中国特殊形式穿支皮瓣的名词术语与定义专家共识

穿支皮瓣是近年来皮瓣外科领域的研究热点,因其改善了皮瓣受区的外形和功能、最大程度减少了皮瓣供区外观和功能的损害,目前已被广泛应用于乳房重建及头、颈、躯干与四肢创面的修复.随着临床应用的推广与深入研究,发现经典的穿支皮瓣仍然存在一定的局限性.近年来在秉承穿支皮瓣核心理念的基础上,穿支皮瓣术式得到了不断发展,如为了不牺牲受区主干血管衍生了血流桥接穿支皮瓣,为了避免皮瓣臃肿衍生了显微削薄穿支皮瓣,为了修复超长创面衍生了联体穿支皮瓣,为了吻合一组血管同时修复多个创面衍生了分叶穿支皮瓣,为了使合并深部骨骼或肌肉组织缺损的创面得到立体美学修复衍生了嵌合穿支皮瓣等等.这些特殊形式穿支皮瓣的衍生和发展,丰富了穿支皮瓣的内涵,扩大了穿支皮瓣的适应证.为促进穿支皮瓣在我国的普及和发展,2012年9月22日至24日,在宁波召开了第二届中国穿支皮瓣高峰论坛,与会专家就特殊形式穿支皮瓣的名词术语与定义达成了如下共识.     

应用高分辨率显微CT进行大鼠周围神经微血管三维可视化研究

目的 探讨采用高分辨率显微CT（Micro-CT）研究大鼠周围神经微血管三维构筑的可行性,比较两种不同的造影剂对成像效果的影响。
方法 SD大鼠40只,随机分为2组,分别灌注明胶-氧化铅和Microfil,取大鼠两侧坐骨神经行Micro-CT扫描,同时设定电压30kVP、功率40W作为
成像时的最佳能量参数。将扫描得到的断层图像转变为Dicom格式输出至个人电脑,利用Mimics 10.0软件对其进行三维重建。结果 将灌注不同
造影剂后得到的标本图片分别从大体和三维两个方面进行对照,发明明胶-氧化铅的造影效果明显优于Microfil;Micro-CT在扫描重建时呈现出低
耗时、低变化以及高清晰度的特点。结论 Microfil 在灌注微血管造影时存在者灌注压力要求高、成像质量差等缺点,而传统的明胶-氧化铅在
微血管造影上仍有其独到的优越性;Micro-CT不失为一种研究大鼠周围神经微血管三维构筑的好方法。     

小腿后部各区穿支间的关系与皮瓣设计

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.     

纤维蛋白原的临床意义及测定

纤维蛋白原（fibrinogen，Fg），分子量34万，由肝细胞合成和分泌，占血浆总蛋白的2％-3％，为机体止血生理中重要的凝血因子。正常人血浆中Fg浓度为2．0g／L-4．0g／L，半寿期约为3d，电泳分离显示在β2区带。Fg是一种急性时相反应蛋白，其增加往往是机体的一种非特异反应，常见于毒血症、肺炎、轻型肝炎、胆囊炎、肺结核等感染及肾病综合征、风湿热、恶性肿瘤、风湿性关节炎、脑血栓、脑梗死、心肌梗死等无菌性炎症；另外如外科手术、放射治疗、月经期及妊娠期也可见Fg轻度增高。Fg减少较少见，但当其〈1．0g／L时，机体可出现出血征象。一种先天性如缺乏症是极为罕见的遗传性疾病，通过常染色体隐性基因遗传，此患者肝脏不能合成Fg；继发性Fg减少的原因是由于纤维蛋白溶解酶溶解纤维蛋白所致，如胎盘早期剥离，     

小腿后部各区穿支间的关系与皮瓣设计

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.     

特殊形式穿支皮瓣及其衍生术式命名专家共识

穿支皮瓣是在传统轴型皮瓣基础上发展而来,以穿支血管供血,仅包括皮肤与浅筋膜组织的一种新型皮瓣,由于改变了深筋膜血管网是皮瓣赖以生存的传统观点,使皮瓣设计和形成更具灵活性和多样性 [ 1, 2, 3] 。2012年唐举玉 [ 4] 在...     

SDF-1及其受体CXCR4在皮瓣外科中的研究进展

<正>基质细胞衍生因子-1(stromal cell-l derived factor1,SDF-1)是α趋化因子家族的一个新成员,可以动员干/祖细胞,通过与其受体CXCR4结合激活一系列信号通路,从而在组织创伤后诱导血管再生。大面积软组织缺损的修复重建常需要移植跨血管供区的大皮瓣,此类皮瓣移植后需要在不同供区之间建立起新的血液循环体系。最近研究证实:SDF-1及CXCR4轴可以促进血管新生,有助于皮瓣内血液循环体系的重建,从     

如何提高基层部队医疗检验设备的使用效能

基层部队医疗检验设备在管理、使用和维护上存在着诸多问题本文就如何提高医疗检验仪器设备的使用效能,如何提升基层部队的卫勤保障能力进行了初步的探讨.     

臀部肌肉注射数字化解剖学研究

目的为临床上确定臀部肌肉内注射的最佳部位及深度提供数字化解剖学依据。方法 (1)23具防腐标本,解剖观测臀肌注射位置与血管干、坐骨神经的距离及软组织厚度;(2)6具明胶-氧化铅灌注的新鲜整尸标本,CT扫描后,行盆部三维重建。结果三分法臀部肌内注射点处的软组织总厚度为(6.63±1.06)cm,臀肌间隙至髂骨翼骨膜的距离为(4.37±0.62)cm,注射针体距臀上血管主干和坐骨神经的距离分别为(5.87±0.93)cm和(7.46±0.94)cm;十字法臀部肌内注射定位点距坐骨神经的距离为(3.63±0.68)cm。结论连线法臀部肌内注射简易而安全,但目前成人常用的注射针头(2.7～4.9cm)普遍偏短,建议选择针梗长6cm以上的针头。     

逆行岛状腓骨肌皮瓣再造足跟

目的探讨逆行岛状腓骨肌皮瓣的血供基础及足跟再造。方法应用解剖学的方法研究腓骨肌皮瓣血供及跟骨的生物力学特征,并在标本上进行摹拟手术。1998年5月为1例右足跟爆炸伤后2个月,全足跟缺损患者采用腓血管蒂逆行岛状腓骨肌皮瓣移位修复,腓骨瓣长14cm,带部分腓骨肌及(口)/(止)母长屈肌,皮瓣为14cm×12cm。结果①腓动脉下端与胫前、胫后动脉有丰富且粗大的吻合,完全可提供逆流供血;血管蒂旋转点因手术需要而定,最低点为外踝上6cm,此处血管蒂解剖可长达20cm;②该瓣的形态与跟骨的生物力学特征相适应,临床应用者术后腓骨肌皮瓣成活好,随访10个月获得满意效果。结论逆行岛状腓骨肌皮瓣可修复足跟严重缺损,尤其为跟骨及骰骨完全缺失者提供了一种新方法。