甲皮瓣供区创面的处理

目的　探讨提高口止母甲皮瓣供瓣区植皮成活的治疗措施。方法　 1982年 6月～ 1998年 4月对 2 5 2例带趾骨片口止母甲皮瓣 ,18例单纯口止母甲皮瓣供区创面采用游离皮片覆盖 ,植皮区适当加压包扎处理。术后 2周拆线 ,对较厚的移植皮片或皮片未完全成活的则需延长包扎时间 ,避免过早下床行走。结果　共有 6 6例植皮坏死 ,其中38例需再次植皮 ,2 8例经换药愈合。在纵劈口止母趾骨髓腔面上植皮比在裸露骨膜上植皮的成活率明显提高。术后皮片的收缩使口止母趾跖内侧保留皮肤组织向跖外侧扩展 ,能覆盖整个口止母趾跖侧面。结论　采用改进口止母甲皮瓣的剥取、注意皮片切取及植皮区包扎等治疗措施后 ,提高了供足植皮的成活率。游离皮片移植应作为口止母甲皮瓣供瓣区创面修复的理想选择。     

Mu甲皮瓣供区创面的处理

目的 探讨提高Mu甲皮瓣供瓣区植皮成活的治疗措施。方法 1982年6月-1998年4月对252例带趾骨片Mu甲皮瓣,18例单纯Mu甲皮瓣供区创面采用游离皮片覆盖,植皮区适当加压包扎处理,术后2周拆线,对较厚的移植皮片或皮片未完全成活的则需延长包扎时间,避免过早下床行走,结果 共有66例植皮坏死,其中38例需再次植皮,28例经换药愈合,在纵劈Mu趾骨髓腔面上植皮比在裸露骨膜上植皮的成活率明显提高,术后皮片的收缩使Mu趾跖内侧保留皮肤组织向跖外侧扩展,能覆盖整个Mu趾跖侧面,结论 采用改进Mu甲皮瓣的剥取、注意皮片切取及植皮区包扎等治疗措施后,提高了供足植皮的成活率,游离皮片移植应作为Mu甲皮瓣供瓣区创面修复的理想选择。     

植皮术中透明气囊加压的实验研究

针对传统植皮手术的包扎法不能监测皮片压力和成活情况的弊端,作者设计了一种透明气囊加压法。具有压力均匀相对恒定,可直视监测皮片成活过程便于及时发现处理并发症的优点。经动物实验证实其对皮片成活率及皮面细菌污染率与传统敷料包扎无显著性差异。     

踇甲皮瓣供区植皮坏死的原因

目的 :探讨甲皮瓣供区植皮坏死的原因及防治措施。方法 :对 2 70例 (2 80侧 )用甲皮瓣修复的手指缺失患者 ,皮瓣剥离时保留甲床骨膜及伸趾腱周围系膜 ,骨髓腔创面在 1cm× 1cm之内 ,供皮瓣区用中厚皮片游离植皮 ,术区适当包扎固定。结果 :66侧趾供皮瓣区植皮有不同程度坏死 ,坏死率 2 3 .6 %。其中甲床植皮坏死 2 2侧 ,趾腓侧区坏死 7侧 ,第Ⅰ趾蹼区坏死 7侧 ,伸肌腱背侧坏死 6侧。有 1 5侧因切取皮片过厚致大腿供皮区创面愈合缓慢 ,1 1侧因包扎不当皮下积血。有 33侧再植皮伤口痊愈 (占 50 % )。结论 :甲皮瓣供区植皮坏死与植皮部位 ,皮片厚度 ,包扎方法及皮瓣剥离厚度有关     

动植皮机在游离皮片移植中的应用

目的:探讨气动植皮机在自体游离皮片移植中的临床应用效果.方法:应用气动植皮机取皮120例,其中中厚皮片82例,刃厚皮片38例.记录取皮用时、皮片大小、厚薄均匀和边缘整齐程度、植皮成活率、供皮区愈合时间及愈合情况.结果:采用气动植皮机取皮操作时间为6～15min,平均9min.所取皮片边缘整齐,厚薄均匀,最大皮片达10.2cm×18cm.皮片移植成活率92％～100％,供皮区愈合时间5～7天,均一期愈合.结论:使用气动植皮机取皮具有手术时间短、所取皮片宽度可调、厚度均匀、边缘整齐、供皮区愈合好、愈合时间短等优点,是一种简单有效的取皮方法.     

应用UW液储存待植皮片的改良储皮法——皮片的储存

目的 营养液可延长移植物的存储时间.本文将探讨应用Wisconsin大学保存液(UW液)灌注组织(皮瓣),使其耐受缺血,以延长皮片保存时间和提高延期移植的成活率.方法 设计小鼠模型,评估待植断层皮片及全厚皮片在普通生理盐水、UW液和Roswell Park Memorial Institute(RPMI)-1640培养基中的活力.将取下的皮片在4℃下分别储存1,2,4,7,10 d,然后回植并分别测定其成活百分率.结果 在储存期内,保存在UW液中的断层皮片与在生理盐水和RPMI-1640中的相比,植皮效果明显改善;而3种液体保存的全厚皮片无明显差异.结论 选用UW液储存断层皮片进行异体植皮或延期植皮可延长储皮时间,并可在保质期内明显改善植皮效果.本研究发现,更厚的皮片厚度会限制保存液的渗透力,从而限制储存全厚皮片的能力.     

负压封闭引流与常规敷料加压包扎治疗大面积皮肤撕脱伤的疗效对比研究

目的探讨负压封闭引流技术治疗大面积皮肤撕脱伤的临床疗效。方法对本院2007年3月—2010年8月采用原位全厚皮片回植方法治疗的62例大面积皮肤撕脱伤病例进行回顾性研究,其中多聚乙烯醇明胶海绵覆盖回植皮片、持续负压封闭吸引（负压引流组）35例,传统敷料加压包扎覆盖回植皮片（敷料加压组）27例。观察两组术后皮片成活情况、创面感染率和创面愈合效果,记录平均住院时间。结果负压引流组中有31例回植全厚皮片全部成活,皮片成活率88.6%,余4例皮片存活面积〉95%,;2例遗留创面感染,感染率5.7%;平均住院时间（12.3±5.4）d。敷料加压组全部成活18例,皮片成活率66.7%,余9例皮片成活面积〉75%;6例遗留创面感染,感染率22.2%;平均住院时间（19.7±8.3）d。对两组皮片成活率、创面感染率和平均住院时间进行比较,差异均有统计学意义（P〈0.05）。两组经换药或二次手术植皮后,撕脱创面均愈合。结论与常规敷料加压包扎技术比较,封闭负压引流技术可提高大面积皮肤撕脱伤创面植皮的成活率,降低感染率,缩短住院天数,是治疗大面积皮肤撕脱伤较为理想的方法。     

持续负压引流系统在游离植皮术中的应用

目的比较应用持续负压引流系统与常规加压包扎植皮术的临床效果。方法 2018年3月～2018年9月急慢性创面并且需要进行植皮手术治疗的病人98例,根据术中皮片包扎方式的不同分为对照组和观察组,每组各49例。对照组采用游离植皮+常规加压包扎术治疗,观察组采用游离植皮+持续负压引流系统进行治疗。比较两组病人手术优良率、满意度、手术时间、伤口愈合时间等手术相关指标及血肿、感染、皮片不成活等术后并发症发生率。结果对照组手术结果优30例、良5例、可7例、差7例;观察组手术结果优41例、良6例、可1例、差1例。观察组病人手术优良率及满意度分别为95.92%和97.96%,对照组分别为71.43%和73.46%,两组比较差异有统计学意义(P0.05),观察组病人手术时间较对照组缩短(P0.05),伤口愈合时间快于对照组(P0.05),观察组病人血肿、感染、皮片不成活等术后并发症发生率为6.12%,对照组为22.45%,两组比较差异有统计学意义(P0.05)。结论游离植皮术应用持续负压引流系统较常规植皮加压包扎可明显提高手术效果和病人术后满意度,促进伤口愈合和降低术后并发症发生率。     

腋窝瘢痕挛缩畸形植皮术后包扎方法的改进

目的:改进传统的腋窝瘢痕挛缩畸形植皮术后包扎技术。方法:分析腋窝形态结构的特殊性而对基于普通弹性绷带的传统"8"字包扎技术进行2方面改进:①加一段弹性绷带在腋下水平缠绕胸、背部一圈,而使腋窝内侧壁包扎到;②在肩峰、上臂上端外侧、腋窝前、下、后侧用7号丝线将绷带相邻边缘缝扎固定一起,形成全腋窝弹性加压包扎法,并将此法用于13例(16侧)腋窝因广泛瘢痕增生并挛缩或粘连畸形而进行全厚皮片移植的患者。结果:手术切口均一期愈合,无血肿及皮片坏死发生,畸形改善明星,每次包扎后可维持7天不松散。全腋窝弹性加压包扎法使对术区包扎达到全方位、长久牢靠。结论:基于对腋窝结构特殊性而新创的全腋窝弹性加压包扎法牢固可靠,其用于腋窝植皮包扎预防皮片坏死效果确切有效。     

中西医结合点状植皮治疗糖尿病足溃疡

目的：观察中西医结合点状植皮法对糖尿病足溃疡的修复作用。方法：在174例糖尿病足溃疡患者创面肉芽组织较新鲜,质地坚实,无明显水肿,分泌物较少,周围无急性炎症时植皮,在局麻下,用锐刀切取点状皮片,将皮片均匀置于创面肉芽组织,使皮片深层与肉芽底部紧密接触,皮片间距0.5--1 cm,无菌网眼纱布覆盖固定,敷以生肌象皮膏纱条,无菌干纱布稍加压包扎。结果：植皮数8--60片,平均成活率80%;创面痊愈时间7--28 d,平均18.7 d。结论：中西医结合点状植皮法治疗糖尿病足溃疡,操作简便,疗效显著,创伤小,不需要特殊技术及设备器械。     

负压封闭引流技术和传统换药治疗四肢软组织缺损创面效果比较

目的:通过对负压封闭引流技术(VSD)与临床传统换药(CDC)两种方法治疗四肢皮肤软组织缺损创面进行临床效果对比,为医院及医疗卫生决策提供理论依据。方法:收集西安交通大学附属第一附属医院烧伤整形美容科2007年1月至2011年7月期间入院的四肢皮肤软组织缺损创面患者共218例,其中使用VSD治疗的患者108例,使用CDC治疗的患者110例。比较两组患者治疗过程中手术前所需的治疗时间、首次植皮存活率、手术次数、并发症、住院时间、创面愈合等级、再次入院率等临床效果指标。结果:VSD与CDC组手术前所需的治疗时间、首次植皮存活率、手术次数、并发症的发生、住院天数、再次入院率的差异均有统计学意义,VSD组临床效果明显优于CDC组。结论:与临床传统换药相比,VSD治疗皮肤软组织缺损创面炎症反应较轻,并发症少且轻,明显缩短首次植皮时间,植皮存活率较高,减少手术次数,且再次入院率低,缩短患者住院时间,降低住院医疗费用,同时减轻了医护人员的劳动强度。     

Differences in prophylactic performance across wound dressing types used to protect from device-related pressure ulcers caused by a continuous positive airway pressure mask

Prolonged use of continuous positive airway pressure masks, as often required for non-invasive ventilation, involves a risk for facial tissue breakdown due to the sustained deformations caused by tightening of the stiff mask surfaces to the head and the moist environment. The risk of developing mask-related facial injuries can be reduced through suitable cushioning materials placed at the skin-mask interfaces to spread the localised contact forces and disperse the surface and internal tissue stresses. Using an integrated experimental-computational approach, we compared the biomechanical protective performance of three popular foam-based wound dressings to that of a market-lead hydrocolloid dressing when applied to protect the facial skin under a mask. We measured the compressive stiffness properties of the four commercial dressing types in dry and moist conditions, and then fed those to an anatomically realistic finite element model of an adult male head, with an applied simulated mask. Through this process, we calculated the protective efficacy index of each dressing type, indicating the relative contribution of the specified dressing to alleviating facial soft tissue loads with respect to the no-dressing case. The foam-based dressings generally performed substantially better than the hydrocolloid, but foam dressings were also demonstrated to vary by their protective performance.     

Removal of adhesive wound dressing and its effects on the stratum corneum of the skin: comparison of eight different adhesive wound dressings

In recent years, adhesive wound dressings have been increasingly applied postoperatively because of their ease of use as they can be kept in place without having to cut and apply surgical tapes and they can cover a wound securely. However, if a wound dressing strongly adheres to the wound, a large amount of stratum corneum is removed from the newly formed epithelium or healthy periwound skin. Various types of adhesives are used on adhesive wound dressings and the extent of skin damage depends on how much an adhesive sticks to the wound or skin surface. We quantitatively determined and compared the amount of stratum corneum removed by eight different wound dressings including polyurethane foam using acrylic adhesive, silicone‐based adhesive dressing, composite hydrocolloid and self‐adhesive polyurethane foam in healthy volunteers. The results showed that wound dressings with silicone adhesive and self‐adhesive polyurethane foam removed less stratum corneum, whereas composite hydrocolloid and polyurethane foam using acrylic adhesive removed more stratum corneum.     

Effective use of negative pressure wound therapy provides quick wound-bed preparation and complete graft take in the management of chronic venous ulcers

Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment.     

Penile reconstruction with dermal template and vacuum therapy in severe skin and soft tissue defects caused by Fournier's gangrene and hidradenitis suppurativa

The aim of this article is to improve the treatment of patients with complete skin loss of the penile shaft after Fournier's gangrene or hidradenitis suppurativa using modern biomatrices and topical negative pressure therapy. From January 2010 to December 2011, three patients with Fournier's gangrene or hidradenitis suppurativa were treated. After initial radical debridements, topical negative pressure therapy was applied for wound stabilisation. After that dermal templates (acellular dermal matrix) were used to achieve early healing and topical negative pressure‐dressing in a special setting or a special foam compression bandage was used together with a urinary catheter. After integration of the dermal template, a split‐thickness skin graft is used for coverage and again secured with a circular total negative pressure‐dressing. In all cases, the split‐thickness skin grafts healed very well applying this therapy concept. The patients were very satisfied with the functional as well as with the aesthetic outcome. We suggest a new method of staged reconstruction to successfully preserve the functionality of the penis after complete loss of the skin and soft tissue of the penile shaft using modern biomatrices and topical negative pressure therapy.     

A study to evaluate primary dressings for the application of cultured keratinocytes.

Despite the recent improvements in cell culture and dermal regeneration methods, tissue engineering of skin has yet to receive widespread acceptance in the management of burn injuries. The reasons for this are complex and include not only the inherent costs of (particularly) setting up and running such a system but also the continuing difficulties in achieving successful engraftment of the neoepidermis. The latter has previously been addressed in a number of ways, including improving the recipient bed and using pre-confluent delivery systems to allow earlier application of cells to that wound bed. One area that has received little attention is that of the optimal wound dressing to use with this technology; the cells are very poorly attached at early time points, and, in this context, the traditional dressing of paraffin gauze has never been formally assessed in comparison with newer materials. Using a porcine acute wound chamber model, we performed a prospective randomised trial to assess four different wound dressings with reference to the amount of epidermal cover gained and the histological quality of the regenerated skin after 3 weeks. Out of the four materials tested, polyurethane foam (Allevyn) was superior histologically (although equal in take rate with paraffin gauze), whilst polythene sheet (Opsite) and silicone sheet were substantially inferior. We conclude that the traditional dressing used with this technology should be compared with polyurethane foam in a clinical trial. In the future, novel dressings should be formally tested against traditional methods before being adopted.     

The "stegosaurus" dressing: a simple and effective method of securing skin grafts in the burn patient

Skin grafts are vulnerable to shear stress, infection, and hematoma formation during the postoperative period, all of which reduce graft survival. Various methods of dressing application and materials have been described in the literature to try and prevent graft loss. The authors report the use of the "stegosaurus dressing" (Eggcrate Pad) in 6 patients to secure skin grafts. Patients chosen were those who were either noncompliant or who sustained burns in unfavorable anatomic sites. All grafts demonstrated complete take without infection and hematoma formation. This foam dressing provides an even pressure to the recipient bed, absorbs drainage, and protects the graft from shearing. It also demonstrates the versatility to be used in difficult nonburn skin graft areas. The stegosaurus dressing is easy to apply, inexpensive, and provides a very secure dressing over the skin graft.     

Biodegradable hydrogel‐based biomaterials with high absorbent properties for non‐adherent wound dressing

Dressing materials involve conventional gauzes and modern materials such as hydrogels and foam‐based biomaterials. Although the choice of dressing material depends on the type of wound, a dressing material is expected to be non‐cytotoxic. Additionally, moist dressing is considered appropriate to accelerate epithelialisation, while dry dressing may cause tissue damage during removal. An ideal dressing material is expected to provide a moist environment and degrade and release the drug for faster wound healing. Thus, we have designed a hydrogel‐based biodegradable dressing material to provide the moist environment with no cytotoxic effect in vitro. The design of the hydrogel involved alginate–collagen reinforced with whisker cellulose derived from cotton. The hydrogel was prepared via amide linkage in the presence of 1‐ethyl‐(dimethylaminopropyl) carbodiimide (EDC) and N‐hydroxysulfosuccinimide (NHS), followed by divalent cationic cross‐linking of alginate and hydrogen bonding with cellulose. The high water retention capability of the hydrogel enables a moist environment to be maintained in the wounded area. The constituents of the hydrogel provided a microenvironment that was suitable for cell proliferation in the vicinity of the hydrogel but inhibited cell attachment on it. The MTT assay results indicated a higher fibroblast proliferation and viability in the presence of the hydrogel.     

扩张皮瓣整复颈部瘢痕挛缩的技巧与美学问题

目的：探讨采用扩张皮瓣整复颈部瘢痕挛缩的技巧与相关的美学问题。方法：根据颈部瘢痕的部位,范围和病灶周围情况选择扩张器的数量、容量与埋植部位,注水过程中采用扩张器托以防止其移位,用改良的下颌部软组织瓣重建颏部与下颌缘关加深颌颈角,借助打包包扎法保证扩张皮瓣成活。结果：除1例因血肿改用全厚皮片移植治疗外,所有扩张皮瓣与移植皮片均100％成活,术后功能满意,外形良好,达到了预期的美学要求,结论：以美学理论为指导,结论适当的手术技巧有助于颈部瘢痕挛缩形术后功能与形态的恢复。     

Occlusive dressing for large soft tissue defects following soft tissue tumor excision

Background  Reconstructive surgery using pedicles or free muscle-skin flaps and skin grafting reduces wound complications and promotes favorable limb function; however, the sacrifice of normal tissue remains problematic and complicated. Occlusive dressings are widely employed for management of injuries, burns, and surgical wounds. However, their effectiveness for treating soft tissue defects following a soft tissue tumor excision has not been fully elucidated. The purpose of this study was to evaluate the effectiveness and safety of an occlusive dressing treatment method for soft tissue defects following soft tissue tumor excisions. Methods  We retrospectively reviewed eight patients (three men, five women) whose wounds were treated with polyurethane foam occlusive dressings to allow reconstruction of the soft tissue defect following soft tissue tumor excision. Their mean age was 64.5 years (range 23–83 years), and the mean size of the defect was 60.1 cm² (range 20–144 cm²). The wound was covered with a hydrophilic polyurethane dressing material. The treatment periods, incidence of complications, and ultimate outcomes were evaluated. Results  Seven defects were completely healed by secondary intention without the requirement of any additional surgery. Mean treatment periods were 21.6 weeks (range 13.5–44.0 weeks). Mean follow-up periods were 33.1 months (range 15.8–48.6 months). One patient with a recurrent malignant fibrous histiocytoma (MFH) who had a history of radiotherapy required a posterior thigh flap 44 weeks after the surgery. Recurrence due to a positive surgical margin was observed in only one patient with recurrent MFH. None of the patients exhibited clinical evidence of superficial or deep infection. Conclusions  This treatment method is simple, safe, and reliable. We concluded that the highly favorable indications of this treatment are ideal for patients who wish to avoid sacrificing their normal tissue, have no history of radiotherapy before surgery, and do not require chemotherapy or radiotherapy after the operation.