耳再造术中自体肋软骨切取技术的改良

目的 探索耳再造术中自体肋软骨切取技术的改良,从而提高手术效率,降低手术并发症的发生。方法 对760例耳再造患者实施肋软骨切除术,从术前准备、术中切口选择、软骨膜的暴露与剥离、切口的闭合等多方面对肋软骨切取技术进行改良。通过切口长度、手术耗时及并发症发生率对手术效果进行评估。结果 760例患者肋软骨切取手术切口平均长度2.6 cm,平均手术耗时35 min。所有患者伤口均愈合良好,无血气胸、大血管损伤等并发症发生,半年随访未见明显胸廓畸形。结论 改良的自体肋软骨切取方法可以提高手术效率,获得良好的手术效果,并且有效减少并发症的发生,值得临床推广应用。     

经乳房下皱襞切口切取肋软骨行耳郭再造术

目的探讨经乳房下皱襞切口切取肋软骨进行耳郭再造术的可行性。方法对于临床上行耳再造术的20例女性患者,应用日本学者Nagata方法实施耳郭再造术。将切取肋软骨的切口设计在乳房下皱襞,切取第6~9肋软骨。随访患者6~12个月,观察切口愈合及耳再造效果。结果经乳房下皱襞切口切取的肋软骨均完整,切口愈合良好,再造耳形态满意。结论经乳房下皱襞切口切取肋软骨,其切口隐蔽,方法可行。     

小切口切取肋软骨的临床经验

目的总结在鼻整形术中应用小切口进行全层肋软骨切取的经验,探讨小切口切取肋软骨的应用效果。方法对29例接受自体肋软骨鼻整形术的患者,由同一名医师进行小切口肋软骨切取,评估并统计切口设计长度,切口缝合后实际长度,所取肋软骨量(整块长度、最宽径、最厚径),切缘挫伤程度及术中并发症。结果本组29例患者术后获随访3～6个月,设计切口长度平均2.2 cm,最小1.5 cm;缝合切口长度平均2.4 cm,最小1.8 cm;切取的肋软骨平均长度为4.5 cm(2.7～7.5 cm),平均最宽径为1.6 cm,平均最厚径为0.8 cm。切口缝合前切缘挫伤程度评估:轻度20例,中度7例,重度2例。结论在充分术前评估、合理进行切口设计、术中精细操作下可以实现小切口切取全层肋软骨,在术中无严重并发症发生的情况下可以达到较理想的供区美容效果。     

耳后延迟皮瓣自体肋软骨支架法外耳再造术

目的 探讨耳后延迟皮瓣自体肋软骨支架法外耳再造术的临床效果.方法 手术分3期进行：Ⅰ期为耳后皮瓣延迟术,术后3周左右进行Ⅱ期手术;Ⅱ期为自体肋软骨支架再造、延迟皮瓣覆盖及自体中厚皮片移植外耳再造术,术后半年据情进行Ⅲ期手术;Ⅲ期行耳屏再造、耳甲腔加深和再造耳局部修整术等.结果 对先天性小耳畸形28例,31只耳,分次完成Ⅰ～Ⅲ期手术23只耳,余8只耳只完成Ⅰ、Ⅱ期手术.术后外耳位置、大小及形态良好,并发症少,患者及家属基本满意.结论 应用皮瓣延迟术不但可获取足够面积富有血运保障的菲薄皮瓣,而且方法简单、安全,所需时间短.耳后延迟皮瓣自体肋软骨支架法外耳再造术,是一种良好的外耳再造术方法.     

先天性小耳畸形自体肋软骨移植Ⅰ期耳再造的手术配合

目的 探讨先天性小耳畸形自体肋软骨移植Ⅰ期耳廓再造术的手术配合.方法 回顾性分析30例先天性小耳畸形自体肋软骨移植Ⅰ期耳廓再造术的手术配合要点,包括术前访视加强对患者的心理护理,手术物品、药物的准备齐全;术中巡回护士熟悉手术步骤,为患者摆放舒适、恰当体位,密切监护生命体征、保持引流管位置的正确及通畅;术中器械护士严格执行无菌技术,积极、密切的配合等.结果 30例患者均成功手术,未出现明显护理差错.术后仅耳廓伤口轻度疤痕增生1例、局部表皮缺失1例、皮肤色泽颜色暗红3例,经创面换药、扩血管药物等治疗后好转;无软骨外露或皮瓣坏死;再造耳廓位置、形态、大小和对侧相似,家属均表示满意.结论 有效的护理及手术配合有利于先天性小耳畸形自体肋软骨移植Ⅰ期耳廓再造的手术成功、提高手术质量.     

小耳甲腔型小耳畸形耳郭再造

目的 探讨Nagata自体肋软骨二期法耳郭再造术治疗小耳甲腔型小耳畸形的方法及疗效.方法 自2016年7月至2021年12月,福建医科大学附属第一医院整形外科收治17例小耳甲腔型小耳畸形患者.按Nagata自体肋软骨二期法耳郭再造术进行手术,一期手术行肋软骨耳郭支架成形和移植,二期行耳颅沟重建.结果 所有患者均顺利完成...     

126例全耳再造术取自体肋软骨的体会

目的 探讨和总结二期全耳再造术中取自体肋软骨的手术方法和相关问题.方法 在2003～2006年126例先天性小耳畸形患者采用二期全耳再造术时取患耳对侧自体肋软骨,保留软骨膜,部分患者剩余软骨切碎后软骨膜腔隙回植.结果 本组126例,取下肋软骨均满足手术需求,无一例发生气胸.术后随访时间最长1年,未见明显的胸廓畸形及发育障碍.结论 本手术方法可减少取自体肋软骨时气胸的发生,胸廓畸形的产生和软骨的回植及软骨膜的保留相关.     

先天性小耳畸形自体肋软骨移植Ⅰ期耳廓再造术的手术配合

目的　探讨先天性小耳畸形自体肋软骨移植Ⅰ期耳廓再造术的手术配合。方法　回顾性分析30例先天性小耳畸形自体肋软骨移植Ⅰ期耳廓再造术的手术配合要点,包括术前访视加强对患者的心理护理,手术物品、药物的准备齐全;术中巡回护士熟悉手术步骤,为患者摆放舒适、恰当体位,密切监护生命体征、保持引流管位置的正确及通畅;术中器械护士严格执行无菌技术,积极、密切的配合等。结果　30例患者均成功手术,未出现明显护理差错。术后仅耳廓伤口轻度疤痕增生1例、局部表皮缺失1例、皮肤色泽颜色暗红3例,经创面换药、扩血管药物等治疗后好转;无软骨外露或皮瓣坏死;再造耳廓位置、形态、大小和对侧相似,家属均表示满意。结论　有效的护理及手术配合有利于先天性小耳畸形自体肋软骨移植Ⅰ期耳廓再造的手术成功、提高手术质量。     

雕刻—拼接法制作自体肋软骨耳支架

目的探索一种自体肋软骨耳支架的雕刻—拼接制作方法,以期获得良好的再造耳形态。方法 2011年1月至2012年1月,共行545侧外耳再造术。应用改良Nagata法耳再造术285例,扩张皮瓣法260例。切取第6~8肋软骨,分2~3层雕刻、拼接耳支架,构建耳轮、对耳轮、耳舟、三角窝、对耳轮上脚、耳屏、对耳屏、耳甲腔等耳廓亚结构,用于外耳再造术。结果术后有6例因局部皮肤坏死致耳支架外露,经再次手术处理后愈合;1例因感染取出肋软骨支架,6个月后再次行外耳再造术。本组患者术后随访6~12个月,488例再造耳廓形态良好,效果满意;80例再造耳廓亚结构欠清晰,效果欠佳;另有19例失访。结论用雕刻—拼接法制作自体肋软骨耳支架,可获得结构稳固、形态逼真的支架,是耳再造获得良好效果的必要步骤。     

自体肋软骨隆鼻术的效果观察

目的 探讨应用自体肋软骨行隆鼻术的方法和效果.方法 自2010年3月至2014年2月,我们应用自体肋软骨对9例患者进行了隆鼻术.切取右侧第7肋软骨,长5～6 cm,雕刻成“柳叶”形.选择鼻小柱侧切口,鼻骨骨膜下钝性分离,形成相应的软骨植入腔隙;将雕刻好的“柳叶”形软骨植入腔隙,并将剩余软骨修剪成“盾牌”形,植于鼻尖点.结果 本组共9例患者.1例患者术后出现肋骨切取伤口脂肪液化,其余患者手术切口均Ⅰ期愈合;1例术后鼻背软骨轻度弯曲,其余患者鼻外形改善,效果满意.结论 自体肋软骨隆鼻效果良好,克服了假体隆鼻的缺点.     

自体肋软骨移植构建鼻尖软骨复合体在鼻整形中的临床应用

目的：通过应用自体肋软骨重塑鼻尖软骨支架结构,形成稳定的鼻尖软骨复合体,来达到完美、立体的鼻尖外形,同时应用膨体聚四氟乙烯或硅胶假体支架抬高鼻背,从而达到理想的鼻部整形美容效果。方法：以鼻小柱基底部＂几＂字形切口和鼻孔内鼻翼软骨外侧缘切口,彻底分离皮肤达鼻翼基底部,对鼻尖短小朝天者可松解到达梨状孔边缘,显露两侧鼻翼软骨及侧鼻软骨,同时暴露鼻中隔软骨游离端;雕刻自体肋软骨,移植、固定到鼻中隔软骨上,贯穿缝合鼻翼软骨、移植的软骨,形成鼻尖软骨支架结构,构建鼻尖软骨复合体。雕刻膨体聚四氟乙烯或硅胶假体支架放置到鼻背鼻骨骨膜下抬高鼻背。结果：本组96例手术者均采用自体肋软骨移植构建鼻尖软骨复合体行鼻整形,术后7天拆线,切口Ⅰ/甲愈合。随诊6～12个月,95例术后鼻尖表现点明显,鼻形立体、挺拔,自然美观,鼻尖活动度好,效果满意。1例术者感觉鼻小柱下垂,通过修复移植软骨,达到满意效果。结论：应用自体肋软骨重塑鼻尖软骨支架结构,构建鼻尖软骨复合体,同时应用膨体聚四氟乙烯或硅胶假体支架抬高鼻背,可以达到理想的鼻部整形美容效果。     

Autologous mastectomy reconstruction: Communication among the breast surgery team to maximize aesthetic and oncologic outcome

Mastectomy breast reconstruction with autologous tissue is challenging. Oncologic and aesthetic goals face previous surgical scars, radiation, chemotherapy, or other comorbidities. We describe a simple approach for autologous mastectomy reconstruction so that breast and plastic and reconstructive surgeons can maximize aesthetic outcomes and minimize wound complications. A retrospective chart review was done on patients who underwent mastectomy and autologous reconstruction. The surgical flight plans were reviewed to delineate an approach, and pre‐ and postoperative photographs were examined to create a step‐by‐step process. The most encountered mastectomy and autologous flap reconstruction scenarios were categorized to create a step‐by‐step process. Successful autologous mastectomy reconstruction to optimize aesthetic outcome and minimize complications requires team communication. Creation of a surgical flight plan using information from the physical examination, MRI and adjunctive imaging, and preoperative photographs is imperative. Thoughtful incision choice and exposure approach are paramount.     

开胸术后肋软骨炎的整形外科治疗

目的探讨开胸术后肋软骨炎的治疗方法。方法对单根的肋软骨炎,在压痛最明显处直接切除受累的肋软骨;对胸上部多根肋软骨炎,可在胸部正中(开胸之瘢痕处)切开,切除受累的肋软骨;对胸下部、肋弓处肋软骨炎,除在胸部正中切开外,再向外下沿肋弓切开,形成以上部为蒂的胸部皮瓣,再切除受累的肋软骨;对肋软骨炎伴胸锁关节炎者,在胸部正中切开,形成一侧的胸部皮瓣,将受累的肋软骨及胸锁关节切除,应用胸大肌瓣转移填塞胸锁关节缺损处。术后行滴注引流,应用敏感抗生素。结果本组7例,2周后伤口愈合,效果良好。结论彻底清除感染的肋软骨是治疗开胸术后肋软骨炎的有效方法。     

Otoplasty with an unusual cartilage scoring approach

Background: An ideal otoplasty procedure should minimise the possible risk of severe complications of otoplasty and provide a good aesthetic outcome; however, there is no standart technique to be applied to all types of auricular deformities in different populations. The aim of this study was to present an otoplasty technique with posterior approach in which small incomplete cartilage incisions and suture fixations were used to form the auricle without a need for anterior skin incision and dissection. Methods: This study involved 42 patients who had bilateral prominent ears with unfurled antihelixes associated with or without conchal excess. The otoplasty procedure mainly consisted of a posterior skin excision, incomplete cartilage incisions in the shape of greater mark, “>”, mattress sutures of the posterior cartilage, earlobe correction, and conchal reduction if necessary. Results: This otoplasty technique consists of easy, simple, and rapid surgical steps without a need for anterior skin dissection and cartilage scoring, so it has a low rate of complications in both early and late postoperative periods. Follow-up time of patients ranged from 1–9 years, with an average of 3 years. No major complications such as haematomas, chondritis, wound infection, skin necrosis, asymmetry, recurrence, hypertrophic scars, granulomas, or irregularities developed in the early and late postoperative periods. A good symmetry and natural appearence were achieved with this otoplasty technique. Patients were satisfied with the results. All over complication rate in the postoperative period was 7%. Conclusion: The presented technique overcomes the drawbacks of anterior skin dissection and anterior scoring, and minimises the risk of severe complications such as anterior skin necrosis, cartilage necrosis or destruction, and ear irregularities. It also reduces the operation time, swelling, bruising, and possibility of suture extrusion and recurrence.     

皮肤减张闭合器缝合与传统缝合对剖宫产术后切口美观度及瘢痕形成情况比较分析

目的:对比皮肤减张闭合器缝合与传统缝合对剖宫产产妇切口美观度以及瘢痕形成的影响。方法:纳入笔者医院2018年1月-2019年1月112例剖宫产产妇,采用随机数字表法分为观察组、对照组各56例,对照组产妇采用常规缝合方式,观察组产妇应用皮肤减张闭合器缝合。比较两组产妇术后1周、术后1个月切口疼痛程度[视觉模拟评分法(Visual analogy score,VAS)]评分,切口愈合情况(创面闭合时间,术后2周甲级愈合率),术后3个月瘢痕遗留情况(瘢痕增生发生率、瘢痕厚度、瘢痕宽度)以及切口美观程度评价。结果:观察组术后1周、术后1个月VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组创面闭合时间小于对照组,术后2周切口甲级愈合率高于对照组,差异均有统计学意义(P<0.05);术后3个月,观察组瘢痕增生发生率低于对照组,瘢痕厚度、瘢痕宽度均小于对照组,观察组切口美观度高于对照组,差异有统计学意义(P<0.05)。结论:对比传统缝合,皮肤减张闭合器缝合可有效改善术后切口疼痛,利于切口愈合,减少瘢痕形成,美观度更高。     

Late reconstruction of chronic distal biceps tendon ruptures using fascia lata autograft and suture anchor fixation

Distal biceps tendon ruptures are a rare injury, and surgical reconstruction is typically recommended for chronic ruptures. There is no consensus regarding the most appropriate reconstruction technique. We present our experience with reconstruction of chronic distal biceps tendon ruptures with fascia lata autograft, secured to the bicipital tuberosity with suture anchors. A single anterior incision is used for all patients. Tension is set with the elbow in 50 degrees of flexion. Ninety-two percent of our patients reported improvement in elbow flexion and supination and were pleased with the surgery. Range of motion and isokinetic flexion and supination strength after this procedure was comparable with other distal biceps tendon reconstruction options using tendon grafts and suture anchor fixation from a single anterior approach. Furthermore, common complications associated with distal biceps tendon repair and reconstruction can be avoided with this technique. We therefore feel that this technique is a viable surgical treatment alternative with good subjective and objective outcomes.Level of Evidence: Level IV.     

'Stab and Split': a 'bloodless' and 'scarless' skin incision technique for minor surgery

The 'stab and split' skin incision technique was applied to children requiring minor surgery. A small stab incision was made on a skin crease and split open with mosquito forceps. After the surgical procedure was completed, the wound was closed in layers with a subcuticular suture to the skin. In all cases, splitting caused virtually no blood loss because subcutaneous veins were left intact, and the wounds healed well, especially in infants. 'Stab and split' is an effective alternative incision technique for minor surgery in younger children.     

The elevation of the constructed auricle with a temporoparietal fascial flap wrapping a resorbable plate.

During the second stage reconstruction of the auricle in patients with microtia, we modified Nagata's method and two technical improvements were possible. After the implanted auricle was separated from the bed, we harvested the temporoparietal fascial flap through helical rim incision instead of incising the temporal scalp. So the surgical scar over the temporal region was avoided. Thereafter, a costal cartilage wedge was carved and grafted to the posterior aspect of the conchal region to get a firm projection. But in cases of unavailable costal cartilage wedge graft, we used a resorbable plate composed of polylactic and polyglycolic acid as a substitute for the former so that we could create firm elevation and sufficient ear projection. Between June 2002 and May 2004, 28 patients underwent this operation with the temporoparietal fascial flap and resorbable plating system. There was no complication resulting from our technique. It was possible to create firm elevation and good frontal projection even if there was no available cartilage wedge. Additionally, by harvesting the temporoparietal fascia through helical rim incision, we avoid creating additional scars on the scalp.     

‘STAB AND SPLIT’: A ‘BLOODLESS’ AND ‘SCARLESS’ SKIN INCISION TECHNIQUE FOR MINOR SURGERY

The ‘stab and split’ skin incision technique was applied to children requiring minor surgery. A small stab incision was made on a skin crease and split open with mosquito forceps. After the surgical procedure was completed, the wound was closed in layers with a subcuticular suture to the skin. In all cases, splitting caused virtually no blood loss because subcutaneous veins were left intact, and the wounds healed well, especially in infants. ‘Stab and split’ is an effective alternative incision technique for minor surgery in younger children.