游离躅趾腓侧皮支皮瓣修复手指创面1例报告

患者男,18岁,因右中指挤压伤,疼痛流血4h于2013年4月29日入院。查体见右中指末节指骨及甲床部分缺损,创面大小约1．5cm×1．5cm。在左足躅趾腓侧设计躅趾腓侧动脉皮支供血的微型皮支皮瓣,游离移植修复创面。手术方法：受区清创后,解剖游离出双侧指固有动脉,保留末节指动脉弓及小分支,末节指掌侧正中解剖出皮下浅静脉,     

足部静脉皮瓣修复断指再植合并血管、皮肤缺损11例疗效观察

目的探讨足部静脉皮瓣修复断指再植合并血管、皮肤缺损的临床疗效。方法对11例断指合并掌侧皮肤、动脉缺损的患者行足内侧浅静脉皮瓣移植及再植手指,一期修复再植手指皮肤与动脉缺损。结果 11例足部静脉皮瓣与再植手指全部成活,外形与功能良好。结论足部静脉皮瓣一期修复再植手指血管与皮肤缺损操作简单,对供区损伤小,成活率高。     

指固有动脉侧方掌侧皮瓣修复糖尿病合并指端缺损效果的临床探讨

目的观察指固有动脉侧方掌侧皮瓣修复糖尿病患者合并指端缺损的临床效果。方法收集近年来某医院治疗的32例糖尿病合并指端缺损患者为研究对象,所有患者均为指固有动脉侧方掌侧皮瓣手术修复,围术期应用胰岛素控制血糖,观察治疗效果。结果所有患者皮瓣全部成活,供区创面Ⅰ期愈合,围术期患者血糖在适宜范围。术后随访6~12个月,伤指术后皮瓣质地、厚度、色泽与受区相似,不臃肿、耐磨,手指伸屈功能满意,外形美观,皮瓣两点分辨觉10~15 mm,感觉良好。结论指固有动脉侧方掌侧皮瓣手术修复糖尿病合并指端缺损患者可在局麻下进行,操作简单,安全可靠,皮瓣切取后供区损伤小可以直接缝合,必须保证患者围术期血糖在适宜范围,治疗效果较为满意,值得临床推广应用。     

游离微型鱼际皮支皮瓣移植修复手指掌侧创面1例报告

患者男,48岁,因左小指刀割伤疼痛流血3h于2009年6月11日入院。患者于3h前不慎割伤左小指,疼痛流血。体格检查：左小指中、远节尺掌侧组织缺损约1．5cm×2．0cm,尺侧指固有动脉、指神经缺损约1cm,骨质外露。在同手鱼际部设计桡动脉掌浅支的皮支供血,微型皮支皮瓣,游离后移植修复创面。手术方法：臂丛麻醉后,上气囊止血带,     

带部分指固有神经的指动脉逆行岛状皮瓣修复指端软组织缺损效果观察

目的 观察带部分指固有神经的指动脉逆行岛状皮瓣修复指端软组织缺损的效果.方法 选择指端软组织缺损31例(40指),采用带部分指固有神经的指动脉逆行岛状皮瓣进行修复.结果 术后修复皮瓣及植皮均顺利成活,切口均一期愈合.本组26例(33指)获随访,随访0.5～2 a;患指皮瓣与健侧指相比,外形美观丰满,残端耐磨,无明显色素沉着及瘢痕挛缩,皮瓣两点辨别觉4.3 ～6.2 mm;患者均恢复了原来的工作,对外形及感觉恢复满意.结论 带部分指固有神经的指动脉逆行岛状皮瓣修复指端软组织缺损操作简单、副损伤较小,可获得满意的外观和优良的功能,并有保护性感觉的优点.     

带单侧指固有动脉的推进皮瓣修复指端指腹缺损

用带单侧指固有动脉的推进皮瓣修复指端指腹缺损29例.皮瓣全部存活,随访3～6个月伤指外形功能感觉恢复良好.认为带单侧指固有动脉的推进皮瓣在修复指端指腹缺损中有非常大的优势.     

同指带指神经随意皮瓣修复指端缺损（附11例观察）

目的探讨以带指神经随意皮瓣修复指端软组织缺损的临床效果。方法对11例指端软组织缺损者（13指）,于伤指创缘近端桡侧或尺侧设计带指神经的皮瓣,深筋膜下锐性分离,逆行转移修复指端缺损。结果11例（13指）除1例皮瓣远端1/4区域出现张力性水泡,表皮脱落后皮瓣成活外,其余皮瓣均一期存活,两点瓣别觉达4～7 mm,手指活动基本正常。结论带指神经随意皮瓣制作简单,对供区损伤小,可保留皮瓣感觉功能,是修复指端软组织缺损较为理想的方法。     

岛状皮瓣在手指及手皮肤软组织缺损修复中的应用

目的 观察手部岛状皮瓣修复手指及手皮肤软组织缺损的临床效果.方法 手指及手皮肤软组织缺损患者33例,其中10例应用掌背皮动脉的逆行岛状皮瓣修复,3例应用虎口背侧的岛状皮瓣修复,7例应用拇指尺背侧动脉的逆行岛状皮瓣修复,4例应用示指后侧的神经血管蒂岛状皮瓣修复,6例应用指动脉蒂逆行的岛状皮瓣修复,3例应用带指固有神经后侧支或指背神经筋膜蒂的逆行岛状皮瓣修复.结果 术后皮瓣顺利存活20例,皮瓣出现张力性水泡10例、淤血2例、表皮坏死1例,经对症处理均存活.术后随访6～24个月,皮瓣柔软有弹性,无明显疼痛感.术中行神经吻合者,术后两点辨别觉平均6.2 mm;未行神经吻合者,术后两点辨别觉平均为8.6mm.按照ATM法评定手功能,结果功能为优40指、良9指、可2指,总优良率96.08％.结论 对手指及手皮肤软组织缺损,采用手部岛状皮瓣进行修复安全、有效.     

第一掌骨颈桡侧穿支皮瓣游离移植修复指腹缺损1例

患者男,21岁。因外伤后右中指末节指腹软组织缺损并指骨外露2 h,于2014年6月11日入院。查体:右中指末节指腹见一大小约2.1 cm×1.6 cm的创面,桡侧指固有动脉、指神经缺损约1.5 cm,指骨质外露。手术设计:术前用多普勒精确探测定位第一掌骨颈桡侧穿支血管走向及分布范围,并划线标记。在鱼际区桡侧设计皮瓣,以拇指桡侧指固有动脉在第一掌骨颈桡侧的穿支为供血动脉蒂。皮瓣静脉选用鱼际区浅静脉。供区处理:创面清创,解剖     

保留与不保留指神经的指动脉逆行岛状皮瓣修复指端缺损比较

目的观察和比较保留与不保留指神经的指动脉逆行岛状皮瓣修复指端缺损的临床疗效。方法选择我院收治的36例手指指端缺损患者作为研究对象,按照是否保留指神经的手术方式分为保留组(B组,18例)和不保留组(F组,18例)。B组采用保留指神经的手术方式,F组采用不保留指神经的手术方式。观察和比较两组患者的患侧皮瓣存活、功能恢复、两点辨别觉情况。结果两组患者患侧皮瓣存活和功能恢复情况均可。F组患者两点辩别觉明显优于B组患者,差异有统计学意义(P0.05)。结论保留与不保留指神经的指动脉逆行岛状皮瓣修复指端缺损,皮瓣存活和功能恢复情况均可,在两点辨别觉方面不保留指神经的手术方式具有明显的优势。     

以第一足心动脉为蒂的足背皮瓣逆行转移修复足部远端创面的可行性探讨

目的探讨足部远端创面修复的可靠方法。方法选取3例第一跖背动脉Ⅲ型足部远端损伤患者,于足背设计皮瓣,供血血管取自足背动脉在第一、二跖骨基底处发出的皮支。皮瓣游离后切断足背动脉近端,沿第一跖骨与第一骨间背侧肌间向深面解剖显露第一足心动脉,并向远端游离适当长度,形成以第一足心动脉为蒂的皮瓣,逆行转移修复足部远端创面。结果所有皮瓣及供区植皮均完全成活,皮瓣面积为3．5cm×2．0cm—8．0cm×6．0cm。随访5～6a,皮瓣平整美观,成活情况良好,患者行走功能正常,感觉功能恢复满意。结论以第一足心动脉为蒂的足背皮瓣逆行转移修复足部远端部位创面效果好,临床可行。     

带神经、血管预构皮瓣的动物实验及临床应用研究

目的探讨带神经、血管的预构皮瓣治疗四肢严重皮肤缺损的可行性.方法动物实验:新西兰大耳白兔15只,随机分为3组各5只.A组:植入腹壁下动静脉血管束;B组:植入阴部外动静脉血管束; C组:植入股动静脉血管束及部分股神经.术后3周观察血管、神经生长情况.临床应用:手背皮肤缺损患者2例,用腹壁下深动脉和股外侧皮神经转移至腹壁皮下预构皮瓣,修复创面.结果动物实验:3组预构皮瓣血管生长良好,C组可见少量神经纤维和轴突向远端生长.临床应用:2例患者皮瓣全部成活良好,且有皮肤浅感觉.结论预制带神经、血管的皮瓣并用于治疗四肢严重皮肤缺损是可行的.     

Retrograde recanalization of coronary artery occlusions: novel method for increase of the rate of successful interventions

First results of the use of a novel method of percutaneous coronary angioplasty of chronic occlusions of coronary arteries are presented. In 8 patients (men aged 54 - 75 years, mean age 60,4 +/- 7.1 years, mean duration of occlusion 45.5 +/- 7.9 months) retrograde recanalization was carried out through collateral branches of right coronary artery (RCA, 6 patients) or left anterior interventricular artery (LAIA, 2 patients). In all cases the procedure was preceded by unsuccessful attempts of antegrade recanalization of occlusion. Retrograde intervention was successful in 6 of 8 cases (5 RCA, 1 - LAIA). Technique of retrograde recanalization is described, criteria of selection of collateral branch, and instrumentation for optimization of the method are presented. As collateral branch in 6 cases we used septal branches either from LAIA (in case of recanalization of RCA) or from posterior interventricular branch of RCA (intervention on LAIA). In 2 cases retrograde recanalization of RCA was performed through posterior-lateral collateral branch of the circumflex artery.     

Unusual complication of aortic dissections: intimo–intimal intussusception

Angiography with a pre-diagnosis of acute coronary syndrome was performed in a 76-year-old female patient presenting to another hospital with symptoms of chest pain and syncope. Upon determination of type III aortic dissection, the patient was referred to our clinic. On CT angiography, the ascending aortic diameter was 57 mm and no dissection flap was observed. There was a filling defect suggestive of intimo–intimal intussusception at the level of the aortic arch, occlusion of the left arteria carotid communis, and a double-channel aorta extending from the left subclavian artery to the iliac artery. On transoesophageal echocardiography, the ascending aorta was seen to be larger than normal and no dissection flap was observed. There were findings suggestive of haematoma and intimo–intimal intussusception at the proximal part of the aortic arch. The dissection flap causing occlusion in the vascular structures was resected. Supracoronary graft replacement of the ascending aorta was performed. Transoesophageal echocardiography is an invasive investigative method with high sensitivity and specificity for the diagnosis of intimo–intimal intussusception.     

Use of transcutaneous electrical nerve stimulation for fingertip analgesia: a pilot study.

STUDY OBJECTIVES: To determine if transcutaneous electrical nerve stimulation (TENS) can produce fingertip analgesia. DESIGN: Randomized, crossover trial. PARTICIPANTS: Fifteen healthy volunteers, naive to the technique of TENS. INTERVENTIONS: TENS stimulation was applied to the middle and ring fingers of each subject's hands by means of small carbon electrodes placed over the digital nerves. Patients received one fingertip puncture from a mechanically driven sterile lancet device to each digit corresponding to one of four conditions: sham, one minute of TENS, ten minutes of TENS, and 20 minutes of TENS. The TENS unit was operated in the "burst" mode, with two eight-pulse burst groups per second (pulse width, 225 mu sec; pulse frequency, 80 Hz). The order of the conditions and the finger used for each condition were assigned randomly. The pain of each puncture was rated on a 10-cm visual-analog scale. Data were analyzed using a repeated-measures analysis of variance with Duncan's multiple comparisons procedure. MEASUREMENTS AND RESULTS: Mean visual-analog scale scores decreased sequentially from sham in each experimental condition: one minute of TENS, 24.4% (P < .025); ten minutes of TENS, 28.2% (P < .025); and 20 minutes of TENS, 55.7% (P < 10(-6)). Two patients had total anesthesia of the fingertip (visual-analog scale = 0 cm) in the 20-minute TENS condition. CONCLUSION: TENS significantly reduces the pain of lancet-induced trauma to the fingertip. Further studies are warranted to determine if this technique is useful clinically as an alternative or adjunct to digital nerve block anesthesia for fingertip surgical procedures.     

Ⅱ型合并室间隔缺损的肺动脉闭锁患者固有肺动脉发育分析

目的:分析Ⅱ型合并室间隔缺损的肺动脉闭锁患者中固有肺动脉的发育情况及其影响因素。方法:回顾21例Ⅱ型合并室间隔缺损的肺动脉闭锁的影像学资料,分析体肺侧枝及固有肺动脉的形态学特点。结果:5例体肺侧枝直接与心包内固有肺动脉相连,不直接供应肺组织血供,肺动脉指数为1.5±0.3,固有肺动脉供应(15.2±3.2)个肺段。16例患者侧枝在肺叶及以下的肺动脉分支与固有肺动脉相连,肺动脉指数0.8±0.4,供应(4.9±4.7)个肺段,两组肺动脉发育及供应肺动脉范围差异有统计学意义。回归分析提示交通支直径是固有肺动脉发育的影响因子。结论:侧枝直接与心包内固有肺动脉相连,固有肺动脉发育好。侧枝在肺叶及以下的肺动脉分支与固有肺动脉相连,固有肺动脉发育差,且变异很大,固有肺动脉发育与交通支直径直接相关。     

Glissonean pedicle transection method for hepatic resection: A new concept of liver segmentation

A new concept of hepatic segmentation along with the Glissonean pedicle tree, and the basis of hepatic resection by the Glissonean pedicle transection method are presented. The portal triad continues from the hepato-duodenal ligament to the intra-hepatic portion as the Glissonean pedicle. That is, the artery, portal vein and bile duct, together with connective tissue, are sheathed by the peritoneum to form a fibroid bundle. The entire length of the primary branches of the Glissonean pedicle and the origin of the secondary branches are located outside the liver and the trunks of the secondary and more peripheral branches run inside the liver. The ramification pattern of the tertiary branches which branch out from each secondary branch is different from patient to patient. The liver is nourished by the secondary branches of the Glissonean pedicle. Each secondary branch feeds one segment. The liver can thus be separated into three segments and an additional caudate area. The area fed by each one of the tertiary branches is cone-shaped; fermed a “cone unit”. Each segment conists of six to eight cone units. In limited resections, the number of cone units to be respected is adjusted and the tertiary branches which feed these areas must be transected selectively through a hilar or a parenchymal approach. To date we have experienced no complications with this procedure, employed for 832 patients with hepatocellular carcinoma.     

游离神经移植修复周围神经缺损100例

目的 探讨自体腓肠神经等感觉神经游离移植修复四肢神经缺损。方法 对100例外伤所致四肢神经缺损者根据神经缺损部位及游离移植神经长度。分别用带血管的神经游离移植和单纯的神经游离移植。神经供区：腓肠神经(87例)、臂内侧皮神经(6例)、前臂内侧皮神经(1例)、前臂外侧皮神经(2例)、腓浅神经(2例)、隐神经(2例)。结果术后随访71例(85条神经)。随访时间18～60个月，其中优(M4S3 )13例(14条)．良(M3S3)22例(26条)。可(M2S2)32例(40条)，差(M1S1以下)4例(1条)。结论 用自体神经移植修复四肢神经缺损，可有效恢复损伤神经．对肢体的功能恢复仍有较为满意的效果。     

Acoustic pressure wound therapy in the treatment of a vasculopathy-associated digital ulcer: a case study

Digital vasculopathy and subsequent digital ulceration are common and painful complications of limited cutaneous systemic sclerosis. Although the use of hydrocolloid occlusive dressings has been found to reduce pain, frequently required surgical or chemical debridement can be intensely painful in such ulcers. Acoustic pressure wound therapy is a noncontact, low-frequency ultrasound therapy used for painless debridement in a variety of acute and chronic wounds. It was administered to treat an intensely painful, methicillin-resistant Staphylococcus aureus-infected finger ulcer resulting from peripheral, bilateral vasculopathy in a 68-year-old man with a history of three prior fingertip amputations secondary to limited cutaneous systemic sclerosis-associated digital vasculopathy. At treatment initiation, 90% of the 11 cm2 wound was covered with firmly adherent fibrin slough. Acoustic pressure wound therapy was performed three times weekly for 5 minutes per treatment and the wound was covered with a hydrocolloid occlusive dressings. Pain scores decreased from 10 (visual analog scale, 0 = none, 10 = extreme) at the beginning of treatment to 0 at the week 8 assessment and his analgesics were discontinued. After 10 weeks (31 acoustic pressure wound therapy treatments), the wound was completely closed.     

Glossopharyngeal innervation of chemo- and baroreceptors in the dorsal carotid artery of the tortoise Testudo hermanni

Electrophysiological studies demonstrate the existence of chemo- and baroreceptors in the dorsal carotid artery of the tortoise, Testudo hermanni Gmelin. A fine nerve branch, 5-7 microns in diameter, originates from the glossopharyngeal nerve and terminates in the part of the dorsal carotid artery between its origin at the subclavian artery and the bifurcation of the tracheal branch. When afferent impulses were recorded from this fine nerve simultaneously with the blood pressure, two kinds of activity were observed. One, synchronous with blood pressure fluctuation, appears to originate in baroreceptors. The other, non-rhythmic, consisted of an increase of impulse frequency to hypoxia, hypercapnia and NaCN, characteristics of an arterial chemoreceptor. Thus this fine nerve seems to correspond to the mammalian carotid nerve. Afferent innervation of the truncal region including the aorta and the pulmonary artery was nearly the same as that in some turtles.