关注非结核性分枝杆菌致皮肤和软组织的感染

目的对国内外有关非结核性分枝杆菌致皮肤软组织感染,在美容医学和整形外科中的发生病因学、诊断、菌种鉴别和防治原则进行综合分析。方法经计算机检索PubMed数据库、中国期刊全文数据库,检索1983年至2006年的相关文献并进行归纳。对美容医学和整形外科中发生非结核性分枝杆菌皮肤软组织感染的文献进行评述。结果在国内外的美容整形外科领域,如假体隆乳术、乳房缩小术、乳房提升术、脂肪抽吸术、面部提升术、重睑成形术、药物注射等,因非结核性分枝杆菌引起的局部感染有增加趋势,已引起人们的关注。结论非结核性分枝杆菌的皮肤软组织感染是可以治愈的。在临床中,只要做到早期诊断和早期处理,就能有效地控制感染的发生。     

皮肤软组织非结核分枝杆菌感染临床分析并国内相关文献复习

目的了解非结核分枝杆菌(NTM)皮肤感染的临床特征、病原学特点及耐药情况,提高对该病的认识及诊治水平。方法回顾性分析本院2009至2013年收治的5例皮肤软组织感染快速生长型非结核分枝杆菌患者的临床表现及预后,并结合1998至2012年相关国内文献进行复习。结果本研究共纳入5例皮肤软组织NTM患者,其中男性1例,女性4例,年龄22~60岁。5例患者可以分为医源性感染组(4例),非医源性感染组(1例),所有患者均为脓肿分枝杆菌感染。检索CBM、CNKI、维普和万方数据库,自1998#以来医源性和非医源性皮肤感染非结核分枝杆菌分别为377例和9例,仅本文报道的1例非结核分枝杆菌感染者对常用抗结核药物及克拉霉素等出现多重耐药。所有患者均接受3~12个月单用克拉霉素或联合抗结核治疗后病情痊愈。结论非结核分枝杆菌所致皮肤感染仍为少见病,且多为院内暴发感染。重视皮肤软组织非结核分枝杆菌感染,早诊断,联合治疗对患者预后良好。     

非结核性分枝杆菌所致手部感染

自从人类发现并使用抗生素以来，引起手部感染的菌群一直在不断发生着一些重要的变化。本文将重点介绍的是近年来不断受到关注的非结核性分枝杆菌所致的手部感染。本病尤其多见于沿海地区经常接触海洋生物或海上作业的人群中，流行病学资料也显示沿海地区分枝杆菌感染率较其它地区高。这里指出的是在沿海地区，尤其是从事渔业的人群当中，除了非结核性分枝杆菌感染较常见，还有许多其它特殊菌群所致手部感染，如非霍乱性弧菌，另外就是伤后继发的各种细菌感染。而且就分枝杆菌的自然分布而言，海水分枝杆菌除了广泛存在于海洋，也同时存在于淡水中。另外几种非结核性分枝杆菌的分布则根本没有沿海与内地的分别。     

注射溶脂致非结核分枝杆菌感染11例临床分析

目的：了解与注射溶脂相关的非结核分枝杆菌(Nontuberculous?mycobacteria,NTM)皮肤及软组织感染临床特点，总结治疗经验。方法：对2020年12月-2021年2月收治的11例注射溶脂术后出现NTM感染患者的临床资料（临床特点、微生物学检查、治疗方法及疗效）进行回顾性分析。结果：感染出现症状的中位时间为14?d，微生物学检查发现，5例快生长非结核分枝杆菌感染，3例NTM与其他病原体合并感染，采取综合治疗方案，11例感染均得到治愈。结论：早期识别注射溶脂术后并发NTM感染十分重要，相关微生物学检查可以明确诊断，采取综合治疗方案可以有效控制感染症状，最大限度的保护正常组织，避免容貌损害。     

非结核性分枝杆菌肺感染病及肺结核未确诊一例

结核分枝杆菌导致的肺结核是呼吸系统常见病。非结核性分枝杆菌（nontuberculosismycobacteria,NTM）是指结核分枝杆菌和麻风分枝杆菌以外的所有分枝杆菌。NTM是一类环境微生物,为条件致病菌。非结核分枝杆菌病指人类感染NTM并引起相关组织或脏器的病变,全国报道上百例非结核性分枝杆菌病,该病属于罕见病例。     

皮肤扩张术临床研究进展

皮肤扩张术研究已有23年历史,但仍然是整形外科的重点研究课题,此类文献在国内10多种医学期刊上发表,其中,中华整形外科杂志、中华医学美学美容杂志、中国美容医学杂志和实用整形美容杂志4个主要专业期刊论文的4%～7%为皮肤扩张术文献。近5年来,皮肤软组织扩张术的研究有了许多新的进展,本文从6个方面作如下综述。1新型皮肤扩张器的研制1.1薄壁垂直导管扩张器:为了开展微创皮肤扩张法,李江研制了薄壁垂直导管扩张器[1]。该新型扩张器导管较长且与扩张器长轴垂直,新式注射壶与导管分离,有以下优点:①扩张器可经微创切口埋入皮下间隙,简化了手…     

硅胶假体隆乳术后并发非结核分枝杆菌感染的临床进展

近年来,全球非结核分枝杆菌(nontuberculous mycobacteria, NTM)感染的患者有逐渐增加的趋势[1-6],尤其是手术、药物注射及其他介入性治疗造成的医源性NTM感染明显增加[1,7-12].各种美容整形手术及美容微创疗法均有可能导致NTM感染,而国外报道最多的是注射疗法[13-17]及硅胶假体隆乳术后假体周围软组织的NTM感染[7,18-28].笔者现将假体隆乳术后NTM感染的病因学、临床表现、诊断、防治及预后综述如下.     

《中国美容整形外科杂志》编委

正张茂红,主任医师,教授,现任东部战区总医院(原解放军第八一医院)整形烧伤科主任。从医四十余年,具有扎实的综合性外科功底及丰富的各类美容整形外科与肿瘤整形外科的临床工作经验,尤其精通各种乳房整形美容技术操作,并擅于应用肿瘤整形外科技术治疗乳房各类肿瘤及体表皮肤与软组织肿瘤,将手术切除肿瘤、残缺创面完美的整形修复与重建、乳房再造与重建,且对注射隆乳等乳房美容整形术后并发症的处置方面具有独到经验。长期担任全国、     

面部蜗轴的解剖及其在美容外科中的重要性

目的 介绍面部蜗轴的相关解剖及其在美容整形外科中的重要作用。方法 应用计算机检索PUBMED和网络上的相关文献，并限定语言种类为英文。同时检索中国期刊全文数据库的相关文章。结果 共检索到包括电子文献在内的英文文章210余篇，中文文章36篇，将符合标准的21篇文献纳入本文的参考文献。结论 面部蜗轴是口周肌肉的止点，与鼻唇沟的形成、SMAS、面部表情的表达、发音和语言等关系密切，在美容整形外科中具有重要作用。     

硅胶乳房置入体的迟发鸟胞内分枝杆菌感染

隆乳术存在着一定的感染概率。尽管典型感染的发病率非常低，一旦发生，对身体、生理以及心理上的健康都有损害。乳腺软组织内注射硅胶隆乳术引起乳腺脓肿的发病率为12％。目前，多数外科医师选用硅胶或盐水置入体隆乳，尽管执行严格的无菌操作技术，仍然有1％～4％患者术后出现隆乳置入体感染，2％～6％患者乳房再造术后感染。     

Infection with Mycobacterium abscessus after Mohs Micrographic Surgery in an Immunocompetent Patient

Background Nontuberculous mycobacterial infections are increasing in incidence. They have been reported following multiple procedures, including dialysis, liposuction, soft tissue augmentation, pedicures, public baths, acupuncture, placement of contaminated foreign devices such as the Norplant (Wyeth Pharmaceuticals, Collegetown, PA, USA), intravenous catheters, and during surgery from contamination of medical instruments.
Objective We report a case of Mycobacterium abscessus infection presenting as erythematous papules occurring after Mohs micrographic surgery. We also review the literature on nontuberculous mycobacterial infection to discuss common presentations, diagnosis, and treatment options.
Methods/Materials One case presenting to an outpatient dermatology surgery clinic is presented with extensive review of the medical literature on M. abscessus.
Results/Conclusion Infection with nontuberculous mycobacteria can present with varied nonspecific morphologies. A high degree of clinical suspicion is necessary to avoid delays in diagnosis and treatment.     

Management of infections due to nontuberculous mycobacteria in solid organ transplant recipients—Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the epidemiology, diagnosis, prevention, and management of nontuberculous mycobacterial infections in the pre‐ and post‐transplant period. NTM commonly cause one of five different clinical syndromes: pleuropulmonary disease, skin and soft tissue infection, osteoarticular infection, disseminated disease, including that caused by catheter‐associated infection, and lymphadenitis. Diagnosis of these infections can be challenging, particularly when they are isolated from nonsterile spaces, owing to their ubiquity in nature. Consequently, diagnosis of pulmonary infections with these pathogens requires fulfillment of microbiologic, radiographic, and clinical criteria to address this concern. A combination of culture and molecular diagnostic techniques is often required to make a species‐level identification. Treatment varies depending on the species isolated and is complex, owing to drug toxicities, need for long‐term multidrug regimens, and consideration of complex drug‐drug interactions between antimicrobials and immunosuppressive agents. Given these treatment challenges, efforts should be made in both the hospital and community settings to limit exposure to these pathogens to the extent feasible.     

面部皮肤挫裂伤伴灰粒嵌入的急诊美容修复

目的:探讨颜面部软组织外伤伴灰尘颗粒嵌入的急诊美容修复技术和方法。方法:根据伤情,分别对62例灰尘颗粒创面进行急诊清创及美容外科修复。结果:本组62例灰尘颗粒创面,除2例因皮肤挫伤严重并缺损行肉芽创面植皮外,余均达到Ⅰ期修复并愈合,外伤性文身不明显。结论:遵循美容整形外科原则修复颜面部灰尘颗粒嵌入创面,可有效地减少伤后颜面部的外伤性文身、瘢痕畸形和医源性毁容。     

Retroperitoneal cold abscess caused by mycobacteria chelonae abscessus after percutaneous nephrolithotomy in India: strategies for detection, management, and prevention in the United States

Atypical, nontuberculous, mycobacteria (NTM) are emerging as significant pathogens in nosocomial infections. Historically, such outbreaks have been limited to developing countries, and clinicians in the United States have not been exposed to the nuances of diagnosing and treating such infections. With an increasing prevalence worldwide, all clinicians should be able to recognize and treat NTM infections. We report a case of a patient who developed a retroperitoneal cold abscess caused by NTM after percutaneous stone surgery in India. Through a comprehensive review of published reports, we offer strategies for the treatment and prevention of such outbreaks.     

Mycobacterium fortuitum Infections Associated with Laparoscopic Gastric Banding

Mycobacterium fortuitum, a rapidly growing atypical mycobacteria, is commonly found in soil and water. This organism is most often known to cause skin, bone, and soft tissue infections associated with local trauma, surgical procedures, and in patients with immunodeficiency. Nosocomial infections associated with a variety of contaminated devices and equipment have also been widely documented. This report presents the first cases of M. fortuitum infection following laparoscopic gastric banding procedures. Both patients had complicated clinical courses necessitating removal of their banding devices and long-term antibiotic therapy.     

Mycobacterial infections after kidney transplant

We looked at mycobacterial infections occurring after a kidney transplant to determine incidence, risk factors, and outcomes. Of 3921 kidney transplants performed between 1984 and 2002, 18 (0.45%) (10 men, eight women; 11 cadaveric donor, seven living donor graft) were identified as having mycobacterial infection at some time posttransplant. Mean age at transplant was 38.3 years. Racial background was: Caucasian (n = 12), African-American (n = 2), Native Indian (n = 2), Hispanic (n = 1), and Middle Eastern (n = 1). The majority had a kidney alone (n = 14). Four recipients had simultaneous transplant of a second organ: pancreas (n = 2), islets (n = 1), and liver (n = 1). None of the 18 recipients had documented mycobacterial infection pretransplant. One recipient had a positive Mantoux test at the time of transplant and then developed pulmonary tuberculosis 4 months posttransplant; the remaining 17 patients had either negative (n = 10) or unavailable (n = 7) pretransplant Mantoux results. Mean time to infection was 3.2 years (range 1 week to 12 years). The most common site of infection was respiratory (n = 8). Other sites included musculoskeletal (n = 4), skin (n = 3), gyn (n = 1), and other (n = 2). Only three of the infections were with mycobacterial tuberculi; the others were with avium (n = 5), chelonae (n = 2), or other nontuberculous mycobacteria. Risk factors included previous TB exposure, occupational exposure, or accidental soft tissue injury. Soft tissue infections often presented as chronic unhealed wounds and required extensive surgical debridements. With mean follow-up of 12.5 years since transplant and 9.2 years since infection, 13 of the recipients are alive and well; causes of death included cardiovascular (n = 3) and sepsis (n = 2).     

Soft tissue coverage of the ankle: An algorithm for appropriate flap selection and the experiences of a newly established Major Trauma Network

IntroductionReplication of the thin and pliable native skin around the ankle remains a challenge for plastic surgeons treating soft tissue defects in this region. Flap reconstruction constitutes the mainstay of management of such injuries. Subsequent management often entails revisional debulking surgery to permit normal footwear and an acceptable aesthetic outcome. In light of limited elective operating capacity throughout the covid-19 pandemic, we adopted an algorithm to inform reconstruction in such injuries and limit the need for revisional surgeries. This study presents this algorithm, which considers patient age, functional status, co-morbidities, body habitus and defect location.MethodsRetrospective analysis of a prospectively maintained database of all patients undergoing lower limb soft tissue reconstruction over 21 months was performed. All flap-based reconstructions of ankle defects were included; direct closures and skin grafts were excluded. All trauma patients were managed via a combined orthoplastic approach as per BOA-BAPRAS standards. All patients had Computed Tomography Angiography prior to their definitive reconstruction. Lower Extremity Functional Scale (LEFS) scores were analysed for patients with over 12 months of postoperative follow up, where available.Results71 flaps were performed in 69 patients. Open ankle fracture was the most common cause (86%); other indications included osteomyelitis and surgical wound dehiscence. Mean age was 50 (13–87 years) with a higher proportion of males to females (ratio 1.25:1). There were 26 pedicled flaps (18 Medial Plantar Artery and 8 Peroneus Brevis) and 45 free flaps (22 Anterolateral thigh, 11 Superficial Circumflex Iliac Artery Perforator, 11 Gracilis and 1 Medial Sural Artery Perforator). Mean follow-up is 13.6 months. There were three flap failures, and four patients subsequently underwent delayed below knee amputation despite successful soft tissue healing. For the patients with a minimum of 12 months follow up, LEFS scores with an average of 51% were achieved (range 15–88%). Four patients have been listed for revisional/debulking surgery.ConclusionAlthough soft tissue defects around the ankle can be difficult to manage, with careful planning and addressing each patient individually, supported by an algorithmic approach, good functional and aesthetic outcomes can be achieved with low rates of secondary revision surgery.     

Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

ObjectiveTo report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocu-taneous flaps.MethodsSix patients with large skin and soft tissue defects were included in this report. There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar. All wounds were in the upper extremity. The sizes of defects ranged from 15 cmx6 cm to 30 cmx18 cm. Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissi-mus dorsi. The thoracodorsal artery and its perforators were carefully protected during surgery.ResultsAll flaps healed primarily without flap congestion, margin necrosis or infection. The skin donor sites either received split-thickness skin graft (3 cases, mostly from the anterior thigh) or was closed primarily (3 cases) and had minimal morbidity. Follow-up of 6-12 months showed that the contour of flap was aesthetic and the function of limb was excellent.ConclusionOur experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for reconstruction of large skin and soft tissue defects in the upper extremity.