Predictors of Complications and Outcomes of External Hemipelvectomy Wounds: Account of 160 Consecutive Cases

Abstarct Background Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence hemipelvectomy wound morbidity. Methods The records of 160 consecutive hemipelvectomy patients were reviewed with a focus on demographics, treatment, and surgical techniques. Multivariate analysis was used to determine risk factors for postoperative hemipelvectomy wound infection and flap necrosis. Results There were 31 standard, 62 modified, and 67 extended hemipelvectomy patients in whom 19 contiguous visceral, 62 spinal, 4 contralateral pelvic resections, and 1 contralateral hemipelvectomy were performed. Hospital mortality rate was 5%, and overall morbidity was 54%. Wound complications such as infection (39%) and flap necrosis (26%) were the most common. For modified, standard, and extended hemipelvectomies, rates of wound infection were 29%, 34%, and 51% (P = .036) and rates of flap necrosis were 16%, 25%, and 35% (P = .046), respectively. Longer operative time and increased complexity were associated with higher wound infection and flap necrosis rates. The hemipelvectomy flap design did not influence the frequency of wound infection (P = .173) or flap necrosis (P = .098). Common iliac vessel ligation was the most statistically significant predictor of flap necrosis and was associated with the 2.7-fold increase in flap necrosis rate (P = .001) in patients undergoing posterior flap hemipelvectomy. Conclusions External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.     

腭黏骨膜组织瓣转移修复颊黏膜缺损的临床应用研究

目的：评价腭黏骨膜组织瓣转移修复颊黏膜缺损的临床效果。方法：对近5 a间27例颊黏膜缺损患者采用腭黏骨膜组织瓣转移修复,其中全腭黏骨膜瓣17例,半侧腭黏骨膜瓣10例。观察腭黏骨膜组织瓣存活,供区的愈合及患者术后功能恢复情况。结果：25例患者腭黏骨膜瓣全部成活,2例腭黏骨膜瓣术后发生部分坏死。所有病例腭黏骨膜瓣供区形态恢复完整,无张口受限。结论：利用腭黏骨膜瓣转移修复颊黏膜缺损是一种简便且有效的方法。     

股方肌骨瓣植骨术治疗股骨颈骨折远期疗效观察

报告３０例股方肌骨瓣植骨术治疗股骨颈骨折的远期疗效，全部病例作了系统追访，最长１０年，最短３年，平均６年零５个月；２９例骨性愈合，占９６．６％，股骨颈变短变粗愈合１１例占３６．６％，股骨头坏死６例，占２０％，股骨头坏死出现时间平均３年零２个月，本组病例说明股方肌骨瓣植骨术能提高股骨颈骨折愈合率，未能降低股骨头坏死率。股骨头坏死与髋关节功能不成正比关系，而股骨颈变短变粗愈合则直接影响髋关节的功能。     

邻指皮瓣修复手指皮肤缺损的临床应用

目的总结邻指皮瓣修复手指皮肤缺损的手术方法并观察临床疗效。方法(1)单纯邻指皮瓣;(2)缝合神经的邻指皮瓣;(3)带神经的邻指皮瓣;(4)邻指皮瓣皮管;(5)手指侧方邻指皮瓣;(6)邻指皮下组织瓣;(7)邻指皮瓣与其他皮瓣联合应用等7种方法修复手指皮肤缺损86例,其中76例行1种邻指皮瓣。结果本组86例117个皮瓣中,有4例邻指皮瓣供区植皮部分坏死,余皮瓣全部成活良好。术后随访3个月-3年,皮瓣血运、弹性、质地及外形良好。结论邻指皮瓣对于部分手指皮肤缺损的患者,手术操作简单,效果良好。     

腹壁下动脉穿支皮瓣游离移植修复四肢创面(附9例报告)

目的:总结应用腹壁下动脉穿支皮瓣游离移植修复四肢创面的手术方法与疗效.方法:对9例四肢皮肤缺损骨外露患者根据伤情切取腹壁下动脉穿支皮瓣游离移植修复创面.结果:8例皮瓣完全成活,1例坏死,成活皮瓣外观较好,不显臃肿,皮瓣供区组织损伤较轻.结论:腹壁下动脉穿支皮瓣游离移植修复四肢创面符合组织移植“受区修复重建好,供区破坏损失小“的原则,疗效满意.     

阴囊中隔皮瓣加阴囊筋膜覆盖一期尿道成形术治疗尿道下裂(附72例分析)

目的 比较阴囊中隔皮瓣加阴囊筋膜覆盖一期尿道成形术与单纯行阴囊中隔皮瓣一期尿道成形术治疗尿道下裂的疗效。方法 本组72例，其中33例行阴囊中隔皮瓣加阴囊筋膜覆盖一期尿道成形术，39例单纯行阴囊中隔皮瓣一期尿道成形术。结果 阴囊中隔皮瓣加阴囊筋膜覆盖一期尿道成形术手术成功率达90．9％，单纯阴囊中隔皮瓣一期尿道成形术手术成功率71．8％，两者差异有显著性意义。结论 阴囊中隔皮瓣加阴囊筋膜覆盖一期尿道成形术的手术方法明显优于单纯行阴囊中隔皮瓣一期尿道成形术，是一种较为理想的治疗尿道下裂的手术方法。     

60Co源辐射事故致双手皮肤损伤1例报告

目的 探讨双手辐射事故损伤后的救治。方法 损伤早期行全身综合治疗,预防感染,早期封闭创面;后期用“生物切除法”控制清创深度,截除失去生机的组织,同期或择期行损伤创面转移皮瓣修复术。结果 经过长达5年的间断治疗,患者截除了失去生机的左中指、无名指和右拇指末节,但保存了双手的主要功能。结论 辐射事故致双手损伤包括皮肤、神经肌腱和骨损伤,这些损伤呈慢性、进行性和不可逆性发展;但积极进行治疗可以保存患者部分肢体功能。     

皮瓣缺血再灌注期间核因子-κB活性的变化及其意义

目的　探讨核因子(NF) κB活性变化在皮瓣缺血再灌注(I/R)损伤中的作用。方法将60只雄性SD大鼠随机分为3组:对照组;I/R组;吡咯烷二硫氨基甲酸酯(PDTC)处理组。制备右下腹岛状皮瓣I/R模型。PDTC处理组于再灌注前及早期,分2次静脉注射PDTC(3 0 0mg/kg体重)。采用免疫组织化学及凝胶电泳迁移率法,检测皮瓣NF κB活化情况,并行组织学观察。结果　I/R组再灌注后NF κBp65阳性细胞较对照组明显增加,NF κB活性于再灌注1、3h显著增强;PDTC处理组再灌注1、2h阳性细胞数(7.90±3 .73、10 .60±3 .2 0 )较I/R组(19.5 0±6.93、18.5 0±5 .68)明显减少(P均<0 .0 1) ,再灌注1hNF κB活性受到抑制,中性粒细胞浸润及组织水肿程度较I/R组明显改善。结论　NF κB活化可能在中性粒细胞介导的皮瓣I/R损伤中起重要作用     

The use of tissue flaps as an adjunct to pelvic surgery

BACKGROUND: The clinical problems of advanced malignancy with invasion of cancers into adjacent organs or structures, fistulizing complications from radiation therapy, postoperative infections, and delayed postoperative healing continue to challenge pelvic surgeons, regardless of subspecialty. The use of autologous muscle and myocutaneous flaps has been applied to the management and prevention of these clinical problems and found to be most helpful. METHODS: Records of patients undergoing abdominopelvic procedures in a single unit during the 15-year period from 1990 to 2005 were reviewed, and patients undergoing autologous tissue flaps were reviewed with respect to indications, complications, and outcomes. RESULTS: Thirty-four patients underwent 35 autologous muscle or myocutaneous flaps for the following indications: large anticipated defects in primary or reoperative cancer surgery (13 patients); malignant, traumatic, inflammatory, or radiation-induced fistulae (12 patients); excision of (an) adjacent organ(s) with need for reconstruction (7 patients); and chronic nonhealing pelvic wounds (2 patients). Wound complications occurred in 41% of patients; however, primary healing of flaps occurred in 88% of patients. CONCLUSIONS: The use of autologous tissue flaps in select patients can be a useful adjunct in pelvic surgery in dealing with a wide variety of problems, specifically in filling large defects, providing vascularized tissue for fistula closure, and avoiding delayed wound healing commonly seen after high-dose radiation.     

Tunica vaginalis interposition flap in the closure of massive disruption of the neourethral tube (macro urethrocutaneous fistulae)

The use of a tunica vaginalis interposition flap in the successful closure of 14 macro urethrocutaneous fistulae (2–4 cm long) is described.