皮肤扩张术治疗面部巨大疣状痣

目的观察皮肤扩张术治疗面部巨大疣状痣的疗效。方法9例面部巨大疣状痣患者,根据皮损形态和大小,选择合适的扩张器和扩张部位进行扩张;手术切除疣状痣组织后用扩张皮瓣修复创面。结果本组9例皮损完全回复,无继发畸形。结论应用皮肤软扩张术治疗面部巨大疣状痣,既能彻底去除皮损组织,又无继发畸形,是一种比较理想的治疗方法。     

肩胛部皮瓣的临床应用(附4例报告)

自1983年1月以来,我们应用肩胛部皮瓣修复手、足部软组织缺损后疤痕挛缩4例,均获成功。初步报告如下。一、应用解剖肩胛部皮瓣的血供来自旋肩胛动脉及其分支。故其血管蒂可选用旋肩胛动脉或肩胛下动脉。肩胛下动脉起源于腋动脉第三段,向内下方行走后分为旋肩胛动脉及胸背动脉。旋肩胛动脉自前向后由三边形肌间隙穿     

预构扩张皮瓣的研究与应用进展

预构扩张皮瓣是将浅表的动静脉血管束移位植入无直接动脉走行的部位预构轴形皮瓣,同时在该皮瓣下放置皮肤软组织扩张器,逐渐充水扩张,以形成扩张变薄的轴形皮瓣。具有血液循环好,皮瓣薄,皮瓣转移后无臃肿,增加预构皮瓣范围,供区可直接缝合不需植皮等优点。现结合国内外文献,对近年来预构扩张皮瓣的研究与应用进展状况综述如下。     

额部岛状皮瓣修复鼻部肿瘤术后缺损

目的 探讨应用额部岛状皮瓣进行鼻缺损修复的手术方法.方法 应用额部岛状皮瓣对10例鼻缺损患者行Ⅰ期鼻再造或修复,方法是在额旁正中皮瓣及额斜皮瓣的基础上设计额部岛状皮瓣,即以一侧滑车上动脉为蒂,皮瓣的"靴筒"部为皮瓣岛状转移的蒂部;而皮瓣的主体为越过额部的正中线直达对侧颞区的横向皮瓣,其中包括对侧滑车动脉供血区及颞浅动脉供血区.结果　术后10例患者随访6～9个月,再造鼻均获成功,鼻的外形及通气功能均良好,效果满意.结论 应用额部岛状皮瓣进行的鼻再造或修复的手术方法,具有操作方便、皮瓣的血供可靠、手术可Ⅰ期完成、术后鼻外观良好等优点,是修复鼻缺损的良好的手术方法.     

微型静脉皮瓣修复再植手指微小创面(附69例报告)

目的 探讨微型静脉皮瓣修复再植手指血管与皮肤缺损的临床价值。方法 在前臂或足背部设计以小静脉为轴心的静脉干皮瓣移植于再植手指，一次性修复再植手指皮肤与血管缺损。结果 静脉皮瓣与再植手指全部成活，外形与功能良好。结论 微型静脉皮瓣一次性修复再植手指血管与皮肤缺损，不仅取材方便、操作简单，而且成活率高。     

颈前区围领式微创扩张皮瓣修复下面部瘢痕6例报告

对于下面部较大面积瘢痕如采用整张游离中厚皮片移植修复，皮片的色泽与受区周围皮肤不一致，如采用传统扩张皮瓣转移修复，则因修复创面较大，在下颌部或颈前遗留拼接切口瘢痕。2000年5月以来，我院采用颌下颈前区围领式微创扩张皮瓣修复下面部瘢痕6例，效果较理想。现报告如下。     

带蒂皮瓣及游离皮瓣移植修复软组织缺损

我院自1987～1989年应用带蒂皮瓣转移和游离皮瓣移植修复软组织缺损19例(20块皮瓣),术后随访平均10个月,20块皮瓣全部成活,外观功能良好。一、临床资料1.一般资料:男16例,女3例;年龄24～80岁,平均34岁。病程1小时至13年。创伤急诊修复7例,感染创面修复11例,腕背部鳞状癌切除后软组织缺损1例。受区部位:手部7例,足部5例,腿部5例,阴茎     

颞浅动静脉预构扩张皮瓣在面、颈部软组织缺损修复中的应用

目的探讨颞浅动静脉预构扩张皮瓣修复面、颈部软组织缺损的疗效及机理。方法对8例面、颈部瘢痕挛缩患者采用颞浅动静脉预构扩张皮瓣修复,观察其临床疗效。结果所有病例皮瓣转移后,出现一过性充血潮红,均完全成活。随访6个月,面、颈部畸形矫正良好,皮瓣色泽接近,厚度、质地适宜,继发面、颈部瘢痕不明显,效果良好。结论预构扩张可提高皮瓣微循环灌注量,增大皮瓣成活面积,从而增加皮瓣移植的安全性。     

旋转推进皮瓣修复颌面部皮肤缺损16例

近年来 ,我们用旋转推进皮瓣对 16例颌面部皮肤缺损患者进行整复美容治疗 ,效果良好。现报告如下。临床资料 :本组男 11例 ,女 5例 ,年龄 6～ 5 5岁。面部黑色素痣 4例 ,面部毛细血管瘤 3例 ,皮肤癌 6例 ,外伤损伤 3例。缺损位于颏部 5例 ,颊部 4例 ,颌下区 3例 ,眶下区 2例 ,耳前区 2例。缺损面积为 1.5 cm× 1.0 cm～ 5 cm× 2 .5 cm。治疗方法与结果 :沿术前设计线将皮瓣全层切开皮肤 ,皮下组织达脂肪层内。根据缺损区的深度将皮瓣逐渐掀起 ,充分止血。可带适量皮下脂肪 ,向缺损区旋转时如张力过大 ,可适当延长基底处切口 ,注意勿使皮瓣…     

拇甲瓣联合第二趾再造拇指(附16例报告)

用以跖背动脉或趾底动脉为血管蒂的拇甲瓣和带胫侧瓣的第二趾组合修复拇指Ⅲ度及Ⅲ度以上缺损,用第二趾腓侧皮瓣修复拇趾供区缺损16例。再造手指及供区的皮瓣全部成活。2例术中、1例术后第2天出现血管危象,手术探查并给予相应处理后皮瓣成活。随访5个月～3a,拇甲瓣指甲外形良好,皮瓣质地柔软,颜色正常,手指活动良好。认为用以跖背动脉或趾底动脉为血管蒂的拇甲瓣与带胫侧瓣的第二趾进行组合再造,是修复拇指Ⅲ度及Ⅲ度以上缺损的好方法。     

Prospective evaluation of the scapular manipulation technique in reducing anterior shoulder dislocations.

STUDY OBJECTIVE: To evaluate the speed, efficacy, and safety of the scapular manipulation technique in reducing acute anterior shoulder dislocations. DESIGN: Prospective study. SETTING: Urban emergency department with an annual census of 65,000 patients. PARTICIPANTS: Forty-eight adult patients with acute anterior shoulder dislocation. INTERVENTIONS: Patients had an initial neurovascular and radiographic evaluation performed. They were sedated with IV fentanyl and midazolam. The shoulder was reduced using the scapular manipulation technique. The patient was re-evaluated for any evidence of complication. The total dose of analgesic required and time to reduction were recorded. RESULTS: The scapular manipulation technique was successful in 46 of 48 (96%) cases. The average time to reduction was 6.05 minutes, and no complications were detected. Average doses of 1.83 mg midazolam and 204 micrograms fentanyl were required for reduction. CONCLUSION: The scapular manipulation technique is a very fast, effective, safe method of reducing anterior shoulder dislocations in the ED. [Kothari RU, Dronen SC: Prospective evaluation of the scapular manipulation technique in reducing anterior shoulder dislocations.     

Repair of anal stricture and mucosal ectropion by simple flap procedures

A technique is described that has proven most effective in correction of postoperative anal stenosis. A modification of this technique also has proven effective in the treatment of symptomatic anal mucosal ectropion--a condition marked by pruritus and perianal soilage from mucosal weeping, usually associated with the Whitehead hemorrhoidectomy. The design of the flap allows primary closure of the donor site and tension-free flap inset with a robust flap blood supply.     

Ipsilateral Ileal Conduit Placement at Vertical Rectus Abdominis Myocutaneous Flap Donor Site in Pelvic Exenteration

Placing of ileal conduit at the time of pelvic exenteration in combination with a same-side vertical rectus abdominis myocutaneous flap is controversial. We report our experience with the placement of the ileal conduit at the same side as the donor site of the vertical rectus abdominis myocutaneous flap in 12 patients and describe our technical approach. Reprints are not available.     

Unusual scapular metastasis as initial manifestation of advanced nonseminomatous germ cell tumor of the mediastinum

Primary malignant germ cell tumors of the mediastinum are relatively rare, occurring predominantly in young male adults, and have a poor prognosis. We present a case of a 27-year-old man who initially experienced a persistent, intractable painful sensation over the right lower scapula despite taking an analgesic agent for 2 months. A scapular x-ray film and a whole-body bone scan showed an expansile osteolytic lesion. Excisional biopsy of the scapula revealed a metastatic carcinoma, suggestive of nonseminomatous germ cell tumor origin. Further examination of the whole abdomen and bilateral testes were negative. Chest computed tomography and magnetic resonance imaging showed a primary tumor mass in the anterior mediastinum. Chemotherapy with cisplatin, bleomycin, and etoposide was administered for six courses. The mediastinal tumor mass was markedly reduced in size and remission without evidence of tracer uptake by [(18)F]fluorodeoxyglucose positron emission tomography examination. Six months after chemotherapy, the patient received advanced surgical intervention to remove the mediastinal tumor, the pathologic features of which were similar to the previous scapular lesion. He was doing well at 1-year follow-up.     

阴股沟皮瓣阴道再造术(附10例报告)

目的总结阴股沟皮瓣阴道再造术经验与体会。方法应用阴股沟皮瓣行阴道再造术10例。结果手术全部成功，随访6个月至5年，效果满意。结论阴股沟皮瓣具有血运丰富、手术易成功、操作简单、术后供区瘢痕隐蔽、外阴形态保持好的优点。     

Bony palatal necrosis in a diabetic patient secondary to palatal rotational flap

Donor site necrosis is a very rare complication of palatal rotational flaps. The aim of this case report is to present a 43-year-old female, Type I diabetic patient with a chronic oroantral fistula in the right second molar region. The patient had bony necrosis in the donor site following palatal rotational flap operation. The treatment approach and the alternative methods are discussed.     

The TRAM dam design: a new method for treatment of an enterocele

A new method for the treatment of an enterocele is described and illustrated with a case report. In a patient with Ehlers Danlos syndrome, a pedicled muscle sparing transverse rectus abdominis myocutaneous flap was used to fill the pelvic inlet and rectovaginal space. The flap prevents descend of bowel into the pelvic inlet and rectovaginal space. The patient’s defecation problems and pelvic discomfort were resolved. The technique does not require the use of a synthetic mesh and causes little donor site morbidity.     

Comparison of the therapeutic effects of intramuscular subscapularis and scapulothoracic bursa injections in patients with scapular pain: a randomized controlled trial

Scapulothoracic bursitis contributes to considerable morbidity in some patients with scapular pain. A scapulothoracic bursa injection can induce symptomatic relief; however, blind injections into the scapulothoracic bursa may involve injecting into the subscapularis muscle itself. The aim of this study was to compare the therapeutic effects of intramuscular injections into the subscapularis under ultrasound (US) guidance with those of blind scapulothoracic bursa injections in patients with scapular pain. This study was a single-center, prospective, randomized, single-blinded, controlled clinical trial. Thirty-six patients with suspected scapulothoracic bursitis, who met the inclusion criteria, were recruited between January 2009 and December 2012. We performed three US-guided intramuscular injections into the subscapularis muscle or three blind scapulothoracic bursa injections at 1-week intervals. A visual analogue scale (VAS) and the Rubin scale at baseline and at 1, 2, and 3 weeks after the last injections were examined and again at 3 months after the last injections by a blinded investigator. Adverse effects were monitored. The VAS scores at baseline were 7.7 ± 1.3 and 7.8 ± 1.4 in the intramuscular injection and scapulothoracic bursa injection groups, respectively. Mean VAS scores after the intramuscular injections were 3.8, 2.7, 1.3, and 3.5, and mean VAS scores after scapulothoracic bursa injections were 4.1, 2.4, 1.6, and 2.9 at 1, 2, 3 weeks and at 3 months after the last injections. VAS scores decreased significantly after the injections in each group (p ≤ 0.05). However, no significant difference was observed between intramuscular injection into the subscapularis and the scapulothoracic bursa injection. No serious complications were encountered. In conclusion, injections at the scapulothoracic bursa without US guidance did not exclude the possibility of an effect of steroid on the subscapularis muscle, as both intramuscular injections into the subscapularis and scapulothoracic bursa injections in patients with scapular pain provided equal symptomatic relief, and all patients developed tenderness in their subscapularis muscle.     

A hundred patients with vertical rectus abdominis myocutaneous (VRAM) flap for pelvic reconstruction after total pelvic exenteration

Purpose

We analysed the outcomes of a series of 100 consecutive patients with anorectal cancer with neoadjuvant radiochemotherapy and abdominoperineal exstirpation or total pelvic exenteration, who received a transpelvic vertical rectus abdominis myocutaneous (VRAM) flap for pelvic, vaginal and/or perineal reconstruction and compare a cohort to patients without VRAM flaps.

Methods

Within a 10-year period (2003–2013) in our institution 924 patients with rectal cancer stage y0 to y IV were surgically treated. Data of those 100 consecutive patients who received a transpelvic VRAM flap were collected and compared to patients without flaps.

Results

In 100 consecutive patients with transpelvic VRAM flaps, major donor site complications occurred in 6 %, VRAM-specific perineal wound complications were observed in 11 % of the patients and overall 30-day mortality was 2 %.

Conclusions

The VRAM flap is a reliable and safe method for pelvic reconstruction in patients with advanced disease requiring pelvic exenteration and irradiation, with a relatively low rate of donor and recipient site complications. In this first study, to compare a large number of patients with VRAM flap reconstruction to patients without pelvic VRAM flap reconstruction, a clear advantage of simultaneous pelvic reconstruction is demonstrated.     

Coexistence of sporadic multiple endocrine neoplasia and scapular ectopic breast. Coincidence or biologically associated?

We describe a patient who presented with sporadic pheochromocytoma and parathyroid adenoma in the absence of medullary thyroid carcinoma, which coexisted with fully developed scapular ectopic breast tissue. If not coincidental, this association might support the concept that all components of multiple endocrine neoplasia type IIA originate from embryonic ectodermal tissue, and that sporadic multiple endocrine neoplasia type IIA, as well as ectopic breast tissue, may result from a noxious event at a critical embryonic stage.