Objective:To investigate the surgical method and clinical effect of the free peroneal artery perforator flap designed by vascular localization with three-dimensional CT angiography（3D-CTA）in repairing soft tissue defects of the dorsal forefoot.Methods:A retrospective case series study was conducted to analyze the clinical data of 17 patients with soft tissue defects of the dorsal forefoot admitted to Hospital of the 80th Group Army of PLA from February 2015 to January 2019，including 11 males and 6 females，aged from 16 to 65 years［（39.2±9.7）years］. The area of soft tissue defects ranged from 3.0 cm×2.0 cm to 10.0 cm×7.0 cm，and the size of skin flap was from 3.5 cm×2.5 cm to 10.5 cm×7.5 cm. Preoperative 3D-CTA was performed to select the appropriate perforator vessels，and a personalized skin flap was designed according to the examination results and wound conditions. Of all，10 patients were repaired with the peroneal perforator flap at the first stage，and 7 patients grafted with peroneal perforator flap with wound expansion in the second stage. The perforator diameter，vertical distance from the starting point of the perforator to the tip of the lateral malleolus and horizontal distance from the starting point of the perforator to the outer edge of the lower leg were compared between preoperative 3D-CTA and actual intraoperative measurements. The survival of the flap and occurrence of the vascular crisis were observed after operation. The foot function was assessed with the American Orthopedic Foot and Ankle Society（AOFAS）ankle hindfoot score preoperatively and at postoperative 6 months. Six months after operation，effect of flap repair was evaluated by using flap satisfaction score and flap sensory function measured by the criteria established by British Medical Rresearch Council（BMRC）. Incision healing and motor function of the donor area were detected.Results:All patients were followed up for 6-12 months［（9.6±2.3）months］. There was no statistically significant differences in perforator diameter，vertical distance from the starting point of the perforator to the tip of the lateral malleolus and horizontal distance from the starting point of the perforator to the outer edge of the lower leg between preoperative 3D-CTA and actual intraoperative measurements（ P>0.05）. All flaps survived without vascular crisis. Six months after operation，a higher AOFAS ankle hindfoot score［（84.0±7.9）points］was found when compared to that preoperatively［（51.3±8.2）points］（P<0.05），with excellent results in 12 patients and good results in 5 patients. At 6 months after the operation，the thickness of the flap was flush with the surrounding skin，which did not affect the wearing of shoes；the thickness of the flap was level with the surrounding skin but did not affect the wearing of shoes. The repair effect was satisfactory with the flap satisfaction score of（8.7±2.3）points.Based on the criteria established by BMRC，the sensory function of the flap continued to improve，including 10 patients reaching the level of S 3-S 4 with the two-point discrimination of（10.2±2.0）mm and 7 patients reaching the level of S 2. All incisions at the donor area were healed well without obvious scar contracture or motion limitation. Conclusions:For soft tissue defects of the dorsal forefoot，3D-CTA assisted vascular localization is able to have individualized and precise design of peroneal artery perforator flap preoperatively to assist rapid and accurate skin flap cutting and accelerate defect healing and functional recovery in the dorsal foot. Moreover，the free peroneal artery perforator flap has advantages of high patients' satisfaction，with minor trauma on donar site or without damaging the main artery.

Objective:To explore the method and clinical effect of the free medial plantar flap with the nerve in the reconstruction of skin and soft tissue defect of heel in children.Methods:A series of retrospective analyses was conducted on the cases with heel skin and soft tissue defects admitted to the 89th Hospital of the PLA from July 2014 to February 2019. The medial plantar skin flap with cutaneous branches of the medial plantar nerve was harvested from the healthy side and transferred to the opposite side to repair the soft tissue defect of the heel of children. Then, the free skin graft was taken from the groin area to cover the donor site, and the wound was sutured directly. The appearance, texture, and color of the flap were observed, and the sensory recovery of the flap was evaluated two years after the operation. The functional condition was elevated by the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot function scoring system.Results:A total of 6 children with heel skin and soft tissue defects were enrolled, including 4 males and 2 females, aged from 3 to 13 years.There were 4 cases on the right, and 2 cases on the left side, the size of skin and soft tissue defect was 2 cm×3 cm-6 cm×7 cm. All 6 flaps survived, the skin graft area healed in one stage, and the size of the flap was 3 cm×4 cm-7 cm×8 cm. The patients were followed up for 2-3 years. The appearance of the flap was not bloated, the color and texture of the flap were similar to the surrounding tissue, and the pedicle was flat. The two-point discrimination of the flap was 5-10 mm, with an average of 7 mm. There were only pigmentation and no obvious scar in the donor site of the uninjured foot. The ankle joint function was evaluated according to the American Association of foot and ankle surgery : 4 cases were excellent and 2 cases were good.Conclusions:The free medial plantar flap with the nerve is similar to the heel tissue, with reliable blood supply, no damage to the main blood vessels, and good sensory recovery after transplantation. It is an ideal flap for repairing heel soft-tissue defects in children.

目的:探讨负压封闭引流技术在促进腹部带蒂皮瓣成活中的应用效果.方法:2010年2月-2017年2月,选择20例手部前臂皮肤软组织缺损应用腹部带蒂皮瓣修复患者,男12例,女8例,年龄16-50岁,平均年龄28岁,其中挤压伤8例,热压伤8例,电烧伤4例,单纯皮瓣修复10例,皮瓣+植皮修复10例,腹部皮瓣蒂部、皮瓣边缘缝合部位、皮片移植区全部应用VSD敷料覆盖,皮瓣蒂部放置负压引流管2-3条,持续负压吸引,术毕无需纱布覆盖包扎,术后10-21天断蒂,比常规断蒂时间3-4周,缩短了1-2周.结果:20例腹部带蒂皮瓣全部成活,无明显淤血肿胀现象,10例移植皮片全部成活,6例皮瓣蒂部皮肤出现红肿渗液,予以换药处理.结论:负压封闭引流技术可以有效保护皮瓣,促进腹部皮瓣血运建立,提高皮瓣的成活率以及缩短断蒂时间.

目的:探讨应用整形观念,大张网状皮片联合VSD技术治疗深度烧伤的临床效果.方法:2010 年2月-2016年10月,选择40例50% TBSA(Ⅲ°≤30% )以下深度烧伤患者,男28例,女12例,年龄16-50岁,平均年龄32岁,烧伤部位为四肢、躯干,包括手足等关节功能部位,切削痂时间为伤后3-7天,1次手术面积控制在20% -30%以下,切削痂创面应用VSD敷料覆盖,术后2周左右,切削痂创面肉芽组织形成,予以大张网状皮片移植,VSD敷料覆盖,持续负压吸引.结果:切削痂术后2周,肉芽组织新鲜生长良好,植皮术后10-14天观察移植皮片成活率95%以上,3-4周后网状皮片扩展良好,创面全部覆盖,随访6个月-1年,外形良好,无明显瘢痕增生及肢体功能活动障碍,生活质量明显提高.结论:应用整形观念,网状皮片移植结合VSD负压吸引技术是治疗深度烧伤的有效方法.

目的:探讨胫后动脉内踝上皮支皮瓣在修复足部远侧半深度创面的可行性及效果.方法:以胫后动脉2支低位皮支为蒂设计逆行内踝上皮支皮瓣,除保留蒂部附近5cm及部分皮肤蒂外游离掀起大部分,原位缝合行皮瓣延迟术,12-14天后行2期皮瓣转移术修复足部远侧半创面,14天后观察皮瓣成活,外形,患足功能,术前及术后血循环情况.与传统胫后动脉内踝上皮支皮瓣对比,评判延迟皮瓣转移术的优缺点.结果:19例患者中,皮瓣面积最大者达到30×12cm, 最远端达膝关节平面,最小者达到18×4cm,最远端达膝关节平面下约10cm.其中16例皮瓣完全成活,3例皮瓣边缘约2-3cm静脉回流略差,最终愈合.皮瓣弹性及色泽良好,外形臃肿较轻,患足术前及术后血循环无减弱,功能良好.结论:胫后动脉内踝上皮支延迟皮瓣形成面积大,长度长,成活率好,是修复足部远侧半深度创面的较理想方法.

Objective: To explore the effect of tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall in emergency treatment of laryngeal edema in patients with burns. Methods: From November 2000 to August 2018, 22 patients with severe burn or extremely severe burn combined with acute laryngeal edema were rescued in the author's unit, including 18 males and 4 females, aged 17 to 68 years. All patients were complicated with mild inhalation injury or above and more than deep partial-thickness burn to head, face, and neck. From November 2000 to October 2012, simple emergency tracheotomy was performed for 12 cases. From May 2013 to August 2018, tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall was performed for 10 cases. Rescue effect and complication of the two kinds of tracheotomy were recorded. Data were processed with Fisher's exact probability test. Results: Among the 12 patients treated with simple emergency tracheotomy, 5 cases survived and 7 cases died of suffocation during tracheotomy. Among the 10 patients treated with tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall, 9 cases survived and 1 case died of cardiac arrest caused by arrhythmia. There was statistically significant difference in successful rescue effect between the two kinds of tracheotomy (P<0.05). Among the 14 patients who were successfully rescued, symptoms of insomnia and post-traumatic stress disorder occurred in 12 cases, which were relieved after symptomatic treatment for 14 to 45 d without permanent hypoxic brain damage. Conclusions: In case of loss of the condition of preventive tracheotomy, first aid of acute laryngeal edema of burn patient is very difficult. Tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall is simple and rapid with high successful rate and amelioration of hypoxia, which is an ideal plan for laryngeal edema.

Background Traumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure. Methods Island flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed. Results The injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively. Conclusions Covering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time.

目的:探讨保留残存真皮的磨痂削痂联合法治疗混合度烧伤的可行性及效果.方法:2008-2014年的切痂植皮为主要术式的第1阶段(对照组)和2014至今的保留残存真皮的磨痂削痂联合手术法为主要术式的第2阶段(观察组).对比2组的手术时间,出血量,创面愈合时间、瘢痕增生情况,评判2种手术方案的优缺点.结果:观察组手术时间、出血量、创面愈合时间分别为(2.89±0.58)小时,(893.75±383.79)ml,(32.19±5.56)天,显著低于对照组的(4.04±0.58)小时(t=-5.894,P<0.01),(1921.05±762.00)ml(t=-4.888,P<0.01),(41.42±7.24)天(t=-4.167,P<0.01).观察创面愈合后瘢痕情况,观察组创面瘢痕增生普遍较轻,对照组瘢痕增生较明显.结论:混合度烧伤在临床大量存在,保留残存真皮的磨痂削痂联合法具有诸多优势,是处理混合深度烧伤创面的理想方法.

目的 探讨隔离皮瓣或皮片联合负压封闭引流(VSD)治疗肛周合并腰背会阴大面积撕脱伤的临床效果.方法 选取该院2010年3月至2016年8月救治的肛周合并腰背会阴大面积撕脱伤的患者10例为研究对象,均为车祸伤.应用隔离皮瓣或皮片联合VSD,附加回肠造口,双腔管绕凡士林油纱布填塞直肠,持续冲洗多管负压引流,创面植皮及多学科专科化处理.观察患者临床治疗效果.结果 10例患者全部治愈.6例肛周不完全性撕脱伤患者,无创面感染发生;4例环形肛周撕脱伤患者,创面感染控制,潜行腔隙闭合;10例植皮患者的整体成活率达90％ 以上.术后无肛门狭窄,分别于术后3个月(6例)和6个月(4例)实施回肠还纳术.结论 隔离皮瓣或皮片联合VSD是一种治疗肛周合并腰背会阴大面积撕脱伤较理想的方法.

<正>患者,男,40岁。不慎触及高压线引燃衣物火焰烧伤后4 h于2009￣11￣07入院。入院查体:体温38℃,意识清,精神差,声音嘶哑,胸闷憋气,尿量较少,头部毛发部分烧焦,头面颈躯干双上肢创面基底红白相间或苍白,阴茎部分创面焦痂存在,臀部双下肢创面大部分焦痂形成,右小腿环形焦痂,右足背动脉搏动未触及,左足背动脉搏动减弱。入院诊断:烧伤

<正>骶尾部褥疮好发于截瘫与自主运动困难者,局部遭受持续垂直压力而发病,治疗不及时或不当,可以久治不愈,并发严重感染后,创面迅速扩大,发展为坏死性筋膜炎,严重者危及生命。笔者所在医院自2005-08以来收治Ⅳ期臀部骶尾部褥疮合并坏死性筋膜炎8例,采用扩大清创、皮瓣或肌皮瓣

1 临床资料及治疗方法 本组18例患者均为大面积头皮及颅骨膜缺损(缺损面积9 cm×4 cm～31 cm×19 cm),均丧失头皮再植条件,其中男3例、女15例,年龄18～42(22±7)岁.致伤原因:车祸伤1例、电烧伤2例、机器辊轴绞伤15例.

患者女,19岁,因煤气中毒倒于火炉上约30 min而致伤,伤后4 h入院.查体:体温37℃,脉搏78次/min,呼吸20次/min,血压120/80 mm Hg(1 mm Hg=0.133 kPa).患者意识清楚,右侧颅、面、颈部烧伤,右额部分颅骨外露,颜色苍白;右眼睑炭化于硬不能睁开,右耳炭化,右侧鼻翼呈焦痂状;右侧嘴唇肿胀明显,张口困难;右颈部分焦痂干硬.左额部及上眼睑烧伤,有痛觉.

<正>小儿手掌侧瘢痕挛缩是烧伤后常见畸形,此类畸形的修复复杂,手术方式繁多,术后效果报道不一,值得深入研究。笔者自1998～2006年应用真皮下血管网皮片移植治疗小儿手掌侧瘢痕挛缩畸形54例,66只手。现将相关资料总结报告如下。

OBJECTIVE:To explore the therapeutic strategy of hot press injury complicating with blood vessel injury in the upper extremity.METHODS:Decompression procedure was carried out in 8 patients with hot press injury complicating with blood vessel injury in the upper extremities, but the effect was not of satisfactory because there were injuries to brachial, radial and ulnar arteries and also injury to the superficial or deep palmar arch. The blood vessels were repaired with direct anastomosis, anastomosis with flexion of the limb, or transplantation with great saphenous vein, and the wounds were covered with intermediate split-thickness skin graft or pedicled thoraco-abdominal skin flap.RESULTS:One patient with repair of the brachial artery and intermediate split thickness skin graft received amputation 4 weeks after operation because of lack of soft tissue coverage. The blood supply recovered completely in the other patients, so the affected limbs were saved.CONCLUSION:Prompt exploration and repair of blood vessel, and coverage of the wound with healthy soft tissue are key procedures for the management of hot press injury complicating with blood vessel injury in the upper extremities.

Objective To explore a new operative way for the treatment of pediatric functional part depth burn.Methods Ten cases(12 parts)with deep partial-thickness burn (① degree) had been treated with tangential excision and denatured preserved- dermis and large sheet thin skin autografting.The operative areas had been bangdaged with pressure for 8-10days.Results All antografts in 10 cases survived and the functions recovered very well.The skin offering wounds healed quickly and there was no scar sequel.Conclusion The combined application of preserved- degenerative reticular dermis and thin skin autografting is demonstrated an ideal way for the treatment of pediatric depth burn.

本组12例,均为男性.年龄19～27岁.致伤原因:热液烫伤8例,电烧伤4例.来院时,4例为伤后0.5h,5例为伤后2h内,3例为2d后.伤情特点:3例为面部烧伤,其中1例合并双手烧伤,5例为足部烧伤,4例为上肢烧伤,最大面积为11%TBSA,最小面积1%TBSA,创面除3例疱皮完全缺失外,其余9例疱皮大部分完整,创面有不同程度污物覆盖,自觉疼痛明显,无其它合并伤.处治方法:9例2h内入院患者均行1:2 000洗必泰纱布冷敷0.5h左右,并及时建立静脉通道、输注平衡液、镇静止痛,行简单清创,消毒后创面外用烫创油(湖南邵阳山秀医药化工有限公司生产),四肢创面用多层无菌纱布包扎,面部用烫创油纱布半暴露处理,适当抬高患肢,3例2d后入院患者用双氧水、1:2000洗必泰尽量清除创面污物后,彻底消毒,用烫创油纱布覆盖,简单包扎.均肌注TAT预防破伤风.经上述处治,后送6例,留观6例,住院时间平均为15d.

OBJECTIVE:To evaluate the result of free transmidline bi-lobed scapular skin flap transplantation to repair massive soft tissue defects in upper and lower extremities.METHODS:Free transmidline bi-lobed scapular skin flap was designed according to the characteristics of scapular skin and its vasculature, and they were used to repair massive soft tissue defects in upper and lower extremities as a result of hot crush injury and avulsion injury in 9 patients. The survival of the flap, the blood supply, the color and elasticity of the flap, as well as scar contraction and impairment in function were observed after operation.RESULTS:The largest flap formed with the horizontal branch and descending branch circumflex scapular artery were 31 x 14 cm and 22 x 16 cm, respectively. The horizontal branch went across the spinal midline for 10 cm. All skin flaps survived with good elasticity and without necrosis. The grafted skin was excellent in the appearance and elasticity, with no scar contracture , and function of the injured extremities recovered well 2 to14 months after the operation.CONCLUSION:Free transmidline bi-lobed scapular skin flap is an ideal procedure for the repair of massive soft tissue defects in upper and lower extremities.

1一般资料我科2002年4月～2005年4月组装改进“注射壶”及外置15例,获得满意效果。男性11例,女性4例。平均年龄27岁。头部4例,前胸2例,面部4例,四肢5例。手术方法：选好扩张器,按3～5毫升扩张1平方厘米计算。头部、前胸皮肤紧,按3ml计算,其余按5ml计算。常规消毒、铺巾张器大画出皮肤所需剥离范围及手术切口,切口一般选择瘢痕上为佳,切开皮肤,皮下组织,头部放在帽状腱膜下,面部放在SMAS筋膜浅层,其余放在深筋膜浅层,潜行分离,钝

Objective To explore the best treatment of residual burn wound.Methods The clinical reports of 118 cases with residual burn wound in our department from Oct.1995 to Oct.2003 were analyzed.Results Local or general water bath was used in all the cases and then different wounds were treated with antibiotics,basic fibroblast growth factor(bFGF) and burn oil.Conclusion Complex treatment after local or general water bath was the most effective method to residual burn wound.