重建整形外科ppt培训课件

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1、重建整形外科整形外科助理教授張高評醫師醫院分機7676Email:kapich@kmu.edu.tw參考資料SABINSTON,TEXTBOOKOFSURGERY,17thedition,SectionXIIIPlasticSurgery,Chapter72SCHWARTZ’S,PRINCIPLESOFSURGERY,8thedition,Chapter44GeneralPlasticSurgicalPrinciplesandTechniquesHeadandNeckTrunkandExternalGenitaliaLowerExtremityBreasta

2、ndAestheticSurgerySECTIONGeneralPlasticSurgicalPrinciplesandTechniquesHeadandNeckTrunkandExternalGenitaliaLowerExtremityBreastandAestheticSurgerySECTIONSkinIncisionsandExcisionsCarefullyplanningofskinincisionssoastoavoidanobviousscar“Langer’slines”DiminishtensionIncisionsperpendicu

3、lartothelongaxisofunderlyingmuscleRSTLs(relaxedskintensionlines)Notfavoredareas:weight-bearingorhigh-usesurfacesLinearscarscontractedupto20%inlongitudinaldirection.FIGURE72-1A.A,Facialrelaxedskintensionlines(RSLTs).B,RSLTsoftheentirebody.OpenWoundsTypesofWoundClosurePrimaryorFirst-

4、intentionclosureSecondaryorSpontaneousintentionBybiologicprocessofcontractureTertiaryorDelayedprimaryclosureForpreventionofinfectioninacontaminatedwoundFIGURE72-2.Impedimentstowoundhealing.CHF,congestiveheartfailure;CAD,coronaryarterydisease.DebridementandIrrigationDebridementRemov

5、alofdevitalizedandcontaminatedtissueswhilepreservingcriticalstructuressuchasnerves,bloodvessels,tendons,andboneOpenwoundshouldbekeptmoistafterdebridement.GraftsandFlapsBasedonthicknessFull-thicknessskingrafts(FTSGs)Split-thicknessskingrafts(STSGs)FTSGEpidermiswithentiretyofdermisDo

6、norsitescanbeclosedprimarilySTSGVaryintheamountofdermisDonorsitesre-epithelizespontaneouslyFIGURE72-4.Crosssectionofskindepictinglevelscontainedinsplit-thicknessandfull-thicknessskingrafts.GraftsandFlapsFlapsPartiallyorcompletelyisolatedsegmentoftissueperfusedwithitsownbloodsupplyD

7、efinedbythesourceofbloodsupplyRandom:notanamedbloodvesselAxial:comprisingofnamedvesselFree:withtheuseofmicrosurgeryFIGURE72-5A.AandB,Vascularpatternsofrandompatternandaxialskinflaps.FIGURE72-6.Graphicrepresentationofcommonlyusedlocalflaps:advancementandrotationflaps.FIGURE72-8.Grap

8、hicrepresentationofthebilo