皮瓣修复腕部高压电烧伤创面的手术时机选择

〔摘 要〕 目的：分析对腕部高压电烧伤患者创面进行手术修复的过程中选取不同手术时机对于患者治疗效果的影响。 方法：选取2018年11月至2019年11月期间娄底市第一人民医院烧伤整形外科收治的100例腕部高压电烧伤患者为研究对象, 依据手术时机的不同将其分为对照组和观察组,各 50 例。对照组患者经其他治疗后进行皮瓣修复治疗,观察组患者在受伤 当日即进行皮瓣修复治疗,对两组患者临床治疗效果进行比较。结果：观察组患者手术用时、皮瓣移植面积以及住院用时 情况均优于对照组,差异具有统计学意义（P ＜ 0.05）;在清创后面积方面,组间比较,差异无统计学意义（P ＞ 0.05）。 在患者恢复情况方面,观察组患者在桡神经、尺神经、正中神经、中腕部屈曲能力以及屈指肌腱功能等方面的恢复效果均 优于对照组,差异具有统计学意义（P ＜ 0.05）。结论：在对腕部高压电烧伤患者进行皮瓣修复的过程中,尽早开展手术, 对于患者手术指标与功能恢复的优化具有一定价值。     

An algorithm to improve outcomes of radial forearm flap donor site

Background: Due to the high rate of donor site complications the Radial Forearm Flap (RFF) has lost ground in favor of the Antero-lateral tight flap (ALT) and other flaps. We have designed a reconstruction algorithm for reconstruction of its donor site. The goal of this study was to retrospectively evaluate the impact of this algorithm on RFF donor site complication rates.

Methods: The authors analyzed retrospectively 31 patients who underwent free radial forearm flap reconstruction between November 2009 and May 2013. Donor site complications were compared with data from patients treated before introdutction of the algorithm. Within the group were compared patients in which the flap was harvested suprafascial with those in which the flap was harvested as subfascial.

Results: Before application of the algorithm, there was a 23.3% complication rate at the RFF donor site, in our experience. After introduction of the algorithm, complication rate has dropped to 3.2%, consisting in a partial skin graft necrosis treated by local wound-care and healed without further intervention.

Conclusions: Application of the algorithm described has led to a significant reduction in RFF donor site complication rates. This demonstrates that if flap donor sites are analyzed and tailor treated in the same way as primary defects are, instead of being given secondary importance and just grafted, outcomes improve.     

Limberg flap in management of pilonidal sinus disease: systematic review and a local experience

Objectives: To review published evidence of Limberg flap (LF) use in pilonidal sinus disease (PSD). We also included our local experience of LF.

Methods: Medline and Embase database were searched for the words ‘pilonidal, sinus, Limberg, flap’. Non-English articles and those not-related to our scope of search were omitted. We included a retrospective study of patients underwent LF in our district hospital. Data including length of hospital stay, post-operative complications and recurrence were collected.

Results: Literature review revealed 68 studies (22 case series, 35 comparative studies, nine RCTs and two meta-analyses). Recurrence rate was 0–7.4% in case series. Recurrence rate in comparative studies was 0–8.3%, compared to 4–37.7% for primary closure and 0–11% for Karydakis flap. RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap. About 26 patients included in the cohort study (16 male, average age 27 years). Six patients presented with recurrent disease. Post-operative length of hospital stay was four to seven days. Post-operative complication rate was 11.5% – [two partial wound dehiscence, one wound infection]. Recurrence rate was 7.7%. Average follow-up was 18 months.

Conclusions: Limberg flap presents a safe and effective method that can be offered for patients with primary or recurrent PSD.     

咽后壁瓣法治疗前后静止位时舌位置的研究

目的:通过对咽后壁瓣治疗前后舌位置变化的研究,了解咽后壁瓣对颌面生长发育的影响。方法:对15例咽后壁瓣治疗前后舌位置的测量及舌与软腭接触关系进行研究,并与正常对照组比较,了解其变化趋势。结果:对照组10例有2例,术前组15例有5例,术后组15例有12例舌腭无接触,两组比较差异无显著性(P=0.27)。术后组与术前及对照组比较有明显统计学意义(P=0.025,P=0.015)。结论:咽后壁瓣术后舌腭接触趋向消失,舌尖向后缩,舌位变低。唇舌肌肉平衡失调,可能为面中1/3发育受限的原因之一。     

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。     

股外侧肌带蒂肌瓣治疗大粗隆部慢性骨髓炎

目的报告股外侧肌带蒂肌瓣治疗大粗隆部慢性骨髓炎临床应用结果。方法自2008年1月至2015年1月,应用股外侧肌带蒂肌瓣治疗大粗隆部慢性骨髓炎6例(男5,女1)。患者年龄28~56岁(平均48岁)。粗隆部软组织缺损范围5 cm×2 cm^8 cm×4 cm。股外侧肌带蒂肌瓣转移至大粗隆部软组织缺损区,在肌瓣表面行一期中厚网状游离植皮,供区直接缝合。结果 1例肌瓣发生小片植皮坏死,经3周换药处理自然愈合。肌瓣全部成活。术后随访2.5~4.0年,平均3年,受区外形较好,慢性骨髓炎没有复发。髋关节功能用HSS评分标准评定其疗效,优5例,良1例。本组取得了较满意的临床效果。结论这种技术安全、可靠,很适用于治疗大粗隆部慢性骨髓炎。     

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。