改良逆行皮神经营养血管皮瓣修复肢端组织创面

目的 探讨常用皮神经营养皮瓣的改进措施,逾越常规方法下的切取面积及旋转距离局限,并提高成活面积,使其适用于各种高能量损伤导致的肢端大面积缺损.方法 以确切的粗大低位穿支为旋转点,或蒂部带入传统轴型皮瓣供血血管表浅段或传统肌皮瓣蒂远端以增加穿支数量,并使旋转点下移,对临床较为常用的腓肠神经营养血管皮瓣、前臂背侧皮神经营养血管皮瓣、股内侧皮神经营养血管皮瓣、腓浅神经营养血管皮瓣进行改进,用本法修复各种高能量损伤导致的肢端中、大面积软组织缺损68例. 结果 皮瓣全部成活,未发生血管危象,足背最远修复距离越过趾璞.手部超过掌指关节.股内侧皮神经营养皮瓣最远可修复小腿中下段缺损,腓肠神经营养血管皮瓣最大切取面积20m×14 cm,最长蒂长18 cm. 结论 通过本方法改进,使得上述常用皮神经营养皮瓣能够满足绝大部分情况下肢体高能量损伤创面修复需要,手术简单,疗效可靠.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

目的 探讨腓肠神经营养血管皮瓣游离移植的手术方法及临床应用效果.方法 切取由腓动脉发出单一皮穿支腓肠神经营养血管皮瓣,游离移植修复手背及涉及足前部的足踝部皮肤软组织缺损.皮瓣穿支动脉、小隐静脉分别与受区邻近的主干动脉分支及头静脉或大隐静脉吻合建立血液循环;亦可单纯吻合穿支动、静脉供血.皮瓣腓肠神经与受区皮神经吻合.结果 2005年1月至2007年12月,于临床应用12例.皮瓣切取面积12 cm× 7 cm～18 cm×11 cm,皮瓣全部成活.术后随访7～27个月,皮瓣外观、质地优良,两点辨别觉7～12 mm,肢体功能恢复满意.结论 本术式综合了游离皮瓣、穿支皮瓣与皮神经营养血管皮瓣的优点,皮瓣设计灵活,切取方便,惨复位置随意,血供可靠,是修复手足皮肤软组织缺损的较好方法.     

游离穿支腓肠神经营养血管皮瓣修复手背软组织缺损

目的 总结吻合腓动脉穿支游离腓肠神经营养血管皮瓣修复手背软组织缺损的手术方法及临床效果.方法 2005年12月-2008年5月,收治5例手背软组织缺损患者.男4例,女1例;年龄17～42岁,甲均29岁.机器绞伤2例,交通伤、慢性感染溃疡及蛇咬伤后皮肤坏死各1例.软组织缺损范围为7 cm×6 cm～10 cm×9 cm.术中采用大小为8 cm×7 cm～12 cm×10 cm的游离穿支腓肠神经营养血管皮瓣修复缺损.供区游离植皮修复闭.结果 术后皮瓣及植皮均成活,供受区创面均Ⅰ期愈合.患者均获随访,随访时间7～13个月.皮瓣外形及功能满意,两点辨别觉为7～11 mm.供区肢体无异常,正常行走.结论 游离穿支腓肠神经营养血管皮瓣厚度适宜,质地优良,切取简便,不牺牲主干血管,是修复手背软组织缺损的理想方法之一.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

高位穿支蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损

目的 报道相对高位单一腓动脉穿支蒂腓肠神经营养血管皮瓣修复踝周及跟底负重区不同面积软组织缺损的手术方法及临床效果.方法 切取以腓动脉发出最下位主穿支为蒂腓肠神经营养血管皮瓣,皮瓣远端与创面相连,血管蒂位于其中下分,旋转180°,近远端交换分别修复缺损创面及部分供区,腓肠神经与受区皮神经吻合重建感觉.结果 临床应用19例,皮瓣全部成活.随访时间12～23个月,皮瓣外观满意,质地优良,两点辨别觉7～14 mm,可正常穿鞋行走.结论 该术式皮瓣可切取面积大,血供可靠,创面修复平整美观,肢体功能恢复满意,适合未涉及前足的足踝部软组织缺损修复,特别是低位缺乏满意穿支者.     

逆行第一趾背皮神经营养血管皮瓣修复足趾端皮肤缺损及骨外露

目的:探讨逆行第一趾背皮神经营养血管皮瓣修复足第一趾远端软组织缺损及骨外露的治疗方法。方法:一期或二期应用逆行第一趾背皮神经营养血管皮瓣修复足第一趾远端软组织缺损及骨外露,切取皮瓣最大面积为4.0cm×3.0cm,临床应用6例。结果:除1例发生边缘坏死外,其余全部成活,术后随访5个月～25个月,皮瓣质地满意,患足功能稳定。结论:使用逆行第一趾背皮神经营养血管皮瓣修复足远端软组织缺损及骨外露,手术简便,疗程短,效果满意。     

下颌骨巨细胞瘤15例X线表现

骨巨细胞瘤为具有局部侵袭性的良性肿瘤，多发于骨发育成熟的个体，收集我院2008年1月至2010年1月下颌骨细胞瘤患者15例，现报告如下。