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31.
Naoya Katsuragi Yutsuki Nakajima Yuji Shiraishi Masahiro Hashizume Nobumasa Takahashi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2005,53(8):440-442
We describe a case of a large bronchial fistula and empyema after right upper lobectomy that was treated successfully with
open window thoracostomy followed by a latissimus dorsi myocutaneous flap and limited thoracoplasty. A latissimus dorsi myocutaneous
flap can provide immediate airtight closure of a large bronchial fistula, allowing lavage and curettage of the empyema cavity
to reduce the chance of postoperative infection. An important aspect of this technique is that the deepithelialized skin side
rather than muscle is sutured to an opening of the bronchus. As compared with other techniques, a latissimus dorsi myocutaneous
flap is superior in that it requires a single incision and does not require an intraop-erative change of position. In addition,
the technique causes little dysfunction of the chest and shoulder and preserves the vascular supply to ensure the viability
of the flap even if it was divided in a previous operation. 相似文献
32.
定向皮肤扩张器在面颈部瘢痕治疗中的应用 总被引:14,自引:9,他引:5
目的:探讨定向扩张器在治疗面颈部瘢痕中的临床应用。方法:回顾性分析我科2000年至2004年用定向扩张器治疗48例面颈部瘢痕患者。手术分两期:先于瘢痕附近正常皮下置入定向扩张器,皮肤充分扩张后行扩张器取出、瘢痕切除、局部皮瓣转移。结果:48例患者共治疗56处瘢痕,置入扩张器60个,一次修复最大面积为12cm×16cm,除5例遗留部分瘢痕经第二次皮肤扩张修复外,所有患者均得到有效治疗;扩张期并发症18处(30%),以扩张器外露最多见。结论:定向皮肤扩张器在面颈部瘢痕治疗中有很大的应用价值。但应重视预防并发症。 相似文献
33.
34.
Péter Móricz Imre Gerlinger Jenő Solt Krisztina Somogyvári József Pytel 《European archives of oto-rhino-laryngology》2007,264(12):1441-1445
Stenosis of the hypopharyngo-oesophageal junction can be a rare complication of laryngectomy and/or partial pharyngectomy
and makes the insertion of voice prosthesis extremely difficult. This study describes the authors’ experiences gained by endoscopic
balloon-catheter dilatation of hypopharyngo-oesophageal stenoses prior to implantation of voice prostheses in four cases.
In two patients a single balloon-catheter dilatation resulted in wide enough pharyngo-oesophageal lumen on the long run. The
average prosthesis wearing-times were 6.8 months in case 1 and 4.6 months in case 2, corresponding to the published literature
data. In case 3, repeated dilatation of the pharyngo-oesophageal transition had proved to be unsuccessful despite taking every
effort with the endoscopic balloon-catheter method. Having excised the stenotic segment, reconstruction with pectoralis major
myocutaneous flap (PMMF) was indicated. Eighteen months later, a repeated restenosis was observed and a free jejunal flap
needed to be performed as a final solution. In case 4, the insertion was carried out into a previously dilated jejunal free
flap, which became gradually ischemic and stenotic since the major head-and neck procedure was carried out that resulted in
prosthesis rejection after just 1 week. The authors emphasize that correct indication of pedicled and free flaps in head and
neck reconstruction is a prerequisite from the aspect of prevention of pharyngo-oesophageal strictures. Endoscopic balloon-catheter
dilatation is a safe and established method for dilatating hypopharyngo-oesophageal stenoses of different origin. The procedure
provides maximum patient benefit with minimal trauma and morbidity; moreover, facilitates insertion of voice prostheses. However,
a single balloon-catheter dilatation cannot always result in wide enough oesophageal lumen on the long run (case 3). Insertion
of a voice prosthesis into a previously dilated ischemic jejunal segment is challenging and avoidable due to risks of complications. 相似文献
35.
处女膜修补手术及麻醉方法的改进 总被引:9,自引:7,他引:2
目的;增大处女膜粘膜瓣的接触面,减少因麻醉造成的处女膜粘膜水肿,提高修复手术的成功率。方法:手术全部采用1%的卡因行粘膜表面麻醉。53例采用瓦合粘膜瓣法,3例用瓦合粘膜瓣联合阴道粘膜瓣修复法。结果:56例术后一月随访,53例处女膜孔径为一指,成功率94.64%。结论:采用1%的卡因粘膜表面麻醉,瓦合粘膜瓣法及瓦合粘膜联合阴道粘膜瓣修复法对处女膜修复是行之有效的。 相似文献
36.
激光上皮下角膜磨镶术后角膜上皮瓣临床观察 总被引:1,自引:0,他引:1
目的 观察及探讨准分子激光上皮下角膜磨镶术(Laser subepithel ialkeratomileusis,LASEK)后,角膜上皮瓣的成活率及其影响因素。方法 对行LASEK治疗的42例(80眼)于术后1、2、3天,1、2、3、4周在裂隙灯显微镜下进行角膜上皮瓣的观察。结果 34例(68眼),角膜上皮瓣成活,成活占85%(68/80);未成活8例(12眼),未成活占15%(12/80)。结论 LASEK术后角膜上皮瓣成活率的高低,决定着LASEK的临床疗效,影响其成活的因素是多方面的。其中角膜上皮瓣边缘不整齐、破裂、对位不良、操作时间过长可能是其主要原因。 相似文献
37.
38.
Andreas Nikolis Apostolos Christopoulos Michel Saint-Cyr Carlos Cordoba Louis Guertin Patrick G Harris 《CANADIAN JOURNAL OF PLASTIC SURGERY》2003,11(1):37-40
Complications following free tissue transfer have been well established in the literature. Common and rare causes of free flap failure must be addressed by the treating surgeon when microvascular patency is threatened. With the evolution and prevalence of microsurgery, ‘rare’ causes of free flap failure will become increasingly frequent. A high index of suspicion must be established in patients with multiple failed operative interventions. A case of recurrent free flap failure secondary to heparin-induced thrombocytopenia is presented in a patient with a history of squamous cell carcinoma of the floor of the mouth, and a long-standing history of alcohol and tobacco consumption. 相似文献
39.
H. Anderl G. Wechselberger M. Ninkovic A. Schwabegger P. Scougall 《European journal of plastic surgery》1996,19(6):327-329
Thoracic duct fistula is a rare but potentially serious complication of head and neck surgery. Such fistulae may be difficult to treat, and several techniques, both operative and non-operative, have been advocated. A case of successful surgical treatment of a chronic thoracic duct fistula is presented. The fistula occurred in a 51-year-old female following treatment of a solitary supraclavicular breast metastasis by local excision and radiotherapy. The divided duct was ligated and the area was covered with the clavicular head of the sternocleidomastoid muscle. 相似文献
40.
P. J. Arumugam T. V. Chandrasekaran A. R. Morgan J. Beynon N. D. Carr 《Colorectal disease》2003,5(3):218-221
Introduction There have been many surgical techniques described for the treatment of pilonidal sinuses. Recurrent disease causes significant morbidity particularly with time from work. Aim To assess the rhomboid flap's role in promoting one‐stage primary healing in pilonidal disease and to evaluate the morbidity and recurrence. Methods Fifty‐three patients were prospectively recruited of which 27 had previous multiple abscess formation requiring surgical drainage from their pilonidal disease, although none had acute disease at the time of surgery. By using the transposition flap, we were able to obliterate the natal cleft and therefore the rolling action of the buttocks between the cleft in these patients and thereby remove one of the factors involved in pilonidal disease. Hospital stay, healing time, wound infection, wound breakdown and recurrence were noted. Results There were 47 males and 6 females with a median age of 28 years (range 16–64 years). Median follow‐up was 24 months (range 3–36 months). Post‐operative morbidity involved superficial wound infection in 7 (13%) which settled with out‐patient dressings. There were four recurrences (7%), two occurred between the flap and the anal canal, and the other two in the flap margin needing intervention. All the patients healed their wounds and the median healing time was 14 days. Conclusion As this condition affects a predominantly young population causing significant time off from work, we feel that the Rhomboid Flap is useful for difficult cases in that it allows early return to full activity and does not necessitate prolonged postoperative care. 相似文献