肢体高压注射伤的临床治疗

目的 分析肢体高压注射伤的治疗和临床效果.方法 2011年6月-2013年1月,对4例肢体高压注射伤患者.均在伤后4h内给予清创,1例清创两次,以交臂皮瓣覆盖创面;1例清创三次,以游离植皮覆盖创面;1例清创一期闭合创口,术后创口感染皮肤缺损,以局部转移皮瓣覆盖创面;1例直接闭合创口.术后均给予系统康复治疗.结果 4例患者术后随访时间为5～24个月,均未出现肢体坏死,皮瓣及植皮全部成活.2例手部高压油漆注射伤患者术后均存在冷诱导综合征和指端感觉异常,按TAM系统法评定：优1指,良2指.2例足部高压水枪注射伤患者术后下肢负重、走路无异常,已重新回到工作岗位.结论 肢体高压注射伤是一种特殊类型的损伤,需要有经验的临床医师依据具体病情制定相应的治疗方案,要积极早期清创,及早闭创,早期进行康复治疗,降低肢体伤残率.     

单指皮肤脱套伤的治疗

目的探讨治疗单手指脱套伤的方法,恢复伤指最佳功能.方法用掌背动脉逆行岛状皮瓣联合邻指带指神经背侧分支的指动脉岛状皮瓣覆盖伤指创面,观察伤指功能恢复.结果9例伤指,除1例背侧皮瓣边缘坏死外,余者均成活,且伤指腹侧恢复感觉功能.结论采用两个岛状皮瓣联合修复,是一种良好的治疗方法.     

手部高压注射伤的治疗

目的 报告6例手部高压注射伤的治疗方法与效果。方法 所有伤指(手)均经2或3次清创，清创后的创面均采用手背逆行筋膜蒂皮瓣修复。结果 1998年10月至2001年10月，用该法治疗手部高压注射伤6例，皮瓣全部存活，伤指运动功能良好。结论 2～3次的清创和早期用皮瓣覆盖创面是保存伤指良好运动功能的关键。     

手指高压注射伤的显微外科治疗

目的总结手部高压注射伤的显微外科治疗方法及疗效。方法回顾性分析2017年1月-2018年4月收治的18例手指高压注射伤患者的临床资料,急诊于臂丛神经阻滞麻醉下行切开引流、显微镜下血管外膜彻底清创、创面敞开引流,术后预防感染,创面Ⅱ期直接缝合或皮瓣修复,早期行患指康复训练。结果术后患指成活14例,其中1例行腹部皮瓣修复创面,余13例伤口Ⅱ期直接缝合;4例患指感染坏死,行残端修整术。随访6～12个月,末次随访按TAM系统评定法评定患指功能,优9例,良3例,可1例,差1例。结论手部高压注射伤是临床相对少见的损伤,治疗困难,预后相对较差,早期经显微镜外科清创治疗,可提高患指成活率,促进患指功能的恢复。     

掌背动脉逆行岛状皮瓣与邻指皮瓣瓦合修复末节缺失的手指中近节脱套伤

目的 分析掌背动脉逆行岛状皮瓣与邻指皮瓣瓦合修复末节缺失的手指中近节脱套伤的临床疗效。方法 回顾性分析自2014-08—2018-05采用掌背动脉逆行岛状皮瓣联合邻指皮瓣瓦合修复12例末节缺失的手指中近节脱套伤,术中采用手背掌背动脉逆行岛状皮瓣修复伤指背侧创面,带指固有神经背侧支及指背神经的邻指皮瓣覆盖伤指掌侧创面。结果 12例均顺利完成手术,随访时间12～26个月,平均18个月。移植的24块皮瓣均顺利成活,其中1例掌背动脉皮瓣出现张力性水泡,及时拆除蒂部部分缝线,皮瓣成活,创面逐渐自行愈合。供区植皮均一期成活。末次随访时伤指外观良好,皮瓣不臃肿,耐磨,质地与周围正常组织相近。掌侧邻指皮瓣静态两点辨别觉5～10 mm,平均7.2 mm;掌背动脉皮瓣为8～12 mm,平均9.5 mm;按照中华医学会手外科学会上肢部分功能评定试用标准评价临床疗效：优6例,良5例,可1例。结论 掌背动脉逆行岛状皮瓣与邻指皮瓣瓦合修复末节缺失的手指中近节脱套伤操作简便,皮瓣成活率高,伤指外形较美观,供区副损伤小,适合在基层医院中推广应用。     

指动脉蒂逆行转移的邻指动脉岛状皮瓣修复手指创面

1999年 6月以来 ,我们根据指掌侧总动脉分成相邻两指 2根指固有动脉的解剖特点 ,结合指动脉逆行岛状皮瓣的应用原理 ,设计了以患指指动脉蒂逆行转移的邻指指动脉岛状皮瓣修复手指创面的术式。临床共修复 8例手指创面 ,效果满意。一、资料与方法　　 1 .一般资料 :本组共 8例 ,男 5例 ,女 3例 ;年龄 1 8～ 45岁。伤因均为多指严重挤压伤。术中均应用本皮瓣进行手指创面的修复。其中用中指桡侧指动脉岛状皮瓣逆行转移修复示指创面 2例 ,示指尺侧指动脉岛状皮瓣逆行转移修复中指创面 1例 ,环指桡侧指动脉岛状皮瓣逆行转移修复中指创面 4例 ,环…     

邻指指动脉岛状皮瓣修复手指皮肤软组织缺损

2005年8月至2010年11月,我们应用邻指指动脉岛状皮瓣修复手指皮肤软组织缺损21例21指,取得较满意效果.1临床资料本组共21例,男15例,女6例,年龄17～46岁.致伤原因:压轧伤9例,割伤3例,磨伤3例,绞伤6例.受伤指别:拇指1指,示指6指,中指9指,环指3指,小指2指.21例均为超过指间关节的缺损,缺损面积为:1.6 cm ×1.5 cm～5.3 cm ×2.0 cm.21例中应用邻指指动脉顺行岛状皮瓣11例,逆行岛状皮瓣7例,邻指指动脉逆行带蒂岛状皮瓣3例.4例因受区指动脉、指神经缺损,用皮瓣内的指动脉及指神经背侧支桥接修复.     

同指指固有动脉背侧分支皮瓣与邻指皮瓣瓦合修复末节脱套伤

目的 探讨采用同指指固有动脉背侧分支皮瓣与邻指皮瓣瓦合修复末节脱套伤的临床效果.方法 2010年6月至2020年12月唐山市第二医院应用同指指固有动脉背侧分支岛状皮瓣联合邻指皮瓣修复30例(30指)新鲜末节脱套伤(伴或不伴末节指骨骨折),其中男18例,女12例;年龄16～60岁,平均(39士3)岁.采用中华医学会手外科...     

改良邻指指动脉逆行岛状皮瓣的应用

目的 探讨改良邻指指动脉逆行岛状皮瓣修复手指中节以远掌侧皮肤软组织缺损的手术方法。方法 以指总动脉作为邻、患指指掌侧固有动脉逆行供血通道，在患指近侧指间关节近侧平面为旋转点，设计邻指指动脉岛状皮瓣逆行翻转，修复10例手指中节以远掌侧皮肤软组织缺损，同时将皮瓣上的感觉神经与患指远端指神经缝合。结果 10例皮瓣全部成活，术后随访6～15个月。手指外观饱满，皮瓣颜色与正常手指相似，皮瓣质软，两点分辨觉为4mm。供区手指功能无影响。结论 改良邻指指动脉逆行岛状皮瓣适用于修复手指中节以远掌侧皮肤软组织缺损创面的覆盖，术后疗效满意。     

两种皮瓣在皮肤缺损型断指再植修复中的应用

目的 总结邻指指动脉岛状皮瓣及静脉血营养的静脉皮瓣在皮肤缺损型断指再植修复中的临床效果.方法 对15例15指皮肤缺损型断指(皮肤缺损位于手指背侧、掌侧及环形),分别采用邻指指动脉岛状皮瓣修复4例,静脉血营养的静脉皮瓣修复9例,邻指指动脉岛状皮瓣联合静脉血营养的静脉皮瓣修复2例.结果 15例断指及其皮瓣全部存活,其中有2例指体术后发生血管危象,行手术探查后断指及皮瓣存活.术后随访1～ 18个月,平均7个月,再植指体无明显短缩,皮瓣质地良好、不臃肿,再植指体外观及功能恢复满意.结论 邻指指动脉岛状皮瓣及静脉血营养的静脉皮瓣是修复皮肤缺损型断指再植的有效手术方法.     

High-pressure injection injuries of the hand in a Chinese population

We performed a retrospective review of 28 digits in 28 patients who suffered high-pressure injection injuries of the hand during the last 10 years. They were all men, with a mean age of 36 years. All were work injury and the injuries were classified into mild, moderate and severe and were either treated conservatively or surgically. There were seven patients with mild injuries and six of these were successfully treated by conservative methods. Sixteen patients had moderate injuries and all were successfully treated with repeated debridement and delayed direct closure. The index fingers of two severely injured patients were salvaged with digital artery flaps and the remainder of the involved fingers were amputated. The authors advocate proper identification of mild injuries to allow conservative treatment, the application of digital artery flaps for resurfacing large finger defects and have formulated a treatment protocol according to the severity of the injury.     

手部高压注射伤的诊断和治疗

目的 总结6例手部高压注射伤的诊治体会.方法 分析1997年5月-2007年10月,6例手部高压注射伤的病情特点和治疗效果.6例患者均为男性;受伤部位分别为示指2例,中指2例,拇指1例,手掌1例;注射物质均为油漆;就诊时间为伤后1 h至2 d.所有病例2～24 h给予清创治疗,2例直接闭合创口,3例清创2次,1例清创3次,后4例以逆行掌背动脉或骨间后动脉皮瓣覆盖创面.术后给予系统康复治疗.结果 6例术后随访7个月至6年,均未出现手指坏死.4例皮瓣完全存活,创口愈合时间为术后17～35 d.全部患者术后1～3年内伤指均有冷诱导综合征和指端感觉异常.4例重新回到了工作岗位,平均时间为术后1.7年.术后4年2例伤指及相邻手指掌指和指间关节僵硬,主、被动活动能力下降.结论 手部高压注射伤是一种严重的复杂损伤,此种损伤对手部未来的功能和重返工作有较为明显的影响.应依据伤情的严重程度制定规范性的个性化治疗方案.     

Vacuum-assisted-closure-Therapie

This article reports the case of a 23-year-old woman who sustained severe soft tissue injuries with open fractures of the left distal femur, the left proximal tibia, a subtotal amputation of the left foot with injuries to the anterior and posterior tibial artery due to a bomb blast. When the patient was transferred to our hospital 17 days after the trauma, all primarily closed wounds were severely infected. The fractures were treated by external fixateur and k-wire fixation. After debridement and initiation of negative pressure therapy the anterior tibial artery was reconstructed after 3 days and partial wound closure by a rectus abdominis muscle flap was achieved after 19 days. After almost total wound closure was accomplished open reduction internal fixation (ORIF) was performed for the distal femur fracture and a modification of the external fixateur for the tibial and foot fractures. The negative pressure therapy is an important component for treatment of complex soft tissue injuries and open fractures; however, it must be embedded in an interdisciplinary treatment plan with well-defined treatment goals.     

Primary or delayed closure for the treatment of poststernotomy wound infections?

OBJECTIVE: The methods of primary versus delayed wound closure for the treatment of sternal wound infections after cardiac surgery were retrospectively compared. METHODS: From January 2001 to March 2003, 132 patients (median age 66 years, male to female ratio 88:44) with sternal wound infection after cardiac surgery were treated at our department. After thorough debridement, 35 patients received preconditioning of the wound before implementation of definitive therapy; the remainder (97 patients) were treated with immediate closure. RESULTS: From the 35 patients with preconditioning, 19 patients proceeded to delayed primary closure, whereas the remaining 14 patients were referred to plastic reconstruction with a pectoralis muscle flap. Primary success rate in this group was 100%. In the immediate primary closure group, 33 patients experienced 1 or more therapy failures, resulting in a recurrence rate of 39%. Fifteen patients received a pectoralis muscle flap as definite treatment modality. CONCLUSIONS: Immediate primary closure is associated with a high rate of local infection recurrence. Surgical debridement and conditioning of the wound until resolution of infections with delayed primary closure or plastic reconstruction is suggested as the more appropriate treatment modality, with promising results.     

Flap reconstruction following high pressure injection injuries of the hand: a report of three cases.

High pressure injection injuries are well known to cause significant injury to the hand, with high amputation rates and poor functional outcome. Surgical treatment consists of early aggressive debridement followed by secondary closure. Flap reconstruction is a reconstruction option which can increase the chance of digit salvage, as well as give an acceptable functional and cosmetic result. We review three cases of flap reconstruction following high pressure injection injuries, and discuss their role in the treatment of these injuries.     

Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection.     

Management of penile gunshot wounds

The management of 10 cases of penile gunshot wounds treated at Henry Ford Hospital from 1982 to 1986 is reviewed. All patients were assaulted by low velocity weapons (handguns). Eight patients had associated injuries, predominantly to the genital region (thigh, pubis, and scrotum). There were 5 urethral injuries; 4 were treated with primary repair, the remaining patient underwent delayed repair, complicated by severe urethral strictures requiring reoperation. Blood at the urethral meatus was suggestive of urethral injury but microscopic hematuria was not. Five penile injuries did not involve the urethra and were treated by debridement and primary wound closure with no immediate or delayed complications. In dealing with these injuries we recommend a high index of suspicion for urethral and regional organ injury and primary urethral closure if at all possible.     

Primary closure for postoperative mediastinitis in children

OBJECTIVES: Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children. METHODS: From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated. RESULTS: One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients. CONCLUSIONS: Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.