OBJECTIVE: To investigate the clinical effects of the microsurgical treatment for the skin-degloving injury of the whole hand or foot. METHODS: From March 1984 to October 2001, we treated 6 cases of skin-degloving injury of the whole hand and foot. In 2 cases of skin-degloving hands, one was treated with free great omentum transplantation plus skin graft, the other with pedical abdominal S-shaped skin flap as well as mid-thick skin graft. In 4 cases of skin-degloving injury of the foot, 2 cases was repaired with free latissimus dosi musculocutaneous flap, 1 case with distall-based lateral skin flap of the leg and 1 case with free tensor fasciae latae muscle flap. The flap size ranged from 7 cm x 9 cm to 22 cm x 15 cm. One case was operated on the emergency stage, the other 5 cases on the delayed stage. The delayed time ranged from 2 to 14 days with an average of 6.6 days. RESULTS: All the flaps survived. After 1-2 year follow-up, the appearance and function of the hand and the foot were good. CONCLUSION: Microsurgery technique in repairing skin-degloving injury of the whole hand and foot can achieve good results. The keys to success are thorough debridement of the recipient area, appropriate selection of the donor site, good vascular anastomosis and active postoperative rehabilitation.
A total of 15 amputated adult upper limbs were used for this experiment by arterial infusion of Chengdu ink in 10% formalin, followed by dissection of the specimens, and then undergoing the process of making the specimens transparent. The speciments were immersed in winter-green oil, and the vascular architecture at the different levels of the flexor tendon of fingers were observed under surgical microscope. It was noted that the vascular supply of the flexor tendons of the fingers had a regular pattern: a richer blood vessels inside te tendon sheath were distributed eccentrically over the tendon; the blood vessels in the interior of the tendon located in the connecive tessues in between the tendon fascicules; the longitudinal blood vessels in the interior of the tendon did not run through the entire length of the tendon, but rather segmentally.
From 1984 to 1994, 236 different types of traumatic defects of foot were repaired by microsurgical tissue grafting. They included simple cutaneous flap in 187 and composite flap in 49. Among the 236 different tissue flaps, vascularized flap was used in 97 and pedicled flap in 139. The 4 fore-foot and 6 heel defects were repaired by composite skeleted cutaneous grafts with scapula and vascularized febula respectively. After the follow-up from 1 to 10 years, all the grafted tissues were survived and healed well. The functions were satisfactory, and 186 patients had resumed their original works. The key to good function following repair was to maintaion the integrity of foot structures and the sensation of the sole and heel.
Through observation on the cast and perfused humen specimens, it was found that in some donor areas of skin flap the veins run loosely in compare with their arteris. The companionship of the axial artery and vein can be divided into 3 types: (1)One set of venous system, which runs loosely in company with the artery, such as the pedicle vessels in flaps of head and face areas; (2)Two sets of accompaned venous system, one of them did not accompany closely with the axial artery, as is the vessel in skin flaps of low abdominal areas; (3) Lack of accompanying venous system, as is found in the dorsal finger flaps. Based on these anatomical companionships of the veins with their arteries, when such flaps as mentioned above are adapted, it is preferable to take abroadened fascial pedicle in order to achieve a higher survival rate of skin flap transplantation.
OBJECTIVE To improve the clinical result of repair on flexor tendon injury, and recover the defected finger function in children as far as possible. METHODS From January 1990 to October 1997, 12 cases with flexor tendon injury were repaired by microsurgical technique, sutured by modified Kessler method with 3/0 or 5/0 nontraumatic thread and followed by invering suture of the gap edge with 7/0 or 8/0 nontraumatic thread after debridement. Appropriate functional practice was performed postoperatively. RESULTS All the defected fingers were healed by first intention. Followed up 6 months to 1 year, there was excellent in 7 cases, better in 4 cases, moderate in 1 case and 91.67% in excellent rate according to the TAM standard of International Hand Committee. CONCLUSION The important measures to improve the clinical result in children’s flexor tendon injury are prompt and accurate diagnosis and repair of the injured tendon by microsurgical technique, and effective postoperative functional practice.
目的 探讨显微手术治疗破裂大脑中动脉动脉瘤（MCAA）的适应证、术前评估及手术技巧。 方法 回顾性分析2008年1月－2011年1月经翼点入路行显微外科手术治疗的65例破裂MCAA患者的临床资料。其中男40例，女25例；年龄22～78岁，平均46.8岁。术前Hunt-Hess分级：Ⅰ级15例，Ⅱ级25例，Ⅲ级13例，Ⅳ级10例，Ⅴ级2例。动脉瘤直径＜5 mm 10个，5～15 mm 36个，15～25 mm 15个，＞25 mm 4个，平均7.8 mm。其中56例动脉瘤位于大脑中动脉分叉部，5例位于大脑中动脉的M1段，4例位于分叉后M2段。 结果 手术夹闭动脉瘤60例，余5例行动脉瘤夹闭加包裹术。患者术后获随访3～36个月，平均16个月，均无动脉瘤复发或再出血发生。按格拉斯哥预后评分（GOS）结果评定：恢复良好58例（GOS 4～5分），差5例（GOS 2～3分），死亡2例（GOS 1分）。 结论 充分的术前评估，合适的手术入路选择，以及手术技巧的灵活应用是显微外科手术成功治疗破裂MCAA的保证。