远端蒂腓肠神经-小隐静脉筋膜皮瓣研究进展

远端蒂腓肠神经-小隐静脉筋膜皮瓣是修复小腿及足部皮肤缺损的常用皮瓣,文章综述该皮瓣的动脉血供及静脉回流的解剖学特点,并就临床应用中的常见问题,如旋转点、蒂的长度和宽度、皮瓣面积和切取范围、术后并发症的处理及皮瓣感觉重建等进行分析总结。     

鼻内镜下经鼻腔行腭裂二期修复的临床应用

目的探讨鼻内镜下用鼻腔组织瓣经鼻腔行腭裂二期修复手术的方法及优越性。方法2003年9月至2007年8月,我们在鼻内镜下经鼻腔用鼻中隔及下鼻道黏骨膜瓣行腭裂二期修复术11例。结果11例腭裂二期修复均一次成功,鼻腔通畅,无不适感。结论鼻腔组织瓣完全能够满足腭裂二期修复的需要。     

Upper Extremity Free Flap Transfers: An Analysis of the National Surgical Quality Improvement Program Database

Introduction  We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods  Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results  One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion  Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.     

Simultaneous Bilateral Reconstruction of the Axilla with Posterior Arm Flap in Recurrent Hidradenitis Suppurativa

Introduction  Hidradenitis suppurativa (HS) is a chronic inflammatory disease, with the axilla being the most commonly affected site. Radical excision of the involved tissue is a definitive treatment. There are numerous techniques described for the reconstruction of the axilla. Patients and methods  Patients with axillary HS who underwent wide excision and posterior arm flap cover between August 2017 and December 2020 were reviewed. Results  A total of 15 flaps were done in eight patients in the study period. Bilateral radical excision of the disease was done simultaneously in all eight patients with the help of a two-team approach. Reconstruction of the axilla was done with a posterior arm flap bilaterally, except one side in a single patient, wherein the split-thickness skin graft was performed. All flaps settled well without significant complications. On follow-up ranging from 12 to 42 months, one patient complained of disease recurrence on one side. The flap and the donor site had settled well in all patients, causing no significant morbidity. Conclusion  Radical excision of axillary hidradenitis must be considered early on presentation. After wide excision, simultaneous bilateral reconstruction with posterior arm flap is a simple and reliable technique with an excellent patient-reported outcome.     

逆行岛状皮瓣静脉回流的实验研究

目的 :建立新西兰大白兔隐动静脉逆行岛状皮瓣实验模型 ,探讨静脉逆向回流的机制。方法 :对 5只新西兰大白兔解剖观察 ,建立隐动静脉逆行岛状皮瓣实验模型 ( 3 .0cm× 3 .0cm ,血管蒂长 3 .0cm )。将 10只兔的两侧后肢随机配对分为 2组 ,进行同体对照 ,每组 10个皮瓣。组 1保留隐动静脉血管鞘的完整 ,即保留静脉回流的“迷路”通道。组 2在手术显微镜下 (× 10 )将 3根血管相互分开 ,各自游离 3cm ,即完全破坏静脉回流的“迷路”通道 ,但不损伤 3根动静脉血管。术中放松止血带后分别在 5、15、3 0和60min测定静脉压力 ,术后 10d测定皮瓣成活率 ,切取血管蒂做切片观察。结果 :放松止血带后 ,两组皮瓣的静脉压力均升高 ,约 15min达到高峰 ,后缓慢下降 ,约在 3 0min达到新的平衡。组 2在 3 0、60min的静脉压力均显著低于组 1(P <1.0 1)。但组 1皮瓣成活率 ( 94.5 % )与组 2 ( 10 0 % )无显著差别 (P >0 .0 5 )。结论 :在逆行岛状皮瓣中 ,瓣膜失活途径”较“迷宫途径”更容易实现静脉血的逆流。     

动脉化静脉皮瓣成活机制的实验研究

目的 直视下观测动脉化静脉皮瓣的血液循环途径,探讨其成活机制。方法 选用15只中国大白兔30只耳朵,设计动脉化静脉皮瓣模型,应用微循环显微镜在不同时间观察皮瓣微循环的血液途径(1h、2h、4h、8h)。结果 皮瓣全部成活。皮瓣组织内毛细管管网是一个“立体”的网状结构;静脉皮瓣早期可见毛细血管床关闭,动脉血在微静脉间快速流动;随毛细血管逐渐开放,动脉血逆流进入微循环,完成循环重建。结论在引流静脉保持通畅的前提下,静脉皮瓣可借助静脉系统重建有效血液循环并保持成活。     

前臂游离皮瓣转移修复软腭部肿瘤术后缺损

目的：探讨腭部肿瘤术后腭部大范围缺损修复的理想方法。方法：对57例腭部肿瘤手术后缺损区同期用前臂游离皮瓣转移修复的病例进行研究。结果：全部皮瓣成活,供区创面一期愈合,前臂无运动功能障碍。患者术后语音评价优良,腭部形态恢复满意。结论：前臂游离皮瓣制作较简单,易于成形且血运好,用于腭部肿瘤术后大范围缺损修复,其外形恢复及功能重建方面效果满意。     

大骨瓣开颅术在大面积脑梗死所致脑疝中的应用

目的 探讨大面积脑梗死所致脑疝的手术方法。方法 对大面积脑梗死所致早、中期小脑幕切迹疝采用标准外伤大骨瓣开颅术及非功能区脑组织切除术。结果 12例中10例存活,2例死亡;10例幸存者随访3～6个月,智能均接近正常,其中6例能独立生活。结论 标准外伤大骨瓣开颅术是治疗脑梗死所致脑疝的有效方法。     

岛状股前外侧皮瓣修复青春期后膀胱外翻腹壁缺损

目的:探讨一种皮瓣转移修复青春期后膀胱外翻耻骨上腹壁缺损的方法.方法:设计以旋股外侧动脉降支为血管蒂的岛状股前外侧皮瓣,掀起皮瓣后经过皮下隧道将其转移至耻骨上腹壁缺损处.对2例青春期后膀胱外翻患者,均以此法进行治疗,转移皮瓣面积为(9 cm×11 cm)～(10 cm×15 cm).结果:临床治疗2例,转移皮瓣均成活良好,外形恢复满意.结论:青春期后膀胱外翻患者多经历数次手术修复,无局部及邻近组织可利用,岛状股前外侧皮瓣是修复耻骨上腹壁缺损的理想的远位皮瓣.     

小腿后侧远端蒂筋膜皮瓣修复踝足部皮肤缺损

小腿下端及足跟部等近踝处皮肤菲薄,血运差,缺损易导致骨骼、肌腱外露。该处软组织缺损的治疗较为棘手1998年9月～2006年6月,我院共收治此类患者60例,采用小腿后侧远端蒂筋膜皮瓣修复此处皮肤缺损,均取得良好效果．报道如下。