三角瓣完全换位+患侧鼻翼切口修复三度唇裂的体会

目的观察三角瓣完全换位＋患侧鼻翼切口修复先天性三度唇裂的术后效果，探讨该手术方法的优缺点及临床应用价值。方法将26例先天性三度唇患者（术前拍照片，术后拍照片）采用三角瓣完全换位＋患侧鼻翼切口的手术方法，与传统的方法进行近期比较。结果26例先天性三度唇裂患者，均获得显著的优于传统手术方法的效果。结论三角瓣换位＋惠侧鼻翼切口修复三度唇裂手术设计简单可靠，效果显著。     

腓肠肌瓣在腘血管损伤并大面积皮肤撕脱伤中的应用

目的:探讨胭动静脉损伤并同侧下肢大面积皮肤撕脱伤的治疗方法。方法:对6例胭动静脉损伤并下肢大面积皮肤撕脱伤者,在修复血管后用以腓肠内或外侧血管为蒂的腓肠肌瓣逆向旋转覆盖外露的腘动静脉,再行游离植皮修复创面。结果:6例经上述方法处理后均得以保肢。随访0.6-3.2年,患者能正常行走,上下楼梯无影响,患踝跖屈肌力无明显下降,膝关节伸0°,过伸5-10°,屈曲可达90-110°,患者对治疗满意。结论:利用腓肠内(外)侧血管为蒂的旋转腓肠肌瓣覆盖损伤外露的胭动静脉联合游离植皮修复创面是处理胭动静脉损伤并下肢大面积皮肤撕脱伤的一种简单、省时、实用的治疗方法,适合急诊处理,可获得良好的功能恢复。     

一期带蒂组织瓣联合万古霉素骨水泥及颗粒骨治疗小腿创伤后骨髓炎伴骨及软组织缺损

目的探讨一期带蒂组织瓣联合万古霉素骨水泥及颗粒骨治疗小腿创伤后骨髓炎伴骨及软组织缺损的方法及疗效。方法 2008年6月~2013年3月,收治小腿创伤后骨髓炎伴骨及软组织缺损患者36例。男25例,女11例;年龄22~60岁,平均46.5岁。病程1~5个月,平均2.5个月。软组织缺损面积为4 cm×5 cm~13cm×8 cm,骨缺损长度0.5 cm~2.5 cm,平均1.8 cm。采用带蒂组织瓣移位联合万古霉素骨水泥及颗粒骨植入一期治疗。选择带蒂的腓肠肌肌瓣16例,比目鱼肌肌瓣12例,腓肠神经营养血管肌皮瓣6例,远端蒂股前外侧肌皮瓣2例,同时一期联合万古霉素骨水泥填充及颗粒骨植骨,肌瓣表面游离植皮处理。结果 36例患者均获随访,随访时间24~55个月,平均39.5个月。2例组织瓣远端发生部分坏死,经清创换药及游离植皮后愈合,4例术后创面渗出患者经换药处理后愈合,2例感染未控制,经再次手术病灶清除及灌洗引流后愈合。所有骨折均骨性愈合,愈合时间6~21个月,平均12个月。末次随访时按Johner-Wruhs标准评定疗效,优20例,良12例,可4例,优良率为88.9%。结论一期应用带蒂组织瓣联合万古霉素骨水泥及颗粒骨治疗小腿创伤后骨髓炎伴骨及软组织缺损,有利于创面愈合、感染控制及骨缺损修复,可获得良好的临床疗效。     

旋髂浅动脉为蒂的髂腹股沟皮瓣修复拇指脱套伤

目的:探讨旋髂浅动脉为蒂的髂腹股沟皮瓣修复拇指脱套伤的效果。方法:对16例拇指脱套伤,急诊采用旋髂浅动脉为蒂的髂腹股沟皮瓣进行修复。结果:术后皮瓣全部成活,平均随访1年,拇指外形美观,皮瓣质地柔韧,拇指对掌功能正常,生活自理。结论:采用旋髂浅动脉为蒂的髂腹股沟皮瓣修复拇指脱套伤具有简单易行、血供好、成活率高、修复后拇指外形美观、功能好等特点。     

四肢大面积皮肤撕脱伤早期处理探讨

四肢大面积皮肤撕脱伤，是由于其皮肤可能未完全离体，或无伤口却有潜行剥离，早期皮肤的颜色接近正常，常漏诊或处理不当，正确的早期处理，对抢救生命，尽早修复创面，恢复肢体功能，缩短治疗时间关系重大。作者对20年中收治的45例大面积皮肤撕脱伤处理作了分析。早期处理，时间愈早愈好；彻底清创是保证创面Ⅰ期愈合的关键；直接缝合只适用于小面积片状撕脱；撕脱皮肤回植，可节省皮源；皮瓣修复适用撕脱层次深，深层组织裸露者；以及手、足、小腿下段特殊需求者。足底、踝、跟腱等处的皮肤撕脱，皮片移植甚难愈合，即使创面修复，亦不能承受重力，要彻底解决皮瓣的耐磨、耐重力问题，仍需作有神经营养、感觉功能的带感觉神经皮瓣移植。     

头颈部皮肤恶性肿瘤的手术切除与修复

目的：总结头颈部皮肤恶性肿瘤手术和修复的临床经验。方法：回顾性分析我科手术治疗的头面部皮肤恶性肿瘤患者125例，术中作冰冻切片监测手术切缘，术后缺损根据患者的情况采用邻近随意皮瓣、直接拉拢、血管化游离皮瓣、带蒂皮瓣、植皮方法修复。结果：本组所有病例均一期修复，甲级愈合。结论：头面部皮肤恶性肿瘤术中作冰冻切片监测手术切缘有助于保证肿瘤的彻底切除。术后缺损的修复方法应根据患者的具体情况而定，其中以邻近随意皮瓣的效果较好。     

旋髂深血管髂骨瓣移植治疗中青年股骨头缺血性坏死远期髋关节功能观察

Morbidityoffemoralheadischemicnecrosisincreasesyearafteryear．Causeofdiseaseisnotclear，whichisrelativetotrauma，drinking，hormoneutilization，anddecompressionsickness．Wetreated７９casesoffemoralheadischemicnecrosiswithgraftingoiliacboneflapwithdeepiliaccircumflexvesselandreceivedgoodcurativeeffects．Wecomparedthemwith１３casestreatedbytrans－plantinggranularboneafterdecompression，summaryasfollow．１Subjectsandmethod１．１SubjectsGraftingofiliacboneflapwithdeepiliaccircum－flexvesselgroupin…     

Early results of a rotational flap to treat chronic anal fissures

Background Treatment of anal fissures has changed dramatically in the past decade. Only a few fail to respond to medical therapy. Sphincterotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60–70% of flap donor sites break down with complications. We proposed that using a rotational flap would overcome this problem.Methods Twenty-one patients (14 women,7 men) with chronic anal fissures were treated with rotation flap from perianal skin. The median age was 43 (range 21–76) years. All patients had failed chemical sphincterotomy and showed no signs of improvement following at least a 3-month course of topical GTN 0.2% ointment.Results The median hospital stay was 2 days. Seventeen patients had complete resolution of symptoms. Only one patient continued to have severe pain. Two developed a recurrent fissure. One patient had a combined fistula–fissure complex at diagnosis and suffered from a breakdown of the flap and donor site. Another patient had had haemorrhoidectomy and an advancement flap in the past. He developed problems with the donor site, which was successfully managed conservatively. One patient had persistent mild pain after surgery, but the cause could not be found. None of the patients suffered continence defects after surgery.Conclusion Use of a rotational flap is a simple, safe and successful treatment for anal fissures. Donor site problems are minimised using this approach. It should be a treatment of choice when surgery is required for chronic anal fissures, particularly in patients in whom there is a risk of incontinence.These are the results of the initial ten cases presented as a poster at the annual meeting of The Association of Coloproctology of Great Britain and Ireland, July 2003. The abstract was published in Colorectal Disease, 5 [Suppl 1]:73, July 2003. Poster presentation at the British Society of Gastroenterology meeting, Glasgow, March 2004. The abstract was published in Gut, A66 [Suppl 3:53, April 2004. Oral presentation at the Association of Surgeons of Great Britain and Ireland meeting, 28–30th April 2004. The abstract was published in Br J Surg 91(1), May 2004.     

自体颅骨修补术后影响骨瓣吸收的危险因素分析

目的探讨影响自体颅骨修补术后骨吸收的危险因素。方法回顾性分析2001年1月至2012年12月期间经临沂市人民医院神经外科行自体颅骨修补的患者178例,含201块自体骨瓣,根据术后CT特点对骨吸收进行分级,探讨各危险因素与骨吸收分级之间的关系。结果骨吸收分级在性别、修补时间和骨瓣面积间的差异无意义(P0.05),患者平均年龄随骨吸收分级上升呈下降趋势,但骨吸收各分级间的平均年龄之间差异无意义(P0.05)。骨吸收分级与缺损位置有关(P0.05),重度骨吸收多发生于额颞部和颞部。伴有骨折的骨瓣重度骨吸收发生率高于骨瓣完整者(P0.05)。伴发脑积水并行脑室-腹腔分流术的患者与未行脑室-腹腔分流术的患者相比,前者术后骨瓣塌陷的发生率高于后者(P0.05)。结论自体颅骨修补术后骨吸收分级与患者性别、年龄、修补时间和骨瓣面积无关。骨吸收分级与缺损位置有关,重度骨吸收多发生于额颞部和颞部。伴有骨折的骨瓣重度骨吸收发生率高于骨瓣完整者。伴发脑积水并行脑室-腹腔分流术后容易发生骨瓣塌陷。     

阴道前壁黏膜瓣悬吊术和传统阴道前壁修补治疗前盆腔器官脱垂的效果比较

目的比较阴道前壁黏膜瓣悬吊术和传统阴道前壁修补治疗前盆腔器官脱垂的效果。方法选取我院收治的40例前盆腔器官脱垂患者,随机分为研究组和对照组各20例。研究组实施阴道前壁黏膜瓣悬吊术,对照组实施传统阴道前壁修补术,比较两组患者的手术时间、术中出血量、并发症发生率、住院时间、医疗费用、术后6个月的客观治愈率以及PFIQ-7、 PFDI-20评分。结果两组患者的手术时间、术中出血量、住院时间比较差异无统计学意义(P>0.05)。研究组的并发症发生率、医疗费用以及术后6个月的PFIQ-7、 PFDI-20评分均低于对照组(P <0.05)。研究组术后6个月的客观治愈率高于对照组(P <0.05)。结论阴道前壁黏膜瓣悬吊术治疗前盆腔器官脱垂,疗效确切,并发症少,安全经济,具有临床推广价值。