reconstructive surgical procedures

重建外科手术
  • 文章类型: Case Reports
    上唇是面部的功能和美学上重要的区域。因此,上唇缺损的重建需要充分考虑,以确保功能和美学恢复。几种方法,比如楔形切除术,旋转襟翼,前进襟翼,和肌粘膜推进皮瓣,已用于重建朱红色缺陷。然而,由于重建后残余的不对称或疤痕的可能性以及对正常嘴唇运动的限制,重建朱红色缺损具有挑战性。我们介绍了一名51岁的女性,该女性因狗咬伤导致上唇朱红缺陷。使用粘膜V-Y推进瓣重建嘴唇缺损。该粘膜瓣基于口轮匝肌,并带有唇上动脉的分支,以确保足够的血液供应。因此,皮瓣存活率很好,皮瓣没有收缩。此外,颜色和轮廓与相邻的嘴唇组织相匹配,并实现了白色卷的重建和足够的嘴唇体积。这种粘膜V-Y推进皮瓣技术代表了一种修复粘膜缺损而不损害皮瓣血管的可靠方法。
    The upper lip is a functionally and aesthetically important area of the face. Therefore, reconstruction of an upper lip defect needs sufficient consideration to ensure functional and aesthetic recovery. Several methods, such as wedge resection, rotation flaps, advancement flaps, and myomucosal advancement flaps, have been used to reconstruct vermilion defects. However, it is challenging to reconstruct a vermilion defect because of the possibility of residual asymmetry or scars and restrictions to normal lip movement after the reconstruction. We present the case of a 51-year-old female that had an upper lip vermilion defect caused by a dog bite. The lip defect was reconstructed using a mucosal V-Y advancement flap. This mucosal flap was based on the orbicularis oris muscle with a branch of the superior labial artery to ensure sufficient blood supply. Therefore, flap survival was excellent, and there was no constriction of the flaps. Moreover, the color and contour were matched to the adjacent lip tissue, and re-establishment of the white roll and adequate lip volume were achieved. This mucosal V-Y advancement flap technique represents a reliable method to repair mucosal defects without vascular compromise of the flap.
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  • 文章类型: Journal Article
    本文提出了一种新的方法来矫正the骨错位和二次重建眶底骨折,强调水合无细胞真皮基质(ADM)的使用,特别是CGDerm一步,在传统的固体植入物无法保持结构完整性和体积的情况下。一名27岁的女性在创伤事件后患有持续性面部畸形,接受了利用ADM进行体积矫正和结构支持的变革性手术,解决眼球内陷和面部轮廓凹陷等重大挑战。整个眶底下降和先前放置的植入物(Medpor)需要这种方法,导致不令人满意的成交量修正。通过将ADM与钛强化风扇板(Synpor)集成,手术成功地恢复了患者的面部对称性,并解决了她的功能问题,包括复视和眼动受限。术后评估证明了该方法的长期有效性,面部轮廓和眼睛对称性的显著改善。我们的研究结果表明,ADM,特别是它的水合形式,提供了一个可靠的替代传统的骨移植和植入物矫正复杂的颅面畸形,提供美学和功能的好处。这个案例强调了适应性的重要性,面部重建手术中的组织模拟材料,提供他们在创伤后面部矫正中更广泛应用的潜力。
    This paper presents a novel approach to the correction of zygomatic malposition and secondary reconstruction orbital floor fractures, highlighting the use of hydrated acellular dermal matrix (ADM), specifically CGDerm One-Step, in a case where traditional solid implants failed to maintain structural integrity and volume. A 27-year-old woman with persistent facial deformities following a traumatic incident underwent a transformative procedure that utilized ADM for volume correction and structural support, addressing significant challenges such as enophthalmos and facial contour depression. This approach was necessitated by the descent of the entire orbital floor and a previously placed implant (Medpor), leading to unsatisfactory volume correction. By integrating ADM with titanium-reinforced fan plates (Synpor), the surgery successfully restored the patient\'s facial symmetry and addressed her functional concerns, including diplopia and limited eye movement. Postoperative evaluations demonstrated the long-term effectiveness of this method, with significant improvements in facial contour and eye symmetry. Our findings suggest that ADM, particularly in its hydrated form, offers a reliable alternative to traditional bone grafts and implants for correcting complex craniofacial deformities, providing both aesthetic and functional benefits. This case underscores the importance of adaptable, tissue-mimicking materials in facial reconstructive surgery, offering insights into their potential for broader application in post-traumatic facial corrections.
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  • 文章类型: Journal Article
    使用3D打印的羟基磷灰石(HA)生物陶瓷患者专用植入物(PSIs)重建颅颌面骨缺损是一项具有巨大潜力的新技术。本研究旨在探讨其优势,缺点,以及这些植入物在颅颌面手术中的临床结果。在PubMed和Embase数据库中搜索了接受生物陶瓷PSIs治疗的颅颌面骨缺损患者。临床结果,如生物相容性,生物力学特性,和美学进行了评估,并与常用的钛或聚醚醚酮(PEEK)植入物和自体骨移植物进行了比较。提出了两个临床病例来说明HA生物陶瓷PSIs的外科手术和临床结果。文献综述显示HAPSIs比钛和PEEK具有更好的生物相容性。最初的生物力学特性不如自体骨移植,PEEK,和钛,但在集成时有所改善。在我们的两个临床病例中发现令人满意的美学结果,稳定性好,没有骨吸收或感染。术后六个月在2例临床病例中观察到成骨的放射学征象。HA生物陶瓷PSIs具有优越的生物相容性,在生物力学和放射学上模仿天然骨。在重建颅颌面区域的负载共享骨缺损中,它们是常规生物材料的非常适合的替代品。
    Reconstruction of craniomaxillofacial bone defects using 3D-printed hydroxyapatite (HA) bioceramic patient-specific implants (PSIs) is a new technique with great potential. This study aimed to investigate the advantages, disadvantages, and clinical outcomes of these implants in craniomaxillofacial surgeries. The PubMed and Embase databases were searched for patients with craniomaxillofacial bone defects treated with bioceramic PSIs. Clinical outcomes such as biocompatibility, biomechanical properties, and aesthetics were evaluated and compared to those of commonly used titanium or poly-ether-ether-ketone (PEEK) implants and autologous bone grafts. Two clinical cases are presented to illustrate the surgical procedure and clinical outcomes of HA bioceramic PSIs. Literature review showed better a biocompatibility of HA PSIs than titanium and PEEK. The initial biomechanical properties were inferior to those of autologous bone grafts, PEEK, and titanium but improved when integrated. Satisfactory aesthetic results were found in our two clinical cases with good stability and absence of bone resorption or infection. Radiological signs of osteogenesis were observed in the two clinical cases six months postoperatively. HA bioceramic PSIs have excellent biocompatible properties and imitate natural bone biomechanically and radiologically. They are a well-suited alternative for conventional biomaterials in the reconstruction of load-sharing bone defects in the craniomaxillofacial region.
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  • 文章类型: Journal Article
    脂肪肉瘤被描述为来源于脂肪组织的软组织肉瘤。在下颌区域发现这种肿瘤非常罕见。截至目前,主要在病例报告和小系列中进行了描述。需要多学科方法来提供最佳治疗,并且可能涉及手术,辐射和全身治疗。这些缺损的手术修复是口腔颌面重建手术的主要挑战。我们介绍了一例54岁的男子,该男子提到我们的中心,下颌骨前部的肿块逐渐增加。活检显示分化良好的粘液样脂肪肉瘤。切除肿瘤并进行额外的初次重建。
    Liposarcomas are described as soft tissue sarcomas derived from adipose tissue. The finding of this tumor in the mandibular region is exceedingly rare. As of now, it has been described mainly in case reports and small series. A multidisciplinary approach is required to offer optimal treatment and may involve surgery, radiation and systemic therapies. Surgical repair of these defects represents a major challenge in oral and maxillofacial reconstructive surgery. We present the case of a 54-year-old man referred to our center with a progressively increasing mass in the anterior portion of the mandible. Biopsy revealed a well-differentiated myxoid liposarcoma. Resection of the tumor was performed with an additional primary reconstruction.
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  • 文章类型: Case Reports
    使用填充剂注射增加阴茎越来越受欢迎;然而,可能会出现异物反应等并发症,导致阴茎溃疡和坏死等问题,随后需要重建。现有的阴茎重建方法主要旨在填补赤字。在本文中,我们描述了一个病例,其中阴囊皮瓣和自体扩增被用来治疗由阴茎填充剂注射后延迟感染引起的软组织缺损。病人,一个41岁的男性,收到了Aquafilling®(Biomedica,布拉格,捷克共和国)填充剂注射在七年前和七年后发展为延迟感染。清创术后,阴茎缺陷跨越了整个轴,松弛阴茎的周长为7.5厘米。使用双侧阴囊皮瓣技术,去上皮化后,两个皮瓣的下缘均向内滚动,以实现自体增强.在术后三个月的随访中,未观察到感染和皮瓣坏死。阴茎周长增加到12厘米,患者报告对结果的满意度很高。这种新的手术技术可以广泛应用于各种阴茎缺损的治疗。
    Penile augmentation using filler injections is gaining popularity; however, complications such as foreign body reactions can arise, leading to issues like penile ulceration and necrosis, subsequently necessitating reconstruction. The existing method of the reconstruction of the penis is primarily aimed at filling the deficit. In this paper, we describe a case in which a scrotal flap and autologous augmentation were utilized to treat a soft tissue defect caused by a delayed infection following a penile filler injection. The patient, a 41-year-old male, had received an Aquafilling® (Biomedica, Prague, Czech Republic) filler injection seven years earlier and later developed a delayed infection. After debridement, the penile defect spanned the entire shaft, and the circumference of the flaccid penis was 7.5 cm. Using a bilateral scrotal flap technique, the lower margins of both flaps were rolled inward after de-epithelialization to achieve autologous augmentation. Over the three-month post-surgery follow-up, neither infections nor flap necrosis were observed. The penile circumference increased to 12 cm, and the patient reported high satisfaction with the outcome. This new surgical technique can be widely applied as treatment for a variety of penile defects.
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  • 文章类型: Case Reports
    头皮缺陷需要不同的方法来成功重建,考虑到缺陷大小等因素,周围组织,和受体容器质量。此病例报告提出了一个具有挑战性的情况,涉及颞侧头皮缺损,而同侧受体血管不可用。利用转位皮瓣和背阔肌游离皮瓣有效重建缺损,与对侧受体血管吻合。我们的报告强调了在没有同侧受体血管的情况下成功重建头皮缺损,强调在不需要血管移植的情况下采用适当外科手术的重要性。
    Scalp defects necessitate diverse approaches for successful reconstruction, taking into account factors such as defect size, surrounding tissue, and recipient vessel quality. This case report presents a challenging scenario involving a temporal scalp defect where ipsilateral recipient vessels were unavailable. The defect was effectively reconstructed utilizing a transposition flap and a latissimus dorsi free flap, which was anastomosed to the contralateral recipient vessels. Our report underscores the successful reconstruction of a scalp defect in the absence of ipsilateral recipient vessels, emphasizing the importance of employing appropriate surgical interventions without necessitating vessel grafts.
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  • 文章类型: Case Reports
    髋关节脱位是一种痛苦的情况,这需要紧急减少。以前,超声(US)引导下的囊周围神经群(PENG)阻滞已用于复位脱位的人工髋关节。我们已在两名假体髋关节脱位患者中使用了地标引导的PENG阻滞。我们建议PENG块的地标引导技术可以安全,成功地用作替代技术,美国设施不可用。
    Dislocated hip joint is a painful condition, which requires urgent reduction. Previously, ultrasound (US)-guided pericapsular nerve group (PENG) block has been used for reduction of dislocated prosthetic hip. We have used landmark-guided PENG block in two patients of dislocation of prosthetic hip. We suggest that the landmark-guided technique of PENG block can be used safely and successfully as an alternative technique, where US facility is not available.
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  • 文章类型: Journal Article
    这项研究的目的是评估使用深旋髂动脉(DCIA)皮瓣进行闭塞驱动的上颌骨重建的可行性和准确性,使用计算机辅助设计和制造(CAD/CAM)技术和口内吻合。2018年12月至2020年12月在口腔颌面外科接受咬合驱动上颌骨重建的11例患者的数据,回顾性分析北京大学口腔医院。记录术后并发症以及功能和美学结果。使用GeomagicControl2014评估术后恢复的准确性。9例患者的重建成功;所有人都对他们的美学和功能结果感到满意。一名患者在口内吻合失败后接受了口外吻合。在另一个病人身上,由于皮瓣失效,手术后必须取下DCIA皮瓣.在10例DCIA皮瓣成功的患者中,彩图分析显示,术前和术后颅颌模型之间的平均偏差为0.40±0.08mm.因此,闭路驱动的DCIA皮瓣上颌骨重建,使用CAD/CAM技术和口内吻合,似乎是修复上颌骨缺损的可行且准确的方法。
    The aim of this study was to evaluate the feasibility and accuracy of occlusion-driven maxillary reconstruction with the deep circumflex iliac artery (DCIA) flap, using computer-assisted design and manufacturing (CAD/CAM) technology and intraoral anastomosis. The data of 11 patients who underwent occlusion-driven maxillary reconstruction with this method between December 2018 and December 2020 in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were reviewed retrospectively. Postoperative complications and functional and aesthetic outcomes were recorded. The accuracy of the postoperative restoration was assessed using Geomagic Control 2014. Reconstruction was successful in nine patients; all were satisfied with their aesthetic and functional outcomes. One patient underwent extraoral anastomosis after failure of intraoral anastomosis. In another patient, the DCIA flap had to be removed after the operation because of flap failure. Among the 10 patients with DCIA flap success, colour map analysis showed a mean deviation of 0.40 ± 0.08 mm between the preoperative and postoperative craniomaxillary models. Thus, occlusion-driven maxillary reconstruction with the DCIA flap, using CAD/CAM technology and intraoral anastomosis, appears to be a feasible and accurate method for the repair of maxillary defects.
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  • 文章类型: Case Reports
    Post-traumatic enophthalmos and hypoglobus are common sequelae of facial bone fractures, even after reduction surgery. They are associated with functional and esthetic issues, which may lower the quality of life. These deformities frequently present late, and adequate correction is difficult. We report three cases of late inferior orbital rim reconstructions with three-dimensional printed implants to help resolve these problems. The average duration between the traumatic event and surgery was 3 years and 4 months. One patient was treated with a completely absorbable implant and exhibited satisfactory results until the implant started to biodegrade at 1 year and 9 months after surgery. Two patients were treated with a permanent implant and demonstrated satisfactory results. However, longer follow-up periods were needed. There were no complications such as infection, diplopia, or restriction of ocular motion and the patients were satisfied with the esthetic results.
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  • 文章类型: Case Reports
    软组织肉瘤(STS)是一种罕见的肿瘤,可能发生在上肢。其表现因生长缓慢和缺乏症状而延迟。通过物理和放射学检查发现病变,并在组织病理学上进行明确诊断。我们介绍了一个63岁的男性手臂背部肿胀的案例,夜间多汗症,和减肥。放射学检查显示可能是恶性和代谢活跃的左腋窝淋巴结。肿瘤被切除了,并用带蒂的背阔肌肌皮瓣覆盖缺损。肌肉的远端部分附着在残余的三头肱肌腱上。术后组织病理学显示高度恶性的STS。患者在辅助化疗方案后仍无复发。在11个月的随访中,令人满意的美学效果和适度的肘部伸展明显。正确处理上肢STS对于预防复发和转移至关重要。
    Soft-tissue sarcoma (STS) is a rare tumor that may occur in the upper extremity. Its presentation is delayed by slow growth and lack of symptoms. Lesions are discovered via physical and radiologic examinations, and definitive diagnosis is conducted histopathologically. We present the case of a 63-year-old man with swelling of the dorsum of the arm,nocturnal hyperhidrosis, and weight loss. Radiologic examination revealed possible malignancy and metabolically active left axillary lymph nodes. The tumor was excised, and the defect was covered using a pedicled myocutaneous latissimus dorsi flap. The distal portion of the muscle was attached to the remnant tricep brachii tendon. Postoperative histopathology revealed a highly malignant STS. The patient remained relapse-free after a regimen for adjuvant chemotherapy. Satisfactory aesthetic results and modest elbow extension were evident during the 11-month follow-up. Properly managing upper extremity STS is crucial for preventing recurrence and metastasis.
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