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错位环扎法治疗下肢深静脉栓塞后小腿溃疡21例

PEDICLE GRAFT OF INTESTINE SEROMUSCULAR LAYER AND SKIN GRAFT FOR RE PAIR OF ABDOMINAL WALL DEFECT

OBJECTIVE: To explore an effective method to repair the abdominal wall defect. METHODS: From July 1996 to December 2000, 7 cases with abdominal wall defect were repaired by pedicle graft of intestine seromuscular layer and skin graft, among them, intestinal fistula caused by previous injury during operation in 4 cases, abdominal wall defect caused by infection after primary fistulization of colon tumor in 2 cases, abdominal wall invaded by intestinal tumor in 1 case. Exploratory laparotomy was performed under general anesthesia, the infective and edematous tissue around abdominal wall defect was gotten rid off, and the pathologic intestine was removed. A segment of intestine with mesentery was intercepted, and the intestine along the longitudinal axis offside mesentery was cutted, the mucous layer of intestine was scraped. The intestine seromuscular layer was sutured to the margin of abdominal wall defect, and grafted by intermediate split thickness skin. RESULTS: The abdominal wall wound in 6 cases were healed by first intention, but part of grafted skin was necrosed, and it was healed by second skin graft. No intestinal anastomotic leakage was observed in all cases. Followed up 1 to 2 years, there were no abdominal hernia or abdominal internal hernia. All the cases could normally defecate. The nutriture of all cases were improved remarkably. CONCLUSION: Pedicle graft of intestine seromuscular layer is a reliable method to repair abdominal wall defect with low regional tension, abundant blood supply and high successful rate.

A COMPARATIVE STUDY ON TREATMENT OF SCAR CONTRACTURE ON FACE, NECK, AND JOINTS WITH PRE-EXPANDED FLAPS AND SKIN GRAFTS

ObjectiveTo study the treatment results of the pre-expanded flaps for scar contracture on face, neck, and joints by comparing with the skin grafts. MethodsA total of 240 cases of scar contracture between July 2004 and June 2014 were included in the study by random sampling; skin grafts were used in 120 cases (skin graft group), and preexpanded flaps in 120 cases (pre-expanded flap group). There was no significant difference in age, sex, injury sites, and disease duration between 2 groups (P>0.05). Re-operation rate and A&F 0-6 quantization score were used to evaluate the treatment results. ResultsThe patients were followed up 12 to 75 months (mean, 23.47 months) in the skin graft group, and 12 to 61 months (mean, 19.62 months) in the pre-expanded flap group. The re-operation rate of the skin graft group was 72.5% (87/120), and was significantly higher than that of the pre-expanded flap group (19.2%, 23/120) (P=0.000). The re-operation rate of the neck contracture in teenagers was the highest. It was 93.9% in the skin graft group and 35.0% in the pre-expanded flap group. In the patients who did not undergo re-operations, A&F 0-6 quantization score of the skin graft group was 2.85±1.12, and was significantly lower than that of the pre-expanded flap group (5.22±0.74) (t=13.830, P=0.000). ConclusionPre-expanded flap for scar contracture on face, neck, and joints has lower re-operation rate and better aesthetic and functional restoration than skin graft. It should be regarded as the preferred method for teenagers.

CLINICAL COMPARATIVE STUDIES ON MULTIPHASE LIPECTOMY AND ONEPHASE LIPECTOMY WITH SKIN GRAFT TRANSPLANTATION IN SKIN FLAP CONTOURING

To discuss the advantages of two flap contouring methods and to explore the best choice for the flap contouring. Methods From March 2002 to March 2006, 59 patients were admitted for a flapcontouring operation. Of the 59 patients, 40 (32 males, 8 females; average age, 34 years) underwent the multiphase lipectomy (the multiphase lipectomy group). The original flaps included the abdominal flap in 19 patients, the groin flap in 10, the thoracic flap in 4, the free anteriolateral thigh flap in 6, and the cross leg flap in 1. The flaps ranged in size from 6cm×4 cm to 32 cm×17 cm. However, the remaining 19 patients (16 males, 3 females; average age, 28 years) underwent the onephase lipectomy with skin graft transplantation(the onephase lipectomy group). The original flaps included the abdominal flap in 4 patients, the groin flap in 6, the thoracic flap in 3, and the free anteriolateral thighflap in 6. The flaps ranged in size from 4 cm×3 cm to 17 cm×8 cm. The resultswere analyzed and compared. Results In the multiphase lipectomy group, partial flap necrosis developed in 4 patients but the other flaps survived. The followedup of 27 patients for 3 months to 2 years revealed that the flaps had a good appearance and texture, having no adhesion with the deep tissues. However, the flaps became fattened in 22 patients with their body weight gaining. The patietns who had a flap gt; 5 cm×5 cm in area had their sensation functions recovering more slowly; only part of the sensations to pain and heat recovered. The two point discrimination did not recover. In the onephase lipectomy group, total graft necrosis developed in 1 patient but the healing was achieved with additional skin graft transplantation; partial graft necrosis developed in 2patients but the wounds were healed after the dressing changes; the remaining flaps survived completely. The followup of the 16 patients for 3 months to 3 years revealed that all the 16 patients had a good sensation recovery, 12 patientshad the two point discrimination lt; 15 mm, with no recurrence of the fattening of the flaps; however, the grafted skin had a more severe pigmentation, and no sliding movement developed between the skin and the tissue basement. Conclusion The multiphase lipectomy and the onephase lipectomy with skin graft transplantation are two skin flap contouring methods, which have their ownadvantages and disadvantages. Which method is taken should be based on the repair location of the 〖WT5”BZ〗skin flap and the condition of the skin flap.

可调节负压引流技术结合植皮治疗皮肤缺损伴感染创面

【摘要】　目的　总结可调节负压引流技术结合植皮治疗皮肤缺损伴感染创面的临床效果。　方法　2008年5月-2011年5月，对106例皮肤缺损伴感染创面患者采用间歇负压引流治疗3～10 d，负压值设为50～120 mm Hg（1 mm Hg=0.133 kPa），创面达到二期植皮条件时，采用大张、网状或邮票状皮片覆盖创面，继续采用持续负压引流治疗3～12 d，负压值设为50～60 mm Hg。　结果　56例大张皮片植皮中，2例皮片出现0.5 cm×1.0 cm～0.8 cm×1.2 cm皮片坏死；21例邮票状植皮者，1例出现皮片移动皱缩。除5例骨外露，先通过植皮创面缩小后行皮瓣修复，101例创面愈合时间7～25 d，平均14 d，无因植皮片未成活需再次植皮和因感染死亡或截肢。　结论　可调节负压引流技术结合植皮治疗皮肤缺损伴感染创面，可有效控制感染，减轻患者换药痛苦，减少医务人员工作量，加快植皮创面愈合，缩短创面治愈时间。

Clinical Experience of Large Medium-thick Skin Grafting for Granulation Wound after Facial Burns

目的　探讨面部烧伤后肉芽创面移植自体大张中厚皮的可行性。 方法　回顾性分析2002年1月－2012年4月收治的27例面部烧伤后肉芽创面进行自体大张中厚皮移植手术患者的临床资料。术中用手术刀刮除肉芽组织至基底层，用取皮鼓或电动取皮刀取患者大腿或者腹部大张中厚皮，移植于受皮区，术后5 d左右打开敷料半暴露或暴露。 结果　27例手术患者中24例大张中厚皮全部成活，3例大部分成活，再次补植皮后愈合。患者创面愈合后外形丰满，皮肤弹性较好，表情丰富。20例随访1～5年，患者面部外观良好，2例发生小口畸形，2例眼睑轻中度外翻，分别行整形手术后改善。 结论　面部烧伤后肉芽创面移植大张中厚皮可获得较满意的治疗效果，可在临床推广使用。

Meek TECHNIQUE SKIN GRAFT FOR TREATING EXCEPTIONALLY LARGE AREA BURNS

Objective To investigate the cl inical effect of Meek technique skin graft in treating exceptionally large area burns. Methods The cl inical data were retrospectively analysed from 10 cases of exceptionally large area burns treated with Meek technique skin graft from April 2009 to February 2010 (Meek group), and were compared with those from 10 casesof exceptionally large area burns treated with the particle skin with large sheet of skin allograft transplantation from January 2002 to December 2006 (particle skin group). In Meek group, there were 8 males and 2 females with an average age of 34.5 years (range, 5-55 years), including 6 cases of flame burns, 2 cases of hot l iquid burns, 1 case of electrical burn, and 1 case of hightemperature dust burn. The burn area was 82.6% ± 3.1% of total body surface area (TBSA). The most were deep II degree to III degree burns. The time from burn to hospital ization was (3.5 ± 1.3) hours. In particle skin group, there were 8 males and 2 females with an average age of 36.8 years (range, 18-62 years), including 5 cases of flame burns, 2 cases of hot l iquid burns, and 3 cases of gunpowder explosion injury. The burn area was 84.1% ± 7.4% of TBSA. The most were deep II degree to III degree burns. The time from burn to hospital ization was (4.9 ± 2.2) hours. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The skin graft survival rate, the time of skin fusion, the systemic wound heal ing time, and the treatment cost of 1% of burn area were 91.23% ± 5.61%, (11.14 ± 2.12) days, (38.89 ± 10.36) days, and (5 113.28 ± 552.44) yuan in Meek group, respectively; and were 78.65% ± 12.29%, (18.37 ± 4.63）days, (48.73 ± 16.92) days, and (7 386.36 ± 867.64) yuan in particle skin group; showing significant differences between 2 groups (P lt; 0.05). Conclusion Meek technique skin graft has good effect in treating exceptionally large area burns with the advantages of high survival rate of skin graft, short time of skin fusion, and low treatment cost of 1% of burn area.

原位植皮法治疗腋臭手术配合与护理

目的　总结原位植皮法治疗腋臭手术的配合与护理经验。 方法　对2010年3月－2011年12月116例行原位植皮法治疗腋臭的患者进行手术配合与护理回顾性分析。术前做好患者全身情况的充分评估与心理护理和治疗方案宣教；术中医护患有效沟通、配合；术后积极做好创面加压包扎、肩关节制动、病情观察和伤口护理，帮助患者正确认识腋臭，以良好的心态接受手术，并主动配合治疗及护理。 结果　116例患者顺利完成手术，97例术后6～12个月获得随访，其中痊愈89例，显效6例，有效2例。患者无上肢外展功能受限，无明显瘢痕，气味消失。 结论　做好原位植皮法治疗腋臭手术的配合与护理，能有效预防并发症，达到根治腋臭、不影响上臂外展功能、无明显瘢痕、无明显手术切口的目的。

掌背动脉逆行岛状筋膜瓣加游离植皮修复指背皮肤缺损

目的 总结掌背动脉逆行岛状筋膜瓣加游离植皮修复手指背侧皮肤缺损的手术方法与临床效果。 方法 2003 年10 月－ 2008 年5 月，收治28 例32 指手指背侧皮肤缺损。男22 例，女6 例；年龄17 ～ 45 岁，平均26 岁。外伤致皮肤缺损24 例28 指，伤后至手术时间1 h ～ 21 d；肿瘤切除后4 例4 指。缺损位于手指近节24 指，中远节8 指。缺损范围为2.1 cm × 1.2 cm ～ 4.5 cm × 2.5 cm。术中采用2.3 cm × 1.4 cm ～ 4.8 cm × 2.8 cm 的掌背动脉逆行岛状筋膜瓣加游离植皮修复，供区直接缝合。 结果 术后2 例皮片边缘部分坏死，经换药后Ⅱ期愈合。余筋膜瓣及皮片全部成活，切口Ⅰ期愈合。供区愈合良好。术后28 例均获随访，随访时间5 ～ 24 个月。手指背侧外形丰满，不臃肿，伸屈活动自如。按国际手外科联合会的评定标准，优26 指，良6 指。 结论 掌背动脉逆行岛状筋膜瓣加游离植皮手术操作简便，不损伤指固有动脉及神经，血供可靠，可修复手指背侧不同部位的皮肤缺损。

EFFECT OF EARLY DERMATOPLASTIC REPAIR ON TESTICULAR Survivin PROTEIN EXPRESSION IN JUVENILE PIGS WITH ENTIRE THIRD DEGREE BURN WOUND OF SCROTUM

【Abstract】 Objective To explore the effect of early scrotal dermatoplasty on spermatogenic functional rehabilitation of testis in juvenile pigs with third degree burn wound of the scrotum. Methods Thirty healthy male Guizhou miniature pigs (weighing 10-15 kg, 2-month-old) were divided into 3 groups: control group (group A, n=10), natural healing group (group B, n=10), and dermatoplasty group (group C, n=10). In group A, the pig was not given any treatment; after third degree burn model of the scrotum was prepared, wounds were not treated in group B and the burn skin was excised and whole hypogastric pachydermia was used for dermatoplasty in group C. At 3 months and 1 year after model preparation, bilateral testis were collected from 5 pigs, respectively. HE staining was performed to observe the effects of different repair method on the morphology of spermatogenic cells and immunohistochemical staining was used to detect Survivin protein expression. Results All pigs survived to the end of the experiment and the wound healed successfully. Histological observation showed that spermatogenic cells had normal shape at all stages and mature sperms were seen in lumens in group A; the thickness of seminiferous epithelium was thinner, having one layer or two layers of spermatogenic cells in group B; the spermatogenic cells in group C were slightly more than that in group B with some spermatids; and in groups B and C, the spermatogenic cells at 1 year were more than that at 3 months. Immunohistochemistry staining showed that the Survivin protein expression in groups B and C was less than in group A, and group B was less than group C, showing significant differences at 3 months and 1 year (P lt; 0.05), but no significant difference between 3 months and 1 year in the same group (P gt; 0.05). Conclusion Dermatoplasty has inhibitory effect on spermatogenic functional rehabilitation of testis. Dermatoplasty can decrease spermatogenic cells and reduce Survivin protein expression, but some spermatids still survive in seminiferous tubule.