体外冲击波疗法对促进创面血管生成及愈合作用的研究进展

改善创面循环血量对创面的快速愈合具有重要意义.研究显示,体外冲击波疗法（extracorporeal shock wave therapy,ESWT）对创面血管生成及创面愈合具有促进作用.本文查阅关于ESWT对创面血管再生及促进创面愈合作用的实验及临床研究论文,并对检索结果进行整理、综合与分析.目前研究结果显示,ESWT照射可通过上调血管生成及组织再生因子,如血管内皮生长因子、内皮型一氧化氮合酶以及增值性细胞核抗原的表达,增加组织灌注,改善局部血液供应,促进组织再生.虽然ESWT可有效改善局部血液供应及促进组织再生,但ESWT应用时的能量、聚焦程度、频率及周期数的最佳设置还有待于进一步研究.     

Hyperbaric oxygen preconditioning promotes neovascularization of transplanted skin flaps in rats

To determine whether Hyperbaric oxygen preconditioning (HBO-PC) promotes neovascularization by increasing Stromal cell derived factor-1 (SDF-1) and CXC chemokine receptor 4 (CXCR4) in transplanted skin flaps of rats. The epigastric pedicle skin flap was established in a rat model. Rats were randomly assigned to the following five groups: 1) sham-operated group (SH); 2) ischemia followed by reperfusion 3 days postoperatively group (IR3d); 3) ischemia followed by reperfusion 5 days postoperatively group (IR5d); 4) hyperbaric oxygen preconditioning and ischemia followed by reperfusion 3 days postoperatively group (HBO-PC3d); and 5) hyperbaric oxygen preconditioning and ischemia followed by reperfusion 5 days postoperatively group(HBO-PC5d). For the groups receiving HBO-PC, animals underwent 1 hour of HBO at 2.0 ATA in 100% O₂ twice per day for 3 days consecutively prior to surgery. After perfusion, Laser Doppler perfusion imaging (LDPI) was performed, and skin flap tissue samples were harvested for histological evaluation and western blot analysis. Perfusion was significantly improved in the HBO-PC groups compared with the IR groups on postoperative 3 and 5. Microvessel density (MVD) was significantly increased by HBO-PC compared with IR groups postoperatively. Western blot analysis revealed that SDF-1 and CXCR4 expression in the HBO-PC groups was significantly increased compared with IR groups. HBO-PC promoted neovascularization via increasing expression levels of SDF-1 and CXCR4 in transplanted skin flaps of rats.     

Microsurgical reconstruction of the head and neck – Current concepts of maxillofacial surgery in Europe

IntroductionMicrovascular surgery following tumour resection has become an important field of oral maxillofacial surgery (OMFS). This paper aims to evaluate current microsurgical practice in Europe.MethodsThe questionnaire of the DOESAK collaborative group for Microsurgical Reconstruction was translated into English, transformed into an online based survey and distributed to 200 OMFS units with the aid of the European Association for Cranio-Maxillo-Facial Surgery (EACMFS).Results65 complete and 72 incomplete questionnaires were returned. Hospitals from the United Kingdom, France, Italy, the Netherlands, Spain, Belgium, Greece, Slovenia and Lithuania participated. 71% of contributing centres were university hospitals, 87% out of these perform microvascular tumour surgery at least on a two-weekly base. Overall complication rate was at around five percent. Most frequently used transplants were the radial forearm flap and the fibular flap. The perioperative management varied widely. Success factors for flap survival, however, were uniformly rated, with the surgical skill being the most important factor, followed by the quality of postoperative management. Medication seems to play a less important role.ConclusionWithin Europe microvascular surgery is a common and safe procedure for maxillofacial reconstructive surgery in the field of OMFS. While there is a major accordance for the surgical procedure itself and the most frequently used flaps, perioperative management shows a wide variety of protocols with low presumed impact on surgical outcome.     

游离上臂外侧穿支皮瓣修复手部中、小面积皮肤缺损的临床疗效

目的 探讨应用游离上臂外侧穿支皮瓣修复手部中、小面积皮肤软组织缺损的临床疗效.方法 回顾性分析自2012年4月至2018年5月内蒙古医科大学第三附属医院手足踝外科采用上臂外侧穿支皮瓣修复伴有深部组织外露的手部软组织缺损19例,其中男17例,女2例;平均年龄(27 +4) (23 ～45)岁,左侧8例,右侧11例;致伤原...     

腓动脉皮支腓肠神经营养血管逆行岛状皮瓣修复足踝部软组织缺损

目的探讨腓动脉皮支腓肠神经营养血管逆行岛状皮瓣修复足踝部软组织缺损的临床应用效果。方法在应用解剖学基础上,设计腓动脉皮支腓肠神经营养血管逆行岛状皮瓣,修复足踝部软组织缺损。结果临床应用15例,皮瓣最大面积25cm×15cm,1例皮缘部分坏死,余全部成活。结论腓动脉皮支腓肠神经营养血管逆行岛状皮瓣血液循环丰富,成活率高,不牺牲主要血管神经,是修复足踝部软组织缺损的理想皮瓣。     

预防性肌瓣在小腿开放性骨折中的应用

目的探讨预防性肌瓣在治疗小腿Ⅱ、Ⅲ度开放性骨折中的应用效果。方法急诊一期彻底清创,选择髓内钉、外固定支架及钢板固定骨折,应用各种不同肌瓣覆盖骨折断端及缺损创面。结果临床应用15例,所有病例伤口均Ⅰ期愈合,无感染发生。随访1～3年,患者肢体功能恢复满意。结论预防性肌瓣一期应用对小腿Ⅱ、Ⅲ度开放性骨折及合并严重软组织缺损的治疗可取得良好疗效。     

应用足底内侧皮瓣修复足跟部软组织缺损

目的探讨应用足底内侧皮瓣转移修复足跟部软组织缺损的临床疗效。方法应用足底内侧皮瓣转移修复15例深达跟骨的足跟部软组织缺损。结果15例皮瓣移植后均成活,术后随访3~12个月,所有皮瓣外形和感觉均恢复良好。结论足底内侧皮瓣修复足跟部深度软组织缺损效果较好。     

不同方法修复儿童足跟轮辐伤皮肤缺损伴跟腱外露

目的 探讨不同方法 修复儿童足跟轮辐伤皮肤缺损伴跟腱外露的临床效果.方法 采用腓肠神经营养血管皮瓣、足跟外侧动脉皮瓣和邻位局部内侧或外侧旋转皮瓣3种皮瓣以及人工真皮覆盖修复22例儿童足跟部轮辐伤皮肤缺损伴跟腱外露创面.观察创面愈合情况.结果 患儿均获得随访,时间3～10个月.2例腓肠神经营养血管皮瓣远端皮缘发生血运障碍...     

颞浅动脉头皮岛状皮瓣修复眉缺损20例体会

【目的】通过对不同原因造成的眉部缺损采用颞浅动脉头皮岛状皮瓣修复,探索颞浅动脉头皮岛状皮瓣修复眉缺损的优越性。【方法】对患者进行相宜的眉型设计和皮瓣设计,切取皮瓣修复缺损眉区创面。【结果】本组共20例28侧皮瓣全部存活,伤口一级愈合,未发现皮瓣坏死及伤口感染。【结论】颞浅动脉头皮岛状皮瓣是修复眉缺损的一种较好的方法,有着更广阔的应用前景。     

腓动脉穿支逆行真皮下血管网皮瓣修复踝部皮肤缺损

目的总结腓动脉穿支逆行真皮下血管网皮瓣修复踝部皮肤缺损的效果。方法8例踝部皮肤缺损患者,缺损面积(3 cm×5 cm)^(5 cm×9 cm),均采用腓动脉穿支逆行真皮下血管网皮瓣修复:以外踝至腓骨小头为轴线,根据创面大小设计皮瓣,以外踝上5 cm为蒂部旋转点,由远端向近端切取皮瓣,修剪皮瓣远端成真皮下血管网皮瓣,转移修复踝部皮肤缺损。结果皮瓣大小(3 cm×7 cm)^(5 cm×15 cm)。除1例皮瓣远端部分坏死外,余皮瓣均成活,外形及功能恢复良好。结论小腿外侧逆行真皮下血管网皮瓣不牺牲主要血管,是修复踝部缺损的较好方法。