含指神经背侧支岛状皮瓣在修复手指掌侧软组织缺损中的临床应用

目的探讨含指神经背侧支的皮瓣修复手指掌侧软组织缺损的疗效。方法采用带指神经背侧支的皮瓣修复26例（31指）伴肌腱或骨组织外露的手指掌侧软组织缺损。其中，对远端指腹缺损患者，术中将指神经背侧支与创面指神经残端吻合重建皮瓣感觉；而对近、中节掌侧软组织缺损者，直接采用邻指或隔指侧方岛状带指神经背侧支皮瓣覆盖。结果术后皮瓣及供区植皮均成活，创面愈合良好；获随访4—27个月，修复后指腹饱满，色泽正常，感觉恢复，静止两点辨别觉达4—8mm，手指功能按TAM法评定为优。结论采用带有指神经背侧支皮瓣修复手指掌侧软组织缺损不仅能修复缺损皮肤，且能重建皮瓣感觉，是修复手指掌侧软组织缺损的有效方法之一。     

带感觉功能上臂外侧嵌合骨皮瓣游离移植修复手指复合组织缺损的效果观察

目的 探讨带感觉功能上臂外侧嵌合骨皮瓣修复手指复合组织缺损的临床效果。方法 回顾性研究。纳入2016年11月—2019年11月徐州仁慈医院手外科收治的6例手指软组织缺损伴指骨、神经缺损患者。其中,男4例,女2例;年龄33~61岁,平均47.3岁;右手2例,左手4例;拇、示、中指各1例,环指3例;皮肤缺损面积1.0 cm×1.5 cm~2.5 cm×3.0 cm,骨缺损长度1.5~2.5 cm。6例患者均采用一期创面彻底清创,创面缺损伴指骨、神经缺损先行异种皮覆盖创面,克氏针维持骨折稳定性;二期带感觉功能的上臂外侧嵌合骨皮瓣游离移植修复治疗,皮瓣设计面积1.5 cm×2.0 cm~3.0 cm×3.5 cm,骨瓣切取大小为1.5 cm×1.0 cm×1.0 cm~3.0 cm×1.5 cm×1.0 cm。术后采用中华医学会手外科学会手部功能评定标准评价手功能,英国医学研究委员会（BMRC）制定的感觉分级方法评价皮瓣感觉恢复效果,Michigan手部功能问卷评定标准评定患指外观满意度。结果 本组6例患者手术均顺利完成,术后随访3~7个月,平均13.5个月。6例皮瓣全部成活,骨折均愈合,骨瓣平均愈合时间3~6个月,平均3.5个月。供区直接缝合,创面均一期愈合。手部功能优5例、良1例,手指感觉恢复至S4级4例、S3+级2例,患指外观满意度评价非常满意1例、满意4例、一般1例。结论 带感觉功能的上臂外侧嵌合骨皮瓣游离移植,可同时修复手指软组织缺损和指骨缺损,对供区影响小,术后手指感觉功能恢复好,是修复手指复合组织缺损的备选方案之一。     

游离足拇指背侧皮瓣修复手指指腹皮肤缺损45例疗效观察

[目的]探讨游离足拇指背侧皮瓣修复手指指腹皮肤缺损的疗效.[方法]选择2012年1月至2014年1月在本院外科接受手术的手指指腹缺损的患者90例,以数字法随机分为两组,每组45例.其中观察组采用游离足拇指背侧皮瓣进行修复,对照组采用髂腹皮瓣进行修复.比较两组手术情况、皮瓣成活率、肿胀情况及治疗前后焦虑、抑郁评分.[结果]观察组皮瓣成活率为95.56％(43/45),显著高于对照组82.22％(37/45);观察组手术时间及出血量均显著少于对照组,而术后皮瓣肿胀及瘀血等的发生率明显少于对照组;观察组修复后感觉功能评分为S3的患者明显少于对照组,而评分为S4的患者多于对照组.两组治疗前SAS、SDS评分比较差异无统计学意义,在治疗后1周观察组SAS、SDS评分显著低于对照组,其差异均有统计学意义(P＜0.05).[结论]采用游离足拇指背侧皮瓣修复手指指腹皮肤缺损中皮瓣成活率高,皮瓣肿胀及瘀血的发生率低,且术后愈合快,外形美观,对患者心理焦虑、抑郁的影响更小,值得临床推广应用.     

Scapular Tip Free Flap for Head and Neck Reconstruction

Objectives

Head and neck reconstruction is still challenging in terms of esthetic and functional outcomes. This study investigated the feasibility of the angular branch-based scapular tip free flap (STFF).

Methods

This was a retrospective study of 17 patients undergoing maxillectomy and mandibulectomy and either primary or secondary reconstruction by STFF. This study included surgical, esthetic, and functional outcomes, and detailed data are presented regarding the flap, such as pedicle length, size of the harvested bone, and failure rate. Medical photographs were used to estimate the esthetic outcome, and computed tomography was used to check the flap status postoperatively.

Results

The data were collected from April 2013 to April 2014. Eight patients underwent maxillary reconstruction, and nine underwent mandibular reconstruction. Maxillary defects usually included unilateral alveolar structures and the palate; mandibular defects were usually those involving mandibular angle and short segment. Vein grafting was not required in any of the patients. Flap failure occurred in one of the 17 patients (5.9%) with successful reconstruction after revision. Of the eight maxillectomy patients, orbital revisions for diplopia after maxillary reconstruction were performed in two patients (25%), and oroantral fistula repair was performed in one patient (12.5%).

Conclusion

This study demonstrated the reconstructive advantages of the angular branch-based STFF, long pedicle, low flap failure, 3-dimensional nature of bone and soft tissues (chimeric flap), and small rate of donor site morbidity with free ambulation. This flap is an excellent option for use in complex three-dimensional head and neck reconstruction.     

Results of Free Flap Reconstruction After Ablative Surgery in the Head and Neck

Objectives

Due to the complex anatomy and function of the head and neck region, the reconstruction of ablative defects in this area is challenging. In addition, an increasing interest in improving the quality of life of patients and achieving good functional results has highlighted the importance of free flaps. The aim of this study was to summarize the results of free flap reconstruction and salvage of free flaps in a single institute, and to analyze differences in the results by the flap donor site, recipient site, and learning curve.

Methods

The medical records of patients who underwent free flap reconstruction from 2004-2012 were reviewed retrospectively. One hundred and fifty free flaps were used in 134 patients, who had an average age of 57.7 years. The types of flaps applied, primary defect sites, success rates, results of salvage operations for compromised flap, and the learning curve were analyzed.

Results

The anterolateral thigh flap was preferred for the reconstruction of head and neck defects. The overall success rate was 90.7%, with 14 cases of failure. A total of 19 salvage operations (12.7%) for compromised flap were performed, and 12 flaps (63.2%) were salvaged successfully. Dependency on the facial vessels as recipient vessels was statistically different when oral and oropharyngeal defects were compared to hypopharyngeal and laryngeal defects. The learning curve for microvascular surgery showed decrease in the failure rate after 50 cases.

Conclusion

The free flap technique is safe but involves a significant learning period and requires careful postoperative monitoring of the patient. Early intervention is important for the salvage of free flaps and for lowering the failure rate.     

Prevention and management of bacterial infections of the donor site of flaps raised for reconstruction in head and neck surgery

Purpose

In the field of reconstructive head and neck surgery, surgical site infections (SSI) are commonly investigated for the recipient site of various reconstructive procedures. Data about SSI of the donor site of different flaps raised for reconstruction are rare.

尺动脉腕上支皮瓣逆行转位修复手部大面积缺损

目的 评价尺动脉腕上支皮瓣用于修复手部大面积软组织缺损的临床效果.方法 对13例手部大面积皮肤软组织缺损应用尺动脉腕上支皮瓣进行修复,皮瓣最小10 cm × 5 cm,最大18 cm ×9 cm,术后随访6个月,观察疗效.结果 13例手术均顺利完成,所有皮瓣均成活,随访6个月,皮瓣血运良好,质地柔软,耐磨,感觉恢复达S3＋,两点分辨率为5mm-11mm.结论 尺动脉腕上支皮瓣用于修复手部大面积软组织缺损时安全、可靠,临床效果良好.     

重建阴囊对睾丸生精功能影响的临床观察及实验研究

目的　探讨重建阴囊对睾丸生精功能的影响。方法　对 2例阴囊皮肤撕脱伤后采用髂腹股沟皮瓣重建阴囊进行长达 4年的随访 ,并分别作了精液常规检查、睾丸活检、性功能及性激素水平测定。为排除临床上可能存在的睾丸及精索挫伤造成的生精功能障碍 ,以育龄家兔为实验动物 ,手术剥脱其阴囊 ,采用下腹部皮瓣重建 ,观察其睾丸的生精功能情况。结果　临床病例随访显示 ,在重建阴囊早期 ,对睾丸的生精功能影响不大 ,但随着时间延长 ,精子数及活动率明显降低。皮瓣重建家兔阴囊 2个月后 ,其睾丸的生精功能明显下降 ,与育龄雌兔交配 ,无生育能力。结论　对阴囊皮肤撕脱伤采用较厚的皮瓣重建应慎重。