臭氧水对烧伤创面的清创消毒作用

目的　探讨臭氧消毒剂 (臭氧水 )对烧伤创面的清创作用。　方法　观察臭氧水对常见烧伤创面分离菌的体外杀菌作用及应用于烧伤创面的清创消毒效果。　结果　臭氧水对所有受试菌有迅速而完全的体外杀灭作用。应用于烧伤创面清创消毒 ,其细菌清除率为 94.5 % ,临床总有效率 97.1%。　结论　臭氧水制备简单 ,价格低廉 ,杀菌消毒效果肯定 ,可作为烧伤创面清创消毒选择之一。     

臭氧水用于产妇会阴切口消毒的效果观察

目的：探讨臭氧水用于产妇会阴切口消毒预防感染的临床效果。方法：将经阴道分娩行会阴侧切的134例产妇随机分成两组，观察组66例采用臭氧水消毒会阴切口，对照组68例采用活力碘消毒。观察两组会阴切口愈合情况，并取其分泌物作细菌培养。结果；观察组产妇会阴切口甲、乙、丙级愈合率分别为95．5％、3．0％、1．5％，对照组分别为91．2％、7．3％；1．5％，两组比较，差异无显著性意义（P＞0．05）；两组细菌菌落数比较，差异亦无显著性意义（P＞0．05）。结论：臭氧水用于妇产科会阴皮肤消毒预防切口感染与活力碘具有相同效果，且臭氧水能直接喷射切口创面，具有使术野清晰、促进局部血液循环、减少渗血等作用。     

碘伏联合贝复济预防急诊腹部污染手术后切口感染的疗效观察

目的观察碘伏联合贝复济预防急诊腹部污染手术后切口感染的临床疗效。方法临床纳入急诊腹部切口污染手术患者76例,根据切口消毒剂的不同分为2组,每组38例。对照组给予2%碘酊与75%酒精消毒;观察组给予0.25%碘伏联合贝复济消毒。观察2组患者切口愈合情况与感染情况。结果观察组切口甲级愈合率高于对照组,切口感染率低于对照组;切口愈合时间、换药次数均优于对照组。2组比较,差异均有统计学意义(P0.05)。结论对急诊腹部污染手术切口使用碘伏联合贝复济消毒,能提高切口愈合率并降低感染率,并缩短切口愈合时间,减少换药次数。     

臭氧水冲洗联合穴位按摩治疗糖尿病足患者的护理

目的探讨臭氧水联合穴位按摩治疗糖尿病足患者的护理效果。方法将40例糖尿病足患者随机分为观察组和对照组各20例;两组均对创面进行间断冲洗引流,对照组采用生理盐水冲洗,观察组采用臭氧水冲洗联合穴位按摩;观察两组创面愈合的效果。结果观察组治愈例数多于对照组;治疗显效时间显著短于对照组(P0.05)。结论臭氧水冲洗联合穴位按摩,能够促进糖尿病足患者创面愈合,改善患者的生活质量。     

LED蓝光照射治疗MRSA感染创面的临床研究

目的:探讨使用LED蓝光照射治疗MRSA感染创面的临床疗效。方法:2012年12月~2014年1月,笔者科室共收治11例MASA感染的难治创面患者,创面大小20cm×20cm~40cm×40cm。通过每日洗澡,双氧水冲洗,LED蓝光照射及碘伏换药治疗。结果:复查细菌培养均未检测出MRSA,创面均完全愈合。结论:LED蓝光照射治疗对MRSA感染创面有较好的临床效果。     

碘伏冲洗对全膝置换术后切口及功能恢复的影响

目的探讨不同的手术冲洗液对全膝置换术后患者切口及功能恢复的影响。方法 150例全膝置换患者随机分为生理盐水组(50例)、庆大霉素液组(50例)及碘伏组(50例),术中分别使用相对应的手术冲洗液,通过观察切口的愈合情况和术后2周及术后1年膝关节功能的HSS评分,比较3种冲洗液的效果。结果庆大霉素液组的切口愈合优良率(90%)明显优于生理盐水组(84%)及碘伏组(76%),庆大霉素液及碘伏冲洗切口在预防感染方面并不优于生理盐水组(P>0.05)。术后2周碘伏组膝关节功能恢复明显差于生理盐水组(P<0.05)及庆大霉素液组(P<0.05)。随访1年时3种冲洗液在患者膝关节功能的恢复方面无差异(P>0.05)。结论术中使用碘伏原液冲洗切口影响患者手术切口的愈合和近期膝关节功能的恢复。     

医用透明质酸锌凝胶治疗四肢皮肤擦伤创面效果观察

四肢皮肤擦伤是门诊的常见伤患,传统处置办法是以碘伏外涂＋凡士林纱布覆盖创面,如果擦伤创面深达真皮层,那么普遍存在愈合时间长、宜合并感染、愈合质量差等缺点。为寻找一种操作更简便、缩短愈合时间、提高愈合质量的处置擦伤创面新方法。2009年3月～2010年3月,笔者采用医用透明质酸锌凝胶治疗四肢皮肤擦伤创面,并与传统方法对比,治疗效果较好。     

PVP碘用于烧伤创面换药的效果观察

对同一烧伤个体取深度相同、类型相同的两处创面,分别采用PVP碘和碘伏消毒剂进行换药.观察两组在换药前后创面有无红肿、分泌物,感染创面细菌定量及创面愈合时间.结果PVP碘换药后感染控制明显;对新鲜深Ⅱ度创面,碘伏组红肿例数多于PVP碘组;对新鲜浅Ⅱ度、新鲜深Ⅱ度、感染创面,碘伏换药3 d后炎性分泌物增多分别为2、2、4例,而PVP碘换药组无1例有炎性分泌物多的情况.PVP碘组感染创面细菌定量明显少于碘伏组(P＜0.05),创面愈合时间明显短于碘伏组(P＜0.05).提示PVP碘消毒剂用于烧伤创面换药效果明显.     

洛本清和碘伏用于面部皮肤消毒的效果分析

目的:比较洛本清和碘伏用于面部消毒的效果,以评价洛本清消毒液用于面部消毒的有效性及安全性.方法:选择我科面部整形美容受术者及医护人员共40例,分别用洛本清和碘伏消毒两侧面部,采样作消毒效果监测.结果:洛本清和碘伏用于面部消毒均达到皮肤消毒效果合格标准,两者间无显著性差异.结论:洛本清溶液对皮肤无刺激性,无着色,不影响手术效果的观察和术后美观,是一种较理想的皮肤消毒剂.     

马铃薯片外敷促进会阴切口愈合的效果观察

目的观察新鲜马铃薯片外敷促进会阴切口愈合的临床效果。方法将住院行会阴侧切术的产妇196例随机分为对照组与观察组各98例。观察组每天采用0.1%碘伏擦洗切口后用新鲜马铃薯片外敷切口,每日2次;对照组每天采用0.1%碘伏擦洗切口2次。结果观察组会阴切口愈合情况显著优于对照组,会阴切口处肿胀及疼痛消退时间显著短于对照组(均P<0.01)。结论使用自制马铃薯薄片贴敷会阴切口能有效加速肿胀及疼痛消退,促进会阴切口愈合。     

水胶体敷料对腹膜透析患者手术切口的愈合护理效果

目的 探讨水胶体敷料的换药方法替代传统敷料的换药方法对腹膜透析患者手术切口的愈合护理效果.方法 回顾性分析了88例腹膜透析患者手术切口的护理效果,其中使用水胶体敷料换药的患者为实验组,共44例,使用传统敷料换药的患者为对照组,共44例.比较两组手术切口的愈合天数.结果 实验组的伤口愈合时间为（9.0±6.3）d,对照组愈合时间为（14.0±9.8）d,两组比较有显著性差异（P＜0.05）.结论 水胶体敷料能促进腹膜透析患者手术切口的愈合,减轻患者的痛苦,提高舒适度.     

A preliminary study of healing of superpulsed carbon dioxide laser incisions in the hard palate of monkeys.

BACKGROUND AND OBJECTIVE: Prior studies of laser wound healing using different animal models have shown a delayed tissue response after carbon dioxide (CO2) laser application. This article reports on the preliminary findings of healing of superpulsed CO2 laser and scalpel incisions in the hard palate of monkeys. STUDY DESIGN/MATERIALS AND METHODS: Twelve parallel incisions using a superpulsed, continuous wave CO2 laser and a scalpel were performed in the hard palate of each of two adult monkeys at 3, 7, and 14 days time schedules. Power levels of 2.0, 4.0, and 6.0 Watts were used for the laser incisions. Wounds were harvested, fixed in 10% formalsaline for at least 48 hours and processed routinely. Each specimen was embedded in paraffin wax at 90 degrees to the surface epithelium and 5 microm thick sections prepared for staining with haematoxylin and eosin, Periodic acid Schiff and Masson-trichrome at a step-serial interval of 100 microm. Sections were evaluated independently. RESULTS: According to the clinical findings we showed a wound closure in all of the wounds (laser and scalpel incisions) at 3, 7, and 14 days of healing. Histologically, we showed that laser incisions at three and seven days demonstrated an increased, power setting-dependent tissue necrosis and marked inflammatory response with minimal organization compared to scalpel incisions. At 14 days both types of incisions exhibited complete wound healing of the epithelium and connective tissue. DISCUSSION AND CONCLUSIONS: According to these preliminary results, superpulsed CO2 laser tends to produce more pronounced changes (due to tissue thermal damage) with corresponding greater inflammatory reaction and delay in tissue organization only initially.     

Mast cell concentration in the wound healing process of incisions made by different instruments

The aim of this study was to compare the concentration of mast cells (MCs) in the healing process of incisions. Thirty rats were submitted to six linear incisions each, performed in the dorsal skin by carbon dioxide (CO₂) and diode lasers, electrocautery and conventional scalpel. The animals were euthanized at intervals of 0 h, 24 h, 48 h, 72 h, 7 days and 14 days after the incisions had been made. Histological sections were obtained and stained with toluidine blue for identification of MCs, which were manually counted by conventional microscopy in 20 microscopic fields in the border of the incision, near the granulation tissue, or in the area of new collagen formation, depending on intervals. The concentration of MCs was significantly higher in the wounds made by scalpel than in those made by other techniques at 48 h and 72 h. After 72 h the number of MCs was also significantly higher after electrocautery than after incisions made by 4 W CO₂ laser. On days 7 and 14, there was no significant difference in the MC count among the different types of incisions. In summary, the MC concentration varied after different surgical incisions at early phases of wound healing. At the end of the healing process, however, there were similar MC concentrations around the incisions, suggesting that, in standard incisions in the surgical techniques studied, the wound healing process ultimately occurred in a similar pattern.     

A prospective randomized trial to compare CO2 laser with standard electrocautery for making thoracotomy incisions

It has been claimed that surgical incisions made with the carbon dioxide laser are superior to those made by diathermy in terms of blood loss, wound healing and postoperative pain. We have done a small controlled trial to test this hypothesis in 16 patients, comparing thoracotomy incisions made by these two techniques. Incisions made by the laser were slower and had greater blood loss and we were unable to demonstrate any differences between the techniques in wound healing or postoperative pain.     

A prospective study of incisional time, blood loss, pain, and healing with carbon dioxide laser, scalpel, and electrosurgery

Carbon dioxide laser incisions are reported to be less painful, less bloody, and less prone to seroma formation and to heal better than scalpel or electrosurgical incisions. We compared all three modalities in a prospective randomized study of cholecystectomy incisions. Time required for the incision and incisional blood loss was less with electrosurgery than with the carbon dioxide laser or scalpel. Postoperative pain and wound healing, however, were the same for all three techniques. The carbon dioxide laser appears to offer no advantage over conventional means of making a standard incision.     

Pharmacokinetics of a new skin wound cleanser

Iodophors are effective germicidal agents that have prolonged antiseptic activity in contaminated wounds. A nontoxic surfactant, Pluronic F-68, has been used to formulate a safe and effective iodophor. The parameters necessary to regulate the activity of the iodophor were studied to develop a potent, yet safe bactericidal solution for use in human subjects.The parameters found to be most important were the pH of the solution and the concentration of sodium iodide. Lowering the pH of iodophors increased their stability and antiseptic activity. The free iodine in iodophor solutions prepared with a low pH is predominantly the highly biocidal diatomic iodine (I₂). The concentration of iodide regulated the equilibrium of the dissolved iodine between its free and complexed form. Increasing the concentration of iodide in the iodophor lowered the amount of free iodine in solution and enhanced the concentration of the complexed iodide. It is the level of free iodine in an iodophor that determines its antiseptic activity. Low levels of free iodine yielded iodophors that had a slow bacterial kill rate but a prolonged duration of action. Manipulation of these variables permitted the generation of iodophors that varied considerably in their kill rates of bacteria and their duration of antibacterial activity. Iodophors tested in this study demonstrated a distinct superiority to noncomplexed iodine solutions (tincture and aqueous iodine solutions) as wound and skin cleansers.     

Reversal of impaired wound healing in irradiated rats by platelet-derived growth factor-BB

This study examined the potential influence of platelet-derived growth factor-BB homodimers (PDGF-BB) on surgical incisions in irradiated animals with depressed wound healing. Rats were irradiated with either 800 rads total body or 2,500 rads surface irradiation. Parallel dorsal skin incisions were made 2 days later, and PDGF-BB was applied topically a single time to one of two incisions. In total body-irradiated rats, bone marrow-derived elements were severely depressed, wound macrophages were virtually eliminated, and PDGF-BB treatment was ineffective. However, in surface-irradiated rats, PDGF-BB treatment recruited macrophages into wounds and partially reversed impaired healing on day 7 (p less than 0.005) and day 12 (p less than 0.001). PDGF-BB-treated wounds were 50 percent stronger than the paired control wounds. The results suggest PDGF requires bone marrow-derived cells, likely wound macrophages, for activity and that it may be useful as a topical agent in postirradiation surgical incisions.     

Experimental studies on the healing of colonic anastomoses

The leakage of colonic anastomoses is a potentially devastating surgical complication. Several factors, such as bowel preparation prior to surgery, surgical technique, nutritional status, and intervening pathological conditions, have been identified as significantly influencing the healing of colonic anastomoses. Due to the multifactorial nature, it is difficult to investigate the mechanisms of occurrence and prevention of colonic dehiscence in the clinical setting. For this reason, many experimental models have been used to study colonic healing and the pathogenesis of anastomotic failure. This report reviews the use of animal models for the study of colonic anastomotic healing. Special emphasis is devoted to the rationale for selecting animal models, parameters of healing, factors influencing anastomotic healing as well as the clinical potential of dietary and pharmacologic manipulations proposed to improve colonic healing.     

Comparison of wound-healing characteristics with feedback circuit electrosurgical generators in a porcine model

The type of incisional instrument used to create a surgical wound can influence the rate of wound healing and overall wound strength. The purpose of this study was to evaluate several facets of wound healing within incisions created in the small intestine, uterus, and skin in a porcine model by using feedback circuit electrosurgical generators and a standard steel scalpel blade in a porcine model. Eighteen pigs were evaluated by creating surgical incisions in the skin, uterus, and small intestine utilizing 2 computerized electrosurgical generators (FX, ValleyLab, Boulder, CO, and PEGASYS, Ethicon Endo-Surgery, Inc., Cincinnati, OH) and a scalpel blade. All incisions were reapproximated with absorbable suture. Incision sites were evaluated histologically at 3, 7, or 14 days postincision according to randomization. The skin and small intestine samples were tested for wound tensile strength at 7 and 14 days. There were no statistically significant differences demonstrated with tensile strength testing comparing the electrosurgical devices to the scalpel-blade incisions for skin or small intestine at all time points. The only significant difference detected with respect to wound tensile strength was when different organ types were compared, regardless of device used (i.e., skin, 19.5 N/cm2 vs. small intestine, 5.78 N/cm2). Histologic evaluation demonstrated that the wounds created by the electrosurgical generators displayed decreased overall wound healing at 3, 7, and 14 days compared to the scalpel group. These findings indicate that the electrosurgical devices tested delay wound healing at the surgical site, but fail to demonstrate any significant difference in overall wound tensile strength. Wound healing may occur at a more rapid rate when a traditional scalpel blade is used to create the surgical incision, but no difference in global wound dynamics could be detected.     

Wound healing after laser treatment of oral and oropharyngeal cancer

 The wound healing after laser surgery is delayed in contrast to conventional scalpel surgery. There are some animal studies, which investigated the effects of laser surgery upon wound healing, whereas clinical investigations on wound healing of human mucous membrane after laser surgery is missing. A histological study on the laryngeal mucosa of 11 patients after laser incisions who underwent emergent laser debulking surgery for acute airway obstruction and a clinical study of 24 patients with oral or oropharynx cancer who were treated by laser surgery were performed to investigate the course of wound healing. The histological findings showed that the beginning of wound healing was delayed after laser surgery. The duration of wound healing after laser surgical tumour resection revealed a clear dependence on the size of the initial defect. The average duration of wound healing after CO₂ laser surgery (32.8 ± 9.2 days) was significantly shorter than after Nd:YAG laser surgery (40.4 ± 9.2). Due to the more pronounced zone of necrosis at the base of the wound ground this effect is more evident using the Nd:YAG laser. However, the different course of wound healing with both laser systems does not seem to have a negative influence on functional results. Received: 8 March 2002 / Accepted: 31 July 2002