带蒂胸大肌肌皮瓣在晚期舌癌舌再造术中的应用

目的分析胸大肌肌皮瓣在晚期舌癌根治术中舌再造的应用效果.方法对33例有完整资料T3、T4晚期舌癌患者因舌大部分或舌根部广泛切除术后大面积缺损,用同侧带蒂胸大肌肌皮瓣进行舌再造,一期修复.结果本组病例中除1例肌皮瓣大部分坏死外,其余均愈合良好,能恢复较理想的吞咽功能及语言表达能力.结论胸大肌肌皮瓣血供丰富,血管走向恒定,组织量大,是晚期舌癌根治术后同期进行舌再造的较理想材料.     

术前放疗对游离皮瓣影响的实验研究

本实验选用成年新西兰白兔２４只作单侧兔耳术前放疗，剂量分别为７Ｇｙ×４（Ⅰ组）、９Ｇｙ×４（Ⅱ组）及１１Ｇｙ×４（Ⅲ组），放疗后３周行双侧耳背皮瓣游离移植术（左右换位）．术后观察皮瓣的变化及成活情况，并于术后不同时期作光镜及电镜组织学观察，并行血管铸型标本制作及扫描电镜下形态计量分析．结果显示：Ⅰ组的皮瓣成活率为７５％（６／８），Ⅱ组为６２．５％（５／８），Ⅲ组为３７．５％（３／８）．光镜显示成活皮瓣存在上皮、皮肤附件及皮下组织明显萎缩现象，电镜下核固缩、胶原纤维水肿、基底膜不完整等表现可持续至术后１年以后，血管铸型标本中发现Ⅲ组血管密度明显低于Ⅱ组     

Abbe皮瓣在上唇鳞状细胞癌术后缺损修复中的应用

目的:观察Abbe皮瓣修复上唇鳞状细胞癌切除术后缺损的临床疗效。方法:对5例37~62岁患有上唇鳞状细胞癌的患者进行肿瘤根治性切除,术后形成的继发性上唇缺损选择Abbe皮瓣修复,并进行临床观察。结果:4例患者术后外形良好,功能正常。1例术后出现轻度小口畸形,对进食,语言功能影响不明显,患者不要求治疗。结论:对上唇缺损宽度小于上唇唇长1/2者,治疗选择Abbe皮瓣修复,不仅能恢复口唇特有的红,白唇结构,而且还能恢复其特有的解解剖,生理功能,符合唇缺损的美学修复要求。     

扩大的耳廓组织瓣游离移植修复鼻基底细胞癌术后缺损

目的:探讨应用扩大的耳廓复合组织瓣修复鼻部基底细胞癌扩大切除术后缺损创面的手术方法及适应证。方法:根据患者病理确诊后实施鼻部基底细胞癌扩大切除术,依据缺损范围,采用单侧或双侧扩大耳廓复合组织瓣游离移植进行修复。术中彻底切除癌组织,病理证实切缘(-),将耳廓复合组织瓣游离,楔形植入鼻部缺损区,适度加压包扎固定,术后2周拆线。结果:本组18例患者,均移植成功,外形满意。修复创面面积约2.0~2.5cm,随访患者3~6个月,移植初期创面组织高出鼻部周缘,后期均发生不同程度回缩,与周缘组织融合自然,外形基本满意。结论:通过病理学证实肿物性质,确保周缘阴性,形成扩大创面,选用扩大耳廓复合组织瓣游离移植修复,通过对移植组织块精细缝合和适度加压固定技术,使创面得以修复,外形自然,供区隐蔽。本术式是较理想修复鼻部较大创面的术式选择。     

预构皮瓣的研究与应用进展

Prefabricated flap is so named as the skin flap is prepared by prefabricating a circulation-rich skin flap by implanting a named blood vessel or a portion of fascia which is incorporated with rich bloo...     

Reconstruction of Compound Loss of Lateral Malleolus and Lateral Ankle Ligaments with Double-Bundle Achilles Tendon–Bone Allograft

Open ankle fracture, including compound loss of the lateral malleolus, lateral ankle ligaments, and overlying skin, is a severe injury and can result in ankle instability and permanent disability. Treatment of this injury is challenging and requires bone grafting and soft tissue reconstruction. In the present report, we describe a unique reconstruction technique for compound loss of the lateral malleolus, lateral ankle ligaments, and the overlying skin using a double-bundle Achilles tendon–bone allograft combined with a reverse sural fasciocutaneous flap. The patient obtained a stable ankle with nearly full range of motion and displayed satisfactory function during the follow-up period.     

Bloqueo axilar ecoguiado: variaciones anatómicas de la disposición de los 4 nervios terminales del plexo braquial en relación con la arteria humeral

ObjectivesTo describe the distribution of the terminal branches of the brachial plexus at the axillary level and define distribution patterns after ultrasound evaluation.Material and methodFifty volunteers underwent ultrasound bilateral axillary brachial plexus scanning exploration. Nerve distribution around the humeral artery was described and the distance between each nerve and the center of the artery was measured. The distance and relationship between the ulnar nerve and the humeral vein were also recorded.ResultsThe median nerve was located in the anterolateral quadrant (−29 ± 40°) and at a mean distance of 2.1 ± 0.9 mm from the artery (85%). The ulnar nerve was found at 53 ± 26° and at 4.2 ± 2.1 mm from the artery in the anteromedial quadrant (90%), anterolateral to the vein in 46% of cases, and deep to it in 54%. The radial nerve was at 122 ± 38° and at 3.3 ± 1.7 mm from the artery in the posteromedial quadrant (86%). The musculocutaneous nerve was found at −103 ± 22° and 9.3 ± 5.6 mm from the artery in the posterolateral quadrant (90%) and in the anterolateral quadrant (−55 ± 16°) at 4.8 ± 2.7 mm (10%). There were no differences regarding laterality, gender or overweight patients.ConclusionsOur results allow defining four different anatomical patterns, two based in the position of the musculocutaneous nerve and two based on the disposition of the ulnar nerve with respect to the humeral vein. These patterns were not related to laterality, gender or body weight.