不同皮瓣修复在外鼻缺损修复中的应用

目的比较不同皮瓣对外鼻不同亚单位缺损修复的效果,总结外鼻不同亚单位缺损的最佳皮瓣修复方式。方法选择2015年8月~2019年1月我科在外鼻皮肤肿瘤切除后进行双叶瓣、鼻唇沟瓣、风筝瓣、耳郭复合组织瓣、菱形皮瓣、Rieger皮瓣修复的病例,比较不同皮瓣修复的优缺点以及修复效果。结果不同皮瓣在外鼻不同亚单位缺损修复中各有优缺点:双叶瓣适合修复鼻尖或鼻翼小而浅的缺损,风筝瓣适合修复周围组织松弛度高的鼻翼或鼻背缺损,鼻唇沟瓣适合修复鼻翼近鼻唇沟处的小缺损,耳郭复合组织瓣适合修复具有软骨缺损的鼻翼缺损,菱形皮瓣适合修复鼻背或鼻根处周围组织松弛的皮肤缺损,Rieger皮瓣适合鼻尖或鼻背处稍大的皮肤缺损。结论对于外鼻不同亚单位的缺损,需选取合适的皮瓣修复,才能在根治肿瘤的基础上获得满意的外形效果。     

游离皮瓣修复头颈部肿瘤术后组织缺损△

目的 探讨不同游离皮瓣在头颈部肿瘤术后组织缺损修复应用中的优缺点。方法 回顾分析46例经游离皮瓣修复的头颈部恶性肿瘤病例临床资料,其中扁桃体癌11例、下咽癌17例、舌根会厌癌4例、鼻腔鼻窦癌术后放疗后复发14例。根据肿瘤切除术后缺损部位和大小,分别采用前臂桡侧皮瓣、股前外侧瓣和背阔肌皮瓣修复术后组织缺损。结果 46例恶性肿瘤患者,应用前臂皮瓣修复20例,应用股前外侧瓣修复20例,采用背阔肌修复6例。46例游离皮瓣成活42例(91.3%)。修复扁桃体癌术后缺损的11例患者,综合治疗后3年总生存率为72.7%(8/11);修复下咽缺损的17例患者,综合治疗后3年总生存率为64.7%(11/17);全舌加全喉切除术后缺损修复的4例患者,综合治疗后3年总生存率为50%(2/4);14例复发性鼻腔鼻窦癌患者,再次手术后总生存率为21.4%(随访2~5年)。结论 游离前臂皮瓣和股前外侧瓣能满足头颈部肿瘤术后不同大小缺损修复的需求。     

外鼻缺损修复重建方法的临床进展

鼻位于面正中突出位置。外鼻缺损修复手术需要同时对其外形和功能进行修复和重建,是一个富有挑战性的临床难题之一。在外鼻缺损修复重建时要遵循亚单位修复和分层重建等原则,同时也要结合鼻缺损实际情况和术者的临床经验选择合适的治疗方法。目前有很多手术方法应用于鼻修复,但是每种方法都有其适应证和优缺点,本文介绍了外鼻缺损常用的手术方法及其注意事项。     

先天性眼睑缺损修复术

目的：探讨利用皮肤旋转滑行皮瓣及异体巩膜分层修复先天性巨大眼睑缺损的效果。方法：设计分层修复巨大眼睑缺损的方法，采用局部转移结膜瓣修复睑结膜面，利用异体巩膜代替睑板，皮肤层面采用缺损区延长切口及鼻侧旋转滑行皮瓣修复，达到一期修复全层眼睑缺损的目的。结果：6例先天眼睑缺损再造术，术后随访6月以上，外观满意，睑裂闭合良好，眼睑瞬目功能正常，角膜透明。结论：皮肤及结膜旋转滑行瓣及异体巩膜代替睑板是一期修复先天性巨大眼睑缺损的简便有效方法。     

《外鼻缺损修复重建方法的研究进展》点评

外鼻缺损修复重建是整形外科富有挑战性的临床难题之一。由于外鼻缺损的位置、范围和层次不同,虽然需要修复或再造的方法也多种多样,但是在修复重建必须要遵循亚单位和分层重建等原则,这样方能获得良好的临床效果。外鼻既是一个美学器官,也是一个功能性器官,故在手术修复过程中时刻要兼顾外形和鼻通气功能,这就要求我们在修复过程中结合外鼻缺损实际情况,制订个性化的治疗方案。本文从临床实践出发对《外鼻缺损修复重建方法的临床进展》进行点评。     

风筝皮瓣修复眼睑黄色瘤切除后的眼睑前层缺损

目的 探讨风筝皮瓣在修复眼睑黄色瘤切除后所致的眼睑前层缺损中的应用.方法 黄色瘤切除后,于缺损颞侧皮肤松弛部位沿皮纹方向设计风筝皮瓣,按设计线切开皮肤,在眼轮匝肌下剥离形成以眼轮匝肌为皮下蒂的风筝皮瓣,推进至皮肤缺损区,用5-0尼龙线缝合切口.自2005年以来共应用16例,20只眼,年龄34～68岁,缺损面积为5mm×10mm～10mm×22mm.结果 皮瓣全部成活,切口Ⅰ期愈合,随访时间3个月至3年,眼睑外形双侧对称,切口瘢痕不明显.结论 对于眼睑较大黄色瘤切除后直接缝合会导致眼睑畸形的眼睑前层缺损,用风筝皮瓣进行修复简单易行,效果可靠.皮瓣转移后局部平整,无须去除多余皮肤组织,手术后恢复时间短,具有取材方便、便于推广等优点.     

大腿皮肤游离中厚皮片修复重度结膜囊狭窄的临床疗效

目的 观察大腿皮肤游离中厚皮片修复重度结膜囊狭窄的临床疗效。方法 收集2018年1月~2019年3月在广西医科大学第一附属医院眼科住院行大腿皮肤游离中厚皮片移植修复结膜囊狭窄的患者资料,共6例(6眼)。观察患者术后移植组织存活情况、结膜囊深度以及是否可戴上义眼。结果 所有患者植片与残留结膜融合良好,组织全部存活。所有患者结膜囊深度恢复,均能安装义眼。2例患者出现再次狭窄,经二次手术修复后,结膜囊狭窄改善,能安装义眼。结论 大腿皮肤游离中厚皮片是修复重度结膜囊狭窄的理想组织材料。     

鼻内镜下取自体骨个体化治疗眶内侧壁骨折疗效分析△

目的 探讨鼻内镜下经筛窦入路利用自体骨行个体化重建眶内侧壁的疗效。方法 采用鼻内镜下经鼻-鼻窦入路,根据患者眶内侧缺损大小及鼻中隔形态,行个体化重建眶内侧壁治疗16例,观察患者术后眼球运动障碍、眼球凹陷、复视症状恢复情况。结果 本组16 例患者术后随访3~13个月,眼球运动障碍、眼球凹陷、复视基本恢复,未出现鼻中隔血肿及穿孔、眶内感染、视力下降、移植骨片脱位等并发症,仅1例患者在术后第5天因不慎挖鼻后反复出现鼻出血行鼻内镜下电凝止血术。结论 经鼻内镜下鼻窦入路,利用自体鼻中隔软骨及筛骨垂直板个体化重建眼眶内侧壁,疗效较确切。     

生物卵膜促进小鼠全层皮肤损伤修复的实验研究△

目的 探讨生物卵膜对小鼠全层皮肤损伤的修复作用。方法 采用68周的健康雄性C57BL/6小鼠40只,在背部制备3个深及筋膜、直径2 mm的圆形皮肤缺损创面。将其随机分为5组:生物卵膜组、生物卵膜+蛋清液组、莫匹罗星(商品名:百多邦)组、聚维酮碘(碘伏)组和对照组。对照组不予生物卵膜覆盖且不涂抹药物。对比相同大小皮肤缺损的愈合时间。5组于造模后第6天、第12天,采用Image Proplusv 1.5图像分析系统测量残余创面面积,比较各组创面愈合率。结果 随着时间的延长,5组残余创面面积逐渐减小,生物卵膜组和聚维酮碘组创面愈合率高于其余3组,愈合时间短于其余3组,差异均有统计学意义。结论 生物卵膜可以明显促进皮肤创面愈合速度,为临床皮肤损伤修复提供新的治疗方法。对于聚维酮碘过敏的情况,生物卵膜有望替代聚维酮碘进行临床推广应用。     

颞区水平皮瓣修复瘢痕性下睑外翻的临床观察

目的探讨外眦角颞侧水平带蒂皮瓣在下睑瘢痕性外翻修复中的应用。方法对11例（11只眼）伴有皮肤组织缺损的下睑外翻患者实施该手术,其中3只眼为局部疖肿溃破后皮肤瘢痕挛缩,2只眼为铝水烫伤后,6只眼为皮肤挫裂伤后。年龄15～58岁。局麻下手术,根据下睑皮肤缺损范围,在颞区设计一以肌肉组织为蒂的水平向皮瓣。皮瓣穿过供、受区之间的皮下隧道后缝合于缺损区。结果术后第2天,有1只眼皮瓣的鼻侧端微紫,1周后色泽日趋正常。术后随访3～6个月,11只眼下睑皮瓣色泽良好,与周围组织差异小,无外翻发生。颞区伤口瘢痕细而淡。结论颞区水平皮瓣在伴有皮肤组织缺损的瘢痕性下睑外翻修复中疗效良好,供区水平伤口愈合佳,瘢痕小。但供皮量受颞区皮肤松弛程度的限制,且应严格控制皮瓣长度,避免因血供不足造成组织坏死,因而更适合于下睑颞侧半皮肤缺损的修复。     

The transnasal advancement flap: A technique for medial canthal area defects

AIM . To illustrate an alternative technique for reconstructing defects in the medial canthal area following tumour removal. MATERIALS AND METHODS . Eight consecutive patients who underwent Mohs¹ micrographic surgery for removal of a basal cell carcinoma in the medial canthal area were prospectively recruited. An experienced dermatologist trained in Mohs¹ micrographic surgery removed the tumour, and subsequently an oculoplastic surgeon reconstructed the defect. An incision is made from the superior end of the defect superomedially towards the midline of the dorsum of the nose following one of the natural lines of the skin (spec name). The incision runs in arcuate fashion just medial to the eyebrow and then reaches the dorsum of the nose and extends on the contralateral aspect of the nose towards the medial canthal area. The skin is then undermined to free up the newly formed flap. The flap is advanced towards the lesion and fixed intra-dermally with Vicryl Rapide® sutures to ensure anchoring into the concavity of the medial canthal region. The skin is then sutured with prolene sutures. RESULTS . The defects presented were oval or round in shape with diameters ranging from 0.5 to 2 cm. In all cases the transnasal flap covered the entire area and the defect was successfully reconstructed. Mean follow-up is 10.8 months (±4.5 SD) (range 4–17 months); all patients had an excellent cosmetic result and were subjectively satisfied. CONCLUSIONS . The transnasal advancement flap seems to have some advantages over the usual reconstruction techniques in use to repair medium defects in the medial canthal area. These are the avoidance of vertical scars in the glabellar area, eyebrow hair is not transposed into the medial canthal area, the skin match is excellent, both in colour and thickness, and surgical scars are hidden within the natural lines of the nasal bridge. We advocate the use of this technique for all minor to medium skin defects.     

The transnasal advancement flap: A technique for medial canthal area defects

AIM. To illustrate an alternative technique for reconstructing defects in the medial canthal area following tumour removal. MATERIALS AND METHODS. Eight consecutive patients who underwent Mohs(1) micrographic surgery for removal of a basal cell carcinoma in the medial canthal area were prospectively recruited. An experienced dermatologist trained in Mohs(1) micrographic surgery removed the tumour, and subsequently an oculoplastic surgeon reconstructed the defect. An incision is made from the superior end of the defect superomedially towards the midline of the dorsum of the nose following one of the natural lines of the skin (spec name). The incision runs in arcuate fashion just medial to the eyebrow and then reaches the dorsum of the nose and extends on the contralateral aspect of the nose towards the medial canthal area. The skin is then undermined to free up the newly formed flap. The flap is advanced towards the lesion and fixed intra-dermally with Vicryl Rapide(R) sutures to ensure anchoring into the concavity of the medial canthal region. The skin is then sutured with prolene sutures. RESULTS. The defects presented were oval or round in shape with diameters ranging from 0.5 to 2 cm. In all cases the transnasal flap covered the entire area and the defect was successfully reconstructed. Mean follow-up is 10.8 months (+/-4.5 SD) (range 4-17 months); all patients had an excellent cosmetic result and were subjectively satisfied. CONCLUSIONS. The transnasal advancement flap seems to have some advantages over the usual reconstruction techniques in use to repair medium defects in the medial canthal area. These are the avoidance of vertical scars in the glabellar area, eyebrow hair is not transposed into the medial canthal area, the skin match is excellent, both in colour and thickness, and surgical scars are hidden within the natural lines of the nasal bridge. We advocate the use of this technique for all minor to medium skin defects.     

转移皮瓣修复眼眶组织巨大缺损

目的:观察几种不同类型转移皮瓣修复眼眶组织巨大缺损的临床效果,探讨眼眶组织巨大缺损的修复技巧。方法:回顾性分析16例被恶性肿瘤广泛破坏眼睑、眶周皮肤、眶内球旁组织及眼球的患者。行控制性或扩大切除肿瘤后,利用眶周健康组织形成转移皮瓣进行修复缺损区,供皮处缺损区取上臂内侧或腹部全厚游离皮片修复。观察术后6mo皮瓣存活情况,分析与皮瓣存活有关的术式及皮瓣类型。结果:患者16例中接受控制性切除肿瘤的患者12例12眼,扩大切除肿瘤者4例4眼;缺损区采用额部或额顶部轴型皮瓣修复10例10眼,皮下蒂皮瓣4例4眼,反转皮瓣2例2眼;术后接受放射治疗12例12眼,未接受放射治疗4例4眼,随访至术后6mo,所有皮瓣均存活。结论:转移皮瓣是修复眼眶组织巨大缺损的安全、有效方法。     

Medial canthal reconstruction by a modified glabellar flap

AIMS: To present a modified technique for the preparation of glabellar skin flaps to reconstruct medial canthal defects. METHODS: Ten consecutively treated patients were included who had skin defects after resection of skin tumours like basal cell carcinomas in the medial canthal area of a medium vertical diameter of 2.5 cm. The defects were closed by preparation of a modified glabellar flap. The pedicle of the flap was guided through a skin tunnel prepared diagonally at the root of the nose. The pedicle was resected 4 weeks after the initial surgery. RESULTS: In all 10 cases, the procedure was adequate for reconstruction of the defect. There were no flap necroses and the cosmetic results were favourable in all cases. The resection of the pedicle could be performed easily in an out-patient procedure 4 weeks after the operation. CONCLUSION: Glabellar flaps are established procedures to reconstruct medium to large defects of the medial canthus. Skin distortion in the area of the flap pedicle leading to a skin bulge and visible scars at the root of the nose and medial transposition of the eye brows can be reduced by a modification of the surgical technique preparing a skin tunnel for the flap pedicle. In our hands, the cosmetic results are better with the modified technique in comparison to the original procedure.