乳头乳晕色素性病变切除的修复

目的探讨去除病变组织同时修复乳头乳晕组织缺损的方法.方法根据乳头缺损的范围,选择乳晕组织瓣,采用逆行设计法对缺损面积准确估计后,皮瓣按常规设计超出缺损面积的10%,使之旋转达乳头缺损区,局部推进皮瓣修复创面.结果本组10例患者,其中6例乳头乳晕均有部分色素痣,4例仅乳晕有色素痣.选用两个皮瓣进行修复,术后两侧对称,功能良好,效果满意.结论本方法可有效切除病变的同时,保持良好的外形,并保留乳头勃起功能.     

A-T皮瓣在修复面部皮肤缺损中的应用

目的评价应用A-T皮瓣修复面部皮肤缺损的效果。方法自1998年以来，应用A-T皮瓣修复面部色素痣、瘢痕、基底细胞癌等切除后皮肤缺损的患者158例，术中将病变组织行圆形或椭圆形切除，再修整成三角形缺损。于缺损邻近处设计、形成A-T皮瓣，将缺损两侧的皮肤向中间推进闭合缺损。结果皮瓣全部成活，切口期愈合，美容效果满意。结论应用A-T皮瓣修复面部皮肤缺损其方法简单易行，效果可靠。     

应用改良A-T皮瓣修复颜面部皮肤缺损

目的:评价应用改良A-T皮瓣修复颜面皮肤软组织缺损的效果。方法:2010年1月-2015年12月,笔者应用改良A-T皮瓣修复颜面色素痣、瘢痕、体表肿瘤等切除后缺损患者48例,术中将病变组织行五边形切除,于缺损邻近处设计改良A-T皮瓣,将A-T皮瓣推进修复缺损。结果:皮瓣全部成活,切口一期愈合,形态满意。结论:改良A-T皮瓣是修复颜面皮肤软组织缺损的较佳选择,其操作简便。     

局部皮瓣在眼周美容整形中的应用

眼部周围(以下简称眼周)的皮肤组织因外伤及瘢痕、肿瘤、色素痣切除后形成的较大面积的缺损难以直接缝合,而应用局部皮瓣转移修复缺损创面是较好的手术方法。自1999年12月至2005年10月,笔者应用局部皮瓣转移修复眼周皮肤组织缺损患者42例,均取得了较好效果。现报道如下。1临床资料本组共42例患者,男性17例,女性25例,年龄10~55岁。上睑色素痣9例,下睑色素痣8例;眉上体表肿瘤5例,下睑体表肿瘤3例;上、下睑外伤缺损各3例;眉上瘢痕4例,眉下瘢痕4例;下睑外翻6例。组织缺损面积0.8cm×1.3cm~1.5cm×2.2cm。均应用眼周不同的局部皮瓣转移修复缺损创…     

应用菱形皮瓣修复皮肤缺损

目的：评价应用菱形皮瓣修复皮肤软组织缺损的效果。方法：2005年1月～2010年12月,我们应用菱形皮瓣修复色素痣、瘢痕、体表肿瘤等切除后缺损患者46例,术中将病变组织行圆形或椭圆形切除,于缺损邻近处设计菱形皮瓣,将菱形皮瓣转移修复缺损,供区直接缝合。结果：皮瓣全部成活,切口Ⅰ期愈合,形态满意。结论：菱形皮瓣是修复皮肤软组织缺损理想的选择,其效果满意,方法简便。     

A-T皮瓣在修复面部皮肤缺损中的应用

目的评价应用A-T皮瓣修复面部皮肤缺损的效果.方法自1998年以来,应用A-T皮瓣修复面部色素痣、瘢痕、基底细胞癌等切除后皮肤缺损的患者158例,术中将病变组织行圆形或椭圆形切除,再修整成三角形缺损,于缺损邻近处设计、形成A-T皮瓣,将缺损两侧的皮肤向中间推进闭合缺损.结果皮瓣全部成活,切口Ⅰ期愈合,美容效果满意.结论应用A-T皮瓣修复面部皮肤缺损其方法简单易行,效果可靠.     

“双风筝”皮瓣在面部皮肤缺损修复中的应用

面部中小面积的全层皮肤缺损,常用的修复方法有皮片移植、局部皮瓣和远位皮瓣移植,因面部是人体的外露部位,美学要求高,选择一种修复后瘢痕不明显、色素沉着轻、肤色接近于正常组织的方法最为理想。自2002年12月以来,我们应用“双风筝”皮下蒂皮瓣修复面部因色素痣、基底细胞癌、鳞癌和瘢痕等病变切除后造成的皮肤缺损18例,效果满意,报告如下。     

相似形改良旋转皮瓣的临床应用体会

目的 探讨相似形改良旋转皮瓣修复外伤创伤、褥疮、肿物切除术等原因导致的皮肤缺损的效果.方法 自2014年3月至2019年5月,哈尔滨医科大学附属第四医院整形美容科收治因头面部外伤、褥疮、色素痣、肿物切除后导致皮肤缺损的27例(缺损27处)患者,采用相似形改良旋转皮瓣修复,术中彻底切除病变组织后,设计相似形改良旋转皮瓣,...     

局部皮瓣在眼周美容整形中的应用

眼部周围（以下简称眼周）的皮肤组织因外伤及瘢痕、肿瘤、色素痣切除后形成的较大面积的缺损难以直接缝合，而应用局部皮瓣转移修复缺损创面是较好的手术方法。自1999年12月至2005年10月，笔者应用局部皮瓣转移修复眼周皮肤组织缺损患者42例，均取得了较好效果。现报道如下。     

双皮瓣修复鼻部皮肤缺损

自1995年8月以来,我们用双皮瓣法,修复鼻部病变切除后的皮肤软组织缺损6例,获得满意效果。1 临床资料本组6例。男2例,女4例。年龄40～47岁。病变均位于鼻中下、侧部。乳头状瘤1例、色素痣3例、基底细胞癌2例。额鼻皮瓣联合应用鼻唇沟皮瓣4例,面颊皮瓣2例。病变切除后,最大缺损面积4cm×3cm,最小2cm×1.5cm。基底细胞癌切缘病理检查阴性。2 手术方法首先在缺损的上部设计一个额鼻皮瓣,皮瓣的轴     

Simultaneous Nipple and Areola Reconstruction: A Review of 50 Cases

Nipple areola complex reconstruction has historically been a staged procedure, the nipple being reconstructed first by graft or local flap techniques and the areola on a later procedure to gain colour. This paper presents a one-stage combined reconstruction procedure using a local flap and immediate areola tattoo: it presents the advantage of reducing the total number of needed procedures and subsequently diminishes the total time needed to obtain a complete result. In this series of 50 consecutive combined procedures with a mean follow-up of ten months, no necrosis of reconstructed nipple was observed and a total of six patients needed minor revision surgery to correct nipple projection or fading of the tattoo. No local infection or wound complications were observed, underlying the safety of the procedure. Patient satisfaction and compliance were good because the procedure is fast and easy with minimal morbidity.     

Simultaneous nipple and areola reconstruction: a review of 50 cases

Nipple areola complex reconstruction has historically been a staged procedure, the nipple being reconstructed first by graft or local flap techniques and the areola on a later procedure to gain colour. This paper presents a one-stage combined reconstruction procedure using a local flap and immediate areola tattoo: it presents the advantage of reducing the total number of needed procedures and subsequently diminishes the total time needed to obtain a complete result. In this series of 50 consecutive combined procedures with a mean follow-up of ten months, no necrosis of reconstructed nipple was observed and a total of six patients needed minor revision surgery to correct nipple projection or fading of the tattoo. No local infection or wound complications were observed, underlying the safety of the procedure. Patient satisfaction and compliance were good because the procedure is fast and easy with minimal morbidity.     

乳房下垂伴小乳房的综合修复术

目的 探讨针对不同程度乳房下垂伴小乳房综合修复治疗的有效手术方法.方法 根据乳房下垂的轻重进行分度,针对不同的分度进行治疗.Ⅰ度下垂伴小乳房,应用胸大肌后间隙置入假体隆胸;Ⅱ度下垂伴小乳房,在Ⅰ度下垂治疗的基础上应用深层乳腺与胸大肌表面脱套剥离及乳腺组织悬吊固定;Ⅲ度下垂伴小乳房,在Ⅱ度下垂治疗的基础上结合双环法多余皮肤切除、深层乳腺与胸大肌表面脱套剥离及乳腺组织悬吊固定;Ⅳ度下垂伴小乳房,应用直线瘢痕法乳房悬吊结合假体隆乳.结果 综合修复治疗乳房下垂伴小乳房116例,无血肿、无感染、无乳头乳晕坏死等并发症发生.术后随访6～31个月,平均随访时间13.3个月,乳房丰满挺拔,乳房下垂得到矫正,乳头乳晕感觉功能正常.结论 针对乳房下垂伴小乳房的不同情况,应用规范化的手术方案可取得较好的临床治疗效果.     

下蒂瓣法乳房缩小整形术的效果

目的:探讨下蒂瓣法乳房缩小整形术治疗中重度乳房肥大症的方法及效果。方法:2010年1月至2019年12月,南京医科大学附属妇产医院整形外科对19例女性患者(年龄18~54岁,平均36.2岁)38侧肥大乳房,以Robbins的垂直下蒂瓣术式为基础,结合乳房血供、神经等解剖学进展,进行乳晕设计、下蒂瓣位置等改进。结果:19...     

Algorithm for an Aesthetically Pleasing Nipple–Areola Complex with the Use of the C-V Flap in Cases of Skin-Sparing Mastectomy and Immediate Reconstruction

Background  This article provides an algorithm for achieving an aesthetically pleasing nipple–areola complex in cases of skin-sparing mastectomy and immediate reconstruction Methods  If the contralateral nipple was big enough and the nipple-sharing technique could be used in the future for reconstruction, we left a round skin paddle at the time of the skin-sparing mastectomy and immediate flap reconstruction. The diameter of the round skin paddle was approximately the same as the contralateral areola. For nipple reconstruction we placed the graft from the contralateral nipple in the middle of the aforementioned skin paddle. If the contralateral nipple was not sufficiently large for use as a donor, then the C-V flap was used for nipple reconstruction. In these cases we deliberately left an oval skin paddle when the skin-sparing mastectomy and immediate flap reconstruction were performed. The short diameter of the oval skin paddle was approximately the same as the diameter of the contralateral areola. The position and the height of the C-V flap were marked in order to transform the oval skin paddle to a round one when the donor site of the C-V flap was closed. Results  Following this algorithm an optical illusion of a nipple–areola complex that is similar to the contralateral normal one is created. Conclusion  From our experience this algorithm can help create an aesthetically pleasing nipple–areola complex and also provides a ready pattern to our tattoing experts for the dermatography of the nipple–areola complex.     

Paget's disease of the breast areola mimicking cutaneous melanoma

Paget's disease of the breast nipple and areola complex represents a cutaneous manifestation of an underlying breast malignancy. The typical skin changes characteristic of breast Paget's disease are usually easily distinguished from those found of malignant melanoma. The rare finding of a pigmented cutaneous breast lesion mimicking melanoma presents a diagnostic dilemma. This case presentation describes a pigmented mammary lesion involving the areola that had undergone changes in diameter and pigmentation. The lesion was not associated with nipple drainage, nipple excoriation, dermal ulceration, or a palpable breast mass. The areola lesion was highly suggestive of a dermatologic malignancy such as malignant melanoma. As such, a biopsy was performed with initial findings suggestive of cutaneous melanoma. Upon more detailed analysis of a larger excision specimen, immunohistochemical staining was highly supportive of the diagnosis of breast Paget's disease. A total mastectomy with sentinel lymph node evaluation was performed along with immediate reconstruction. The final pathology revealed a small focus of ductal carcinoma in situ of the breast associated with the areola changes. Histologic and immunohistochemical analysis of a biopsy specimen were paramount in differentiating these two lesions.     

双新月形乳晕瓣结合乳腺组织瓣矫治重度乳头内陷

目的：探索一种效果持久且美容效果良好的矫治重度乳头内陷的方法。方法：彻底松解乳头下引起乳头内陷的纤维束和部分缩短的乳腺导管,移植乳腺组织瓣填充乳头下的空隙。设计上下两个新月形乳晕瓣旋转缝合至乳头颈部,增加乳头颈高度并使乳头挺立、饱满。结果：2001年3月至2008年5月共矫治43例72侧重度乳头内陷患者,经随访6个月～2年,效果持久,无一例复发,远期乳头感觉及勃起功能正常,乳头外形良好,切口痕迹不显。结论：双新月形乳晕瓣加强乳头颈部结合乳腺组织瓣填充原乳头下空隙是矫治重度乳头内陷的较为理想的方法,值得临床推广。     

Immediate reconstruction of the nipple/areola complex in oncoplastic surgery after central quadrantectomy

BACKGROUND: Oncoplastic surgery adds valuable techniques for breast-conservation therapy that allows for wide excisions and prevents breast deformities. However, no such technique has addressed loss of the nipple/areola complex (NAC) after central lumpectomy. We present a simple and effective technique for immediate reconstruction of the NAC after such loss due to tumorectomy. METHODS: After central tumorectomy, a local tissue flap is created above the defect to restore the nipple. Then the neonipple is carried on a superior-based, dermoglandular pedicle to its new position, similar to breast reduction surgery. The operation is continued with resection of redundant tissue lateral to the pedicle for optimal breast shape. From the discarded breast tissue, a full-thickness skin graft is harvested and used to reconstruct the areola. The contralateral breast is treated with a usual mammaplasty and tailored to the specific needs of the opposite side. RESULTS: Nine patients with central tumors of the breast were treated in this fashion at our institution. In all patients, the aesthetic result was good to excellent. In 1 patient, there was delayed wound healing of the full-thickness skin graft for the areola, which healed by secondary intention. CONCLUSION: The presented technique is easily achieved and produced excellent results after breast-conservation surgery. It will expand the armamentarium of oncoplastic surgery to meet central defects with loss of the nipple/areola complex.     

Nipple reconstruction in Asian females using banked cartilage graft and modified top hat flap.

Nipple reconstruction is usually the final stage of breast reconstruction and there are over 50 articles that describe different techniques. The majority of methods use local soft tissue as local flaps but they face the disadvantage of reduction in nipple projection after the initial two months. This is particularly troublesome in Asian females who may have wider nipples with prominent projection but small areola surface area. We developed a method to correct this problem using cartilage graft harvested during the initial breast reconstruction operation and banked beneath the skin flap. Using the modified 'top hat' flap, we found that no excess soft tissue is required to compensate for the reduction. We have used this method in 25 cases of nipple reconstruction and have obtained satisfactory result in projection.     

皮瓣充填加乳头短期持续牵引治疗重度乳头内陷

目的：探索一种效果持久、不易复发、对乳腺导管损伤比较轻的治疗重度乳头内陷的方法。方法：在凹陷乳头两侧乳晕内设计制作去表皮真皮组织瓣,乳头基底部钝性分离贯通,直视下钝性松解条索,不剪断乳腺导管,真皮组织充填支撑乳头基底。用七号注射器针头贯穿乳头基底部,乳晕处用纱布垫付,持续牵引乳头2周。结果：2005年～2009年8月采用此方法共治疗26例重度乳头内陷的患者,效果满意,乳头形态正常,感觉良好,哺乳正常。结论：采用真皮组织瓣充填支撑加乳头持续牵引是治疗重度乳头内陷的可靠方法,可有效防止术后复发。术中不剪断乳腺导管,尽量保持了术后哺乳功能。手术加牵引可缩短牵引治疗时间,用纱布块衬垫作牵引装置简便,舒适,实用。