O-Z皮瓣在头皮肿瘤切除后创面缺损修复中的应用

目的评价O-Z皮瓣修复头皮肿瘤切除后创面缺损的效果。方法将头皮肿瘤作圆形或椭圆形切除,根据创面的大小、部位及其周围头皮的松动性和毛发分布情况,在创面左右侧或前后方形成两个方向相反的旋转皮瓣,并将其相向旋转将创面封闭。结果28例中,创面面积最小为3 cm×4 cm, 最大为6 cm×6 cm。术后皮瓣全部成活,无并发症发生。其中16例随访3～12个月,头皮形态良好,未见肿瘤复发。结论O-Z皮瓣可有效地修复面积小于6 cm×6 cm的头皮肿瘤切除后的创面缺损,并可获得满意的美容效果。     

局部任意皮瓣修复头皮缺损的临床分析

目的探讨局部任意皮瓣修复头皮缺损的临床效果。方法 2011年1月—2016年1月23例头皮任意瓣膜修复手术患者均来自我院皮肤科门诊,术后随访3~12个月,观察皮损恢复情况及皮瓣部毛发生长情况。结果23例患者术后皮瓣成活率100%,无皮瓣坏死、切口感染等术后并发症。其中1例患者出现小面积皮瓣边缘发黑结痂,经过多次换药后二期愈合。1例患者术后出现头皮下小面积积液囊肿,经积极抽取积液进行封闭注射治疗后痊愈。术后随访3~12个月,皮瓣部分毛发生长正常,切口无瘢痕增生,且皮损无复发。结论头皮皮损切除后创面修复是皮肤外科的常见问题,临床处理方法有所不同,局部任意皮瓣修复头皮缺损是直径在6 cm以内的头皮缺损的常用方法[1],且具有外形美观,皮损切除和创面修复1次完成,皮损无复发的理想方法。     

“门轴样”瘢痕修薄皮瓣修复耳轮瘢痕疙瘩创面的应用

目的:“门轴样”瘢痕修薄皮瓣在耳轮瘢痕疙瘩切除后缺损修复的临床效果。方法:选取我科2018年8月至2021年12月耳轮瘢痕疙瘩14例，均采用“门轴样”瘢痕修薄皮瓣修复切除后创面，缝合后将切口线置于耳廓凸面，观察患者愈合情况及耳廓外形，评价其疗效。结果:术后14例患者皮瓣均成活，切口为Ⅰ期愈合。耳正面观未见切口线，切口线隐蔽，耳廓外形美观。未见继发缺损，耳廓未见变形。结论:“门轴样”瘢痕修薄皮瓣修复耳轮瘢痕疙瘩切口隐蔽，耳廓外形美观。     

几何分割法治疗头皮大面积圆形缺损

目的探讨治疗头皮大面积圆形缺损的手术方法。方法采用几何分割法将圆形缺损分为几个类矩形缺损,应用扩张皮瓣转移修复头皮圆形大面积缺损。结果7例头皮大面积圆形缺损患者,术后均取得满意疗效,局部外形及毛发分布良好。结论采取几何分割法应用扩张皮瓣修复大面积圆形缺损是1种较为理想的手术方法。     

头皮扩张术治疗大面积瘢痕性秃发2例

目的总结头皮扩张术治疗大面积瘢痕性秃发的临床经验。方法 2014年7月—2014年12月,应用皮肤软组织扩张术治疗因头皮烫伤愈合遗留的大面积瘢痕性秃发2例。根据秃发及正常头皮的面积选择扩张器大小,将扩张器置入帽状腱膜下,放置引流管,7 d后开始向扩张囊注液,注液总量据瘢痕秃发面积而定,一般修复1 cm2头皮,需要注水4 m L。行扩张器取出、瘢痕秃发切除、头皮皮瓣转移术。结果临床治疗2例大面积瘢痕性秃发病人,均取得满意效果。结论皮肤软组织扩张术是修复大面积瘢痕性秃发的理想方法。     

应用头皮扩张术修复瘢痕性秃发

头部烧伤、烫伤、创伤、头皮局部感染或头皮肿瘤常导致瘢痕性秃发，大面积的瘢痕性秃发治疗上通常比较困难。头皮组织扩张术是将皮肤软组织扩张器埋植于正常头皮组织下方，经过一定时间的扩张后增加了正常头皮的面积，再将其设计成各种皮瓣的方式用于覆盖切除瘢痕后的继发性头皮缺损，修复效果良好。我科2000～2004年应用皮肤组织扩张术治疗大面积瘢痕性秃发45例，取得满意效果。现报告如下。     

局部皮瓣在鼻部皮肤肿瘤切除后创面修复中的应用

【摘要】 目的 探讨局部皮瓣在鼻部皮肤肿瘤切除后创面修复中的效果。方法 2015年3月至2016年8月于新疆维吾尔自治区人民医院皮肤科纳入65例鼻部皮肤肿瘤患者,手术切除鼻部肿瘤,根据鼻缺损的部位、大小、形状以及周围皮肤情况等选择鼻唇沟皮瓣、改良菱形皮瓣、双叶皮瓣或额鼻皮瓣等修复皮肤软组织缺损。结果 65例患者中,基底细胞癌38例,色素痣20例,角化棘皮瘤5例,鳞状细胞癌2例。切除后缺损长径均未超过2.5 cm,32例用鼻唇沟皮瓣修复缺损,16例用改良菱形皮瓣,12例用双叶皮瓣,5例用额鼻皮瓣,术后皮瓣全部成活,未见鼻部明显变形,随访1年未见复发。结论 对于鼻部皮肤肿瘤切除后长径未超过2.5 cm的皮肤缺损,用鼻唇沟皮瓣、改良菱形皮瓣、双叶皮瓣、额鼻皮瓣等修复可以获得较满意的效果。     

局部任意皮瓣修复头皮缺损22例分析

头皮皮损切除后创面修复是皮肤外科的常见问题。由于皮损部位、周边皮肤伸展性及皮损良恶性的不同,临床处理方法有所不同,常用修复方法有直接拉拢缝合、游离皮片移植、局部任意、带蒂皮瓣修复及应用皮肤扩张器等。直接拉拢缝合无疑是最简便、安全的选择,但在头皮缺损面积较大或周边头皮移动性差的情况下常不能直接缝合。相对于游离皮片移植术后美观性差［1］、皮肤扩张器手术耗时长［2］且并发症多［3］等缺点,局部任意皮瓣修复成为此类头皮缺损的常用方法。有报道提出［4］,直径在6 cm以内的头皮缺损均可通过局部任意皮瓣完成一期修复。我科自2009年10月至2014年12月共完成头皮任意皮瓣修复手术22例,现报告如下……     

动脉跨区供血的头皮瓣一期修复肿瘤切除与创伤后的大面积头皮缺损

目的探讨大面积头皮缺损的一期修复方法。方法应用颞浅动脉跨区供血的头皮瓣、眶上动脉-枕动脉双蒂跨区供血的头皮瓣,修复伴有颅骨缺失的大面积头皮缺损5例。结果5例动脉跨区供血的头皮瓣全部成活,创面均一期修复,效果满意。结论应用单支或双支头皮动脉跨区供血的大型头皮瓣,可以安全地一期修复大面积头皮缺损。     

A-T皮瓣修复颞部皮肤肿瘤切除后缺损32例

目的 介绍应用A-T皮瓣修复颞部皮肤肿瘤切除术后创面缺损的经验和体会。方法 在遵循皮肤肿瘤切除原则基础上彻底切除皮肤肿瘤,设计A-T皮瓣修复颞部皮肤缺损,A形两侧切口线顺应眼部鱼尾纹走向,T形底边为顺应或平行发际线和耳前轮廓线的曲线,形成上下两个推进皮瓣修复中间三角形缺损,术后的切口线隐蔽。结果 本组共32例患者,颞部皮肤缺损面积最大2.8cm×4.0cm,术后皮瓣全部成活,外形美观。随访2年,未见复发,效果满意。结论 应用A-T皮瓣修复颞部皮肤肿瘤切除术后创面缺损,术后可获得满意的美容修复效果。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Pathogenic role of IL-17 in psoriasis and psoriatic arthritis

Psoriasis is a chronic inflammatory skin disorder resulting from a complex network of cytokines and chemokines produced by various immune cell types and tissue cells. Emerging evidence suggests a central role of IL-17 and IL-23/T17 axis in the pathogenesis of psoriasis, giving a rationale for using IL-17-blocking agents as therapeutics.Three agents targeting IL-17 signaling are being studied in Phase III clinical trials: secukinumab and ixekizumab (IL-17 neutralizing agents), and brodalumab (IL-17 receptor antagonist). Preliminary results are highly promising for all anti-IL17 agents, creating fair expectations on this class of agents as the new effective therapeutic approach for the treatment of psoriasis.