The purse-string suture in facial reconstruction.

Mohs surgical defects in 26 patients were reconstructed utilizing a purse-string suture and a full-thickness graft. The placement of the purse-string suture decreased the surface area of the wound an average of 53%. A full-thickness graft was then placed in the remaining defect. This technique enabled us to repair large wounds of the facial region with a relatively small full-thickness graft. There were no complications in our series. The resultant areas were cosmetically acceptable and resistant to trauma.     

The effect of recombinant human growth hormone on wound healing in normal individuals

Growth hormone therapy has been suggested to speed wound healing in postoperative patients and in patients with severe burns. This study was undertaken to determine the effect of recombinant human growth hormone on the rate of wound healing in normal individuals. Twenty-three healthy males were evaluated in a randomized, double-blind placebo-controlled study. Each subject received a split-thickness wound (Davol-Keratome) on one buttock and a full-thickness wound (3-mm punch biopsy) on the other. The full-thickness wound healed significantly more slowly in the recombinant human growth hormone-treated group as compared with the placebo control group (t-test, P = .001). No statistically significant difference was noted in the healing of the split-thickness wounds. It is concluded that recombinant human growth hormone may impede healing in normal patients with full-thickness wounds as compared with treatment with placebo. We cannot rule out, however, that the recombinant human growth hormone affected the quality of the scab in full-thickness wounds and thereby only appeared to alter the wound-healing process.     

Keratinocyte grafting: a new means of transplantation for full-thickness wounds

Twenty adult individuals with chronic leg ulcers caused by venous insufficiency, and 5 patients with full-thickness burns were treated. Twenty of the patients (15 with leg ulcers and 5 with burns) were grafted with separated autologous keratinocytes. In these cases the cells were fixed to the wound bed by a fibrin net. Five other patients (with leg ulcers) were treated with fibrin without keratinocytes. In 16 of the 20 patients grafted with keratinocytes in a fibrin net, the defect healed completely in 14 to 21 days. On the other hand, the fibrin net without keratinocytes failed to significantly accelerate the process of reepithelialization. Our experience suggests that a rapid healing of full-thickness skin defects can be achieved through keratinocyte grafting.     

改良型富血小板纤维蛋白在面部皮肤癌术后软组织缺损修复中的应用

目的探讨A PRF联合腹部全厚皮片移植修复面部恶性非黑色素瘤皮肤癌术后软组织缺损中的可行性及疗效。方法选择于2020年1月至2022年6月徐州医科大学附属淮安医院收治的面部皮肤癌术后需行全厚皮片移植患者80例,并根据随机数字表法将患者分为对照组（行皮片移植,外加多层无菌辅料,n=40）和研究组（将A PRF凝胶覆盖创面后,行皮片移植,外加多层无菌敷料包扎,n=40）,比较两组患者术后创面愈合情况,手术后 1月及 3 个月时患者的瘢痕评估（POSAS）得分,两组患者住院期间的平均换药次数、住院时间以及术后至出院前并发症发生率。结果研究组患者术后7 d的皮片存活率高于对照组（P＜0.05）, 研究组患者术后15 d及21 d的创面愈合情况优于对照组（P＜0.05）,研究组的创面完全愈合时间低于对照组（P＜0.05）;两组患者术后1个月和3个月的POSAS评分比较,差异具有统计学意义（P＜0.05）;研究组的平均换药次数、住院时间以及并发症发生率均低于对照组（P＜0.05）。结论A PRF联合腹部全厚皮片移植能够有效地修复面部恶性非黑色素瘤皮肤癌术后软组织缺损,且减少并发症的发生,减短患者的住院时间,值得临床推广应用。     

The quantitative and qualitative impairment of wound healing by adriamycin.

Clinical impression suggests that Adriamycin (ADR) interferes with wound healing. To examine the effects of ADR on wound healing, male Fischer rats were subjected to a dorsal, midline, full-thickness longitudinal incision (day 0). Wound clips were removed on day +7. Twenty animals per group were given intravenous ADR on day -7, day 0, day +3 and day +7. Twenty animals served as non-treated, wounded controls (C). Five animals/group were sacrificed on days +7, +14 and +21, at which time two 9.5 mm wide strips were taken from each animal perpendicular to the wound axis and submitted for wound breaking strength (WBS) measurements and load-extension curve analysis. WBS differed most markedly at Day 21 between C(1671 +/- 59g) and ADR day -7(1360 + 71 g) p less than 0.01; C and ADR day 0 (1051 +/- 108 g) p less than 0.001; C and ADR day + 3(1134 +/- 176 g) p less than 0.02. No difference existed between C and day +7 (1790 +/- 153 g). A point of inflection always occurred between 55-60% elongation in ADR treated animals only. This portion of the curve has been previously shown to represent collagen content. It is concluded that perioperative ADR administration (day -7 through day +3) significantly and substantially impairs skin wound healing in the rat. A form of collagen yielding underlies and may contribute to this defect.     

改良简易负压吸引装置在食管癌术后难愈性切口中的应用研究

目的 探讨改良创面负压吸引装置治疗食管癌术后胸部难愈性切口的临床效果。 方法 收集江苏省肿瘤医院胸外科2013年1月至2017年12月期间,食管癌手术后发生切口全层感染患者。将符合要求的研究对象60例患者分为试验组和对照组。采用传统高渗盐水治疗的30例为对照组（2013年1月至2015年12月期间）;采用改良负压吸引装置治疗的30例为试验组（2016年1月至2017年12月期间）。比较两组患者的切口可行Ⅱ期缝合的时间、换药次数、换药费用。 结果 试验组患者的切口可行Ⅱ期缝合的时间为（81±25）d,换药次数为（74±22）次,换药费用为（1 5005±2058）元;对照组分别为（144±46）d、（158±51）次及（3 8004±4807）元,两组比较差异均有统计学意义（均P＜001）。 结论 使用自制负压吸引装置治疗胸部难愈性切口临床效果满意且更为经济实用,可以有效缩短创面愈合时间,降低换药费用。       

The role of topical agents in the healing of full-thickness wounds

Eight topical agents in current use were studied for their effects on wound contraction and rate of reepithelialization of full-thickness excisions using a porcine animal model. The following agents were applied daily for a period of 27 days: scarlet red ointment, benzoyl peroxide lotion, bacitracin ointment, silver sulfadiazine cream, aloe vera gel, tretinoin cream, capsaicin cream, and mupirocin ointment. The rate of reepithelialization was significantly enhanced by treatment with capsaicin, bacitracin, silver sulfadiazine, and scarlet red, and was markedly retarded by treatment with tretinoin. Wound contraction was significantly retarded by mupirocin, bacitracin, and silver sulfadizine. Knowledge of the effects of topical agents on various aspects of healing allows the clinician to choose the most appropriate material to use in a given clinical situation to optimize the healing process and produce the best final result.     

Skin grafting: perioperative technique and management

The transfer and successful "take" of a full-thickness skin graft depends on the critical, early events leading toward graft revascularization. The paper discusses and illustrates operative technique as well as methodology of wound care and dressing design directed toward achieving such a goal.     

Surgical repair of atresia of nasal passages

Surgical correction of nasal atresia following healing of smallpox lesions in a 15-year-old girl is presented. The surgical technique used was complete excision of the scars and resurfacing of the resulting wound with grafts of full-thickness retroauricular skin. Particular attention was paid to prevention of postoperative contracture.     

Growth factors and wound healing in the hamster

We have investigated the effect of topically applied mitogenic preparations on the healing of full-thickness skin wounds in the Syrian hamster. In an attempt to accelerate the healing process, dexamethasone and insulin, platelet-derived growth factor, fibroblast growth factor, thrombin, defined medium F for fibroblasts, liver cell supernatant, epidermal growth factor, and colostrum were applied to the wounds. These mitogens had no significant influence on the rate of wound contraction or on the time to complete healing in full-thickness, noncompromised skin wounds in this animal model.     

The effect of 13-cis-retinoic acid on wound healing in dogs

13-cis-retinoic acid is currently accepted as a valuable treatment for patients with severe nodulocystic acne. Many of these individuals express interest in surgical scar-correcting procedures. To ascertain the effect of 13-cis-retinoic acid on wound healing, sequential biopsies were examined from partial and full-thickness wounds in dogs following a 2-month course of retinoids. No significant difference was histologically observed from the control animal.     

Visualized basting sutures in the application of full-thickness skin grafts

This paper describes a simple technique for inserting basting sutures to secure full-thickness skin grafts. By applying the suture under visualized conditions before fully securing the perimeter of the graft, exact placement and knot security of the basting suture can be enhanced, and injury to underlying structures can be avoided. Furthermore, by securing the center of the graft early in the repair, alignment on and conformation to the underlying wound bed is improved.     

Two cases of cutaneous cryptococcosis

We report two cases of cutaneous cryptococcosis in male patients without underlying disease. Case 1 had a granulomatous mass on his right neck, gradually enlarging for 3 months. After the mass was debrided surgically in a hospital, the incision wound gradually developed into a severe ulceration. Mycological examination revealed Cryptococcus neoformans infection. It was significant that histopathology of both pre-surgery granuloma and post-surgery ulceration revealed thick-walled spores with thick capsule. Chest X-ray revealed a shadow in the left lower lung. After treatment with amphotec for 21 days, the lesion healed. Case 2 had an approximately 2 x 2 cm solitary dull nodule on his right thigh, which had been present for 8 months. Mycological examination confirmed that the lesion was caused by C. neoformans. The patient's ratio of peripheral blood CD4(+) cell was slightly reduced. After 14 days of treatment with oral fluconazole, followed by oral itraconazole for 2 months, mycological and clinical cure were achieved. The two isolates were identified as C. neoformans var. gattii serotype C and C. neoformans var. grubii serotype A.     

右半结肠癌根治术合并十二指肠缺损修复治疗的体会

目的　探讨右半结肠癌根治术合并十二指肠缺损修复治疗的疗效及并发症。方法　２００８年２月至２０１１年２月,对１２例右半结肠癌侵及十二指肠患者行Ｄ３根治术,十二指肠缺损的修复均用３.０爱惜康可吸收线横向连续全层缝合,１号丝线间断浆肌层缝合加强,留置复尔凯鼻肠管至空肠,十二指肠创面旁置冲洗引流管一根。观察手术情况、并发症及预后。结果　１２例均一期恢复,无围手术期死亡,术后无十二指肠瘘、狭窄、梗阻及溃疡等并发症,术后１个月上消化道钡餐造影显示十二指肠蠕动和排空正常。术后所有患者均接受术后辅助化疗８～１２周期,截止２０１１年７月,除２例发生肝转移再次手术切除病灶外,其余患者均无复发及转移征象。结论　右半结肠癌侵犯十二指肠行Ｄ３根治术是减少肿瘤复发的有效术式,对十二指肠缺损采用横向连续全层缝合加间断浆肌层加强以及留置鼻肠管,利于创面愈合,加速患者康复。     

面部基底细胞癌的手术治疗

目的:探讨面部基底细胞癌合适的手术治疗方法和美容修复方法。方法:1994年1月～2004年11月,共收治面部基底细胞癌患者26例,根据美学理论与整形美容技术,分别采用直接缝合、皮片移植、局部皮瓣转移的方法修复创面。结果:在病灶扩大切除26例患者切口愈合良好,术后外形满意。结论:面部基底细胞癌首选手术治疗,适宜的手术方式与美学结合,可取得理想的治疗效果。     

青少年皮肤恶性肿瘤的治疗

目的：总结青少年皮肤恶性肿瘤的治疗经验。方法：分析1991年2月～2003年9月间,收治13例青少年皮肤恶性肿瘤的临床资料,采用病灶彻底切除、皮瓣转移或全厚皮片移植修复术,辅以放射、化学或免疫等方法治疗,对其治疗效果与随访结果进行总结。结果：鳞状细胞癌6例、基底细胞癌2例、恶性黑色素瘤4例和血管内皮肉瘤1例,是本组病例的主要类型,术后随访2～8年,随访12例,失访1例。局部复发与淋巴结转移3例,截肢（指）2例,死亡2例,其余术区外形和功能恢复良好。结论：彻底切除病灶是皮肤肿瘤治疗取得良好疗效的关键,皮瓣、皮片修复有助于术区外形和功能的恢复。放射、化学和免疫等辅助治疗是预防术后复发的有效方法。     

An unpredicted side effect of prophylactic antibiotic use

Abstract

Introduction and Objective:

We investigated the effects of cefazolin sodium (CS), on wound healing in rats.

Material and Method:

Forty rats in which an incisional wound model was created by removing two skin strips (4×1 cm), and suturing the wound edges, were included. Four groups were formed in a randomized way with each having 10 rats. The Control group (Group 1) received 1 cc 0·9% NaCl twice daily, whereas Group 2 received single-dose preoperative 30 mg/kg CS, Group 3 received single-dose preoperative 30 mg/kg CS followed by the same dose for three postoperative days, and Group 4 received single-dose preoperative 30 mg/kg CS followed by the same dose for seven postoperative days (via i.p. route). On the first day of the study, as the wound was created, a skin strip of 1×1 cm area was collected for bacteriologic examination. On the third day, specimens were acquired from the incision for histopathologic examination. The rats were sacrificed on the seventh day and more specimens were gained for histopathologic, tensiometric, and bacteriologic tests.

Result:

Group 4 demonstrated disrupted normal skin flora; reduced inflammatory cell density, fibroblastic activity, and collagen density; and decreased wound tensile strength. The histopathologic findings with Groups 2 and 3 were as same as with Group 4 and wound tensile strength showed no significant difference compared with the Control group. Group 2 revealed no significant difference compared with the Control group with regard to all parameters.

Discussion:

Seven-day CS therapy had a negative effect on wound healing and changed the normal skin flora.     

Effects of cyclophosphamide and adriamycin on the healing of surgical wounds in mice.

Administration of therapeutic dose levels of cyclophosphamide as a single dose or as daily treatments for 5 days during the perisurgical period resulted in a significant decrease in the strength of surgical skin wounds in mice as measured 21 days after surgery. Administration of a single dose of 200 mg/kg either at the time of surgery or up to 4 days prior to or after surgery impaired 21-day wound strength, with the most extensive depression observed when the drug was given 1 or 2 days after surgery. Earlier stages of wound healing (day 3 or day 7) were not as sensitive to cyclophosphamide. Adriamycin in the therapeutic dosage range for mice did not significantly impair wound healing. This drug had an effect only at the LD10 dosage level. Combination treatment with cyclophosphamide plus adriamycin at the time of surgery impaired 21-day wound strength to a greater degree than observed with either agent alone, but did not significantly depress wound strength 3 or 7 days after surgery. These studies indicate that dosage level, the time of drug administration relative to surgery, and the time at which wound strength measurements are made are important parameters in determination of the effects of antineoplastic agents on wound healing.     

The effect of dacarbazine on wound healing

The effects of dacarbazine on wound healing were studied in an animal model. Sixty rats were divided into four groups. Each animal received a standard dorsal midline wound on day 0. Group 1 was injected with normal saline and acted as control; group 2 received 4 mg/kg of dacarbazine daily on days -3, -2, -1 (preoperative); group 3 received dacarbazine on days +1, +2, +3 (perioperatively); and group 4 received dacarbazine on days +5, +6, +7 (postoperatively). Wound bursting strength (WBS) was measured on days +7, +14, and +21. There was a significant decrease in WBS in experimental animals in groups 3 and 4 (perioperative and postoperative administration) compared to control animals, but no significant effect of preoperative dacarbazine on WBS in experimental animals (group 2). It is suggested that these effects are mediated through the late inflammatory phase of wound healing.