鼓式切皮机固定台架的制作

在以往使用鼓式切皮机（又称取皮鼓）制作整张异体（种）皮时，操作必须左予握持皮鼓手柄，右手行取皮操作。由于双手同时反向用力，皮鼓不易固定，皮片容易切破或切取厚度不均匀；操作时劳动强度大，操作容易疲劳，而且比较费时。为此，笔针对以往制作大张移植皮过程的不足，研制出一种将取皮鼓固定住手术台上进行取皮的台架。经临床应用，切取异种皮30例次，效果满意.现介绍如下。     

鼓式取皮机的改良

鼓式取皮机在临床的应用极为广泛,但对手背部的烧伤创面移植取皮时仍受限。笔者单位在鼓式取皮机鼓面上附加不同大小和形状(如梯形)的不锈钢鼓面,调节皮鼓刻度和不锈钢厚度,按皮鼓取皮操作规范不但能够获取满意的中厚皮片,而且还能提高手部创面的修复质量。图1　取皮机梯型附加鼓面正面　　操作方法:采用厚度为0 .3～0 .5mm的硬质不锈钢片,将移植皮片切割成长轴为2 4 .5cm、宽≤15 .5cm的不同形状、大小若干皮片,在皮片长轴两端各取1.0cm折向半圆形皮鼓的凹面,将不同规格的皮片置于取皮机鼓面上,反折部分恰好卡在皮鼓的头、尾部(图1)。按创…     

自制简易计尿器

心脏外科术后患者需严密观察尿量,以往,我们采用一次性50ml注射器针筒,连接于一次性尿袋上计量尿量的方法,由于针筒容量较小容易出现溢尿现象,而目前市售计尿器价格较贵,患者不易接受。经临床实践,我们利用用过的一次性高压注射器针筒自制计尿器,应用效果较好,介绍如下。将用过的100ml高压注射器针筒用清水冲洗后放入0.2%健之素液中浸泡消毒或用环氧乙烷消毒备用,将针筒的末端倒立以系带固定于床下10cm,尿管延长管末端置入针筒内,将一次性尿袋接头直接与针筒乳头连接,在尿袋连接管上接一调节装置定时放尿并记录尿量。自制简易计尿器采用CT…     

介绍一种自制氧气连接管

临床护理工作中橡胶氧气管与塑料鼻导管采用的是玻璃接头 ,这种接头在实际操作中存在容易破损、连接不紧密、不易消毒等缺点。因此 ,笔者自制一种氧气连接管 ,介绍如下。　　①材料 :一次性 1ml注射器、剪刀 1把。②制作方法 :取一次性 1ml注射器 1副 ,取下针头部分及活塞部分 ,保留针筒 ,用剪刀将针筒的尾翼部分剪下即可。③使用方法 :取乳头一端与鼻导管连接 ,另一端与氧气管连接即可。④优点 :取材容易 ,制作简易 ,使用安全 ,连接紧密。此连接管同样适用于吸痰装置。介绍一种自制氧气连接管$武汉市儿童医院七内科!湖北武汉430016@丁晒莉…     

第三届全国创伤外科学术研讨会征文通知

鼓式取皮机在临床的应用极为广泛，但对手背部的烧伤创面移植取皮时仍受限。笔单位在鼓式取皮机鼓面上附加不同大小和形状（如梯形）的不锈钢鼓面，调节皮鼓刻度和不锈钢厚度，按皮鼓取皮操作规范不但能够获取满意的中厚皮片，而且还能提高手部创面的修复质量。     

鼓式取皮法切取大张次全厚皮片修复皮肤软组织缺损效果探讨

目的：探讨鼓式取皮法切取大张次全厚皮片修复皮肤软组织缺损及薄断层皮片修复供区的效果。方法：2019年12月-2020年12月,采用鼓式取皮法切取大张次全厚皮片修复瘢痕及皮肤肿瘤切除后皮肤软组织缺损,同时在供区相邻部位切取薄断层皮片修复次全厚皮供皮区。次全厚皮片修复面积为70～200 cm²。结果：鼓式取皮法切取大张次全厚皮片、薄断层皮片快速、简便。本组10例患者除1例有小面积皮片下血肿(经换药后愈合),其余均成活理想。术后1～12个月随访,次全厚移植皮片平整,无明显挛缩畸形,皮片弹性良好,质地柔软,色素沉着较轻;次全厚皮片供区及薄断层皮片供区无明显瘢痕增生。结论：鼓式取皮法切取大张次全厚皮片,且供皮区以薄断层皮片修复方法快速、简便;而且受区移植皮片成活质量好,远期效果佳,供皮区愈合良好,无明显瘢痕增生,是皮片移植术兼顾受区及供区的一种好方法。     

两种薄中厚皮片治疗皮肤撕脱伤临床效果对比研究

目的:对比研究撕脱皮肤反取薄中厚皮片与常规切取薄中厚皮片在治疗皮肤撕脱伤中的移植效果。方法:选取2008年6月~2012年6月就诊的52例四肢皮肤撕脱伤患者为研究对象,其中23例因撕脱皮肤毁损严重无法利用,只能采用常规切取薄中厚皮片游离移植修复撕脱伤创面,其余29例利用撕脱皮肤反取制备薄中厚皮片,全部薄中厚皮片打孔直径1cm,术后均采取加压包扎。结果:所有移植皮片均成活,常规切取薄中厚皮片移植的23例患者中,Ⅰ期愈合者21例,Ⅰ期愈合率为91.3%;撕脱皮肤反取薄中厚皮片的29例患者中,Ⅰ期愈合者24例,Ⅰ期愈合率为82.8%。结论:常规切取薄中厚皮片移植与撕脱皮肤反取薄中厚皮片移植的Ⅰ期愈合率相仿,临床应尽可能利用撕脱皮肤反取制备薄中厚皮片移植修复撕脱伤创面,如撕脱皮肤难以利用则应选用薄中厚皮片移植修复。     

气管套管帽的制作与应用

采用一次性注射器针筒自制气管套管帽,患者气管切开后直接扣于套管上,氧气管从侧孔插入.气管套管帽还适用于各种呼吸道湿化.此套管帽制作简单、使用方便、经济实用.     

气管套管帽的制作与应用

采用一次性注射器针筒自制气管套管帽，患者气管切开后直接扣于套管上，氧气管从侧孔插入。气管套管帽还适用于各种呼吸道湿化。此套管帽制作简单、使用方便、经济实用。     

无瘢痕皮肤移植术在手背皮肤重建中的应用

目的：研究手背皮肤缺损的理想修复方法。方法：将手背外伤性创面和手背瘢痕切除后创面的边缘修成斜面形。另用布片制作创面定形模板，并以此在供皮区制作与创面完全相同的定形斜缘皮片。最后将皮片移植于受区，术区均匀加压包扎，术后10—12天拆线。随访1年。结果：切取的38个定形次全厚薄边皮片与受皮区完全吻合，32个皮片顺利成活，一年后随访，皮片色泽和质地优良，边缘部无明显瘢痕形成，美学效果优良。6个定形次全厚薄边皮片术后有点状坏死、水疱形成，后期有小量瘢痕形成和色素沉着，手背大体外观仍然比较好。结论：本文设计的新式植皮技术可以达到无瘢痕愈合效果，术后手功能良好而且美学效果优良。     

Intraoperative recording of sacral root nerve signals in humans

Electroneurographic signals were intraoperatively recorded from the S3 sacral nerve root in two SCI patients. The aim of this study was to record afferent nerve signals in response to mechanical stimulation of the urinary bladder, rectum, and dermatome. Such signals could be used in an implantable neuroprosthesis to treat neurogenic detrusor overactivity. In both patients a neural response was recorded from the dermatome and the rectum, but from the bladder only in one patient. The results were consistent with results from animal and other human studies. Further studies are however, needed because the number of subjects investigated remains low.     

Free stamp-graft autodermoplasty in the treatment of granulating wounds and ulcers

A new stamp--graft method of free autodermoplasty was used in 36 out of 70 patients operated upon with using stamps only and their combination with pedicled graft or partly put secondary sutures. It proved to be as effective as all other modifications of stamps with different methods and gave better final results as compared with the known publications concerning possible healing of dermatome split grafts known to have wider prospects in the treatment of mainly great burn wounds. Stamps and grafts were found to be more resistant to harmful effects of bad granulation medium, more reliable in adaptation and healing and to be good stimulators of the natural reparative regeneration. The optimum conditions were created by local oxybarotherapy, hemotransfusion by heparin--treated blood or direct transfusions and by preventing a purulent reaction by the administration of chlorophyllid, sulfomylon and enzymes.     

A dermatome for experiments with small animals

A dermatome for experiments with small animals in which split skin grafts are required has been introduced. The dermatome is inexpensive and it is easy to remove skin of correct thickness. It can also be used to create comparable raw areas in an experimental model using small animals.     

A dermatome for experiments with small animals

Summary A dermatome for experiments with small animals in which split skin grafts are required has been introduced. The dermatome is inexpensive and it is easy to remove skin of correct thickness. It can also be used to create comparable raw areas in an experimental model using small animals.     

Hand knife versus powered dermatome: current opinions, practices, and evidence

Some surgeons prefer to use powered dermatomes when harvesting split-thickness skin grafts, while others prefer the hand knife. We conducted a postal survey of British plastic surgery units, contacted medicolegal departments, and investigated the literature to explore the reasoning for any preferences and the existing evidence to support such practices.Two hundred thirty-eight surgeons from 30 units replied, 145 (61%) preferring to use the powered dermatome, primarily as they believed it provided for better-quality graft and donor sites. Ninety-five (40%) respondents felt they were potentially open to successful litigation by using a hand knife when a powered dermatome was available.We found no evidence to support such clinical or medicolegal views and conclude that numerous misconceptions exist about skin-graft harvesting instruments. We suggest that surgeons should use whichever instrument they feel will, in their hands, provide the optimum result and not be directed by unfounded opinions.     

A simple system for splicing strip grafts into sheets.

An alternative method of joining small strips of skin graft into larger sheeets in order to achieve complete coverage of large defects is reported. Split-thickness grafts are often needed larger than the skin strip obtained by dermatome. Suturing grafts together to form a larger sheet is difficult and often results in tearing and puckering of the graft so that spots do not adhere properly. A rapid, simple method of joining sheets of skin using neurosurgical clips is described. Removal of these clips is faster and easier than suture removal. The method is most useful where "tie-over" stent dressings are used, but also has general applications.     

A microbiological study of the contamination of the syringes used in anaesthesia practice

In many operating theatres, it is common practice to reuse disposable plastic syringes with the same needles for several injections to different patients during the same day. This practice could lead to bacterial contamination of these syringes, making them an infection hazard to patients. We did a microbiologic survey of 100 of the most frequently reused syringes in our operating rooms and a control group of 100 single-use syringes. Only three of the syringes were contaminated in each group. None of the patients exposed to the syringes having a positive culture showed any sign of sepsis. Our data suggest that reusing plastic syringes is not associated with an increase in the incidence of bacterial contamination. However, contamination of the syringes by patients' blood, with the risk of cross-infections, remains a possibility and further studies are needed to evaluate this potential hazard.     

Determination of the Depth of Excision Using a Dermatome (Aesculap®) to Export all Hair Follicle Bulbs from a Donor Site in the Dog

The aim of the study was to determine the depth of excision using a dermatome to excise all hair follicle bulbs from the donor site. Partial‐thickness skin samples of different depth, ranging from 0.4 to 1 mm, were excised using a dermatome (Aesculap^®) from the dorsal aspect of the trunk of the dog. Biopsies, using a 6‐mm biopsy punch, were performed in the centre of each donor site and excised sample. They were processed routinely for histological examination and the aspect of the hair follicles was observed. Split‐thickness skin grafts of ≥0.7 mm deep performed with a dermatome contain the entire hair follicle.     

The mesh skin graft--true expansion rate

Using the mesh graft II dermatome (Zimmer) for split skin graft expansion, the 3 to 1 and 1.5 to 1 expansion rates were evaluated for true clinical expansion. In one hundred and one 1.5 to 1 expanded grafts the actual expansion was 1.2 and in sixty 3 to 1 expanded grafts, it was 1.5.     

Hypoglycemia caused by siphoning of an insulin infusion

STUDY OBJECTIVE: To determine--through reconstruction of a clinical situation in which a syringe filled with insulin was removed from the syringe pump, placed above the patient, then emptied into the patient--the different physical forces at work, and to examine the height of the syringe (and thus the hydrostatic force) necessary to move the plunger. DESIGN: Prospective study. SETTING: Research laboratory of a university. MEASUREMENTS: The clinical situation was simulated using eight 50-mL and eight 20-mL syringes. A pressure transducer, placed between the syringe and the extension tubing, measured the pressure difference over the extension tubing. The Poiseuille equation of the viscous resistance was used to calculate flow. MAIN RESULTS: The mean height needed for initiation of flow in the 50-mL syringes was 76 cm (range, 60-90 cm). In the 20-mL syringes, no flow could be generated up to heights of 200 cm. There was a large variability in the height and time required to generate flow in apparently identical syringes, probably due to differences in the static sticking of the plunger to the barrel. CONCLUSIONS: Studies testing the effect of siphoning using one syringe cannot be interpreted reliably. Smaller syringes are safer to avoid siphoning.