大鼠皮瓣血液循环的磁共振波谱学初步研究

观察皮瓣的能量代谢。方法：利用磁共振波谱技术分别对大鼠皮瓣在正常灌注、动脉阻流、静脉阻流、失活等条件下ＡＴＰ、ＰＣｒ、Ｐｉ峰形的变化进行分析。结果正常时,Ｐｉ低于ＡＴＰ的γ及α峰。     

小腿内侧逆行筋膜岛状皮瓣修复足部软组织缺损

目的探讨小腿内侧皮瓣在修复足部软组织缺损方面的应用.方法设计应用小腿内侧逆行筋膜岛状皮瓣修复足部软组织缺损15例.其中,男11例,女4例;缺损原因电烧伤3例,皮肤肿瘤2例,慢性溃疡7例,化学烧伤2例,热压伤1例.结果15例病例皮瓣全部成活.足外形、感觉及行走的稳定性均恢复良好.结论小腿内侧逆行岛状皮瓣与足部皮肤组织类似,血运及神经支配有保证,成活率高;蒂部较长,操作简便;特别适用于足跟及底部软组织缺损的修复.     

The distally based subcutaneous tarsometatarsal flap

Injuries to the distal part of the foot, or even the toes, can still provide reconstructive problems. It is not always wise to amputate the damaged, distal part of the foot. Some surgeons have stated that reconstruction of the distal foot is not necessary, but it is our opinion that it has a similar priority to reconstruction of the hand. While large defects are mostly reconstructed by free flaps, minor defects should also be considered for reconstruction. As in a previous paper, Small toe muscles for defect coverage [12], we are presenting a new way to reconstruct damaged tissue distal to the tarsometatarsal region.Correspondence to: G. Wechselberger     

Use of a pericardial fat pad flap for preventing bronchopleural fistula: An experimental study focusing on the angiogenesis and cytokine production of the fat pad

An experimental study was conducted to determine whether pericardial fat tissue could induce neovascularization and produce cytokines related to tissue repair. Neovascularization was examined using chick chorioallantoic membranes. Pieces of pericardial fat tissue, omentum, and intercostal muscle were individually placed on a number of chorioallantoic membranes and neovascularization induced by each material was assayed 6 days after the implantation. The intensity of neovascularization was in the order of pericardial fat omentum > muscle. Cytokines, such as interleukin 1 (IL-1) and , tumor necrosis factor- (TNF), interferon- (IFN-), and interleukin 6 (IL-6) were assayed in a culture supernatant of pericardial fat tissue. The latter was obtained 24h after the addition of lipopolysaccharide (LPS) following various incubation times. All cytokines other than IFN are known to play a part in tissue repair, whereas IFN is negatively related to tissue repair because it inhibits fibroblast growth. The pericardial fat tissue incubated with LPS produced a certain amount of IL-1 on day 1, and TNF on days 1 and 8, whereafter these values decreased to an undetectable level. Irrespective of the addition of LPS, a large amount of IL-6 was observed in the supernatant of pericardial fat tissue and it was detectable until day 29. On the contrary, INF was not detected at any assay time. These observations suggest that a pericardial fat pad flap could possibly be beneficial in the prevention of bronchopleural fistula after pulmonary resection.     

Transanaler rektaler Verschiebelappen (rectal advancement flap) versus mukosaflap mit internusnaht im management komplizierter fisteln des anorektums Eine prospektive klinische und manometrische studie

A prospective study was carried out on 55 patients with complicated anal fistulas (41 transsphincteric, 5 suprasphincteric and 9 rectovaginal) to evaluate the value of two sphincter-conserving techniques with primary occlusion of the internal ostium and endorectal advancement flap (group A, n=34) or mucosal flap (group B, n=21). Ten of the patients had Crohn's disease. Both techniques consist in one-stage fistulectomy without drainage of the intersphincteric space. The inflamed proctodeal and granulation tissue was carefully cleared. The site of the former primary orifice of the fistula was adapted by means of two or three peranally performed single stitches. The peranally applied suture included the layers of the internal anal sphincter muscle only. A mobilized flap of rectal wall (group A) and rectal mucosa and submucosa (group B) about 4 cm × 3 cm in size was stitched below the muscular sphincter. The perianal part of the wound was left to heal by second intention. Postoperatively there were 16 cases of suture leakage (23.5% in group A, and 38% in group B), and 19 patients (26% or 47% in both groups) had to have revision surgery because of recurrent fistula or sutur leakage; 2 patients (3.6%) developed incontinence with intermittent fecal soiling. Complete incontinence was not observed in any patient. No significant difference in clinical and functional results was determined between the two groups.

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Transanaler rektaler Verschiebelappen (rectal advancement flap) versus mukosaflap mit internusnaht im management komplizierter fisteln des anorektums Eine prospektive klinische und manometrische studie

Zusammenfassung Bei 55 Patienten mit komplizierten Analfisteln (41 transsphinktere, 5 suprasphinktere, 9 rektovaginale Fisteln) wurde eine prospektive Studie zur Bewertung von 2 sphinktererhaltenden Techniken mit primärem Verschlu des inneren Fistelostiums and anschlieender Deckung durch einen endorektalen Verschiebelappen (Gruppe A, n=34) oder Mukosalappen (Gruppe B, n=21) durchgeführt. Zehn Patienten hatten M. Crohn. Beide Techniken bestehen aus einer einzeitigen Fistulektomie ohne Drainage des Intersphinkterraumes. Das entzündlich veränderte Procdodealdrüsen- und Granulationsgewebe wurde vorsichtig mit dem scharfen Löffel entfernt. Der Ort der früeren Primäröffnung der Fistel wurde mit zwei bzw. drei peranal angelegten Einzelknopfnähten verschlossen. Die peranal gelegte Naht umfate die Schichten des M. spincter ani internus. Ein mobilisierter Rektumwandlappen (Gruppe A) oder ein Mukosa-Submukosalappen (Gruppe B), in einer Gröe von ca. 4×3 cm wurde versetzt und über den muskulären Verschlu gedeckt. Der perianale Teil der Wunde heilte sekundär. Postoperativ trat bei 16 Fällen eitle Nahtinsuffizienz auf (23,5% in Gruppe A, 38% in Gruppe B). Neunzehn Patienten (26% gegenüber 47% in beiden Gruppen) erforderten eine erneute Operation aufgrund von wiederkehrenden Fisteln oder Nahtinsuffizienzen. Zwei Patienten (3,6%) entwickelten eine Inkontinenz in Hinblick auf intermittierendes Stuhlschmieren. Eine völlige Störung der Kontinenz wurde in keinem Fall beobachtet. Ein signifikanter Unterschied zwischen beiden Gruppen war weder in klinischen noch in den funktionellen Ergebnissen zu ermitteln.

     

带血管蒂皮瓣修复肢体软组织缺损及综合康复42例报告

目的：提高皮瓣转移的成功率与功能康复。方法：对４２例皮瓣转移患者采用了术前、术后的康复治疗,并进行了随访。结果：成功率达９５％,修复的缺损部位的功能恢复满意。结论：综合性康复治疗对提高皮瓣转移术的成功率及降低术后功能障碍是不可或缺的方法     

胫后侧逆行岛状筋膜蒂皮瓣修复踝周围软组织缺损

总结１９９３年５月－１９９８年８月,应用胫后侧二种逆行岛状筋膜蒂皮瓣多向转位修复踝部周围皮肤缺损的临床效果。利用胫后动脉肌间隙的穿动脉,腓动脉肌间隙支,腓动脉外踝支与腓肠浅动脉广泛吻合,设计胫后侧两种筋膜蒂皮瓣。     

颞肌筋膜瓣在上颌骨缺损修复中的应用

目的与方法：本文总结了颞肌筋膜瓣修复上颌骨缺损２０例经验。其中上颌骨全部切除９例,上颌骨扩大切除３例,上颌骨部分切除８例。结果与结论：颞肌筋膜瓣全部成活,口腔内无覆盖的颞肌筋膜瓣发生上皮化。２例术后出现轻度张口受限外,未发现其它并发症,作者对颞肌筋膜剖要点及手术方法进行了描术,并对颞肌膜瓣的优点及注意事项进行了讨论。     

两种LASIK微型角膜刀的临床应用探讨

目的　比较ＫＮ－ ５０００ 型微型角膜刀与Ｍｏｒｉａ 微型角膜刀在ＬＡＳＩＫ 术中制作角膜瓣时的优缺点。方法　选用连续病例５６ 例１０３ 眼,随机分ＫＮ 组和Ｍｏｒｉａ 组,ＫＮ 组２８ 例５３眼,术前近视度数平均为－ ９－２１±７－４１Ｄ,散光≤－５－００Ｄ,Ｍｏｒｉａ 组２８ 人５０ 眼,术前近视度数平均为－１０－４７±３－７３Ｄ,散光≤－２－５０Ｄ,术中分别用ＫＮ－５０００ 微型角膜刀和Ｍｏｒｉａ 微型角膜刀制作角膜瓣。结果　两组病例角膜瓣边缘整齐。基质面：ＫＮ组全部术眼光滑、规则,Ｍｏｒｉａ 组部分术眼有“搓衣板”现象。瓣异常：ＫＮ组游离瓣２ 眼,Ｍｏｒｉａ 组不全瓣５ 眼。ＫＮ组角膜瓣质量优于Ｍｏｒｉａ 组,瓣异常率低于Ｍｏｒｉａ 组。结论　ＫＮ－ ５０００ 微型角膜刀在ＬＡＳＩＫ术中制瓣时性能及安全性、稳定性优于Ｍｏｒｉａ 组微型角膜刀。ＫＮ－ ５０００ 微型角膜刀还具有良好的易学性和进行ＬＡＳＩＫ角膜板层移植的功能。     

Aesthetic considerations in facial reconstructive surgery: The V-Y flap revisited

The subcutaneous pedicled V-Y advancement flap (also known as the kite flap of Dufourmentel) has been described by many authors. Its versatility in reconstructive surgery is well known, both in facial reconstructive surgery as well as surgery of the trunk and extremities. Its advantages in achieving aesthetic reconstruction in specific facial regions have been less well emphasized in the literature. The flap can be designed within natural facial creases and heals inconspicuously because of its widely based subcutaneous or muscle pedicle which incorporates venous and lymphatic drainage over most of its length. The undesirable biscuiting or flap edema frequently observed with other conventional transposition flaps is avoided. We have found the V-Y flap particularly useful in reconstructing the lower eyelid/medial canthus, supra-alar, and nasolabial regions. Our experience with over 40 such flaps is described, and technical considerations in designing and elevating the flap are discussed.