端侧吻合神经恢复皮神经营养动脉逆行皮瓣感觉修复足跟软组织缺损

目的端侧吻合皮神经恢复皮神经营养动脉逆行皮瓣感觉修复足跟软组织缺损.方法对5例足跟部软组织缺损用皮神经营养动脉逆行皮瓣移植修复,应用神经端侧吻合技术恢复皮瓣感觉功能.结果5例均获成功,皮瓣感觉恢复良好.结论应用神经端侧吻合技术可恢复皮瓣感觉功能.     

端侧吻合神经恢复皮神经营养动脉逆行皮瓣感觉修复足跟软组织缺损

目的　端侧吻合皮神经恢复皮神经营养动脉逆行皮瓣感觉修复足跟软组织缺损。方法　对 5例足跟部软组织缺损用皮神经营养动脉逆行皮瓣移植修复 ,应用神经端侧吻合技术恢复皮瓣感觉功能。结果　 5例均获成功 ,皮瓣感觉恢复良好。结论　应用神经端侧吻合技术可恢复皮瓣感觉功能。     

第一掌骨背动脉桡侧皮支蒂桡神经浅支皮瓣的临床应用

目的 介绍应用第一掌骨背动脉桡侧皮支蒂桡神经浅支皮瓣修复拇指软组织缺损的体会.方法 2006年6月至2009年8月,对9例拇指桡侧软组织缺损患者,应用以第一掌骨背动脉桡侧皮支为轴心血管并携带桡神经浅支皮瓣进行修复,切取面积4.0 cm×2.0cm～7.0 cm× 3.5 cm.结果 术后9例皮瓣全部存活,6例获得随访,3例失访,随访时间为11～34个月.皮瓣质地良好,感觉恢复至S2～S3+,供区植皮愈合良好,轻度色素沉着,无痛性神经瘤发生.结论 第一掌骨背动脉桡侧皮支蒂桡神经浅支皮瓣血供可靠,成活率高,方法简单,可修复拇指全指腹缺损,是修复拇指软组织缺损的方法之一.     

端侧吻合神经恢复皮神经营养动脉逆行皮瓣感觉修复足跟软组织缺损

目的：端侧吻合皮神经恢复皮神经营养动脉逆行皮瓣感觉修复足跟软组织缺损。方法：对5例足跟部软组织缺损用皮神经营养动脉逆行皮瓣移植修复,应用神经端侧吻合技术恢复皮瓣感觉。结果：5例均获成功,皮瓣感觉恢复良好。结论：应用神经端侧吻合技术可恢复皮瓣感觉功能。     

前臂外侧皮神经移植加移位修复桡神经损伤

目的 探讨前臂外侧皮神经移植加移位修复前臂上段肘关节平面桡神经损伤的临床疗效.方法 采用前臂外侧皮神经移植加移位修复桡神经损伤患者11例,男9例,女2例,年龄20 ～ 52岁,平均34.5岁.受伤原因:电锯伤7例,磨具伤2例,挫裂伤2例.受伤部位:前臂上段肘关节附近,桡神经深、浅分支处,深、浅支均断裂伴缺损.急诊行神经修复术,术中将前臂外侧皮神经切断,近端神经移位与桡神经浅支远端吻合,远端作为供体切取神经段,游离移植桥接桡神经深支的缺损. 结果 11例患者术后随访12 ～24个月,桡神经浅支感觉功能恢复时间为4～9个月,平均5.4个月,其中5个月开始恢复功能9例,9个月开始恢复功能2例,虎口区两点辨别觉3 ～6 mm,平均4.5 mm.桡神经深支功能恢复平均时间7.6个月,6个月开始恢复4例,7个月开始恢复2例,8个月开始恢复5例.有9例肌力恢复至五级,平均时间19个月. 结论 前臂外侧皮神经移植加移位修复桡神经损伤应用同一神经既恢复了运动功能,又恢复了手虎口区感觉功能,为临床提供了一种修复桡神经损伤的新方法.     

腓肠神经移植修复桡神经深支缺损的疗效分析

目的 探讨腓肠神经移植修复桡神经深支缺损的手术技巧及临床疗效. 方法 2002年5月至2011年6月,对26例陈旧性桡神经深支损伤患者二期修复,行腓肠神经移植术.神经缺损长度为1.2～5.5 cm.缺损在其近侧、不涉及分支者,根据其粗细将切取神经裁为2～3段并固定在一起,将几股神经的两端0.5～0.8cm相邻外膜切除后,再把两端保留的相邻外膜缝合,形成一个共同外膜,移植于缺损处；缺损涉及分支者,则将几股神经近端外膜修整缝合后与损伤神经近端缝合,远端几股分别与分支吻合. 结果 术后创口均一期愈合.26例患者均获随访,随访时间14～ 39个月,平均24.5个月.末次随访时,2例完全恢复,拇长伸肌肌力5级；20例大部分恢复,拇长伸肌肌力4级；3例部分恢复,拇长伸肌肌力3级；1例疗效较差,拇长伸肌肌力2级. 结论 应用腓肠神经移植二期修复桡神经深支缺损,可取得较好的临床疗效.     

神经吻合感觉重建在皮瓣修复手掌皮肤缺损中的应用

目的探讨采用神经端侧吻合感觉重建在足背动脉岛状游离皮瓣修复手掌部大面积皮肤缺损中应用的临床效果。方法采用足背动脉岛状皮瓣游离移植修复手掌部大面积皮肤缺损4例,术中将隐神经前支和足背中间皮神经与桡神经浅支和尺神经行端侧吻合,术后根据皮瓣感觉恢复的情况进行评价。结果本组全部获得随访,时间7个月～5年,平均13.1个月。术后皮瓣完全成活,皮瓣部位两点辨别觉在5～10 mm。结论神经端侧吻合可重建皮瓣的感觉功能,吻合后侧支发芽支配与供体神经无关的皮肤,对被吻合神经的功能无影响。神经端侧吻合操作简单,疗效好,具有广阔的临床应用价值。     

双皮神经吻合局部带蒂皮瓣修复拇指缺损

[目的]介绍同侧双皮神经吻合带蒂皮瓣修复拇指软组织缺损的手术技巧和初步临床效果。[方法] 2018年5月—2020年6月,对20例拇指指端或掌侧软组织缺损采用携带前臂外侧皮神经与桡神经浅支终末支的桡侧神经血管蒂皮瓣进行修复。清创后依据组织缺损大小与部位设计皮瓣。先切开皮瓣近侧缘,显露桡神经浅支终末支和前臂外侧皮神经,皮瓣携带2条皮神经,并保留轴线两侧宽约1.0 cm皮下筋膜组织的血管蒂。将皮瓣通过开放隧道转位覆盖远端创面,在显微镜下将皮瓣携带的2条皮神经与指固有神经残端进行端-端吻合,皮瓣供区直接缝合。[结果] 20例患者块皮瓣全部成活。随访时间（12.20±1.70）个月。末次随访时拇指外形美观,桡侧供区仅残留线性瘢痕。皮瓣静态两点辨别觉为4～8 mm,平均（6.25±0.91） mm。[结论]相对于单一皮神经吻合带蒂皮瓣,双皮神经吻合的带蒂皮瓣修复拇指缺损技术可行,感觉恢复可能更好。     

腓肠神经移植修复桡神经深支损伤

目的 报道不同长度腓肠神经移植修复桡神经深支缺损的临床疗效。方法伤后3个月内的桡神经深支缺损2l例，缺损1～2cm者6例，2～5cm者12例，5～8cm者3例。采用相应长度腓肠神经移植修复。结果随访6个月至10年，平均13个月，21例桡神经深支功能均恢复较好，肌力均在Ⅳ～Ⅴ级。结论小于8cm长度的桡神经深支缺损，神经移植修复效果较满意。     

带神经的邻指皮瓣修复示中环指指腹缺损

目的 介绍一种修复示、中、环指指腹缺损的方法。方法 运用带有尺侧指固有神经背侧支的邻指皮瓣,修复示、中、环指指腹缺损,并将所带神经吻合于桡侧指固有神经残端。术后待皮瓣断蒂后测量并随访其疗效。结果 皮瓣全部成活,外观良好,患者自觉满意。随访并测量两点辨别觉桡侧达5～7mm,尺侧达8～10mm。结论 对于示、中、环指指腹缺损,修复其创面,恢复其感觉功能,尤其是桡侧的皮肤感觉功能比较重要。此方法操作简单、成活率高,值得推广。     

Patency of radial arteries reconstructed after radial forearm flap harvest

Poor patency is cited as a reason to not perform radial artery reconstruction after the harvest of the radial forearm flap. The need for a long vein graft and the presence of a patent ulnar artery are offered as explanations for thrombosis of the reconstruction in this setting. Similar arguments have been made regarding radial artery reconstruction in the trauma setting. In this study, the patency rate for patients undergoing radial forearm flap harvest with immediate reconstruction with reversed interposition vein grafting was evaluated. The mean follow-up time was 24 months, and all seven patients had patent reconstructions. Ultrasound examination revealed slightly larger diameters of the vein grafts compared with native arteries. No areas of stenosis were detected. No complications resulted from harvest of the vein. From these data, we conclude that radial artery reconstruction can be performed with the expectation of patency.     

Delayed dislocation of radial head following upper radial epiphysial injury

Injury to the upper radial epiphysis is mainly a radiological diagnosis. Delayed dislocation of the radial head following such injuries, where there is no evidence of primary subluxation or dislocation, has not been recorded in the literature. We have identified three such cases that needed open reduction. As long term results of delayed treatment of dislocation of any joint is not good, we advocate the awareness of this complication and also a longer period of routine follow-up (up to a year) of all upper radial epiphysial injuries, to avoid a catastrophe in an entirely preventable situation.     

Management of radial dysplasia

An appreciation of the clinicopathologic presentation of children with radial dysplasia (radial club hand) is important. Management decisions depend upon the degree of radial ray defect present; in most cases these are surgical. Current surgical options favor centralization without resection of carpal bones, stabilized by tendon transfers. When the thumb ray is deficient, pollicization is a rewarding procedure.     

Reconstruction of radial polydactyly

The spectrum that encompasses radial polydactyly can be categorized by the Wassel classification. Reconstruction of radial polydactyly depends on the size and quality of each of the thumbs. Most commonly, the ulnar thumb is larger and is maintained, whereas the smaller radial thumb is excised. In a Wassel type 4, after the redundant thumb is excised, the remaining thumb is centralized and aligned, and the radial collateral ligament of the maintained thumb is reconstructed. Other types of radial polydactyly are more complicated and require more complex reconstructions.     

A comparison of one-stage radial keratotomy with two-stage radial keratotomy in myopia

To determine the efficacy of one-stage compared with two-stage radial keratotomy, a study was designed to compare both eyes of the same patient with moderate myopia; one eye was operated in one stage and the fellow eye in two stages. The surgical technique was identical in all four procedures of the two patients. Although the case for greater effectiveness with one-stage radial keratotomy cannot be proven on the basis of only a few cases, one-stage surgery appears to be more effective and more predictable.     

The radial artery forearm flap: an anomaly of the radial artery

The radial forearm flap derives its blood supply from the radial artery. Anatomical variations of this vessel are uncommon. This report describes an anomaly which has relevance for the radial forearm flap.