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Objective To explore the effect of bladder muscle flaps for long segment defect of ureter middle-lower segment and reconstruction method in laparoscopic surgery. Methods Clinical data of 3 patients with long segment defect of ureter middle-lower segment, all of whom underwent laparoscopic surgery from May 2014 to April 2016 was retrospectively evaluated. There were 1 male and 2 females, in 2 cases with history of ureteroscopy holmium laser lithotripsy in ureter middle-lower segment, in 2 cases with history of repeated ESWL. Preoperative urinary tract ultrasound, CT and intravenous urography imaging showed severe hydronephrosis, ureter middle-upper segment severe hydroureter, ureter middle-lower segment severe stricture. Results Operations were successful in 3 cases. After reconstruction bladder muscle flaps average length of is 9.6 cm, The average operation time of 180 min, The average length of hospital stay for 10 d, Postoperative eighth weeks extracted the double J tube and used ureteroscopy showed anastomotic unobstructed, it may smooth Through 8.5 F ureteroscopy, and no infection and urinary leakage occurred, Follow-up ranged from 3 to 18 months. 3 cases hydronephrosis and hydroureter significantly reduce, ureter unobstructed, no narrow in ureter and muscle flap of tube joint, serum creatinine valueswere in normal range. Conclusions The bladder muscle flaps for the treatment of long segment defect of ureter middle-lower segment in laparoscopic surgery was a safe and effective therapy, but it must be accomplished by seasoned doctors.
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Objective@#To explore effects of perforator flaps combined with muscle flaps for repairing grade Ⅳ pressure ulcers in ischial tuberosity of elderly patients.@*Methods@#Nine elderly patients with grade Ⅳ pressure ulcers in ischial tuberosity were hospitalized in our burn ward from April 2014 to April 2017. Size of wounds ranged from 5 cm×3 cm to 12 cm×7 cm, and depth of sinus ranged from 6 to 22 cm. After admission, emergency debridement or debridement in selective time was performed. After debridement, the wounds were treated with continuous vacuum assisted closure therapy. After the treatment for 1 to 2 weeks, tissue flaps repair operations were performed. Four patients were repaired with inferior gluteal artery perforator flaps combined with long head of biceps femoris muscle flaps. Three patients were repaired with inferior gluteal artery perforator flaps combined with semimembranous muscle flaps. One patient was repaired with inferior gluteal artery perforator flap combined with gracilis muscle flap. One patient was repaired with femoral profound artery perforator flap combined with gluteus maximus muscle flap, and the distal area of femoral profound artery perforator flap of the patient which showed intraoperative cyanosis of 6 cm×4 cm was thinned to medium thickness skin to cover the muscle flap. The other eight patients showed no abnormality during operation. Size of perforator flaps ranged from 7 cm×5 cm to 14 cm×12 cm, and size of muscle flaps ranged from 11 cm×4 cm to 24 cm×6 cm. The donor sites of flaps were all sutured directly.@*Results@#The tissue flaps and skin graft of all patients survived well after operation. During follow-up of 8 to 35 weeks, operative area of all patients showed good shape and texture, with no local diabrosis or recurrence of pressure ulcers.@*Conclusions@#The combination of perforator flaps and muscle flaps is effective in repairing and reducing recurrence of grade Ⅳ pressure ulcers in ischial tuberosity of elderly patients.
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Objective:To assess the outcome for prevention the gustatory sweating syndrome and facial contour deformity with sternocleidomastoid muscle flaps in the parotidectomy. Method:It was a prospective study. Eighty-one patients who underwent parotidectomy were randomly divided into 2 groups, sternocleidomastoid muscle flaps group and control group. They were tested with the subjective and objective function testing in 3, 6, 9, 12 months after operation. We assessed the result. Result:All of the result of the sternocleidomastoid muscle flaps group was obviously better than the control group. There was significant difference between the 2 groups (P<0.05). Conclusion:It effectively prevented the gustatory sweating syndrome and facial contour deformity that we used the sternocleidomastoid muscle flaps to fill the cavity in the parotidectomy.
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Objective To provide anatomical basis for one-stage full dynamic correction of late facial palsy with double latissimus dorsi segmental muscle flaps.MethodsForty sides of formaldehyde fixed latissimus dorsi in twenty cadavers were selected to microsurgery anatomy,three sides fresh latissimus dorsi specimens were blood vessel casted.The extramusclar and intramuscular neurovascular distribution were observed.Results①In 92.5%of the thoracodorsal nerve divides into a medial and a lateral branch be fore entering the muscle.In 7.5%of the thoracodorsal nerve divides into three major branches.The coordinate of the bifurcation point of the thoracodorsal Here was[(7.94±1.23)cm,(3.71±1.68)cm].In the district of this angle's middle line,the numbers of vessels and nerves is relative few.②The lateral muscle flaps of the latissimus dorsi can be divided into 3-5 independent segmental flaps,the medial muscle flaps of the latissimus dorsi Can be divided into 2-4 independent segmental flaps.③The segmental nerve usually locate the two sides of vessel,which are arranged(from medial to lateral)in a NVAV order in the reedial segmental branches(100%),in a VAVN order in the lateral segmental branches(85.0%)and in a NVAV order in the lateral segmental branches(15.0%).④The neural pedicle Was cut from the lateral bifurcation point,the mean length of the third medial muscle neural pedicle was 16 cm；the mean length of the third or the forth lateral muscle neural pedicle was 12 cm.Conclusion Late facial palsy can be cuwd with onestage cross-facial transplantation of neurovascularized free double latissimus dorsi segmental muscle flaps.