乳癌放疗后放射性溃疡的治疗

目的　探讨乳癌放射性治疗 (下简称放疗 )后放射性溃疡的治疗方法 ,阐述放疗后臂丛神经损伤的广泛性和严重性。方法　 1999年以来分别应用腹直肌肌皮瓣转移、皮肤软组织扩张、局部皮瓣转移和局部延迟皮瓣转移等方法修复乳癌放疗后放射性溃疡 16例 ,并常规行肌电图检查了解臂丛神经损伤的情况。结果　除 1例患者因创口感染而皮瓣部分坏死外 ,其余皮瓣成活良好 ,创面修复满意 ;10例行肌电图检查的患者中 ,有 7例合并有臂丛神经损伤。结论　乳癌放疗后引起的放射性溃疡常伴有臂丛神经损伤 ,这些损伤呈慢性、进行性和不可逆性改变 ;应用血运良好的皮瓣可有效地修复溃疡创面。     

应用皮瓣修复乳腺癌术后放射性溃疡

目的探讨应用皮瓣修复乳腺癌根治术后放疗所致放射性溃疡的疗效.方法回顾性分析9例乳腺癌术后放射性溃疡患者,分别采用背阔肌肌皮瓣修复5例、腹直肌肌皮瓣修复1例和局部侧胸皮瓣转移3例修复.结果除1例因局部缺血出现皮瓣部分坏死外,其余皮瓣成活良好,创面修复满意.结论应用血运良好的皮瓣可有效修复乳腺癌手术放疗后放射性溃疡创面.     

腹直肌肌皮瓣修复胸前壁放射性溃疡5例

腹直肌肌皮瓣修复胸前壁放射性溃疡５例作者单位：２１０００２南京军区总医院烧伤整形科汪军姜会庆洪志坚胡心宝陈一飞乳癌根治术后放疗易发生放射性溃疡，因局部组织血供极差，且伴有感染和深部组织外露，常需皮瓣移植修复。２年来，我们收治胸前壁放射性溃疡５例，采用...     

游离皮片移植治疗乳癌慢性巨大溃疡一例

乳癌溃疡多为术后放射性溃疡,修复多以皮瓣转移修复为主,如背阔肌肌皮瓣,腹直肌肌皮瓣或局部旋转皮瓣。而笔者在临床上遇到了一例乳癌溃疡并非术后放射性溃疡,而是未行手术形成的慢性乳癌溃疡或手术后复发的癌性溃疡,此种情况较少。     

应用肌皮瓣修复乳腺癌术后胸壁放射性溃疡创面

目的 探讨应用肌皮瓣修复乳腺癌术后胸壁放射性溃疡的临床治疗效果. 方法 2009年1月-2011年1月,对乳腺癌术后胸壁放射性溃疡患者18例,手术扩创后应用肌皮瓣修复,其中采用背阔肌肌皮瓣修复12例,腹直肌肌皮瓣6例对于溃疡较深,累及胸膜或并发放射性骨髓炎的5例,先采用Prolene网或Marlex网修复骨性胸壁缺损,再用肌皮瓣覆盖缝合创面. 结果 18例肌皮瓣全部成活,1例腹直肌皮瓣修复术后第4天局部边缘有渗液,经拆线引流、换药后痊愈,其余17例患者伤口愈合良好.随访6～12个月,无溃疡复发,无皮瓣坏死、皮瓣感染以及皮下积液. 结论 应用血运良好的肌皮瓣可有效修复乳腺癌术后胸壁的放射性溃疡创面.     

多种皮瓣修复乳腺癌术后放疗继发前胸壁放射性溃疡的临床评价

目的 总结多种皮瓣修复乳腺癌术后放疔继发前胸壁放射性溃疡的疗效和经验.方法 自2000年1月至2008年12月,共收治乳腺癌术后放疗继发前胸肇放射性溃疡患者24例.采用下腹部横行腹直肌肌皮瓣(11例)、背阔肌肌皮瓣带蒂转移术(9例)和健侧乳房皮瓣(4例)转移修复溃疡.肌皮瓣面积为18 cm×12 cm～36 cm ×9 cm,乳房皮瓣面积为13 cm ×6 cm～16 cm×6 cm.2例患者在行背阔肌肌皮瓣转移术前行DSA检查,明确胸背动脉的位置.背阔肌肌皮瓣供区行中厚皮片移植修复,其余供瓣区直接拉拢缝合.结果 1例因下腹腹直肌肌皮瓣巨大、脂肪过于肥厚而出现尖端皮肤干性坏死和脂肪液化,其余23例皮瓣均完全成活.术后随访3～12个月,溃疡无复发.结论 背阔肌肌皮瓣是修复前胸壁放射性溃疡的首选皮瓣.术前行DSA检杳明确胸背动脉的位置,是保证手术成功的有效方法.带蒂下腹腹直肌肌皮瓣因手术难度和创伤较大,可作为次选.健侧乳房皮瓣可导致健侧乳房畸形,且供瓣区面积有限,因而尽可能避免选用.     

应用中下腹横形腹直肌皮瓣修复胸壁慢性放射性溃疡

目的 探讨乳癌根治术后胸部慢性放射性溃疡的特点及防治特点.方法 对胸部放射溃疡并肋骨、肋软骨或胸骨外露的患者,采用中下腹部横形腹直肌肌皮瓣(TRAM)修复12例,其中单腹直肌蒂6例,单腹直肌蒂附加血管吻合双蒂皮瓣6例.结果 皮瓣全部成活,皮瓣和创缘均一期愈合.随访1～4年,皮瓣色泽、质地、弹性良好.周边瘢痕性组织血运得以改善.结论 TRAM皮瓣是修复胸壁放射性溃疡的理想选择,必要时可附加血管吻合形成双蒂皮瓣.     

对侧胸三角皮瓣修复乳癌根治术后放疗溃疡

对侧胸三角皮瓣修复乳癌根治术后放疗溃疡张嘉一郑妍丽哈芬孙强姜涛许慧艳乳癌根治术后放射治疗所致胸壁巨大溃疡，由于局部曾受到辐射损伤，细菌感染，及切除后缺损面积大，修复十分困难。采用背阔肌或腹直肌肌皮瓣修复，创伤较大。近年来，我院采用对侧胸三角皮瓣治疗４...     

带蒂腹直肌肌皮瓣修复胸壁深度放射性溃疡

目的探讨胸壁深度放射性溃疡清创后应用带蒂腹直肌肌皮瓣修复的临床效果。方法 2012年1月至2018年12月,共收治5例胸壁深度放射性溃疡患者,创面给予手术清创后,应用带蒂腹直肌肌皮瓣进行修复。结果移植皮瓣全部成活,溃疡愈合良好。术后随访0.5~1年,胸壁溃疡无复发。结论胸壁深度放射性溃疡经有效外科清创后,采用血管恒定、血供丰富、组织量大的带蒂腹直肌肌皮瓣进行修复,是临床较好的选择。     

腹直肌肌皮瓣修复胸壁放射性溃疡

腹直肌肌皮瓣修复胸壁放射性溃疡谢舒，李素芝放射性溃疡因其病理生理、组织学特点，治疗较为棘手。我们采用腹直肌肌皮瓣移泣修复２例因Ⅲ期乳腺癌行乳癌根治术后，放射治疗致胸壁溃疡。溃疡发生时间距最后一次照射１例５年，１例７年。面积分别为１０×１４ｃｍ和６×２...     

Reconstruction of full-thickness chest wall defects using rectus abdominis musculocutaneous flap: a report of fifteen cases

In 15 patients chest walls were excised because of recurrent breast cancer, radiation ulcer, or rib tumor. In most cases the full-thickness defect of the chest wall was about 10 x 10 cm. Reconstruction was performed using only a rectus abdominis musculocutaneous flap. No patient developed circulation problems in the flap or severe flail chest, and we had successful results in all our cases. These results show that the rectus abdominis musculocutaneous flap is quite effective and safe to use in the reconstruction of chest wall defects.     

严重放射性溃疡的修复

目的探讨严重放射性溃疡的修复方法及其临床效果。方法 自１９８８年８月～１９９８年１２月,采用肌瓣或肌皮瓣移位修复严重放射性溃疡１２例,其中胸大肌肌瓣１例,三叶状横形腹直肌肌皮瓣３例,背胸肌肌皮瓣２例,阔筋膜张肌肌皮瓣１例,纵形腹直肌肌眼瓣与阔筋膜张肌肌眼瓣１例,腓肠肌肌瓣１例,臀大肌肌眼瓣１例,下肢巨大别骨肌皮瓣１例,上肢剔骨肌皮瓣１例。结果 肌瓣、肌皮瓣全部成活,伤口期愈合９例,２期愈合３例。２     

腹壁下动脉穿支皮瓣在乳房再造和胸壁溃疡修复中的应用

目的　在解剖学研究基础上 ,对以腹壁下动静脉为蒂的横行腹直肌 (TRAM)肌皮瓣的切取进行完善和改进 ,将其精确为腹壁下动脉穿支 (DIEP)皮瓣 ,从而提供一种更为理想的乳腺癌术后乳房再造和胸壁创面修复的皮瓣。　方法切取DIEP皮瓣 ,移植至胸壁受区 ,腹壁下动静脉分别与胸廓内动静脉相吻合 ,用于乳腺癌术后乳房再造和胸壁放射性溃疡的修复。　结果　解剖学研究和临床观察发现自腹壁下动脉有粗大的肌皮穿支或皮支自血管主干发出 ,穿过腹直肌纤维直接进入皮瓣 ,因此 ,术中只剪开腹直肌前鞘 ,钝性分离腹壁下动静脉及其穿支周围的腹直肌纤维 ,无须离断腹直肌纤维 ,临床应用DIEP皮瓣再造乳房 4例 ,修复胸壁缺损 2例 ,皮瓣面积 (10cm× 12cm )～ (12cm× 35cm) ,全部成活 ,效果满意。　结论　DIEP皮瓣是对传统的TRAM皮瓣的一种技术改良 ,既保留了TRAM皮瓣血运丰富、组织量大、易于塑形的优点 ,尚可保持腹直肌的完整性 ,同期进行腹壁整形     

Free flap reconstruction in massive upper extremity burns

In massive burns, early excision and a free flap reconstruction is, in some cases, limb saving. From October 1979 to August 1993, eleven patients with massive burn injury in the upper extremity were treated using a free flap reconstruction. Eight cases were acute or subacute and three were late reconstructions. The following free flaps were used: rectus femoris microneurovascular musculocutaneous flap (2), latissimus dorsi flap (4), rectus abdominis flap (3), gluteal thigh flap (1), lateral arm flap (1), and serratus flap (1). The gluteal thigh flap was lost and it was later replaced by a rectus abdominis flap. In three cases successful reanastomosis was performed. Functional late reconstructions were performed in nine patients. In all eleven patients the limb was saved and functional recovery was satisfactory. We recommend that a free musculocutaneous or muscle flap is used, proximal to the wrist, if after careful excision of nonviable tissue, tendons, bone joint or major vessels are exposed. The rectus femoris musculocutaneous flap is a useful solution to restore extensor musculature of the forearm after extensive injury.     

游离腹直肌瓣加中厚植皮修复四肢骨及肌腱外露

目的：观察应用游离腹直肌瓣加中厚游离植皮修复四肢骨,肌腱外露的疗效。方法：应用游离腹直肌瓣加中厚游离植皮修复前臂桡骨,肌腱外露1例,股骨外露2例,足部骨骼外露5例。结果;腹直肌瓣均全部成活,2例植皮坏死,经再次植皮愈合,外形及功能尚满意。结论：游离腹直肌瓣血管蒂长,口径粗,解剖恒定,操作简便,损伤小,无形成腹壁疝的缺点,游离腹直肌瓣加中厚游离植皮具有抗感染力强,顺应性好,无肥厚且外形好的优点。     

Transurethral resection of the prostate among medicare beneficiaries: 1984 to 1997. For the Patient Outcomes Research Team for Prostatic Diseases

PURPOSE: Urethrovaginal fistulas are commonly repaired transvaginally with local tissue flaps, such as the Martius labial fat pad graft. Although this flap is ideal, if it fails and the fistula persists, subsequent treatment options are limited. We describe the use of a pedicled rectus abdominis muscle flap for the repair of complex and refractory urethrovaginal fistulas. MATERIALS AND METHODS: Six women with a mean age of 53 years (range 41 to 62) who had complex and refractory urethrovaginal fistulas were referred to our continence center. Mean number of prior attempted repairs was 1.3 and in all cases at least 1 Martius flap had failed. Transvaginal urethrovaginal fistula closure was performed followed by a pedicled rectus abdominis muscle flap interposed between the fistula closure and vaginal suture line. The muscle flap was based on the inferior epigastric vessels, and provided additional support to the urethra, bladder neck and bladder base. RESULTS: Urethrovaginal fistula repair with the rectus abdominis muscle flap was successful in all cases. No fistula recurred. Of the patients 5 (83%) were continent and able to void to completion at a mean followup of 23 months (range 2 to 66). CONCLUSIONS: The rectus abdominis muscle flap is a useful adjunct in the repair of complex and refractory urethrovaginal fistulas. It can be used with confidence to provide support to the bladder neck and proximal urethra in patients after failed prior repair with the Martius flap procedure. The pelvic surgeon may be able to recognize other applications for the rectus abdominis muscle flap in pelvic floor reconstruction.     

Chest wall reconstruction with rectus abdominis musculocutaneous flap for sternum osteomyelitis after radiation

We report a case of reconstruction of radiation ulcer on the chest wall and sternum osteomyelitis using a rectus abdominis musculocutaneous flap. A case of 67-year-old woman, Halsted operation was performed for right breast cancer, 23 years ago. After 4 years, transcatheter arterial injection and radiation therapy was performed to treat recurrence of parasternal lymph nodes. Since then, she had been without recurrence of the tumor, but suffered from repeated scabbing of parasternal skin. In 2009, she suffered from pain, redness and purulent discharge of the wound, and diagnosed with sternum osteomyelitis. She was admitted to our hospital and underwent debridement of sternum, and the resection of surrounding skin. Sixteen days later, reconstruction using a rectus abdominis musculocutaneous flap was performed. Twenty months after the operation, she is well without any evidence of recurrence.     

游离腹直肌肌瓣加植皮治愈7例胫骨下段难治性慢性骨髓炎

目的:探讨应用游离腹直肌肌瓣+中厚游离植皮治疗胫骨下段难治性慢性骨髓炎的方法和疗效。方法:自2003年5月～2009年12月,采用以腹壁下动、静脉为血管蒂的一侧腹直肌肌瓣游离移植加中厚植皮治疗7例胫骨下端慢性骨髓炎。慢性骨髓炎清创后缺损范围为4cm×5cm～7cm×10cm,切取腹直肌肌瓣的大小为5cm×6cm～8cm×15cm。结果:术后7例移植的腹直肌肌瓣均成活良好,中厚植皮无坏死。随访6月～2年,踝部外形及功能良好,2例患者硬化性骨坏死恢复正常。结论:游离腹直肌肌瓣+中厚游离植皮治疗胫骨下段的难治性慢性骨髓炎具有血运好、抗感染力强和顺应性好等优点,术后踝部外形及功能良好。     

聚丙烯补片预防游离腹直肌皮瓣术后切口疝的作用

目的 探讨聚丙烯补片（Prolene)预防游离腹直肌皮瓣术后切口疝发生的作用。方法 1999年11月9日-2000年10月22日对26例患者行游离腹直肌皮瓣移植术时,采用聚丙烯补片作腹直肌前鞘修补,分析聚丙烯补片植入后的组织反应及创口愈合情况,以及切口疝发生的情况。结果 25例患者腹部创口均Ⅰ期愈合,1例术后腹部创口出现局部积液,经保守治疗好转,未出现排异和感染等并发症,术后随访1-12个月,全部患者聚丙烯补片愈合良好,无排出或取出,腹部不适,切口疝及腹壁膨隆。结论 聚丙烯补片具有较好的生物相容性,其植入体内后不会发生排异和增加创口感染的机会,用于腹直肌前鞘的修补安全可靠,能有效预防游离腹直肌皮瓣术后切口疝的发生,值得进一步观察和应用。     

Superiorly based rectus abdominis wraparound flap for axillofemoral graft sepsis

Prosthetic vascular graft sepsis, although uncommon, can lead to catastrophic sequelae for life and limb. Axillofemoral grafts are predisposed to sepsis and perigraft seromas because of their length, subcutaneous tunneling, and infrainguinal anastomosis, and are often performed in elderly, debilitated patients. The authors detail the use of a superiorly based rectus abdominis muscle flap, in combination with a sartorius muscle flap to salvage a Szilagy/Samson grade III septic axillounifemoral graft. The superiorly based rectus abdominis wraparound muscle flap should be considered a salvage option for select cases of sepsis involving axillofemoral grafts.