上臂皮管法修复鼻再造失败病例

目的 探讨针对鼻再造失败或效果不佳,且额部组织已完全破坏的病例,再次行全鼻再造的方法 。方法 自2008年1月至2010年1月,对3例鼻再造失败病例以上臂皮管法行全鼻再造。手术分四期进行。Ⅰ期:于左上臂内侧形成皮管(18 cm×8 cm);Ⅱ期:3周后切断皮管上端并转移至鼻根;Ⅲ期:3周后将皮管从上臂离断,形成皮瓣修剪成三叶状并向内折叠,以塑形成鼻翼、鼻尖和鼻小柱。同期取第7、8肋软骨,制成“L”形支架并固定;Ⅳ期:3周后进行断蒂修整。结果 3例患者均获成功,随访1~2年,再造鼻颜色、质地与周围皮肤较为匹配,外形及通气功能均达到满意效果。结论 对于额部组织已被破坏的鼻再造失败患者和坚决反对在额部留下任何痕迹的患者,采用上臂皮管行全鼻再造是行之有效的方法。     

上臂皮管法全鼻再造手术的护理

各种原因引起的鼻大部分缺损常影响患者的容貌,给患者造成生理和心理上的影响,因此需全鼻再造。全鼻再造术不但可以恢复其生理功能,还可以治愈患者的心理创伤,重树自信。全鼻再造手术方式较多,额部皮瓣法心用最早也较常用,但有的患者顾虑破坏面容,而不愿接受。上臂皮管,则可提供充裕组织而不产生局部继发畸形,因而患者乐意接受。我科自2003-2008年应用上臂皮管全鼻再造12例均获成功,术后效果满意。现将护理体会报道如下。     

细长皮管修复鼻小柱缺损

目的 总结通过留“桥”技术形成的细长皮管在鼻小柱再造中的应用。方法 １９６８年３月１９９８年８月,利用留“桥”技术形成细长皮管,分次转移,修复复杂鼻小柱缺损共１８例。采用上臂内侧纵行皮管１３例,颈部锁骨上横行皮管５例,设计皮管宽度２．０～２．５ｃｍ,长度１１～１５ｃｍ,皮管中段３～７ｃｍ于其一侧留“桥”。结果 １８例皮管均成活,无并发症,随访３～６０个月,再造鼻小柱外形、质地、色泽、抗损伤能力均良     

上臂皮管移植联合Q开关及CO2激光治疗鼻面部复杂性黑色素痣

目的：探讨皮管移植联合Q开关及CO2激光技术治疗鼻面部复杂性黑色素痣的效果,总结手术及激光治疗的技巧。方法：6例鼻面部复杂性黑色素痣采用手术切除后上臂皮管移植联合Q开关及CO2激光治疗,观察治疗效果。结果：本组6例患者经过皮管移植联合Q开关及CO2激光治疗后,皮瓣存活良好,存活后皮瓣颜色与邻近部位无明显差异,术后激光治疗1个疗程后鼻面部黑色素痣区域色素基本消失,手术切口瘢痕淡化,外观改善满意,随访1年无复发。结论：采用皮管移植联合Q开关及CO2激光治疗鼻面部复杂性黑色素痣临床疗效显著,是目前较为理想的方法。     

扩张后额部皮瓣法鼻再造术探讨

目的为了进一步提高手术质量，探讨扩张后额部皮瓣法鼻再造术的相关技术。方法自1999年以来．临床治疗14例患者．其中3例行岛状皮瓣转移，儿例行带蒂转移。总结相关技术与效果的关系，并结合国内文献进行讨论。结果本组14例患者，2例岛状皮瓣转移的患者鼻翼边缘有少许坏死，余12例患者鼻外形与鼻通气功能均较好。随访3～18个月。皮瓣无明显回缩。结论扩张后额部皮瓣为鼻再造的首选治疗方案。大容量的扩张器能较充分的扩张，而且带蒂转移的术式更安全可靠。恒压持续快速扩张，能充分利用有效时间，达到最佳的有效扩张。这也是今后鼻再造的研究方向。     

扩张后额部皮瓣法鼻再造术探讨

目的为了进一步提高手术质量,探讨扩张后额部皮瓣法鼻再造术的相关技术.方法自1999年以来,临床治疗14例患者,其中3例行岛状皮瓣转移,11例行带蒂转移.总结相关技术与效果的关系,并结合国内文献进行讨论.结果本组14例患者,2例岛状皮瓣转移的患者鼻翼边缘有少许坏死,余12例患者鼻外形与鼻通气功能均较好.随访3～18个月,皮瓣无明显回缩.结论扩张后额部皮瓣为鼻再造的首选治疗方案.大容量的扩张器能较充分的扩张,而且带蒂转移的术式更安全可靠.恒压持续快速扩张,能充分利用有效时间,达到最佳的有效扩张,这也是今后鼻再造的研究方向.     

耳廓复合组织修复鼻翼缺损(附20例报告)

我科1977～1987年底共收治各种类型的鼻缺损患者26例,其中应用耳廓复合组织移植修复鼻翼缺损20例,前额正中皮瓣一次手术完成全鼻再造4例,鼻端局部用皮管法修复2例。取得了较满意的效果,现将耳廓复合组织移植修复鼻翼缺损的点滴体会介绍如下: 临床资料 本组20例,男女各10例,年龄7～40岁,平均20岁。人、鼠、兔咬伤16例,     

上臂皮管修复鼻缺损及下睑缺损的临床研究

目的讨论通过上臂皮管同时修复全鼻缺损及下睑缺损的临床效果。方法对12例鼻缺损合并双下睑缺损的患者,通过上臂皮管皮瓣带蒂转移修复鼻缺损的同时修复双侧下睑缺损。一期手术行上臂皮管成形,二、三期手术皮管带蒂转移至鼻部,四～六期手术在皮管断蒂的同时应用皮管修复双侧下睑缺损和鼻背缺损。结果本组12例患者鼻缺损及双下睑缺损均修复满意,矫正了下睑外翻,外鼻通过后期的皮瓣修薄形态良好。结论在面部皮肤大面积受损的前提下,上臂皮管皮瓣可以有效地作为皮瓣来源供区同时修复鼻部、下睑等重要器官缺损,经长期观察效果良好。     

全鼻再造手术方法的探讨

目的　介绍 4种全鼻再造的手术方法及适应证。方法　 1975～ 2 0 0 3年我们应用①上臂皮管全鼻再造术、②传统前额正中皮瓣全鼻再造术 额部植皮术、③额部正中皮瓣全鼻再造术 双侧额颞皮瓣滑行修复额部供区、④额部皮瓣扩张术后行额正中皮瓣全鼻再造术 ,对 2 2例行上述全鼻再造术者进行了回顾性分析 ,并讨论了上述手术方法的优缺点及其适应证。结果　本组病例均获成功 ,外形及通气功能效果良好。应用第 2种方法虽然再造鼻外形满意 ,但在额部留下明显而深暗的凹陷痕迹 ,影响美观 ;而应用第 1种方法额部不留任何痕迹 ,但鼻再造所需时间较长 (约 2个月 ) ,且需将上臂与头部间固定 3周 ,是其不足之处。结论　如采用前额正中皮瓣法行全鼻再造时 ,建议对鼻型较小者应用第 3种方法 ;而对鼻型较大者以用第 4种方法为好 ;而对于不接受在额部造成新的创伤或额部组织不足者 ,应选用第 1种方法为宜     

上臂内侧皮瓣修复鼻缺损16例

鼻缺损的修复方法较多 ,因鼻部缺损的情况各异 ,其修复方法亦各具所长。鼻尖、鼻翼、鼻小柱等小缺损 ,可采用局部皮瓣、鼻唇沟皮瓣 ,复合组织瓣等修复。全鼻及较大的缺损多以额部皮瓣、胸肩皮管、腹部皮管等再造鼻。以上修复方法存在供区皮肤有限或面部遗留切口瘢痕等不足。 1988年以来 ,我们采用上臂内侧皮瓣修复鼻缺损 16例 ,较好的解决了上述不足 ,治疗效果满意。1　临床资料　本组 16例。男 11例 ,女 5例。烧伤 10例 ,外伤 6例。全鼻缺损 5例 ,次全鼻缺损 4例 ,鼻尖、鼻翼部分缺损 7例。治疗结果均满意。2　手术方法　2 .1　Ⅰ期手术　…     

Tubed latissimus dorsi musculocutaneous flaps for thoracic esophageal replacement in dogs: possible clinical application

A circumferential defect of the intrathoracic esophagus was successfully replaced with a tubed latissimus dorsi musculocutaneous flap in dogs. This flap obviates the necessity for laparotomy. Therefore, this technique might offer an alternative means of esophageal reconstruction in debilitated patients.     

Pectoralis myocutaneous flap for replacement of cervical esophagus

The authors report experience with 10 cases of pharyngoesophageal replacement with tubed pectoralis major myocutaneous (PM) flap. Six patients had primary reconstruction following total pharyngolaryngectomy for cancer; the other 4 had severe pharyngoesophageal stenosis requiring resection and replacement following previous laryngectomy. Seven of the patients were octogenarians, 6 had been irradiated previously, and all were severely debilitated. Two patients died postoperatively of cardiac disease. The remaining eight regained satisfactory with lasting deglutition. Four fistulae healed spontaneously, and one postoperative stenosis responded to a single dilitation. The interval to swallowing was 10-21 days in nonirradiated patients and 3-13 weeks in irradiated patients. There was one local recurrence 6 months after resection; the other patients remained free of disease. The authors conclude that the tubed PM flap is a reliable technique for pharyngoesophageal reconstruction that is particularly useful in elderly and debilitated patients.     

Total esophageal reconstruction using a tubed parascapular free flap

A method for total esophageal reconstruction when intestinal options are no longer available is presented. The technique described utilizes the parascapular microsurgical free flap, which is tubed and interposed between the cervical esophagus and the gastric remnant in the abdomen. The technique involves a well-recognized microsurgical flap and may be added to the armamentarium for total esophageal reconstruction.     

Subtotal nasal reconstruction using a bi valved paramedian forehead flap

Many surgical options have been proposed for total or subtotal reconstruction of the nose after extirpative surgery or trauma. Careful replacement of all anatomic layers including the structural framework and internal and external nasal lining is essential to successful reconstruction. If adequate internal lining is present, reconstruction of the structure of the nose and the external nasal lining is often straightforward. Difficulty arises with providing sufficient internal nasal lining in patients who underwent full thickness reconstruction of half of the nose with a bi-valved paramedian forehead flap. A different plane of dissection is used for the flap and structural grafts are placed between the layers of the axial pattern flap. The anatomy, plane of flap dissection, and biomechanics of flap transfer are presented as well as the specific technique for nasal reconstruction. The bi-valved paramedian forehead flap presents another surgical option for reconstruction of full thickness defects of the nose.     

Reconstruction of the Helical Rim with the Rubber Band-Conditioned Postauricular Tubed Flap: A Case Report

Objective: A case with posttraumatic tissue loss of the auricle is presented, where successful reconstruction with the aid of a tubed flap is achieved by gradual lysis within three stages. Background: Helical rim losses may be reconstructed with a tubed flap created from postauricular tissue. Method: The vascularity of the tubed flap was increased with the intermittent application of a rubber band tourniquet. Conclusion: The use of a tourniquet before completing the third stage of the helical rim reconstruction may enhance the reliability of this procedure.     

额部扩张皮瓣法半鼻再造术修复部分鼻缺损

目的：探讨应用扩张额部皮瓣行半鼻再造术修复部分鼻缺损的效果。方法：2008年6月～2010年12月,收治部分鼻缺损患者5例,男1例,女4例,均采用额部扩张皮瓣法半鼻再造术修复。手术分3期进行：Ⅰ期行额部额肌下扩张器置入术皮肤扩张;Ⅱ期行额部扩张皮瓣转移半鼻再造术;Ⅲ期行鼻根部皮瓣断蒂修整术。结果：术后患者均愈合良好,无明显并发症发生。5例患者均获随访,随访时间6月～1年。再造鼻形态满意,颜色、质地与周围皮肤较为匹配,额部供区无明显瘢痕及畸形。结论：额部扩张皮瓣法行半鼻再造术修复鼻缺损,手术方法简单可靠,术后效果满意。     

Tubed deltopectoral flap for creation of a controlled esophagocutaneous fistula in patients with persistent choking following esophageal reconstruction with free diversionary jejunum

Esophageal reconstruction in patients with abnormal pharyngeal muscles or epiglottis may result in episodes of choking. The jejunal flap has been used to prevent choking by insetting the proximal end into the gingivobuccal sulcus and separating the digestive tract from the airway. A technique has been developed to deal with patients with aspiration due to collection of food near the nonfunctioning epiglottis. Between 1997 and 2004, 25 patients underwent reconstruction with jejunal flaps inset into the gingivobuccal sulcus. Postoperatively, 5 patients presented with episodes of choking. All patients underwent creation of an esophagocutaneous fistula using a deltopectoral flap. All flaps survived. Choking resolved and vocal performance was preserved in all patients. The jejunum, inset proximally into the gingivobuccal sulcus, has been successful in reconstructing patients unable to separate the airway from the digestive tract. The deltopectoral flap provides tissue for creation of a tubed flap and allows for the creation of a long fistula that prevents aspiration and can divert oral fluids away from a tracheostomy or a fresh wound.     

A method of umbilical reconstruction

Summary A technique of umbilical reconstruction is described. This procedure uses a tubed skin flap consisting of scar tissue; a deep and cosmetically excellent umbilicus is achieved even in patients with a thin abdominal wall consisting entirely of scar tissue. This is especially suitable in the cases of deficient umbilicus with a significant vertical scar and a thin abdominal wall due to the prior trauma or surgery.     

改良腹部皮管在多指毁损伤中的临床应用

目的：评估改良腹部皮管在多指毁损伤中的临床疗效。方法2012年10月—2013年12月,应用改良腹部皮管修复11例多指毁损伤,切取皮管后,覆盖缺损处,皮管供区直接拉拢缝合。结果11例皮管全部成活,创面一期愈合。随访5～18个月,皮管外形与残指功能恢复满意。结论改良腹部皮管治疗多指毁损伤,具有供区损伤小,可操作性强,易于推广,安全有效等优点,值得临床推广应用。