五种皮瓣修复拇指软组织缺损的疗效分析

目的探讨五种微型皮瓣修复拇指软组织缺损的疗效及其适应证。方法1998年1月～2003年3月,对52例拇指软组织缺损应用甲皮瓣5例、拇指尺背侧动脉逆行岛状皮瓣15例、大鱼际皮瓣10例、指动脉侧方岛状皮瓣8例、示指背侧岛状皮瓣14例进行修复。缺损部位:拇指脱套伤5例,拇指指腹缺损12例,拇指近节掌侧缺损6例,拇指全掌侧缺损5例,拇指背缺损7例,拇指尺侧缘缺损6例,拇指桡侧缘缺损7例,拇指指端缺损4例。男40例,女12例;年龄17～35岁,平均25岁;左拇指23例,右拇指29例。皮瓣面积最大5.0cm×2.5cm,最小2.0cm×1.5cm。结果皮瓣全部成活,术后随访6～36个月,平均20个月。皮瓣血运、质地良好,外形、功能满意。自带神经皮瓣及吻合神经皮瓣共46例的平均两点分辨觉:甲皮瓣为5.8mm,拇指尺背侧动脉逆行岛状皮瓣为8.5mm,大鱼际皮瓣为7.0mm,指动脉侧方岛状皮瓣为6.2mm,示指背侧岛状皮瓣为8.8mm;6例未吻合神经的皮瓣拇指仅恢复触痛觉,两点分辨觉恢复较差。结论五种皮瓣修复拇指软组织缺损安全可靠,其中甲皮瓣和指动脉侧方岛状皮瓣感觉功能恢复最佳,拇指尺背侧动脉逆行岛状皮瓣和大鱼际皮瓣操作容易,损伤最小。应根据拇指的缺损部位,选择不同修复皮瓣。     

尺动脉腕上支皮瓣修复手部皮肤缺损

目的 对尺动脉腕上支皮瓣的手术方法进行改进。方法 新鲜成人上肢标本20侧，对前臂尺动脉腕背支进行解剖测量，对皮瓣的切取方法进行改进。临床应用尺动脉腕上支皮瓣修复手掌、手背、小鱼际、大鱼际、拇指的皮肤缺损创面18例，提出了避免皮瓣坏死的方法。结果 15例全部成活，3例大部成活，且对供区的功能影响很小。结论 尺动脉腕上支皮瓣在应用过程中，有许多不确定的干扰因素，应以准确的解剖学知识、丰富的经验为基础灵活掌握。     

我国烧伤免疫的研究

The electric burn is a kind of special injury, in which the injured areas are not big, but deep tissues and organs are often injured, resulting in higher rates of mortality and amputation than thermal injury. In the process of management, besides the treatment for systemic and pathologic changes, wound repair is also emphasized for restoration of function. In the past 50 years, ten thound patients with electric burn were cured in our country, including hundreds of severe electric burn patients with extensive injury. Lots of operative regimes for electric burn were developed, and the scope of experimental research was broadening. As aresult, six monographs concerning electric burns were published. However, clinical management of severe electric burn to give a satisfactory result is still difficult, therefore further indepth research is necessary, especially in the field of the use of artificial skin, vessels, nerves, muscular tendon, etc. from gene and tissue engineering to improve quality of wound repair.     

Ileocolic free flap for voice and swallowing rehabilitation after pharyngolaryngo-esophagectomy: a preliminary report

The usual approach for patients with advanced hypopharyngeal cancer is a multimodal treatment with surgical resection and radiation therapy. A circular pharyngolaryngoesophagectomy is mandatory in cases with advanced disease, even if it extends above the upper esophageal sphincter, followed by an immediate reconstruction. A microsurgical reconstructive technique is advised, based on Kawahara’s technique, using an ileocolic free flap as a single stage procedure for voice and swallowing rehabilitation. A total of four patients with advanced squamous cell carcinoma of the oropharynx was submitted to surgery. After pharyngolaryngoesophagectomy, the ileocolic complex was transposed and revascularized in the cervical field; the digestive tract restoration was performed with the cecum and ascending colon, while the last ileal loop was anastomosed to the cervical trachea. The continence mechanism of the ileocecal valve was used to protect the airways from inhalation of food and saliva and to obtain a monotonic phonation. A tracheal stoma was maintained to permit satisfactory breathing. All patients underwent this procedure successfully, with recovery of swallowing function and vocal performance within a short time, varying from 18 to 38 days. Received: 10 June 1999 / Accepted: 5 January 2000     

The Naso-labial and lateral forehead flaps as a single stage: A case report and review of literature

We present here the case of a patient with a major traumatic nasal loses who had a near-total nasal reconstruction as a single-stage procedure. A 35 year-old civil servant who was involved in a road traffic injury about two years before presentation. He sustained extensive and multiple facial injuries with complete loss of nasal cover and lining. Reconstruction was performed by using superiorly based, bilateral, nasolabial flaps to line the floor and the nasal septum, and a paramedian forehead flap for skin cover. The patient did well postoperatively and was discharged home on the 7^th postoperative day. If the principles concerning cover, support, and lining are adhered to, excellent functional and aesthetic results can be achieved as we have obtained in our patient.     

Applied anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery

A study of the anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery was performed to help the elaboration of a fasciocutaneous flap for the reconstruction of skin and subcutaneous and deep fascia of the knee and popliteal region.Forty thighs in 27 fresh cadavers were dissected. In all of the thighs, the third perforator artery was found to arise from the deep femoral artery and reach the posterior aspect of the thigh after perforating the adductor magnus muscle. At that point it was also found that the third perforator artery gives off a branch that emerges through the intermuscular septum between the vast lateral muscle and the long head of the biceps femoral muscle, then crosses the posterior cutaneous nerve and moves directly on to perforate the deep fascia and then to bifurcate into two other branches: one ascending and one descending.The cutaneous area of the flap of the thigh’s posterior region, nourished by the fasciocutaneous branch, was evaluated through the injection of dye. Dying of the upper medial, middle medial, lower medial and lower lateral areas of the flap was not successful in all of the dissected thighs. Nevertheless, the upper lateral and the middle lateral areas were dyed successfully in all 40 dissected thighs of the 27 cadavers.     

皮肤软组织并联扩张术修复面中部瘢痕

目的寻求修复面中部瘢痕的新方法。方法15例面中部瘢痕患者于Ⅰ期手术时,在其颌面、颈、耳后部皮肤软组织下并联埋置2个扩张器,待扩张至有足够的“额外”皮肤软组织后,施行Ⅱ期手术,旋转并推进扩张皮瓣以修复面中部瘢痕。结果本组患者术后切口相对隐蔽,修复部位皮肤颜色、质地等符合要求,面部外观得到明显改善。结论颌面、颈、耳后部皮肤软组织并联扩张术是一种修复面中部瘢痕的较好方法,有一定的临床应用价值。     

维拉帕米在大鼠缺血随意皮瓣中作用的研究

目的研究局部使用维拉帕米对大鼠缺血随意型皮瓣的作用。方法建立大鼠背部缺血随意型皮瓣的动物模型(长：宽=6：1)，术后在皮瓣下一次性注射维拉帕米5mg，术后7d取材，测定皮瓣坏死率和中段组织中丙二醛含量，并进行标本大体观察及病理切片观察。结果维拉帕米组皮瓣坏死率15．9％，中段组织中丙二醛含量为164．8nmol/L。对照组皮瓣坏死率为21．8％，丙二醛含量为195．8nmol/L。两组比较差异具有显著性意义。光镜下，实验组的炎性反应较对照组明显减轻。结论维拉帕米能提高缺血随意皮瓣的成活率，且大剂量一次性给药的方法具有可行性。     

Fasciocutaneous flaps

Summary 26 consecutive fasciocutaneous flaps comprising skin, fat and deep fascia have been successfully used to close a variety of defects on the lower leg and trunk. The advantages of these flaps over others are enumerated and the blood supply of the deep fascia and overlying tissues is described.     

带蒂鼻底粘骨膜瓣加自体颞肌筋膜修补鼻中隔较大穿孔

目的探讨采用带蒂鼻底粘骨膜瓣加自体颞肌筋膜修补鼻中隔较大穿孔的疗效。方法分离鼻中隔一侧穿孔周围的粘软骨膜及骨膜,切取自体颞肌筋膜,用颞肌筋膜覆盖鼻中隔穿孔一侧,再分离对侧鼻中隔穿孔周围的粘软骨膜及骨膜,制备带基蒂的鼻底粘骨膜瓣,将鼻底粘骨膜瓣向后上旋转与穿孔前、上缘缝合,覆盖鼻中隔穿孔对侧。结果15例鼻中隔穿孔患者均Ⅰ期愈合,双侧鼻腔通气良好,鼻部症状完全消失。随访1～3年,鼻中隔未见穿孔。结论采用自体带蒂鼻腔底粘骨膜瓣加自体颞肌筋膜修补鼻中隔穿孔,取材方便,无排斥反应,成活率高,可为修补鼻中隔较大穿孔提供足够的移植材料。