目的 探討腔鏡深筋膜下交通支結扎（SEPS）+潰瘍周圍環縫術聯合治療慢性下肢靜脈性潰瘍的臨床療效。方法 2004年3月至2006年9月對23例慢性下肢靜脈性潰瘍患者實施SEPS+潰瘍周圍環縫術（聯合治療組）。另有SEPS組(19例)和潰瘍周圍環縫組(30例)作對照。所有病例均行常規大隱靜脈高位結扎+剝脫術。結果 聯合治療組潰瘍于術后12~60 d愈合，平均25.7 d； SEPS組于術后18~90 d愈合，平均35.1 d; 潰瘍周圍環縫組于術后21~90 d愈合，平均47.3 d，各組間差異均有統計學意義（P＜0.05）。3組間復發率比較，差異無統計學意義（Pgt;0.05）。結論 SEPS+潰瘍周圍環縫術能夠有效地治療慢性下肢靜脈性潰瘍，2個術式聯合應用其潰瘍愈合時間較單獨應用縮短。
OBJECTIVE: To investigate the therapeutic effect of subfascial endoscopic perforator vein surgery (SEPS) in treatment of varicose of the lower limb. METHODS: From 1999. 11 to 2000. 12, 108 patients with varicose of the lower limb underwent venous surgery and 34 of them were treated by SEPS. There were 16 males and 18 females aged 20-79(averaged 51.4 years). Thirty limbs (26 cases) had open ulcers and the diameter of ulcer was 1.5-12.0 cm. Eleven limbs (8 cases) had severe pigmentation and the skin changes had been presented for 1 month to 15 years. According to the severity of illness, flush saphenofemoral ligation, great saphenous vein stripping, percutaneous continuous venous circum suture, external femoral vein valve repair and SEPS were performed separately or simultaneously. RESULTS: Active ulcers healed in 19 limbs after 1 month, in 7 limbs after 3 months, and in the other 4 ulcers after skin transplantation. There was no ulcer recurrence during follow-up (ranged 9-22 months). CONCLUSION: SEPS can accelerate the healing of venous ulcers, and it is one of important methods in the treatment of chronic venous insufficiency.
Ten cases of soft tissue defect at palm orwrist were repaired by reversed fasciocutaneousflap from the forearm. All were. survived excepttwo cases having necrosis of the distal portion ofthe graft. The blood supply of the skin of the fore-arm was comming from the perforation fasciocuta-neous and musculocutaneous giving rise from theulna , radial and interosseous arteries. Therefore ,when the flap was designed,it was best to have thefascial pedicle over the arterial trunks in order toinclude more perforating arteries in the flap . It was indicated that venous supply might also played an important role in flap nutrition.
目的 探討腔鏡深筋膜下交通支離斷術（subfascial endoscopic perforating vein surgery，SEPS）治療下肢靜脈性潰瘍的效果及優勢。方法 對蘇州大學附屬第一醫院2006年12月至2008年5月期間收治的30例下肢靜脈性潰瘍患者（32條患肢）實施SEPS。術后觀察潰瘍的愈合情況及其他癥狀的改善情況。結果 全組隨訪3～15個月（平均8.5個月），靜脈性潰瘍于術后27～103 d(平均65 d)內愈合，濕疹消失，色素沉著逐漸變淺； 隨訪期間無切口感染等并發癥，未見潰瘍復發及新生潰瘍。結論 SEPS安全有效，損傷小，并發癥少，是治療下肢靜脈性潰瘍較為有效的方法。
Considering the abundant vascular anastomotic networks in the deep fascia of the posterior calf, three kinds of distally based facial flap containing deep fascial vascular network were applied clinically. They were: 1. posterolateral distally based island fascial flap which could be used to repair the skin defect of heel, dorsum of foot and lateral-distal part of leg; 2. posteromedial distally based island fascial flap which could be used to repair the skin defect of heel, medial malleolus and medial-distal part of leg and 3. posterolateral malleolar distally based fascial flap which could be used to repair the skin defect of heel and lateral malleolus. Eighteen cases with soft tissue defects around the distal calf were treated, the area of skin defect ranged from 4 cm x 3 cm to 13 cm x 6 cm. All the flaps were survived completely after operation with an average of follow-up for 15 months (ranged from 6 months to 2 years). So the advantages of these flaps were as follows: the blood supply was reliable, preparation of the flap was easy and the major arteries of the calf needed not be sacrificed; the flap had a long and rotatable pedicle so that they would basically satisfy the need to repair skin defect of lower leg, dorsum of foot, heel and malleolus and the resistance of the flap to pressure and wear was better. However, the injury to the superficial sural nerve was the shortcoming.
The noses of eight patients being dead for 2hours were dissected to investigate the layers andstructure of the nose, and the stability of theimplanted silicone noae prosthesis was tested.According to the structure and microstructure ofthe nose studied by us, we suggested a newconcept of nasal muscle and dorsal deepfasciacomplex. We confirmed the prcathesis should beimplanted in the space between the nasal boneand the complex. The reason for complicationhappened in this approach was that...