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Soleus Flap for Lower Leg Reconstruction 比目鱼肌瓣用于小腿重建
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0086
J. Friedman, E. Ruff
Open wounds in the middle third of the lower leg often require soft tissue reconstruction to allow for primary wound healing. The soleus muscle flap is uniquely suited for this purpose and is used primarily as a muscle flap without the accompanying overlying skin. This muscle has a blood supply that is segmental in nature, arising from multiple perforators from the posterior tibial vessels. Given that that this blood supply is primarily located in the proximal third of the leg, the soleus muscle flap is generally based proximally to allow for coverage of middle-third defects. While the muscle has a clear intermuscular septum which separates the medial head from the lateral segment, the use of a so-called hemi-soleus flap is less reliable and thus used on an infrequent basis. The soleus muscle flap can also be based distally in the leg for small distal-third defects; however, this flap can often be unreliable due to a paucity of sufficient perforators located in this area.
小腿中间三分之一的开放性伤口通常需要软组织重建,以使伤口初步愈合。比目鱼肌瓣是唯一适合于这一目的,主要用作肌肉瓣,没有伴随的覆盖皮肤。这块肌肉的血液供应是节段性的,起源于胫骨后血管的多个穿支。鉴于这种血液供应主要位于腿的近三分之一,比目鱼肌瓣通常以近端为基础,以覆盖中间三分之一的缺陷。虽然肌肉有清晰的肌间隔将内侧头与外侧段分开,但使用所谓的半比目鱼肌瓣不太可靠,因此很少使用。比目鱼肌瓣也可用于小腿远端小缺损;然而,由于在该区域缺乏足够的穿支,这种皮瓣往往不可靠。
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引用次数: 0
Replantation 再植
Pub Date : 2019-07-01 DOI: 10.1093/med/9780190499075.003.0094
Grant M. Kleiber, K. Brandt
Successful replantation depends on multiple variables. A coordinated effort of emergency transport services, emergency room personnel, operating room staff, anesthesiologists and postoperative nursing is required for success. The need for this team approach has led to the development of several specialized replantation centers worldwide. The authors discuss the various mechanisms of injury and their chances for successful replantation. This chapter examines the indications and contraindications for appropriate replantation. Also provided are many useful techniques for vessel and nerve repair, bony fixation, tendon repair, and soft tissue coverage. The chapter also discusses postoperative management, rehabilitation, and follow-up.
成功的再植取决于多个变量。成功需要紧急运输服务、急诊室人员、手术室工作人员、麻醉师和术后护理人员的协调努力。对这种团队方法的需求导致了世界范围内几个专门的再植中心的发展。作者讨论了各种损伤机制及其成功再植的机会。本章探讨适当再植的适应症和禁忌症。还提供了许多有用的技术血管和神经修复,骨固定,肌腱修复和软组织覆盖。本章还讨论了术后管理、康复和随访。
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引用次数: 0
Extensor Tendon Repair 伸肌腱修复
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0091
S. Oates
Because of their location on the dorsum of the hand, the extensor tendons are particularly vulnerable to injury. This is even more likely over the joints since the dorsal skin is particularly thin there. Injuries can occur from both sharp and blunt trauma. Untreated extensor tendon injuries can result in significant functional impairment and potential long-term permanent deformities of the hand. There are significant differences in treatment for extensor tendon injuries involving the finger zones versus the hand. This chapter will describe the most common treatment modalities for extensor tendon injuries to the hand and forearm.
由于其位置在手背,伸肌腱特别容易受伤。这在关节上更有可能,因为背部的皮肤特别薄。锐器外伤和钝器外伤都可能造成伤害。未经治疗的伸肌腱损伤可导致严重的功能损伤和潜在的手部长期永久性畸形。涉及手指区和手部的伸肌腱损伤的治疗有显著差异。本章将描述手和前臂伸肌腱损伤最常见的治疗方式。
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引用次数: 0
Pharyngeal Flap 咽皮瓣
Pub Date : 2019-07-01 DOI: 10.1093/med/9780190499075.003.0051
Raj Yvas, L. Patty, Donald S. Mowlds
Closure of the velopharyngeal sphincter is necessary for the correct phonation of vowels and most consonants. Dysfunction of the velopharyngeal sphincter allows excess air passage into the nasal cavity, resulting in altered speech. Surgeons rely on a handful of diagnostic modalities as well as perceptual speech analysis by cleft-trained speech-language pathologists for proper evaluation of the underlying abnormality causing velopharyngeal dysfunction and for determination of subsequent treatment options. Pharyngeal flap surgery is considered in patients whose dysfunction occurs due to velopharyngeal insufficiency from a large anteroposterior central gap during closure of the velum and pharynx. The pharyngeal flap creates a static central obstruction while maintaining two patent lateral airway openings, ultimately aiding in improved phonation of oral consonants.
腭咽括约肌的闭合对于元音和大多数辅音的正确发音是必要的。腭咽括约肌功能障碍使过量的空气进入鼻腔,导致语言改变。外科医生依靠少数几种诊断方式,以及由受过裂隙训练的语言病理学家进行的感知语言分析,对导致腭咽功能障碍的潜在异常进行适当的评估,并确定后续的治疗方案。对于在闭合腭咽过程中由于前后中央间隙过大而导致腭咽功能不全的患者,可考虑咽瓣手术。咽瓣在维持两个通畅的侧气道开口的同时,形成一个静态的中心阻塞,最终有助于改善口腔辅音的发音。
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引用次数: 1
Alveolar Bone Grafting 牙槽骨移植
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0012
R. Vyas, Gennaya L. Mattison
Alveolar bone grafting plays a crucial role in cleft reconstruction. When neonatal presurgical orthodontia is successful in aligning the cleft segments, alveolar reconstruction can be initiated as a gingivoperiosteoplasty during primary cleft lip repair. In children with cleft palate, alveolar bone grafting is usually done after transverse maxillary expansion with a palatal expander. Exact timing of bone grafting is controversial; most centers initiate orthodontic evaluation/expansion between ages 7 and 8 years (beginning of mixed dentition) with an aim to bone graft before age 10 in order to allow osteogenic incorporation prior to eruption of the permanent canine teeth.
牙槽骨移植在腭裂重建中起着至关重要的作用。当新生儿手术正畸成功对准裂节段时,牙槽重建可以作为龈周成形术在初级唇裂修复中开始。在腭裂儿童中,牙槽骨移植通常是在上颌横向扩张后用腭扩张器进行的。植骨的确切时间是有争议的;大多数中心在7到8岁之间(混合牙列的开始)开始正畸评估/扩展,目的是在10岁之前进行骨移植,以便在恒牙长出之前允许成骨融合。
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引用次数: 0
Naso-orbito-ethmoidal Complex Injuries 鼻-眶-筛复合损伤
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0057
H. Alqattan, Ajani G. Nugent, S. Thaller
Comprehensive reconstruction of naso-orbito-ethmoidal fractures remains among the most challenging clinical problems for plastic surgeons. Successful repair centers on accurate diagnosis through a comprehensive history and physical examination and diagnostic imaging. Once this foundation is achieved, accurate anatomic reconstruction requires a stepwise approach and an intimate knowledge of the normal bony and soft tissue anatomy. The cornerstone remains the precise repositioning of the medial canthal tendon. Once this foundation is successfully reconstructed, the remaining bony framework can be anatomically, repositioned, reinforced, replaced with bone grafts &stabilized with rigid internal fixation.
鼻眶筛骨折的全面重建一直是整形外科最具挑战性的临床问题之一。成功的修复关键在于通过全面的病史、体格检查和诊断成像进行准确的诊断。一旦达到这个基础,准确的解剖重建需要一步一步的方法和正常骨和软组织解剖的亲密知识。基石仍然是精确地重新定位内侧眦肌腱。一旦这个基础被成功重建,剩余的骨框架可以解剖,重新定位,加强,用骨移植物代替,并用刚性内固定稳定。
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引用次数: 0
Advances in Hair Transplantation 毛发移植研究进展
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0026
A. Barrera
This chapter presents a brief review of the history of hair transplantation and the anatomy and physiology of hair follicular units. Also presented is a step-by-step description of the author’s preferred technique and pearls learned over the past 25 years to consistently accomplish natural and aesthetically pleasing results. This very labor-intensive procedure requires a team of skillful assistants to be able to do this well and comfortably. The author also describes the details of equipment and instrumentation needed, from surgical blades to the dissection microscopes, and more. The most frequent cases seen in practice include male pattern baldness, female pattern alopecia, and scarring alopecias secondary to previous surgeries (i.e., post rhytidectomy). The restoration of lost sideburns and a temporal hairline will demonstrate some of these examples.
本章简要回顾了毛发移植的历史以及毛囊单位的解剖学和生理学。此外,还介绍了作者在过去25年中学习的首选技术和珍珠的逐步描述,以始终如一地完成自然和美观的结果。这个非常劳动密集型的程序需要一组熟练的助手才能顺利完成。作者还描述了设备和仪器所需的细节,从手术刀片解剖显微镜,等等。在实践中最常见的病例包括男性型秃顶,女性型脱发和疤痕性脱发继发于以前的手术(即,除皱后)。恢复失去的鬓角和颞发际线将展示这些例子中的一些。
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引用次数: 1
Anesthesia 麻醉
Pub Date : 2019-07-01 DOI: 10.1093/med/9780190499075.003.0002
W. Sivak, Erica Sivak, K. Shestak
Regional anesthesia, or rendering only a targeted part of the body anesthetized, has numerous benefits for both the surgeon and patient. Local anesthetic agents are essential to create and maintain regional blockades, and detailed knowledge of these agents is essential to providing safe and effective care. This chapter begins with review of the basic pharmacology, indications, and contraindications for the use of regional anesthesia. Numerous specific blockades used to anesthetize distinct regions of the body are reviewed with specific focus on anatomy and technique. When safely performed, regional anesthesia can provide an optimal experience for both surgeon and patient.
局部麻醉,或只麻醉身体的某一部分,对外科医生和病人都有很多好处。局部麻醉剂对于形成和维持区域封锁至关重要,对这些药物的详细了解对于提供安全有效的护理至关重要。本章首先回顾区域麻醉的基本药理学、适应症和禁忌症。许多特定的阻塞用于麻醉身体的不同区域进行审查,特别侧重于解剖和技术。当安全操作时,区域麻醉可以为外科医生和患者提供最佳体验。
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引用次数: 0
The Rectus Femoris Flap for Groin Reconstruction 股直肌皮瓣在腹股沟重建中的应用
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0079
P. Neligan
The rectus femoris muscle is an important but expendable knee extensor. It is a bipennate muscle with a dense and strong fascia on its undersurface. This feature makes it extremely attractive for the repair of defects of the lower abdominal wall and groin as a pedicled flap. It is centrally located between the vastus medialis and vastus lateralis muscles. It is generally used as a pedicled muscle and usually taken as a muscle flap without a skin paddle. The muscle is then grafted. Following harvest, the extensor tendons need to be centralized and repaired for a distance of 6–8 cm above the knee. In many situations this flap has been superseded by the ALT flap.
股直肌是一个重要但可消耗的膝关节伸肌。它是一种两足动物肌肉,其下表面有致密而结实的筋膜。这一特点使其作为带蒂皮瓣修复下腹壁和腹股沟缺损具有极大的吸引力。它位于股内侧肌和股外侧肌之间的中心位置。它通常用作带蒂的肌肉,通常用作没有皮肤桨的肌肉瓣。然后移植肌肉。收获后,伸肌腱需要集中并修复膝盖以上6 - 8cm的距离。在许多情况下,这个皮瓣已被ALT皮瓣所取代。
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引用次数: 0
The Rectus Abdominis Flap
Pub Date : 2019-07-01 DOI: 10.1093/MED/9780190499075.003.0039
Melissa A. Mueller, G. Evans
The rectus abdominis flap is a versatile, workhorse flap. It is ideal for head and neck reconstruction requiring large, soft tissue bulk without bony reconstruction, particularly for defects of the tongue, orbits, maxilla, cheek, posterior mandible, and cranial base. Its ability to be folded upon itself and harvested with multiple skin paddles makes it versatile for complex three-dimensional and multilaminar defects. Its pedicle size and length and consistent vascular anatomy make the flap a reliable choice for head and neck reconstruction. Its indications in head and neck reconstruction and technique in harvest are elaborated in this chapter.
腹直肌皮瓣是一种多功能的,工作马皮瓣。对于需要大量软组织而不需要骨重建的头颈部重建,尤其是舌、眶、上颌骨、脸颊、下颌骨后部和颅底的缺损,它是理想的。它的折叠能力,并收获与多个皮肤桨,使其多功能复杂的三维和多层缺陷。其蒂的大小和长度以及一致的血管解剖结构使皮瓣成为头颈部重建的可靠选择。本章阐述了其在头颈部重建中的适应症和采收技术。
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Operative Techniques in Plastic and Reconstructive Surgery
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