颈横动脉颈段皮支岛状瓣在治疗颈部瘢痕挛缩中的应用

目的:探讨颈横动脉颈段皮支岛状瓣对烧伤晚期重度颈部瘢痕挛缩畸形治疗的临床应用。方法:对17例重度颈部瘢痕挛缩畸形患者全部采用颈横动脉颈段皮支岛状瓣修复。供瓣区采用游离皮片覆盖。结果:术后皮瓣全部成活,蒂部平整,无猫耳形成,颈部外形及功能恢复良好。2例供瓣区所植皮片因皮下血运不良而部分坏死,经换药处置后愈合。结论:对于轻、中度颈部瘢痕挛缩畸形的病例,采用颈、胸随意皮瓣,胸三角皮瓣即可得到较满意的效果。而对于重度颈部瘢痕挛缩畸形的病例,因瘢痕多累及颈前、颈侧、颏部及前胸,而限制了颈胸皮瓣,胸三角皮瓣等随意皮瓣及轴形瓣的应用,且游离皮片容易继发挛缩,加重畸形。颈横动脉段皮支岛状瓣的应用则避免了上述治疗的不足,是一种治疗重度瘢痕畸形的好方法。     

重组酸性成纤维细胞生长因子持续冲洗合并负压引流治疗难愈性创面

目的研究重组人酸性成纤维细胞生长因子联合负压引流在难愈性创面治疗中的作用。方法收集2010年1月-2012年12月难愈性创面患者54例,按照交替法分为两组。试验组29例,使用酸性成纤维细胞生长因子持续冲洗（冲洗液中加入5支rh-aFGF）合并负压引流进行治疗;对照组25例,除冲洗液加生理盐水外,操作同试验组。记录治疗前后的创面及深部组织外露面积,并计算创面愈合率和伤腔容积减少值。结果试验组可见创面肉芽生长良好,骨肌腱外露面积缩小,伤腔容积减少值、创面愈合率均好于对照组（P〈0.05）,试验组创面经过短期换药后愈合或经植皮修复满意,对照组创面需要经过皮瓣移植或长时间换药才能完全愈合。结论本研究通过外源性持续补充aFGF,达到替代治疗的目的。     

Impact of reconstructive microsurgery on patients with cancer of the head and neck: a prospective study of quality of life,particularly in older patients

Treatment of cancer of the head and neck often requires extended resection and major reconstructive surgery, both of which can have great functional and emotional impact. It is fundamental to evaluate the outcome with respect not only to the clinical aspects but also to the quality of life (QoL) perceived by the patients. In the light of the reported increasing incidence of oral cancer in older patients, we decided to see if there was an association between QoL and age. Between June 2015 and December 2016 we submitted the Italian version of the 36-item Short Form Health Survey (SF-36) to 30 patients (mean (range) age 65.5 (23–87) years) who had had resection and microsurgical reconstruction at the Ospedale Maggiore Policlinico of Milan. The questionnaires were completed before operation, and 12 months afterwards, and clinical and personal data were also collected. From the results of SF-36 we obtained the Short Form 12 (SF-12), Physical Health Composite Score (PCS), and Mental Health Composite Score (MCS) and looked at how age influences the variation in QoL scores. The variation between SF-36 and SF-12 results (preoperatively and postoperatively) did not seem to correlate with age. Our study confirmed that reconstructive microsurgery can be realistically proposed to older as well as younger patients because, according to the QoL index, older patients are able to manage (and therefore take advantage of) this complex surgical technique.     

带神经的组合皮瓣再造多指

目的：探讨用带神经的组合皮瓣对２～５指缺损进行多指再造。方法：用带掌背神经的掌背逆行岛状皮瓣与带神经的前臂或小腿内侧皮瓣组合，利用废弃指的骨肌腱支架或游离髂骨移植，对７例掌揩关节以远多指缺损的患者行多指再造术，二期行分指术、肌腱松解术。结果：再造手指全部成活，感觉在术后６周左右开始恢复。掌指关节活动范围０－７５度；指间关节活动范围１０－５０度，患者可完成对指、持物功能。手指长度和外形满意。结论：应用该方法再造的手指，有功能长度，外形满意，有感觉，具有一定的功能活动。尤其适用于不愿损伤足趾的患者。     

第五掌骨尺侧逆行筋膜皮瓣修复小指软组织缺损

目的介绍第五掌骨尺侧逆行筋膜皮瓣修复小指软组织缺损的手术方法。方法2000年～2002年,对12例患者应用第五掌骨尺侧逆行筋膜皮瓣,分别修复小指掌侧、背侧和尺侧软组织缺损。皮瓣设计以第五掌骨头尺侧与豌豆骨连线为轴线,其蒂部转折点在掌指关节以近0.5cm～1.0cm处。皮瓣面积最大6.0cm×3.0cm,最小2.5cm×1.5cm。结果12例皮瓣全部成活,术后随访5～7个月,外形美观,质地柔软,两点辨别觉8mm～12mm。结论第五掌骨尺侧逆行筋膜皮瓣具有血供可靠、切取方便、质地良好等优点,是修复小指软组织缺损的良好方法。     

Surgical treatment for baldness

Surgery is a successful method for the treatment of alopecia. In particular, use of a parietal-occipital flap in a 3-stage operation has given satisfactory results with few serious complications to patients treated over the past 15 years by the authors. The technique is described and the results in several patients are portrayed.     

Patterns of sensory and autonomic reinnervation of long-standing myocutaneous microvascular flaps and split-skin grafts applied to fascial beds

BACKGROUND:

There is a paucity of reports in the literature examining the pattern of sensory and autonomic neural recovery of myocutaneous microvascular flaps and skin grafts to the lower limbs after a prolonged period of time.

OBJECTIVES:

To investigate the recovery of sensation and autonomic nerve activity in long-standing split-skin grafts applied to fascial beds and in myocutaneous microvascular flaps.

METHODS:

The patients were divided into two groups: group A consisted of patients with a split-skin graft applied to a fascial bed (n=11) and group B consisted of patients with free microvascular flaps (n=4). Patients in both groups underwent various clinical subjective and objective tests, including the measurement of electrical resistance and thermal sensory analysis. Laser Doppler flowmetry was used to investigate the blood flow patterns.

RESULTS:

Patients in both groups showed significantly reduced sensory modalities. However, the findings of both the electrical resistance and laser Doppler flowmetry were significantly different among the patients in group A compared with controls. In contrast, electrical resistance and laser Doppler flowmetry test results were similar in group B and controls.

CONCLUSIONS:

Both split-skin grafts applied to fascial beds and microvascular flaps on the lower limb had poor sensory recovery. However, after 15 years, the microvascular flaps regained the ability to sweat and some degree of thermoregulatory function. This may imply that the long-standing myocutaneous free flaps regained some aspects of their autonomic innervation, whereas the split-skin grafts had not.     

538只手背深度烧伤早期修复疗效分析

目的：探讨５３８只手背深度烧伤手术治疗近期疗效及影响因素。方法：拟定术后近期疗铲评估标准,５３８只手背深度烧伤采用切痂、削痂植皮或皮瓣转移修复,分析伤后施行手术时间,烧伤面积和不同致伤因素对手术近期疗效的影响。结果：术后近期优良率为９２．７％（４９９只手）,其优良率与伤后施行手术时间、烧伤面积和致伤因素有直接关系。结论：手背深度烧伤,为确保手功能最大限度地恢复,应在挽救生命的同时早期施行切痂、削痂植皮或皮瓣转移手术。     

兔耳远端蒂浅静脉-耳大神经营养血管皮瓣的研究

目的探讨浅静脉干对远端蒂耳大神经营养血管皮瓣成活的影响。方法以30只日本大耳白兔作为实验对象随机分为3组：Ⅰ组静脉-神经组、Ⅱ组神经组及Ⅲ组对照组。另外2只日本大耳白兔作为实验对照。于兔耳根部中央区设计远端蒂皮瓣1．2cm×3．8cm，Ⅰ组保留静脉和神经；Ⅱ组保留神经；Ⅲ组动、静脉和神经均不保留，皮瓣制备完成后即刻原位缝合。术后1h对3组皮瓣进行组织学观察并测定皮瓣的丙二醛（MDA）含量。术后1周，测量3组皮瓣的成活面积。结果术后1h，各组皮瓣均出现不同程度的出血和水肿，其中Ⅰ组反应相对较轻；MDA含量Ⅰ组与Ⅱ组间没有显著性差异，Ⅰ组与Ⅲ组、Ⅱ组与Ⅲ组间有显著性差异。术后1周，各组皮瓣的成活率以Ⅰ组最高。结论保留浅静脉干没有增加兔耳远端蒂耳大神经营养血管皮瓣的回流负荷，对皮瓣的成活有利。