巩膜瓣移动缝线在小梁切除术中的应用

目的　寻求一种更有效地解决青光眼术后前房恢复迟缓的方法。方法　在小梁切除术中采用可移动缝线关闭巩膜瓣联合应用抗纤维生成抑制剂 ,术后根据前房恢复情况从结膜外拆巩膜瓣缝线。结果　在 36只眼中 ,术后眼压均在正常范围 ,2 4眼术后 48h恢复前房 (6 6 6 7% ) ,12眼术后 72h恢复前房 (33 33% )。结论　本方法对于促进术后滤过作用 ,避免前房恢复迟缓有一定效果。     

Reconstruction of Large Area of Deep Wound in the Foot and Ankle with Chimeric Anterolateral Thigh Perforator Flap

ObjectiveTo evaluate the clinical application and surgical efficacy of the chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap for the reconstruction of the large area of deep wound in foot and ankle.MethodsClinical data of 32 cases who underwent chimeric anterolateral thigh perforator flap to repair the large area of deep wound of the foot and ankle from January 2015 to December 2018 were retrospectively analyzed. The sizes of the defects ranged from 18 cm × 10 cm to 35 cm × 20 cm, with exposed tendon and bone and/or partial defects and necrosis, contaminations, accompanied by different degrees of infection. Following the radical debridement and VSD, chimeric anterolateral thigh perforator flap was employed to repair the deep wounds according to the position, site and deep‐tissue injury of the soft‐tissue defects. The skin flap and muscle flap were fanned out on the wound, and single‐ or two‐staged split‐thickness skin grafting was performed on the muscle flap. The operation time and blood loss were recorded. The survival and healing conditions of the operational site with chimeric anterolateral thigh perforator flap were evaluated post‐operationally. Complications at both recipient site and donor site were carefully recorded.ResultsThe mean time of the operation was 325.5 min and average blood loss was 424.8 mL. Among the 32 cases, two cases developed vascular crisis, which were alleviated with intensive investigation and treatment; Four cases suffered from partial necrosis of the flap or skin graft on the muscle flap or on the residual local wound, which were improved after treatment of further dressing change and skin grafting. Another four cases experienced post‐traumatic osteomyelitis accompanied by bone defect were treated with simple bone grafting or Mesquelet bone grafting at 6–8 months after wound healing. Postoperatively, the wounds were properly healed, and the infection was effectively controlled without sinus tract forming. Overall, all 32 cases received satisfactory efficacy, without influencing subsequent functional reconstruction, and observed infection during the 12–36 months post‐operational follow‐up.ConclusionThe chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap provides an effective and relative safe procedure for the repair of a large area of deep wound in the foot and ankle, particularly with irregular defect or deep dead space.     

眼科检查仪器数据采集系统的研制

目的研制一套符合眼科临床需求的数字化检查仪器数据采集方案,实现检查结果统一存储、远程调阅、集中管理。方法针对眼科医疗过程中常用的临床检查手段,选取20多种不同型号、不同厂商的数字化检查仪器,对其源数据格式、仪器接口、目标数据格式进行分析、提炼、归纳。抽象出通用的数据采集模型。结果依据设计模型顺利构建出眼科数字化采集系统。在温州医科大学附属眼视光医院部署应用超过5年,其采集效果良好,具有较好的通用性和扩展性。能满足现行大多数眼科数字化检查仪器的采集需求,支持新品种仪器的扩展。结论该方案对眼科仪器的输出途径、数据格式进行归纳,建立一套通用的数据采集方案,提高了眼科信息化建设的效率,其结果数据满足大多数临床诊断需求,有效地解决了“信息孤岛”问题,实现“一处检查,全院共享”。     

地塞米松在大鼠缺血随意皮瓣中的作用

目的：研究局部使用地塞米松对大鼠缺血随意皮瓣的作用。方法：建立大鼠背部缺血随意皮瓣的动物模型，随机分为2组，实验组术后皮瓣下一次给予地塞米松5mg(用生理盐水稀释至3ml)，对照组术后皮瓣下一次给予0．9％生理盐水3ml。均于术后7d取材，测定皮瓣坏死率和组织中丙二醛含量，观察大体及病理切片。结果：实验组皮瓣坏死率和丙二醛含量较对照组显著降低(P＜0．01)。光镜下，实验组的炎性反应较对照组明显减轻。结论：地塞米松能提高缺血随意皮瓣的成活率，大剂量一次性给药的方法是可行的。     

Re-use of pectoralis major myocutaneous flap for the treatment of recurrent hypopharyngeal stenosis following total laryngectomy and postoperative radiotherapy: a case report

Management of recurrent hypopharyngeal stenosis following total laryngectomy and postoperative radiotherapy is a challenging problem. Because of previous surgery, free flaps may not always be performed. We report a case of recurrent hypopharyngeal stenosis after a first attempt of reconstruction with a pectoralis major myocutaneous pedicled flap (PMMPF) failed. The problem was solved by reusing the previous PMMPF as a rotary door flap according to Eliachar and suturing it to the prevertrebral fascia according to Spriano. The follow-up is now of 9 months without recurrence. This new technique is described and discussed in comparison with other possible options.     

不同术式对高血压基底节脑出血的临床效果观察

目的 探讨应用小骨窗显微镜下手术及CT引导穿刺微创碎吸术治疗高血压基底节区出血并对其临床效果进行比较分析.方法 回顾分析我院2009年6月至2010年12月期间62例高血压脑出血患者资料,其中32例采用小骨窗开颅术治疗(小骨窗组),30例采用CT引导穿刺微创碎吸术治疗(微创碎吸组),所有患者术后记录意识障碍的恢复时间,并完成1个月的随访对患者进行神经功能缺损程度评分对比观察两组患者的治疗效果.结果 小骨窗组患者意识障碍恢复时间为(2.75±1.18)天,神经功能缺损评分由(41.69±1.26)分改善为(18.53±2.16)分,微创碎吸组患者意识障碍恢复时间为(7.51±1.22)天,神经功能缺损评分由(41.32±1.32)分改善为(26.84±2.30)分,在意识障碍恢复时间及神经功能缺损程度评分方面,小骨窗组效果优于微创碎吸组,差异具有统计学意义(P＜0.05);同样对于血肿清除量,小骨窗组也优于微创碎吸组,差异具有统计学意义(P＜0.05).结论 高血压基底节区出血,应用小骨窗显微镜下手术可以充分清除血肿并彻底止血,临床效果明显优于CT引导穿刺微创碎吸术.     

Techniques of Upper Eyelid Reconstruction

Reconstruction of the upper eyelid is one of the greatest challenges facing the orbitofacial surgeon. This comprehensive review outlines the principles of reconstruction and the range of techniques available. Methods of assessing upper eyelid defects are discussed, and an algorithm for reconstruction based on defect size and lamellar involvement is given. The review contains numerous detailed examples of reconstructive techniques, including secondary intention healing, local flaps, distal flaps, simple and composite grafts, occlusive and non-occlusive methods, and canthal fixation. Eyebrow and eyelash reconstruction is also covered.     

Deltoid flap combined with fascia lata autograft for rotator cuff defects: a histologic study

The purpose of this study was to compare the histological characteristics of an autogenous fascia lata graft alone and a fascia lata graft combined with a deltoid flap in the reconstruction of rotator cuff tears. Ten New Zealand white rabbits were divided into two groups. Infraspinatus tendon defects (1 × 1 cm) were created in each animal. Reconstruction consisted of either a fascia lata graft alone or a fascia lata graft combined with a distally based deltoid flap. At 3 months, tissue harvest and histological analysis was performed. Compared to the fascia lata graft alone, there was significantly increased remodeling activity and neovascularization in the group that included a deltoid flap. Also, there was pronounced interdigitation at the graft/flap interface in the latter group. A mutually beneficial relationship may exist when an autogenous fascial graft is combined with a functional deltoid flap for reconstructing large rotator cuff defects.     

Free flap reconstruction in massive upper extremity burns

In massive burns, early excision and a free flap reconstruction is, in some cases, limb saving. From October 1979 to August 1993, eleven patients with massive burn injury in the upper extremity were treated using a free flap reconstruction. Eight cases were acute or subacute and three were late reconstructions. The following free flaps were used: rectus femoris microneurovascular musculocutaneous flap (2), latissimus dorsi flap (4), rectus abdominis flap (3), gluteal thigh flap (1), lateral arm flap (1), and serratus flap (1). The gluteal thigh flap was lost and it was later replaced by a rectus abdominis flap. In three cases successful reanastomosis was performed. Functional late reconstructions were performed in nine patients. In all eleven patients the limb was saved and functional recovery was satisfactory. We recommend that a free musculocutaneous or muscle flap is used, proximal to the wrist, if after careful excision of nonviable tissue, tendons, bone joint or major vessels are exposed. The rectus femoris musculocutaneous flap is a useful solution to restore extensor musculature of the forearm after extensive injury.