声门下喉气管狭窄外科治疗

目的探讨复杂声门下喉及气管狭窄的外科治疗,提高喉气管狭窄的手术疗效。方法对20例因环状软骨和气管软骨环部分缺损或声门下瘢痕组织增生所致的声门下喉气管狭窄患者分别实施了胸骨舌骨肌蒂舌骨瓣(7例)、胸锁乳突肌锁骨骨膜瓣(12例)、游离皮片(1例)转移重建术,术后放置T型管。结果20例患者均于术后6个月顺利拔除T型管,恢复了较满意的呼吸和发音功能。结论胸骨舌骨肌蒂舌骨瓣、胸锁乳突肌锁骨骨膜瓣、游离皮片转移加T型管植入修复声门下喉气管狭窄的重建手术,具有较高的成功率和较好疗效。     

原位翻转胸骨舌骨肌筋膜瓣修复喉部分切除术后缺损的疗效分析

目的探讨原位翻转胸骨舌骨肌筋膜瓣（in situ turnover sternohyoid fasciomuscular flap,ITSF）修复喉部分切除喉部缺损的可行性和效果。方法采用ITSF对因喉癌、喉咽癌实施喉部分切除术所致的喉部分缺损进行修复,观察其重建喉结构和功能的效果。结果共实施197例不同类型的喉部分切除术,同时采用ITSF一期修复喉缺损,重建喉结构,恢复喉功能。术后3例（1.5%）患者发生肌筋膜瓣坏死,其中2例坏死的ITSF自行排除,形成喉狭窄不能拔管,但保留了发音功能,另1例通过清创、抗感染和喉全切除治愈,但丧失了喉功能,其余194例患者ITSF修复手术均获得成功,喉功能得到不同程度恢复。术后初次拔除气管套管173例（89.2%）,21例（10.8%）患者初次未能拔除气管套管。初次拔管后再狭窄18例,经过支撑喉镜下激光手术治愈10例,其余8例未能拔除气管套管。在手术成功的194例患者中,总拔管率为85.1%（165/194）。结论ITSF是一种简便、易行和可靠的修复喉部分缺损的方法。     

足跟软组织缺损患者皮瓣修复术后的康复训练

总结了足跟软组织缺损患者皮瓣修复术后的护理要点.35例足跟部软组织缺损皮瓣修复术后使用硅胶鞋垫,结合阶段性康复训练方法进行行走锻炼.随访6～12个月,无一例皮瓣发生局部溃疡,只有2例发生足跟疼痛.本组均能正常行走及负重,满足日常生活工作需要.     

Closing the gap: skin grafts and flaps

Wounds occur via a multitude of causal mechanisms, and vary greatly in their nature. Therefore, reconstructing such defects requires meticulous consideration of the patient and wound. Conservative measures are sometimes sufficient for healing, but some wounds will benefit from surgical reconstruction. Knowledge of the human vascular network, in particular within the fascia, subcutaneous tissue and skin, permits an understanding of the use of one’s own tissue to help heal another body site. Skin grafts are simple thin sections of tissue that lack their own blood supply, and are transferred from one site on the body to another. Flaps, however, are composite blocks of tissue that contain their own blood supply and can be moved locally, regionally, distantly or freely to the desired site. This article reviews the use of skin grafts and flaps in aiding wound closure.     

A Case of Nonisland Pedicled Foot Fillet Flap for Below-Knee Amputation Stump Wound: Treatment Option for Compartment Syndrome after Fibular Free Flap Surgery

Despite the frequent use of the fibular free flap, there have been no reports of severe compartment syndrome of the donor leg that necessitated limb amputation. A 66-yr-old man had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome. An extensive chronic leg wound resulted, which was treated with multiple debridements and finally with below-knee amputation. Successful coverage of the below-knee amputation stump was accomplished with a nonisland pedicled foot fillet flap. Various foot fillet flaps may be used acutely as a free or an island pedicled flap, but dissection of the vascular pedicle may be difficult in a chronically inflamed wound because of inflammation and adhesions to surrounding tissue. The nonisland pedicled foot fillet flap may be considered as a useful option for treatment of a chronically inflamed stump wound after below-knee amputation.

Graphical Abstract

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游离皮瓣在老年患者中应用体会

目的探讨游离皮瓣修复老年患者组织缺损的临床效果。方法对我院及兄弟医院在2004年9月—2013年2月期间采用游离皮瓣治疗的各种组织缺损进行回顾性分析。共收治164例,按年龄将其分成两组,其中老年组(≥60岁)54例,年轻组(<60岁)110例。其中口腔肿瘤78例,四肢创伤66例,四肢骨与软组织肿瘤10例,头皮缺损5例,放射性骨髓炎5例,所有组织缺损均采用游离皮瓣进行修复。主要对手术时间、出血量、皮瓣坏死率、血管探查率进行比较分析。结果两组患者术后30天内均无死亡病例,在手术时间、出血量、皮瓣坏死率及血管探查率方面均无统计学差异。结论采用游离皮瓣技术修复老年患者组织缺损是安全可靠的,高龄并不是游离皮瓣手术禁忌症,但必须严格把握适应症,注意并存疾病对手术结果的影响。     

游离皮瓣在乳腺重建术患者中的的应用

【目的】探讨应用游离皮瓣对乳腺癌手术患者进行乳房重建的应用方法及疗效。【方法】收集本科2008年1月至2011年1月间住院的40例乳腺癌手术患者,随机分为研究组和对照组,研究组应用腹壁下动脉穿支游离皮瓣进行乳房重建,对照组给予转移下腹部横行腹直肌肌皮瓣进行乳房重建,对比两组手术的疗效。【结果】研究组重建的乳房未见明显萎缩,质地柔软,色泽外形接近正常乳房,腹部供区恢复良好未见腹壁薄弱的现象发生。研究组手术时间为（6．1±0．7）h,术后住院时间平均为（7．2±1．1）d与对照组（5．9±1．9,14．7±2．3）比较无显著差异（ P＞0．05）,未见术后腹部供区的皮下积血等腹部并发症的发生,与对照组比较具有显著差异（ P ＜0．05）。【结论】应用腹壁下动脉穿支游离皮瓣进行乳房重建效果确切,减少了腹部并发症发生的机率同时不影响肿瘤的治疗,达到患者对于胸部塑形的要求,值得在临床上推广应用。     

Delay of muscle flaps by denervation

Summary Muscle flaps which have several vascular pedicles are prone to necrosis when one or more of these pedicles are divided. An experimental study using rabbits was undertaken to see if denervation two weeks prior to raising the flap would avoid or minimise this necrosis. Results showed a significant protection against necrosis following denervation. The mechanism and possible clinical significance are discussed.     

金属硫蛋白与皮瓣缺血预处理延迟保护作用的实验研究

目的：探讨金属硫蛋白（MT）参与皮瓣缺血预处理（PC）延迟保护作用（DP）的可能性。方法：在猪背阔肌岛状皮瓣PC和培养肌细胞PC的模型上，检测PC后即刻，12h和24h MT含量变化，观察PC后24h对再次长时间缺血再灌注（I／R）或缺氧复氧（A／R）损伤的保护作用以及用丝裂素蛋白激酶抑制剂（PD098059）抑制PC后MT含量增高对PC和DP的影响。结果：MT含量在PC后12h（肌细胞）和24h（肌细胞和皮瓣组织）显著增高，与未PC的皮瓣组织或肌细胞遭受I／R或A／R的损伤相比较，PC后24h其皮瓣坏死范围缩小（P＜0．05），血浆乳酸脱氢酶（LDH）活性降低（P＜0．05），肌细胞存活率增高，细胞丙二醛（MDA）含量和LDH释放均降低（P＜0．01）。用PD098059抑制后则消除了PC后的DP作用，上述皮瓣损伤指标接近单纯I／R组或A／R组（P＞0．05）。结论：①PC后24h对皮瓣或肌细胞的再次I／R或A／R损伤具有保护作用；②MT参与了皮瓣或肌细胞PC后的DP作用。