The subcutaneous loop: a single suture technique for skin closure after superficial and subcutaneous surgery

BACKGROUND: Removal of subcutaneous skin masses and certain deep skin injuries results in defects, which demand immediate closure. Although primary closure of these defects in 2 layers is an acceptable solution, this technique has a number of drawbacks, such as extended time consumption upon performance, demand for additional suture material and occasional tissue response or foreign body reaction to retained absorbable stitches leading to infection and its sequelae. OBJECTIVE: We describe an approach intended to furnish a satisfactory solution to the needs of tissue closure in such cases. The significant innovation of this technique is the closure of both deep and superficial layers of skin in one single suture. MATERIALS AND METHODS: Our suture combines the advantages of the classic mattress suture together with those of the buried subcutaneous suture. We performed the vertical mattress suture with 3/0 polypropylene or monofilament suture and added a subcutaneous loop to achieve sufficient approximation of deep tissue surfaces. This suture technique was applied in our first 50 cases. The defects were closed without adverse sequelae. No tissue infections were observed. Wound dehiscence occurred in one case after premature suture removal. The stitches were slightly more difficult to remove than regular sutures. Review of the resulting scars exhibited acceptable results similar to those of parallel closure techniques. CONCLUSIONS: This easily performed technique yields the benefits of reducing suture cost, annulling foreign body reaction, and resulting in both a functional and aesthetically pleasing outcome. The subcutaneous loop technique has become our standard closure of choice for wounds demanding simultaneous cutaneous and subcutaneous repair.     

腹腔镜戳口三种闭合法前瞻性比较

目的：比较常用三种戳口缝合法及各法的特点。方法：2002年1月至2002年11月，应用手缝法、U型针缝法和EndoClose缝法闭合共60例病人脐部戳口。结果：三种戳口缝法，闭合脐部戳口满意，无并发症发生。结论：三种常用的戳口缝法，均可取得戳口缝闭的结果，用U型针缝合脐部戳口耗时短。但针对不同类型的戳口可选用不同的缝法。     

腹部手术切口的改良缝合438例体会

目的探讨腹部手术切口的缝合方法,优点及疗效。方法回顾性分析1999年8月至2010年9月。使用改良缝合方法438例,上腹部手术168例,下腹部手术270例。结果 438例病例中除有3例直肠癌根治术后因体质肥胖,皮下脂肪液化,经换药后痊愈。2例大肠癌梗阻,术后切口裂开,二期缝合痊愈。其余全部甲级愈合。结论该方法缝合快捷方便,手术切口瘢痕小,无任何切口并发症,很值得推广运用。     

皮内缝合法在会阴伤口中的应用

目的:探讨皮内缝合法在会阴伤口中的应用效果.方法:收集我院行会阴侧切自然分娩的320例产妇资料,按照自愿的原则,会阴皮肤行皮内缝合125例(研究组),丝线间断缝合195例(对照组),观察缝合时间、住院时间及伤口情况.结果:研究组平均缝合时间5 min,对照组平均缝合时间7.5 min,研究组48 h出院,对照组需住院3～5 d;对比两组伤口疼痛、伤口甲级愈合差异均有显著性,线结反应差异无显著性.结论:研究组缝合时间及住院时间短,减少了产妇的痛苦及经济负担,值得推广.     

两种Ethicon可吸收缝线在髌骨骨折治疗中的比较分析

目的 比较并分析Ethicon两种可吸收缝线治疗髌骨骨折的临床疗效。方法 选取河南省人民医院自2010年9月至2013年10月髌骨骨折患者共120例,随机分为抗菌薇乔（VICRYL PLUS）组和普迪思（PDSII）组,均进行髌骨骨折环形缝扎术。结果 术后120例得到随访,时间6-18个月,平均14.3月。平均骨折愈合时间为2.9个月。两组手术时间、出血量比较无统计学意义。两组术后较术前关节疼痛NRS评分改善值有统计学意义。抗菌薇乔组手术切口全部一期愈合,普迪思（PDSII）组出现2例切口延迟愈合。两组患者疗效按Bostman功能标准评定优良率分别为92.42%、90.74%。结论 可吸收线环扎法治疗髌骨骨折是一种理想的手术方式,两种缝线对于骨折愈合均安全有效。抗菌薇乔（VICRYL PLUS）由于其特性在临床治疗中疗效更佳。     

可吸收缝线分层连续缝合在腹部切口关闭中的应用

目的比较可吸收线分层连续缝合与丝线间断缝合的疗效。方法将2005年6月至2009年12月行腹部手术患者随机分为两组,由相同的人分别采用可吸收线分层连续缝合及丝线间断缝合,比较观察两组患者的切口愈合情况。结果可吸收线分层连续缝合组有3例脂肪液化,5例切口感染,经换药很快愈合,无切口裂开及切口疝发生。丝线间断缝合组发生脂肪液化12例,感染16例,经换药,有部分需要拆除缝线,平均愈合时间大于可吸收缝线组。两组比较差异有统计学意义(P<0.05)。结论可吸收线分层连续缝合是安全、可靠的方法,能够明显减少切口感染、脂肪液化的发生,对于愈合后切口的美观也有很大帮助。     

无针缝合器在妇产科开腹手术切口闭合中的应用

目的回顾性总结我院妇产科近3年多来在妇产科开腹手术切口闭合中使用无针缝合器的临床疗效。方法回顾性分析我院300例开腹妇科手术患者,采用随机数字法平均分为实验组与对照组,分别给予无针缝合器及传统针线缝合手术切口皮肤,比较两组患者临床差异及患者满意度。结果无针缝合器与传统针线缝合方式相比较,无皮肤创伤、无蜈蚣足样瘢痕、无异物、无炎症反应、无压迫、血供良好、排出通畅、自助拆除无拆线疼痛。无针缝合器缝合切口皮肤时间（2．74±0．54）s,住院天数（5．32±0．54）d,伤口瘢痕宽度（0．22±0．55）cm明显低于传统针线缝合缝合切口皮肤时间（5．85±1．45）S,住院天数（6．43±1．98）d,伤口瘢痕宽度（5．14±2．54）cm,两组差异有统计学意义（P〈0．05）。无针缝合器满意度评分（7．89±1．68）分明显高于传统针线缝合满意度评分（6．45±1．67）分,两组差异有统计学意义（P〈0．05）。结论妇产科开腹手术行无针缝合器闭合切口有较好的临床疗效,切口对合整齐,切口一期愈合率高,愈合完整美观,患者及家属有较高的满意度,值得临床推广应用。     

剖宫产170例腹壁缝合临床探讨

目的:探讨剖宫产腹壁缝合的临床意义.方法:将产妇分两组,改良组70例缝合腹膜,皮肤皮内缝合.对照组100例,不缝腹膜,皮肤外缝三大针.结果:改良组术后腹壁伤口渗出液少,住院时间短,两组比较有显著差异.结论:改良组术后恢复快,粘连少,腹壁伤口渗出液少,腹部伤口平整、疤痕轻、住院时间短、医疗费用低值得推广.     

内窥镜下缝合法用于泪囊鼻腔吻合的临床研究

目的：探讨内镜下经鼻泪囊鼻腔吻合术（ET-DCR）中缝合技术的临床价值。方法选择慢性泪囊炎患者85例98眼,按照随机数字表法分为两组（当双眼均为泪囊炎时,确定右眼是对照组还是观察组,左眼为另一组）对照组（不缝合）和观察组（缝合）。所有患者均随访超过12个月。比较两组治愈率和肉芽组织形成情况。结果观察组治愈率96．00％（48／50）,高于对照组的81．25％（39／48）（χ^2＝5．35,P＜0．05）。在随访期间,观察组有14．00％（7／50）、对照组有31．25％（15／48）患者吻合口周围发生肉芽组织增生（χ^2＝4．19,P＜0.05）。结论应用缝合技术的ET-DCR可减少肉芽组织形成,提高手术成功率,特别是对小泪囊患者可能存在特别优势。     

宫颈缝扎术治疗宫颈机能不全临床分析

目的探讨宫颈缝扎术治疗宫颈机能不全的临床疗效。方法分析2000年1月～2011年6月19例因宫颈机能不全行宫颈缝扎术患者的临床资料。结果 19例宫颈机能不全患者中17例获得活婴,2例失败,手术总成功率为89.5%。其中孕20周前行宫颈缝扎术者15例,手术成功14例;孕20周后手术者4例,成功3例;急诊手术2例,均成功。手术方式分别为U型缝合法、Shirodkar法、McDonald法。结论宫颈缝扎术治疗宫颈机能不全疗效肯定,手术时机宜选择在孕20周前。经阴道行宫颈缝扎术方法简单,术式较多,采用术式应根据病情变化进行合理选择。经临床实践,急诊行宫颈缝扎术是可行的,它可以改善宫颈机能不全患者的妊娠结局。     

Synthesis and<Emphasis Type="Italic">in vitro</Emphasis> properties of prednisolone 21-sulfate sodium as a colon-specific prodrug of prednisolone

Colon-specific delivery of glucocorticoids is highly desirable for the efficient treatment of inflammatory bowel disease. We synthesized prednisolone 21-sulfate sodium (PDS) as a colon-specific prodrug of prednisolone (PD) and investigated its properties using rats as test animals. We expected that introduction of sulfate ester as a sodium salt might increase the hydrophilicity and restrict the absorption in the GI tract. If PDS is stable and nonabsorbable in the upper intestine, it will be delivered to the colon as an intact form, where it hydrolyze by the sulfatase to release PD. Compared with PD, the solubility of PDS increased and the apparent partition coefficient decreased greatly. PDS was stable on incubation with pH 1.2 and 6.8 buffer solutions and with the contents of the stomach and small intestine. On incubation with the cecal contents, PDS decreased to 9.6% of the dose in 10 h producing PD. The amount of PD increased to give a maximum 54% of the dose and decreased. As a control, when PD was incubated with the cecal contents, it decreased to 29% of the dose in 8 h, which implied that reduction of PD proceeded under such conditions. These results suggested that hydrolysis of PDS took place to produce and accumulate PD, which decreased by reduction as the incubation period extended. Our results suggested that PDS can be a promising colon-specific prodrug of PD, and sulfate ester group might serve as a potential colon-specific promoiety, especially for the drugs which are resistant to reduction in the colon.     

385例胃十二指肠溃疡穿孔临床分析

目的 分析胃十二指肠溃疡穿孔临床特点及治疗的疗效。方法 对我院1988年至2002年收治的385例溃疡穿孔病人临床特点。治疗疗效总结分析。结果溃疡穿孔发病年龄有上升趋势,溃疡穿孔发病率无明显降低。非手术疗法和单纯缝合后溃疡复发率相似(7/54,16/146),单纯缝合修补无手术死亡,平均手术时间42min,平均住院时间9d,均 显著短于胃大部分切除和高选迷切加修补术(P<0.01),且单纯缝合术后1、3、5年溃疡复发率分别为11％(16/146),22％(27/121)和25％(24/96)与高选迷切加修补相比,无显著差异(P>0.05),远期并发症发生率为8％(12/146),亦低于后二者(P<0.05)。结论溃疡穿孔单纯缝合修补,操作简单、安全、并发症少,术后结合正规内科治疗,效果满意。     

坚强内固定技术在颌面骨骨折中的临床应用

目的探讨颌面骨骨折的治疗。方法对84例颌面部不同部位的骨折采用坚强内固定技术治疗。结果84例伤口Ⅰ期愈合。2例Ⅱ期愈合,系由外伤性颌骨外软组织撕脱缝合困难所致。有6例颧骨粉碎骨折外形欠佳,其余骨折对位良好,张闭口功能正常,无牙畸形。结论坚强内固定技术用于颌面骨骨折操作方便,创伤小,缩短手术时间,效果可靠。     

人参二醇组皂苷和三醇组皂苷对血虚模型大鼠的治疗作用

目的:比较人参二醇组皂苷(panaxadiol saponin, PDS)和人参三醇组皂苷(panaxatriol saponin, PTS)对环磷酰胺(cyoclphosphnalide, CP)和乙酰苯肼(acetylphenylhydrazine, APH)诱导的血虚模型大鼠的治疗作用。方法:采用高效液相色谱仪检测皂苷组成；采用CP和APH建立血虚模型，将大鼠随机分为空白对照组、模型组、PDS组和PTS组，血液分析仪检测大鼠血常规指标；采用酶联免疫吸附试验(ELISA)检测血清中相关造血因子和炎症因子的含量；采用流式细胞术检测骨髓、胸腺和脾脏的细胞周期。结果:在皂苷分析中，PDS中主要包括Rb1、Rc、Rb2和Rd,原人参二醇型皂苷约占91.58%;PTS中主要包括Re、Rg1和Rf,原人参三醇型皂苷约占77.10%。与空白组相比，模型组大鼠血常规、造血因子和炎症因子水平均显著下降；骨髓、脾脏和胸腺细胞的G0/G1期比例显著降低，同时S期比例显著增加。与模型组相比，PDS组和PTS组以上指标均不同程度改善。结论:PDS和PTS均可改善CP和APH引起的大鼠血虚，且PDS的作用明显...     

Endoscopy-assisted totally laparoscopic resection of a submucosal tumor of the duodenum

Although, endoscopic polypectomy is one of the first options for diagnosis and treatment of submucosal tumors of the duodenum, it is sometimes difficult for large or sessile tumors. Therefore, local excision or more extended surgery is performed under open laparotomy. In this paper, we present a laparoscopic resection of Brunner's gland hyperplasia of the duodenum which demonstrated rapid interval size change. A 73-year-old male with a histologically unproven submucosal tumor underwent endoscopy-assisted laparoscopic resection of the tumor and intracorporeal suturing of the defect. Simultaneous duodenoscopy and laparoscopy were performed to identify the line of resection. A duodenotomy was performed and the tumor was excised after everting the tumor toward the abdominal cavity. The defect was handsewn with the greater curvature side rolled caudally with an exteriorized stay suture. Postoperative pain was minimal and the patient quickly returned to normal activity. Our new technique provides a minimal invasive treatment for tumors of the duodenum.     

精细缝合与局部皮瓣在面部外伤修复中的应用

目的 探讨精细缝合与局部皮瓣在修复面部外伤中的疗效,总结分析其应用效果.方法 面部外伤患者80例,分为观察组(40例)与对照组(40例),观察组采用精细缝合与局部皮瓣方式进行修复,对照组以传统缝合方式修复,分析两组患者伤口愈后瘢痕情况及患者满意度的区别.结果 术后3个月随诊患者满意度评分,观察组(89.21 ±5.45)分,对照组(64.84 ± 7.36)分,观察组明显高于对照组(t=16.830,P<0.05),观察组和对照组瘢痕宽度[(0.68 ±0.47)vs(1.96 ±0.31)mm]、瘢痕评分[(0.72 ±0.63)vs(1.85 ±0.78)分]比较,差异有统计学意义(P<0.05).结论 对面部外伤采用精细缝合或应用局部皮瓣修复,能够有效减轻瘢痕形成,满足患者的美容要求.     

会阴切口3种缝合方法的对比与分析

目的对3种会阴切口缝合方法进行比较与分析,探讨一种更合适的缝合方法。方法随机将3123例产妇分成观察组、对照Ⅰ组和对照Ⅱ组。分别采取分层连续法、传统法和分层间断+皮内连续缝合法3种方法缝合会阴切口。结果与对照Ⅰ组和对照Ⅱ组比较,观察组产妇伤口愈合率和术后性生活满意度高,线结反应低,差异具有统计学意义(P<0.05)。结论合成线分层连续缝合会阴切口,疼痛轻,无线结反应,恢复快,线状愈合,美观,不用拆线,住院时间短,产后性生活满意度高,更适合用于会阴切口的缝合。     

改良式B-Lynch缝合法在剖宫产术中的应用

目的：评价改良式B-Lynch缝合法在剖宫产术中子宫收缩乏力致大出血的止血效果。方法：回顾性分析43例剖宫产术中宫缩乏力致大出血患者,分别采用不同止血方法,观察其止血效果、对比技术易掌握性、评价其实用价值。结果：宫腔纱条填塞13例止血均有效,其中4例术后并发宫腔感染、2例再次大出血;子宫动脉结扎10例,其中8例止血不彻底,加用其他方法;改良式B-Lynch缝合15例,止血效果明显,1例失败;子宫次全切除5例止血彻底,但子宫缺失。结论：剖宫产术中宫缩乏力致大出血时采用改良式B-Lynch缝合法止血,具有止血效果明显、省时、技术简单易行、无需特殊器械、保留子宫等优点,在产科临床中有推广价值。     

中药汤剂外洗保守疗法治疗炎性痔疗效分析

目的观察中药外洗方治疗炎性痔疮效果和机制。方法选择炎性痔疮患者300例,随机分为两组。治疗组以痔疮外洗方熏洗坐浴.对照组用1：5000高锰酸钾溶液（PP液）熏洗坐浴。结果应用Ridit检验对其结果进行比较和分析。治疗组总有效率91%,对照组总有效率65%,P〈0.01。结论痔疮外洗方治疗炎性痔的效果明显优于对照组,价廉,方便实用,值得推广应用。     

Optical methods for measurements of skin penetration

Fourier transform infrared photoacoustic (PAS), photothermal deflection (PDS) and Raman spectroscopy belong to the modern innovative noninvasive analytical tools that are beginning to be recognized as highly potential techniques for the noninvasive study of biological tissues and human skin under in vivo conditions. They can be applied to obtain information regarding the molecular composition of the skin down to several hundred micrometers below the skin surface. All three methods allow depth-resolved investigations. While PAS and PDS use a frequency modulation of the excitation beam to reach deeper regions in the sample, the principle of confocal Raman microspectroscopy (CRM) is a movement of the specimen in the focal plane. In consideration of depth measurements PAS and PDS complete the applicable spectrum of CRM, since Raman microscopy requires particular transparent materials.