以腓动静脉为蒂的小腿外侧皮瓣修复足部软组织缺损

足部外伤后容易造成肌腱或骨关节外露，需要用皮瓣移位或移植修复。1995年8月-2003年10月，我们应用以腓动静脉为蒂的小腿外侧皮瓣修复足部软组织缺损36例，其中吻合血管的游离皮瓣移植修复前足部软组织缺损22例，带血管蒂的逆行岛状皮瓣转移修复后足部软组织缺损14例，皮瓣全部成活，取得了良好的临床效果。     

游离股前外侧皮瓣修复烧伤致头部大面积颅骨外露三例

游离股前外侧皮瓣由于其解剖位置恒定，可供吻合的血管粗大，已在四肢软组织缺损的修复中得到了广泛应用。烧伤所致的大面积颅骨外露一直是临床治疗的难点，笔单位近3年来应用游离股前外侧皮瓣移植修复烧伤至大面积颅骨外露3例，骨外露得到一期修复，外形满意，特报告如下。     

应用游离胸脐皮瓣早期修复足踝部严重烧伤

足踝部软组织少、电烧伤后易造成软组织缺损，肌腱、神经、血管、骨质外露或毁损，且局部血供及创面条件差，传统植皮、局部任意皮瓣转移修复很难取得满意效果。2003年3月-2007年10月我们采用游离胸脐皮瓣早期修复足踝部严重烧伤致大面积皮肤缺损10例，取得满意效果，报道如下。     

人工真皮在手外科皮肤缺损中的应用

[目的]评价人工真皮修复在手外伤骨及肌腱外露创面应用的临床效果及可行性。[方法]收集2015年7月～2017年4月本院骨五科39例手外伤皮肤缺损伴骨或者肌腱外露患者的临床资料,所有患者均为一期彻底清创后人工真皮覆盖,二期行自体游离植皮手术,观察人工真皮及自体游离植皮成活情况。[结果] 37例患者人工真皮及自体游离植皮皮片全部成活,骨或肌腱外露均得到良好修复,外观平整,供皮区无明显瘢痕增生,2例失访。[结论]人工真皮联合自体游离皮片移植治疗手外伤皮肤缺损伴骨或者肌腱外露是一种有效的方法,值得推广应用。     

应用外科皮瓣修复四肢Ⅲ度烧伤并骨肌腱外露创面

目的报道应用各种皮瓣修复四肢Ⅲ度烧伤并骨肌腱外露创面的临床效果,探讨皮瓣的选用方法及手术成功要素。方法1996年3月以来应用各种皮瓣修复四肢Ⅲ度烧伤并骨肌腱外露创面48例。其中半岛状皮瓣3例,岛状皮瓣31例,肌皮瓣10例,游离皮瓣4例。切取皮瓣最大面积为12cm×22cm。结果术后皮瓣全部成活46例,部分成活2例,随访2个月～8年6个月,经皮瓣修复后皮肤色泽红润,质地柔软,患肢功能良好。结论皮瓣是修复四肢Ⅲ度烧伤并骨肌腱外露创面的良好方法。     

头皮缺损颅骨外露的修复

我科１９８０－１９９１年收治外伤性或颅面部肿切除后头皮缺损颅骨外露９例，分别应用吻合血管的游离大网膜结合中厚皮片移植，游离皮瓣或轴型皮转位结合皮片移植修复。讨论了修复时机，修复方法以及手术注意事项，认为双侧股前外侧游离皮瓣是修复头皮缺损颅骨外露的可取方法，而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。     

股前外侧皮瓣修复足背跖骨、肌腱外露创面临床体会

足部皮肤缺损是常她的损伤,常有肌腱、骨骼外露,需要用游离皮瓣修复。本院从2000年至2006年用股前外侧皮瓣修复足背部跖骨、肌腱外露创面10例,效果满意。现报道如下。     

游离皮片修复手(足)背肌腱外露

手（足）背皮肤组织缺失,肌腱外露通常采用皮瓣修复创面.我院于2003年1月～2005年3月,对17例因皮肤软组织缺失伴肌腱、骨外露的患者,采用了筋膜皮下组织瓣转移、游离植皮的方法修复创面,此法简单易行,取得了较理想的效果,现报道如下.     

游离皮瓣移植修复四肢复杂性软组织缺损

目的 报道应用显微外科技术游离皮瓣修复四肢复杂性组织缺损的临床应用效果。方法 应用肌皮瓣及皮瓣，通过游离移植的方法，修复四肢严重创伤所致的软组织缺损、肌腱及骨质缺损或外露。结果 临床应用移植128个皮瓣，其中成活123个，部分坏死5个，成活率96％；经3个月～15年随访，皮瓣成活良好，修复的肢体均保留和恢复功能。结论 游离皮瓣移植修复四肢复杂性软组织缺损疗程短、疗效好，功能恢复较满意。     

削薄型股前外侧皮瓣修复手外伤21例报告

各种创伤所致的四肢软组织缺损常合并肌腱、神经、血管等重要组织外露，游离植皮很难修复创面，常需皮瓣修复。笔者自2003年以来，共采取游离削薄型股前外侧皮瓣移植修复手腕部及前臂严重软组织缺损21例，效果满意。报道如下。     

The first human renal transplant and the first xenotransplant in Italy

The authors describe the first human renal transplantation and the first renal xenotransplant in Italy and the atmosphere at the University of Rome where these transplants were performed. Just a few months after those events, a state law was approved which allowed kidney donation.     

Osteoclastoma of the first metacarpal

A case of osteoclastoma of the first metacarpal is reported. Reconstruction by en bloc excision and autologous bone graft is described. Other therapeutic options are reviewed.     

Hypermobility of the first ray

Hypermobility of the first ray is one of the causative components in common foot problems (such as hallux valgus) with a large intermetatarsal angle and metatarsus primus varus. Although not always associated with hallux valgus, hypermobility is a predisposing factor for this deformity, especially in conjunction with extrinsic factors, such as disruption of the plantar first metatarsal cuneiform ligament and tendon-muscle imbalance. Hypermobility is also frequently found in adolescents with hallux valgus, especially when associated with a large intermetatarsal angle. Motion at the first metatarsocuneiform joint occurs in the sagittal and transverse planes. Most studies agree that greater than 4 degrees and greater than 8 degrees, respectively, constitutes excessive motion. Clinically, hypermobility is evaluated by determining sagittal motion (the grasping test) and transverse motion (the clinical squeeze test) and by identifying signs such as the presence of a dorsal bunion, intractable plantar keratosis beneath the second metatarsal head, and arthritis of the first and second metatarsocuneiform joint. Radiographically, hypermobility is evaluated by measurements from the modified Coleman block test (for sagittal motion) and the radiographic squeeze test (for transverse motion) and by the identification of signs, such as cortical hypertrophy along the medial border of the second metatarsal shaft, a cuneiform split, the presence of os intermetatarseum, and the round shape and increased medial slope of the first metatarsocuneiform joint. Usually, treatment for hypermobility of the first ray is operative, but surgery is contraindicated for patients less than 20 years of age (especially when the epiphysis is not closed) and for patients with generalized ligamentous laxity, short first metatarsal, and arthritis of the hallux MTP joint. The authors' surgical treatment of choice is arthrodesis of the tarsometatarsal joint (as part of the hallux valgus correction), exostectomy, capsulorraphy, and distal soft tissue release to correct and stabilize the first metatarsal at the apex of the deformity. The authors have found it unnecessary to include the base of the second metatarsal. The main complications associated with the Lapidus procedure and its modifications are nonunion, malunion, and dorsal elevation of the first metatarsal. Although radiographic nonunion is the most frequent complication, only 25% of the patients with this condition have associated clinical findings; the results have been defined as good or excellent in two series. These results closely equal those in rheumatoid or sedentary patients managed with newer, modified, less traumatic techniques that stabilize the first metatarsocuneiform joint with screws rather than with arthrodesis.     

Elongation of the first metatarsal

A case is described in which a 30% elongation of the first metatarsal was achieved by gradual distraction with a mini-Hoffman device. The procedure resulted in considerable cosmetic improvement.     

Oncogenic hypophosphatemic osteomalacia: From the first signal of disease to the first signal of healthy

IntroductionThe physical incapacitation of the oncogenic hypophosphatemic osteomalacia (OHO) can be catastrophic and can lead to deformities, metabolic and organic instability and death. The only positive outcome is through early diagnosis by the clinical suspicion. At this moment, medical center infrastructure is also a keypoint.Presentation of caseThis case report is about a 60-year old woman with multiple fractures, gradual loss of strength and muscle mass and limiting deformities in two years of evolution until the diagnostic.DiscussionThe lack of knowledge of this disease causes a delay in diagnosis that can bring deformities to the patient, as well as death. Is crucial that is hypothesized to carry out the necessary tests, since they are expensive and not always available.ConclusionThis case reinforces the importance to understand the OHO and tumoral search, once this lesion is, in most cases, imperceptible to physical examination or several imaging studies.