连续Y-V成形术治疗蹼状瘢痕挛缩

烧伤后蹼状瘢痕挛缩的治疗 ,常用方法为 Z成形及其演变术式。但对于较长的蹼状瘢痕 ,该术式治疗松解挛缩欠充分 ,尚有组织移位范围大 ,“猫耳”,皮瓣尖端易坏死等弊端。笔者应用连续 Y-V成形 [1 ]治疗烧伤后蹼状瘢痕挛缩效果满意 ,报告如下。1　临床资料本组 4例 ,男 3例 ,女 1例 ,年龄 2岁～ 1 0岁。烧伤后蹼状瘢痕 8处 ,部位 :右上肢 1处 ,左小指 2处 ,左拇指 1处 ,手掌 1处 ,指蹼 3处。瘢痕形成时间 3月至 3年。2　手术方法在保持蹼状瘢痕张力下 ,标出蹼状瘢痕两侧的下缘 ,以下缘为顶端设计出斜跨蹼状瘢痕的连续 V瓣。每个 V瓣两臂所形…     

掌背岛状皮瓣治疗指蹼瘢痕挛缩的疗效

目的总结在指蹼瘢痕挛缩治疗中采用掌背岛状皮瓣重建指蹼的方法及疗效。方法 2009年6月-2010年12月,收治指蹼瘢痕挛缩患者10例。男6例,女4例;年龄14～57岁,平均30岁。均为单个指蹼瘢痕挛缩。外伤后瘢痕增生挛缩8例,烧伤后瘢痕挛缩1例,并指分指术后瘢痕挛缩1例。虎口挛缩1例,示中指指蹼挛缩3例,中环指指蹼挛缩5例,环小指指蹼挛缩1例。病程3～9个月,平均5个月。指蹼最大外展度10～20°。瘢痕切除后指蹼间缺损范围为2.0 cm×1.0 cm～3.0 cm×1.8 cm,采用大小为3.5 cm×1.2 cm～4.0 cm×2.0 cm的掌背岛状皮瓣重建指蹼。供区直接缝合或局部皮瓣移位修复。结果术后第2天1例皮瓣出现静脉危象,对症处理后皮瓣成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区皮瓣均成活,切口Ⅰ期愈合。10例均获随访,随访时间6～15个月,平均9个月。重建指蹼外形良好,其中1例虎口挛缩者,最大外展度达80°;余9例指蹼最大外展度为35～45°,平均40°。8例瘢痕增生患者,随访期间未见再次瘢痕爬行、挛缩。结论采用掌背岛状皮瓣重建指蹼治疗指蹼瘢痕挛缩,可获得较好的指蹼外观及功能。     

拇指指蹼瘢痕挛缩的修复

为了更好地恢复拇指指蹼瘢痕挛缩患者的手功能，１９８６年～１９９４年对不同原因所致拇指指蹼瘢痕挛缩６４例，根据不同伤情、皮肤及拇收肌挛缩的程度，选择皮瓣转移的方法进行修复。术后用克氏针弯成形弹性装置撑开拇指指蹼或用克氏针穿过第１，２掌骨保持拇外展位。结果表明，术后应用形弹性装置撑开拇指指蹼可以保持拇指指蹼有足够宽度，防止其再次挛缩。认为，修复拇指指蹼时应根据皮肤及拇收肌挛缩的程度，采用恰当的修复方式才能取得较好治疗效果     

蝶形皮瓣治疗手部蹼状瘢痕挛缩的临床应用

手部蹼状瘢痕挛缩常继发于严重烧伤、烫伤及外伤等,从而导致严重的外观畸形及功能障碍。一般指蹼深处多有部分正常皮肤组织,而相邻的指侧亦有正常皮肤组织存在,应充分利用其正常皮肤再造一个接近正常的指蹼,对恢复手的功能十分重要。自2008年1月至2013年12月,我们采用蝶形皮瓣治疗手部蹼状瘢痕挛缩患者27例,术后外形及功能均良好,无再次挛缩发生。现报道如下。     

连续Z成形术治疗索条状或蹼状瘢痕挛缩畸形

自2004年2月至2008年10月,我们应用连续Z成形术矫正大关节部位索条状和蹼状瘢痕挛缩畸形36例51个部位,术后经3～6个月的随访,疗效满意,现介绍如下。     

阶梯松解术修复手指掌侧严重瘢痕挛缩29例

手指掌侧瘢痕挛缩是烧伤后最常见的畸形之一,笔者单位自2001年10月以来,采用阶梯松解术修复手指掌侧严重瘢痕挛缩29例,效果满意。临床资料:本组29例患者共63指出现严重瘢痕挛缩,其中男21例、女8例。年龄3~39岁,以儿童多见。均为深度烧伤后瘢痕增生挛缩,瘢痕形成时间为3个月~2年     

烧伤后手指严重屈曲挛缩和指蹼粘连的Ⅰ期修复

目的：探索应用一种新的手术方式一次性修复烧伤后手指屈曲畸形和指蹼粘连。方法：在指蹼间作平行纵切口，近端向手背侧延伸，远端向掌指横纹处延伸，指蹼间形成矩形掌背双蒂皮瓣，腹部取全厚皮片移植于双蒂皮瓣两侧和手指创面，后期加强功能锻炼。结果：自1999年12月至2002年5月，共完成24例37只烧伤后患手，术后均一次性矫治了手部指蹼粘连和手指屈曲畸形，经6个月以上临床随访，患手功能及外形均可。结论：本手术方法在指蹼间保留皮瓣，两侧植皮，切口延伸同时解决手指屈曲畸形，方法简便，创伤小，减少了住院次数并降低了住院费用，术后功能外观均好，值得推广。     

指蹼瘢痕挛缩畸形的修复

目的探讨指蹼瘢痕挛缩畸形的修复方法.方法对指蹼背侧瘢痕,在指侧形成旗状瓣修复.对于掌侧瘢痕,设计矩形皮瓣转移修复.指侧不能直接拉拢缝合,而采用断层或全层皮片移植修复.结果本组68个指蹼,采用旗状瓣修复54个、矩形瓣修复14个,无皮瓣血运障碍,再造指蹼的大小及深度近似正常指蹼,效果满意.结论指蹼背侧瘢痕挛缩采用旗状瓣修复,掌侧瘢痕挛缩采用矩形瓣修复,是治疗指蹼挛缩畸形的较好方法.     

儿童手指掌侧瘢痕挛缩手术治疗临床报告

目的探讨小儿手指侧方岛状皮瓣修复邻指掌侧瘢痕挛缩临床疗效。方法回顾性分析自2005年6月至2007年8月共收治儿童手指掌侧瘢痕挛缩畸形16例19指,作者采用包含掌侧固有神经背侧支的邻指侧方岛状皮瓣进行修复,观察临床效果。结果16例19指皮瓣均成活,并全部获得随访,皮瓣两点分辨觉2~6 mm,患指主动活动正常或接近正常,健指植皮区均成活,活动正常。结论小儿手指侧方岛状皮瓣修复邻指掌侧瘢痕挛缩是一种较好的治疗方法。     

六瓣Z成形术在蹼状瘢痕挛缩中的应用

蹼状瘢痕挛缩常见于烧伤后期，易发生于指蹼、颈前、腋窝、肘部及足背等功能部位，其矫正方法较多。利用蹼状挛缩瘢痕周边组织的松动性，通过总Ｚ角达１３５°、实际主轴的延长率约为１８０％的六瓣Ｚ成形术，矫治刀例不同部位的蹼状瘢痕挛缩，经１～２年随访，疗效稳定，功能及外观满意。六瓣Ｚ成形术，手术设计简单，勿需游离皮片移植，术后瘢痕不易再挛缩，外观满意。     

Use of distant V-Y plasty in reconstruction of defects on the nasal dorsum: A new modification of V-Y plasty

Nasal reconstruction requires a good aesthetic outcome because the nose is located in the centre of the face. Two problems commonly occur after reconstruction of the nose: abnormal appearance of the new nose, and nasal airway obstruction. The nasal dorsum should be treated as a separate unit. Several local flaps have been described for reconstruction of tissue defects on the dorsum of the nose. Most of these techniques have some disadvantages, such as colour mismatch, dog-ear formation, thickness of flaps and requirement of surgery for revision. Two patients in whom the nasal dorsum was reconstructed with distant V-Y plasty are presented. Six months later, cosmetically acceptable results were obtained. The authors believe that the distant V-Y plasty is an effective alternative to the current techniques in reconstruction of the nasal dorsum. The advantages of this technique include the following: distant V-Y plasty is a safe and useful way to reconstruct medium and large defects of the nasal dorsum; it provides good texture and colour match; the resultant scar cannot cause contour deformity because it is not a bulky flap; there are no formation of dog-ear; it can be used to cover larger defects in elderly patients; it can be used under local anesthesia in almost all cases; it requires a shorter period of operating time and hospitalization; and it is less costly.     

七瓣成形与五瓣成形的应用

五瓣成形术与七瓣成形术均利用局部有限的皮肤组织松解瘢痕挛缩。我们分别于１９８８年至１９９４年运用五瓣成形术整复瘢痕挛缩１９例，内眦赘皮７例；七瓣成形术整复瘢痕挛缩１２例，均获得满意效果。本文就手术设计、原理、操作、适应证进行比较分析，得出：①两者几何学上有区别，并认为七瓣成形术由五瓣成形术演变而来；②理论计算与临床运用表明七瓣成形术后延长率大于五瓣成形术，同样条件下七瓣成形松解瘢痕挛缩比五瓣成形彻底；③五瓣成形较适用于如腋、虎口处蹼状瘢痕，以及内眦赘皮的整复；七瓣成形较适用于“蹼”狭小的瘢痕挛缩如指蹼瘢痕挛缩及主轴需延长较多者如手指掌侧瘢痕挛缩的整复。     

V-Y Plasty as Treatment of Finger Tip Amputations

V-Y plasty was performed in 28 patients who suffered from a transverse amputation of the finger tip. Bilateral V-Y plasty was carried out in 16 cases and single volar V-Y plasty in 12 cases. The average follow-up period was 32 months. Six patients had postoperative complications, requiring reoperation in four patients. The follow-up results were satisfactory. The results showed that V-Y plasty is indicated in transverse amputations through the distal one-third to one-half of the nailbed, but only in patients to whom the length of the finger is of importance.     

阴茎延长中使用V-Y成形术是否必要？介绍一种新的手术方式：单纯冠状沟下环形切口阴茎延长增粗术

本研究介绍了一种新的通过冠状沟下环形切口的悬韧带松解术，并确定其安全性和有效性。过去的7年中，我们连续做了82例阴茎增粗术。前35例男性患者接受下腹部V-Y成形切口韧带松解术（A组），后续47例男性患者接受冠状沟下环形切口韧带松解术（B组）。我们比较了两组手术时间、手术并发症和手术前后的阴茎长度和周径值以及手术前后的自信心、满意度评分。患者平均年龄为32岁（18—56岁）。79例患阴茎短小综合征，3例为小阴茎（牵拉长度〈7．5厘米）。A组和B组的平均手术时间分别为150．7分钟和125．2分钟（P=0．005）。4例（11％）A组患者和3例（6％）B组患者术后分别出现了阴茎回缩（P=0．453）。18例（51％）A组患者出现了手术瘢痕增生，而在环形切口手术组则未观察到明显切口并发症。两者阴茎长度和周径改善效果相当。但环形切口手术组满意度和自尊心和性关系问卷（SEAR）改善程度更高（P值分别为0．007和〈0．001）。在严格的病例筛选标准下，与V-Y成形术相比较，环形切口悬韧带松解术在安全性、手术时间、阴茎回缩率和外观方面均有改善，而在阴茎大小改善效果上无差异。     

Total excision and V-Y plasty technique in the anal area condyloma acuminatum

Condyloma acuminatum is located in the perianal region, anal canal, vagina and the perineum. It is caused by human papillomavirus types 6 and 11. A 18 year-old man was admitted to the clinic because of a perianal mass. On examination of the patient''s perianal area and inside the anal canal, a mass was found, which was nearly 8 × 8 cm in size. We could not obtain any information about venereal transmission. The mass was totally excised and the defect was reconstructed with a bilateral V-Y advancement flap. This technique has been used for sacrococcygeal, ischial and other defects but rarely used for condyloma acuminatum. We think that total excision and the use of the V-Y advancement flap technique is safe and has low morbidity in the treatment of condyloma acuminatum.     

指动脉顺行V-Y岛状皮瓣修复指腹缺损

目的评价指动脉顺行"V-Y"岛状皮瓣修复手指指腹缺损的临床疗效。方法2015年3月-2018年6月,应用指动脉顺行"V-Y"岛状皮瓣修复手指指腹缺损20例,均有末节指骨外露,缺损面积最小1.0 cm×1.0 cm,最大1.5 cm×1.5 cm,供区均直接闭合。结果20例皮瓣全部成活,皮瓣及手指外形满意。随访3~6个月,平均4.5个月,两点辨别觉3~5 mm。指间关节屈曲活动18例均无明显受限,2例因手指屈曲位缝合皮瓣,出现手指远指间关节屈伸轻度受限。按TAM法评定标准评定:优良率90%。结论顺行指动脉"V-Y"岛状皮瓣手术操作不仅简单,同时内含血管神经束,血供稳定,感觉恢复良好,能够恢复良好的手指外形和功能,是修复指腹缺损的比较理想的手术方式之一。     

The invisible frown plasty

The sad or sinister look in young and middle-aged patients produces an unhappy attitude in these patients. An approach is recommended in which the corrugator and procerus muscles can be removed with a curette either transnasally or via a small supercilliary incision. No complications are associated with this procedure.     

横切法内眦赘皮矫正及同期切开法重睑成形术

目的 探讨横切法内眦赘皮矫正同期行切开法重睑成形术的临床效果.方法 采用横切法,在新的内眦定点至原内眦角点横行直线切开,达原内眦角点后,沿下睑缘做平行浅弧形切口,行切口上下方皮下充分分离,松解去除错位异构的眼轮匝肌及增厚的组织,使内眦赘皮皮肤自然复位,必要时折叠缝合内眦韧带浅头,去除内眦切口颞侧的小“猫耳”,缝合切后口;常规行切开法重睑成形术,但重睑切口与内眦切口勿相连续.结果 临床应用258例,随访3～18个月,内眦赘皮消失,新内眦外形良好,瘢痕不明显,内眦赘皮无复发,重睑外形美观.结论 横切法内眦赘皮矫正同期行切开法重睑成形术,是矫治单睑伴内眦赘皮的一种简单而较为实用的理想方法,值得临床推广.     

The size of the Y: the multiple Y-V plasty revisited

BACKGROUND: The multiple Y-V plasty is often used in the release of burn scar contracture bands. Although there are established views regarding its design, no attempts have yet been made to describe the mathematical principles upon which it is based. An understanding of the mathematics, however, should incur a greater ability to "fine tune" or "tailor" the outcome. METHOD: Our standard method of design and execution is presented, and the mathematical properties underlying the technique are elucidated, using a simple trigonometric model. RESULTS: In a Euclidian plane, the equation describing the gain in length for a rectangular scar or contracture of length l and width a, to which the technique of multiple Y-V plasty has been applied, can be simplified to lx/a, where x is the only variable and represents the distance by which the component triangular V-shaped flaps have been advanced relative to one another. CONCLUSION: This equation illustrates that (a) neither the angles of the Ys nor the number of triangles in the design play a role in the ultimate length gained and (b) the distance of advancement of the individual triangular flaps is the sole determinant of final length.     

M-Y及M-V成形术在处女膜修补中的应用

目的：探讨不同处女膜修复术式的选择及应用。方法：选择月经结束后10天内患者60例，根据破裂程度和部位，对于以12点为中心的患者，笔者进行了M—Y成形术，对于以6点为中心的患者，笔者采用W—V成形术，对于以3点或9点为中心的，笔者采用直接缝合或瓦合瓣法。术后随访2周，观察处女膜外观及处女膜口径。结果：有2例因术后分泌物较多致使手术失败，1例患者因术后骑车致修补处撕裂，均进行第二次手术。其他患者术后2周随访发现恢复良好，处女膜口约纳小指尖。结论：根据不同患者采用相应的手术方法进行处女膜修补，不仅可以修复裂口，还可以同时起到缩小处女膜内口的作用，确保了手术的成功率。