数字化与虚拟现实技术在皮瓣移植中的应用

目的研究数字化与虚拟现实技术在股前外侧皮瓣解剖设计与可视化中的应用。方法①应用“虚拟中国人”男性3号数据集,在薄层断面图像上观察旋股外侧动脉的主要解剖结构,应用Amira 3．1 (TGS)软件对股前外侧皮瓣结构进行计算机三维重建并立体显示。②明胶一氧化铅混悬液灌注的新鲜成人下肢标本1具,行连续螺旋CT扫描,观测旋股外侧动脉分布及彼此间的吻合情况,应用Amira 3．1软件对股前外侧皮瓣结构进行计算机三维重建并立体显示。结果重建的数字化模型可准确反映股前外侧皮瓣的解剖学结构特点。结论重建的图像可以提供正常股前外侧皮瓣三维动态解剖,为临床教学术前皮瓣设计提供了直观的数字化解剖依据；同时可为下一步虚拟手术的设计奠定良好的基础。     

A comparison of axial circumference between superficial circumflex iliac artery perforator flap and other workhorse flaps in dorsal foot reconstruction

Background: Management and reconstruction of dorsal foot defects present various difficulties and challenges. The main purpose of this article is to discuss experiences of using superficial circumflex iliac perforator (SCIP) flap in various defects of the dorsal foot region.

Methods: From August 2012 to February 2015, a total of 13 patients – nine males and four females – received a reconstruction operation for dorsal foot defects using SCIP flaps (the SCIP group). The defects were caused by trauma (n?=?9), diabetes (n?=?3), and malignancy (n?=?1). The mean age was 43.07 years, which ranged between 19–70 years. Additionally, 19 other patients, who underwent reconstruction operation of the foot dorsum using ALT and TDAP flaps during the same study period, were recruited for comparison. The axial circumference of the operated foot and unoperated contralateral foot was measured, and the difference were compared between all patients, as well as between the two groups.

Results: All of the flaps survived after the operation, but secondary procedures were performed in two cases due to partial skin necrosis. The mean follow-up period was 13 months. The mean axial circumference discrepancy of the SCIP group (12.08?±?2.96?mm) was significantly lower compared with ALT (25.21?±?3.16?mm) and TDAP (29.88?±?1.55?mm) groups (p?Conclusions: The authors experienced good results with using the SCIP flap in dorsal foot reconstruction. Reconstruction with the SCIP flap can be a good surgical option, with better postoperative symmetry and minimal donor sequelae, compared to conventional workhorse flaps.     

Scrotum reconstruction with the anterolateral (ALT) thigh flap

Scrotum reconstruction is challenging. Both the functional and cosmetic outcome are considered. Many reconstructive methods have been described, from burying the exposed testicles into a subcutaneous pocket to local musculocutaneous or fasciocutaneous flaps. We report our experience of treating three patients for scrotal reconstruction by using the anterolateral thigh island flap. Three patients received scrotum reconstruction with the anterolateral thigh island flap from 2003 to 2007. Two of them had Fournier’s gangrene and one had hidradenitis suppurativa. In two occasions a “true” perforator flap was used and in one a small muscle cuff of the vastus lateralis muscle was also included. All three flaps were successful. One patient had a proximal donor site wound dehiscence due to inadequate drainage. Simple conservative treatment resolved the problem. No patient had any functional donor site morbidity. We conclude that the anterolateral thigh flap is a valuable tool in reconstruction of the scrotum. It should be considered as a sound alternative within the available reconstructive procedures.     

Transformation of the glabellar flap into an island flap

Summary Glabellar flaps have traditionally been used to cover nasal skin and soft tissue defects. The narrowing of its vascular pedicle to the cutaneous arterial branch of the angular artery categorizing it as an axial flap pattern. Three cases are presented, the first of which typifies the standard glabellar flap with an intact skin and subcutaneous pedicle. The other two cases utilize a glabellar island flap based on a subcutaneous pedicle containing cutaneous arterial branch of the angular artery. This technique extends the mobility of this flap to allow one-stage reconstruction of adjacent defects.     

Composite tempororetroauricular flap for the reconstruction of the lower lid and eye socket in the elderly

In this paper, experience with the composite tempororetroauricular flap (TRF) in three elderly patients undergoing lid reconstruction and one elderly patient undergoing socket reconstruction are presented. The composite TRF allows three layered cover in orbital reconstruction. The secondary defect and scarring of the donor site is concealed behind the ear and in the hair-bearing scalp. The procedure is completed in a single stage.Presented at the 15th Congress of the Turkish Society of Plastic Surgeons, Istanbul, Turkey, September 27–29, 1993     

Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction

Background  The process of reconstruction of tracheal defects is complex and still not optimum. Options range from using staged reconstructions, combining flaps with autologous or alloplastic implants, as well as use of tissue-engineered constructs combined with vascularized tissues which are lined with cell cultures. Staged reconstructions using prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex structure. Prefabricating the flap at a different site allows for integration of the tissues prior to its transfer. Method  This article reports two patients planned for tracheal reconstruction for the purpose of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated with buccal mucosa, was performed. However, in the latter case, an intraoperative decision by the head and neck team to limit excision of the trachea sparing the mucosa was taken; the reconstruct in the forearm was redundant and needed to be discarded, replacing the defect with a free superficial circumflex iliac artery perforator (SCIP) flap. Result  At 3 years follow-up, both the patients are free of disease, with the construct serving its purpose in the older female.     

皮管法鼻再造术探讨

目的:探讨皮管法鼻再造的手术相关技术和适应证。方法:自1999年以来,我们应用上臂皮管、胸部皮管、腹部皮管临床治疗18例鼻缺损患者。总结相关技术及术式的优缺点和适应证。结果:本组18例患者手术均获成功,外形及通气效果良好。随访3￣12个月,皮瓣无明显回缩。结论:对于此组额、面部大面积烧伤的病人,皮管法鼻再造是首选治疗方案。     

DIEAP flap for safe definitive autologous breast reconstruction

BackgroundBreast cancer is the commonest form of cancer in women affecting almost a quarter of a million patients in the US annually. 30 percent of these patients and patients with genetic mutations undergo removal of the breast, as highlighted in a high profile celebrity patient. Although breast reconstruction with free microvascular transfer of a DIEAP flap from the abdomen is an ideal form of reconstruction, there have been misgivings about the complexity and potential complications. This study was aimed at clearing these misunderstandings and establishing the value of this form of breast reconstruction.Methods1036 DIEAP flap breast reconstructions carried out at the University Hospital, Gent (five year period) and at the Sana Kliniken, Düsseldorf (three year period) were included prospectively. Comorbid factors like chemotherapy, radiotherapy, patient age >65 years, BMI >30 and smoking were recorded. Outcomes were evaluated over a mean follow up of 2 years.ResultsOverall complication rate related to the reconstructed breast and donor abdominal area was 6.8 percent. Total flap loss was seen in only 0.8 percent. The mean operating time was less than five hours. Older age, higher BMI, chemotherapy and radiotherapy did not have a significant influence on complication rates, however smoking resulted in significant delay in wound healing in the breast (p = 0.025) and abdominal wounds (p = 0.019).ConclusionThe DIEAP flap is an excellent option for breast reconstruction, with a low level of donor site morbidity and complications. It is an autologous reconstruction that provides a stable long term result.     

Reconstruction of the orbital region with the “blepharoplasty flap”

A modified technique of unipedicled orbicularis oculi myocutaneous flap raised along an upper or lower blepharoplasty incision line for reconstruction of the orbital region is described. This procedure provides excellent aesthetic improvement in older patients with a standard blepharoplasty being performed on the other eyelid.     

A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance

BACKGROUND:

Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome.

METHODS:

The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors’ knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction.

RESULTS:

The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required.

CONCLUSIONS:

This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.