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find Author "林伟枫" 5 results
  • 动静脉转流术结合拔甲在幼儿 Ishikawa Ⅱ区断指再植中的应用

    目的 总结动静脉转流术结合拔甲用于幼儿 Ishikawa Ⅱ区断指再植中的疗效。 方法 2013 年 9 月—2018 年 3 月,采用动静脉转流术结合拔甲对 23 例远端无静脉吻合条件的幼儿 IshikawaⅡ区断指进行再植。男 16 例(19 指),女 7 例(7 指);年龄 1~3 岁,平均 2.3 岁。致伤原因:门挤压伤 8 例,重物压砸伤 7 例,机器轧伤 3 例,机械绞伤 5 例。伤指指别:示指 8 指,中指 10 指,环指 8 指。受伤至手术时间 3~9 h,平均 4.7 h。 结果 术后 5 例出现静脉回流障碍,2 例出现指尖挑拨口皮肤软组织部分坏死,均经对症处理后成活;其余断指再植后均顺利成活。23 例患儿均获随访,随访时间 3~14 个月,平均 9.4 个月。指尖外形佳、指腹饱满,指体无明显萎缩,指甲生长较平整,手指外形满意。再植手指远指间关节活动度无受限。 结论 动静脉转流术结合拔甲用于远端无静脉吻合条件的幼儿 Ishikawa Ⅱ区再植中,能提高再植成活率,临床疗效良好。

    Release date:2018-12-04 03:41 Export PDF Favorites Scan
  • 不携带一级源血管的游离股前外侧穿支皮瓣修复儿童手背创面

    目的总结不携带一级源血管的游离股前外侧穿支皮瓣修复儿童手背创面的效果。方法2015 年 1 月—2018 年 11 月,采用不携带一级源血管的游离股前外侧穿支皮瓣修复 6 例儿童手背创面。男 4 例,女 2 例;年龄 18 个月~14 岁,平均 4.6 岁。受伤至皮瓣修复时间为 4~13 d,平均 5.1 d。手背创面范围为 5 cm×4 cm~11 cm×8 cm,皮瓣切取范围为 5.0 cm×5.0 cm~20.0 cm×4.5 cm。供区均直接缝合。结果术后皮瓣均顺利成活;1 例创面愈合不良经换药后愈合,其余创面Ⅰ期愈合。供区切口均Ⅰ期愈合。患儿均获随访,随访时间 5~43 个月,平均 22.3 个月。末次随访时,皮瓣外形、质地均满意,有排汗功能,恢复部分浅感觉;根据中华医学会手外科学会上肢部分功能评定试用标准:优 2 例,良 2 例,中 2 例。结论不携带一级源血管的游离股前外侧穿支皮瓣修复儿童手背创面具有血供可靠、供受区损伤小的优点,能获得较好疗效。

    Release date:2019-12-23 09:44 Export PDF Favorites Scan
  • Diagnosis and treatment of thumb polydactyly with symphalangism in children

    ObjectiveTo investigate the diagnosis and treatment of thumb polydactyly with symphalangism in children.MethodsSeven cases of thumb polydactyly with symphalangism were treated between January 2013 and May 2017. There were 5 males and 2 females, aged from 10 months to 11 years, with an average age of 3.1 years. The thumb-polydactyly was diagnosed with MRI and it was seen that the base of radial multi-finger and the proximal phalangeal joint were connected by cartilage. All patients were treated with resection, lateral collateral ligament reconstruction, bone osteotomy and internal fixation.ResultsThe operation was successfully completed, and there was no early complications such as infection and flap necrosis. All patients were followed up 6-23 months (mean, 14.1 months). At last follow-up, there was no deformity finger, scar contracture, and other complications. The extension of the interphalangeal joint was no limited, and the flexion range of the interphalangeal joint was 20-75° (mean, 56.7°). The appearance and function of the thumb was rated as excellent in 3 cases and good in 4 cases by Japanese Society for Surgery of the Hand (JSSH) scoring, with the excellent and good rate of 100%.ConclusionThe thumb polydactyly with symphalangism in children can be combined with clinical manifestations, X-ray film, and MRI examination to diagnose, and can obtain satisfactory results through the reconstruction of lateral collateral ligament, bone osteotomy, and internal fixation.

    Release date:2018-10-09 10:34 Export PDF Favorites Scan
  • Application of anterograde fascial flap of digital artery in Wassel Ⅳ-D thumb duplication reconstruction

    ObjectiveTo explore the effectiveness of anterograde fascial flap of digital artery in reconstruction of Wassel Ⅳ-D thumb duplication.MethodsTwelve cases of Wassel Ⅳ-D thumb duplication were treated with anterograde fascial flap of digital artery between June 2014 and March 2017. There were 7 boys and 5 girls with an age of 9-32 months (mean, 13.3 months). Eight cases were on the left side and 4 cases on the right side. The main bunion bed width was 70%-85% of the healthy side (mean, 75.3%). The degree of fullness was 50%-75% of the healthy side (mean, 62.4%). The anterograde fascial flap with one proper digital artery was used to fill the nail fold on the radial side of the finger and increase the circumference of the finger. At last follow-up, the ratio of circumference of deformed finger to contralateral finger was measured at the base of nail. The appearance and function of all reconstructed thumbs were evaluated with Japanese Society for Surgery of the Hand (JSSH) scoring.ResultsAll the operations were successfully completed without early complications such as infection and skin necrosis. All children were followed up 7-27 months (mean, 14.3 months). At last follow-up, there was no recurrence of deformity in the digital body and no obvious change of scar contracture in the surgical wound. Pulp and nail fold symmetry improved in all cases. The ratio of circumference of deformed finger to contralateral finger was 93%-96% (mean, 94.7%). The JSSH score was 15-20 (mean, 17.9); the results were excellent in 8 cases, good in 2 cases, and fair in 2 cases.ConclusionThe anterograde fascial flap of digital artery is a safe and effective approach to restore symmetry for esthetic improvement in treatment of Wassel Ⅳ-D thumb duplication.

    Release date:2018-09-03 10:13 Export PDF Favorites Scan
  • One-stage thumb opponensplasty and polygonal flap in congenital spade hand reconstruction

    ObjectiveTo explore the effectiveness of one-stage metacarpal osteotomy, thumb opponensplasty and polygonal flap reconstruction in the treatment of congenital spade hand deformity. MethodsEight cases of congenital spade hand were treated between January 2013 and March 2017. There were 5 males and 3 females, with an average age of 17.5 months (range, 13-35 months). The clinical manifestations of all the children were congenital spade hand and the affected hand was shorter than the healthy side. The contralateral hand was normal and there was no chest, skull, or facial deformity. The operation was performed with metacarpal osteotomy and thumb opponensplasty, and through the dorsal metacarpal rectangular flap to reconstruct the first web and through rotation of polygonal skin flap to reconstruct thumb web and lateral fold of thumb index nail. The dorsal ulnar and proximal radial segment of thumb were repaired by skin grafting. A vernier caliper was used to measure the first web space and the thumb function was evaluated by modified Tada score. ResultsThe reconstruction of palmar function and the formation of first web were completed in one stage in 8 children. Skin grafting on the dorsal ulnar side of thumb and radial side of index finger survived after operation. All the children were followed up 13-29 months, with an average of 16.1 months. There was no infection, skin flap necrosis, lateral deviation of thumb, scar contracture, or other complications. At last follow-up, there was no significant difference in skin color between the healthy side and the first web of the affected hand. The opening distance of first web space was 3.5-5.0 cm, with an average of 4.2 cm. According to the modified Tada scoring system, the results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. The thumb could grasp and pinch actively, and the palm opposition function was good. ConclusionOne-stage thumb opponensplasty combined with polygonal flap for reconstruction of congenital spade hand deformity can improve hand function very well. The reasonable designing of skin flap can effectively cover important areas, and the operation is safe and reliable.

    Release date:2019-01-25 09:40 Export PDF Favorites Scan
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