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find Author "金文虎" 32 results
  • EFFECT OF SCROTAL RECONSTRUCTION WITH FREE SKIN GRAFT ON SPERMATOGENESIS

    Objective To summarize the effect of free skin graft for repairing scrotal avulsion injury, and to investigate the repair impact of the method on spermatogenesis. Methods Between June 2001 and June 2010, 8 cases of complete avulsion injury of the scrotal skin were treated with the free skin graft, aged 22 to 64 years (mean, 29 years). The causes of injury included machine twisting in 4 cases, animal attack in 3 cases, and traffic accident in 1 case. The time between injury and hospital ization was 1-7 hours (mean, 3.5 hours). Five cases compl icated by avulsion of penile skin, 3 by perineal lacerationwith exposure of testes and spermatic cord, and 1 by avulsion of leg skin. Results After 10 days, 80% to 95% grafted skinsurvived. The reconstructed scrotum had shrinks and the wound healed by first intention after dressing change. Eight patients were followed up 12 to 24 months (mean, 16 months). At last follow-up, the patients had relaxed and droop scrotum, and penile erection was normal. Semen qual ity analysis showed: semen volume of 2-6 mL (mean, 4.2 mL); complete l iquefaction with l iquefaction time of 15-30 minutes (mean, 23 minutes); sperm density of (12-27) × 106/mL (mean, 16 × 106/mL); sperm motil ity of 45%-65% (mean, 56%); and sperm motil ity (grade A) of 25%-42% (mean, 32%). Conclusion Complete avulsion of the scrotal skin can be repaired by free skin graft, which has no significant effect on spermatogenesis.

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • Imaging study and clinical application of peroneal perforating chimeric tissue flap

    Objective To explore the feasibility of peroneal perforating chimeric tissue flap in repairing the composite defects of calf and heel based on lower limb angiography, and the clinical effect. Methods The digital subtraction angiography images of lower limbs of 50 patients met the selection criteria between May 2011 and October 2014 were used as the research object to observe the course of peroneal artery and its perforating vessels. Based on the observation results, between April 2015 and October 2020, the peroneal perforating chimeric tissue flap was designed to repair 7 cases of composite defects of the calf and heel. There were 5 males and 2 females with an average age of 38 years (range, 25-55 years). The causes of injury included traffic accident in 4 cases, falling from height in 2 cases, and machine strangulation in 1 case. There were 5 cases of calf skin defect and tibial defect. The size of skin defect ranged from 5 cm×3 cm to 11 cm×7 cm, and the length of bone defect was 5-8 cm. There were 2 cases of heel skin defect and calcaneal defect. The sizes of skin defects were 5.0 cm×4.0 cm and 7.5 cm×6.5 cm, and the bone defects were 3.0 cm×2.6 cm and 4.0 cm× 3.0 cm. For the calf defect, the size of skin flap ranged from 6 cm×4 cm to 12 cm×8 cm, and the length of the fibula was the same as that of the tibial defect. For the heel defect, the sizes of the skin flaps were 8.5 cm×5.5 cm and 13.0 cm×5.0 cm, and the lengths of the fibulae were 10 cm and 12 cm. Free transplantation was performed in 5 cases and pedicle transplantation in 2 cases. The wound at donor site was repaired with skin grafting or sutured directly. Results The peroneal artery ran close to the fibula 7.25-8.40 cm below the fibula head and send out 5-7 perforating vessels, with an average of 6.5 vessels. Perforating vessels mainly appeared in four places, which were (9.75±0.91), (13.21±0.74), (18.15±1.22), and (21.40±0.75) cm below the fibular head, with the occurrence rates of 94%, 90%, 96%, and 88%, respectively. Clinical application of 7 cases of peroneal perforating chimeric tissue flap all survived, all wounds healed by first intention. The skin graft at donor site survived and the incision healed by first intention. All patients were followed up 6-36 months, with an average of 12 months. Peroneal perforator chimeric tissue flap had good shape and soft texture. X-ray films showed that the bone graft healed well, and the healing time was 6-11 months (mean, 7 months). No obvious bone resorption was observed during follow-up. Five patients had no pain when walking, and 1 had mild pain with claudication. Postoperative heel ulcers formed in 1 case and healed after wearing custom plantar pressure dispersing shoes. At 6 months after operation, 2 patients were rated as grade Ⅳ and 5 patients as grade Ⅴ according to Holden walking function score. ConclusionThe peroneal perforating vessel distribution is constant and the peroneal perforating chimeric tissue flap is safe and reliable for repairing the composite defects of calf and heel.

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  • Anatomic study and clinical application of iliac crest chimeric tissue flap

    Objective To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds. Methods Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured. Results Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up. Conclusion The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.

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  • 不同程度耳廓撕脱伤的修复

    目的 总结不同程度耳廓撕脱伤修复方法的选择及疗效。 方法2005 年8月-2010年12月,收治26例耳廓撕脱伤患者。男10例,女16例;年龄5~63岁,平均27.5岁。致伤原因:机器绞伤9例,交通事故伤5例,暴力撕脱伤6例,动物咬伤6例。损伤部位:全耳廓撕脱6例,耳廓上1/3~2/3撕脱8例,耳廓外1/5~2/3撕脱6例,耳垂撕脱6例。受伤至手术时间1~12 h,平均4.5 h。直接清创原位缝合8例,血管吻合再植7例,一期清创、二期皮瓣再造5例,残端修整缝合6例。 结果术后6例残端修整缝合切口均Ⅰ期愈合;其余患者中耳廓完全成活14例,部分成活3 例,坏死3例。26例均获随访,随访时间6~24个月,平均16个月。直接清创原位缝合及血管吻合再植成活者耳廓外观优于其余方法。患者听力均正常。 结论对于全耳廓撕脱伤应首选血管吻合再植修复,对于耳廓撕脱组织小且无可供吻合血管者可选择原位直接缝合。

    Release date:2016-08-31 04:22 Export PDF Favorites Scan
  • RECONSTRUCTION OF POSTBURN POPLITEAL FOSSA CONTRACTURES USING POPLITEAL FOSSA MIDDLE ARTERY PEDICLED FLAPS IN CHILDREN

    Objective To investigate the characteristics of blood supply of popliteal fossa middle artery pedicled flaps and the feasibility of reconstruction of postburn popliteal fossa contractures using the flaps in children. Methods Between January 2008 and October 2010, 6 cases of postburn popliteal fossa contractures were recontructed using popliteal fossa middle artery pedicled flaps. Of them, 2 were boys and 4 were girls, aged from 2 years and 2 months to10 years. All burns were caused by hot water. The wound ranged from 5 cm × 4 cm to 10 cm × 8 cm after scar relaxation. The size of the flap ranged from 6 cm × 4 cm to 11 cm × 9 cm. Donor sites were covered with split-thickness skin graft in 5 cases, and sutured directly in 1 case. Results All the flaps and the skingraft survived; no vascular crisis or flap necrosis occurred. All incisions at donors and wounds healed by first intention. All patients were followed up 12-24 months. The color, texture, and appearance of the flaps were good. Hyperplastic scar was found at incision of popliteal fossa in 1 case at 6 months after operation; the range of motion (ROM) of the knee joint was 0-175°, and no obvious change was observed at 15 months after operation. The others had no functional disturbance of the knee joints or claudication; the ROM of the knee joint was 0-180°. Conclusion The popliteal fossa middle artery pedicled flap has reliable blood supply, simple operative procedure, and good results in reconstruction of popliteal fossa contracture.

    Release date:2016-08-31 04:24 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
  • 重建感觉的指固有动脉穿支蒂逆行岛状皮瓣的临床应用

    目的 总结重建感觉的指固有动脉穿支蒂逆行岛状皮瓣修复手指软组织缺损伴骨外露的临床疗效。 方法 2006 年9 月- 2010 年9 月,应用携带指固有神经背支或桡神经终支的指固有动脉穿支蒂逆行岛状皮瓣修复23 例26 指手指中末节软组织缺损伴骨外露。男14 例,女9 例;年龄15 ~ 60 岁,平均38 岁。示指10 指,中指9 指,环指7 指。创面范围为1 cm × 1 cm ~ 3 cm × 2 cm。病程1 h ~ 14 d。术中皮瓣切取范围为1.5 cm × 1.0 cm ~ 3.5 cm × 2.0 cm,供区全厚皮片植皮修复。 结果 术后1 例皮瓣出现远端青紫,经对症处理后成活;其余皮瓣及植皮均顺利成活,创面Ⅰ期愈合。术后14 例16 指获随访,随访时间6 ~ 12 个月,平均8 个月。皮瓣外形无臃肿,色泽、质地良好。术后6 个月根据手指总主动活动度(TAM)评定法:获优11 指,良4 指,可1 指。皮瓣感觉功能评定:S2 1 指,S3 2 指,S4 3 指,S5 10 指。 结论 采用重建感觉的指固有动脉穿支蒂逆行岛状皮瓣修复手指软组织缺损具有手术操作简便、供区隐蔽、血供可靠、成功率高的优点;术后可重建手指精细感觉,最大程度恢复手指功能。

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • CLINICAL APPLICATION OF LINK-PATTERN LATERAL POPLITEAL ARTERY PERFORATOR FLAP IN REPAIR OF POPLITEAL FOSSA SCAR

    ObjectiveTo discuss the feasibility and effectiveness of link-pattern lateral popliteal artery perforator flap in repairing popliteal fossa scar contracture in children or teenagers. MethodsBetween January 2009 and January 2013, 12 patients with popliteal fossa scar were admitted. Of them, 7 cases were male and 5 cases were female, aged from 3 to 17 years (median, 12 years). The disease duration was from 6 months to 5 years (median, 3 years). Wound was repaired with link-pattern lateral popliteal artery perforator flap after remission of popliteal fossa scar. The wound ranged from 6 cm×4 cm to 10 cm×7 cm, and the flap size ranged from 7 cm×4 cm to 12 cm×9 cm. The flap was with lateral sural cutaneous nerve in 5 cases, and lateral sural cutaneous nerve was retained at the donor area of 7 cases. The donor site was repaired using split-thickness skin graft. ResultsAll pedicled flaps and skin graft survived smoothly after operation. The wound at donor site healed by first intention. All the cases were followed up 12-36 months, with an average of 18 months. The flaps had good color, texture, and shape; scar obviously became softened, without hyperplasia or ulceration. The patients were free from lameness with knee range of motion of 0-180°. The squatting function was normal. Grafting skin was smooth in the donor area of the calf, without depression or scar hyperplasia. The senses of posterior-inferior calf and lateral of foot decreased or disappeared in 5 cases of flaps with lateral sural cutaneous nerve; at 6 months after operation, two-point discrimination was 12-14 mm (mean, 13 mm). The posterior-inferior calf was numb and discomfort in 7 cases of flaps with retained lateral sural cutaneous nerve; but after 3-6 months, the sense was obviously recovered, with no sense loss; at 6 months after operation, two-point discrimination was 5-7 mm (mean, 6 mm). ConclusionLink-pattern lateral popliteal artery perforator flap has reliable blood supply and the operation was simple. The cutaneous nerve can be retained in donor area. It is an ideal method for repairing wound after remission of popliteal fossa scar in children or teenagers.

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  • Repair of composite tissue defects and functional reconstruction of upper arm with latissimus dorsi Kiss flap

    Objective To investigate the effectiveness of latissimus dorsi Kiss flap for repairing composite tissue defects and functional reconstruction of upper arm. Methods Between March 2010 and November 2016, 12 cases of composite tissue defects of upper arm were repaired by latissimus dorsi Kiss flap with blood vessel and nerve bunch. There were 8 males and 4 females with a median age of 34 years (range, 21-50 years). The reason of injury included plowing mechanical injury in 4 cases, traffic accident injury in 5 cases, electrical injury in 2 cases, and resecting upper arm soft tissue sarcoma in 1 case. There were deltoid defect in 5 cases, triceps brachii and brachialis defect in 4 cases, and deltoid, triceps brachii, and brachialis damaged in varying degrees in 3 cases. The defect area ranged from 13 cm×7 cm to 20 cm×8 cm. Among them, there were 6 cases of fracture combined with partial bone exposure, one of them with bone defect. The disease duration was 3 hours to 6 months. The flap size ranged from 10 cm×6 cm to 15 cm×7 cm, and the donor sites were directly sutured. Results Twelve flaps survived with primary healing of wounds. Ten patients were followed up 6-26 months (mean, 14 months). At last follow-up, the flaps were soft and the skin color was similar to the surrounding skin. No obvious scar was found at donor sites. The abduction range of motion of shoulder was 30-90°. The muscle strength of brachialis were all at grade 4 or above. The superficial sensation and tactile sensation recovered partialy (S1 in 2 cases, S2 in 6 cases, S3 in 2 cases). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the shoulder joint function was excellent in 2 cases, good in 4 cases, and fair in 4 cases. Conclusion The design of the latissimus dorsi Kiss flaps are flexible, and the donor site can be directly sutured, with the nerves of the latissimus dorsi muscle can partialy reconstruct abduction function of upper arm. In general, the Kiss flap repairing upper arm defect can obtain satisfactory effectiveness.

    Release date:2017-09-07 10:34 Export PDF Favorites Scan
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