胸大肌肌皮瓣修复颊部缺损并应激性溃疡出血的护理

近年来,胸大肌肌皮瓣在头颈重建外科领域得到了广泛应用。但是,在移植术后约有6％～20％的患者会出现组织瓣缺血坏死等严重并发症。我科应用胸大肌肌皮瓣转移修复颊部粘膜癌切除术后组织缺损1例,术后第1天并发应激性溃疡出血,经处理后取得满意效果。现将护理体会报告如下。     

背阔肌肌皮瓣修复肩背部软组织肉瘤术后缺损研究

目的：分析背阔肌肌皮瓣在肩背部软组织肉瘤扩大切除术后缺损修复中的方便性及优越性。方法：选取临床确诊肩背部软组织肉瘤患者8例,行肩背部病灶扩大切除术后,依据背阔肌肌皮瓣解剖学特点,选择合适的背阔肌肌皮瓣转移修复肩背部缺损。结果：皮瓣全部存活,随访6月至28月,肩背部外形满意,日常活动无明显影响。结论：应用背阔肌肌皮瓣修复肩背部软组织肉瘤扩大术后缺损是一种行之有效的方法。该方法简单易行,临床效果明显。     

背阔肌肌皮瓣修复肩背部软组织肉瘤术后缺损研究

目的:分析背阔肌肌皮瓣在肩背部软组织肉瘤扩大切除术后缺损修复中的方便性及优越性。方法:选取临床确诊肩背部软组织肉瘤患者8例,行肩背部病灶扩大切除术后,依据背阔肌肌皮瓣解剖学特点,选择合适的背阔肌肌皮瓣转移修复肩背部缺损。结果:皮瓣全部存活,随访6月至28月,肩背部外形满意,日常活动无明显影响。结论:应用背阔肌肌皮瓣修复肩背部软组织肉瘤扩大术后缺损是一种行之有效的方法。该方法简单易行,临床效果明显。     

贵州苏铁根的解剖学研究

对贵州苏铁（Cycas guizhouensis K.M.Lan et R.F.Zou）的根进行了解剖学研究,结果表明：（1）据外部形态和内部结构不同,贵州苏铁的根可分为正常根、珊瑚状根和肉质根三种类型。（2）正常根与肉质根的木栓形成层起源于表皮内方第1～2层皮层薄壁细胞,珊瑚状根的木栓形成层则起源于外方皮层的第2～3层细胞,而非中柱鞘。（3）首次发现肉质根一种新的增粗方式,是由周皮内方的皮层薄壁细胞恢复分裂能力,持续或周期性产生新的皮层薄壁细胞,引起根的增粗。     

改良胸大肌岛状肌皮瓣与传统皮瓣对舌癌术后修复影响的对比研究

目的：对比研究改良胸大肌岛状肌皮瓣与传统胸大肌岛状肌皮瓣在舌癌连续整块切除术后缺损修复中的的治疗效果。方法：选取2007年08月-2012年01月行舌癌连续整块切除术患者97例,其中49例采用改良胸大肌岛状肌皮瓣,48例采用传统胸大肌岛状肌皮瓣,分别命名为A组和B组,比较两组患者治疗效果和并发症发生情况。结果：A组治疗效果甲级、乙级、丙级分别为65．3％、28．6％、6．1％,B组治疗效果甲级、乙级、丙级分别为41．7％、33．3％、25．0％,A组治疗效果优于B组;A组术后并发症少于B组。结论：与传统胸大肌肌皮瓣相比,改良胸大肌岛状肌皮瓣治疗效果好,并发症少,能更好地实现舌癌连续整块切除术后缺损修复。     

贵州苏铁根的解剖学研究*

对贵州苏铁( Cycas guizhouensis K. M. Lan et R. F. Zou) 的根进行了解剖学研究, 结果表明: ( 1)
据外部形态和内部结构不同, 贵州苏铁的根可分为正常根、珊瑚状根和肉质根三种类型。( 2) 正常根与肉
质根的木栓形成层起源于表皮内方第1~ 2 层皮层薄壁细胞, 珊瑚状根的木栓形成层则起源于外方皮层的
第2~ 3 层细胞, 而非中柱鞘。( 3) 首次发现肉质根一种新的增粗方式, 是由周皮内方的皮层薄壁细胞恢
复分裂能力, 持续或周期性产生新的皮层薄壁细胞, 引起根的增粗。     

即时扩展型背阔肌肌皮瓣乳房再造在保留乳头乳晕复合体乳癌术后的运用分析

目的：探讨分析即时扩展型背阔肌肌皮瓣乳房再造在保留乳头乳晕复合体乳癌术后的运用。方法：回顾性分析我院2008年2月-2012年4月收治的乳腺癌术后患者106例,采用乳癌术即时扩展型背阔肌肌皮瓣乳房再造保留乳头乳晕复合体,观察手术效果以及满意度。结果：术后患者乳房美容优良率为88．68％明显大于对照组的47．17％,并且术后6个月治疗组生活质量评价总分明显大于对照组总分术后6个月患者生活质量评价总分明显大于术前评价总分,差异具有条件下意义（P〈0．05）,差异均具有统计学意义（P〈0．05）。结论：即时扩展型背阔肌肌皮瓣乳房再造在保留乳头乳晕复合体乳癌术后患者乳房美容效果较好,提高患者生活质量高,值得在临床上推广,但在手术后需积极处理可能存在的并发症情况。     

改良带蒂胸大肌肌皮瓣修复口腔颌面肿瘤术后缺损的临床分析

目的:探讨只带血管蒂的改良胸大肌皮瓣转移修复口腔颌面部组织缺损的临床效果。方法:取胸大肌皮瓣时蒂部只保留血管,利用改良只带血管蒂的胸大肌皮瓣对6例不同口腔颌面部组织缺损进行修复,包括舌癌3例、舌咽癌1例、牙龈癌1例、颊癌1例。结果:术后皮瓣血供良好,完整成活,成活率100%;所有患者获得3~18个月随访,在随访期内均存活;重建的舌外形良好,虽然味觉功能无法恢复,运动功能随切除范围增加而降低,但均能满足发音、吞咽和咀嚼功能需要。结论:只带血管蒂的改良胸大肌皮瓣是修复口腔颌面部组织缺损有效而可靠的方法,为恶性肿瘤根治术后造成的缺损提供了有力修复保障。     

爬树蕨的解剖学研究

本文对爬树蕨（Ａｒｔｈｒｏｐｔｅｒｉｓｏｂｌｉｔｅｒａｔａ（Ｒ．Ｂｒ．）Ｊ．Ｓｍ）孢子体各主要器官进行了解剖学研究及对孢子进行了电子显微镜扫描观察,研究结果表明;茎的中柱具有两个新月形的维管束;幼茎的中部有髓．在较老的茎,髓部及中柱周围的细胞均特化为厚壁细胞．根属二原型中柱．木质分化方式是外始式;在对正后生木质部的两侧的皮层有几层特化为厚壁细胞。叶的叶肉细胞不分化出栅栏组织和海绵组织,为等面对。孢子囊具有纵向环带,孢子的形状、外壁的纹饰和裂缝情况均与以前的研究有所不同。     

A new arterial flap from the postauricular surface: its anatomic basis and clinical application

We studied the arterial pattern of the postauricular surface in 16 cadavers and compared them to the results of Doppler probing in the auricles of 15 human volunteers. The dissections revealed that the postauricular surface is mainly supplied by three to five sizable branches from the upper, middle, and lower divisions of the posterior auricular artery, traversing in a rather straight and cephalic direction toward the auricular rim. One or more branches of the middle division are constantly present and distribute over the upper two-thirds of the postauricular surface. These anatomic findings were compatible with the results of the Doppler probing. We have done four auricular reconstructions with postauricular arterial flaps with excellent postoperative results. It is worthwhile to use the postauricular arterial flap in restoring the middle third of the auricle.     

Anatomical structure of the buccal fat pad and its clinical adaptations

Before performing plastic and aesthetic surgery around the buccal area, the authors reviewed the anatomical structures of the buccal fat pad in 11 head specimens (i.e., 22 sides of the face). The enveloping, fixed tissues and the source of the nutritional vessels to the buccal fat pad and its relationship with surrounding structures were observed in detail, with the dissection procedure described step by step. The dissection showed that the buccal fat pad can be divided into three lobes-anterior, intermediate, and posterior-according to the structure of the lobar envelopes, the formation of the ligaments, and the source of the nutritional vessels. The buccal, pterygoid, pterygopalatine, and temporal extensions (superficial and profound) are derived from the posterior lobe. The buccal fat pad is fixed by six ligaments to the maxilla, posterior zygoma, and inner and outer rim of the infraorbital fissure, temporalis tendon, or buccinator membrane. Several nutritional vessels exist in each lobe and in the subcapsular vascular plexus forms. The buccal fat pads function to fill the deep tissue spaces, to act as gliding pads when masticatory and mimetic muscles contract, and to cushion important structures from the extrusion of muscle contraction or outer force impulsion. The volume of the buccal fat pad may change throughout a person's life. Based on the findings of the dissections, the authors provide several clinical applications for the buccal fat pad, such as the mechanism of deepening the nasolabial fold and possible rhytidectomy to suspend the anterior lobe upward and backward. They suggest that relaxation, poor development of the ligaments, or rupture of the buccal fat pad capsules can make the buccal extension drop or prolapse to the mouth or subcutaneous layer. As such, the authors refined their methods and heightened their focus when using the buccal fat pad to perform a random or pedicled buccal fat pad fat flap or to correct a buccal skin protrusion or hollow.     

Fibular osteoseptocutaneous flap: anatomic study and clinical application

The vascularized fibular graft has been expanded to an osteoseptocutaneous flap by including a cutaneous flap on the lateral aspect of the lower leg. The cutaneous flap can serve not only for postoperative monitoring of the grafted fibula, but also as extra skin coverage to replace substantial skin defects or prevent tight closure of the wound. From anatomic studies of 20 cadaver legs and 15 clinical cases, it has been possible to demonstrate adequate circulation to the skin of the lateral aspect of the lower leg from the septocutaneous branches of the peroneal artery alone. This finding has allowed the development of a new concept and technique to elevate the fibula as an osteoseptocutaneous flap for reconstruction which provides the following advantages: Elevation of the fibular osteoseptocutaneous unit is easy and fast. The cutaneous flap of the fibular osteoseptocutaneous unit can slide almost freely while attached to the paper-thin posterior crural septum without being tethered by a bulky muscle cuff, facilitating the setting of the fibular osteocutaneous flap when the bone and skin are widely separated. Intraoperatively, in a situation in which it is necessary to change from originally selected recipient vessels to ones more suitable, the thin posterior crural septum can be folded around the fibula allowing more flexibility in choice of recipient vessels. The fibular osteoseptocutaneous flap meets the criteria outlined for composite tissue reconstruction of defects of the extremities.(ABSTRACT TRUNCATED AT 250 WORDS)     

The vasculature and clinical application of the posterior tibial perforator-based flap.

Use of the posterior tibial flap pedicled on the posterior tibial vessels has been described by several authors, but with it there is the major disadvantage of an unavoidable transection of the posterior tibial artery. To overcome this disadvantage, we anatomically studied the perforators from the posterior tibial artery and used posterior tibial perforator-based flaps clinically. Based on our anatomic study of 25 cadaveric legs, the cutaneous perforators were considered to be distributed from the distal to the proximal sides of the lower leg through the medial border of the tibia, and they were classified into three types: septocutaneous perforators mainly located in the distal third of the leg, muscle perforators located in the proximal half, and periosteal perforators in the proximal third of the leg. The average size and number of perforators was 0.8 mm and 3.1 in one leg, respectively. A considerable number were located at sites from 70 to 140 mm superior to the medial malleolus. Based on our clinical cases repaired with flaps, we consider this flap to be useful as a free flap for the repair of defects of the extremities and as an island flap for reconstruction of defects on the anteromedial aspect of the lower leg. The territory of the flap is relatively wide, being 19 x 13 cm. The long saphenous vein can be used safely as the venous drainage system in the case of free-flap transfer.     

干细胞研究及其在临床医学上的应用

干细胞是一类具有自我更新和分化潜能的细胞,可以分为胚胎干细胞和成体干细胞两类。近来干细胞研究的二项重大技术突破：胚胎干细胞的体外培养和成体干细胞的横向分化,为干细胞在临床医学上的应用开辟了广阔的前景。