会阴部瘢痕挛缩畸形45例整复治疗

目的讨论、总结会阴部瘢痕挛缩畸形整复治疗的经验.方法我科自1989年以来对45例会阴部瘢痕挛缩畸形患者进行了整复治疗.术前强调肠道清洁和局部瘢痕清洗;术中根据瘢痕挛缩畸形的具体情况,联合采用局部皮瓣及中厚皮片移植31例,全厚皮片移植8例,单纯用局部皮瓣移植6例;术后注意保持创面的清洁干燥和进行及时有效的功能锻炼.结果患者在接受整复治疗后形态、功能均获得良好恢复,总优良率达95.5%.结论根据会阴部瘢痕挛缩畸形的特殊性,重视术前准备及术后处理,合理设计、选择手术方法,才能够获得满意的治疗效果.     

会阴部瘢痕挛缩畸形45例整复治疗

目的 讨论、总结会阴部瘢痕挛缩畸形整复治疗的经验。方法 我科自1989年以来对45例会阴部瘢痕挛缩畸形患者进行了整复治疗。术前强调肠道清洁和局部瘢痕清洗；术中根据瘢痕挛缩畸形的具体情况，联合采用局部皮瓣及中厚皮片移植31例，全厚皮片移植8例，单纯用局部皮瓣移植6例；术后注意保持创面的清洁干燥和进行及时有效的功能锻炼。结果 患者在接受整复治疗后形态、功能均获得良好恢复，总优良率达95．5％。结论 根据会阴部瘢痕挛缩畸形的特殊性，重视术前准备及术后处理，合理设计、选择手术方法，才能够获得满意的治疗效果。     

烧伤后会阴部瘢痕挛缩畸形30例整复

烧伤后会阴部瘢痕挛缩畸形的整复较其它烧伤晚期畸形相比，有一定的特殊性，我们自１９８９年以来共收治这类病人３０例，获是较为满意的治疗效果，本文从其特殊性出发，就术前，术后处理及手术方法的选择进行了讨论，提出了自己的见解及处理原则。     

烧伤后会阴部瘢痕挛缩畸形30例整复

烧伤后会阴部瘢痕挛缩畸形的整复较其它烧伤晚期畸形相比,有一定的特殊性。我科自1989年以来共收治这类病人30例。获得较为满意的治疗效果。本文从其特殊性出发,就术前、术后处理及手术方法的选择进行了讨论,提出了自己的见解及处理原则。     

会阴部及肛周重度瘢痕挛缩畸形整复治疗的临床观察

目的 探讨会阴及肛周重度瘢痕挛缩畸形整复的治疗方法及临床效果.方法 自2002年1月至2008年1月,共治疗会阴、肛周瘢痕挛缩50例患者.术前行肠道清洁和局部瘢痕清洗,然后分别采用"Z"成形术或"五瓣"成形术、皮片移植、局部皮瓣移植进行治疗,术后注意保持创面清洁、干燥,并及时有效地进行功能锻炼.结果 局部畸形完全纠正,阴茎、阴囊及大阴唇恢复至正常位置,肛门复位,排便不受限,两侧髋关节活动正常.40例植皮患者,术后皮片成活39例,1例患者出现皮片周边糜烂、坏死,经换药后愈合;10例局部皮瓣修复患者,9例皮瓣完全成活,1例皮瓣远端术后发黑坏死,经移植刃厚皮片覆盖后愈合.供区均Ⅰ期愈合.25例患者获随访3～6个月,局部外形及功能恢复均满意.结论 根据会阴部瘢痕挛缩畸形的特殊性,合理设计、选择手术方法,并结合术后功能锻炼,可获得满意的治疗效果.     

利用皮片移植及皮瓣转移修复会阴部烧伤后瘢痕挛缩畸形

目的:探讨修复烧伤后会阴部瘢痕挛缩畸形的手术方法。方法:对1990年以来收治的38例会阴部烧伤后瘢痕挛缩畸形患者行瘢痕切除松解,21例患者单纯中厚或全厚植皮,4例患者单纯局部皮瓣转移修复,13例患者皮瓣转移配合植皮修复。结果:1例皮瓣尖端2cm坏死,2例部分皮瓣色暗紫,2例植皮部分成活欠佳,经换药及对症处理痊愈,余均疗效满意。结论:皮片移植及皮瓣转移为治疗会阴部瘢痕挛缩畸形的较好手术方法。     

儿童手部烧伤后瘢痕挛缩畸形的整复体会

目的探讨儿童手部烧伤后瘢痕挛缩畸形的整复体会。方法对22例手部烧伤后瘢痕挛缩畸形患儿进行整复手术并对临床资料进行总结。结果伤口愈合情况较好,所有皮片、移植均完全成活。随访0.5～1 a,优14例,良6例,可1例,差1例,优良率90.90%。结论畸形的整复对彻底切除瘢痕组织、选择合理的创面修复方法,对儿童手部烧伤后瘢痕挛缩畸形的整复效果非常重要,术后积极主动和被动功能锻炼对手部功能恢复有重要意义。     

会阴肛周瘢痕挛缩的整复治疗

目的：探讨会阴肛周部瘢痕挛缩的各种整复治疗方法。方法：1995年1月至2005年6月对23例患者分别采用直接缝合、皮片移植和皮瓣移植进行治疗。结果：23例患者中一次手术修复19例，局部形态及功能恢复良好。结论：会阴肛周部位置特殊，欲获得良好的整复治疗效果，需要在合理选择手术方法的同时，重视术前准备、术后护理及功能锻炼。     

矩形皮瓣联合肌腱延长术治疗小儿手掌瘢痕挛缩

目的 探讨利用矩形皮瓣联合肌腱延长术治疗小儿手掌瘢痕挛缩的可行性及优势.方法 自2014年9月至2019年9月,辽宁省人民医院整形美容外科对26例(31侧)手掌瘢痕挛缩的患儿行手术治疗及功能性修复.以矩形皮瓣修复蹼状畸形,以肌腱延长术修复严重的屈曲畸形,其余瘢痕松解部位以游离皮片移植或邻近皮瓣转移的方式修复,术后配合功...     

手部瘢痕挛缩畸形的手术治疗

目的：总结和探讨手部瘢痕挛缩畸形的手术治疗和临床效果。方法：1995年6月-2001年6月，我们对68例手部瘢痕挛缩进行手术治疗，彻底切除和松解瘢痕，应用皮瓣或植皮修复创面，其中皮瓣（包括Z成形）46例，植皮22例。结果：皮瓣组有2例出现皮瓣远端坏死；植皮组全部成活。60例病人获得随访，随访时间6个月-3年，再次发生瘢痕挛缩4例，均为植皮组；皮瓣组中有2例因外观臃肿而行整形术。病人手功能及外观较为满意，总优良率达78.3％。结论：选择适当手术时机、正确的修复方法及术后早期、有效的功能锻炼，是取得良好疗效的重要因素。     

First experience of endoscopic implantation of tissue expanders in plastic and reconstructive surgery

Background: Over the last 15 years, tissue expansion has been used in the treatment of 324 patients at the A. V. Vishnevsky Institute of Surgery. The principal drawbacks of the traditional technique for tissue expansion are the prolonged time needed to complete the process and a high rate of complications. With the traditional technique, the wound created by the implantation of the expander inhibits the expansion of the tissue until healing takes place, which requires 10–14 days. However, attempts to reduce of the length of the incision have been limited by the necessity to ensure good hemostasis in the expander pocket. We describe our initial experience with the endoscopic insertion of tissue expanders. Methods: We performed the endoscopic implantation of 20 tissue expanders in nine patients. Six patients had postburn scar deformities, one had congenital microtia, one had a capillary malformation, and one had a capillary malformation combined with postburn scar deformity. Tissue expanders were inserted in the head, face, neck, chest wall, scapular, shoulder, forearm, and calf regions. The endoscopic technique was specially adapted according to the features of the different anatomic sites. Endoscopy enabled creation of the expander pocket, with good control of hemostasis, through incisions 1 cm. The orientation of these incisions was parallel to forces of tension. Therefore, full expansion began immediately after placement of the expander, without any risk of postoperative wound dehiscence. The expanders were fully inflated intraoperatively accordingly to the principals followed in the traditional technique of implantation for inflation over a 3-week period. Further inflations were carried out regularly either daily or once every other day. Results: The average time required for the tissue expansion was 34 days, which was less than half the time needed with the traditional technique. All flaps remained extant after reconstruction with the expanded tissues. There were no complications. Conclusion: The advantages of the endoscopic implantation of tissue expanders are a reduction in expansion time, a shorter hospital stay, less patient discomfort, and the prevention of complications (hematoma, seroma, infection, wound dehiscence). Presented at the 10th International Congress of the European Association for Endoscopic Surgery (EAES), Lisbon, Portugal, 2–5 June 2002     

人工真皮模板在烧伤瘢痕整复中的应用

目的介绍一种应用人工真皮模板+自体大张表层皮片或表皮片移植修复瘢痕畸形的方法。方法于瘢痕挛缩部位进行松解或切除后的创面上,将人工真皮模板铺平、固定,纳米纱布覆盖,术后无排异反应。2~4周后,除去人工真皮模板的表层薄膜,仔细清理修整创面,用电动或气动取皮机切取自体大张表层皮片或表皮片,覆盖固定。结果1999年8月至2003年6月共用于15例19个部位,其中躯干5例次,肢体14例次。瘢痕切除后创面面积为10cm×25cm至30cm×75cm,移植大张极薄的自体表层皮片或表皮片,全部存活。随访半年至4年,皮肤色泽、弹性良好,平坦、光滑,未见继发性挛缩,功能基本恢复,供区无瘢痕,有轻度色素脱失或沉着。结论人工真皮模板+大张表层皮片或表皮片移植是治疗瘢痕或瘢痕挛缩的有效方法之一,而且后者效果更好,供区无明显痕迹。     

Career development resource for plastic and reconstructive surgery

Plastic surgery is a broad-based discipline with emphasis on areas such as breast, craniomaxillofacial, burn, aesthetic, and hand surgery as well as complex wounds and wound healing. Plastic surgery as a specialty captures a great deal of media attention over many other fields of medicine, so education, training, and credentialing have become an area of national interest. The purpose of this article was to provide information on the organization, basic requirements for training, fellowship, and volunteer opportunities within the specialty.