应用皮瓣治疗足跟部软组织缺损并感染

目的 探讨足跟感染软组织缺损创面有效修复方法.方法 对足跟软组织缺损感染创面,第1种方法是采用腓肠神经营养血管皮瓣旋转180°与足跟部创面吻合,第2种方法是切取股前外游离皮瓣用旋股外侧动脉血管吻合胫后动脉及其2条伴行静脉,以此两种方法来修复足跟部感染缺损.结果 自2008年以来,腓肠神经营养血管皮瓣于临床应用10例,股前外皮瓣于临床应用4例,14例皮瓣中术后1例皮瓣远端坏死,Ⅱ期游离植皮,2例皮瓣外观较为臃肿,患者穿鞋困难、行走不便,经Ⅱ期手术修薄皮瓣,效果满意.其余术后无皮瓣坏死、无血管危象及感染等并发症.随访8~48个月,根据AOFAS踝-后足功能评分(满分100分),14例病例据评分表中关于疼痛、功能等多方面指标综合得分,80分以上9例,60~80分3例,60分以下2例.术后除1例皮瓣远端坏死,Ⅱ期游离植皮,其余皮瓣全部成活,随访8~48个月,皮瓣质地柔软,踝关节功能恢复满意,供区未见功能障碍.结论 远端蒂腓肠神经营养血管皮瓣和股前外侧游离皮瓣均是修复足跟部感染及软组织缺损的较佳选择.     

下肢严重软组织缺损的游离皮瓣修复

目的：探讨游离皮瓣修复下肢严重软组织缺损的治疗效果。方法：自2006-01～2008—12,我科应用背阔肌皮瓣、股前外侧皮瓣、肩胛皮瓣、足背皮瓣、腓骨骨皮瓣对36例严重下肢软组织缺损的病例进行修复。结果：术后34例完全存活,2例股前外侧皮瓣远端部分坏死2～3cm,给予清除坏死部分的皮瓣组织后植皮,伤口愈合;随访3个月～3年,皮瓣质地良好,下肢功能改善和最大限度保留。结论：游离皮瓣修复下肢严重软组织缺损,根据损伤部位、范围、伤情选择不同的游离皮瓣进行修复效果可靠。     

股前外侧皮瓣游离移植修复足踝部皮肤软组织缺损

目的总结股前外侧皮瓣游离移植足踝部,尤其是小儿跟腱部皮肤软组织缺损的临床疗效。方法 2010年2月~2014年12月,采用股前外侧皮瓣修复23例足踝部皮肤软组织缺损,男性17例,女性6例;年龄4~45岁,平均21岁。创面均伴血管、骨及肌腱外露,创面缺损范围4cm×6cm~23cm×18cm,皮瓣切取范围为6cm×8cm~25cm×20cm,供区游离植皮修复。结果 1例移植皮瓣坏死,其余皮瓣及供区植皮均顺利成活,创面均Ⅰ期愈合。患者均获随访,随访时间8~46个月,平均16个月。皮瓣耐磨,无局部溃烂,均恢复保护性感觉。4例全足脱套伤患者皮瓣外形臃肿于术后8~12个月行二次手术皮瓣修整后,外形满意。结论股前外侧皮瓣具有切取范围大、血管口径粗、部位隐蔽等特点,由于股前外侧皮神经吻合可以获得较好的保护性感觉,可广泛用于足踝部皮肤软组织缺损的修复。     

双叶股前外侧皮瓣在创面修复中的临床应用

目的 探讨双叶股前外侧皮瓣修复相邻两处创面的方法 和疗效. 方法 2001年3月-2007年1月采用吻合血管的双叶股前外侧皮瓣修复9例不同部位的相邻两处创面,包括3例洞穿性缺损创面. 结果 9例皮瓣全部成活.术后Ⅰ例皮瓣出现远端浅表坏死,经换药及抗感染治疗愈合.9例均得到随访,皮瓣外形满意. 结论 双叶股前外侧皮瓣除具有股前外侧皮瓣的优点外,还可同时修复相邻两处缺损,是修复同一肢体相邻两处缺损的有效方法 .     

吻合血管皮瓣移植修复前臂和手部复杂性软组织缺损

目的探讨吻合血管皮瓣移植修复前臂和手部复杂软组织缺损的临床效果。方法对17例前臂和手部复杂软组织缺损采用股前外侧皮瓣、胸脐皮瓣、小腿内侧与股前外侧皮瓣的串联皮瓣游离移植修复创面。创面面积11 cm×8 cm～26 cm×9 cm,皮瓣切取面积13 cm×9 cm～27 cm×10 cm。结果移植皮瓣全部成活;8例皮瓣臃肿,需再次手术整形;4例骨缺损在皮瓣成活后半年施行自体髂骨植骨钢板内固定,骨折愈合,前臂的旋转功能和手部功能恢复满意;3例肌腱缺损者术后3～5个月用健侧掌长肌腱或手屈指浅肌腱移植修复,手部功能获得部分恢复;2例尺、桡动脉严重损伤,合并重度皮肤肌肉组织缺损者手部功能获得部分恢复,其余患者前臂旋转功能和手部功能恢复满意。结论吻合血管皮瓣移植能有效地修复前臂和手部复杂软组织缺损,控制创面感染,有助于骨折愈合和手部功能的恢复。     

胸脐皮瓣股前外侧皮瓣游离移植修复足背大面积软组织缺损

目的:探讨运用游离胸脐皮瓣、股前外侧皮瓣移植修复创伤后足背大面积软组织缺损合并肌腱、骨质外露,骨髓炎、骨缺损。方法:运用游离胸脐皮瓣或股前外侧皮瓣修复足背大面积软组织缺损合并肌腱外露、跖骨外露、骨髓炎、骨缺损9例。皮瓣切取面积最大为(10×20)cm、最小为(6×8)cm。结果:术后1例发生血管危象,9例皮瓣均成活。术后随访2~19个月,足背皮肤质地柔软,弹性好,外形稍臃肿,功能满意。结论:游离胸脐皮瓣、股前外侧皮瓣移植修复足背大面积软组织缺损,方法可靠,皮瓣成活后疗效优良,是一种理想的治疗方法。     

四肢皮肤软组织缺损的综合治疗分析

目的探讨四肢皮肤软组织缺损采用游离股前外侧皮瓣修复综合治疗的效果。方法四肢皮肤软组织缺损30例根据皮瓣选择的不同分为两组一治疗组与对照组各15例,对照组采取带蒂皮瓣修复治疗,治疗组采取游离股前外侧皮瓣修复综合治疗。结果治疗组的修复时间明显少于对照组（P〈0．05）,修复成功率明显高于对照组（P〈0．05）,而两组血管危象并发症发生率对比无明显差异（P〉0．05）。结论四肢皮肤软组织缺损采用游离股前外侧皮瓣修复综合治疗手术操作简单,能达到彻底清创的目的,同时安全性好。     

游离股前外侧皮瓣修复前臂皮肤软组织缺损85例体会

目的探讨游离股前外侧皮瓣修复前臂皮肤软组织缺损的临床效果。方法85例前臂皮肤软组织缺损患者,采用游离旋股外侧动脉降支发出的肌皮支营养皮瓣进行修复。结果85例全部成活,住院25—30d;术后随访1．5个月-1年,修复皮瓣色泽红润,质地柔软,患肢功能良好。结论应用游离股前外侧皮瓣修复前臂皮肤软组织缺损,能最大限度保存肢体功能,缩短住院时间,减少患者多次手术的痛苦。     

VSD修复肢体严重创伤后大面积软组织缺损感染的疗效观察

目的探讨封闭负压引流技术(VSD)修复肢体严重创伤后大面积软组织缺损感染的疗效。方法将我院收治的25例严重创伤引起大面积软组织缺损感染患者,根据手术方式不同分为对照组(12例)和治疗组(13例);治疗组采用VSD技术结合游离皮瓣修复大面积软组织缺损,对照组单纯采用游离皮瓣修复。结果治疗组术前住院时间、总住院时间均显著低于对照组,且差异有统计学意义(P<0.05);两组术后住院时间差异无统计学意义(P>0.05);治疗组患者切取皮瓣面积、创面感染、骨折愈合时间均显著低于对照组,差异有统计学意义(P<0.05)。结论 VSD技术结合游离皮瓣修复治疗严重创伤后大面积软组织缺损感染,可显著缩短治疗时间,降低创面感染的发生,加快骨折愈合。     

游离股前外侧皮瓣修复足部软组织缺损

<正>足部皮肤软组织大面积缺损,常伴随有神经、血管、肌腱及骨骼的裸露及损伤,损伤的面积大且局部血供差,易造成严重感染。由于足部位于下肢的远端,损伤后使用小腿逆行皮瓣修复具有一定限制[1]。2008年12月—2013年5月,我们采用吻合血管的游离股前外侧皮瓣移植修复足部软组织缺损13例,术后皮瓣成活良好,效果满意,现报告如下。1资料与方法1.1一般资料本组13例,男9例,女4例;年龄18~     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.