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find Keyword "供区" 17 results
  • 改良第一趾蹼皮瓣游离移植术后供区创面的修复

    目的总结应用穿支血管蒂足内侧隐神经营养血管皮瓣修复改良第1趾蹼皮瓣游离移植后供区创面的疗效。 方法2009年5月-2012年8月,对9例手部皮肤缺损患者应用改良第1趾蹼皮瓣游离移植修复后,供区遗留3.8 cm × 3.3 cm~5.2 cm × 3.6 cm大小创面,均不能通过直接缝合或植皮修复。男7例,女2例;年龄28~56岁,平均36.2岁。创面合并第1、2趾趾伸肌腱或第1、2趾跖骨外露。手部皮肤缺损修复后一期采用大小为4.2 cm × 3.6 cm~6.0 cm × 4.0 cm的穿支血管蒂足内侧隐神经营养血管皮瓣移位修复供区创面。 结果术后9例皮瓣均顺利成活,创面Ⅰ期愈合。患者均获随访,随访时间6~13个月,平均7个月。皮瓣颜色、质地与受区周围皮肤相似。第1趾蹼夹持、伸展等功能恢复良好。术后6个月,皮瓣静态两点辨别觉达4~9 mm,平均4.8 mm;皮瓣感觉功能恢复至S3 3例,S3+ 4例,S4 2例。 结论应用穿支血管蒂足内侧隐神经营养血管皮瓣修复改良第1趾蹼皮瓣移植后供区创面可获满意疗效。

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • 第一掌骨桡背侧穿支皮瓣修复拇指背岛状皮瓣供区

    目的 总结第1掌骨桡背侧穿支皮瓣修复拇指背岛状皮瓣供区的疗效。 方法 2010年1月-2012年7月,收治21例拇指软组织缺损患者。男13例,女8例;年龄17~56岁,平均32.3岁。指端缺损7例,指腹缺损10例,甲床缺损4例。创面范围1.5 cm × 1.5 cm~2.0 cm × 1.8 cm。受伤至入院时间20 min~14 h,平均4.6 h。采用大小为1.8 cm × 1.8 cm~2.3 cm × 2.0 cm的近节指背岛状皮瓣修复创面后,利用大小为1.3 cm × 1.1 cm~2.0 cm × 1.5 cm的第1掌骨桡背侧穿支皮瓣修复供区,穿支皮瓣供区直接缝合。 结果术后拇指背岛状皮瓣和第1掌骨桡背侧穿支皮瓣均顺利成活,创面Ⅰ期愈合。19例获随访,随访时间5~17个月,平均10.4个月。皮瓣血运、弹性好,手指无疼痛。末次随访时,供区皮瓣两点辨别觉为8~12 mm,平均9.6 mm。拇指对掌、对指功能正常。根据中华医学会手外科学会断指再植功能评定试用标准,获优16例,良3例,优良率100%。 结论采用第1掌骨桡背侧穿支皮瓣修复拇指背岛状皮瓣供区,避免植皮后掌指关节背侧瘢痕挛缩,最大限度保留掌指关节功能,穿支皮瓣供区可直接缝合,是一种有效术式。

    Release date:2016-08-31 04:12 Export PDF Favorites Scan
  • ANALYSIS OF THE DONOR-SITE COMPLICATIONS OF THE ANTEROLATERAL THIGH FLAP

    Objective To investigate the donor-site compl ications of the anterolateral thigh flap and its influencing factors. Methods Between July 1988 and July 2007, 427 patients were treated with anterolateral thigh flap. Among them, 33 patients had postoperative donor-site compl ications and their cl inical data were analyzed retrospectively. There were 21 malesand 12 females aged 14-47 years old (average 32.7 years old). The size of the wound defect ranged from 16 cm × 7 cm to 28 cm × 13 cm. The area of the flap harvested during operation ranged from 16 cm × 7 cm to 30 cm × 13 cm. The donor sites were treated by direct suture in 7 cases; free spl it-thickness skin graft in 23 cases, and reverse superficial epigastric artery flap repair in 3 cases. The size of graft in the donor site ranged from 10 cm × 5 cm to 18 cm × 8 cm. The occurrence of short-term (within 4 weeks) and long-term (over 6 months) compl ications were analyzed. Results All patients were followed up for 8-54 months (average 21 months). There were 26 patients (78.8%) with short-term and long-term compl ications and 7 patients (21.2%) with long-term compl ications. The short-term compl ications included skin graft necrosis in 23 cases (69.7%), wound infection in 17 cases (51.5%), and muscle necrosis in 2 cases (6.1%). The long-term compl ications included non-heal ing wounds in 21 cases (63.6%), serious scar in 28 cases (84.8%), discomfort in 25 cases (75.8%), and dysfunction of the quadriceps femoris in 16 cases (48.5%). Conclusion The occurrence of anterolateral thigh flap donor-site compl ications is related to the anatomical structure of the anterolateral thigh region, the surgical procedure, and the patient’s physique.

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • REFORM OF THE PEDICLED ABDOMINAL FLAP AND ITS CLINICAL APPLICATION

    Objective To investigate the closing method of wound after removalof the traditional pedicled abdominal flap. Methods Accordingto the design,the pedicled abdominal flaps were cut and lifted, and then the incision were extended from both sides on base of the flap to anterior superior iliac spine, respectively. After separating on superficial fascia, two flaps were obtained. The wound of donor site was closed completely by these two pedicled flaps. Twelvepatients with skin defects on hands or forearms were treated using the reformedmethod of traditional pedicled abdominal flap. Results All of the 12 reformed pedicled abdominal flaps survived, and only one had local necrosis on the distalpart of the abdominal flap, about 1.5 cm ×2.0 cm. Conclusion This new designcould provide a good method to close the abdominal wound after removal of pedicled abdominal flap.

    Release date:2016-09-01 09:29 Export PDF Favorites Scan
  • treatment of the wound on donor site after great toe-nail flap grafting

    OBJECTIVE: To investigate the method of improving the vitality of skin graft on donor site of the great toe-nail skin flap. METHODS: From June 1982 to April 1998, 252 cases of the great toe-nail flaps with piece of phalangeal bone and 18 cases of the simple great toe-nail flap were repaired with thin skin graft and packed under proper pressure. The stitches were removed two weeks later in common situation. It should be postponed on split thickness or partial survival skin flap avoiding early mobilization. RESULTS: Sixty-six cases of skin graft were necrotic after operation. Among them, 38 cases needed second skin grafting and 28 cases were healed after changing dressing. The survival rate of skin grafting was obviously higher on phalangeal marrow surface than on periosteum of the naked phalange. Contracture of the skin graft after operation made the retained skin flap expanding from medial side to lateral side and covered the whole plantar surface of the great toe. CONCLUSION: The survival rate of the skin graft on donor foot is improved after adopting the improved measures on taking the flap from great toe and paying attention to skin graft planting and packing. Free flap grafting is advocated for repairing of the wound on donor area of the great toe nail flap.

    Release date:2016-09-01 10:21 Export PDF Favorites Scan
  • 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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  • 鼻咽窝穿支V-Y接力皮瓣修复拇指指背动脉皮瓣供区

    目的总结应用鼻咽窝穿支V-Y接力皮瓣修复拇指指背动脉皮瓣供区的疗效。 方法2012年6月-2013年4月,收治9例拇指末节指背、指腹缺损患者。男5例,女4例;年龄18~69岁,平均30岁。致伤原因:冲床伤4例,电刨伤3例,链条绞伤2例。受伤至手术时间4 h~5 d,平均72 h。手指末节缺损范围1.8 cm×1.0 cm~3.0 cm×2.0 cm,采用大小为2.0 cm×1.2 cm~3.0 cm×2.2 cm的拇指指背动脉岛状皮瓣修复后,供区创面采用大小为2.4 cm×1.2 cm~4.4 cm×2.2 cm的鼻咽窝穿支V-Y接力皮瓣修复。 结果术后指背动脉岛状皮瓣及鼻咽窝穿支V-Y接力皮瓣均顺利成活,创面Ⅰ期愈合。患者均获随访,随访时间5个月~2年,平均13个月。皮瓣外观及弹性良好,伤指无疼痛。末次随访时,鼻咽窝穿支V-Y接力皮瓣静止两点辨别觉为12~14 mm,平均13 mm。拇指各关节活动正常,手功能按主动活动度(ATM)评定标准:获优7例,良2例。 结论采用鼻咽窝穿支V-Y接力皮瓣修复拇指指背动脉皮瓣供区操作简便,术后疗效满意。

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  • FREE CROIN FLAP FOR REPAIRING DEFECTS OF DONOR AFTER TOE TISSUE TRANS PLANTATION

    ObjectiveTo discuss the effectiveness of free croin flap in repairing defects of donor after toe or feet tissue flap transplantation. MethodsBetween March 2010 and May 2015, 23 cases of defects of donor after toe or feet tissue flap transplantation were repaired with free croin flap and followed up for more than 6 months, and the clinical data were retrospectively analyzed. There were 15 males and 8 females, with an age range from 17 to 52 years (mean, 25.6 years). All finger or soft tissue defects were caused by trauma. Defects were repaired in emergency operation with toe or feet tissue flap transplantation in 18 cases, defects were secondarily reconstructed at 3-8 months after injury in 5 cases. The defect area at the feet donor site ranged from 3 cm×3 cm to 10 cm×6 cm, all accompanied with exposure of bone, and tendon. The area of free croin flap was 3.5 cm×3.5 cm-11.0 cm×6.5 cm, the vessel of flap was anastomosed with artery and vein of foot. The inguinal donor site was sutured directly. ResultsThe operation time was 3-9 hours (mean, 4.5 hours); the intraoperative blood loss was 50-300 mL (mean, 120 mL). Vessel crisis occurred in 1 case postoperatively; mild and moderate swelling occurred in 3 cases, with small sporadic blisters formation; free croin flap survived completely in the other cases, and primary healing was obtained at feet wound and inguinal donor sites. Twenty-three cases were followed up 6-24 months (mean, 9 months). The color and texture of the croin flaps were similar to that of the adjacent skin, no obvious scar contracture and pigmentation were observed; the patient could walk with weight loading, the two-point discrimination was 18-35 mm (mean, 26 mm) at 6 months after operation. The color, texture, and shape of reconstructed finger was good; the function of grasping and pinching recovered well; the two-point discrimination was 5.5-11.0 mm (mean, 6.5 mm) at 6 months after operation. According to upper extremity functional evaluation standard by Chinese Medical Association, the results were excellent in 18 cases and good in 5 cases. ConclusionFree croin flap can effectively repair skin and soft tissue defects of donor after toe or feet tissue flap transplantation, and good function and appearance of feet can be obtained.

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  • 指蹼穿支蒂V-Y推进皮瓣修复指动脉逆行岛状皮瓣供区

    目的 总结采用指蹼穿支蒂V-Y推进皮瓣修复指动脉逆行岛状皮瓣供区疗效。 方法 2011年3月-2015年9月,收治35例(35指)指端缺损患者。男18例,女17例;年龄18~70岁,平均44岁。致伤原因:机器压砸伤19例,磨削伤7例,电刨伤5例,烫伤4例。受伤至手术时间2~8 h,平均5 h。损伤指别:示指11例,中指17例,环指5例,小指2例。指端缺损范围1.5 cm×1.0 cm~2.0 cm×1.5 cm。首先切取大小为2.0 cm×1.5 cm~2.2 cm×2.0 cm的指动脉逆行岛状皮瓣修复指端创面后,供区以大小为2.0 cm×1.5 cm~2.5 cm×2.0 cm的指蹼穿支蒂V-Y推进皮瓣修复。 结果 术后皮瓣均顺利成活,供、受区创面均Ⅰ期愈合。32例获随访,随访时间6个月~3 年,平均21个月。皮瓣质地、色泽良好,外形不臃肿,指端无触痛。末次随访时,指动脉逆行岛状皮瓣两点辨别觉为8~13 mm,平均10.5 mm;指蹼穿支蒂V-Y推进皮瓣两点辨别觉为7~12 mm,平均9.5 mm。指蹼无挛缩,最大外展角达30~40°,平均35°;根据手指总主动活动度(TAM)系统评定:获优30例,良1例,差1例,优良率96.87%。 结论 采用邻近创面的指蹼穿支蒂V-Y推进皮瓣修复指动脉逆行岛状皮瓣供区,手指外观和功能均恢复较好,并避免了游离植皮修复的相关并发症。

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  • 真皮下袋状包埋结合分时拉拢修复2~5指脱套伤及供区创面处理

    目的总结应用真皮下袋状包埋结合分时拉拢修复2~5指脱套伤及腹部供区创面处理的临床疗效。 方法2012年12月-2014年3月收治7例2~5指脱套伤患者,男4例,女3例;年龄42~68岁,平均56岁。均为机器撕脱伤。2~5指掌指关节以远手指脱套伤无再植条件,创面肌腱、骨外露;其中2例合并手背创面,无肌腱、骨外露。创面范围28 cm×7 cm~29 cm×9 cm。受伤至手术时间5 h~3 d,平均16 h。采用真皮下袋状包埋修复结合可吸收线分时拉拢3周后分指断蒂掌侧植皮,腹部供区创面无法直接缝合,采用近创面旋髂深动脉肌皮穿支为蒂的V-Y接力皮瓣修复供瓣区,V-Y接力皮瓣范围16 cm×8 cm~24 cm×12 cm。 结果7例28指皮瓣植皮及供区皮瓣全部成活,创面均Ⅰ期愈合。7例均获随访,随访时间6~24个月,平均12个月。手指外形较好,皮瓣质地柔韧,无臃肿,患指掌指关节屈伸0~90°,平均70°;近侧指间关节屈伸0~30°,平均20°;可与拇指完成基本的握、捏动作。患指深感觉及痛温觉有所恢复,两点辨别觉为12~14 mm,平均13 mm。腹部供瓣区皮瓣外观、质地、色泽及弹性良好;腹部伤口愈合较平整,无明显凹陷,肚脐无明显偏斜。患者对手功能和外形及腹部外观均较为满意。末次随访时手功能采用总主动活动度(TAM)法评定,优5指,良1指,可1指。 结论该术式操作简便、疗效满意,是对传统腹部包埋法及供区修复方法的改进。

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