乳腺癌术后皮瓣坏死的原因及预防

目的:探讨乳腺癌根治术后皮瓣坏死高发生率的原因及预防措施。方法:93例经改良手术方法行乳腺癌根治术病例与过去实施的172例病人术后皮瓣坏死和皮下积液发生率进行对照研究。结果:乳腺癌根治术后的皮瓣坏死 率由原来的54.7％降至3.2％,皮下积液发生率由57％降至8.6％,经统计学处理有显著差异。结论:乳腺癌根治术后减少皮瓣坏死的关键是:一定的皮瓣厚度、防止淋巴管瘘、通畅的引流和适当的胸带包扎力。     

乳腺癌术后皮瓣下积液的防治

为探讨降低乳腺癌根治术后皮瓣下积液的方法，笔者采用改进手术术式加皮瓣与胸壁固定加Y型管负压引流的新方法治疗乳腺癌，并与乳腺癌传统根治方法进行对比。结果示，新方法乳腺癌根治术后皮瓣下积液率由原来的23.4％下降至8.0％，效果显著。提示对乳腺癌手术术中、术后采取改进手术术式加皮瓣与胸壁固定加Y型管负压引流的新方法，可明显降低皮瓣下积液的发生率。     

乳腺癌根治术后皮瓣坏死及皮下积液的预防

目的:探讨乳腺癌根治术后皮瓣坏死皮下积液的原因与对策。方法:行乳腺癌根治术游离皮瓣时电刀采用小频率，皮缘3 cm以内不用电凝;应用较细的硅胶管螺旋式剪侧孔，置于术野边缘一圈，距皮缘3cm处缝皮瓣至胸壁，采取小负压吸引，无需胸带及皮外加压包扎。结果:42例乳腺癌根治术，仅1例行皮瓣转移患者有少许皮瓣坏死外，其余均为一期愈合。结论:乳腺癌根治术后皮瓣坏死，皮下积液及淋巴漏是可以预防的。     

乳腺癌根治术后预防皮瓣坏死的探讨

目的认识和探讨乳腺癌根治术后皮瓣坏死的前体症及发生率。方法通过对58例手术病历采用预防皮瓣坏死新方法的乳腺癌根治术与过去的480例乳腺癌根治术病例分组对比进行探讨。结果乳腺癌根治术的皮瓣坏死率由原来的32%降低到目前的2%,根据统计,二者明显差异。结论在乳腺癌根治术中关键在于防止腋下积液(淋巴管瘘),皮瓣游离区及腋下引流、术后胸带的松紧度及游离皮瓣的厚度和切缘缝合的张力。     

乳癌术后皮瓣坏死发生原因和预防

乳癌术后皮瓣坏死发生原因和预防罗力，迟宝恩，刘一龙乳腺癌根治术后并发皮瓣坏死是乳癌术后最常见的并发症，国内报导其发生率约为５１～７０％。我们自１９９０年１月至１９９３年１０月共施行乳癌根治术１０８例，其皮瓣坏死发生率为２４．１％。本文就其发生原因及预...     

乳腺癌改良根治术皮瓣处理效果分析

目的探讨乳腺癌改良根治术不同皮瓣处理方法对术后皮下积液及切口皮缘坏死的影响。方法回顾分析4年余行乳癌改良根治术（保留胸大、小肌）119例的临床资料，分析术中4种皮瓣处理方式的术后皮下积液及切口皮缘坏死的情况。结果119例患者术后发生皮下积液和／或皮缘坏死共43例。用横切口的79例中，术后积液13例，皮缘坏死3例；用纵切口40例中积液20例，皮缘坏死7例；用“皮瓣处理1”60例中积液23例，皮缘坏死8例；用“皮瓣处理2”59例中积液10例，皮缘坏死2例。结论横切口加1／400肾上腺素生理盐水皮下注入，加刀片分离皮瓣、加“铆钉”式缝合固定皮瓣的术式能有效地减少术后皮下积液和切口皮缘坏死的发生率。     

乳腺癌根治术后皮瓣下积液防治体会(附98例报告)

目的探讨乳腺癌术后皮瓣下积液的原因及预防措施,降低乳腺癌术后皮瓣下积液的发生率。方法对98例接受手术治疗的乳腺癌患者采取综合治疗措施,包括术中电刀的合理应用,彻底止血和淋巴管结扎,纤维蛋白胶的使用,重视术后切口的包扎,术中放置及术后适时拔除引流管,观察术后皮下积液的发生率。结果本组仅9例患者发生皮瓣下积液,发生率为9.18%,均经细针穿刺后消失。结论乳腺癌根治术后采取综合措施可降低皮瓣下积液的发生率。     

乳腺癌根治术后皮瓣坏死的原因分析与护理对策

乳腺癌的治疗仍以手术根治术为主,根治术后创面的护理很重要。引流不畅,易发生皮瓣坏死[1]。本文仅对乳腺癌术后皮瓣坏死的预防与护理浅谈体会。1临床资料全部病例均为女性,年龄30~65岁,手术病理诊断为单纯癌28例,浸润性导管癌16例,浸润性小叶癌6例,粘液腺癌5例,髓样癌2例。术后切口甲级愈合36例,9例出现血供不足、皮下积液,经治疗2例痊愈,7例发生皮瓣坏死。2皮瓣坏死原因分析根据本组资料及结合文献,导致术后皮瓣坏死的原因有:①游离皮瓣时,将皮肤与其下方的动、静脉血管切断,使皮瓣的血液循环差,这是主要原因;②皮下积液造成皮瓣长期处于…     

乳腺癌根治术的皮瓣处理

1989年1月至1991年12月,我们共施行乳腺癌根治术54例,其皮瓣处理方法随机分成皮瓣戳孔加压包扎组和皮下置管负压吸引组,结果前者术后皮下积血、积液和皮肤坏死等并发症的发生率明显低于后者,有显著性差异(P相似文献   

乳腺癌根治术后创面不加压包扎对预防皮瓣坏死的影响

目的探讨乳腺癌术后皮瓣坏死的发生原因及预防措施。方法回顾性分析2006年1月～2010年12月郑州人民医院280例乳腺癌手术患者的临床资料,其中创面加压包扎140例,创面不加压包扎140例。结果乳腺癌根治术后创面加压包扎皮瓣坏死29例,发生率为20.71%,创面不加压包扎皮瓣坏死15例,发生率为10.71%。结论乳腺癌根治术后创面不加压包扎是预防皮瓣坏死的一种方法。     

扩张皮肤软组织修复缺损中菱形皮瓣的应用

目的 探讨菱形皮瓣设计对扩张皮瓣中问松弛部分的充分利用.方法扩张后的皮肤软组织在设计旋转皮瓣修复缺损时,如果中间松弛部分不能充分利用.在旋转皮瓣上再次设计菱形皮瓣来充分利用扩张后的皮肤软组织,菱形皮瓣的尖部设计在扩张最充分部分,皮瓣蒂部设计在旋转皮瓣的切口侧,要注意保证菱形皮瓣与旋转皮瓣形成的复合皮瓣的长度与蒂的宽度比例在2.5:1.0.结果 11例在旋转皮瓣上再次设计菱形皮瓣,复合皮瓣的长宽比例最大达到3:1,多数在2.5:1.0.皮瓣全部存活,有1例皮瓣尖部小面积血运障碍,1例菱形皮瓣尖部早先轻度淤血.结论 该设计较充分、合理的利用了扩张后的皮肤软组织,最大可能的修复了缺损.复合皮瓣设计,一是注意长宽比例,二是尽量选择蒂部有知名血管的轴型皮瓣以策安全.只要设计合理,该方法是安全的,值得推广.     

A new skin flap method for total auricular reconstruction: extended scalp skin flap in continuity with postauricular skin flap and isolated conchal flap: four skin flaps and temporoparietal fascia flap

A sufficient skin envelope of good quality as well as definite auricular framework is a prerequisite for a successful auricular reconstruction. Various surgical techniques, such as recruitment of mastoid skin, skin graft, tissue expansion, and so on, have been used to get the necessary skin for covering of the auricular framework. However, debates about the drawbacks of these techniques have continued. In this article, I report on a new skin flap method for total auricular reconstruction, which is an extended scalp skin flap in continuity with postauricular skin flap and isolated conchal flap. Between January 2009 and March 2010, a total of 20 patients underwent an auricular reconstruction using a Medpor framework (Porex Surgical, Inc, Newnan, GA) and the new skin flap method. Follow-up time range was 4 to 17 months. The reconstructed ear showed no definite true hair growth except for some fine hair, which can be ignored. More favorable results such as a good color matched skin, well-formed ear convolution, no other donor site scars can now be achieved using this new method.     

远端蒂皮瓣或逆行岛状皮瓣转移术蒂部减张皮瓣的设计与应用

目的 探讨在远端蒂皮瓣或逆行岛状皮瓣蒂部设计减张皮瓣的可行性和临床应用效果.方法 临床应用胫后动脉内踝上皮支逆行岛状皮瓣修复9例,胫后动脉小腿内侧穿支远端蒂皮瓣修复2例,腓动脉外踝上皮穿支逆行岛状皮瓣修复8例,腓浅神经营养血管逆行岛状皮瓣修复4例,远端蒂腓肠神经营养血管皮瓣修复3例,掌背筋膜蒂逆行岛状皮瓣修复2例.蒂部减张瓣呈梭形或圆形,面积为1.0 am×1.0 cm～5.0 cm×3.5 cm.结果 28例皮瓣术后血运良好,无肿胀、淤血,全部成活,随访皮瓣质地良好,外形美观,供区均一期愈合,疗效满意.结论 在远端蒂皮瓣或逆行岛状皮瓣蒂部设计减张皮瓣是可行的.可有效地防止蒂部血管受压或血管网破坏而影响皮瓣的血运,是一种可靠的预防远端蒂皮瓣或逆行岛状皮瓣血供障碍的新方法.     

皮瓣与肌皮瓣联合法下睑袋整形术

下睑袋是由于下睑皮肤、眼轮匝肌、眶隔和眦韧带等结构的薄弱、松弛及张力减退而形成的下睑外观异常与袋状畸形.下睑袋的出现是中面部衰老的主要特征之一.近年来,由于生活水平的提高,对松弛的下睑结构进行修复和加强的下睑袋整形术已成为美容外科最常见的手术之一.     

额部阶梯状皮瓣与肌、皮双瓣鼻再造术

目的　改良目前常用的额肌皮瓣鼻再造术 ,克服其形态臃肿 ,再造鼻高度受限等不足 ,进一步提高手术效果。方法　根据新观察到的滑车上动脉于眉上存在一相同走向的皮支的解剖特点 ,设计额部阶梯状皮瓣与肌、皮双瓣 ,前者用于克服肌皮瓣臃肿 ,再造鼻形态欠佳的缺点 ,一次成形鼻各组成结构。后者组成结构肌瓣用于构建鼻中隔结构 ,适用于复杂病例 ,并可增加再造鼻高度。结果　 9例患者术中均可见滑车上动脉于眶缘上 1 2～ 1 7cm开始有皮支行于皮下 ,且与对侧有交通支。术后皮瓣全部成活 ,其中 1例鼻小柱右侧支架外露 ,经二次手术修复痊愈。鼻各组成结构塑形良好。结论　额部阶梯状肌皮瓣和肌、皮双瓣适用于修复不同程度的鼻缺损 ,再造鼻形态较好 ,可为鼻再造的首选方法。     

Nicotinamide enhances skin flap survival

The effects of nicotinamide in an abdominal island pedicle skin flap were examined. A 7 x 7 cm island pedicle skin flap ligating the left inferior neurovascular pedicle was created on 50 male Sprague Dawley rats (250-275 grams) that were divided into five groups. Animals received either 0.6 cc of saline or doses of nicotinamide for 16 days (14 days preoperatively and 2 days postoperatively): 25 mg b.i.d., 50 mg b.i.d., 100 mg b.i.d. or 200 mg b.i.d. Forty-eight hours postoperatively each animal received 25 mg of Fluorescein via the tail vein. The area of necrosis was visualized and quantified and is presented as % survival. A one factor Fisher PLSD test was performed with a statistical significance of p less than 0.05 with the results as follows: saline 58.8%, 25 mg 68.6%, 50 mg 82%, 100 mg 80.8%, and 200 mg 86%. From this data it would appear that the angiogenic factor nicotinamide may increase random flap survival.     

The bilobed skin flap rotation

The bilateral rotational skin flap is a plastic surgical technique suitable for filling defects on the foot too large to be served by a single pedicle flap. The execution of such a procedure requires careful planning and evaluation for sufficient circulatory support. Consideration for weight bearing is essential. No such flap rotations should be undertaken without a full understanding and acceptance of the consequences of failure, both on the part of the patient as well as the surgeon.     

Lateral lower leg skin flap

Use of a lower leg lateral skin flap in 7 patients since January 1982 is described. Satisfactory results were obtained in 6 of 7 patients. The blood supply of this new flap is based on the peroneal artery, which gives rise to cutaneous or musculocutaneous branches to nourish the flap. The venous blood of the flap is drained by the venae comites accompanying these cutaneous or musculocutaneous branches. In clinical practice, the beginning portion of the peroneal artery and the vein arising from the posterior tibial vein are used for vascular anastomosis. The caliber of the peroneal artery is 2.5 to 3.0 mm, and that of the peroneal vein is 3 to 4 mm. The vascular pedicle can be as long as 8 to 12 cm. In 4 of these patients, the flaps were freely transferred using a microvascular technique; in the remaining 3, a reversed transfer for treating defects over the foot was used.