闭孔动脉跨区供血的长型股薄肌肌皮瓣即时重建癌切除后的女阴阴道缺损

目的探讨女阴阴道癌扩大根治术后即时进行修复再造的方法。方法应用闭孔动脉跨区供血的股薄肌肌皮瓣对女阴阴道癌切除后的缺损进行即时的修复与重建。肌皮瓣的肌肉组织可充填癌切除后的组织缺损,皮肤组织则可修复创面和再造阴道。术中还可对癌切后的创面直接进行放射治疗。结果临床应用4例,其中1例术中进行放疗。全部转移的肌皮瓣均100%成活,切口甲级愈合,再造的外阴及阴道无挛缩,外观酷似正常,性功能如常。结论闭孔动脉跨区供血的长型股薄肌肌皮瓣,不仅具有与传统股薄肌肌皮瓣相同的修复机能,而且由于其蒂部在耻骨闭孔处,故转移弧度更广,更适合会阴癌切除后的修复再造,也不影响术前、术中和术后进行放疗和化疗。     

乳房再造76例

目的探讨应用各种自体组织移植和人工材料置入的方法再造乳房的适应证与优缺点。方法分别应用下腹部腹直肌(TRAM)与腹壁下动脉穿支(DIEP)联合皮瓣、双侧DIEP皮瓣、单侧DIEP皮瓣、TRAM皮瓣、扩大背阔肌肌皮瓣、背阔肌带蒂移植与硅凝胶假体置入联合应用、硅凝胶假体置入等方法再造乳房76例,按手术方法分类,并对手术效果、并发症进行分析和评估。结果76例乳房再造患者中,有67例患者应用了合计70侧自体组织移植皮瓣,90%的移植皮瓣完全成活,4侧(5.7%)出现皮瓣远端局部脂肪硬结,3侧(4.3%)皮瓣因血管吻合口栓塞而完全失活。再造乳房与健侧基本对称,形态自然,绝大多数再造乳房的形态优于健侧乳房。结论要充分考虑各种乳房再造手术方法的适应证,针对患者的具体情况选择不同的再造方法,最终可重建出左右对称、形态完美、富有魁力的乳房。     

下腹部横行皮瓣行乳房再造术的护理

女性乳房是女性美的一个象征。乳房缺失不仅影响女性体态的完美,且会影响其心理健康。乳房再造则可塑造一个完美的女性体型,重建其自信心理。腹部是乳房再造的良好供区,它基本上能满足各种类型乳房再造术的要求。应用下腹部横行皮瓣再造的乳房形态自然,是目前乳房再造的首选方法[1]。我们通过对31例乳房再造的护理实践,总结其护理要点,报告如下。1资料与方法1.1一般资料2003年11月～2005年6月,我们应用下腹部横行皮瓣移植行乳房再造的女性患者共31例。年龄31～51岁,平均为43岁。均为单侧乳腺癌术后乳房缺失:左侧21例,右侧10例。其中,乳腺癌…     

具有味觉和运动功能的一期全舌再造探索(随访18年病例报告)

目的探索一项具有味觉和舌自主运动功能的全舌再造技术。方法将完整保存神经血管并含有舌外肌的口底组织,沿下颌骨后缘整块切开、自下颌舌骨肌浅面分离后,向上、向前抬起作为再造舌,用岛状颈阔肌肌皮瓣经颏下转入口腔,分别覆盖再造舌的腹侧创面和口底的口腔侧创面。颈部供瓣区中厚植皮。结果对1例曾被切去全舌的患者,应用该法再造全舌,术后获得完全的味觉感觉及良好的吞咽、语言等自主运动功能。结论在保存有完整神经血管及口底组织的情况下,该法是有效可行的舌再造方法之一。     

创伤后计划性腹疝确定性重建的新方法——改良腹直肌推徙术

目的探讨开放腹腔手术后巨大计划性腹疝的新的手术方式改良腹直肌推徙术的治疗效果。方法总结分析12例巨大计划性腹疝患者的临床资料和改良腹直肌推徙术的治疗结果。其中,男9例,女3例,平均41．5岁。术前合并结肠造口5例;回肠造口2例;胰瘘1例;胃空肠吻合口一腹壁瘘1例;慢性胆囊炎1例。计划性腹疝至确定性重建的时间平均为6．5个月。结果本组12例患者手术后救治成功12例（成功率100％）,术后发生皮下血清肿1例,皮缘坏死2例,经引流及换药治愈。术后无严重感染并发症,无复发性腹腔间隙综合征发生,无脏器功能障碍发生。腹直肌功能恢复良好,无其他不适症状。随访2～25个月,平均13．6个月,轻度复发1例。结论改良腹直肌推徙术治疗巨大计划性腹疝,方法实用,操作简单,效果良好,为开放腹腔手术后巨大计划性腹疝患者临床治疗提供了新的可供选择的手术方法。     

乳腺癌改良根治术同期乳房再造26例

目的介绍乳腺癌改良根治术同期应用自体组织及硅凝胶假体植入行乳房再造的经验。方法对Ⅰ、Ⅱ期乳腺癌,行改良根治术,同时应用自体组织(胸小肌及背阔肌瓣)及硅凝胶假体植入行乳房再造。结果26例患者再造乳房形态良好,生活质量明显提高。结论乳腺癌改良根治术同期乳房再造,能减少乳房缺失的心理压力,满足肿瘤治疗和形体美容两方面要求,提高患者生存质量。     

性别异位症的临床治疗

目的探讨性别异位症的临床特点及其手术变性治疗.方法变性手术均分期施行.男性变女性采用一期睾丸切除及阴蒂、阴道、外阴再造,采用阴茎阴囊皮瓣法再造阴道及外阴,再二期行隆胸手术以及乳头、乳晕整形.女性变男性先行子宫及双附件切除,阴道切除闭合,后行乳房整形,再行阴茎再造术.阴茎再造采用腹壁及旋髂浅动脉为蒂的皮瓣与腹直肌肌瓣瓦合成形法.结果自1989年至2007年共诊治性别异位症患者78例,行变性手术治疗21例,其中男性变为女性者15例,女性变男性6例.术后随访1～11年,无严重并发症.受术者社会性别转变后,生活状态良好.结论对于性别异位症患者,手术行性别改变是安全、有效的治疗方法.     

唇癌的外科治疗与即时唇再造--兼论保存口角轴在唇再造术中的意义

目的评价唇癌根治切除后即时进行唇再造的方法与效果。方法对69例唇癌患者,癌切除后即时应用交叉唇瓣、扇形瓣、鼻唇沟或唇颊沟组织瓣、V形切除推进缝合、面动脉蒂的唇颊组织岛状瓣等方法进行唇再造。术后随诊1～6年,观察其形态与功能效果。结果所有患者术后病情稳定,再造唇均成活。再造唇中保存口角轴的53例,其功能与形态效果均优良。应用扇形瓣或口角唇组织瓣转移修复者13例,术后唇形前突,运动时口角不对称。因组织量不足和术后感染致唇形态欠佳者3例。结论①鉴于唇癌容易早期发现,一般恶性程度较低,唇癌切除即时进行唇再造可作为一个常规的治疗方法。②口角轴是口唇运动和表情形态的核心。保存口角轴的唇再造,可使再造唇的形态与功能的损害减少到最低限度。全部割断口角轴的唇再造,必导致再造唇形态与功能的严重损害。交叉唇瓣是一个首选的方法。     

自体脂肪移植的临床应用及安全性:ASPS脂肪移植工作组报告

<正>美国整形医师协会(ASPS)脂肪移植工作组利用循证医学的方法,对自体脂肪移植(特别是应用于乳房)的效果和安全性进行了评估,并为后续的研究提供了建议。经工作组总结,自体脂肪移植应用于乳房的适应证主要包括:乳房过小、假体隆乳术后畸形、乳房结节、Poland's综合征、乳房肿瘤切除术后畸形、乳房切除术后畸形、经保守治疗或假体重建和(或)皮瓣(背阔肌皮     

再造乳房皮瓣感觉恢复情况研究现状

乳腺癌的发病率逐年增加,严重威胁女性的身体健康。现代人在解除病灶痛苦之后,更关心身心健康的恢复,乳腺切除术后乳房再造已经为越来越多的患者所认识并接受。乳房再造能满足她们恢复完美躯体的愿望、减缓心理压力、增加社会适应能力。在过去的几十年中,乳房再造技术有了一系列的发展进步,自体组织乳房再造也已有许多成熟的手术方案。许多患者感受到再造乳房有不同程度的感觉恢复,而感觉恢复满意的患者对手术也有更高的评价。感觉重建是器官再造的组成部分,也极富挑战性,在乳房这一女性独特器官的再造中是具有临床意义的。1再造乳房感觉恢…     

Monodermatomal herpes zoster in a pseudodisseminated distribution following breast reconstruction surgery

A 45-year-old woman underwent a modified radical mastectomy with transverse rectus abdominis myocutaneous (TRAM) flap reconstruction for newly diagnosed stage III breast cancer. Three months after beginning chemotherapy, she developed an erythematous, vesicular, painful rash along the right side of her abdomen that extended to the right side of her chest. Although the rash had the qualities of herpes zoster, the distribution was not dermatomal in nature; instead, it crossed multiple dermatomes. The initial presentation was suspicious for disseminated herpes zoster because of its clinical presentation and her clinical history. A more extensive examination revealed the patient had monodermatomal herpes zoster masquerading as disseminated herpes zoster secondary to her TRAM flap procedure whereby the nerves were realigned and created this pseudodisseminated appearance of the rash.     

Reverse latissimus dorsi musculocutaneous flap for reconstruction of lumbar radiation ulcer

The surgical treatment of large, deep defects on the midline of the lower back or lumbar area comprises difficult reconstructive challenges. Various flaps have been designed to reconstruct the defect area. We herein report a 70-year-old Japanese woman with a large, deep ulcer in the midline of the lower back, caused by postoperative radiation therapy for eccrine porocarcinoma. The ulcer was successfully treated with surgical debridement followed by reverse latissimus dorsi musculocutaneous flap. This flap is reliable and useful for reconstruction of a large, deep midline defect of the lower back, having large and bulky tissue with a sufficient blood supply.     

乳房重建患者术后焦虑调查及相关因素分析

目的探讨乳房重建患者术后情绪焦虑的状况及相关因素分析。方法选取2016年1月至2018年2月中国医科大学附属盛京医院乳腺外科诊治的102例接受乳房重建手术患者为研究对象,对其术后焦虑情绪进行调查,并对可能影响患者焦虑情绪的因素进行单因素和多因素Logistic回归分析。结果102例患者中,68例患者有焦虑情绪,筛出率为66.7%。焦虑自评量表(SAS)、症状自评量表(SCL-90)总分高于国内常模,差异具有统计学意义(P<0.05)。单因素分析显示,年龄、文化程度、社会支持度、工作性质、家庭收入、对重建效果的担心、角色定位、对疾病的认识、丈夫的态度及术后锻炼情况是患者焦虑情绪的影响因素(P<0.05)。多因素Logistic回归分析显示,年龄、角色定位、社会支持度、对疾病的认识、乳房重建的时间以及对重建效果的担心是影响焦虑情绪的关键因素(P<0.05)。结论乳房重建患者的术后焦虑情绪比较突出,其影响因素较多,医护工作者应该针对本文筛选出的相关因素制订相应的心理干预对策,引导患者走出心理误区。     

Breast Cancer Cutaneous Metastasis at Core Needle Biopsy Site

Cutaneous metastasis from breast cancer can occur by direct invasion, lymphatic and vascular spread as well as iatrogenic implantation. Metastasis that occurs by iatrogenic implantation after needle biopsy is very rare but the potential risk must be considered. In this report, we describe a case of breast cancer cutaneous metastasis that occurred by iatrogenic implantation following core needle biopsy. A 53-year-old woman presented with a 1×1 cm sized erythematous nodule at the biopsy site after breast conserving surgery for primary cancer. Histopathological findings confirmed cutaneous metastasis. The possibility of this consequence must be considered when performing needle biopsies.     

Total and near‐total lower eyelid reconstruction with prefabricated orbicularis oculi musculocutaneous island flap

Full thickness lower lid defects are frequently encountered during daily practice. The unique anatomy of the eyelids hinders reconstructive efforts. The aim of the study is to develop an effective and easy procedure for the reconstruction of full thickness defects of the lower eyelid. Here we present six cases, which we treated with an orbicularis oculi musculocutaneous island flap prefabricated with a chondrocutaneous graft. Five of the six cases suffered from tumors, while one had congenital coloboma of the lower lid. A chondrocutaneous graft harvested from the ear was placed under the orbicularis oculi musculocutaneous flap. Three weeks later, the defect was created and the prefabricated flap was transposed to the defect. Two cases had superficial distal skin loss and one had prolonged oedema. No major complication or tumor recurrence was seen. Using this method, the principle “replace with like” is fulfilled. Orbicularis oculi musculocutaneous island flap prefabricated with postauricular chondrocutaneous composite graft seems to be a feasible method for the reconstruction of full thickness defects of the lower eyelid with its low donor morbidity and good outcomes.     

Island pedicle flaps for medial canthus repair

Background The medial canthus is a frequent site for skin cancer and reconstruction after Mohs surgery can prove to be challenging. In the literature various reconstruction methods are recommended for these cases. Flap reconstructions are mostly transposition flaps from the glabella, skin with different properties from that in the canthal region, hence mostly requiring correction in a second stage. Objectives To ascertain the utility of a different reconstruction method, applying island pedicle flaps for medial canthal lesions and obviating the necessity for second‐stage corrections. Methods A review was undertaken of the medical records and photographs of patients who had a pedicle island flap reconstruction for medial canthal defects after Mohs surgery. There were four different possibilities: a pedicle island flap from the cheek, the back of the nose or the glabella or a combination of these flaps. Results Sixteen patients were reconstructed by pedicle island flaps for defects of the medial canthal area. A follow‐up for all patients after 1 year indicated that all patients showed good to excellent results. No cases of web deformation and ectropion were found. Conclusions This flap is not mentioned in textbooks in reference to the reconstruction of canthal lesions and its value for this particular location is probably underestimated.