甲沟重建术治疗嵌甲症

嵌甲症作为一种常见病，虽然国内外有多种治疗方法报告，但其复发率可达７３％ ；为了降低嵌甲症治疗后的复发率。自１９９３ 年以来，我们采用了一种病灶切除，利用一侧甲襞推进皮瓣重建甲沟的新方法。结果：治愈率达９５ ．５％ ，重建甲沟形态良好，效果较满意。结论：嵌甲症发生的病理解剖基础是病变甲沟处甲床向甲襞上皮移行中断，炎性肉芽过度充填，局灶性瘢痕形成等，致使甲床向趾骨反折，过度生长，这是造成一般治疗容易复发的根本原因。通过临床实践，我们认为，甲沟重建术是针对这一病理改变所进行的手术设计，确实可靠有效，值得推广。     

甲沟重建术治疗嵌甲症

嵌甲症作为一种常见病,虽然国内外有多种治疗方法报告,但其复发率可达７３％,为了降低嵌甲症治疗后的复发率。自１９９３年以来,我们采用了一种病灶切除,利用一侧甲襞推进皮瓣重整甲沟的新方法。结果：治愈率达９５．５％,重建甲沟形态良好,效果较满意,结论：嵌甲症发生的病理理解基础是病变甲沟处甲床向甲襞上皮移行中断,炎性肉芽过度充填,局灶性紫痕形成等,致使甲床向趾骨反折,过度生长,这是造成一般治疗容易复发的根     

重度拇嵌甲症192例的外科治疗观察

目的:提高拇嵌甲症的临床治愈率。方法:分析了192例重度拇嵌甲症发生的原因。在单纯拔甲术的基础上,行拇趾患侧的甲床、软组织及相应的甲根部、甲床纵行切除术。根据病情补加趾患侧甲沟前侧缘新月形皮肤皮下软组织切除术。结果:192例重度拇嵌甲症,随访185例,手术治愈180例,延迟愈合5例。结论:该手术治疗方法矫正了重度拇嵌甲症的解剖病变,明显提高了临床治愈率。     

甲床部分切除联合甲沟重建治疗嵌甲性甲沟炎

目的探讨甲床部分切除联合甲沟重建治疗嵌甲性甲沟炎的临床疗效。方法对48例（51足）嵌甲性甲沟炎采用甲床部分切除联合甲沟重建手术治疗,手术前0.5%碘伏浸泡患趾,切除增生的肉芽组织及病变甲沟,纵形切除约1/5甲床,重建甲沟,术后加压包扎,抗炎换药治疗。结果本组均获随访,随访时间4个月～2年,术后复发1例,二次手术后痊愈;术后感染2例;其余患者甲沟重建外观美观、无复发,患者满意。结论嵌甲性甲沟炎采用甲床部分切除联合甲沟重建治疗,可以取得满意的疗效。     

切除同侧甲根、甲床重建甲沟治疗嵌甲症36例报告

嵌甲症,是指正常的指甲长入正常的皮肤组织内,是一种常见的甲病,好发于足部(呣)趾,女性好发,与其长期穿高跟或尖足鞋有关.嵌甲症造成疼痛,也导致了甲沟炎的发生,以往多采用拨甲,极易复发.我院自2000年6月～2002年6月,运用同侧甲根、甲床切除,同侧甲襞推进,重建甲沟,治疗嵌甲症36例,效果满意,无复发,现报道如下.……     

甲床矫形术治疗顽固性嵌甲25例分析

目的 总结带蒂软组织瓣甲床侧缘下移植,进行甲板整形手术,彻底治愈顽固性嵌甲的经验。方法 对2001年2月至2009年6月唐山铁路中心医院收治的25例顽固性嵌甲的临床资料进行分析。设计带蒂软组织瓣,将甲床侧缘从趾骨上剥离,用软组织瓣填塞其下支撑甲床,使甲床垫起,甲沟变浅,矫正其侧下翻畸形,矫正畸形甲板。 结果 25例（34趾）顽固性嵌甲均行病变甲基质部分切除、带蒂软组织瓣甲床侧缘下移植手术。随访6个月至1年均取得满意疗效。 结论 甲床矫形术去除了嵌甲的病因,外形美观,手术并发症少,复发率低。     

趾部分甲皱襞和甲床楔形切除治疗嵌甲

嵌甲是对趾甲护理不当引起的钩状生长,趾甲向深部,长入叠盖的甲皱襞,嵌入甲沟内,使两侧甲沟消失。嵌甲多见于趾,目前临床上对嵌甲期(炎症期)和期(脓肿期)的早期采取保守治疗;而对于期的晚期和期采取手术治疗,但术后复发率较高。为降低复发率,我们在1998年6月~2004年9月,采用楔形切除部分甲皱襞和甲床治疗嵌甲,疗效满意。报告如下。1临床资料1.1一般资料本组139例(164侧)。男117例(140侧),女22例(24侧)。年龄12~28岁,平均17.3岁。病程2个月~6年。期主要表现为局部红肿、多汗及疼痛剧烈,两侧甲皱襞肿胀高出甲板侧缘,有渗出;期主要表现为甲板…     

踇趾部分甲皱襞和甲床楔形切除治疗嵌甲

嵌甲是对趾甲护理不当引起的钩状生长，趾甲向深部，长入叠盖的甲皱襞，嵌入甲沟内，使两侧甲沟消失。嵌甲多见于四趾，目前临床上对嵌甲Ⅰ期（炎症期）和Ⅱ期（脓肿期）的早期采取保守治疗；而对于Ⅱ期的晚期和Ⅲ期采取手术治疗，但术后复发率较高。为降低复发率，我们在1998年6月～2004年9月，采用楔形切除部分甲皱襞和甲床治疗嵌甲，疗效满意。报告如下。     

应用部分(足母)甲瓣急诊修复拇指末节缺损12例

目的 探讨应用部分(足母)甲瓣急诊修复拇指末节缺损的临床效果. 方法 对于拇指甲床并两侧甲襞皮肤完全缺损,切取同侧(足母)趾腓侧2/3甲床,另取拇指桡背侧逆行岛状皮瓣作为拇指桡侧甲襞.如拇指末节残留一侧甲襞皮肤和少许甲床,遵循“缺多少,补多少”的原则,采用同侧或对侧(足母)甲瓣游离移植修复拇指缺损.吻合趾-指固有动脉、神经和趾-指背侧静脉.(足母)趾残留甲床、骨骼及皮肤软组织体于甲根部咬断骨骼,组织体旋转90°转移覆盖(足母)趾创面.急诊手术. 结果 术后12例(足母)甲瓣均顺利成活.术后经过8～24个月随访,再造拇指外形良好,持物时无疼痛,持物方便舒适,两点辨别觉5～10 mm.供区行走无影响,供区(足母)趾保留部分趾甲生长,外观良好. 结论 应用部分(足母)甲瓣急诊修复拇指末节缺损临床效果良好.     

(足母)趾部分甲皱襞和甲床楔形切除治疗嵌甲

嵌甲是对趾甲护理不当引起的钩状生长,趾甲向深部,长入叠盖的甲皱襞,嵌入甲沟内,使两侧甲沟消失.嵌甲多见于(足母)趾,目前临床上对嵌甲Ⅰ期(炎症期)和Ⅱ期(脓肿期)的早期采取保守治疗;而对于Ⅱ期的晚期和Ⅲ期采取手术治疗,但术后复发率较高.为降低复发率,我们在1998年6月～2004年9月,采用楔形切除部分甲皱襞和甲床治疗嵌甲,疗效满意.报告如下.     

Tumors of the nail and nail bed

This article reviews the tumors that most frequently affect the nail and nail bed. Clinical appearance, histopathology, differential diagnosis, and treatment are discussed.     

Half-and-half nail

Clinical and Experimental Nephrology -     

Vascularized nail flap vs. free nail graft

Summary With recent improvements in microvascular surgery, the vascularized nail flap procedure has had considerable success. On the other hand, free nail graft without microvascular anastomoses is still used but little has been published to make a comparison between these two procedures. Thus, it is not known which is the better procedure. In the past, hand nail defects in 12 patients have been reconstructed by the free nail graft procedure and in four patients by vascularized nail flap procedure. In this article, the free nail graft is compared with the vascularized nail flap and the merits and demerits of both techniques are presented. Requests for reprints: T. Endo, M.D.     

The microvasculature of the nail bed, nail matrix, and nail fold of a normal human fingertip

The organization of the microvasculature of the dorsal human fingertip based on a vascular corrosion cast was examined using a stereoscopic microscope. The variations of the superficial capillary network of the 3 specialized areas of skin of the dorsal fingertip (the nail bed, the nail matrix, and the nail fold) are described. In the nail bed numerous capillary loops were observed arising from a deeper regular arrangement of sagittally aligned, parallel rows of vessels. The size and direction of inclination of the capillary loops varied, getting longer and more inclined to the nail bed distally, with the longest capillary loops seen at the hyponychium. There were no capillary loops at the nail matrix region, but there was a single, layered, rectangular plexus of capillaries in the plane of the nail matrix. This extended distally to sagittally stretched coils of vessels that straightened out as the nail matrix enters the nail bed region. At the edge of the proximal nail fold the capillary loops looked like fine bristles and were approximately 3 times shorter than those found on the nail bed and hyponychium. This study provides a baseline for future work in understanding the changes in the microvasculature of the dorsal fingertip due to injury or pathology.     

引钉法矩形髓内钉治疗胫腓骨骨

目的 避免矩形髓内钉在治疗胫腓骨骨折中髓腔内交叉。方法 应用引钉法矩形髓内钉治疗３０例胫腓骨骨折。结果 ３０例患者的矩形髓内钉均一次打入,无交叉,打钉时间最长４８ｍｉｎ,最短１０ｍｉｎ,平均２５ｍｉｎ。术后优良率为９３．３３％,无严重并发症。结论 引钉法操作简单,可大大缩短手术时间,且固定可靠。     

Treatment of post-traumatic nail bed deformities with split-thickness nail bed grafts

INTRODUCTION: Split-thickness nail bed graft have been proposed for treatment of post-traumatic nail bed dystrophies. Only three papers reported good results in 60 to 90% of cases. We report our experience. MATERIAL AND METHODS: We reviewed 18 cases of split-thickness nail bed grafts from operative and consultation files and photographs. Evaluation was made using criteria as the nail plate shape, its adhesion on the nail bed, patient satisfaction and possible sequelae on the donor finger. RESULTANTS: Thirteen patients have been reviewed with a sufficient follow-up to assess the results. In 13 cases, the graft was taken from the hallux. The nail-bed graft was used for hallux reconstruction two times, the thumb six times, index six times, middle and ring finger one each, and the little finger two times. In every patient the graft was molded using either the patient nail or the nail plate from the donor finger. Clinical results were excellent in five cases, good in three and poor in five cases. Five failures were due to wrong indications in three cases in which matrix problem has been underestimated, and infectious failures in two cases. Fifteen per cent of our patients had some sequelae on the donor finger.