带蒂下部前锯肌肌皮瓣及筋膜皮瓣的临床应用

目的：探讨带蒂下部前锯肌肌皮瓣及筋膜皮瓣修复皮肤软组织缺损的可行性。方法：采用5例肌皮瓣、4例筋膜皮瓣修复皮肤软组织缺损患者共9例，其中腋窝3例，颈部2例，胸部2例，上臂1例，背部1例。结果：9例皮瓣完全存活，无供血不足及静脉回流障碍，供区瘢痕隐蔽，无“翼状”肩胛出现。结论：下部前锯肌肌皮瓣或筋膜皮瓣血管蒂长，血管管径粗，便于操作，皮瓣不臃肿，易于塑形，供区并发症少，是一种值得推广应用的皮瓣。     

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。     

Lower abdominal peritoneal flap based on the deep inferior epigastric artery: an anatomic study

Free flaps based on the deep inferior epigastric artery are known to be easily raised and offer a long and reliable vascular pedicle. According to the defect size and consistency, they can be raised as muscular, myocutaneous and as a sandwich flap, including the peritoneum [5]. A free flap consisting of only the peritoneum has been speculated on. Seventeen dissections on fresh cadavers were performed. The visualization of the vascular pedicle was obtained by blue dye coloration, contrast medium angiography, and intravascular silicone latex injections. It was found that the parietal peritoneum of the lower abdomen was constantly supplied by an axial branch of the deep inferior epigastric artery and not by muscle perforators.     

皮瓣和肌皮瓣在食管外科中的应用

食管切除后常用胃或结肠来进行重建,但对于一些病变位置过高、合并胃或结肠病变、胃或结肠已做过手术、局限性严重食管狭窄患者,可选择其他方法重建或修复。能用于修复及重建食管皮瓣、肌皮瓣有十余种,根据血供来源分为游离皮瓣及带蒂肌皮瓣。游离皮瓣需血管吻合,一旦出现血管阻塞,易发生皮瓣坏死,以选择带蒂肌皮瓣修复及重建食管为宜。胸大肌皮瓣及背阔肌皮瓣尽管血运丰富,但肌皮瓣臃肿,且难以形成管状重建全周食管。颈阔肌皮瓣面积大,多源性血液供应,单侧可用于修复颈段食管缺损,双侧能重建全周颈段食管,手术操作简便,疗效可靠,长期随访皮瓣无溃疡及毛发生长,且能耐受放疗,值得推广应用。     

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。     

The gracilis flap revisited

The gracilis muscle or myocutaneous flap is a Mathes and Nahai neurovascular flap type II. It can be used either as a pedicled flap, or as a free flap. Since 1983, 21 gracilis muscle flaps were used in 19 patients at this department; 15 were pedicled while six were free flaps. Two pedicled flaps were lost, possibly due to an intraoperative spasm of the feeding artery. The indications for using the gracilis muscle are discussed, and the results with an average follow-up of more than a decade are presented. Received: 6 December 1999 / Accepted: 7 June 2000     

应用下斜方肌皮瓣修复颈部放射性溃疡

目的探讨鼻咽癌放射治疗后颈部放射性溃疡的治疗方法;阐述放疗后臂丛神经损伤的广泛性和严重性。方法1999年以来应用下斜方肌皮瓣岛状转移的方法修复颈部慢性放射性溃疡15例,并常规行肌电图检查了解臂丛神经损伤的情况。结果除1例面积为9 cm×10 cm的肌皮瓣因创面严重感染而坏死外,其余肌皮瓣成活良好,创面修复满意;该组病例中同时存在的并发症有臂丛神经麻痹、耳聋、老年性痴呆、声带麻痹和甲状腺功能低下。结论应用血运良好的下斜方肌皮瓣可有效地修复颈部上段的放射性溃疡创面。     

Intraoral reconstruction with latissimus dorsi myocutaneous island flap

Summary Intraoral reconstruction for large defects using a latissimus dorsi myocutaneous island flap in ten patients is presented. All flaps were transferred successfully in one stage and provided adequate flap tissue for the intraoral defect. Five cases involved hemiglossectomy. The postoperative atrophy of the flap was minor and the intraoral defects were adequately resurfaced. The postoperative function of the remaining tongue was satisfactory. The latissimus dorsai myocutaneous flap was found to be reliable and useful for intraoral reconstruction.     

不同类型的颈阔肌肌皮瓣存活情况的临床分析

目的分析54例不同类型的颈阔肌肌皮瓣修复口腔癌口内组织缺损的效果，以指导临床实践。方法12例应用横向型颈阔肌肌皮瓣，42例为纵向型颈阔肌肌皮瓣；42例纵向型颈阔肌肌皮瓣中26例保留颌外动脉及面前静脉，16例未保留，比较各类型肌皮瓣的存活情况。结果12例横向型颈阔肌肌皮瓣中10例完全存活，2例出现远端部分坏死；26例纵向型保留颌外动脉及面前静脉的颈阔肌肌皮瓣中23例完全存活，3例出现远端部分坏死；16例未保留颌外动脉及面前静脉的纵向型颈阔肌肌皮瓣中10例完全存活，4例出现远端部分坏死，2例完全坏死。结论纵向型未保留颌外动脉及面前静脉的颈阔肌肌皮瓣存活率较低，临床应用时应慎重选择适应证。     

重度褥疮的临床治疗经验

目的 总结重度褥疮的临床治疗经验.方法 2007年8月至2011年6月,湖南省郴州市第一人民医院烧伤整形科收治21例重度褥疮患者,共43处Ⅲ～Ⅳ度褥疮创面,应用封闭负压引流技术,以及局部任意筋膜瓣、上位或下位臀大肌岛状肌皮瓣、下位臀大肌局部旋转肌皮瓣、股后皮神经营养血管皮瓣、阔筋膜张肌岛状肌皮瓣、游离背阔肌肌皮瓣和中厚皮片移植修复,配合翻身床,术后全程护理跟踪指导联合治疗.21例中有13例为多发性褥疮,其中有5处为Ⅲ度褥疮,以移植皮片封闭,3处非骶尾部Ⅲ度褥疮宽度＜2 cm,予扩创后直接拉拢缝合;8例为单个Ⅳ度褥疮.结果 21例43处创面均治愈,3例5处创面中有2处创面因引流不畅皮瓣下积液,重新放置引流管通畅引流后伤口愈合,另有3处创面皮瓣移植后伤口愈合不良,再次扩创二期缝合后伤口亦愈合,所有皮瓣(肌皮瓣)均成活良好.16例获2个月至2年2个月的随访,其中4例因出院后未按要求注意护理再次受压复发,其余均未复发.结论 综合应用封闭负压引流技术,多种皮瓣及移植皮片,配合翻身床及出院后护理跟踪指导,对重度褥疮进行治疗,能达到满意疗效.     

Flap techniques as an adjunct in vaginal fistulectomy

This paper reviews the method of vaginal fistulectomy as currently practiced worldwide. In addition, the tissue flap techniques available for repair of extensive injuries not amenable to primary multilayer closure are presented. Specific optional flap procedures proposed in fistula closure include: random tissue flaps, the labial fat pad (Martius graft), the bulbocavernosus muscle flap and the gracilis or rectus abdominis myocutaneous tissue flaps. The uses and advantages of each procedure and a comparison with split-thickness skin grafts are discussed.The opinions and assertions contained herein are those of the authors and are not to be construed as official or as representing the views of the Department of the Army or the Department of Defense.     

The cascade flap for nasal tip repair

Summary A two flap repair of nasal tip and bridge defects is presented. The nasal bridge flap transposes down over the tip while a lower forehead or glabella flap hinges to the upper nose. These are random myocutaneous flaps and the design may be varied for different defects.     

The influence of tissue tension on the microcirculation in myocutaneous flaps: an experimental study in dogs

The effect of increased and decreased uniaxial tissue tension on capillary blood flow, plasma volume, edema formation, and vascular permeability in myocutaneous flaps was studied. A total of 64 equally sized arterialized myocutaneous flaps were outlined on the abdomen of 16 dogs. The four areas on each dog were randomized to either untouched control area, reattachment to normal tension, increased (one and one-half times the original length), or decreased (one-half times the original length). Capillary blood flow measured by the radioactive microsphere technique two hours after operation was decreased in the muscular part of flaps reattached at decreased and normal tension (p less than 0.05). The muscular blood flow was unchanged when flaps were reattached at increased tension and significantly higher than in flaps reattached at decreased tension (p less than 0.05). No differences were found in skin or subcutaneous blood flow. There were no differences in plasma volume, vascular permeability, or total water content between flaps attached under different tensions, whereas the plasma volume was increased in muscle in all three flap types (p less than 0.05) presumably secondary to venous stasis. The study implies that the decreased capillary blood flow seen in the muscular component of a myocutaneous flap in the immediate postoperative period may be counteracted by a somewhat increased reattachment tension.     

岛状肌皮瓣在颈胸部难治性创面中的应用

目的介绍岛状肌皮瓣在颈胸部难治性创面中的应用经验。方法1994年8月～2004年12月，收治98例颈胸部难治性创面患者，男42例，女56例；年龄21～68岁。病程3h～13个月。胸前部29例，颈部28例，项部18例，腋下或腋窝部15例，胸侧壁8例。创面范围6cm×4cm～20cm×15cm，其中感染创面27例，骨外露48例，心、肺等胸腔器官外露7例，深部重要血管、神经外露33例。根据创面所在部位、性质及致病因素的不同，采用不同的岛状肌皮瓣修复。其中岛状胸大肌肌皮瓣28例，岛状背阔肌肌皮瓣34例，岛状斜方肌肌皮瓣19例，岛状腹直肌肌皮瓣17例，皮瓣切取范围8cm×6cm-35cm×15cm。结果术后92例创面Ⅰ期愈合，肌皮瓣全部成活；6例肌皮瓣部分坏死，经对症处理后成活。83例获随访2周～5年，皮瓣色泽正常、质地良好，均获得满意功能和外形。结论修复颈项部创面可选用岛状胸大肌肌皮瓣、岛状背阔肌肌皮瓣、岛状斜方肌肌皮瓣；修复胸部创面可选用岛状背阔肌肌皮瓣、岛状腹直肌肌皮瓣；根据创面的具体情况选择适当的岛状肌皮瓣修复颈胸部难治性创面可获得满意功能和外形。     

改良胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用

目的探讨一种保留胸大肌功能的改良胸大肌肌皮瓣的制作方法。方法根据胸大肌肌皮瓣的解剖学特点设计皮岛，将胸大肌肌皮瓣的血管蒂完全解剖出来而不携带肌肉，使肌皮瓣成为名副其实的岛状瓣，从而完整保留了胸大肌的锁骨部分以及胸大肌外侧大部分肌纤维。结果2002至2005年采用该方法制做改良胸大肌肌皮瓣29例，其中20例修复口内缺损，4例修复颈部缺损。3例修复腮腺区缺损，2例修复下咽部缺损。术后皮瓣全部成活，随访6个月至2年，所有患者术后进食、吞咽功能良好，语言功能大多恢复良好。结论改良胸大肌肌皮瓣应用于头颈外科克服了传统的胸大肌肌皮瓣的缺点，提高了肌皮瓣血供的可靠性，最大程度地保留了胸大肌的功能和胸部的外形。     

背阔肌游离肌皮瓣用于颅颌面部缺损重建

目的　提高颅颌面部组织缺损的修复水平。方法　本组 8例颅颌面部组织缺损患者 ,皮肤和黏膜缺损面积最小 10cm× 8cm ,最大 30cm× 12cm ,应用背阔肌游离肌皮瓣移植修复 ,所有皮瓣的神经均与受区神经吻合。 7例患者一期手术完成 ,另 1例分 3次手术完成 :第 1次行皮瓣延迟 ,第 2次手术行游离皮瓣移植 ,第 3次手术行口角成形术。肌皮瓣面积最小 12cm× 10cm ,最大 32cm× 16cm。结果　术后随访 6个月～ 4年 ,所有患者功能和形态满意 ,感觉恢复良好 ,无皮瓣发生坏死和溃疡。结论　背阔肌游离肌皮瓣移植是一种修复严重颅颌面部组织缺损的较为理想的方法 ,具有血供可靠、抗感染力强、供瓣面积大、供区隐蔽、可重建运动和感觉功能等优点。     

Secondary pharyngeal reconstruction after pharyngolaryngectomy using two platysma myocutaneous flaps

Summary A case of secondary pharyngeal reconstruction using a new technique based on two platysma myocutaneous flaps is presented. The technique is described. The advantages are: the thickness of the reconstructed wall is similar to that of the pharynx; it is hairless; crippling and excessive scarring is avoided.     

岛状胸锁乳突肌肌皮瓣在面颊部复合组织缺损修复中的应用

目的 探讨岛状胸锁乳突肌肌皮瓣在面颊部复合组织缺损尤其是面颊部洞穿性组织缺损修复中的应用.方法 以胸锁乳突肌上端为蒂部,蒂部包含枕动脉,以乳突尖下2 cm处为肌皮瓣旋转轴点,根据缺损部位及大小进行肌皮瓣设计,以该点至缺损区最远点为肌瓣的长度,肌瓣宽度以稍大于创面宽度即可,但最大宽度不宜超过7 cm,下界不超过锁骨下2 cm.沿设计线切开,切断胸锁乳突肌起点,在胸锁乳突肌下分离切取皮瓣.蒂部仅包含胸锁乳突肌而不带皮肤.肌皮瓣经蒂部与缺损之间皮下隧道转移至缺损区,逐层缝合切口.供区视缺损大小可行直接拉拢缝合或邻近皮瓣转移或植皮修复.结果 应用岛状胸锁乳突肌肌皮瓣转移修复面颊部组织缺损12例,其中面颊部软组织肿瘤10例,颊部洞穿性缺损2例,术后肌皮瓣全部成活,被修复处色泽、厚度及外形均尚满意.结论 岛状胸锁乳突肌肌皮瓣血供丰富,血管恒定,切取及转移方便,是修复面颊部较大面积复合组织缺损的理想肌皮瓣.     

背阔肌肌皮瓣移植修复严重深度烧伤

目的总结高压电烧伤、热压伤创面适用背阔肌肌皮瓣进行修复的经验。方法26例严重深度烧伤创面,应用背阔肌肌皮瓣移植,其中岛状转位25例,游离移植1例。对上肢广泛电击伤及热压伤创面采用该肌皮瓣与侧胸皮瓣及髂腰部皮瓣联合移植修复,全跟腱坏死应用游离背阔肌肌皮瓣修复。结果皮瓣面积最大40cm×20cm,除1例皮瓣尖端坏死2cm,其余全部成活。跟腱的功能恢复满意。结论背阔肌肌皮瓣修复严重深度烧伤是一种理想的方法。     

带蒂斜方肌肌皮瓣的应用研究

在头颈肿瘤根治性切除手术后的组织缺损修复重建中，经常选用带蒂斜方肌组织瓣。但对该组织瓣的血供和临床应用等问题尚有争议。为此，采用解剖学研究方法，对５７具１１４侧尸体进行解剖，观察斜方肌的形态结构和动脉血供。斜方肌的动脉血供呈多源性，其中肩胛背动脉的出现率为１００％，其起点与颈横动脉共干者占６８．４％，直接单独起始者占３１．６％。临床应用斜方肌上部肌皮瓣６例，下部岛状肌皮瓣７例，获得较好的效果。认为带蒂胸大肌肌皮瓣、斜方肌上部肌皮瓣和下部岛状肌皮瓣三者各有优缺点，并互为补充。临床应用灵活，可提高头颈部癌术后组织缺损修复和功能重建的效果。