改良第一趾蹼皮瓣游离移植修复拇指指腹缺损

目的总结吻合血管改良第1趾蹼皮瓣游离移植修复拇指指腹缺损的疗效。方法 2008年2月-2011年2月,收治拇指指腹缺损12例。男8例,女4例;年龄20～57岁,平均32.9岁。机器绞伤7例,电刨伤3例,压砸伤2例。新鲜创面10例,受伤至入院时间为2～6 h;陈旧性创面2例,均为拇指再植术后指腹坏死,于伤后13 d及15 d入院。创面范围3.0 cm×2.0 cm～3.6 cm×2.8 cm,采用吻合血管改良第1趾蹼皮瓣游离移植修复,切取的改良皮瓣保留了趾蹼原有功能结构,皮瓣切取范围3.4 cm×2.3 cm～4.4 cm×3.0 cm;供区游离植皮或用穿支血管蒂足内侧隐神经营养血管皮瓣修复。结果术后供、受区皮瓣和植皮均完全成活,切口Ⅰ期愈合。术后患者均获随访,随访时间8～24个月,平均10个月。修复后拇指外形美观,伸屈、对掌功能正常,感觉恢复至S34例,S3+6例,S42例。结论吻合血管改良第1趾蹼皮瓣游离移植修复拇指指腹缺损,外形、功能恢复好,供区损伤小,是较好的修复方法之一。     

应用第一趾蹼皮瓣修复Mu趾皮肤缺损并骨外露

目的探讨     

第一趾蹼皮支蒂岛状皮瓣修复趾软组织缺损

目的总结第1趾蹼皮支蒂岛状皮瓣修复趾软组织缺损的疗效。方法 2009年11月-2011年1月,收治7例重物砸伤致趾皮肤软组织缺损男性患者。年龄23～42岁,平均32岁。伤后至入院时间为5～10 d,平均7 d。趾末节软组织缺损合并末节趾骨外露3例,甲床坏死伴骨外露1例,趾腓侧皮肤软组织缺损伴骨外露2例,趾背侧皮肤软组织坏死1例。创面范围3.5 cm×2.5 cm～4.5 cm×4.5 cm。应用大小为4.0 cm×2.5 cm～5.0 cm×5.0 cm的第1趾蹼皮支蒂岛状皮瓣修复。供区植皮修复。结果术后皮瓣及植皮均成活,创面Ⅰ期愈合。患者均获随访,随访时间11～20个月,平均14个月。皮瓣质软,外形无臃肿。术后6个月按照神经感觉恢复标准评定,皮瓣感觉S1～S3,植皮区感觉S1～S2。患者第1趾蹼均遗留轻度瘢痕,患足功能良好。结论第1趾蹼皮支蒂岛状皮瓣修复趾软组织缺损具有供区创伤小、手术操作简便的优点,适合任何分型的第1跖背动脉。     

第一趾蹼皮瓣修复手掌手指软组织缺损

手掌指软组织缺损常可用各种带蒂皮瓣修复,但常有皮瓣臃肿,外观欠佳,感觉不良,患手固定时间长等缺点。自1992年1月以来我科用吻合血管神经的第一趾蹼游离皮瓣修复手掌指软组织缺损14例,效果良好。临床资料本组14例中,男性10例,女性4例,年龄最大45岁,最小21岁。软组织缺损部位:虎口处缺损5例,拇指掌侧缺损4例,拇指掌侧伴虎口处缺损3例,食指掌侧缺损2例。拇食指处缺损均伴有指神经缺损,肌腱及或指骨外露。软组织缺损面积,最大4cm×6cm,最小2.5cm×4cm。修复方法:切取第一趾蹼游离皮瓣,其中足背动脉与桡动脉腕背支吻合,大隐静脉与头静脉吻合,腓…     

应用第1趾蹼皮瓣游离移植修复拇指及手指指蹼软组织缺损

目的:探讨应用第1趾蹼皮瓣游离移植修复拇、手指指蹼软组织缺损的临床疗效。方法:2016年7月至2019年7月,收治9例拇、手指指蹼软组织缺损患者,男5例,女4例,年龄20~49岁。软组织缺损位于指蹼,缺损面积1.9 cm×5.5 cm~3.3 cm×7.2 cm,创面合并骨外露;均采用第1趾蹼皮瓣游离移植修复,切取皮瓣...     

趾腹趾蹼游离皮瓣移植修复手部瘢痕

目的探讨趾腹、趾蹼游离皮瓣修复手部掌侧皮肤瘢痕挛缩的临床应用价值。方法1998年1月～2006年12月,应用吻合血管游离趾腹、趾蹼皮瓣,或趾腹联合趾蹼皮瓣,修复手部掌侧皮肤瘢痕挛缩12例。结果3例皮瓣边缘部分坏死,其余皮瓣全部成活。10例获得随访6～10个月,术后手部外形满意,皮纹清晰,两点分辨觉5～7mm,手指功能良好。结论足部趾腹、趾蹼皮瓣,或趾腹、趾蹼联合皮瓣,是修复手、手指掌侧皮肤挛缩的良好供区。     

第一趾蹼皮瓣修复重度虎口挛缩

临床上，多种因素可导致手部虎口区的挛缩。对重度虎口挛缩，采用第一趾蹼皮瓣不仅能修复虎口开大后的皮肤缺损，且在外形和功能上都令患者感到满意。2004年以来，我院应用改良的第一趾蹼皮瓣修复重度虎口挛缩3例，术后取得了满意的疗效。     

第一趾蹼皮瓣游离移植重建口角的应用解剖

目的为第一趾蹼皮瓣移植修复重建颜面口角软组织缺损提供解剖学基础。方法解剖观测40侧成人下肢标本第一趾蹼皮肤软组织区域的血管和神经分布。结果该区由第一跖背动脉供血,第一跖背动脉为足背动脉的分支,其主干长为(4.6士0.6)cm,起始处外径为(1.6士0.3)mm,感觉神经来自腓深神经。结论第一趾蹼皮瓣与口角形态、厚薄近似,取材方便,吻合血管易于成活,是口角再造的理想组织瓣。     

第一趾蹼区游离皮瓣修复虎口及指腹缺损的疗效

目的介绍用第一趾蹼区游离皮瓣修复虎口及指腹软组织缺损的疗效。方法对2例虎口瘢痕挛缩以及5例外伤后手指指腹软组织缺损者,采用第一趾蹼区游离皮瓣修复瘢痕切除后的创面和软组织缺损创面。供区用全厚皮片植皮。结果7例皮瓣全部存活。术后平均随访8个月,虎口开大为健侧的70%,手指指腹外形良好,屈伸自如,两点分辨觉为10~12mm。7例术后3个月足部行走正常,无疼痛;其中2例趾蹼处有瘢痕。结论应用第一趾蹼区游离皮瓣修复虎口及手指指腹皮肤缺损,手术虽然复杂,但术后感觉恢复满意。     

额鼻皮瓣在鼻尖部缺损修复中的应用

目的介绍额鼻皮瓣在鼻尖部缺损修复中的应用经验。方法在遵循鼻亚单位组成的美学原则基础上,根据鼻尖部创面的大小、形状、深度,设计以内眦动脉分支血管为蒂的轴型额鼻皮瓣覆盖创面。结果共施行手术21例,创面面积1.2cm×1.2cm~2.0cm×2.0cm。术后皮瓣全部成活,无明显并发症发生。其中18例获得随访1~36个月,鼻外形轮廓较好,修复组织与周围皮肤匹配良好。结论遵循鼻亚单位美学原则,应用额鼻皮瓣修复鼻尖部2.0cm×2.0cm以下创面,色泽、质地、轮廓等方面能达到较好的匹配和协调,可获得满意功能和美学效果。     

额鼻皮瓣在鼻尖部缺损修复中的应用

目的 介绍额鼻皮瓣在鼻尖部缺损修复中的应用经验.方法 在遵循鼻亚单位组成的美学原则基础上,根据鼻尖部创面的大小、形状、深度,设计以内眦动脉分支血管为蒂的轴型额鼻皮瓣覆盖创面.结果 共施行手术21例,创面面积1.2 Gm×1.2 cm～2.0 cm×2.0 cm.术后皮瓣全部成活,无明显并发症发生.其中18例获得随访1～36个月,鼻外形轮廓较好,修复组织与周围皮肤匹配良好.结论 遵循鼻亚单位美学原则,应用额鼻皮瓣修复鼻尖部2.0 cm×2.0 cm以下创面,色泽、质地、轮廓等方面能达到较好的匹配和协调,可获得满意功能和美学效果.     

同指双侧指动脉顺行岛状皮瓣修复指端缺损

目的总结双侧指动脉顺行岛状皮瓣修复指端缺损的临床疗效。方法2010年12月-2012年8月,采用双侧指动脉顺行岛状皮瓣修复指端软组织缺损13例,面积最大为22mm×25mm,最小为12mm×18mm。结果13例皮瓣全部成活,伤口愈合良好。术后随访3-12个月,皮瓣外形满意、质地柔软、弹性良好．两点辨别觉达6～8mm,手功能TAM法评定：优12例,良1例,优良率100％。结论该手术方法操作简便、安全,术后效果满意,是修复指端缺损较为理想的方法。     

鼻前庭三角瓣法唇裂修复术

目的　介绍鼻前庭三角瓣法修复Ⅱ度唇裂的手术方法及其优点。方法　鼻前庭三角瓣法唇裂修复术按直线法定点 ,根据鼻底部三角形大小设计鼻前庭三角瓣修复Ⅱ度唇裂 ,并充分考虑Ⅱ度唇裂特点 ,在延长患唇时只延长裂隙内侧而不延长外侧 ,保留和合理利用了上方 (鼻孔底部 )本该切除的等边三角形皮瓣 ,使手术效果更令人满意。结果　 1993年 3月至 2 0 0 0年 12月行鼻前庭三角瓣法手术修复 2 0 8例唇裂患者 ,随访 136例 ,随访时间为 3个月至 6年零 5个月 ,优良率为 92 .6 %。结论　鼻前庭三角瓣法唇裂修复术既保留了直线法与上三角瓣法的优点 ,又克服了其他方法的不足 ,适用于Ⅱ度唇裂的修复     

Nasal tip repair with axial flap of nasal muscle

The procedure described here consists of a myocutaneous axial flap with lateral pedicle. It uses the transverse part of the nasal muscle that goes forward in rotation and the lateral and superior portions of the flap in the V-Y. The procedure is useful for repairing losses of nasal tip and the surrounding area. It is a simple method that can be used to reconstruct the brim near the tip of the nose, yielding an aesthetically and functionally efficient nose.     

Reconstruction of the columella using the prefabricated reverse flow submental flap: A case report

BACKGROUND: The reconstruction of columellar defects is still a challenging procedure because of limited local and regional flap options and the characteristics of the anatomy of this site. Although a number of methods are available to repair nasal columella defects, no treatment of choice ensuring an excellent texture- and color-matched tissue in one stage has been determined to date. METHOD: In this case, we used a reverse-flow submental island flap prefabricated with the costal cartilage for the reconstruction of a complex columellar defect. RESULT: The flap survived completely with reversible venous congestion. The cosmetic result and nasal respiratory function were acceptable during the follow-up time of 6 months. CONCLUSION: We propose that the prefabricated reverse submental flap may be an alternative among the surgical options for columellar defects. This flap may also be considered in the reconstructive repertoire of other composite defects of the head and neck region.     

示指固有动脉指背皮瓣和前臂逆行桡动脉皮支皮瓣修复鼻尖、鼻小柱缺损

目的探讨在颜面以外的部位寻找合适的供皮瓣区修复鼻尖、鼻小柱缺损。方法采用示指固有动脉指背皮瓣和前臂逆行桡动脉皮支皮瓣两种手术方法，修复7例鼻尖、鼻小柱缺损。结果所有皮瓣均成活良好，通过1～4年的随访，外形良好，皮瓣色泽、质地和周围正常皮肤十分接近。结论采用示指固有动脉指背皮瓣和前臂逆行桡动脉细小皮支皮瓣修复鼻尖、鼻小柱畸形，避免了在颜面部遗留明显的继发畸形，后期多无需去脂，较易被患者接受。     

The chondrocutaneous ear helical free flap for the reconstruction of the defects of the nasal tip, columella and/or ala

Reconstruction of the full-thickness defect of the tip of nose, columella, and ala has always been a challenge. Local flaps can be used, but this often results in a bulky nose with an unsatisfactory aesthetic appearance requiring secondary surgical procedures. The use of the ear as a donor site for a microvascular free flap, although not general consensus despite structural similarities between the nose and ear, offers a possibility of a good reconstruction for such patients. Five patients presented with composite tissue defects of the tip, columella and ala of the nose resulting from human bites. Reconstruction was performed early in order to avoid possible infection. The free flap was designed and elevated from the upper part of the helix and concha of the opposite ear; the flap matched the traumatic defect on the nose and was based on the anterior auricular branches of the superficial temporal vessels. The free flap was brought to the defect and sutured to the margins. Direct end-to-end anastomosis of both vessels was performed in four patients while a venous grafts was needed in one patient. The donor flap area was closed directly. The follow-up period ranged from six months to five years. The reconstruction was satisfactory as to contour, symmetry and colour match in four patients. The final aesthetic result was obtained by touch-up procedures under local anesthesia. The donor site deformity was minimal. In one patient, the free flap was lost due to venous thrombosis and late reintervention. The chondrocutaneous free flap represents a dependable vascularized composite tissue transfer that offers a straightforward one-stage reconstruction of tissue defects of the tip, columella, and ala of the nose. The additional advantages of freedom in the flap design and structural similarity between the nose and ear makes it an ideal choice for such defects.Presented at the 5th EURAPS Meeting, Geneva, Switzerland, May 13, 1994     

吻合血管的逆行游离耳前皮瓣移植修复鼻部分缺损

目的旨在设计以颞浅动脉远端为蒂的逆行游离耳前皮瓣进行吻合血管的移植一期修复鼻部分缺损。方法本组共3例,1例为鼻尖缺损,1例为右侧鼻翼缺损,1例为鼻尖缺损、右侧鼻翼完全缺损及左侧鼻翼不完全缺损。术中将游离逆行耳前皮瓣的颞浅动、静脉分别与鼻唇沟部面动、静脉吻合,其中1例急诊患者颞浅静脉是与下睑伤口的一条静脉吻合。结果逆行游离耳前皮瓣大小范围为3.0 cm×2.5 cm~6 cm×2 cm,血管蒂长5~6 cm。3例患者皮瓣均成活,再造的鼻尖、鼻翼外形逼真,皮肤色泽、质地与鼻部皮肤接近。耳前供区切口隐蔽不遗留明显瘢痕。结论耳前皮瓣皮肤颜色、质地与鼻部接近,皮瓣血管蒂长,不需要血管移植,可通过显微外科技术一期修复鼻部分缺损,该皮瓣也可用于面部其他皮肤缺损的修复。     

Reconstruction of fully shaped fingers using a free great toe nail flap combined with a second toe tissue flap

To explore the clinical outcome of a free great toe nail flap (GTNF) combined with a second toe tissue flap (STTF) for fully shaped finger reconstruction (FSFR). From January 2013 to January 20, 2019, patients with finger defects underwent finger reconstruction using free GTNF combined with an STTF. All 20 fully shaped, reconstructed fingers survived without complications. The average follow‐up time was 44.4 months (range 12‐60 months). The reconstructed fingers had better function and appearance. The length of the fingers was close to normal, and the joint positions were normal. The fingers were able to extend −15° to −5° and flex 40° to 85°. The reconstructed fingers had no pain or numbness, and the function of the feet was restored well. The reconstruction of fully shaped fingers using GTNF combined with an STTF results in better function and appearance. This surgical method is worthy of promotion. This article introduces a new surgical method that is related to finger reconstruction. Finger defects bring psychological and functional regrets to patients and their families. Through this operation, the reconstructed finger is more perfect in appearance and function. I think this technology is very effective and worth promoting.