Long term follow up study and development of skin and musculocutanous flaps in lower extremities, effects of wound healing using omental flap and muscle flap

1997 ~ 1999年，我们对下肢皮肤和肌肉皮瓣的长期随访研究进展及大网膜皮瓣或肌肉皮瓣的创面愈合效果进行了研究。我们调查了122例肢体骨或软组织恶性肿瘤重建术后随访3年以上的患者。采用皮/肌/皮皮瓣带骨/人工关节，可避免截肢，提高患者满意度，提高生活质量。在一些有较大骨缺损的病例中，我们转移热处理过的骨以减少手术侵入。在这种情况下，覆盖在血液循环丰富的肌肉瓣是特别有用的。我们提出了一系列治疗慢性顽固性溃疡的方案，如脊柱裂和糖尿病。该方案是基于长期随访，不仅手术治疗，而且保守治疗和康复。现在我们开发并成功了新的皮瓣方法，例如带血管的腓骨和网膜皮瓣治疗顽固性骨不连。对于大网膜瓣，我们研究了大网膜脂质组分对大网膜瓣的影响，发现大网膜脂质组分扩大了大网膜瓣的存活面积，扩大了大网膜瓣及周围组织的血管扩张和血管形成。我们积极使用具有可塑性和血管桥接可能性的大网膜瓣，扩大了适应症。网膜瓣与其他皮瓣联合应用，对下肢困难的病例取得了满意的效果。同时，我们还设计了新的网膜瓣摘取方法。为减少手术侵入和收获时间，我们尝试了内镜下收获、内镜下小开腹和手口内镜下收获。这些都是在一些会议上宣布的。

We studied long term follow up study and development of skin and musclocutaneous flap in lower extremities and effects of wound healing using omental flap or muscle flap at 1997 to 1999.We investigated 122 patients that were followed up over 3 years after reconstruction of bone or soft tissue malignant tumors in extremities. Using skin/musclocutaneous skin flap with bone/artificial joint could avoid a amptation and contributed to the patient's satisfaction, the improvement of quality of life. In some cases with large bone defects, we transfered the heat-treated bone for reduction of operating invasion. In this cases, covering in the muscle flap with rich blood circulation especially was useful. And we brought up a series of protocol for chronic intractable ulcer etc. with spina bifida or diabetes. The protocol was based by long term follow up, not only surgical treatment, but also conservative treatmental and rehabilitation. Now we developed and successed new flap methods for example that vascularized fibula and omental flaps convined intractable non-union.As for the omental flap, we investigated the effect of lipid fraction in rat omentum, and indicated the omentum lipid fraction made extension of survival area in flaps, vasodilation and vascularization in flaps and surrounding tissue. We aggressively used the omental flap had characteristic plasticity and possibility for bridging of vessel and extended the indication. By the combination of omental flap and other flaps, we obtain satisfactory results for the difficult cases in lower extremes. And, we devised new methods of harvest of omental flap. For decreasing of operation invasion and harvest time, we tried endoscopic harvest, mini-laparotomy with endoscope and endoscopic harvest with hand-port. These were announced in some meeting.