肩胛皮瓣再造阴茎

目的：探索一种新的阴茎再造手术方式。方法：应用肩胛皮瓣游离移植和银丝棒硅胶阴茎假体置入行阴茎再造。结果：自2000年3月起，已在临床应用6例，术后皮瓣全部成活。经随访6－12个月，阴茎形态和功能良好，结论：此手术方法设计合理，术后形态功能良好，供区无明显继发畸形，是一种较好的阴茎再造方法。     

脐旁皮瓣联合肋缘软骨瓣转移一期阴茎再造的解剖基础

先天性或后天性阴茎缺损，都需要行阴茎再造术。临床上阴茎再造主要包括阴茎体、支撑体和尿道形成。早在１９３６年Ｂｏｒｇｏｒａｓ采用腹部皮管和肋软骨移植再造阴茎。１９７７年Ｈｏｌ－ｓｏｎ首创股薄肌肌皮瓣一次再造阴茎。以后国内外学者采用各种皮瓣方法带蒂转移或游离移植行阴茎再造［１，２］。阴茎支撑体多采用自体肋软骨、骨块植入或代用品植入等方法。由于游离骨或软骨缺乏血运，存在吸收变形问题；硅胶及塑料代用品，不能融为一体，易出现疼痛，异物反应及感染等问题。我们在上述基础上进行了术式改进，设计以脐旁皮瓣联合肋缘…     

理想的阴茎再造新方法——肩胛皮瓣阴茎再造术

目的　为了满足阴茎再造的理想要求 ,探索一种全新的手术方式。方法　应用肩胛皮瓣游离移植和硅胶—银丝棒阴茎假体植入行阴茎再造 6例。结果　 6例皮瓣全部成活 ,术后随访 6～ 12月 ,阴茎形态和功能良好 ,获得了良好的手术效果。结论　此方法设计合理、术后形态功能良好、供区无明显继发畸形 ,是阴茎再造的理想新方法 ,值得推广应用。     

髂腹股沟骨皮瓣在阴茎再造中的临床应用

目的为了解决阴茎再造术后游离移植骨吸收和外露的问题.方法以髂骨由旋髂浅血管供血为解剖学基础,设计髂腹骨沟骨皮瓣.结果 5例患者的手术效果良好,随访时间最长10年,无一例明显骨吸收及外露.结论阴茎再造的方法很多,而髂腹股沟骨皮瓣应用于阴茎再造,很好地解决了游离移植骨的吸收和外露的问题.     

前臂游离皮瓣移植阴茎再造1例护理

某男，34岁，2002年4月被11万伏高压电击伤右上肢、会阴部、双下肢，伤后转入我科，经行阴茎大部分及左侧阴囊、睾丸切除术并将阴茎残体腹部皮下埋置、右下肢截肢术、并行膀胱造瘘术等多次手术，术后创面愈合良好，带尿管出院，2003年1月17日，因阴茎缺如而收住。     

髂腹股沟骨皮瓣在阴茎再造中的临床应用

目的 为了解决阴茎再造术后游离移植骨吸收和外露的问题。方法 以髂骨由旋髂浅血管供血为解剖学基础。设计髂腹骨沟骨皮瓣。结果 5例患者的手术效果良好，随访时间最长10年，无一例明显骨吸收及外露。结论 阴茎再造的方法很多，而髂腹股沟骨皮瓣应用于阴茎再造，很好地解决了游离移植骨的吸收和外露的问题。     

应用肩胛皮瓣游离移植阴茎再造术的护理

应用肩胛皮瓣游离移植阴茎再造术 6例 ,其中 2例皮瓣在术后 72小时内出现血管危象 ,经及时手术探查 ,解除了血管危象 ,实践证明 ,我们一系的护理措施及密切观察是手术成功必不可少的因素。     

下腹部轴型皮瓣在阴茎延长术的应用

目的：较好的覆盖阴茎延长术后的继发创面,方法：在16例患者中,利用以腹壁浅动脉为蒂的轴型皮瓣,旋转覆盖阴茎延长术后的耻骨上区继发创面。结果：16例全部成活,随访3个-2上,皮瓣回缩少,延长效果好,结论：此皮瓣特别适用于耻骨上区较大创面及有瘢痕患者。     

阴股沟皮下蒂皮瓣Ⅰ期阴道成形术

目的探索阴道再造的理想方法。方法自1989年以来,我们设计了阴股沟皮下蒂皮瓣Ⅰ期阴道成形术。结果用于70例,皆获成功,效果满意。结论阴股沟皮瓣阴道成形术创伤小,操作简单,供区隐蔽,能保持外阴的正常形态,再造阴道具有感觉,以及足够的深度和宽敞度。本术式已趋成熟定型,易于推广,是一种较为理想的阴道再造方法。     

耳后延迟皮瓣自体肋软骨支架法外耳再造术

目的 探讨耳后延迟皮瓣自体肋软骨支架法外耳再造术的临床效果.方法 手术分3期进行：Ⅰ期为耳后皮瓣延迟术,术后3周左右进行Ⅱ期手术;Ⅱ期为自体肋软骨支架再造、延迟皮瓣覆盖及自体中厚皮片移植外耳再造术,术后半年据情进行Ⅲ期手术;Ⅲ期行耳屏再造、耳甲腔加深和再造耳局部修整术等.结果 对先天性小耳畸形28例,31只耳,分次完成Ⅰ～Ⅲ期手术23只耳,余8只耳只完成Ⅰ、Ⅱ期手术.术后外耳位置、大小及形态良好,并发症少,患者及家属基本满意.结论 应用皮瓣延迟术不但可获取足够面积富有血运保障的菲薄皮瓣,而且方法简单、安全,所需时间短.耳后延迟皮瓣自体肋软骨支架法外耳再造术,是一种良好的外耳再造术方法.     

The free fascio-peritoneal flap: an anatomical study

The blood supply of the periumbilical posterior rectus fascia and peritoneum was studied in 60 hemiabdomens on 30 fresh human cadavers. An umbilical peritoneal vascular pedicle deriving from the deep inferior epigastric artery was present in 95% of the specimens with a mean length of 6.5 cm and 15 cm including the deep inferior epigastric artery pedicle. The mean pedicle diameter was 1.5 mm (artery) or 2 mm (veins). The surface of the free fascio-peritoneal flap measures on average 15×8 cm. This thin flap is a good alternative for fascial coverage of exposed tendons and intraoral reconstruction, and if necessary the rectus abdominis muscle and a skin paddle can be included as a composite flap.     

额部阶梯状皮瓣与肌、皮双瓣鼻再造术

目的　改良目前常用的额肌皮瓣鼻再造术 ,克服其形态臃肿 ,再造鼻高度受限等不足 ,进一步提高手术效果。方法　根据新观察到的滑车上动脉于眉上存在一相同走向的皮支的解剖特点 ,设计额部阶梯状皮瓣与肌、皮双瓣 ,前者用于克服肌皮瓣臃肿 ,再造鼻形态欠佳的缺点 ,一次成形鼻各组成结构。后者组成结构肌瓣用于构建鼻中隔结构 ,适用于复杂病例 ,并可增加再造鼻高度。结果　 9例患者术中均可见滑车上动脉于眶缘上 1 2～ 1 7cm开始有皮支行于皮下 ,且与对侧有交通支。术后皮瓣全部成活 ,其中 1例鼻小柱右侧支架外露 ,经二次手术修复痊愈。鼻各组成结构塑形良好。结论　额部阶梯状肌皮瓣和肌、皮双瓣适用于修复不同程度的鼻缺损 ,再造鼻形态较好 ,可为鼻再造的首选方法。     

Beard reconstruction using hair grafts in a free flap

Hair transplantation using micrografts or minigrafts is a standard procedure used for hair restoration in androgenic, burn scar and cicatricial alopecia. These grafts have also been used to reconstruct the eyebrow, eyelash, mustache, beard and pubic escutcheon. A patient who underwent successful micrograft and minigraft hair transplantation into a free osteocutaneous mandibular flap reconstruction is presented. The patient was very satisfied with his reconstruction, and the hair transplants provided excellent camouflage for the flap.     

Roux-en-Y reconstruction using staplers during pancreaticoduodenectomy: Results of a prospective preliminary study

Purpose  The aim of this study was to reveal the utility of alimentary reconstruction using staplers during pancreaticoduodenectomy (PD), focusing on the occurrence of delayed gastric emptying. Methods  Between 2003 and 2007, 72 PDs with alimentary reconstruction were performed by a single surgeon. Since August 2006, the new Roux-en-Y reconstruction methods using staplers were applied in 26 of the patients. We compared their clinical outcomes with those of the 46 patients who underwent PD using the conventional hand-sewn reconstruction methods. Results  The results of upper gastrointestinal study showed improvement within 10 postoperative days (PODs; P = 0.03): the patients resumed eating their regular diet sooner (13 vs 6 days, P < 0.001), and both the incidence of delayed gastric emptying (43% vs 19%, P = 0.04) and the hospital stay (27 vs 21 days, P = 0.008) were reduced significantly in patients with stapled reconstruction. Despite the fact that operative costs were significantly higher for patients with stapled reconstruction (P = 0.009), hospital costs were significantly lower (P = 0.049) for those who underwent the conventional method. Conclusions  Our retrospective analysis shows that stapled reconstructions might reduce the incidence of delayed gastric emptying; however, further study will be necessary to evaluate the utility of this new method.