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find Author "祁建平" 17 results
  • 指蹼动脉穿支掌背皮瓣修复手指近节供区创面

    目的总结指蹼动脉穿支掌背皮瓣修复手指近节供区创面的疗效。 方法2010年9月-2013年9月,采用指蹼动脉穿支掌背皮瓣修复23例手指近节供区创面。男14例,女9例;年龄8~68岁,中位年龄40岁。示指11例,中指5例,环指4例,小指3例。近节供区创面范围为2.0 cm×1.4 cm~3.6 cm×2.0 cm,指蹼动脉穿支掌背皮瓣切取范围为2.0 cm×1.4 cm~3.6 cm×2.0 cm。掌背皮瓣供区均直接缝合。 结果术后指蹼动脉穿支掌背皮瓣均顺利成活,创面Ⅰ期愈合;供区切口Ⅰ期愈合。20例获随访,随访时间2~18个月,平均12个月。皮瓣外形良好,掌背肌腱无粘连,掌指关节活动良好,指蹼无瘢痕增生及挛缩;皮瓣两点辨别觉8~12 mm,平均10 mm。末次随访时,根据中华医学会手外科学会上肢部分功能评定试用标准评定手指主动活动度,获优16例,良3例,可1例,优良率95%。 结论采用指蹼动脉穿支掌背皮瓣修复手指近节供区创面具有手术操作简便、皮瓣血供可靠的优点,术后指蹼及掌指关节外观及功能良好。

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  • Imaging study and clinical application of peroneal perforating chimeric tissue flap

    Objective To explore the feasibility of peroneal perforating chimeric tissue flap in repairing the composite defects of calf and heel based on lower limb angiography, and the clinical effect. Methods The digital subtraction angiography images of lower limbs of 50 patients met the selection criteria between May 2011 and October 2014 were used as the research object to observe the course of peroneal artery and its perforating vessels. Based on the observation results, between April 2015 and October 2020, the peroneal perforating chimeric tissue flap was designed to repair 7 cases of composite defects of the calf and heel. There were 5 males and 2 females with an average age of 38 years (range, 25-55 years). The causes of injury included traffic accident in 4 cases, falling from height in 2 cases, and machine strangulation in 1 case. There were 5 cases of calf skin defect and tibial defect. The size of skin defect ranged from 5 cm×3 cm to 11 cm×7 cm, and the length of bone defect was 5-8 cm. There were 2 cases of heel skin defect and calcaneal defect. The sizes of skin defects were 5.0 cm×4.0 cm and 7.5 cm×6.5 cm, and the bone defects were 3.0 cm×2.6 cm and 4.0 cm× 3.0 cm. For the calf defect, the size of skin flap ranged from 6 cm×4 cm to 12 cm×8 cm, and the length of the fibula was the same as that of the tibial defect. For the heel defect, the sizes of the skin flaps were 8.5 cm×5.5 cm and 13.0 cm×5.0 cm, and the lengths of the fibulae were 10 cm and 12 cm. Free transplantation was performed in 5 cases and pedicle transplantation in 2 cases. The wound at donor site was repaired with skin grafting or sutured directly. Results The peroneal artery ran close to the fibula 7.25-8.40 cm below the fibula head and send out 5-7 perforating vessels, with an average of 6.5 vessels. Perforating vessels mainly appeared in four places, which were (9.75±0.91), (13.21±0.74), (18.15±1.22), and (21.40±0.75) cm below the fibular head, with the occurrence rates of 94%, 90%, 96%, and 88%, respectively. Clinical application of 7 cases of peroneal perforating chimeric tissue flap all survived, all wounds healed by first intention. The skin graft at donor site survived and the incision healed by first intention. All patients were followed up 6-36 months, with an average of 12 months. Peroneal perforator chimeric tissue flap had good shape and soft texture. X-ray films showed that the bone graft healed well, and the healing time was 6-11 months (mean, 7 months). No obvious bone resorption was observed during follow-up. Five patients had no pain when walking, and 1 had mild pain with claudication. Postoperative heel ulcers formed in 1 case and healed after wearing custom plantar pressure dispersing shoes. At 6 months after operation, 2 patients were rated as grade Ⅳ and 5 patients as grade Ⅴ according to Holden walking function score. ConclusionThe peroneal perforating vessel distribution is constant and the peroneal perforating chimeric tissue flap is safe and reliable for repairing the composite defects of calf and heel.

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  • 游离旋股外侧动脉降支穿支皮瓣联合同种异体肌腱修复儿童足背复合软组织缺损一例

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  • 第五掌骨桡背侧逆行筋膜蒂岛状皮瓣修复环小指皮肤缺损

    目的 总结第5 掌骨桡背侧逆行筋膜蒂岛状皮瓣修复环、小指皮肤缺损的手术方法及疗效。 方法 2004 年9 月- 2009 年10 月,应用第5 掌骨桡背侧逆行筋膜蒂岛状皮瓣修复环、小指皮肤缺损26 例。男18 例,女8 例;年龄18 ~ 56 岁,平均28.5 岁。机器绞伤12 例,电刨伤6 例,电锯伤8 例。损伤指别:环指10 例,小指16 例。损伤部位:掌侧皮肤缺损8 例,指背皮肤缺损18 例。创面范围2.5 cm × 1.5 cm~ 4.5 cm × 3.0 cm。受伤至手术时间1 ~ 9 h,平均4.5 h。术中皮瓣切取范围为3.0 cm × 2.0 cm ~ 5.0 cm × 3.5 cm。供区直接缝合或植皮修复。 结果 术后3 ~ 5 d 4 例皮瓣远端发生静脉回流障碍,发生张力性水疱,经换药处理后表皮脱落愈合;其余皮瓣及供区植皮均顺利成活,切口均Ⅰ期愈合。26 例术后均获随访,随访时间6 ~ 24 个月,平均12 个月。其中10 例因皮瓣臃肿于术后6 ~ 8 个月行皮瓣整形术。末次随访时皮瓣外形均满意,质地与受区相似,两点辨别觉为0.8 ~ 1.2 cm。掌指关节屈曲达80 ~ 90°,平均84°;近侧指间关节屈曲达80 ~ 100°,平均90°。 结论 第5 掌骨桡背侧逆行筋膜岛状皮瓣具有血供可靠、切取方便、质地良好等优点,是修复环、小指皮肤缺损的一种较好方法。

    Release date:2016-08-31 05:41 Export PDF Favorites Scan
  • 重建感觉的指固有动脉穿支蒂逆行岛状皮瓣的临床应用

    目的 总结重建感觉的指固有动脉穿支蒂逆行岛状皮瓣修复手指软组织缺损伴骨外露的临床疗效。 方法 2006 年9 月- 2010 年9 月,应用携带指固有神经背支或桡神经终支的指固有动脉穿支蒂逆行岛状皮瓣修复23 例26 指手指中末节软组织缺损伴骨外露。男14 例,女9 例;年龄15 ~ 60 岁,平均38 岁。示指10 指,中指9 指,环指7 指。创面范围为1 cm × 1 cm ~ 3 cm × 2 cm。病程1 h ~ 14 d。术中皮瓣切取范围为1.5 cm × 1.0 cm ~ 3.5 cm × 2.0 cm,供区全厚皮片植皮修复。 结果 术后1 例皮瓣出现远端青紫,经对症处理后成活;其余皮瓣及植皮均顺利成活,创面Ⅰ期愈合。术后14 例16 指获随访,随访时间6 ~ 12 个月,平均8 个月。皮瓣外形无臃肿,色泽、质地良好。术后6 个月根据手指总主动活动度(TAM)评定法:获优11 指,良4 指,可1 指。皮瓣感觉功能评定:S2 1 指,S3 2 指,S4 3 指,S5 10 指。 结论 采用重建感觉的指固有动脉穿支蒂逆行岛状皮瓣修复手指软组织缺损具有手术操作简便、供区隐蔽、血供可靠、成功率高的优点;术后可重建手指精细感觉,最大程度恢复手指功能。

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • 足背岛状动脉皮瓣修复小腿中下段软组织缺损

    Release date:2016-09-01 09:26 Export PDF Favorites Scan
  • 颈浅动脉皮瓣修复头皮缺损

    Release date:2016-09-01 11:07 Export PDF Favorites Scan
  • Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap

    Objective To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm. Methods Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured. Results Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S1 in 2 cases, S2 in 6 cases, S3 in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases. Conclusion The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.

    Release date:2017-09-07 10:34 Export PDF Favorites Scan
  • Application of lateral circumflex femoral artery chimeric flap to repair complex wounds of foot and ankle

    ObjectiveTo investigate the effectiveness of lateral circumflex femoral artery chimeric flap transplantation in repair of complex wounds of foot and ankle.MethodsA retrospective study was conducted to analyze the clinical data of 20 patients with complex wounds of foot and ankle treated with lateral circumflex femoral artery chimeric flap between June 2017 and June 2020. There were 14 males and 6 females with an average age of 42.8 years (range, 21-65 years). Among them, 8 cases had dorsalis pedis tendon defect with or without bone exposure, 4 cases had partial or total Achilles tendon defect without bone exposure, and 8 cases had deep cavity and bone exposure. The wound area ranged from 10 cm×6 cm to 21 cm×11 cm. The time from injury to operation ranged from 6 to 22 days, with an average of 9.4 days. The lateral femoral circumflex artery flap was used in 6 cases with fascia lata flap, 6 cases with rectus femoris aponeurosis flap, and 8 cases with lateral femoral muscle flap. The flap area ranged from 12.0 cm×6.5 cm to 35.0 cm×7.5 cm. All flap donor sites were sutured directly. The survival, appearance, texture, sensation of the flap, and complications of the donor site were observed. The foot and ankle function was evaluated by Kofoed score.ResultsAll patients were followed up 8-24 months (mean, 14.2 months). On the 3rd day after operation, 1 case had partial necrosis of 1 flap with fascia lata flap and healed after dressing change; 1 case of chimeric muscle flap developed venous crisis at 12 hours after operation; the chimeric flaps survived successfully in the other 18 patients and the wounds were primary healing. The color and texture of the flaps were good, the flaps recovered protective sensation. Only linear scar remained in the donor site of thigh. There was no sensory disturbance around the incision or walking disturbance. The Kofoed score of the foot and ankle function at last follow-up was 75-96, with an average of 89.8. Among them, 15 cases were excellent, 4 cases were good, and 1 case was qualified. The excellent and good rate was 95.0%.ConclusionThe application of lateral circumflex femoral artery chimeric flap can accurately and stereoscopically repair the complex wounds of foot and ankle and achieve satisfactory effectiveness.

    Release date:2021-06-30 04:43 Export PDF Favorites Scan
  • CLINICAL OBSERVATION OF BASIC FIBROBLAST GROWTH FACTOR COMBINED WITH TOPICAL OXYGEN THERAPY IN ENHANCING BURN WOUND HEALING

    Objective To investigate the efficacy of basic fibroblast growth factor (bFGF) combined with topical oxygen therapy for deep II degree burn wounds, by comparing the effects of bFGF combined with topical oxygen therapy and bFGF with routine therapy. Methods From February 2004 to July 2009, 85 patients with deep II degree burn wounds (117 wounds) were enrolled and divided into 4 groups randomly according to different treatments. There was no significant difference in sex, age, disease course, wound size, and wound treatment size among 4 groups (P gt; 0.05). In group A, 18 patients (28 wounds) were treated routinely; in group B, 23 patients (30 wounds) were treated with routine methods and topical oxygen therapy; in group C, 19 patients (25 wounds) were treated with routine methods and bFGF therapy; and in group D, 25 patients (34 wounds) were treated with routine methods and bFGF/topical oxygen therapy. Topical oxygen therapy was administered to the wound for 90 minutes per day for 3 weeks. The bFGF therapy was appl ied everyday (150 U/ cm2) for 3 weeks. Results All cases were followed up 6-12 months (9 months on average). The wound heal ing times in groups A, B, C, and D were (27.3 ± 6.6), (24.2 ± 5.8), (22.2 ± 6.8), and (18.2 ± 4.8) days, respectively; showing significant difference between group A and group D (P lt; 0.05). The wound heal ing rates in groups A, B, C, and Dwere 67.8% ± 12.1%, 85.1% ± 7.5%, 89.2% ± 8.3%, and 96.1% ± 5.6%, respectively; showing significant differences between group A and groups B, C, D (P lt; 0.05). The therapic effective rates in groups A, B, C, and D were 75%, 90%, 92%, and 100%, respectively; showing significant difference between group A and group D (P lt; 0.05). The Vancouver scar scale scoring of group D 6 months after treatment was better than that of group A (P lt; 0.05). Conclusion The bFGF combined with topical oxygen therapy can enhance deep II degree burn wound heal ing. Furthermore, the therapy method is simple and convenient.

    Release date:2016-08-31 05:48 Export PDF Favorites Scan
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