“拆东墙补西墙”析——正确评价皮瓣在修复外科中的价值

皮瓣指把皮肤和皮下组织做成瓣状,带蒂或不带蒂（但需吻合血管）移植到局部或远处,前者称带蒂皮瓣,后者叫游离皮瓣。被广泛用于修复重要功能部位的皮肤缺损,创伤、烧伤的早、晚期修复,多种器官再造,覆盖裸露的深部组织（大血管、神经、肌腱、骨关节）和血液供应不良的创面。因为供区常需植皮,所以一些学者对皮瓣“横眉冷对”,认为这是“拆东墙补西墙”。从皮瓣的发展历程可以看出此说的渊源。１　“呱呱坠地”期１９１７年,Ｆｉｌａｔｏｖ［１］首次创用带蒂的皮瓣移植,修复患者的皮肤、软组织缺损,震惊了当时的学术界,因为它使…     

鼻烟窝皮瓣修复拇指大面积皮肤缺损的临床应用

探讨鼻烟窝皮瓣在修复拇指大面积皮肤缺损中的方法和治疗效果。从2008年1月～2013年10月间应用桡动脉在解剖鼻烟窝穿支为血管蒂的鼻烟窝皮瓣,逆行修复拇指大面积皮肤缺损26例,年龄17岁～55岁。术后平均随访时间25个月,皮瓣全部成活。皮瓣色泽及质地与健侧拇指背侧皮肤相近,拇指活动度基本正常。因此,鼻烟窝皮瓣是一种简便经济、效果理想、患者易于接受的术式,适合应用于拇指大面积皮肤缺损的治疗。     

指动脉背侧支皮瓣在手指末节皮肤缺损治疗中的临床应用

分析指背动脉背侧支与其血管网联合供血滋养皮辩在指末端皮肤缺损的修复中的应用效果.取中节手指固有动脉的背侧支为蒂血管,逆行切取指背皮辩31例共35指,移植修补位于远端指间关节或其远端的皮肤缺损.若同时伴有骨、关节、肌腱等的损伤.则予以同期修复.本研究中最大切取皮瓣1.5cm×3.5cm,平均随访6±0.5个月(3至9个月),皮瓣成活率100%,皮辩两点辨别觉9±0.2mm,95%的患者具有良好的指间关节活动能力.因此,指动脉背侧支皮瓣手术操作简单,术后成功率高且患者恢复效果好.     

带腓肠神经腓骨复合组织瓣移植修复前臂尺侧缺损

观察以带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损的临床效果。对15例前臂尺侧复合组织缺损的患者实行带腓肠神经的腓骨复合组织瓣移植修复术。结果15例组织瓣全部成活,前臂功能恢复良好。应用带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损,是一种治疗复合组织缺损的有效手术方法。     

带腓肠神经腓骨复合组织瓣移植修复前臂尺侧缺损

观察以带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损的临床效果.时15例前臂尺侧复合组织缺损的患者实行带腓肠神经的腓骨复合组织瓣移植修复术.结果15例组织瓣全部成活,前臂功能恢复良好.应用带腓肠神经的腓骨复合组织瓣移植修复前臂尺侧缺损,是一种治疗复合组织缺损的有效手术方法.     

皮肤缺损与皮瓣修复治疗的分析与思考

皮瓣移植是整形外科治疗皮肤缺损的重要方法.为皮瓣修复治疗更好的临床效果,需要在正确分析病情的基础上,兼顾医疗技术,关注预后,把握皮瓣修复治疗的指征;同时注重疾病的系统和综合治疗,并不断进行理论创新、技术创新,以促进皮瓣外科的发展.唯物辩证法的矛盾论、系统论和发展现对临床治疗具有普遍的指导意义.     

复合皮移植技术与传统方法治疗烧伤后大面积瘢痕效果比较

探讨分析整形术中应用复合皮移植技术治疗烧伤后大面积瘢痕的效果,以为临床外科应用提供依据。选取2012年9月~2017年12月笔者所在医院收治的因烧伤引起的大面积瘢痕整形患者104例,根据瘢痕修复方法分为研究组52例(经复合皮移植修复)、对照组52例(采用反复切取后躯干瘢痕皮的方法)。观察比较两组患者的疗效、治疗情况及安全性。研究组、对照组总有效分别为49例(94.23%)、41例(78.85%),P0.05。研究组、对照组1周平均创面愈合率分别为(28.74±8.13)%、(26.89±7.27)%,P0.05;研究组、对照组2周、4周平均创面愈合率分别为(66.38±9.77)%、(96.14±11.05)%和(55.25±9.64)%、(90.95±10.23)%,P0.05。研究组、对照组1周炎症反应积分分别为(-0.39±0.15)分、(-0.29±0.13)分,P0.05;2、4周分别为(1.46±0.17)分、(2.02±0.48)分和(0.75±0.12)分、(1.55±0.31)分,P0.05。研究组、对照组总不良反应分别为4例(7.69%)、12例(23.08%),P0.05。研究组、对照组平均治疗费用分别为(3.89±1.57)万元、(4.20±1.44)万元;创面愈合时间分别为(14.02±2.98)天、(18.35±3.14)天;P0.05。大面积烧伤瘢痕患者整形术中应用复合皮移植技术的治疗效果较佳,创面愈合率高,并发症少,安全性高,适合临床推广。     

指动脉背侧支皮瓣在手指末节皮肤缺损治疗中的临床应用

分析指背动脉背侧支与其血管网联合供血滋养皮瓣在指末端皮肤缺损的修复中的应用效果。取中节手指固有动脉的背侧支为蒂血管,逆行切取指背皮瓣31例共35指,移植修补位于远端指间关节或其远端的皮肤缺损。若同时伴有骨、关节、肌腱等的损伤,则予以同期修复。本研究中最大切取皮瓣1.5cm×3.5cm,平均随访6±0.5个月(3至9个月),皮瓣成活率100%,皮瓣两点辨别觉9±0.2mm,95%的患者具有良好的指间关节活动能力。因此,指动脉背侧支皮瓣手术操作简单,术后成功率高且患者恢复效果好。     

示中环指指尖缺损的鱼际皮瓣修复

探讨应用鱼际皮瓣修复示中环指指尖缺损的方法和效果.自2010年8月～2013年3月,应用鱼际皮瓣修复示中环指指尖缺损28例,术后评价皮瓣外观及供区愈合情况.结果术后28例皮瓣全部存活,随访时间为2个月～8个月.患指指尖皮瓣质地柔软,外形饱满,颜色与周围一致,指端无压痛,供区直接缝合,未发现刀口疲痕挛缩影响拇指及虎口功能.鱼际皮瓣修复示中环指指尖缺损手术操作简单,修复后患指指尖外观满意、供区损伤小.患者顺从性好,易于为临床医生所接受.     

辩证认识处理烧伤创面

人体是对立统一的有机整体,烧伤后皮肤局部形态结构和功能发生改变,进而引发局部与全身病理生理变化,烧伤创面处理贯穿于烧伤治疗的全过程。辩证认识和正确处理烧伤创面,提高烧伤治愈率;并将皮肤组织工程、整形外科等先进的技术手段和方法应用于烧伤创面的修复治疗,降低烧伤患者晚期畸形发生率,最大程度地让患者重返社会,恢复正常的生活和工作,这是现代烧伤治疗的目标。     

以中节指动脉弓为蒂逆行指动脉岛状皮瓣修复指端缺损

观察以中节指动脉弓为蒂逆行指动脉岛状皮瓣修复指端缺损的临床效果。对24例指端缺损的患者实行以中节指动脉弓为蒂逆行指动脉岛状皮瓣修复术。结果24例患者皮瓣全部成活,术后随访3个月~6个月,手指功能恢复良好。该手术操作简便,术后功能外观好,是修复指端特别是指腹皮肤软组织缺损的首选手术方法。     

Vaginoplasty in Male to Female Transsexuals Using Penile Skin and Urethral Flap

ABSTRACT.

Objectives: Vaginoplasty presents the main problem in male to female surgery. There are many operative techniques that can be used, but none is ideal. We present our one stage vaginoplasty in male to female sex reassignment surgery.

Patients and Methods: The principle of our technique is based on penile disassembly and usage of all penile entities for vaginoplasty except corpora cavernosa. We developed our disassembly technique on a very large number of severe hypospadias reconstruction and adrenogenital “conversions.” Penile skin flaps and urethral work are used in each of these. Our new vagina consists of two parts: a long vascularized urethral flap and a pedicled island tube skin flap created from the penile skin. The urethral flap is embedded into the skin tube. The tube, consisting of skin and urethral flap, is inverted, thus forming the new vagina. The new vagina is inserted into the previously prepared perineal cavity between the urethra, bladder, and rectum. The new vagina is fixed to the sacrospinous ligament. The labia minora and majora are formed from the remaining penile and scrotal skin.

Results: The follow-up ranged from 3 months to 6 years (mean 4.6 years). Good cosmetic and functional results were obtained in 77 out of 89 patients (87%).

Conclusions: The technique provides results that have the most normal anatomical and physiological characteristics, in comparison to other methods, since all penile entities are used (except corpora cavernosa) to form almost normal external female genitalia. Vaginoplasty using pedicled penile skin with a urethral flap could be a very good alternative to other methods of vaginoplasty.     

食管裂孔疝的外科治疗进展

食管裂孔疝即腹腔内脏器经食管裂孔疝入胸腔,并引发烧心、反酸等消化道及其他非消化道症状。按其解剖及临床表现可分为四型。通过病史采集、体格检查及一系列客观检查可以明确食管裂孔疝的诊断、分型及疾病进展程度。食管裂孔滑动疝并发反流、食管裂孔旁疝合并明显症状、混合型及多器官型食管裂孔疝或内科治疗效果不佳的通常应优先考虑手术治疗,以消除疝形成的因素,控制胃食管反流。食管裂孔疝手术目前通常采取腹腔镜下疝修补、补片加强及胃底折叠术,同时也存在食管延长、胃固定等其他替代术式。围手术期通过积极地控制风险因素,有助于降低各类术中、术后并发症风险及复发率。对复发、儿童及肥胖等特殊患者,也应视患者条件积极实施手术治疗。随着研究的进一步深入,食管裂孔疝手术在手术入路、补片材料、复发及并发症控制、日间手术模式应用等方面将取得更大的进展。     

The effects of brief cognitive-behaviour therapy for pathological skin picking: A randomized comparison to wait-list control

Thirty-four college students suffering from pathological skin picking were randomly assigned to a four-session cognitive-behavioural treatment (n = 17) or a waiting-list condition (n = 17). Severity of skin picking, psycho-social impact of skin picking, strength of skin-picking-related dysfunctional cognitions, and severity of skin injury were measured at pre-, post-, and two-months follow-up assessment. Participants in the treatment condition showed a significantly larger reduction on all measured variables in comparison to the waiting-list condition. The obtained effect sizes for the outcome measures were large, ranging from .90 to 1.89. Treatment effects were maintained at follow-up. In conclusion, cognitive-behavioural therapy, even in brief form, constitutes an adequate treatment option for pathological skin-picking behaviour.     

Against over-estimating the role of ethics in technology development

The role of ethics in technology development has been often questioned, especially in the early days of societal reflection of technology. However, the situation has changed dramatically. Ethical consideration now is generally declared to be indispensable in shaping technology in a socially acceptable and sustainable way. The expectations of ethics are large; often even a kind of “New Ethics” is postulated. In the present paper an over-estimation of the role of ethics for technology development is rejected. It is argued that ethical reflection is, indeed, indispensable in certain problem areas and situation types; but there is, on the other hand, space for technology development free from the requirement for ethical reflection. The absence of a requirement for ethical reflection, however, always has to be considered relative to some “morale provisoire” (provisional morality) as an accepted normative framework within which technology development may occur without explicit ethical reflection. If this framework, however, is doubted or is shown to be insufficient the situation changes completely. Ethical reflection in this case becomes necessary, to consider this normative framework in order to offer modifications or supplements.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

Body image dissatisfaction among women with scleroderma: extent and relationship to psychosocial function.

Body image dissatisfaction and its relationship to psychosocial function were investigated in 127 women with scleroderma Results indicated elevated body image dissatisfaction, with participants reporting higher levels than a sample of patients with severe burn injuries. Age, skin tightening above the elbows, and functional disability were related to heightened body image dissatisfaction, suggesting that younger patients with more severe disease may be at greatest risk for developing body image concerns. Path analysis revealed that depression mediated the relationship between body image dissatisfaction and psychosocial function. Results suggest that body image dissatisfaction is a significant concern in women with scleroderma and should be assessed routinely. Early identification and treatment of body image dissatisfaction may help prevent the development of depression and psychosocial impairment in this population.