面颊部沿穿性缺损修复方法的探讨

为了探讨面颊部沿穿性缺损的修复方法，利用缺损边缘皮瓣翻转，局部唇颊瓣转移，带蒂肌皮瓣及游离皮瓣吻合移植等作为洞穿性缺损的衬里；面颊部局部皮瓣，远位肌皮瓣带蒂转移或吻合移植等修复皮肤缺损。     

唇颊部洞穿性缺损的综合外科修复

目的：探讨修复复杂毁损性面颊部洞穿性缺损的方法,分析唇颊部洞穿性缺损修复的特点。方法：采用个体化治疗方案,以组织移植为基本方法,综合应用多项整形外科技术以及颅颌面外科技术,对10例唇颊部洞穿性缺损进行分期序列治疗。治疗周期最短半年,最长4年。结果：随访半年至3年,面部毁损性容貌明显改善,面部轮廓形态接近正常,功能恢复良好,患者满意度较高。结论：唇颊部洞穿性缺损治疗难度大,技术要求高,在熟练掌握整形外科基本技能的前提下,结合多项整形外科基本技术,分期序列进行修复,可以获得比较满意的效果。     

瓦合式肌皮瓣修复面颌部洞穿性缺损的护理

１９９３年６月至１９９８年７月,对２４例面颌部洞穿性组织缺损病人采用瓦合式胸大肌肌皮瓣修复,皮瓣成活率达１０％。随访１￣３年,２４例病人进食,发音功能及外形良好,修复处平整。其护理要点（１）术前进行营养补充,治愈口腔炎症,给予心理支持,授予相关知识;（２）术后密切观察皮瓣血液循环,了解皮瓣成活情况,加强口腔护理,保证负压引流通畅,加强营养及进行复康指导。     

面颌部洞穿缺损的双皮瓣及肌皮瓣修复

目的 为解决由各种原因引起的面颌部洞穿性缺损的修复问题。方法 采用两个带蒂的组织瓣搭配使用修复面颌部洞穿缺损45例,共用组织瓣90个。其中胸三角皮瓣58个（占64％）,依次是颈阔肌肌皮瓣,胸大肌肌皮瓣,额部皮瓣,胸锁乳突肌肌皮瓣,背阔肌肌皮瓣等。结果 45例洞穿性缺损所用90个组织瓣中全部成活及绝大部分成活者87个,成活率达97％,全部或大部分坏死的3个（占3％）。结论 面颌部洞穿性缺损即刻修复是可行的。修复洞穿缺损有多种皮瓣、肌皮瓣可供选择;提出胸三角皮瓣、颈阔肌肌皮瓣、胸大肌肌皮瓣等是修复面颌部洞穿性缺损的优质组织瓣。临床应用中取得了功能与外形同时修复的效果。     

皮瓣折迭修复颌面部洞穿性缺损

报道应用皮瓣折迭的方法一期修复口腔癌根治术后颌面部洞穿缺损11例,除3例小区皮肤坏死外,其余均完全成活。文章对修复方法,皮瓣选择及本法的优点和存在问题进行了讨论,认为选用一块组织瓣折迭修复颌面部洞穿缺损是简便实用的。     

应用颞浅筋膜瓣修复颌面部洞穿性缺损

目的探讨应用颞浅筋膜瓣转移加游离植皮的方法修复颌面部洞穿性缺损的临床效果.方法对13例因肿瘤术后、炎症、外伤等造成的颌面部洞穿性缺损的患者,采用带颞浅血管蒂颞浅筋膜瓣转移加游离植皮进行修复.结果13例患者均得到了较满意的封闭修复,其中2例患者植皮区部分坏死,1例患者颞浅筋膜瓣的边缘出现小的洞穿性瘘口,经换药及再次局部手术后痊愈.随访6个月至2年,效果较满意.结论颞浅筋膜瓣血供丰富,安全可靠,供区不留畸形,是修复颌面部洞穿性缺损的良好的自体组织材料.     

应用颞浅筋膜瓣修复颌面部洞穿性缺损

目的 探讨应用颞浅筋膜瓣转移加游离植皮的方法修复领面部洞穿性缺损的临床效果。方法 对13例因肿瘤术后、炎症、外伤等造成的领面部洞穿性缺损的患者，采用带额浅血管蒂额浅筋膜瓣转移加游离植皮进行修复。结果 13例患者均得到了较满意的封闭修复，其中2例患者植皮区部分坏死，1例患者颈浅筋膜瓣的边缘出现小的洞穿性瘘口，经换药及再次局部手术后痊愈。随访6个月至2年，效果较满意。结论 颞浅筋膜瓣血供丰富，安全可靠，供区不留畸形，是修复领面部洞穿性缺损的良好的自体组织材料。     

额部皮瓣在面颊部缺损修复中的应用

目的 报道额部岛状皮瓣在面颊部缺损修复中的应用. 方法 根据面颊部缺损的情况分别采用额部岛状皮瓣转移、局部组织翻转形成衬里加额部皮瓣转移、额部皮瓣内面植皮转移等方法进行修复. 结果 本组16例,缺损最大10 cm×6 cm,最小3 cm×2 cm.额部皮瓣转移修复颊部皮肤缺损7例;局部黏膜或皮肤翻转衬里加额部皮瓣修复皮肤缺损6例,额部皮瓣内侧植皮作为衬里3例.除1例额部皮瓣坏死及2例皮瓣远端部分表皮坏死外,余皮瓣成活良好,色泽正常,面颊部外形及功能恢复良好. 结论 额部岛状皮瓣血供可靠、血管蒂长、色泽良好、操作简单,是修复面颊部缺损的较好方法.     

Reconstruction of full-thickness cheek defects using platysma myocutaneous flaps

Summary Myocutaneous flaps play an important role in reconstruction of full-thickness defects of the head and neck area. In this study, a different application of the platysma myocutaneous flap for the reconstruction of full-thickness cheek defects is presented. The technique described has provided an acceptable cosmetic and functional result. It was used in four patients operated on under local anesthesia. Reconstruction of full-thickness cheek defects is easily achieved, especially for palliation in poor risk patients.     

硬腭黏膜游离移植在全层眼睑缺损修复中的应用

目的 探讨硬腭黏膜游离移植在修复中、重度全层眼睑缺损中的应用效果.方法 首先根据睑板的缺损范围切取硬腭黏膜,行游离移植修复眼睑后层(睑板结膜层),再依据眼睑软组织的缺损部位和范围设计皮瓣,并转移皮瓣修复.结果 本组共198例患者(198只眼).其中上睑58例,下睑131例,上下睑联合缺损9例;硬腭移植面积最小10 mm×5 mm,最大35 mm×20 mm.术后随访3～24个月,硬腭黏膜均成活良好,无明显回缩,眼球未见损伤,眼睑外观及功能改善满意.1例眼轮匝肌蒂皮瓣远端2/3坏死,术后2周采用局部皮瓣修复,1个月后随访发现硬腭黏膜完全成活.结论 对中、重度全层眼睑缺损的衬里修复采用硬腭黏膜游离移植,手术操作简便,易成活,远期效果肯定.     

The use of a modified skin stretching device (SSD) together with a lower cheek and neck flap for coverage of a large cheek skin defect

A method of closing a large defect using a skin stretching device is presented. This was accomplished by moving neck skin cranially without caudal movement of the upper cheek skin or lower eyelid.     

面颊部扩张皮瓣的设计和转移

目的探讨利用扩张皮瓣修复面颊不同部位皮肤缺损的扩张皮瓣设计。方法269例面颊部血管瘤、瘢痕、色素痣患者,依不同的皮肤缺损位置,在邻近部位放置大小适度的1~3个50~400ml容积的扩张器,扩张充分后采用推进皮瓣法、旋转推进皮瓣法和易位皮瓣法修复。结果269例中共形成305个扩张皮瓣,利用推进皮瓣121个,旋转推进皮瓣145个,易位皮瓣39个;共出现并发症52例,分别为扩张皮瓣远端血运障碍、血肿形成、感染、注水壶渗漏、扩张器外露、睑外翻和包囊挛缩,这些并发症基本未影响最终的手术效果,术后面颊部形态正常。结论我们提出的扩张皮瓣的设计和转移原则,对于面颊部的皮肤缺损组织扩张术治疗有非常重要的参考价值。     

Reconstruction of large intraoral and adjacent cheek defects by free radial forearm flap

Summary Eighteen patients with intraoral and oropharyngeal carcinoma were treated by radical excision for extensive infiltration of tumour into adjacent tissue. Defects were repaired by free radial forearm flaps. Three patients had bony defects in addition to mucosal and skin defects. The free flap can be easily folded to repair skin and mucosa simultaneously. We consider the free forearm flap to be the procedure of choice in selected cases of large intraoral and adjacent cheek defects.     

Immediate full-thickness facial defects reconstruction using the radial forearm free flap

Summary The restoration of composite tissue defects of the oral cavity involving skin and mucosa remains a difficult problem for reconstructive surgeons. A method for immediate one-stage reconstruction of combined intraoral and facial defects with the radial forearm free flap is described. Four patients operated on between July and December of 1991 for advanced squamous cell carcinoma of oral cavity involving oral mucosa, skin and in two cases the mandible were reconstructed with a radial forearm flap to obtain reconstruction of facial and intraoral mucosa. The area of the fold is deepithelialized to be sutured to adjacent tissue.     

胸壁全层缺损的修复重建

目的探讨胸壁全层缺损的修复重建方法及疗效。方法 2006年1月-2010年12月,收治14例胸壁全层缺损患者。男8例,女6例;年龄23～65岁,平均42岁。恶性肿瘤切除术后继发胸壁全层缺损12例,乳腺癌术后继发放射性损伤1例,热压伤1例。缺损范围为8 cm×5 cm～26 cm×14 cm。所有患者均伴肋骨缺损(1～5根),3例伴胸骨缺损。术中10例患者应用涤纶网或聚四氟乙烯补片行骨性重建,4例未作骨性重建。分别采用双叶皮瓣、胸大肌肌皮瓣、背阔肌肌皮瓣、腹直肌肌皮瓣修复软组织缺损,皮瓣切取范围为10 cm×7 cm～25 cm×13 cm。供区直接拉拢缝合或游离植皮修复。结果术后2例发生创面愈合不良,经再次彻底清创、肌皮瓣修复和补充植皮后愈合;其余皮瓣均顺利成活,创面Ⅰ期愈合。术后患者均获随访,随访时间6～36个月,平均8个月。除1例骨肉瘤患者因肝转移于术后6个月死亡,其他肿瘤患者随访期间均无复发。热压伤患者未同期行胸壁骨性重建,术后5 d出现短暂轻度反常呼吸,其他患者术后胸廓稳定性良好,无明显反常呼吸及呼吸困难。结论根据胸壁缺损病因、面积和部位,单独或联合应用局部皮瓣或肌皮瓣进行胸壁软组织缺损修复,必要时应用人工材料行胸壁骨性重建,可有效修复严重胸壁全层缺损。     

Folded forehead flap for reconstruction of full-thickness defects of the cheek

A simplified technique is described for reconstruction of through-and-through full-thickness defects of the cheek following resection of cancer. The standard forehead flap is employed with an extended application, whereby it is folded over itself twice to provide both an inner and an outer lining. This alternative technique appears to be a reliable and quick way of obtaining both cover and lining for reconstruction of through-and-through defects of the cheek.     

Analyses of early events during chondrogenic repair in rat full-thickness articular cartilage defects

In this study we investigated the cellular events that occur during the onset of chondrogenic differentiation during the repair of full-thickness defects of articular cartilage. The V-shaped full-thickness cartilage defects (width 0.7 or 1.5 mm; depth 0.8 mm; length 4 mm) were created in the femoral patellar groove of rats using a custom-built twin-blade device. The time course of the repair response in these cartilage defects was examined using a semi-quantitative histological grading scale. Cartilaginous repair responses failed to occur in the larger 1.5 mm defects, which was covered only by fibrous scar tissue. In contrast, hyaline-like articular cartilage was regenerated concomitantly with the repair of the subchondral bone by 4 weeks in smaller 0.7 mm width defects. Cells in the reparative regions were then characterized by immunohistochemistry and in situ hybridization. Undifferentiated mesenchymal cells migrate into the defects and fill the cavities within 4 days of their creation. The expression of PCNA, N-cadherin, and PTH/PTHrP receptors was induced in cells at the center of the defects, where type II collagen-positive polygonal-shaped cells also begin to appear at day 7. Marrow-derived mesenchymal cells acquire higher levels of proliferative activity in induced cartilage cavities after their initial migration and filling of the smaller 0.7 mm defects. During the regenerative repair of articular cartilage in the rat, there is a distinctive step that appears to be analogous to the precartilaginous condensation that is pivotal during chondrogenesis in development.