重塑趾(指)甲治疗难治性甲沟炎

甲沟炎是门诊外科一常见病、多发病.一般认为病因为[1]:①嵌甲 趾(指)甲嵌入甲沟软组织内,导致甲沟部软组织受到挤压.影响局部血液循环产生炎性反应,是引起甲沟炎的主要原因.嵌甲可能与不良生活习惯有关,如鞋子较小、鞋头狭窄等.②感染 可能与拔手指甲肉刺、咬指甲等不良卫生习惯有关.甲沟部污物积聚,细菌繁殖产生炎性反应.③外伤 跌伤、踢伤或剪甲等造成甲沟或甲床组织损伤,继发细菌感染.临床上对于第2、3种病因所致甲沟炎,治疗效果好,但对于第1种病因所致甲沟炎的治疗效果欠佳.目前一般采用拔甲、甲床部分切除、趾(指)侧梭形切除等方式治疗,但复发率高,特别是嵌甲及感染后拔甲治疗复发率为100％.2008年3月至2010年5月我们采用重塑趾(指)甲及甲皱襞,治疗难治性甲沟炎30例,术后随访无复发病例.     

甲床部分切除联合甲沟重建治疗嵌甲性甲沟炎

目的探讨甲床部分切除联合甲沟重建治疗嵌甲性甲沟炎的临床疗效。方法对48例（51足）嵌甲性甲沟炎采用甲床部分切除联合甲沟重建手术治疗,手术前0.5%碘伏浸泡患趾,切除增生的肉芽组织及病变甲沟,纵形切除约1/5甲床,重建甲沟,术后加压包扎,抗炎换药治疗。结果本组均获随访,随访时间4个月～2年,术后复发1例,二次手术后痊愈;术后感染2例;其余患者甲沟重建外观美观、无复发,患者满意。结论嵌甲性甲沟炎采用甲床部分切除联合甲沟重建治疗,可以取得满意的疗效。     

嵌甲并发甲沟炎发病原因及手术方法的探讨

甲沟炎是一种趾甲感染的常见病,主要表现为患趾疼痛流脓,迁延不愈,并影响行走.对其治疗的方法虽然较多,如修整法、嵌甲部分切除、全甲拔除、甲沟"V"形组织瓣切除等,但均有损伤大、易复发等不足.自2000年2月至2008年5月,笔者应用保留甲根甲床的甲沟成形方法,治疗嵌甲引起的甲沟炎患者230例,获得了良好的效果.现报道如下.     

100例嵌甲患者的手术治疗效果分析

目的：通过对100例嵌甲病人的手术治疗探讨部分甲皱襞和甲床切除术治疗甲沟炎的疗效。方法：对三种类型共100例甲沟炎病人施以部分甲皱襞和甲床切除术加以治疗。结果：共治疗100例,99治愈（其中80例一期愈合,19例感染,经引流、换药后二期愈合）。随访2～8个月,平均5个月,一例复发,无复发患者对趾甲外形满意。结论：嵌甲是引起甲沟炎主要的原因,部分甲皱襞和甲床切除术对治疗各类型嵌甲时手术操作简单,效果满意,复发率低,同时一定程度上有美甲作用。     

嵌甲性甲沟炎的治疗

甲沟炎一般是因甲廓部的倒刺、甲廓损伤或慢性刺激导致细菌侵入皮下引起,也可由指（趾）甲长入甲沟内引起,前者可经过清创、换药、切开引流等措施治疗,对于后者引起的甲沟炎,传统的治疗方法往往是拔甲,而拔甲术后效果持续时间较短,待到新趾甲长出又会引起甲沟炎,需再次行拔甲术,临床上经常看到反复拔甲1～4次仍未痊愈的患者。笔者近3年来对嵌甲性甲沟炎患者采取切除嵌甲侧少部分趾甲、甲床及部分侧甲廓、对应的少部分甲母、甲沟内炎性组织,术后取得良好的治疗效果,笔者称其为嵌甲整形术,可一次性治愈嵌甲性甲沟炎。     

切除同侧甲根、甲床重建甲沟治疗嵌甲症36例报告

嵌甲症,是指正常的指甲长入正常的皮肤组织内,是一种常见的甲病,好发于足部(呣)趾,女性好发,与其长期穿高跟或尖足鞋有关.嵌甲症造成疼痛,也导致了甲沟炎的发生,以往多采用拨甲,极易复发.我院自2000年6月～2002年6月,运用同侧甲根、甲床切除,同侧甲襞推进,重建甲沟,治疗嵌甲症36例,效果满意,无复发,现报道如下.……     

48例嵌趾甲的病因分析及手术治疗

目的探讨趾嵌趾甲的病因,介绍一种新的手术治疗方法。方法对1997年10月至2003年10月我科收治的趾嵌甲患者48例51趾患者均进行手术治疗,咬除末节趾骨末端爪粗隆部分,梭形切除趾端及趾甲两旁软组织。随访观察趾端及趾甲的外形、了解嵌甲复发情况。结果所有病例平均随访26个月,47例50趾嵌甲治愈,1例1趾复发,经再次手术后治愈。结论趾末节趾骨爪粗隆突上翘是形成趾嵌甲的原因之一,咬除趾骨末端爪粗隆并梭形切除趾端及甲根两旁软组织是治疗嵌甲的一种有效方法。     

改良的甲板及甲基质部分切除治疗嵌甲性甲沟炎

目的探讨改良的甲板及甲基质部分切除治疗嵌甲性甲沟炎的临床疗效。方法选择2012年7月-2016年3月收治的86例95趾足部嵌甲性甲沟炎患者,采用患侧部分拔甲、甲基质部分(约1/5)切除、甲床外翻抬高、增生肉芽组织切除联合甲襞修整方法治疗,观察术后疗效。结果患者术后愈合佳,除3例术后创面感染,再次清创后愈合,其余切口均Ⅰ期愈合。81例获随访,随访时间10个月~4年,平均12.4个月,患者趾甲外观完整,患趾感觉及运动功能正常,无复发,无并发症、后遗症发生。结论该术式是目前治疗嵌甲性甲沟炎的有效方法之一,手术时间短、微创、方法简单可行、恢复快、治愈率高、远期疗效确切,尤其不影响甲部整体外形美观,患者易于接受,值得推广。     

简化的嵌甲矫正术

目的:介绍一种简单的嵌甲及其引起的甲沟炎的治疗方法.方法:对于无症状的嵌甲或甲沟炎早期,采取简化的嵌甲矫正术,即部分拔甲和部分切除甲根部的甲床、甲母质;对于嵌甲引起的甲沟炎的化脓期或慢性肉芽肿期,行拔除部分趾甲、清创引流术,待炎症控制、创面愈合一个月后行简化的嵌甲矫正术.结果:本组共86例,病人经过12～18个月随访,均无复发.结论:采用简化嵌甲矫正术,患者恢复快、无复发,值得推广.     

部分甲体甲床甲母质切除甲沟成形术治疗嵌甲型甲沟炎256例

目的:探讨一种利用甲侧襞皮瓣改变甲体与甲沟的位置结构,从而彻底治愈嵌甲型甲沟炎的手术方法。方法:切除部分甲体、甲床及甲母质,并利用甲侧襞皮瓣成形甲床、甲沟、甲侧襞联合结构。结果:本院2010年1月～2011年6月对256例嵌甲患者,足趾255例、手指1例,共376侧嵌甲进行甲沟成形手术,随访6月～2年,取得满意效果。结论:本手术从根本上彻底解决了嵌甲的病因,手术并发症少,复发率极低。     

甲板及甲基质部分切除联合拇趾腹重建甲沟治疗嵌甲性甲沟炎

目的探讨甲板及甲基质部分切除联合拇趾腹重建甲沟治疗嵌甲性甲沟炎的临床疗效。方法对76例嵌甲性甲沟炎患者采用甲板及甲基质部分切除联合拇趾腹重建甲沟术治疗,评价治疗效果。结果 76例均获随访,时间8~12个月。2例复发残甲,总有效率达97.4%。结论采用甲板及甲基质部分切除联合拇趾腹重建甲沟术治疗嵌甲性甲沟炎操作简便,对趾甲损伤小,患者痛苦轻,并发症少,治愈率高。     

成人先天性胆管囊状扩张症的临床分析

目的:探讨成人先天性胆管囊状扩张症的诊断及治疗。方法:回顾性分析1996年1月—2012年5月收治的53例成人先天性胆管囊状扩张症患者的临床资料。结果:53例患者均行手术治疗,Ia,Ib,Ic型39例和II型4例行囊肿完整切除、肝总管空肠Roux-en-Y吻合术,另3例Ia型行囊肿大部分切除、肝总管空肠Roux-en-Y吻合术;IVa型1例行肝左外叶切除、囊肿完整切除、胆管成形、肝总管空肠Roux-en-Y吻合术,另1例行囊肿完整切除、肝总管空肠Roux-en-Y吻合术;V型1例行左肝内胆管囊肿切除术;2例癌变患者,其中1例行癌变囊肿切除、局部转移淋巴结清扫术,1例行囊肿切除、左肝内胆管肿瘤切除术。53例手术患者中获随访42例,随访时间为6个月至3年,良性患者情况良好;2例癌变患者,1例术后生存26个月,死于肿瘤复发,多系统器官功能衰竭,1例术后26个月肿瘤复发,肝转移,再次手术行左半肝切除、S5(第V段肝脏)切除、肝肠吻合术,术后2个月出现肿瘤进展,死于多系统器官功能衰竭。结论:成人先天性胆管囊状扩张症的手术方式选择与治疗效果密切相关,不同的临床分型应选择不同的手术方式。     

Surgical Treatment of Ingrown Toenail without Matricectomy

BACKGROUND Partial excision of the nail matrix (matricectomy) is generally considered necessary in the surgical treatment of ingrown toenail. Recurrences may occur, however, and poor cosmetic results are frequently observed.
OBJECTIVE The objective is to present a new surgical procedure for ingrown toenail with complete preservation of the nail matrix.
METHODS Twenty-three patients with ingrown toenail were included in this study. The surgical excision was performed 1 week after the completion of treatment of the initial infection. A large volume of soft tissue surrounding the nail plate was removed under local anesthesia. No matrix excision was performed.
RESULTS Short-term results were excellent. No recurrences or severe complications were observed during the minimum 12-months follow-up period. Cosmetic results were remarkable.
CONCLUSIONS Ingrown toenail results from the compression of the lateral nail folds on the nail plate. This study shows that ingrown toenail can be surgically treated without matricectomy. A large volume of soft tissue surrounding the nail plate should be removed to decompress the nail and reduce inflammation. Cosmetic results are excellent and superior to the classical Emmert plasty. Postoperative nail dystrophies and spicule formation are not observed. The main advantage of this surgical approach is the complete preservation of the anatomy and function of the nail to improve both therapeutic and cosmetic results.     

Fingertip reconstruction with flaps and nail bed grafts

We retrospectively reviewed the cases of 14 fingertips reconstructed with a combination of local or regional flaps and nail bed grafts, some of which were placed wholly or partially over a de-epithelialized flap. Most of the fingertips sustained a crushing injury and were reconstructed at the time of the injury. Soft tissue coverage was provided by palmar V-Y flaps in 6 cases, thenar flaps in 4, lateral V-Y flaps in 2, a Moberg flap in 1, and a cross-finger flap in 1. Split toenail bed grafts were used in 6 cases, full-thickness nail bed grafts from the amputated part in 6, and split nail bed grafts from the injured digit in 2. There was 1 partial graft loss and 1 partial flap loss. The remaining cases had completely successful grafts and good soft tissue healing. Subsequent nail growth and adherence were good in all but the 1 digit requiring secondary composite grafting.     

En Bloc Excision of Proximal Nail Fold for Treatment of Chronic Paronychia

BACKGROUND: Chronic paronychia is a very recalcitrant dermatosis, which is particularly prevalent in housewives. Medical treatment for this condition is unsatisfactory in a significant number of cases. Surgical approach forms an important part of management, however, this area has received little attention. Various surgical approaches have been tried in the past but a comparative analysis has not been attempted. OBJECTIVES: The present study aims at assessing the efficacy of en bloc excision of proximal nail fold (PNF). Moreover, a comparative analysis has been undertaken to assess whether or not simultaneous nail plate avulsion improves the treatment outcome. METHODS: Thirty patients of chronic paronychia with nail plate irregularities were randomly divided into two treatment groups (15 patients each). After a detailed evaluation, en bloc excision of PNF with or without nail plate removal was performed. Postoperative measures were advised and the patients were kept under regular follow-up thereafter. Assessment of postoperative complications was also performed. RESULTS: Twelve patients in group I and 13 patients in group II completed the treatment protocol. Of these, 70% of patients were cured in group II (en bloc excision with nail avulsion) whereas only 41% were cured in group I (en bloc excision without nail avulsion). CONCLUSION: En bloc excision of the PNF is a useful method in recalcitrant chronic paronychia. Simultaneous avulsion of the nail plate improves the surgical outcome. Strict avoidance of irritant exposure is necessary to ensure complete treatment and prevent recurrence.     

第二足趾再造手指外形的重塑整形

目的 比较三种不同方法重塑第二足趾再造手指外形的疗效.方法 2003年4月-2008年1月,对31例第二足趾再造手指,分别采用三种不同方法重塑再造指外形.其中7例一期采用再造指局部三角皮瓣转移;9例一期采用邻趾侧方皮瓣转移嵌入再造指指腹颈部;15例二期采用再造指指腹侧方梭形切除术.结果 术后31例再造手指全部存活.16块转移皮瓣,除1块邻趾侧方皮瓣部分坏死,经二期换药后愈合外,其余转移皮瓣均存活.经8～15个月的随访,一期整形的再造指外形明显改善;二期整形的再造指指腹膨大得到明显改善,但指腹颈部的狭窄没有改善.所有再造指感觉均恢复,两点分辨觉为6～11mm. 结论一期行再造指局部三角皮瓣转移重塑外形,同时改善了再造指指腹膨大和掌侧颈部狭窄的外形缺陷,是改善再造指外形的较好方法.     

儿童先天性拇指扳机指13例报告

目的 :探讨儿童先天性拇指扳机指的成因 ,病理改变 ;并对其进行分型 ,对治疗方法进行探讨。方法 :静脉全麻下 ,对11例患儿行狭窄腱鞘部分切除术 ;2例加用肌腱成形术治疗。结果 :全部病例经 6个月～ 5年随访 ,均未复发 ,无术后粘连。结论 :儿童先天性拇指扳机指绝大多数不能自愈 ,非手术治疗效果差。直视下的狭窄腱鞘部分切除术或加用肌腱成形术是目前较好的治疗方法。     

Zur Behandlung des eingewachsenen Zehennagels

In Germany,"Emmert plasty" is one of the terms most frequently used in daily surgical practice. It describes the wedge excision of nail fold, nail edge, and corresponding matrix for advanced stages of ingrown toenail in most standard textbooks of surgery but without direct reference to Emmert. The method, however,was apparently first described by the French military surgeon Baudens in 1850 and was strongly opposed by Emmert himself who propagated a pure soft tissue resection. This text gives a short historical review of the various treatment methods of ingrown toenails.     

Ebstein心脏畸形139例手术治疗经验

目的：总结Ebstein心脏畸形手术治疗的经验。方法：回顾性分析1980年6月至2000年1月手术治疗139例Ebstein心脏畸形病人。其中行三尖瓣成形、房化右心室折叠和三尖瓣环DeVega成形111例，三尖瓣置换术27例，右心室发育不全行心外管道全腔静脉-肺动脉连接术（ETCPC）1例。结果：全组手术死亡12例（8.6％）；近10年手术死亡率降至3.3％。成形组中10例再次行瓣膜置换术，均生存。结论：对Ebstein心脏畸形应根据其美丽解剖特征选择手术方案，轻型可选用三尖瓣成形术；中间A型可选用成形术，中间B型应慎重选择成形或瓣膜置换术；重型选用瓣膜置换术。