四肢血管损伤的急救与修复

自１９８６年７月至１９９５年１２月，共收治四肢主要血管损伤６７例（８１条血管），除１例Ｇｕｏ动脉损伤截肢外，余均获成功。作者提出：四肢血管损伤的急救止血，倡导敷料压迫法；显微外科手术在临床的应用，血管重建术成功率明显增高，因而，对于单一的尺或桡动脉、胫前或胫后动脉损伤亦应力救修复，以防寒冷季节肢端出现供血不足等不良表现。     

脉搏血氧饱和度仪在筋膜间室综合征及四肢血管损伤中的应用价值

我们自1993年3月以来应用脉搏血氧饱和度仪对9例筋膜间室综合征及四肢血管损伤进行监测,有一些初步应用的体会,现介绍如下。9例均为男性,年龄20～48岁;伤因:车祸6例,刀砍伤2例,缆绳绞伤1例;伤情:胫腓骨骨折并小腿筋膜间室综合征4例,股骨骨折并股动脉挫伤1例;胫腓骨骨折并胫前胫后动脉损伤2例,尺、桡动脉损伤1例,胫前动脉损伤1例。受伤至手术时间最短4小时,最长13小时。4例小腿筋膜间室综合征均有肢体严重肿胀、足趾被动牵拉痛、皮肤感觉减退、足背动脉搏动减弱或消失的体征。2例胫前胫后动脉损伤及1例股动脉挫伤者有肢体远端皮温降低、苍白、     

四肢血管损伤治疗失败20例临床分析

随着显微外科血管吻合技术的应用,四肢血管损伤的救治成功率已明显提高,但是仍有一部分有望挽救的肢体发生坏死或者严重致残。作者收集了1986～1999年本科和外院会诊的20例这类的病例,从中分析失败的原因。1　临床资料11　一般资料　男性18例,女性2例。儿童2例(8岁,10岁),成年人18例,年龄18～50岁。受伤原因:车祸伤8例,机器绞轧伤6例,重物压伤4例,刀刺伤2例。血管损伤情况:动脉损伤12例,肱动脉损伤6例,(1例双侧肱动脉),股动脉损伤1例,胫前动脉与胫后动脉损伤1例。动脉损伤类型:血管断裂15例,内膜挫伤后栓塞5例。闭合性损伤10例,均为动脉…     

四肢大血管损伤22例临床分析

四肢大血管损伤多见于车祸、机械损伤、挤压辗挫伤及锐器伤。如果未及时处理或处理不当,轻者会发生肢体缺血性损害,影响肢体功能,重者则造成截肢或危及生命[1]。近3年来,我院共收治四肢大血管损伤患者22例,现报告如下。1资料与方法1.1一般资料:本组共22例,男性20例,年龄最大52岁,最小10岁,平均34.5岁。血管损伤部位:锁骨下动静脉1例,腋动静脉3例,单纯腋动脉2例,肱动静脉2例,尺动静脉1例,桡尺动静脉合并损伤1例,股动静脉损伤3例,单纯动脉损伤3例,动静脉合并伤4例,胫前后动静脉均损伤2例。血管损伤类型:血管完全断裂15例,其中含动脉断裂、…     

应用显微外科技术修复四肢血管损伤

1996年 1月～ 1999年 12月 ,应用显微外科技术修复四肢血管损伤 5 6例共 78条 ,报道如下。临床资料本组男 41例 ,女 15例。年龄最大 5 5岁 ,最小 13岁。开放性损伤 40例 ,闭合性损伤 16例。受伤原因 :刀伤 30例 ,车祸伤12例 ,玻璃伤 10例 ,其他伤 4例。复合伤 49例 ,其中合并神经损伤 35例 ,骨折 34例 ,颅脑损伤 10例 ,胸部损伤 6例。血管损伤部位及类型 :股动脉损伤 5例 ,动脉损伤 7例 ,胫前动脉损伤 6例 ,足背动脉损伤 13例 ,胫后动脉损伤 10例 ,腋动脉损伤2例 ,肱动脉损伤 5例 ,尺动脉损伤 16例 ,桡动脉损伤 14例。动脉断裂 34例 ,裂伤…     

钢珠弹致血管损伤的救治

四肢血管损伤比较常见。 Hermreck等 [1 ]报道四肢血管损伤占总创伤的 3%。对损伤血管的早期诊断及显微修复是抢救肢体成功率降低伤残率的关键。我院自 1992～ 1998年共收治钢珠弹致血管伤 18例 ,应用显微修复 ,本组 18例全部为男性 ,年龄 4～ 43岁 ,平均 2 5岁。其中股动脉伤 9例 ,动脉伤 6例 ,肱动脉伤 2例 ,腋动脉伤 1例 ,合并股深动脉、旋股外侧动脉伤2例 ,动脉伤合并胫前、后动脉伤 2例。损伤类型及合并伤 :完全断裂伤 5例 ,部分断裂伤 11例 ,挫伤、栓塞伤 2例。其中伴行静脉损伤 14例 ,1条动脉裂口 1个 2例 ,2个裂口 14例 ,3个以…     

四肢动脉损伤患者的护理体会

四肢动脉损伤在战时及科技发达的今天都较常见。若处理不及时,会因肢体坏死而截肢,严重者可危及生命,近年来,随着医学的发展血管重建术得到普及,使许多四肢动脉损伤患者得到救治。我院在1990年1月至1999年9月共收治四肢动脉损伤患者76例,男性48例,女性28例,年龄10～50岁,平均31岁。刀剌伤56例,外伤性骨折造成动脉损伤20例。肱动脉45例,股动脉5例,胫后动脉20例,动脉6例,均行手术治疗。手术方法:动脉吻合修补术及自身静脉移植术,均取得良好治疗效果,现根据我们的护理体会,浅谈在护理动脉损伤患者时应注意的几个问题。一、预防局部出血四肢动…     

游离胸背动脉穿支皮瓣桥式移植修复小腿软组织缺损

目的总结游离胸背动脉穿支皮瓣或肌瓣桥式移植修复小腿软组织缺损的临床应用效果。方法自2006年9月至2009年1月,应用游离胸背动脉穿支皮瓣或肌瓣桥式移植修复小腿软组织缺损11例,缺损范围4cm×8cm至8cm×22cm。皮瓣切取连带肩胛下与旋肩胛血管,血管蒂呈T形,与健侧小腿胫后动脉行端端吻合,血管蒂用中厚网状游离植皮覆盖。结果除1例术后皮瓣远端发生小的表浅感染,经换药后愈合外,本组皮瓣全部成活。术后随访9个月至3.6年(平均2.9年),没有发现明显的供区功能障碍,供区与受区外形较好,健侧小腿经临床观察与Doppler检查,胫后动脉通畅。结论本方法适用于修复四肢软组织缺损后,患者仅存1条主要动脉者;行桥式游离胸背动脉穿支皮瓣或肌瓣移植不损伤健侧小腿胫后动脉,降低了对供区的损伤。     

四肢骨折脱位合并血管损伤的治疗

四肢主要动脉损伤在各种创伤病例中有上升的趋势 ,且其后果严重。如能早期诊断 ,及时妥善处理 ,则可使受伤肢体获得挽救。 6年中我院共收治 76例四肢骨折脱位合并血管损伤病人 ,效果满意。报告如下。1　临床资料本组 76例 (95条血管 ) ,男 6 0例 ,女 16例 ;年龄 8～ 70岁 ,平均 2 8岁。损伤类型 :锐性损伤 2 9例 ,钝性损伤 47例 ;栓塞 16例 ,部分断裂 4例 ,完全性断裂 5 6例 ;开放性损伤 5 8例 ,闭合性损伤 18例。血管损伤分布 :尺桡动脉 2 1条 ,肱动脉 13条 ,腋动脉 5条 ,股动脉 17条 ,动脉 2 8条 ,胫前后动脉 11条 ,主要伴行静脉损伤 39…     

儿童四肢动脉损伤29例分析

198 6年 8月～ 2 0 0 0年 3月接诊治疗儿童四肢动脉损伤2 9例 ,回顾治疗过程及预后观察 ,就儿童四肢动脉损伤的临床治疗特点分析于后。资料与方法一、一般资料　男性 2 1例 ,女性 8例 ,年龄 3～ 14岁 ,平均10岁。闭合伤 8例 ,开放伤 19例 ,医源性损伤 2例。计锁骨下动脉 1例 ,肱动脉 8例 ,前臂中远端尺桡动脉 6例 ,股动脉 7例 ,动脉 6例 ,胫后动脉 (小腿下段 ) 1例。 12例伴有同名静脉损伤 ,14例合并邻位神经损伤。 3例合并肱骨粉碎骨折。二、治疗方法　血管断端整齐 ,清创后张力不大者行动脉端端吻合术 ,计 2 1例 ,2 6条血管。血管挫伤较重…     

四肢主干动脉损伤的诊治

目的 探讨四肢主干动脉损伤的诊断与治疗。方法 1999年9月～2002年6月，收治129例176条动脉损伤，应用显微外科方法修复122例162条动脉。结果 患肢成活116例154条血管，总成活率89．9％；血管再通率95．06％。结论 认真细致的体格检查和血管多普勒探测仪检测可避免漏诊；早期应用显微外科技术进行血管修复，可成功地挽救肢体。     

侧脑室脑膜瘤的显微外科治疗

目的 研究侧脑室脑膜瘤临床特点及显微外科手术治疗的效果。方法 利用CT、MRI及脑血管造影明确肿瘤的诊断,16例脑室脑膜瘤的采用显微外科手术摘除。结果 本组病例肿瘤全部切除,无手术死亡。结论 CT、MRI是诊断侧 脑室脑膜瘤最可靠的方法,血管造影明确肿瘤的 供血情况,选择合理的手术入路应用显微外科手术可达到肿瘤的全切除。     

Colon transplantation: A new microvascular technique

This paper describes a new transplantation technique, using the colon instead of the small bowel for intestinal transplantation. With microsurgical techniques, aljogeneic colon transplantation was carried out in rats in a hetero-topic fashion. The vascular pedicle containing the aortic cuff and the portal vein was anastomosed to the aorta and the inferior vena cava of the host, respectively. The technique has proven reliable and reproducible, and our preliminary results suggest that the colon produces a milder rejection response than transplantation of the small bowel. © 1993 Wiley-Liss Inc.     

Urologist's perspectives of single-stage hypospadias repair in the 1980s. Experience of 100 patients

During the last two decades major advances have been made in techniques of hypospadias repair. Many areas warrant meticulous attention to achieve further satisfactory results. We present areas of technique that have improved our results in genital reconstruction and hypospadias repair in particular. In addition to surgical technique modifications, we present technical refinements of patient positioning, use of cold antibiotic mixed saline, subcutaneous epinephrine at judicious sites, and microsurgical instruments as well as optical magnification and suture material. In genital anomalies, use of plastic surgical techniques with skin grafts and knowledge of the intrinsic vascular supply of the foreskin have further improved the outcome. Since 1982, 100 patients have been followed. Immediate complications total less than 1 percent; late complications total 10 percent including 9 percent fistula rate and 5 percent stenosis rate (urethral or meatal). No loss of skin flap or of neourethra were recorded.     

Microvascular soft-tissue coverage and distraction osteosynthesis for lower-extremity salvage

In our attempts to salvage massive lower-extremity injuries, even in the presence of severe peripheral vascular pathology, adequate soft-tissue coverage is no longer a limiting factor due to recent advances in microvascular composite tissue transfer. Restoration of tibial continuity without shortening has emerged as the last obstacle in the formidable task of salvaging lower extremities with grade III B and III C defects. Proposed solutions to this problem include conventional free cancellous bone-grafting applicable to small defects only, vascularized bone grafts, or shortening of the leg with subsequent elongation using the Ilizarov technique. We present our experience with 3 consecutive cases of lower-limb salvage, utilizing a new approach in which microsurgical soft-tissue reconstruction has been combined with bony reconstruction by distraction osteosynthesis. Bone transport by distraction osteosynthesis under a free flap performed while preserving the initial limb length throughout the treatment period proved to be superior to other methods in selected cases and is presented as a new technique for the management of problematic lower-limb injuries. © 1998 Wiley-Liss, Inc. 1998     

Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies

At the present time, an update to the classical microsurgical transoral decompression is strongly provided by the most recent literature dealing with the introduction of the endoscopy in spine surgery. In this paper, we present our experience on the endoscope-assisted microsurgical transoral approach to anterior craniovertebral junction (CVJ) compressive pathology. We analysed seven patients (3 paediatrics and 4 adults ranging from 6 to 78 years) operated on for CVJ decompressive procedures using an open access, microsurgical technique, neuronavigation and endoscopy. All techniques mentioned were simultaneously employed. Among the endoscopic routes described in the literature, we have preferred the transoral using 30° endoscopes. In all the cases endoscopy allowed a radical decompression compared to the microsurgical technique alone, as confirmed intraoperatively with contrast medium fluoroscopy. In conclusion, endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ; it provides information for a better decompression with no need for soft palate splitting, hard palate resection, or extended maxillotomy. Moreover, intraoperative fluoroscopy helps to recognize residual compression. Virtually, in normal anatomic conditions, no surgical limitations exist for endoscopically assisted transoral approach, compared with the pure endonasal and transcervical endoscopic approaches. In our opinion, the endoscope deserves a role as “support” to the standard transoral microsurgical approach since 30° angulated endoscopy significantly increases the surgical area exposed at the level of the anterior CVJ.     

From simple interrupted to complex spiral: a systematic review of various suture techniques for microvascular anastomoses

Accomplishing successful microvascular anastomoses is undoubtedly one of the most critical steps in performing free tissue transfer. However, the ideal technique has often been a subject of debate. Therefore, our objective was to review the current literature in an attempt to find objective evidence supporting the superiority of one particular technique. A PubMed and OVID on-line search was performed in November 2007 using the following keywords: microvascular anastomoses, microsurgical anastomosis, continuous suture, interrupted suture, mattress suture, and sleeve anastomosis. Our literature review found no difference in short- and/or long-term patency rates between the six main published techniques, which includes continuous suture, interrupted suture, locking continuous, continuous horizontal, horizontal interrupted with eversion, and sleeve anastomoses. These findings were consistent for each technique as long as the microsurgeon maintained standard microsurgical principles and practice, including suture line eversion, minimized tension, and direct intima-to-intima contact. Current literature supports no overall statistical difference in short- and/or long-term patency rates between any of the various techniques. The choice to perform one suture technique over another ultimately depends on the plastic surgeon's preference and microsurgical experience. To date, there are no human randomized, controlled clinical trials comparing the efficacy and clinical outcomes of each of the various suture techniques, and therefore one's comfort and familiarity should dictate his or her microsurgical technique. However, "exposure to many and mastery of one" simply provides the plastic surgery resident, fellow, or staff the technical flexibility needed for less-complicated surgical planning when performing free tissue transfer.     

Selective microsurgery in arteriogenic erectile failure

Summary On the basis of strict exclusion criteria, penile revascularization was considered to be promising in only 12.8% of our patients with erectile dysfunction. Major venous leakage and other etiologies should be excluded as the origin of erectile failure before microsurgical repair is carried out. A 1-year success rate of 80% confirms the long-term benefit achieved using these procedures. The broad spectrum of peripheral occlusion patterns demands a differentiated surgical approach, including various operative techniques. A final decision as to the ideal revascularization technique should be made intraoperatively. Nevertheless, an algorithm of only three different methods was sufficient to cover all individual vascular situations in our first 23 patients.     

107例同种原位肝移植肝动脉重建的体会

目的探讨肝脏移植手术中肝动脉重建技术的要点和影响肝动脉重建结果的因素。方法回顾性总结 10 7例肝脏移植患者的临床资料 ,分析肝脏移植手术中可能影响肝动脉重建的因素 ,以及肝动脉重建的技术要点。结果肝脏移植术中肝动脉重建与外科手术方式相关。供肝动脉的完整性、供体受体动脉的重建方式以及显微外科技术的应用是影响肝动脉重建结果的重要因素。结论供肝动脉的质量、动脉的重建方式和显微外科技术的应用是肝动脉重建的关键。     

Hepatic lobectomy and segmentectomy models using microsurgical techniques

The mouse and rat models are the most commonly utilized experimental models of partial liver resection. Microscope-assisted partial hepatectomy is associated with better outcomes by reducing the risk of vena cava stenosis after ligature and injury to other liver pedicles. In addition, microsurgery allows lobectomies and segmentectomies after individual ligation of intrahepatic vascular branches, including the left and right segments of the median lobe, which has not been reported before. Here, we describe a new technique (catheter-assisted suture technique) and report our experience with partial hepatectomies in rodents using a microsurgical approach.