改良桡动脉鼻咽窝上行穿支逆行皮瓣的临床应用

目的 探讨改良桡动脉鼻咽窝上行穿支逆行皮瓣的临床应用效果.方法 用此皮瓣修复手部创面20例,观察其疗效.结果 20例全部成活,无一例出现皮瓣静脉回流障碍,术后随访外形、功能良好.结论 改良桡动脉鼻咽窝上行穿支逆行皮瓣供区原位保留头静脉及桡神经浅支,不影响前臂远端的静脉回流及浅感觉,较传统桡动脉鼻咽窝上行穿支逆行皮瓣有明显优势,是修复手部软组织缺损理想的选择.     

前臂皮神经营养血管蒂皮瓣的临床应用

目的:观察前臂皮神经营养血管蒂岛状皮瓣修复手部创面的临床应用效果.方法:在前臂设计并切取桡神经浅支、前臂内侧皮神经、前臂外侧皮神经和前臂后外侧皮神经营养血管蒂皮瓣逆行转位修复虎口、手掌及手背皮肤缺损15例.结果:15例中除2例皮瓣远端皮缘表皮坏死外,其余皮瓣全部成活,随访6～36个月,皮瓣外形和功能恢复满意.结论:前臂皮神经养血管蒂岛状皮瓣血供可靠,操作简单,可以修复虎口、手掌和手背皮肤软组织缺损.     

桡动脉逆行岛状皮瓣治疗手掌瘢痕挛缩

目的：探讨前臂带桡动脉蒂逆行岛状皮瓣治疗手掌瘢痕挛缩。方法：对9例手掌瘢痕挛缩患手术彻底切除瘢痕，松解挛缩，采用前臂带桡动脉蒂逆行岛状皮瓣一期修复创面，前臂供皮创面行游离植皮术。结果：9例患皮瓣全部存活，皮肤弹性及手部功能恢复良好，除1例皮瓣明显臃肿，经二次手术修整外，其余病例外形恢复满意。结论：前臂带桡动脉蒂逆行岛状皮瓣治疗手掌瘢痕挛缩，手术简单，疗效满意，适合基层医院开展，但术前及术中应仔细检查手部的血液循环情况，以防发生手部缺血坏死。     

前臂皮神经营养血管蒂皮瓣的临床应用

目的:观察前臂皮神经营养血管蒂岛状皮瓣修复手部创面的临床应用效果.方法:在前臂设计并切取桡神经浅支、前臂内侧皮神经、前臂外侧皮神经和前臂后外侧皮神经营养血管蒂皮瓣逆行转位修复虎口、手掌及手背皮肤缺损15例.结果:15例中除2例皮瓣远端皮缘表皮坏死外,其余皮瓣全部成活,随访6～36个月,皮瓣外形和功能恢复满意.结论:前臂皮神经养血管蒂岛状皮瓣血供可靠,操作简单,可以修复虎口、手掌和手背皮肤软组织缺损.     

带血管蒂前臂挠侧逆行岛状皮瓣在手部创伤的应用

目的探讨带血管蒂前臂挠侧逆行岛状皮瓣修复手部创伤软组织缺损的临床疗效。方法自1996年6月至2006年12月,采用带血管蒂前臂挠侧逆行岛状皮瓣修复手部创伤后软组织缺损23例,均急诊行皮瓣一期修复;结果23例全部成活,随访3个月～2年,皮瓣质地良好,外观满意。结论带血管蒂前臂挠侧逆行岛状皮瓣操作简单,成活率高,是修复手部软组织缺损有效方法之一。     

以桡动脉为蒂的前臂逆行岛状皮瓣修复手部皮肤缺损

手部皮肤软组织外伤性缺损,如不能及时覆盖创面,常导致肌腱、神经血管及骨外露,甚至感染、肌腱坏死及骨髓炎,皮肤覆盖为临床常见难题。1998年至今,应用以桡动脉为蒂的前臂逆行岛状皮瓣修复手部皮肤缺损10例,取得满意效果。     

改良骨间背动脉逆行岛状皮瓣在急诊手外伤手术中的应用

目的 介绍改良方法切取骨间背侧动脉逆行岛状皮瓣急诊手术修复手部外伤皮肤软组织缺损创面的方法.方法 用改良方法切取前臂骨间背侧动脉皮瓣逆行转移急诊亚急诊手术修复各种原因致手部皮肤缺损16例.结果 14例皮瓣均完全成活,有2例皮瓣远段表皮坏死,经换药后创面愈合.结论 通过对前臂骨间背侧皮瓣切取方法的改进,可补救急诊手外伤手术中发现或出现的血管损伤及解剖变异对皮瓣成活的影响,并降低手术难度,缩短了住院时间,值得推广.     

前臂背侧骨间动脉穿支逆行岛状皮瓣修复手部皮肤软组织缺损的临床观察

目的：观察前臂背侧骨间动脉逆行岛状皮瓣修复手部皮肤软组织缺损的临床疗效。方法选择本院2013年1月~2014年5月收治的65例手部皮肤软组织缺损患者为研究对象,均接受皮瓣修复治疗,其中前臂背侧骨间动脉穿支逆行岛状皮瓣修复35例,为观察组,任意型皮瓣修复30例,为对照组,比较两组皮瓣存活率、手功能恢复、并发症及手术前后VAS（视觉模拟评分法）评分情况。结果观察组皮瓣存活率、并发症发生率分别为100.00%、2.86%,与对照组的86.67%、20.00%比较,差异有统计学意义（P<0.05）。观察组和对照组术后3 d的VAS评分分别为（7.38±0.45）、（8.11±0.57）分,15 d的VAS评分分别为（4.52±0.23）、（6.65±0.34）分,差异有统计学意义（P<0.05）。术后随访6个月,两组患者手功能优良率比较,差异无统计学意义（P>0.05）。结论前臂背侧骨间动脉穿支逆行岛状皮瓣修复术具有皮瓣存活率高、减轻患者疼痛、并发症少等特点,可作为手部皮肤软组织缺损治疗有效手段。     

手部岛状皮瓣在手外科修复中的应用

目的 研究手部不同类型岛状皮瓣修复手部皮肤缺损的临床效果。方法 根据手部皮肤缺损的部位，应用食指背侧岛状皮瓣、指动脉掌侧推进皮瓣、掌背动脉逆行岛状皮瓣、指固有动脉岛状皮瓣、指固有动脉逆行岛状皮瓣等转位修复手部皮肤缺损126例。结果 126例皮瓣全部成活。术后随访6个月一1年，皮瓣红润，质地柔软，外形及功能满意。结论 采用手部岛状皮瓣修复手部皮肤缺损，对供区影响不大，效果好，并发症少，是理想的术式选择。     

腓动脉穿支跨区供血的腓肠神经营养血管逆行岛状皮瓣的临床应用体会

目的探索分析腓动脉穿支跨区供血的腓肠神经营养血管逆行岛状皮瓣临床应用。方法选择于我院进行疾病治疗的内踝及足跟皮肤缺损患者72例,将其随机分为对照组和观察组,对照组患者采用邻近皮瓣修复进行治疗,而观察组患者采取腓肠神经营养血管逆行岛状皮瓣修复治疗。观察两组内踝及足跟皮肤缺损患者的临床疗效。结果观察组中患者的皮瓣坏死率11.11%明显低于对照组患者皮瓣坏死率44.44%,P<0.05。结论腓动脉穿支跨区供血的腓肠神经营养血管逆行岛状皮瓣修复手术治疗内踝及足跟皮肤缺损患者疗效显著,且皮瓣供血可靠,切取简单,并发症发生率较小,有较好的临床疾病治疗效果,值得积极推广使用。     

腹部皮下血管网皮瓣修复手指皮肤脱套伤

目的客观判定腹部皮下血管网皮瓣修复术治疗手指皮肤脱套伤的疗效。方法应用传统的腹部袋状皮瓣和腹部带皮下血管网皮瓣治疗手部脱套伤,并将两种方法的治疗结果进行对比。结果 手指的屈伸功能效果方面,实验组82.2,对照组46.6;治疗后的外观效果方面,实验组优良率68.9,对照组优良率37.78。结论腹部皮下血管网皮瓣修复法是一种较理想的修复手指皮肤脱套伤的治疗方法。     

Main approaches for delivering antioxidant vitamins through the skin to prevent skin ageing

INTRODUCTION: One of the major contributions to skin photoageing and diseases is oxidative stress, caused by UV radiation inducing reactive oxygen and nitrogen species. Successful prophylaxis and therapy would necessitate control of the oxidant/antioxidant balance at the affected site, which can be achieved through the external supply of endogenous antioxidants. AREAS COVERED: This review discusses possible strategies for dermal delivery of the antioxidant vitamins E and C, as oral supplementation has proved insufficient. These antioxidants have low skin bioavailability, owing to their poor solubility, inefficient skin permeability, or instability during storage. These drawbacks can be overcome by various approaches, such as chemical modification of the vitamins and the use of new colloidal drug delivery systems. New knowledge is included about the importance of: enhancing the endogenous skin antioxidant defense through external supply; the balance between various skin antioxidants; factors that can improve the skin bioavailability of antioxidants; and new delivery systems, such as microemulsions, used to deliver vitamins C and E into the skin simultaneously. EXPERT OPINION: A promising strategy for enhancing skin protection from oxidative stress is to support the endogenous antioxidant system, with antioxidants containing products that are normally present in the skin.     

Main approaches for delivering antioxidant vitamins through the skin to prevent skin ageing

Introduction: One of the major contributions to skin photoageing and diseases is oxidative stress, caused by UV radiation inducing reactive oxygen and nitrogen species. Successful prophylaxis and therapy would necessitate control of the oxidant/antioxidant balance at the affected site, which can be achieved through the external supply of endogenous antioxidants.

Areas covered: This review discusses possible strategies for dermal delivery of the antioxidant vitamins E and C, as oral supplementation has proved insufficient. These antioxidants have low skin bioavailability, owing to their poor solubility, inefficient skin permeability, or instability during storage. These drawbacks can be overcome by various approaches, such as chemical modification of the vitamins and the use of new colloidal drug delivery systems. New knowledge is included about the importance of: enhancing the endogenous skin antioxidant defense through external supply; the balance between various skin antioxidants; factors that can improve the skin bioavailability of antioxidants; and new delivery systems, such as microemulsions, used to deliver vitamins C and E into the skin simultaneously.

Expert opinion: A promising strategy for enhancing skin protection from oxidative stress is to support the endogenous antioxidant system, with antioxidants containing products that are normally present in the skin.     

掌背皮动脉逆行岛状皮瓣修复手指皮肤缺损

目的介绍应用掌背皮动脉逆行岛状皮瓣修复2～5指近中节皮肤缺损的方法。方法对26例2～5指缺损的患者,应用掌背皮动脉逆行岛状皮瓣对手指皮肤缺损进行修复,其中第2掌背皮动脉皮瓣16例,第3、4掌背皮动脉皮瓣各5例。皮肤缺损面积为1.5cm×2.0cm～2.5cm×4.0cm。结果 26例皮瓣全部成活,供区创面Ⅰ期愈合。术后随访5～13个月,手指外形、功能满意,皮瓣质地、色泽与正常指相近,皮瓣不臃肿,两点辨别觉为8～11mm。结论掌背皮动脉逆行岛状皮瓣操作方便,易切取,损伤小,不牺牲主干动脉,患者容易接受,皮瓣供区靠近创面,可同时修复多指皮肤缺损,术后皮瓣外形满意,是修复2～5指皮肤缺损较理想的手术方法。     

Dyphylline liposomes for delivery to the skin.

Delivery of dyphylline to the skin using liposomes was investigated. Xanthines are inhibitors of cAMP phosphodiesterase and have been considered for treatment of psoriasis. Dyphylline was chosen because of its solubility in water, which should allow for incorporation of higher concentrations within the liposomes. Liposomes containing dyphylline were prepared by a method using sonication. Transmission electron micrography (TEM) visualization showed small particles ranging from 40 to 100 nm, and particle size distribution determined by light scattering showed the vesicles to have an average diameter of 360 nm. The transdermal delivery of free dyphylline and dyphylline incorporated in unilamellar liposomes was measured from polyethylene glycol (PEG), Carbopol gel, a PEG enhancer base, and water. For comparison, similar experiments were carried out with theophylline as well. When the drugs were incorporated in Carbopol gel, a large difference was seen between their fluxes, with free dyphylline having the highest permeation, followed by liposomal dyphylline, and then theophylline. With the PEG enhancer base, a very high permeation of theophylline was observed relative to dyphylline and liposomal dyphylline. From the PEG base, liposomal dyphylline exhibited the lowest skin permeation flux relative to other bases. Using the PEG base for dyphylline incorporated in liposomes, a high skin partitioning of the drug, along with low transdermal permeation, was measured. These results may indicate that the drug is localized in the skin.     

Formulation of carbenoxolone for delivery to the skin

Carbenoxolone (CEX), a semi-synthetic derivative of glycyrrhetinic acid, has previously been used as a disodium salt for the management of dyspepsia and peptic ulcer because of its anti-inflammatory properties. Although glycyrrhetinic acid is available in pharmaceutical and personal care products for skin care, the topical use of the free acid form of CEX, has not previously been reported. In this work we investigated the percutaneous penetration of CEX. Solubility and permeability studies were conducted using a range of solvents or skin permeation enhancers (SPEs) commonly used for skin delivery. Binary combinations of dimethyl isosorbide (DMI) and Transcutol™ (TC) with isopropyl myristate (IPM) were effective in promoting skin permeation of CEX although individual solvents were not. Alternative fatty acid esters to IPM were subsequently investigated with the most promising formulation consisting of TC and propylene glycol laurate (PGL). Interestingly, propylene glycol monolaurate (PGML) did not demonstrate comparable efficacy when combined with TC. A ternary formulation consisting of TC, PGL and IPM demonstrated the best permeation enhancement of CEX compared with all other vehicles. The findings confirm (i) the feasibility of promoting CEX penetration across the skin (ii) the synergistic effect of combinations of solvents and SPEs on dermal and transdermal delivery (iii) the necessity for more fundamental studies to explain the differential effects of fatty acid esters on the skin barrier.     

Using skin models to assess the effects of a protection cream on skin barrier function

BACKGROUND: There is a basic necessity to understand the mechanisms of the protective effects of emulsions. This would promote the development of protective cosmetics and therefore improve the prevention and treatment of occupational skin diseases. However, for such studies, no reliable skin model is available. OBJECTIVE: An in vitro skin model test was developed to evaluate the protective mechanism of cosmetic ingredients. METHODS: The efficacy of three products was assessed by an in vivo test (Repetitive Occlusive Irritation Test) and then 3-dimensional skin model tests were carried out. RESULTS: In vivo test results demonstrate that the best protection against sodium dodecyl sulphate is offered by a multiple emulsion. In the case of a skin model test, sodium dodecyl sulphate led to cell damage, an increase in pro-inflammatory markers and some barrier lipids. The multiple emulsion increased the content of skin lipids, without inducing irritation or cell death. CONCLUSION: Skin models react similarly to sodium dodecyl sulphate compared to human skin and therefore they are suitable to study barrier repair after sodium dodecyl sulphate damage. It is likely that the superior protective effect of the multiple emulsion in vivo is based on the increased amount of skin barrier lipids.