显微外科 PPT课件.ppt

1、显微外科Microsurgery(MS),Tissue defects tough problem,Trauma amputated extremity, tissue defect Infection Destroy normal tissues Tumor Congenital deforms,extremity amputation secondary trauma,Trauma,Tumor,HOW TO TREAT?,Traditional method-discard,disadvantages functional incapacitation Bad quality of lif

2、e,TRADITIONAL METHOD:STAGED REPAIR-cross leg pedicle flap,disadvantages uncomfortable Long length of stay costly,Impossible with traditional method,Adopting microsurgery,To replant amputated tissue Primary repair wounds Radical excise tumor and primary repair defects,A fantastic technique to reconst

3、ruct the defective body,What is microsurgery?,Performing surgical procedures finely under magnifying loupes or operating microscope with special instruments and materials. Optical magnifying equipments Microsurgical instruments Microsurgical techniques,Brief history of MS,Initiation period(1960s),La

4、boratory: in 1960，Jacobson JH and Suarez EL achieved anastomosis in small vessels using microscope and acquired 100% patency rate when applied in vessels of diameter of 1.6 -3.2mm Clinic: Replantation of broken limbs and fingers Malt(1962) replanted a broken arm Chen Zhong-wei(1963) replanted a brok

5、en forearm Chinese surgeons(1966) replanted the arm after removal of malignant tumor Chinese surgeons(1967) replanted broken fingers,Evolution period（1970s）,Transplantation of vascularized tissues Skin flap (Yang Dong-yue, 1973) Muscle (Chen Zhong-wei, 1973) Bone (Chen Zhong-wei, 1977) Joint (Yang D

6、ong-yue, 1977) Nerve (Taylor, 1979) Reconstruction of thumb and finger,Mature period（1980s）,Establishment of some theories and guidelines Microsurgical anatomy Pathophysiology about small vessel anastomosis, nerve repair and flap transplantation Classification and name of flap Criteria to select the

7、 indications of microsurgical operation,Elevation period（1990s）,The technique of small vascular anastomosis was widely used in all fields of surgery The selection of flap donor site trend to optimization Introduction of nerve nutrient vessel flap、perforator flap and the concept of super-microsurgery

8、 Biological material, tissue engineering and genetic technology were applied in microsurgery,Difference between traditional surgery and microsurgery,Surgical technique Instruments,Magnifying equipments,Magnifying loupes: 2.5x-10 x,Operative Microscope: 10 x-40 x,Microsurgical instruments,Jewelers fo

9、rceps Microscissors Microneedle holder Microvascular clamps Dilating probes Microirrigating cannulas,Microsurgical instruments,Suture material Nylon 9-0,10-0,11-0,12-0. Diameters of 35um to 18um,Microsurgical Technique,Microvascular anastomosis The core technique of replantation and free vascularize

10、d tissue transplant Peripheral Neurosuture,Training of microsurgical technique,Approximately 6-8 hours of daily practice in the laboratory for 3 weeks Tail artery of rat,Microvascular anastomosis,Preparation of vessel,Approximate vessel ends place colored rubber or plastic sheet behind the vessel fo

11、r contrasting,Trim adventitia,Irrigate the lumens with heparinized saline,End-to-end anastomosis,Place the first two sutures 120 degree apart on the vessels circumference,Use Interrupted sutures,Rotate clamp and expose the posterior wall, Place a stitch 120 degrees from the initial two stitches,Plac

12、e additional stitches in the remaining space to complete the anastomosis,Patency test-make sure blood flow,Occlude a segment of vessel with forceps distal to the anastomosis,Strip blood from the segment from proximal to distal,Release the proximal forcep, rapid filling of the emptied segment indicat

13、es a patent anastomosis,End-to-side anastomosis,Excise a small longitudinal elliptical portion of the recipient vessel wall,Place the first two sutures at the proximal and distal ends of the ellipse,Principles of microvascular anastomosis,1 Normal vessel 2 Normal blood flow 3 proper tension 4 approx

14、imate calibre 5 eversion suture 6 micro-invasion,Postoperative treatment,Keep warm Absolute bedrest elevation Prohibit smoking Avoid compression Relieve pain Ensure sufficient blood volume,Drug treatment“tri-anti”,Antibiotic anticoagulation dextran Aspirin persantine Anti-vasospasm papaverine anisod

15、amine（6542） tolazoline,monitoring of circulation,Skin color：ruddy, not pallor or cyanotic Skin temperature：a little bit higher than normal tissue digital pressure capillary reaction ：Capillary filling time less than 2s tension：turgor Needling bleeding：bright red bleeding in 12s,Microsurgical treatme

16、nt of nerve injuries,Peripheral nerve structure,Three methods: Peripheral nerve repair,epineural neurorrhaphy,perineurial neurorrhaphy,Periepineural neurorrhaphy,Microsurgical techniques are widely used in all fields of operative specialities.,1. replantation,Replantation of amputated extremity,comp

17、lete amputated extremity Traumatic extremity break up without anything connecting Or some tissue connecting but must be transected when perform debridement Incomplete amputated extremity Fracture or dislocation combined with more than two-thirds soft tissue break up and distal extremity would necros

18、is if not to repair the main ruptured vessels.,Replantation of amputated palms of bilateral hand,Replantation of multisegment finger amputation,Replantation of amputated ten fingers,Replantation of amputated wrist,Replantation of amputated forearm,replantation of scalp avulsion,Replantation of amputated penis,replantation of amputated ear,Replantation of amputated lip,Replantation of tissue piece,2、 Transplantation with vascular anastomosis,1).free cutaneous flap transplantationt to repair facial tissue defect,2).repa