腹腔镜手术切口处理:爱必肤粘合剂与传统方法的对比研究

目的:对比研究爱必肤粘合剂与传统方法对腹腔镜手术切口的作用。方法:将腹腔镜手术53例、185个切口用爱必肤胶粘合,同期腹腔镜手术39例、140个切口用传统无菌胶带粘合,观察其愈合时间、并发症、感染率、切口疼痛程度及美观效果。结果:爱必肤组切口愈合时间短、切口疼痛轻(P<0.05);感染率、并发症、美观效果两者无差异。结论:爱必肤可促进切口愈合,减轻切口疼痛,临床应用安全有效。     

组织瓣移植术在整形外科领域的发展

组织瓣移植术是整形外科修复组织器官缺损的重要手段，在组织瓣移植术中以皮瓣移植的应用最为广泛。随着显微外科技术的发展、推广和成熟，皮瓣游离移植的成活率已很可观，皮瓣的挖掘也几乎到了“弹尽粮绝”的地步．皮瓣移植的创新性研究越来越少。尽管如此，整形外科医师们仍然没有放弃对这一领域的探索和总结，在许多方面取得了重要成果，如：减少供区创伤开发保留知名轴型血管的皮瓣移植；局部扩张皮瓣覆盖游离皮瓣切取的供区不造成二次损伤；保留伴行支配神经和肌肉的穿支或带少量肌肉的肌皮瓣移植，能够避免肌皮瓣切取后的肌肉缺损和功能障碍；预制游离皮瓣移植的器官再造；组织工程人工皮肤的研制等。这些研究成果必然引导临床医师们产生新的治疗思维。     

皮肤环形缝扎术在整形外科中的应用

目的：探讨如何应用环形缝扎术关闭皮肤缺损创面。方法：用不可吸收缝线环绕创缘皮下或皮内缝合一周,收紧缝线打结将伤口缩拢关闭。结果：该法应用于32例共41处创面,术后形成瘢痕短小,外形好。结论：本法封闭创面简便、快速,效果好,可作为整形外科的一项基本技术应用。     

纤维蛋白粘合剂及其临床应用

纤维蛋白粘合剂是由纯化的人纤维蛋白原及牛凝血酶、Ca~(++)、第ⅩⅢ因子、抑肽酶组成的生物制品。经基础与临床研究,现已逐步成为弥补缝合法缺陷的辅助方法之一。临床已用于游离皮瓣的移植、小血管、周围神经、肌腱等的吻合、微小粉碎性骨折片的固定、大血管夹层动脉瘤的填充、支气管瘘的封闭、肝脾等实质脏器手术创面止血修补等,临床效果满意。本文详细介绍了纤维蛋白粘合剂的成份、使用方法、治疗机理、应用范围及注意事项等。     

A型肉毒素在美容整形外科中的应用

自Carruthersl987年首次将A型肉毒素用于治疗眉间区域皱纹以来，很快在面部除皱中得到广泛应用，并扩展到美容整形外科的其他领域，如通过降低机能亢进的肌肉来减轻面部的隆起而达到轮廓整形的目的等。本文就肉毒素的历史，作用机理及其在美容整形外科中的应用作一综述。     

The use of cyanoacrylate tissue adhesive in high-risk intestinal anastomoses

The success of every intestinal surgical procedure primarily depends on correct technical execution of the intestinal sutures. Despite the continuing improvements in intestinal synthesis techniques and the introduction of mechanical staplers, the risk of anastomotic dehiscence remains a major concern. For high-risk anastomoses, defined as those performed under critical conditions, n-butyl-2-cyanoacrylate tissue adhesive allows for quick sealing of the two stumps and supports the physiological wound-healing process. Furthermore, no experimental or clinical studies have shown that this glue has any carcinogenic or mutagenic properties. Thus, we believe that n-butyl-2-cyanoacrylate will be extremely useful for intestinal anastomoses with a high risk of dehiscence.     

皮肤软组织扩张术在整形修复中的临床应用

目的:探讨皮肤软组织扩张术在整形修复治疗中的临床应用情况。方法:收集2011年1月~2014年3月,在我科利用皮肤软组织扩张术修复瘢痕或皮肤软组织缺损的病例58例,其中头皮缺损17例,四肢瘢痕13例,颈前瘢痕7例,胸腹部瘢痕12,颌面部瘢痕9例。对患者的临床资料、术后修复情况以及病人自身治疗体会进行研究与总结。结果:本组58例患者,共埋置71个扩张器,其中,扩张器外露2个,感染2个,血肿1个,并发症发生率为8.6%。经及时处理后正常扩张,扩张后皮瓣均满足修复区所需。术后随访6~18个月,扩张皮瓣平整、无明显回缩,皮肤色泽正常,外形良好,无功能障碍,疗效满意。结论:皮肤软组织扩张术在整形修复治疗中的应用效果较好,值得进一步在临床推广应用。     

人体组织粘合剂在包皮环切中的应用价值（附258例报告）

目的对比研究人体组织粘合剂与传统缝合方法对包皮环切术切口的治疗效果。方珐门诊包皮环切术488例随机分成A、B两组,A组258例切口应用人体组织粘合剂粘合,B组230例应用丝线或可吸收线间断缝合,观察并比较关闭切口时间、切口疼痛发生率、术后疼痛持续时问、术后水肿情况、切口愈合分级的情况。培杲在关闭切口时间、切口疼痛发生率、术后疼痛持续时间方面A组与B组有显著差异性（P〈0．05）。在术后水肿情况、切口愈合分级方面A组与B组无显著性差异（P〉0．05）。站论应用人体组织粘合剂行包皮环切术具有诸多优点,在包皮环切手术中值得广泛推广。     

Fibrin tissue adhesive reduces postoperative blood loss in total knee arthroplasty

Background

Blood transfusion is often required in total knee replacement; various methods of blood preservation have been studied. The best solution is to reduce the loss of blood during and after surgery.

Materials and methods

We designed this study to evaluate the hemostatic efficacy and safety of fibrin tissue adhesive (Quixil) in patients receiving total knee arthroplasty [low contact stress (LCS, DePuy, Warsaw, IN, US) cementless total knee replacement (TKR)] with a prospective, randomized, standard treatment controlled study. Thirty-five patients were randomized to receive treatment with fibrin tissue adhesive (treatment group), and 35 were randomized to be managed with postoperative blood recovery and reinfusion (control group). Blood loss in suction drain, decrease in hemoglobin values, and transfusions were recorded.

Results

A significant reduction in apparent total blood loss was detected in the treatment group compared with the control group. There was also a lower decrease in hemoglobin level, although this difference was not significant. When fibrin tissue adhesive was administered, the need for transfusions was lower. No major adverse events were recorded in our series.

Conclusions

Fibrin tissue adhesive reduced blood loss in TKR and seemed to significantly reduce the need for blood transfusion. Fibrin tissue adhesive can be an appropriate solution to enhance hemostasis and vessel sealing at the operative site in TKR, in order to reduce blood loss after surgery and the risk of complications.     

Laparoscopic injection of dermabond tissue adhesive for the repair of inguinal hernia: short- and long-term follow-up

Purpose

Is laparoscopic injection of 2-octyl-cyanoacrylate tissue adhesive (Dermabond: Db) into the inguinal hernia sac (IHS) effective for inguinal hernia repair?

Methods

Thirty male 4-week-old Lewis rats were used as subjects for this study. In the right Db (R-Db) group (n = 10), a fine catheter was passed through an 18-guage indwelling intravenous cannula inserted in the right lower quadrant, and 0.2 mL Db was injected into the right IHS under laparoscopic control. The left side was not treated. Both IHSs were treated in the bilateral Db (B-Db) group (n = 10). In the no Db (N-Db or control) group (n = 10), only laparoscope insertion was performed. Herniography was performed before death. B-Db and N-Db rats were mated 50 days after treatment. Half of all rats were killed 2 months after treatment and the remaining half 12 months after treatment.

Results

All rats survived until killing. Macroscopic findings postdeath confirmed herniography results; treated IHS were closed, and untreated IHS were patent. There were minor adhesions in 3 of 20 treated rats. Sperm were identified in the vaginas of all mated rats.

Conclusions

These results suggest that our new technique is simple, safe, and reliable as an alternative to standard operative repair for inguinal hernia.     

整形外科原则和技术在面部软组织创伤急诊处理中的应用

目的：应用整形外科原则和技术急诊修复面部软组织创伤。方法：在面部软组织创伤急诊清创术中，遵循整形外科原则，用皮肤磨削、无张力缝合、植皮、皮瓣转移等技术进行修复。结果：460例患者中，术后1～2年中随访356例患者，均无瘢痕增生和错位畸形等并发症。结论：面部软组织创伤用整形外科原则和技术修复，能避免患者术后错位畸形，减少瘢痕。     

Reconstructive plastic surgery in soft tissue sarcomas of the extremities

Summary Limb-sparing resection in combination with radio/chemotherapy is recommended in cases of soft tissue sarcomas of the extremities. Plastic surgery techniques and clinical results in 69 patients with 71 malignant soft tissue tumors who had hadergone resection, as well as additional reconstructive procedures for functional improvement, are discussed. The integration of patients suffering from soft tissue sarcomas of the extremities into the treatment protocols of interdisciplinary tumor boards is recommended. Plastic surgery salvage procedures (including microsurgical free-tissue transfer) are discussed in detail. If the patient is judged unsuitable for these procedures or if distalization is not possible, amputation is the final option.     

Laser tissue interaction in plastic surgery and dermatology: Cases of choice

An anatomo-pathological study was undertaken to evaluate the early effects of high and low powered non-contact mode of YAG laser on pulmonary tissue and to compare these effects with those resulting from electro-diathermy.In 40 patients with bronchial carcinoma, thoracotomy was carried out using conventional surgical methods, the part of the lung destined to be excised was then exposed to: Non-contact YAG laser of high or low power (Group A, n=15); cutting/ or coagulation electro-diathermy (Group B,n=15); and mixed (blend) cutting and coagulation electro-diathermy (Group C,n=10). The results indicated that high power non-contact YAG laser is capable of incising the pulmonary parenchyma without bleeding or air leak, only the larger and sub-segmental vessels and bronchial branches needed suturing. This was not the case for electro-diathermy, either in its cutting or blend form. The low power laser was capable of sealing off the superficial bleeding vessels and contracting the alveolar sacs, thus preventing bleeding and air leak. Only the superficial bleeding could be stopped by coagulation diathermy which had no effect in preventing air leak from the parenchyma.Microscopically, apart from evaporation, laser produced charring and coagulative necrosis in the remaining exposed tissue. No evaporation of tissue occurred with electro-diathermy (either in its cutting, blend or coagulation mode). Only a very limited charring and coagulative necrosis was present in the remaining tissues exposed to coagulation electro-diathermy.