两种薄中厚皮片治疗皮肤撕脱伤临床效果对比研究

目的:对比研究撕脱皮肤反取薄中厚皮片与常规切取薄中厚皮片在治疗皮肤撕脱伤中的移植效果。方法:选取2008年6月~2012年6月就诊的52例四肢皮肤撕脱伤患者为研究对象,其中23例因撕脱皮肤毁损严重无法利用,只能采用常规切取薄中厚皮片游离移植修复撕脱伤创面,其余29例利用撕脱皮肤反取制备薄中厚皮片,全部薄中厚皮片打孔直径1cm,术后均采取加压包扎。结果:所有移植皮片均成活,常规切取薄中厚皮片移植的23例患者中,Ⅰ期愈合者21例,Ⅰ期愈合率为91.3%;撕脱皮肤反取薄中厚皮片的29例患者中,Ⅰ期愈合者24例,Ⅰ期愈合率为82.8%。结论:常规切取薄中厚皮片移植与撕脱皮肤反取薄中厚皮片移植的Ⅰ期愈合率相仿,临床应尽可能利用撕脱皮肤反取制备薄中厚皮片移植修复撕脱伤创面,如撕脱皮肤难以利用则应选用薄中厚皮片移植修复。     

薄层削片法自体表皮移植治疗白癜风37例

目的：观察采用超脉冲CO2激光磨削皮损区后移植薄层削片法获得的自体表皮移植治疗白癜风的疗效。方法：37例患者采用超脉冲CO2激光磨削皮损区后移植薄层削片的自体表皮,观察表皮移植后的疗效。结果：37例患者移植皮片共132片,其中痊愈42片,占31．8％;有效88片,占66．4％;无效2片,占1．8％,总有效率为98．2％。结论：采用超脉冲CO2激光磨削皮损区后移植薄层削片法获得的自体表皮治疗白癜风较为简便有效。     

口腔内游离皮片移植手术的护理

口腔是人类消化道和呼吸道的起始部位 ,有其特殊的解剖特点和生理功能。游离皮片移植是颌面整形外科常用的手术方法之一。我科近年收治各种原因所致的口腔内瘢痕挛缩畸形患者 6例 ,入院后采用“口内瘢痕松解、自体游离皮片移植修复术”治疗 ,获得较满意的效果。通过对这 6例患者的治疗和护理 ,我们体会到口腔内皮肤移植与其它部位的皮肤移植既有相同之处 ,又有其特殊性。现将我们的护理体会总结如下。1　临床资料本组病例男 5例、女 1例 ,年龄最大者 45岁 ,最小者 2 3岁 ;皮片面积最大 3cm× 5cm,最小2 cm× 3cm;6例皮片成活率1 0 0 % ,功能…     

全厚皮片游离移植矫治大面积眼睑分裂痣

目的：探讨全厚皮片游离移植矫治大面积眼睑分裂痣的效果及优势。方法：2002年9月～2006年8月,利用耳后或上臂内侧全厚皮片游离移植矫治大面积眼睑分裂痣6例,男性2例,女性4例,年龄12～28岁;黑痣直径3～6cm。结果：6例患者,2例行耳后皮片移植,4例行上臂内侧皮片移植。所有患者分裂痣完全切除,植皮全部成活。随访3个月～4年,形态、功能良好,无并发症发生,效果满意。结论：全厚皮片游离移植矫治大面积眼睑分裂痣简单易行、适应证广、疗效可靠,是治疗此类疾病比较理想的术式。     

舱内高压氧治疗下行全厚皮移植术疗效观察

自 1 994年 1 0月以来 ,我们对 1 2例患者采用舱内高压氧治疗的同时进行全厚皮片移植术 ,此方法有利地促进了受皮区皮片的存活 ,取得了满意的效果。1　临床资料本组 1 2例 ,男 7例 ,女 5例 ;年龄 7岁～ 35岁 ,平均年龄 1 7岁。病因 :皮肤毛细血管瘤 3例 ,黑色素痣 6例 ,烧伤疤痕 3例。移植皮片部位 :颜面部9例 ,四肢 3例。供皮区部位 :全部采用双上臂内侧全厚皮。移植皮片平均面积为 1 9.8cm2。2　治疗方法均切除病变 ,按创面大小取自体全厚皮片移植 ,供皮区拉拢缝合。手术中我们采用高压氧作为整形外科全厚皮片移植的辅助治疗。高压氧压力…     

自体刃厚头皮片移植厚中厚皮片供区以抑制瘢痕增生

目的:探讨应用自体刃厚头皮片移植厚中厚皮片供区以抑制瘢痕增生的可行性及应用效果。方法:烧伤后全身大范围的增生性瘢痕患者24例,行功能部位的增生性瘢痕切除,应用非功能部位的大张厚中厚皮片修复,厚中厚皮片供区应用刃厚头皮片移植修复。结果:24例患者非功能部位厚中厚皮片供区经刃厚头皮片移植后,未见有明显的瘢痕增生。经随访半年至2年11例,2年以上3例,均未见有明显的瘢痕增生。头皮片供区无瘢痕形成,头发生长良好。结论:应用自体刃厚头皮片移植厚中厚皮片供区抑制瘢痕增生是一种可行的方法,值得临床推广。     

鼻尖、鼻翼缺损修复方法的探讨

１９５７年以来共收治鼻尖、鼻翼缺损１１９例，据情分别采用以下四种方法修复：①全层皮片移植２７例；②游离耳廓复合组织片移植３６例；③鼻唇沟皮瓣移转１２例；④上臂内侧皮管移植４４例，效果较为满意。我们在文章中就选用的原则、手术方法及注意事项等进行了探讨     

自体中厚皮片移植结合高压氧治疗难治性小腿皮肤溃疡25例

目的:探讨自体中厚皮片移植结合高压氧(hyperbolic oxygen,HBO)治疗难治性小腿皮肤溃疡的疗法。方法:将50例难治性小腿皮肤溃疡患者随机分为:对照组25例;治疗组25例。对照组仅对溃疡创面进行自体中厚皮片移植治疗;治疗组对溃疡创面进行自体中厚皮片移植,同时于术前1周、术后2周连续进行HBO治疗。两组患者分别于术后7～20d观察溃疡创面愈合情况。结果:治疗组创面治愈率为84.0％;对照组为36.0％。治疗组平均愈合天数为10±2.6d;对照组为14±2.8d。两组间有显著性差异(P<0.01)。结论:自体中厚皮片移植结合HBO治疗难治性小腿皮肤溃疡优于单纯自体中厚皮移植。     

厚中厚皮片游离移植修复下肢慢性溃疡创面

目的:探讨厚中厚皮片游离移植治疗下肢慢性溃疡创面的临床效果。方法:2016年1月-2018年12月,收治20例下肢慢性溃疡创面患者,切除肉芽创面基底纤维板层后,进行厚中厚皮片游离移植修复手术。结果:17例患者皮片完全成活,2例患者皮片出现少量水疱,1例患者皮片出现局部感染、坏死。术后随访6~12个月,下肢外观及功能恢复良好。结论:去除肉芽创面基底纤维板层,应用厚中厚皮片游离移植修复下肢慢性溃疡创面,可获得良好临床效果。     

异体脱细胞真皮基质与自体皮片复合移植的临床应用

目的:探讨异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面及其愈合后皮肤的外形和功能。方法:应用异体脱细胞真皮基质与自体刃厚皮片组成复合皮移植,以自体刃厚皮片移植作为对照,采用一步移植法治疗切痂后大面积深度烧伤创面及瘢痕切除后皮肤缺损共56例患者60处创面,观察术后皮片的成活情况、外形及功能恢复情况并随访。结果:60处创面全部愈合,移植皮片生长良好,瘢痕增生不明显,未见明显挛缩,皮肤弹性较好。在6～12个月的观察期内,自体刃厚皮片与异体脱细胞真皮基质复合移植后,功能和形态优于单纯自体刃厚皮片移植;随访2年复合移植未发现明显的排异反应。结论:异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面愈合良好,无瘢痕增生,皮肤外观功能满意,无排异反应。     

颈阔肌瓣双向翻转在颈部严重瘢痕增生挛缩整复中的应用

目的介绍颈阔肌瓣双向翻转技术在修复颈部瘢痕挛缩中的应用。方法针对15例烧伤后颈部瘢痕挛缩患者,利用颈阔肌瓣双向翻转技术加深颏颈角并形成缓和自然的颈胸部过渡,颈部创面移植厚中厚皮片或全厚皮片。结果15例患者皮片均成活良好,颏颈角明显,颈部自然曲线和活动度基本恢复,效果满意。结论颈阔肌瓣双向翻转技术能有效解决颈部瘢痕挛缩．具有进一步深入探讨和推广应用的价值。     

头面部体表组织缺损的修复

目的回顾性总结头面部体表组织缺损修复的临床经验。方法对86例99处头而部体表组织缺损,分别采用分次切除或直接拉拢缝合、植皮、邻近随意皮瓣、大网膜+皮片游离移植、皮肤软组织扩张法等方法修复。结果扩张器外露1例,4例皮瓣远端小部分坏死和创面延期愈合:3例皮片部分坏死(10～15%)或水疱形成;1例大网膜坏死;77例伤口I期愈合。24例经3个月至10年随访,2例皮瓣蒂部“猫耳”需再次手术矫正;3例植皮周边疤痕增生,经再次手术矫正;3例死亡(肺部转移2例;脑溢血1例);16例功能、外形均满意,头发生长良好。结论头面部体表组织缺损的修复方法应根据患者的具体情况灵活运用,以邻近随意皮瓣的效果为好。     

阴囊纵隔皮瓣与阴囊中厚皮片对合移植Ⅰ期修复重型尿道下裂

目的探索一种可行的安全可靠的手术方法修复尿道,矫正重型尿道下裂畸形。方法对于严重型尿道下裂而阴囊发育正常的患者,运用阴囊纵隔岛状皮瓣同时对合取舍自阴囊的中厚皮片移植,Ⅰ期修复尿道治疗尿道下裂畸形。结果共计15例,术后随访1年,包括阴茎近端和阴茎阴囊及阴囊型尿道下裂,Ⅰ期完成治疗,治疗效果良好,没有尿道狭窄和尿瘘等并发症发生,手术后的尿道外口正位于阴茎头中央,阴茎矫直,无偏曲,排尿尿线直,尿道镜检查再造尿道内壁平整光滑。结论利用阴囊纵隔瓣对合阴囊中厚皮片Ⅰ期成形尿道,完成严重型尿道下裂的修复,效果可靠,操作简单,对合技术同时综合了皮片和皮瓣再造尿道的优点,并且能充分保证矫正阴茎下弯畸形,取得再造阴茎外观和功能上的满意疗效,是一种较理想的治疗手段。     

Posterior arm flap in management of axillary contracture

Introduction

Management of post burn contracture can be difficult, particularly for the axilla. Any handicap related to upper limb has a detrimental physical, psycohological, and economical effect.

Patients and methods

We have released 20 axillae in 16 patients. These patients had axillary contracture for long duration and 5 had been operated previously by release and skin graft.We used posterior arm fasciocutaneous flaps for coverage of the defect after release of contracture.

Results and conclusion

All the patients had a good post op release. Their range of movement is excellent. No post op splintage was utilised in any of the cases with no incidence of recontracture.     

用深筋膜皮瓣修复皮肤软组织缺损59例

目的 :皮肤软组织缺损的修复。方法 :采用深筋膜皮瓣修复皮肤软组织缺损 5 9例。结果 :皮瓣成活 ,缺损区均Ⅰ期愈合。经 2～ 10年随访未见病灶复发。结论 :采用深筋膜皮瓣修复皮肤软组织缺损具有手术安全、皮瓣切取容易、操作简单 ;不用吻合血管神经 ,省时省力 ;远期效果好。与其他岛状皮瓣相比尚有不牺牲主要血管的优点。对皮瓣的血供特点、优点、适应证进行了讨论     

Reconstruction of the medial canthus: full-thickness skin graft or local flap?

Summary Forty-nine patients with skin tumors in the medial canthal area were operated on from 1986 to 1992. Forty-one of 43 surviving patients (95%) could be re-examined with an average follow-up of two years. In 20 patients, a full-thickness skin graft was used for the immediate reconstruction, in 21 patients a local flap, and in a further 8 patients, both methods were used in combination for the surgical repair. The histology of the lesions was mainly basal cell carcinoma; these may show aggressive extension in the medial canthal region. With the high accuracy intraoperative frozen section, immediate reconstructive surgery was performed after surgical excision. The results of the medial canthal reconstruction, using local flaps or full-thickness skin grafts, were compared in terms of the final functional and cosmetic result. The size and depth of the defect after eradication of the tumor was taken into consideration.     

Skin grafted forehead flap for total nasal reconstruction in severe postburn facial deformity

Summary Total or subtotal nasal loss is one of the sequelae of severe facial burns and requires total nasal reconstruction. Distant flaps or tube pedicles were used but the result was not good in terms of skin color match and texture. Since 1982 the authors have used a skin grafted forehead flap for nasal reconstruction and have achieved a better color match for the new nose. This forehead flap is quite rigid and a bone graft is not needed for support. However, the flap is not as easily brought down to the nasal area as the standard forehead flap; thus, in the last five cases the supraorbital and the supratrochlear arteries on both sides had to be sacrificed. There was no compromise of the blood supply to the flap and the mechanism by which the flap retains its good blood supply remains to be elucidated.     

Composite Skin Grafts for Basal Cell Carcinoma Defects of the Nose

Basal cell carcinoma is the most frequent cutaneous cancer of the nose and is characterized by its local spreading and exceptionally rare tendency to metastasize. Since a significant advantage has been seen in surgery compared to other treatments, surgical excision ensuring the highest chance of cure is frequently employed. Excision defects of the nose may be covered with either local flap or a full-thickness skin graft. In resurfacing such defects following excision of basal cell carcinomas, we favor the technique of composite-skin grafting which involves the harvesting of composite-skin graft including the epidermis, dermis and superficial layers of subcutaneous tissue to obtain the required thickness in the recipient site. This technique was used for defects remaining after the excision of basal cell carcinomas in a series of 15 patients. The areas involved were lateral nasal region (5 cases), nasal tip (4 cases), dorsum (3 cases), alar lobule (2 cases), and soft triangle (1 case). The mean follow-up was 14.2 months. The color, texture and thickness of the composite-skin graft harvested from the preauricular site and the neck compare favorably with the skin of the nose region. Satisfactory results, both clinically and in patient appreciation, have been obtained in both the reconstruction site and the appearance of the donor site in all patients.