皮肤移植在修复手部损伤中的应用（附43例分析）

本文报告应用四种修复方法治疗手部大块软组织缺损43例。作者认为，手背大块皮肤缺损不伴骨或腱外露者，以游离植皮为宜；手掌软组织缺损，手背皮肤缺损伴骨、关节或腱外露者．条件允许时，以前臂逆行岛扶皮瓣为佳；拇指皮肤缺损，单纯虎口狭窄以及第一掌骨挠背侧皮肤缺损。选用食指背侧皮瓣最理想；上进方法均不宜采用时。再选择游离皮瓣移植。     

Dermoscopy and ultrosound monitoring actinic keratosis with cutaneous squamous cell carcinoma: A case report and literature review

Actinic keratosis(AK) is a common premalignant skin lesion that can progress to invasive squamous cell carcinoma(iSCC). Clinically, AK presents as reddish or brownish macules, papules, or hyperkeratotic plaques. AK cannot be reliably predicted whether it will transform into invasive carcinomas, so skin biopsy is currently a gold standard for identifying suspicious malignancy. Currently, there are non-invasive methods to help diagnose and determine the difference between AKs and iSCC. For example, dermoscopy and ultrasound can be very useful in diagnosing and monitoring skin diseases non-invasively. Therefore, we report a case of multiple facial AKs with poorly differentiated skin squamous cell carcinoma, which was diagnosed early through dermoscopy and ultrasound, and confirmed by histopathology.     

头皮缺损97例治疗分析

目的探讨头皮撕脱伤及头皮烧伤后头皮缺损治疗的方法及效果。方法回顾本院1994年8月—2007年12月对97例头皮撕脱伤及头皮烧伤后头皮缺损的治疗情况,对颅骨外露、颅骨全层烧伤等采用颅骨钻孔、培育肉芽组织、中厚皮片移植,皮管带蒂皮瓣移植,局部转移皮瓣移植,皮肤扩张器应用后皮瓣转移等消灭头皮缺损。结果颅骨外露宜采用颅骨钻孔、肉芽生长后再行中厚皮片移植,孔径1～2mm,孔间距1～1.5mm;颅骨坏死宜采用局部皮瓣移植或皮管带蒂皮瓣移植;颅骨外有帽状腱膜等软组织存在,可直接用中厚自体皮移植,但无头发。皮肤扩张器扩张正常头皮后再转移皮瓣移植消灭颅骨外露,虽然治疗疗程长,但毛发正常生长,外观好。结论头皮撕脱伤的不同病例,应采用不同的治疗方法,才能达到最好的治疗效果。     

Sudden Death of an Ice Hockey Player

Dry skin is a concern during winter months among those who are active outdoors. Management focuses on rehydrating the skin and preventing further moisture loss. Practical treatment methods include liberal use of emollients, humidifying home air, showering only once a day, and avoiding soaps and other products that can remove moisture-retaining lipids from the skin. Implementing these measures before the onset of symptoms can help patients prevent xerosis. Severe cases may require topical therapies such as corticosteroids, alpha-hydroxy acids, or antibiotics.     

50例下肢大面积皮肤撕脱伤的处理

目的 探讨不肢大面积皮肤撕脱伤的外科处理。方法 ５０例下肢大面积皮肢撕脱伤,１９例采取带蒂反取皮法修复,３３例采取单纯反取皮法修复。结果 带蒂反取皮法治疗１９例,皮片成活率达９４．７％（１８／１９）;单纯反取皮法治疗３１例,皮片成活率为８７．１％（２７／３１）。结论 对下肢大面积皮肤撕脱伤,根据损伤程度和撕脱完整与否、血供良好与否、采取带蒂反取皮法或不带蒂单纯反取皮法修复创面,可取得良好效果。     

Short communication: Practical aspects for the evaluation of skin doses in interventional cardiology using a new slow film

Mapping skin doses in complex fluoroscopy interventions is useful to determine the probability of a possible injury, to detect areas of overlapping irradiation fields and to obtain a permanent register of the most exposed patient skin areas. To fulfil this task, large films with slow X-ray response can be used. Recently, Kodak has introduced a new radiotherapy verification film, named EDR2 (Extended Dose Range). The aim of this paper is to analyse the possibilities of using this new film for estimating skin dose distributions in interventions with potentially higher doses, such as complex percutaneous transluminal coronary angioplasty (PTCA), intravascular brachytherapy procedures (IVB) or cardiac ablations. The EDR2 film by Kodak is an improved option to be used in interventional cardiology to obtain maps of patient skin doses and to estimate maximum skin doses up to 1400 mGy. Film kVp dependence is negligible and the processor conditions can be standardized to obtain skin dose estimations. The linear range for accurate dose measurements is from 50 mGy to 500 mGy.     

Lesions and characteristic injury patterns caused by high-voltage fault arcs

Exposure to high-voltage electric arcs as a result of an accident or by means to commit suicide can affect people’s health and cause death. There are characteristic external findings that can be found on external examination. These include extensive skin burns, periorbital recesses or “crow’s feet,” vapor deposition of conductor material, known as metallization, and tightly spaced, roundish, crocodile skin like burns. The Institute of Legal Medicine of the Rostock University Medical Center recorded 16 deaths caused by exposure to electricity between 1990 and 2018. Six of these deaths were caused by exposure to high-voltage electric arcs and five of these deaths (83 %) showed crocodile skin like burns and one had periorbital recesses burns on the face as a result of a fault arc. To our knowledge, the present paper is the first report describing the frequent occurrence of crocodile skin like burns due to high-voltage fault arcs.     

Self-reported skin cancer protection strategies and location of skin cancer in retired cricketers: A case study from membership of the Emu Cricket Club

Cricket is one of Australia's most popular sports with approximately 470,000 registered participants. Played as a summer sport, participants can spend long periods in the sun with potential skin damage a possible contributor to skin cancer. Three hundred and sixty-eight retired regional representative players received and were invited to complete a comprehensive survey that included questions relating to their individual playing history, injury rate, sun protection strategies and reported location of skin cancer. A total of 164 players (mean age 45.2 ± 12.1 years) responded to the survey representing a response rate of 44.6%. Of these, 61.6% reported no diagnosis of skin cancer. However, 38.4% had been diagnosed with at least one skin cancer with the most common site being the face followed by the arms. Of those respondents reporting the diagnosis of a skin cancer, 7.9% had skin cancer on 4 or more separate locations. Proportionally, the 45–55 years group had the highest incidence, with 55.8% of this group indicating they had a skin cancer in at least one anatomical location. By comparison those in the under 35 years age group reported an incidence rate of 16.7%. The incidence of skin cancer among respondents (n = 63) reporting either, occasionally, very rarely or never wearing sunscreen, a hat or long sleeved shirt was (n = 27) 42.9, (n = 14) 22.2 and (n = 39) 61.9%, respectively. The results suggest that skin protection strategies, such as wearing a wide brimmed hat, long sleeved shirt and the use of sunscreen, may help to reduce the risk of skin cancer in cricketers.     

Cutaneous complications of hepatic chemoembolization via extrahepatic collaterals

PURPOSE: To report cutaneous complications occurring after chemoembolization of hepatic tumors via extrahepatic collaterals. METHODS: Five patients underwent chemoembolization via the internal mammary (n = 3), intercostal (n = 1), or multiple extrahepatic collateral vessels supplying liver metastases. RESULTS: Painful induration and discoloration of the skin in the distribution of the superior epigastric or intercostal arteries occurred in four patients, with transmural necrosis in two. One required surgical excision. One patient developed a radiation burn after 12 procedures and eventually developed a squamous cell carcinoma at the site, which required resection and skin grafting. CONCLUSION: Cutaneous injury can occur after chemoembolization of extrahepatic collaterals. Scrupulous technique is required to avoid nontarget embolization of chemotherapeutic drugs. High cumulative radiation doses to localized areas of skin can occur in patients undergoing multiple procedures.     

皮瓣、肌皮瓣修复慢性难愈性溃疡创面

目的探讨应用皮瓣、肌皮瓣修复慢性难愈性溃疡创面的效果。方法1994—2005年我们应用局部皮瓣4个,轴形皮瓣38个,肌皮瓣移植19个,肌瓣转移2个。修复慢性溃疡创面59例(63个创面)。结果除2个皮瓣边缘出现表皮坏死,换药后治愈,其余61个皮瓣、肌皮瓣、肌瓣均全部成活,创面一期修复。结论皮瓣、肌皮瓣血运丰富,不失为是一种修复复杂、慢性难愈性溃疡创面的好方法。     

远红外辐射陶瓷纤维－X_1对人体微循环影响的研究

为了探明某些具有在人体红外线的作用下可辐射远红外线功能的陶瓷纤维对微循环的影响，我们通过双盲序贯实验观察了国产软性陶瓷纤维—Ｘ１对人体皮肤温度、皮肤血流量的作用。发现无论穿着含有多量或少量—Ｘ１的衣袖，均使穿着部位的皮肤血流量明显增加，且血流量的变化与Ｘ１的含量及穿着时间成正比。而实验期间皮肤温度的变化不甚明显，并与血流量改变无关。说明Ｘ１具有一定的活血化淤功效，在运动医学、康复医学和健康保健等领域中有着广泛的应用前景。     

Thermoregulatory function during the marathon

Marathon races are performed over a broad range of environmental conditions. Hyperthermia is a primary challenge for runners in temperate and warm weather, but hypothermia can be a concern during cool-wet or cold conditions. Body temperature during the marathon is a balance between metabolic heat production and exchange with the environment described by the heat balance equation. During exercise, core temperature is proportional to the metabolic rate and largely independent of a wide range of environmental conditions. In temperate or cool conditions, a large skin-to-ambient temperature gradient facilitates radiant and convective heat loss, and reduces skin blood flow requirements, which may explain the tolerance for high core temperature observed during marathons in cool conditions. However, in warmer environments, skin temperatures and sweating rates increase. In addition, greater skin blood flow is required for heat loss, magnifying thermoregulatory and circulatory strain. The combined challenge of exercise and environment associated with marathon running can substantially challenge the human thermoregulatory system.     

预构皮瓣的研制及其进展

预构皮瓣是按照一定的设想和设计,通过手术将皮瓣预先施以加。,改造成具有一定要求,功能和特性的皮瓣,使其更便于修复器官缺损,更好地恢复其功能与形态。也由于在皮瓣内植入轴型血管或大网膜或肌肉,将随意皮瓣变成轴形血管皮瓣,扩大了游离皮瓣供区的选择。这一技术已逐渐被广大整形外科医生所重视,并视为整形外科领域中又一个新进展。1994年Prifag将血管植入皮瓣形成轴型皮瓣称为预构皮瓣（Pre．fabrication）。而在皮瓣中填加骨,软骨等行器官再造称为预置（Prelaminatio）,我们姑且将二者合在一起,统称为预构皮瓣,现在已经被临床应用的有：预构皮瓣鼻成形术,预构皮瓣耳成形术,预构皮瓣眼睑成形术,预构皮瓣阴茎成形术。预构大网膜轴型皮瓣,预构血管植入轴型皮瓣。预构肌皮瓣,预构扩张皮瓣等等,均获得了良好的临床效果。     

General considerations of the choice of dose limits, averaging areas and weighting factors for the skin in the light of revised skin cancer risk figures and experimental data on non-stochastic effects

In recent years considerable clinical and experimental data have become available which can form the basis of a better understanding of the response of skin to radiation exposure and should lead to improved radiological protection criteria. Recent biological data from man and pig on the non-stochastic effects following exposure with a range of beta-emitters are combined with recent epidemiological analyses of skin cancer risks in man to form a basis for suggested improved protection criteria for the skin following whole- or partial-body skin exposures. Specific consideration is given to the choice of an organ weighting factor for the evaluation of effective dose-equivalent. Since the stochastic and non-stochastic end-points involve different cell types, which reside at different depths in the skin, the design of an ideal physical dosemeter may depend on the proportion of the body skin that is exposed and the penetrating power of the radiation. Possible choices of design parameters for skin dosemeters are discussed. The limitation of skin exposure from small radioactive sources ('hot particles') is an important practical problem, which is addressed for the first time using animal data. Dose limitation on the basis of an average dose to an area of skin in the vicinity of the particle or on the basis of number of beta-particles emitted could be used. Animal data, for several energies and sizes of beta-emitting sources, indicate that limitation of the average dose to 1 Gy (average dose to 1 cm2 of skin at a depth between 100 and 150 microns) should prevent the occurrence of transient acute ulceration from small sources with dimensions of less than about 1 mm.     

瘢痕疙瘩周围皮肤纤维细胞凋亡的实验研究

探讨瘢痕疙瘩周围皮肤是否存在异常成纤维细胞,以期进一步了解瘢痕疙瘩的发展机制。体外培养瘢痕疙瘩及其周围皮肤成纤维细胞,运用流式细胞仪比较无血清培养条件下和FasMcAb作用下瘢痕疙瘩及其周围皮肤成纤维细胞凋亡率的差异。结果显示,无血清培养条件下瘢痕疙瘩周围皮肤（距瘢痕疙瘩边缘0.5cm范围内）成纤维细胞凋亡增长率介于瘢痕疙瘩和正常皮肤之间。FasMcAb作用下,瘢痕疙瘩周围皮肤成纤维细胞凋亡率增加,与正常皮肤比较差异有显著性意义（P<0.01）,但总体上与瘢痕疙瘩差异无显著性意义（P>0.05）。研究表明,瘢痕疙瘩周围皮肤至少有部分成纤维细胞不能正常凋亡。     

Inherent cellular radiosensitivity of human tumors of varying clinical curability.

It is well known that radiation therapy can be successfully used to cure or control some types of human tumors, while consistently failing in others. This has been ascribed to several factors including differences in the intrinsic sensitivity of the tumor cells and in their ability to recover from radiation damage. In this study, human tumor cells from an osteogenic sarcoma, a glioblastoma, and two medulloblastomas, as well as cells from human skin, were established in tissue culture, and the in vitrox x-ray survival and DNA repair parameters determined. No significant differences in either clonogenic survival or DNA strand rejoining ability could be detected among these human tumors or skin cells, despite the wide variability in their radiocurability in vivo. In addition, skin cell strains derived from patients exhibiting markedly sensitive or resistant skin reactions during fractionated radiotherapy showed no differences in survival characteristics from normal controls. It is therefore suggested that the wide range of radiocurabilities seen among various human tumors cannot be explained on the basis of inherent cellular factors responsible for the survival of tumor cells after x-irradiation.     

皮肤再生医疗技术治疗糖尿病足溃疡疗效分析

目的:分析、总结、探讨皮肤再生医疗技术在临床上治疗糖尿病足溃疡的可行性与有效性。方法:对32例糖尿病足溃疡住院病人采用皮肤再生医疗技术为主、必要时配合植皮的治疗方法进行局部创面修复。结果:32例糖尿病足溃疡应用皮肤再生医疗技术获得修复9例(占28.1％),皮肤再生医疗技术 皮片移植12例(占37．5％),皮肤再生医疗技术 皮瓣修复5例(占15．6％),进行截肢6例(占18．8％)。结论:及时就诊、及时采用皮肤再生医疗技术为主的治疗方法能有效修复溃疡创面、降低糖尿病足截肢率。     

腕部高压电烧伤临床治疗经验

目的：减少腕部电烧伤的致残率，提高伤后的生活、工作质量。方法：患者入院后立即行无损伤性焦痴薄化、切开减张，创面涂MEBO，待创面残余坏死组织液化干净后，行中厚皮移植或皮瓣转移术。结果：83例腕部电烧伤全都恢复基本功能。结论：MEBT／MEBO与手术结合治疗腕部电烧伤能明显降低致残率和畸形形成，方法简单，易掌握。     

IV度烧伤骨外露创面的修复

目的：总结修复Ⅳ度烧伤骨外露创面的经验.方法：1994-04～2004-12,采用5种不同的修复方法治疗61例102处Ⅳ度烧伤骨外露创面,对其临床治疗与随访资料进行分析总结.结果：除修复3例3处长管状骨外露创面的皮片完全坏死,板障层移植皮片成活率约为90%外,其余皮片、皮瓣和扩张皮瓣均100%成活,伤口一期愈合.15个扩张囊经超量注水,扩张容量达到390～820 ml,注水过程中无1例发生并发症.术后随访1～15个月,创面愈合良好,毛发生长满意.结论：骨髓面或板障层皮片移植术可用于修复短管状骨或板状骨外露,但不能用于长管状骨外露创面的修复;在条件允许的情况下皮瓣或筋膜瓣可用于修复各种骨外露创面;头皮扩张术是修复颅骨外露创面的良好方法.     

耳垂缺损的不同方法修复效果观察

目的探讨用不同方法行耳垂缺损再造修复的可行性及优缺点。方法1995年1月-2006年7月共收治耳垂缺损患者45例,根据耳垂缺损的大小及对侧耳垂情况分别采用不同的手术方式进行修复再造。对于18例缺损面积较小的耳垂缺损采用耳轮滑行推进皮瓣法修复,15例中等程度缺损患者采用耳后皮瓣法修复,12例完全缺损,或虽不是完全缺损但健侧耳垂较大的患者采用皮肤扩张术 自体肋软骨移植法修复。结果45例患者分别采用上述方法进行再造修复后,耳廓、耳垂形态良好,随访4个月-8年,效果满意。结论对于不同程度的耳垂缺损畸形,应根据具体情况采用相应的修复方法,以达到最佳治疗效果。对于耳垂完全缺损或虽不是完全缺损但对侧耳垂较大的患者,应首选皮肤扩张术 自体肋软骨移植法,以获得形态良好而持久的再造耳垂。