微血管吻合器在皮瓣修复足踝创面中的应用

目的 探讨应用微血管吻合器在游离股前外侧皮瓣修复足踝部皮肤软组织缺损中的疗效分析。方法 回顾性分析2018年1月至2020年6月间36例在本院住院并接受游离股前外侧皮瓣修复足踝部皮肤软组织缺损患者的临床资料,根据静脉血管吻合方式不同,将其分为吻合器组（18例）和手工组（18例）,吻合器组皮瓣中的两条静脉应用微血管吻合器行端端吻合,手工组中患者的两条静脉手工行端端吻合。所有动脉均手工行端端吻合。结果 应用微血管吻合器静脉吻合的时间为（12.3±1.1）分钟,较手工吻合时间（24.4±2.2）分钟明显缩短,差异具有统计学意义（P<0.001）。微血管吻合器组术后静脉通畅,未见血栓形成,术后皮瓣血运良好;手工吻合组有2例皮瓣静脉血栓形成导致血管危象。吻合器组术后血管吻合通畅率为100%,手工组术后血管通畅率为89%。结论 微血管吻合器在游离股前外侧皮瓣修复足踝部皮肤软组织缺损中吻合口通畅、操作时间短,术后并发症少。     

血管吻合器在游离组织瓣修复颌面缺损中的应用

目的:探讨血管吻合器在游离组织瓣移植修复口腔颌面部缺损中的应用效果。方法:34例游离组织瓣修复口腔颌面缺损患者,静脉采用血管吻合器行端端吻合,动脉采用手工端端吻合,另选取30例同期手工吻合血管作为对照组,比较两组病例的静脉吻合手术时间、术后并发症及皮瓣成活率。结果:应用血管吻合器行单根静脉吻合平均用时(5.8±1.8)min,明显低于手工吻合平均用时(13.2±2.2)min;两组均无血栓形成,对照组静脉危象发生率为6.67%,与研究组相比无显著性差异。结论:血管吻合器在游离组织瓣修复颌面部缺损中应用,静脉吻合操作简单、快捷,吻合质量可靠,有较高的临床应用价值。     

可吸收吻合环在老年大肠手术中应用的前瞻随机性研究

目的探讨生物可吸收吻合环在老年肠道手术中的应用价值。方法将我院近3年收治的182例老年大肠手术患者随机分为吻合环与缝线组、吻合环与吻合器组，比较手术时间、术后肠功能恢复时间、住院时间及术后并发症等情况，并作统计学分析。结果手术时间吻合环比缝线组明显缩短，而和吻合器组无显著差别，吻合环组患者肠功能恢复时间均较快，总的并发症发生率明显下降。结论生物可吸收吻合环在老年大肠手术中的具有较高的临床应用价值，可作为老年大肠手术常规的吻合方法。     

小儿游离肩胛皮瓣移植

目的儿童创伤愈合后的瘢痕组织挛缩影响外形、功能及局部生长发育,应用带血运的游离皮瓣移植效果良好。方法近年,对旋肩胛动脉皮支供血的肩胛皮瓣解剖上有了更进一步的认识:血管出三边孔后分为向上行的升支;平行于肩胛冈向内行的水平支;平行于肩胛骨腋缘向下行的降支。形成了上可超过肩胛冈5cm,下达两侧髂嵴平面的长肩胛游离皮瓣,利用吻合微血管技术,治疗5～9岁患儿面颈部损伤8例,获得良好效果。结果游离肩胛皮瓣最大面积为22.0cm×6.5cm,无一例出现血管危象,平均历时5小时,术中出血量平均约100ml。结论我们认为尽可能缩短手术时间,控制出血量在儿童体重的1％以内,掌握熟练的显微整形外科技术和解剖学基础是小儿游离皮瓣移植成功的关健。在4～10岁儿童应用游离皮瓣移植治疗面颈部损伤,具有手术成功率高,血管不易栓塞,术后恢复快,切口愈合良好,效果可靠等优点。     

小儿游离肩胛皮瓣移植

目的儿童创伤愈合后的瘢痕组织挛缩影响外形、功能及局部生长发育，应用带血运的游离皮瓣移植效果良好。方法近年，对旋肩胛动脉皮支供血的肩胛皮瓣解剖上有了更进一步的认识：血管出三边孔后分为向上行的升支；平行于肩胛冈向内行的水平支；平行于肩胛骨腋缘向下行的降支。形成了上可超过肩胛冈５ｃｍ，下达两侧髂嵴平面的长肩胛游离皮瓣，利用吻合微血管技术，治疗５～９岁患儿面颈部损伤８例，获得良好效果。结果游离肩胛皮瓣最大面积为２２．０ｃｍ×６．５ｃｍ，无一例出现血管危象，平均历时５小时，术中出血量平均约１００ｍｌ。结论我们认为尽可能缩短手术时间，控制出血量在儿童体重的１％以内，掌握熟练的显微整形外科技术和解剖学基础是小儿游离皮瓣移植成功的关健。在４～１０岁儿童应用游离皮瓣移植治疗面颈部损伤，具有手术成功率高，血管不易栓塞，术后恢复快，切口愈合良好，效果可靠等优点。     

护理工作对预防游离皮瓣手术后血管危象中的作用

随着医学新领域的拓展,游离皮瓣在手术中应用也越来越广泛,但游离皮瓣的并发症还是很多。据报道血管吻合术后出现血管危象发生率10～30%。手术后游离皮瓣因血管栓塞而发生血管危象,导致皮瓣缺血、缺氧甚至坏死。应早发现血管危象,采取有效措施,必要时行手术探查,提高皮瓣成活率,降低手术风险。我科对45例游离皮瓣手术患者着重加强术前、术后的健康宣教和护理措施,减少了术后血管危象的发生率,取得了很好的效果,现报道如下。     

端侧吻合血管进行胸脐皮瓣游离移植12例

目的 总结端侧吻合血管在胸脐皮瓣游离移植修复四肢软组织缺损中的临床治疗效果. 方法 自2006年11月至2012年12月,施行胸脐皮瓣游离移植修复四肢软组织缺损12例,皮瓣切取面积8 cm×6 cm～ 20 cm×15 cm,应用端侧吻合法吻合血管. 结果 术后皮瓣全部成活,1例皮瓣远端表浅小部分坏死,经换药后愈合.随访3个月～1年,移植皮瓣血运良好,色泽红润,质地柔软,术后无肢体供血不足发生. 结论 端侧吻合血管进行胸脐皮瓣游离移植修复组织缺损,临床效果良好.     

磁吻合技术实现无缝线肝脏快速植入的临床前研究

肝移植是终末期肝病唯一有效的治疗手段。虽然移植器官保存技术、免疫抑制剂及外科手术的不断进展在很大程度上提高了肝移植成功率,但是术中传统的手工缝合血管的方法,易引起器官缺血-再灌注损伤、血管狭窄等并发症,导致患者生存质量下降。研制并发明一种能高效完成血管无缝线吻合的新型血管吻合器,利用磁压榨吻合技术达到血管快速吻合的目的,最终得以实现肝移植术中肝脏附属管道无缝线快速重建,尽可能地降低手术难度、缩短无肝期、减少手术并发症发生率。全面、深入、系统地研究磁吻合技术的基础理论和临床应用的可行性、安全性,可促进血管吻合重建技术的临床转化应用。     

游离腓骨肌皮瓣一期修复下颌骨及软组织缺损的手术配合

采用自体吻合血管游离腓骨皮瓣修复下颌骨及软组织缺损１０例，术后２周行＾９９ｍ锝扫描及Ｘ线片检查，９例骨瓣成活，８例皮瓣成活，１例移植骨供血不良。提出做好术前准备；术中严格无菌操作保护游离组织，密切观察供以体血运，注意安全操作，术后密切配合，可提高游离移植皮瓣的成活率，减少并发症。     

受区炎性疤痕吻合血管游离皮瓣移植术中的血管处理

目的探讨受区炎性疤痕吻合血管游离皮瓣移植术中的血管的正确判断和处理方法,提高游离皮瓣手术的成功率。方法受区炎性疤痕,需行游离皮瓣修复7例,其中桥式交叉吻合1例,血管移植3例,扩大清创至正常区域吻合3例。结果所有皮瓣均完全存活,未出现血管危象,术后功能恢复良好。结论受区慢性感染所致的炎性疤痕内的血管不可行血管吻合,吻合处应位于正常组织内,以提高皮瓣存活率,减少术后血管危象发生。     

Clinical Experience of Frame Ring Utilization in Applying Interintestinal Anastomoses in Urgent Surgery

The problem of restoration of intestinal integrity preserves its importance as the intestinal suture is a basis for digestive tract surgery. Tightness failure in the intestinal suture during gastrointestinal surgery is a threatening and, unfortunately, frequent complication, and it gets especial importance in emergency patients and those with severe concomitant pathologies. The research is carried out on utilization of a metal frame ring in applying interintestinal anastomoses. Clinical utilization of the method developed was preceded with a series of experiments on animals with morphological researches with the use of the device. Seventy operations were performed with utilization of a frame metal ring during application of interintestinal anastomoses. After performing an operation, intestinal peristalsis restored faster. In the postoperative period, all patients undertook study of abdominal exudates to determine for early diagnostics of development of intestinal suture failure. In clinical practice, utilization of a frame ring is indicated in applying primary interintestinal anastomoses in adverse conditions, namely, peritonitis and intestinal obstruction.     

Incidence and time of intraoperative vascular complications in head and neck microsurgery

Vascular occlusion is still the main reason for flap loss and occurs mostly within the first hours after performing anastomoses. Many surgeons still prefer to perform reconstruction and close the defect before starting to anastomose. The aim of this investigation was to find out if detection of early vascular occlusion is facilitated with a prolonged observation period. Between January 2000 and August of 2006, 350 consecutive free flap transfers for reconstruction in maxillofacial surgery were analyzed. In all flaps vascular anastomoses were performed prior to definite flap insertion. The flaps were controlled continuously during soft tissue or bony reconstruction until final wound closure at the neck. Complete operation time, ischemia time of the flap, and time from reperfusion to wound closure (direct pedicle observation time) were registered for each flap. In 350 flaps (138 radial forearm, 94 fibular, 53 ALT, 23 DCIA, 26 soleus perforator, 9 lateral arm, 5 lat. dorsi, and 2 scapular), operation time in average was 8.5 h, ischemia time varied between 78 and 139 min (average 104 min), and direct pedicle observation time of the flaps was 144 min in average (93-192 min). Four arteries and 2 veins showed immediate failure within 5 min after clamp removal, 10 arteries and 6 veins developed thromboses during the direct pedicle observation time. Out of these 16 vascular complications, 15 developed later than 15 min, 7 of them later than 30 min, and 2 of them later than 45 min. The overall complication rate including secondary revision of the pedicle was 16.8%, and an overall flap survival rate resulted in 95.4%. We conclude that microvascular anastomoses should be controlled for at least 45 min before definite wound closure. By performing anastomoses first and flap insertion second, this can be easily warranted.     

联合肩胛/肩胛旁分叶皮瓣修复严重颌颈部瘢痕挛缩

目的探讨临床应用联合肩胛/肩胛旁分叶皮瓣显微修复严重颌颈部瘢痕挛缩畸形,并重建颈部三维活动功能及轮廓外观的方法和疗效。方法2003年1月~2004年11月,收治9例严重颌颈部瘢痕挛缩畸形患者,年龄9~32岁。病程2~18年。瘢痕挛缩程度为3~4度。行瘢痕切除,对颈部挛缩组织松解复位所致软组织缺损创面采用联合肩胛/肩胛旁分叶皮瓣进行解剖分区的显微修复。分叶皮瓣范围最大分叶皮瓣为20cm×8cm~20cm×11cm,最小分叶皮瓣为15cm×4cm~15cm×6cm。结果9例患者有8例分叶皮瓣成活,1例肩胛皮瓣远端发紫,经换药加压包扎后成活。其中8例术后获3~9个月随访,畸形无复发,颌颈角恢复至90~105°;3例行二期皮瓣臃肿修整手术。患者对术后颌颈部外观和功能均满意。结论对于严重颌颈部瘢痕挛缩畸形,联合肩胛/肩胛旁分叶皮瓣可提供足够的组织覆盖,有可靠的血管蒂,对于重建颌颈部功能和外形,是一种较好的手术选择。     

Suture-Free Small Bowel Anastomoses Using Collagen Fleece Covered with Fibrin Glue in Pigs

Background: Several studies investigating anastomotic healing could objectify that the regularly used suture material leads to an impairment of wound healing due to ischemia at the anastomotic line. This study was initiated to test a hypothesis that a reduction of suture material leading to suture-free glued intestinal anastomoses is feasible and enables an improved wound healing. Materials and Methods: Three different types of anastomoses were carried out at the small bowel of 16 pigs. Standard hand-sewn anastomoses, anastomoses with loose-fitting skin staples, and suture-free glued anastomoses using a fibrin covered collagen fleece. When the animals were killed, both gross inspection of the parietes, bursting pressure and tissue for histological study became the basis for evaluation. Analyses were also made regarding the collagen I/III ratio and the expression of MMP 1 and 13. Results: Four leakages at the stapled, one at the sutured, and one at the glued anastomoses occurred. All other anastomoses healed without complications. The bursting pressure did not differ significantly between the groups. The macroscopic inspection and the microscopic examination both showed an improved healing pattern for the material reduced techniques without onset of a deep ulcer at the anastomotic line as seen at the conventional sutured anastomoses. These findings were supported by the immunohistochemical studies. Conclusions: These observations suggest that a suture-free bowel anastomoses using collagen fleece covered with fibrin glue is technically feasible. Obviously, a reduction of foreign body material at the anastomotic line avoids unnecessary ischemia and thus supports a physiological improved wound healing process.     

Comparison of laser vascular welding,interrupted sutures,and continuous sutures in growing vascular anastomoses

Background and Objectives: The argon laser-assisted vascular anastomosis may solve the problems of conventional sutured anastomosis, such as vascular stenosis and arrest of growth owing to a foreign-body reaction to suture material. Study Design/Materials and Methods: Twelve argon laser-assisted vascular anastomoses, seven conventional anastomoses with interrupted sutures, and five conventional anastomoses with continuous sutures were performed in 12 young mongrel dogs. Results: Five months later, the external diameter at the anastomosis had increased 70.5% in the laser group, 67.0% in the interrupted suture group, and 22.9% in the continuous suture group. Histological examination of the laser-assisted anastomoses showed almost complete healing, with no granulomatous response around the anastomotic site. In the interrupted suture group, marked scaring and foreign body reactions were observed on the vessel wall at the site of the anastomosis. The continuous suture group showed more remarkable disorientation of the vascular layer and intimal hyperplasia than the interrupted suture group. Conclusion: Vascular anastomosis using the argon laser offers advantages over the conventional procedure in growing vessels.     

Scapular free flap for repair of massive lower facial composite defects

The scapular osteocutaneous free flap provides excellent tissue for reconstruction of massive lower facial defects. Five cases of full-thickness cheek and lip defects associated with mandibular loss were successfully repaired with sandwiched osteocutaneous scapular flaps plus a parascapular or latissimus dorsi flap. In two instances the osteocutaneous scapular flap was harvested along with a parascapular skin paddle. The other three patients had latissimus dorsi myocutaneous units taken with the scapular osteocutaneous flap from the same subscapular pedicle.     

Freier Paraskapular-/Skapularlappen bei frakturbegleitendem Weichteildefekt an Talus oder Kalkaneus

BASIS: Fractures of the talus or calcaneus with accompanying soft tissue damage require precisely planned treatment to prevent infection of the wound over time, especially in severely injured patients. MATERIAL AND METHODS: Seven patients with fractures of the talus or calcaneus and accompanying 2nd and 3rd degree open or 3rd degree closed soft tissue injuries were followed up retrospectively. These patients were operated on between January 1999 and January 2006 with free fasciocutaneous scapular or parascapular flaps. The average age was 34 (range 16-54). Follow-up was at 6-36 months. RESULTS: Osteosynthesis was primarily in six cases, post-primarily in one, and in four cases exterior fixation was used additively. Temporary vacuum therapy was performed for a mean of 28 days (6-42). Parascapular, scapular, and Latissimus dorsi flap coverage was performed six, one, and one times, respectively. Six flaps healed without complication. One necrosis of a parascapular flap occurred and made a Latissimus dorsi flap necessary. In one case of donor-site wound dehiscense, a local rotation flap became necessary. There was no joint infection or osteomyelitis. Bony consolidation was achieved within all fractures. CONCLUSION: Traumatic soft tissue damage must be taken into account when primary or secondary internal fixation is performed and should influence the choice of implant. Free fasciocutaneous parascapular or scapular flaps are a powerful tool for preventing infection if local flaps are not sufficient to achieve stable soft tissue coverage.     

Free ascending scapular flap.

Four patients with free tissue transfer using ascending cutaneous branches of circumflex scapular vessels are herein presented. The free ascending scapular flap is located on the superior vertical axis, differentiated with the scapular flap horizontally and the parascapular flap vertically designed. The flap is an excellent choice because of easy dissection, a constant artery and venous system, 2- to 3-mm-diameter vessels, and sufficient length of the vascular pedicle. All flaps survived completely with a fairly thin skin. The shoulder donor site could be closed primarily. No functional deficit of the shoulder was observed.     

The efficacy of preoperative vascular mapping by MDCTA in selecting flap in abdominal flap breast reconstruction

Current methods of breast reconstruction using abdominal tissue include the transverse abdominal myocutaneous (TRAM) flap, deep inferior epigastric arterial perforator (DIEP) flap, superficial inferior epigastric arterial (SIEA) flap, and some other composite flaps. Because of the variant vascular anatomy in abdominal region, it is hard to choose an appropriate flap for a specific patient without accurate preoperative vascular mapping. This study was drawn to address the efficacy of preoperative vascular mapping by multidetector-row computed tomographic angiography (MDCTA) in selecting flap in abdominal flap breast reconstruction. A total of 34 breast reconstructions using abdominal flap from December 2006 to July 2009 were included. In all the patients included, MDCTA was performed preoperatively. Three indexes were obtained including choice of flaps, operation time, and flap complication rate. Then, these data were compared with the former data stored in the databank of our hospital from January 2004 to December 2006, before MDCTA was introduced in our center. Among the 34 patients, the flap selection was: SIEA flaps 11.8%, DIEP flaps 61.8%, TRAM flaps 11.8%, and bilateral flaps 14.7%. The correlate indexes from the data bank were as follows: SIEA flap 0; DIEP flaps 51.7%; TRAM flaps 32.8%; bilateral flaps 15.5%. p < 0.05 occurred between the comparison of SIEA, DIEP, and TRAM flap choice in the two groups. The operation time in the study group was as follows: SIEA flap (4.02 ± 0.46) hours, DIEP flap (6.23 ± 1.42) hours, TRAM flap (4.72 ± 1.53) hours, Bilateral flap (7.86 ± 1.16) hours; while the former correlate data were: DIEP (9.67 ± 1.74) hours, TRAM flap (6.64 ± 1.83) hours, bilateral flap (11.83 ± 1.35) (all the three comparison p < 0.05). The total flap complication rate was about 5.9% in the test group; while in the databank, it was 12.1% (p < 0.05). With the accurate mapping of vascular territory in abdomen by MDCTA, we could easily select a suitable abdominal flap for breast reconstruction, and we can also simplify the procedure to save operation time and make the process more safely.     

一次性包皮环切吻合器与包皮环扎和传统包皮环切术的疗效比较

目的:探讨应用一次性包皮环切吻合器与包皮环扎和传统包皮环切术式的临床疗效比较。方法:对包茎和包皮过长患者,分别采用一次性包皮环切吻合器环切术、包皮环扎术、传统包皮环切术,并对其术前、术中、术后三方面进行比较。结果:一次性包皮环切吻合器环切术除价格相对较贵外,其它方面都优于包皮环扎术和传统包皮环切术。结论:一次性包皮环切吻合器环切术简单、安全、无需缝合、外观美观,值得临床推广应用。