第一掌背动脉双叶皮瓣在手外科中的应用

我们设计主要以第1掌背动脉为蒂的手背双叶皮瓣,同时修复两个部位的手部皮肤缺损和拇指再造,共10例均获成功。皮瓣面积最小10cm×3cm,最大13cm×5cm,蒂宽1.5cm×2.5cm。皮瓣每叶面积最小为3.5cm×2cm,最大6cm×3cm。文中介绍了本皮瓣的解剖学基础,并对其手术适应证和优缺点进行了讨论。     

真皮下血管网皮瓣的过氧化脂质测定

对12只豚鼠背部随意型真皮下血管网皮瓣的过氧化脂质含量进行了动态观测.结果表明,过氧化脂质的含量与皮瓣损伤程度呈同步变化;与皮瓣血运重建的时间密切相关.氧自由基对皮瓣组织的损伤主要发生在移植后1～5天.     

面部瘢痕整形手术后胶布减张治疗疗效观察

目的:探讨使用免缝胶布对伤口减张制动的方法和治疗效果。方法:对62例面部瘢痕或痣切除手术患者,随机分组,45例为治疗组,术后5天拆线,拆线当天开始使用免缝胶布。胶布垂直跨越伤口线粘贴,使创缘处于无张力状态。17例为对照组,未使用免缝胶布。术后6个月对瘢痕进行临床评分,治疗组与对照组对比,统计分析。结果:62例患者伤口均一期愈合,治疗组37位(82%)、对照组4位(23%)患者瘢痕恢复至成熟期,没有痒或刺痛的主观症状,瘢痕颜色淡、平坦、质地软;治疗组5位(11.1%)、对照组13位(76.5%)患者瘢痕增宽,有痒或刺痛的症状,瘢痕颜色红,突出皮面。结论:免缝胶布可以有效地减轻伤口两侧张力,减少瘢痕增生,是一种瘢痕术后重要的辅助治疗。     

Effect of age, breast size, menopausal and hormonal status on mammographic skin thickness

Background/purpose: The localized or generalized skin thickness detected on mammography may reflect an underlying pathology of breast or a systemic disease involving the skin. The aim of this report is to describe the range of normal breast skin thickness in women using a film-screen mammographic technique.
Methods: Measurement of the mammographic skin thickness over different parts of the breast was performed in 144 women who had normal findings in a combined mammographic and ultrasonographic examination. Patients were grouped as premenopause, postmenopause and surgical menopause who were under continuous oestrogen treatment. The skin thickness in four regions (superior, inferior, medial, lateral) of both breasts was compared, and their relations with age, breast size, menopausal and hormonal status were investigated. The interobserver reliability was tested in a small subgroup of patients.
Results: Interobserver agreement was good for all measurements. The range of normal breast skin thickness was between 0.50 and 3.10 mm. There were no differences in skin thickness between the corresponding regions of the breasts, with significant differences between the regions in the same breast. While breast size increased with age, skin thickness decreased in all regions.
Conclusion: The breast size, age, regional variations and hormonal status of the patients should be considered when defining the normal range of skin thickness in mammographic examinations. We assume that upper limit of mammographic skin thickness should be set as 3.0 mm, regardless of the focal spot size and film-focus distance.     

S-nitrosoglutathione-containing hydrogel accelerates rat cutaneous wound repair

BACKGROUND: Nitric oxide (NO) plays a key role in wound repair and S-nitrosothiols like S-nitrosoglutathione (GSNO) are well known NO donors. METHODS: Animals were separated in two groups and submitted to excisional wounds on the dorsal surface at the first day. GSNO (100 microm)-containing hydrogels were topically applied on the wound bed in the GSNO group, daily, during the first 4 days. Control group was topically treated with hydrogel without GSNO for the same period. Wound contraction and re-epithelialization were measured. Animals were sacrificed 21 days after wounding. Samples of lesion and normal tissue were formalin-fixed, paraffin embedded for histological analysis. RESULTS: Wound contraction, measured 14 and 21 days after wounding, was greater in the GSNO group than in the control group (P<0.05 for both). The re-epithelialized wound area, measured 14 days after wounding, was higher in the GSNO group than in the control group (P<0.05). A higher amount of inflammatory cells was observed in superficial and deep areas of the granulation tissue of the control group compared to the GSNO group. Twenty-one days after wounding, thin red-yellow collagen fibers arranged perpendicularly to the surface were found in the granulation tissue of the control group, whereas in the GSNO-treated group collagen fibers were thicker and arranged parallel to the surface. Increased number of mast cells was observed in the GSNO group compared with that in the control group. Vascularization and myofibroblast distribution were similar in both groups. CONCLUSION: Topical application of GSNO-containing hydrogel during the early phases of rat cutaneous wound repair accelerates wound closure and re-epithelialization and affects granulation tissue organization.     

颞区眼轮匝肌皮瓣修复眼睑皮肤软组织缺损

目的：探讨修复眼睑皮肤缺损的方法．方法：应用颞部眼轮匝肌皮瓣修复同侧眼睑皮肤软组织缺损１０例．其中男 ７例，女３例．缺损原因：疤痕切除后创面 ７例，色素痣切除后创面１例，化学烧伤 ２例．均为下睑皮肤软组织缺损．结果：所有病例皮瓣成活良好，外形效果满意．结论：颞部眼轮匝肌皮瓣血供可靠，转移方便，皮肤质地、厚度与眼睑皮肤相近，是一个修复眼睑皮肤缺损的理想的皮瓣．     

网状减张小切口缝合法提高大鼠背部张力皮瓣存活机制

Foropenseverewoundandthewoundafterdebridement,mostscholarsthinkthewoundshouldbeclosedindelayedfirst-phase.Meshrelaxingshortincision(MRSI)methodcanclosemoreskindeficiencyandhightensionopenwound,andavoidsubcutaneoushematomaandskinflapdrift.Intheexperiment,theexperimentalmodelonrattensionskinflaphasbeeninvolved,andthecontentofendothelin(ET)inratskinflaptissuehasbeenmeasuredinvariousperiodofwoundhealingaftermeshedrelaxingshortincisionsuturewithimmunohistochemistry,inordertodiscussprobablemechani…     

灼皮美容术的临床与实验研究

为了探索治疗天花、痤疮遗留表浅瘢痕与大面积色素斑较简易有效的新方法，利用ＧＸ－Ⅱ型多功能电离子手术治疗机烧灼皮肤至真皮浅层代替皮肤磨削这种传统术式。采用动物皮肤烧灼试验，切片显微观察其病理反应及愈合情况，并对６８例患者进行了临床疗效观察。结果显示：动物皮肤烧灼深度达真皮浅层，甚或毛囊破坏（已达真皮深层），但大部分区域表皮通过毛囊再生而全层修复，少部分区域也为单层基底细胞被覆，表明灼皮术后皮肤的良好修复过程。临床应用不仅疗效好，而且较皮肤磨削术具有易操作，安全，无菌条件要求低，术中及术后不出血，疼痛不明显，术后不必包扎、换药等优点。动物试验表明：表皮全层灼烧气化后，真皮浅层也呈现不同程度的灼伤，因此在操作时应注意掌握深度。     

Blood platelets in severely injured burned patients

Unbelievable decrease of blood-platelet in the severely burned patients during the treatment of skingrafting caused two patients to unexpected death. From the records of changes of platelet number, a certain ‘platelet curve’ was made. By observing the curve, our treatments of skingrafting were carried out during the stable period and from then on we had no death cases.     

Cryopreserved cadaveric allografts for treatment of unexcised partial thickness flame burns: clinical experience with 12 patients

Partial thickness burns (PTB) usually heal within 3 weeks. Prevention of infection and desiccation of the wounds are crucial for optimal healing. Early tangential excision of the burn eschar and allografting prevent deepening of the burns, and are therefore advocated for treatment with the best functional and aesthetic results. For superficial partial thickness burns (SPTB) conservative use of topical antimicrobial agents with frequent dressing changes are implemented. We compared the conservarive treatment for PTBs and SPTBs to grafting cryopreserved cadaveric allografts with no prior excision.

Twelve patients with flame PTB areas were allografted after mechanical debridement without excision of the burn wounds. The allografts were cadaveric skin cryopreserved by programmed freezing and stored at −180°C for 30–48 months. Matching burns for depth and area were treated with silver sulfadiazine (SSD) one to two times daily until healing or debridement and grafting were required.

It was found that 80 per cent of the cryopreserved allografts adhered well and 76 per cent of the treated areas healed within 21 days, whereas only 40 per cent of the SSD-treated burns healed within 21 days.

Partial thickness burns can be treated successfully with viable human allografts (cryopreserved cadaveric skin) with no prior surgical excision. The burn wounds heal well within 3 weeks. For deep partial thickness burns (DPTB) treatment with allografts has no advantage if they have not been previously excised.