改良(足母)趾腓侧皮瓣在修复手指皮肤缺损中的应用

目的 报道应用改良躅趾腓侧皮瓣修复手指皮肤缺损的方法及临床效果.方法 手术时将皮瓣近端向第一、二趾间隙延伸,回流静脉选取(足母)趾腓侧与第二趾胫侧共干后静脉及其近端以扩大皮瓣切取面积,改善皮瓣静脉回流.创面选择加压打包全厚皮片移植修复.术后用短腿石膏托固定,并按显微外科常规处理.结果 术后17例皮瓣全部存活,其中2例术后24 h内发生静脉危象,经手术探查、处理后解除.13例获得2个月～1年随访,手功能按中华医学会手外科学会上肢部分功能评定试用标准评定:结果优9例,良4例.皮瓣两点辨别觉为4～8 mm,16例对皮瓣外形满意.供区创面植皮全部存活,供足行走无受限,步态正常,对日常生活、工作无影响.结论 改良(足母)趾腓侧皮瓣可扩大皮瓣修复面积,改善皮瓣静脉回流,降低手术风险.     

Primary skin closure of large groin defects after inguinal lymphadenectomy for penile cancer using an abdominal cutaneous advancement flap

PURPOSE Large groin defects may be created after inguinal lymphadenectomy for bulky metastatic penile cancer. We describe a new method of primary closure of a large groin skin defect.MATERIALS AND METHODS In 3 patients with large volume inguinal lymph node metastases with skin breakdown and secondary infection extensive inguinal lymphadenectomy was done with wide surgical excision of skin and subcutaneous tissue. The procedures resulted in a large groin defect. Sartorius muscle was transferred to cover the femoral vessels. An abdominal advancement cutaneous flap was placed for soft tissue and skin coverage of the wound.RESULTS Primary closure of a large skin defect was possible using an abdominal advancement flap. In all patients the wound healed primarily with good cosmesis. A single patient underwent postoperative external beam radiation therapy to the flap site with no untoward effect on graft survival.CONCLUSIONS Large groin skin defects can be closed primarily using an abdominal advancement flap. This technique may also be used for bilateral groin defects. Compared with other types of flaps advocated for this purpose the main advantages of the procedure are simplicity, lower morbidity and superior cosmetic results.     

足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部软组织缺损

目的探讨足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部皮肤软组织缺损的临床效果。方法回顾性分析2015年10月至2020年12月榆林市第二医院烧伤整形手足外科收治的足跟部皮肤软组织缺损患者的临床资料。患者经急诊清创或扩创后,应用足底内侧岛状皮瓣修复足跟部创面,腹股沟游离皮瓣修复足底内侧供区创面,腹股沟供区直接缝合。术后观察皮瓣血运及存活、皮瓣供区愈合情况,并对足跟外形与功能恢复情况进行随访。结果共纳入8例患者,男7例,女1例,年龄20~71岁,平均32.2岁。其中5例为足跟外伤,1例足跟鳞状细胞癌,1例足跟冻伤,1例足跟溃疡。足跟部创面面积4 cm×3 cm~7 cm×6 cm。手术过程顺利,足跟岛状皮瓣及腹股沟皮瓣切取范围较足跟创面扩大0.5~1.0 cm。8例患者术后皮瓣血运良好,创面均一期愈合。术后随访3~12个月,所有患者足跟弹性佳,外形无臃肿,耐磨、耐压,感觉及行走功能满意;足底内侧供区无凹陷,无瘢痕增生及挛缩,无局部皮肤溃疡;腹股沟供区仅见线性瘢痕。结论足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部缺损,足部外观及功能恢复良好,效果满意。     

腹部随意单蒂三叶皮瓣修复多指末端皮肤缺损

目的:探讨采用腹部随意单蒂三叶皮瓣修复多指末端皮肤缺损的修复疗效。方法:自2005年3月至2010年10月,共收治30例90指,男20例60指,女10例30指;年龄15～56岁,平均36岁。同手中节指骨远端以远指体的皮肤脱套伤或横行缺损患者,选用腹部随意单蒂三叶皮瓣进行修复。术后随访观察皮瓣存活情况、皮瓣外形及术后并发症发生情况,并测定皮瓣两点辨别觉恢复情况。结果:30例患者术后获得随访,平均12.6个月,皮瓣全部存活,皮瓣色泽、质地、外形良好,两点辨别觉5～10mm,手功能恢复优良。结论:腹部随意单蒂三叶皮瓣手术方法简单、安全,供区损伤小,修复多指末端皮肤缺损可获得较为满意的疗效。     

Quadriceps keystone island flap for radical inguinal lymphadenectomy: a reliable locoregional island flap for large groin defects

Background: Radical inguinal lymphadenectomy (RIL) for bulky metastatic melanoma and non‐melanoma skin cancers of the inguinal region, while shown to improve morbidity and survival oncologically, can result in substantial morbidity from wound complications. Skin defects cannot be closed primarily and the substantial dead space predisposes to seroma, wound dehiscence and infection. Despite the clear need for reconstructive options, extended series describing reconstruction of large inguinal defects in this setting have not been reported. Methods: A prospectively entered, retrospectively reviewed study of 20 consecutive patients undergoing quadriceps keystone island flaps (QKIF) for the closure of complicated inguinal defects is described. Results: There was 100% flap survival, with no partial or complete flap losses. A reduction in wound breakdown/dehiscence from reported rates was seen, with four patients (20%) having wound breakdown, compared to double that rate in reported series. Other wound complications comprised six patients (30%) with mild wound infections, seven patients (35%) with seromas and two patients (10%) with haematomas. Conclusion: The QKIF is an effective means of reconstructing inguinal defects after RIL, particularly in high‐risk patients, and is technically simpler than other reconstructive techniques advocated for this purpose. Furthermore, the QKIF offers patients with advanced disease (where management is primarily palliative) a potentially improved quality of life with reduced operative morbidity.     

Sub-brow flap procedure for the closure of glabellar defects

Abtract Defects of the glabella and nasal root region are usually difficult to manage, when the aesthetic aspects are taken into consideration. Efforts at reconstruction may result in intercanthal contractures, a longitudinal scar extending to the forehead, nasal deformities or at least a visible scar at one of the most significant aesthetic units of the face. A surgical technique is presented for the reconstruction of glabellar defects designed in order to place the scars in natural wrinkle lines and to minimize closure tension. Seven patients underwent the sub-brow flap procedure for reconstruction of glabellar defects of various sizes. No complications were seen during the follow-up period and satisfactory cosmetic results were achieved.     

Refinement of reverse digital arterial flap for finger defects: surgical technique

We have designed a refinement of the reverse digital artery flap technique for soft-tissue defects on the dorsum of the fingers. In contrast with the traditional reverse digital artery flap it reduces the morbidity at the donor site and increases the ease and availability of resurfacing the defect. We suggest it is an alternative for the resurfacing of finger defects, especially over the dorsum.     

Composite osteo-cutaneous groin flap for the reconstruction of wrist and forearm defects

Two patients with severe traumatic soft tissue and bone loss at the wrist and involving the ulnar compartment of the forearm have been successfully treated with a compound osteo-cutaneous groin flap. The bone scans of the iliac bone graft showed good vascularity 8 weeks after the operation.     

改良(足母)趾腓侧皮瓣修复拇手指指腹缺损

目的介绍改良躅趾腓侧皮瓣修复拇、手指指腹缺损的手术方法。方法对15例拇、手指指腹缺损的患者，采用改良的躅趾腓侧皮瓣移植修复。该皮瓣在传统躅趾腓侧皮瓣设计方法基础上，将皮瓣腓侧缘及近端分别向背侧及趾蹼侧移动，从而避开口径细小又紧贴于皮下的躅趾腓侧浅静脉，直接游离第一跖背浅静脉；皮瓣的动脉和神经游离仍以常规方式进行。结果术后15例皮瓣全部成活，未发生动、静脉危象。12例获得4～11个月随访，3例失访。手功能评定：优10例，良2例。皮瓣两点分辨觉为4～8mm，12例对皮瓣外形满意。供区行走无影响，步态正常。10例对供区外观满意，2例欠满意，其中1例蹲趾腓侧偶有触痛。结论应用改良躅趾腓侧皮瓣可显著降低手术难度，提高成功率。     

Reversed cross finger subcutaneous flap: A rapid way to cover finger defects

Adequate coverage of dorsal finger wounds is often a challenge. The reversed cross finger subcutaneous flap to cover defects on the dorsum of phalanx constitutes an excellent option for coverage of wounds over the middle and distal phalanges of the index, middle, ring, and small fingers. It''s an easy flap and represents our first choice to cover those defects.     

The adipofascial turn-over flap for the coverage of finger defects

Summary This procedure was used to resurface finger defects in seven cases. The flaps survived completely, except one which had a 20% loss. The clinical results and pertinent literature are described and discussed.     

改良食指背侧岛状皮瓣修复拇指末节A区软组织缺损

[目的] 探讨改良食指背侧岛状皮瓣修复拇指末节A区软组织缺损的临床价值.[方法] 2006年1月-2008年6月,采用改良食指背侧岛状皮瓣修复拇指末节软组织缺损13例.按国内拇指截指三类六区分类,均属I类(拇指末节缺损)A区(拇指指端1/2缺损)损伤,缺损面积1.5 cm×2.5 cm～2.0 cm×3.0 cm.术后随访期间评价患手的功能及并发症情况.[结果] 13例皮瓣全部成活.经11～32个月(平均20个月)随访,皮瓣质地良好,患者对拇指功能和外观满意;皮瓣感觉恢复到S_3、S_4.按中华医学会手外科学会拇指再造功能评定试用标准评定:患者拇指功能优10例,良3例.[结论] 改良食指背侧岛状皮瓣具有血供可靠、切取方便、皮肤质地和感觉好等优点,是修复拇指末节软组织缺损的理想方法之一.     

Pericranial flap for closure of paramedian anterior skull base defects

OBJECTIVE: We sought to examine the position of a pericranial flap reconstruction of anterior skull base defects with respect to the original floor of the anterior cranial fossa. STUDY DESIGN: A retrospective chart and radiology review of 17 patients (1993-2001) with pericranial flap reconstruction for anterior skull base defects and 17 controls was performed. RESULTS: At 6 or more months after surgery, the new positions of the pericranial flaps ranged from 5 mm above to 11.3 mm below the positions of the original cribriform plates. There were no complications related to the pericranial flaps such as hemorrhage, flap loss, or brain herniation except for 2 (11.8%) cerebrospinal fluid leaks, 1 of which required operative correction. CONCLUSION: Pericranial flap reconstruction is a reliable method with low morbidity for closure of the most common skull base defect from the craniofacial resection that entails removal-unilateral or bilateral-of the fovea ethmoidalis, cribriform plate, and/or superior septum. This flap creates a watertight seal between the extradural space and the nasal cavity, prevents clinically significant brain herniation, and is associated with a low rate of cerebrospinal fluid leakage even without postoperative lumbar subarachnoid drainage of the cerebrospinal fluid.     

Vastus lateralis myocutaneous flap for reconstruction of defects around the groin and pelvis

We present our experience using the vastus lateralis myocutaneous flap for the repair of defects around the groin and pelvis. It is a relatively new technique, with many advantages over other flaps used in this area, though it has limitations. The history, anatomy and surgical technique of raising the flap are described and clinical cases are discussed. The importance of patient selection is highlighted.