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踝关节缺损的修复重建二例

改良第一趾蹼皮瓣游离移植修复拇指指腹缺损

目的 总结吻合血管改良第1 趾蹼皮瓣游离移植修复拇指指腹缺损的疗效。 方法 2008 年2 月－2011 年2 月，收治拇指指腹缺损12 例。男8 例，女4 例；年龄20 ～ 57 岁，平均32.9 岁。机器绞伤7 例，电刨伤3 例，压砸伤2 例。新鲜创面10 例，受伤至入院时间为2 ～ 6 h；陈旧性创面2 例，均为拇指再植术后指腹坏死，于伤后13 d 及15 d 入院。创面范围3.0 cm × 2.0 cm ～ 3.6 cm × 2.8 cm，采用吻合血管改良第1 趾蹼皮瓣游离移植修复，切取的改良皮瓣保留了趾蹼原有功能结构，皮瓣切取范围3.4 cm × 2.3 cm ～ 4.4 cm × 3.0 cm；供区游离植皮或用穿支血管蒂足内侧隐神经营养血管皮瓣修复。 结果 术后供、受区皮瓣和植皮均完全成活，切口Ⅰ期愈合。术后患者均获随访，随访时间8 ～24 个月，平均10 个月。修复后拇指外形美观，伸屈、对掌功能正常，感觉恢复至S3 4 例，S3+ 6 例，S4 2 例。 结论 吻合血管改良第1 趾蹼皮瓣游离移植修复拇指指腹缺损，外形、功能恢复好，供区损伤小，是较好的修复方法之一。

（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。

The management of day surgery in minimally invasive surgery for 517 patients with early-stage lung cancer by enhanced recovery after surgery

ObjectiveTo evaluate the safety and effect of day surgery in minimally invasive surgical treatment of early-stage lung cancer by enhanced recovery after surgery (ERAS).MethodsWe included the patients discharged from the day surgery ward of thoracic surgery after surgery in Shanghai Pulmonary Hospital between June and November 2019. We retrospectively analyzed surgical indications of day surgery, management and perioperative medical history of the patients. A total of 517 patients were included, with 156 male and 361 female patients aged 46.4±10.9 years. A total of 45 patients underwent single port VATS segmentectomy and 472 patients underwent single port VATS wedge resection.ResultsThe average operation duration was 33.7±18.5 min. The average intraoperative blood loss was 28.5±21.4 mL. There was no intraoperative blood transfusion or conversion to thoracotomy. Postoperative pain score was 2.1±0.2. The average hospitalization was 1.94±0.89 days. The total hospitalization cost of the patients was 34686.51±6228.09 Yuan, which was 29.93% lower than the same surgery methods in the general ward. A percentage of 98.2% patients were satisfied or very satisfied in the patient satisfaction survey.ConclusionDay surgery and ERAS are effective and safe in minimally invasive surgery of early-stage lung cancer. It can also speed up the postoperative recovery of patients, improve the occupancy efficiency of hospital beds and save the medical cost.