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find Keyword "皮肤缺损" 95 results
  • 足趾侧方皮瓣修复多趾背皮肤缺损

    目的 总结足趾侧方皮瓣修复多趾背皮肤缺损的疗效。 方法2008年8月-2011年12月,收治 6例(14趾)多趾背皮肤缺损。男5例,女1例;年龄21~57岁,平均35岁。致伤原因:压砸伤4例,热压伤1例,机器轧伤1例。受伤至手术时间5 d~1个月。3趾趾背皮肤缺损2例,2趾趾背皮肤缺损4例。皮肤缺损范围为1.2 cm × 1.2 cm~2.5 cm × 1.8 cm。创面均伴有深部组织外露或损伤。采用大小为1.3 cm × 1.2 cm~2.6 cm × 1.8 cm足趾侧方皮瓣修复缺损,供区游离植皮修复。 结果术后皮瓣及供区植皮均顺利成活,创面Ⅰ期愈合。患者均获随访,随访时间4~12个月。皮瓣外观无明显臃肿,血运、感觉恢复良好,穿鞋及行走无障碍。供区移植皮片有不同程度挛缩。 结论足趾侧方皮瓣解剖恒定、切取简便、成活率高,是修复多趾背皮肤缺损的有效方法之一。

    Release date:2016-08-31 04:06 Export PDF Favorites Scan
  • 指固有动脉中段背侧支岛状皮瓣移位修复指间关节背侧皮肤软组织缺损

    目的 总结指固有动脉中段背侧支岛状皮瓣移位修复指间关节背侧皮肤软组织缺损的疗效。 方法 2008年3月-2012年5月,收治36例38指指间关节背侧皮肤缺损患者。男19例20指,女17例18指;年龄17~63岁,平均38岁。损伤原因:挤压伤10例,压砸伤6例,热压伤2例,机器绞伤8例,电锯伤7例,交通事故伤3例。病程1 h~34 d,平均4 h。损伤指别:示指9指,中指13指,环指11指,小指5指。皮肤缺损范围为0.6 cm × 0.4 cm~2.1 cm × 1.8 cm。采用大小为0.7 cm × 0.5 cm~2.3 cm × 2.0 cm的指固有动脉中段背侧支岛状皮瓣移位修复。供区行全厚皮片打包缝合。 结果术后皮瓣及供区植皮均成活,创面Ⅰ期愈合。36例均获随访,随访时间6个月~1年11个月,平均10个月。皮瓣质地、色泽、外形良好。末次随访时,指关节采用手部总主动活动度(TAM)评价法评定:获优29指,良8指,可1指,优良率达97.4%。 结论采用指固有动脉中段背侧支岛状皮瓣移位修复近、远侧指间关节背侧皮肤软组织缺损,是一种较理想的方法。

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • EXPERIMENTAL STUDY ON REPAIR OF SKIN DEFECTS BY TISSUE ENGINEERED SKIN WITH ISOGENEIC CELLS

    Objective To evaluate the effect of tissue engineered skin with isogeneic cells on repairing skin defects in inbred rat model so as to provide relevant evidences for the clinical application. Methods The skins of newborn inbred F344 rats were harvested and treated with Dispase trypsin to isolate the epidermal cells. The skins of adult Sprague Dawley rats were obtained and treated with hypertonic sodium-SDS-trypsin to prepare the acellular dermal matrix. The tissue engineered skin was reconstructed by submerging culturing and air-liquid interface culturing in vitro. The full-thickness skin defects of 1.5 cm × 1.5 cm in size were prepared along the dorsal both sides of 36 adult inbred F344 rats, and 72 defects were repaired with tissue engineered skin in experimental group (n=24), with allogeneic acellular dermal matrix in negative control group (n=24), and with autologous full-thickness skin in positive control group (n=24). Finally the gross observation, the survival rate, wound contraction rate, and histological observation were used to evaluate the effect. Results The wound healed by first intension at 4 weeks postoperatively in the experimental group; the grafts connected with the adjacent tissue tightly and had normal appearance. At 4 weeks after operation, the survival rate of the graft was 0 in the negative control group; the survival rates were 62.5% (15/24) in the experimental group and 91.7% (22/24) in the positive control group, showing significant difference between 2 groups (χ2=5.779, P=0.016). The wound contraction rates of the experimental group and positive control group were significantly lower than that of the negative control group (P lt; 0.05), but no significant difference was found between the experimental group and positive control group (P gt; 0.05). Histological observation showed that slight inflammation reaction appeared at 1 week postoperatively in the experimental group; the regeneration of the blood vessel and the proliferation of the fibroblasts in dermis and the gradual maturation of epidermis were observed at 2 weeks, and new collagen deposition and collagen remodeling in the dermis of the graft were found at 4 weeks postoperatively. Conclusion The tissue engineered skin is able to repair full-thickness skin defect of rats effectively, it has similar effect to the autologous full-thickness skin in preventing the wound contraction and promoting the wound healing, which provides experimental evidences for the clinical application.

    Release date:2016-08-31 04:22 Export PDF Favorites Scan
  • 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
  • (足母)趾底内侧动脉皮穿支血管蒂隐神经营养血管逆行皮瓣修复前足皮肤缺损

    目的 探讨(足母)趾底内侧动脉皮穿支血管蒂隐神经营养血管逆行皮瓣修复前足皮肤缺损的疗效。 方 法 2007 年2 月- 2010 年3 月,收治前足皮肤缺损患者16 例。男11 例,女5 例;年龄22 ~ 53 岁,平均37.5岁。致伤原因:交通事故伤4 例,压榨伤12 例。缺损部位:(足母)趾5 例,前足跖侧8 例、背侧3 例。新鲜创面12 例,陈旧创面4 例。创面范围为5.0 cm × 3.5 cm ~ 10.0 cm × 6.0 cm。术中切取大小为8 cm × 6 cm ~ 12 cm × 7 cm、以(足母)趾底内侧动脉皮穿支为血管蒂的隐神经营养血管逆行皮瓣修复缺损。供区游离植皮修复。 结果 术后6 d 1 例皮瓣出现远端浅表坏死,经换药1 周后愈合;其余皮瓣及供区植皮均顺利成活,创面Ⅰ期愈合。患者术后均获随访,随访时间7 ~ 18 个月,平均8 个月。皮瓣外观、质地良好;感觉功能恢复至S1 1 例,S2 3 例,S3 12 例;两点辨别觉2 ~ 4 mm,平均2.6 mm。足趾及踝关节活动范围正常。 结论 (足母)趾底内侧动脉皮穿支蒂隐神经营养血管逆行皮瓣为多源性供血,手术切取简便、安全,术后外形良好,可恢复受区感觉,是修复前足皮肤缺损的有效方法之一。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • 封闭式负压引流技术应用于植皮术的临床疗效

    目的 通过与传统打包加压植皮法比较,分析封闭式负压引流技术(vaccum sealing drainage,VSD)应用于骨科植皮手术的临床效果。 方法 2006 年8 月- 2010 年6 月,收治106 例四肢各种组织损伤合并皮肤缺损者,其中57 例采用VSD 联合植皮术治疗(试验组),49 例采用传统打包加压植皮法治疗(对照组)。试验组:男31 例,女26例;年龄18 ~ 52 岁,平均35.6 岁;植皮部位:上臂1 例,前臂8 例,手背8 例,大腿3 例,小腿25 例,足踝12 例;创面范围7 cm × 6 cm ~ 25 cm × 20 cm;伤后至植皮术时间8 ~ 26 d,平均12.7 d。对照组:男28 例,女21 例;年龄16 ~ 59 岁,平均38.3 岁;植皮部位:上臂1 例,前臂5 例,手背7 例,大腿2 例,小腿25 例,足踝9 例;创面范围5 cm × 5 cm ~ 15 cm ×13 cm;伤后至植皮术时间7 ~ 38 d,平均14.6 d。两组患者一般资料比较,差异均无统计学意义(P gt; 0.05),具有可比性。 结果 试验组:术后植皮均成活,成活率100%;植皮愈合时间(8.8 ± 3.2)d。对照组:术后9 d 11 例出现皮片局部感染,5 例出现皮片缺血性坏死,成活率67.3%;植皮愈合时间(15.9 ± 5.8)d。两组植皮成活率比较,差异有统计学意义(χ2=19.440,P=0.000);植皮愈合时间比较,差异有统计学意义(t=1.730,P=0.000)。患者均获随访,随访时间3 ~ 18 个月, 平 均7.6 个月。试验组植皮区外观良好,瘢痕组织较对照组少。 结论 VSD 可使皮片与创面充分、紧密接触,加压均匀,提高了植皮术后皮片成活率。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • (足母)趾腓侧皮瓣游离移植修复手指掌侧皮肤缺损

    目的 总结(足母)趾腓侧皮瓣游离移植修复手指掌侧皮肤缺损的疗效。 方法 2005 年7 月-2009 年9 月,收治手指掌侧皮肤缺损20 例。男16 例,女4 例;年龄18 ~ 56 岁,平均28.5 岁。致伤原因:机器绞伤12 例,爆炸伤5 例,感染引起局部坏死3 例。拇指14 例,示指3 例,中指3 例。17 例外伤创面有不同程度污染,伤后至入院时间为1 ~ 6 h;3 例感染创面发生局部皮肤坏死,伤后至该次入院时间为15 ~ 53 d。创面缺损范围3.0 cm × 2.0 cm ~ 3.5 cm × 2.5 cm。术中采用大小为3.5 cm × 2.5 cm ~ 4.0 cm × 3.0 cm 的(足母)趾腓侧皮瓣游离移植修复创面,供区植皮修复。 结果 1 例术后2 d 因动脉危象导致皮瓣坏死,行邻指指固有动脉侧方皮瓣移位修复后成活;其余皮瓣及植皮均顺利成活,创面均Ⅰ期愈合。术后19 例获随访,随访时间6 ~ 18 个月,平均12 个月。手指外形、质地较好。末次随访时示、中指掌指关节屈曲达80 ~ 90°,近侧指间关节屈曲达80 ~ 100°,远侧指间关节屈曲达20 ~ 30°;拇指指间关节屈曲30 ~ 80°;对指、对掌功能不受限。供足行走正常。 结论 (足母)趾腓侧皮瓣游离移植修复手指掌侧皮肤缺损具有质地结构相似、精细感觉恢复优良、不需二次整形等优点,是有效治疗方法之一。

    Release date:2016-08-31 05:43 Export PDF Favorites Scan
  • 掌背动脉肌腱皮瓣修复手指皮肤合并肌腱缺损

    目的 总结第2、4 掌背动脉肌腱皮瓣修复手指皮肤合并肌腱缺损的临床疗效。 方法 1995 年7 月- 2010 年6 月,采用第2、4 掌背动脉肌腱皮瓣修复28 例外伤致手指皮肤合并肌腱缺损患者。男19 例,女9 例;年龄17 ~ 48 岁,平均29 岁。示指14 例,中指9 例,环指5 例。指背23 例,指腹5 例。皮肤缺损范围为2.5 cm × 2.4 cm~ 5.6 cm ×4.5 cm,肌腱缺损长度为1.3 ~ 4.8 cm。急诊手术19 例,择期手术9 例。术中皮瓣切取范围为3.5 cm × 3.4 cm ~ 6.6 cm ×5.5 cm。5 例伴指骨缺损者取自体髂骨植骨修复。供区直接拉拢缝合。 结果 术后4 d 7 例皮瓣远端出现水疱,经换药痊愈;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合。28 例均获随访,随访时间5 ~ 12 个月,平均10 个月。5 例指骨缺损者术后3 个月植骨均骨性愈合。皮瓣外形较满意,质地柔软。末次随访时肌腱功能恢复按手指总主动活动度(TAM)评定法:获优9 例,良15 例,中4 例,优良率85.7%。 结论 第2、4 掌背动脉肌腱皮瓣修复手指皮肤合并肌腱缺损具有外形及功能恢复满意的优点,是一种较好的修复方法。

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • EXPERIMENTAL STUDY ON PORCINE ACELLULAR DERMAL MATRIX AND SPLIT-THICKNESS SKIN GRAFTS TO REPAIR FULL-THICKNESS SKIN DEFECTS

    Objective To compare the effect of the composite skin graft consisting of spl it-thickness skin grafts (STSGs) and porcine acellular dermal matrix (PADM) with STSGs only, and to histologically observe the turnover of the PADM in rats. Methods Twenty female Sprague-Dawley rats, weighing 200-225 g, were included. The size of 4.0 cm × 2.5 cm PADM was implanted into hypoderm of the left side of Sprague-Dawley rats’ back. After 10-14 days, the size of 4.0 cm × 2.5 cm full-thickness skin defects were made on the left to expose the PADM under the skin and the same size of full-thickness skin defects were made on the right of the rats’ back. The excised full-thickness skin was made to STSGs about 0.2 mm by drum dermatome. The defects were grafted with composite skin (STSGs on the PADM, experimental group) and STSGs only (control group). The survival rate, the constraction degree of grafts, and the histological change in grafts area were observed at 2, 4, 8, and 20 weeks after operation. Results At 2 weeks after STSGs (0.2 mm) placed on vascularized PADM, STSGs and PADM adhered together and the composite skin had a good survival. The control group also had a good survival. Histological observations showed that STSGs and PADM grew together, neutrophil ic granulocytes and lymphocytes infiltrated in the PADM and some macrophages around the PADM. Fibrous connective tissues were filled under the STSGs in control group. At 4-8 weeks after transplantation, the composite skin had a good survival and the composite skin was thick, soft, and elastic. STSGs survived almost totally in control group, but the grafts were thin. Histological observations showed that inflammatory reactions of PADM faded gradually in experimental group; scar tissues formed under the STSGs in control group. At 20 weeks after transplantation, composite skin was flat, thick, and elastic in experimental group, but the STSGs were thinner and less elastic in control group. Histological observations showed that histological structures of the PADM were similar to the dermal matrix of rats, and the results showed that the collagen matrix of PADM was gradually replaced by the rats’ collagen matrix. Scar tissues were filled under the STSGs in control group. Wound heal ing rates of experimental group were lower than those of control group at 4 and 8 weeks (P﹤0.05); wound contraction rates of experimental group had lower tendency than those of control group, but showing no significant differences (P gt; 0.05). Conclusion  Coverage wound with composite skin which composed of STSGs and PADM could improve wound heal ing qual ity; the composite skin is thicker and better elastic than STSGs only. The collagen matrix of PADM is gradually replaced by rats’ collagen matrix.

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • AN EXPERIMENTAL STUDY ON REPAIRING FULL-THICKNESS SKIN WOUND BY HUMAN ACELLULAR AMNIOTIC MEMBRANE LOADED WITH ADIPOSE-DERIVED STEM CELLS IN RATS

    Objective Human acellular amniotic membrane (HAAM) contains collagens, glucoproteins, proteinpolysaccharide,integrin, and lamellar, which can supply rich nutrition to cell prol iferation and differentiation. To explore the possibil ity of HAAM with adi pose-derived stem cells (ADSCs) as a good engineered skin substitute for repairing skin defect. Methods Primary ADSCs were obtained from inguinal fat of 30 healthy 4-month-old SD rats, male or female, weighing 250-300 g, and cultured in vitro and purified. The 3rd passage ADSCs were used to detect CD44, CD49d and CD34 by immunocytochemistry staining. After physical and trypsin preparation, the HAAM was observed by HE staining and scanning electron microscope(SEM) respectively. ADSCs were seeded on epithel ial side of HAAM at the density of 2 × 105/cm2, cocultured, and observed by SEM at different time. MTT test was used to detect viabil ity of cells that seeded on HAAM, the group without HAAM was used as control. Thirty SD rats were made models of full-thickness skin wound and randomly divided into three groups (A, B, and C). Wound was repaired with HAAM/ADSCs composites in group A, with HAAM in group B, and with gauze as control in group C. The rats underwent postoperative assessment of wound heal ing rate and histological observation at the 1st, 2nd, and 4th weeks. Results HE staining showed that the 3rd passage ADSCs was spindle-shaped with an ovoid nucleus which located in the middle of cell; the immunocytochemistry staining showed positive result for CD44 and CD49d and negative result for CD34. There were no residues of cells in the HAAM by HE staining. SEM showed that there were different structures at the two sides of HAAM;one side had compact reticular structure and the other side had fibrous structure. After 3 days of co-culture, ADSCs showed good growth on HAAM; the cells were closely packed onto the HAAM, attached firmly and prol iferated to confluence on the stromal surface of HAAM. MTT test showed that the cells on the HAAM grew well and had b prol iferation vital ity. There was no significant difference between ADSCs cultured in the HAAM and control group (P gt; 0.05). One, 2, 4 weeks after graft, there were significant differences in wound heal ing rate between group A and groups B, C (P lt; 0.05), between group B and group C (P lt; 0.05). HE staining showed that wound healed faster in group A than in groups B, C. Cytokeratin 19 (CK19) immunohistochemical statining showed that there were more CK19 positive cells in group A than in groups B, C. Conclusion The graft of HAAM with ADSCs plays an effective role in promoting the repair of full-thickness skin wound

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
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