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find Author "许立" 10 results
  • 掌部及跖部撕脱皮肤异位寄养后回植的临床研究

    目的 总结掌、跖部撕脱皮肤异位寄养后回植的方法及临床疗效。 方法2007年3月-2012年3月,收治8例掌、跖部皮肤撕脱伤患者。男5例,女3例;年龄18~50岁,平均34岁。致伤原因:交通事故伤4例,重物砸伤2例,机器绞伤2例。损伤部位:手掌2例,足跟3例,前足2例,足底1例。伤后至入院时间为1~7 h,平均4 h。皮肤撕脱范围为5 cm × 3 cm~20 cm × 10 cm。一期手术将掌、跖部撕脱皮肤寄养在股前外侧区域的深筋膜层(即预制皮瓣);二期切取预制皮瓣原位回植修复创面。 结果一期寄养术后2周3例切口有渗液,应用红光理疗仪治疗后,寄养皮片成活;其余5例寄养皮片均顺利成活。二期原位回植术后皮瓣均顺利成活,寄养部位及回植修复创面均Ⅰ期愈合。患者均获随访,随访时间6~12个月,平均7.5个月。皮瓣外形满意,质地柔软。术后6个月,皮瓣感觉达S3;两点辨别觉为20~25 mm,平均22.5 mm。手功能基本恢复,足部恢复正常行走及负重。 结论对于掌、跖部皮肤撕脱伤,经一期寄养撕脱皮肤、二期原位回植后,成活率高,保存了原掌、跖部皮肤,是重建掌、跖部功能的较好手术选择。

    Release date:2016-08-31 10:53 Export PDF Favorites Scan
  • 游离静脉皮瓣在复杂性断指再植中的应用

    目的 总结游离静脉皮瓣在复杂性断指再植中的应用。 方法2008年1月-2011年12月,在59例(59指)断指再植术中采用腕掌侧静脉皮瓣游离移植修复缺损。男46例,女13例;年龄17~56岁,平均29.6岁。致伤原因:冲压伤31例,压砸伤17例,爆炸伤11例。受伤至入院时间30 min~3 h 30 min,平均95 min。损伤指别:拇指11例,示指17例,中指12例,环指9例,小指10例。皮肤软组织缺损范围1.5 cm × 1.5 cm~ 5.0 cm × 3.0 cm。皮瓣切取范围2 cm × 2 cm~5 cm × 3 cm。供区创面直接拉拢缝合。 结果术后第7天2例皮瓣边缘表皮坏死,1例再植手指坏死。51例获随访,随访时间12~18个月,平均15.5个月。皮瓣外观、质地良好,皮瓣及手指浅痛觉及触觉恢复,两点辨别觉为5.0~8.5 mm,平均7.4 mm。术后12个月,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,获优38例,良11例,差2例,优良率为96.1%。 结论在合并血管缺损的复杂性断指再植中应用游离静脉皮瓣,可同时修复血管缺损及创面,扩大了断指再植适应证,疗效满意。

    Release date:2016-08-31 04:21 Export PDF Favorites Scan
  • 双套血供的前臂尺背侧逆行岛状皮瓣修复手部创面

    目的总结双套血供的前臂尺背侧逆行岛状皮瓣修复手部创面的临床疗效。 方法2010年3 月-2012年6月,采用带尺动脉腕上皮支和骨间背侧血管双套血供的前臂尺背侧逆行岛状皮瓣修复手部创面21例。其中男13例,女8例;年龄19~58岁,平均33.5岁。机器绞伤9例,挤压伤7例,热压伤5例。创面部位:虎口3例,手背侧12例,手掌侧6例。创面范围6 cm × 5 cm~13 cm × 10 cm。伤后至手术时间1.5 h~11 d,平均5.5 d;其中一期修复11例,二期修复10例。术中皮瓣切取范围7 cm × 6 cm~16 cm × 12 cm。 结果术后1例皮瓣以远1/3发生坏死,经二期植皮后成活;其余皮瓣及供区植皮均顺利成活,切口Ⅰ期愈合。术后14例获随访,随访时间6~18个月,皮瓣色泽、质地好,温、痛、触觉恢复。末次随访时,手功能采用中华医学会手外科学会上肢部分功能评定试用标准评定:获优8例,良4例,中1 例,差1例,优良率85.7%。供区无功能影响。 结论双套血供的前臂尺背侧逆行岛状皮瓣修复手部创面具有操作简便、可切取面积大、血运可靠、术后外观及功能恢复良好等优点。

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • 尺动脉腕上皮支双叶游离皮瓣修复手指复杂创面

    目的 总结尺动脉腕上皮支双叶游离皮瓣修复手指复杂创面的方法和临床效果。 方法 2009年5 月-2012年5月,对12例手指复杂创面患者采用以尺动脉腕上皮支为蒂,分别以其上行支和下行支为轴心血管的双叶游离皮瓣修复。其中男7例,女5例;年龄20~45岁,平均31岁。手指脱套伤2例,相邻两指软组织缺损4例,一指两处缺损6例。缺损范围6.0 cm × 1.5 cm~10.0 cm × 3.0 cm。皮瓣切取范围为上叶5.0 cm × 2.0 cm~8.0 cm × 4.0 cm,下叶3.5 cm × 1.8 cm~6.0 cm × 3.0 cm。供区直接缝合或游离植皮修复。 结果 1例术后12 h出现动脉危象,1例上叶皮瓣远端表皮部分坏死,经相应处理后愈合;其余皮瓣及供区植皮均顺利成活,切口Ⅰ期愈合。11例获随访,随访时间6~18个月,平均11个月,皮瓣颜色及质地与周围正常皮肤相似,手指外形满意。手指恢复部分浅感觉,两点辨别觉为6~8 mm,平均7 mm。术后6个月,按中华医学会手外科学会上肢部分功能评定试用标准评定,获优7例,良3例,中1例,优良率90.9%。 结论 尺动脉腕上皮支的上、下行支管径与指血管匹配,以此为蒂的双叶游离皮瓣修复后外观、感觉恢复满意,是修复手指复杂创面的理想方法之一。

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • 右小腿环形灼伤修复一例

    Release date:2016-09-01 09:30 Export PDF Favorites Scan
  • Population Attributed Risk Proportion Associated with Poor Self-Rated Health in the Elderly: A Systematic Review

    Objective To systematically review the evidence of the factors associated with self-rated health (SRH) and estimating the population attributable risk proportion (PARP) of interests in the elderly. Methods MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data were searched (from January 1960 to April 2011) for relevant literature. The combined effect on each factor associated with poor SRH was expressed as RR or OR (95%CI). The contribution of each factor to poor SRH in the elderly population was estimated with PARP. Meta-analysis was performed using RevMan 5.1 software. Results Twelve studies involving a total of 35 349 participants aged 60 or above were eligible in this systematic review. Ten studies were conducted in China and the rest two studies were from the USA and Brazil. Of them, only one was prospective cohort study and 11 studies were cross-sectional. The results of meta-analysis showed that the main factors associated with poor SRH in the elderly were dependency, diabetes and coronary heart disease with the corresponding OR and 95%CI as 12.10 (6.31, 23.20), 6.49 (3.21, 13.09) and 5.60 (1.07, 29.42), respectively. However, the top three factors contributing to poor SRH in the elderly population were coronary heart disease, having illness half one year ago and chronic disorders with the corresponding PARP as 53.91%, 52.56%, and 50.09%, respectively. It was not possible to perform sub-group analysis because of the limited quantity of studies on each factor associated with poor SRH. Conclusion Based on the current available evidence, it appears that chronic disorders are closely related to poor SRH and contribute most in the elderly population. However, due to the limitation of the included predominantly cross sectional studies which are not enough for causal argument, it is insufficient to determine the association of many factors with poor SRH. Further high-quality prospective cohort studies are needed.

    Release date:2016-09-07 11:00 Export PDF Favorites Scan
  • APPLICATION OF VENOUS Flow-through FLAP IN FINGER REPLANTATION WITH CIRCULARITY SOFT TISSUE DEFECT

    ObjectiveTo investigate the treatment outcome of applying venous Flow-through flap in the replantation of severed finger with circularity soft tissue defect and vascular defect. MethodsBetween January 2010 and December 2012,11 cases (11 fingers) of severed finger with circularity soft tissue defect and vascular defect underwent replantation with venous Flow-through flaps.There were 8 males and 3 females,aged 18-42 years (mean,24.6 years).The cause of injury was squeeze injury in 6 cases,crush injury in 3 cases,and strangulation in 2 cases.Combined injuries included nerve defect in 3 cases (1.0,2.0,and 3.5 cm in length),and tendon defect in 2 cases (2.0 and 6.5 cm in length); cyclic skin and soft tissue defect was 3.0-4.5 cm in width,was 1/2-1 finger circumference in length,and was 2.0 cm×1.0 cm to 7.0 cm×4.5 cm in size.Six cases had complete circular defect (both finger artery and vein defects),and 5 cases had incomplete circular defect (only finger artery defect),and vascular defect was 1.0-4.5 cm in length.The time from injury to operation was 1.5-4.5 hours. ResultsVenous crisis occurred in 1 case at 2 days after operation,was cured after vein graft; flap edge necrosis was observed in 2 cases and was cured after dressing change and skin grafting respectively; flap edema and blister occurred in 2 cases and relieved spontaneously.The other 6 flaps and replanted fingers survived completely,with primary healing of incision.Ten cases were followed up 12-18 months (mean,15.5 months).Only a linear scar was seen at the donor sites,with no functional limitation.The flaps had similar color and texture to adjacent skin.The two-point discrimination was 6.5-13.0 mm (mean,8.6 mm).According to replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association,the results were excellent in 6 cases,good in 3 cases,and poor in 1 case at last follow-up,and the excellent and good rate was 90%. ConclusionVenous Flow-through flap can repair both vascular defect and soft tissue defect,so it has good outcome in increasing the survival rate of replanted finger for severed finger replantation with circularity soft tissue defect and vascular defect.

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  • APPLICATION OF WRIST CREASE ISLAND FLAP BASED ON THE SUPERFICIAL PALMAR BRANCH OF THE RADIAL ARTERY FOR THUMB RECONSTRUCTION

    ObjectiveTo investigate the effectiveness of the island flaps based on the superficial palmar branch of the radial artery (SPBRA) to repair the thumb wound. MethodsBetween February 2012 and November 2013, 8 cases of thumb defects and bilateral artery defect were treated. There were 5 males and 3 females with an average age of 30.5 years (range, 19-51 years). The injury was caused by crush (4 cases), avulsion (3 cases), and twist (1 case). The injury located at the metacarpophalangeal joints in 3 cases, at the proximal palmar side in 2 cases, and at the interphalangeal joints in 3 cases. The defect size ranged from 3.5 cm×1.5 cm to 6.5 cm×2.0 cm. The digital artery defect was 2.5-8.5 cm (mean, 5.3 cm). The disease duration was 2.0-4.5 hours (mean, 3.2 hours). The reversed island flaps based on the SPBRA were designed, which size was 4.0 cm×2.0 cm to 7.5 cm×3.0 cm. The donor sites were closed directly. ResultsThe operation was successfully completed in 7 patients except 1 patient having vascular variation. All flaps survived completely. Wound and incision at the donor site healed by first intention. All patients were followed up 6-18 months (mean, 13 months). The flaps had similar color and texture to adjacent skin. Linear scar was seen at the donor site in 1 patient, with no functional limitation. According to the functional assessment criteria of upper limb by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 6 cases, good in 1 case, and fair in 1 case, with an excellent and good rate of 87.5%. ConclusionThe reversed island flap based on the SPBRA is an ideal flap for the thumb reconstruction because the advantages of reliable blood supply, easy dissection, less injury at donor site, and good repair results.

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  • 动脉化静脉复合组织瓣应对桡动脉掌浅支组织瓣血管变异一例

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  • Clinical observation of superficial branch of radial artery wrist crease flap for repairing ring tissue defect of fingers

    Objective To explore the effectiveness and operation method of the superficial branch of radial artery wrist crease flap for repair of ring tissue defect of the fingers. Methods Between June 2013 and March 2016, the superficial branch of radial artery wrist crease flap was used to repair ring finger tissue defect in 20 cases (21 fingers). There were 14 males and 6 females with an average age of 39.3 years (range, 12-61 years). The causes included machine injury in 9 cases, traffic accident injury in 6 cases, heat inury in 2 cases, and avulsed injury in 3 cases. The index finger was involved in 6 cases, middle finger in 6 cases, ring finger in 3 cases, and little finger in 6 cases. Combined injuries included exposure of bone, tendon, vessel, and nerve. The mean time of injury to operation was 3 hours (range, 0.5-5.5 hours) in 17 patients undergoing emergency operation, and was 8.5 days (range, 7-10 days) in 3 patients undergoing selective operation. The superficial palmar branch of the radial artery from the flap was used for bridging proper digital artery. The donor site was directly sutured in 19 cases and was repaired by skin grafting in 1 case. Results One case had blood blister at distal flap, which was cured after dressing change; the other flaps survived, and primary healing was obtained. Healing of incision at the donor site healed by first intention. The patients were followed up 6-24 months (mean, 12 months). The appearance, texture, and color of the flaps were satisfactory. The two-point discrimination ranged from 6 to 13 mm (mean, 9 mm) at 6 months after operation. According to the Chinese Medical Association Society of hand surgery of thumb and finger reconstruction function evaluation standard, the results were excellent in 13 cases, good in 4 cases, and fair in 3 cases; the excellent and good rate was 85%. Conclusion The superficial branch of radial artery wrist crease flap is an ideal choice for the repair of ring tissue defect of the fingers.

    Release date:2017-07-13 11:11 Export PDF Favorites Scan
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