负压创面治疗技术修复难愈性创面

目的:探讨负压创面治疗技术在难愈性创面修复中的临床应用及疗效。方法:对2015年10月至2017年10月住院的50例慢性难愈性溃疡患者行负压创面治疗,后期行植皮或者有利皮瓣修复。结果:50例慢性难愈性创面患者经过清创、负压封闭引流治疗后,小部分患者直接痊愈,大部分患者创面明显改善,为二期植皮或皮瓣手术修复创造了条件,取得了满意临床效果。结论:负压创面治疗技术是一种促进创面愈合的治疗技术,已成为创面处理领域重要的治疗手段之一,为很多难愈性创面的处理提供了一个较为便捷、有效的方法。     

烧伤创面与糖尿病溃疡创面的比较

目的比较烧伤创面与糖尿病溃疡创面的差异，初步分析糖尿病患者溃疡创面难愈的机制。方法分别切取非糖尿病烧伤患者的足部创面（对照组）和糖尿病患者的足部溃疡创面（试验组）组织，行组织块培养。用酶联免疫吸附测定（ELISA）法、反转录-PCR法分别检测创面组织释放的成纤维细胞生长因子2（FGF2）、血管内皮生长因子（VEGF）蛋白质及其mRNA水平；免疫组织化学法检测创面微血管密度（MVD）的变化。人脐静脉内皮细胞分别在含5mmol／L葡萄糖的培养液（正常培养液组）、含30mmol／L葡萄糖的培养液（高糖组）、含30mmol／L甘露醇的培养液（甘露醇组）中培养7d，以ELISA法测定VEGF蛋白质水平。结果对照组患者FGF2、VEGF蛋白质水平分别为（59±3）ng／ml、（56±7）pg／ml，试验组2种蛋白质水平分别为（89±6）ng／ml、（108±5）pg／ml，组间比较差异均有统计学意义（P〈0．05或P〈0．01），mRNA比较结果与蛋白质相似；2组的MVD水平，差异亦有统计学意义（P〈0．05）。体外细胞培养时当培养液含FGF2，高糖组与正常培养液组的VEGF蛋白质水平相近（P〉0．05）；移去FGF2后2、5d，正常培养液组该指标明显高于高糖组（P〈0．05或P〈0．01）。结论糖尿病患者溃疡创面难愈与血管化受到抑制以及调控血管生长的因子低表达密切相关。     

皮瓣对创面细菌的清除与创面愈合

皮瓣对创面细菌的清除与创面愈合杨勇何清濂林子豪吴其林在外科临床实践中，伴有严重细菌污染或感染的皮肤软组织缺损创面颇为常见。这类创面常延迟愈合，有的甚至不能愈合，当伴有局部血供障碍时，如电击伤创面、褥疮、放射性溃疡、慢性骨髓炎等，更增加了创面愈合的难度...     

转移皮瓣修复手部污染创面和感染创面

我院3年中应用转移皮瓣治疗28例手外伤患者,污染创面15例,感染创面13例。手背10例,手掌6例,虎口5例,手指7例。转移皮瓣种类:食指背皮瓣6例,邻指皮瓣7     

皮瓣对创面细菌的清除与创面愈合

在外科临床实践中,伴有严重细菌污染或感染的皮肤软组织缺损创面颇为常见。这类创面常延迟愈合,有的甚至不能愈合,当伴有局部血供障碍时,如电击伤刨面、褥疮、放射性溃疡、慢性骨髓炎等,更增加了创面愈合的难度。目前临床常通过带蒂皮瓣移转修复,因皮瓣不仅能覆盖创面,且其本身具有丰富的血供,能为低氧、血运差、多瘢痕的严重污染或感染创面提供机体防御机制的各种成分,如具有吞噬杀菌功能的白细胞、免     

手部创面修复

手部因创伤造成软组织缺损应及时闭合创口,否则一旦创面感染,最终以瘢痕形式愈合,必将严重影响手的外形和功能.皮瓣移植是目前修复手部伴有骨、关节、肌腱外露创面最常用的方法.目前用于修复手部创面的皮瓣虽然很多,但具体选择何种皮瓣为宜,需根据供区与受区情况、修复方法,权衡利弊,加以比较,总的原则是选择方法简便、效果满意,对供区影响小且成功率高的皮瓣[1].但如何合理选用修复手部创面的皮瓣,除遵循上述皮瓣选择的一般原则外,尚需考虑手部皮肤缺损修复的特殊要求.     

烧伤创面真菌感染

回顾了所在烧伤中心最近10年处理烧伤创面真菌感染的经验。临床资料来自1979年7月～1989年6月住院烧伤病人2114例,研究期间创面早晚交替应用磺胺米隆和SD-Ag,未预防性全身应用抗生素。疑有感染的创面在局麻下活检取标本送检。创面感染的诊断:组织学检查见创面下或附近健康组织中有微生物存在。真菌感染的创面局部用药:1％三苯甲咪唑冷霜等。而主要治疗方法是切除所有感染创面。两性霉素B仅用于疑有弥散性真菌感染或切片     

创面修复研究进展

创伤在中国,乃至全世界均是导致创面形成,甚至引起患者死亡的主要原因,再加上每年数百万计的手术创面使得修复外观、最大程度恢复肢体功能成为国内众多医疗机构骨科医师面临的难题。尽管对于无基础疾病的患者来说,大部分的微小创面都能顺利闭合,但对于创伤面积大、局部感染、年老体弱或合并基础疾病,如糖尿病、血管性疾病,以及肿瘤等患者,创面修复困难重重,其相关的病理生理机制至今不明。     

烧伤创面用药

For bum patients, topical treatment is as important as systemic treatment. Reasonable and timely wound treatment will influence the homeostatic equilibrium, and the progression, the prognosis, and the outcome of the disease. The therapeutic principle should be varied for wounds with different depth of injury. But avoiding or at least alleviating infection, and accelerating healing period, were the common principles. In common, the medication for local wound treatment includes: topical antiseptic, surgical dressing products, artificial skins, and so on.Ideal topical antiseptic should have the following zcharacteristics: the antimierobial spectrum is broad, including Pseudomonas aeruginosa and MRSA; be able to penetrate necrotic tissue; does not induce drug resistatance easily; no local irritating effect and not painful; no side effect to body; can be applied easily; low cost. The functions of surgical dressing in clude: protect the wounds, keep the microcirculation open, and accelerate wound healing. Artificial skin has been used as the autoskin carrier in skin transplantation operation for large burn area to protect the autoskin grafts, accelerate wound healing, and cover the wounds temporarily. Bums therapy has developed for 50 years in China, the study of local treatment for burn wounds has also experienced a tortuous path of trial and error. This review might contribute some ideas future research.     

烧伤创面愈合

本文重点阐述有关原理。并讨论组织修复和创面愈合。有关热力损伤内容原则上各种原因烧伤。     

Thoraco-abdominal wound in gunshot multiple wound

Thoracoabdominal wounding in the shot gun polytrauma was revealed in 56 (25.6%) of injured persons, severe shock of III-IV degree--in 71.4%. Operative intervention on the abdominal cavity organs was done in all injured persons, on the thoracic one--in 92.9%, and on the other anatomical regions--in 55.4%.     

Burn wound coverage and burn wound closure

Early excision and grafting changed dramatically topical wound treatment, but are restricted by difficulty in diagnosing burn depth, by limited donor sites and by technical skills to excise special areas (perineum, face). In addition to the extent of burn and the age of the patient the depth is determinant of mortality, morbidity and of patient's quality of life. It results from the time-temperature relation and is further influenced by local and systemic causes of conversion: dehydration, edema, infection and shock hypoxia, metabolic derangements, peripheral vessels diseases may contribute do deepening of burn wound. Superficial burn on day one appears deep dermal by day three, where spontaneous epithelization lasts much longer than 21 days and results in hypertrophic scarring. To prevent this sequelae deep dermal burn may be treated like full-thickness injury with excision and autografting. Another way is removal of dead layers of corium and using biological or synthetic cover. We have found a more effective way to reach wound closure (not only cover) in the method of "upside-down" application of recombined human/pig skin (RHPS), composed of allogeneic human keratinocytes cultured on cell-free pig dermis. The allogeneic epidermal cells temporarily "take", "close" the excised wound and simultaneously encourage epithelization from adnexa remnants in the wound bed. Thus definitive closure is achieved.     

Titanium wound chambers for wound healing research

Standardized and reproducible animal models are crucial in medical research. Rodents are commonly used in wound healing studies since, they are easily available, affordable and simple to handle and house. However, the most significant limitation of rodent models is that the wounds heal by contraction while in humans the primary mechanisms of healing are reepithelialization and granulation tissue formation. The robust contraction results in faster wound closure that complicates the reproducibility of rodent studies in clinical trials. We have developed a titanium wound chamber for rodent wound healing research. The chamber is engineered from two pieces of titanium and is placed transcutaneously on the dorsum of a rodent. The chamber inhibits wound contraction and provides a means for controlled monitoring and sampling of the wound environment in vivo with minimal foreign body reaction. This technical report introduces two modalities utilizing the titanium chambers in rats: (1) Wound in a skin island model and, (2) Wound without skin model. Here, we demonstrate in rats how the “wound in a skin island model” slows down wound contraction and how the “wound without skin” model completely prevents the closure. The titanium wound chamber provides a reproducible standardized models for wound healing research in rodents.     

Vacuum-assisted wound closure in postoperative spinal wound infection

Combined with antibiotic therapy, vacuum-assisted wound closure may help reduce the need for serial irrigation and debridement surgery, contributing to a decrease in overall hospital stay.     

Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives

Our objective was to review and assess the treatment of low-tension wounds and evaluate the cost-effectiveness of wound closure methods. We used a health economic model to estimate cost/closure of adhesive wound closure strips, tissue adhesives and sutures. The model incorporated cost-driving variables: application time, costs and the likelihood and costs of dehiscence and infection. The model was populated with variable estimates derived from the literature. Cost estimates and cosmetic results were compared. Parameter values were estimated using national healthcare and labour statistics. Sensitivity analyses were used to verify the results. Our analysis suggests that adhesive wound closure strips had the lowest average cost per laceration ($7.54), the lowest cost per infected laceration ($53.40) and the lowest cost per laceration with dehiscence ($25.40). The costs for sutures were $24.11, $69.91 and $41.91, respectively; the costs for tissue adhesives were $28.77, $74.68 and $46.68, respectively. The cosmetic outcome for all three treatments was equivalent. We conclude adhesive wound closure strips were both a cost-saving and a cost-effective alternative to sutures and tissue adhesives in the closure of low-tension lacerations.