动脉跨区供血的头皮瓣一期修复肿瘤切除与创伤后的大面积头皮缺损

目的探讨大面积头皮缺损的一期修复方法。方法应用颞浅动脉跨区供血的头皮瓣、眶上动脉-枕动脉双蒂跨区供血的头皮瓣,修复伴有颅骨缺失的大面积头皮缺损5例。结果5例动脉跨区供血的头皮瓣全部成活,创面均一期修复,效果满意。结论应用单支或双支头皮动脉跨区供血的大型头皮瓣,可以安全地一期修复大面积头皮缺损。     

鬓角区瘢痕性秃发修复方法的探讨

目的探讨鬓角区瘢痕性秃发的修复方法及其效果。方法萎缩性瘢痕采用分次切除4例;分次切除加额颞顶有发头皮瓣旋转推进3例;带颞浅动脉头皮岛状瓣转移1例;微小头皮片毛发移植3例,其中同期以耳轮缺损缘为蒂耳后乳突区皮瓣修复耳轮大部缺损1例;头皮预扩张鬓角重建4例。结果除瘢痕分次切除额鬓角发际线不整1例外,14例效果满意。结论根据鬓角区瘢痕部位、形状大小、邻接有发头皮残存状况、患者意愿及经济能力等因素选择修复方法。面积小于3.0 cm×2.5 cm的宜采用分次切除或毛发移植;大部分或完全缺失者,用头皮扩张术可获得较理想的鬓角重建。     

动脉经吻合支跨区供血的反流轴型皮瓣与常规轴型皮瓣的比较--22年临床回顾性分析

目的对动脉经吻合支跨区供血的反流轴型皮瓣的安全性及其转归进行回顾性评价。方法随机选择160例近22年来应用较广的5种动脉跨区供血反流轴型皮瓣,即:颞浅血管为蒂的乳突区皮瓣、眶上血管为蒂的岛状耳廓复合组织瓣、颏下动脉蒂的对侧颏颈皮瓣、颈横动脉供血的项肩背皮瓣、会阴动脉供血的股内侧皮瓣,考查其完全成活率、部分成活率、完全坏死率、动脉缺血发生率、动脉缺血致皮瓣坏死率、静脉淤血发生率、静脉淤血致皮瓣坏死率等指标,并与我院同期内应用的常规顺流轴型皮瓣随机样本120例进行比较。结果反流轴型皮瓣与常规顺流轴型皮瓣的完全成活率、部分成活率、完全坏死率、动脉缺血发生率相近似。反流轴型皮瓣的静脉淤血发生率高于顺流轴型皮瓣(P<0.01),但静脉淤血致皮瓣坏死率却显著低于顺流轴型皮瓣(P<0.05)。结论①反流轴型皮瓣与常规轴型皮瓣比较,其总的成活率无显著性差异。这5种反流轴型皮瓣是安全可靠的,可以作为常规皮瓣在临床上应用。②反流轴型皮瓣虽易发生早期静脉淤血现象,但只要手术设计、术中操作、术后护理得当,淤血及因此造成的皮瓣坏死是可以避免的。     

腹壁浅血管超灌注的腹壁轴型皮瓣即时重建癌根治术后的女阴(附病例报告)

目的探讨腹壁浅血管超灌注的腹壁轴型皮瓣应用于女阴恶性肿瘤广泛切除后即时重建的可能性。方法女阴癌行广泛全女阴切除和淋巴清扫后,根据女阴创面的大小和形状,设计以腹壁浅血管为轴的腹壁皮瓣。皮瓣的范围可超越腹壁浅血管的供血范围和跨越腹中线,以腹壁浅动脉起始部为旋转点向下转移修复全女阴创面,腹壁供瓣区作局部整形缝合加部分中厚植皮。结果临床应用2例,皮瓣100%成活,色泽形态及功能酷似正常。供区愈合良好。结论腹壁浅动脉超灌注的腹壁轴型皮瓣血运良好、成活率高、抗感染力强,可为全女阴的修复再造开辟一条新的途径。     

应用Limberg瓣再造耳垂

目的探讨Limberg瓣再造耳垂的新方法及效果。方法于耳下颈区,根据耳垂的缺损程度,邻接耳垂缺损残迹缘引平行线,设计Limberg瓣或近似矩形瓣(改进),其瓣长约为缺损边长的2倍,宽略大于耳垂缺损游离缘(弧形线),将Limberg瓣切取移位至耳垂缺损区,瓣远端部分向耳后相互折叠形成新的耳垂。若耳轮下部有缺损,附加上份耳轮向下滑行瓣修复切迹状缺损。结果再造耳垂5例5侧耳一期完成。Limberg瓣或矩形瓣移位无坏死,其中1例人咬伤耳垂缺损回植失败,延期12天,清创即期再造也获得成功。随访12～16个月,再造耳垂外形恢复满意。结论设计Limberg瓣或矩形瓣法再造耳垂,血供可靠,手术简便,损伤小,外形满意,供区瘢痕较隐蔽,是一期耳垂再造值得推崇应用的新方法。     

上睑眼轮匝肌岛状皮瓣修复眼睑及眶周皮肤肿瘤切除后继发缺损28例回顾性分析

目的总结分析上睑眼轮匝肌岛状皮瓣修复眶周皮肤肿瘤切除后继发缺损的效果。方法回顾性分析2019年8月至2021年6月杭州市第三人民医院皮肤科应用上睑眼轮匝肌岛状皮瓣修复眼睑及眶周皮肤缺损的28例患者的临床资料, 包括术后皮瓣成活情况以及上眼睑与眶周皮肤外观及肿瘤复发情况。结果 28例中, 男6例, 女22例;年龄47 ～ 87(70.5 ± 10.9)岁, 80 ～ 89岁患者7例, 70 ～ 79岁8例, 60 ～ 69岁8例, 50 ～ 59岁4例, 40 ～ 49岁1例;皮肤缺损分布在上眼睑1例、下眼睑9例、内眦1例、外眦3例、眉上1例、鼻背3例, 鼻部外侧与内眦、下睑交界区10例;缺损面积为1.0 cm × 0.5 cm ～ 3.1 cm × 2.3 cm。设计的上睑眼轮匝肌皮瓣宽0.5 ～ 1.8 cm, 长3 ～ 4 cm, 皮下隧道长1.2 ～ 2.5 cm。在6个月至1.5年的随访时间内, 皮瓣全部存活;上睑供瓣区瘢痕不明显;术后无上睑外翻, 无倒睫, 无闭合功能障碍。结论上睑眼轮匝肌岛状皮瓣可以成功修复眼睑及眶周皮肤中、小缺损, 并具有良好的美容效果, 供瓣区隐蔽。     

股前外侧皮瓣修复头面颈部畸形缺损:兼论皮瓣分型

目的总结应用股前外侧皮瓣修复头面颈部畸形缺损的经验,并深入探讨股前外侧皮瓣的血管分型。方法采用股前外侧皮瓣游离移植修复头面颈部烧伤及创伤性缺损、慢性溃疡、半面萎缩、肿瘤切除术后洞穿性缺损、增生性瘢痕及挛缩畸形等。结果58例股前外侧皮瓣的蒂血管中,45例来源于旋股外侧动脉降支,7例来源于旋股外侧动脉横支,其它血供来源包括旋股外侧动脉主干4例,股深动脉1例,股动脉1例。58例皮瓣全部成活,仅1例远端10%坏死,随访2～19年,外形和功能恢复满意。结论①股前外侧皮瓣可根据蒂血管来源和皮肤血供类型来表示其分型,即“血供来源─血供形式”分型法。②股前外侧皮瓣因其具有恒定而较长的血管蒂、易于解剖分离、能提供充足的组织量以及供区隐蔽等优点,对头面颈部畸形和缺损的修复有独特效果。     

趾腓侧皮瓣在前足微小创面修复中的应用

目的前足软组织缺损在临床修复中一直是一个重要的挑战。虽然很多作者提出了多种皮瓣,但是受区感觉和供区损伤的恢复都不是很满意。作者应用了趾腓侧皮瓣修复前足缺损可以同时解决这两个问题,是一种可行的方法。方法本研究分为两个部分:解剖研究和临床实施。在解剖研究中20具尸体40例足部明胶氧化铅灌注标本后,解剖出趾的血管走行。临床实施,我们应用趾腓侧皮瓣修复了43例不同的前足软组织缺损。结果解剖学研究显示趾腓侧皮瓣是第1趾动脉供血皮瓣内带有趾底固有神经,第1趾底动脉自第1趾蹼处起源于第1跖背动脉或第1跖底动脉。血管起源和走行恒定,蒂部有一定的可旋转范围。在实际临床中,所有皮瓣均成活,受区感觉恢复佳。结论趾腓侧动脉岛状皮瓣顺行转移修复前足微小面积皮肤缺损,皮瓣耐磨、有神经支配、解剖位置恒定,供区隐蔽,是修复足趾及前足跖底负重区微小面积皮肤缺损的好方法。     

眼轮匝肌蒂睑颞皮瓣修复眼睑缺损

目的探讨眼睑缺损的修复技术及其效果。方法在睑颞侧设计以眼轮匝肌为蒂的睑颞长型皮瓣,将皮瓣向内推进或旋转180°修复睑缺损区。结果用此法修复眼睑基底细胞癌、分裂痣和睑缺损8例,所有皮瓣100%成活,色泽、形态良好。结论眼轮匝肌为蒂可携带较长的局部岛状皮瓣,旋转转移方便,血供良好,色泽协调,是修复眼睑的良好选择。     

枕动脉跨区供血的反流轴型头皮瓣一次修复大面积复杂性头皮缺损

目的探讨一次手术完成复杂性大面积头皮缺损的修复方法。方法采用枕动脉跨区供血的反流轴型头皮瓣,修复8例复杂性大面积头皮缺损。结果8例头皮瓣均100%成活,一次完成修复,效果满意。结论枕动脉与头皮其它血管的吻合恒定,血运丰富。以枕动脉为供血源,跨区切取大面积的头皮瓣一次修复面积达1/3～1/2的头皮缺损,是一种安全可靠的有效方法。     

Birhombic flap,a modified bilobed flap,for repair of nasal defect

Background Reconstruction of longitudinal defects of the lateral nasal alar might be challenging. Reconstruction with a bilobed flap is common for round defects normally the bilobed flap is less suited for longitudinal defects. Objective We describe a birhombic flap for longitudinal defect. Methods Demonstration of the technique and practical application for this kind of reconstruction. Results The bilobed flap is a very useful flap for lateral nasal tip or distal alar reconstruction. We show that a small modification of the flap allows to cover also longitudinal defects on the lateral tip of the nose. As the first lobe movement corresponds more to the rhomboid transposition flap, we prefer to call it birhombic flap. Conclusion The birhombic flap has its place in reconstructive surgery. This flap has a specific indication and precise advantages to other repairs in particular to the bilobed flap.     

Rotation flap reconstruction for nasal tip defect after mohs surgery

BACKGROUND: Skin cancer of the nasal tip is frequent, and reconstruction after Mohs surgery might be challenging. The rotation flap is a very commonly used flap for reconstructions on the vertex and the extremities but rarely on the nose. In textbooks rotation flaps in nose reconstruction are rarely mentioned. OBJECTIVE: We present a rotation flap from the caudal tip and the columella of the nose for defects of the lateral tip of the nose. METHODS: With graphics and photographs of case studies we explain the mechanism of placement and movement of the flap. RESULTS: The rotation flap is useful for reconstructions of medium-size defects of the distal lateral nose tip. CONCLUSION: The rotation flap can be used in the reconstruction of laterally placed nasal tip defects. As this flap is not mentioned in textbooks for nasal tip reconstruction, its value for this localization is probably underestimated.     

The axial frontonasal flap for reconstruction of large nasal-tip defects based on modified nasal subunits in East Asians

The nasal tip is a prominent landmark on the face, and skin carcinomas of this area are very common. Moderate and large deep skin defects of the nasal tip normally represent a difficult reconstructive challenge. Nasal-tip reconstruction techniques have evolved to allow not only filling of the gap, but cosmetic and functional retention. Numerous flap options are available to reconstruct the defect of the tip of the nose. In this paper, we report the technique of the axial frontonasal flap and its use in reconstruction of large nasal-tip defects in East Asians. The axial frontonasal flap described is a good alternative for reconstruction of nasal-tip defects > 15 mm in diameter, with excellent aesthetic results. This technique is reliable, yields excellent functional and cosmetic results, and we believe that it is a valuable alternative to other techniques of reconstruction for defects of the nasal tip.     

Nevus sebaceus of Jadassohn revisited with reconstruction options

BACKGROUND: Nevus sebaceus of Jadassohn (NS) has the classic presentation on the head and neck of a yellow-orange-colored, waxy, pebble-like, papule or plaque. Its reported malignant potential varies between 0.8% and 50%. The common location of NS on the temporal hairline leaves a cosmetic defect. METHODS: We retrospectively reviewed a consecutive series of patients with NS located in the temporal scalp region. Thirteen patients were included. Twelve patients were reconstructed with a temporal flap. One patient had a primary linear scalp closure after excision. Clinical, histopathologic, surgical, and photographic records were used to review the clinical, anatomic, and pathologic presentation of the lesions. Reconstructions were rated on a scale of 1-5 by two independent examiners. The cosmetic results were also assessed by the patients. RESULTS: Patients ranged in age from 3 to 40 years. All of the lesions were located in the temporal area of the scalp. All cases were pathologically determined as NS. Two cases contained basal cell carcinoma (15%). Two cases were re-excisions of confirmed NS. One case was excised and closed with difficulty using a linear primary closure. Rotation flaps based on the superior temporal artery were used for the reconstruction of the defects in 12 patients. Nine of the flaps were anterior rotation flaps and three were posterior. The average score for the cosmetic results of the patients was 3.75, with the lowest score being 2, and the highest 5. The score for the linear closure was 2. CONCLUSION: A rotation flap based on the superficial temporal artery is an excellent reconstructive solution for NS located in the temporal scalp region.     

Aesthetic reconstruction of retroauricular keloid: Creating a keystone flap from the mastoid‐helix area

Advances in aesthetic rhinoplasty using conchal cartilage grafts have led to a high occurrence of retroauricular keloids. The purpose of this study is to introduce our surgical experiences using a keystone flap in retroauricular keloids following conchal cartilage grafts. The present study is a retrospective review of patients with pathologically confirmed retroauricular keloids following conchal cartilage grafts. These cases were surgically excised and we covered the defect with a keystone flap followed by one‐time steroid injection at postoperative day 14 and silicone gel sheeting application for 3 months. Treatment outcome was recorded as recurrence or non‐recurrence. In all patients, a follow‐up period of minimum 12 months was required. Of these patients, 90.0% had successful treatment of their auricular keloids, whereas 10.0% had recurrences. The postoperative course was uneventful. In conclusion, our aesthetic reconstruction using a keystone flap created from the mastoid‐helix area is a useful treatment strategy in terms of retroauricular keloids following conchal cartilage grafts.     

Colgajo crescéntico nasoyugal en la reconstrucción de defectos de punta nasal: una serie de 13 casos

Reconstruction of the tip of the nose following the excision of skin cancer is a cosmetic and surgical challenge. We propose using a crescentic nasojugal flap, also known as a perialar crescentic advancement flap, to repair such defects. We present a series of 13 cases in which cutaneous carcinoma (mostly basal cell carcinoma) was excised from the lateral nasal tip with clear margins and the defect repaired with a crescentic nasojugal flap. The technique was successful in all cases. None of the patients developed notable surgical complications and the postoperative outcomes were satisfactory, with no significant functional or cosmetic problems. The crescentic nasojugal flap is therefore a good option for repairing medium-sized defects on the tip of the nose.     

Using the Peng flap for a wide dorsal nasal defect

Reconstructions of large surgical defects of the central part of the nose pose a challenge for the surgeon due to its cosmetically prominent location. Treatment options include second intention healing, full‐thickness skin grafts and various local flaps. In the present case the “Peng flap” was used for the reconstruction of a 3.1 × 7 cm sized deep defect of the convex curve of the central nasal area in a 66‐year‐old woman. The Peng flap was performed as single‐stage procedure without complications. Good cosmetic outcome was provided by the use of adjacent skin from the lax perinasal area, the placement of the scar lines between facial cosmetic units, and the excellent tissue match for the sebaceous nasal skin. Considering the few complications of a single‐stage procedure associated with an excellent aesthetic outcome, the Peng flap should be considered not only as an effective choice for reconstruction of the cosmetically complex midline nasal tip but also the convex curve of the central nose.     

Silicone auricular prosthesis

Skin cancer surgery of the ear may result in a large defect of skin and cartilage requiring a staged flap procedure for reconstruction. An alternative to surgical reconstruction is the creation of a silicone auricular prosthesis. These prostheses provide a cost-effective and cosmetically acceptable means of camouflage for patients who decline or postpone surgical reconstruction. The process of creating a silicone auricular prosthesis is discussed.     

鼻唇沟皮瓣在口腔颌面肿瘤手术中的应用

目的探讨鼻唇沟皮瓣在口腔颌面肿瘤术后缺损修复中的应用。方法应用鼻唇沟皮瓣一期修复口腔颌面部肿瘤术后缺损21例,其中修复鼻部缺损13例,面中部皮肤组织缺损2例,口颊部缺损5例,下睑部缺损1例。结果21例皮瓣全部成活,面部供瓣区无明显继发畸形。结论鼻唇沟皮瓣血运丰富,转移灵活,对于修复口腔颌面部肿瘤术后所致的较小缺损不失为一个实用而有效的方法。