“旗形”胸脐皮瓣结合自体肋软骨支架在阴茎再造术中的应用(1)
[摘要]目的：探讨利用“旗形”胸脐皮瓣结合自体肋软骨支架行阴茎再造的临床效果。方法：以腹壁下动脉为蒂设计脐旁皮瓣，皮瓣形态呈旗状，“旗杆”部为皮瓣血管蒂，“旗面”部用于阴茎成形及尿道成形。以“旗杆”为轴旋转180°转移至会阴部，将皮瓣翻转卷成管状形成尿道及阴茎体，并与会阴部尿道口吻合。手术同期切取自体肋软骨，雕刻为支撑材料置入阴茎体。术后半年可行二期手术修整阴茎形态，包括皮瓣去脂修薄、瘢痕切除等。结果：2010年8月-2016年8月供实施8例，术后皮瓣血运均良好，皮瓣供区均可于术中直接缝合关闭创面，伤口一期愈合。术后随访5～14个月，其中2例患者阴茎臃肿，于阴茎再造术后1年行皮瓣去脂修薄改善阴茎外形，满足性生活；2例术后3个月因尿瘘再次行手术修补；其余4例患者再造阴茎外观及功能均良好。所有患者均未见软骨外露，除脐部位置稍向皮瓣供区侧偏移，腹壁外形轮廓基本正常。结论：“旗形”胸脐皮瓣阴茎再造设计简单，术后效果较为理想，避免了传统胸脐皮瓣阴茎再造需要植皮覆盖创面的问题，减轻了腹壁继发畸形的发生，是一种可供选择及推广的阴茎再造术式。
, 百拇医药 [关键词]阴茎再造；胸脐皮瓣；“旗形”皮瓣；易性病；自体肋软骨
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)11-0016-03
Abstract： Objective To investigate the application of flag-shaped paraumbilical flap combined with autologous costal cartilage framework implantation in penile reconstruction. Methods Flag-shaped paraumbilical flap was designed for penile reconstruction and costal cartilage framework implantation. The flag-shaped flap based on inferior epigastric artery was designed for the penile and urethra reconstruction. Autologous costal cartilage was harvested as well， applied as supportive structure. Second stage of surgery for appearance improving was performed when necessary. Results Eight patients were underwent there kind flaps for penile reconstruction from August 2010 to August 2016. All the flaps remained 100% viable postoperatively. Due to the appropriate flap planning， the donor site can be sutured directly ， skin graft was unnecessary as well. Follow-up ranged from 5 months to 14 months. There were 2 cases of flap defat for better appearance and 2 cases of urethral fistula， while none of cartilage implant extrusion happened. For other 4 patient， both function and appearance are satisfying. The malformation of the donor site was inconspicuous， a little bit of umbilicus shift was acceptable. Conclusion Flag-shaped paraumbilical flap for penile reconstruction was a modification based on traditional paraumbilical flap planning， skin graft for donor site coverage was unnecessary and the donor site deformity was minimal.
, 百拇医药
Key words： penile reconstruction； paraumbilical flap； flag shaped flap； transsexualism； autogenous costal cartilage
阴茎再造主要应用于各种原因导致的阴茎损伤的修复、两性畸形及易性病患者的阴茎重建等。不同患者个体差异较大，缺损或功能障碍不同，患者的要求也不尽相同，如何能够通过手术再造阴茎以达到满意的远期效果，是临床工作的难点。胸脐皮瓣应用解剖学研究明确[1-4]，腹壁下动脉及其脐旁穿支为皮瓣主要的营养血管。腹壁下动脉起于髂外动脉，经腹股沟韧带斜向上进入腹直肌后方，在腹直肌内靠近后鞘处上行，沿途发出分支供养腹直肌及表面皮肤，脐旁穿支为1支主要的分支，管径粗大。因腹壁下动脉血管位置恒定，管径较粗，易于分离及吻合，临床应用较多。林子豪等[2-3]于1988年报道其应用于阴茎再造，手术效果良好。笔者科室在傳统的胸脐皮瓣阴茎再造术的基础上进行术式改良，采用“旗形”皮瓣设计，达到外观及功能双重恢复的同时，改善了皮瓣供区的继发缺损，取得了满意效果。, http://www.100md.com(董玉林 董立维 夏文森)
, 百拇医药 [关键词]阴茎再造；胸脐皮瓣；“旗形”皮瓣；易性病；自体肋软骨
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)11-0016-03
Abstract： Objective To investigate the application of flag-shaped paraumbilical flap combined with autologous costal cartilage framework implantation in penile reconstruction. Methods Flag-shaped paraumbilical flap was designed for penile reconstruction and costal cartilage framework implantation. The flag-shaped flap based on inferior epigastric artery was designed for the penile and urethra reconstruction. Autologous costal cartilage was harvested as well， applied as supportive structure. Second stage of surgery for appearance improving was performed when necessary. Results Eight patients were underwent there kind flaps for penile reconstruction from August 2010 to August 2016. All the flaps remained 100% viable postoperatively. Due to the appropriate flap planning， the donor site can be sutured directly ， skin graft was unnecessary as well. Follow-up ranged from 5 months to 14 months. There were 2 cases of flap defat for better appearance and 2 cases of urethral fistula， while none of cartilage implant extrusion happened. For other 4 patient， both function and appearance are satisfying. The malformation of the donor site was inconspicuous， a little bit of umbilicus shift was acceptable. Conclusion Flag-shaped paraumbilical flap for penile reconstruction was a modification based on traditional paraumbilical flap planning， skin graft for donor site coverage was unnecessary and the donor site deformity was minimal.
, 百拇医药
Key words： penile reconstruction； paraumbilical flap； flag shaped flap； transsexualism； autogenous costal cartilage
阴茎再造主要应用于各种原因导致的阴茎损伤的修复、两性畸形及易性病患者的阴茎重建等。不同患者个体差异较大，缺损或功能障碍不同，患者的要求也不尽相同，如何能够通过手术再造阴茎以达到满意的远期效果，是临床工作的难点。胸脐皮瓣应用解剖学研究明确[1-4]，腹壁下动脉及其脐旁穿支为皮瓣主要的营养血管。腹壁下动脉起于髂外动脉，经腹股沟韧带斜向上进入腹直肌后方，在腹直肌内靠近后鞘处上行，沿途发出分支供养腹直肌及表面皮肤，脐旁穿支为1支主要的分支，管径粗大。因腹壁下动脉血管位置恒定，管径较粗，易于分离及吻合，临床应用较多。林子豪等[2-3]于1988年报道其应用于阴茎再造，手术效果良好。笔者科室在傳统的胸脐皮瓣阴茎再造术的基础上进行术式改良，采用“旗形”皮瓣设计，达到外观及功能双重恢复的同时，改善了皮瓣供区的继发缺损，取得了满意效果。, http://www.100md.com(董玉林 董立维 夏文森)
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