【摘要】 目的 觀察綜合治療體表血管瘤及脈管畸形的臨床療效。 方法 2008年1月-2010年9月，收治體表血管瘤和脈管畸形患者共205例。手術治療156例，其中單純手術治療103例，合并介入治療9例，硬化劑治療44例；非手術治療49例，其中介入治療1例，硬化劑治療38例，介入合并硬化劑治療10例。術后隨訪6個月～3年。 結果 15例手術治療患者于術后6個月～2年復發，其中單純手術治療患者10例（復發率9.71%），合并介入治療患者2例（復發率22.22%），合并硬化劑治療患者3例（復發率6.82%），均再次手術治療后痊愈。9例非手術治療患者于治療后3個月～2年復發，其中8例硬化劑治療患者，1例介入合并硬化劑治療患者，均經手術治療后痊愈。余患者未見復發。 結論 以手術治療為主的綜合治療，是體表血管瘤和脈管畸形治療的良好方法。【Abstract】 Objective To observe the clinical therapeutic efficacy of comprehensive treatment on body surface hemangioma and vascular malformations. Methods Between January 2008 and September 2010, 205 pateints with surface hemangioma and vascular malformation were treated. A total of 156 patients received surgical treatment, in whom 103 received surgery alone, 9 underwent combined interventional treatment, and 44 received combined sclerotherapy. There were 49 patients underwent non-surgical treatment, including intervention in 1, sclerotherapy in 38 involving 10 had combined sclerotherapy. The patients were followed up for 6 months to 3 years. Results A total of 15 patients who had received surgical treatment recurred 6 months to 2 years after the treatment, including 10 who had been treated with surgery alone (with the recurrence rate of 9.71%), 2 combined with interventional treatment (with the recurrence rate of 22.22%), and 3 combined with sclerotherapy (with the recurrence rate of 6.82%). They were all cured after reoperation. Nine cases of non-surgical treatment recurred 3 months to 2 years after the treatment, including 8 who had received sclerotherapy, and 1 combined with interventional treatment and sclerotherapy. Patients were all cured after surgery. The other patients had no recurrence. Conclusion Applying mainly on surgical treatment, the combined therapy is a good way for body surface hemangioma and vascular malformations.
目的：探討N-乙酰半胱氨酸對燙傷大鼠炎癥反應的影響。方法：48只Wistar大鼠隨機分為實驗組和對照組，制作燙傷休克模型，傷后1小時腹腔注射生理鹽水40ml/kg抗休克，實驗組于抗休克鹽水中加入N-乙酰半胱氨酸160mg/kg，其后足量飲水。分別于燙傷前、燙傷后8小時、16小時及24小時，處死每組各6只大鼠并立即心臟取血，采用ELISA法檢測大鼠血清中TNF-a含量，于創周近頭側 0.5cm處取皮膚全層組織，在顯微鏡下進行中性粒細胞計數。 結果：兩組大鼠血清TNF-a含量傷后顯著升高，8小時達到高峰，其后逐漸下降，兩組各時點比較有顯著差異（P＜0.05）；創周組織中性粒細胞計數于傷后隨時間延長逐漸增多，兩組比較有顯著性差異（P＜0.05）。 結論：N-乙酰半胱氨酸有助于降低燙傷大鼠血漿中TNF-a含量及創周組織中的中性粒細胞計數量，減輕燙傷大鼠的全身及局部炎癥反應。
目的:回顧性分析臀會陰及下肢大面積皮膚軟組織撕脫傷的治療體會。方法:2005年1月至2007年6月,對8例臀會陰及下肢大面積皮膚軟組織撕脫傷患者進行綜合治療。男4例,女4例,年齡4～48歲,平均26歲,病程1天～1月,平均2周。皮膚撕脫達體表總面積8%～20%。致傷原因:車禍傷7例,高墜傷1例。其中7例成人均上翻身床治療,1例小孩床上自行翻身,6例由于創面距肛門較近或脊髓損傷不能控制大便而行結腸造瘺,通過造瘺口排便,創面愈合3月后行造瘺還納術。所有患者均通過積極創面處理、肉芽新鮮后行刃厚植皮術而痊愈。結果:8例患者經過我們的綜合治療后傷口均愈合,隨訪6月后皮膚愈合良好。6例行結腸造瘺的患者中3例因骨盆骨折穩定于出院后3月左右行結腸造瘺還納術,恢復肛門排便,3例伴有脊髓損傷患者而不能自行控制排便的患者在隨訪期間未行結腸造瘺還納術。結論:臀會陰及下肢大面積皮膚軟組織撕脫傷患者通過上翻身床,必要時行結腸造瘺,積極的創面處理及對癥支持治療能取得較好效果。
Objective To discuss the operative method and experience, through analyzing the medium-term and long-term effect of combined therapy for cutaneous squamous cancer of head and face. Methods From January 1998to December 2002, 37 patients with head or neck cutaneous squamous cancer received combined therapy of operation and radiation. The determination of resect area was based on the stage of the tumor, and according to the resect area and the freedom of peripheral tissue, 3 different operation procedures were adopted respectively. The follow-up was ended in June 2004. Results The follow-up was 5 to 69 months. The median follow-up interval was 38 months. Four patients (10.8%) relapsed during the follow-up, and 2 of them (5.4%) relapsed within 3 years after operation. two patients (5.4%) died from the primary affection, 4 patients (10.8%) died from other causes. According to Kaplan-Meier Method, the 3-year survival rate was 97.14% and the standard error was 0.0358, and 5-year survival rate was 92.28% and the standard error was 0.1047. Conclusion The recurrence rate of cutaneous squamous cancer of head and face witha better prognosis is lower than the ones from other origins. And the survival rate may be improved from proper operative method.
Objective?To investigate the operative method and efficacy of subcutaneous pedicle scar-band rotation flap in the treatment of cervical postburn scar contracture.?Methods?Between August 2008 and May 2010, 15 patients with cervical postburn scar contracture were treated with subcutaneous pedicle scar-band rotation flaps, including 9 males and 6 females with an average age of 17.3 years (range, 7-35 years). The disease duration was 1-8 years (mean, 3 years). The locations were the left cervical region in 6 cases, the right cervical region in 8 cases, and mental cervical angle region in 1 case. According to LI Ao’s classification standard for cicartrical contracture, there were 12 cases of grade I and 3 cases of grade II. The area of scar ranged from 8 cm × 5 cm to 25 cm × 12 cm. After scar relaxation, wounds were repaired with the subcutaneous pedicle scar-band rotation flaps of 7 cm × 5 cm to 15 cm × 10 cm at size. In 3 cases of grade II, free split thickness skin grafts (7 cm × 4 cm to 12 cm × 7 cm at size) were used simultaneously.?Results?After 2 weeks of operation, 2 scar-band flaps had distal partial necrosis and healing was achieved after dressing change with formation of hypertrophic scar; the others survived with healing of incisions by first intention. After 6-12 months of follow-up, all patients possessed good cervical contours, sufficient release of scar contractures, and normal cervico-mandicular or mental cervical angles. The skin’s color and texture were satisfactory. There was no recurrence of cervical scar contracture and other complications. All patients acquired normal cervical movement at last follow-up.?Conclusion?Subcutaneous pedicle scar-band rotation flap is a simple, efficient, and versatile technique in release of cervical postburn scar contracture. It is an effective method to make use of the lateral excess scar flap to resurface defects caused by scar release.
Objective To investigate the surgical treatment and curative effect of hemangioma and vascular malformation in body surface. Methods From May 2003 to December 2006, 145 patients with hemangioma or vascular malformation (81 males and 64 females, aging from 2 months to 40 years with median of 17 years) were treated with surgical therapy. The course of disease was from 2 months to 40 years. The locations were head and face in 85 cases, extremities in 34 casesand trunk in 26 cases. The size ranged from 1 cm × 1 cm to 27 cm × 24 cm. Wounds were sutured directly after lesions excision in 40 cases, were repaired with 3 cm × 2 cm-18 cm × 11 cm local flap transferring in 21 cases (donor site sutured directly in 18 and free skin grafted in 3) and with 5 cm × 3 cm-27 cm × 18 cm middle-thick skin graft in 84 cases (abdominal skin donor site sutured directly in 61, thigh skin donor site thin-partial-thickness grafted in 5 and skin in-situ regrafted in 18). Results The pathological results showed 38 cases of capillary hemangioma, 23 cases of venular malformation, 67 cases of venous malformation, 15 cases of arteriovenous malformation and 2 cases of lymphatic malformation. Six of 84 cases receiving free skin graft had partial skin necrosis; one case compl icating by skull exposure achieved heal ing after local fascial flap transferring and other 5 cases achieved heal ing by second intention after dressing changes. Other free skin graft survived. All the donor sites healed by first intention. All patients were followed up for 1-3 years. Recurrence occurred in 12 cases 6 months to 2 years after operation, including 4 cases of arteriovenous malformation, 7 cases of venous malformation and 1 case of venular malformation. They were cured after second operation. The others achieved good results with no recurrence. Conclusion Extensive and thorough excision was the effective way to cure hemangioma and vascular malformation in body surface. All cases should be followed up closely to deal with recurrence promptly.
Objective To investigate the feasibility and effectiveness of thoracodorsal artery perforator (TDAP) flap for repairing serious scar contracture of the opisthenar. Methods Between March 2015 and June 2017, 7 cases of serious scar contracture of opisthenar were repaired with TDAP flaps. There were 5 males and 2 females with an average age of 31 years (range, 11-48 years). The time from injury to operation was 8-67 months, with an average of 42 months. After the relocation of the joint and release of the scar, the size of soft tissue defect ranged from 5 cm×4 cm to 10 cm×8 cm. The size of TDAP flap ranged from 5.5 cm×5.0 cm to 10.5 cm×9.0 cm. Results All flaps survived completely with primary healing at both donor site and recipient site. The flaps of 3 patients were bulky and underwent second-stage skin flap thinning at 3 months after operation. All 7 patients were followed up 6-32 months, with an average of 15 months. The skin flaps were soft and elastic. According to the upper limb function evaluation system recommended by Chinese Society of Hand Surgery, sensory function was classified as \begin{document}$\small{{\rm{S}}_{{{\scriptsize 3}^ + }}}$\end{document} in 2 cases, \begin{document}$\small{{\rm{S}}_{{{\scriptsize 3} }}}$\end{document} in 1 case, \begin{document}$\small{{\rm{S}}_{{{\scriptsize 2} }}}$\end{document} in 3 cases, and \begin{document}$\small{{\rm{S}}_{{{\scriptsize 1} }}}$\end{document} in 1 case. The hand function was excellent in 2 cases, good in 4 cases, and fair in 1 case. There was no significant effect on shoulder movement. Conclusion The TDAP flap is an ideal method for serious scar contracture of opisthenar.
Objective To review the emergency management and perioperative strategies for ruptured neurofibromatosis type 1 (NF1)-related giant plexiform neurofibroma (PNF), providing a systematic treatment protocol to improve the therapeutic outcomes and quality of life for patients with giant PNF. Methods The literature on the management of giant PNF rupture and hemorrhage was reviewed, and the diagnosis, treatment, and perioperative management were summarized based on clinical experiences. Results By implementing an integrated diagnostic and treatment strategy that includes early diagnosis, imaging evaluation, emergency ultra-selective arterial embolization combined with surgical excision, acute hemorrhage can be effectively controlled while also reducing the risk of major intraoperative bleeding and minimizing postoperative complications. As a result, this approach significantly improves treatment success rates and patient quality of life. Conclusion For ruptured NF1-related giant PNF, employing emergency ultra-selective arterial embolization combined with surgical excision, under the collaboration of a multidisciplinary team, can effectively improve treatment success rates, rapidly control bleeding, reduce tumor size, and lower mortality. Future research should focus on assessing the long-term quality of life of patients treated for ruptured and hemorrhaging giant PNF and on further optimizing treatment protocols.
ObjectiveTo explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy.MethodsBetween January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m2, with an average of 30.8 kg/m2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g).ResultsThe skin flap necrosis at the " T” trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15).ConclusionFor severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.
ObjectiveTo investigate the effectiveness of internal mammary artery perforator (IMAP) propeller flap repair combined with radiotherapy for chest keloid in female patients.MethodsBetween January 2015 and December 2016, 15 female patients with chest keloids were treated, aged 28-75 years (mean, 45.2 years). The keloid disease duration was 1-28 years (median, 6 years). The causes of disease included secondary keloid caused by folliculitis in 7 cases, cardiac surgery in 4 cases, skin abrasion in 2 cases, mosquito bite in 1 case, and unknown etiology in 1 case. The size of keloid ranged from 5 cm×3 cm to 17 cm×6 cm. The IMAP propeller flaps were used to repair the defects after chest keloid excision. The size of flaps ranged from 7 cm×5 cm to 14 cm×8 cm. The donor sits were sutured directly. The routine radiotherapy was performed after operation.ResultsAll IMAP propeller flaps survived well, and the donor sites healed by first intention. All 15 patients were followed up 12-24 months (mean, 16 months). No telangiectasia or incision dehiscence occurred. No radiation-related carcinogenesis occurred during follow-up. The patients were satisfied with the breast shape and symmetry after operation. The symptoms of pain and itching relieved at keloid area in 13 cases (86.7%), with no obvious recurrence of keloid at the donor site and the primary site. Only 2 cases (13.3%) recurred and were treated with continuously conservative treatment.ConclusionIMAP propeller flap is an ideal reconstruction method for repairing the wounds after chest keloid excision in female patients, which can preserve the good breast shape. The IMAP propeller flap repair combined with early postoperative radiotherapy can effectively reduce the recurrence rate, and the effectiveness is satisfactory.