高压冲洗在急诊污染创面中的应用

目的:观察高压冲洗在急诊污染创面清创术中的的临床疗效。方法:将2012年6月至2014年6月皮肤软组织挫裂伤患者100例,随机分为对照组和观察组,每组50例。观察组采用0.9%生理盐水高压冲洗创面,对照组采用0.9%生理盐水行普通冲洗创面清洗创面后两组均行常规消毒清创治疗;比较创面清洗的时间,创面愈合时间以及创面感染率情况。结果:与对照组比较,观察组清洗的时间及创面愈合时间明显缩短,细菌感染率明显减少(P<0.05)。结论:高压冲洗能有效的清除污染创面中的微小颗粒,减少伤口的细菌,降低伤口的感染率。     

臭氧水对感染性创面抗炎修复的影响

目的研究臭氧水对感染性创面的抗炎与修复作用的效果。方法将50只vista大鼠随机分成5组,洗必泰治疗组、低、中、高浓度臭氧水治疗组、对照组(不做特殊处理)各10只。首先在大鼠背部造成实验性感染性伤口,感染成功后48h进行治疗,每天1次,9d为1疗程。在治疗前、治疗后3、6、9d后分别对感染伤口的变化进行观察,抽取鼠尾静脉血检查白细胞计数,切取皮肤、肌肉组织标本进行光镜病理分析。结果与结论综合各项指标,各臭氧水治疗组的效果明显优于对照组以及洗必泰治疗组,其中10mg/L与20mg/L浓度组的优于5mg/L组,前两者治疗效果相当。     

冷沉淀外敷对家兔感染创面修复的影响

目的 观察血浆冷沉淀治疗家兔感染性创面修复的效果,阐述血浆冷沉淀促进家兔感染性创面修复的作用机制。方法 将健康的新西兰成年家兔12 只,按照改良付小兵全层皮肤缺损法复制创伤感染性动物体表溃疡模型,分别予冷沉淀、康复新液、湿润烧伤膏和凡士林纱布换药,测定治疗后第3、7、12、17天创面微血管密度（MVD）,创面愈合率和新生上皮覆盖率,创面转化生长因子β1（TGF-β1）表达情况。结果 各组治疗第3 天MVD 均呈上升趋势,第3、7 天冷沉淀组MVD 与其他3 组比较,差异有统计学意义（P <0.05）,第12 天后新生血管逐渐减少;冷沉淀组创面愈合率、新生上皮覆盖率与康复新液组、凡士林组比较,差异有统计学意义（P <0.05）,冷沉淀组创面完全愈合时间与其他3 组比较,差异有统计学意义（H =11.169,P =0.011）,冷沉淀组缩短;冷沉淀组治疗早期TGF-β1 表达与其他3 组比较差异有统计学意义（P <0.05）,并在整个修复过程中维持高表达。结论 冷沉淀可能通过上调创面TGF-β1 表达、加速创面MVD,达到提高创面新生上皮覆盖率,促进创面快速愈合的目的。     

60例创伤创面感染细菌学分析

目的探讨创伤创面感染的细菌谱特点及药敏结果。方法前瞻性收集本中心2006年5月至2007年8月收治的60例慢性感染创面分泌物采用Mueller-Hinton琼脂作细菌培养,OXOID公司药敏反应试剂板行药敏试验,VITEK-2型微生物分析仪判读MIC值。结果60例患者中有55例培养出22种细菌,前5位的是大肠埃希菌13例(23.6%),鲍曼不动杆菌10例(18.2%),铜绿假单胞杆菌8例(14.5%),凝固酶阴性葡萄球菌和金黄色葡萄球菌各6例(10.9%)。敏感性较高的抗生素依次为万古霉素(93.1%)、替考拉宁(87.0%)、美洛培南(71.9%)、亚胺培南(70.1%)和阿米卡星(66.7%)。结论创伤创面感染多为院内感染,细菌对抗生素耐药较普遍,对新型抗生素较为敏感。     

烧伤患者创口常见病原菌及药敏情况

目的 研究烧伤后创面常见的感染细菌及细菌的药物敏感性.方法 收集该院2004年1月～2007年12月4年间120例烧伤病人感染创面分泌物、血液和痰等进行细菌培养及药物敏感试验.结果 120例烧伤感染创面共分离出细菌、真菌32种.检出率较高的依次为铜绿假单胞菌(占检出菌总数的23.88%),鲍曼氏不动杆菌(占检出菌总数的12.69%)和金黄色葡萄球菌(占检出菌总数的10.45%).结论 烧伤感染创面感染的细菌以革兰氏阴性菌为主,常见细菌对阿米卡星、环丙沙星、亚胺培南和万古霉素等的敏感率较高.     

不同生肌药治愈感染性伤口的时间比较

目的 探讨不同生肌药治疗感染性伤口的愈合时间.方法 2009年1月～2010年12月,北京市顺义区第二医院外科分别应用湿润烧伤膏、京万红软膏各治疗15例感染性伤口患者,将两组患者伤口愈合时间进行比较.结果湿润烧伤膏组患者伤口愈合时间明显短于京万红软膏组,差异有统计学意义.结论湿润烧伤膏治疗感染性伤口,伤口愈合更快.     

New technologies for the management of major extremity wounds

Soft tissue reconstruction for large or difficult defects, particularly of distal extremities, may be associated with a variety of problems. Crush injuries and infection are often background settings requiring use of considerable resources, time, and skilled personnel for appropriate treatment. Harvested tissue, known as a flap, is used for transferring healthy, viable tissue from one location to the area of tissue loss. Conventional techniques, procedures, and imaging studies used in soft tissue wounds are associated with limitations that often mandate the use of microvascular tissue transfer for lack of a clear alternative. Newer technology, however, may provide an alternative in a significant number of cases. The developments of the perforator flap, digital subtraction angiography, and real-time laser-assisted indocyanine green fluorescent-dye angiography have enabled the use of local tissue for reconstruction heretofore not thought possible. Three cases with distal extremity soft tissue defects were reconstructed using local perforator flaps designed by using these innovative technologies.     

Hyperbaric oxygen therapy in the management of diabetic lower limb wounds

INTRODUCTION: Hyperbaric oxygen therapy (HBOT) involves the inhalation of 100 percent oxygen at pressures greater than at sea level. One of the most common indications for HBOT is to aid healing of diabetic foot wounds. METHODS: All cases of diabetic foot wounds that were seen by the Hyperbaric Medicine Centre in Tan Tock Seng Hospital from May 2005 to March 2006 were analysed in terms of outcome (wound healing) after HBOT. RESULTS: A total of 45 cases of foot ulcers/wounds were analysed. 32 patients had a favourable outcome, giving a success rate of 71 percent. The remaining 13 (28 percent) did not have a favourable outcome to HBOT. The success rate was even more significant as a large number of these patients (34 [77 percent]) were told by their specialist that they were at high risk of a further amputation. No major complications were noted. CONCLUSION: The experience of the Hyperbaric Medicine Centre in Singapore is consistent with that reported in other centres. With proper patient selection, HBOT, together with a multidisciplinary team of vascular and orthopaedic surgeons, podiatrists, infection disease physicians and endocrinologists, can help reduce the numbers and severity of amputations as well as downtime due to increased wound healing.