[医学]修复重建和美容外科选修课PPT-1.pptVIP

* * * * 1、生理纹路： Larger’s线 关节平行线、毛发、皮纹平行、轮廓线 切口设计 Incise Larger’s线 切开 Incise: At right angles to the skin Z-Plasty 切口设计 2 1 1 2 3 3 4 4 1 2 1 2 30度 25% 45度 50% 60度 75% 75度 100% 角度 长度 “Ｚ”字成形： 改变疤痕方向，转移皮肤 缝合技术 Suture 间断缝合 Interrupted Suture 皮内缝合 Intradermal Suture 连续皮内缝合 Running Intradermal Suture 连续扣缝合 Edge-locking Suture 褥式缝合 Mattress Suture 移植和皮瓣Grafts Flaps 皮肤移植 Skin Grafts Grafts are harvested from a donor site and transferred to the recipient site without carrying its own blood supply. It relies on new blood vessels from the recipient site bed to be generated (angiogenesis). .. 皮肤移植分类 Classification 全厚皮移植 Full Thickness consist of the entire epidermis and dermis. 断层皮片移植Split Thickness consist of the epidermis and varying degrees of dermis. They can be described as thin, intermediate, or thick. Skin Anatomy 供区 Donor Site 全厚皮移植 Full thickness must be closed must be taken from an area that has skin redundancy usually harvested with a knife between the dermis and the subcutaneous fat 断层皮片移植Split thickness can be repopulate and resurfaced usually harvested with either a special blade or dermatome harvested with a special blade that can be set to a desired thickness 受区 Recipient Site 全厚皮移植 Full Thickness usually used to resurface smaller defects commonly used to resurface defects of the face provides a better color consistency, texture, and undergoes less secondary contraction 断层皮片移植Split Thickness usually used to resurface larger defects undergoing secondary contraction as they heal 存活Survival 机制 Survival Mechanisms absorbing the nutrients in the wound bed by diffusion Inosculation — By day 3, the cut ends of the vessels on the underside of the dermis begin to form connections with those of the wound bed Angiogenesis — By day 5, new blood vessels grow into the graft 失败Failure Mechanisms Poor wound bed Sheer —