颞肌带蒂延长肌瓣及颅骨骨膜瓣修复颅底缺损

脑脊液漏以及随之发生的颅内感染是颅底外科手术后的严重并发症之一，由于致残率和死亡率较高，固而长期困扰和阻碍了颅底外科的进展。近几年来修复颅底缺损技术的不断改进，使修复成功率有所提高，从而大大地避免了发生术后脑脊液漏和脑膜炎的危险。作者自1973年开始研究并首创以颞肌带蒂延长肌瓣修复颅底缺损，经临床应用均获成功。     

利用颞、枕肌肌瓣修复大面积头皮及颅骨缺损

大面积头皮缺损同时合并大面积的颅骨缺损在神经外科中比较少见,常伴有脑积液漏和伤口感染,甚至是颅内及全身感染,治疗难度大。我科近年来采用颞、枕肌肌瓣转移术成功治疗此类病人6例,现总结分析如下。1临床资料1.1一般资料男4例,女2例;年龄6～56岁;爆炸伤2例,刀砍伤1例,交通伤3例;受伤时头皮、颅骨同时缺损2例,清创不当所致4例。1.2临床表现入院时昏迷3例,神志清楚3例;发热3例;GCS评分<8分者2例,8～12分者4例;单侧瞳孔散大1例,6例均有不同程度肢体偏瘫;头皮、颅骨缺损的部位:右侧额顶部3例,右侧枕顶部2例,左侧顶部1例;头皮缺损面积7.8cm…     

三蒂皮瓣转移修复大面积头皮缺损三例报告

我院自1986年8月至11月,采用三蒂皮瓣转移修复大面积头皮缺损3例,效果良好,报告如下: 临床资料 本组男2例,女1例。年龄19～56岁。头皮癌1例,瘢痕2例。顶部2例,枕部1例。缺损面积28.8～110cm~2。 例1男,19岁。因后枕部头皮肿物19年,溃     

胫后动脉穿支筋膜蒂皮瓣移植修复小腿皮肤软组织缺损★

选择2003-02/2007-02于福州总医院骨科应用胫后动脉穿支筋膜蒂皮瓣移植修复小腿皮肤软组织缺损的患者16例，在解剖学基础上，设计胫后动脉穿支筋膜蒂皮瓣，轴线在胫骨内侧髁后与内踝、跟腱间中点的连线，旋转点在最邻近创面、其蒂部在有胫后动脉穿支的轴线上。根据术前超声多普勒血流仪穿支探测，要求皮瓣、蒂部及穿支表面有良好的皮肤。顺行设计皮瓣修复小腿上段，逆行设计修复小腿中下段，其中小腿下段9例，小腿中段3例，小腿上段4例。皮肤软组织缺损范围为2.0 cm×1.5 cm~12.5 cm×7.5 cm，胫后动脉穿支筋膜蒂皮瓣最大面积为15.0 cm×10.0 cm，最小为4.0 cm×2.5 cm。观察其修复效果。术后皮瓣均成活。有2例远端部分皮肤坏死，但其皮下有肉芽生长，其中1例经换药愈合，1例用中厚皮植皮愈合。所有病例均随访半年以上，患肢正常步态行走，有痛觉。应用胫后动脉穿支筋膜蒂皮瓣移植修复小腿皮肤软组织缺损，供区在小腿内后侧，损伤后蒂部保存良好，切取便利，不损伤主要血管，血供可靠，成活率高，是修复小腿皮肤软组织缺损的首选术式之一。     

双叶皮瓣修复鼻部皮肤缺损92例

目的：探讨双叶皮瓣修复鼻部皮肤组织缺损后创面即刻修复的过程及优点。　 方法：局部麻醉下取双叶皮瓣修补鼻部组织缺损,于缺损部位附近的正常皮肤处设计双叶皮瓣,皮瓣最大1.8 cm×2.5 cm,最小0.8 cm×1.0 cm。转移至修复缺损部位,切口距病变边缘:血管瘤为0.2 cm,基底细胞癌0.5~0.7 cm,黑色素瘤1.0 cm,瘢痕沿其边缘即可,切除深度达浅筋膜层,创面彻底止血。 结果：92例患者, 修复后随访6个月50例,随访1年42例,病变组织切除后均完整修复,创面Ⅰ期愈合,鼻外形轮廓较好,修复组织色泽、质地与周围皮肤匹配良好。 结论：采用双叶皮瓣修复鼻部皮肤缺损的方法比较简单,且效果满意。     

自体颅骨瓣修复颅骨缺损研究进展

对颅骨缺损进行修复的目的，不仅包括修复缺损，还应矫正轮廊畸形。若要达到二和谐统一，需要有性质稳定、可靠的生物材料作为基础，以及简单易行的修复方法。随着医学、影像学和工程技术的发展，各种生物材料应运而生，这些材料所具备的实用性强、操作简便、可终生保持形态且可缩短手术时间等优点，使它们在颅骨修复术中的应用率逐年增加。但生物材料移植后由于无法被机体所吸收，仍然存在排异和炎症反应、难与宿主组织相容且手术后感染率高等诸多并发症。而采用自体颅骨瓣修复颅骨缺损则无异物反应且远期并发症少，即使在当今，自体颅骨的骨质结构及转导、诱导成骨的潜能，仍是异源性生物材料和其他合成材料无法比拟的，因此是颅骨重建优先选择的材料之一。     

带蒂旋转皮瓣及游离皮片移植修复大面积头皮缺损

目的探讨大面积头皮缺损的手术修复方法。方法回顾性分析35例因头部外伤及头皮恶性肿瘤术后遗留大面积头皮缺损,应用旋转皮瓣及游离皮片移植修复患者的临床资料。结果所有植皮均存活,20例一期修复,15例二期修复,术后18例头皮缺损处有毛发生长,4例部分毛发生长,13例无毛发生长。30例患者随访6月至2年,未发现头皮坏死及术后肿瘤复发。结论带蒂旋转皮瓣及游离皮片移植相结合是修复大面积头皮缺损较为理想的方法。     

游离背阔肌肌皮瓣移植修复头皮恶性肿瘤切除后的复杂创面

目的 修复头皮恶性肿瘤切除后的复杂创面,尤其是伴有部分颅骨缺损,甚至部分硬脑膜缺损的创而.方法 应用游离背阔肌肌皮瓣,修复17例头皮恶性肿瘤切除后的创而(>200 cm2).结果 17例皮瓣全部存活,1例皮瓣下局部感染,经换药后愈合.9例术后4周开始放疗.17例均未要求颅骨修补.随访6-25个月,4例肿瘤复发,其中3例死亡;1例肺转移;12例无瘤生存.结论 游离背阔肌肌皮瓣是修复头皮恶性肿痛切除后复杂创面的理想选择之一.     

Unilateral reverse latissimus dorsi muscle flap for postoperative CSF leak and wound dehiscence in lumbosacral defects: a lifeboat approach

A lumbosacral defect with cerebrospinal fluid (CSF) leak, particularly after breakdown of a repaired lipomeningomyelocele, is often a difficult problem to manage. Although several methods of local flap coverage have been used, local wound infection and tissue cellulitis associated with the wound dehiscence makes the repair prone to redehiscence. The associated CSF leak requires a good reliable closure as a matter of urgency. We describe two patients with lipomeningomyelocele, operated upon for tethered cord syndrome, who developed postoperative CSF leak and wound dehiscence. The associated wound infection and signs of meningitis made re-exploration, debridement and a dependable, well vascularized cover of the dura mandatory. The reverse latissimus dorsi flap provided a good vascularized seal. Both patients recovered rapidly.     

Effects of spinal cord stimulation on the differentiation of posterior latissimus dorsi nerve in the chick embryo

Spinal cord stimulation was carried out during embryonic development of the chick from the 10th day until 13.5, 14.5, or 15.5 days of embryonic life. The effects of this superimposed neuronal activity upon the cytodifferentiation of the nerve entering the posterior latissimus dorsi (PLD) muscle were studied by comparative analysis of electron micrographs of PLD nerves from control and spinal cord-stimulated embryos. For each embryonic stage studied, electrical stimulation of the spinal cord appeared to accelerate the growth of axons, to enhance Schwann cell mitosis, and the enclosure of a single axon in a Schwann cell, i.e., the process of myelination. These results underline the role of neuronal activity in the maturation of a developing nerve.     

股前外侧皮瓣移植修复四肢及口腔颌面软组织缺损

背景：高能量损伤所致四肢大面积软组织缺损及口腔颌面部肿瘤切除术后软组织缺损是临床常见的组织缺损,应用股前外侧皮瓣修复此类缺损不但能覆盖创面而且对供区影响小。 目的：总结分析游离股前外侧皮瓣在四肢及口腔颌面软组织缺损修复中的临床效果及治疗经验。 方法：收集41例四肢及口腔颌面创伤或肿瘤切除后软组织缺损应用游离股前外侧皮瓣修复的临床资料,软组织缺损面积为(12~25) cm×(5~11) cm,根据受区软组织缺损大小、形态切取股前外侧皮瓣,将皮瓣动静脉与受区动静脉吻合,覆盖创面。观察移植后股前外侧皮瓣成活、供区愈合情况,患者对手术的满意程度,受区的功能恢复情况。 结果与结论：所有皮瓣均完全成活,其中2例出现血管危象,均为移植后24~36 h出现皮瓣淤黑,予及时血管探查发现均为静脉栓塞,经手术取栓后皮瓣成活。病例随访4个月~3年,均得到覆盖创面的目的,2例患者移植后因皮瓣臃肿再次入院行削薄手术。游离股前外侧皮瓣血管恒定,血管口径大,可切取面积大,修复四肢及口腔颌面皮肤黏膜大面积软组织缺损安全可靠。     

Changes in genotypic expression, development, and the effects of chronic penicillamine treatment on the electrical properties of the posterior latissimus dorsi muscle in two lines of normal and dystrophic chickens.

When line 304 dystrophic chickens were outcrossed, a new line of genetically dystrophic chickens designated 413 was produced together with a genetically related normal animal (line 412). The expected alteration in membrane resistance in the surface fibers of the posterior latissimus dorsi (PLD) muscle was eliminated in this new line of dystrophic chickens. Although the input resistance of PLD fibers from both lines 200 and 304 chickens declined simultaneously from 1 to 2 Mω at 5 weeks ex ovo to 0.3 Mω at 17 to 33 weeks ex ovo, specific membrane resistance, membrane space and time constants, and fiber radius of line 304-dystrophic fibers were significantly greater than in line 200-normal fibers at various times ex ovo. Only the membrane time constant and capacitance of PLD fibers of line 413-dystrophic chickens were greater than in line 412-normal at 8 weeks ex ovo. Other differences in electrical properties were also seen. Only in line 413-dystrophic chickens were the resting membrane potentials and action potential properties significantly different from line 412. Outcrossing of line 304 chickens [has thus] revealed that various electrical properties of muscle such as membrane resistance are under genetic control but did not influence the development of dystrophy. On the other hand, alterations in action potential activity persists after outcrossing and appear to have a greater role in the symptomatology of muscular dystrophy. A therapeutic approach to the disease using oral d-penicillamine treatment was initiated 9 days ex ovo in normal (line 412) and dystrophic (line 413) chickens of either sex and continued 7 to 10 weeks. An improvement in the righting ability of treated vs. untreated dystrophic birds was first noted at 6 weeks ex ovo, and by 8 weeks, treated dystrophic chickens were always able to right themselves whereas untreated dystrophic chickens failed 75% of the time. The body weights and rates of growth in untreated normal and dystrophic chickens were similar but that of treated birds were 35 to 40% lower. The drug had no effect on the resting membrane potential of PLD surface fibers in treated chickens. The beneficial effect of the drug was initially correlated with the ability of the PLD muscle to respond with a twitch to single indirect stimulation and to the absence of a decrementing response in muscle to repetitive nerve stimulation. Penicillamine only decreased the action potential threshold in dystrophic chickens. Penicillamine treatment reduced the depression of the probability of release of transmitter in dystrophic muscle. The higher threshold for excitation and greater resting membrane potential in the newer line of dystrophic chickens may account in part for the inability of these chickens to right themselves when placed on their backs. It is suggested that the beneficial effect of penicillamine is related to an alteration of synaptic function and lowering of the threshold for excitation in muscle.