目的 探讨腔镜深筋膜下交通支离断术（subfascial endoscopic perforating vein surgery，SEPS）治疗下肢静脉性溃疡的效果及优势。方法 对苏州大学附属第一医院2006年12月至2008年5月期间收治的30例下肢静脉性溃疡患者（32条患肢）实施SEPS。术后观察溃疡的愈合情况及其他症状的改善情况。结果 全组随访3～15个月（平均8.5个月），静脉性溃疡于术后27～103 d(平均65 d)内愈合，湿疹消失，色素沉着逐渐变浅； 随访期间无切口感染等并发症，未见溃疡复发及新生溃疡。结论 SEPS安全有效，损伤小，并发症少，是治疗下肢静脉性溃疡较为有效的方法。
The noses of eight patients being dead for 2hours were dissected to investigate the layers andstructure of the nose, and the stability of theimplanted silicone noae prosthesis was tested.According to the structure and microstructure ofthe nose studied by us, we suggested a newconcept of nasal muscle and dorsal deepfasciacomplex. We confirmed the prcathesis should beimplanted in the space between the nasal boneand the complex. The reason for complicationhappened in this approach was that...
目的 探讨腔镜深筋膜下交通支结扎（SEPS）+溃疡周围环缝术联合治疗慢性下肢静脉性溃疡的临床疗效。方法 2004年3月至2006年9月对23例慢性下肢静脉性溃疡患者实施SEPS+溃疡周围环缝术（联合治疗组）。另有SEPS组(19例)和溃疡周围环缝组(30例)作对照。所有病例均行常规大隐静脉高位结扎+剥脱术。结果 联合治疗组溃疡于术后12~60 d愈合，平均25.7 d； SEPS组于术后18~90 d愈合，平均35.1 d; 溃疡周围环缝组于术后21~90 d愈合，平均47.3 d，各组间差异均有统计学意义（P＜0.05）。3组间复发率比较，差异无统计学意义（Pgt;0.05）。结论 SEPS+溃疡周围环缝术能够有效地治疗慢性下肢静脉性溃疡，2个术式联合应用其溃疡愈合时间较单独应用缩短。
OBJECTIVE: To investigate the therapeutic effect of subfascial endoscopic perforator vein surgery (SEPS) in treatment of varicose of the lower limb. METHODS: From 1999. 11 to 2000. 12, 108 patients with varicose of the lower limb underwent venous surgery and 34 of them were treated by SEPS. There were 16 males and 18 females aged 20-79(averaged 51.4 years). Thirty limbs (26 cases) had open ulcers and the diameter of ulcer was 1.5-12.0 cm. Eleven limbs (8 cases) had severe pigmentation and the skin changes had been presented for 1 month to 15 years. According to the severity of illness, flush saphenofemoral ligation, great saphenous vein stripping, percutaneous continuous venous circum suture, external femoral vein valve repair and SEPS were performed separately or simultaneously. RESULTS: Active ulcers healed in 19 limbs after 1 month, in 7 limbs after 3 months, and in the other 4 ulcers after skin transplantation. There was no ulcer recurrence during follow-up (ranged 9-22 months). CONCLUSION: SEPS can accelerate the healing of venous ulcers, and it is one of important methods in the treatment of chronic venous insufficiency.
Considering the abundant vascular anastomotic networks in the deep fascia of the posterior calf, three kinds of distally based facial flap containing deep fascial vascular network were applied clinically. They were: 1. posterolateral distally based island fascial flap which could be used to repair the skin defect of heel, dorsum of foot and lateral-distal part of leg; 2. posteromedial distally based island fascial flap which could be used to repair the skin defect of heel, medial malleolus and medial-distal part of leg and 3. posterolateral malleolar distally based fascial flap which could be used to repair the skin defect of heel and lateral malleolus. Eighteen cases with soft tissue defects around the distal calf were treated, the area of skin defect ranged from 4 cm x 3 cm to 13 cm x 6 cm. All the flaps were survived completely after operation with an average of follow-up for 15 months (ranged from 6 months to 2 years). So the advantages of these flaps were as follows: the blood supply was reliable, preparation of the flap was easy and the major arteries of the calf needed not be sacrificed; the flap had a long and rotatable pedicle so that they would basically satisfy the need to repair skin defect of lower leg, dorsum of foot, heel and malleolus and the resistance of the flap to pressure and wear was better. However, the injury to the superficial sural nerve was the shortcoming.
Ten cases of soft tissue defect at palm orwrist were repaired by reversed fasciocutaneousflap from the forearm. All were. survived excepttwo cases having necrosis of the distal portion ofthe graft. The blood supply of the skin of the fore-arm was comming from the perforation fasciocuta-neous and musculocutaneous giving rise from theulna , radial and interosseous arteries. Therefore ,when the flap was designed,it was best to have thefascial pedicle over the arterial trunks in order toinclude more perforating arteries in the flap . It was indicated that venous supply might also played an important role in flap nutrition.