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足跟完全離斷再植一例

帶血管神經蒂的手部軸型島狀皮瓣的臨床應用

惡性原發性心臟腫瘤術后遠期生存三例

直視雙極射頻消融術治療心瓣膜病合并慢性心房顫動

目的 介紹直視雙極射頻消融術治療心瓣膜病合并慢性心房顫動（AF）的初步體會，探討控制慢性AF的有效方法。 方法 2005年5月至2007年11月，對23例心瓣膜病合并慢性AF患者采用直視雙極射頻消融術治療，在常溫體外循環心臟跳動下進行右心房的消融，然后在中度低溫心臟停搏下做左、右肺靜脈口和左心耳的消融隔離，最后行心瓣膜置換術。 結果 射頻消融時間18～26 min。術后因特發性血小板減少致消化道大出血住院死亡1例，生存的22例患者隨訪3～30個月，出院時、3個月、1年和2年竇性心律轉復率分別是81.8%、86.4%、82.4%和77.8%，無Ⅲ度房室傳導阻滯、病竇綜合征和栓塞等并發癥發生。 結論 直視雙極射頻消融術治療心瓣膜病合并慢性AF操作簡單、效果滿意、并發癥較少。

Free sensate intercostal artery perforator flap for hand soft tissue reconstruction

ObjectiveTo investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction.MethodsBetween March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases).ResultsAll of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily. Conclusion Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.