超薄皮瓣和全厚皮片联合体成形治疗四肢大面积皮肤撕脱伤

目的 探讨整合超薄皮瓣和全厚皮片回植治疗四肢大面积皮肤撕脱伤的临床效果.方法 2002年4月至2007年10月应用超皮瓣和全厚皮片联合体成形回植治疗四肢大面积皮肤撕脱伤患者21例.根据皮肤损伤特点和创面情况,将撕脱皮肤自游离缘向蒂部的绝对缺血区、部分缺血区和供血相对正常区分别修剪成皮片区、交界区和超薄皮瓣区,将成形的联合体回植修复创面.结果 本组21例,撕脱皮肤占体表面积2%～6%,平均3.3%,成活皮肤面积占撕脱皮肤90%～100%,平均94.1%,无创面感染,随访12例,一年后回植皮肤质地柔软,无明显挛缩,功能基本恢复.结论 本术式有效地整合超薄皮瓣和全厚皮片移植的优点,最大限度地保存了撕脱皮肤的形态学特点,提高撕脱皮肤成活率,手术简单安全易行.     

Endoscopic harvest of temporoparietal fascial free flaps for coverage of hand wounds

The temporoparietal fascial (TPF) flap is a thin, pliable, and well-vascularized flap that is ideal for reconstructing hand defects. Conventionally harvested flaps, however, result in a large scar over the temporal fossa, which may be problematic in patients with male-pattern baldness. We describe an endoscopic technique for harvesting the TPF flap through a 4-cm preauricular incision to reduce donor site morbidity. Five TPF flaps were used to cover hand wounds. Three of the flaps were successful and there were no injuries to the frontal branch of the facial nerve in this series. Endoscopic harvest of the TPF flap is an ideal solution for covering medium-sized hand defects without potentially prominent scars in the temporal area.     

Functional and aesthetic outcomes of abdominal full-thickness skin grafts in paediatric postburn digital and palmar flexion contractures

The study aimed to assess the functional and aesthetic outcomes of abdominal full-thickness skin grafts (FTSGs) in paediatric postburn digital and palmar flexion contractures. The digital and palmar functions and aesthetics of 50 children who met the criteria were evaluated at pre-operation, the 3rd- and 12th-month post-operation, respectively. In the evaluation, the Vancouver Scar Scale (VSS), total active movement (TAM), and Jebsen–Taylor Hand Function Test (JHFT) were used. The contralateral, unaffected hand served as the criteria for functional recovery. The complications of donor sites were observed, and the take rate of skin grafts was calculated. The VSS scores at the 3rd and 12th months post-operation were lower than those before the operation. The TAM of each finger was improved at the 3rd and 12th months post-operation, compared with that before the operation. There was a significant difference in the time to complete the JHFT between the affected hand and the unaffected at the 3rd month post-operation, but no significant difference between them at the 12th month post-operation. The excellent and good take rate of the skin grafts was 90.00%.No donor site complications were observed. The abdominal FTSGs are effective in repairing paediatric digital and palmar scar contractures, with satisfying functional and aesthetic results, especially in large defects after scar release and resection.     

Complications of skin grafts and pedicle flaps

Skin coverage complications of hand wounds can be divided into two categories: those associated with problems of the wound bed itself and those associated with failure of the skin graft or flap coverage. Wound problems generally are the result of inadequate preparation, infection, or excess scarring due to a long interval between injury and time of coverage. If the wound is adequately debrided, removing all devitalized tissue or tissue colonized with bacteria, coverage can usually be undertaken no later than 3 days after injury. Injuries that result in loss of skin only are best treated with skin grafts. If the bed is well vascularized, complications generally are only mechanical ones, either establishment of a barrier such as hematoma between the bed and the graft, or shearing forces tearing the graft from the bed. Skin flaps carry their own blood supply so they are not generally subject to those kinds of complications; but they are dependent upon continuation of adequate circulation until vascularization takes place. Because they are much thicker than grafts, this is a slower process, and the flap is vulnerable to problems of kinking or tension of the base. Careful attention must be paid to prevention of these problems, especially in the first few days. Axial flaps are preferable to random ones, but any flap must be carefully planned in order to assure adequate vascular perfusion and minimal tension.     

Endoscopic-assisted harvest of the temporoparietal fascial flap

Elevation of the temporoparietal fascial flap by conventional T or Y incisions in the temporal region frequently leaves conspicuous scarring, hair thinning, or baldness. To avoid such undesirable effects, endoscopic-assisted harvest of the temporoparietal fascial flap was performed in 9 patients with microtia. Through two horizontal incisions in the temporal region, the temporoparietal fascia was dissected, and the flap was harvested using bipolar scissors and coagulating shears. Flaps were dissected and harvested successfully without any complications in 7 patients, although extra incisions were required to facilitate coagulation in 2 patients. The authors introduce this harvesting technique and describe some representative cases. Using endoscopic guidance, this is a versatile, safe procedure with minimal morbidity, and is applicable to other reconstructive procedures that require a temporoparietal fascial flap, including the free flap.     

Closing the gap: skin grafts and flaps

Wounds occur via a multitude of causal mechanisms, and vary greatly in their nature. Therefore, reconstructing such defects requires meticulous consideration of the patient and wound. Conservative measures are sometimes sufficient for healing, but some wounds will benefit from surgical reconstruction. Knowledge of the human vascular network, in particular within the fascia, subcutaneous tissue and skin, permits an understanding of the use of one’s own tissue to help heal another body site. Skin grafts are simple thin sections of tissue that lack their own blood supply, and are transferred from one site on the body to another. Flaps, however, are composite blocks of tissue that contain their own blood supply and can be moved locally, regionally, distantly or freely to the desired site. This article reviews the use of skin grafts and flaps in aiding wound closure.     

指动脉穿支筋膜瓣联合人工真皮Ⅰ期修复手指背侧皮肤缺损

目的：探讨指动脉穿支筋膜瓣联合人工真皮Ⅰ期修复手指中节背侧皮肤缺损的临床疗效。方法：自2019年1月至2020年5月对21例27指中节背侧皮肤缺损的患者采用指动脉穿支筋膜瓣联合人工真皮Ⅰ期进行修复,均为急诊病例,均伴有骨肌腱外露及骨膜、肌腱膜缺损。其中男11例,女10例;年龄18～66(39.00±8.01)岁;示指10指,中指9指,环指8指;皮肤缺损面积为（2.5～3.5） cm×（1.5～3.0） cm,骨肌腱外露面积（1.5～2.0） cm×（1.0～2.0） cm,伤后就诊时间1～6 h,受伤至手术时间3～8 h。观察术后创面愈合情况,并采用中华医学会手外科学会上肢部分功能评定试用标准进行临床疗效评价。结果：所有患者获得随访,时间6～12(9.66±1.05)个月。手术时间45～60 min。26指术后4～6周后创面完全愈合,1指创面感染,真皮未完全上皮化,经过创面换药,8周后达到创面愈合。所有指体外观饱满、瘢痕小,愈合创面平于周围皮肤,与周围皮肤色泽质地相近,耐磨性、柔韧性良好,手指活动度正常。按照中华医学会手外科学会上肢部分功能评定试用标准评定,本组总分72～100分;优2...     

Retroauricular full-thickness skin grafts in syndactyly repair: outcome and comparison with inguinal full-thickness skin grafts: retrospective (cross-sectional) study

Objective: Most surgeons recommend the use of full-thickness skin grafts for syndactyly repair. Common donor sites include the groin and elbow, but only one publication has previously mentioned retroauricular skin. No publication has compared the results for full-thickness skin grafts between retroauricular and other donor sites. This study aims at comparing functional and aesthetic outcomes and parents’ satisfaction with retroauricular vs inguinal full-thickness skin grafts. Methods: Eleven children with retroauricular and 15 with inguinal full-thickness skin grafts were included in this retrospective study. Examination included the Patient and Observer Scar Assessment Scale, parent satisfaction, and a colour match measurement. Results: Both pigmentation match and parents’ overall impression of the donor site were significantly better for retroauricular than for inguinal full-thickness skin grafts. Conclusion: Due to the excellent pigmentation match and the inconspicuousness of the donor site, this study recommends the use of retroauricular full-thickness skin grafts for syndactyly repair.     

The anatomy of the skin and fascial layers of the face in aesthetic surgery

The superficial musculo-aponeurotic system (SMAS) has been described as a discrete fascial layer that divides the subcutaneous fat into two distinct layers. The authors discuss the anatomic significance of this system in facial aesthetic surgery.     

Free temporoparietal fascial flap for coverage of a large palmar forearm wound after hand replantation

A free temporoparietal fascial flap with a split-thickness skin graft was used to cover a large palmar forearm wound in a patient whose hand had been replanted 21 days earlier after traumatic amputation at the distal forearm level. At a 39-month follow-up, the patient had achieved an excellent cosmetic and functional result, with no alopecia or facial nerve injury. The flap is advantageous for coverage of wounds that require a large amount of thin, pliable tissue, and it leaves a concealed donor-site scar.