小腿前外侧的皮瓣及筋膜瓣的临床应用

目的介绍小腿前外侧的皮瓣筋膜瓣的应用解剖、手术方式、方法及临床应用。方法在14侧成人下肢标本及1条断腿上,观察了腓浅血管的起始部位、行程及皮支的分布情况,设计了小腿前外侧组织瓣的4种术式。1988年以来,临床应用26例。结果术后皮瓣筋膜瓣全部成活,切口Ⅰ期愈合23例,Ⅱ期愈合3例,20例随访4个月到5年,情况稳定良好,无复发。结论手术操作简单、安全可靠,对供区影响小,是修复小腿及对侧踝及跟部后方创面及治疗胫骨慢性骨髓炎的一种可供选用的方法。     

蒂部潜移法增加V-Y筋膜皮瓣的推进距离

目的:为修复上肢中小创面提供一种V-Y推进皮瓣。方法:在邻近创面的健康皮肤,依纵行的筋膜皮下血管丛方向设计V-Y筋膜皮瓣,通过对蒂部在深筋膜下间隙及皮下疏松组织中不同层次的潜行分离,既增加了皮瓣的推进距离,又不影响皮瓣的血供基础。结果:临床修复上肢创面6例,皮瓣面积为3cm×4cm~5cm×8cm,推进距离2.5cm~5.0cm,均完全成活。结论:皮瓣蒂部潜移法能安全有效地增加V-Y筋膜皮瓣的推进距离,是修复中小面积创面的较好方法。     

Experience with the forearm septofascial flap

Summary Fascia has a well vascularized surface, and when it is covered with a split skin graft, it provides the thinnest possible flap. The authors present their own experience with the use of the forearm septofascial flap in 23 patients. A free septofascial flap was used in 15 patients and an island flap in 8 patients. Seven days later, only 25% of the patients had complete take of the split skin graft, while in 60% of the cases, there was only partial take of the graft. The results at 6 months, regarding appearance of the flap and donor site, were good. In 2 patients, a composite osteofascial flap was used for reconstruction of the mandible. In those patients, the viability of the bone was assessed with scintigraphy. There were no significant complications with the donor site. The forearm septofascial flap proved to be a good and reliable method of reconstruction in those parts of the body where thin cover was required. Constant anatomy and minimal postoperative complications are great advantages of the forearm septofascial flap when compared with other fascial flaps.     

Distally-based superficial sural flap: Advantages of the adipofascial over the fasciocutaneous flap

Abstract

The distally-based superficial sural flap has proved to be an easy and reliable method of reconstruction in soft tissue cover of the distal third part of the leg. There are two ways to prepare this flap: as a fasciocutaneous flap, which includes the fascia with the subcutaneous tissue including the skin; or as an adipofascial flap, which is made up of both the fascia and the subcutaneous adipose tissue. In the latter case, the flap is covered with a partial thickness skin graft either immediately after or at a later stage. The aim of this study was to assess the advantages and disadvantages of the two flaps. The adipofascial flap seems to be better, as it is associated with less donor site morbidity, improved quality of reconstruction, and fewer complications.     

皮神经营养血管组织瓣的临床应用原则与命名

目的 探讨皮神经营养血管组织瓣的临床应用原则，并提出新的命名方法。方法 总结皮神经营养血管组织瓣的解剖研究和临床经验。结果 皮神经多与皮静脉伴行，在其周围均存在丰富的链式吻合血管丛，显著增加了这类组织瓣的血供。临床以远端(31例)或近端(3例)为蒂，在前臂(26例)和小腿(8例)切取带皮神经和皮静脉营养血管的岛状筋膜皮瓣(20例)和筋膜皮下组织瓣(14例)共34例，长宽比例2．7～5．1：1，平均3．5：1，完全成活。结论 带皮神经营养血管的组织瓣是传统筋膜皮瓣和筋膜皮下组织瓣的特殊范例，临床应用应遵循一定的原则。     

Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes

Study aims

To report the surgical anatomy of the perforator arteries at the lower leg, analyse clinical outcomes in previous studies, and forward methodological recommendations for future studies of post-traumatic perforator flap reconstructions.

Methods

A study sample of 640 human patients drawn from 24 clinical reports was included for review. The sample comprised of four subsets: sural flap reconstructions (n = 257), saphenous flaps (n = 122), supramalleolar flaps (n = 92), and propeller flaps (n = 169).

Results

Statistical analysis of samples from anatomical studies documents significant differences in the perforator distribution from the tibial and peroneal artery; peroneal perforator arteries are randomly organised whereas tibial artery perforators are clustered at three definite levels. The failure rates in clinical studies ranged from 0% to 6%, being lowest for supramalleolar flap reconstructions and highest for saphenous flaps; however, differences between the four subsets were not statistically significant at the 95% confidence level. Due to methodological flaws, outcome comparisons in the actual study sample should be interpreted cautiously; in most clinical studies both risk variables and outcome indicators are poorly defined. The outcome of Dynamic Infrared Thermography imaging of post-transposition changes of flap perfusion is reported.

Summary

Fasciocutaneous perforator flaps seem to have high survival rates and represent a feasible approach to post-traumatic reconstructions, especially in low-resource settings. A template for data gathering is recommended for higher accuracy in future comparative studies, and for scientific analysis of success and risk factors. New imaging techniques indicate a promising potential of micro-circular angiogenesis during the first two weeks after flap transpose.     

Deltopectoral flap revisited: Role of the extended flap in reconstruction of the head and neck

The extended deltopectoral flap is still the best choice in selected cases. During the period 1987-2004, 34 patients required reconstruction of the head and neck using this flap. Twenty-nine had had one or more failed attempts at microsurgical reconstruction after excision of cancer. Five were treated primarily. The flap was divided at least three weeks after the primary operation. All 34 survived, and there were no donor site complications. Twenty-seven patients had an uncomplicated outcome, but the remaining seven required later closure or skin grafting, usually under local anaesthesia, for complications. The extended deltopectoral flap has been used successfully to provide stable coverage of defects in the head and neck and should remain in the armamentarium of reconstructive microsurgeons.     

Regional first web flap used to cover the amputated stump of the thumb

Abstract

The regional first web flap is a distally-based flap that is raised from the radiodorsal aspect of the metacarpophalangeal joint of the index finger towards the dorsal first web, and used to cover a thumb amputation. The advantage of this flap over the conventional cross-finger flap is that is gives a thicker and hairless flap with no skin graft to the donor site. Mobilisation of the joints, including the metacarpophalangeal joint of the index finger, can also be maintained during the immobilisation period between two stages.     

带蒂组织瓣转移手术修复肢体软组织缺损35例分析

目的　分析带蒂组织瓣转移手术修复肢体软组织缺损创面的疗效。方法　选择肌瓣、岛状皮瓣、岛状肌皮瓣转移 ,直接修复缺损或转移肌瓣表面植皮覆盖。结果　 2 9例慢性骨髓炎和 6例外伤后软组织缺损创面 ,肌瓣、岛状皮瓣、岛状肌皮瓣转移修复疗效满意。结论　带有营养血管的肌瓣、皮瓣肌皮瓣转移手术 ,一期修复肢体创伤、骨髓炎等所致的骨缺损腔及软组织缺损创面 ,效果好 ,因不需吻合血管 ,手术相对简单 ,临床使用安全。     

带膝上外侧动脉蒂逆行股前外侧岛状皮瓣和肌皮瓣临床应用

目的：报道带膝上外侧动脉蒂逆行股前外侧皮瓣修复膝关节周围组织缺损的结果。方法：应用股前外侧皮瓣和肌皮瓣逆行转移修复膝关节周围缺损，该皮瓣以膝上外侧动脉为蒂，通过膝上外则动脉与旋股外侧动脉降支之间的吻合支营养股前外侧皮瓣，血供丰富。皮瓣大小１２～１５ｃｍ×３～７ｃｍ，供区均原位缝合，结果：修复膝关节周围缺损４例，小腿淋巴水肿桥接淋巴通道１例，皮瓣均成活。术后外形及功能恢复良好。结论：作者认为该皮瓣是膝关节周围组织缺损修复较为理想的方法。     

分叶型穿支皮瓣在四肢皮肤软组织缺损修复中的临床应用

目的 探讨多个同源穿支血管为蒂的分叶型穿支皮瓣游离移植修复四肢不规则软组织缺损的临床疗效. 方法 2009年9月至2012年12月,我科采用吻合一组血管的分叶型穿支皮瓣游离移植修复四肢不规则创面15例.其中,股前外侧分叶穿支皮瓣10例、骨间后动脉分叶穿支皮瓣3例、腓肠内侧动脉分叶穿支皮瓣2例;双叶型皮瓣12例,三叶型皮瓣3例;皮瓣单叶切取面积2.5 cm×2.0 cm～15 cm×8.0 cm.所有皮瓣供区创面均一期缝合关闭. 结果 13例皮瓣顺利成活,2例各有一叶皮瓣部分坏死,经二期植皮可覆盖残留创面.术后随访3～15个月,皮瓣面积无明显回缩,色泽与受区相似,供区瘢痕挛缩不明显. 结论 由同一源血管供养的分叶型穿支皮瓣血供可靠,能一次性覆盖肢体相邻的多个创面;同时,通过皮瓣各叶间的不同组合,它又能把长条状皮瓣变为各种形状,特别适合于四肢不规则创面的修复重建.     

Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction

Background  The process of reconstruction of tracheal defects is complex and still not optimum. Options range from using staged reconstructions, combining flaps with autologous or alloplastic implants, as well as use of tissue-engineered constructs combined with vascularized tissues which are lined with cell cultures. Staged reconstructions using prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex structure. Prefabricating the flap at a different site allows for integration of the tissues prior to its transfer. Method  This article reports two patients planned for tracheal reconstruction for the purpose of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated with buccal mucosa, was performed. However, in the latter case, an intraoperative decision by the head and neck team to limit excision of the trachea sparing the mucosa was taken; the reconstruct in the forearm was redundant and needed to be discarded, replacing the defect with a free superficial circumflex iliac artery perforator (SCIP) flap. Result  At 3 years follow-up, both the patients are free of disease, with the construct serving its purpose in the older female.     

Making the V-Y advancement flap safer in fingertip amputations

Amputation of the fingertip is a common injury of the upper extremity. Over the years, a variety of reconstructive techniques have been described. For dorsal oblique and transverse amputations, the Atasoy V-Y advancement flap is a popular choice because it preserves finger length, sensation and function. However, closure under tension remains a problem, putting the flap at risk of partial or full necrosis. To avoid this untoward complication, the classic V-Y advancement technique has been modified to allow for a tension-free closure.     

A pedicled anterolateral thigh flap for abdominal reconstruction after previous degloving injury of the donor site: Revascularisation of the donor site

A pedicled anterolateral thigh flap was used to reconstruct an abdominal defect after traumatic degloving of the entire skin of the right upper leg two-and-a-half years earlier. There are few reports about revascularisation of skin flaps after previous interruption of the blood supply. As far as I know this is the first report of a revascularised (anterolateral thigh) perforator flap.     

皮瓣延迟后对皮瓣预制时间影响的实验研究

为了探寻缩短皮瓣预制时间的新方法，作者设计了两组皮瓣预制方法进行比较。Ａ组为皮瓣延迟实验组，Ｂ组为正常皮瓣预制对照组。皮瓣预制后２周进行血管灌注检查和皮瓣移植。结果：Ａ组皮瓣成活范围大，植入血管与原皮瓣之间血管吻合支多；Ｂ组皮瓣成活面积小，血管网形成范围小，吻合支少。结论：皮瓣延迟后皮瓣预制时间可大大缩短，从而缩短了手术周期。     

The occipito-parietal flap method in the treatment of male baldness

Which hair transplant technique to use for correcting male baldness is decided on by the type of baldness, the condition and direction of the donor's hair, and the favored hairstyle. In the occipital-parietal flap technique presented here, a flap is raised on one side of the occipital part. The flap is 4 cm wide and stretches toward the lower part of the parietal. After a week's delay, the flap is transplanted from the top of the head to the frontal part under general anesthesia. Light pressure is applied to the transferred flap with a tie-over dressing. With this technique the hair grows downward and covers both the front and top parts of the head. It is important to choose a case for which this type of procedure is appropriate. The authors' technique can be applied to types IV, V and Va of Norwood's classification.     

静脉皮瓣的临床应用研究

临床应用静脉皮瓣6例共7块修复四肢组织缺损,完全成活6块,1块表皮及部分真皮坏死,最大成活皮瓣的面积为5cm×15cm。提出临床应用静脉皮瓣的原则及应注意的事项,