ObjectiveTo introduce the surgical method and effectiveness of repairing skin and soft tissue defect in the palm or dorsum of the hand and forearm with epigastric bilobed flap. MethodsBetween October 2010 and December 2013, 4 male patients with skin and soft tissue defect in the palm or dorsum of the hand and forearm were treated, aged from 36 to 62 years. Of them, 3 cases had degloving injury caused by machines and 1 case had necrosis of fingers and skin after surgery of crush injury. The time from injury to hospitalization was from 3 hours to 15 days. Among the 4 cases, the size of palmar defect was 7 cm×4 cm to 16 cm×6 cm, and the size of dorsal defect was 10 cm×7 cm to 20 cm×10 cm. The epigastric bilobed flap was designed based on the axial vessel which was formed by inferior epigastric artery, superior epigastric artery, and intercostals arteries. The size of flap ranged from 12 cm×4 cm to 18 cm×6 cm in the vertical direction, 15 cm×8 cm to 22 cm×11 cm in the oblique direction. The donor site was directly closed. The pedicles were cut at 22 to 24 days after repairing operation. ResultsAll the flaps survived well with the wound healing by first intention. Four patients were followed up 3 months to 1 year and 2 months. The other flaps had good appearance and texture except 1 bulky flap. The flap sensation basically restored to S2-S3. The function of the hands recovered well. ConclusionSkin and soft tissue defect in the palm or dorsum of the hand and forearm can be repaired with the epigastric bilobed flap, because it has such advantages as big dermatomic area and adequate blood supply. Besides, the operation is practical, safe, and simple.
ObjectiveTo investigate the effectiveness of using a sensory prefabricated flap to repair the heel avulsion injury. MethodsBetween August 2012 and August 2013, 6 cases of heel avulsion injury were treated. There were 4 males and 2 females, aged 16-54 years (mean, 29 years). The causes were crush injury in 4 cases and wheel twist injury in 2 cases. The injury to admission time was 2-6 hours (mean, 4 hours). The size of skin avulsion ranged from 5 cm×3 cm to 15 cm×8 cm. Avulsion skin had no replanted condition. At one stage operation, the avulsed heel skin soft tissue was made the full thickness skin graft which was fostered on the anterolateral thigh with lateral circumflex femoral artery perforator, and the lateral femoral cutaneous nerve was put beneath the skin to prefabricate the prefabricated flap; at two stage operation, the prefabricated skin flap pedicled with lateral circumflex femoral artery was used to repair the wound, and the lateral femoral nerve was anastomosed with the calcaneal nerve to reconstruct the feeling. ResultsSix prefabricated flaps all survived, and re-plantation flaps survived after operation. The wounds healed by first intention at donor site and recipient site. The patients were followed up 1-2 years (mean, 1.5 years). The flaps had satisfactory appearance and soft texture. At 1 year after operation, the sensation of the flaps was S3, with two-point discrimination of 22-27 mm (mean, 24.3 mm). According to ZHANG Ming's evaluation standards, the results were excellent in 5 cases, and good in 1 case. The patients could walk normally or with weight-bearing; only linear scar formed at the donor site. ConclusionFor patients with heel soft tissue avulsion injury without replantation qualification, a sensory prefabricated flap by the avulsed heel skin soft tissue can transplanted to repair the heel defect. Satisfactory effectiveness can be obtained in heel appearance and function recovery.
〖GK3!3〗〖HT5”H〗摘要:目的:探讨复合鼻小柱侧面皮瓣法治疗完全性单侧唇裂的疗效。方法:自2003年3月至2007年10月采用复合鼻小柱侧面皮瓣法治疗完全性单侧唇裂24例。结果: 24例均成功,唇弓形态满意,唇峰降至水平位置,两侧鼻翼基底位于同一水平线上,唇红丰满、自然,上唇松动,瘢痕不明显。3例鼻小柱侧面皮瓣出现表皮糜烂,换药后痊愈。随访9例,最短4月,最长15月,平均83个月。结论: 复合鼻小柱侧面皮瓣法充分利用周围有限的组织,解决了完全性唇裂唇峰不易下降至水平、缝合张力大等问题,具有以往传统方法不具有的优势,但尚需要病例的积累和时间的验证。
摘要:目的:探讨创伤性感染性假性股动脉瘤的诊断和外科治疗的临床经验。方法:回顾性分析２１例创伤性感染性假性股动脉瘤的临床资料,均行瘤体摘除及彻底的清创后,分别采用了血管结扎术和血管修复重建术两种不同的手术治疗方法。结果:血管修复重建术组中３例术后出现血管破裂大出血,要再次手术,１５例行股动脉结扎术,全部保肢成功。结论:瘤体切除加血管移植术是一种理想的方法,但在无条件行血管移植时,股动脉结扎术可做为一种有效的方案,对伴有皮肤缺损者行对侧胸脐皮瓣转移术。Abstract: Objective: 〖WT5”BZ〗To explore the traumatic infected femoral pseudoaneurysm diagnosis and surgical treatment of clinical experience. Methods: Retrospective analysis of 21 cases of traumatic infected femoral pseudoaneurysm of the clinical data were performed and the tumor removed after thorough debridement, respectively vascular ligation and blood vessel repair and reconstruction surgery of two different surgical treatment. Results: The blood vessel repair and reconstruction surgery group, three cases of postoperative bleeding blood vessel ruptures occurred, we must resurgery, 15 routine femoral artery ligation, all of the success of limb salvage. Conclusion: The tumor resection plus vascular graft is an ideal way, but in an unconditional line of vascular grafts, the femoral artery ligation can be used as an effective program for skin defects associated with the contralateral breast underwent umbilical flap transfer of patients.
Objective To study the role of ultracision harmonic scalpel and skin flap in axillary fossa external fixation in operation of breast cancer. Methods One hundred and sixty-six patients with breast cancer were included in this study between May 2009 and November 2009. Combined group (n=51) applied ultracision harmonic scalpel combined with skin flap external fixation. External fixation group （n=52） used the skill of skin flap external fixation. Routine group included 63 patients. Operative time, accidental injury during operation， volume of bleed and drainage, time of drainage, detection amount of lymph node, and complications such like subcutaneous fluidity were observed and recorded. Results The operative time and detection amount of lymph node were not different among three groups （Pgt;0.05）. The volume of bleed in combined group was less than that in other groups （Plt;0.05）. The volume of drainage and the time of drainage were decreased or shorten by turns from routine group, external fixation group to combined group （Plt;0.05）. The incidence rate of subcutaneous fluidity in combined group was lower than that in routine group （Plt;0.05）. Conclusions Using ultracision harmonic scalpel in operation of breast cancer can remarkably reduce the volume of bleed and drain postoperatively. Ultracision harmonic scalpel combined with skin flap external fixation is safety and can reduce the incidence rate of subcutaneous fluidity, thus can be applied widely in breast cancer operation.
目的 报告筛状皮瓣替代游离皮片用于修复乳腺癌手术中皮肤缺损的可行性与临床效果。 方法 在手术切口两侧的皮瓣上作全层0.5~1 cm长的小切口，与原切口平行，交错排列，一次性修复创面。 结果 32例乳腺癌手术病例的皮瓣均无坏死和积液，而且弹性好。 结论 筛状皮瓣用于乳腺癌手术中修复胸壁皮肤缺损，具有简捷、省时、美观、疗效确切、不影响患侧上肢功能等优点，可以替代游离植皮术式。
目的探讨皮瓣鱼网式打孔在乳腺癌根治术后创面覆盖中的应用。方法对80例女性乳腺癌患者行乳腺癌根治术或改良根治术，而后在皮瓣上、下缘予以鱼网式打孔，常规缝合创面。结果全部病例均未植皮，有15例在术后2～5天内有皮瓣血供不良，其余65例均无皮瓣坏死，创面愈合良好。结论皮瓣鱼网式打孔可有效地减小皮瓣缝合张力，减少皮瓣坏死的并发症，可应用于乳腺癌根治术的创面覆盖。
Abstract： Objective To summarize the application experience of Gore-Tex patch in clinical chest wall reconstruction. Methods A retrospective analysis was performed in 33 patients who underwent chest wall reconstruction using Gore-Tex patch from January 2001 to December 2010 in Shanghai Changhai Hospital, Second Military Medical University. There were 19 men and 14 women, ranging in age from 20 to 73 years with a median age of 45.7 years. The surgical strategies included choosing different incisions according to tumor location and size, and preserving normal chest wall soft tissue as much as possible during surgery. Gore-Tex patch was used to reconstruct the huge chest wall defect, and covered by transferred muscle flaps. Results All the 33 patients underwent surgical reconstruction successfully and there was no perioperative death. Complete tumor resection was performed in all the patients, including 25 patients with malignant tumor and 8 patients with benign tumor. The diameter of the resected tumors ranged from 8 to 20 cm. All the patients were followed up from 5 to 60 months, except that 3 patients （9.09%） were lost during follow-up. There was no rejection response, abnormal breathing and foreign body sensation during follow-up. The infection incidence was 3%（1/33）. Conclusion Gore-Tex patch is a safe and effective material for chest wall reconstruction due to its excellent biocompatibility. Appropriate selection of muscle flap for covering Gore-Tex patch can reduce postoperative complications.