狭长窄蒂皮瓣在面额部皮肤癌治疗中的应用

目的 介绍一种打破常规任意皮瓣长宽比例限制的狭长窄蒂皮瓣在面额部皮肤癌切除后组织缺损修复中的应用,并探讨其成活机制.方法 设计不带知名血管,以耳前或耳后狭长皮肤筋膜或单纯筋膜为蒂的侧颌颈部皮瓣,修复面额部皮肤癌切除后组织缺损26例,其中颞额区皮肤基底细胞癌5例,皮肤鳞状细胞癌6例,面部恶性黑色素瘤1例,基底细胞癌8例,鳞状细胞癌5例,皮肤黏液癌1例.26例皮瓣的蒂部有24例在耳前,2例在耳后;4例仅为筋膜蒂.皮瓣最大10.0 cm×8.0 cm,最小3.0 cm×2.5cm,蒂宽1.0～1.5 cm,蒂长2～6 cm.结果 26例狭长窄蒂皮瓣除5例皮瓣远端淤血,其后渐恢复,其余全部成活,修复后局部外形理想.结论 该狭长窄蒂皮瓣不带知名血管,其长宽比例超过常规任意皮瓣,无需解剖血管,切取容易,蒂部狭长使其旋转和覆盖范围大,供、受区邻近,是修复面额部皮肤癌扩大切除后组织缺损的理想皮瓣.     

耳后皮下蒂岛状皮瓣修复耳甲腔皮肤缺损

目的 探讨耳后皮下蒂岛状皮瓣修复耳甲腔皮肤缺损的治疗效果.方法 对2009年1月至2012年6月收治的12例耳甲腔皮肤缺损行耳后皮下蒂岛状皮瓣修复患者行回顾性分析.恶性肿瘤经术中病理检查确定基底及周缘无肿瘤细胞残留,根据创面大小设计耳后皮下蒂岛状皮瓣,经供区与缺损之间的隧道,转移至耳甲腔缺损处覆盖创面,耳后供区直接拉拢缝合.结果 共修复12例耳甲腔皮肤缺损患者,创面以1.5cm×2.5cm~2.5cm×3.0cm大小不等皮瓣覆盖,术后皮瓣血运良好.随访14～55个月（平均28个月）,肿瘤无复发,局部瘢痕不明显,皮瓣色泽与正常皮肤相协调,外耳郭形态正常,患者对耳郭外观满意.结论 耳后皮下蒂岛状皮瓣是临床修复耳甲腔皮肤缺损的一个简单、方便、有效的方法之一.     

窄蒂侧颌颈部皮瓣修复面部组织缺损

目的　介绍一种因多种原因导致的面部皮肤及深层组织缺损与畸形的修复方法。方法　设计以耳前狭窄皮肤筋膜为蒂的侧颌颈部皮瓣移转修复缺损。皮瓣最大 10cm× 11cm ,最小5cm× 6cm。蒂部宽 1 0～ 1 5cm ,长 2～ 5cm。结果　应用窄蒂侧颌颈部皮瓣治疗 2 1例 ,除 1例皮瓣远端皮肤坏死外 ,其余全部成活。结论　本皮瓣不带知名血管 ,打破带蒂随意皮瓣的长宽比例规定 ,是一种新的皮瓣设计 ,窄蒂移转方便 ,修复后外形满意 ,是修复面部较大面积组织缺损的较理想方法     

狭长窄蒂皮瓣在老年人皮肤癌治疗中的应用

目的 探讨狭长窄蒂皮瓣在老年肿瘤切除后软组织缺损修复中的应用及成活机制.方法 设计蒂部位于肿瘤切除后创面旁沿知名或穿支血管走向的狭长窄蒂皮瓣,用于老年人肿瘤切除后软组织缺损的修复.皮瓣切取最大面积12 cm×10 cm,最小3 cm×4 cm,蒂宽1.0～1.5 cm,蒂长2～8 cm.结果 共17例,14例Ⅰ期成活,外形良好,3例因早期包扎不当,延迟愈合.结论 老年人皮肤组织细胞代谢率低,移植后皮瓣组织本身的耐缺血缺氧能力强,设计狭长窄蒂皮瓣修复老年肿瘤切除后软组织缺损,较易成活,且窄蒂狭长,转移容易,皮瓣不臃肿,同时利于肿瘤的早期综合治疗,是老年肿瘤术后修复较理想方法.     

改良筋膜蒂皮瓣的临床应用

目的 对四肢筋膜蒂皮瓣手术方法进行改良及总结,进一步提高疗效.方法 应用筋膜蒂皮瓣修复四肢皮肤、软组织缺损48例.其中小腿中下段胫前皮肤缺损16例,足跟部皮肢缺损10例,踝关节皮肤缺损15例,膝关节周围皮肤缺损2例.骶尾部巨大褥疮1例,手腕背部皮肤缺损4例.创面范围4.5 cm×3.0 cm～19.0cm×12.0cm,根据创面不同采取四肢不同部位筋膜蒂皮瓣修复创面,其中前臂内侧皮神经、贵要静脉筋膜蒂皮瓣4例,前臂外侧皮神经、头静脉筋膜蒂皮瓣1例,顺行带隐神经、大隐静脉的筋膜蒂皮瓣3例,右大腿股后皮神经筋膜蒂皮瓣1例,带腓肠神经、小隐静脉逆行筋膜蒂皮瓣22例,带隐神经、大隐静脉筋膜蒂皮瓣7例.皮瓣范围6.0 cm×4.0 cm～18.0 cm×13.0cm.供区创面29例直接缝合,19例取大腿或下腹部全厚皮片6.0 cm×3.0 cm～13.0 cm×6.0 cm植皮修复. 结果 术后15例皮瓣肿胀、淤血,经远端小切口放血3～5d,其中12例皮瓣成活,创面Ⅰ期愈合;3例远端皮缘部分坏死,经再次手术清创植皮后成活.余患者皮瓣均成活,创面愈合.供区创面Ⅰ期愈合,植皮成活.48例患者均获随访1～24个月,平均9.5个月.皮瓣色泽正常,质地柔软,外形和功能满意. 结论 四肢筋膜蒂皮瓣是修复四肢皮肤、软组织缺损的理想治疗方法.通过手术方法的改良,可使皮瓣成活率进一步提高.     

蒂部潜移法增加V-Y筋膜皮瓣的推进距离

目的:为修复上肢中小创面提供一种V-Y推进皮瓣。方法:在邻近创面的健康皮肤,依纵行的筋膜皮下血管丛方向设计V-Y筋膜皮瓣,通过对蒂部在深筋膜下间隙及皮下疏松组织中不同层次的潜行分离,既增加了皮瓣的推进距离,又不影响皮瓣的血供基础。结果:临床修复上肢创面6例,皮瓣面积为3cm×4cm~5cm×8cm,推进距离2.5cm~5.0cm,均完全成活。结论:皮瓣蒂部潜移法能安全有效地增加V-Y筋膜皮瓣的推进距离,是修复中小面积创面的较好方法。     

随意超薄皮瓣的超薄层次及长宽比例的实验研究

选用１２只体重２５～３０ｋｇ的家猪为实验动物，对随意超薄皮瓣的超薄层次、长宽比例及断蒂时间与传统随意型皮瓣移植后作对比研究。结果表明，传统随意皮瓣成活的长宽比为２：１；皮瓣超薄至在真皮下血管网的下方保留２～３ｍｍ脂肪及在真皮下血管网的下方保留１／３浅筋膜，这二种超薄层次的皮瓣成活的长宽比例均为２．５：１，并可提前到术后６天断蒂。     

耳后皮下蒂岛状皮瓣修复耳甲腔缺损

目的:观察皮下蒂岛状皮瓣(旋转门皮瓣)修复耳甲腔皮肤缺损创面的效果。方法:2018年4月至2019年4月,东南大学附属徐州医院整形美容科用耳后皮下蒂旋转门皮瓣治疗耳甲腔皮肤缺损10例,男6例,女4例,年龄2个月至68岁,平均57岁;缺损大小1.0 cm×1.0 cm~2.5 cm×1.5 cm。结果:10例患者术后均一...     

穿支血管筋膜蒂真皮下血管网皮瓣修复四肢创面

目的探讨应用穿支血管筋膜蒂真皮下血管网皮瓣修复四肢创面的方法．方法2009年3月-2012年3月对四肢皮肤组织缺损创面．采用穿支血管筋膜蒂真皮下血管网皮瓣修复。结果皮瓣全部成活,随访3～6个月,皮瓣及供区外观、质地、弹性良好。结论穿支血管筋膜蒂真皮下血管网皮瓣修复四肢创面皮瓣及供区外观恢复满意。是修复四肢创面的有效方法。     

改良小腿筋膜蒂皮瓣修复皮肤缺损的临床应用

目的 探讨改良的小腿筋膜蒂皮瓣修复皮肤缺损的临床应用.方法 对6例小腿皮肤缺损钢板或骨外露创面患者,缺损面积：1.8 cm×3.0 cm～3.2 cm×6.5 cm,分别以改良的小腿筋膜蒂转移皮瓣修复,经过精确测量,将皮瓣通过皮下隧道转移至受区覆盖皮肤缺损创面,供区直接缝合.结果 6例皮瓣全部成活,供区仅线性瘢痕.术后随访2个月～2年,平均7个月,小腿功能良好,皮瓣外观满意,皮肤质地好.结论 改良的小腿筋膜蒂皮瓣在修复皮肤缺损的临床应用中是一种简单、安全、理想的手术方式.     

皮神经营养血管组织瓣的临床应用原则与命名

目的 探讨皮神经营养血管组织瓣的临床应用原则，并提出新的命名方法。方法 总结皮神经营养血管组织瓣的解剖研究和临床经验。结果 皮神经多与皮静脉伴行，在其周围均存在丰富的链式吻合血管丛，显著增加了这类组织瓣的血供。临床以远端(31例)或近端(3例)为蒂，在前臂(26例)和小腿(8例)切取带皮神经和皮静脉营养血管的岛状筋膜皮瓣(20例)和筋膜皮下组织瓣(14例)共34例，长宽比例2．7～5．1：1，平均3．5：1，完全成活。结论 带皮神经营养血管的组织瓣是传统筋膜皮瓣和筋膜皮下组织瓣的特殊范例，临床应用应遵循一定的原则。     

带膝上外侧动脉蒂逆行股前外侧岛状皮瓣和肌皮瓣临床应用

目的：报道带膝上外侧动脉蒂逆行股前外侧皮瓣修复膝关节周围组织缺损的结果。方法：应用股前外侧皮瓣和肌皮瓣逆行转移修复膝关节周围缺损，该皮瓣以膝上外侧动脉为蒂，通过膝上外则动脉与旋股外侧动脉降支之间的吻合支营养股前外侧皮瓣，血供丰富。皮瓣大小１２～１５ｃｍ×３～７ｃｍ，供区均原位缝合，结果：修复膝关节周围缺损４例，小腿淋巴水肿桥接淋巴通道１例，皮瓣均成活。术后外形及功能恢复良好。结论：作者认为该皮瓣是膝关节周围组织缺损修复较为理想的方法。     

Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes

Study aims

To report the surgical anatomy of the perforator arteries at the lower leg, analyse clinical outcomes in previous studies, and forward methodological recommendations for future studies of post-traumatic perforator flap reconstructions.

Methods

A study sample of 640 human patients drawn from 24 clinical reports was included for review. The sample comprised of four subsets: sural flap reconstructions (n = 257), saphenous flaps (n = 122), supramalleolar flaps (n = 92), and propeller flaps (n = 169).

Results

Statistical analysis of samples from anatomical studies documents significant differences in the perforator distribution from the tibial and peroneal artery; peroneal perforator arteries are randomly organised whereas tibial artery perforators are clustered at three definite levels. The failure rates in clinical studies ranged from 0% to 6%, being lowest for supramalleolar flap reconstructions and highest for saphenous flaps; however, differences between the four subsets were not statistically significant at the 95% confidence level. Due to methodological flaws, outcome comparisons in the actual study sample should be interpreted cautiously; in most clinical studies both risk variables and outcome indicators are poorly defined. The outcome of Dynamic Infrared Thermography imaging of post-transposition changes of flap perfusion is reported.

Summary

Fasciocutaneous perforator flaps seem to have high survival rates and represent a feasible approach to post-traumatic reconstructions, especially in low-resource settings. A template for data gathering is recommended for higher accuracy in future comparative studies, and for scientific analysis of success and risk factors. New imaging techniques indicate a promising potential of micro-circular angiogenesis during the first two weeks after flap transpose.     

小腿前外侧的皮瓣及筋膜瓣的临床应用

目的介绍小腿前外侧的皮瓣筋膜瓣的应用解剖、手术方式、方法及临床应用。方法在14侧成人下肢标本及1条断腿上,观察了腓浅血管的起始部位、行程及皮支的分布情况,设计了小腿前外侧组织瓣的4种术式。1988年以来,临床应用26例。结果术后皮瓣筋膜瓣全部成活,切口Ⅰ期愈合23例,Ⅱ期愈合3例,20例随访4个月到5年,情况稳定良好,无复发。结论手术操作简单、安全可靠,对供区影响小,是修复小腿及对侧踝及跟部后方创面及治疗胫骨慢性骨髓炎的一种可供选用的方法。     

The medial femoral trochlea flap with a monitor skin island—Report of two cases

In this report, we present two cases of the bony reconstruction with the medial trochlea (MFT) flap including a skin island that was used to monitor the perfusion of flap in the postoperative period. Between March 2013 and April 2015, we performed surgery on two patients who suffered from scaphoid and talus non‐union after trauma and initial treatment by osteosynthesis. A skin island (1 cm × 1 cm and 3 cm × 1 cm, respectively) was included with the osseous flap (1.6 cm × 1 cm × 1 cm and 2 cm × 3 cm × 2 cm, respectively) to assess the perfusion of the flap. The design of the skin island was based on either the saphenous artery perforator or a cutaneous perforator of the descending genicular artery. Both flaps remained viable throughout the postoperative period, and there were no donor site complications. After a follow‐up of 36 and 11 months, bony union was observed in both patients with a high degree of satisfaction. Thus, a MFT flap with a skin island could be a tool to assess the perfusion of the flap in the early postoperative period. © 2016 Wiley Periodicals, Inc. Microsurgery 37:431–435, 2017.     

带蒂组织瓣转移手术修复肢体软组织缺损35例分析

目的　分析带蒂组织瓣转移手术修复肢体软组织缺损创面的疗效。方法　选择肌瓣、岛状皮瓣、岛状肌皮瓣转移 ,直接修复缺损或转移肌瓣表面植皮覆盖。结果　 2 9例慢性骨髓炎和 6例外伤后软组织缺损创面 ,肌瓣、岛状皮瓣、岛状肌皮瓣转移修复疗效满意。结论　带有营养血管的肌瓣、皮瓣肌皮瓣转移手术 ,一期修复肢体创伤、骨髓炎等所致的骨缺损腔及软组织缺损创面 ,效果好 ,因不需吻合血管 ,手术相对简单 ,临床使用安全。     

Soft tissue reconstruction of theupper extremity

Soft tissue coverage of the upper extremity requires careful analysis of each defect by the surgeon to establish an appropriate plan for reconstruction. Each anatomic area of the upper extremity has unique reconstructive requirements. Also, patient characteristics including age, compliance, and medical history play a role in the management of upper extremity wounds. The surgeon must incorporate all of these elements to select a suitable reconstructive option that will maximize function and aesthetics as well as minimize morbidity.     

Distally-based superficial sural flap: Advantages of the adipofascial over the fasciocutaneous flap

Abstract

The distally-based superficial sural flap has proved to be an easy and reliable method of reconstruction in soft tissue cover of the distal third part of the leg. There are two ways to prepare this flap: as a fasciocutaneous flap, which includes the fascia with the subcutaneous tissue including the skin; or as an adipofascial flap, which is made up of both the fascia and the subcutaneous adipose tissue. In the latter case, the flap is covered with a partial thickness skin graft either immediately after or at a later stage. The aim of this study was to assess the advantages and disadvantages of the two flaps. The adipofascial flap seems to be better, as it is associated with less donor site morbidity, improved quality of reconstruction, and fewer complications.