手指z字成形术手术操作视频

手指z字成形术手术操作视频

此视频仅专业人士可见

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机器翻译字幕，仅供参考：

hi， I'm dr. Tom McLellan .I want to show you a great example today of a z-plasty.

嗨，我是博士。Tom McLellan 今天我想向 你展示一个很好的例子 z-

a z-plasty is a tissue rearrangement which us plastic and hand surgeons often

plasty z-plasty 是一种组织重排 ，我们整形和手外科医生

use on the fingers or around the eye in which we want to elongate （ 拉长）a scar scars

经常在手指或眼睛周围使用 它，我们想要拉长疤痕 疤痕

注：从上图来看，不同角度可以增加皮肤延展长度，角度越大，增加越多。

tend to contract over time ten shorten, and when they do shorten they tend to

往往 随着时间的推移收缩 10 缩短 当它们确实缩短时，它们往往会

contract a joint particularly in the hand. it's common after burns and trauma

收缩关节，特别是在 手上 烧伤和外伤后，组织沿直线愈合是很常见的，

in which tissue heals in a straight line .this is why we often create bruders

 这就是为什么我们经常在手指上做粗

incisions or zigzag incisions （锯齿形切口）on the finger ,so that we don't get those scar

切口或锯齿形切口 我们不会得到那些疤痕

contractures .you'll see how I design the z-plasty , how I dissect(解剖) it out and you'll

挛缩 你会看到我如何设计 z-plasty 我如何解剖它 你会

see real time how it elongates the scar to allow this particular finger to

实时看到它如何拉长疤痕 ，让这个特定的手指

extend as always. if you have any questions please feel free to send us an

像往常一样伸展 如果你有任何 问题 请随时给我们发送

email and thank you so much for watching .as you can see the original scar on the

电子邮件，非常感谢您的观看， 因为您可以在

left once you put isay plaster you can get a significant increase in the length

放置 isay 石膏后看到左侧的原始疤痕，通过插入瓣 1 和瓣，您 可以显着增加

of the overall scar by interposing flap 1 and flap 2 that causes the lengthening

整个疤痕的长度 2 导致

of the scar and depending upon the angle in which you make the z-plasty .you can

疤痕变长，根据 您进行 z 成形术的角度，您

get from a 25 percent gain in length to a 75 percent gain in length. this patient

可以从长度增加 25% 到 75% 长度增加该患者

on her ring finger she sustained(遭受) a burn as a child and she's developed a

无名指上的她持续 烧伤 孩子，她出现了疤痕

scar contracture（瘢痕挛缩） which is contracting the the pip joint （proximal interphalangeal joint 近端指间关节） of the ring finger as you can

挛缩，它正在收缩 无名指的 pip关节，正如你

see here. she can force out the finger but it naturally rests at a bent

在这里看到的，她可以用力向外伸出手指， 但它自然地停留在弯曲的

position so I find the longitudinal axis (纵轴)of the scar contracture and then I'm

位置，所以我找到 了疤痕挛缩的纵轴，然后我

designing my z-plasty with my flap 1 and flap 2 and I design that out in an angle

我用我的皮瓣 1 和皮瓣 2 设计我的 z 成形术，我 

based off of that longitudinal. here I'm dissecting each flap and right here this

根据纵向设计出一个角度，在这里我正在 解剖每个皮瓣，就在这里，这

is the tough scar portion which I'll show you a little bit more of here in a

是坚韧的疤痕部分，我 将向您展示一点 一分钟后这里还有一点

minute and as I dissect down. I utilize (利用)a 15

 ，当我向下解剖时，我使用 15

blade to perform the dissection of each flap and here's part of the scar Prok

刀片进行每个皮瓣的解剖 ，这是沿着手指径向部分的 Prok Emily 疤痕的一部分

Emily along the radial segment(径向/辐射状部分) of the finger and I just gently pushed through

 ，我只是轻轻地推过

this scar to release it from the z-plasty field and as I do release that

这个疤痕以释放它 从 z-pla 麦粒肿场，当我释放时，

you will start to see the digital nerve (指神经)on the radial side come into view right

你会开始看到桡侧的数字神经 在那里进入视野

there and then I'll switch over to the littler scissors and I'll complete that

，然后我将切换到 较小的剪刀，我将完成

I section(（手术中）把……切开) around the radial nerve and break up the remainder of that.

我在桡神经周围的部分并 断裂 剩下的

I'll also perform this on the owner section of the flap as well and I'll

我也将在皮瓣的所有者部分执行此操作 ，我将

dissect down through the scar and as you'll notice the scar brought the

通过疤痕向下解剖， 你会注意到疤痕使尺

ulnar nerve vascular bundle (尺侧神经血管束)more medially then here I'm going through the scar with the

神经血管束更靠内侧，然后 我在这里 用 15 刀片穿过疤痕，

15 blade but I'll very quickly come down on to

 但我会很快下降

the neurovascular bundle which is there you can see the nerve and then I'll

到神经血管束，在那里 你可以看到神经，然后我会

switch over to the littler scissors to dissect both proximally and distally to

切换到小剪刀， 从近端和远端解剖以

free up the nerve （松解神经）from the scar and just to show you here is the the digital

释放神经 疤痕上的神经，只是 为了向您展示这里是指

nerve

神经，

you now you'll see here that the flaps have already changed position they rest very

您现在会在这里看到皮瓣 已经改变了位置

nicely. if you can remember the flaps were in a different position when I

如果您还记得 当我开始这个案例时皮瓣处于不同的位置，它们会很好地休息

started the case once released the finger. you'll see that the these flaps

释放了 手指你会看到这些

were actually in this position and the finger was slightly contracted before we

皮瓣实际上处于这个位置 手指在我们松开它之前略微收缩

released it. now once we release the scar, see how the flaps they want to

现在一旦我们释放疤痕 看看他们想要如何

automatically go to a new position of orientation .which you'll see here and it

自动去一个新的 方向位置 你会看到 在这里，它

allows the finger to relax and go out straight and so this will be the final

允许手指放松并 伸直，所以这将

resting place of those flaps. now this is the finger once we've completed suturing

是这些皮瓣的最后休息位置，现在这是 我们完成缝合后的手指

up and I'd like to test it to make sure that it's nice and loose and released as

，我想测试它以 确保它很好 正如

you can see here it is. this is the patient two months after surgery with

你在这里看到的那样松散和释放 这是 手术后两个月的病人

full flexion and full extension without pressure on the pip joint （proximal interphalangeal joint 近端指间关节）showing a

完全屈曲和完全伸展 pip 关节没有压力显示出

great result

很好的结果