一种低耗材牵张装置在皮肤缺损创面中的应用

目的探讨一种低耗材皮肤牵张装置在皮肤软组织缺损创面的临床疗效。方法 2016年12月～2018年2月,应用自制皮肤牵张装置(由扎带和克氏针组成)治疗皮肤软组织缺损创面15例,其中缺损创面为大腿皮瓣供区者5例,小腿慢性不愈合创面4例,骨筋膜室综合征切开后缺损创面3例,体表肿物切除后缺损创面3例。缺损范围2.5 cm×4.0 cm～8.0 cm×15.0 cm。结果 5例创面术中即刻闭合,术后2周拆除皮肤牵张装置;10例创面经术后持续牵拉闭合,平均闭合时间18.9天;15例病人均获随访,随访时间8～12个月,平均10.2个月。创缘皮肤呈线性愈合,瘢痕较小,克氏针孔处会遗留点状瘢痕,无皮肤坏死、感觉功能减退等并发症发生。结论该装置制作简便,治疗急慢性创面中疗效显著。     

皮肤牵张器在下肢骨折后皮肤软组织缺损创面修复中的应用

目的：探讨皮肤牵张器在下肢骨折后皮肤软组织缺损创面修复中的应用效果。方法：选取2015年1月-2020年1月在笔者医院治疗的下肢骨折后皮肤软组织缺损患者150例,简单随机分组为观察组(n=75)和对照组(n=75)。对照组应用皮瓣修复,观察组应用皮肤牵张器的方法进行创面修复,两组患者均持续治疗直至创面愈合。比较两组患者透明质酸(Hyaluronic acid,HA)及血管内皮生长因子(Vascular endothelial growth factor,VEGF)水平;比较两组术后并发症发生率。治疗后3个月,比较两组治疗有效率,使用温哥华瘢痕量表(Vancouver scar scale,VSS)比较两组创面愈合情况,包括创面色泽、血管分布、创面厚度和创面柔软度。结果：术后10 d,观察组患者HA水平、VECF水平显著高于对照组,差异有统计学意义(P<0.05)。两组治疗后并发症发生率比较差异无统计学意义(P>0.05)。治疗后3个月随访,观察组治疗总有效率(97.33%)显著高于对照组(88.00%),差异有统计学意义(P<0.05)。且观察组创面色泽、血管分布、创...     

自制皮肤牵张器在皮损修复中的应用

目的提高皮肤缺损治疗效果。方法自制皮肤牵张器,对28例皮肤缺损患者行皮肤牵张治疗15～21d。结果创面均愈合（未拆线）出院,13～15d后返院拆线;随访3～12个月,外观仅留有线形瘢痕,局部无色素沉着,皮肤器官完整,皮肤弹性正常,相邻关节功能正常。结论自制皮肤牵张器设计合理,可有效治愈较大皮肤缺损创面,外观可达美容效果。     

乳腺癌术后胸壁复发再手术时胸壁重建方法探讨(附6例报告)

目的 探讨乳腺癌根治术后,或术后加放疗后,局部胸壁复发需再次手术时,形成全胸壁缺损修复及重建的相应方法.方法 本组6例胸壁缺损大小,部位均不同,采用皮瓣及肌皮瓣修复、人工材料重建胸壁等手术方法.结果 全胸壁缺损宜采用人工材料修补,尤以"三明治"法为优.除1例三个月后因人工材料与机体组织不相容而取出外,余均获得成功.结论 应根据不同部位、不同缺损面积及术后是否放疗而采用相应修复及重建方法,既能提高手术成功率又能提升生存质量.     

皮肤牵张闭合器在四肢创面修复中的应用

目的探讨皮肤牵张闭合器在四肢创面修复中的临床应用价值。方法选取自2014-06—2016-03诊治的46例四肢皮肤软组织缺损,采用皮肤牵张闭合器治疗23例(皮肤牵张闭合器组),采用负压封闭引流技术(VSD)治疗23例(VSD组)。比较2组术后伤口感染例数、再次手术例数、伤口愈合时间。结果 46例均获得1~3个月随访,未见伤口裂开或再次骨外露。VSD组2例在第1次手术后感染,皮肤牵张闭合器组1例术后出现感染,2组术后感染发生例数比较差异无统计学意义(χ~2=0.357,P=0.550)。皮肤牵张闭合器组再次手术例数明显少于VSD组,差异有统计学意义(χ~2=7.263,P=0.007)。皮肤牵张闭合器组伤口愈合时间较VSD组短,差异有统计学意义(χ~2=6.571,P=0.010)。结论与VSD技术相比,应用皮肤牵张闭合器修复四肢创面更简单、方便,能缩短创面愈合时间,愈合瘢痕小。     

胸壁肿瘤切除术胸壁缺损钛网重建五例

胸壁肿瘤的根治性大块切除所致的胸壁缺损必将破坏胸膜腔的密闭性和胸廓的坚固性与稳定性,容易导致血气胸、胸壁软化、反常呼吸及纵隔摆动、低氧血症、伤口和肺部感染、肺动脉栓塞等,严重影响呼吸循环功能。因此,对胸壁大块缺损必须予以妥善的修复。我院于2010年5月至2013年11月为5例胸壁肿瘤患者施行胸壁肿瘤扩大切除术,用钛网修补缺损,效果满意,现总结其临床经验。     

皮肤牵张术在整形外科的综合应用

目的探讨皮肤牵张术的适应证.方法选择110患者因各种原因引起的皮肤缺损用微型牵张器封闭创面,评价近期、远期效果.结果皮肤牵张术可修复21种原因引起的皮肤缺损.高张力线方向皮肤缺损封闭宽度为2.5～6.0?cm.低张力线方向封闭宽度为4.0～13.5?cm.皮肤病变或缺损实际修复面积最小为3.0?cm×6.0?cm,最大为13.5?cm×21.0?cm.伤口Ⅰ期愈合率达到97.3%.结论皮肤牵张术可用于多种皮肤缺损的修复,可避免一些不必要的皮片和局部皮瓣移植.     

皮肤牵张术在整形外科的综合应用

目的　探讨皮肤牵张术的适应证。方法　选择 110患者因各种原因引起的皮肤缺损用微型牵张器封闭创面 ,评价近期、远期效果。结果　皮肤牵张术可修复 2 1种原因引起的皮肤缺损。高张力线方向皮肤缺损封闭宽度为2 .5～ 6.0cm。低张力线方向封闭宽度为 4.0～ 13 .5cm。皮肤病变或缺损实际修复面积最小为 3 .0cm× 6.0cm ,最大为 13 .5cm× 2 1.0cm。伤口Ⅰ期愈合率达到 97.3 %。结论　皮肤牵张术可用于多种皮肤缺损的修复 ,可避免一些不必要的皮片和局部皮瓣移植     

应用皮肤牵张器闭合胫骨骨折术后皮肤软组织缺损北大核心CSCD

目的探讨应用皮肤牵张器治疗胫骨骨折术后皮肤软组织缺损的疗效。方法 2016年4月—2017年3月,采用皮肤牵张器治疗15例胫骨骨折术后皮肤软组织缺损患者。其中男11例,女4例;年龄24～59岁,平均37.5岁。致伤原因:交通事故伤7例,重物砸伤3例,高处坠落伤3例,摔伤2例;均无神经及血管损伤。闭合骨折3例,伤后行切开复位内固定术;开放骨折12例,伤后行创面清创、外支架固定术。首次手术后1～3个月小腿皮肤软组织缺损未愈合,缺损范围为14 cm×5 cm～20 cm×7 cm,均为长条形或梭形。在皮肤缺损纵轴线两侧的皮肤边缘穿入克氏针,然后以皮肤牵张器扣锁两侧克氏针后适当收紧,根据皮缘血供及小腿肌肉受压情况,及时调整牵张器的张力,待皮缘相互接触时去除克氏针及牵张器,行间断缝合术。结果 15例皮肤软组织缺损经6～13 d牵张均得到覆盖,间断缝合后12 d伤口均愈合拆线。伤口愈合评分从术后当天的(3.40±0.51)分降至术后12 d的(1.27±0.46)分,差异有统计学意义(t=12.911,P=0.000)。15例患者均获随访,随访时间4～12个月,平均6.5个月。牵张后皮肤色泽、弹性及痛触觉均与正常皮肤相似,毛发生长正常。术后出现1例钉道感染和2例小腿不适感,经治疗后症状均缓解。结论利用皮肤牵张器闭合胫骨骨折术后皮肤软组织缺损是一种有效的治疗方法。     

Chest wall resection and reconstruction for locoregionally advanced or recurrent breast cancer

Ten patients, including 7 with local recurrent breast cancer, 2 with primary advanced cancer and 1 with radionecrosis, underwent chest wall resection and immediate reconstruction, using large pedicled skin flaps or musculocutaneous flaps. A rectus abdominis musculocutaneous flap was used in 4 cases and a latissimus dorsi musculocutaneous flap was used in 1 case. The postoperative course of all the patients was uneventful and there was no incidence of flail chest or respiratory failure. The postoperative performance status and also the quality of life were improved in 9 of the 10 patients. Eight of the 10 patients are presently alive with or without disease, the longest survival time thus far being 8 years.     

Surgical closure of chest wall in noninflammatory locally advanced breast carcinoma with ulceration of the skin

Patients with noninflammatory locally advanced breast cancer with ulceration of skin or muscle or parietal wall infiltration, better named "extended locally advanced breast cancer," may require cancer surgery and plastic reconstruction of the chest wall after multidisciplinary evaluation. The decision is made to improve quality of life, independently of prognosis, and severity of the disease. The aim of this study is to evaluate the best method for surgical closure of the chest wall and to check whether ablative surgery is an appropriate procedure in regards to the treatment of cancer. From October 1997 to June 2006, 27 patients with noninflammatory extended locally advanced breast cancer with ulceration of the skin, who were not candidate or did not respond to a neo-adjuvant treatment, underwent radical mastectomy and reconstructive surgery. Sixteen patients (59%) were affected by primary tumors of the breast, and eleven patients (41%) had local recurrence after mastectomy or conservative breast surgery. Two main techniques were used for breast reconstruction: transverse rectus-abdominis musculo cutaneous flap in 19 patients (70%), and a fasciocutaneous flap in eight patients (30%). The best procedure in each patient was chosen according to the extent of skin loss or previous radiotherapy to the chest wall. Fourteen patients (52%) died during the follow-up and the median length of survival was 16 months (range 3-79) in transverse rectus-abdominis musculo cutaneous group and 4 months (range 2-23) in fasciocutaneous flap group. The median length of follow-up after treatment for patients still alive was 32.5 months (range 0-96) in transverse rectus-abdominis musculo cutaneous flap group, and 18 months (range 8-41) in fasciocutaneous flap group. At the end of the follow-up, 10 patients were alive without evidence of disease and three patients developed metastatic lesion or local recurrence. The longest recorded disease free interval for a patient still alive and tumor free was 96 months. Only three patients (11%) had local complications: two wound infections and one partial necrosis of the transverse rectus-abdominis musculo cutaneous flap. Median hospital stay was 7 days (range 3-13) for transverse rectus-abdominis musculo cutaneous and 6 days (range 3-13) for fasciocutaneous flap. Our results confirmed that transverse rectus-abdominis musculo cutaneous group and fasciocutaneous flap flaps are good reconstructive options in patients with extended locally advanced breast cancer. Quality of life has improved in this group of patients, with acceptable survival periods and in some cases very important survival rates.     

Omental transposition and skin graft in patients for advanced or recurrent breast cancer

Nine patients, including 4 with primary advanced breast cancer (stage IV) and 5 with local recurrent cancer, underwent chest wall reconstruction using an omental flap and mesh skin grafting. In 2 of these patients the defect of bony chest wall was reconstructed with an acryl-resin plate and omental flap. The postoperative course in all patients was uneventful, except for a slight necrosis on the transposed mesh skin. Flail chest or dypsnea did not occur in those with a bony chest wall reconstruction. The immediate postoperative performans status in 6 of 9 patients and also quality of life improved.     

Correction of chest wall deformity after implant-based breast reconstruction using poly-L-lactic acid (Sculptra)

Abstract:  Implant-based breast reconstruction after mastectomy offers excellent cosmetic results in select individuals. However, this technique may result in a step-off between the implant and the soft tissue of the chest wall, which can be problematic in the extremely thin patient. Also, the removal of soft tissue can result in prominent ribs and visible intercostal spaces. A number of surgical options exist to correct these defects and include dermal grafts, flap reconstruction, and implant exchange. We present the case of a thin woman with a persistent "step-off" deformity and visible intercostal spaces after mastectomy and two-stage implant reconstruction. Placement of acellular cadaveric dermis (Alloderm) failed to improve the appearance of her chest wall. The authors utilized poly- l -lactic acid (Sculptra) for soft tissue augmentation of her chest wall with significant esthetic improvement. This novel use of poly- l -lactic acid offers a useful alternative to invasive surgical procedures to correct a soft tissue deformity of the chest wall. While poly- l -lactic acid has recently gained popularity for soft tissue augmentation of the face, to date, no reports in the literature exist describing its use in the correction of difficult chest wall defects after mastectomy and implant reconstruction. We maintain that poly- l -lactic acid may also be useful to improve a variety of soft tissue deformities of the breast.     

背阔肌肌皮瓣在前胸部肿瘤切除后皮肤缺损中的应用

目的探讨应用背阔肌肌皮瓣修复前胸部肿瘤切除后皮肤缺损的临床疗效。方法对28例前胸部皮肤肿瘤患者根据其性质切除肿瘤后,按皮肤肌肉缺损面积,设计背阔肌肌皮瓣转移至缺损区修复。结果28例患者相应的局部皮瓣转移修复至缺损区,术后皮瓣均全部成活,供受区切口均Ⅰ期愈合,随访3～24个月,效果满意。结论背阔肌肌皮瓣是临床上修复胸部肿瘤切除后皮肤缺损的实用而有效的方法。     

Chest wall resection and reconstruction for recurrent breast cancer – A multidisciplinary approach

BackgroundDespite therapeutic advances in the management of breast cancer, a significant number of patients present with locoregional recurrence. Treatment with hormonal, chemo or radiotherapy remains standard in such cases. However, in selected patients of recurrent breast cancer involving chest wall, multidisciplinary surgical approach could be considered.MethodsBetween 2010 and 2018, 21 patients with recurrent breast cancer, involving chest wall, were treated at a tertiary care center with resection and reconstruction. The mean age of the patients was 55 years (22–77 years).ResultsThe median interval from first breast resection to chest wall resection (CWR) for recurrent disease was 6 years (1–24 years). Eighteen patients underwent bony resection and 3 patients required extensive soft tissue resection. Complete resection was achieved in 90% of patients. All patients had chest wall reconstruction. There was no in-hospital mortality. During follow-up, 8 patients died, of which 7 were due to distant metastases. The 1 year and 3-year overall survival were 90% (95% CI 66–97) and 61% (95% CI 31–81) respectively. The disease-free survival at 1 and 3 years was the same at 70% (95% CI 45–86). At a mean follow up of 23 months, the average survival in patients operated for local recurrence is 51.7 months (95% CI 37.7–65.7) and 24.5 months (95% CI 7.3–41.7) for patients with distant metastatic recurrence.ConclusionA multidisciplinary oncoplastic approach for recurrent breast cancer, which includes chest wall resection and reconstruction is a useful adjunct in selected group of patients. This improves local disease control, symptoms and possibly disease-free survival.     

Full thickness chest wall reconstruction after tumor resection by myocutaneous flap

Full thickness chest wall defects result when a chest wall tumor resection is necessary. The feasibility of a reconstruction is sometimes unfamiliar to the oncologist or thoracic surgeon; this can be the reason for refusing the possibility of surgical resection or inappropriate coverage of the defect. Our experiences over the last 7 years in collaboration between plastic the thoracic surgical services, shows that it is generally possible to utilize a myocutaneous flap for reconstruction of even extensive full thickness chest wall defects. The reconstruction of any full thickness chest wall defect after tumor resection by myocutaneous flaps is almost always possible with low mortality, acceptable morbidity and good results, mechanically and aesthetically. The experience with the different reconstruction techniques clearly shows the preference for the latissimus dorsi myocutaneous flap, but also emphazises that the other kinds of reconstruction must be kept in mind for special indications.     

Utility of the free deep inferior epigastric perforator flap in chest wall reconstruction

Breast cancer chest wall recurrence is often treated with chemotherapy, radical surgery, and radiation. Extensive chest wall resection requires soft-tissue reconstruction with tissue that provides chest wall stability and durability for additional radiation. Local and regional muscle and musculocutaneous flaps are often used for reconstruction. Free flaps, such as the transverse rectus abdominis musculocutaneous flap, are used for large defects, although donor site morbidity can result. The free deep inferior epigastric perforator (DIEP) flap provides coverage for large defects and may have less donor site morbidity. We describe the use of the free DIEP flap to reconstruct large chest wall defects (mean, 501 cm2 defects) after the resection of recurrent breast cancer in two patients. One patient had 2% flap loss. No donor site morbidity occurred. The free DIEP flap is a durable and reliable flap that provided immediate and complete coverage of these large chest wall defects with no donor site morbidity and did not delay the administration of adjuvant therapy.     

A phase I dose escalation trial of gemcitabine with radiotherapy for breast cancer in the treatment of unresectable chest wall recurrences

The purpose of this study was to determine the maximum tolerated dose (MTD) of gemcitabine when given concurrently with standard radiotherapy for the treatment of chest wall recurrences, and to compare actuarial rates of local-regional control with those achieved in historical controls. Patients with unresectable chest wall recurrences were enrolled in a phase I trial of concurrent gemcitabine and radiotherapy. Gemcitabine was increased at 150 mg/m(2)/week increments, starting at 300 mg/m(2)/week. Radiotherapy was delivered to the chest wall and regional nodes to a total of 60 to 70 Gy in 2 Gy daily fractions. Treatment toxicity was assessed and a comparison of treatment outcome was performed between study patients and historical groups treated with either radiotherapy alone or excision followed by radiotherapy. The dose-limiting toxicities of neutropenia and thrombocytopenia occurred at the second planned dose of 450 mg/m(2)/week after accrual of only six patients, resulting in a MTD of 300 mg/m(2)/week. Myelosuppression and skin desquamation were commonly observed. Actuarial rates of local-regional control were 100%, 50%, and 90% at 2 years for the gemcitabine with radiotherapy, radiotherapy alone, and excision followed by radiotherapy groups, respectively (p = 0.105). The difference among the Kaplan-Meier curves for overall local-regional control was statistically significant at p = 0.007 in favor of combined gemcitabine and radiotherapy. The MTD of gemcitabine is 300 mg/m(2)/week when gemcitabine is delivered concurrently with radiotherapy for unresectable chest wall failures. This novel approach suggests excellent local-regional control when compared to historical controls. A phase II trial is warranted.     

应用邻近扩张皮瓣修复T4期局部晚期乳腺癌术中大面积软组织缺损的临床研究

目的在皮肤累及较大的局部晚期乳腺癌根治术中应用邻近扩张皮瓣修复胸壁大面积缺损,减少术后并发症,降低局部复发率。方法 64例新辅助化疗完全缓解(complete remission,CR)、部分缓解(partial remission,PR)的患者,在新辅助化疗同期行患侧乳房周围皮下扩张器置入术,并持续液压扩张皮肤至化疗结束,行乳腺癌根治术同期取扩张器,推进扩张皮瓣修复创面。37例同期游离植皮修复患者为对照组。结果 64例采用扩张皮瓣的患者术后伤口全部一期愈合,术后放疗未出现皮肤放射性溃疡,随访3年局部复发率明显低于游离植皮组。结论对于新辅助化疗有效的T4期乳腺癌患者,根治术中应用邻近扩张皮瓣修复可减少皮瓣坏死和放射性溃疡的发生,降低局部复发率。