耳后皮瓣在眼险恶性肿瘤切除术后缺损一期修复中的应用

目的　探讨带血管蒂耳后皮瓣在眼睑恶性肿瘤切除后所致眼睑及周围组织缺损一期修复的临床应用。方法　本组 8例眼睑恶性肿瘤切除后所致眼睑及周围组织缺损 ,用带血管蒂耳后皮瓣一期修复 (缺损大小 2 5mm× 2 5mm～ 6 5mm× 6 0mm)。结果　 1例皮瓣表皮坏死。所有病例均取得较好外观 ,均保存视力。1例失访 ,7例获得随访。 1例死于局部复发。结论　耳后皮瓣具有血供可靠 ,供瓣区隐蔽 ,厚薄适中 ,操作方便等优点 ,术后形态恢复较满意 ,是修复眼睑大面积缺损的一个理想选择     

耳后皮瓣一期修复耳廓内软组织缺损

耳廓内肿物较少见，肿物切除后创面的修复常很棘手，如植皮则影响美观。从2001年3月～2006年11月我们共收治耳廓内肿物9例，清除病灶后用耳后皮瓣进行修复，效果良好。     

眼睑恶性肿瘤切除术后缺损一期修复19例临床研究

[目的]探讨眼睑恶性肿瘤广泛切除后所致眼睑及周围组织缺损的一期修复.[方法]19例眼睑恶性肿瘤根据不同类型,选用最佳距离切除.在冰冻组织学监控下证实切缘无瘤者,根据缺损部位及大小采用不同皮瓣一期修复眼睑大面积缺损(25mm×25mm～65mm×60mm).[结果]1例皮瓣远端部分坏死,1例表皮坏死.所有病例均取得较好外观,均保存视力.1例死于局部复发,1例死于远处转移.[结论]不同皮瓣一期修复眼睑广泛恶性肿瘤切除后的大范围缺损,可获得较好的外形及功能恢复.耳后皮瓣具有血供可靠,供瓣区隐蔽,厚薄适中,操作方便等优点,术后形态恢复较满意,是修复眼睑大面积缺损的一个理想选择.     

耳后皮瓣一期修复耳廓内软组织缺损

耳廓内肿物较少见,肿物切除后创面的修复常很棘手,如植皮则影响美观。从2001年3月～2006年11月我们共收治耳廓内肿物9例,清除病灶后用耳后皮瓣进行修复,效果良好。1资料与方法1.1临床资料本组共23例,年龄5岁～80岁。其中基底细胞癌1例,耳内痣6例,混台性血管瘤2例。病灶切除后创     

小腿内侧皮瓣在足跟部恶性肿瘤切除术后创面修复中的应用

我科自2005年2月以来,应用小腿内侧皮瓣修复足跟部恶性肿瘤切除后创面共10例,效果满意,现报告如下。     

额部皮瓣修复眼睑内侧缺损眼12例分析

[目的]探讨应用额部皮瓣修复眼睑内侧肿瘤切除术后眼睑缺损的临床价值。[方法]采用对侧眶上动脉和滑车上动脉为蒂的额部皮瓣修复眼睑内侧癌术后缺损12例。[结果]12例皮瓣11例全部成活,1例皮瓣远端约1/4表皮坏死。12例眼睑外形、色泽良好,功能满意。随访1～11年,1例术后4年因脑溢血死亡,无眼睑肿瘤复发者。[结论]额部皮瓣厚度和韧度与眼睑相仿,色泽与眼睑相同,皮瓣有感觉神经支配,成活率高,是修复眼睑内侧缺损的理想材料。     

眼睑恶性肿瘤术后眼睑修复的临床体会

眼睑对保护眼球起着十分重要的作用。因眼睑恶性肿瘤切除而造成眼睑全层缺损的病例临床虽不甚多见 ,但眼睑缺损不仅导致眼睑闭合不全 ,引起视功能损害 ,而且严重影响颜面仪容 ,在考虑手术时我们应在损伤最小的程度上尽可能的对其修复和重建。1　资料与方法1 1　临床资料　自 1998年 9月 - 2 0 0 1年 12月 ,在我院及上海第二医科大学附属第九人民医院眼科进修期间共收治眼睑恶性肿瘤 2 7例。病理诊断为 :基底细胞癌 11例 ,睑板腺癌 9例 ,鳞状细胞癌 5例 ,眼睑恶性黑色素瘤 2例。其中男性 15例 ,女性 12例。肿瘤位于上睑者 19例 ,下睑者 8例 ,…     

游离皮瓣移植术修复口腔颌面恶性肿瘤切除术后组织缺损的临床效果

目的 探讨游离皮瓣移植术在口腔颌面恶性肿瘤切除术后组织缺损中的应用效果。方法 选取口腔颌面恶性肿瘤切除术后组织缺损患者64例,按随机数字表法分为2组,各32例。所有患者均施以游离皮瓣移植术,对照组施行股前外侧皮瓣移植,观察组则给予前臂皮瓣移植。观察到术后3个月,对比2组吞咽功能、手术相关指标、美观满意度、并发症。结果 2组吞咽功能相比,无统计学差异(P>0.05);观察组出血量[(319.48±23.57)ml]少于对照组[(453.75±26.84)ml],住院时间[(5.71±1.05)d]短于对照组[(7.35±1.27)d],美观满意度[93.75%(30/32)]高于对照组[75.00%(24/32)],并发症发生率[9.38%(3/32)]低于对照组[31.25%(10/32)],差异有统计学意义(P<0.05)。结论 与股前外侧皮瓣移植术相比,前臂游离皮瓣移植术在口腔颌面恶性肿瘤切除术后组织缺损修复中效果更确切,可有效减少出血量,缩短住院时间,促进吞咽功能恢复,提升美观满意度,降低并发症发生率。     

胸三角皮瓣在头颈部软组织缺损修复中的应用

自 Bakamjian 上世纪六十年代首次报道胸三角皮瓣的临床应用以来［1］,该皮瓣已被陆续报道用于头颈部软组织缺损的一期修复。然而,由于解剖学的认识不足,以及相对较短的血管蒂,在一定程度上限制了其在临床上的广泛应用。在 Pubmed 以关键词“deltopectoral flap”检索至今为止可查见报道也仅有284篇。近年来随着对内乳动脉穿支的解剖学认识,胸三角皮瓣尤其是应用于修复头颈部软组织缺损时的优势已被逐步认识。本文就其在头颈部软组织缺损修复中的应用做简要报道。     

Resolution of hypoalbuminemia after excision of malignant phyllodes tumor

A 42-year-old woman presented with a rapidly growing tumor of the breast accompanied by anemia (7.4 g/dL), hypoalbuminemia (1.6 g/dL), and increased alkaline phosphatase (256 U/L). Magnetic resonance imaging of the breast demonstrated a heterogeneous mass composed of verrucous solid components with hemorrhagic areas. There was no evidence of cachexia, and the metastatic workup was negative. Final pathology revealed a 22-cm malignant phyllodes tumor. Hypoalbuminemia and alkaline phosphatase quickly resolved after surgical excision without any further treatment.     

瘤段骨切除灭活再植治疗骨关节恶性肿瘤(附16例报告)

目的 分析瘤段骨切除、去除瘤组织、灭活处理后，原位再植重建骨缺损治疗骨肿瘤的疗效。方法1998年10月-2003年4月，对16例长骨恶性肿瘤患施行广泛切除，瘤段骨离体灭活，95％酒精浸泡45分钟灭活，彻底清除瘤组织，回植原位，修复关节韧带，髓内钉内固定，手术前后辅助化疗。结果 全部病例平均随访28个月，2例因肺转移死亡，1例感染、1例髓内钉折断，随后局部复发截肢，灭活骨骨折、塌陷各1例，并发症发生率37．5％，保肢率75％。结论 瘤段骨切除灭活再植，手术简便，花费低廉，无排斥反应，骨连接处可达生物愈合，是治疗骨肿瘤保肢的有效方法。     

皮肤恶性肿瘤组织缺损修复重建策略专家共识(2020)

外科手术是皮肤恶性肿瘤主要的治疗方式,局部软组织缺损的修复重建是治疗的重点和难点,可能严重影响外科手术的彻底性、修复的完整性和外观的美容性.皮肤肿瘤软组织缺损皮瓣修复重建的最终目标是在确保手术切除外科边界的前提下,通过皮瓣修复局部软组织缺损,尽量达到修复缺损、重建组织功能、外观美容化的目标,提高皮肤肿瘤的外科手术效果和...     

Immediate maxillary reconstruction after malignant tumor extirpation.

AIMS: Immediate maxillary reconstruction after malignant tumor extirpation differs from other types of maxillary reconstruction. Our reconstruction algorithm is described in this article. METHODS: One hundred ninety-four patients who had undergone maxillectomy for malignant tumors were reviewed, and maxillectomy defects were classified with the method of Cordeiro and Santamaria. RESULTS: Mean total blood loss was 848 ml, and 71 patients died within 2 years after surgery. For type IIIa defects of the orbital floor, titanium mesh or vascularized bone or cartilage was used for reconstruction, but the rate of postoperative complications did not differ between titanium and autografts. Therefore, to reconstruct orbital floor defects we have recently used only titanium mesh. For type I or II defects, we use autografts for only selected cases. CONCLUSIONS: We strive to perform less-invasive reconstructive surgery after resection for maxillary malignancy.     

Pelvic reconstruction with a combined hemipelvic prostheses after resection of primary malignant tumor

BackgroundHemipelvic resections for primary malignant bone tumor require reconstruction to restore weight bearing along anatomic axes. However, reconstruction of the pelvic arch remains a major surgical challenge because of the high rate of associated complications. We designed a combined hemipelvic prosthetic system to reconstruct the pelvis and purpose of this investigation was to assess the oncology and functional outcome and complication rate following this procedures.Methodswe retrospectively reviewed 18 patients who had primary malignant pelvic tumor resections and reconstructions with the combined hemipelvic prosthesis using pedicle screw-rod constructs augmented with antibiotic cement in combination with a special designed acetabular reinforcement shell and hip prosthesis between 2001 and 2007. Patients were examined clinically and radiographically and were assessed functionally with Musculoskeletal Tumor Society score.ResultsFive (27.8%) patients had type II periacetabular pelvic resection and 5 (27.8%) had types I and II (periacetabular and ilium) pelvic resections. Six (33.3%) patients had types II and III (periacetabular and pubis) pelvic resections, 1 (5.6%) had types I and II and III resections and 1 (5.6%) had a types I and II and IV (periacetabular and ilium and sacrum) resections. Patient survival status, function, and complications were evaluated at a mean following up of 41 months (range, 7–73 months). Ten patients (55.6%) had no evidence of disease, five patients (27.7%) had died from their disease, and three patients (16.7%) were alive with disease. The overall survival rate was 72.2% at 5 years. Local recurrence occurred in four patients (22.2%). Six of 17 patients (35.3%) showed lung metastatic progression. The average MSTS 93 score was 65.5% and 71.7% at three months after surgery and at the last followup. Six (33.3%) patients had surgery-related complications including dislocation in 2, wound dehiscence in 2, deep-vein thrombosis in 1, screw loosening in 1 and sciatic nerve palsy in 1. There was no infection occurred in this series.ConclusionsPelvic reconstruction using combined hemipelvic prosthetic system after a limb-salvage resection is an acceptable method because of its lower complication and satisfactory functional outcome and its feasibility of reconstruction for any type of periacetabular tumor resection without elaborate preoperative customize.Level of evidenceLevel IV, therapeutic study.     

小块异体骨移植在骨肿瘤切除术后骨缺损中的应用

目的探讨小块冷冻异体骨治疗良性骨肿瘤切除术后骨缺损中的临床应用及疗效.方法自2000年11月至2004年11月应用打压植骨技术对小块异体骨进行打压植骨来治疗四肢长骨良性骨肿瘤手术切除后残留骨缺损病例22例.结果本组随访6～80个月,平均31个月.因肿瘤复发行肿瘤再切除植骨术1例,3例患者因术后未行有效固定,外伤后出现植骨区骨折,二次手术行内固定术.X线片显示,其余病例的骨缺损腔隙均有骨小梁通过,无感染病例.结论用小块异体骨移植充填肿瘤切除后的骨缺损具有良好的临床效果.彻底切除肿物、正确使用同种异体冷干骨、熟练掌握打压植骨技术、适当固定、应用抗生素及恰当的负重时机是手术成功的关键.     

游离腓骨移植重建胫骨骨纤维结构不良病灶切除后骨缺损

目的 探讨吻合血管的游离腓骨移植重建胫骨骨纤维结构不良病灶切除后骨缺损的疗效。方法 对27例胫骨骨纤维结构不良患，行病灶彻底切除，所遗骨缺损以吻合血管的游离腓骨移植重建。移植腓骨长6cm～26cm，平均14．2cm。术后随访2年～12年，平均6．6年。结果 移植的腓骨术后平均4．2个月(3～8个月)达到骨性愈合，双下肢等长，功能接近正常。结论 吻合血管的游离腓骨移植重建胫骨骨纤维结构不良病灶切除后骨缺损，可最大限度地恢复患肢功能，是行之有效的方法。     

四肢恶性骨肿瘤切除后骨缺损使用异体骨移植术重建修复的疗效

目的:研究同种异体骨移植术修复重建四肢恶性骨肿瘤切除后骨缺损的临床疗效。方法:选取2016年03月至2019年08月我院收治的四肢恶性骨肿瘤切除后骨缺损行同种异体骨移植重建修复的患者15例和行复合肿瘤型人工关节置换的患者9例;本文研究对象均经穿刺活检和术后病理确诊;Enneking分期Ⅰb期6例,Ⅱb期18例;术前尤文肉瘤3例和骨肉瘤15例患者均行2个疗程化疗和术后规范化疗;应用MSTS评价术后患者的肢体功能情况。结果:所有患者均获得随访,随访时间为8~46个月,平均（29.63±11.21）个月;24例患者术后均未发生假体周围骨折或移植异体骨折,且无假体松动和关节脱位;20例患者术后肢体功能优良,MSTS评分为16~28分,平均（22.80±4.46）分。结论:四肢恶性骨肿瘤切除术后骨缺损使用异体骨段移植重建长骨干缺损和或肿瘤型人工关节复合置换治疗的临床疗效显著。