皮下组织蒂推进皮瓣在面部皮肤软组织缺损修复中的应用

目的：探讨皮下组织蒂推进皮瓣修复面部皮肤软组织缺损的方法。方法：在拟修复区域旁顺皮纹方向设计近似三角形皮瓣，底边位于近缺损侧。于三角形皮瓣两腰切开皮肤，向下潜行分离皮下组织，形成皮下组织蒂皮瓣，向缺损侧推进，修复面部皮肤软组织缺损。结果：应用皮下组织蒂推进皮瓣修复面部皮肤软组织缺损25例，切口Ⅰ期愈合，形态、质地好，瘢痕不明显。结论：皮下组织蒂推进皮瓣修复面部皮肤软组织缺损，效果确定，操作简单，是修复面部小创面较好的方法之一。     

鼻唇沟皮下组织蒂皮瓣在上唇缺损修复中的应用

目的：介绍鼻唇沟皮下组织蒂皮瓣在上唇缺损修复中的应用。方法：2006年6月～2010年4月间,应用鼻唇沟皮下组织蒂皮瓣修复上唇缺损31例。于缺损邻近部位设计鼻唇沟皮下组织蒂皮瓣,按设计线切开皮肤,向下及周围潜行分离形成皮瓣,滑行或旋转修复上唇缺损。结果：应用此法修复上唇缺损31例,切口均I期愈合,皮瓣全部成活,术区平整,无＂猫耳＂畸形,面部形态满意,远期瘢痕不明显。结论：鼻唇沟皮下组织蒂皮瓣修复上唇缺损,手术效果肯定,能达到良好的美学效果,是一种较理想的修复方法。     

耳后皮下组织蒂皮瓣在耳前缺损修复中的应用

目的：介绍耳后皮下组织蒂皮瓣在耳前缺损修复中的应用。方法：2006年5月～2010年10月间,应用耳后皮下组织蒂皮瓣修复耳前缺损32例。于耳后及乳突区设计耳后皮下组织蒂皮瓣,按设计线切开皮肤,自皮瓣远端开始向周围潜行分离形成皮瓣,旋转修复耳前缺损。结果：应用此法修复耳前缺损32例,切口均Ⅰ期愈合,皮瓣全部成活,术区平整,耳部形态满意,远期瘢痕不明显。结论：耳后皮下组织蒂皮瓣修复耳前缺损,方法简单,手术效果肯定,能达到良好的美学效果,是一种较理想的修复方法。     

皮下蒂皮瓣与旋转皮瓣在颞部皮肤缺损修复中的联合应用

目的：探讨利用耳前邻近皮瓣与颞区邻近皮瓣联合应用修复颞部皮肤缺损的方法。方法：根据患者颞部皮肤肿物的大小,设计患侧耳前方皮下蒂皮瓣的切取范围并将切口线设计在耳前皱襞上。在颞部肿物外缘向耳上方延长切口线约为皮肤肿物直径的4倍,设计旋转皮瓣。2个皮瓣联合应用,修复颞部较大面积皮肤缺损。供区直接缝合。结果：共施行此类手术12例,患侧皮肤缺损修复满意,切口线相对隐蔽,面部器官形态功能均未受到影响,供区头发自然生长,瘢痕不明显。结论：利用皮下蒂皮瓣与旋转皮瓣联合修复颞部较大面积皮肤缺损,辅助切口少且切口隐蔽,同时皮瓣转移后自然平滑过渡,创面修复满意,无需植皮,瘢痕不明显。     

“风筝”皮下蒂皮瓣在面部皮肤缺损中的应用

目的 探讨应用“风筝”皮下蒂皮瓣修复面部皮肤缺损的临床效果。方法 自2000年6月以来，应用“风筝”皮下蒂皮瓣修复因面部病变组织切除术后的皮肤缺损患者36例。按病变组织的形状将其行圆形或椭圆形切除．于缺损的一侧设计、形成以皮瓣基底部皮下组织为蒂或以皮瓣两侧皮下组织为蒂的皮瓣，皮瓣最大宽度小于或等于缺损直径．长度约为缺损直径的1．5～2．0倍，推进覆盖缺损部位。结果 36例患者的皮瓣全部成活。术后随访3个月至1年．瘢痕不明显，皮瓣颜色与周围正常皮肤相近，形态较好。结论 此方法具有操作简单、皮瓣的血运可靠及转动灵活、愈后切口瘢痕不明显等优点，对于因直接缝合张力大或可能引起面部器官移位的面部皮肤缺损的修复，是比较理想的手术方法。     

"风筝"皮下蒂皮瓣在面部皮肤缺损中的应用

目的探讨应用"风筝"皮下蒂皮瓣修复面部皮肤缺损的临床效果.方法自2000年6月以来,应用"风筝"皮下蒂皮瓣修复因面部病变组织切除术后的皮肤缺损患者36例.按病变组织的形状将其行圆形或椭圆形切除,于缺损的一侧设计、形成以皮瓣基底部皮下组织为蒂或以皮瓣两侧皮下组织为蒂的皮瓣,皮瓣最大宽度小于或等于缺损直径,长度约为缺损直径的1.5～2.0倍,推进覆盖缺损部位.结果36例患者的皮瓣全部成活.术后随访3个月至1年,瘢痕不明显,皮瓣颜色与周围正常皮肤相近,形态较好.结论此方法具有操作简单、皮瓣的血运可靠及转动灵活、愈后切口瘢痕不明显等优点,对于因直接缝合张力大或可能引起面部器官移位的面部皮肤缺损的修复,是比较理想的手术方法.     

颞区皮下蒂皮瓣转移修复眉额部皮肤缺损

目的：探讨应用颞区皮下蒂皮瓣转移修复眉额部皮肤缺损的方法。方法：对10例眉额部皮肤缺损的患者,应用颞区皮下蒂皮瓣转移修复。结果：10例患者皮瓣全部成活,颜色、质地与正常额部皮肤相似,效果满意。结论：应用颞区皮下蒂皮瓣转移修复眉额部皮肤缺损是一种简单、可行的方法。     

鼻唇沟区岛状皮瓣在鼻部皮肤缺损美学修复中的应用

目的:探讨应用鼻唇沟区岛状皮瓣在鼻部缺损修复中的效果。方法:回顾性分析32例因外伤或肿瘤切除后鼻部皮肤缺损患者应用鼻唇沟岛状皮瓣行鼻重建修复术后的功能恢复和美学效果。鼻重建方法采用同侧或对侧鼻唇沟区切取皮瓣,皮瓣长宽比例不超过4:1,蒂部去除皮下组织及表皮,保留真皮下血管网,穿过皮下隧道修复鼻部缺损,供瓣区两侧皮下游离后直接缝合。结果:本组共32例患者,随访6～12个月,其转移皮瓣均成活良好,无坏死,鼻部外观良好。供瓣区直接缝合后无继发畸形,切口瘢痕不明显,双侧面部对称,外观满意。结论:应用鼻唇沟区岛状皮瓣修复鼻部缺损虽是一种简单易行的手术方法,但可达到良好的功能修复和美学效果。     

鼻唇沟皮下蒂岛状皮瓣修复鼻部皮肤缺损

目的：探讨鼻唇沟皮下蒂岛状皮瓣在修复鼻部皮肤缺损中的应用。方法：应用鼻唇沟皮下蒂岛状皮瓣对12例患者修复鼻部皮肤缺损,缺损部位包括鼻翼、鼻尖及鼻背,最大缺损面积3．0cm×4．0cm。皮瓣沿鼻唇沟走行方向设计,蒂宽1．0～1．5cm,皮瓣长宽比不超过3：1,蒂部旋转点位于皮瓣远端与缺损远端连线的中点。结果：12例患者皮瓣全部成活,其中1例因蒂部卡压术后当天皮瓣颜色略紫,术后第2天予蒂部松解后好转。术后随访半年到1年,皮肤质地、色泽与周围皮肤相近,瘢痕不明显。结论：鼻唇沟皮下蒂岛状皮瓣是修复鼻部皮肤缺损的理想方法。     

颞侧眼轮匝肌蒂皮瓣修复眼睑缺损

目的：探讨以眼轮匝肌为蒂的颞区皮瓣修复眼睑缺损的临床应用。方法：在颞侧设计眼轮匝肌为蒂的皮瓣,将皮瓣向内推进或旋转1800修复睑缺损区。结果：7例眼睑缺损修复均取得了满意的效果,未出现并发症。结论：眼轮匝肌蒂颞区皮瓣修复眼睑缺损比局部或皮下蒂组织瓣易于移转,修复后外形满意且供区隐蔽,是修复眼睑缺损的良好选择。     

皮下组织蒂岛状皮瓣在面部皮肤缺损修复中的应用

目的介绍皮下组织蒂岛状皮瓣在面部皮肤缺损中的应用。方法以面部皮下组织作为皮瓣的供血蒂,转移皮瓣修复面部缺损。皮瓣面积为1.0cm×1.0cm至3.0cm×4.0cm。结果本组25例患者,切口均Ⅰ期愈合,皮瓣全部成活,术后面部形态满意,术区平整,无"猫耳"畸形,切口瘢痕不明显。结论皮下组织蒂岛状皮瓣修复面部皮肤缺损可以达到良好的美学效果。     

Subcutaneous Pedicle Limberg Flap for Facial Reconstruction

Background. A residual dog-ear arising from the traditional Limberg flap transposition sometimes influences the cosmetic outcomes, and the Limberg flap with a subcutaneous pedicle is an innovation applicable to a variety of facial defects and free from the dog-ear.
Objective. To investigate the outcome of the subcutaneous pedicle Limberg flap for the reconstruction of medium-sized facial skin defects.
Materials and Methods. From August 2002 to June 2004, the subcutaneous pedicle Limberg flap was designed to repair facial skin defects in 17 patients (19 flaps), and the size of the lesions ranged from 2.0 × 1.9 cm to 5.0 × 4.5 cm.
Results. All flaps survived with primary healing postoperatively. The patients were followed up from 1 to 22 months, and functionally and cosmetically satisfactory outcomes were achieved.
Conclusions. This subcutaneous pedicle Limberg flap provides a competitive repair alternative for the treatment of medium-sized skin defects in the face.     

The Island Pedicle Flap

Background. Surgical defects following the extirpation of cutaneous neoplasia may present challenges to the dermatologic surgeon. There are many repair options for an individual defect, including second-intention healing, primary closure, skin graft, and skin flap closure. The island pedicle flap is a random pattern advancement flap well suited to reconstruct a variety of small- to intermediate-sized soft tissue wounds.
Objective. To review the utility of the island pedicle flap in reconstructive dermatologic surgery and to detail the operative technique to achieve reproducible functional and esthetic results.
Methods. The method of flap reconstruction is presented. A variety of defects repaired with this technique are reviewed.
Results. The subcutaneous island pedicle flap yielded excellent functional and cosmetic repair of the presented defects with minimal operative morbidity. Secondary to a well-preserved central vascular pedicle, complications are infrequent.
Conclusions. The random pattern island pedicle flap is a versatile and robust flap used to repair a variety of soft tissue wounds in a single-stage procedure with reproducible operative outcomes.     

腓肠神经营养血管逆行岛状皮瓣修复跟腱断裂术后小面积皮肤缺损

目的:观察应用腓肠神经营养血管逆行岛状皮瓣修复跟腱断裂术后小面积皮肤缺损的临床效果。方法:12例跟腱断裂术后皮肤缺损的患者清创后,应用腓肠神经营养血管逆行岛状皮瓣进行修复,并观察其疗效。结果:经3～18个月随访,12例中除1例边缘部分坏死外,其余皮瓣全部成活。结论:应用腓肠神经营养血管逆行岛状皮瓣,可有效修复跟腱断裂术后小面积皮肤缺损。     

Role of the anterolateral thigh flap in head and neck reconstruction: advantages of moderate skin and subcutaneous thickness

Skin-flap thickness is an important consideration when choosing a free flap for head and neck reconstruction. The anterolateral thigh flap, the rectus abdominis flap, and the radial forearm flap, which included the epidermis, the dermal, and the subcutaneous layers, were measured using ultrasonography in 31 patients. The mean skin and subcutaneous thickness of the anterolateral thigh flap was 7.1 mm; the rectus abdominis flap was 13.7 mm; and the radial forearm flap was 2.1 mm. Further analysis revealed a statistically significant difference among the skin and subcutaneous thickness of the three flap groups. Of the 44 anterolateral thigh flap transfers done for head and neck reconstruction after cancer ablative surgery, 41 (93.2 percent) were transferred successfully. The anterolateral thigh flap creates a moderately thick skin flap, and is less variable in thickness across its area than is the rectus abdominis flap. The flap is adaptable for reconstruction of head and neck soft-tissue defects.     

A technique of undermining a V-Y subcutaneous island flap to maximise advancement

A method is described where the planned directional undermining of a subcutaneous triangular flap creates a long pedicle and in the process the flap is "unfolded" to increase its advancement. The flap can be undermined and advanced without any tension. This method is recommended where more conservative undermining is inadequate for mobilisation, particularly in larger defects and in the replacement of skin defects on the lower eyelid which needs to support the eyelid. This technique depends on the richness of the random blood supply in the head and neck regions and the availability of adequate depth of subcutaneous tissue for the development of a long pedicle. Using this method in 53 cases, it has been found possible to advance the flap way past the defect if so desired. Some minor disadvantages of this flap are also described.     

应用双蒂“风筝”皮瓣修复鼻唇沟旁皮肤缺损

目的探讨应用双蒂"风筝"皮下蒂皮瓣修复鼻唇沟旁肿物切除后皮肤缺损的方法及效果。方法在局部麻醉下完整切除鼻唇沟旁皮肤肿物,沿鼻唇沟走行方向设计以皮瓣两侧皮下组织为蒂的"风筝"皮瓣,推进修复皮肤缺损。结果本组共15例患者。术后皮瓣均成活较好。随访6~24个月,术区外观较满意,瘢痕不明显。结论采用双蒂"风筝"皮瓣修复鼻唇沟旁皮肤缺损是较理想的手术方法;掌握"风筝"皮瓣的手术要点,可进一步提升手术效果。     

Preservation of lateral thoracic artery to improve vascular supply of distal skin without compromising pedicle length in harvesting pectoralis major myocutaneous flap.

The pectoralis major myocutaneous (PM) flap is supplied by three arterial systems. The lower chest skin of the PM flap is mainly supplied by the branches of lateral thoracic artery and internal mammary artery. The conventional harvesting technique for head and neck reconstruction utilizes single arterial supply from the pectoral branch of thoracoacromial artery. The distal skin island of PM flap is therefore compromised and requires indirect blood supply by communicating vessels. In harvesting the PM flap, the pectoralis minor muscle is divided to preserve the lateral thoracic artery and its blood supply to the lateral distal skin island of PM flap without compromising the pedicle length for head and neck reconstruction. Six PM flaps were harvested for reconstruction of head and neck defects with preservation of both the pectoral artery and lateral thoracic artery. The focal pint of swing of all six flaps was at the same point just below the mid-point of clavicle for both pectoral artery and lateral thoracic artery. The flaps can reach the oral cavity, tonsil or hypopharynx without limitation and there is no flap necrosis. In conclusion, the lateral thoracic artery can be preserved without compromising the pedicle length of PM flap. It is a recommended technique to improve the blood supply to the distal skin of PM flap.     

Modified bilobular (“gemini”) pectoralis major myocutaneous flap

The bilobular or gemini type of pectoralis major myocutaneous flap evolved from a desire to simplify the closure of large surgical defects of both mucosa and skin that could not be satisfactorily closed primarily. Previously, such defects often required combined or multiple reconstructive procedures such as myocutaneous and deltopectoral flap operations. The mucosal and skin defects are closed by two skin paddles supported by a single muscular vascular pedicle.The skin paddles are fashioned side by side and separated from each other as the muscle is folded between them parallel to the vascular axis. All of the defects were successfully closed and the major portion of all grafts survived. This operation permits single-stage reconstruction after ablation of tumors or treatment of complications which produce large through-and-through mucocutaneous defects of the head and neck area.