共查询到20条相似文献,搜索用时 15 毫秒
1.
Duteille F Waast D Perrot P Cronier P Hubert L Pannier M 《Annales de chirurgie plastique et esthétique》2005,50(1):71-75
Between 2001 and 2003, 30 serratus anterior free flaps have been realized in our unit for reconstruction of lower limb. The flaps were indicated for repair of traumatic soft tissue defect in 19 cases, for chronic wound in six cases, for purpura fulminans in two cases, for pressure sore in one case and after tumor resection in 1 case. There were 29 patients: 25 males and four females. They ranged in age from 5 to 64 years. The size of the soft tissue defects ranged between 15 and 180 cm(2). Four different types of serratus anterior flaps were used: 20 muscle flaps ; four myocutaneous flaps ; five costo-osteomuscular flap ; one costo-osteomyocutaneous flap . In all cases we used osteo flap (8 th rib) in order to restore bone defect, which ranged from 9 to 15 cm. Necrosis occurred in two flaps because of venous thrombosis. The functional outcome was good for all patients and the aesthetic sequelae at the donor site were considered as minor. The serratus anterior flap can be used in many different ways: different kinds of flaps (osteo-cutaneous-muscle); very variable size of flap (15 to 180 cm(2) in our series) , different length of pedicle possible. Because of his versatility and his absence of major functional or aesthetic sequelae the serratus anterior free flap has become day by day our favourite option in limb reconstruction. 相似文献
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Luís?Azevedo Horácio?Zenha Leonor?Rios Hugo?Sequeira Gustavo?Coelho Augusta?Cardoso Maria?da?Luz Barroso Cristina?Cunha Horácio?Costa
Bone structure is fundamental for the function of the lower limbs—orthostatism and locomotion. Before the technical evolution
observed in the last two decades, many extremities that are saved now were amputated in the past. Lower limb bone defects
are generally associated with complex traumatic lesions and constitute a permanent reconstructive challenge. The management
of this kind of defect requires a multidisciplinary approach involving plastic and orthopedic surgeons. The bone free flaps
are a very important and technically exacting tool for lower limb bone reconstruction. We present and analyze our experience
in 25 traumatic cases where we used 17 fibula free flaps and 2 iliac crest free flaps for tibia and talus reconstruction;
5 fibula free flaps for femur reconstruction; and 1 antebrachial radial osteocutaneous free flap for first metatarsal reconstruction.
We registered 88% of success (three flap necroses—12%) with good bone integration and good functional recovery. Lower limb
bone reconstruction is a long and tortuous stair whose success depends not only on the multidisciplinary surgical team but
also on the patient's cooperation and determination 相似文献
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Dinesh Kadam 《Indian Journal of Plastic Surgery》2010,43(1):108-110
Below knee stump preservation reduces ambulatory energy expenditure and improves the quality of life. Reconstruction of soft tissue loss around the stump is a challenging task. Below knee stump reconstruction demands stable skin with sufficient soft tissue to allow weigh bearing. Microsurgical tissue transfer is increasingly being used as a salvage option. Anterolateral thigh flap with additional vastus lateralis muscle provides extra cushioning effect. We report two cases of amputation below knee successfully salvaged. The anterolteral flap with abundant tissue and stable skin offers a reliable option for cover. Two patients with below knee amputation were reconstructed secondarily. After 6 to 20 months of follow -up, stumps showed no signs of pressure effects. Patients are able to bear 50-70 hours of weight per week. 相似文献
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目的 介绍应用倒“Y”形血管吻合的游离穿支皮瓣与肌皮瓣移植在肢体创面修复与功能重建中的临床应用价值和手术技巧. 方法 2006年6月至2010年9月,采用倒“Y”形血管吻合的22个游离穿支皮瓣与肌皮瓣移植治疗18例患者,其中四肢软组织缺损患者12例,四肢功能重建6例;肘关节周围5例,小腿及足踝部13例.对12例感染性创面,经彻底清创后,采用负压封闭引流1~2次临时覆盖创面,直至肉芽组织生长良好.根据受区创面修复及功能重建的需要,选择保留一个粗大分支构建的倒“Y”形血管蒂游离股前外侧皮瓣或背阔肌皮瓣进行移植.在受区稍近端解剖并分离出一段主干血管并切断后,将游离皮瓣的倒“Y”形血管蒂嵌入桥接受区主干血管切断处,分别与受区切断的主干血管的近、远端行端端吻合,形成倒“Y”形血管吻合.在保证皮瓣血供的同时,不影响受区肢体远端的血液循环.如果受区的浅静脉可供吻合,则只需进行倒“Y”形动脉吻合,保留静脉的连续性不必切断.术后密切观察肢体远端的血液循环情况,并对皮瓣的存活和愈合质量进行随访. 结果 术后18例患者移植的21个游离皮瓣全部成活,未发生血管危象,1例皮瓣远端部分坏死,经换药后愈合;肢体远端血液循环正常.随访6 ~ 36个月,平均16.2个月,皮瓣质地、外形良好,重建患肢功能恢复满意,供区未出现明显并发症. 结论 倒“Y”形血管吻合游离皮瓣移植为肢体创面修复与功能重建提供了新的可行且有效的技术方法,特别适合于肘部及已有一条血管毁损的小腿创面的修复与功能重建,手术操作便捷,临床应用方便. 相似文献
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Vein grafts are used frequently in microvascular surgery, but an adequate supply of autogenous veins is not always available. The search for an ideal substitute for autogenous vein continues. We present a case of lower extremity reconstruction made difficult by lack of suitable autogenous vein for venous outflow from a rectus abdominus free flap. A 36 cm cryopreserved allograft saphenous vein was used on an emergency basis for this problem. 相似文献
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Background:
The facial asymmetry correction in complex craniofacial malformations presents a challenging problem for reconstructive surgeons. Progressive hemifacial atrophy (HFA) and hemifacial microsomia (HFM) can manifest in different grades of severity. Most patients require only soft-tissue augmentation. Free flaps are the best option for correction of severe facial soft-tissue deficiency.Materials and Methods:
Twenty-two patients of HFM and HFA were included in this study from January 2006 to March 2009 in the Department of Plastic and Reconstructive Surgery, SMS Medical College and Hospital. In all cases, atrophy correction was done using de-epithelialised parascapular free flap with the de-epithelialised surface was placed under the skin. A small skin paddle was taken for monitoring.Results:
All cases were reconstructed with de-epithelialised parascapular free flap. There was no flap loss in this series. Hematoma was noted in five cases. Debulking and removal of skin paddle were done in all cases after 6 months. Atrophy recurrence was not observed in any of the cases on follow-up.Conclusion:
Contouring of face in cases of HMF and HFA is satisfactorily done with the parascapular free flap. It gives better cosmetic results with minimal donor site morbidity. Facial vessels are better recipient vessels for anastomosis. Keeping de-epithelialised surface of flap under the skin helped in preventing sagging.KEY WORDS: Hemifacial atrophy, hemifacial microsomia, parascapular flap 相似文献8.
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Tongue reconstruction with free radial forearm flap after hemiglossectomy: a functional assessment 总被引:2,自引:0,他引:2
Thirty-three patients with squamous cell carcinoma of the anteriolateral part of the tongue underwent a 50 percent resection of the tongue. The surgical defect was reconstructed with a microvascular radial forearm flap. All the flaps were especially designed to have a narrow waist, shaped like an omega in cross-section, thus allowing for a free tongue tip, and avoiding suturing the edge of the flap to the soft palate and tongue base. Sixteen patients were evaluated for swallowing and speech function at least 6 months following reconstruction. With this technique, the majority of the patients had nearly normal deglutition, although their speech was still unsatisfactory. However, the speech function in this series was better than that in other reported series. 相似文献
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R. Dumortier V. L. Martinot P. Patenotre M. J. Schoofs P. N. Pellerin 《European journal of plastic surgery》1999,22(2-3):69-73
A series of 11 inferior gluteal free flaps is presented in eight patients with a mean age of 3 years and 3 months. The flap
has been used four times for breast reconstruction, five times for the sequelae of axillary and popliteal burns, and twice
for posttraumatic problems. Three necrosis were observed due to poor limb vascularity (electric burns, atheroma, sequelae
of trauma). It is possible to form a pedicle of 7–8 cm. There is minimal donor site scarring which is the flap’s strong point.
Undoubtedly this flap deserves a place with other classical breast reconstruction techniques. It can also be used as a back-up
technique for release of contractures over joints.
Received: 7 January 1997 / Accepted: 16 November 1998 相似文献
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A patient who developed multiple metachronous primary carcinomas of the oval cavity is presented. After initial radiation therapy, a right hemimandibulectomy was required, followed ten months later by a left hemimandibulectomy. Immediate reconstruction of each defect was performed with a free vascularized iliac crest osteocutaneous flap. Using this flap, both bony continuity and intraoral lining were successfully restored. The patient was able to return rapidly to his previous activities. The results of this case suggest that preservation of the mandibular condyle for lateral fixation of the bone graft is superior to disarticulation of the temporomandibular joint in terms of cosmetic and functional outcomes. 相似文献
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Forequarter amputation combined with chest wall resection may present a difficult closure problem. In a recent case, the defect was satisfactorily closed with a free flap from the amputated extremity, employing the entire soft tissue of the forearm. 相似文献
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自 1996年以来我们采用吻合血管拇趾甲皮瓣移植再造拇指 8例 ,取得满意效果。1 材料与方法1.1 病例资料 本组 8例 ,男 6例 ,女 2例 ,年龄 18~ 2 2岁。机器绞扎伤 4例 ,挤压伤 2例 ,砸伤 2例。拇指Ⅱ度缺损1例 ,Ⅲ度缺损 2例 ,Ⅳ度缺损 1例 ;拇指皮肤撕脱伤 2例 ,其中合并虎口及掌背桡侧皮肤坏死 1例 ;拇指再植术后坏死 2例。亚急诊再造 5例 ,择期再造 3例。带足背皮瓣的拇趾甲皮瓣移植 3例 ,拇趾甲皮瓣移植 5例。1.2手术方法 臂丛阻滞及硬膜外麻醉或高、低硬膜外麻醉。受区处理 :对拇指皮肤脱套伤和拇指离断再植失败的病例 ,常规清创 ;… 相似文献
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Autologous breast reconstruction with a perforator flap has become increasingly popular. This paper presents the free lumbar artery perforator (LAP) flap as an option for breast reconstruction. Flap harvest is easy, no muscle is sacrificed and donor-site morbidity is minimal. Anastomosis of the sensory nerve to the fourth intercostal nerve is possible. The successful use of a LAP flap for breast reconstruction is illustrated with a case report, and the surgical technique is described. This method may be a good alternative for patients with relative contraindications to breast reconstruction with a DIEP flap. 相似文献
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By use of sophisticated techniques now available from the science of Speech Pathology, we can now document, quantify, and critically analyze the surgeon's reconstructive efforts in the oral cavity. Using these methods, we have evaluated the neurotized lateral arm free flap in six patients receiving oral reconstruction. Two of these are reported in detail. This study has provided a protocol that results in the objective analysis of swallowing, articulation, and range of tongue motion and sensation. All of these tests can be routinely performed by a speech pathologist to document both operative performance as well as patient progress in speech and swallowing. It would appear that we have quantified evidence that the neurotized lateral arm free flap may represent a significant step forward in reducing the morbidity of total and subtotal glossectomy by providing a truly functional reconstruction. 相似文献
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H Wang S K Li M Y Yang Y Q Li Q Li W Chen Y Q Wang 《Journal of plastic, reconstructive & aesthetic surgery》2007,60(11):1200-1203
INTRODUCTION: There are many possible methods for penis reconstruction, among them, pedicled flaps, myocutaneous flaps, combined osseocutaneous flaps, and free skin flaps. This study evaluated the free scapular skin flap method for penile reconstruction. METHODS: Fifteen men aged 20 to 48 underwent the procedure between March 2000 and February 2006, with follow-up examinations from 6 months to 5 years. RESULTS: Fourteen of the reconstructions were successful, with patients enjoying good cosmetic results as well as functionality. CONCLUSION: The free scapular skin flap technique is a good method for penile reconstruction. 相似文献
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The treatment of complete ring avulsion injuries is very demanding, and frequently the results are less than optimal. We present a case of a degloved middle finger reconstructed with a temporoparietal fascial free flap and skin grafting. This produced an aesthetic and functional finger. 相似文献