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find Keyword "四肢" 36 results
  • Diagnosis and Treatment of Lesions of Major Artery in Limbs

    目的  探讨四肢动脉损伤的诊断和治疗方法。方法 回顾分析我院1996年1月至2006年7月共诊治的23例四肢动脉损伤患者的临床资料。分别采用直接动脉修补、动脉结扎、端端吻合、自体大隐静脉移植及人工血管吻合。术中取栓6例,合并静脉损伤修复8例。结果 截肢3例(13.0%)。获得随访12例,随访时间3个月~5年,11例多普勒超声证实损伤血管血流通畅,下肢肌肉挛缩1例; 下肢血供不足1例。结论 早期诊断是提高肢体存活率和避免假性动脉瘤发生的关键。手术方式的合理选择、Fogarty导管常规取栓和早期筋膜切开可提高治愈率。

    Release date:2016-08-28 04:08 Export PDF Favorites Scan
  • TEMPORARY INTRAVASCULAR SHUNTS FOR QUICK RESTORATION OF PERFUSION TO THE EXTREMITYWITH MAJOR VASCULAR INJURY

    【Abstract】 Objective To report cl inical experience in the use of temporary intravascular shunts (TIVS) for quickrestoration of perfusion to the extremity with major vascular injury. Methods Between August 2009 and March 2011, TIVSwas applied temporarily to restore blood perfusion to the extremity in 6 patients with major extremity vascular structure injury secondary to trauma (4 patients) or tumor resection (2 patients), who would received vascular transplantation and underwent long ischemia. The patterns of vascular shunts included external carotid artery-subclavian artery, axillary artery-axillary artery, axillary vein-subclavian vein, brachial artery-brachial artery, brachial vein-brachial vein, brachial artery-radial artery, femoral artery-popliteal artery, and popliteal artery-posterior tibial artery. After TIVS, extensive debridement, fracture fixation, or tumor excision was performed. Then the shunted tubes were removed, and the vessels were repaired definitly. Six vessels were repaired by transplanting the great saphenous veins; one vessel was anastomosed directly without tension; and one vessel was repaired by artificial vascular graft. Results All shunted tubes were successfully established within 5 to 10 minutes (mean, 8.2 minutes). The duration of bypass ranged from 67 to 210 minutes. After establishment of TIVS, blood perfusion to the affected limb was improved. When shunted tubes were removed, thrombosis and partial obstruction occurred in one who accepted amputation, and the others kept patency. No loosening of tubes and haemorrhage occurred. At 2-15 months of follow-up, affected limbs had good blood supply. Conclusion TIVS is rapid and simple, which can quickly restore blood perfusion to the extremity with major vascular injury and shorten the ischemic time of the affected extremity.

    Release date:2016-08-31 04:22 Export PDF Favorites Scan
  • 皮肤回植联合封闭式负压引流技术治疗四肢皮肤脱套伤

    目的 总结封闭式负压引流技术(vaccum sealing drainage,VSD)联合一期皮肤回植治疗四肢皮肤脱套伤的临床效果。 方法 2009 年3 月- 2010 年3 月,采用VSD 联合一期皮肤回植修复25 例四肢皮肤脱套伤患者。男16 例,女9 例;年龄9 ~ 53 岁,中位年龄32 岁。致伤原因:交通事故伤19 例,高处坠落伤3 例,重物砸伤3 例。部位:手背3 例,前臂6 例,小腿10 例,足踝及足背 6 例。脱套范围为14 cm × 9 cm ~ 42 cm × 23 cm。合并骨折8 例,血管、神经损伤2 例。受伤至入院时间4 ~ 8 h。 结果  22 例经7 ~ 10 d VSD 治疗后,回植皮肤顺利成活;3 例经VSD 治疗10 d 后仍有点状坏死,经换药后愈合。25 例均获随访,随访时间3 ~ 12 个月,平均9 个月。全厚皮片回植后颜色接近正常皮肤,弹性良好,质地柔软,小腿两点辨别觉2 ~ 3 cm;中厚皮回植后部分颜色发暗,质地较硬,小腿两点辨别觉6 ~ 8 cm。8 例合并骨折者骨折愈合时间3 ~ 8 个月,平均5 个月;1 例尺神经断裂者6 个月后骨间肌萎缩,另1 例血运、感觉、运动均较好。 结 论 急诊VSD 在治疗四肢皮肤脱套伤中能充分引流、均匀加压、改善血循环、促进脱套皮肤成活。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • REPAIR OF SOFT TISSUE DEFECT IN EXTREMITIES WITH ANTEROLATERAL THIGH PERFORATOR FLAP

    Objective To summarize the cl inical effect of anterolateral thigh pedicle or free perforator flap in repairing soft tissue defect in the extremities. Methods From March 2000 to January 2009, 32 cases of soft tissue defect were treated with pedicle or free anterolateral thigh perforator flap. There were 30 males and 2 females with an median age of28 years (4-53 years). Soft tissue defects included left radial side in 3 cases, the left lateral elbow in 1 case, knee in 5 cases, calf in 14 cases, dorsal is pedis in 5 cases, and planta pedis in 4 cases. The defect area ranged from 9 cm × 6 cm to 15 cm × 13 cm. Nine cases compl icated by bone defect and 1 case by radial nerve defect. The time from injury to hospital ization was 1 hourto 4 months (mean 5 days). Defects in 27 cases were repaired by anterolateral thigh perforator flap, simultaneously combined with transplantation with the second toe in 1 case, with sural nerve using arterial ized small saphenous vein in 1 case, nd with fibular or il ium in 4 cases. Defects in other 5 cases were repaired with flaps pedicled with superior lateral genicular artery. Neuroanastomosis was performed in 14 cases of the flaps. The size of the flaps ranged from 10 cm × 8 cm to 16 cm × 15 cm. Skin defects at donor site were repaired with spl it thickness skin graft or sutured directly. Results All patients were followed up from 8 months to 9 years with an average of 18 months. The flaps survived well and the wounds healed by first intention in 29 cases, 3 flaps necrosed and cured after symptomatic management. Skin graft at donor site survived completely in 9 cases. The color and texture and thickness of the flaps were similar to those of recipient site. After 6 months, the sensation of the flaps recovered to grade S3-4 in 14 patients whose cutaneous nerve were anastomosed, partial recovery was observed in other patients. In 4 patients receiving transplantation of fibular or il ium, the bony heal ing was achieved within 4 to 6 months. No obvious dysfunction was found at the donor site. Conclusion The pedicle anterolateral thigh perforator flap is long and thick with constant location. Anastomosis or transferring is easy to perform. It can provide big area and feel ing recovery by nerve anastomosis. It is an effective method to repair soft tissue defect of the extremities.

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • 中厚皮片和真皮下血管网皮瓣联合封闭式负压引流技术修复四肢大面积皮肤撕脱伤

    目的 总结中厚皮片和真皮下血管网皮瓣联合封闭式负压引流技术(vacuum sealing drainage,VSD)修复四肢大面积皮肤撕脱伤的疗效。 方法 2008 年1 月- 2009 年2 月,采用中厚皮片和真皮下血管网皮瓣联合VSD修复12 例四肢大面积皮肤撕脱伤。男9 例,女3 例;年龄17 ~ 65 岁。交通伤7 例,机器轧伤3 例,其他伤2 例。损伤部位:上肢2 例,小腿8 例,足踝及足背2 例。创面范围为9 cm × 7 cm ~ 38 cm × 24 cm。受伤至入院时间3 ~ 11 h,平均 5 h。 结果 10 例经5 ~ 7 d VSD 治疗后,95% 以上撕脱皮肤成活;2 例创面缩小50% 及60%,直接拉拢缝合后于大腿外侧取中厚皮片修复残余创面,同时联合VSD 治疗5 ~ 7 d 后移植皮片成活。患者术后均获随访,随访时间6 ~ 12 个月。创面无明显瘢痕增生,关节功能恢复满意。 结论 中厚皮片和真皮下血管网皮瓣联合VSD 修复四肢大面积皮肤撕脱伤具有早期封闭创面、减轻水肿、降低感染几率、促进撕脱皮肤成活等优点。

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • DIAGNOSIS AND TREATMENT OF VASCULAR INJURY IN LIMBS

    To report the diagnosis methods and cl inical treatment effects of blood vessel trunk damage in l imbs. Methods From January 2001 to June 2006, 72 patients with vascular injury in l imbs were treated. There were 50 males and 22 females, aged from 5-60 years (median 39 years) and including 44 cases of open injury and 28 cases of closed injury.The locations were subclavian artery in 1, femoral artery in 23, popl iteal artery in 20, radia artery and ulna artery in 12, brachial artery in 11, axilary artery in 3 and anterior and posterior tibia artery in 2. The disease course was 30 minutes to 27 days. Injured arteries were repaired by suturing directly in 3 cases, by end-end anastomosis in 39 cases and by saphenous transplantation in 30 cases. The length of transplant veins was 3 cm to 8 cm. Results In 72 cases, 67 survived and 5 were given amputation. Fortyeight cases were followed up 6 months to 5 years. The blood flow rate and the diameter of blood vessel on the affected l imbs were not different from that of normal l imbs by colorful Doppler blood flow monitor. Forty cases recovered satisfactory l imb function. Eight cases had different degrees of dysfunction, of them, four cases received functional reconstructive operation, and the function and appearance were improved. Conclusion To investigate the mechanism and situation of injury, to examine patients carefully and analyze comprehensively are the key points of making earl ier diagnosis for branch blood vessel damage; microsurgical repair of the injured blood vessel is the assurance of the blood flow rate. For the blood vessel above elbow and knee injured and lacked blood supply more than 4 hours and fascia syndrome, earl ier opening the fascia cavity is the effective methods to recover the function of the l imbs and to avoid disabil ity.

    Release date:2016-09-01 09:12 Export PDF Favorites Scan
  • 四肢主要血管火器伤的修复重建

    对40 例四肢主要血管火器伤患者的临床资料进行回顾性分析,总结损伤的有效救治方法。 方 法 1986 年5 月- 2006 年11 月,收治40 例四肢主要血管火器伤患者。男35 例,女5 例;年龄16 ~ 50 岁,平均31. 2 岁。动脉完全断裂16 例,动脉部分断裂6 例,动脉缺损14 例,动脉血栓形成2 例,假性动脉瘤2 例。病程12 min ~ 20 h。彻底清创、充分减压和引流,根据不同情况选择自体静脉移植25 例,人造血管移植3 例,血管吻合6 例,血管修补4 例,带血管蒂的轴型皮瓣游离移植2 例。 结果 经抗感染、输血补液及抗凝、扩张血管等治疗,死亡1 例,截肢2 例,肾衰竭截肢1 例,成功修复36 例。伤口Ⅰ期愈合29 例,Ⅱ期愈合7 例。经7 个月~ 2 年随访,修复血管均恢复通血,肢端血运良好,动脉搏动正常,按英国医学会感觉运动功能评定标准:优28 例,良6 例,差2 例。 结论 “生命第一、肢体第二”是四肢主要血管火器伤的救治原则,采用自体静脉或人造血管旁路移植修复可获良好效果。

    Release date:2016-09-01 09:12 Export PDF Favorites Scan
  • MPROVEMENT OF SURGICAL TECHNIQUES IN FASCIOCUTANEOUS FLAP OF LIMBS

    To summarize the effectiveness of the improv ed surgical techniques in fasciocutaneous flaps of the limbs. MethodsFrom February 1999 to December 2005, 58 patients (39 males, 19 females, aged 1068 years) underwent repairs of the skin defects with improved fasciaocu taneous flaps of the limbs. Twentyone patients had the skin defects in front of the tibial bone in the middle and lower parts, 12 patients had the skin defect s in the heels, 16 patients had the skin defects in the ankles, 3 patients had t he skin defects around the knees, 1 patient had a wide sacrococcygeal bedsore, and 5 patients had the skin defects in the wrists and hands. The wounds ranged in size from 5 cm×3 cm to 18 cm× 12 cm. According to the wound lo cations, the following flaps were selected: 4 cutaneous antebrachii medialis nerve and basilic vein fasciocutaneous flaps, 1 cutaneous antebrachii lateralis nerve and cephalic vein fasciocutaneous flap, 3 saphenous nerve and great saphenousvein fasciocutaneous flaps, 1 cutaneous nerve of thigh posterior fasciocutaneous flap, 32 reverse sural nerve and saphenous vein fasciocutaneous flaps, and 17 reverse saphenous nerve and great saphenous vein fasciocutaneous flaps. The dissected flaps ranged in size from 6 cm× 4 cm to 18 cm× 13 cm. The donor wounds underwent straight sutures in 39 patients, and the skin grafting (6 cm×3 cm to 13 cm× 6 cm) was performed on 19 patients after the donor wounds were closed. Results The wounds healed by first intention, and the flaps survived completely in 54 patients. The flaps developed partial necrosis in 4 patients. The followup for 120 months (average, 8 months) revealed that the flaps had a satisfactory appearance with a soft texture and the function was also satisfactory. Conclusion A fasciocutaneous flap of the limbs is an ideal flap for repairing defects in the skins and soft tissues of the limbs. The survival rate of the flap can be further improved by an improvement of the surgical techniques.

    Release date:2016-09-01 09:22 Export PDF Favorites Scan
  • CROSSBRIDGE VASCULAR ANASTOMOSIS FREE TISSUE TRANSPLANTATION IN REPAIRING TISSUE DEFECTS OF EXTREMITIES

    Objective To investigate the application and effect of the crossbridge vascular anastomosis free flap transplantation for tissue defects of extremities. Methods From May 1982 to November 2005, 110 cases of tissue defects of extremities were treated with cross-bridgevascular anastomosis free tissue transplantation. Of 110 patitents, 80 were male and 30 were female with a median age of 30 years(5 to 54 years). Tissue defects were caused by traffic accidents (59 cases), machine injuries (32 cases) and mangled injuries (19 cases). The locations were the forearms in 2 cases and the legs in 108 cases. And 69 cases had simple soft tissue defects, 6 cases had simple bone defects, and 35 cases had complicated defects. The length of bone defectranged from 5 cm to 19 cm and the area of soft tissue defect ranged from 6 cm×10 cm to 15 cm×35 cm. The graft tissue included latissimus dorsi musculocutaneous flap, vastus anterolateral flap,cutaneous fibula flap, osseous fibula flap, and cutaneous iliac flap. The cross-bridge of the two lower extremities wasperformed in 106 cases, the cross-bridge of the two upper extremities in 2 cass, and the crossbridge of the upper-lower extremities in 2 cases. The compoite tissue transplantation was used if the graft tissues were two or more. The wounds of donor site was directly sutured in 67 cases, and partly sutured with skingrafting in 43 cases. Results Vascular crisis occurred in 9 cases. Vascular crisis was relieved in 5 cases and grafting tissues was survival after exploring the vessel; 4 cases failed. The graft tissue was survival in 101 cases, and the survivalrate was 96.4%. The follow-up time was 4 months to 22 years with an average of 6.3 years. Graft bone healed and mean healing time was 4 months. The flap appearance was satisfactory and extremity function was restored to normal. One case became necrosis in the edge of the flap and cured by debridement, dressing and skingrafting, the other got primary healing at 2-3 weeks after operation. Conclusion The application of the cross-bridge vascular anastomosis free tissue transplantation for tissue defects of extremities is an effective method, when extremities have no vessel anastomosed. 

    Release date:2016-09-01 09:23 Export PDF Favorites Scan
  • 四肢主干动脉损伤早期诊断与修复

    目的 总结四肢主干动脉损伤应用显微外科技术修复的经验。方法 1997年8月~2006年8月,对200例(316条)四肢主干动脉损伤患者,采用显微镜下血管吻合、修补、自体静脉移植或人工血管移植,并同时对缺损皮肤和肌腱进行一期修复或二期功能重建。血管损伤类型:开放性损伤161例,闭合性损伤39例。完全断裂189条,不完全断裂127条。血管缺损2~8 cm。结果 术中输血量800~4 000ml。手术成功(一次修复)169例,血栓形成二次修复19例,术后死亡3例,截肢9例。126例获随访3个月~4年,120例肢体血液循环恢复正常,6例肢体存在不同程度功能障碍,可能与合并神经损伤有关。结论 对于四肢主干动脉损伤,采用显微外科技术修复,能获得良好效果,明显提高患肢存活率。

    Release date:2016-09-01 09:23 Export PDF Favorites Scan
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