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錯位環扎法治療下肢深靜脈栓塞后小腿潰瘍21例

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.

EXPRESSION OF α-MELANOCYTE-STIMULATING HORMONE mRNA AND ITS SIGNIFICANCE IN HUMAN SKIN AUTOGRAFTS

Objective To discuss the expression of α-melanocyte-stimulating hormone(α-MSH) mRNA in human medium thickness skin autografts and to investigatethe role of αMSH in hyperpigmented process of skin autografts. Methods The samples were from medium thickness skin autografts on neck of the patients after 1 year of surgery. The size of sample was about 1.0 cm×0.5 cm. RT-PCR technique was performed to detect the expression of α-MSH mRNA in medium thickness skinautografts and normal skin respectively. Masson-Fontana stain technique was performed to detect the contents of melanin in medium thickness skin autografts andnormal skin epidermis respectively. Results The expression ofα-MSH mRNA in medium thickness skin autografts was much ber than that in control normal skin, showing statistically significant difference (P＜0.01). The expression of α-MSH/β2-microglobulin mRNA in normal skin of donor area was no statistically significant differences compared with normal skin around recipient area. The contents of melaninin medium thickness skin autografts epidermis obviously increased when compared with that of control normal skin. The expression of α-MSH mRNA was positive correlated with the contents of melanin in epidermis. Conclusion The above results indicate that the expression of α-MSH increases greater in medium thicknessskin autografts than in cortrol samples and was correlated with the pigmentation of skin autografts. Overexpression of α-MSH may play an important role in hyperpigmented process of skin autografts.

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.

延期植皮術在燒傷后重度瘢痕攣縮畸形修復中的應用

目的 總結治療燒傷后嚴重瘢痕攣縮致頦頸胸粘連和肢體關節畸形簡便有效的整復方法。 方法 1994年2月～2003年12月，采用延期植皮術治療燒傷后嚴重頦頸胸瘢痕粘連186例，男112例，女74例；年齡2～55歲，病程6個月～5年；瘢痕范圍10 cm×9 cm～26 cm×15 cm。治療燒傷后重度肢體關節畸形26例，男19例，女7例；年齡4～49歲，病程1～6年；瘢痕范圍9 cm×7 cm～22 cm×15 cm。一期手術切除攣縮的瘢痕，創面延期3～5 d后切取中厚皮片范圍10 cm×9 cm～26 cm×15 cm進行修復，觀察皮片成活質量及遠期整復效果。 結果 術后皮片成活率90％以上者199例，13例皮片失活的小創面均通過換藥愈合。頦頸胸瘢痕粘連者頸部松解良好，患者頦頸角生理角度均恢復；術后獲隨訪104例，隨訪時間6個月～3年，頸部后仰、前屈、左右轉動功能無明顯障礙。肢體關節畸形患者均在術中被完全復位，術后經6～12個月隨訪，關節屈伸功能基本不受限，能正常行走。 結論 延期植皮術是治療重度頦頸胸粘連和肢體關節畸形的一種有效的整復方法。

EXPRESSION OF c-kit IN HUMAN INTERMEDIATE-SPLIT-THICKNESS SKIN GRAFTS

Objective To investigate the expression of c-kit in human intermediate-spl it-thickness skin grafts and normal skin, and to recognize the role of c-kit in hyperpigmented process of the skin grafts. Methods The hyperpigmented intermediate-spl it-thickness skin grafts of 16 patients’ face and cervicum 1 year after operation was harvested and the normal skins around the recipient site and the donor site were used as controls. Envision immunohistochemical technique was usedto detect the expression and distribution of c-kit in the skin grafts and in the normal control skins, respectively. Medical image quantitative analysis system was used to quantitate the positive expression index (PI). Results The expression of c-kit was located in endochylema and cytolemma of melanocytes and keratinocytes in the basilar part of epidermis. The positive expression of c-kit was obvious in the intermediate-spl it-thickness skin grafts and blown zone was observed in the basilar part of epidermis; and was not obvious and local in normal control skins. The PI of c-kit in the intermediate-spl it-thickness skin grafts (131 216 ± 19 130) was significantly higher than that in the normal skin around the recipient site (92 958 ± 16 208) and in the normal skin around the donor site (91 306 ± 8 135); showing statistically significant difference (P lt; 0.05). Conclusion The expression of c-kit in intermediate-spl it-thickness skin grafts increases remarkably compared with that in normal control skin. c-kit may play an important adjusting role in the process of hyperpigmentation of skin grafts．

Adjustable Negative Pressure Drainage Technology Combined with Skin Grafting in Treating Skin Defect Patients with Infected Wounds and Its Nursing

目的　探討可調節負壓引流技術結合植皮治療皮膚缺損伴感染創面的臨床效果及護理要點。 方法　對2008年5月－2011年5月收治的106例皮膚缺損伴感染創面患者，采用間歇負壓引流治療3～10 d，負壓值設為50～120 mm Hg（1 mm Hg=0.133 kPa），創面達到Ⅱ期植皮條件時，采用大張、網狀或郵票狀皮片覆蓋創面，繼續采用持續負壓引流治療3～12 d，負壓值設為50～60 mm Hg，同時進行患者心理和可調節負壓引流技術創面等護理。 結果　56例大張皮片植皮中，2例皮片出現0.5 cm×1 cm～0.8 cm×1.2 cm皮片壞死；21例郵票狀植皮者，1例出現皮片移動皺縮。除5例骨外露，先通過植皮創面縮小后行皮瓣轉移，101例創面愈合時間7～25 d，平均14 d，無因所植皮片未成活需再次植皮和因感染死亡或截肢。 結論　可調節負壓引流技術結合植皮治療皮膚缺損伴感染創面，可有效控制感染，減輕患者換藥痛苦，減少醫務人員換藥和護理工作量，加快植皮創面愈合，縮短創面治愈時間。

Reconstruction of ankle and foot with combination of free perforator flaps and skin graft

Objective To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. Methods Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. Results Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. Conclusion Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.

Reparation of Large-area Hand Avulsed Wound and Soft Tissue Defects with Abdominal Skin Flaps and Skin Grafting Combined with Vacuum Sealing Drainage Technique

【摘要】　目的　探討大面積手部皮膚脫套傷并缺損的修復方式。　方法　2005年6月－2010年1月，應用腹部皮瓣包埋和游離中厚皮片植皮結合負壓封閉引流（vacuum sealing drainage，VSD）技術治療手部大面積皮膚脫套傷合并缺損12例，其中男8例，女4例；年齡21~56歲，平均34歲。機器絞傷9例，車禍傷3例。所有損傷均合并肌腱、關節或骨質外露；軟組織缺損范圍為9 cm×8 cm~25 cm×18 cm。受傷至手術時間4~17 h，平均6.5 h。手掌及手指缺損部位采用腹部帶蒂皮瓣包埋；手掌及手指以外肌肉、筋膜完好的部位采用大腿游離中厚皮片植皮，再于植皮表面覆蓋VSD敷料，接負壓行持續吸引；所有患者均二期斷蒂并進行分指或皮瓣成形手術。　結果　術后2例手指部分皮瓣或植皮壞死，2例小部分皮瓣及植皮邊緣壞死，經單純換藥后逐漸愈合，1例缺損較大、較深，先行換藥，待創面肉芽新鮮后行二期植皮手術，愈合良好 。其余皮瓣及植皮均成活，創面Ⅰ期愈合；供區植皮均成活，切口均Ⅰ期愈合。12例均獲6~42個月隨訪，2例手指末節軟組織缺損嚴重、血運差，術后7~10 d末節壞死后短縮；3例掌側皮瓣移植后較臃腫；其余外觀均較滿意。所有患者創面愈合后1個月內深、淺感覺功能均稍差，3~6個月逐漸恢復，但手指精細感覺恢復差，兩點辨別覺為6~13 mm，平均9.5 mm。所有患手平均掌指關節主動活動50°，指間關節20°。　結論　腹部皮瓣包埋和游離中厚皮片植皮結合VSD技術能較好地修復手部大面積皮膚脫套傷并缺損，是一種實用、安全且簡便的手術方法。【Abstract】　Objective　To investigate the ideal repair method for large-area hand avulsed wound and soft tissue defects.　Methods　From June 2005 to January 2010, 12 patients with large-area hand avulsed wound and soft tissue defects were repaired with abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique. The patients included 8 males and 4 females with their age ranged from 21 to 56 years averaging at 34 years. The causes of injury were machine twist injury in 9 cases and road accident injury in 3 cases. All the injuries combined with exposure of tendon, joint or bone. The area of defects ranged from 8 cm×9 cm to 18 cm×25 cm. The time between injury and operation was 4 to 17 hours averaging at 6.5 hours. The palm of hand and fingers were repaired by abdominal pedicle skin flaps, and the dorsum of hand and wrist were repaired by skin grafting combined with vacuum sealing drainage. About 3 weeks later, all pedicles of the abdominal flaps were cut off and flaps plasty were carried out.　Results　All patients were followed up from 6 to 42 months with an average period of 17 months. All of the flaps and skin grafts survived. Only 6 patients had distal edge partial necrosis, and all of them healed after a short time of dressing changes or second-stage skin grafting. All skin grafts of the donor sites survived and all the wounds healed by first intention. All the injured hands recovered well to their original shape and function except partial bad skin sensation. The sense of two-point discrimination was from 6 mm to 13 mm with an average distance of 9.5 mm. The active motion of metacarpophalangeal joints averaged at 60°, and the interphalangeal articulations averaged at 30°.　Conclusion　Abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique can be used to repair large-area hand avulsed wound and soft tissue defects, and it is practical, safe and simple.

植皮聯合分裂式骨牽引矯治脫套傷后手掌橫向攣縮一例