应用菱形皮瓣修复体表软组织缺损

目的为了寻找一种适用性较广的体表软组织缺损皮瓣修复手术方法。方法参照临床上多种相同几何原理的局部皮瓣，自行设计改进的菱形皮瓣，以修复各种形状的体表软组织缺损。结果临床用于２１９例２５４个创面，取得了满意的效果。结论本皮瓣设计合理、取材方便、操作简便、灵活易学、应用广泛，适应性强，是临床即时修复体表软组织缺损较好的方法之一     

Rate of elongation provided by multiple subcutaneous pedicle rhomboid flaps-an experimental study in the rat inguinal skin

PURPOSE: To investigate the rate of elongation provided by multiple subcutaneous pedicle rhomboid flaps. MATERIALS AND METHODS: Lower extremities of 20 male Sprague-Dawley rats were strained and fixed on a table to provide a tension line over the inguinal area. Two rhomboid shaped adjacent flaps with subcutaneous pedicles were designed over the tension line. Each flap was 1cm long and the distance between two flaps was 0.5 cm. The total pre-operative length was 2.5 cm. Flaps were incised and freed from the stretched skin. Tension line over the inguinal area was relieved by relaxation incisions. The resulting defects were then closed by suturing the rhomboid flaps in V-Y advancement along the tension line and in Y-V advancement along the relaxation incisions. The final elongation was measured and the results were analysed statistically. RESULTS: All relaxation incisions were effective in relief of tension over the inguinal area and in lengthening the tension line. Pre-operative 2.5 cm lengths ranged between 5.7 and 6.3 cm post-operatively (mean +/- standard deviation = 5.99 +/- 17 cm). The mean difference between pre- and post-operative measurements was 3.49 cm (139.6% gain in length). The subcutaneous pedicle rhomboid flaps easily closed all defects generated by relaxation and elongation. Statistical analysis revealed that two adjacent subcutaneous pedicle rhomboid flaps were efficient to close the defects generated by the relaxation incisions that produced a 139% gain in length (P < 0.001). CONCLUSION: The results of this experimental study show that multiple subcutaneous pedicle rhomboid flaps promise to be a good alternate technique in the treatment of long contracture bands in terms of rate of elongation and simplicity.     

皮下组织蒂的改良菱形皮瓣在面部皮肤缺损修复中的应用

目的介绍一种皮下组织蒂的改良菱形皮瓣及其在面部皮肤缺损中的应用和效果。方法于面部各种缺损的附近设计以皮下组织为蒂的改良菱形皮瓣,即在改良菱形皮瓣的尾部作“V”形切口,小范围剥离后行皮瓣无张力转移。皮瓣面积为1.5 cm×2.0 cm~4.0 cm×4.5 cm。结果本组16例患者,切口均Ⅰ期愈合,皮瓣全部成活。随访12例患者1.5个月至1.5年,面部形态满意,术区平整,无“猫耳朵”形成,切口瘢痕不明显。结论应用皮下组织蒂的改良菱形皮瓣修复面部皮肤缺损,方法简便易行,术后效果较好。     

改进菱形皮瓣修复头面部肿瘤切除术后皮肤缺损

目的 为了提高头面部皮肤肿瘤切除术后皮肤缺损创面的修复效果.方法 1994年～2002年根据Z字成形及几何学原理,应用改进菱形皮瓣转位修复头面部皮肤肿瘤切除术后形成的皮肤组织圆形缺损创面36例,其中有2个感染创面,创面缺损部位:头部8例、面部28例.皮肤圆形缺损创面直径1.5cm～3cm.造成皮肤创面缺损的原因有皮肤血管瘤、黑毛痣、皮肤鳞状上皮癌等病灶切除术后所致皮肤缺损.结果 34例伤口甲级愈合,外形美观,没有形成直线瘢痕;2例创面皮瓣远端中间部分1cm～2mm小范围皮肤干性坏死经换药后治愈,手术获得良好效果.皮肤鳞状上皮癌病人在伤口拆线后按常规进行放疗,皮瓣没有发生放射性损伤.结论 应用改进菱形皮瓣修复皮肤圆形组织缺损具有设计合理、灵活性强的优点,是头面部皮肤肿瘤切除术后创面皮肤缺损修复的一种良好方法.     

Lateral chest wall fasciocutaneous flaps in the management of burn contractures on the dorsum of the hand

Summary Post-burn contracture involving the dorsum of the hand with hyperextension and volar subluxation of the metacarpophalangeal joints of the fingers plus adduction contracture of the thumb is a crippling disability. Adequate release of such contractures leaves raw areas on the dorsum of the hand, forgers and in the first web space. Fasciocutaneous flaps from the contralateral chest wall (the lateral thoracic flap and the subaxillary flap) have been used in eight patients. The comfortable fixation position, the non-hairy nature of the flaps, the excellent vascularity and a concealed donor site, which can often be primarily closed, make these flaps attractive for the defects. Within a follow-up period of five to twelve months, all the patients returned to their previous vocation.     

Use of free dorsoulnar perforator flap in the treatment of postburn contractures of the fingers

BACKGROUND: Burns of the hand cause not only the impairment of hand function but also cosmetic deformity. Cases with dysfunctional hands with severe contractures increase if rehabilitation of the acutely burned hand is not done properly. PURPOSE: We present the use of free dorsoulnar perforator flap in the treatment of postburn contractures as an alternative when local flaps cannot be used. METHODS: Free dorsoulnar perforator flap was used in the treatment of seven hands with postburn contracture. Five of them had multiple digital postburn flexion contractures. Combined use of cross-finger and side finger transposition flaps was preferred when the adjacent finger was suitable for being cross-finger flap donor. When the adjacent finger was not suitable for being cross-finger flap donor, the free dorsoulnar perforator flap was preferred. Two of the patients had postburn web contractures. Free dorsoulnar perforator flap was used to release the web and to form a new web commissure. CONCLUSION: The free dorsoulnar perforator flap could be a good alternative to cover the defects created with the hand contracture release.     

Reconstruction of the face and neck scar contractures using staged transfer of expanded "Super-thin flaps"

BACKGROUND: The authors introduced the "Super-thin flap" concept, which is sometimes called the subdermal vascular network (SVN) flap, in 1994. Since 1994, we have reconstructed face and neck scar contractures using various types of "Super-thin flaps." In this report, we introduce expanded "Super-thin flaps" for reconstruction of the face and neck for the first time in a patient. METHODS: Since 2000 we have used 21 expanded flaps to reconstruct 21 face or neck scar cases in nine males and 12 females. In the first operation, an expander was inserted on the fascia of the pectoralis major muscle, and then about 1,000 cc of saline was injected during a 2-month period. In the second operation, the flap was thinned primarily and applied to the recipient site. Three weeks after the second operation, the pedicle of the flap was cut down and sutured. RESULTS: Flap size ranged from 4 cm x 14 cm to 10 cm x 22 cm. Expanded volume ranged from 800 cc to 1,200 cc. All flaps survived completely and scar tissues were replaced with normal skin. Flaps did not shrink after the operations, and contractures did not recur. CONCLUSION: Advantages of the expanded flaps are presented: (1) Large flaps can be harvested because of the expander; (2) Extremely thin flaps can be safely employed; (3) Texture and color match are good; (4) Donor site can be closed primarily; and (5) Microsurgery is not required. However, the disadvantage of the method is the requirement for two or three operations.     

Comparison of contraction rates of epigastric and extended dorsal island skin flaps in rats

Flap surgery is a wide field in plastic and reconstructive surgery practice and experimental research is needed to improve surgical success. These research is often performed on rats. Rat is a loose-skinned animal and contraction of skin flaps on rats is an underestimated condition. Besides this variable contraction of survived and necrotic tissues may mislead calculations and results. In this study, contraction patterns of epigastric and dorsal island skin flaps were investigated to identify this phenomenon. Forty-two male Sprague-Dawley rats were divided into four groups. Eleven epigastric flaps with unilateral pedicles, 11 epigastric flaps with bilateral pedicles, 10 extended dorsal island skin flaps with unilateral pedicles, and 10 extended dorsal island skin flaps with bilateral pedicles were prepared. Total, necrotic and viable flap areas were calculated from standardized photographs which were taken daily. The animals were placed on marked papers and image processing software was used the calculate flap areas from the photographs. Respect to these daily flap areas, the contraction rates in epigastric flaps were highly significant. The area loss in necrotic tissues were faster than the viable areas. Compared to the epigastric flaps, the contraction was not significant in extended dorsal island skin flaps flap groups. In conclusion, the rat extended dorsal island skin flap is a more reliable model for experimental flap research, which is resistant to contraction, when compared to the epigastric skin flap model.     

三种皮瓣修复足跟部恶性黑色素瘤术后缺损的疗效比较

目的比较逆行腓肠神经营养皮瓣、足底内侧皮瓣和胫后动脉逆行皮瓣修复足跟部恶性黑色素瘤切除后软组织缺损的疗效,分析各皮瓣优缺点。方法回顾分析2007年3月-2010年3月24例采用皮瓣修复恶性黑色素瘤切除后足跟部缺损患者的临床资料,其中12例采用范围为8 cm×7 cm～14 cm×12 cm的逆行腓肠神经营养皮瓣修复(A组),7例采用范围为6 cm×5 cm～8 cm×7 cm的足底内侧皮瓣修复(B组),5例采用范围为9 cm×7 cm～15 cm×13 cm的胫后动脉逆行皮瓣修复(C组)。3组患者性别、年龄、病程、临床分期、病变直径等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术中供区直接拉拢缝合或游离植皮修复。结果 3组手术时间及术中出血量比较,差异均无统计学意义(P>0.05)。术后皮瓣及植皮均顺利成活,创面均Ⅰ期愈合;供区植皮均成活,切口Ⅰ期愈合。所有患者均获随访,随访时间1～3年。皮瓣质地、颜色等均正常,无继发性溃疡发生。术后1年A、B、C组皮瓣感觉恢复率分别为0、100%、20%,差异有统计学意义(P=0.001)。患者足跟部外形基本正常,A组10例(83%),B组6例(86%),C组4例(80%)可不负重无痛行走,组间比较差异无统计学意义(χ2=40.000,P=0.135)。但负重行走时患足均伴不同程度疼痛,3组疼痛视觉模拟评分(VAS)比较差异均有统计学意义(P<0.05)。3组患侧踝关节活动度比较差异均无统计学意义(P>0.05)。A组1例术后1个月伤口周围肿瘤复发,其余患者均无复发。结论采用逆行腓肠神经营养皮瓣、足底内侧皮瓣和胫后动脉逆行皮瓣修复足跟部恶性黑色素瘤切除后软组织缺损,均可获得较好疗效,但对缺损范围较小者首选足底内侧皮瓣。     

扩张后胸三角皮瓣修复面颈部较大面积皮肤软组织缺损

目的：探讨应用扩张后胸三角皮瓣修复面颈部较大面积皮肤软组织缺损的效果。方法：自2006年以来,对我科收治的20例患者,其中17例面部瘢痕、2例颈部瘢痕和1例面部黑毛痣,在胸三角区置入300～400ml柱形扩张器,经3～5个月注水,注水后容量为500～1000ml获得足够的皮肤后,切除面颈部瘢痕,创面应用扩张后胸三角皮瓣转移修复,1月后断蒂,利用蒂部皮瓣修复剩余瘢痕切除后的创面。结果：共置入22个扩张器,除1例扩张器外露,1例出现感染终止扩张,18例（20个）扩张器顺利扩张。皮瓣转移后2例皮瓣远端发生少量坏死,经换药或植皮后创面愈合,其余16例（18个扩张器）转移的皮瓣全部成活,皮瓣色泽厚度质地接近正常部位,患者和家属均满意,取得了很好的修复效果。结论：对于面颈部瘢痕或体表病变手术后的较大面积皮肤软组织缺损,应用扩张后胸三角皮瓣修复是一种很好的方法。     

吻合血管的骨膜瓣和筋膜瓣联合移植治疗难治性骨不连

目的 探讨吻合血管的骨膜瓣和筋膜瓣联合移植治疗骨不连的疗效。方法 先预制家兔骨不连动物模型将54只随机分为三组，每组18只。A组单纯用带血管的骨膜瓣包绕骨折端；B组单纯用带血管的筋膜瓣同法处理；C组（实验组）两者联合应用。术后1、2、4、8周分别行大体观察、X线、组织学及碱性磷酸酶检查。并在实验研究的基础上临床应用63例。结果 C组愈合时间较A、B组早1－2周，且愈合率明显高于A、B两组，临床X线随访：2个月大量骨痂生长，3.5-4.5个月骨折线基本消失。结论 用吻合和管的骨膜瓣和筋膜瓣联合治疗难治性骨不连是一种有效的方法。     

不同类型皮瓣修复虎口挛缩

目的 探讨治疗手部虎口挛缩的理想方法。方法 自1994年3月－2002年2月，对收治的96例因各种原因引起的手中虎口挛缩患，根据皮肤，皮下组织，肌腱，骨骼具体伤情，分别施行不同的皮瓣修复及功能重建术，术后随访并比较各自功能恢复情况。结果 91例获满意松解，皮瓣外形及虎口功能良好，治愈率灰94．8％；另5例因第一腕掌关节严重毁损，虎口外形修复，但功能欠佳。结论 针对不同程度的虎口挛缩，采用不同皮瓣修复及肌，骨骼动力重建，是治疗虎口挛缩的有效措施。     

Effects of ozone gas on skin flaps viability in rats: an experimental study

Background: The main purpose of this study was to assess the effects of ozone gas on the viability of flaps for reconstruction and to determine the optimum application method. The antioxidant, immunomodulatory, and reperfusion effects of ozone gas have been previously assessed, and successful results have been reported. However, only one study has investigated the effect of ozone gas on flap viability. In the present study, it was hypothesised that the antioxidant and reperfusion effects of ozone gas would enhance flap viability.

Methods: Forty female Wistar rats were randomly divided into four groups of 10 rats each. A cranial-based, 3?×?11?cm modified McFarlane flap including the panniculus carnosus was raised from the dorsum of a rat and re-sutured to its own bed using 3/0 sharp propylene. Group 1 (n?=?10): no pharmacological agent was used after the operation. Group 2 (n?=?10): vegetable (olive) oil group; vegetable-oil-impregnated gauze was used as a dressing for 7 days. Group 3 (n?=?10): Vegetable (olive) oil with ozone peroxide group; vegetable oil with ozone peroxide-impregnated gauze was used as a dressing for 7 days. Group 4 (n?=?10): Hemo-ozone therapy group; hemo-ozone therapy was applied rectally once every day for 7 days. All rats were sacrificed at the end of week 1 and assessed macroscopically and histopathologically.

Results: The proportion of substantive necrosis was less in group 4 than in the other three groups. Survival area ratios were better in groups 2 and 3 than in group 1; however, there was no significant difference between groups 2 and 3. No significant differences in the histopathological scores were observed among the groups.

Conclusion: Ozone gas enhanced flap viability. No differences in flap viability were observed between the vegetable oil and vegetable oil with ozone peroxide groups. The greatest benefit ratios were found in the hemo-ozone therapy group.     

Comparison of normal and venous flaps. An experimental study]

The abdominal skin of 135 rats was fashioned to be normal on venous flap for investigating the difference in quality of the two. For normal flap, the right superficial epigastric artery was used to serve as the nourishing vessel and the left superficial epigastric vein the draining one. For venous flap, the right superficial epigastric vein was made to be the nourishing vessel and the left superficial epigastric vein the draining one. The flap in group I was fed with blood from the distal end of the femoral vein; the flap in group II was supplied with blood from the distal end of the femoral artery; and the flap in group III was nourished with blood from the femoral artery. It demonstrated that the venous flaps in group I were better in quality than the normal flaps in terms of survival rate, elasticity and size of ulcer. However, the results in group II and group III were quite different. As for clinical use, it would be all right to cover small wound with venous flap; while repairing large defect, particularly in exposed part or area near a joint, normal flap should be of the choice.     

虎口挛缩的皮瓣修复

目的 介绍虎口挛缩的皮瓣修复体会.方法 回顾1985年以来诊治的112例116个虎口挛缩病例,就其皮瓣修复的手术适应证及预后进行总结分析.结果 术后116个皮瓣完全成活112个,有4例前臂骨间后动脉逆行岛状皮瓣尖端有3.0 cm×1.5 cm表皮坏死,经换药后愈合.有16例皮瓣在术后3～6个月再次行皮瓣整形术.术后随访1～24个月,平均4.5个月.虎口饱满,外形满意,皮色正常,无继发挛缩;拇指对掌、内收、外展功能均近于正常.移位皮瓣在术后3个月开始恢复感觉功能.结论 恰当的皮瓣移植修复可以保证虎口的外形及功能的恢复.     

鼻烟窝皮瓣修复中重度虎口挛缩

虎口是特殊的指蹼，在拇指外展、对掌活动中起重要作用，虎口因各种原因引起挛缩，严重影响拇指的功能，而拇指在手的功能中有非常重要的位置，是完成手指捏合握物所必不可少的，因此，虎口挛缩必须修复。2000年1月-2004年12月，我们应用鼻烟窝皮瓣修复中重度虎口挛缩患者12例，经临床观察，效果满意，报告如下。     

Use of the superficial temporal artery island flap for facial and upper lip reconstruction

The posterior superficial temporal artery hairbearing island flap was successfully employed in 3 cases who had partial loss of beard and moustache as a result of burns to their cheek, oral commissure and upper lip regions. Follow-up at 3 months showed excellent beard and moustache growth in all cases, and the facial appearance was satisfactory.     

Enterocutaneous fistulae — report of three patients successfully treated by “turnover” flaps from surrounding tissue, reinforced by musculocutaneous flaps and other local flaps: a new method

This is a report of a new method used to successfully repair three cases of enterocutaneous fistula. This consisted of debridement of the unhealthy excoriated skin surrounding the fistulous opening. A turnover flap from neighboring tissue was used to cover the fistula and form a lining. The resultant raw area was reinforced by transposition of highly vascularized skin in the form of musculocutaneous flaps or local transposition flaps. Intraperitoneal surgery in a metabolically compromised, sick patient was avoided. This operation is indicated where there is no distal obstruction, no disease infiltrating the wall of the fistula, and there is mucocutaneous continuity at the margin of the fistula.