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1.
游离皮瓣修复肿瘤切除术后喉咽和颈段食管缺损 总被引:1,自引:0,他引:1
晚期喉咽、喉癌手术切除后常造成颈前皮肤、喉咽和颈段食管的复杂缺损。以往修复的方法很多,但均有一定的优点和局限性。近年来,随着显微外科的发展,用游离皮瓣修复晚期头颈肿瘤切除术后的缺损,受到广泛的重视。1994年以来,我们对3例晚期喉咽、喉癌手术切除后,用游离皮瓣显微手术修复喉咽和颈段食管缺损,效果满意。现报告如下。 相似文献
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目的 探讨隧道皮瓣修复外鼻肿瘤切除术后缺损的意义。 方法 回顾分析2012年6月至2014年6月收治的27例外鼻肿瘤的临床资料,均行手术切除并根据肿瘤位于外鼻的部位和侵犯深度的不同,设计不同的隧道皮瓣修复缺损。 结果 27例患者皮瓣均一期修复成活,2个月后外观自然、皮色相近,患者接受度高,随访3个月~2年,1例鳞状细胞癌复发,再次手术切除,术后放疗。 结论 隧道皮瓣修复外鼻肿瘤切除术后缺损,皮瓣成活率高,术后外观自然,患者易于接受。 相似文献
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目的:总结菱形皮瓣修复头颈部皮肤肿瘤切除术后缺损的临床经验.方法:2002年7月~2006年9月收治的24例头颈部皮肤肿瘤患者.所有患者均采用术中冷冻切片监测标本及切缘,皮肤缺损范围为1.0 cm×1.5 cm~3.0 cm×3.5 cm,全部缺损均采用菱形皮瓣修复.结果:所有患者Ⅰ期修复,随访6个月~3年,术区皮肤色质正常、瘢痕不明显,无继发明显畸形.术后无复发.结论:菱形皮瓣设计合理,取材方便、操作简便,是临床即时修复头颈部皮肤肿瘤根治件切除术后缺损的较好方法. 相似文献
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目的 探讨耳颞部晚期肿瘤切除术后巨大组织缺损的一期重建方法。方法 对11例耳颞部晚期肿瘤患者实施肿瘤扩大根治性切除及带蒂胸大肌肌皮瓣、背阔肌肌皮瓣和游离腹直肌肌皮瓣转移耳颞部巨大缺损一期重建术。结果 所有患者的肿瘤都得到了完整切除,并在手术切除后于耳颞区留下一个巨大的复合组织缺损。根据缺损的位置和特点共实施带蒂胸大肌肌皮瓣移植8例,带蒂背阔肌肌皮瓣1例,游离腹直肌肌皮瓣移植2例,皮瓣全部成活。术后除1例发生皮瓣下感染外无其它并发症发生,所有患者的缺损都得以满意修复。结论 只要手术适应症选择恰当,修复方法选择合理,这类病人的手术治疗仍是值得提倡的。 相似文献
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目的胸肩峰动脉穿支皮瓣(thoracoacromial artery perforator,TAAP)是近年来应用于颈部和咽部组织缺损的新技术,本文分析使用TAAP修复颈咽部缺损的经验。方法回顾分析2013年5月~2017年4月诊治20例TAAP修复咽瘘、咽部黏膜缺损和颈部皮肤缺损。本组患者年龄48~68岁,平均年龄53岁。下咽癌切除+全喉切除10例,保留喉功能的下咽癌切除7例,颈部皮肤缺损3例。咽部黏膜缺损4.5 cm×3 cm~6.5 cm×5 cm,颈部皮肤缺损5.5 cm×4 cm~8 cm×6 cm,皮瓣大小6 cm×4 cm~8 cm×6 cm。结果18例术后皮瓣成活,供区直接拉拢缝合,没有出现皮瓣坏死,其中15例行下咽黏膜修复的患者,术后2~5周恢复经口进食并行术后放疗,剂量60~67 Gy。另2例术中发现穿支血运障碍,更换成颏下皮瓣修复下咽缺损。随访3~36个月,1例术后14个月出现胸段食管癌,1例术后18个月出现纵膈淋巴结转移,均予以放化疗, 1例术后1年出现颈部淋巴结转移复发予以化疗,余病例无复发。结论胸肩峰动脉穿支皮瓣因为邻近颈部、血管相对恒定、皮瓣薄适用于修复咽部黏膜和颈段食管缺损;胸肩峰动脉为血管蒂的一蒂双岛的TAAP和胸大肌皮瓣同时修复复杂的颈部皮肤和咽部黏膜缺损。胸肩峰动脉穿支皮瓣的穿支细小,穿越锁骨下隧道时穿支区域和血管蒂不能扭曲,发现皮瓣血运异常应及时更换其他修复方法。 相似文献
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孙兴和 《国外医学:耳鼻咽喉科学分册》1984,(3)
由于术前放疗、多次手术等原因引起局部组织缺损、瘢痕形成以及皮肤营养不良,喉癌术后发生的较大咽食管缺损不能完全采用局部组织修复。此时,往往采用费拉托夫皮瓣等方法修复。这些方法,需分期手术,住院时间长。为了增加皮瓣的血供,术后需要作特殊的练习。作者从1976年开始采用菲薄((?))带蒂皮瓣修复咽食管缺损,减少了手术次数,缩短了住院时间。共治疗12例,皆为T_(3~4)喉癌扩大喉全切除术后发生较大的咽食管缺损者。病人都是男性,年龄为38~62岁。10人术前放疗5000~8000拉德。4例因术后创口感染发生咽、食管缺损;8例术中切除了咽、食管前、侧壁。5人同时行颈廓清清术 相似文献
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目的 :探讨前臂皮瓣在耳鼻咽喉 头颈外科头颈部恶性肿瘤手术中的应用。方法 :对 6例咽喉部肿瘤切除后软组织缺损的病例 ,通常采用前臂皮瓣修复 ,即将皮瓣的桡动脉、头静脉与甲状腺上动脉和面静脉分别端端显微吻合 ,Ⅰ期修复组织缺损。结果 :修复成功 4例 ,失败 2例。结论 :前臂皮瓣具有血管表浅 ,行程稳定 ,口径粗 ,血管长 ,前臂皮肤薄、软、皮下脂肪少 ,具可塑性 ,可折叠等优点。经临床应用证实 ,前臂皮瓣修复是一种灵活多用 ,技术完善的头面、咽部及口底缺损修复的手段 相似文献
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邻位皮瓣修复鼻部皮肤恶性肿瘤切除术后缺损 总被引:1,自引:0,他引:1
目的介绍鼻部皮肤恶性肿瘤切除术后缺损的美容性修复方法。方法根据缺损大小、形状、部位及周围皮肤情况,选择相应邻位皮瓣修复鼻部皮肤恶性肿瘤切除术后缺损37例,其中基底细胞癌25例,鳞状细胞癌12例。肿瘤切除术后鼻部缺损面积0.8 cm×0.8 cm至5.0 cm×4.0 cm。皮瓣来源于菱形皮瓣9例,鼻唇沟皮瓣15例,皮下蒂皮瓣13例,供瓣区缺损直接拉拢缝合。结果术后皮瓣全部成活,切口Ⅰ期愈合,术后31例患者获随访1~18个月,鼻外形良好,恶性肿瘤无复发。结论应用颜色、质地相匹配的邻位皮瓣修复鼻部皮肤恶性肿瘤切除术后缺损,在治疗疾病同时,又获得了满意的美容效果。 相似文献
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目的:探讨应用外鼻临近局部皮瓣修复外鼻小面积缺损的方法与临床疗效。方法:42例鼻小面积缺损(直径〈2cm)的患者分别应用外鼻局部皮瓣(鼻背瓣、鼻唇沟瓣和双叶瓣)修复。皮肤恶性肿瘤切除后缺损38例,皮肤其他良性病变4例,缺损直径1~2cm。鼻尖缺损7例采用鼻背旋转皮瓣一期修复;鼻侧部缺损30例采用鼻唇沟瓣修复,其中使用岛状鼻唇沟瓣一期修复7例,插补式皮瓣二期修复18例,滑行瓣修复5例;鼻侧上方缺损5例采用双叶瓣一期修复。结果:所有患者均修复成功,组织皮瓣全部成活。患者平均随访3个月~2年,肿瘤无复发。结论:外鼻局部皮瓣如鼻背瓣、鼻唇沟瓣和双叶瓣是修复鼻部小面积皮肤缺损的有效方法,疗效满意。 相似文献
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Fritsch MH 《Otolaryngologic clinics of North America》2002,35(2):425-444
The large ablations needed to remove some lateral skull base pathologic conditions remain a challenge to the reconstructive surgeon. Major shortcomings abound despite significant development of surgical techniques and advances in the understanding of healing. The tremendous advances of the past 30 years with the dawn of major tissue transfer techniques, new biomaterials, and the use of surgical teams with enormous combined clinical knowledge bases have catapulted surgical reconstruction efforts. Progress has been tempered by the realization that normal tissue functions are still incompletely rebuilt. As work on tissue culture, genomic understanding, biomechanics, blood oxygenation substituted, and other research fronts progress and converge, newer and better ways of addressing lateral skull base reconstruction will arise. 相似文献
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V G Lawson 《The Journal of otolaryngology》1984,13(3):191-193
The pre-auricular skin reservoir provides an excellent source of full thickness skin for reconstruction of defects of the pinna. Pre-auricular flaps may be based superiorly or inferiorly. The skin texture and color match is ideal for pinna reconstruction. 相似文献
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Mucosal loss of the hypopharynx, following pharyngostome or wide resection of carcinoma, poses problems for repair. The authors emphasize a reconstructive procedure based on the use of three elements combined together in various ways: residual strip of mucosa of the posterior pharyngeal wall, a musculomucosal pedicled flap obtained from the base of the tongue, a pectoralis major musculocutaneous flap. Thus any defect of the hypopharynx can be repaired in one stage. The safety of the procedure is well tested with good clinical results and lack of complications. 相似文献
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多种游离组织瓣在面颊洞穿缺损修复中的应用 总被引:2,自引:0,他引:2
目的 评价多种游离皮瓣及肌皮瓣在面颊洞穿缺损修复中的作用.方法 2004年3月~2007年4月,对23例口腔颌面恶性肿瘤术后面颊洞穿性缺损患者应用股前外侧皮瓣、脐旁皮瓣、腹膜皮瓣、腹直肌皮瓣进行修复.皮瓣大小为8 cm×4 cm~21 cm×8cm.结果 23例皮瓣均成活,外观基本满意.仅1例脐旁皮瓣内侧部分坏死,3例出现口角瘘,1例腹部伤口裂开.随访满3年者6例,其中4例无瘤生存,2例分别死于局部复发及远处转移.结论 股前外侧皮瓣适用于不伴上下颌骨大范围缺损的面颊洞穿性缺损;脐旁皮瓣及腹直肌皮瓣适于伴有颌骨缺损的复杂颊部洞穿缺损修复;腹膜皮瓣适用于唇、颊复合洞穿缺损的修复. 相似文献
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目的:探讨精准切除外鼻恶性肿瘤以及准确评估、合理修复组织缺损的方法。方法:回顾性分析解放军联勤保障部队第九八〇医院2010年1月至2020年6月期间收治的48例外鼻恶性肿瘤患者,其中男性28例,女性20例,年龄36~86岁。肿瘤病理类型包括基底细胞癌29例,鳞状细胞癌11例,外毛根鞘癌6例,腺样囊性癌1例,非霍奇金淋巴... 相似文献
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Importance
Repair of nasal septal perforations is challenging regardless of surgical technique due to their location and the health of surrounding tissue. There is currently no surgical procedure which is completely effective in the treatment of anteriorly located perforations.Objective
To report a novel method of closing anterior septal perforations using an inferiorly based mucosal rotation flap and an acellular dermal interposition graft, as well as expand upon a previous series.Design
The study includes patients who underwent surgical repair for septal perforations by the senior author between 2003 and 2015.Setting
The study took place at MetroHealth Medical Center in Cleveland, Ohio.Participants
Thirty-nine patients (15 male) with septal perforations of various size and etiology underwent endonasal repair using rotation flaps. The average age of patients was 42-years old (range 10–67 years).Intervention for clinical trials or exposure for observational studies
Five patients had perforations such that we used inferiorly based flaps, while 35 cases utilized posteriorly based flaps. Acellular dermis was used in addition to a unilateral rotation flap.Main outcomes and measures
The primary outcome desired was a complete closure of the septal perforation. The success, or lack thereof, was monitored after healing from surgery.Results
Thirty-seven of the forty surgical procedures demonstrated complete closure of the perforation, a 92.5% success rate. Perforations were separated based upon size. Small perforations (< 1 cm) had a 93.3% success rate, medium (1–2 cm) 88.9%, and all seven large perforations (> 2 cm) were closed successfully. In addition, all five of the inferiorly based procedures resulted in complete closure of the perforation. Of the failed repairs, one required revision surgery to repair a recurring perforation, while the other two were asymptomatic following the procedure.Conclusions and relevance
Endonasal repair using inferiorly based mucosal rotation flaps coupled with an acellular dermal interposition graft is a valid technique for the repair of septal perforations. Posterior rotation flaps are preferred due to major septal blood supply from branches of the sphenopalatine artery, but inferiorly based flaps are also viable options for repair for perforations located in the anterior septum. 相似文献19.