The rhomboid flap for pilonidal disease

Introduction There have been many surgical techniques described for the treatment of pilonidal sinuses. Recurrent disease causes significant morbidity particularly with time from work. Aim To assess the rhomboid flap's role in promoting one‐stage primary healing in pilonidal disease and to evaluate the morbidity and recurrence. Methods Fifty‐three patients were prospectively recruited of which 27 had previous multiple abscess formation requiring surgical drainage from their pilonidal disease, although none had acute disease at the time of surgery. By using the transposition flap, we were able to obliterate the natal cleft and therefore the rolling action of the buttocks between the cleft in these patients and thereby remove one of the factors involved in pilonidal disease. Hospital stay, healing time, wound infection, wound breakdown and recurrence were noted. Results There were 47 males and 6 females with a median age of 28 years (range 16–64 years). Median follow‐up was 24 months (range 3–36 months). Post‐operative morbidity involved superficial wound infection in 7 (13%) which settled with out‐patient dressings. There were four recurrences (7%), two occurred between the flap and the anal canal, and the other two in the flap margin needing intervention. All the patients healed their wounds and the median healing time was 14 days. Conclusion As this condition affects a predominantly young population causing significant time off from work, we feel that the Rhomboid Flap is useful for difficult cases in that it allows early return to full activity and does not necessitate prolonged postoperative care.     

头皮缺损颅骨外露的修复

我科1980～1991年收治外伤性或颅面部肿瘤切除后头皮缺损颅骨外露9例,分别应用吻合血管的游离大网膜结合中厚皮片移植、游离皮瓣或轴型皮瓣转位结合皮片移植修复。讨论了修复时机、修复方法以及手术注意事项。认为双侧股前外侧游离皮瓣是修复全头皮缺损颅骨外露的可取方法,而吻合血管的游离大网膜移植修复颅骨外露的方法应尽量避免。     

肩胛皮瓣再造阴茎

目的：探索一种新的阴茎再造手术方式。方法：应用肩胛皮瓣游离移植和银丝棒硅胶阴茎假体置入行阴茎再造。结果：自2000年3月起，已在临床应用6例，术后皮瓣全部成活。经随访6－12个月，阴茎形态和功能良好，结论：此手术方法设计合理，术后形态功能良好，供区无明显继发畸形，是一种较好的阴茎再造方法。     

Laparoscopic treatment of nonparasitic cysts of the liver with omental transposition flap

Background: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing; the last 13 of them also received an omental transposition flap in addition. Methods: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An omental transposition flap was fashioned and stapled into the cyst cavity itself. Results: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection which was aspirated percutaneously. On average, patients were discharged on the 4th (2–14) postoperative day. Follow-up was performed with abdominal ultrasound for 2–43 months (mean 19 months). There were two early cyst recurrences, both in cases without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0). Conclusions: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver cysts and can be performed using minimal-access surgical techniques. Received: 19 January 1996/Accepted: 26 August 1996     

第一掌背动脉双叶皮瓣在手外科中的应用

我们设计主要以第1掌背动脉为蒂的手背双叶皮瓣,同时修复两个部位的手部皮肤缺损和拇指再造,共10例均获成功。皮瓣面积最小10cm×3cm,最大13cm×5cm,蒂宽1.5cm×2.5cm。皮瓣每叶面积最小为3.5cm×2cm,最大6cm×3cm。文中介绍了本皮瓣的解剖学基础,并对其手术适应证和优缺点进行了讨论。     

真皮下血管网皮瓣的过氧化脂质测定

对12只豚鼠背部随意型真皮下血管网皮瓣的过氧化脂质含量进行了动态观测.结果表明,过氧化脂质的含量与皮瓣损伤程度呈同步变化;与皮瓣血运重建的时间密切相关.氧自由基对皮瓣组织的损伤主要发生在移植后1～5天.     

不同方案缺血预处理对大鼠横形腹直肌肌皮瓣再灌注损伤的影响

目的 探讨不同方案缺血预处理（ischemic preconditioning，IPC）对大鼠横形腹直肌肌皮瓣（transverse rectus abdominis musculocutaneous flap，TRAM）移植后再灌注损伤的影响。方法选取雄性Wistar大鼠90只，建立TRAM模型，随机分为对照组和实验组，对照组10只，无需预处理过程，持续缺血4h后，恢复肌皮瓣血供；实验组分为8个亚组，每组10只，以微血管夹阻断腹壁下血管5min，再恢复血流5min，处理1次为sIPC5／5组，处理2次为bIPC5／5组，依次为sIPC5／10组（缺血5min／再灌注10min1次）、bIPC5／10组（缺血5min／再灌注10min2次）、sIPC10／5组（缺血10min／再灌注5min 1次）、bIPC 10／5组（缺血10min／再灌注5min2次）、sIPC10／10组（缺血10min／再灌注10min1次）、bIPC10／10组（缺血10min／再灌注10min2次），其余实验步骤与对照组相同；每组肌皮瓣恢复血供4h后，取3只处死取材，测定肌组织含水量及HE染色镜检观察骨骼肌组织结构，其余动物于术后第7天判断皮瓣成活情况，计算成活面积百分比。结果恢复血供12h后，各实验组肌皮瓣两侧边缘部分肿胀，色泽黯淡，较对照组肿胀范围小，程度轻；光镜下见各实验组肌纤维轻度肿胀，染色均一，肌纤维结构尚完整，胞核呈梭形，无明显肿胀。对照组肿胀明显，部分肌纤维断裂。各实验组与对照组相比肌组织水含量明显减少（P〈0．001），皮瓣成活面积提高了2～3倍（P〈0.001）。两次预处理对肌皮瓣成活面积的影响与相应的单次预处理比较，差异有统计学意义（P〈0．05）。结论IPC可明显减轻大鼠TRAM再灌注损伤程度，其保护效应受缺血／再灌注时间、处理次数等因素的影响。     

带血管蒂跗骨瓣移位术修复踝及足部骨病损

目的 为治疗踝及足部骨质病损提供系列手术方式。方法 在解剖学研究基础上，设计了带血管蒂的骰骨瓣、内侧楔骨瓣、舟骨瓣和跟骨前外侧骨瓣移位术，以修复踝及足骨质病损。临床应用55例。结果 术后经l—10年随访48例，平均为4年6个月，疗效满意。结论 上述4种跗骨瓣均具有血管蒂位置表浅、解剖容易和手术安全可靠等优点。     

Esophagus atresia after cervical spine surgery: case report and literature review

We report on a case of esophageal atresia following cervical spine surgery. A swallowing examination was performed using fibre-optic endoscopy and videofluoroscopy. There was scar tissue fixation of the larynx and esophagus to the cervical spine. Operative mobilization of the larynx and esophagus and formation of a sliding layer using a platysma-fascia flap was done. The PEG and tracheal cannula were removed; oral nutrition was initiated after 3 months. Swallowing disorders following operations on the upper cervical spine should be investigated. Careful preparation that preserves the layers should be carried out. Fixation of tissues as a result of scarring should be treated with a sliding layer.     

Canal wall reconstruction and mastoid obliteration with composite multi-fractured osteoperiosteal flap

We used inferior pedicled composite multi-fractured osteoperiosteal flap (CMOF), our original and new surgical approach, to obliterate the mastoid cavity and reconstruct the external auditory canal (EAC) to prevent the open cavity problems. CMOF was used to obliterate the mastoid cavity and reconstruct the EAC in 24 patients (13 women, 11 men; age span 12–51 years) who underwent radical mastoidectomy to treat the chronic otitis media between 1998 and 2004. Small meatoplasty was done in all 24 patients to relive their aesthetical concerns. Temporal bone CT scanning was done to observe the neo-osteogenesis in the mastoidectomy cavity and the CMOF, and the EAC volume was measured postoperatively. All our patients were followed-up for 2 years. The epithelization of the new EAC in our patients was complete at the end of the second month. Cholesteatoma, granulation, and recurrence of osteitis did not occur in any of the patients. We saw the new bone formation filling the mastoid cavity in the postoperative temporal bone CT scanning images. The mean volume of the new EAC on the 24th month was 1.83 ± 0.56 cm³. We had an almost natural EAC, which owed its existence to the neo-osteogenesis that grows behind the CMOF, which we use to obliterate the mastoid cavity and to reconstruct the EAC.This technique, composite multi-fractured osteoperiosteal flap, was presented in the symposium of Gulhane Military Medical Academy on otology and audiology, 15–18 September, 2005, Antalya, Turkey.