阴股沟岛状皮瓣修复阴囊皮肤软组织缺损

目的 探讨阴股沟岛状皮瓣修复阴囊皮肤软组织缺损的治疗效果。方法 分析2010年9月-2019年9月收治的5例阴囊皮肤软组织缺损患者的临床资料,扩创后皮肤软组织缺损面积:3.0 cm×2.0 cm~10.1 cm×5.3 cm。创面术前准备完毕后均采用阴股沟岛状皮瓣修复,供瓣区直接拉拢缝合,观察皮瓣成活及患者随访情况。结果 术后5例皮瓣均顺利成活,供区创面愈合良好,随访6~24个月,皮瓣外形良好,色泽接近周围皮肤,质地柔软,感觉S3级,两点辨别觉6~9 mm。结论 阴股沟岛状皮瓣既能修复阴囊缺损创面,又能获得患者满意的外观及感觉功能重建。     

阴茎阴囊电烧伤创面的修复

阴茎阴囊电烧伤少见,处理棘手。1990年以来,我科收治阴茎阴囊电烧伤患者16例,依其损伤程度不同,主要采用阴茎海绵体延伸及皮瓣修复创面,效果满意。1　临床资料　本组患者16例,年龄5～46岁,致伤电压1000～6600伏,15例急诊入院,1例伤后16天入院。阴囊皮肤部分及完全缺损各1例,分别采用阴囊皮肤推进皮瓣和阴股沟皮瓣修复,术后效果好,性生活正常,阴茎皮肤及部分海绵体缺损8例均行阴囊纵隔皮瓣修复和阴茎海绵体延伸,排尿功能恢复;阴茎海绵体完全缺损6例,均采用阴茎海绵体延伸及邻近皮瓣修复,创面愈合良好(图1)。术前术后6个月图1　会阴、阴茎、阴…     

阴股沟皮瓣的解剖及其在男性会阴部修复重建中的应用

目的明确阴股沟皮瓣解剖基础,为临床设计和应用此皮瓣提供解剖依据和手术方法。方法解剖研究15具成年男尸阴股沟区的血供和神经支配情况。依据研究结果为男性会阴部修复重建患者设计合理的皮瓣。结果阴股沟区动脉血液供应充足,静脉回流丰富,神经支配可靠。该区的动脉血供有阴部外浅动脉、闭孔动脉前皮支、阴囊后动脉的主干和外侧支,并且位置均比较恒定。三组血管网贯穿了皮瓣的上、中、下部。临床应用阴股沟皮瓣23例,皮瓣切取最大为17cm×9cm,最小8cm×5cm,均取得理想的治疗效果。结论阴股沟皮瓣血运丰富,切取方便,供区隐蔽,在修复、重建男性会阴部时,可以取上、中、下蒂皮瓣。术后皮瓣成活率高,外形及神经感觉均取得理想结果。     

阴股沟岛状皮瓣修复阴囊皮肤组织缺损一例

阴股沟岛状皮瓣修复阴囊皮肤组织缺损一例梁明陈从云病例男，３５岁。误用腐蚀性药液烧伤阴囊月余入院。全阴囊皮肤缺损，双侧睾丸部分外露，缺损面积６ｃｍ×１０ｃｍ（图１）。连续硬膜外麻醉下，在会阴与右股内侧之间设计，以会阴部及大腿间皱襞为纵轴、以阴囊后动脉为...     

阴股沟岛状瓣在会阴区修复重建中的应用

目的:验证阴股沟皮瓣作为岛状皮瓣在性器官和会阴区重建修复中应用的多样性.方法:本文报道了15例采用双侧阴股沟皮瓣阴道再造术(先天性阴道闭锁10例,女性假两性畸形3例,肿瘤切除术后阴道缺损2例);单侧阴股沟皮瓣修复直肠阴道瘘(1例)和会阴部严重瘢痕导致后尿道部缺损(1例).结果:32例阴股沟皮瓣全部存活.其中,有2例患者的伤口部分裂开,2例患者阴道口处需要微小的矫正.虽然部分皮瓣处有毛发生长,但术后皮瓣的功能良好.结论:应用阴股沟皮瓣修复重建性器官和会阴区手术操作简单、安全、可靠,供区瘢痕比较隐蔽,其应用具有多样性.     

轴型皮瓣再造阴道126例经验体会

目的：总结6种皮瓣再造阴道的临床经验，方法：应用下腹部皮瓣，脐旁皮瓣、小脐唇皮瓣、阴囊皮瓣、阴茎皮瓣和阴股沟皮瓣再造阴道126例，结果：下腹部皮瓣坏死1例，其余皮瓣全部成活，阴茎皮瓣法发生阴道口狭窄1例，阴股沟皮瓣法有3例阴道变浅，结论：阴股沟皮瓣法距受区最近，转移方便，皮瓣薄，血管神经分丰富，再造的阴道柔软，弹性好，有会阴部部感觉，供区极隐蔽并可直接缝合，是阴道再嘉宾 首选皮瓣。     

阴股沟双皮瓣阴囊再造术治愈阴囊高压电击伤一例

阴囊大面积深度烧伤切痂后双侧睾丸暴露,由于其部位的特殊性,不宜行游离皮片移植。最近笔者应用阴股沟双皮瓣行阴囊再造术治愈阴囊高压电击伤1例,现报告如下。临床资料:患者男,35岁,工作时不慎被10 kV高压电击伤会阴、双下肢,于伤后2 h收入笔者单位。查体见患者阴囊约95％被烧伤,深Ⅱ～Ⅲ度,阴茎末端包皮被烧焦(图1)。入院后立即留置导尿管,创面清创,给予抗生素抗感染。经术前准备,于伤后22 h在蛛网膜下腔阻滞麻醉下行阴囊及双下肢切削痂术、阴股沟双皮瓣阴囊再造术、双下肢游离植皮     

阴股沟皮瓣解剖及在男科的应用进展

阴股沟皮瓣动脉有阴部外动脉、阴囊（唇）后动脉的外侧支、闭孔动脉前皮支等，位置均较恒定；阴股沟皮瓣的静脉与阴部外浅动脉伴行；阴股沟皮瓣的感觉神经有髂腹股沟神经、阴唇后神经、股后皮神经会阴支。男科临床常用于阴囊再造、阴茎再造、阴茎增粗。手术切取皮瓣方便，无需显微吻合血管，供区隐蔽。     

下腹部岛状皮瓣在阴囊毁损性电烧伤修复中的应用

目的探索阴囊毁损性电烧伤造成阴囊缺损的修复方法。方法应用下腹部岛状皮瓣再造毁损性电烧伤的缺损阴囊。结果2001年10月至2009年12月,共8例,均采用下腹部岛状皮瓣进行阴囊缺损的修复,切取皮瓣面积8 cm×11 cm至10 cm×12 cm,皮瓣全部成活。结论下腹部岛状皮瓣是阴囊毁损性电烧伤后阴囊再造的良好方法。     

联合远位组织再造尿道修复复杂尿道下裂

目的：探索并总结复杂尿道下裂的修复方法。方法：2003年6月至2006年12月对32例复杂尿道下裂分别采用阴股沟中厚皮片游离移植，口腔粘膜游离移植、口腔粘膜耦合局部皮瓣、阴股沟中厚皮片耦合局部皮瓣再造尿道4种方法修复各型复杂尿道下裂。结果：随访半年～2年，除2例尿漏外，其余病例阴茎形态良好，排尿正常，无一例发生尿道狭窄或憩室，供区无明显畸形。结论：对于复杂的尿道下裂应遵循整体考虑，联合远位组织，综合利用现有材料，留有后路的指导思想，联合应用口腔粘膜，阴股沟中厚皮片再造尿道或与邻位皮瓣组合的方法修复的成功率高，值得推广。     

旋肩胛血管横支岛状皮瓣修复严重腋窝瘢痕挛缩畸形

目的 探讨应用旋肩胛血管横支岛状皮瓣修复严重腋窝瘢痕挛缩畸形的可行性.方法 对12例患者共15侧严重腋窝瘢痕挛缩畸形采用旋肩胛血管横支为蒂的岛状皮瓣修复,皮瓣面积12 cm×5 cm至20 cm×10 cm,旋转180°覆盖创面,供瓣区直接拉拢缝合.结果 所有皮瓣全部成活,挛缩腋窝得到了基本纠正,8例患者随访1～3年,腋窝外观满意,肩关节功能良好.结论 旋肩胛血管横支岛状皮瓣是修复严重腋窝瘢痕挛缩的良好方法,特别适合于女性或不适宜选用旋肩胛血管降支或升支形成旋肩胛皮瓣的患者.     

Utilization of skin flap for reconstruction of the genitalia after an electric burn

The objective of this article is to describe a case of an electric burn to the genitalia causing scrotal and testicular lesion, and the subsequent reconstruction using a skin graft. The patient was a 10-year-old boy who was victim of an electric burn that harmed the genitalia. There was extended skin loss, penile, scrotal and partial testicular lesion. The treatment consisted of plastic surgery to reconstruct the genitalia with skin flaps grafted on the left thigh, the scrotum and the base of the penis. The patient recovered well and was discharged after two weeks. We concluded that in severe cases of electric burns to the genitalia, skin graft offer a good therapeutic option.     

Salvage of an arm by means of a free cutaneous flap based on the posterior tibial artery

A case involving medial calf, free cutaneous flap based on the posterior tibial artery for one-stage reconstruction of soft tissue and main vessel damage is presented. Flap anatomy is outlined, and operative techniques for transfer are detailed, in a case of deep contact burn of an arm.     

A safe and simple technique using the distal pedicled reversed upper arm flap to cover large elbow defects.

The reconstruction of large soft-tissue defects at the elbow is hard to achieve by conventional techniques and is complicated by the difficulty of transferring sufficient tissue with adequate elasticity and sensate skin. Surgical treatment should permit early mobilisation to avoid permanent functional impairment. Clinical experience with the distal pedicled reversed upper arm flap in 10 patients suffering from large elbow defects is presented (seven male, three female; age 40-70 years). The patient sample included six patients with chronic ulcer, two with tissue defects due to excision of a histiocytoma, and one patient with burn contracture. In the two cases of histiocytoma, defect closure of the elbow's ulnar area was achieved by using a recurrent medial upper arm flap. In the eight other patients we used a flap from the lateral upper arm with a flap rotation of 180 degrees. Average wound size ranged from 4 to 10 cm, average wound area from 30 to 80 cm(2). Flap dimensions ranged from 15 x 8 cm for the lateral upper arm flap to 29 x 8 cm for the medial upper arm flap. The inferior posterior radial and ulnar collateral arteries are the major nutrient vessels of the reversed lateral and medial upper arm flaps. Perforating vessels are identified preoperatively using colour Doppler ultrasonography. Flap failure did not occur. Secondary wound closure became necessary due to initial wound healing difficulties in one patient. Mean operation time was 1.5 h and mean follow-up period 12 months. Good defect coverage with tension-free wound closure was achieved in all cases. Stable defect coverage led to long-term wound stability without any restriction of elbow movement. The lateral and medial upper arm flaps represent a safe and reliable surgical treatment option for large elbow defects. The surgical technique is comparatively simple and quick.     

Free flap cover of acute burns and post-burn deformity

Free flaps are currently used in reconstructive surgery as a one-stage procedure to achieve optimal functional and aesthetic results. The results of free flap reconstruction performed on 23 patients, ten of whom had acute burns and 13 with secondary burn deformity, are presented. The latissimus dorsi, parascapular, dorsalis pedis, temporalis and posterior calf fascia where the free flap donor sites. Flap necrosis due to venous thrombosis occurred in only one instance.     

Free medial thigh perforator flap for reconstruction of the dynamic and static complex burn scar contracture

Introduction

Dynamic and static complex scar contractures after burn commonly cause tendon adhesion, deep adipose tissue stiffness and further limitation of major joints motion. Skin autografting or locoregional flaps are not adequate reconstructive options, because of the easy recurrence and limitation of donor sites. Therefore, free perforator flaps are playing increasing role in reconstruction of complex scar contractures.

Patients and methods

The free medial thigh perforator (MTP) flap is an addition to the reconstructive armamentarium and is particularly useful since the medial thigh is commonly spared in burn injury. Between December 2001 and October 2005, eight patients with severe post-burn scar contractures received free MTP flaps treatment in the Linkou Burn Center. The free MTP flap harvest was modified to enhance its reliability and versatility. Flap sizes ranged from 5 × 15 cm to 8 × 24 cm. The follow-up period was from 12 to 26 months. Flap harvest is rapid, averaging 37.8 min.

Results

The significantly improved range of motion of the contracture joints approximated to normal activity at 6–22-month follow-up (p < 0.05). No free major MTP flap complication was noted, except for mild marginal necrosis in one case.

Conclusion

The free MTP flap with new modified harvest is a good choice for dynamic an static complex scar contractures of major joints, due to short harvesting time and few variations of the pedicle. However, thick skin paddle was considered in secondary hand reconstruction.     

幼年猪全阴囊Ⅲ度烧伤创面早期植皮修复对睾丸Survivin蛋白表达的影响

目的探讨幼年猪全阴囊Ⅲ度烧伤后早期植皮修复阴囊对睾丸生精功能恢复的影响。方法取2月龄雄性贵州小型猪30只,体重10～15 kg;随机分为3组,每组10只,分别为正常对照组(A组)、自然愈合组(B组)、植皮组(C组)。A组小型猪不作任何处理;B、C组小型猪制备阴囊Ⅲ度烧伤模型后,B组不作处理,待其自行愈合;C组切除烧伤阴囊皮肤,取下腹部全厚皮植皮修复。术后观察B、C组实验动物一般情况,并于模型制备3个月(实验动物已成年)及1年每组分别取5只实验动物双侧睾丸标本,HE染色观察不同方式修复阴囊对睾丸生精细胞的形态学影响,免疫组织化学染色检测Survivin蛋白表达。结果实验动物均存活至实验完成,创面均顺利愈合。组织学观察示A组各级生精细胞形态正常,管腔中可见成熟精子;B组生精上皮明显变薄,仅1～2层生精细胞;C组生精细胞较B组稍多,部分可见精子细胞;术后1年B、C组生精细胞较3个月时增加。免疫组织化学染色示术后3个月及1年B、C组Survivin蛋白表达少于A组,B组少于C组,差异均有统计学意义(P<0.05);组内两时间点比较,差异均无统计学意义(P>0.05)。结论植皮修复全阴囊Ⅲ度烧伤创面对猪睾丸生精功能有抑制作用,可导致生精细胞减少,Survivin蛋白表达降低,但生精小管内仍有部分精子细胞残存。     

阴囊Paget病的诊断与治疗(附64例分析)

目的：探讨有关阴囊Paget病的临床特点、预后因素和手术处理原则，提高外科医生对阴囊Paget病的认识。方法：回顾性分析我院1993～2003年收治的64例阴囊Paget病患者的临床资料。结果：104例患者平均年龄68岁，从初发症状到明确诊断的间隔时间平均为2年9个月。除1例采用激光治疗外，其余均采用手术病灶切除术，术后皮肤结构重建，效果满意。术后局部复发8例，其中与该病相关死亡3例。结论：阴囊Paget病容易漏诊，发现阴囊、会阴附近部位皮肤出现可疑的湿疹样病变，应尽早行皮肤活检。早期彻底切除病灶能减少局部复发。     

残端疝囊剥离联合腹股沟管引流对巨大腹股沟斜疝术后阴囊并发症的影响

目的探讨残端疝囊剥离联合腹股沟管引流对巨大腹股沟斜疝术后相关阴囊并发症的影响及残端疝囊剥离的手术技巧。方法回顾性分析2010年1月至2013年10月,成都军区总医院收治的巨大腹股沟斜疝患者20例临床资料,疝囊直径≥10cm,进入同侧阴囊。术中均完整剥离残端疝囊并在腹股沟管内放置血浆引流管引流。结果手术均取得成功,剥离残端疝囊时间为3～7min,平均4．6min。剥离残端疝囊出血量：出血量≤2ml12例,出血量～5ml 8例,术后住院时间1～3d,平均1．6d。术后阴囊无明显肿胀,无积液积血。患者无阴囊下坠等不适。结论精细解剖和分离疝外组织,完整剥离疝囊,彻底止血并联合腹股沟管内引流,可减少腹股沟疝术后阴囊并发症的发生。