<正>手指皮肤缺损在临床上十分常见,处理不当会影响手指的外观和功能。现将笔者所在医院采用带掌(指)背皮神经的逆行筋膜蒂岛状皮瓣修复手指皮肤缺损22例报告如下。1资料与方法1.1一般资料本组22例22指。男16例,女6例;年龄18～52岁,平均28岁。其中拇指3例,示指4例,中指9例,环

目的 探讨应用掌指背皮神经筋膜蒂岛状皮瓣修复再植术后手指皮肤缺损的临床效果.方法 设计包含掌指背神经的筋膜蒂岛状皮瓣,逆行旋转修复再植术后手指皮肤缺损19例,皮瓣面积:1.5cm×1.9cm～2.0cm×5.5cm.结果 19例皮瓣全部成活,术后随访6～12个月,平均7.8个月,皮瓣外观良好、质地柔软、色泽正常、功能满意.结论 掌指背皮神经筋膜蒂岛状皮瓣操作简单,不损伤手指主要血管、神经,创伤小,对再植手指血运影响小,外观满意,是处理手指再植术后皮肤缺损的良好选择.

Objective To study the anatomy of the soleus muscle perforator flap and its clinical application.Methods In 6 cadavers specimen with 12 lower limbs,the cutaneous branches and soleus muscle perforator artery were dissected and their measurements were recorded.Fourteen patients with skin and soft tissue defects from July 2002 to October 2010 were repaired by the soleus muscle perforator flap.Of the 14 patients,eight for dorsal and anterior defects of foot,two for anterior defects of malleolus,two for hand defects,two for elbow defects.The size of the flaps was 5 cm × 6 cm - 12 cm × 20 cm.Flap success rates and postoperative course were evaluated. Results The soleus musclocutaneous perforators mostly appeared within 5 - 24 cm length below the head of fibula.The diameter of the artery cutaneous perforator was( 1.08 ±0.22)mm,vena concomitants was (1.20 ± 0.32)mm.All flaps were survived completely and the wounds got primary closure in 14 cases.The flaps were not overstaffed,and their shape,texture and color were similar to normal.All of the 14 cases were evaluated as satisfactory after 6 months to 12 months follow-up. Conclusion The free soleus muscle perforator flap is an ideal flap for repairing skin and soft tissue defects with the merit of simple procedure,minimal trauma and more physiological circulation established.

目的 回顾总结手部复合组织缺损修复重建的方法以及对手术方法评价分析.方法 对于手部骨关节、皮肤等复合组织缺损,采用(带血管)自体骨与皮瓣组合,带血管跖趾关节或游离足趾与皮瓣组合等方法,再造重建残缺腕、手与手指.骨、关节及皮肤缺损根据伤情可采用同期重建也可采用分期重建方法,伴有肌腱缺损可采用自体肌腱移植方法二期重建.结果 本组18例经8个月～2年随访,参照中华医学会手外科学会断指再植功能及上肢功能评定试用标准,我们从运动、感觉、外观三方面予以评价:(1)运动功能评价(手指运动功能按手指总活动度,TAM),优5例,良6例,优良率61.1 %.(2)感觉功能评价:指骨、掌骨、掌指关节重建患者手指感觉功能无明显缺失,优(S5)8例,良(S4)1例;残缺手分期重建病例感觉较差(S3)4例.(3)外观评价(按照外形、臃肿度、有无崎形及患者主观满意度等几方面):优6例,良7例,美观满意率为72.2 %.结论 采用自体骨与皮瓣组合、自体足趾及关节移植与皮瓣组合等方法重建手部复合组织缺损,能在一定程度上恢复手部外形及功能,降低手和手指伤残程度.

Objective To study the method of solving the complications of large allograft including resorption, nonunion and refracture by means of vascularization and the way of improving bone healing. Methods The bone defect longer than 10 cm of limbs were found in 21 cases, plate or external fixator were used to fix allograft bone, and then vascularied autologous bone or periosteum were transplanted or inserted to the massive allograft In order to vascularizate allograft, improve bone healing and prevent complications of bone resorption and osteolysis. 4 cases were implanted by local vascular bondle in one end. 4 cases were transplanted vascular iliac bone into middle part the allograft bone, 2 cases were into one end. 2 cases were transplanted by vascular fibular bone. 6 cases were used vascular periosteum. 3 cases were used combined methods. Results Twenty-one cases with 10 cm or more bone defect in this group were treated by the method above. 14 cases were achieved primary healing, 6 were healing by farther operation, 1 failure. Complications were found in 7 cases, 4 occur infection in all. All were achieved satisfactory function and outlook by follow-up. Conclusion The method of vascularied autologous bone or periosteum combined with massive allograft are effective to improve bone union, reduce the complication of bone resorption and osteolysis,which proved usefull to treat large bone defect.

腕舟骨骨折是临床上较常见骨折,由于血供较差和治疗不当,常见骨折延迟愈合和骨不连.我科在2004年12月至2007年12月期间采用带桡动脉返支的桡骨瓣并舟骨中心植骨治疗陈旧性腕舟骨骨折患者15 例,疗效较好,现分析报告如下.

<正>严重外伤造成跖骨及足部软组织缺损导致前足缺损是临床常见损伤,如何修复骨和皮肤的复合缺损,重建前足负重功能,恢复足部的生物力学特性,一直是显微外科领域内的一个难题。2000-02～2009-12笔者所在科采用游离皮瓣复

Objective To explore and solve the problem of insufficiency and malformation due to cripple hand and defect of digital bone resulted of innate and injured. Evaluation to the methods of bone autografting combinated with flaps to reconstruct the deficient hand and digits. Methods Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps were used to reconstruct the defected bone in palm or fingers. Combined with tendon absence in such cases should be repaired or restituted by tendon autografting in one stage or by stages. Results Total 16 cases were treated by the methods metioned above. Except 1 of 16 was failure resulted in severe infection, the others were reconstructed successfully. 13 of 16 were followed up 8 months to 2 years, the evalution of the group from motion,sensation and appearance shew that the fine rate of motion was 53.8 percent, the rate of appearance and sensation were both 69 percent. Conclusion Vascularized iliac bone or metatarsophalangeal joints (MPJ) or toes transplantation incorporated with flaps are available to reconstruct the defected bone in palm or fingers, and can reduce disability effectively while obtain a satisfactory outlook and proper functions by those methods.

踝关节在下肢负重行走功能中有着不可替代的作用,内外踝缺损将影响踝关节完整与稳定,导致踝关节内外翻畸形与创伤性关节炎的发生,对于骨骺未闭合的儿童,尤为重要。随着显微外科技术的发展,对其缺损的修复与重建日益受到

目的 研究因手指、掌骨缺损而导致手的外形和功能受限,通过显微外科技术重建的手术方法.方法 采用自体游离或带血管髂骨与皮瓣组合、带血管跖趾关节或游离足趾与皮瓣组合等方法一期或分期再造残缺手或手指.用局部皮瓣游离皮瓣或串联皮瓣修复缺损的软组织,同时修复关节囊及肌腱缺损.根据重建类型,术后1-3周予以康复训练.结果 本组19例,术后1例因严重感染导致手术失败并截指,2例部分皮肤创面予以二期覆盖,其余16例经8月～2.5年随访,按照中华医学会手外科学会断指再植功能评定试用标准评价结果,运动功能:优3例,良7例;感觉功能:优(S5)11例,良(S4)2例;外观评价:优5例,良6例.结论 采用自体骨与皮瓣组合、自体足趾及关节移植与皮瓣组合等方法重建手与手指骨缺损,能最大程度地恢复手部外形及功能,降低手和手指残缺率.

<正>肱骨干骨折骨不连在临床上并非少见,其原因甚多,其中由于医源性处理不妥导致延迟愈合及骨不连发生不可忽视。笔者通过对1999～2007年一组肱骨骨不连患者资料回顾性研究发现:内、外固定失当等原因为骨不连的重要原因之一。

目的 分析跖骨缺损对足弓的影响及髂骨重建对足功能恢复的意义.方法用三维激光测量仪测绘成人正常足骨骼标本,得到足的点云图和解剖特征数据,再结合临床实用简化模拟出胫侧组(1～3跖骨)、腓侧组(4～5)跖骨缺损后,以有限元法计算足弓应力和位移的改变;评价采用髂骨重建后足位移及应力恢复数据和结果.结果跖骨缺损导致足位移和应力的改变:与完整足相比较,1～3跖骨100%缺损,位移(USUM)增加2.15倍,应力(VON)增加2.12倍;1～3跖骨50%缺损USUM增加1.65倍,VON增加2.05倍;4～5跖骨100%缺损后VON增加1.09倍,USUM增加1.44倍;50%缺损VON增加1.03倍.临床采用髂骨重建后,足弓及足支撑点恢复,有限元模拟结果数据接近正常值,临床病例随访效果满意.结论前足损伤致足跖骨缺损临床上应予重建修复,恢复足的三点支撑和足弓.采用游离髂骨加皮瓣组合移植是较为理想的手术方式。

Objective To discuss the methods for repair and reconstruction of foot defects in order to reduce the deformity and insufficiency of f oot and to restore its functional and cosmetic aspects.Methods 247cases were treated for their foot defects of bon e and /or soft tissue.The defects of s imple soft tissue at dorsum,forefoot,heel,and sub-ankle were repaired by local transfer or rotation of cutaneous br anch flap,fascial flap,and free ski n flap or free full-thickness skin-grafting.The plantar defects were repaired w ith prefabricated flaps.The compou nd defects at the forefoot,heel and tarsal bones were reconstructed by using vascularized iliac bone incorporated with fr ee flap transfer.Results All the 247cases achieved satisfactory clinical results.They were asse ssed according to USA foot-malleolus scores of AOFAS.84c ases were excellent,107good,42fair,and 14poor.Conclusions Being flat in shape and rich in blood supply,the iliac bone is a valuable supply b one for foot defects,especially mul -ti-metatarsal and calcaneal ones.Defects of malleolus should be reconstructed by free iliac bone or free fib ular head graft with fascial strip.Vascularized bone grafts incorporated with va scularized flaps provide an ideal me thod for re-construction of compound foot defects.[