拇趾腓侧皮瓣塑形第二足趾中段再造手指

目的 介绍将拇趾腓侧皮瓣塑形第二足趾中段后用于手指再造的手术方法.方法 切取第二足趾的同时游离并切取带翼状组织瓣的拇趾腓侧皮瓣,将拇趾腓侧皮瓣嵌入第二足趾跖侧,拇趾腓侧皮瓣上的翼状组织瓣嵌入第二足趾中段两侧皮下.将塑形后的第二足趾中段移植于缺损的手指.自2005年1月至2007年4月,采用该方法为15例手指缺损患者行再造术.结果 术后15例患者的所有皮瓣全部成活,并经1个月至2年的随访,再造手指的外形及痛温觉恢复较好,对掌对指功能基本恢复.结论 拇趾腓侧皮瓣嵌入第二足趾,能较好地重塑第二足趾外形,再造的手指较传统的第二足趾移植手指再造术更接近于正常.     

急诊拇趾腓侧皮瓣嵌入塑形第2足趾移植拇指再造

目的 总结在急诊第2足趾移植拇指再造术中,应用拇趾腓侧皮瓣嵌入塑形的临床经验.方法 1998年1月-2003年1月,急诊应用带拇趾腓侧皮瓣嵌入塑形的第2足趾移植再造外伤性拇指缺损12例,男9例,女3例;年龄23～45岁.撕脱伤5例,压砸伤7例.缺损程度:Ⅲ度5例,Ⅳ度1例(清创后为Ⅴ度缺损),Ⅴ度6例.伤后至手术时间2～7 h,平均5.4 h.术中切取拇趾腓侧皮瓣范围1.5 cm×0.5 cm～2.0 cm×0.8 cm.拇趾腓侧供区直接缝合,第2足趾供区游离植皮覆盖.结果 术后伤口及供区切口均Ⅰ期愈合.12例再造拇指全部成活.随访2年,再造拇指关节活动度为60～90°,平均74°;两点辨别觉为6～10 mm,平均8 mm.再造拇指功能、运动、外观均满意.结论 拇趾腓侧皮瓣嵌入塑形急诊第2足趾移植再造拇指,具有操作简便、安全、经济的优点,外观良好,功能满意.     

拇(手)指Ⅰ期塑形再造

目的改善游离第二足趾再造拇（手）指的外形及功能，探讨一种更为理想的拇（手）指再造方式。方法首先在游离第二足趾的同时，切取以拇趾腓侧固有动脉为蒂的拇趾腓侧条形复合组织瓣（或与示指背岛状皮瓣联合）镶嵌于第二足趾后进行拇指再造，增粗再造拇指的周径。将拇趾腓侧纵条形复合组织瓣反转镶嵌于第二足趾跖侧并切取与第二足趾基底相连的双月牙形跖背皮瓣及跖骨联合再造手指，增粗再造手指的周径及延长再造手指的长度。结果临床应用再造拇（手）指36例（48指），全部成活，随访半年一3年，其粗细、长度接近正常，外形及功能良好，满意、基本满意28例。拇趾的外观及功能无明显影响，行走感觉不适、有轻微疼痛者3例但不影响行走及工作。结论应用此方法对供区破坏较小，患者易接受，再造的拇（手）指外观明显改善，是一种较理想的拇（手）指再造方法。     

游离足第2趾并拇趾腓侧T形皮瓣移植再造拇指

目的：探讨应用游离足第2趾并拇趾腓侧T形皮瓣移植修复拇指缺损以改善其功能及外形的临床效果。方法：以第一跖背动脉为蒂,第2足趾及同足拇趾腓侧T形皮瓣游离移植修复拇指II～V度缺损9例9指。结果：术后移植足趾及拇趾腓侧T形皮瓣存活良好,无感染及坏死,再造指体饱满,随访至今,再造拇指内收、外展、对掌功能恢复良好,无常见＂驼颈＂畸形。结论：应用游离足第2趾并拇趾腓侧T形皮瓣移植修复拇指缺损的方法,再造拇指外观及功能恢复良好,一期达到修复效果,无需二期整形,外形满意,提高患者生活质量及治疗效率。     

重塑第二足趾再造拇、手指的手术方法

本文介绍应用趾腓侧条形岛状皮瓣或与示指背岛状皮瓣联合重塑第二足趾再造拇指周径、应用（足母）趾腓侧条形岛状皮瓣与第二足趾基底半月形双翼跖背皮瓣联合延长再造手指长度的手术方法。     

第二足趾联合第一足趾腓侧皮瓣移植加甲床扩大修饰性再造拇指25例

目的 探索应用第二足趾联合第一足趾腓侧皮瓣移植加甲床扩大修饰性再造拇指的临床效果.方法 对外伤性拇指缺损进行清创后采用第二足趾联合第一足趾腓侧条形岛状皮瓣镶嵌移植加甲床扩大一期再造拇指25例.结果 再造拇指术后25例全部成活,经1年以上的随访,再造拇指血运良好,指甲与正常拇指近似,接近正常拇指外形,所有病例恢复触、痛、温觉.结论 应用显微外科技术,设计采用游离第二足趾联合第一足趾腓侧皮瓣移植加甲床扩大行急诊修饰性再造拇指,可获得较好的临床效果.     

外伤性拇指缺损的重建

目的探讨不同程度外伤性拇指缺损的最佳重建方法。方法根据Serafin的三度分类法,对自2003年1月～2010年1月收治的189例不同程度外伤性拇指缺损采用不同的方法进行重建:Ⅰ型,对63例指骨在末节或IP关节平面的缺损,采用携带部分或全部末节趾骨的拇甲瓣再造拇指。Ⅱ型,对指骨在近节或MP关节平面的缺损,采用两种方法进行重建:①第2足趾移植再造拇指,若再造指皮肤不够,可携带拇趾腓侧皮瓣或足背皮瓣(92例);②用髂骨植骨,再用皮瓣覆盖(16例)。Ⅲ型,对指骨在掌骨或CMC关节平面的缺损,同样采用两种方法进行重建:①示指拇化再造拇指,皮瓣修复虎口(5例);②拇甲瓣联合第2足趾骨、关节和肌腱组织再造拇指,1块岛状皮瓣或游离皮瓣修复虎口(13例)。结果 189例中155获得6个月以上的随访,均获得了满意的外形和功能。其中握力并不明显低于健侧,但捏力和两点辨别觉明显低于健侧。再造拇指的功能随着时间的延长而逐步改善,供足的功能不受影响。结论足趾移植再造拇指是个良好的术式,对于重度拇指缺损,选择示指拇化或联合足趾组织移植需根据患者的意愿。     

不同部位拇指缺损的再造31例

目的 探讨不同部位拇指缺损的再造方法和临床效果.方法 应用不同方法对不同部位拇指缺损进行再造.其中应用第1、2足趾趾甲瓣互换或联合(踇)趾腓侧皮瓣嵌入第2足趾狭细颈部改形后再造拇指Ⅲ°-Ⅳ°缺损6例,采用(踇)趾末节移植再造拇指末节10例,采用(踇)趾趾尖部再造拇指指尖15例.结果 再造的拇指全部成活,随访3个月～3年,再造的拇指与正常的拇指相似,指甲、指纹生长良好,两点辨别觉4～6 mm.结论 应用(踇)趾末节、(踇)趾趾尖部和第1、2足趾趾甲皮瓣互换或者(踇)趾腓侧皮瓣改形第2足趾分别再造拇指末节缺损、指尖部缺损和拇指Ⅲ°～Ⅳ°缺损临床效果好,外观更加逼真,拇指的功能恢复好.     

趾腓侧皮瓣嵌入第二足趾改形法再造拇手指

目的　研究第二足趾改形方法 ,使再造后的手指外形更美观。方法　切取第二足趾的同时游离并切取带翼状组织瓣的趾腓侧皮瓣 ,将趾腓侧皮瓣嵌入第二足趾跖侧 ,趾腓侧皮瓣上的翼状组织瓣嵌入第二足趾中部两侧皮下。结果　再造 3 6例 46指全部成活 ,嵌入的趾腓侧皮瓣也全部成活。术后随访 6～ 2 4个月 ,再造的拇指及 2～ 4指 (第二足趾 )的外形 ,较传统的第二足趾移植有了不同程度的改善。结论　趾腓侧皮瓣嵌入第二足趾 ,能较好地改变第二足趾外形 ,使之更接近正常的拇指与手指     

Mu趾腓侧皮瓣嵌入第二足趾改形法再造拇手指

目的 研究第二足趾改形方法，使再造后的手指外形更美观。方法 切取第二足趾的同时游离并切取带翼状组织瓣的Mu趾腓侧皮瓣，将Mu趾腓侧皮瓣嵌入第二足趾跖侧，Mu趾腓侧皮瓣上的翼状组织瓣嵌入第二足趾中部两侧皮下。结果 再造36例46指全部成活，嵌入的Mu趾腓侧皮瓣也全部成活，术后随访6-24个月，再造的拇指及2-4指（第二足趾）的外形，较传统的第二足趾移植有了不同程度的改善。结论 Mu趾腓侧皮瓣嵌入第二足趾，能较好地改变第二足趾外形，使之更接近正常的拇指与手指。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.