上交大外科學(xué)課件12皮膚與軟組織外科傷病

皮膚與軟組織外科傷病

disordersofskinand

subcutaneoustissue

Chapter1皮膚的解剖

AnatomyofSkin皮膚的組成1、表皮（epidermis)2、真皮（dermis)血管、淋巴管、神經(jīng)末梢及大、小汗腺、皮脂腺3、皮下組織(subcutaneousfattissue)毛囊、甲等附屬器Chapter2TraumaofskinandsofttissueLacerations撕裂傷andFingertip指尖andComplexSoftTissueInjuries1、Sprain扭傷2、contusion挫傷

3、Prickingwound刺傷4、Foreignbody異物5、Incisedwound割裂傷6、Bitesandstings叮咬傷Sprain扭傷、contusion挫傷鈍性暴力軟組織閉合性損傷腫脹、疼痛、皮下淤血，甚至關(guān)節(jié)活動障礙24H內(nèi)不宜熱敷及活血化瘀關(guān)節(jié)扭傷需固定2周Prickingwound刺傷、Foreignbody異物銳器戳刺皮膚傷口小易造成深部組織損傷易繼發(fā)化膿性感染和破傷風(fēng)傷口處理術(shù)后應(yīng)用抗生素及破傷風(fēng)抗毒素異物：透光、不透光Incisedwound割裂傷銳器割裂大血管破裂致休克神經(jīng)損傷致運動感覺喪失肌腱損傷致運動障礙傷口處理包括神經(jīng)肌腱術(shù)后應(yīng)用抗生素及破傷風(fēng)抗毒素Bitesandstings叮咬傷

獸咬傷animalbites清創(chuàng)：3%過氧化氫、生理鹽水原則上不一期縫合傷口術(shù)后應(yīng)用抗生素及破傷風(fēng)抗毒素、狂犬疫苗毒蛇咬傷snakebites神經(jīng)毒：延髓及脊神經(jīng)細(xì)胞，0.5~2H呼吸肌麻痹。

金環(huán)蛇、銀環(huán)蛇血液毒:溶組織、溶血及抗凝作用致組織壞死感染。

竹葉青、五步蛇阻斷靜脈血、淋巴液回流、清創(chuàng)服用蛇藥：南通季得勝蛇藥、廣州何曉生蛇藥口服10#T.I.D或外用應(yīng)用抗生素及破傷風(fēng)抗毒素、抗蛇毒血清氣管切開蜂螫傷beestings：過敏反應(yīng)及組織損害蜈蚣咬傷centipedebites：同上蝎螫傷scorpionstings：類似毒蛇咬傷局部處理：挑出蜂刺，避免擠壓全身處理:補液、腎上腺皮質(zhì)激素、抗組胺藥SurgicalWoundTypesClassificationTypeI(Clean):infectionrisk1to5%TypeII(Clean-contaminated):infectionrisk5to10%TypeIII(Contaminated):infectionrisk10to15%TypeIV(Dirty):infectionrisk30to50%SurgicalWoundTypesClassification(continued)TypeI(Clean)NontraumaticNoinflammationpresent無炎癥表現(xiàn)TypeII(Clean-contaminated)Nonsterilebodyregion體內(nèi)無菌環(huán)境entered(gastro-intestinal胃腸道,urogenital生殖道,biliarytract膽道orrespiratorytract呼吸道,oropharynx鼻咽道,etc.)TypeIII:ContaminatedWoundsGrossspillage溢出fromgastro-intestinaltractInfectedgastro-intestinal,urogenital生殖道orbiliarytractenteredFreshtraumaticwound(throughunpreparedskin未消毒的皮膚)TypeIV:DirtyWoundsWoundsassociatedwithperforatedviscus內(nèi)臟(stomach,bowel,gallbladder)Traumaticwoundswith:Imbeddedforeignbody異物植入Fecalcontamination糞便污染Delayedpresentation>12to24hoursforfaceorscalp>6hourselsewhereonbodyProperSequenceofStepsforRoutineWoundCare&Repair1.Adequatelyexposethewoundarea充分暴露創(chuàng)面2.Removesuperficialcontaminants(gravel,etc.)淺表污染物去除3.Cleansearoundthewound傷口清洗4.Considerlocalhairremoval局部備皮

usuallydonotneedtoremovehair(canjustslickitdown withbetadineorK-Yjelly聚維酮碘及K-Y膠凍劑消毒) shavingincreaseswoundinfectionrates localshavingcausestemporarycosmeticproblem NEVERshaveaneyebrow眉毛(itmightnotgrowback)不剔除眉毛（由于眉毛不會生長）ProperSequenceofStepsforWoundCare&Repair(cont.)5.Irrigate沖洗thewound(mostimportantstepforreducing bacterialcountsinthewound)6.Reprepwoundedges傷口周圍消毒切口消毒區(qū)域大于切7.Drapethewound沖洗傷口傷口鋪巾8.Locallyanesthetizethewound局部麻醉9.Close(suture)thewound縫合傷口10.Dressandbandagethewound包扎傷口11.Instructthepatientinfollow-upwoundcare指導(dǎo)患者隨訪指導(dǎo)患者隨訪Chapter3SuperficialInfection淺表軟組織感染HighRiskFactorsObesity肥胖Diabetes糖尿病Poorhygienecondition衛(wèi)生條件不理想Intravenousdrugs靜脈補液癤（Furuncle)單個毛囊及其所屬皮脂腺的急性化膿性感染，常擴(kuò)展至皮下組織Infectioninvolvinganentirehairfollicle&theunderlyingskintissue

Infectioninvolvinganentirehairfollicleandtheunderlyingskintissue

病原體Pathogens葡萄球菌（Staphylococci）grampositivebacteriaproducingbetahemolysinsandenzymessuppurationandcharacteristicthick,yellowpuswithoutfoulsmelling金黃色葡萄球菌（S.aureus）

furuncle&carbuncle表皮葡萄球菌（S.epidermidis）aftersurgerywithforeignmaterial癤——臨床表現(xiàn)

Clinicalfindings

ofFuruncleBackoftheneck（頸背部）Face（臉）Buttocks（臀部）Thighs（大腿）Groin（腹股溝）Breast（乳房）Theunderarmarea（腋下）好發(fā)部位癤——臨床表現(xiàn)

Clinicalfindings

ofFuruncle紅（shiny,brightred）腫（raised）觸痛（tender）張力增高（intense）跳痛（throbbingpain）黃色或白色的滲出液yelloworwhitecreamydischarge(matured)癤——臨床表現(xiàn)

Clinicalfindings

ofFuruncle癤——臨床表現(xiàn)

Clinicalfindings

ofFuruncle危險三角區(qū)全身癥狀不明顯危險三角區(qū)感染－－內(nèi)眥V、眼V－－化膿性海綿狀靜脈竇炎Localtreatment——fomentation熱敷及魚石脂軟膏Surgicalincisiondrainage——maturation、fluctuation波動感Antibiotics——systemicsymptomAvoidcompression擠壓——diffusion擴(kuò)散癤——治療原則

TreatmentofFuruncle癰Carbuncle多個相鄰毛囊及其所屬皮脂腺、汗腺的急性化膿性感染，或由多個癤融合而成Aconfluent融合infectioninvolvingmultiplecontiguous相鄰的follicles毛囊inwhichtheinfectionislimitedtothesubcutaneoustissuebythickoverlyingskinanddensesubcutaneousfascia好發(fā)于厚韌皮膚部位——頸項、背部對口瘡搭背癰——臨床表現(xiàn)

ClinicalFindingsofCarbuncle痛（Pain）腫（Swelling）硬塊（Indurationofthesurroundingskin）多個小膿頭（Multiplesmallabscess）黃色膿液（Yellowthickpus）癰——臨床表現(xiàn)

ClinicalFindingsofCarbuncle

發(fā)熱（Fever）全身乏力（Fatigue）白細(xì)胞升高（Leukocytosis）膿毒癥（Sepsis）癰——臨床表現(xiàn)ClinicalFindingsofCarbuncle

全身癥狀明顯Warm,moistcompresses（熱敷）helptopromotedrainage

Surgicalincisiondrainage（外科引流）Large&deepenoughincision唇癰不宜切開引流－化膿性海綿狀靜脈竇炎Antibiotics（抗菌素）Penicillin（青霉素）Erythromycin（紅霉素）Clindamycin（克林霉素）癰——治療原則

TtreatmentofCarbuncle

Management：Surgicaldrainage癤、癰——預(yù)防（Prevention）goodhygiene（良好的衛(wèi)生習(xí)慣）useofantibacterialsoap（抗菌肥皂）avoidingintravenousdruguse（避免靜脈用藥）wearinglooseclothingthatallowsairtocirculate（寬松透氣服裝）急性蜂窩織炎

AcuteCellulitis，Phlegmon皮下、筋膜下、肌間隙、深部蜂窩組織的化膿性感染溶血性鏈球菌、金葡菌、厭氧菌發(fā)展迅速、不易局限、邊界不清acutespreadinginfectionofthedermis&subcutaneoustissuesresultinginpain,erythema,edema,andwarmth病原體Pathogens最常見A型溶血性鏈球菌（groupAStreptococci）葡萄球菌（Staphylococcusaureus）嬰兒（infants）

B型溶血性鏈球菌（groupBStreptococci）免疫力低下（Immunocompromised）肺炎球菌（Pneumococcus）革蘭氏陰性桿菌（gram-negativerods）真菌（fungi）創(chuàng)口（Wounds）嗜水氣單胞菌（Aeromonashydrophila）革蘭氏陰性桿菌（gram-negativerods）急性蜂窩織炎——病史

HistoryofAcuteCellulitis外傷、手術(shù)史（traumaorsurgery）皮膚潰破史（causingabreakintheskin）沒有明確皮膚外傷史（nodiscernibledermalinjury）

Cellulitis

typicallydevelopsoveraperiodofseveraldays急性蜂窩織炎——臨床表現(xiàn)

ClinicalFindingsofAcuteCellulitis淺表Redness（紅）Edema（腫）Tenderness（痛）Warmth（熱）深部局部水腫、壓痛厭氧菌致捻發(fā)音性蜂窩組織炎Irregularmarginsbutnotraisedsecond-degreeburnfirst-degreeburn急性蜂窩織炎——臨床表現(xiàn)

ClinicalFindingsofAcuteCellulitisAnulceratedareainthecenterIntenseerythemainapatchydistributionPainfulandwarmtothetouchAscendinglymphangitisSeverecellulitis急性蜂窩織炎——治療

TreatmentofAcuteCellulitis抗生素（Antibiotics）penicillinase-resistantsyntheticpenicillinfirst-generationcephalosporin一代頭孢Clindamycin克林霉素Metronidazole甲硝唑熱敷（Warm,moistcompresses）不能控制者需作廣泛多處切開引流口底、頜下—－及早氣管切開防止喉頭水腫捻發(fā)音性蜂窩組織炎及早切開引流、切除壞死組織，傷口予3%過氧化氫沖洗丹毒

Erysipelas皮膚和粘膜網(wǎng)狀淋巴管的急性炎癥（askininfectionInvolvingdermisandlymphatics）Β-溶血性鏈球菌（beta-hemolyticstreptococci）丹毒

Erysipelaslowerextremitiesin70-80%faceaffectedin5-20%全身反應(yīng)劇烈（Systemicinfectiousmanifestations）Initialfeverandchills(發(fā)熱)Muscleandjointpain（肌肉關(guān)節(jié)酸痛）Nausea（惡心）Headache（頭痛）組織壞死、化膿少見容易復(fù)發(fā)丹毒

——臨床表現(xiàn)

Clinicalfindings

ofErysipelas丹毒——臨床表現(xiàn)

Clinicalfindings

ofErysipelas痛性紅疹Painful,Erythematous,EdematousRash淺表性感染、中間較淡moresuperficialsubcutaneousinfectionthancellulitis丹毒

——臨床表現(xiàn)

Clinicalfindings

ofErysipelas邊界清楚Sharply-raisedborderwithabruptdemarcationfromhealthyadjacentskin丹毒——臨床表現(xiàn)

Clinicalfindings

ofErysipelas丹毒——臨床表現(xiàn)

Clinicalfindings

ofErysipelas紅腫沿淋巴管擴(kuò)展，可致橡皮腫Erythemaisirregularwithextensionsthatmayfollowlymphaticchannels丹毒——治療

Treatment

ofErysipelas抬高患處局部50%硫酸鎂濕敷Antibiotics（抗生素）——assoonaspossiblePenicillin（青霉素）Erythromycin（紅霉素）Cephalexin

（頭孢菌素）Symptomatictreatment（對癥處理）Antipyretic（退熱劑）Analgesics（鎮(zhèn)痛劑）處理足癬Gangrene&Amputation壞疽甚至截肢Bacteremia&Sepsis菌血癥及膿毒癥Scarletfever猩紅熱Pneumonia肺炎Abscess膿腫Embolism血栓Meningitis腦膜炎Death死亡Complications：Theinfectionoflymphnodes

(glands)usuallyassociatedwiththesiteoftheunderlyinginfection,tumor,inflammationcommonresultofacellulitis蜂窩織炎o(hù)rotherbacteriainfectionLymphadenitis淋巴結(jié)炎：Characteristicswollen,tender,hardnodes腫、壓痛、硬結(jié)smoothorirregulartotouch表面光滑或不規(guī)則orsoftand“rubbery”(fluctuant)ifanabscesshasformed質(zhì)軟、韌，膿腫形成時呈波動感theskinoveranodemaybereddenedandhot皮膚紅、皮溫高Lymphadenitis：Signs&SymptomsInfectionoflymphvessels/channelsCommonlyresultsfromcellulitis蜂窩織炎o(hù)rabscess

intheskinorsofttissuesAprogressinginfectionraisingspreadofbacteriatothebloodstreamlife-threateninginfections

Be

confusedwitha

clotinavein(thrombophlebitis)易于血栓性靜脈炎混淆Lymphangitis管狀淋巴管炎LYMPHANGITISredstreaks淺層淋巴管炎可出現(xiàn)紅線frominfectedareatothearmpit腋窩orgroin腹股溝throbbingpain搏動性疼痛alongtheaffectedarealymphnodes

feverandchills

malaise,lossofappetite,headache,muscleachesPhysicalexaminationBiopsy(LN)Bloodculture血培養(yǎng)Lymphadenitisandlymphangitismayspreadwithinhours,spreadingtothebloodstreammaybefatal致命的.Diagnosis：TreatmentshouldbeginpromptlySpecificantibiotics抗生素Surgicaldrainage外科引流Hotmoistcompresses濕熱敷Primarydiseasemanagement扁桃體炎、齲齒、手足感染Management：手部急性化膿性感染

HandInfection甲(nail)（角質(zhì)形成細(xì)胞構(gòu)成）

甲板（外露部）甲床（甲板下）甲甲根（深入近端皮膚、甲根之下甲床甲母質(zhì)）甲周（甲板周圍皮膚甲皺襞）甲半月（新月狀淡色區(qū)）

1、掌面表皮厚--啞鈴狀感染2、掌面皮下組織致密--腱鞘炎、骨髓炎3、背面疏松、淋巴引流掌向背—掌不腫、背腫4、組織致密—張力高、疼痛劇烈5、腱鞘、滑囊、間隙互通—感染易蔓延手部感染的特點CharacteristicsofHandInfection手部感染的背景

BackgroundofHandInfection及時、準(zhǔn)確地診斷手部感染的來源和位置并非容易Difficulttomakeacorrectdiagnosisforseriousinfectionofnature&position手部的間隙錯綜復(fù)雜Multiplecompartmentsandplanesinhand手部感染是沿著筋膜發(fā)展InfectionsaredictatedbyfascialboundariesinhandHandInfection甲溝炎（Paronychia）膿性指頭炎（Felon）手掌側(cè)化膿性腱鞘炎（Tenosynovitis）掌深間隙感染（Deepfascialspaceinfections）RecenttraumatolateralnailfoldNailbiting（手指咬傷）Manicuring（修剪手指甲）Dishwashing（洗碗工作）Fingersucking（吮吸手指）

甲溝炎(Paronychia)甲溝炎

Paronychia側(cè)甲褶感染（Infectionofthelateralnailfold）急性蜂窩織炎（Cellulitis）甲床積膿（Eponychia）甲溝炎——臨床表現(xiàn)

ClinicalFindingsofParonychiaalonglateraledgeofnailfold

Edema（腫）Erythema（紅）Pain（痛）膿腫形成（frankabscessformation）甲溝炎——臨床表現(xiàn)

ClinicalFindingsofParonychiaIfnofrankabscess無膿腫形成

frequenthotsoaks&antibiotics

（抗生素+熱液浸泡）Ifpusispresent膿腫形成

incisionanddrainage

（切開引流）Ifpushastrackedbeneaththenail甲下有膿

removeanadjacentlongitudinalsection

（部分拔甲）

Ifeponychiaisresulted甲床積膿

removetheentirenailplate

（拔甲術(shù)）甲溝炎——治療原則

TreatmentofParonychia甲溝炎——并發(fā)癥

ComplicationsofParonychia

Eponychia(甲床積膿)Osteomyelitis（骨髓炎）Felon（指頭炎）Chronicinfection（慢性感染）指頭炎

Felon末節(jié)手指掌面皮下化膿性感染（掌側(cè)）Theinfectionofdistalpalmarphalanx密閉腔（aclosedcompartment）Topreventtheproximalspreadofinfection（防止感染擴(kuò)散）Toincreasepressurewithintheclosedcompartment（增加密閉腔壓力）Toimpairvenousoutflow&leadtoalocalcompartmentsyndrome（室間隔綜合征）

osteomyelitis（骨髓炎）指頭炎——病理

PathologyofFelon

近期有指墊外傷或甲溝炎史Recenttraumatofingerpadorparonychia典型的手指波動性跳痛TypicallyThrobbingPain手指墊紅腫、張力增高Swelling,Pressure,Erythema指頭炎——臨床表現(xiàn)

ClinicalfindingsofFelon

手指墊紅腫、疼痛、張力增高Painful,Tense,Erythematousfingerpad膿腫形成Abscess指間關(guān)節(jié)受累Thedistalinterphalangealjoint其他手指創(chuàng)傷依據(jù)Evidenceofpenetratingtrauma指頭炎——臨床表現(xiàn)

ClinicalfindingsofFelon

手術(shù)指征（indication）手指搏動性跳痛（TypicallyThrobbingPain）膿腫形成（Frankabscess）指墊張力增高（tensefingerpad）指頭炎——治療

TreatmentofFelon

切口（incision）以波動感最明顯處為中心作縱行切口近端不超越指節(jié)橫紋；遠(yuǎn)端不超越甲溝1/2引流（drainage）用血管鉗作鈍性分離

填塞（packing）指頭炎——治療

TreatmentofFelon

指頭炎——治療

TreatmentofFelon

ImproperIncisionScarring疤痕sensoryloss感覺減退unnecessarypain疼痛instabilityofthefingerpad指墊不穩(wěn)定spreadofinfectionintotheadjacenttendonsheath感染向鄰近腱鞘擴(kuò)散FelonThetenosynovialcoveringsofthesecond,third,andfourthdigitsdonotcommunicatewitheithertheradialorulnarbursae尺橈側(cè)滑液囊inmostindividualsInfectionwithinatendonsheath腱鞘usuallyistheresultofdirectinoculationofbacteriafrompenetratingtrauma.由穿透性外傷細(xì)菌的直接接種導(dǎo)致。InfectiousTenosynovitis腱鞘炎Recentpenetratingtraumatohand手部刺傷Gonococcal淋球菌infection,particularlydisseminatedinfection感染擴(kuò)散Pain,especiallywithpassiveextensionoffinger主動伸指疼痛Edemaofentirefinger水腫Variablehistoryoffever發(fā)熱InfectiousTenosynovitisTenderness壓痛alongthecourseoftheflexortendon屈肌腱Symmetricedema均勻水腫

ofinvolvedfingerPainonpassiveextension(themostimportantsign)Flexedrestingpostureoffinger手指強迫姿勢All4signspossiblynotpresentearlyinthecourseofinfectionMayhaveassociatedlymphangitis,lymphadenopathy,andfeverInfectiousTenosynovitisTendondestruction肌腱破壞Functionaldisability功能障礙Extensionofinfectiontodeepfascialspace手掌深部間隙感染Complications：Deepfascialspaceinfections手掌深部間隙感染

midpalmarspace掌中間隙thenarspace魚際間隙dorsalsubaponeuroticspace背側(cè)腱膜下間隙subfascialwebspace皮下網(wǎng)狀間隙Recentpenetratingtraumatohandoruntreatedtenosynovitis腱鞘炎Palmarblister掌水皰(mayresultinsubfascialwebspaceabscess)PainandedemaofhandPainwithmovementoffingersVariablehistoryoffeverDeepfascialspaceinfectionsPain,swelling,lossofpalmarconcavity手掌凹面消失PainwithmovementofthethirdandfourthdigitsDorsalswelling背部腫脹secondarytothetracking追蹤ofinfectiondorsallyalongthelymphaticsMidpalmarspaceinfectionsMarkedswellingofthethumb-indexwebspaceFlexedandabductedrestingpostureofthethumb拇指屈位強制姿勢Painwithpassiveadduction主動內(nèi)收疼痛Thenar魚際spaceinfectionsFunctionaldisability功能障礙Tendondestruction肌腱破壞Sepsis膿毒血癥Handloss截肢Complications：painreliefantibiotictherapyelevatingandimmobilizingthehand患手抬高固定consultinganexperiencedhandsurgeon專業(yè)手外科醫(yī)師處理incisionanddrainage切開引流Management：Dependingontheextentionoftissuedestruction組織破壞程度bonyinvolvement累及骨preexistingvascularinsufficiencysystemiccomplications(bacteremia,sepsis)Prognosis：竇道與瘺管瘺管：Fistulacannulas

兩個開口竇道：Sinustract

一個開口，病理性盲管慢性潰瘍

Chroniculcer腫瘤性潰瘍血運障礙性潰瘍結(jié)核性潰瘍?nèi)殳廋hapter4淺表軟組織腫塊

softtissuetumornevus痣皮膚良性色素斑塊皮內(nèi)痣：無活躍痣細(xì)胞，常有毛發(fā)交界痣：有活躍痣細(xì)胞，一般無毛發(fā)混合痣：同時存在ClinicalFindingsThelesionsareoftenflat扁平atbirth,browntoblackincolor.Theyoftengrowproportionallytothebodysizeasthechildmatures.Astheymature,theyoftendevelopthickness厚,andbecomeselevated隆起.Prominentterminalhairsoftenform,especiallyafterpuberty.Withmaturity,thenevuscanhavevariationincolor,andthesurfacemightbetexturedwithgrowths.TreatmentSurgicalexcision手術(shù)切除isthestandardofcare.Theuseofhairremovallaserforthetreatmentislikelysafeandeffectiveforsmallcongenitalnevus.對于淺表較小的色素痣也可使用激光ifmalignancydevelopedfromadeepcomponentofthenevusthatisnotreachedbythelaser.Lipoma脂肪瘤Alipomaisabenigntumorcomposedoffattytissue.Thesearethemostcommonformofsofttissuetumor.最常見體表良性腫瘤Lipomasaresofttothetouch質(zhì)軟,usuallymoveable活動度佳,andaregenerallypainless.Manylipomasaresmall(underonecentimeterdiameter)butcanenlargetosizesgreaterthansixcentimeters.Somesourcessaythatmalignanttransformationcanoccur.TreatmentUsually,treatmentofalipomaisnotnecessary,unlessthetumorbecomespainfulorrestrictsmovement.一般脂肪瘤不必積極治療，除非其出現(xiàn)疼痛及限制正?；顒?。Theyareusuallyremovedforcosmeticreasons,iftheygrowverylarge,orforhistopathologytocheckthattheyarenotamoredangeroustypeoftumorsuchasaliposarcoma.通常為了外表美觀、進(jìn)行性增大或為了鑒別脂肪肉瘤而手術(shù)切除。sebaceouscyst皮脂腺囊腫Asebaceouscyst(aformoftrichilemmalcyst)isaclosedsacorcystbelowthesurfaceoftheskinthathasaliningthatresemblestheuppermostpart(infundibulum)ofahairfollicleandfillswithafattywhite,semi-solidmaterialcalledsebum.皮脂腺囊腫（毛囊囊腫的一種形式）是表皮下封閉的囊袋。開口于毛囊頂端，內(nèi)含有脂白色的半固體的皮脂。Sebumisproducedbysebaceousglandsoftheepidermis.皮脂由表皮的皮脂腺分泌。TreatmentSebaceouscystsgenerallydonotrequiremedicaltreatment.However,iftheycontinuetogrow,theymaybecomeunsightly不美觀,painful,infected,oralloftheabove.Surgicalexcisionofasebaceouscystisasimpleproceduretocompletelyremovethesacanditscontents.Aninfectedcystmayrequireoralantibioticsorothertreatmentbeforeand/orafterexcision.SurgicalexcisionofasebaceouscystGanglionCysts腱鞘囊腫Ganglions腱鞘囊腫areformedbyanoutpouching隆起ofthesynovialmembrane滑膜fromajoint關(guān)節(jié)ortendonsheath腱鞘andcontainthickjelly-likemucinousmaterial稠厚的凍膠樣黏液樣物質(zhì)similarincompositiontosynovialfluid滑囊液.PyogenicGranulomaPyogenicgranuloma炎性肉芽腫isamisnomer別稱foranexuberantoutburstofhighlyvasculargranulationtissue高度增生的血管肉芽組織atthesiteofpreviousrelativelytrivialtrauma輕微損傷.Theselesionsareveryfriable質(zhì)脆,bleedeasily,andmaygrowrapidly.Theyrespondtoeithercurettage刮除術(shù)orsimpleexcision.Theyoccurmostcommonlyonthefingertips