游离胸脐皮瓣治疗复杂足踝部大面积皮肤软组织缺损

目的探讨游离胸脐皮瓣移植修复复杂足踝部大面积皮肤软组织缺损创面的疗效。方法分析2009年1月—2015年1月,采用游离胸脐皮瓣移植修复的复杂足踝部大面积皮肤软组织缺损创面病例共25例,其中男性13例,女性12例;年龄19~64岁,平均38.3岁。创面缺损部位:足内侧+内踝4例,足背+踝关节10例,足外侧+外踝6例,足底+足内侧5例;创面缺损面积:16cm×12cm~36cm×14cm;所有病例均在骨折固定、创面无明显感染下进行。所有病例均于术后4周在支具保护下行早期康复训练,术后半年依据情况行皮瓣修整术,进一步改善患肢外观及功能。结果术后随访9~22个月,平均14.2个月;皮瓣全部成活,仅2例皮瓣边缘小面积坏死,经换药、清创、植皮等治疗后完全愈合;创面愈合时间12~34d,平均17.1d;术后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;根据Maryland足功能评定标准,优22例,良3例。结论游离胸脐皮瓣移植修复复杂足踝部大面积皮肤软组织缺损创面,皮瓣可切取面积大且易于切取,能够最大限度地保存足部残余功能,降低截肢率。     

胸脐皮瓣修复足部脱套伤的临床应用

目的探讨胸脐皮瓣移植修复足部脱套伤的临床效果。方法对31例足脱套伤患者采用胸脐皮瓣游离移植修复创面,男性18例,女性13例;年龄15～50岁,平均35岁。创面面积16cm×6cm～28cm×12cm。结果移植皮瓣全部成活,3例皮瓣臃肿,需再次手术整形。其余病例外观和足部功能恢复满意。结论胸脐皮瓣为腹壁下动脉供血,血运丰富,血管解剖恒定,血管蒂长,可切取面积大且易于切取,适宜修复足脱套伤,尤其适用于有部分足底皮肤缺损者。     

吻合血管的胸脐皮瓣修复下肢巨大软组织缺损的临床观察

目的 应用吻合血管的胸脐皮瓣修复下肢巨大软组织缺损的临床观察.方法 临床应用脐旁皮瓣修复下肢不同部位的软组织缺损23例.修复部位:胫前10例,足背6例,足底5例,踝2例.结果 皮瓣完全成活,术后随访2个月～3年,成活的皮瓣外观良好.结论 胸脐皮瓣为腹壁下动脉供血,血运丰富,血管解剖恒定,血管蒂长,可切取面积大且易于切取,适宜修复下肢软组织缺损,尤其适用于巨大面积的纵向软组织缺损.     

非恒定蒂腓动脉链式穿支皮瓣修复足踝部皮肤缺损19例

目的 探讨应用非恒定蒂腓动脉链式穿支皮瓣修复小腿及足踝部皮肤软组织缺损的方法及临床效果. 方法 2005 - 2010年应用非恒定蒂腓动脉链式穿支皮瓣修复小腿及足踝部皮肤软组织缺损患者19例,术前应用多普勒血流仪探测腓动脉皮支位置,利用各皮支形成的链式供血方式,选择距创面直线距离最近的皮支点作为旋转点切取皮瓣修复创面.皮瓣切取面积最大25 cm×8 cm,最小16 cm×6 cm. 结果 经1.5个月～3.5年的随访,18例皮瓣成活良好,外观满意,仅1例皮瓣远端出现边缘坏死. 结论 非恒定蒂腓动脉链式穿支皮瓣不受蒂部位置的限制,切取灵活方便,是一种修复小腿及足踝部皮肤软组织缺损的理想方法.     

股前外侧皮瓣移植修复小腿下段及足踝部软组织缺损

1 目的报告应用股前外侧皮瓣移植修复小腿下段及足踝部皮肤软组织缺损的临床效果. 2 方法应用股前外侧皮瓣移植修复小腿下段及足踝部皮肤软组织缺损,切取皮瓣面积10 cm×8 cm～20 cm×12 cm不等,供区中厚或全厚皮片植皮修复.     

胸脐皮瓣股前外侧皮瓣游离移植修复足背大面积软组织缺损

目的:探讨运用游离胸脐皮瓣、股前外侧皮瓣移植修复创伤后足背大面积软组织缺损合并肌腱、骨质外露,骨髓炎、骨缺损。方法:运用游离胸脐皮瓣或股前外侧皮瓣修复足背大面积软组织缺损合并肌腱外露、跖骨外露、骨髓炎、骨缺损9例。皮瓣切取面积最大为(10×20)cm、最小为(6×8)cm。结果:术后1例发生血管危象,9例皮瓣均成活。术后随访2~19个月,足背皮肤质地柔软,弹性好,外形稍臃肿,功能满意。结论:游离胸脐皮瓣、股前外侧皮瓣移植修复足背大面积软组织缺损,方法可靠,皮瓣成活后疗效优良,是一种理想的治疗方法。     

股前外侧皮瓣游离移植修复足踝部皮肤软组织缺损

目的总结股前外侧皮瓣游离移植足踝部,尤其是小儿跟腱部皮肤软组织缺损的临床疗效。方法 2010年2月~2014年12月,采用股前外侧皮瓣修复23例足踝部皮肤软组织缺损,男性17例,女性6例;年龄4~45岁,平均21岁。创面均伴血管、骨及肌腱外露,创面缺损范围4cm×6cm~23cm×18cm,皮瓣切取范围为6cm×8cm~25cm×20cm,供区游离植皮修复。结果 1例移植皮瓣坏死,其余皮瓣及供区植皮均顺利成活,创面均Ⅰ期愈合。患者均获随访,随访时间8~46个月,平均16个月。皮瓣耐磨,无局部溃烂,均恢复保护性感觉。4例全足脱套伤患者皮瓣外形臃肿于术后8~12个月行二次手术皮瓣修整后,外形满意。结论股前外侧皮瓣具有切取范围大、血管口径粗、部位隐蔽等特点,由于股前外侧皮神经吻合可以获得较好的保护性感觉,可广泛用于足踝部皮肤软组织缺损的修复。     

吻合血管皮瓣移植修复前臂和手部复杂性软组织缺损

目的探讨吻合血管皮瓣移植修复前臂和手部复杂软组织缺损的临床效果。方法对17例前臂和手部复杂软组织缺损采用股前外侧皮瓣、胸脐皮瓣、小腿内侧与股前外侧皮瓣的串联皮瓣游离移植修复创面。创面面积11 cm×8 cm～26 cm×9 cm,皮瓣切取面积13 cm×9 cm～27 cm×10 cm。结果移植皮瓣全部成活;8例皮瓣臃肿,需再次手术整形;4例骨缺损在皮瓣成活后半年施行自体髂骨植骨钢板内固定,骨折愈合,前臂的旋转功能和手部功能恢复满意;3例肌腱缺损者术后3～5个月用健侧掌长肌腱或手屈指浅肌腱移植修复,手部功能获得部分恢复;2例尺、桡动脉严重损伤,合并重度皮肤肌肉组织缺损者手部功能获得部分恢复,其余患者前臂旋转功能和手部功能恢复满意。结论吻合血管皮瓣移植能有效地修复前臂和手部复杂软组织缺损,控制创面感染,有助于骨折愈合和手部功能的恢复。     

应用内踝上逆行皮瓣修复足踝部皮肤软组织缺损

目的 观察应用内踝上逆行皮瓣修复足踝部皮肤软组织缺损并骨外露或跟腱外露的效果.方法 自2000年来应用内踝上逆行皮瓣27例,转移修复由车祸外伤、肿瘤等所致的足踝部皮肤软组织缺损并骨外露或跟腱外露.修复皮肤软组织缺损最大面积6cm×14cm,跟骨外露最大面积5cm×10cm.结果 共切取内踝上逆行皮瓣27块,其中血管蒂逆行皮瓣9例,筋膜血管蒂逆行皮瓣12例,带部分皮肤的筋膜血管蒂逆行皮瓣6例.其中1例皮瓣术后坏死,行游离背阔肌肌皮瓣移植修复愈合,其余逆行皮瓣及供瓣区所植皮片均完全成活,术后随访6个月～4年,效果满意.结论 内踝上逆行皮瓣移植是修复足踝部皮肤软组织缺损并骨外露或跟腱外露的理想方法之一.     

逆行腓肠神经营养血管皮瓣的临床应用体会

目的 研究逆行腓肠神经营养血管皮瓣修复小腿胫前区及足部创伤的临床效果.方法 我科2009年9月~2012年11月应用逆行腓肠神经营养血管皮瓣修复小腿胫前及足部软组织缺损19例,其中4例合并Ⅱ型糖尿病,3例合并慢性骨髓炎及窦道形成.皮肤缺损面积8 cm×5 cm～17 cm×11 cm.结果 本组17例术后皮瓣存活良好,伤口一期愈合.1例术后皮瓣因引流不充分出现积血致远端部分坏死,行二期皮片移植术后愈合;1例因皮瓣蒂部软组织挫伤致血供不良改行交腿皮瓣后愈合.结论 逆行腓肠神经营养血管皮瓣可切取范围较大,血供丰富,解剖容易,不易损伤大血管,蒂部旋转灵活,能修复的创面部位较多,皮瓣成活率高.     

大鼠胚胎大脑组织的冷冻保存研究

用组织培养测定活性的方法研究了胎龄18d大鼠胚胎大脑组织的适宜冻存条件,较系统地观察了有关低温保护剂、冷冻和复温速率、保存时间等条件对胎鼠脑组织活性的影响。结果表明,以下条件能使冻存组织获得良好的培养结果:以1mol/L的二甲亚砜作为低温保护剂,以1℃/min的速率冷冻至-70℃,液氮保存,37℃水浴快速复温。在液氮中保存60d活性无明显变化。2mol/L甘油对胎脑组织也有一定的保护作用,但不如1mol/L二甲亚砜,而聚乙烯吡咯烷酮无明显保护作用。冷冻速率等于或超过5℃/min,则组织活性急剧下降,说明冷冻速率对胚胎大脑组织活性影响较大。     

裂变中子场的比释动能测定

用自行研制的IRM80S-TE1和IRM81T-TE1两种组织等效电离室与用Mullard G-M计数管组装的γ剂量计,组成双探测器,建立了裂变中子-γ混合场比释动能测定方法。测量结果总的估计不确定度为±5.2％。并与用美国FWT IC-17A组织等效电离室所测得的数据进行了比较,三种电离室在裂变中子场中的总响应及中子比释动能的测量结果在±0.4％之内符合。本文所用的测量方法对其它快中子场测量也是适用的。     

Percutaneous needle biopsy of soft tissue tumors guided by ultrasound and computed tomography

Ultrasound and computed tomography (CT) guided percutaneous needle biopsy of soft tissue lesions was performed in 39 patients. A correct diagnosis was obtained in 35 of 42 biopsies, with an overall accuracy rate of 83%. No false-positive diagnoses were obtained, and no complications related to the procedure were encountered. The value of this technique in the management of selected patients with soft tissue masses is detailed.     

腹壁下血管皮瓣移植修复足部大面积软组织缺损

目的 介绍带血管腹壁下血管皮瓣移植修复足部巨大软组织缺损的方法，分析治疗效果。方法 对2002年9月-2006年3月收治的14例足部巨大软组织缺损病例，采用吻合血管的腹壁下血管皮瓣修复创面。结果 术后14例移植皮瓣全部存活，缺损创面得以修复，外观，功能良好。结论 该术式腹壁下血管解剖比较恒定，皮瓣血供丰富，对供区破坏小，可应用于修复足部巨大软组织缺损。     

带前臂外侧皮神经营养皮瓣修复手背部软组织缺损

目的探讨带前臂外侧皮神经营养血管皮瓣修复软组织缺损的临床效果。方法对27例手背部软组织缺损采用带前臂外侧皮神经营养血管皮瓣进行修复,切取皮瓣面积最大为12 cm×8 cm,最小7 cm×5 cm。结果23例皮瓣完全成活,4例皮瓣边缘部分坏死,术后随访5~8个月,皮瓣质地良好,外观满意。结论带前臂外侧皮神经营养血管皮瓣切取简便,成功率高,是修复手背部软组织缺损的理想供区。     

A multispectral analysis of brain tissues

With the increasing use of three-dimensional MRI techniques it is becoming necessary to explore automated techniques for locating pathology in the volume images. The suitability of a specific technique to locate and identify healthy tissues of the brain was examined as a first step toward eventually identifying pathology in images. This technique, called multispectral image segmentation, is based on the classification of tissue types in an image according to their characteristics in various spectral regions. The spectral regions chosen for this study were the hydrogen spin-lattice relaxation time T₁ spin-spin relaxation time T₂, and spin density, ?. Single-echo, spin-echo magnetic resonance images of axial slices through the brain at the level of the lateral ventricles were recorded on a 1.5 Tesla imager from 20 volunteers ranging in age from 17 to 72 years. These images were used to calculate the T₁, T₂, and ? images used for the classification. Tissue classification was performed by locating clusters of pixels in a threedimensional T₁-¹-T₂-¹-ρ histogram. Gray matter, white matter, cerebrospinal fluid, meninges, muscle, and adipose tissues were readily classified in magnetic resonance images of the volunteers with a single set of T₁, T₂, and ρ values. Cluster characteristics, such as size, shape, and location, provided information on the imaging procedure and tissue characteristics.     

Benign soft tissue chondroma of the foot

Soft tissue chondroma is an uncommon soft-tissue cartilaginous tumor of benign nature, it considers a variant of extra-skeletal chondromas that undergoes extensive ossification. This case of a 37?years old Egyptian male presented with a recurrent slowly growing painful palpable heel mass arises at the plantar aspect of his RT foot.The case is pathologically proven to be benign soft tissue chondroma.     

双皮瓣联合修复足跟部大面积皮肤软组织缺损

目的　总结联合应用足底内侧皮瓣及足外侧皮瓣修复足跟部大面积皮肤软组织缺损的方法及效果。方法　 1995年 1月～ 2 0 0 1年 10月联合运用同侧足底内侧皮瓣和足外侧皮瓣转位修复足跟底部及跟后部大面积皮肤、软组织缺损 9例 ,其中外伤 5例、慢性骨髓炎 2例、鳞状细胞癌 2例。创面最大为 16 .5cm×6 .5cm ,最小为 10 .0cm× 4 .0cm。结果　术后未发生血管危象 ,皮瓣全部成活 ,伤口Ⅰ期愈合。随访 6个月～6年 ,所有病例皮瓣外观及功能均恢复良好。结论　足跟部为负重区 ,跟后部为摩擦区 ,对此处大面积皮肤软组织缺损后的修复要求较高。用上述 2个皮瓣联合使用完全符合足部修复要求 ,修复后效果良好     

Post-treatment complications of soft tissue tumours

Purpose

To identify local and distant complications of patients with soft tissue tumours and evaluate their relationships to types of therapy.

Methods and materials

Fifty-one patients (29 males and 22 females, ages 14–80 years) with 34 malignant and 17 benign soft tissue tumours were evaluated for local and distant complications after resection or amputation only (26 patients) or after the addition of radiotherapy (25 patients: 17 patients had external beam therapy, 7 patients had external beam therapy and brachytherapy, and one patient had extracorporeal irradiation and reimplantation). Duration of follow-up averaged 3.75 years for malignant tumours and 2.79 years for benign tumours. Follow-up studies included radiography, T1- and T2-weighted magnetic resonance (MR) imaging, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), computed tomography for thoracic and abdominal metastases, and 3-phase technetium-99m-labeled-methylene-diphosphonate scintigraphy for bone metastases.

Results

Recurrent tumours were 2.2 times more frequent in patients who had undergone their initial resection at an outside hospital as compared with those first treated at the university hospital. Nine of 11 recurrences occurred after marginal surgery. Metastases from soft tissue sarcomas, most commonly to lung (nine patients) and to bone and muscle (five patients), showed no specific relationship to type of therapy. DCE-MRI differentiated rapidly enhancing soft tissue recurrences (11 patients) and residual tumours (6 patients) from slowly enhancing muscle inflammation, and non-enhancing fibrosis and seromas that usually did not enhance. Seromas developed in 76% of patients who had postoperative radiation therapy and in 7.7% of patients who had only surgery. Subcutaneous and cutaneous oedema and muscle inflammation was at least four times more frequent after adjunct radiotherapy than after resection alone. Irrespective of the type of treatment, inflammatory changes in muscle and subcutaneous and cutaneous tissue and the majority of seromas were evident at the first follow-up study. Although seromas after resection and external beam therapy resolved with time, seromas after additional brachytherapy persisted. Inflammatory changes in muscle and cutaneous and subcutaneous tissue after resection alone disappeared by the second follow-up study, whereas these changes after radiotherapy resolved months to years after treatment. Fourteen of 51 patients showed MR findings of chronic muscular atrophy, predominantly located in the lower extremity. Heterotopic ossification was seen in three patients after resection and amputation without radiotherapy. Except for one patient with aggressive fibromatosis, bone and nerve complications occurred in patients with soft tissue malignancy. Twelve patients had osteoporosis. Six patients sustained fractures in irradiated osteoporotic bone of the lower extremity, and one patient had a vertebral fracture in radiographically normal but irradiated bone. In addition, one patient was found to have a medullary infarct in an irradiated femur. In nerve entrapment, DCE-MRI demonstrated the rapidly enhancing recurrent tumour or non-enhancing fibrosis surrounding the slowly enhancing nerve. T1- and T2-weighted MR images displayed the acute and chronic sequelae of nerve entrapment and nerve transection with denervation as T2-hyperintense acute muscle atrophy or T1-hypertense chronic fatty muscular atrophy with decrease in muscle volume.

Conclusion

This study suggests a possible relationship between types of treatment of soft tissue tumours and subsequent complications. Postoperative radiotherapy was associated with a significant number of patients with seromas, muscle, cutaneous and subcutaneous inflammation, and fractures. Incomplete or difficult surgery resulted in residual or recurrent tumours and heterotopic ossification. Muscle atrophy and nerve entrapment were related to both treatments (resection alone or radiotherapy after resection). Diligent follow-up of patients with soft tissue tumours with recognition of these complications and their differentiation from recurrent or residual tumour can help guide clinical care and may negate the need for surgery when benign disease is defined.     

局部组织瓣修复小腿复合组织创伤创面

目的 研究小腿骨折合并有皮肤、皮下组织、肌肉、肌腱、血管、神经、骨等软组织缺损的复合组织创伤创面的修复方法.方法 对26例小腿复合组织创伤,急诊Ⅰ期或延期采用局部组织瓣修复.结果 全部病例的创面均Ⅰ期愈合,术后随访12～50周,26例全部或大部分保存小腿功能.结论 局部组织瓣修复小腿复合组织创伤创面安全、有效、简单、方便.