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Posterior Thigh Flap for Pressure Sores 股后皮瓣治疗褥疮
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0071
Christopher L. Ellstrom, G. Evans
Management of pressure ulcers requires a multifaceted approach for both prevention and treatment. The posterior thigh flap is one option for definitive surgical management. Treatment is initiated optimizing factors for wound healing and minimizing risk factors for recurrence. Obtaining adequate pressure offloading, moisture control, decreased wound contamination, and correction of any malnutrition should be addressed before considering surgery. The arc of rotation allows for potential closure of defects of the upper gluteal region, lower sacrum, greater trochanter, pubis, or perineum. Ischial ulcers treated with the posterior thigh flap can have a high rate of wound healing complications, but total flap loss and other serious complications are relatively rare. Partial loss or recurrence can often be treated with flap readvancement. Patient selection and preparation are keys to success.
压疮的管理需要多方面的预防和治疗方法。股后皮瓣是确定手术治疗的一种选择。治疗开始优化因素的伤口愈合和减少复发的危险因素。在考虑手术前,应考虑适当的减压、控制湿度、减少伤口污染和纠正任何营养不良。旋转弧度可以潜在地闭合臀上区、骶骨下段、大转子、耻骨或会阴的缺损。采用股后皮瓣治疗坐骨溃疡,创面愈合并发症发生率高,但皮瓣全失等严重并发症相对少见。部分缺损或复发通常可通过皮瓣再推进治疗。病人的选择和准备是成功的关键。
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引用次数: 0
Orthognathic Surgery Orthognathic手术
Pub Date : 2019-07-01 DOI: 10.1093/med/9780190499075.003.0058
Ryan Moore, R. Vyas
Orthognathic surgery restores the facial function and aesthetics affected by skeletal and dental deformities. A comprehensive preoperative evaluation, including cephalometric analysis, is essential to correcting facial skeletal imbalance and asymmetry. Operative planning must account for maxillary-to-mandibular occlusal relationship and dental compensations, as well as facial proportions in all dimensions. Virtual surgical planning has recently emerged as a way to facilitate more precise and accurate surgical planning. Operative techniques used to correct facial skeletal and dental deformities, broadly categorized as maxillary or mandibular excess or deficiency, include the LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty.
正颌手术恢复面部功能和美学影响的骨骼和牙齿畸形。全面的术前评估,包括头部测量分析,是纠正面部骨骼不平衡和不对称的必要条件。手术计划必须考虑上颌-下颌咬合关系和牙齿代偿,以及面部各方面的比例。虚拟手术计划最近作为一种促进更精确和准确的手术计划的方法而出现。用于矫正面部骨骼和牙齿畸形的手术技术,大致分为上颌或下颌的过度或不足,包括LeFort I截骨术,双侧矢状劈开截骨术和颏成形术。
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引用次数: 0
Nasal Fractures 鼻子骨折
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0032
Christine J. Lee, R. Vyas
The nose has several vital functions, including respiration and olfaction. The nose, as the leading point of the face, is without protective covering and is the least resistant of the facial bones to the application of a directional mechanical force. The management of isolated nasal fractures, therefore, requires a systematic approach to diagnosis, treatment, and follow-up care to ensure optimal functional and aesthetic results while minimizing complications. Good results can usually be obtained from a closed reduction of most nasal fractures in appropriately selected patients. Open reduction and wire or plate fixation should be considered in very displaced and severely comminuted fractures or when accompanied by adjacent facial fractures. Proper early operative management minimizes the need for secondary surgical revision.
鼻子有几个重要的功能,包括呼吸和嗅觉。鼻子作为面部的引导点,没有保护性的覆盖物,是面部骨骼中对定向机械力应用的抵抗力最低的。因此,孤立性鼻骨折的治疗需要系统的诊断、治疗和后续护理,以确保最佳的功能和美观效果,同时最大限度地减少并发症。在适当选择的患者中,对大多数鼻骨折进行闭合复位通常可以获得良好的结果。对于高度移位和严重粉碎性骨折或伴有邻近面部骨折的患者,应考虑切开复位和钢丝或钢板固定。适当的早期手术处理可以减少二次手术翻修的需要。
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引用次数: 0
Rhytidectomy 整容术
Pub Date : 2019-07-01 DOI: 10.1093/med/9780190499075.003.0023
M. Paul
Current concepts in rejuvenating the aging face and neck have evolved from simple undermining of the skin resulting in skin tension-based closure to various techniques that utilize the superficial musculoaponeurotic system (SMAS) as a supporting layer with no tension on the skin. The evolution of techniques regarding the manipulation of the SMAS began with an understanding of the anatomy of the facial nerve and sub-SMAS anatomy. Both volume-based and vector-based corrections are required. The selection of the appropriate technique is based on the clinical examination and the surgical options that the surgeon possesses. A safely performed procedure that provides impressive rejuvenation of the aging face and neck is always the goal.
目前,面部和颈部衰老的恢复概念已经从简单的皮肤破坏导致皮肤紧张闭合发展到利用浅表肌肉腱神经系统(SMAS)作为支持层而不产生皮肤张力的各种技术。关于SMAS的操作技术的发展始于对面神经和SMAS下解剖结构的理解。基于体积和基于矢量的校正都是必需的。选择合适的技术是基于临床检查和外科医生拥有的手术选择。一个安全的执行程序,提供令人印象深刻的复兴老化的脸和脖子一直是目标。
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引用次数: 0
Trigger Finger 扣扳机的手指
Pub Date : 2019-07-01 DOI: 10.1093/med/9780190499075.003.0095
R. Sood, Joshua M. Adkinson, B. Hartman
Stenosing flexor tenosynovitis of the digits, commonly known as trigger finger, is one of the most common conditions affecting the hand. It is characterized by a painful locking or clicking of the finger during flexion or extension. This can lead to significant pain or eventual flexion deformity. Treatment varies based on the duration, severity, and etiology and can be either conservative or operative. The complication rate of surgical intervention remains low, with the most common being pain at the operative site. Treatment of trigger finger in the patient with rheumatoid disease should be approached with caution. Overall management of trigger finger, whether conservative or operative, is routinely successful with the final result of a satisfied patient.
手指狭窄性屈肌腱滑膜炎,俗称扳机指,是影响手部最常见的疾病之一。它的特点是在屈曲或伸展时手指疼痛的锁定或咔嗒声。这可能导致明显的疼痛或最终的屈曲畸形。治疗根据病程、严重程度和病因不同而不同,可以采用保守治疗或手术治疗。手术干预的并发症率仍然很低,最常见的是手术部位的疼痛。类风湿病患者扳机指的治疗应谨慎处理。扳机指的整体管理,无论是保守还是手术,通常都是成功的,最终结果是一个满意的病人。
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引用次数: 0
Abdominoplasty 腹壁整形术
Pub Date : 2019-07-01 DOI: 10.1093/med/9780190499075.003.0015
M. Paul
The evolution of abdominal contouring began with excision of skin and subcutaneous tissue more than 100 years ago. This evolved into proper lower abdominal horizontal incision placement and fascial repair along with dermo-lipectomy. The introduction of liposuction was a sentinel event in body contouring, applicable as well to the entire abdomen. Taken further, abdominoplasty matured with targeted fat removal, fat grafting, and high-definition lipo-contouring. Limited undermining combined with targeted liposuction created an aesthetically pleasing abdominal contour while safely preserving the blood supply to the undermined flap. The introduction of barbed sutures for fascial repair and for wound closure, the use of basting sutures, and lateral to medial flap advancement moved modern abdominoplasty to a safer procedure with impressive aesthetic results. While producing an impressive aesthetic improvement was always the primary goal, increasing attention that focused on decreasing the risks of adverse events and sequelae was an important goal.
腹部轮廓术的发展始于100多年前对皮肤和皮下组织的切除。这演变为适当的下腹部水平切口放置和筋膜修复以及皮脂切除术。吸脂术的引入是身体轮廓的前哨事件,也适用于整个腹部。更进一步,腹部成形术随着有针对性的脂肪去除、脂肪移植和高清晰度的脂肪轮廓而成熟。有限的破坏结合有针对性的吸脂创造了一个美观的腹部轮廓,同时安全地保留了破坏皮瓣的血液供应。引入有刺缝线用于筋膜修复和伤口闭合,使用缝合线,外侧到内侧皮瓣推进使现代腹部成形术更安全,并具有令人印象深刻的美学效果。虽然产生令人印象深刻的美学改善始终是首要目标,但增加对减少不良事件和后遗症风险的关注是一个重要目标。
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引用次数: 0
Compression Neuropathies of the Upper Extremity 上肢压迫性神经病
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0100
W. K. Ng
Compression neuropathies of the upper extremity are common, and these conditions can be symptomatically debilitating for patients. Although the author acknowledges that nerve compression can still occur at various sites from the neck proximally to the hand distally for all of the described nerves herein, the author aims with this chapter to describe a series of straightforward, reproducible, and reliable approaches to the evaluation and management of three upper extremity peripheral neuropathies to each of the three major nerves to the hand: carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome.
上肢压迫性神经病是常见的,这些情况可使患者症状衰弱。尽管作者承认,从颈部近端到手部远端,对于本文所描述的所有神经,神经压迫仍然可能发生在不同的部位,但作者在本章的目的是描述一系列简单、可重复和可靠的方法,以评估和处理涉及手部三大主要神经的三种上肢周围神经病变:腕管综合征、肘管综合征和桡管综合征。
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引用次数: 0
Carpal Fractures and Dislocations 腕关节骨折和脱位
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0103
J. Ko, N. Vedder, Rahul Kasukurthi
Nearly 1.5 million hand and wrist fractures are treated in the United States annually. Wrist fractures encompass fractures to the carpal bones, distal radius, and ulna. Most hand and forearm fractures occur in the home and are not work related. The scaphoid bone is most commonly involved, accounting for 60–85% of carpal fractures. The burden of wrist fractures is projected to increase as the population ages, and prompt and accurate diagnosis and treatment are necessary to avoid long-term disability. This chapter will focus on pathophysiology, diagnosis, imaging, and treatment of carpal injuries with emphasis on scaphoid fractures and perilunate dislocations.
在美国,每年有近150万手部和手腕骨折患者接受治疗。腕部骨折包括腕骨、桡骨远端和尺骨骨折。大多数手部和前臂骨折发生在家中,与工作无关。舟状骨最常受累,占腕骨折的60-85%。随着人口老龄化,腕部骨折的负担预计会增加,及时准确的诊断和治疗对于避免长期残疾是必要的。本章将重点介绍腕关节损伤的病理生理学、诊断、影像学和治疗,重点是舟状骨骨折和月骨周围脱位。
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引用次数: 0
Zygomaticomaxillary Complex Fractures 颧颌复合体骨折
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0059
R. Ettinger, S. Buchman
The zygomatic bone is a critical component of the midfacial complex. Its prominence within the face makes it susceptible to trauma and its intricate anatomy make posttraumatic repair of zygomaticomaxillary complex (ZMC) fractures challenging. The zygoma has a “tetrapod” structure with four key articulation points: the zygomaticomaxillary articulation and inferior orbital rim, zygomaticosphenoid articulation in the lateral orbital wall, zygomaticofrontal articulation and the lateral orbital rim, and the zygomatic arch. The zygoma is also a key contributor to several facial buttresses and a main determinant of malar projection and transverse facial width. Several approaches to the ZMC may be required to ensure appropriate reduction of each articulation site during operative repair. Concomitant injuries to other facial structures can be seen with ZMC fractures, given the zygomatic bones close association with the orbit, nasal bones, and the maxilla. Adequate ZMC fracture repair requires appropriate exposure of all involved fractures, robust mobilization of bone fragments, and application or rigid fixation while ensuring simultaneous reduction at all involved ZMC articulation points. Midface soft tissue resuspension should be performed following ZMC reduction and fixation to prevent unwanted soft tissue descent and lower lid malposition.
颧骨是面中复合体的重要组成部分。颧骨在面部的突出位置使其易受创伤,其复杂的解剖结构使创伤后修复颧骨腋窝复合体(ZMC)骨折具有挑战性。颧骨呈“四足”结构,有四个关键关节点:颧腋关节及眶下缘、眶外壁颧蝶骨关节、颧额关节及眶外缘、颧弓。颧骨也是几个面部支撑的关键贡献者,也是颧突和横向面部宽度的主要决定因素。在手术修复过程中,可能需要几种入路来确保每个关节部位的适当复位。由于颧骨与眼眶、鼻骨和上颌骨密切相关,ZMC骨折可同时损伤其他面部结构。充分的ZMC骨折修复需要适当暴露所有受损伤骨折,强健地移动骨碎片,应用或刚性固定,同时确保所有受损伤的ZMC关节点同时复位。在ZMC复位和固定后应进行中脸软组织重悬,以防止不必要的软组织下降和下眼睑错位。
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引用次数: 0
Eyelid Reconstruction 双眼皮
Pub Date : 2019-07-01 DOI: 10.1093/med/9780190499075.003.0029
S. Grob, D. Kikkawa, D. Park
Eyelid reconstruction is indicated in the setting of trauma, following cancer excision, for congenital deformities, and for age-related degeneration. As the eyelids have a large impact on the appearance of the eyes, the aesthetic result of reconstruction is as important as the restoration of eyelid function in ocular surface protection and lubrication. In this chapter, the authors discuss the operative care of patients with defects of varying extent involving the upper and lower eyelids, as well as common degenerative conditions such as eyelid margin malrotation and eyelid malposition, such as ptosis, retraction, entropion, and ectropion. Planning for repair should begin during the initial examination. The surgeon can evaluate the size of an eyelid lesion and attempt to predict the size of the possible defect after excision.
眼睑重建指的是创伤,癌症切除后,先天性畸形和年龄相关的变性。由于眼睑对眼睛的外观有很大的影响,因此在眼表保护和润滑方面,重建的美学效果与眼睑功能的恢复同样重要。在本章中,作者讨论了不同程度的上、下眼睑缺损患者的手术护理,以及常见的退行性疾病,如睑缘旋转不良和睑位不正,如上睑下垂、内翻、内翻和外翻。维修计划应在初步检查时开始。外科医生可以评估眼睑病变的大小,并试图预测切除后可能出现的缺损的大小。
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引用次数: 0
期刊
Operative Techniques in Plastic and Reconstructive Surgery
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