圖書(shū)-課件020如何閉合創(chuàng)口

HowtoclosethiswoundUniv.Prof.Dr.GillesDupréDipl.ECVSDIUKlinikfürChirurgieundAugenheilkundeVeterin?rmedizinischeUniversit?tWienAminoroperationiswhattheother TechniquesavailableforLocalflapsAxialpatternflapsDistantflapsGraftsQuestionA問(wèn)題ToclosethiswoundIWaitforsecondintention等待其二期Pulltheskinformallskinedgesinacentripetalmanner從皮膚各個(gè)邊緣 牽拉皮Useafreeskingraft用游離皮Makeanadvancementflap做一個(gè)推進(jìn)ToclosethiswoundIWaitforsecondintention等待其二期Pulltheskinformallskinedgesinacentripetalmanner ToclosethiswoundIToclosethiswoundIWaitforsecondintentionPulltheskinformallskinedgesinacentripetalmannerUseafreeskingraft用游離皮ToclosethiswoundIWaitforsecondintentionPulltheskinformallskinedgesinacentripetalmannerUseafreeskinMakeanadvancementflap做一個(gè)推進(jìn) Theclosuremethodshouldbe…閉合的方法應(yīng)該是Thesafest最安Thesimplest最簡(jiǎn)單Thelessexpensive較經(jīng)濟(jì)M.FlapsorgraftwillprovideAnimmediatesolution即刻的解決Ahigh-techimage技術(shù)含量高的TheonlypossibilityforcancerQuestionB問(wèn)題InamonopedicularadvancementThebloodsupplycomesfromtheTherecipientbedshouldbeafreshwound移植床應(yīng)該是新鮮創(chuàng)Thesub-cutisshouldnotbe不應(yīng)包括皮A1/1ratioisconsideredassafeInamonopedicularadvancementThebloodsupplycomesfromthe InamonopedicularadvancementThebloodsupplycomesfromtherecipientbedTherecipientbedshouldbeafresh InamonopedicularadvancementThebloodsupplycomesfromtherecipientbedTherecipientbedshouldbeafreshThesub-cutisshouldnotbe不應(yīng)包括皮Hypodermis&Panniculusloosefat,collagenoustrabeculaeandelasticmuscle與脂膜肌肉混雜essentialforblood*ComparisonoftheRoleoftheSubcutaneousTissuesinInamonopedicularadvancementThebloodsupplycomesfromtherecipientbedTherecipientbedshouldbeafreshThesub-cutisshouldnotbeA1/1ratioisconsideredassafeThemonopedicularadvancementflapGregoire,2yOldShar-PeiMastcellgrade2QuestionC問(wèn)題ToremovethistumorITakeatleast4cm切除至少4cm的邊Shouldneverremovetheunderlyingfasciaasitisabarrier不應(yīng)該去除其下的筋膜，因?yàn)樗且粋€(gè)屏Changeinstrumentsandglovesbeforeclosure在閉合前更換器械和手套Consider1cmmarginas認(rèn)為1cm的邊緣CWeisseetal(Pen):RecurrenceratesandsitesforgradeIIcaninecutaneousmastcelltumorsfollowingcompletesurgicalexcision犬皮下肥大細(xì)JAAHA,38,71-73,Feb2002ThedoubleadvancementQuestionAdoublemonopedicularadvancementCanbeusedonlyalongagiven僅可用于沿著既定Isthemethodofchoicefordistalextremitiesclosure是四肢末梢閉合的 tosmall在體型小的患寵中Shouldincludethesub-cutisAdoublemonopedicularadvancementCanbeusedonlyalongagivenaxis僅可QuestionAdoublemonopedicularadvancement雙側(cè)皮瓣推進(jìn)CanbeusedonlyalongagivenIsthemethodofchoicefordistalextremitiesclosure是四肢末梢閉合的方法 tosmallShouldincludethesub-cutisPapillomatousmassina14yearold AdoublemonopedicularadvancementflapCanbeusedonlyalongaIsthemethodofchoicefordistalextremitiesclosure tosmall在體型小的患寵中Shouldincludethesub-cutis應(yīng)包括Labrador,3yearoldBurrow’s?dog’earsInguinal折AxillaryfoldInguinal折?Onlyiflooseskin?OnlyiflooseskinTestalldirectionsTwoflapsOneflap2個(gè)皮瓣>Inalocalflapthevascularsupplycomesrandomlyfromitsbase局部皮瓣中血管供應(yīng)InanaxialpatternflapamajordirectcutaneousarteryisperfusingtheskinCharles,4yearOldmixedbreedAbrasioninjuryQuestionD問(wèn)題InanaxialpatternflapThebloodsupplycomesrandomlyfromtheskinbase血液供應(yīng)隨機(jī)地從皮膚基Thesurgeonshouldremovethesub-cutis外科醫(yī)生應(yīng)去除皮下TherecipientbedshouldbeaTheskinbasecanbe皮膚基部可以InanaxialpatternflapThebloodsupplycomesrandomlyfromtheskinbase血液供應(yīng)隨機(jī)地從皮膚基InanaxialpatternflapThebloodsupplycomesrandomlyfromtheskinbaseThesurgeonshouldremovethesub-InanaxialpatternflapThebloodsupplycomesrandomlyfromtheskinbaseThesurgeonshouldremovethesub-TherecipientbedshouldbeaInsularflapInsularflapActivedrainageInanaxialpatternflapThebloodsupplycomesrandomlyfromtheskinbaseTherecipientbedshouldbeagranulationCaudalsuperficialepigastricMm3,4,5Insularor Ipsiorcontrolateral Andplentyofotheraxialpatternflaps…以及許多其它軸向皮瓣DeepcirconflexSuperficialSuperficialLateralCaudalReverse…AtlasofsmallanimalreconstructiveFlapsavailableforLocalDistantflaps遠(yuǎn)距離皮Marius,3YearoldpoodleDeglovinginjury SurgicalprotocolIncisethethoraco-abdominalwallSlidethelimbbeneaththeflapSurgicalprotocol(1)andfixthelimbPainPainmedicationDistantflaps:LargedeficitscoverageElbowtometacarpiormoreKneetometatarsiormore36O°360Surgicalprotocol10-14dayslater…外科操作規(guī)程）10-14天以NoNomobilityProximalhealing

DistalhealingAssesshealingandmobilitySurgicalprotocol外科操作規(guī)程StagedStagedreleaseStagedStagedreleaseSurgicalprotocol外科操作規(guī)程ClosureofrecipientanddonorbedQuestionE問(wèn)題APouchflapCanbeappliedonlyonthefront僅可用于Cannotbeusedincats tosmallpatients僅用于小型患Canbeappliedonafreshwound可用于新鮮APouchflapCanbeappliedonlyonthefront僅可用于前APouchflapCanbeappliedonlyonthefront僅可用于前Mimi,SCCfrontlimbSCCAPouchCanbeappliedonlyonthefrontCannotbeusedin tosmallpatients僅用于小型Escalatorwoundina60kgsMastiffAPouchCanbeappliedonlyonthefrontCannotbeusedin tosmallCanbeappliedonafresh可用于新鮮AxillaryandInguinalfolds TheaxillaryfoldflapWhereistheelasticskinavailable Theinguinalfold AxillaryandInguinalfolds *Skin-FoldAdvancementFlapsforClosingLargeProximalLimbTrunkDefectsinDogsandG.Huntetal.Vet.Surg.30:440-448, ThinkvascularLocalflaps局部皮 Fromtheskin從皮膚ThinkvascularLocalflaps局部皮瓣FromtheskinbaseAxial

ThinkvascularFromtheFromtheskinbaseAxialpatternDistant

Fromtwoskinbases Thinkvascular皮Localflaps皮

AxialpatternFromaknownvessel從一條已知FromtwoskinbasesDistantflapsReci