两侧反向Z成形筋膜皮瓣修复创面

自１９９０年以来，利用深膜层血管网的丰富血供，结合Ｚ成形术术式，设计两侧反向Ｚ成形筋膜皮瓣修复四肢关节，小腿胫前、头面及骶尾部有深部组织裸露的创面共已２１例。可以最大限度地利用邻近皮肤形成皮瓣将创面完全修复，获得了较好外形和功能效果。     

筋膜皮瓣Z整形修复胫骨外露创面的应用

目的：寻求方法简单,过程安全,效果良好的皮瓣修复胫骨外露创面的手术方法。方法：设计筋膜皮瓣Z整形修复胫骨外露创面,包括单侧Z整形筋膜皮瓣,两侧反向对称Z整形筋膜皮瓣,两侧反向不对称Z整形筋膜皮瓣等整形修复胫骨外露创面的手术方法。结果：自1990年至今完成筋膜皮瓣Z整形修复胫骨外露创面共21例,手术全部成功,小腿外形美观,行走功能正常,获得成功的创伤创面整形修复的手术治疗经验。结论：筋膜皮瓣Z整形修复胫骨外露创面,是利用深筋膜层血管网的丰富血供增加皮瓣的长宽比例,结合Z整形术术式充分利用和合理调整邻近皮肤形成皮瓣修复胫骨外露创面。本手术方法具有方法简单,过程安全,就地取材,能最大限度地利用邻近皮瓣修复胫前创面及术后小腿外形和功能均较良好的创伤创面整形修复的手术方法。     

皮肤移植修复体表创面的应用

目的：探讨皮肤移植修复体表创面的手术方法，使各部位体表创面能有比较简单、安全、效果好的修复办法。方法：总结术者近15年371例采用全厚皮移植，筋膜皮瓣移植，全厚皮与筋膜皮瓣联合移植修复创面的手术经验。结果：采用全厚皮片或筋膜皮瓣修复创面，全厚皮片与筋膜皮瓣联合修复各部位各类型创面共371例，外观及功能恢复良好。结论：全厚皮可修复各类型软组织创面，筋膜皮瓣可修复有深部组织裸露创面，全厚皮与筋膜皮瓣联合修复不能单独利用皮片或皮瓣修复的创面，其方法简单、安全，适合全身体表各部位的创面修复，能达到功能与外形的良好恢复。     

含深筋膜血管网的三种小腿后侧逆行筋膜皮瓣的临床应用

总结１９９４年１０月～１９９６年５月，应用三种小腿后侧逆行筋膜皮瓣的临床效果。利用腓肠浅动脉在小腿远端与腓动脉肌间隙支、胫后动脉穿支和腓动脉外踝支在深筋膜内的广泛吻合，分别设计成小腿后外侧逆行岛状筋膜皮瓣、后内侧逆行岛状筋膜皮瓣和后外踝逆行筋膜皮瓣。临床用于修复足跟及踝关节周围创面共１８例，皮瓣切取面积６ｃｍ×５ｃｍ～１５ｃｍ×８ｃｍ。术后皮瓣均全部成活，创面完全修复。认为，该组皮瓣血供可靠，切取方便，不牺牲主干血管，基本可满足小腿下段、足背、足跟及踝关节周围创面的修复。     

两侧反向Z成形筋膜皮瓣修复创面

自1990年以来,利用深筋膜层血管网的丰富血供,结合z成形术术式,设计两侧反向Z成形筋膜皮瓣修复四肢关节、小腿胫前、头面及骶尾部有深部组织裸露的创面共已21例。可以最大限度地利用邻近皮肤形成皮瓣将创面完全修复,获得了较好外形和功能效果。     

小腿逆行岛状筋膜皮瓣的临床应用

为修复足跟、足背、内外踝等部位瘢痕及溃疡切除后创面，设计了小腿筋膜蒂逆行岛状筋膜皮瓣手术，共已应用１４例，一期完成，均获成功。本筋膜皮瓣血运丰富，愈合力强。可直接旋转１８０°，通过皮下遂道移转到达创面，不牺牲知名血管，手术简单易行，且皮瓣较耐磨损，是修复足部创面具有可行性的皮瓣     

指背筋膜脂肪翻转皮瓣修复指腹缺损

目的 介绍应用指背筋膜脂肪翻转皮瓣，修复因外伤引起的屈指腱鞘和屈指肌腱的裸露创面的临床效果。方法 指背筋膜脂肪翻转皮瓣包括以指动脉背侧支血管为蒂的同指背所有的筋膜脂肪组织，翻转修复指掌侧的软组织缺损伴屈指肌腱暴露的创面。结果 本组5例患者，行指背筋膜脂肪翻转皮瓣修复术后皮瓣均成活．临床效果满意。结论 指背筋膜脂肪翻转皮瓣修复指腹缺损的手术方法具有操作简单、血供恒定、外形恢复令人满意、有利于手屈指功能恢复等优点。此手术方法非常适合指掌侧的组织重建。     

感染缺损性创面岛状皮瓣修复的实验研究

目的：探讨皮瓣修复感染性创面机理，为临床提供实验依据。方法：实验选用兔侧胸岛状皮瓣转移修复皮肤、肌肉、骨骼缺损性创面。通过接种不同浓度绿脓杆菌混合液，观察修复后创面渗出液、皮瓣深浅层组织细菌数变化以及血流量改变，结合皮瓣成活、组织学检查等观察。结果：岛状皮瓣修复感染性创面在创面细菌数高于１０７个／ｍｌ时，皮瓣难以成活。结论：岛状皮瓣修复感染性创面与血供及白细胞吞噬功能存在密切关系，移植皮瓣修复感染创面是有一定限度的，且皮瓣深浅层抗菌力是不同的，以深筋膜层较强。     

蒂部潜移法增加V—Y筋膜皮瓣的推进距离

为修复上肢中小创面提供一种Ｖ－Ｙ推进皮瓣。在邻近创面的健康皮肤，依纵行的筋膜皮下血管丛方向设计Ｖ－Ｙ筋膜皮瓣，通过对蒂部在深筋膜下间隙及皮下疏松组织中不同层次的潜行分离，即增加了皮瓣的推进距离，又不影响皮瓣的血供基础。     

前臂桡动脉皮支血管网逆行筋膜皮瓣修复手部创面

目的根据前臂皮肤的解剖特点,形成较大面积的前臂逆行筋膜皮瓣,解决手部较大创面的修复。方法利用前臂远端桡动脉皮支血管网供血,设计前臂逆行筋膜皮瓣,蒂部转折点在茎突近端3～5cm 处,皮瓣远端至肘横纹上方3～5cm,皮瓣要覆盖手背、手掌较大创面。结果采用前臂桡动脉皮支血管网逆行筋膜皮瓣修复手部创面42例,手术全部成功,术后随访18例,其外形及手功能的恢复达到满意效果。结论前臂桡动脉皮支血管网逆行筋膜皮瓣可取皮瓣面积大,不损伤桡动脉主干,为手部皮肤缺损找到了简单、安全,损伤小的修复方法。     

Do rhomboid flaps provide more elongation than Z-plasty flaps? An experimental study

Background and aim: A Z-plasty flap is one of the most widely used geometric relaxation methods to release contracture bands. A rhomboid flap is a lesser used geometric relaxation method than a Z-plasty flap. This study aimed to determine the length and rate of elongation provided by rhomboid and Z-plasty flaps.

Methods: Bilateral contracture bands were created in the inguinal skins of rats. A rhomboid flap was planned for the right side of the inguinal region, and a single Z-plasty flap was planned for the left side. The length and rate of elongation provided by the two flaps were calculated after completing the procedures and were compared using Student’s t-test.

Results: Experimental contracture bands disappeared in both the inguinal regions after creating rhomboid and Z-plasty flaps. The mean postoperative elongation of the contracture band was 1.4?±?0.119 and 2.47?±?0.281?cm using the rhomboid and Z-plasty flaps, respectively. The difference was statistically significant (p?Conclusion: Z-plasty flaps provide more elongation than rhomboid flaps and also appear to be better options for releasing linear contracture bands. However, rhomboid flaps may be used as alternatives when Z-plasty flaps cannot be used and in regions such as the axilla, genital region, nipple-areola, where their distortion effects should be avoided.     

兰氏和双反Z法腭裂修复术后患儿语音清晰度对比

目的比较兰氏和双反Z法腭裂修复术后患儿的语音清晰度,寻找重建腭咽闭合的最佳手术方法。方法选取2009年至2013年在我院口腔颌面外科就诊的先天性软腭裂患儿69例,其中行双反Z法腭裂修复术35例(双反Z法组),行兰氏法腭裂修复术34例(兰氏法组)。患儿3.5岁后随访,由3名语音师进行单盲性审听,比较两组患儿术后语音清晰度。结果语音测评结果显示,双反Z法组患儿术后患者语音清晰度平均达到88.72%±6.05%,明显高于兰氏法组的71.31%±3.46%,语音改善明显。结论双反Z法能够充分缩小咽腔、延长软腭,重建软腭肌肉结构,更有利于恢复良好的腭咽闭合功能。     

Treatment of checkrein deformity of the hallux

We studied 11 patients with checkrein deformities of the hallux who underwent surgical treatment. Six had lengthening of the flexor hallucis longus tendon by Z-plasty in the midfoot, and five underwent release of adhesions and lengthening of the tendon by Z-plasty at the musculotendinous junction at the fracture site. All six patients who underwent Z-plasty at the midfoot showed complete correction of the deformity without recurrence. Of the five who had release of adhesions and Z-plasty of the tendon at the fracture site, two showed partial and one showed complete recurrence.     

Comparative study between V-Y pushback technique and Furlow technique in cleft soft palate repair

Many methods of cleft palate repair have been described. Two effective methods are commonly used for repair of soft palate clefts: the Wardill-Kilner V-Y push back and the Furlow double opposing Z-plasty; each has advantages and disadvantages. The aim of this study was to compare between the V-Y push back technique and the Furlow Z-plasty technique regarding effectiveness in palatal reconstruction and improvement of velopharyngeal closure in cases of cleft soft palate. Also, operative duration time and blood loss were considered. This study was conducted on 60 patients diagnosed to have cleft soft palate. The patients were randomly classified into two equal groups A and B. In group A, the cleft palate was repaired using V-Y push back technique while in group B the cleft palate was repaired using Furlow double opposing Z-plasty technique. Flexible nasopharyngoscopy and perceptual speech resonance evaluation were used to assess the velopharyngeal closure and speech outcome, respectively. Nasalance score was measured for nasal and oral sentences in both groups. The average operative duration time and blood loss were lesser in Z-plasty than in V-Y pushback technique. Two of the cases subjected to V-Y pushback technique developed fistula while none of the cases subjected to Z-plasty showed this complication. Velopharyngeal closure and speech outcome was better after Z-plasty than after V-Y pushback technique with significant nasometric data. The Furlow Z-plasty is better than the V-Y pushback technique in the repair of clefts involving the soft palate as it has a higher success rate regarding speech outcome and velopharyngeal closure; also, it has a lower operative time and blood loss.     

Direction of suture lines in Z-plasty scar revision

Conventional methods of Z-plasty, a basic technique of plastic surgery, are incorrect since they are based on the assumption that the suture lines as designed prior to Z-plasty and those that actually result will coincide. For Z-plasty to be satisfactorily applied in scar revision, sufficient thought must be given to the actual directions in which the suture lines will lie in comparison with those envisioned.     

Direction of suture lines in Z-plasty scar revision

Conventional methods of Z-plasty, a basic technique of plastic surgery, are incorrect since they are based on the assumption that the suture lines as designed prior to Z-plasty and those that actually result will coincide. For Z-plasty to be satisfactorily applied in scar revision, sufficient thought must be given to the actual directions in which the suture lines will lie in comparision with those envisioned.     

Pilonidal Sinus Treated by Z-Plasty1

The rationale and technique of Z-plasty treatment for sacro-coccygeal pilonidal sinus are presented. Z-plasty achieves healing by primary intention, and by modification of the local environment prevents recurrence.     

Z成形术治疗重度臀肌筋膜挛缩症及其所致腰臀部畸形

目的探索重度臀肌筋膜挛缩症及其所致臀腰部畸形的最佳治疗方法。方法对25例重度臀肌筋膜挛缩症及其所致臀腰部畸形患者,依Z成形术原则进行挛缩带和挛缩瘢痕的松解后,将局部皮肤进行重新分配和塑形加以治疗。结果25例双侧髋关节功能完全恢复,步态正常,腰臀部形态基本平整,无坐骨神经损伤。术后随访6个月至3年,平均1．6年,无畸形复发。结论Z成形术既解除了挛缩带对关节功能的牵制,又可对局部皮肤进行重新分配,矫正挛缩造成的凹陷畸形,术后功能和外形效果均佳,是治疗重度臀肌筋膜症及其所致臀腰部畸形的良好方法。     

The Z in Z-plasty must have a long trunk

Erroneous thinking in regard to Z-plasty, which is a fundamental technique in plastic surgery, has been pointed out. In most cases of Z-plasty, the trunk of the Z should be designed longer than the two limbs.