乌鸦的拇指

乌鸦的拇指（精选12篇）

乌鸦的拇指 篇1

《乌鸦的拇指》读后感

《乌鸦的拇指》内容简介：被高利贷压迫、走投无路的五个人偶然走到同一屋檐下。他们策划了一个惊天的“复活”计划！然而故事的走向却出乎所有人的意料，道尾秀介导演了一幕最神奇的悬疑剧。   乌鸦的拇指的读后感，来自淘宝网的网友：之所以没给力荐是因为，如果有人是为了悬疑而来，我真的.不是很推荐这本书。抱着猎奇的目的看了这本书，结局却是出乎意料的温柔。这只是一个关于人与人之间互相体谅与生存的故事。自从看了道尾秀介的书之后，倒是改掉了我看书的一个毛病，老是看着一半儿就去翻结局。因为剧情总是急转直下，翻了也不是很有用，反而倒是有点摸不着头脑。小的时候老是觉得自己像是电视剧的悲情主角，长大之后回头看看过去那些事情，才发现其实我们不过是活在别人设的一个局里。或者是走啊走，总是走不出社会给你画的圈子。这本书里的每个人都有一段自己的悲惨故事，刨除那些个别的职业和偶尔有点血淋淋的场面，我们和这些人物之间也其实并无什么分别，不过都是因为是普通人而必须要为了生存而挣扎在这个世界上。想要重新生活在现实里，想要洗刷过去，想要用尽最后一点力气帮助曾和自己一样苦难的人们，出于这样的目的，才有了这个故事。如果说神是救人的，那么这个世界上确实是有神的，然而也不过是一些想要赎罪的人罢了。老铁，武泽，真寻，八寻，贯贯这五个人都是想要通过拯救别人来赎罪的人。只不过就像是生物链一样，位置有先有后罢了。作者是个有意思的人，前面交待地每个细节都没放过，最后全都指向了结局。热切地建议每个读完这本书的人再回来想想这个题目，乌鸦的拇指。你就会发现，其实作者剧透了........ 乌鸦的拇指的读后感，来自当当网的网友：我还真没怎么看过推理小说，更没写过书评。本来想的一个题目，想了想发现有剧透的嫌疑，还是厚道一点改了。至于推理小说的流派，什么本格变格新本格等等，反正我是一无所知，只听说松本清张好像是社会派。估计也就跟从来不看科幻的人这么说一样：哎呀，我好像只听说过凡尔纳写过机器人三定律，至于什么软科幻硬科幻稀饭科幻我一点都不知道是什么东西.....所以只来说说故事吧。五个社会最底层的人，都是小偷、骗子、诈骗犯，然而每个人却都有一段不为人知的往事。黑暗的过去就像沉重的负担压在每一个人的身上，抛不开，甩不掉，也就没有办法走上有着阳光照耀的道路。所以与其说这是一个复仇的故事，不如说是一个同过去战斗的故事。而且，我喜欢它是一个在尽头处有朝阳的故事。     引用链接：www.ilucking.com/duhougan/2011/880/

乌鸦的拇指 篇2

1 临床资料

本组6例, 男3例, 女3例。年龄18~45岁。均为机器绞伤致拇指完全撕脱, 同时合并手背部第一、二掌骨背侧皮肤撕脱, 撕脱的拇指均无再植条件。患者在急诊科接受处理时, 首先将创面清创包扎, 并将撕脱的拇指皮肤剥除, 将骨骼、肌腱完整保留, 埋植于腹部或前臂皮下, 以保持骨骼、肌腱的活性, 然后收住院, 5~7d后行拇指再造。拇指再造时用带足背皮肤的扩大范围的游离拇甲皮瓣移植, 包裹埋植于腹部或前臂皮下的骨骼和肌腱, 形成新的拇指;而足背皮瓣供区创面的覆盖, 则采用游离膝上外皮瓣移植覆盖, 膝上外皮瓣供区直接缝合[2]。本组再造拇指均成功, 移植于足背的皮瓣完全成活, 无感染、血管危象发生。经过6个月至1年的随访, 再造拇指外形逼真, 功能恢复良好, 供足外形好, 行走无疼痛, 无皮肤破溃发生, 手术效果十分满意。

2 手术方式简介

将患手彻底扩创, 清除坏死感染组织。然后将埋植于腹部或前臂皮下的撕脱的拇指骨骼、肌腱回植于拇指残端上, 以重建骨支架。根据对侧正常拇指的粗细及患侧手部皮肤缺损的面积, 在同侧足部设计拇甲皮瓣。拇甲皮瓣包括拇趾趾甲、拇趾大部分皮肤和足背皮肤。皮瓣供血动脉为足背动脉-第一跖背动脉-趾背动脉系统;静脉系统为大隐静脉及其属支。皮瓣切取后移植于手部, 包裹拇指指骨, 并覆盖手背皮肤缺损区域。桡动脉与皮瓣的足背动脉吻合, 头静脉与皮瓣大隐静脉吻合。足背创面直接取股部中厚皮片打包植皮。

3 术后护理

3.1 一般护理

术后尽可能为患者创造良好的环境, 尽量安排患者住在小病房, 以减少干扰。室内严禁吸烟, 因为香烟中的尼古丁会引起血管严重痉挛, 危及皮瓣的存活。室温保持在23℃左右。为预防血管危象的发生, 术后患者保持绝对卧床7d, 患肢 (再造拇指和供足) 给予软枕垫高15°并制动, 以减少肿胀。为避免两处游离皮瓣受凉导致血管收缩, 双患肢均给予60W旁照灯持续局部照射, 距离患肢40~60cm, 保持局部温度为25℃。协助患者每小时侧15min。本组未出现压疮。患者长时间卧床, 后背骨隆突部位容易受压, 使患者难以坚持, 因此要经常变换卧姿, 并按摩受压部位, 防止压疮形成。烤灯的照射会影响患者的睡眠, 我们用灯罩遮光, 避免光线直射到患者面部。随时观察伤口渗血情况和石膏包扎的松紧度。做好患者及家属的工作, 避免不必要的探视, 使患者能静心疗养。

3.2 心理护理

本组均为突发的意外伤害, 且具有损伤大、疼痛和失血多的特点。护理人员耐心与患者交谈, 认真倾听患者诉说, 与患者建立良好的护患关系。实事求是地向患者讲解手术的目的在于恢复拇指的部分功能, 经过锻炼可达到生活基本自理, 避免患者对手术的期待值过高。

3.3 疼痛的护理

疼痛对于患者是一种不良的刺激, 可引起血管痉挛, 影响皮瓣的血液循环。术后常规应用镇痛剂治疗。本科室和麻醉科合作应用术后镇痛泵, 效果良好, 极少数病人会出现疼痛难忍, 分析与术后皮瓣肿胀有关, 可给予抬高患肢, 强痛定及度冷丁肌注, 效果良好, 普通镇痛药效果欠佳。

3.4 血管危象的观察与护理

血管危象的观察包括2部分:再造拇指、手背皮瓣 (足背动脉皮瓣) 。术后3d内每小时观察2次, 3d后每小时观察1次。观察拇甲皮瓣要在自然光下进行, 通过下列方法来确定皮瓣的血运: (1) 看:皮瓣颜色红润, 与其他正常手指的皮色相一致为正常;皮瓣颜色发白提示动脉血液循环障碍;颜色发紫提示静脉危象。 (2) 摸:直接触摸皮瓣, 感觉皮瓣的饱满度。皮瓣血供正常时则指腹饱满, 弹性好;动脉危象时皮瓣张力小, 弹性差;而静脉危象时皮瓣张力明显增高。 (3) 压:观察皮瓣毛细血管反应, 正常1-3s, 如低于1s, 有可能是静脉危象, 如大于3s, 提示皮瓣动脉血液循环出现障碍。 (4) 测:采用超声多普乐可直接检查血管通畅情况。笔者总结6例病人, 病人出现静脉危象的可能性大于动脉危象, 且常于术后12h发生, 如术后出现皮瓣及再植指肿胀严重, 须尽早拆开引流, 待消肿后再行缝合。因此术后12h的观察护理非常重要。

3.5 用药后不良反应的观察与护理

3.5.1 低分子右旋糖酐是游离皮瓣移植术后常用的改善微循环和扩充血容量的药物, 方法为低分子右旋糖酐500ml静滴, 2次/d。

应用低分子右旋糖酐会发生腹痛、腹胀的不良反应[3], 本组中有两例患者在用药后20min时出现腹痛、腹胀现象, 腹痛为轻度绞痛, 给予减慢滴注速度、局部热敷后缓解。同时给予患者低脂、易消化的食物。为不影响患者的睡眠, 尽量不在夜间使用低分子右旋糖酐。不良反应在停药后可自行消失。

3.5.2

本组需大剂量联合使用扩血管药、抗凝剂和防止血管痉挛的药物, 影响了患者正常的凝血功能, 容易出现内外出血情况, 需及时观察, 术后7d内常规监测凝血机制对预防出血并症有非常重要的作用。

3.5.3 长期大剂量应用扩血管药物后, 常引起皮肤瘙痒。

这种不良反应常为迟发性, 在用药后数天甚至停药后出现, 白天症状轻, 夜间重;情绪激动时容易引起;瘙痒的同时不伴有皮疹或皮肤颜色的改变, 常影响睡眠。若发生皮肤瘙痒可用炉甘石洗剂为患者涂抹止痒, 嘱患者不用热水擦拭、不抓挠, 保持皮肤完整性。症状在停药半年后可逐步自行消退。本组未出现此症状。

3.6 出院指导

术后2个月, 由于再造拇指的骨骼尚未愈合, 需佩带支具保护。再造拇指的感觉恢复一般在4个月以后, 这期间拇指感觉差, 要避免冻伤、烫伤, 冬季可自制厚棉手套加以保护, 鞋要尽量宽松、柔软。由于切取拇甲皮瓣时不可避免地会损伤足部的某些韧带结构, 因此患者1个月内避免过多下地活动, 以减少供足的负重, 利于软组织的修复。再造拇指骨愈合后, 可开始全面练习掌指关节、指间关节的屈伸活动及对掌功能。

参考文献

[1]王澍寰, 主编.手部创伤的修复[M].北京:北京出版社, 1997:477～480.

[2]潘勇卫, 田文, 田光磊, 等.改良游离拇甲皮瓣移植再造拇指[J].中华手外科杂志, 2005, 21 (2) :79～82.

读《沉睡的大拇指》有感 篇3

有一个小男孩名字叫盖尔，他的一只手从他出生的那天起，便与众不同，因为它长了六根手指。在学校里，同学们嘲笑和讽刺他，盖尔十分伤心。他的爷爷知道后，不想让这种事再发生，于是将大拇指缩到手心，并且告诉盖尔，他帮爷爷多长了一根手指。从此，再也没有人讥笑他了。但他爷爷的手却因为长时间蜷缩，完全失去了最初的力量，萎缩变形了!后来随着男孩年龄的增长，可以切除第六指时，他却不肯。爷爷告诉盖尔自己的手已经好了，他的第六指已经完成了历史使命，盖尔相信了爷爷，切除了那根多余的手指。爷爷去世后，盖尔的父母再也忍不住了，将真相告诉他。盖尔听后，呆住了，泪水止不住地流了下来……

这个爷爷是多么好啊，他不想让一个男孩的自尊心受到伤害!他用自己的手指，维护了男孩的自尊心。他虽然撒了两次谎，但那是爱的谎言!

我也有一些相似的经历。从会写字开始，我的握笔姿势就不对，所以写字慢。小朋友们一见，都有些奇怪。我觉得他们用一种异样的眼光在看我，我很伤心。回家向妈妈倾诉，妈妈听了，告诉我写的慢并不代表字不漂亮，姿势不对是可以改正的。打那以后，每次书写工整几乎都有我，小朋友们再也不那样对待我了。上小学后，妈妈也开始要求我自觉地去改正握笔姿势。现在，我写得越来越快了!

《沉睡的大拇指》读后感 篇4

在美国，一个普通的家庭，一个小男孩了。父母也为他起好了名字――小亮。可是，在小亮右手小拇指的旁边，却长出了第六指。医生说，得等到小亮七岁时，才能做切除第六指的手术。

小亮上幼儿园时，其他小朋友看见小亮比其他们多了一个手指，都来嘲笑他。小亮回家问爷爷：“爷爷，我为什么跟你们不一样啊?幼儿园里的小朋友都说我是怪物。”爷爷听了，悄悄背过身，把自己右手大拇指压在掌心，然后转过来，对小亮说：“小亮，你不是怪物，你多出来的手指是为爷爷长的呀!不信，你看。”爷爷把自己右手和小亮的右手合起来：不多不少，刚好十个手指。小亮很高兴，因为他认为自己能为爷爷长一个手指是一种光荣。第二天，他跟幼儿园的小朋友讲了这件事。从此，大家再也不嘲笑他，反而很崇拜他。

等到小亮七岁时，他却不愿意切除第六个小指头了：“我不要切除小指头，这是爷爷的手指，除非爷爷的大拇指能醒来。”于是，爷爷便把自己的右手缠上纱布，跟小亮说自己的大拇指动了手术，很快就能醒来。小亮开心地去做了手术。可是，爷爷的大拇指却再也伸不直了……

大拇指的读后感200字 篇5

不管遇到了什么事情都很冷静的去想，去思考，所以，什么事都难不倒他。

我觉得，我们应该向要向大拇指学习。不管在遇到什么困难时，都应该冷静的去思考，这样，才能解决问题，克服一切困难。在已发生的火灾中，有很多在火灾中不幸遇难的人员中，有很多人并不是被大火烧死的，而是没有选择正确的逃生方法，有的是跳楼而造成的死伤，有的是窒息而死亡的......

因此，我们做事一定要像大拇指那样沉着冷静，这样，才能作出正确选择。

乌鸦的拇指 篇6

1 资料与方法

1.1 一般资料

本组15 例, 男11 例, 女4 例;年龄20～50 岁, 平均35.2 岁。压砸伤7 例, 热压伤3 例, 切割伤3 例, 撕脱伤2 例;远节指背软组织缺损5 例, 远、中节指背软组织缺损2 例, 指端软组织缺损2 例, 指腹软组织缺损6 例;缺损面积1.5 cm×2.0 cm～2.5 cm×4.0 cm。

1.2 手术方法

臂丛神经阻滞麻醉, 上臂上气囊止血带止血, 压力250 mm Hg, 消毒铺单, 创面清创, 据创面形状、大小设计并掀取皮瓣。

1.2.1 拇指尺背侧皮瓣[1]

a) 旋转点。最远可至指间关节尺侧;b) 轴心线。作拇指指间关节和掌指关节背侧中点的连线, 在第1掌骨头尺侧、距中点连线约1 cm处, 以及指间关节尺侧、距中点连线约0.7 cm处做标记, 二者的连线即为拇指尺背侧动脉 (与指背皮神经伴行) 走行的体表投影, 也就是皮瓣的轴心线, 实际是以指背皮神经为轴线设计;c) 皮瓣位置。据创面形状、大小及创面近端与旋转点的距离, 在拇指掌骨或掌指关节尺背侧设计皮瓣;d) 解剖平面。位于伸肌腱膜浅面;e) 步骤。先沿皮瓣轮廓线切开, 于两侧略加分离, 向下切开皮下组织达伸肌腱膜浅面, 确认拇指尺背侧动脉走行线, 以及有皮支进入皮瓣蒂, 然后于皮瓣近端找到指背皮神经[2], 切断指背皮神经及血管, 沿指背皮神经走行向远侧游离, 连带神经血管蒂两侧0.5 cm的皮下组织, 即蒂宽1 cm, 直至旋转点, 将指背皮神经包含在皮瓣内, 纵行切开皮瓣远端与创面近端之间的皮肤, 将皮瓣翻转到拇指远端, 覆盖创面, 指背神经与指固有神经的分支端端吻合。供区直接缝合或移植皮片覆盖。

1.2.2 拇指桡背侧皮瓣[1]

a) 旋转点。最远可至指间关节桡侧;b) 轴心线。拇指腕掌关节桡侧与指间关节桡侧的连线。c) 皮瓣位置。第1掌骨头桡背侧;d) 解剖平面同尺背侧皮瓣;e) 步骤。同尺背侧皮瓣, 只是所用血管为拇指桡背侧动脉 (见图1～4) 。

尺背侧皮瓣移位9 例, 桡背侧皮瓣移位6 例, 皮瓣切取面积1.5 cm×2.0 cm～2.5 cm×4.0 cm。指背神经与指固有神经的分支端端吻合。

2 结果

术后15 例皮瓣全部存活, 其中2 例术中出现短暂缺血, 拆除缝线、重新调整皮瓣张力后恢复血运。

术后随访6～12个月, 平均8个月。皮瓣外形饱满, 弹性好, 两点分辨觉为5～9 mm, 平均6 mm。拇指指间关节活动正常, 供区无瘢痕挛缩、肌健黏连等并发症。

3 讨论

手拇指软组织缺损, 一致拇指外观形变, 二致感觉功能障碍, 需要积极的治疗, 闭合创面、减少外观残缺、恢复感觉功能。在众多的治疗方法当中, 皮瓣移植或移位则是首选的治疗方法。其中, 最有应用价值的当属拇指尺背侧、桡背侧皮瓣, 操作简单、供区损伤小、拇指外观及感觉功能恢复好。我们的临床应用结果证实了这一点。

拇指尺背侧、桡背侧皮瓣移位, 尽管操作简单, 但还是需要注意以下方面:a) 保护筋膜瓣中的血管。在指背神经周围5 mm左右的范围内[1], 均有丰富的皮神经营养血管 (丛) , 或称指背皮神经营养血管束, 并在不同的平面接受多个神经营养交通吻合血管的加入。拇指尺背侧动脉及指背动脉为皮神经营养血管, 管径较细, 尤其是至皮瓣的皮支, 切开皮下组织后应先显露指背神经, 但不要游离, 于皮瓣近端切断, 然后再向远侧游离, 连同神经两侧0.5 cm宽的软组织及皮肤, 将指背皮神经包含在皮瓣内, 以减少损伤血管的可能性。b) 避免皮瓣张力过大。具体的方法是: (a) 止血彻底, 以免因出血而增加皮瓣张力, 影响其血液循环; (b) 皮瓣形似水滴状, 蒂部也有皮肤覆盖, 在皮瓣翻向远侧后与周围皮肤缝合, 避免经过皮下隧道时压迫皮瓣蒂, 引发静脉回流障碍;c) 皮瓣缝合要张力均衡且少带皮下组织, 以免缝合过紧致皮瓣障碍;d) 敷料包裹压力适中;e) 术后石膏托外固定, 减少因手指活动时血供障碍影响皮瓣血供。 (c) 常规应用抗炎及改善微循环的药物, 避免低温和受冻, 防止血管痉挛。 (d) 常规观察手指皮瓣的血运, 若手指苍白, 则及时手术减压。

参考文献

[1]侯春林, 顾玉东.皮瓣外科学[M].上海:上海科学技术出版社, 2006:540-541.

大拇指班的妈妈-六年级作文 篇7

我有两个爱我的妈妈，大家是不是觉得奇怪?怎麽会有两个妈妈呢?是这样的，在家，有一个照顾我生活的妈妈，在学校，有一位教我知识的“妈妈”，她就是我的班主任王老师。

其实，这是我心里的一个小秘密，从王老师给我们上的`第一节课开始，我就把她也当成了妈妈。

记得刚刚升入小学的第一天，妈妈把我送进校门就回家了，我紧张地走进教室，就看到王老师站在讲台上忙碌着，紧接着，该点名了，念到我的名字的时候，王老师笑着说：“曹元科，你这个名字真好，预示着你将来要当状元!你一定要好好学习啊!”听到这句话，刚刚还在我心里砰砰直跳的小兔子一下子就消失了，我开心极了!原来老师也像妈妈一样和蔼可亲啊!

我喜欢王老师，是她纠正了我很多的坏习惯，让我健康的成长。

记得有一次，学校要求家长在一封安全责任书上签字，然后第二天带回学校，结果我回家后就忘记了，第二天，同学们都交给了老师，班长查完数以后，发现少了一张，但我担心老师批评，就没有承认是我没交，我想：好在我平时学习好老师一定会给我面子不当众批评我的。最后，王老师通过一个个点名，查出了是我没交，她很生气地说：“我们班不缺学习好的学生，就缺诚实的学生，你要承认错误，做一个诚实的好孩子!”我知道自己错了，赶紧向老师和同学们承认了错误，决心以后一定要做一名诚实的小学生。从那以后，我就更加崇拜王老师了，她是一个正直、和蔼的好“妈妈”。

大拇指定律 篇8

“大拇指定律”最初产生于经济领域，一般用来阐述风险投资收益的一个普遍现象。创业路上艰难坎坷，长路漫漫，一个企业的命运就像在海上行船，就像迷路在十字路口充满了不确定性：

——产品没特色，被市场淘汰 ——质量不过关，被消费者淘汰

——安于现状，不思进取，被竞争对手淘汰 ——前景不明朗，被投资者淘汰

——缺乏先进管理体系，被资本市场淘汰 ——没有远景规划，被经济发展的趋势淘汰

只有战胜了重重困难，自如应对市场的变化多端，才能在激烈的竞争中站稳脚跟，获得创业梦想的成功；只有高瞻远瞩，步步为营，才能在众多的胜出者中脱颖而出，成为卓尔不群的明星企业和业界的领头羊。不仅在风险投资领域有着这样一条定律，其实在生活中，我们同样面临着许多不确定性，同样面临多种多样的选择。走对了一步，是为了今后前进的方向奠定基础；而走错了一步，往往会前功尽弃，功亏一篑。人生之初，我们的起点都是一样的，而多年之后，之所以有人默默无闻，有人功成名就，有人脱颖而出，是“大拇指定律”在起作用。

做人也像做企业一样，只有战胜困难才能避免被淘汰，只有精益求精才能避免被落下，只有高瞻远瞩才能取得卓越非凡的成就。失败的人和企业都是一样的失败，成功的人和企业却分成很多的层次。你是否是金字塔上最高的尖顶？是否是夜空中最耀眼的明星？五指连心，大拇指却只有一个！只有不断进取，卓尔不群，才能永远站在顶峰。

如果你不够强大，那么就只能依靠更拼命，更迅速，更勇猛来赢得长足的进展。不做第一，就注定被埋没。只有奋起直追，勇往直前，才能缔造一个个商业帝国。

今天学了“大拇指定律”，使我更加坚定生活的信念：为自己竖起大拇指！

提到大拇指，我们就会联想到那些功名显赫、自己很崇拜的人物。的确，众所周知，大拇指是为别人竖起的。但是，我想说的是，它不仅仅可以为别人竖起，同样也可以为自己竖起。

生活之路上不免有太多的挑战、太多的坎坷、太多的考验。当你在面临这些绊脚石面前，你可曾感到举步维艰过？哲人告诉我们“苦难是人生最好的大学。”既然，他们都这么认为，由此可见，如果你同苦难作斗争，一定会给你带来更多人生的财富。那么，你还害怕什么？为自己竖起大拇指，拿出你的信心，相信苦难是奠基你美好人生的基石，勇敢地去拼搏，相信你一定会干得很漂亮的，相信阻挡你前进的一切终究会变成你人生路上的垫脚石。

为别人竖起大拇指是发自肺腑由衷的敬佩，为自己竖起大拇指则是一股强大的动力，能驱动着你；是一条有力的鞭子，能鞭策着你；是一个足劲的肋推器，能推动着你。为自己竖起大拇指其实就是一种赞扬，是一种鼓励。准确来说，它是人类的“加油站”，当我们碰到困难的时候，它会在我们身边说：“加油”！

在现实生活中，也有类似的例子，如：毛泽东、宋庆龄、温家宝、许地山等一些有气节的人物。他们在人生的旅途中不管受到怎样的欺凌，不管遇到多少磨难，从来都是顶天立地，勇敢地面对。这是为什么？因为他们都有着一颗坚强的心和勇于面对困难的意志，再加上他们也曾为自己竖立过大拇指，鼓励自己，所以才有今日的成功。

乌鸦的拇指 篇9

1 资料和方法

1.1 一般资料

本组9 例, 男7 例, 女2 例;年龄18～25 岁, 平均20 岁。机器绞扎伤4 例, 挤压伤3 例, 砸伤2 例。其中拇指Ⅲ度缺损2 例, 拇指Ⅳ度缺损2 例, 拇指皮肤撕脱伤3 例, 其中1 例合并虎口及掌背桡侧皮肤坏死, 拇指再植术后坏死2 例。亚急诊再造5 例, 择期再造4 例, 带足背皮瓣的足母趾甲皮瓣移植5 例, 足母趾甲皮瓣移植4 例。

1.2 手术方法

手术在臂丛阻滞及硬膜外麻醉下进行。根据受区设计带或不带足背皮瓣的足母趾甲皮瓣移植。按常规切取足母趾甲皮瓣, 皮瓣不带趾骨末节, 保留足母趾趾骨的完整。本组第一跖骨背动脉属GilbertⅠ型2 例, GilbertⅡ型6 例, Gilbert Ⅲ型1 例。对拇指缺损的病例取适当长度的髂骨作为骨支架, 再造拇指仍以其原有的肌腱作为动力, 将皮瓣断蒂后移植再造拇指。其余病例均直接将皮瓣移植于手部包裹拇指创面再造拇指, 吻合血管、神经和肌腱。供区行中厚皮肤移植覆盖, 局部使用甲壳胺人工皮膜, 以促进创面愈合。

2 结果

9 例再造拇指全部成活, 经随访1～6年, 再造拇指外形美观, 对指活动灵活, 再造拇指抓、握、捏有力, 两点辨别觉8～12 mm, 患者对再造拇指均满意。供区足母甲皮瓣切取后植皮大部分成活, 部分病例遗留创面经甲壳胺人工皮膜局部使用后愈合。足母趾均保留了全长, 无供区破溃及疼痛病例, 术后对供足的站立行走及负重功能无明显影响。典型病例图片见图1～4。

3 讨论

外形与功能并重, 按照“缺多少, 补多少”的原则进行修复。1980年Morrison[1]首次采用足母趾甲皮瓣再造拇指以来, 该方法已广泛应用于临床。足母甲瓣移植再造拇指外形美观、功能良好, 且供足足趾数目不减少, 是理想的拇指再造方法。本组均为18～25 岁的患者, 对再造拇指的外形要求高。因此, 术前需精确测量健侧拇指长度与周径, 对供足准确设计, 术中精细操作, 以达到再造拇指外形美观的要求。本组9 例再造拇指外形逼真, 患者均满意。

重视供区的处理。本组9 例均未咬除末节远端趾骨, 保留了供足足母趾趾骨的完整性, 经植皮后获得了良好的外形, 对供足功能影响小, 更符合“受区修复重建好, 供区破坏损伤小”的组织移植原则。以足母趾为供区切取游离组织瓣后若处理不当, 可能造成供区创面长期不愈合, 尤其容易发生在足母趾甲皮瓣切取后供区创面植皮失败[2]。传统方法是去除末节趾骨, 将保留的胫侧皮瓣覆盖趾骨外露骨面后再取全厚皮片移植, 这样可使植皮片一期成活而减少足部瘢痕, 从而减少疼痛, 改善患者行走功能[3]。但这样足母趾末节缺损, 外形及功能受到一定影响, 不易被患者接受。王东等[4]采用第二跖背动脉逆行岛状皮瓣修复足母趾甲瓣切除后的创面, 该术式增加了手术操作步骤, 而且在切取带足背皮瓣的足母趾甲皮瓣时受到一定限制。亦有报道采用第二足趾皮肤覆盖修复足母趾甲皮瓣切取后遗留的创面, 这样损伤了一个足趾, 又丧失一个足趾, 对供足影响较大, 也不易被患者接受。我们的体会是, 术中应保留适当宽度的足母趾胫侧舌状瓣, 保留足母趾趾骨全长, 仔细解剖分离甲床, 在甲床与骨膜之间解剖游离, 做到既不能损伤甲床, 也不能破坏骨膜, 这样才能保证术后供区植皮的成活和再造指甲的生长。供区采用中厚皮肤移植修复, 本组术后供区植皮大部分成活, 对供足植皮后残留部分创面的病例, 应用甲壳胺人工皮膜覆盖创面, 以促进创面愈合, 常规换药, 1周更换1次皮膜, 经更换2～4次后, 创面均良好愈合。不带趾骨的游离足母趾甲皮瓣移植再造拇指外形逼真, 功能恢复好, 疗程短, 术后供区无疼痛及破溃病例, 保留了供区趾骨及长度, 对供区外形及功能影响小, 患者易接受, 是治疗拇指皮肤撕脱伤、Ⅲ～Ⅳ度拇指缺损及再植术后拇指坏死补救的理想手术方法。

参考文献

[1]Morrison WA, O′Brien BM, Macleod AM.Thumb re-construction with a free neurovascular wrap-around flap from the big toe[J].J Hand Surg, 1980, 5 (7) :573-583.

[2]朱盛修, 张伯勋, 卢世璧, 等.趾甲皮瓣切取后存留趾端胫侧皮肤和创面植皮坏死原因探讨[J].显微医学杂志, 1985, 8 (4) :207-208.

[3]成红兵, 潘丞中, 侍德.游离趾甲皮瓣再造拇指的远期疗效[J].中华显微外科杂志, 1998, 21 (2) :105-108.

拇指姑娘作文 篇10

夜里，一只老癞蛤蟆把她背走了。他想要拇指姑娘做他的儿媳。癞蛤蟆把拇指姑娘放在荷叶上。拇指姑娘醒来后赶紧划着花瓣船逃走了。

一只好心的金龟子把拇指姑娘带到树林里，可是金龟子小姐们都不喜欢她。金龟子也离开了她，整个夏天，可怜的拇指姑娘一个人孤零零地生活在森里。

冬天来了拇指姑娘又冷又饿。她来到了一只田鼠的家门口，田鼠收留了她。就这样，拇指姑娘和田鼠生活在一起，拇指姑娘每天帮田鼠做一些家务。

一天，邻居鼹鼠先生来田鼠家做客，他喜欢上了拇指姑娘，就挖了条地道供她散步。

夜里，拇指姑娘在地道里散步时，发现了一只被冻得奄奄一息的燕子，就把棉被裹在他身上。在拇指姑娘的照料下，燕子一天天好了起来。后来，鼹鼠先生向拇指姑娘求婚了。

《拇指姑娘》读书心得 篇11

过了一个月女巫和癞蛤蟆占领了，拇子姑娘和王子被关了起来，他们的女儿被吊在水里惨不忍睹啊。

一年又一年过去了，一天门卫不注意，让他们跑了女巫知道后就派人去追杀。他们回到了家里，可是女巫知道会这样所以派人在他们家埋伏好了，没办法只好有逃了。

有一次。猎人注意了他们说：“你们一看就是落难的人了。”他们一五一十地告诉猎人。猎人答应了。

一个月后，他们和猎人回到了祖国用了很短的时间就把那夺了回来。女巫也受到了同样的后果。

乌鸦的拇指 篇12

This poem describes two figures, one is a sorrowful man who lost his love Lenore, and the other is the raven, which is the symbol of death and ominous.In a midnight, the young man is missing his beloved Lenore in the narrow and isolated chamber, which is the love nest of the two love birds.The raven flies to the chamber, arousing the deep grief of the young man.All the poem expresses the deep grief and sad.

1 Aestheticism in The Raven

Edgar Allan Poe puts forward that the purpose of poetry is creating beauty.Extraordinary beauty is the proper way to entertainment, which means the hamony of the different element in the poem, such as the rhyme and emotion, in order to create the unique aesthetic feelings.

Poe’s poetry is the monologue of his heart, and beauty is the soul of the poetry.Poe does not limit to one special as rhythmic beauty, melancholy beauty, and visual and auditory sense when he capture the inspiration of poetry.He embodies the pure beauty through a realistic and extrasensory subjective thinking process with full heart.

Poe’s conception on the beaty is different with other writers, and his illiberal aesthetic is very different among the American writers in that times.Poe’s poems are the reflection of himself.He thinks that poems should touch the hearts of the readers, and the beauty is the ultimate aim.In his essay The philosophy od Composition, Poe Prompts the idea of“death of beaty”.He declares that the death of a beautiful woman is the most poetical topic in the world.Poe has emploied this theme in many of his works, including both poems and stories.

Edgar Allen Poe advocates beauty, and he points out that the purpose of the poem is reappearance of beauty.There is a summary on the theme of Poe’s poem in A Survey of American Literature.

The poem should be short, readable at one sitting.Its chief aim is beauty, which for him means two things:a.an art work is a created beauty (form;“The Poetic Principle”) ;b.the poetry should write about beauty (content) .Beauty aims at“an elevating excitement of the soul, ”and“beauty of whatever kind, in its supreme development, invariably excites the sensitive soul to tears.Thus melancholy is the most legitimate of all the poetic tones”and“the death of a beautiful woman is, unquestionably, the most poetical topic in the world. (常耀信149)

So Edgar Allen Poe's poems are mostly about death.Death is an eternal theme.There are always a beautiful women in his poems, and these beautiful angels always end with the same fatalistic destiny—die, which is actually the extreme of romanticism and aestheticism.Edgar Allen Poe thinks that the reality is brutal and ugly after he feels the strong conflict between ideal and reality.He faces the life and express his emotional society on his unique perspective.In his poems, beauty are always with death, and happy and fear show by turns.Melancholy and death are expressed in his particular ways.Lenore in The Raven, who is a beautiful girl and love of the poet, dies in her young age.The poet shows his maximum melancholy, and expresses his grief and despair, which embodies the poet’s dark psychology, deep loneliness and the loss of self.This kind of poems inspires the modernist writers, especially the symbolic writers.

Edgar Allen Poe lives in this world for only forty years.He was suffered a lot and ill-fated in addition to the happy time in his childhood and youth when he was living in his foster parents’house.His life experience lead to his unique character.In November, 1845, The Raven was published, Poe said in the preface of poem, "for me, the poem is not a purpose, but a excitement.The kind of excitement should be respected."As in The Poetic Principle,

I need scarcely observe that a poem deserves its title only in as much as it excites, by elevating the soul.The value of the poem is in the ratio of this elevating excitement.But all excitement which would entitle a poem to be so called at all, can not be sustained throughout a composition of any great length.After the lapse of half an hour, at the very utmost, it flags-fails-a revulsion ensues-and then the poem is, in effect, and in fact, no longer such. (Poe 1460)

Poe creats his works with the excitement, and most of his works are about beauty, which fit the his aestheticism.

The raven embodies Poe's creating thoughts and skills.Poe says in The Poetic Principle, “Dividing the world of mind into its three most immediately obvious distinctions, we have the Pure Intellect, Taste, and the Moral Sence” (1463) .Poetry is the creation of the beauty.This poem also reflects Poe’s view of life and the eternal theme in his heart:the beauty and disillusionment of it, the terror of death, melancholic choke and the suspicion to the strange things.His fate reminds people of the lonely black bird in The Raven, who is always singing“nevermore”.

2 Gothic in The Raven

Edgar Allen Poe's another best known theme is Gothic, a genre he followed to appease the public taste.Gothic is his most recurring theme deal with questions of death, including the physical signs, the effects of decomposition, concerns of premature butal, the reanimation of the dead, and mouring.

2.1 Characterization

There are two main images in The Raven, which are the raven and the young man.The man has just lost his beloved girl Lenore, so he indulges in the books trying to forget his love.Obviously, this way does not relieve his pain, the more he reads, the heavier his pain and loneliness become.One night, a raven comes the chamber which belongs to him and his beloved Lenore when he is pondering in the room.The raven is the ominous symbol of death.

This poem also creates some important artistic conceptions, which are contributing for the sublimation of the theme.One of the artistic conceptions is the black.Black is a kind of pure color, and pure color is a kind of emotional colors which can make the person strongly feel happy or sad, so that the young man in the poem has a strong fear and sadness.

In The Raven, the word“nevermore”appears again and again, because this word has a wealth of symbolic meanings in the poem, for example when the raven appears, the man asks the name of raven, “nevermore”is the raven’s answer to the man.

Then this ebony bird beguiling my sad fancy into smiling.

By the grave and stern decorum of the countenance it wore.

“Though thy crest be shorn and shaven, thou, ”I said, “art sure no craven,

Ghastly grim and ancient raven wandering from the Nightly shore-

Tell me what thy lordly name is on the Night’s Plutonian shore!”

Quoth the raven, “Nevermore.”

However, the raven always answer with the word“nevermore”, when the young man asks the prophet about the nepenthe which can effectively reduce his miss for Lenore, and whether they will meet in the heaven at last, and when he asks the raven to leave the chamber.It is precisely because of this word“nevermore”, the man gets stuck in the abyss of pain.

2.2 Scene

Edgar Allen Poe portrays a very sad setting in the beginning of the poem.In the midnight, there are the evil wind making people feel creepy and chilling, the mysterious young man and a raven.It’s deadly quiet all around in addition to the sound of the bleak wind and the man’s page turning.The black of the midnight spreads around the whole world, but the small world in the room is flicking under the reflection of the lights.All of a sudden, there is a quick tapping on the door of the chamber, but when he gets up and opens the door, nothing more outside except the endless night and howling wind in his sight.Then he closes the door, turns around into the room, the tapping sounds again outside the chamber, a raven flies in and lands in his door at this time.

But, why does the author set the background of the poem in the midnight?In general, the midnight has a kind of horrific and mysterious color, which is the appearing time for the ghosts and spirits in many novels and movies, and this kind of creepy depressive scene lays the foundation for the appearance of the raven.And the poet deliberately set the story in a narrow and lonely chamber.First of all, this kind of scenario and the mysterious atmosphere has an important helping role for build the atmosphere of the gothic horror.Secondly, the chamber used to be the love nest of the couple, but with the death of the heroine, all the previous happiness and good memories disappear, only a man stays in the empty nest memorizing his beloved, which is a very sad scene.The author sets this scene for resonating the readers to the greatest extent.

2.3 The setup of the answers

“Nevermore”is always the raven’s answer to the man, although the answers are same every time, but for the hero, every answer can let him have a different feeling.The man finally realizes that the raven’s answer“nevermore”for him is a negative one when the raven always answers his questions with the same word, but the man still insists on asking the raven all sorts of questions and hopes the raven can bring satisfying answer for him one day.However, the raven replies the only answer for all the questions forever, which makes the hero suffering more severe setback psychologically.The author meticulously designs the questions from first to last one, which are from weak to strong progressively, so the more the readers read, the more strange they feel.At the same time, the man proposed these problems to help the readers know more about the hero's psychological changes, and the gothic charm gets to bloom with more and more horrific emotion.The author expresses the gothic theme mainly in the mentioned three aspects.

3 Writing Technique in The Raven

Edgar Allen Poe has used many writing techniques to show the beauty of The Raven.He uses symbolism to describe the poem vividly.And he also uses some other ways, for example alliteration, to express the rhythmic beauty.

3.1 Symbolism

Symbolism is a kind of figurative means, which means the use of symbols to represent ideas, especially in art and literature.Symbolism is very important in The Raven.Because of the sad atmosphere of the poem and the traditional ominous meaning of the raven, Edgar Allen Poe chooses it to make a sound of“nevermore”to create the effect.For the raven’s symbolic meaning, different readers have different opinions.But the raven is usually seen as a messenger delivering the narrator's sadness and hopelessness, or directly representing the narrator’s despair and grief.

For the poet, he seems to incline to another explanation.The raven symbolizes the death itself instead of the narrator's self-imposed torture.Although the author experiences a long time of loneliness after the death of his beloved, he still wants to meet with Lenore.However, the raven gives him a desperate answer“nevermore”as a symbol of death, which makes him realize the fact that Lenore has died and the remaining is only the painful memories.For example, the readers can find clues in the sentence in The Raven.

Though thy crest be shorn and shaven, thou, ”I said, “art sure no craven.

Ghastly grim and ancient raven wandering from the Nightly shore-

Tell me what thy lordly name is on the Night’s Plutonian shore! (Poe 1370)

In Greek mythology, Pluto is god of death and the ruler of the underground world.The readers can understand the relationship between the raven and death.Many people think that the raven is a product of the narrator’s own fantasy or his crazy anthropomorphic performance.The reader may tend to think that a kind of external forces shattered the narrator's illusion.

Another important symbol in the Poem is the statue of Pallas.In Greek mythology, Pallas is Athena who is the daughter of the Lord god Jupiter who is the goddess of wisdom.One possible reason for the raven staying on the status of Pallas is that the raven is wise, and it does not do a monotonous repetition.At the same time, the statue and the raven have formed a huge contrast:one is black and the other is white, one is moving and the other is static, as the contrast between the stormy night with the quiet room, or the contrast between intelligence and death, which also highlights the narrator's despair and depressing atmosphere, and emphasizing the artistic tension.

There are other symbols in the poem, such as midnight and December which give a person a kind of feeling of end and beginning, and also many similar examples.Edgar Allan Poe puts:The creation of beauty should be indirect;the poem should bring the readers other things besides the literary meaning through symbolism and word choosing from the assembly and sound of the words.

3.2 The rhyme

Edgar Allen Poe is good at using alliterate and the internal rhyme in The Raven, which enhances the artistic expression of poetry and rhythmic beauty.For example in twelve stanza.

But the raven still beguiling all my fancy into smiling.

Straight I wheeled a cushioned seat in front of bird and bust and door;

Then, upon the velvet sinking, I betook myself to linking

Fancy unto fancy, thinking what this ominous bird of yore.

What this grim, ungainly, ghastly, gaunt, and ominous bird of yore-

Meant in croaking“Nevermore. (Poe 1371)

The word“grim”, “ghastly”and“gaunt”in the sentence“What this grim, ungainly, ghastly, gaunt, and ominous bird of yore-”is the typical example of alliteration.And in the very first sentence of the poem, “Once upon a midnight dreary, while I pondered weak and weary”, “weak”and“weary”form the internal rhyme to emphasize the beauty of rhyme.

And the“nevermore”has been used eleven times in the poem to express the sad, painful and depressed tones, which has been chosen because the long vowel“o”and“r”constitute the deep long sound, giving the feeling of gloom and melancholy, highlighting the theme of death.

4 Conclusion

The Raven is the representative poetry of Edgar Allen Poe, which has shows the aesthetic and gothic theme of the author.The aestheticism mostly focuses on the death of beauty, which is the enternal beauty in the world on Poe’s perspective.And the gothic mainly embodies in the background, such as the time and place of the poem.The beauty shows not only in the theme of aestheticism, but also in the rhyme.Poe uses sounds of the English words to create the alliteration, in order to increasing the readability of the poem.

Poe has maken every effort to create a good poem.The Raven is the products of his hard work, which has brought the fame to Poe and laid the foundation of his literary status.Poe’s works also have great influence many writers in the world.In a word, Edgar Allen Poe is not only the great master in the history of American literature, but also in the whole English literary history, and even in the literary history of the world.

摘要：《乌鸦》是埃德加·艾伦·坡的著名诗篇, 爱伦坡以他独特的视角创作了这一首诗。这首诗通过“美女之死”表现了美的极致, 体现了作者与众不同的审美。哥特式是这首诗的另一主题, 主要表现在诗歌的背景和形象中。《乌鸦》的魅力还体现在朗朗上口的诗句上, 诗人运用多种修辞方法使这首诗歌简单易读。埃德加·艾伦·坡的种种努力促成了这首诗的成功。