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中华显微外科杂志
中山大学
中华显微外科杂志

中山大学

庞水发

双月刊

1001-2036

zhxwwk@mail.sysu.edu.cn

020-87330683

510080

广东省广州市中山二路74号中山大学北校区期刊大楼二楼

中华显微外科杂志/Journal Chinese Journal of MicrosurgeryCSCD北大核心CSTPCD
查看更多>>1978年8月创刊，中华医学会主办。本刊为我国惟一的显微外科专业性刊物，是中华医学会显微外科学会的学术性期刊；一直是中文核心期刊,被国内所有检索系统和数据库及WPRIM收录，被引频次、引文和影响因子等一直名列全国科技期刊前列。本刊及时报道国内外显微外科的新进展，反映我国显微外科水平和发展方向，同时积极介绍基层医院开展和普及显微外科的情况，适合从事显微外科、骨科、整形外科、手外科、神经外科、关节外科、泌尿外科、口腔颌面外科、眼科、耳鼻喉科、妇科、脊柱外科、腔镜和内镜的应用等手术学科及解剖学等基础医学专业人员投稿和阅读。
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    传承创新　做好显微外科学科建设

    顾立强汪华侨刘小林朱庆棠...
    1-3页
    查看更多>>摘要：显微外科不仅是一项技术，更是一门科学。1992年显微外科学成为国家临床医学三级学科（学科代码320.2715）。新时代的显微外科学科建设要传承创新，求真务实；依托外科各专科平台，拓展显微外科阵地；坚持显微外科技术核心竞争力，勇扛显微外科特色大旗，服务各临床手术专科；医、教、研并重；团结协作，加强国内外学术交流；注重人才建设（培养大国工匠、领军人物）；支持和帮助社会办显微外科特色医院发展；加强《中华显微外科杂志》对学科建设支撑作用，促进显微外科高质量发展。 Microsurgery is not only a technology, but also a science. Microsurgery was enlisted as a tier-three discipline in the Classification of National Clinical Medicine Disciplines (Discipline code 320.2715) in 1992. In the new era, the discipline development of microsurgery should be inherited, innovated, realistic and pragmatic, and it also relies on the other surgical specialties to expand the applications of microsurgery. Microsurgery technology should firmly adhere to its core competitiveness and hold high the banner of microsurgical characteristics by offering the best possible serves to all the clinical surgical disciplines Pay equal attention to medicine, teaching and scientific researches Unite, collaborate and strengthen academic exchanges at home and abroad Focus on talent training (i.e. exports of great country, leading figures, etc.) and support the development of private hospitals specialised in microsurgery. The supportive roles of the Chinese Journal of Microsurgery shall be further enforced to facilitate the discipline development of microsurgery and promoting high-quality development of microsurgery.

    显微外科学科建设传承创新中国

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    继承和发扬中国显微外科精神

    侯春林
    4-7页
    查看更多>>摘要：1963年上海第六人民医院陈中伟世界首次报道人类断肢再植成功，开创了中国显微外科新纪元。60年来，一代代中国显微外科学者以敢为人先的创新精神、救死扶伤的仁爱精神、不畏艰辛的拼搏精神、追求卓越的工匠精神和紧密协作的团队精神，救治了无数患者，创造了许多医学奇迹，取得了极其辉煌的成就，形成了极其宝贵的精神财富。希望年轻一代继承和发扬中国显微外科精神，推动显微外科继续取得更大的发展。

    显微外科中国中国显微外科精神

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    前沿技术赋能显微外科发展

    裴国献
    7-11页
    查看更多>>摘要：近30年来，我国的显微外科技术水平已达到了相当成熟的发展阶段，如何进一步发展、提升、再有一个质的飞跃?前沿技术对科学研究和技术发展有着重要的推动作用，其赋能显微外科是显微外科未来发展的必然趋势，探讨前沿技术赋能显微外科发展已成为显微外科学科的重要议题之一，它必将进一步拓展显微外科工作者的视野,推动显微外科学科可持续、向更高层面发展。

    显微外科前沿技术学科赋能

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    以创新为驱动　促进显微外科蓬勃发展

    徐永清
    11-12页
    查看更多>>摘要：显微外科是近代医学领域一门崭新的外科手术技术,它萌芽于上世纪60年代。显微外科技术的应用和发展推动了骨科、整形外科、眼科、耳鼻喉科、神经外科、心血管外科、妇产科、移植外科等多学科的发展。1989年中华医学会显微外科学分会成立后，我国显微外科得到蓬勃发展。面对新医科教育和新时代的召唤,显微外科发展面临机遇和挑战，搭建好学术交流平台、推动学科的发展方向和做好人才培养是促进我国显微外科学进一步发展的主要工作。

    显微外科创新学科中国显微外科精神

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    数字医学和生物材料在显微外科中的应用

    赵德伟王峰
    13-16页
    查看更多>>摘要：显微外科是利用光学放大设备和显微外科器材，进行精细手术的学科。近年来随着理论与技术的进步和发展，显微外科逐渐成长为一门成熟的学科。为了促进显微外科进一步的发展，越来越多的学者重视其在医工结合中所取得的突破，数字医学和金属生物材料在显微外科已展现出广泛的应用前景。

    显微外科医工结合数字医学金属生物材料

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    宽频线阵容积探头引导下三维超声技术在股前外侧穿支皮瓣术前穿支定位中的应用

    张宇轩许亚军周建东许同龙...
    17-21页
    查看更多>>摘要：目的 探讨宽频线阵容积探头引导下三维超声技术在游离股前外侧穿支皮瓣（ALTPF）术前穿支定位中的应用价值，更准确快速地指导切取ALTPF。 方法 自2020年5月至2022年10月，回顾性分析无锡市第九人民医院足踝外科35例足踝部软组织缺损行游离ALTPF修复患者，其中足部创面25例，踝关节创面10例；年龄20~66岁，缺损面积11.0 cm×8.0 cm~28.0 cm×9.0 cm，皮瓣面积12.0 cm×9.0 cm~29.0 cm×10.0 cm。术前采用宽频线阵容积探头对ALTPF血管穿支进行探测，获得穿支三维图像，记录穿支数量、位置、分型，选择合适的穿支，精准设计皮瓣，指导术中皮瓣的切取，术中观察宽频线阵容积探头术前定位的准确性；术后患者均定期行门诊随访。 结果 术前定位穿支70条，术中发现穿支72条，术前与术中相符穿支67条；67条相符穿支中，Kimura I型19例，Kimura Ⅱ型27例，Kimura Ⅲ型21例；二维超声技术术前探测敏感度为95.7%，阳性预测值为93.1%；25例皮瓣为筋膜下切取，10例为筋膜上切取超薄ALTPF，切取皮瓣面积平均大小17.7 cm×8.6 cm；所有皮瓣切取时显露的穿支与术前三维成像基本符合，术后所有皮瓣均完全成活，未出现血管危象情况。术后随访8~20个月，平均12.7个月。 结论 宽频线阵容积探头引导下三维超声技术在ALTPF术前穿支定位准确，在超薄ALTPF切取中更有优势，值得在临床推广。 Objective To investigate the application of 3-D ultrasonography enabled by a wide band linear matrix array volume transducer in the localisation of perforating vessels of a free anterolateral thigh perforator flap (ALTPF) before surgery, and to guide microsurgeons in precise design and harvest of a ALTPF. Methods From May 2020 to October 2022, a retrospective study was carried out on 35 patients who had soft tissue defects and undertaken free ALTPF surgery in Department of Foot and Ankle Surgery, Wuxi No.9 People's Hospital Affiliated to Soochow University. ALTPFs were transfered for reconstruction of soft tissue defects of foot in 25 patients and of ankle in 10 patients. The age of patients were 20 to 66 years old. The defects were 11.0 cm×8.0 cm-28.0 cm×9.0 cm in size. The sizes of ALTPFs were at 12.0 cm×9.0 cm-29.0 cm×10.0 cm. Before surgery, ultrasound scans with a wide band linear matrix array volume transducer were performed to locate the perforating vessels. The 3-D ultrasound images showing the perforating vessels of ALTPFs were acquired and the number, location and classification of the perforating vessels were saved. After the appropriate perforating vessels had been determined, ALTPFs were designed for precisely intraoperative incision. The accuracy of preoperative location of perforating vessels by the linear matrix array volume ultrasound transducer was investigated in surgery. All patients received the scheduled postoperative follow-up at outpatient clinics. Results Of the 72 perforating vessels discovered in surgery, 70 matched with those being located by ultrasound before surgery. It was found that a total of 67 perforating vessels located before surgery by ultrasonography were consistently mapped with the perforators discovered in surgery. Of the 67 consistently mapped perforating vessels, 19 were Kimura type I, 27 of Kimura type II and 21 of Kimura type III perforators. The rate of sensitivity and positive prediction were 95.7% and 93.1%, respectively, in the preoperative localisation of perforating vessels of ALTPFs with a wide band linear matrix array volume ultrasound transducer. Twenty-five ALTPFs were harvested subfascially and 10 superfascially. Average size of ALTPFs was 17.7 cm × 8.6 cm. The perforating vessels revealed during the harvest of all ALTPFs were basically consistent with the preoperative 3-D ultrasound. All flaps survived after surgery without any incident. The postoperative follow-up lasted 8 to 20 months, with 12.7 months in average. Conclusion The 3-D ultrasonography with a wide band linear matrix array volume ultrasound transducer can accurately locate the perforating vessels of ALTPF before surgery. This technique has many advantages in the design and harvest of super-thin ALTPFs.

    股前外侧穿支皮瓣线阵容积探头三维超声术前定位

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    分叶股前外侧穿支皮瓣修复踝关节周围大面积软组织缺损11例

    梁涛唐金明潘军华林尊文...
    22-27页
    查看更多>>摘要：目的 探讨分叶股前外侧穿支皮瓣（ALTPF）修复踝关节周围大面积软组织缺损的可行性及临床效果。 方法 2019年6月至2022年10月,南昌大学第一附属医院骨科采用分叶ALTPF修复踝关节周围大面积软组织缺损11例，其中交通伤所致8例，重物砸伤3例。所有创面均宽大（15.0 cm×14.0 cm~30.0 cm×20.0 cm）且合并不同程度的感染。术中切取大小为16.0 cm×14.5 cm~23.0 cm×18.5 cm的分叶ALTPF修复缺损，深部死腔用抗生素骨水泥填充，供区直接缝合或植皮修复。分别于术后1、3、6个月及之后每半年通过门诊、电话等方式进行随访，记录皮瓣的外形、颜色及供区愈合情况，并根据美国足踝关节协会（AOFAS）踝-后足评分量表评价足踝部运动功能恢复情况。 结果 11例皮瓣全部成活，受区术后未出现血肿和继发感染，供区一期愈合；1例分叶皮瓣远端发生静脉回流障碍，予以远端静脉放血1周后皮瓣完全成活。术后随访6~24（15.27±5.21）个月，所有皮瓣血运良好，外形满意，无明显臃肿，色泽、质地与受区相近，皮瓣无溃疡形成；皮瓣供区仅留线形瘢痕或少量片状植皮伤口，位置隐蔽；AOFAS踝-后足评分为（88.36±10.21）分，结果优6例，良4例，可1例。 结论 分叶ALTPF可将皮瓣长度转变成皮瓣宽度，是踝关节周围大面积软组织缺损修复的一种良好方法。 Objective To evaluate the viability and clinical effect of polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of large soft tissue defect around ankle. Methods From June 2019 to October 2022, large soft tissue defects around ankle of 11 patients were reconstructed with ALTPF in the Department of Orthopaedics of the First Affiliated Hospital of Nanchang University. The causes of injury were traffic accident in 8 patients and heavy objects in 3 patients. All wounds were large defects (15.0 cm×14.0 cm-30.0 cm×20.0 cm) and combined with various degrees of infection. Intraoperatively, polyfoliate ALTPFs sized 16.0 cm×14.5 cm-23.0 cm×18.5 cm were used in reconstruction of the defects. Deep dead spaces were filled with antibiotic bone cement, and direct suture was performed to close the donor sites or by skin grafting repair. Postoperative follow-ups were scheduled at 1, 3 and 6 months, and 6 monthly thereafter at outpatient clinics and via telephone interviews. The appearance and colour of the flaps and healing of donor sites were recorded together with evaluation of the recovery of ankle motor function according to the ankle-hindfoot rating scale of American Orthopaedic Foot and Ankle Society (AOFAS). Results All flaps survived. No haematoma or secondary infection occurred at the recipient site after surgery. All donor sites healed primarily. One patient had venous occlusion at the distal end of the polyfoliate ALTPF. The flap survived completely at 1 week after distal venous bloodletting. Postoperative follow-ups lasted 6-24 (15.27±5.21) months. All flaps had good blood supply with satisfactory appearance, similar colour and texture to the recipient sites, and without obvious bloat nor ulceration. Only a linear scar or few skin graft scar was left at the flap donor sites in concealed locations. The mean AOFAS ankle-hindfoot score was (88.36±10.21) point. There were 6 cases of excellent, 4 cases of good, and 1 case of fair. Conclusion A polyfoliate ALTPF is an ideal flap for reconstruction of soft tissue defects around ankle by converting the length of a flap to the width.

    股前外侧穿支皮瓣分叶皮瓣踝关节软组织缺损

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    增强现实技术导航辅助设计分叶股前外侧穿支皮瓣修复四肢软组织缺损8例

    罗翔杨克勤韦平欧莫勇军...
    28-33页
    查看更多>>摘要：目的 探讨增强现实（AR）技术导航辅助设计分叶股前外侧穿支皮瓣（ALTPF）修复四肢软组织缺损的可行性及临床效果。 方法 2017年6月至2023年6月，贵港市人民医院手足显微外科应用AR导航辅助设计分叶ALTPF修复肢体软组织缺损8例；均为车祸伤或机器伤，缺损部位小腿3例，踝部2例，手部2例，足部1例，所有创面均为宽大或不规则，缺损大小14 cm×14 cm~25 cm×13 cm；术前CTA检查获取患者双侧大腿动脉图像，选择优势侧、优势穿支血管，应用Mimics软件进行三维重建，应用AR导航进行患者体表血管及穿支浅出点定位，指导分叶ALTPF的设计与切取，皮瓣面积15 cm×16 cm~26 cm×14 cm，供区直接缝合；分别于术后1、3、6、12个月门诊或通过微信图片、视频方法随访，记录皮瓣外形、颜色、质地、感染是否复发及皮瓣供区侧伸膝功能等。 结果 8例均按术前设计完成分叶穿支皮瓣切取与移植，术中探查穿支血管浅出点与术前定位一致。术后所有皮瓣均顺利成活，皮瓣受区与供区均一期愈合。术后随访3~12(平均8.6)个月，皮瓣色泽、质地优良，皮瓣供、受区外形满意；2例手部损伤患者应用密歇根手功能简表（MHQ）评分，分别为43.74分、81.25分，6例下肢损伤患者应用Maryland足踝部功能评分，优2例，良3例，可1例。 结论 应用AR导航可以有效辅助分叶ALTPF的设计，为临床开展分叶穿支皮瓣的个性化评估与设计提供有效的依据。 Objective To investigate the feasibility and clinical effects of the application of augmented reality (AR) navigation on assisted design of the chimeric twin-paddled anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects in extremities. Methods From June 2017 to June 2023, 8 patients with soft tissue defects in extremities received reconstruction of chimeric twin-paddled ALTPF designed with the assistance of AR navigation in Department of Hand & Foot Microsurgery Orthopaedics, Guigang City People’s Hospital. All of them were traffic accidents or machine injuries, with 3 cases of calf, 2 cases of ankle, 1 case of foot, and 2 cases of hand defects. All the wounds were wide or irregular (defect sized 14 cm×14 cm-25 cm×13 cm). The images of bilateral thighs were acquired by CT angiography preoperatively. The dominant side and dominant perforators were selected. Three dimensional reconstruction was performed by Mimics software. AR technology was applied to guide the design and harvest of the chimeric twin-paddled ALTPF. Flap area was 15 cm × 16 cm to 26 cm × 14 cm. The donor site was sutured directly. Follow-up with outpatient visits or WeChat images and videos at 1, 3, 6 and 12 months postoperatively to record the appearance, colour, texture, recurrence of infection, and knee extension function of the flap donor site. Results According to the preoperative design, the perforator flaps were harvested and transferred in all the 8 patients. All flaps survived and the recipient and donor sites healed in one stage. All patients entered postoperative follow-up for 3 to 12 (mean, 8.6)months. The colour and texture of the flaps were excellent, and the appearance of donor and recipient sites was satisfactory. Two patients with hand injuries were evaluated using the brief Michigan Hand Outcomes Questionnaire (MHQ), with scores of 43.74 and 81.25, respectively. Six patients with lower limb injuries were evaluated using the Maryland foot score, with scores of 2 excellent, 3 good and 1 fair. Conclusion The application of AR navigation can effectively assist the design of a chimeric twin-paddled ALTPF. It also provides an effective basis for clinical personalised flap design.

    股前外侧穿支皮瓣分叶皮瓣增强现实技术CT血管造影导航

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    端侧吻合非一级源血管的游离股前外侧穿支皮瓣修复四肢软组织缺损14例

    马涛孟飞秦宏玖
    34-38页
    查看更多>>摘要：目的 探讨端侧吻合非一级源血管的游离股前外侧穿支皮瓣（ALTPF）修复四肢软组织缺损的临床疗效。 方法 2020年2月至2021年7月，皖南医学院第一附属医院手足外科收治14例四肢软组织缺损患者，其中男12例，女2例，年龄30~69岁，平均52岁。创面位于左手1例，左足及踝关节7例，右足及踝关节6例。创面大小7 cm×7 cm~9 cm×22 cm，均伴有肌腱、神经或骨组织外露。采用端侧吻合非一级源血管的游离ALTPF修复创面，皮瓣切取面积8 cm×8 cm~10 cm×23 cm，术中将非一级源血管的皮瓣动脉与受区动脉端侧吻合，皮瓣静脉与受区动脉的伴行静脉端端吻合，供区均直接缝合。术后进行门诊或微信随访，观察皮瓣及供区愈合情况，使用Likert量表评价患者对重建外观的满意度。 结果 术后本组皮瓣均完全成活，1例受区创面术后反复渗出，经换药引流后愈合；供区手术切口均一期愈合。患者均获随访，随访时间9~18个月，平均12.6个月，皮瓣质软，外形良好，无明显臃肿。末次随访时，根据Likert量表评价重建肢体外观，获优4例，良8例，可2例。 结论 端侧吻合非一级源血管的游离ALTPF可有效修复四肢软组织缺损，皮瓣血运可靠，能获得良好的重建外观。 Objective To explore the clinical effects of end-to-side anastomosis of non-primary perforating vessels carried by free anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue of limb. Methods Between February 2020 and July 2021, 14 patients with soft tissue defect of limb were admitted in the Department of Hand and Foot Surgery, the First Affiliated Hospital of Wannan Medical College. The patients were 12 males and 2 females, aged between 30 and 69 years old, with a median age of 52 years old. One defect was found in left hand, 7 in left foot and ankle and 6 in right foot and ankle. Wound sizes were 7 cm×7 cm-9 cm×22 cm, all accompanied with exposed tendons, nerves or bone tissue. The size of flaps ranged from 8 cm×8 cm to 10 cm×23 cm. ALTPFs carrying non-primary source vessels were applied in reconstruction of soft tissue defects. The non-primary perforating vessels of ALTPF was anastomosed with the artery in recipient site in an end-to-side fashion and the vein of ALTPF was end-to-end anastomosed with the accompanying vein of the recipient artery. All donor sites were sutured directly. The follow-up was conducted by online reviews via WeChat or by visit of outpatient clinics. Appearance of flap and donor site were observed and the aesthetic satisfaction of the patients recipient sites were assessed subjectively using Likert scale. Results All 14 ALTPFs survived uneventfully. Wound exudation occurred in 1 flap, and healed after dressing change and drainage. All patients received 9-18 (mean 12.6) months of follow-up. The ALTPFs were in good texture and shape. According to the Likert scale, appearance were excellent in 4 flaps, good in 8 flaps and fair in 2 flaps. Conclusion Application of free ALTPF of non-primary source vessels with end-to-side anastomosis is not only effective in the reconstruction of limb defects, but also has advantages of reliable blood perfusion and cosmetic appearance.

    股前外侧穿支皮瓣四肢软组织缺损修复端侧吻合

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    游离双足 趾腓侧皮瓣修复相邻双指指腹缺损7例

    陈鑫梅俊霞杨坤宋振磊...
    39-43页
    查看更多>>摘要：目的 探讨应用双足趾腓侧皮瓣修复相邻双指指腹缺损的临床效果。 方法 自2020年8月至2023年1月，周口淮海医院显微手足外科采用双足趾腓侧皮瓣修复7例14指指腹缺损，男4例，女3例；年龄19~45岁，平均28岁。创面位于左手4例，右手3例；示、中指损伤3例，中、环指损伤2例，拇、示指损伤2例，软组织缺损面积为1.2 cm×1.5 cm~3.0 cm×2.5 cm，皮瓣切取面积为1.5 cm×1.8 cm~3.2 cm×2.8 cm。其中急诊修复1例，择期手术修复6例；皮瓣供区直接闭合，创缘缝合张力较大时于足底内侧切取中厚皮片移植。术后采用门诊复诊、微信联系定期随访，观察手指外形、感觉、功能恢复与皮瓣挛缩情况以及双足趾活动情况。 结果 术后7例皮瓣均顺利成活，皮瓣供区甲级愈合。术后定期随访6个月~2年，平均9个月。皮瓣外形美观、感觉优良，TPD达3~6 mm，手指功能恢复满意。趾皮瓣供区均只遗留线形瘢痕，关节活动度及行走步态正常。按中华医学会手外科学会上肢部分功能评定试用标准评定：优5例，良2例。 结论 应用双足趾腓侧游离皮瓣是同期修复相邻双指指腹缺损的理想方法，可以达到良好的重建效果。 Objective To explore the clinical effect of using great toe fibular flaps of both feet on reconstruction of pulp defects of two neighbouring digits. Methods A total of 14 digit pulp defects in 7 cases were repaired in Zhoukou Huaihai Hospital using great toe fibular flaps of both feet from August 2020 to January 2023. Of the 7 cases, there were 4 males and 3 females, with an average of 28 years old, ranging from 19 to 45 years old. Meanwhile, there were 4 cases in left hand and 3 cases in right hand. There were 3 cases of digit pulp defects in index and middle fingers, 2 in middle and ring fingers, and 2 in thumb and index fingers. The area of soft tissue defect in 1.2 cm×1.5 cm-3.0 cm×2.5 cm, and flap was 1.5 cm ×1.8 cm-3.2 cm×2.8 cm. Furthermore, 1 case underwent emergency surgery and 5 were repaired in elective surgery. The donor site of the flap was closed directly, and an intermediate-thickness skin graft was prepared from the medial plantar area for transfer in the case of high suture tension at the wound edge. After surgery, patients received postoperative by outpatient clinic and WeChat to observe the appearance, sensation, functional recovery and flap contracture of digits, as well as the movement of the great toes of both feet. Results After the surgery, all flaps in the 7 cases survived smoothly and the donor sites healed. All patients entered scheduled follow-ups postoperatively for 6 months to 2 years, with an average of 9 months. The flap showed an aesthetic appearance and excellent sensation, with a TPD of 3-6 mm, and satisfactory digit function. The donor site of the great toe fibular flap left linear scars only, without abnormality in range of motion and gait in walking. In addition, there were 5 in excellent and 2 in good according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. Conclusion Application of great toe fibular flaps of both feet is an ideal option for the simultaneous repair of pulp defects of two neighbouring digits, which can achieve good reconstructive results.

    指腹软组织缺损显微外科技术

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