west china medical publishers
Author
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Author "张文龙" 14 results
  • REPAIR OF FINGER SOFT TISSUE DEFECT WITH ISLAND FLAP BASED ON VASCULAR CHAIN OF CUTANEOUS BRANCH OF DORSAL METACARPAL ARTERY

    Objective To investigate the operative procedure and the clinical results of the island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery for repairing finger soft tissue defect. Methods Between January 2008 and March 2012, 28 cases of tissue defect of fingers (32 fingers) were repaired with the island flaps based on the vascular chain of the cutaneous branch of dorsal metacarpal artery. There were 20 males (23 fingers) and 8 females (9 fingers), with an average age of 29.5 years (range, 14-67 years). The injury causes included 14 cases of crush injury, 6 cases of pressing injury, 5 cases of cutting injury, and 3 cases of avulsion injury. The locations included 10 index fingers, 13 long fingers, 6 ring fingers, and 3 little fingers. There were 9 defects of proximal segment, 12 defects of middle segment, and 11 defects of distal segment. The area of defect ranged from 1.0 cm × 0.8 cm to 5.2 cm × 3.5 cm. The disease duration was 1 hour to 15 days. The area of flaps ranged from 1.2 cm × 1.0 cm to 5.5 cm × 3.8 cm. The donors were closed by suture or were repaired with skin graft. Results Tense blister occurred in 3 cases, which was cured after dressing change; the other flaps survived. Wound obtained primary healing. Twenty-five patients (27 fingers) were followed up 6-25 months (mean, 16.8 months). The flaps had soft texture and satisfactory appearance. Two point discrimination was 6-9 mm (mean, 7.7 mm) at 6 months after operation. The total active movement of fingers was 105-230° (mean, 204.6°). The results were excellent in 17 fingers, good in 8 fingers, and fair in 2 fingers with an excellent and good rate of 92.6%. Conclusion The island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery has the advantages of the deverting point from the dorsal point to the palm, the extended vessel pedicle, and expanded operation indications, so it is not necessary to cut the dorsal metacarpal artery. It can be used to repair finger tissue defect.

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • REPAIR OF FINGER TISSUE DEFECT WITH MODIFIED ISLAND FLAP BASED ON REVERSED DORSAL METACARPAL ARTERY

    Objective To investigate the operative procedure and the cl inical results of the modified island flap based on the reversed dorsal metacarpal artery for repairing finger tissue defect. Methods From January 2004 to March 2009, 38 patients (43 fingers) with finger tissue defect were treated with the modified island flaps based on the reversed dorsal metacarpal artery. The deverting point was altered from the dorsal point to the palm. There were 27 males (31 fingers) and 11 females (12 fingers) with an average age of 43.6 years (range, 12-67 years). Defect was caused by crash injury in 18 cases, crush injury in 14 cases, and cutting injury in 6 cases. Of them, 11 index fingers, 23 middle fingers, 7 ring fingers, and 2 l ittle fingers were involved. The area of the defect ranged from 1.0 cm × 0.7 cm to 3.2 cm × 2.5 cm. The area of flaps ranged from 1.2 cm × 1.0 cm to 3.5 cm × 2.8 cm. The donor sites were sutured directly. Results Tension vesicular scabbing occurred in distal part of flap, and was cured after dressing change in 3 cases. The other flaps survived and incision healed primarily. All incision at donor sites healed primarily. Thirty-one patients (35 fingers) were followed up 6-29 months (15.3 months on average). All flaps survived with satisfactory appearance, sensation, and function. Two-point discrimination was 6-9 mm (7.9 mm on average). The results were excellent in 20 fingers, good in 13 fingers, and fair in 2 fingers according to the total active movement (TAM) standards; the excellent and good rate was 94.3%. Conclusion The treatment of finger tissue defect with the modified island flap based on the reversed dorsal metacarpal artery is recommendable. The deverting point was altered from the dorsal point to the palm. The vessel pedicle is extended. It can be easily and conveniently performed for more cases.

    Release date:2016-08-31 05:48 Export PDF Favorites Scan
  • 逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤

    目的 总结逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤的手术方法和临床效 果。 方法 2004 年 8 月- 2008 年12 月,收治 22 例23 指末节毁损型离断伤患者。男 16 例17 指,女 6 例 6 指;年龄12 ~ 67 岁,平均36 岁。撕脱伤11 例11 指,压砸伤9 例10 指,爆炸伤2 例2 指。示指9 指,中指7 指,环指5 指,小指2 指。缺损平面均在中节指骨以远,缺损长度1.1 ~ 2.3 cm。受伤至手术时间为30 min ~ 8 h。术中采用范围为4.6 cm ×0.6 cm ~ 6.1 cm × 2.2 cm 的逆行指动脉背侧支三叶皮瓣修复。供区植皮修复。 结果 术后3 例皮瓣出现静脉危象,经换药愈合;其余皮瓣及供区植皮均顺利成活,切口Ⅰ期愈合。16 例16 指获随访,随访时间6 ~ 25 个月,平均16.5 个月。皮瓣质地柔软,外观饱满,无臃肿,指端无触痛。皮瓣两点辨别觉为6 ~ 10 mm。术后6 个月手功能按总主动活动度法评定,优9 指,良6 指,可1 指,优良率93.8%。 结 论 逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤手术简便、安全,疗程短,是一种较为理想的方法。

    Release date:2016-09-01 09:08 Export PDF Favorites Scan
  • TREATMENT OF POST-MASTECTOMY UPPER LIMB LYMPHEDEMA BY MODIFIED SIDE-TO-END LYMPHATICOVENULAR ANASTOMOSIS

    ObjectiveTo investigate the therapeutic effect of modified side-to-end lymphaticovenular anastomosis in the treatment of post-mastectomy upper limb lymphedema. MethodsBetween May 2010 and May 2011, 11 female patients with post-mastectomy upper limb lymphedema underwent a modified side-to-end lymphaticovenular anastomosis. The average age was 49.5 years (range, 38-55 years). Lymphedema occurred at 7-30 months (mean, 18.3 months) after resection of breast cancer, with an average disease duration of 25.5 months (range, 10-38 months). The left upper limb was involved in 5 cases and the right upper limb in 6 cases. In accordance with difference value between health and affected sides criteria, 5 cases were rated as moderate, and 6 cases as severe. ResultsModified side-to-end lymphaticovenular anastomosis was successfully completed in all patients. Primary healing of incision was obtained in the other patients except 1 case of delayed healing. All patients were followed up for an average of 38.4 months (range, 36-40 months). Limb pain and swelling were relieved; no episodic attack or recurrence was observed. The circumference of affected upper arm was significantly decreased from preoperative (33.9±3.7) cm to postoperative (31.0±3.5) cm at 6 months and (30.9±3.5) cm at 36 months (P<0.05), but no significant difference was found between at 3 and 6 months (P>0.05); the circumference of affected forearm was significantly decreased from preoperative (30.1±3.6) cm to postoperative (27.8±3.4) cm at 6 months and (27.7±3.3) cm at 36 months (P<0.05), but no significant difference was shown between at 6 and 36 months (P>0.05). According to Campisi evaluation standard to assess efficacy, the results were excellent in 3 cases, good in 6 cases, and improved in 2 cases. ConclusionUsing modified side-to-end lymphaticovenular anastomosis may be effective in the treatment of upper limb lymphedema after mastectomy.

    Release date: Export PDF Favorites Scan
  • 双套圈交叉加压缝合法治疗手指近侧指间关节侧副韧带损伤

    目的总结双套圈交叉加压缝合法治疗手指近侧指间关节侧副韧带损伤的疗效。 方法2008年12月-2013年2月,采用双套圈交叉加压缝合法治疗18例(20指)近侧指间关节侧副韧带起、止点断裂患者。男10例,女8例;年龄18~56岁,平均36.5岁。致伤原因:扭伤10例(10指),绞伤5例(7指),戳伤3例(3指)。损伤指别:示指8指,中指8指,环指4指。患指关节屈伸活动受限;侧方应力试验(+)。2例(2指)合并细小撕脱骨块。伤后至手术时间2~10 d,平均6.5 d。 结果术后切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间8~50个月,平均30个月。术后患指均无疼痛、关节稳定,侧方应力试验(-),关节分别遗留不同程度梭形肿胀。术后8个月,根据总主动活动度系统评定方法:获优12指,良7指,差1指,优良率95%。 结论双套圈交叉加压缝合法治疗手指近侧指间关节侧副韧带损伤疗效满意。

    Release date: Export PDF Favorites Scan
  • 改良邻指双叶皮瓣修复指掌侧大面积皮肤缺损

    目的总结采用改良邻指双叶皮瓣修复指掌侧大面积皮肤软组织缺损的疗效。 方法2004年3月-2013年5月,采用改良邻指双叶皮瓣修复23例(23指)指掌侧大面积皮肤软组织缺损。男19例,女4例;年龄23~38岁,平均28.5岁。致伤原因:挤压伤12例,锐器伤6例,绞伤2例,高压灌注伤3例。损伤指别:示指13例,中指8例,环指2例。18例为外伤急诊入院,伤后至手术时间2~6 h,平均4.5 h;5例为外伤后指掌侧皮肤软组织坏死择期手术,伤后至手术时间12~26 d,平均18.6 d。 结果术后皮瓣及植皮均成活,创面Ⅰ期愈合。患者均获随访,随访时间6~30个月,平均20个月。手指皮瓣外形满意,色泽正常,质地柔软。末次随访时根据手指总主动活动度(TAM)系统评定,获优20例,良2例,可1例,优良率95.7%。 结论改良邻指双叶皮瓣修复指掌侧大面积皮肤软组织缺损手术操作简便,术后皮瓣外观好,伤指功能恢复满意。

    Release date: Export PDF Favorites Scan
  • ANTEROLATERAL THIGH FLAP PEDICLED WITH MEDIAL SURAL VESSELS AS RECIPIENT VESSELS IN RECONSTRUCTION OF LEG SKIN AND SOFT TISSUE DEFECTS

    ObjectiveTo discuss the effectiveness of free anterolateral thigh flap pedicled with medial sural vessels for treatment of leg skin and soft tissue defects. MethodsBetween July 2008 and January 2014, 32 cases of serious skin and soft tissue defects in the leg were repaired by using free anterolateral thigh flap pedicled with medial sural artery and vein. Of them, there were 22 males and 10 females, aged 23 to 50 years (mean, 36.5 years). Defects were caused by traffic accidents injury in 9 cases, crash injury of heavy object in 15 cases, and machine twist injury in 8 cases. The left side was involved in 10 cases and the right side in 22 cases. The mean interval of injury and admission was 2.5 hours (range, 1-4 hours). The location was the upper, middle, and lower one third of the anterior tibia in 15 cases, 10 cases, and 7 cases respectively. The area of defect ranged from 10 cm×5 cm to 23 cm×9 cm. After debridement and vaccum sealing drainage treatment, the anterolateral thigh flap ranging from 12 cm×7 cm to 25 cm×11 cm pedicled with the medial sural vessels was used to repair the wound. The donor site was sutured directly or repaired with the skingrafts. ResultsAll flaps and skingrafts survived after operation, and primary healing of wound was obtained. After 6-23 months (mean, 14.5 months) follow-up, all flaps were characterized by soft texture, good color, and satisfactory appearance. The sensation of the flaps were recovered to S2~S3+ according to the Britain's Medical Research Council criteria at 6 months after operation. No obvious scar contracture was observed at donor site. ConclusionThe medial sural artery has the advantages of constant anatomical position, large diameter, rich blood flow, and a long artery pedicle, so the medial sural vessels is an ideal choice as recipient vessels for the reconstruction of leg skin and soft tissue defect.

    Release date: Export PDF Favorites Scan
  • DORSALIS PEDIS FLAP SERIES-PARALLEL BIG TOE NAIL COMPOSITE TISSUE FLAP TO REPAIR HAND SKIN OF DEGLOVING INJURY WITH THUMB DEFECT

    ObjectiveTo investigate the effectiveness of dorsalis pedis flap series-parallel big toe nail composite tissue flap in the repairment of hand skin of degloving injury with tumb defect. MethodsBetween March 2009 and June 2013, 8 cases of hand degloving injury with thumb defect caused by machine twisting were treated. There were 7 males and 1 female with the mean age of 36 years (range, 26-48 years). Injury located at the left hand in 3 cases and at the right hand in 5 cases. The time from injury to hospitalization was 1.5-4.0 hours (mean, 2.5 hours). The defect area was 8 cm×6 cm to 15 cm×11 cm. The thumb defect was rated as degree I in 5 cases and as degree II in 3 cases. The contralateral dorsal skin flap (9 cm×7 cm to 10 cm×8 cm) combined with ipsilateral big toe nail composite tissue flap (2.5 cm×1.8 cm to 3.0 cm×2.0 cm) was used, including 3 parallel anastomosis flaps and 5 series anastomosis flaps. The donor site of the dorsal flap was repaired with thick skin grafts, the stumps wound was covered with tongue flap at the shank side of big toe. ResultsVascular crisis occurred in 1 big toe nail composite tissue flap, margin necrosis occurred in 2 dorsalis pedis flap;the other flaps survived, and primary healing of wound was obtained. The grafted skin at dorsal donor site all survived, skin of hallux toe stump had no necrosis. Eight cases were followed up 4-20 months (mean, 15.5 months). All flaps had soft texture and satisfactory appearance;the cutaneous sensory recovery time was 4-7 months (mean, 5 months). At 4 months after operation, the two-point discrimination of the thumb pulp was 8-10 mm (mean, 9 mm), and the two-point discrimination of dorsal skin flap was 7-9 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the results were excellent in 4 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. ConclusionDorsalis pedis flap series-parallel big toe nail composite tissue flap is an ideal way to repair hand skin defect, and reconstructs the thumb, which has many advantages, including simple surgical procedure, no limitation to recipient site, soft texture, satisfactory appearance and function of reconstructing thumb, and small donor foot loss.

    Release date: Export PDF Favorites Scan
  • 指动脉皮支皮瓣修复手指皮肤缺损

    目的总结应用指动脉皮支皮瓣修复手指软组织缺损的方法及效果。 方法2008年8月-2014年8月,以指动脉皮支供血设计切取皮瓣修复2~5指软组织缺损52例65指,其中男36例,女16例;年龄18~66岁,平均39.6岁。创面缺损范围10 mm×6 mm~26 mm×22 mm。受伤至手术时间2~10 h,平均6.5 h。皮瓣切取范围13 mm×10 mm~30 mm×25 mm。 结果4例皮瓣有水疱形成,1例皮瓣远端皮缘坏死,均经相应处理后愈合;其余皮瓣均成活,切口Ⅰ期愈合。供区创面植皮Ⅰ期愈合。47例58指获随访,随访时间6~25个月,平均14.3个月。术后皮瓣外观及感觉良好,皮瓣感觉恢复达S3;两点辨别觉6~10 mm,平均7.8 mm。手指功能恢复满意,按手指总主动活动度(TAM)法评定获优39指,良17指,可2指,优良率96.6%。供区无瘢痕挛缩、肌腱粘连等并发症发生。 结论指动脉皮支皮瓣不牺牲主要血管、血供可靠,操作简便、安全,术后效果满意,是修复手指皮肤软组织缺损较理想方法。

    Release date: Export PDF Favorites Scan
  • 陈旧性第一掌骨基底部骨折脱位的手术治疗

    目的 总结手术治疗陈旧性第 1 掌骨基底部骨折脱位(Bennett骨折)疗效。 方法 2012 年 2 月—2015 年 3 月,采用韧带松解联合克氏针固定方法治疗 10 例陈旧性 Bennett 骨折患者。其中男 8 例,女 2 例;年龄 24~44 岁,平均 35.3 岁。伤后至手术时间为 5~14 周,平均 7.5 周。术前拇示指捏力为 1~3 级,平均 1.8 级。术后石膏外固定 4~8 周,骨折愈合后去除克氏针,期间在康复师指导下进行功能锻炼。 结果 术后切口均Ⅰ期愈合。10 例均获随访,随访时间 7~16 个月,平均 12.5 个月。X 线片及 CT 检查示第 1 腕掌关节对位好,无再脱位发生;骨折均愈合,愈合时间 2~4 个月,平均 3.5 个月。1 例伤后 14 周手术患者,术后第 1 腕掌关节仍存在持续疼痛症状,X 线片检查见关节毛糙、间隙变窄,证实第 1 腕掌关节炎形成;其余患者无关节炎发生,第 1 腕掌关节处无明显疼痛,关节稳定。末次随访时,拇示指捏力为 3~12 级,平均 6.8 级。根据手指关节总活动度(TAM)系统评定方法评价疗效,优 7 例,良 2 例,差 1 例,优良率 90%。 结论 对于陈旧性 Bennett 骨折,通过适当松解桡背侧韧带联合克氏针内固定治疗,可取得良好疗效。

    Release date:2017-06-15 10:04 Export PDF Favorites Scan
2 pages Previous 1 2 Next

Format

Content