改进的食指背侧岛状皮瓣转移一期修复拇指及虎口皮肤缺损

自1983年5月以来,我们应用改进的食指背测岛状皮瓣转移一期修复拇指及虎口皮肤缺损,效果良好。 手术方法 根据受区创面范围,在食指背侧进行皮瓣设计。先在远端及两侧切开,切至深筋膜下及伸肌腱浅面,将皮瓣向近端掀起。皮瓣蒂之切     

拇指创伤性截指后的再植与再造

拇指的功能占手功能的50%左右,一旦缺失则捏、夹、握、抓等功能难易进行,故拇指创伤性截指后,常需重建新的拇指。理想的拇指重建,应尽可能满足下述要求:(1)有足够的长度与稳定性;(2)能活动,能对指,有力量;(3)有良好的感觉与血     

神经束膜间吻合动物实验与临床应用

神经损伤后,能否尽快修复是肢体功能与劳动力恢复的关键。以往对神经损伤的修复通常采用对端缝合神经外膜的方法,效果不够理想。自1975～1976年,我们通过动物实验做坐骨神经吻合,初步掌握了神经束膜间吻合法,并解决了吻合部张力问题,而后用于临床,对17例周围神经损伤的患者进行束膜间吻合,取得了较好的效果。现小结如下。     

手部开放性损伤的早期处理(附180例分析)

我院自1974年7月至1979年7月,共收治手部开放性损伤784例,现将其中经住院治疗,并经早期处理的180例作一粗浅分析。一、临床资料: 1.年龄与性别:本组180例中,20岁以下者45例,占25%;31岁以上者30例,占16.5%;20～30岁者105例,占58.5%,此年龄组患者之所以多,与劳动强度较大、工作经验较少及工作性质有关。     

先天性股四头肌挛缩手术矫形1例

先天性股四头肌挛缩查阅有关文献、尚未见报道;最近我们收治1例,经手术矫形,效果良好,报道于下:患者女,5岁。自生后14个月发现右膝弯曲受限,但无自觉症状,后渐加重且右大腿渐较对侧细小,5岁后右膝基本为伸直位不能弯曲,行走跛行。检查:右股部较对侧明显为     

带感觉神经的静脉网动脉化皮瓣移植修复手指脱套伤

采用带感觉神经的静脉网动脉化皮瓣修复手指脱套伤６例７指，皮瓣全部成活。此种手术的优点：①一次手术完成手指脱套伤组织皮肤缺损的修复，代价小、功能好。②由于皮瓣内含有感觉神经，伤指可恢复良好的感觉，两点瓣别觉５￣１０ｍｍ。③皮瓣薄，质地好，手指的外形及功能满意。对手术方法、适应证的选择、皮瓣的成活因素进行了讨论。     

腓骨头复合组织瓣修复儿童内踝骨皮肤缺损四例

Objective To investigate the therapeutic effect of fibular head composite flap for bone and skin defect at medial malleolus in children. Methods From Aug. 2005 to Apr. 2009, 4 children cases(2 male, 2 famale, from 3 to 11 year) with bone and skin defect at medial malleolus were reconstructed with fibular head composite flaps pedicled with lateral inferior genicular vascular bundle. The skin defect was 3- 6 cm × 8-10 cm in size. Results All the 4 compostie flaps survived completely. The patients were followed up for 4 months to 4 years with good bony healing. Both esthetic and functional results were satisfactory in ankle joint. Conclusions The fibular head composite tissue flap has a good therapeutic effect for bone and skin defect at medial malleolus in children.     

尺动脉腕上皮支在断掌中的应用

手掌离断伴有掌侧皮肤缺损往往影响再植的成功率及术后功能的恢复,利用尺动脉腕上皮支皮瓣加以修复,可以大大提高手术的成功率及术后功能的康复。     

五个月婴儿示指中指末节离断再植成功一例

患儿　男 ,出生 5个月零 2 3天 ,因左手示、中指末节被折叠椅挤断 3h于 2 0 0 0年 8月 2日入院。检查 :左手中指末节自远指间关节处完全断离 ,断面周围软组织挫伤较重 ,皮下广泛瘀血 ,指甲脱落 ;中节指骨头碎裂 ,末节指骨基底关节软骨部分缺损。左手示指末节软组织自甲根部伤断 ,指骨自掌指关节处断离 ,断面处仅有指深屈肌腱相连 ,断面以远手指无血运 ,断面周围组织挫伤严重 ,皮下瘀血 ;伤后 4h时全麻下行左手示、中指再植术。示指再植 :清创 ,用直径 0 .8mm的克氏针髓内贯穿固定中末节指骨 ,用 5 - 0针线修复指伸肌腱 ,吻合指掌侧动脉 2条 …     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.