髂腹股沟皮瓣与阴股沟皮瓣联合应用修复阴茎及阴囊皮肤软组织缺损1例

患者男,35岁,因阴茎及阴囊皮肤破溃坏死进行性加重近1个月余于2010年4月9日入院。主诉入院前27 d无明显诱因出现会阴部皮肤红肿,口服安乃近及扑热息痛后阴茎及阴囊皮肤红肿较前加重并伴有明显触痛,遂前往当地医院给予对症处理,后创面逐渐增大,治疗共持续1个月余,症状未明显     

微型皮瓣修复拇指指腹缺损(附52例报告)

2000～2003年,我们应用4种微型皮瓣来修复拇指指腹缺损52例,同时重建拇指感觉,效果满意。现报告如下。     

微型静脉皮瓣修复再植手指微小创面(附69例报告)

目的 探讨微型静脉皮瓣修复再植手指血管与皮肤缺损的临床价值。方法 在前臂或足背部设计以小静脉为轴心的静脉干皮瓣移植于再植手指，一次性修复再植手指皮肤与血管缺损。结果 静脉皮瓣与再植手指全部成活，外形与功能良好。结论 微型静脉皮瓣一次性修复再植手指血管与皮肤缺损，不仅取材方便、操作简单，而且成活率高。     

全膀胱切除联合回肠新膀胱原位再造术治疗膀胱癌(附8例报告)

应用全膀胱切除联合回肠新膀胱原位再造术治疗膀胱癌患者8例.原位回肠再造的新膀胱控尿、排尿情况良好,术后静脉尿路造影、B超检查均未见上尿路扩张,膀胱造影术未发现输尿管反流,患者血生化正常.术后随访8～22个月,未发现新膀胱或尿道肿瘤复发.认为全膀胱切除联合回肠新膀胱原位再造术是治疗浸润性膀胱癌的理想方法.     

游离皮瓣移植修复肢体软组织缺损(附59例报告)

对 5 9例严重肢体软组织缺损伤患者 ,取自体组织皮瓣游离移植修复肢体缺损。根据不同缺损与缺损的范围应用不同的游离皮瓣。皮瓣面积最小 10 cm× 12 cm,最大 2 0 cm× 40 cm。其中背阔肌皮瓣 43例 ,股前外侧皮瓣 7例 ,侧胸皮瓣 6例 ,脐胸皮瓣 3例。结果 :完全成活 5 6例。因受区创面不新鲜感染 ,2例部分坏死 ,1例完全坏死。认为用游离自体皮瓣移植修复严重的肢体软组织缺损 ,可有效修复肢体创面 ,防止因皮肤缺损所致血管、神经和骨骼的进一步损伤或感染 ,提高伤肢修复的疗效和功能     

贲门癌切除贲门再造术42例报告

为减少贲门癌术后吻合口瘘及狭窄 ,预防返流性食管炎发生 ,我们设计了贲门癌切除贲门再造术。1999年 10月～ 2 0 0 2年 10月 ,我院施行贲门癌切除贲门再造术 42例 ,并与同期施行贲门癌切除胃食管套入吻合术的 42例进行对比分析。现报告如下。一般资料 :同期收治贲门癌 84例 ,随机分为两组 :1观察组 ( 42例 ) :贲门再造 ,采用胃食管粘膜外翻吻合 ,重建胃底及 His角。男 2 9例 ,女 13例 ;年龄 3 7～ 73岁 ,平均 ( 5 2 .0±2 1.1)岁。病理分期 : 期 2 5例 , 期 10例 , 期 7例。2对照组 ( 42例 ) :套入式吻合 ,采用胃食管全层缝合加深包埋术。…     

阴道肿瘤的诊治(附30例分析)

分析３０例阴道肿瘤患者的临床资料,其中良性阴道肿瘤１４例,原发恶性阴道肿瘤１２例,转移性恶性阴道肿瘤４例,结果显示,良必阴道肿瘤订在表现为阴道肿物,以平滑肌瘤多见,行手术切除即可,阴道恶性肿瘤以阴道黑色素瘤及原发性阴道癌多见,转移瘤多来自邻近器官、其治疗宜行根治术,术后可辅以放疗、化疗及免疫治疗。     

婴儿单心室室间隔再造术1例报告

患儿女，7个月，体重5kg，因反复肺炎、心衰1个月，于2002年4月12日入院。查体：一般情况好，口唇轻度紫绀，无杵状指(趾)，胸骨左缘3～4肋间可闻及Ⅱ／6级收缩期杂音，肺动脉瓣第二心音亢进。X线胸片示两肺多血，心影增大，心胸比0．7，心腰凸出，心尖圆钝。心电图示不完全性右束支传导阻滞。心脏彩超检查示室间隔膜部巨大缺损1．6cm，房间隔     

急性女阴潰瘍(附八例报告)

急性女阴潰瘍(Ulcus VulVae acutone)是一种急性发作的女性外阴部的溃瘍性皮肤病。临床特征是:非传染性,只侵犯女性外阴(包括大、小阴唇),发病急而疼痛严重,复发率高。有的患者同时并发有阿弗他性口腔炎(口疮)、結节性紅斑、眼结合膜及角膜的炎症改变。本病在国内先后有刘輔仁,汪心治,云沛霖氏等报告过。我院皮膚科近一年来(58年3月-59年4月)共发现八例,摘要报告如下。病例报告: 例一赵××,女性;41岁,家庭妇女,已婚。主诉:外阴生疮两个月多。患者在两个月前外阴部发生二、三个丘疹触之疼痛,不久即行破潰,疼痛加剧。特别当排尿及行走时更痛。同时下唇发生一口疮損害,饮食时觉痛。小腿有数个紅色斑块,捫之觉硬而痛,其下有結节,并发水肿。右小腿并发生一溃疡。过去史:患者于17岁結婚,婚后三个月即在外阴发生溃瘍性損害,疼痛剧烈,同时口腔粘膜发生口     

侧胸壁皮瓣修复功能部位深度烧伤后巨大软组织缺损(附18例报告)

目的探讨侧胸壁皮瓣修复功能部位巨大软组织缺损的可行性及效果。方法对18例功能部位深度烧伤后巨大组织缺损患者采用侧胸壁皮瓣一期修复。切取皮瓣面积16cm×30cm～22cm×30cm,其中游离吻合血管皮瓣16例、岛状瓣2例,结果均一次性修复成功。随访6～12个月,皮瓣稍显臃肿,无需修整。结论侧胸壁皮瓣血管恒定、口径粗大、无变异,供瓣部位隐蔽,血运丰富,切取范围大,抗感染能力强,适用于深度烧伤后软组织缺损的修复。     

Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report

Rationale:Cutaneous perforators of peroneal vessels are divided into proximal and distal perforators on the basis of perforator distributions and musculocutaneous or septocutaneous properties. The traditional fibular osteocutaneous free flap is raised over the distal two-thirds of the fibula with a skin paddle based on distal perforators, which is affixed to the posterior crural septum. However, the skin pedicle may not be available due to anatomic variations or intraoperative injuries. Herein, because of the absence of distal perforators, we reserved and expropriated proximal perforators originating from the musculocutaneous branch of the superior part of the peroneal artery before it divided into nutrient and arcuate arteries and successfully harvested a separate osteal fibula and proximal perforator skin paddle with a single vascular pedicle-peroneal vessel.Patient concerns:A 62-year-old man with a 6-month history of mandibular swelling and soft tissue invasion was referred to us.Diagnosis:Panoramic radiography and computed tomography showed an irregular radiolucent lesion of the mandibular body, and histopathological analysis confirmed a follicular-pattern ameloblastoma.Interventions:The diseased mandible and soft tissue were resected and reconstructed with a vascularized fibular osteal flap with the proximal perforator skin paddle.Outcomes:The mandibular contour was successfully restored; the skin paddle in the mouth was in good condition after 8 months of follow-up.Lessons:The proximal perforator is reliable and practical for supplying a skin paddle and has significant potential for future applications. We recommend reserving the proximal perforator skin paddle as a backup flap when planning to raise a fibula flap, since unavailability or injury of the traditional fibular skin island based on distal perforators occurs frequently. This approach can avoid the exploration for a second donor site, save surgical time, and reduce surgical complexity. Moreover, we anticipate more frequent use of the proximal perforator flap in the future because of its flexibility and large volume, and since it can be combined with the osteal fibula or fibular osteocutaneous flap. However, an understanding of the traits of the proximal perforator and determination of its peroneal origin by computed tomography angiography is crucial for predesigning fibular osteal flaps with a proximal perforator skin paddle.     

Reconstruction of extensive plantar forefoot defects with free anterolateral thigh flap

Purpose:The aim of the soft tissue reconstruction of plantar forefoot should yield weight-bearing function and aesthetic contour, which poses a significant challenge for reconstructive surgeons to provide an appropriate flap according to the “like for like” reconstructive principle. Local flaps and pedicled flaps have been described for the reconstruction of small- to medium-sized defects of plantar forefoot and achieved optimal results. However, reconstruction of extensive defects of plantar forefoot is rarely investigated. In this study, we present our experience using the free anterolateral thigh (ALT) flap in the reconstruction of extensive defects of plantar forefoot.Methods:Between November 2011 and April 2017, 9 patients were treated for extensive soft tissue defects in the plantar forefoot areas with ALT flaps. The mean age at the time of surgery was 39.3 years (range, 25–64 years).Results:The follow-up period ranged from 12 to 77 months, with a mean of 31 months. All flaps survived well, and the patients were satisfied with the aesthetic and functional results. The size of the flaps ranged from 63 to 455 cm², with a mean of 197.7 cm². Seven patients with no bony involvement began to gradually weight-bear at 3 weeks postoperatively. During the follow-up time, postoperative ulceration at the reconstructed weight-bearing areas was not encountered.Conclusion:The ALT flap is a reliable option for treatment of extensive defects of plantar forefoot, resulting in an optimal functional and aesthetic outcome. Even when a total plantar loss exits, excellent results can be achieved.     

Designing with relaxed skin tension line in perforator-based island flap for sacral sore reconstruction: A STROBE-compliant observational study

Many various types of operative techniques have been performed used to treat make-up for sacral defects. Perforator-based flaps with flap transposition, but achieving an optimal flap design and tension-free flap closure without skeletonizing the perforator requires a great deal of clinical experience. In this study, we demonstrate perforator selection based on considerations of the relaxed skin tension line (RSTL), which has proven to be a suitable method of achieving an efficient flap design that enables primary closure.Twenty-five perforator-based flap procedures were performed on 25 patients at a single institution from February 2018 to January 2021. The medical records of patients were retrospectively reviewed.Twenty-three flaps survived completely. Two flaps developed partial tip necrosis but recovered after secondary healing, and 1 patient developed temporary congestion, which resolved spontaneously. No recipient or donor site recurrence or dehiscence was identified during follow-up.We report our clinical experiences of perforator-based flap use in the sacral region. When selecting an appropriate perforating vessel, 2 important points should be considered, that is, a flap long axis parallel to RSTLs and defect shape. According to the method presented in this paper, perforator-based flaps can be transposed safely and easily with few complications and serve as useful practice models to cover sacral defects.     

Postoperative outcomes of free myocutaneous flap and pedicled myocutaneous flap for reconstruction in locally invasive thyroid carcinoma

Locally invasive thyroid carcinoma (TC) often involves trachea. In such patients, the trachea needs to be reconstructed after surgery. We discuss the postoperative outcome and complications after trachea reconstruction by free myocutaneous flap (FMF) and pedicled myocutaneous flap (PMF).From January 2009 to September 2019, the clinical data of 38 patients with TC were retrospectively analyzed. Demographics, pathologic results, neoplasm staging, surgical protocol, decannulation, subjective speech function, and complications were documented.A total of 38 patients were analyzed (22 FMFs and 16 PMFs). Of the 38 patients, there is a similar rate of decannulation (81.8% in FMF and 75% in PMF), subjective speech function and complications.The FMF reconstruction and the PMF reconstruction have a similar result in terms of postoperative outcome and complications.     

数字化三维重建技术在组织瓣临床解剖教学中的应用

目的探讨数字化三维重建技术在组织瓣临床解剖教学中的应用。方法利用组织瓣三维重建中最常用的两种方法对2例健康志愿者和1具尸体的背阔肌皮瓣、腓肠肌肌皮瓣和髂骨瓣进行数字化构建。结果三维表面重建后的图像可清晰地观察各组织瓣的解剖结构,特别是动脉的分支情况和体表的投影。利用软件自带的Movie Maker模板创建电影文件,将其制作为电影,画面清晰流畅,可直观、立体的显示形态特征,方便临床解剖教学。结论采用数字化三维重建技术可以直观显示正常组织瓣的三维解剖形态,为临床计算机辅助外科手术提供立体形态学基础和数据,实现更多人体解剖结构可视化,为解剖教学展示提供参考。     

Protective effect of melatonin on random pattern skin flap necrosis in pinealectomized rat

Random pattern skin flaps are still widely used in plastic surgery. However, necrosis in the distal portion resulting from ischemia is a serious problem, increasing the cost of treatment and hospitalization. Free oxygen radicals and increased neutrophil accumulation play an important role in tissue injury and may lead to partial or complete flap necrosis. To enhance skin flap viability, a variety of pharmacological agents have been intensively investigated. The aim of this study is to test the effects of melatonin, the chief secretory product of the pineal gland and a highly effective antioxidant, on random pattern skin flap survival in rats. Herein, to investigate the physiological and pharmacological role of melatonin on dorsal skin flap survival. Pharmacological (0.4, 4 and 40 mg/kg) levels of melatonin were given intraperitoneally (i.p.). For this, pinealectomized (Px) and sham operated (non-Px) rats were used. The effects of melatonin on levels of malondialdehyde (MDA), nitric oxide (NO), glutathione (GSH) and the activities of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were measured in the skin flap. The ratio of skin flap necrosis was compared among the experimental groups by using planimetry. MDA and NO levels were found to be higher in Px than non-Px rats; while GSH levels and GSH-Px, and SOD activities were reduced. Melatonin administration to Px rats reduced MDA and NO levels and increased GSH, GSH-Px, SOD levels. Melatonin also reduced the ratio of flap necrosis determined by using planimetry and supported through the photography. In conclusion, these results show that both physiological and pharmacological concentrations of melatonin improve skin flap viability.     

改良带蒂阴囊纵隔皮瓣一期修复术治疗阴茎阴囊型尿道下裂28例分析

目的探讨采用改良带蒂阴囊纵隔皮瓣一期修复术治疗阴茎阴囊型尿道下裂的临床效果。方法对28例阴茎阴囊型尿道下裂患儿采用改良带蒂阴囊纵隔皮瓣一期修复手术。结果28例均获痊愈,尿道元狭窄,无尿瘘,阴茎外形好。结论改良带蒂阴囊纵隔皮瓣一期修复术治疗阴茎阴囊型尿道下裂临床效果好,具有血运好、操作简单和并发症少等优点,可作为阴茎阴囊型尿道下裂手术的首选方法之一,值得在基层医院推广应用。