the flap instead of more complex and invasive methods. Conclusion: When feasible, a second skin island based on a separate set of perforator vessels provides an easy, safe and simple method of monitoring a buried free‐flap.     

逆行股前外侧皮瓣移位修复胫骨外露创面

目的探讨逆行股前外侧皮瓣、肌皮瓣修复小腿中上段胫骨外露创面的方法及疗效。方法 2005年10月-2010年4月,应用逆行股前外侧皮瓣、肌皮瓣移位修复小腿中上段胫骨外露创面16例。男10例,女6例;年龄16～52岁。交通事故伤11例,重物压伤5例。10例为伤后1～6 h入院,平均3 h;6例伤后于外院行胫骨骨折钢板内固定术后创面严重感染,伤后至该次入院时间为6～14 d,平均10 d。创面范围13 cm×7 cm～20 cm×13 cm。皮瓣切取范围16 cm×10 cm～23 cm×15 cm。供区取中厚皮游离移植修复。结果术后5～7 d 2例皮瓣发生感染,经换药1周后愈合;其余皮瓣成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,植皮成活。患者均获随访,随访时间10～23个月,平均18个月。患肢皮瓣外形稍臃肿,色泽、质地满意。骨折均于术后8～10个月愈合。结论采用逆行股前外侧皮瓣、肌皮瓣可有效修复小腿中上段胫骨外露创面。     

The pedicled anterolateral thigh island flap for inguinal defects

The interpolated anterolateral thigh flap islanded on its vascular pedicle, is a durable local flap option for large skin and soft tissue defects caused by inguinal block dissections. So far, this flap has not been described for resurfacing such defects. Two cases are presented to highlight the technique. Received: 5 March 1999 / Accepted: 7 July 1999     

First web-space reconstruction by the anterolateral thigh flap

Four patients with severe contracture of the first web space were treated with an anterolateral thigh perforator flap. The flap size ranged from 10 to 13 cm in length and from 7 to 8 cm in width. The donor site was closed directly and thinning of the flap was performed in all cases. All flaps survived and there were no re-explorations. Web space opening was maintained over the follow-up period. There was an average postoperative increase of the angle of the first web space of 61 degrees. The thinned anterolateral thigh flap provides a pliable vascularized tissue for resurfacing the skin after release of severe contracture of the first web space and represents a reliable alternative to other flaps.