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.     

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.     

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。     

应用烧伤整形外科技术治疗大面积皮肤撕脱伤

探讨大面积皮肤撕脱伤的治疗方法。分析总结大面积皮肤撕脱伤及合并损伤17例,根据伤情综合应用清创撕脱皮肤缝合、带蒂真皮下血管网皮瓣回植、撕脱皮肤反取皮回植、组织瓣转移修复、游离皮片移植、头皮取皮术、异体／异种皮移植、创面持续负压吸引VSD等治疗方法,观察创面修复、肢体外观及功能恢复情况。结果17例患者经综合治疗后创面均愈合。功能部位均予全层皮片或皮瓣修复;19处创面有深部组织外露,予皮瓣或肌瓣修复;随访6个月～3年,所有肢体功能良好。根据皮肤软组织损伤情况而综合运用多种烧伤整形外科技术修复大面积撕脱伤可缩短疗程,并最大可能保留受伤区域的功能与外观,改善患者生活质量。     

23例局部随意皮瓣修复头皮缺损的临床分析

分析局部随意皮瓣修复头皮缺损的临床效果。选取2011年1月~2016年1月笔者所在医院烧伤整形科完成23例头皮随意皮瓣修复手术,术后随访3个月~12个月,结果显示,本组23例患者术后皮瓣成活100%,无皮瓣坏死、切口感染等术后并发症。其中1例患者出现小面积皮瓣边缘发黑结痂,经过多次换药后二期愈合。1例患者术后出现头皮下小面积积液囊肿,经积极抽取积液进行封闭注射治疗后痊愈。术后随访中,皮瓣部分毛发生长正常,切口无瘢痕增生,且皮损无复发。局部随意皮瓣修复头皮缺损是直径在6cm以内的头皮缺损的常用方法,且具有外形美观,皮损切除和创面修复一次完成,皮损无复发的理想方法。     

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.     

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。     

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.     

“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…     

交腿皮瓣修复血栓闭塞性脉管炎的足底溃疡

为了探讨应用交腿皮瓣修复对侧血栓闭塞性脉管炎足底溃疡的临床效果,对2008年3月～2011年7月期间收治的8例血栓闭塞性脉管炎足底溃疡的患者进行研究,观察采用交腿皮瓣修复对侧足底渍疡的手术治疗效果。结果显示8例患者术后全部一期愈合,效果良好。因此,应用交腿皮瓣修复对侧缺乏有效动脉血供的血栓闭塞性脉管炎足底溃疡是一种简单...     

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。     

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.     

APPARENT COVARIATION BETWEEN CHILD HABIT DISORDERS: EFFECTS OF SUCCESSFUL TREATMENT FOR THUMB SUCKING ON UNTARGETED CHRONIC HAIR PULLING

We evaluated the effects of aversive taste treatment of thumb sucking on untreated trichotillomania (habitual hair pulling) in two children who chronically pulled their hair and sucked their thumbs. A combination of withdrawal and nonconcurrent multiple baseline designs showed that, concomitant with the successful treatment of thumb sucking, hair pulling was also eliminated. The results suggest an efficient method for changing behaviors that are difficult to treat directly.     

双血供胸大肌皮瓣修补咽颈部缺损

探讨双血供胸大肌皮瓣修补咽颈部缺损的可行性。介绍应用双血供胸大肌皮瓣修补咽颈部缺损36例,窄蒂胸大肌皮瓣修补咽颈部缺损7例。结果前者愈合23例,出血3例,感染5例,咽瘘5例,皮瓣坏死无;后者愈合2例,出血1例,感染1例,咽瘘2例,皮瓣坏死1例。双血供胸大肌皮瓣修补咽颈部缺损更利于术后愈合、预防咽瘘。     

Adapting chronometric tests for field studies of cognitive ability

This study was designed to examine the relationship of hand preference to performance on a thumb-positioning task. Two hypotheses were proposed on the basis of hemispheric lateralization. The first stated that all subjects would perform the task more accurately using the left thumb, regardless of hand preference. The second hypothesis tested was that left-handed subjects would perform more accurately than right-handed subjects. Each of 20 neurologically intact adults grouped by hand preference reproduced a criterion thumb position with both thumbs simultaneously. Absolute error, recorded for each movement and analyzed by mixed analysis of variance, did support the first hypothesis. However, the left-handed group did not perform statistically differently from right-handed subjects. Factors influencing the data are discussed and recommendations for further studies are made.     

The effects of mental imagery on skin temperature and skin temperature sensation

In a series of six experimental sessions five subjects were instructed to imagine their hand in a hot and cold water stream. During the imagery period the subjects estimated with a psychophysical scale their subjective temperature sensations caused by the imagery. Skin temperature was measured from the thumb of the subjects' dominant hand. After each session the subjects were asked whether they had succeeded in producing an imagery. The skin temperature changes deviated significantly from the control level in the successful imagery experiments. Differences in the skin temperature changes between the successful and unsuccessful imagery experiments were significant. The skin temperature changes measured and the subjects' temperature sensations, produced by the imagery, were similar in the successful imagery experiments. The possible relationships between mental imagery and changes in skin temperature and skin temperature sensation are discussed.