Acetic acid iontophoresis for recalcitrant scarring in post-operative hand patients

Study designRetrospective cohort comparison.IntroductionUsing acetic acid iontophoresis (AAI) as a treatment modality significantly improved the functionality of hand in patients with recalcitrant scarring.MethodsOpen trigger finger release patients followed up exclusively at a hand clinic between 2009 and 2011 were analyzed. Group I recovered optimal total active range of motion (TAM) after 14 standard of care (SOC) therapy sessions but Group II (10 digits) could only reach optimal recovery after 7 additional AAI sessions.ResultsAfter SOC therapy, Group I's TAM recovery plateaued at 245 and Group II's at 219 (p < 0.01). After undergoing AAI, the TAM of Group II increased from 219 to 239 (p < 0.01).DiscussionClinical studies suggest that AAI can modify collagen structure in scars. AAI could be a novel non-surgical treatment for restoring functionality to areas affected by difficult, recalcitrant scars.ConclusionAAI significantly improved the TAM of hand surgical patients who could not recover optimally with SOC therapy alone.Level of evidenceLevel 3.     

The Meek micrograft technique for burns; review on its outcomes: Searching for the superior skin grafting technique

IntroductionAutologous split thickness skin grafting is the standard-of-care for the majority of deep dermal and full thickness burns: Meshed grafting is most commonly used. Patients with extensive burn injuries have limited donor site availability. Meek micrografting is a well-known technique to enable larger expansions. A review was conducted on the outcomes of the Meek micrograft technique.MethodA database search in PubMed, Web of Science, Google Scholar and the Cochrane Library was conducted from the first Meek micrografting report in 1958 until 2021, including terms ‘burns’, ‘micrografting’ and/or ‘Meek’. Original papers reporting outcomes of Meek micrografting were included.Results1529 papers were identified and eventually 15 articles were included, the majority classified as poor quality according to Chambers criteria. 310 patients with 56% mean TBSA were described. Weighted averages were calculated for ‘graft take’ 82 ± 7%, ‘time to wound closure’ 53 ± 20 days and ‘length of hospital stay’ 61 ± 31 days. Scar quality was minimally described and often poorly assessed. Limited data were available on outcomes ‘donor site size’, ‘number of operations’, ‘cost effectiveness’ and ‘bacterial load/wound infection rate’.ConclusionOverall poor study quality and the specific lack of data on scar quality, made it impossible to draw conclusions on the outcomes of Meek micrografting. A randomized controlled trial is required to further investigate the performance of the Meek micrograft technique.     

瘢痕子宫妊娠早产经阴道分娩的可行性与安全性

目的:探讨瘢痕子宫妊娠早产经阴道分娩的可行性与安全性。方法:选择2012年1月至2016年12月在广州医科大学附属第三医院产科经阴道分娩的瘢痕子宫妊娠早产患者137例为研究组,同时期的瘢痕子宫妊娠早产行剖宫产患者454例为对照组,对两组的分娩结局、母婴并发症及住院时间等进行分析。结果:研究组产后24小时出血量(302.3±173.3 ml)和住院时间(5.01±3.60天)明显少于对照组(358.9±223.6 ml,9.80±6.20天),差异有统计学意义(P<0.05)。研究组与对照组在新生儿死亡、新生儿窒息率、新生儿黄疸、心肌损害、新生儿肺炎、代谢性酸中毒、新生儿呼吸窘迫综合征、入住NICU方面比较,差异无统计学意义(P>0.05)。结论:瘢痕子宫妊娠早产患者经阴道分娩未增加新生儿并发症,母儿获得较好妊娠结局。严格把握剖宫产指征,充分评估病情,瘢痕子宫妊娠早产经阴道分娩是安全可行的,并能减少产后出血量及住院时间。     

四氢叶酸肌注联合甲氨蝶呤局部用药、口服米非司酮治疗孕≤8周瘢痕妊娠效果

目的:探讨四氢叶酸肌注联合甲氨蝶呤局部用药、口服米非司酮终止孕周≤8周瘢痕妊娠患者临床效果及安全性。方法:选取本院孕≤8周瘢痕妊娠孕妇70例,对照组予以四氢叶酸肌注联合甲氨蝶呤,观察组在对照组基础上加口服米非司酮,治疗前后测定血清孕酮(P)、人绒毛膜促性腺激素(β-hCG)水平,QLQ-C30量表评定生活质量以及临床症状、体征缓解时间,对比临床疗效及不良反应。结果:与治疗前比较,两组治疗后血清P、β-hCG水平均降低,QLQ-C30量表评分降低,且观察组低于对照组(P<0.05);术后观察组出血时间(11.9±4.0d)、住院时间(16.9±3.2d)、β-hCG转阴时间(16.5±4.5d)以及月经恢复时间(63.3±5.4d)均低于对照组,有效率(91.4%)高于对照组(71.4%),发热(2.9%)、白细胞降低(5.7%)等发生率低于对照组(17.1%、22.9%)(P<0.05)。结论:四氢叶酸肌注联合甲氨蝶呤、口服米非司酮对孕周≤8周瘢痕妊娠疗效确切,能提高患者生活质量,不良反应更低。     

Squamous cell carcinoma at sites of old maxillary fractures

Malignancies have been reported to occasionally arise in scar tissue following injury. One hypothesis involves prolonged overactivation of tissue repair systems due to chronic inflammation and irritation, although the pathogenesis of cancers occurring in scars is not fully understood. We describe here two cases with a history of maxillary fracture at the site where squamous cell carcinoma (SCC) subsequently developed. The first patient developed SCC 7 years after right maxillary fractures resulting from a traffic accident. He underwent chemoradiotherapy (70 Gy in 35 fractions) and maintained complete response (CR) for 10 months. The second patient developed SCC 3 years after sustaining right maxillary fractures in an ice hockey game. Radiotherapy and total maxillectomy were performed, but local recurrence arose and he has since been receiving chemotherapy.     

干细胞抑制病理性瘢痕形成的研究进展

病理性瘢痕当前临床治疗方法的效果尚不理想，干细胞因其自我更新和分化能力有望给治疗带来新思路，本文介绍了病理性瘢痕干细胞疗法中常见的不同来源的细胞类型，包括各类间充质干细胞、人羊膜上皮细胞、胚胎干细胞和诱导性多能干细胞，以及各类干细胞用于临床治疗的优、缺点，指出了干细胞疗法的关键突破点在于分泌蛋白的调控、干细胞使用的时机、干性的传递与维持、为患者选择合适的干细胞群等，为病理性瘢痕干细胞疗法的发展方向提供了参考。     

宫腹腔镜配合手术治疗剖宫产瘢痕憩室的术中护理分析

目的探讨宫腹腔镜配合手术治疗剖宫产瘢痕憩室的术中护理方法及临床应用效果。方法随机选取2014年5月~2016年5月在我院妇产科进行治疗的50例子宫瘢痕憩室患者,所有患者均行宫腹腔镜配合手术治疗,将患者随机分为两组,对照组患者术中给予常规护理,观察组在对照组的基础上加用并发症护理,对比两组患者护理效果。结果观察组患者护理有效率为96.0%,对照组患者护理有效率为72.0%,观察组患者生活质量评分明显优于对照组,两组结果对比差异具有统计学意义(P0.05)。结论宫腹腔镜配合手术治疗剖宫产瘢痕憩室临床疗效较好,在术中对患者及时进行护理,能够显著改善患者的恢复情况,促进伤口愈合,减少并发症的发生。