局部皮瓣修复头面部缺损43例分析

目的:探讨局部皮瓣修复头面部不同类型缺损的应用及注意事项。方法:根据43例缺损的特点,选择Burow’s楔形皮瓣、Tripier单侧皮瓣、风筝皮瓣等相应皮瓣进行一期修复。结果:43例皮瓣全部成活,其中1例皮瓣尖端坏死,1例皮下脂肪液化,经换药后自行愈合。术后随访1~24个月,皮瓣血运、质地良好,患者满意。结论:头面部缺损应用局部皮瓣进行美容修复,根据肿物大小、切除后皮损范围、皮纹走向、皮肤周边色泽、质地、毛发分布等因素选择合适的皮瓣,可以达到理想的效果。     

双叶皮瓣修复面中部基底细胞癌切除后皮肤缺损19例

目的探讨面中部皮肤肿瘤手术切除后缺损修复的有效方法,分析双叶皮瓣修复皮肤缺损的设计模式。方法面中部皮肤肿瘤手术切除后,根据皮损位置和大小,在皮损外侧规范设计双叶皮瓣,充分皮下游离,转移皮瓣,分层间断缝合。结果19例患者,4例第二叶皮瓣远端皮肤术后发生0．1cm×0．2cm范嗣内的皮瓣血运障碍、坏死,后经积极换药后愈合;15例第二叶皮瓣、19例第一叶皮瓣术后全部成活。全部病例手术后眼、鼻、口外观均未见明显畸形。结论皮肤缺损外侧模式设计的双叶皮瓣,是一种能够修复面中部皮肤缺损的成形方法。     

股前外侧皮瓣修复头面颈部畸形缺损:兼论皮瓣分型

目的总结应用股前外侧皮瓣修复头面颈部畸形缺损的经验,并深入探讨股前外侧皮瓣的血管分型。方法采用股前外侧皮瓣游离移植修复头面颈部烧伤及创伤性缺损、慢性溃疡、半面萎缩、肿瘤切除术后洞穿性缺损、增生性瘢痕及挛缩畸形等。结果58例股前外侧皮瓣的蒂血管中,45例来源于旋股外侧动脉降支,7例来源于旋股外侧动脉横支,其它血供来源包括旋股外侧动脉主干4例,股深动脉1例,股动脉1例。58例皮瓣全部成活,仅1例远端10%坏死,随访2～19年,外形和功能恢复满意。结论①股前外侧皮瓣可根据蒂血管来源和皮肤血供类型来表示其分型,即“血供来源─血供形式”分型法。②股前外侧皮瓣因其具有恒定而较长的血管蒂、易于解剖分离、能提供充足的组织量以及供区隐蔽等优点,对头面颈部畸形和缺损的修复有独特效果。     

颜面部皮肤癌手术方式探讨

目的探讨颜面部皮肤恶性肿瘤的手术治疗方法与面部形态及美容的关系。方法从1998年～2003年对69例颜面部恶性肿瘤,根据病灶的部位和范围,扩大切除后行单纯缝合、游离植皮、局部皮瓣 植皮、皮瓣转移等方法修复创面,并辅以放疗或化疗。结果皮瓣全部成活,皮片有3例表皮坏死,其余全部成活,切口愈合良好。随访6个月～3年,术区外形与功能良好。结论颜面部恶性肿瘤宜早期手术扩大切除,选用适宜的修复方式有助于恢复容貌,并取得较满意的外形及预后。     

逆行足底内侧动脉蒂岛状皮瓣及其临床应用

从足底内侧切取带足底内侧动脉蒂的皮瓣,反向移至第一跖骨头处,以修复足底溃疡;以之治疗两例,皮瓣完全成活,随防6个月和2年,溃疡没有复发。     

逆行足底内侧动脉蒂岛状皮瓣及其临床应用

从足底内侧切取带足底内侧动脉蒂的皮瓣，反向移至第一跖骨头处，以修复足底溃疡，以之治疗两例，皮瓣完全成活，随访６个月和２年，溃疡没有复发。     

细菌性皮肤病

20 0 0 1495　轴型皮瓣修复小腿和足部慢性溃疡创面 /柴勇 (安徽铜陵市医院烧伤整形科 )…∥安徽医科大学学报 .- 1999,34 ( 4 ) .- 32 2采用轴型皮瓣修复小腿及足部的慢性溃疡创面2 6例 ,1例皮瓣因感染坏死 ,其余均 10 0 %成活 , 期愈合率 88.5%。作者认为轴型皮瓣血供丰富 ,抗感染能力强 ,不受长宽比例限制 ,切取范围较大 ,足以 期覆盖创面 ,修复缺损 ,并保持愈合后的稳定 ,且不需吻接血管 ,手术操作简便、安全、可靠。作者还讨论了皮瓣设计及手术注意事项。参 2　 (赵恩兵 )2 0 0 0 1496　溃疡糊 (贴 )治疗皮肤溃疡疗效观察 /李小英 (广…     

枕动脉跨区供血的反流轴型头皮瓣一次修复大面积复杂性头皮缺损

目的探讨一次手术完成复杂性大面积头皮缺损的修复方法。方法采用枕动脉跨区供血的反流轴型头皮瓣,修复8例复杂性大面积头皮缺损。结果8例头皮瓣均100%成活,一次完成修复,效果满意。结论枕动脉与头皮其它血管的吻合恒定,血运丰富。以枕动脉为供血源,跨区切取大面积的头皮瓣一次修复面积达1/3～1/2的头皮缺损,是一种安全可靠的有效方法。     

臀大肌皮瓣手术治疗骶尾部坏死性筋膜炎一例分析

坏死性筋膜炎为皮肤及筋膜多种细菌混合感染(包括需氧菌和厌氧菌)。临床上早期需全身联合应用足量有效抗生素,并行局部扩大清创换药及支持治疗。后期因病变广泛而扩大清创,其创面大多数无法直接缝合,常采用游离植皮及皮瓣转移修复创面。现采用臀上带动脉的臀大肌肌皮瓣修复1例骶尾部坏死性筋膜炎创面。     

应用足外侧皮瓣治疗足跟部恶性黑色素瘤

目的修复足跟部恶性黑色素瘤切除后遗留的足跟部创面。方法应用足外侧皮瓣转移修复创面,皮瓣供区以中厚皮片移植。结果6例患者皮瓣全部成活,随访3～12个月,2例患者因黑色素瘤全身转移死亡,4例患者足跟部皮瓣形态、感觉及功能均满意。结论足外侧皮瓣具有皮瓣薄、质地好、血运好,解剖容易,转移方便,感觉好,抗磨耐压等特点,是修复足跟部皮肤缺损的理想皮瓣。     

Cassiopeia flap: modification of Limberg flap for saving normal skin

Local flaps have the advantages of texture matching and increased flap survival rate. The proper local flap planning for each lesion causes the dermatologist to be reluctant to employ them. We propose a modified local flap, the "Cassiopeia flap", with three simple marking points made on the ends of the diameter and on the equidistant point along the diameter; two points from equilateral triangles form a "W (Cassiopeia)". We applied this modification to ten lesions on the face, scalp, trunk and thigh with excellent results.     

Horizontal advancement flap for lateral dorsal nasal defects

BACKGROUND: Repairing dorsal nasal defects is a frequent challenge for dermatologic surgeons, mainly due to the high frequency of basal cell carcinomas on this site. Obvious scars, mismatched skin and distortion of the nasal contour are the surgical hazards that must be avoided in these cases. AIM: Our aim was to perform surgery involving a simple flap in order to repair medium to large defects on the dorsal side of the nose. METHODS: The dorsal horizontal advancement flap was studied in 12 patients, in order to evaluate the benefits and limits of this surgical procedure. RESULTS: The resulting scars on most of our patients were well-camouflaged among their natural skin lines, and there was neither distortion of the alar contour nor the nostril. CONCLUSIONS: This flap is easy to perform and, in selected cases, provides an outstanding alternative to second-intention healing, full-thickness skin grafts, transposition, rotation and pedicle flaps.     

Two Cases of Annular Skin Defects Repaired with Quadruple Fan Flaps (O-X Flap)

Nowadays, patients have high expectations when it comes to minimization of postoperative scarring after dermatologic surgical procedures. When an annular lesion is being excised, normal skin should be excised, as well, to prevent a dog ears resulting in a long scar. We introduce a new flap reducing the scar length in annular defects. In order to avoid a long scar, we designed a quadruple fan flap (O-X flap) that is a variation of the rotation flap. It consists of four rotation flaps arranged like fans, with open and closed configuration. We suggest that the quadruple fan flap (O-X flap) is a viable option for treating annular skin defects, because it shortens the scar line, preserves normal tissue, and provides a cosmetically favorable outcome.     

Three cases of reconstruction with a simply designed bilobed flap after excision of squamous cell carcinomas of the lateral eyebrow areas

Squamous cell carcinoma is frequently observed on the lateral eyebrow, one of the most difficult sites for one‐stage reconstruction because of its location close to the eyelids. The reconstruction of defects by the single‐stage flap is advantageous for elderly patients because of its good functional and aesthetic outcome. We surgically treated three cases of squamous cell carcinoma on this area and performed reconstruction with a simply designed bilobed flap, all of which resulted in favorable outcomes. We therefore report on the usefulness of this reconstructive method for the lateral eyebrow defects.     

Customized reconstruction with modified keystone flaps

The reconstruction of soft tissue defects with a similar type of tissue and minimizing morbidities are important. Herein, we describe our surgical experience using customized reconstruction with a series of modified keystone flaps. We retrospectively reviewed data of 48 consecutive soft tissue reconstructions using modified keystone flaps between March and December 2017. Soft tissue reconstruction was performed and there was no major complication in the follow‐up period. The dimensions of the wound defect ranged from 1 × 1 cm² to 20 × 18 cm² with a mean size of 4.7 × 3.5 cm², while the dimensions of the customized keystone design flap ranged from 2 × 1 cm² to 23 × 19 cm² with a mean size of 7.9 × 5.4 cm². Minor dehiscence in three cases (6%) and partial flap loss in one case (2%) were noticed. Two cases healed spontaneously and other two cases were surgically recovered. Due to its simplicity, reliability, versatility and minimal morbidity, our modified keystone flaps could be excellent surgical options in various soft tissue reconstructions.     

背阔肌肌皮瓣修复小儿胸部巨大缺损

目的探讨背阔肌肌皮瓣修复小儿胸部巨大血管瘤切除后缺损的疗效。方法用带蒂背阔肌肌皮瓣修复小儿胸部巨大血管瘤切除后缺损12例。皮瓣切取面积为18～40cm2。结果12例皮瓣全部存活,随访1～2年,胸部外形满意,上肢运动功能正常。结论应用背阔肌肌皮瓣修复胸部大面积皮肤、组织缺损,能较满意恢复胸部外形。     

Reconstruction of a traumatic plantar foot defect with a novel free flap: The medial triceps brachii free flap

Introduction: Lower extremity defects may account for 14.6% of the approximately 117 million visits to emergency departments in the U. S. in 2007. In this article, we present a reconstruction of a traumatic plantar foot defect with a medial triceps brachii (MTB) free flap. Clinical case: A 53-year-old man sustained an accidental gunshot wound to the right foot. The patient was admitted after the failure of a sural flap procedure performed in another hospital. He presented with a soft-tissue defect with calcaneal exposition and osteomyelitis. The defect was reconstructed with a MTB free flap anastomosed to his dorsalis pedis vessels. Results: Flap raising time was 52 min. There were no intraoperative complications. The total flap surface was 38.5 cm². The pedicle length was 3 cm. The diameters of the artery and vein of the flap pedicle were 1.1 mm and 1.4 mm, respectively. Ischemia time was 28 min. His donor site healed uneventfully without any morbidity, and the scar was well concealed. The flaps survived and there was no partial flap necrosis. A split-thickness skin graft was performed 12 days postoperatively. Two months later, he had a completely healed wound with no contour abnormality. The total follow-up was 24 months. The patient was able to walk normally. Conclusion: MTB free flap appears to be an excellent option for plantar foot defects in patients with preserved vascularization of the foot. Due to the anatomical shape of the flap, the position of its pedicle, and the moldability of the muscle, we predict that the use of the MTB free flap will grow and develop rapidly for reconstruction of ankle and foot defects.