CROSS-BRIDGE TRANSPLANTATION OF FREE LATISSIMUS DORSI SKIN FLAP IN ONE CASE

Extensive skin and soft tissue defect accom- panied by damage and/or absence of blood vessels in the local and adja.cent regioins is a formidable problem which often cannot be effectively solved by conventional means as skin tube transfer,, crossed skin flap or free skin grafting. An original operative procedure des;igned by our group and applied successfully to repair a Inassive left leg defect with extensive scarring measuring 30xi25 cm and extending deep into the periosteum is presented in this paper. The left anterior tibial vessels and great saphenous vein were also ba.dly damaged. A free latissimus dorsi skin flap is excised and transplanted onto th.ei defect, while the right leg is flexed so the ankle crosses over and lies just behind the upper end of the left leg forming a 600 angle betweeaa the 2 legs A pedicle skin flap is mobilized from the right ankle region and sutured to the le.ft leg wound ma.rgin to form the "floor" of the skin bridge. The right anteriorr tibial artery and its continuation, the dorsal pedal artery, the continuation of the great saphenous vein, and the dorsal pedal vein were mobilized and severed. They ar'e anastomosed end-to-end respectively with the thoracodorsal artery and vein of the free latissimus dorsi skin flape Finally, the free latissimus dorsi skin flap is sutured to the right ankle skin incision edge to form the "surface" of the skin bridge. The vascular pedicle of the free latissimus dorsi skin flap is made to span the crossed legs, serving as a skin bridge through which flows the t.em- porary blood, supply to the free skin flap. After vascular training to promote new circulation formation, t.he skin bridge is severed 6 weeks postoperatively. The free skin flap survives The succes^s of this procedure makes pos- sible the plastic reconstructive repair in pa- tients with large area skin and compound tissue defects, broa.dening the range of reconstructive surgery and the operative indicat.ions for large area skin and compound tissue loss.     

游离断层皮片移植再造鼻泪管

目的：探讨一种采取自体组织行泪道再造的手术方法，用以治疗泪道阻塞、鼻泪管断裂所造成的泪道不通。方法：采用游离皮片移植———内嵌管状植皮手术的方法重建泪道（１５例）。１５例均是因外伤后鼻泪管损伤，经其它鼻泪管再通手术失败。结果：１３例术后鼻泪管通畅好，达到完全治愈的目的；２例因支撑管硬膜外管提前脱出，需第二次手术。结论：此手术效果可靠，适用于各种原因造成的鼻泪道阻塞的再通。     

带血管蒂皮瓣、肌皮瓣转位修复软组织缺损

用各部位带血管蒂皮瓣、肌皮辦转位一期修复多种原因造成的软组织缺损20例,手术简便,术后功能及外形亦比较满意。讨论了带血管蒂皮瓣、肌皮瓣的优点、应用选择、适应证和经验教训。     

ECONSTRUCTION OF FINGER FLEXION FUNCTION WITH LATISSIMUS DORSI MYOCUTANEOUS FREE FLAP AND MICRONE.UROVASCULAR SURGERY

2 cases of restoration of finger flexion with latissimus dorsi myocutaneous free flaps are re- ported. Follow-up for two and a half years revealed normal electromyograms and Grade 3- 4 muscular power. Operative indications and technics are also de.scribed.     

游离皮瓣移植修复手部及前臂皮肤缺损的临床效果

目的 观察游离皮瓣移植修复手部及前臂皮肤缺损的临床效果.方法 2012年6月-2015年2月就诊的90例游离皮瓣移植修复前臂以及手部皮肤缺损患者,根据血管吻合方式将其分为A组(34例)、B组(22例)、C组(34例)三组,A组患者行常规游离植皮,B组则采取手术放大镜下缝线法实施血管吻合,C组采取显微镜下缝线法实施血管吻合,观察三组皮瓣长度、动脉吻合时间、缺血时间、静脉吻合时间以及总血管吻合时间,并对研究结果作统计学分析.结果 本组90例患者均成功修复,修复成功率为100.0％;术后随访发现患者移植皮瓣处弹性良好,血运以及质地较佳.足部皮瓣以及足趾组织瓣(不同类型)移植修复的手指以及拇指外观良好,其中指腹两点分辨觉最低为5mm,最高为8mm.与A、B二组相比,C组皮瓣长度更短,动脉吻合时间、缺血时间、静脉吻合时间以及总血管吻合时间更短,组间差异具有统计学意义(P＜0.05).结论 在手部以及前臂皮肤缺损修复方案中,游离皮瓣移植是其中较为理想的一种方法,特别在显微镜下缝线法实施血管吻合的效果更佳,值得推广使用.     

回流静脉对跨越中线的腹壁游离皮瓣影响的实验研究

用100只Spragne Dawley大鼠分为5组,各组均以右侧腹壁浅动脉为皮瓣的动脉,组1保留同侧伴行的腹壁浅静脉,组2保留同侧腹壁外侧静脉;组3保留对侧腹壁外侧静脉;组4保留对侧腹壁浅静脉;组5保留两侧腹壁外侧静脉及对侧腹壁浅静脉。结果组4和组5皮瓣的成活率最高,溃疡面积最小。作者讨论了回流静脉对游离皮瓣的影响,并认为吻合非伴行静脉有利于术后游离皮瓣内血循环的重新调整。这对临床上作游离皮瓣有参考价值。     

髌内侧滑膜皱襞综合征的诊断和治疗

报告了１１例髌内侧滑膜皱襞综合征的诊断和治疗结果。１１例均经关节镜检查而确诊，同时行关节镜下滑膜皱臂切除术，术后平均随访１年８个月，疗效满意。作者认为，对滑膜皱襞综合征的诊断应持慎重态度。只有在排除关节内其他病变，而皱襞又呈现明显的病理变化时，诊断才能确立。本文对该综合征的发病机制及治疗也进行了讨论。     

足趾皮瓣游离移植修复拇指和手指皮肤缺损效果

目的 探讨6种足趾皮瓣游离移植修饰性修复拇、手指皮肤缺损的疗效.方法 1998年1月～2008年6月,采用6种足趾皮瓣游离移植修复拇、手指皮肤缺损82例.其中,吻合血管的趾腓侧趾腹皮瓣移植修复拇、手指指腹缺损22例;吻合血管的第二趾胫侧皮瓣移植修复拇、手指指腹缺损5例;吻合血管的趾甲瓣移植修复指甲缺损6例; 拇甲瓣或第二趾趾甲皮瓣移植修复拇、手指皮肤套状撕脱伤37例;拇趾近节腓侧半月形皮瓣移植修复拇、手指近节与(或)中节皮肤环形缺损7例;拇趾末节腓侧半复合组织瓣或第二趾胫侧半复合组织瓣移植修复拇、手指末节半侧缺损5例.结果 成功81例,成功率为98.8%.术后经0.5～5.0年(平均1.5年)的随访,皮瓣血运、质地、弹性及拇、手指外形良好,修复的指腹二点辨别觉为5～8 mm,6例移植指甲外观、生长良好.结论 针对性采用6种类型的足趾皮瓣游离移植是修复拇、手指特定部位皮肤缺损的理想方法.     

失神经皮瓣移植术后感觉神经再生的研究

目的：通过动物实验，观察无神经支配的皮瓣移植术后感觉神经有无再生及其再生规律。方法：以大白鼠为实验材料，作右下腹腹壁皮瓣切除手术，原位缝合，随机分成四组；分别于术后1月、2月、3月取材作皮瓣组织切片，用改良Bielschowsky银染法及抗NF抗体，抗S-100作一抗的免疫组化方法染色观察术后不同时期及正常皮瓣内感觉神经末梢再生的情况。结果：术后1月神经末梢短小，零乱，稀少，均数为0.32条/mm(免疫组化S-100抗体），0.30条/mm(免疫组化NF抗体）0.43条/mm(银染）；术后2月，稀疏零乱的神经渐渐增长，呈短弧形，密度略有增加，平均数分别为0.72条/mm,0.74条/mm,0.81条/mm。术后3月神经末梢密度增加，短弧形变成长弧形，长丝状，其长度接近正常，密度与正常比似乎略有差异。平均数分别为1.32条/mm,1.25条/mm,1.20条/mm。对照组大白鼠腹壁皮瓣神经末梢平均数为1.35条/mm。结论：失神经皮瓣移植术后感觉神经末梢可以再生。其再生一般从边缘开始向中央生长，再生速度为1mm/10d。其再生速度与皮瓣的大小与厚度有关。     

乳腺癌根治术后皮下积液及皮瓣坏死的综合防治

目的：探讨综合防治乳腺癌根治术后皮下积液及皮瓣坏死的临床疗效。方法：将我院最近3a来乳腺癌根治术后的病人602例分为两组：观察组289例（A组），均采用综合防治，包括保留适度皮瓣、创面充分止血、淋巴管残端结扎、双管负压引流、适当加压包扎、生物蛋白胶的使用、消灭皮下死腔、患肢功能锻炼等措施；对照组313例（B组），未采用综合防治措施。将A、B两组各类手术的引流参数、出血、皮下积液和皮瓣坏死例数进行统计学分析：结果：A、B两组在出血、皮下积液、皮瓣坏死．第一天引流量．总引流量和拔管天数上都存在着显著差异（P＜0．05）。结论：对乳腺癌根治术后皮下积液和皮瓣坏死进行综合防治，有较明显的疗效，值得推广和应用。     

THE EFFECT OF SKIN GRAFTING AT DIFFERENT TIME POST BLOOD TRANSFUSION AND BONE MARROW TRANSPLANTATION ON RATS COMBINED RADIATION——BURN INJURY

After the rats were iufficted with 8Gy total body gamma ray irradiation and 15% total body surface area (TBSA) full thickness burn injury, they were treated with blood transfusion (BT) and bone marrow transplantation (BMT). Then the survival of allografts grafted on the eschareetomized burn wounds in the 24, 48 and 72 h postinjury was observed. It was found that when the burn wounds were closed with allografts in the 24h postinjury, there were an early elevation of leucocytes, the appearance of the donor‘‘s cells and a significantly higher survival rate of the rats on the 30 day postinjury. The allogaafts could survive longer and wounds showed no signs of infection and healed quicker. When the allografts were grafted in the 48 h or 72 h postinjury, only harmful effects to hasten the death of rats were observed.