重构肌皮瓣游离移植术(附1例报告)

介绍一种重新构制肌皮瓣的方法。将肌肉的主要动静脉血管束连带其供应的一小束肌肉解剖出来,避免损伤肌肉的主要运动神经,移位植于附近皮瓣下。数周后切取此肌肉-皮肤瓣作岛状移位或吻合血管的游离移植。1例颈部烧伤后瘢痕挛缩畸形病人,用背阔肌的胸背动静脉及一束肌肉12×3cm大小,在侧胸壁重构肌皮瓣32×24cm,吻合血管游离移植于颈部成功。避免了常规肌皮瓣的臃肿及供区大块肌肉缺损造成畸形及功能丧失。     

前臂逆行桡动脉筋膜瓣移位术

从1983年起,我们在前臂桡动脉逆行皮瓣移位修复手部创面及再造拇指经验,以及利用深筋膜延长非轴型皮瓣存活的经验的启发下,设计应用前臂逆行桡动脉筋膜瓣移位术修复手部烧伤及瘢痕挛缩,效果良好。现将应用3例报道如下:     

1例腕部电烧伤探讨早期血管移植术的问题

腕部电烧伤出现手血运障碍时,应尽早行血管移植。术前先行患肢动脉造影,有助于手术的成功。造影示动脉有任何损伤者,迟早将发生栓塞,宜尽早择期手术。尺、桡动脉均已栓塞而手未坏死者,多系保守治疗病例,若早期扩创,势必破坏软组织侧枝循环及骨间动脉,而发生患肢血运障碍。亦有保守治疗数日后,深部组织坏死、感染,仍导致血管栓塞者,故应行血管移植,保存患肢。     

EARLY VASCULAR GRAFTING TO PREVENT UPPER EXTREMITY NECROSIS AFTER ELECTRICAL, BURNSJNDICATIONS FOR SURGERY

Early vascular grafting to reestablish the circula tion of the wrist has been used since 1972. In treat ing electrical injuries in which the wrist is the center of the injury and arteries are involved, this approach has yielded good results and prevented necrosis of the injured limb. However, the indications for this operation are still poorly defined. Is the injury severe enough to affect distal circulation and there by lead to necrosis? There are still no reliable clinical signs to help the doctor decide whether the operation is indicated. In this article, indications for this operation are discussed based on our clinical experience in recent years, and a case of electrical burns of both upper extremities is presented as an illustration.     

EARLY VASCULAR GRAFTING TO PREVENT UPPER EXTREMITY NECROSIS AFTER ELECTRICAL BURNS Beijing Jishuitan Hospital,, Beijing

Since May 1972, vein grafts have been used tO restore circulation in electrical injuries of the upper extremity when the wrist is the center of electrical injury associated with obstructed blood supply. Saphenous vein grafts were used in 15 limbs of 14 patients where wrist electrical in- juries threatened complete hand loss. Ten of the hands were free of necrosis with motion and sensibility basically recovered. The other 4 (5 limbs) failed operatively for va.riolus reasons, resulting in forearm amputatiom Clinical prac- tice shows that successful surgery depends upon whether secondary infection is effectively con- trolled, particularly in those who are brought to the hospital late Wjth wound infection finger gangrene. This paper reviews the measures for controlling postoperative infections in vascular grafts to restore wrist blood flow and the clinical experience gained in the successful treatment of these patients (6 injured limbs of 6 cases), pre- venting amputation. We hope the method will be improved and its use broadened.     

重构肌皮瓣(摘要)

近年来肌皮瓣在外科临床上的应用日渐增多,因其血管蒂粗、解剖变异少、血运丰富、抗感染力强,无论是作带血管蒂的岛状移位,或是作吻合血管的游离移植,手术均较容易而且成功率高。肌皮瓣可用于修复创面(主要利用其皮肤部分)或用于肌肉动力重建(主要利用其肌肉部分)。在前种情况下,除非创面凹陷或缺     

健康老年人的心功能研究

心阻抗图是近10多年发展起来的无损伤检查心功能的技术。为研究老年人心脏功能的变化规律,我们对125例健康老年人及120例健康老年前期和青壮年进行了心脏阻抗图微分波检查,以观察年龄、性别及心率对心功能指标的影响。     

大腿前内侧肌间隙动脉皮瓣游离移植术(2例报告)

大腿前内侧面积大而平坦,皮肤质地细腻而薄,软组织丰厚,愈合快,且部位隐蔽,是最常取游离皮片的部位,也是理想的游离皮瓣供区。但此处缺乏能缝接的直接皮肤动脉,长期以来未得到利用。钟世镇等曾提出利用肌间隙及肌间隔血管的轴型皮瓣的概念,给临床设计游离皮瓣很大帮助。1982年郭恩覃等使用的是股动脉中1/3下段内侧壁发出的、从缝匠